• Airway obstruction and gas leak during mask ventilation of preterm infants in the delivery room.

      Schmölzer, Georg M; Dawson, Jennifer A; Kamlin, C Omar F; O'Donnell, Colm P F; Morley, Colin J; Davis, Peter G; Neonatal Services, The Royal Women’s Hospital, Melbourne, Australia. georg.schmoelzer@me.com (Archives of disease in childhood. Fetal and neonatal edition, 2011-07)
      Preterm infants with inadequate breathing receive positive pressure ventilation (PPV) by mask with variable success. The authors examined recordings of PPV given to preterm infants in the delivery room for prevalence of mask leak and airway obstruction.
    • Biomarkers of acute kidney injury in neonatal encephalopathy.

      Sweetman, D U; Molloy, E J; Department of Neonatology, National Maternity Hospital, Holles Street, Dublin, Ireland. dee.sweetman@gmail.com (2013-03)
      Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia-ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.
    • Fetal metabolic influences of neonatal anthropometry and adiposity.

      Donnelly, Jean M; Lindsay, Karen L; Walsh, Jennifer M; Horan, Mary; Molloy, Eleanor J; McAuliffe, Fionnuala M (BioMed Central, 2015)
      Large for gestational age infants have an increased risk of obesity, cardiovascular and metabolic complications during life. Knowledge of the key predictive factors of neonatal adiposity is required to devise targeted antenatal interventions. Our objective was to determine the fetal metabolic factors that influence regional neonatal adiposity in a cohort of women with previous large for gestational age offspring.
    • Gestational Age at Birth and 'Body-Mind' Health at 5 Years of Age: A Population Based Cohort Study.

      Cronin, Frances M; Segurado, Ricardo; McAuliffe, Fionnuala M; Kelleher, Cecily C; Tremblay, Richard E (2016)
      Numerous studies have identified the effects of prematurity on the neonate's physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000-2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children's general health and severity of behavior problems. The association between parent's general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32-36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%-6.2%), compared to 1% (0.2-2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.
    • Imaging and assessment of placental function.

      Moran, Mary; McAuliffe, Fionnuala M; School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. (Journal of clinical ultrasound : JCU, 2011-09)
      The placenta is the vital support organ for the developing fetus. This article reviews current ultrasound (US) methods of assessing placental function. The ability of ultrasound to detect placental pathology is discussed. Doppler technology to investigate the fetal, placental, and maternal circulations in both high-risk and uncomplicated pregnancies is discussed and the current literature on the value of three-dimensional power Doppler studies to assess placental volume and vascularization is also evaluated. The article highlights the need for further research into three-dimensional ultrasound and alternative methods of placental evaluation if progress is to be made in optimizing placental function assessment.
    • Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

      Barrett, Michael Joseph; Donoghue, Veronica; Mooney, Eoghan E; Slevin, Marie; Persaud, Thara; Twomey, Eilish; Ryan, Stephanie; Laffan, Eoghan; Twomey, Anne; Department of Neonatology, National Maternity Hospital, Holles Street, Dublin 2, Ireland. mjjbarrett@hotmail.com (2013-03)
      We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.
    • Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial.

      Walsh, Jennifer M; McGowan, Ciara A; Mahony, Rhona; Foley, Michael E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2012-08)
      To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group.
    • Oxygenation with T-piece versus self-inflating bag for ventilation of extremely preterm infants at birth: a randomized controlled trial.

      Dawson, Jennifer A; Schmölzer, Georg M; Kamlin, C Omar F; Te Pas, Arjan B; O'Donnell, Colm P F; Donath, Susan M; Davis, Peter G; Morley, Colin J; Newborn Services, The Royal Women's Hospital, Melbourne, Australia. jennifer.dawson@thewomens.org.au (The Journal of pediatrics, 2011-06)
      To investigate whether infants < 29 weeks gestation who receive positive pressure ventilation (PPV) immediately after birth with a T-piece have higher oxygen saturation (SpO₂) measurements at 5 minutes than infants ventilated with a self inflating bag (SIB).
    • Prediction of safe and successful vaginal twin birth.

      Breathnach, Fionnuala M; McAuliffe, Fionnuala M; Geary, Michael; Daly, Sean; Higgins, John R; Dornan, James; Morrison, John J; Burke, Gerard; Higgins, Shane; Dicker, Patrick; et al. (American journal of obstetrics and gynecology, 2011-09)
      The objective of the study was to establish predictors of vaginal twin birth and evaluate perinatal morbidity according to mode of delivery.
    • A randomized trial of exothermic mattresses for preterm newborns in polyethylene bags.

      McCarthy, Lisa K; Molloy, Eleanor J; Twomey, Anne R; Murphy, John F A; O'Donnell, Colm P F; The National Maternity Hospital, Holles Street, Dublin, Ireland. (2013-07)
      Hypothermia on admission to the NICU is associated with increased mortality in preterm infants. Many newborns are hypothermic on admission despite using polyethylene bags (PBs). Using exothermic mattresses (EMs) in addition to PBs may reduce hypothermia but increase hyperthermia. We wished to determine whether placing preterm newborns in PBs on EMs in the DR results in more infants with rectal temperature outside the range 36.5 to 37.5°C on NICU admission.
    • The relationship between maternal and fetal vitamin D, insulin resistance, and fetal growth.

