• Fallout of the enterocolitis, autism, MMR vaccine paper.

      Murphy, J F A (Irish Medical Journal, 2011-02)
      On the 28th Feb 1998 The Lancet published a paper by Andrew Wakefield 1 that proposed a new condition of enterocolitis, regressive autism and an association with MMR vaccine as the apparent precipitating event. At a press conference describing the 12 children case series he urged the use of single vaccines instead of MMR. The study generated immediate alarm and controversy. After its publication the findings had far reaching consequences. The implication that the MMR vaccine could precipitate Crohnâ s disease and Autism was widely disseminated by the media. Attempts by the health authorities to reassure and calm fears were ineffective. Parents became extremely alarmed. Public confidence in the MMR vaccine was undermined and immunisation rates fell sharply below the critical 92% required for herd immunity. There was a rapid resurgence in the numbers of children affected with measles. Dublin was particularly badly affected. A paper published in 2003 describing the Irish experience of measles reappearance received worldwide attention 2 . It graphically illustrated the damage that can be caused when a vaccination programme is impaired. A total of 355 children attended Temple Street A&E with Measles and 111 were admitted with either pneumonitis or dehydration. Seven children required ventilation and 3 children died. The allegations against the MMR vaccine were difficult to refute and the restoration of confidence in the vaccine was painfully slow. An IMJ commentary in 2000 stated that the current large number of children developing Measles was due to the significant reduction in the proportion being administered MMR vaccination 3 . Vaccination rates were as low as 75% in some parts of the country. The Dept. of Health had become very concerned. The then Minister for Health and Children Michael Martin launched â A Vaccination Awareness Campaignâ to highlight the problem. Despite everybodyâ s best efforts the problem of low vaccine uptake rumbled on. This is not surprising. Allegations of vaccine risk are difficult to defend. In relation to vaccination, todayâ s allegation is remembered long after tomorrowâ s explanation is forgotten.
    • Fatigue and the delivery of medical care

      Murphy, JFA (Irish medical Journal, 2011-01)
      Lack of sleep has well established effects on physiological, cognitive and behavioural functionality. Sleep deprivation can adversely affect clinical performance as severely as alcohol according to some sources. Sleep deficiency may be due to loss of one night’s sleep or repeated interruptions of sleep. Chronic sleep degrades the ability to recognise one’s ability to recognise the impairments induced by sleep loss. The problem of sleep deprivation has vexed acute medical practice for decades. Improvement has been painfully slow. The problem is that all 168 hours throughout every week of every year have to be covered and there are a finite number of doctors to shoulder the burden. There are many strongly held views about how best to provide night-time and week-end care. Constructive innovations are thin on the ground. The biggest gap is between administration and doctors with financial considerations being the limiting factor. It is, however, generally accepted on all sides that sleep loss and fatigue can have adverse effects on both patients and doctors.
    • 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 death in twins.

      Mahony, Rhona; Mulcahy, Celia; McAuliffe, Fionnuala; Herlihy, Colm O; Carroll, Stephen; Foley, Michael E; Department of Obstetrics and Gynaecology, National Maternity Hospital, University College Dublin, Dublin, Ireland. rhonamahony@hotmail.com (2011-11)
      To examine the pattern and prospective risk of intrauterine fetal death (IUFD) in twin pregnancy by chorionicity.
    • Fetal loss rates from intrauterine fetal transfusion: a prospective tertiary center study

      Walsh, C; Russell, N (American Journal of Obstetrics and Gynaecology, 2012-01)
    • 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.
    • The first minute of life: how does real life compare to algorithms

      McCarthy, L; O'Donnell, CP (Pediatric Research, 2011-11)
      52 Annual Meeting of the European Society for Paediatric Research Newcastle UK Oct 2011
    • First trimester maternal urinary metabolomic profile to predict macrosomia

      Walshe, J; Brennan, L; Mahony, R; Foley, M; McAuliffe, F (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2010
    • Folic acid supplement use in the prevention of neural tube defects.

