Research by staff afiliated to Cork University Maternity Hospital

Recent Submissions

  • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2018 Aggregate Report 2016–2018

    Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2020-02)
    This is the Neonatal Therapeutic Hypothermia in Ireland report for 2018. It is a collaborative initiative undertaken by the National Clinical Programme for Paediatrics and Neonatology (NCPPN), the National Perinatal Epidemiology Centre (NPEC) and the National Women and Infants Health Programme (NWIHP). The Therapeutic Hypothermia steering committee has overseen the governance of the project. This report serves as a valuable resource to Medical, Midwifery and Nursing staff who are striving to make quality changes in the services we deliver to mothers and their babies. The recently formed National Neonatal Encephalopathy Action Group reflects this. The group comprises representatives from the Department of Health, the States Claims Agency, and the Health Service Executive, the NWIHP, the NPEC, Clinical Leads and patient advocates. The group acknowledges the long-lasting consequences caused by Neonatal Encephalopathy. The group aims to reduce avoidable instances of Neonatal Encephalopathy through the identification of known causes and risk factors and plans to drive initiatives to eliminate or mitigate them. The aspiration is a reduction in cases requiring therapeutic hypothermia intervention in our national maternity units/ hospitals. This working group has been endorsed by the Minister for Health Mr Simon Harris.
  • Neonatal Therapeutic Hypothermia in Ireland Annual Report | 2016-2017

    Meaney, S.; McGinley, J.; Horkan, S.; Corcoran, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2018-11)
    This report contains maternal and infant data pertaining to Neonatal Therapeutic Hypothermia (TH) in Ireland for the period of 2016/2017. Anonymised data was collected on maternal characteristics, history of antenatal care and delivery. Data were collected on infant characteristics, resuscitation, assessment, hospital transfers, their 72-hour clinical course, rewarming, feeding and outcomes.
  • Severe maternal morbidity in Ireland annual report 2019

    Leitao, S.; Manning, E.; Corcoran, P.; San Lazaro Campillo, I.; Greene, R.A. (National Perinatal Epidemiology Centre, 2021-04)
    The eighth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 375 cases of SMM occurring in all 19 Irish maternity units in 2019. The SMM rate is a composite rate of a group of clearly defined severe maternal morbidities. Over two thirds of the women who experienced SMM in 2019 were diagnosed with one morbidity (n=253, 67.5%); 25% (n=95) were diagnosed with two morbidities; 6% (n=24) with three SMMs; 0.5% (n=2) with four morbidities; and 0.3% (n=1) with five morbidities. The SMM rate has shown a steady increase since the reference year of 2011. From 2011 to 2019, the SMM rate has increased by 68% from 3.85 to 6.47 per 1,000 maternities. The incidence has changed from one case of SMM for every 260 maternities in 2011 to one case in 155 maternities in 2019.
  • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2019 Aggregate Report 2016-2019

    Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2021-04)
    This is the Neonatal Therapeutic Hypothermia report for 2019. The working partnership between the National Perinatal Epidemiology Centre, the National Women and Infant Health Programme and the National Clinical Programme for Paediatrics and Neonatology continues to be productive. This year marks the third published report. The Therapeutic Hypothermia (TH) steering committee continues to oversee the governance of this project and its members remain committed to the building of a national register for TH cases in Republic of Ireland. The electronic register was launched in early March 2020 and this system was utilised for the 2019 TH data collection. The data was collected and verified by the National TH Co-ordinator who visited the maternity units. The findings are accurate and applicable to clinical practice. This year, for the first time, data was collected on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) assessment of the infants. This developmental assessment is undertaken when the infant is aged two years. This assessment provides information on the longerterm outcome of the infant cohort.
  • Placental growth factor in assessment of women with suspected pre-eclampsia to reduce maternal morbidity: a stepped wedge cluster randomised control trial (PARROT Ireland).

