• 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.
    • How safe is vaginal twin birth? Evidence from the prospective ESPRiT study

      Daly, S; Higgins, J; Burke, G; Mahony, R; Higgins, S; Geary, M; Breathnach, F; Dicker, P (Am J Obstet Gynecol, 2011-01)
      Society for Maternal-Fetal Medicine. The pregnancy Meeting Feb 2011
    • Identification of a myometrial molecular profile for dystocic labor.

      Brennan, Donal J; McGee, Sharon F; Rexhepaj, Elton; O'Connor, Darran P; Robson, Michael; O'Herlihy, Colm; National Maternity Hospital, Dublin , Ireland. (2011)
      The most common indication for cesarean section (CS) in nulliparous women is dystocia secondary to ineffective myometrial contractility. The aim of this study was to identify a molecular profile in myometrium associated with dystocic labor.
    • Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy.

      Walsh, Jennifer M; Mahony, Rhona M; Canty, Gillian; Foley, Michael E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital,Dublin,Republic of Ireland. (2014-08-28)
      The present study is a secondary analysis of the ROLO study, a randomised control trial of a low-glycaemic index (GI) diet in pregnancy to prevent the recurrence of fetal macrosomia. The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures: birth weight; maternal glucose intolerance; gestational weight gain (GWG). In early pregnancy, 372 women had their mid-upper arm circumference recorded and BMI calculated. Concentrations of glucose, insulin and leptin were measured in early pregnancy and at 28 weeks. At delivery, infant birth weight was recorded and fetal glucose, C-peptide and leptin concentrations were measured in the cord blood. Women who benefited in terms of infant birth weight were shorter, with a lower education level. Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies, with no difference being observed in maternal height. Women who at 28 weeks of gestation developed glucose intolerance, despite the low-GI diet, had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance. They also had significantly higher-interval pregnancy weight gain. For each analysis, women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not. These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance, whereas birth weight is mediated more by genetic factors. It highlights key areas, which warrant further interrogation before future pregnancy intervention studies, in particular, maternal education level and inter-pregnancy weight gain.
    • 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.
    • The impact of diet, body composition, and physical activity on child bone mineral density at five years of age-findings from the ROLO Kids Study.

      McVey, Marco K; Geraghty, Aisling A; O'Brien, Eileen C; McKenna, Malachi J; Kilbane, Mark T; Crowley, Rachel K; Twomey, Patrick J; McAuliffe, Fionnuala M (2019-11-01)
      Bone health is extremely important in early childhood because children with low bone mineral density (BMD) are at a greater risk of bone fractures. While physical activity and intake of both calcium and vitamin D benefit BMD in older children, there is limited research on the determinants of good bone health in early childhood. The aim of this cross-sectional study was to investigate the impact of diet, physical activity, and body composition on BMD at five years of age. Dietary intakes and physical activity levels were measured through questionnaires. Whole body BMD was measured by dual-energy X-ray absorptiometry in 102 children. Child weight, height, circumferences, skinfolds and serum 25-hydroxyvitamin D (25OHD) concentrations were assessed. There was no association between BMD and dietary calcium, dietary vitamin D, 25OHD, physical activity, or sedentary behaviour. Several measures of body composition were significantly positively associated with BMD; however, neither fat mass nor lean body mass was associated with BMD.Conclusion: Although we found no association between self-reported dietary and lifestyle factors and bone health in early years, increased body size was linked with higher BMD. These findings are important as identifying modifiable factors that can improve bone health at a young age is of utmost importance.What is Known:• Bone health is extremely important in early childhood, as children with low bone mineral density (BMD) are at greater risk of bone fractures.• Physical activity has been found to be beneficial for bone health in adolescents, and body composition has also been associated with BMD in teenage years.• Limited research on the determinants of good bone health in early childhood.What is New:• No association between self-reported lifestyle and dietary factors with bone health in early childhood.• Increased body size was associated with higher BMD at five years of age.
    • Impact of maternal age and parity in management ansd outcome of major obstetric haemorrhage

      O'Connor, H; Hehir, M; Walsh, J; Fitzpatrick, C; Coulter-Smith, S; Geary, M; Higgins, S; Malone, F (American Journal of Obstetrics and Gynaecology, 2012-01)
    • Impact of maternal and fetal adiposity on maternal and fetal vitamin D

      Walsh, J; Kilbane, M; Mahony, R (American Journal of Obstetrics and Gynaecology, 2012-01)
    • Improving Assessment During Noninvasive Ventilation in the Delivery Room

      Lista, G.; Schmolzer, G. M.; O'Donnell, C. P. F. (NeoReviews, 2012-06)
    • 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.