      Delany, C; McDonnell, R; Robson, M; Corcoran, S; Fitzpatrick, C; De La Harpe, D; RCSI, 123 St Stephen's Green, Dublin 2. (Irish medical journal, 2011-01)
      In 2008, planned folic acid fortification for the prevention of Neural Tube Defects (NTD) was postponed. Concurrently, the economic recession may have affected dietary folic acid intake, placing increased emphasis on supplement use. This study examined folic acid supplement use in 2009. A cross-sectional survey of 300 ante-natal women was undertaken to assess folic acid knowledge and use. Associations between demographic, obstetric variables and folic acid knowledge and use were examined. A majority, 284/297 (96%), had heard of folic acid, and 178/297 (60%) knew that it could prevent NTD. Most, 270/297 (91%) had taken it during their pregnancy, but only 107/297 (36%) had used it periconceptionally. Being older, married, planned pregnancy and better socioeconomic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from economic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from earlier years. Continuous promotion efforts are necessary. Close monitoring of folic acid intake and NTD rates is essential, particularly in the absence of fortification.
    • Follow up of infants born to women with Hepatitis B in the National Maternity Hospital

      Travers, CP; Connell, J; Thornton, L; Keane, E; Knowles, S; Murphy, JFA (Irish Medical Journal, 2015-05)
    • 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.
    • Ghrelin concentrations in maternal and cord blood of type 1 diabetic and non-diabetic pregnancies at term

      Heir, MP; Lausen, H; Higgins, MF; Brennan, DJ; O'Connor, DP; Russell, NE; Foley, M; McAuliffe, F (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting Nov 2010
    • 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)
    • Glucose homeostasis in the intensive care: the end of a cycle

      Murphy, JFA (Irish Medical Journal, 2012-10)
      Over the last decade there has been extensive literature and debate about blood glucose control in adults and children undergoing intensive care. The concept of tight glycaemic management began in adults and subsequently trickled down to paediatric patients. Hyperglycaemia is known to correlate with the degree of organ failure and death. The central question is whether hyperglycaemia is simply a marker of illness severity or a contributory factor in the patient’s illness. This is of fundamental importance in that it determines whether one should intervene or defer insulin treatment. The other issue is whether treatment with insulin is beneficial or harmful in this ICU setting. Possible explanations for the adverse effects of high glucose include pro-inflammatory responses. It was postulated that lethal perfusion injury to vital organs could be reduced by the prevention of hyperglycaemia with insulin. It was clear that randomised trials were needed to determine the best course of action.
    • Guidelines and avoiding meltdown

      Murphy, JFA (Irish Medical Journal, 2011-10)
      The provision of medical care has become more complex and correspondingly more stressful. Patients’ expectations of doctors are high. Poor medical outcomes are in many cases likely to be perceived as physician or surgeon failure rather than the inevitable consequences of the underlying disease. Both the substance and the process of individual cases are closely scrutinised. It is about how you do it as well as what you do.
    • Guidelines and avoiding meltdown.

      Murphy, J F A (Irish Medical Journal (IMJ), 2011-10)
    • Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth.

      Di Renzo, Gian Carlo; Roura, Lluis Cabero; Facchinetti, Fabio; Antsaklis, Aris; Breborowicz, Gregor; Gratacos, Eduard; Husslein, Peter; Lamont, Ronnie; Mikhailov, Anton; Montenegro, Nuno; et al. (The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2011-05)
    • Gynaecology training for higher specialist trainees in obstetrics and gynaecology: a personal view

      Maher, N; Foley, M (Irish Medical Journal (IMJ), 2015-10)
      As a specialist trainee in Obstetrics and Gynaecology in Ireland, I wish to add some supportive information to reinforce the suggestion that the minimum time spent training in gynaecology be one year.
    • 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.