Research by staff affiliated to the Rotunda Hospital, Dublin

Recent Submissions

  • Staff Attitudes towards Patient Safety Culture and Working Conditions in an Irish Tertiary Neonatal Unit

    Dwyer, L; Smith, A; McDermott, R; Breatnach, C; El-Khuffash, A; Corcoran, JD; Rotunda Hospital, Dublin (Irish Medical Journal, 2018-07)
    There is little published research evaluating attitudes towards patient safety culture and working conditions in neonatal units. This study aimed to explore this within a Level III Irish neonatal unit setting.
  • The Triangular Sign, a Useful Diagnostic Marker for Biliary Atresia: A Case Series of Three Irish Infants

    Smith, A; Shankar, A; Collins, A; Tarrant, A; Boyle, MA (Irish Medical Journal, 2018-06)
    The triangular cord (TC) sign is the appearance of a triangular shaped echogenic density visualised immediately cranial to the portal vein bifurcation on ultrasonographic examination. Several studies have reported that this ultrasonographic sign is a reliable and helpful marker in identifying Biliary Atresia (BA).
  • A Review of the Parenteral Nutrition Supply Service in an Irish Neonatal Unit

    Smith, A; Glynn, AC; Shankar, A; McDermott, C; McCallion, N (Irish Medical Journal, 2018-06)
    Neonatal Intensive Care (NICU) patients have individual nutritional requirements often requiring Patient Specific Parenteral Nutrition (PSPN). From October 2015, the national PSPN compounding service availability changed from 7 days per week service to 5 days per week (i.e. no weekend and limited bank holiday ordering available). The aim of this study was to examine the introduction of a 5 day only PSPN supply on neonatal patient parenteral nutrition availability in a tertiary NICU.
  • The Utility of Routine Echocardiography in Newborn Infants with a Persistent Oxygen Requirement

    Walsh, N; Breathnach, C; El-Khuffash, A; Franklin, O; Corcoran, JD (Irish Medical Journal, 2018-05)
    In the era of antenatal screening for congenital heart disease (CHD), infants presenting with an undiagnosed significant CHD are rare. However, term infants admitted with an initial diagnosis of TTN and a prolonged oxygen requirement often undergo an echocardiogram. We aimed to assess whether this practice yields any additional cases of undiagnosed CHD. We performed a retrospective chart review over a three year period [2013 – 2015] of term (> 36 weeks) infants admitted to the NICU for ≥ 5 days with a diagnosis of TTN and received an echocardiogram. The presence of CHD on the echocardiogram was assessed. Forty-seven infants were enrolled. The median age of echocardiogram was day four [2 – 8]. No infant had a diagnosis of significant CHD on the postnatal echocardiogram. A small muscular VSD was identified in two infants. Routine echocardiography for this cohort of infants to rule out major CHD appears to be unwarranted.
  • Caesarean Section at Full Dilatation and Risk of Major Obstetric Haemorrhage

    O’Dwyer, V; Freyne, A; Joyce, N; Coulter-Smith, S (Irish Medical Journal, 2018-03)
    The purpose of the study was to examine the risk factors for caesarean section (CS) at full dilatation and to assess the risk and management of haemorrhage. The study took place in a tertiary referral maternity hospital. Women who had a CS at full dilatation were included. Clinical and demographic details were recorded. There were 199 cases. The average age was 30.3 years and average BMI was 25.8kg/m2. There were 79.9 % (159) primigravidas and 20.1% (40) multigravidas. The average gestation at delivery was 39.4 weeks. Labour was induced in 46.9 % (92) and spontaneous in 53.8% (107). Oxytocin was used in 67.8 % (135). An instrumental delivery was attempted in 46.7 % (93). The rate of malposition was 46.5 % (92). The average birthweight was 3,629g and 9 babies weighed ≥4.5kg. The average estimated blood loss (EBL) was 665mls and 34 had EBL>1L. Most had an oxytocin infusion (141). Other uterotonic agents were used in 70 women. Seven women had blood transfusions. The highest rate of CS at full dilatation was in primigravidas due to malposition. There was a low rate of major obstetric haemorrhage.
  • The use of cold coagulation for the treatment of cervical intraepithelial neoplasia

