• 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.
    • The association between TNF-α and insulin resistance in euglycemic women.

      Walsh, Jennifer M; McGowan, Ciara A; Byrne, Jacinta A; Rath, Ann; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, Ireland; National Maternity Hospital, Dublin, Ireland. Electronic address: msjenniferwalsh@gmail.com. (2013-10)
      Chronic low levels of inflammation have links to obesity, diabetes and insulin resistance. We sought to assess the relationship between cytokine tumor necrosis factor (TNF-α) and insulin resistance in a healthy, euglycemic population. This is a prospective study of 574 non-diabetic mother and infant pairs. Maternal body mass index (BMI), TNF-α, glucose and insulin were measured in early pregnancy and at 28 weeks. Insulin resistance was calculated by HOMA index. At delivery birthweight was recorded and cord blood analysed for fetal C-peptide and TNF-α. In a multivariate model, maternal TNF-α in early pregnancy was predicted by maternal insulin resistance at the same time-point, (β=0.54, p<0.01), and maternal TNF-α at 28 weeks was predicted by maternal insulin resistance in early pregnancy (β=0.24, p<0.01) and at 28 weeks (β=0.39, p<0.01). These results, in a large cohort of healthy, non-diabetic women have shown that insulin resistance, even at levels below those diagnostic of gestational diabetes, is associated with maternal and fetal inflammatory response. These findings have important implications for defining the pathways of fetal programming of later metabolic syndrome and childhood obesity.
    • The benefit of early treatment without rescreening in women with a history of gestational diabetes.

      Maher, Nicola; McAuliffe, Fionnuala; Foley, Michael; UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland. mahernicola@hotmail.com (2013-02)
      In this center, women with a history of gestational diabetes (GDM) are treated without rescreening from early pregnancy in any subsequent pregnancies, commencing with a low glycemic diet and insulin if and when indicated. The objective of this study was to see if this practice reduced the incidence of macrosomia compared with the index pregnancy.
    • 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.
    • Caesarean section in a parturient with a spinal cord stimulator.

      Sommerfield, D; Hu, P; O'Keeffe, D; McKeating A, K; Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland. dsommerfield@hotmail.com (2010-01)
      A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.
    • Caffeine therapy in neonatal intensive care.

      Vavasseur, C (Irish Medical Journal (IMJ), 2012-03)
    • Cardiac biomarkers in neonatal hypoxic ischaemia.

      Sweetman, D; Armstrong, K; Murphy, J F A; Molloy, E J; Neonatology, National Maternity Hospital, Dublin, Ireland. dsweetman@nmh.ie (2012-04)
      Following a perinatal hypoxic-ischaemic insult, term infants commonly develop cardiovascular dysfunction. Troponin-T, troponin-I and brain natriuretic peptide are sensitive indicators of myocardial compromise. The long-term effects of cardiovascular dysfunction on neurodevelopmental outcome following perinatal hypoxic ischaemia remain controversial. Follow-up studies are warranted to ensure optimal cardiac function in adulthood. CONCLUSION: Cardiac biomarkers may improve the diagnosis of myocardial injury, help guide management, estimate mortality risk and may also aid in longterm neurodevelopmental outcome prediction following neonatal hypoxic-ischaemia.
    • Cardiovascular dysfunction in infants with neonatal encephalopathy.

      Armstrong, Katey; Franklin, Orla; Sweetman, Deirdre; Molloy, Eleanor J; Department of Paediatrics, National Maternity Hospital, Holles St, Dublin 2, Ireland. katey21@hotmail.com (2012-04)
      Severe perinatal asphyxia with hypoxic ischaemic encephalopathy occurs in approximately 1-2/1000 live births and is an important cause of cerebral palsy and associated neurological disabilities in children. Multiorgan dysfunction commonly occurs as part of the asphyxial episode, with cardiovascular dysfunction occurring in up to a third of infants. This narrative paper attempts to review the literature on the importance of early recognition of cardiac dysfunction using echocardiography and biomarkers such as troponin and brain type natriuretic peptide. These tools may allow accurate assessment of cardiac dysfunction and guide therapy to improve outcome.
    • Delayed villous maturation of the placenta: quantitative assessment in different cohorts.

      Treacy, Ann; Higgins, Mary; Kearney, John M; McAuliffe, Fionnuala; Mooney, Eoghan E; Department of Pathology, National Maternity Hospital, Dublin, Ireland. anntreacy@mac.com (2013)
      Placental villous maturation is maximal in the 3rd trimester, with an abundance of terminal villi. Delayed villous maturation (DVM) of the placenta is associated with chromosomal abnormalities, gestational diabetes, and an adverse outcome. This study compares quantitative assessment of vasculo-syncytial membranes (VSM) in cases of liveborn infants, perinatal deaths, and controls. Cases were selected as follows: (1) liveborn infants with a qualitative diagnosis of DVM (n  =  15); (2) controls matched for gestational age whose placentas did not have DVM (n  =  15); (3) stillbirths (SB)/neonatal deaths (NND) showing DVM (n  =  13); and (4) SB from autopsies in which DVM was felt to be the cause of death (COD) (n  =  12). Vasculo-syncytial membranes were counted in 10 terminal villi in each of 10 consecutive high-power fields on 3 slides. Data analysis was carried out using SPSS. Liveborn cases with DVM showed statistically significantly less VSM than controls (mean 1.01 vs 2.42, P < 0.0001). The SB/NND group also showed significantly less VSM than the control group (mean 0.46 vs 2.42, P < 0.0001) and less than the liveborn DVM group (mean 0.46 vs 1.01, P  =  0.001). The COD group was significantly different from the control group (mean 0.42 vs 2.42, P < 0.0001) and the liveborn DVM group (mean 0.42 vs 1.01, P < 0.0001) but not significantly different from the SB/NND group. There is a quantitative reduction in VSM in cases of DVM compared to controls.
    • Efficacy and safety of intravenous Ig and alterations in haematological parameters of infants with isoimmune haemolytic disease.

