• 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)
    • 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.
    • 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.
    • Brainstem encephalitis in pregnancy a rare but potentially fatal occurrence: A case report

      Maher, N; Barrett, N; Walsh, J; Cooley, S; Carroll, S (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
    • Breast feeding practice in the National Maternity Hospital, Dublin: Report of a limited intervention lactation, promotion and educational programme, carried out 1981-1983.

      Connolly, John A.; Foley, Robert; Cullen, John H.; McDonald, Dermot; Irish Foundation for Human Development. Healthcare and Psychosomatic Unit. (Eastern Health Board (EHB), 1983)
    • CA125 Measured During Menstruation Can Be Misleading

      Crosby, DA; Glover, LE; Martyn, F; Wingfield, M (Irish Medical Journal, 2018-04)
      Abstract The aim of these case reports and literature review is to report the importance of cyclical variation of serum CA-125 levels in two patients with endometriosis. Two case reports and a literature review of cyclical variation in serum CA-125 levels are discussed. There was significant variation in serum CA-125 levels taken during menses and mid-cycle in these two cases. Serum CA-125 levels increase dramatically during menstruation in women with endometriosis. This is important when assessing disease status.
    • Caesarean section in a parturient with a spinal cord stimulator.

      Sommerfield, D; Hu, P; O'Keeffe, D; McKeating A, K; Department of Anaesthesia, National Maternity Hospital, Dublin, Ireland. dsommerfield@hotmail.com (2010-01)
      A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.
    • Caffeine therapy in neonatal intensive care.

      Vavasseur, C (Irish Medical Journal (IMJ), 2012-03)
    • Cardiac biomarkers in neonatal hypoxic ischaemia.

      Sweetman, D; Armstrong, K; Murphy, J F A; Molloy, E J; Neonatology, National Maternity Hospital, Dublin, Ireland. dsweetman@nmh.ie (2012-04)
      Following a perinatal hypoxic-ischaemic insult, term infants commonly develop cardiovascular dysfunction. Troponin-T, troponin-I and brain natriuretic peptide are sensitive indicators of myocardial compromise. The long-term effects of cardiovascular dysfunction on neurodevelopmental outcome following perinatal hypoxic ischaemia remain controversial. Follow-up studies are warranted to ensure optimal cardiac function in adulthood. CONCLUSION: Cardiac biomarkers may improve the diagnosis of myocardial injury, help guide management, estimate mortality risk and may also aid in longterm neurodevelopmental outcome prediction following neonatal hypoxic-ischaemia.
    • Cardiotocography as a predictor of fetal outcome in women presenting with reduced fetal movement.

      Daly, Niamh; Brennan, Donal; Foley, Michael; O'Herlihy, Colm; National Maternity Hospital, Dublin, Ireland. (2011-09-05)
      OBJECTIVE: To examine the obstetric and perinatal outcomes of women presenting with reduced fetal movement (RFM) during the third trimester, specifically in relation to the diagnostic capacity of non-stress cardiotocography (CTG) used as the primary investigation in this clinical scenario. STUDY DESIGN: This was a retrospective population-based cohort study of pregnancy outcomes of all women ≥28 weeks' gestation with singleton pregnancies presenting during one calendar year with maternal perception of RFM, all of whom underwent CTG at presentation. Main outcome measures included: obstetric intervention (induction of labour, spontaneous vaginal delivery, operative vaginal delivery, emergency caesarean section), and perinatal outcome (subsequent perinatal death, low Apgar scores (<7(5)), neonatal resuscitation and NICU admission). RESULTS: In all, 524 women presented with RFM and a live fetus, representing 7% of the antenatal obstetric population; 284 women (54%) were nulliparous. The reassuring CTG group comprised 482 (92%) women in whom initial CTG was reassuring and 15 (3%) where a repeat tracing within 1h was reassuring. The non-reassuring/abnormal CTG group (n=27, 5%) either underwent emergency delivery or comprehensive serial fetal assessment; this group had significantly higher rates of emergency caesarean delivery, neonatal resuscitation and NICU admission; the incidence of small-for-gestational-age infants did not differ significantly. No perinatal death occurred in either group following CTG. CONCLUSION: Normal non-stress CTG is a reliable screening indicator of fetal wellbeing in women presenting with perception of RFM in the third trimester; abnormal pregnancy outcomes were more common when initial CTG was abnormal or persistently non-reassuring.
    • Cardiovascular dysfunction in infants with neonatal encephalopathy.