    Hayes-Ryan, D; Khashan, A S; Hemming, K; Easter, C; Devane, D; Murphy, D J; Hunter, A; Cotter, A; McAuliffe, F M; Morrison, J J; et al. (BMJ, 2021-08-13)
    Objective: To determine whether the addition of placental growth factor (PlGF) measurement to current clinical assessment of women with suspected pre-eclampsia before 37 weeks' gestation would reduce maternal morbidity without increasing neonatal morbidity. Design: Stepped wedge cluster randomised control trial from 29 June 2017 to 26 April 2019. Setting: National multisite trial in seven maternity hospitals throughout the island of Ireland PARTICIPANTS: Women with a singleton pregnancy between 20+0 to 36+6 weeks' gestation, with signs or symptoms suggestive of evolving pre-eclampsia. Of the 5718 women screened, 2583 were eligible and 2313 elected to participate. Intervention: Participants were assigned randomly to either usual care or to usual care plus the addition of point-of-care PlGF testing based on the randomisation status of their maternity hospital at the time point of enrolment. Main outcomes measures: Co-primary outcomes of composite maternal morbidity and composite neonatal morbidity. Analysis was on an individual participant level using mixed-effects Poisson regression adjusted for time effects (with robust standard errors) by intention-to-treat. Results: Of the 4000 anticipated recruitment target, 2313 eligible participants (57%) were enrolled, of whom 2219 (96%) were included in the primary analysis. Of these, 1202 (54%) participants were assigned to the usual care group, and 1017 (46%) were assigned the intervention of additional point-of-care PlGF testing. The results demonstrate that the integration of point-of-care PlGF testing resulted in no evidence of a difference in maternal morbidity-457/1202 (38%) of women in the control group versus 330/1017 (32%) of women in the intervention group (adjusted risk ratio (RR) 1.01 (95% CI 0.76 to 1.36), P=0.92)-or in neonatal morbidity-527/1202 (43%) of neonates in the control group versus 484/1017 (47%) in the intervention group (adjusted RR 1.03 (0.89 to 1.21), P=0.67). Conclusions: This was a pragmatic evaluation of an interventional diagnostic test, conducted nationally across multiple sites. These results do not support the incorporation of PlGF testing into routine clinical investigations for women presenting with suspected preterm pre-eclampsia, but nor do they exclude its potential benefit. Trial registration: ClinicalTrials.gov NCT02881073.
  • Systematic review and network meta-analysis with individual participant data on cord management at preterm birth (iCOMP): study protocol.

    Seidler, Anna Lene; Duley, Lelia; Katheria, Anup C; De Paco Matallana, Catalina; Dempsey, Eugene; Rabe, Heike; Kattwinkel, John; Mercer, Judith; Josephsen, Justin; Fairchild, Karen; et al. (2020-03-29)
    ntroduction: Timing of cord clamping and other cord management strategies may improve outcomes at preterm birth. However, it is unclear whether benefits apply to all preterm subgroups. Previous and current trials compare various policies, including time-based or physiology-based deferred cord clamping, and cord milking. Individual participant data (IPD) enable exploration of different strategies within subgroups. Network meta-analysis (NMA) enables comparison and ranking of all available interventions using a combination of direct and indirect comparisons. Objectives: (1) To evaluate the effectiveness of cord management strategies for preterm infants on neonatal mortality and morbidity overall and for different participant characteristics using IPD meta-analysis. (2) To evaluate and rank the effect of different cord management strategies for preterm births on mortality and other key outcomes using NMA. Methods and analysis: Systematic searches of Medline, Embase, clinical trial registries, and other sources for all ongoing and completed randomised controlled trials comparing cord management strategies at preterm birth (before 37 weeks' gestation) have been completed up to 13 February 2019, but will be updated regularly to include additional trials. IPD will be sought for all trials; aggregate summary data will be included where IPD are unavailable. First, deferred clamping and cord milking will be compared with immediate clamping in pairwise IPD meta-analyses. The primary outcome will be death prior to hospital discharge. Effect differences will be explored for prespecified participant subgroups. Second, all identified cord management strategies will be compared and ranked in an IPD NMA for the primary outcome and the key secondary outcomes. Treatment effect differences by participant characteristics will be identified. Inconsistency and heterogeneity will be explored.
  • Perinatal factors affect the gut microbiota up to four years after birth.

