• Activated protein C alters neutrophil reactive oxygen intermediates in preterm neonates

      Eliwan, HO; Watson, W; O'Neill, A; O'Hare, F; Molloy, EJ (Archives of Disease in Childhood, 2012-10)
    • A audit of the use of PICC lines in preterm infants (<33 weeks) in a tertiary neonatal intensive care unit

      Nosherwan, A; Gill, I; Walsh, H; Knowles, S; Twomey, A (Archives of Disease in Childhood, 2012-10)
    • 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.
    • A correlation between severe haemolytic disease of the fetus and newborn and maternal ABO blood group.

      Doyle, B; Quigley, J; Lambert, M; Crumlish, J; Walsh, C; McParland, P; Culliton, M; Murphy, K; Fitzgerald, J; Red Cell Immunohaematology Laboratory, Irish Blood Transfusion Service, Dublin, Ireland. (Transfusion medicine (Oxford, England), 2014-06-28)
      To analyse anti-D quantification levels and frequency of intrauterine transfusion (IUT), per maternal ABO blood group.
    • An exploration of the experiences of mothers as they suppress lactation following late miscarriage, stillbirth or neonatal death

      McGuinness, D; Coghlan, B; Butler, Michelle; National Maternity Hospital, Holles St. UCD School of Nursing Midwifery and Health Systems,The University of British Columbia. (Royal College of Midwives, 2014)
      Objective. To explore the experiences of bereaved mothers as they suppress lactation following late miscarriage (>20 weeks), stillbirth or neonatal death. Method. A qualitative, focused ethnographic approach was used involving in-depth interviews with 15 bereaved mothers, who attended a maternity hospital in Dublin. Data were collected from January to August 2012. Findings. Three key themes were identified: (1) suppression of lactation following the loss of a baby: silent tears; (2) mothering; (3) supportive care needs and the bereaved mother’s experience. This paper focuses on the first global theme. The majority of bereaved mothers found engorgement and leaking milk particularly challenging both physically and emotionally following the loss of their baby; especially as their baby’s funeral or wake took place during this period. The study highlights a number of areas where women could be better prepared for this experience. Conclusion. The findings highlight that the majority of bereaved mothers will require improved guidance and support with their breast care needs following the loss of their baby with awareness and sensitivity to their shortened motherhood.
    • 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.
    • Gentamicin dosing in therapeutic hypothermia; a quality improvement initiative

      Whitla, L; Fitzgerald, D; Twomey, A; Knowles, S; Murphy, JFA (Irish Medical Journal, 2016-01)
      We read with interest a number of articles on gentamicin dosing in neonates treated with therapeutic hypothermia 1-3 . Therapeutic hypothermia has now become the standard of care for newborn infants with hypoxic-ischaemic encephalopathy. Many of these infants concurrently receive gentamicin. Gentamicin is nephrotoxic and ototoxic at high serum concentrations. We therefore carried out a study in The National Maternity Hospital Holles St to analyse trough and peak gentamicin levels in infants who were cooled and compared them to a control group of non-cooled infants.
    • 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.
    • 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.
    • Maternal and neonatal morbidity during off peak hours in a busy obstetric unit. Are deliveries after midnight more complicated?

      Hehir, Mark P; Walsh, Jennifer M; Higgins, Shane; Mahony, Rhona; National Maternity Hospital, Dublin, Ireland. (2014-02)
      We sought to compare maternal and neonatal outcomes in deliveries occurring overnight with those in daylight hours.
    • 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 meningitis: a diagnostic dilemma.

      Parameshwar, M; Ismail, A M; Matheson, M; Knowles, S; Molloy, E J (Irish Medical Journal, 2012-09)
    • Neonatal respiratory extracorporeal membrane oxygenation (ECMO) referrals

      EL-Khuffash, A; Kieran, E (Irish Medical Journal, 2011-03)
    • Perinatal treponema pallidum: Evidence based guidelines to reduce mother to child transmission

      Freyne, B; Stafford, A; Knowles, S; O’ Hora, A; Molloy, E (Irish Medical Journal (IMJ), 2014-01)
      Universal antenatal screening for T. pallidum is standard in Irish maternity units. The prevalence of adult syphilis has increased in Ireland. We audited the neonatal management of infants exposed to T. pallidum in utero. A cross sectional retrospective analysis of all pregnancies with confirmed positive serology for T. pallidum from January 2005 to December 2010 was conducted at the National Maternity Hospital, Holles St. Data were analysed using SPSS 14.0. Ethical approval was obtained. There were 55,058 live births during the study period. Fifty-eight women had positive serology and 41 met inclusion criteria. Infant evaluation and follow up was decided by allocation to an evidence based algorithm. Twenty-one infants (51%) were accurately allocated and assessed, 5 (12%) had a partial assessment and the algorithm was incorrectly applied in 15 (36%) of cases. Failure to adhere to evidence based neonatal guidelines is common and undermines efficacy of the screening program.
    • Placental pathology in small for gestational age infants

      Thorne, J; Downey, P; Mooney, EE (Irish Medical Journal, 2014-09)
      Infants with intrauterine growth restriction (IUGR) are at an increased risk of perinatal disease, including death. Many, but not all small for gestational age infants (SGA) have IUGR. Placental disease is an important cause of IUGR, and gross and microscopic examination is critical in explaining such cases. Reports of placentas from infants with a birth weight <2SD from the mean (approx 3rd centile) born between Jan 2004-Dec 2011 were evaluated. The principal pathology was determined in each case. Where two or more pathologic findings were present, they were ranked as principal and co-existing in terms of severity. There were 69,493 deliveries over the study period. 461 SGA cases were identified. No placenta was available in 44 cases, and 21 cases of known anomalies were excluded, leaving a study group of 396 cases. Pathology potentially causing or contributing to SGA and/or IUGR was identified in 84.1% of cases. Significant co-existing pathology was seen in 88 cases (22%). Placental examination provides key information in understanding abnormal fetal growth
    • Placental pathology, birthweight discordance, and growth restriction in twin pregnancy: results of the ESPRiT Study.

      Kent, Etaoin M; Breathnach, Fionnuala M; Gillan, John E; McAuliffe, Fionnuala M; Geary, Michael P; Daly, Sean; Higgins, John R; Hunter, Alyson; Morrison, John J; Burke, Gerard; et al. (American journal of obstetrics and gynecology, 2012-09)
      We sought to evaluate the association between placental histological abnormalities and birthweight discordance and growth restriction in twin pregnancies.
    • Pulmonary haemorrhage in very low birth weight infants: 10 year experience in tertiary NICU

      Nosherwan, A; Bermijo, K; O'Leary, D; Molloy, E (Archives of Disease in Childhood, 2012-10)
    • Randomised trial of single nasal prong or face mask for respiratory support for preterm infants in delivery room

      McCarthy, LK; Molloy, EJ; Twomey, AR; Murphy, JF; O'Donnell, CPF (Archives of Disease in Childhood, 2012-10)
    • Significantly elevated systemic neutrophil reactive oxygen intermediates are associated with severe neonatal encephalopathy

      O'Hare, F; Watson, R; O'Neill, A; Donoghue, V; O'Donnell, C; Murphy, J; Twomey, A; Molloy, E (Pediatric Research, 2011-11)
      52nd Annual Meeting of the European Society for Paediatric Research UK Oct 2011