    Wyse, A; Seah, WA; O’Neill, J; Byrne, P (Irish Medical Journal, 2017-05)
    In 2015, Cold Coagulation was introduced as a treatment for cervical intraepithelial neoplasia (CIN) at our colposcopy clinic. We reviewed the 6-month follow up data of the first 200 women who underwent Cold Coagulation using cytology and HPV status as tests of cure (TOC). A random sample of 200 patients treated by Large Loop Excision of the Transformation Zone (LLETZ) during the same period was used to compare treatment outcome. Six months following treatment,173 (86.5%) of the women treated by CC and 167 (83.5%) treated by LLETZ had negative cytology. (x2= P>0.05). 148 (74%) treated by Cold Coagulation and 166 (83%) treated by LLETZ were HPV negative (x2= P<0.05). One hundred and thirty-nine (70%) women treated by Cold Coagulation and 152 (76%) treated with LLETZ had normal cytology and were HPV negative. This audit of our initial experience supports the observation that Cold Coagulation is as effective as LLETZ in the management of CIN when cervical cytology is used as a test of cure.
  • Invasive meningococcal disease in children in Ireland, 2001-2011.

    Ó Maoldomhnaigh, Cilian; Drew, Richard J; Gavin, Patrick; Cafferkey, Mary; Butler, Karina M (2016-12)
    In 1999, invasive meningococcal disease was hyperendemic in Ireland at 14.75/100 000 population, with 60% group B and 30% group C diseases. National sepsis guidelines and meningococcal C vaccines were introduced in 2000. Despite a spontaneous decline in group B infection, invasive meningococcal disease remains a leading cause of sepsis. This study characterises the epidemiology of invasive meningococcal disease in children in Ireland since the introduction of meningococcal C vaccine and reviews its clinical presentation, hospital course and outcome in anticipation of meningococcal B vaccine introduction.
  • Neonatal Bacteraemia Among 112,360 Live Births

    Huggard, D; Drew, R; McCallion, N (Irish Medical Journal, 2016-10)
    Our aims were to determine the incidence of bacteraemia in a cohort of neonatal patients over a 14 year period, to describe the organisms involved, and to establish the rates of sepsis with regard to both early onset sepsis (EOS) and late onset sepsis (LOS). Lastly, we investigated the trends of neonatal sepsis, to determine whether changes in clinical practice influenced the rate of blood culture positivity. With regards to EOS, GBS was the predominant pathogen, followed by E.coli, CoNS, and S. aureus . The overall mean EO rate per 1000 live births (LBs) was 1.19. Looking at LOS, S. aureus , CoNS , Enterococcus spp. were the most common bacteria cultured. The mean LOS rate was 1.88 per 1000 live births. The overall rate of EOS remained fairly steady. GBS remains the major pathogen in EOS; however its incidence has remained largely unchanged over time in relation to both EOS and LOS. Conversely the rate of LOS peaked from ’05-’09, mainly due to an increase in Staphylococcus aureus , CoNS and Enterococcus spp. cases, and then improved dramatically in the following years. This was likely due to a change in hospital policies in relation to hand hygiene and intravenous line placement and maintenance.
  • Maternal Mortality in Women with Epilepsy

    Holohan, M (Irish Medical Journal, 2016-10)
    It is estimated that, in Ireland, there are 10,000 women with epilepsy of childbearing potential1. In this paper the maternal mortality rate for women with epilepsy attending the Rotunda Hospital Epilepsy Clinic 2004 - 2013 was determined. There were 3 maternal deaths in women with epilepsy during this time, which represents a mortality rate of 0.8%. In those women who died, there were concerns in relation to risks to the foetus by taking Anti-Epileptic Drugs (AED) and also issues with access to neurology services before pregnancy, acceptance of specialist support and lack of consistency in advice from health care professionals outside of Ireland. Implementing the nationally agreed care plan for women with epilepsy will improve the quality of care given and potentially we will see a reduction in maternal mortality in these women.
  • Advanced maternal age and assisted reproductive technologies in an Irish population

