• Thoraco-amniotic shunting for fetal pleural effusion--a case series.

      Walsh, J; Mahony, R; Higgins, S; McParland, P; Carroll, S; McAuliffe, F; National Maternity Hospital, Holles St, Dublin 2. jennifer.walsh@ucd.ie (2011-11-15)
      Fetal pleural effusion is a rare occurrence, with an incidence of 1 per 10-15,000 pregnancies. The prognosis is related to the underlying cause and is often poor. There is increasing evidence that in utero therapy with thoraco-amniotic shunting improves prognosis by allowing lung expansion thereby preventing hydrops and pulmonary hypoplasia. This is a review of all cases of fetal pleural effusion managed over an eight year period the National Maternity Hospital Dublin. Over the nine year period there were 21 cases of fetal pleural effusion giving an overall incidence of 1 per 9281 deliveries. Of these, 15 underwent thoraco-amniotic shunting. There were associated anomalies diagnosed in 5 (33%) of cases. The overall survival in our cohort was 53%. The presence of hydrops was a poor prognostic factor, with survival in cases with hydrops of 33% (3/9) compared to 83% (5/6) in those cases without associated hydrops.
    • Timing of interventions in the delivery room: does reality compare with neonatal resuscitation guidelines?

      McCarthy, Lisa K; Morley, Colin J; Davis, Peter G; Kamlin, C Omar F; O'Donnell, Colm P F (2013-12)
      To determine the proportion of infants who had the tasks recommended in the neonatal resuscitation guidelines performed within 30 and 60 seconds of birth, and the time taken to perform each task.
    • Tissue Doppler Imaging Quantifies Early Changes in Preterm Myocardium

      Armstrong, K; Molloy, E; Franklin, O (Archives of Disease in Childhood, 2012-10)
      Abstract Introduction Haemodynamic changes occurring during the fetal – neonatal transition may impact on global myocardial function in the first week of life. Tissue Doppler imaging (TDI) offers a novel technique to measure changes in systolic and diastolic function in neonates. Aims To use TDI to assess myocardial function in preterm infants compared to gold standard measures. Methods Preterm infants < 32 weeks gestation were recruited. Echocardiography was carried out by a single observer (KA) using the GE Vivid I, on Day 1, 3–4 and Day 7. Clinical parameters were recorded at time of echocardiogram. Standard M mode echocardiography was used to determine shortening and ejection fraction. Myocardial velocities were obtained using a pulsed wave doppler sample from the lateral mitral/tricuspid annuli and intraventricular septum from an apical four chamber view. Peak systolic (S’), early diastolic (E’) and late diastolic (A’) velocities were recorded. Results 140 echocardiograms were performed on 60 neonates with structurally normal hearts. Gestational age range-23+ 6–31+ 6 weeks. There was a significant increase in heart rate (p=0.002)and systolic blood pressure over the 1st week. (p=0.001). There was an increase in myocardial velocities across all measurements, with right ventricular early systolic and late diastolic velocities increasing significantly (p<0.002). There was a significant increase in the left ventricle late diastolic velocities (p=0.036). There was no significant difference in shortening/ejection fraction over the first week. Conclusion TDI offers a reliable measure of myocardial velocities over the first week. Current gold standard measures shortening/ejection fraction showed no significant change in myocardial contractility however TDI demonstrated significant changes in both RV and LV systolic and diastolic velocities.
    • Toll-like receptors in neonatal sepsis.

      O'Hare, Fiona M; William Watson, R; Molloy, Eleanor J (2013-06)
      Toll-like receptors are vital transmembrane receptors that initiate the innate immune response to many micro-organisms. The discovery of these receptors has improved our understanding of host-pathogen interactions, and these receptors play an important role in the pathogenesis of multiple neonatal conditions such as sepsis and brain injury. Toll-like receptors, especially TLRs 2 and 4, are associated with necrotizing enterocolitis, periventricular leukomalacia and sepsis.
    • Towards evidence based medicine for paediatricians. Question 2. What is the ideal dose of vitamin D supplementation for term neonates?

      Onwuneme, Chike; Carroll, Aoife; McCarthy, Roberta; Kilbane, Mark; McKenna, Malachi; Murphy, Nuala; Molloy, Eleanor J; Department of Paediatrics, National Maternity Hospital, Holles Street, Dublin 2, Ireland. chike.onwuneme@gmail.com (2012-04)
    • Troponin T, N-terminal pro natriuretic peptide and a patent ductus arteriosus scoring system predict death before discharge or neurodevelopmental outcome at 2 years in preterm infants.