      Freyne, B; O'Hare, F M; Molloy, E J (Archives of disease in childhood. Fetal and neonatal edition, 2012-01)
    • Fetal and maternal leptin in pre-gestational diabetic pregnancy.

      Higgins, Mary F; Russell, Noirin M; Brazil, Derek P; Firth, Richard G; McAuliffe, Fionnuala M; UCD Obstetrics and Gynecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2013-02)
      To compare maternal and fetal leptin among women without diabetes, women with type 1 diabetes, and women with type 2 diabetes.
    • 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.
    • Ghrelin concentrations in maternal and cord blood of type 1 diabetic and non-diabetic pregnancies at term.

      Hehir, Mark P; Laursen, Henriette; Higgins, Mary F; Brennan, Donal J; O'Connor, Darran P; McAuliffe, Fionnuala M; UCD Obstetrics & Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. markhehir23@gmail.com (Springer, 2013-02)
    • High flow nasal cannula for respiratory support in preterm infants.

      Wilkinson, Dominic; Andersen, Chad; O'Donnell, Colm Pf; De Paoli, Antonio G; Discipline of Obstetrics and Gynecology, Women's and Children's Hospital, University of Adelaide, 72 King William Road, North Adelaide, SA, Australia, 5006. (The Cochrane database of systematic reviews, 2011)
      High flow nasal cannulae (HFNC) are small, thin, tapered cannulae used to deliver oxygen or blended oxygen and air at flow rates of > 1 L/min. HFNC can be used to provide high concentrations of oxygen and may deliver positive end-expiratory pressure.
    • In vitro effect of exothermic mattresses on temperature in the delivery room.

      McCarthy, Lisa K; Hensey, Conor C; O'Donnell, Colm P F (Resuscitation, 2012-10)
    • Increasing rates of operative vaginal delivery across two decades: accompanying outcomes and instrument preferences.

      Hehir, Mark P; Reidy, Fiona R; Wilkinson, Michael N; Mahony, Rhona; National Maternity Hospital, Holles St, Dublin, Ireland. Electronic address: markhehir23@gmail.com. (2013-11)
      To examine rates and outcomes of operative vaginal delivery over a 20-year study period and the changing preference for various instruments during this period.
    • The influence of maternal glycaemia and dietary glycaemic index on pregnancy outcome in healthy mothers.

      McGowan, Ciara A; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, National Maternity Hospital, University College Dublin, Holles Street, Dublin 2, Republic of Ireland. (2010-07)
      Infant birth weight has increased in Ireland in recent years along with levels of childhood overweight and obesity. The present article reviews the current literature on maternal glycaemia and the role of the dietary glycaemic index (GI) and its impact on pregnancy outcomes. It is known that maternal weight and weight gain significantly influence infant birth weight. Fetal macrosomia (birth weight >4000 g) is associated with an increased risk of perinatal trauma to both mother and infant. Furthermore, macrosomic infants have greater risk of being obese in childhood, adolescence and adulthood compared to normal-sized infants. There is evidence that there is a direct relationship between maternal blood glucose levels during pregnancy and fetal growth and size at birth, even when maternal blood glucose levels are within their normal range. Thus, maintaining blood glucose concentrations within normal parameters during pregnancy may reduce the incidence of fetal macrosomia. Maternal diet, and particularly its carbohydrate (CHO) type and content, influences maternal blood glucose concentrations. However, different CHO foods produce different glycaemic responses. The GI was conceived by Jenkins in 1981 as a method for assessing the glycaemic responses of different CHO. Data from clinical studies in healthy pregnant women have documented that consuming a low-GI diet during pregnancy reduces peaks in postprandial glucose levels and normalises infant birth weight. Pregnancy is a physiological condition where the GI may be of particular relevance as glucose is the primary fuel for fetal growth.
    • 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.
    • Management of renal dysfunction following term perinatal hypoxia-ischaemia.

      Sweetman, Deirdre U; Riordan, Michael; Molloy, Eleanor J; Neonatology, National Maternity Hospital, Dublin, Ireland. dee.sweetman@gmail.com (2013-03)
      Acute kidney injury frequently develops following the term perinatal hypoxia-ischaemia. Quantifying the degree of acute kidney injury is difficult, however, as the methods currently in use are suboptimal. Acute kidney injury management is largely supportive with little evidence basis for many interventions. This review discusses management strategies and novel biomarkers that may improve diagnosis and management of renal injury following perinatal hypoxia-ischaemia.