    O’Shea, L; Hughes, C; Mocanu, EV (Irish Medical Journal, 2015-09)
    In recent decades the amount of women over 40 seeking assisted reproductive technology (ART) interventions in order to become pregnant has dramatically increased, both in Ireland and worldwide. This is due to an increase in the average age at which women are choosing to have their first child while additionally, many couples are choosing to have a second family later in life. However, as with natural conception, ART success rates decrease with maternal age. In the present study, we perform a 16 year retrospective analysis on our clinical data of women between 40 and 45 years of age, who have undergone ART at a tertiary referral ART clinic. The percentage of patients in this age group was analysed over time, in order to determine follicle recruitment, % oocyte yield, embryonic quality, positive hCG (pregnancy rate), clinical pregnancy rate and rate of preclinical pregnancy loss. Results from our clinic show that women greater than 43 years of age have a significantly reduced reproductive potential compared to women in the 40 to 42 years age group. Woman in the 43-45 age group showed reduced fertilization rates (53.73% versus 58.82%), reduced positive hCG rates (11.51% versus 19.03%) and clinical pregnancy rates (5.04% versus 12.52%) and increased rates of preclinical pregnancy loss (56.23% versus 34.23%), compared to women in the 40-42 age group. With the age at which couples are choosing to have children constantly increasing, novel ART treatment strategies need to be developed.
  • Postnatal MRI brain in infants treated for Twin–Twin Transfusion Syndrome

    Boyle, M; Lyons, A; Ryan, S; Malone, F; Foran, A; Ryan, S (Irish Medical Journal, 2015-09)
    Untreated twin-twin transfusion syndrome (TTTS) is associated with significant mortality and neurological impairment. Fetoscopic laser surgery (FLS) is the treatment of choice. We sought to assess intracranial abnormalities in TTTS twins following treatment. In this prospective, blinded study MRI scans were performed on 3 groups; (1) monochorionic diamniotic (MCDA) twins with TTTS who had undergone FLS (n=10), (2) MCDA twins without TTTS (n=8) and (3) dichorionic twins (n=8). Scans were scored as either normal or abnormal. The primary outcome was a composite of abnormal MRI brain or intrauterine fetal demise. The primary outcome occurred in 6/10 (60%) of the TTTS group versus 3/8 (37.5%) in the MCDA group. The primary outcome was significantly different across all study groups [p = 0.029; X² = 7.112]. We found that twins treated for TTTS are more likely to have abnormalities on MRI brain at term than other twin groups. This group merits term-corrected MRI as part of their postnatal assessment
  • The association of cord serum cytokines with neurodevelopmental outcomes.

    Varner, Michael W; Marshall, Nicole E; Rouse, Dwight J; Jablonski, Kathleen A; Leveno, Kenneth J; Reddy, Uma M; Mercer, Brian M; Iams, Jay D; Wapner, Ronald J; Sorokin, Yoram; Thorp, John M; Malone, Fergal D; Carpenter, Marshall; O'Sullivan, Mary J; Peaceman, Alan M; Hankins, Gary D V; Dudley, Donald J; Caritis, Steve N; Rotunda Hospital (2015-02)
    To test whether elevated umbilical cord serum inflammatory cytokine levels predicted subsequent cerebral palsy (CP) or neurodevelopmental delay (NDD).
  • Effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes.

    Horton, Amanda L; Lai, Yinglei; Rouse, Dwight J; Spong, Catherine Y; Leveno, Kenneth J; Varner, Michael W; Mercer, Brian M; Iams, Jay D; Wapner, Ronald J; Sorokin, Yoram; Thorp, John M; Ramin, Susan M; Malone, Fergal D; O'Sullivan, Mary J; Hankins, Gary D V; Caritis, Steve N; Rotunda Hospital (2015-03)
    This study aims to evaluate whether magnesium sulfate administration for neuroprotection prolongs latency in women with preterm premature rupture of membranes (PPROM) between 24 and 31(6/7) weeks' gestation.
  • Guidelines on fetal growth restriction: a comparison of recent national publications.