    Fouhy, Fiona; Watkins, Claire; Hill, Cian J; O'Shea, Carol-Anne; Nagle, Brid; Dempsey, Eugene M; O'Toole, Paul W; Ross, R Paul; Ryan, C Anthony; Stanton, Catherine (2019-04-03)
    Perinatal factors impact gut microbiota development in early life, however, little is known on the effects of these factors on microbes in later life. Here we sequence DNA from faecal samples of children over the first four years and reveal a perpetual evolution of the gut microbiota during this period. The significant impact of gestational age at birth and delivery mode on gut microbiota progression is evident in the first four years of life, while no measurable effects of antibiotics are found in the first year. Microbiota profiles are also characteristic in children dependant on gestational age and maturity. Full term delivery is characterised by Bacteroides (year one), Parabacteroides (year two) and Christensenellaceae (year four). Preterm delivery is characterised by Lactobacillus (year one), Streptococcus (year two) and Carnobacterium (year four). This study reveals that the gut retains distinct microbial profiles of perinatal factors up to four years of age.
  • Activation of a TLR9 mediated innate immune response in preeclampsia.

    Williamson, Rachel D; McCarthy, Fergus P; Kenny, Louise C; McCarthy, Cathal M (Scientific Reports, 2019-04-11)
    Preeclampsia is a multisystemic disorder leading to the development of a placental ischemic microenvironment with a resultant increase in oxidative stress. There is evidence that mitochondrial dysfunction and the innate immune system both play a role in the pathophysiology of this disease. Mitochondrial DAMPs such as mtDNA bind specifc pattern recognition receptors such as Toll-like receptor 9 (TLR9) on the endosomal surface of immune cells, in particular neutrophils, subsequently activating them and triggering an innate response. We hypothesised that the exaggerated innate immune response seen in preeclampsia is provoked by dysfunctional mitochondria. Here we provide evidence that TLR9 activity is signifcantly increased at time of disease in women with preeclampsia. Furthermore, we show activation of neutrophil markers, Calprotectin, Myeloperoxidase (MPO), and IL-8 are signifcantly increased at time of disease compared to uncomplicated pregnancies. This research supports a potential role of TLR9 activation of an innate immune response evident in preeclampsia which may possibly be initially triggered by dysfunctional mitochondria.
  • Patients' perception of privacy and confidentiality in the emergency department of a busy obstetric unit.

    Hartigan, Lucia; Cussen, Leanne; Meaney, Sarah; O'Donoghue, Keelin (BMC Health Services Research, 2018-12-18)
    Privacy and confidentiality are central components of patient care and are of particular importance in obstetrics and gynaecology, where clinical situations of a sensitive nature regularly occur. The layout of the emergency department (ED) in maternity units is often not conducive to maintaining privacy. Our study aimed to discover if changing the environment could improve patients' experiences in the ED. We surveyed patients and asked specific questions about their perception of privacy in the ED. We then repeated the survey following renovations to the ED which involved replacing curtained patient areas with walled cubicles. There were 75 pre-renovation surveys and 82 post-renovation surveys completed. Before the renovations took place, only 21% (n = 16) found their privacy to be adequate during their visit to the ED. However this rose to 89% (n = 73) post-renovation. Our study showed that patients' perception of privacy and confidentiality significantly improved following refurbishment of the ED.
  • Neonatal Therapeutic Hypothermia in Ireland Annual Report 2016-2017