      El-Khuffash, Afif F; Slevin, Marie; McNamara, Patrick J; Molloy, Eleanor J; Department of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada. afif_faisal@hotmail.com (Archives of disease in childhood. Fetal and neonatal edition, 2011-03)
      There is little consensus regarding the use of echocardiography in patent ductus arteriosus (PDA) treatment in preterm infants. The use of troponin T (cTnT) and N-terminal Pro-BNP (NTpBNP) in combination with echocardiography assessment may facilitate the development of a superior predictive model.
    • Turn and face the strange - ch..ch..ch..changes to neonatal resuscitation guidelines in the past decade.

      O'Donnell, Colm P F; The National Maternity Hospital, Our Lady's Children's Hospital, National Children's Research Centre, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. codonnell@nmh.ie (2012-09)
      Resuscitation of newborns has been described since ancient times and is among the most commonly performed emergency medical interventions. The International Liaison Committee on Resuscitation first made recommendations on resuscitation in newborns in 1999. Over the last decade, new research and careful review of the available evidence have resulted in substantial changes to these recommendations - in particular, regarding the assessment of colour, giving supplemental oxygen, suctioning infants born through meconium-stained liquor, confirming endotracheal tube position, the use of pulse oximetry, giving CPAP to premature infants, keeping preterm infants warm using polyethylene wrapping and cooling term infants with encephalopathy. This process has also highlighted the paucity of evidence to support much of the care given to infants in the delivery room and the need for research to refine our techniques.
    • Ultrasonically detectable cerebellar haemorrhage in preterm infants.

      McCarthy, Lisa Kenyon; Donoghue, V; Murphy, J F A; Department of Neonatology, The National Maternity Hospital, Dublin, Ireland. lmccarthy@nmh.ie (2011-07)
      To determine the frequency and pattern of cerebellar haemorrhage (CBH) on routine cranial ultrasound (cUS) imaging in infants of ≤32 weeks gestation, and to investigate how extremely preterm infants with CBH differ from those with severe intraventricular haemorrhage (IVH).
    • Unmarried Mothers Delivered in the National Maternity Hospital - 1987

      Richardson, Valerie; Winston, Nessa; Department of Social Administration and Social Work, University College, Dublin 4. (The National Maternity Hospital Holles St, 1989)
      This report is the second in a series presenting the results of the on-going work of the Social Work Research Unit in the National Maternity Hospital. The Social Work Research Unit was set up in December 1985 as a joint project between the National Maternity Hospital and the Department of Social Work in University College, Dublin.
    • Unmarried Mothers Delivered in the National Maternity Hospital 1986

      Richardson, Valerie; Keenan, Jacqueline; Department of Social Administration & Social Work, University College, Dublin 4 (The National Maternity Office Holles St, 1987)
    • Unmarried Mothers Delivered in the National Maternity Hospital 1988

      Donohoe, Josephine; Fitzpatrick, Ann; Flanagan, Niamh; Scanlan, Sheila (National Maternity Hospital, Holles Street,, 1990)
    • Uptake of the Influenza Vaccination in Pregnancy

      Crosby, DA; Deleau, D; Brophy, C; Mcauliffe, FM; Mahony, R (Irish Medical Journal, 2016-09)
      Influenza is caused by a highly infectious RNA virus, which usually occurs in a seasonal pattern with epidemics in the winter months. The objective of this study was to determine the uptake of the influenza vaccine in a pregnant population and ascertain the reasons why some women did not receive it. A prospective cohort study was conducted over a two-week period in January 2016 in the National Maternity Hospital Dublin, a tertiary referral maternity hospital delivering over 9000 infants per year. There were 504 women studied over the 2-week period. Overall, 197(39.1%) women received the vaccine at a mean gestational age 20.9 weeks (SD 7.0). Given the increased rates of influenza in the community and the associated implications for mother and infant, it is important that pregnant women are educated regarding the risks of influenza in pregnancy and encourage this cohort to be vaccinated.
    • Use of Oxytocin in multiparous women in labour

      Chummum, K; Walsh, J; Shackleton, A; Boylan, P (Irish Journal of Medical Science, 2011)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting Junior Obstetrics & Gynecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Matenity Hospitals Report Meeting Friday 26th Nov 2010
    • Villitis of unknown aetiology: correlation of recurrence with clinical outcome.