      Walsh, Jennifer M; McGowan, Ciara A; Kilbane, Mark; McKenna, Malachi J; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland (2013-05)
      Evidence for a role of vitamin D in maintaining normal glucose homeostasis is inconclusive. We sought to clarify the relationship between maternal and fetal insulin resistance and vitamin D status. This is a prospective cohort study of 60 caucasian pregnant women. Concentrations of 25-hydroxyvitamin D (25-OHD), glucose, insulin, and leptin were measured in early pregnancy and at 28 weeks. Ultrasound at 34 weeks assessed fetal anthropometry including abdominal wall width, a marker of fetal adiposity. At delivery birth weight was recorded and fetal 25-OHD, glucose, C-peptide, and leptin measured in cord blood. Insulin resistance was calculated using the Homeostasis Model Assessment (HOMA) equation. We found that those with lower 25-OHD in early pregnancy had higher HOMA indices at 28 weeks, (r = -.32, P = .02). No significant relationship existed between maternal or fetal leptin and 25-OHD, or between maternal or fetal 25-OHD and fetal anthropometry or birth weight. The incidence of vitamin D deficiency was high at each time point (15%-45%). These findings lend support to routine antenatal supplementation with vitamin D in at risk populations.
    • Serum magnesium in the first week of life in extremely low birth weight infants.

      Noone, D; Kieran, E; Molloy, E J; Department of Paediatrics, National Maternity Hospital, Dublin, Ireland. dgnoone@gmail.com (2012)
      Evidence that antenatal administration of magnesium sulfate (MgSO(4)) to women in preterm labor may confer fetal neuroprotection is growing. MgSO(4) crosses the placenta and can affect the neonate. Magnesium homeostasis in extremely low birth weight (ELBW) infants remains to be clarified.
    • Successful fetoscopic laser coagulation for twin-to-twin transfusion syndrome under local anaesthesia.

      Cooley, S; Walsh, J; Mahony, R; Carroll, S; Higgins, S; McParland, P; McAuliffe, F; National Maternity Hospital, Holles St, Dublin 2. smcooley@hotmail.com (2011-06)
      A review of the efficacy and outcome of fifteen fetoscopic laser ablations under local anaesthesia for twin to twin transfusion syndrome (TTTS) in the National Maternity Hospital Dublin was undertaken. The mean gestation at laser was 19.7 weeks (range 16-25 weeks) with a mean gestation at delivery of 29.1 weeks (range 20-35 weeks). The overall liveborn birth rate was 79% (22 infants) and one pregnancy was still ongoing. There were four neonatal deaths secondary to complications of prematurity. The surviving eighteen infants (64%) undergo regular paediatric review. The procedure was performed successfully in all cases with local anaesthesia. In no case was there maternal discomfort that warranted the procedure to be abandoned and good visual access of the vascular anastamoses was obtained in all cases. Local anaesthesia therefore offers a safe effective anaesthetic option for fetoscopic laser coagulation in monochorionic pregnancies complicated by TTTS.
    • Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants.

      El-Khuffash, Afif F; Slevin, Marie; McNamara, Patrick J; Molloy, Eleanor J; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. afif_faisal@hotmail.com (Archives of disease in childhood. Fetal and neonatal edition, 2011-03)
      There is little consensus regarding the use of echocardiography in patent ductus arteriosus (PDA) treatment in preterm infants. The use of troponin T (cTnT) and N-terminal Pro-BNP (NTpBNP) in combination with echocardiography assessment may facilitate the development of a superior predictive model.
    • Ultrasonically detectable cerebellar haemorrhage in preterm infants.

      McCarthy, Lisa Kenyon; Donoghue, V; Murphy, J F A; Department of Neonatology, The National Maternity Hospital, Dublin, Ireland. lmccarthy@nmh.ie (2011-07)
      To determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of ≤32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH).
    • Vitamin D nutritional status in preterm infants and response to supplementation.

      McCarthy, Roberta A; McKenna, Malachi J; Oyefeso, Oyinkansola; Uduma, Ogenna; Murray, Barbara F; Brady, Jennifer J; Kilbane, Mark T; Murphy, John F; Twomey, Anne; O' Donnell, Colm P; et al. (2013-07-14)
      Little is known about vitamin D status in preterm infants and their response to supplementation. To investigate this, we assessed serum 25-hydroxyvitamin D (25OHD) levels using RIA in a consecutive sample of stable preterm very low birth weight (VLBW) infants (born ≤ 32 weeks gestation or birth weight ≤ 1·5 kg), and we explored associated factors. Serum 25OHD level was first assessed once infants were tolerating feeds (n 274). If this first 25OHD level was below 50 nmol/l (20 ng/ml), which is the level associated with covering requirements in terms of skeletal health in the majority, then we recommended prolonged augmented vitamin D intake ( ≥ 10 μg (400 IU) daily) from a combination of fortified feeds and vitamin supplements and follow-up re-assessment at approximately 6 weeks corrected age (n 148). The first assessment, conducted at a median for chronological age of 18 (interquartile range (IQR) 11-28) d, found that 78 % had serum 25OHD levels below 50 nmol/l. Multivariable analysis demonstrated that the determinants of serum 25OHD levels were duration of vitamin D supplementation and gestational age at birth (r 2 0·215; P< 0·001). At follow-up, after a median of 104 (IQR 78-127) d, 87 % achieved levels ≥ 50 nmol/l and 8 % had levels >125 nmol/l, a level associated with potential risk of harm. We conclude that low 25OHD levels are an issue for preterm VLBW infants, warranting early nutritional intervention. In infants with serum 25OHD levels < 50 nmol/l, a vitamin D intake of ≥ 10 μg (400 IU) daily achieves target levels in the majority; however, further work is needed to determine the exact dose to safely meet target levels without overcorrection.