• 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 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.
    • A case of recurrent familial male miscarriages with hypercoiled umbilical cord: a possible X-linked association?

      Beggan, Caitlin; Mooney, Eoghan E; Downey, Paul; Carroll, Stephen; Reardon, Willie; Department of Histopathology, National Maternity Hospital, Dublin, Ireland. (2014-01)
    • Closed and open breathing circuit function in healthy volunteers during exercise at Mount Everest base camp (5300 m).

      McMorrow, R C N; Windsor, J S; Hart, N D; Richards, P; Rodway, G W; Ahuja, V Y; O'Dwyer, M J; Mythen, M G; Grocott, M P W; UCL Centre for Altitude Space and Extreme Environment Medicine, UCL Institute of Child Health, University College London, London, UK. mcmorrow.roger@gmail.com (Anaesthesia, 2012-08)
      We present a randomised, controlled, crossover trial of the Caudwell Xtreme Everest (CXE) closed circuit breathing system vs an open circuit and ambient air control in six healthy, hypoxic volunteers at rest and exercise at Everest Base Camp, at 5300 m. Compared with control, arterial oxygen saturations were improved at rest with both circuits. There was no difference in the magnitude of this improvement as both circuits restored median (IQR [range]) saturation from 75%, (69.5-78.9 [68-80]%) to > 99.8% (p = 0.028). During exercise, the CXE closed circuit improved median (IQR [range]) saturation from a baseline of 70.8% (63.8-74.5 [57-76]%) to 98.8% (96.5-100 [95-100]%) vs the open circuit improvement to 87.5%, (84.1-88.6 [82-89]%; p = 0.028). These data demonstrate the inverse relationship between supply and demand with open circuits and suggest that ambulatory closed circuits may offer twin advantages of supplying higher inspired oxygen concentrations and/or economy of gas use for exercising hypoxic adults.
    • 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.
    • 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.
    • Maternal Nutrition and Glycaemic Index during Pregnancy Impacts on Offspring Adiposity at 6 Months of Age--Analysis from the ROLO Randomised Controlled Trial.

      Horan, Mary K; McGowan, Ciara A; Gibney, Eileen R; Byrne, Jacinta; Donnelly, Jean M; McAuliffe, Fionnuala M (MDPI AG, 2016-01-04)
      Childhood obesity is associated with increased risk of adult obesity and metabolic disease. Diet and lifestyle in pregnancy influence fetal programming; however the influence of specific dietary components, including low glycaemic index (GI), remains complex. We examined the effect of a maternal low GI dietary intervention on offspring adiposity at 6 months and explored the association between diet and lifestyle factors in pregnancy and infant body composition at 6 months. 280 6-month old infant and mother pairs from the control (n = 142) and intervention group (n = 138), who received low GI dietary advice in pregnancy, in the ROLO study were analysed. Questionnaires (food diaries and lifestyle) were completed during pregnancy, followed by maternal lifestyle and infant feeding questionnaires at 6 months postpartum. Maternal anthropometry was measured throughout pregnancy and at 6 months post-delivery, along with infant anthropometry. No difference was found in 6 months infant adiposity between control and intervention groups. Maternal trimester three GI, trimester two saturated fats and trimester one and three sodium intake were positively associated with offspring adiposity, while trimester two and three vitamin C intake was negatively associated. In conclusion associations were observed between maternal dietary intake and GI during pregnancy and offspring adiposity at 6 months of age.
    • Mode of delivery at term and adverse neonatal outcomes.

      Walsh, Colin A; Robson, Michael; McAuliffe, Fionnuala M; National Maternity Hospital and UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. colwalsh@hotmail.com (2013-01)
      To determine the relationship between mode of delivery and serious adverse neonatal outcomes in term, singleton, cephalic neonates.
    • Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals.

      El-Khuffash, A; Kieran, E; Palmer, K; Molloy, E; Department of Paediatrics, National Maternity hospital, Holles St, Dublin 2. (2011-03)
      Extracorporeal membrane oxygenation (ECMO) is a complex technique for providing life support in neonatal respiratory failure. T UK Collaborative ECMO trial demonstrated cost-effectiveness and substantial improvements in neurological morbidity and mortality. Currently, infants requiring ECMO in Ireland are referred to one of various centres in the UK and Scandinavia. We aimed to review the number of infants referred from Ireland for respiratory ECMO. All infants with a non-cardiac condition referred from Ireland for ECMO were reviewed for diagnosis and outcomes. Eleven infants required ECMO between June 2006 and January 2009 and were referred to the Scandinavian team for ECMO transport although one infant improved and did not require ECMO following the arrival of the team. Four infants died: one infant died prior to arrival of the ECMO team, 3 infants had fatal diagnoses and one infant with congenital diaphragmatic hernia received pre-op ECMO. The median (inter-quartile range) gestational age was 39.7 (38.3-40.7) weeks and birth weight of 3.7 (3.2-4.0) kg. The median age at the decision to transfer for ECMO was 13h (4-123) and the team arrived at 23 h (12-132). All infants had a normal cranial ultrasound and echo prior to ECMO and 2 infants had an abnormal MRI post-ECMO. The time on ECMO was 9 days (3-17) and total length of hospital stay was 32 d (23-36). There were no pre-ECMO clinical or biochemical
    • Non-blood group-specific red blood cell transfusions in preterm infants and necrotizing enterocolitis.

      Morgan, Conall T; Culliton, Marie; McCarthy, Roberta; Molloy, Eleanor J (Journal of Pediatrics, 2012-02)
    • 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).
    • Plastics bags reduce hypothermia in newly born infants in the developing world.

      O'Donnell, Colm P F; Department of Neonatology, The National Maternity Hospital, , Dublin, Ireland. (2014-04)
    • Pulse oximetry screening for congenital heart disease.

      Travers, C; Murphy, J F A (Irish Medical Journal, 2012-04)
    • A randomised crossover study of low-flow air or oxygen via nasal cannulae to prevent desaturation in preterm infants.

      Hensey, Conor C; Hayden, Eoghan; O'Donnell, Colm Patrick Finbarr; Department of Neonatology, The National Maternity Hospital, Dublin, Ireland. (2013-09)
      To compare the efficacy of low-flow oxygen, low-flow air and sham treatment given via nasal cannulae in preventing desaturation (falls in oxygen saturation (SpO2)) in preterm infants.
    • 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.
    • Randomized trial of prongs or mask for nasal continuous positive airway pressure in preterm infants.

      Kieran, Emily A; Twomey, Anne R; Molloy, Eleanor J; Murphy, John F A; O'Donnell, Colm P F; The National Maternity Hospital, Dublin, Ireland. (2012-11)
      To determine whether nasal continuous positive airway pressure (NCPAP) given with nasal prongs compared with nasal mask reduces the rate of intubation and mechanical ventilation in preterm infants within 72 hours of starting therapy.
    • Seen but not heard: congenital cytomegalovirus.

      Harrison, G; Waters, A; De Gascun, C F; Boyle, M; Knowles, S; Molloy, E J (Archives of disease in childhood. Fetal and neonatal edition, 2012-09)
    • 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.
    • Stereology of the placenta in type 1 and type 2 diabetes.

      Higgins, M; Felle, P; Mooney, E E; Bannigan, J; McAuliffe, F M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland. (2011-08)
      To assess by stereology the placental structure in type 1 (T1DM) and type 2 (T2DM) diabetic pregnancies compared to normal non-diabetic (ND) controls.