      Armstrong, Katey; Franklin, Orla; Sweetman, Deirdre; Molloy, Eleanor J; Department of Paediatrics, National Maternity Hospital, Holles St, Dublin 2, Ireland. katey21@hotmail.com (2012-04)
      Severe perinatal asphyxia with hypoxic ischaemic encephalopathy occurs in approximately 1-2/1000 live births and is an important cause of cerebral palsy and associated neurological disabilities in children. Multiorgan dysfunction commonly occurs as part of the asphyxial episode, with cardiovascular dysfunction occurring in up to a third of infants. This narrative paper attempts to review the literature on the importance of early recognition of cardiac dysfunction using echocardiography and biomarkers such as troponin and brain type natriuretic peptide. These tools may allow accurate assessment of cardiac dysfunction and guide therapy to improve outcome.
    • 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)
    • Changing rates of antepartum death and attitudes to postmortem over a 10 year period

      Robson, M; O'Connor, H; Heir, M; Coulter-Smith, S; Malone, F (American Journal of Obstetrics and Gynecology, 2011-01)
      Society for Maternal-Fetal Medicine. The Pregnancy meeting
    • Chronic uteroplacental insufficiency can be associated with normal birth weight in both twin and singleton placentas: A sterological study

      Cooley, S; Mthunzi, A; Donnelly, J; O'Malley, A; Geary, M; Gillan, J; Kent, E; Breathnach, F; Malone, F (Am Jrl Obstet Gynecol, 2011-01)
      Society for Maternal-Fetal Medicine. The Pregnancy Meeting Feb 2011
    • Clinical and ultrasound features of placental maturation in pre-gestational diabetic pregnancy.

      Higgins, Mary F; Russell, Noirin M; Mooney, Eoghan E; McAuliffe, Fionnuala M; UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Ireland. (2012-10)
      Pre-gestational diabetes (PGDM) is a significant cause of neonatal morbidity and mortality. Delayed villous maturation (DVM) is a placental diagnosis with increased risk of perinatal mortality.
    • Clinical associations with a placental diagnosis of delayed villous maturation: a retrospective study.

      Higgins, Mary; McAuliffe, Fionnuala M; Mooney, Eoghan E; School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin, Ireland.
      Delayed villous maturation (DVM) is a spectrum of placental disease characterized by decreased tertiary villus formation, reduced vasculosyncytial membrane formation, and, in its more severe forms, increased large bullous villi. In some series it has been associated with an increased risk of stillbirth in the late third trimester, but overall there are few data on its significance. The aim of this study was to assess perinatal factors associated with, and the clinical significance of, the finding of DVM on placental histology. This was a retrospective study investigating all pregnancies with DVM diagnosed on placental histology in a tertiary level unit between December 2001 and August 2006. Over a 6-year period, 2915 placentas were triaged for histopathological assessment, representing 6.1% of all 48 054 deliveries in this time period. One hundred ninety (6.3%) of these selected cases showed DVM. Fifteen placentas from infants with less than 34 completed weeks of gestation were excluded, leaving 175 for further analysis. When compared with controls matched for gestation and delivering within the same time period (n  =  175), DVM was significantly associated with pregestational diabetes (8% vs 2.8%, P < .05; relative risk 2.8 [95% confidence interval 1.03-7.6]), gestational diabetes (8.6% vs 3.4%, P < 0.05; relative risk 2.5 [95% confidence interval 0.99-6.3]), and prenatal or intrapartum intrauterine death (8.6% vs 0%, P < 0.05). Delayed villous maturation is associated with both gestational and pregestational diabetes mellitus and with perinatal death.
    • Clinical correlation of maternal and fetal placental growth hormone in Type 1 diabetic pregnancy

      Higgins, M; Russell, N; Crossey, P; Nyhan, K; Brazil, D; 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 2011
    • 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.
    • Cocaine and amphetamine-regulated transcript (CART) concentration in maternal and cord blood in type 1 diabetic and non diabetic pregnancies at term

      Hehir, MP; Laursen, H; Higgins, MF; Brennan, DJ; O'Connor, DP; McAuliffe, FM (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
    • Comparative Effectiveness Research

      Murphy, J F A (Irish Medical Journal, 2011-05)
      Comparative effectiveness research is the generation of evidence that compares the benefits and harms of alternative methods to prevent or manage a clinical condition or improve the delivery of care (CER). In 2008 the Institute of Medicine issued a report calling for research that would support better decision making about innovations in healthcare. In Feb 2009 President Obama signed into law an initial $1 billion to support research on the comparative effectiveness of drugs, medical devices, surgical procedures and other treatments. CER has the potential to improve care and reduce costs. The objective is to advise on health care both at an individual and population level. It helps by reducing overuse, underuse and misuse of therapies and technology. CER has the potential to identify the most effective interventions and to significantly improve health outcomes. In order to drive the process the Patient-Centred Outcomes Research Institute (PCORI) has been established in the US1. It has a budget of half a billion dollars a year to spend on research and information dissemination.