      Feeley, L; Mooney, E E; Department of Pathology and Laboratory Medicine, National Maternity Hospital, Dublin, Ireland. (2010)
      Villitis of unknown aetiology (VUA) is associated with adverse pregnancy outcome. Consequently, an ability to predict recurrence could be clinically relevant. We examined placentas where villitis was diagnosed in a previous pregnancy to establish the risk of recurrence and outcome. A total of 304 cases of VUA were diagnosed in our laboratory over a 4-year period. Subsequently, 19 of this cohort had a second placenta examined histologically. Recurrence and clinical outcome were recorded. Villitis recurred in 7 of 19 cases (37%). There was a high level of adverse pregnancy outcome in this cohort overall, characterised by small for gestational age infants and stillbirth, particularly in cases with high-grade villitis. We identified recurrent villitis more frequently than previously reported. Our findings confirm an association between high-grade villitis and poor outcome. Adequately powered prospective studies are required to determine if enhanced surveillance of subsequent pregnancies is indicated following a diagnosis of villitis.
    • Viral screening of couples undergoing partner donation in assisted reproduction with regard to EU Directives 2004/23/EC, 2006/17/EC and 2006/86/EC: what is the evidence for repeated screening?

      Wingfield, M; Cottell, E; Merrion Fertility Clinic, National Maternity Hospital, Dublin, Ireland. mwingfield@nmh.ie (2010-12)
      This paper concerns the requirements of the EU Tissue and Cells Directives with regard to the biological screening of donors of reproductive cells which are to be used for partner donation.
    • Vitamin D and neonatal immune function.

      Clancy, N; Onwuneme, C; Carroll, A; McCarthy, R; McKenna, M J; Murphy, N; Molloy, E J (2013-05)
      Vitamin D deficiency is widespread in the neonatal and paediatric population of northern latitudes, particularly in children of African, Middle Eastern and Asian ethnicity. This is associated with diminished immune function and increases the risk of Th1 autoimmune diseases like type 1 diabetes. Epidermiological studies have also shown a link between vitamin D deficiency in children and a more severe course of illness with lower respiratory tract infection or Respiratory Syncitial Virus (RSV) bronchiolitis. The mechanism by which vitamin D enhances immunity is complex. It acts through the innate immune system by inducing antimicrobial peptides in epithelial cells, neutrophils and macrophages. The role of Vitamin D in neonatal and paediatric immunomodulation requires further study.
    • Vitamin D deficiency is associated with altered hematologic indexes in very low birth weight infants.

      Velagapudi, Amit; McCarthy, Roberta; McKenna, Malachi; Brady, Jennifer; Murray, Barbara; Molloy, Eleanor J (The Journal of pediatrics, 2011-04)
    • Vitamin D Levels and myocardial function in preterm infants

      Armstrong, K; Onwunmeme, C; Franklin, O; Molloy, E (Archives of Disease in Childhood, 2013-08-20)
      Bakground Low Vitamin D levels have been linked to cardiac failure in the adults and children. Tissue Doppler Imaging (TDI) is evolving as a superior measure of subtle changes in myocardial contractility in preterm infants. We aimed to correlate Vitamin D levels at birth with TDI measures of systolic and diastolic function. Methods Preterm infants < 32 weeks gestation were recruited. Vitamin D levels were measured at birth and echocardiography was carried out on Day 1. TDI myocardial velocities were recorded using a pulsed wave doppler sample from the lateral left/right ventricular wall & intraventricular septum. Peak systolic (S’), early diastolic (E’) and late diastolic (A’) velocities were recorded. Results Ten preterm infants with structurally normal hearts were recruited. Mean (SD) gestational age was 28 (1.7) weeks and birthweight 1.29 (0.3)kg. There was no significant increase in Right ventricular systolic (5.1cm/sec vs 4.8cm/sec)or diastolic myocardial velocity measures (5.2cm/sec vs 5.1cm/sec) or left myocardial velocity systolic (3.7cm/sec vs 3.9cm/sec) or diastolic (4.1cm/sec vs 4.0cm/sec) measures between those with severe Vitamin D deficiency (<30 nmol/L) and those with low normal levels of Vitamin D. Conclusion Neonates with severe Vitamin D deficiency have similar TDI measures of systolic and diastolic velocity to those with near normal levels. In our small cohort severe Vitamin D deficiency appears to cause no impairment in myocardial contractility.
    • Vitamin D nutrient intake for all life stages.

      McKenna, M; McCarthy, R; Kilbane, M; Molloy, E (Irish medical journal, 2011-04)
      Vitamin D, unlike other nutrients, is a conditionally required nutrient being obtained from two sources – predominantly by skin production upon exposure to natural ultraviolet (UV) solar radiation, and to a lesser extent by oral intake. Being a fat soluble vitamin it has a long half-life of about two weeks and is stored in fat tissues.1 For nearly six months of the year from October to March in Ireland, skin production is absent and the population is dependent on oral intake from natural foodstuffs, (which are consumed in small quantities only), fortified foodstuffs (most notably some milk products for the past 25 years) and vitamin D supplements, either in multivitamin tablets or in combination with calcium tablets.