    Meaney, S; McGinley, J; Horkan, S; Corcoran, P; Greene, RA; Murphy, J; National Perinatal Epidemiology Centre Department of Obstetrics and Gynaecology University College Cork (National Perinatal Epidemiology Centre, 2018)
  • Infants who required Therapeutic Hypothermia in Ireland, 2016-2017: lay summary

    National Perinatal Epidemiology Centre (NPEC) (Cork University Maternity Hospital, 2018)
    The National Clinical Programme Paediatrics and Neonatology (NCPPN) has identified a gap in the knowledge available nationally to clinicians and managers regarding TH. In 2017, a collaboration was agreed between the NCPPN and the National Perinatal Epidemiology Centre to examine the care of all infants who underwent TH in the years, 2016 and 2017. The primary aim of this report is to present an overview and national statistics on TH in Ireland for the years 2016 and 2017.
  • Placental FKBP51 mediates a link between second trimester maternal anxiety and birthweight in female infants.

    Togher, Katie L; O'Keeffe, Gerard W; Khashan, Ali S; Clarke, Gerard; Kenny, Louise C; Cork University Maternity Hospital and University College Cork (Scientific Reports, 2018-10-11)
    Prenatal distress is associated with adverse outcomes in affected offspring. Alterations in placental glucocorticoid signalling and subsequent foetal overexposure to glucocorticoids have been implicated as an underlying mechanism. Infant sex is emerging as an important factor in disease susceptibility. This study aimed to examine the effects of maternal distress across pregnancy on birth outcomes and placental glucocorticoid genes in a sex-dependent manner. Participants completed psychological distress questionnaires throughout pregnancy. Placental HSD11B2, NR3C1 and FKBP51 were analysed by real time PCR and cortisol was measured in new-born hair. Second trimester stress was negatively correlated with birthweight in males and positively correlated with placental NR3C1 mRNA in females. Second trimester anxiety was negatively correlated with birthweight and placental FKBP51 mRNA in females. In mediation analysis, placental FKBP51 mRNA expression was found to mediate the link between prenatal anxiety and birthweight. New-born cortisol was negatively correlated with second trimester anxiety and positively correlated with female placental FKBP51 mRNA levels. Again, FKBP51 mRNA was found to mediate the link between anxiety and new-born cortisol. These results highlight a role for FKBP51 in the placental response to prenatal distress in females. The precise role that placental FKBP51 has in foetal and infant development has not been extensively studied and warrants further investigations.
  • Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 - 2014; a descriptive study.

    McNamara, K; O'Donoghue, K; Greene, R A (BMC Pregnancy Childbirth, 2018-01-04)
    Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014. Anonymised data pertaining to all intrapartum fetal deaths and unexpected neonatal deaths for the study time period was obtained from the national perinatal epidemiology centre. All statistical analyses were conducted using Statistical package for the Social Sciences (SPSS). There were 81 intrapartum fetal deaths from 2011 to 2014, and 36 unexpected neonatal deaths from 2012 to 2014. The overall intrapartum death rate was 0.29 per 1000 births and the corrected intrapartum fetal death rate was 0.16 per 1000 births. The overall unexpected neonatal death rate was 0.17 per 1000 live births. Major Congenital Malformation accounted for 36/81 intrapartum deaths, chorioamnionitis for 18/81, and placental abruption accounted for eight babies' deaths. Intrapartum asphyxia accounted for eight of the intrapartum deaths. With respect to the neonatal deaths over half (21/36, 58.3%) of the babies died as a result of hypoxic ischaemic encephalopathy. Information is also reported on both maternal and individual baby demographics. This is the first detailed descriptive analysis of intrapartum deaths and unexpected intrapartum event related neonatal deaths in Ireland. The corrected intrapartum fetal death rate was 0.16 per 1000 births. Despite our results being based on the best available national data on intrapartum deaths and unexpected neonatal deaths, we were unable to identify if any of these deaths could have been prevented. A more formal confidential inquiry based system is necessary to fully appraise these cases.
  • Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives.