    Unterscheider, Julia; O'Donoghue, Keelin; Malone, Fergal D; Rotunda Hospital (2015-03)
    This study aims to compare recommendations from recently published national clinical guidelines for pregnancies complicated by fetal growth restriction (FGR).
  • Platelet function in patients with a history of unexplained recurrent miscarriage who subsequently miscarry again.

    Dempsey, Mark Anthony; Flood, Karen; Burke, Naomi; Murray, Aoife; Cotter, Brian; Mullers, Sieglinde; Dicker, Patrick; Fletcher, Patricia; Geary, Michael; Kenny, Dermot; Malone, Fergal D; Rotunda Hospital (2015-05)
    This study was designed to evaluate platelet aggregation in pregnant women with a history of unexplained recurrent miscarriage (RM) and to compare platelet function in such patients who go on to have either another subsequent miscarriage or a successful pregnancy.
  • Length of latency with preterm premature rupture of membranes before 32 weeks' gestation.

    Peaceman, Alan M; Lai, Yinglei; Rouse, Dwight J; Spong, Catherine Y; Mercer, Brian M; Varner, Michael W; Thorp, John M; Ramin, Susan M; Malone, Fergal D; O'Sullivan, Mary J; Hankins, Gary D V; Rotunda Hospital (2015-01)
    The objective of the article is to describe latency for patients with preterm premature membrane rupture (PPROM) between 24(0/7) and 31(6/7) weeks' gestation.
  • Association of cord blood digitalis-like factor and necrotizing enterocolitis.

    Graves, Steven W; Esplin, Michael S; McGee, Paula; Rouse, Dwight J; Leveno, Kenneth J; Mercer, Brian M; Iams, Jay D; Wapner, Ronald J; Sorokin, Yoram; Thorp, John M; Ramin, Susan M; Malone, Fergal D; O'Sullivan, Mary J; Peaceman, Alan M; Hankins, Gary D V; Dudley, Donald J; Caritis, Steven N; Rotunda Hospital (2014-04)
    Endogenous digoxin-like factor (EDLF) has been linked to vasoconstriction, altered membrane transport, and apoptosis. Our objective was to determine whether increased EDLF in the cord sera of preterm infants was associated with an increased incidence of necrotizing enterocolitis (NEC).
  • Changing trends in diabetes mellitus in pregnancy.

    Khalifeh, A; Breathnach, F; Coulter-Smith, S; Robson, M; Fitzpatrick, C; Malone, F; Rotunda Hospital (2014-02)
    The purpose of this study was to identify any changing trends in the incidence and caesarean section (CS) rate of pre-gestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM) over a 10- year period, between 1999 and 2008. Although the incidence of pre-gestational DM has not significantly changed over the course of the last 10 years, there is an obvious rising trend in the incidence of GDM. Despite an increase in the overall CS rate during this time period, a parallel increase in the CS rate has not been observed among women whose pregnancies are complicated either by gestational or by pre-gestational diabetes (PGD).
  • Relation between birth weight and weight and height at the age of 2 in children born preterm.

    Olson, Gayle; Weiner, Steven J; Rouse, Dwight J; Reddy, Uma M; Mercer, Brian M; Varner, Michael W; Leveno, Kenneth J; Iams, Jay D; Wapner, Ronald J; Ramin, Susan M; Malone, Fergal D; Carpenter, Marshall W; O'Sullivan, Mary J; Dinsmoor, Mara J; Hankins, Gary D V; Caritis, Steve N; Rotunda Hospital (2015-05)
    The aim of the study was to evaluate associations between fetal growth and weight at 2 years in infants born preterm using a customized approach for birth weight.
  • What is new in obstetric antecedents of chronic disease? Best articles from the past year.

    Malone, Fergal D; Rotunda Hospital (2014-04)
    This month, we focus on current research in obstetric antecedents of chronic disease. Dr Malone discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page along with direct links to the abstracts.

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