    Mc Carthy, Vera J C; Murphy, Ashling; Savage, Eileen; Hegarty, Josephine; Coffey, Alice; Leahy-Warren, Patricia; Horgan, Aine; O'Connell, Rhona; Marsh, Lynne; Drennan, Jonathan (Journal of Nursing Management, 2018-08-31)
    The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items). Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management.
  • Standardized Parenteral Nutrition for the Transition Phase in Preterm Infants: A Bag That Fits.

    Brennan, Ann-Marie; Kiely, Mairead E; Fenton, Sarah; Murphy, Brendan P (Nutrients, 2018-02-02)
    The optimal composition of standardized parenteral nutrition (SPN) is not yet known, contributing to nutrient deficit accrual and growth failure, with the period of parenteral nutrition weaning, i.e., transition (TN) phase, being identified as particularly vulnerable. We created a comprehensive nutrition database, representative of the nutritional course of a diverse range of preterm infants (n = 59, birth weight ≤ 1500 g, gestation < 34 weeks) by collecting hourly macronutrient intake data as part of a prospective, observational study over 19 months. Using a nutrient modeling technique for the TN phase, various amino acid (AA) concentrations of SPN were tested within the database, whilst acknowledging the nutritional contribution from enteral feeds until target AA intakes were consistently achieved. From the modeling, the AA composition of SPN was determined at 3.5 g/100 mL, which was the maximum to avoid exceeding target intakes at any point in the TN phase. However, in order to consistently achieve target AA intakes, additional nutritional strategies were required, which included increasing the exclusion of enteral feeds in fluid and nutrient calculations from <20 mL/kg/day to <40 mL/kg/day, and earlier fortification of breastmilk at 80 mL/kg/day. This data-driven nutrient modeling process supported the development of an improved SPN regimen for our preterm population in the TN phase.
  • The impact of stillbirth on bereaved parents: A qualitative study.

    Nuzum, Daniel; Meaney, Sarah; O'Donoghue, Keelin (PloS one, 2018-01-24)
    To explore the lived experiences and personal impact of stillbirth on bereaved parents.
  • The Expression of Inflammatory Mediators in Bladder Pain Syndrome.

    Offiah, Ifeoma; Didangelos, Athanasios; Dawes, John; Cartwright, Rufus; Khullar, Vik; Bradbury, Elizabeth J; O'Sullivan, Suzanne; Williams, Dic; Chessell, Iain P; Pallas, Kenny; et al. (European urology, 2016-08)
    Bladder pain syndrome (BPS) pathology is poorly understood. Treatment strategies are empirical, with limited efficacy, and affected patients have diminished quality of life.
  • Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 – 2014; a descriptive study

    McNamara, K.; O’Donoghue, K.; Greene, R. A. (BMC Pregnancy and Childbirth, 2018-01-04)
    : Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014
  • Women's experience of maternal morbidity: a qualitative analysis.

    Meaney, S; Lutomski, J E; O' Connor, L; O' Donoghue, K; Greene, R A (BMC Pregnancy and Childbirth, 2016-07)
    Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women's experiences of maternal morbidity.
  • Oocyte Donation Pregnancies- Non-Disclosure of Oocyte Recipient Status to Obstetric Care Providers and Perinatal Outcomes.

    Geisler; Meaney, S; O’Donoghue, K; Waterstone, J (Irish Medical Journal, 2017-11)
    Oocyte donation pregnancies- non-disclosure of oocyte recipient (OR) status to obstetric care providers and perinatal outcomes.Many studies report a higher rate of pregnancy-induced hypertension (PIH) and severe pre-eclampsia (PET) in OR pregnancies. The objective is to determine the rates of non-disclosure of OR pregnancy to obstetric care providers and also the rates of perinatal complications.

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