• N-Acetyl-Cystein improves results of long term culture of frozen thawed human ovarian tissue [Poster]

      Fabbri, R; Pasquinelli, G; Magnani, V; Keane, D; Cabello, Vives; Venturoli, S; Rotunda Hospital (2009-04-19)
    • N-terminal Pro-B-type natriuretic peptide: a measure of significant patent cuctus arteriosus

      OFarombi-Oghuvbu, IO; Matthews, Thomas; Mayne, Philip D; Guerin, Hilda; Corcoran, David (BMJ, 2008-01-24)
      Background: B type natriuretic peptide (BNP) is a marker for ventricular dysfunction secreted as a pre-prohormone, Pro-B-type natriuretic peptide (ProBNP), and cleaved into BNP and a biologically inactive fragment, N-terminal pro-B-type natriuretic peptide (NT-proBNP). Little is known about the clinical usefulness of NT-proBNP in preterm infants. Objective: To evaluate the usefulness of plasma NT-proBNP in diagnosing hsPDA in neonates and examine some factors that could affect this. Methods: Infants born at <34 weeks gestation (GA) and < 2kg birth weight (BW) were prospectively enrolled within 6 to 12 hours of birth. Plasma NT-proBNP levels were measured on days 1, 3, 5 and 10 with simultaneous echocardiography done to detect hsPDA and assess ventricular function. Significant PDA diagnosed by large ductal flow with left to right shunt on colour Doppler measuring >1.6mm on 2D echocardiography along with clinical features of PDA. Results: Forty-nine infants analysed. Median GA 30 weeks (range: 24-33) and median BW 1220 grams (range: 550-1950gm). Eighteen hsPDA infants had higher day 3 plasma NT-proBNP values (median 32907pg/mL; range: 11396-127155) (p<0.001) compared with controls (median 3147pg/mL; range: 521-10343). Infants who developed sepsis had higher day 10 plasma NT-proBNP levels. Area under ROC curve for detection of hsPDA, by day 3 NT-proBNP value, was significant 0.978 (95% CI: 0.930-1.026). NT-proBNP was predictive of hsPDA (sensitivity 100%; specificity 95%) at cut-off value of 11395pg/mL. Conclusion: Plasma NT-proBNP level on day 3 is a good marker for hsPDA in preterm infants. Serial measurements of NT-proBNP may be useful in assessing the clinical course of PDA.
    • National neonatal weight policy survey.

      Walsh, B; McDermott, C; Foran, A; Clarke, T; Department of Paediatrics, Rotunda Hospital, Parnell Square, Dublin 1. walshbrianhenry@hotmail.com (2009-06)
      This survey was conducted to review the current practice regarding frequency of weight measurement in neonatal units in the Republic of Ireland, and whether these practices are in keeping with best practice as described in the literature. There was an 88.5% (23 of 26) response rate to this survey. 6 (26%) units had a written policy, and 16 (70%) had an unwritten agreed practice. In the Vermont Oxford Network's potentially better practices daily weight measurements on newborn infants are recommended until the infant is stable and growing and then alternate day measurements The most common practices in this survey were to weigh infants on alternate days, this occurred in 9 (39%) units, and twice weekly in 6 (26%). Less than 31% of units had a separate policy for those less than 30 weeks, on assisted ventilation, or transitioning to enteral feeds. Most weigh infants on alternate days, and plot weights weekly, which is in keeping with best practice. Few units have separate policies for specific subgroups as is recommended in the limited literature. Consensus guidelines should be developed and promoted nationally.
    • National neonatal weight policy survey.

      Walsh, B; McDermott, C; Foran, A; Clarke, T; Department of Paediatrics, Rotunda Hospital, Parnell Square, Dublin 1., walshbrianhenry@hotmail.com (2012-02-01)
      This survey was conducted to review the current practice regarding frequency of weight measurement in neonatal units in the Republic of Ireland, and whether these practices are in keeping with best practice as described in the literature. There was an 88.5% (23 of 26) response rate to this survey. 6 (26%) units had a written policy, and 16 (70%) had an unwritten agreed practice. In the Vermont Oxford Network's potentially better practices daily weight measurements on newborn infants are recommended until the infant is stable and growing and then alternate day measurements The most common practices in this survey were to weigh infants on alternate days, this occurred in 9 (39%) units, and twice weekly in 6 (26%). Less than 31% of units had a separate policy for those less than 30 weeks, on assisted ventilation, or transitioning to enteral feeds. Most weigh infants on alternate days, and plot weights weekly, which is in keeping with best practice. Few units have separate policies for specific subgroups as is recommended in the limited literature. Consensus guidelines should be developed and promoted nationally.
    • The need for brain imaging in clinical psychiatry

      Davoren, M.; Doherty, A.; Breen, E.; Sheehan, J.; Kelly, B. D. (2011-11-17)
    • 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.
    • Neonatal blood cultures

      Woodhead, E (2010)
    • Neonatal outcomes and operative vaginal delivery versus cesarean delivery.

      Contag, Stephen A; Clifton, Rebecca G; Bloom, Steven L; Spong, Catherine Y; Varner, Michael W; Rouse, Dwight J; Ramin, Susan M; Caritis, Steve N; Peaceman, Alan M; Sorokin, Yoram; et al. (2010-06)
      We compared outcomes for neonates with forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. This is a secondary analysis of a randomized trial in laboring, low-risk, nulliparous women at >or=36 weeks' gestation. Neonatal outcomes after use of forceps, vacuum, and cesarean were compared among women in the second stage of labor at station +1 or below (thirds scale) for failure of descent or nonreassuring fetal status. Nine hundred ninety women were included in this analysis: 549 (55%) with an indication for delivery of failure of descent and 441 (45%) for a nonreassuring fetal status. Umbilical cord gases were available for 87% of neonates. We found no differences in the base excess (P = 0.35 and 0.78 for failure of descent and nonreassuring fetal status) or frequencies of pH below 7.0 (P = 0.73 and 0.34 for failure of descent and nonreassuring fetal status) among the three delivery methods. Birth outcomes and umbilical cord blood gas values were similar for those neonates with a forceps-assisted, vacuum-assisted, or cesarean delivery in the second stage of labor. The occurrence of significant fetal acidemia was not different among the three delivery methods regardless of the indication.
    • Neural Tube Defects: contemporary outcome setting in pregnancy

      Unterscheider, Julia; Rotunda Hospital /RCSI (BMJ Publishers, 2011-01)
    • Neurodevelopmental outcome at seven years in term, acidotic newborns

      Diviney, M; Pinnamaneni, R; Murphy, JFA; Lynch, B; Rushe, H; Madigan, C; Geary, M; Foran, A (Irish Medical Journal, 2015-04)
      The objective was to follow up a cohort of acidotic full-term infants with or without hypoxic ischemic encephalopathy (HIE) and determine if at 7 years they displayed any neurodevelopmental delays. Children (n=44) were divided according to those with mild (n=25) or severe (n=19) acidosis and were then further subdivided into those with or without HIE. Participants were assessed using the Wechsler Intelligence Scale for Children (WISC-IVUK) and Achenbach Child Behaviour Checklist (CBCL). No differences in WISC-IVUK scores in children without HIE irrespective of the cord pH values were found. Children with HIE grade I scored significantly higher in perceptual reasoning than those with grade III (p<0.01). CBCL scores revealed no differences between groups. Findings suggest evidence of impairment at school-age that correlates with the degree of encephalopathy. Acidosis without the presence of clinical encephalopathy was associated with normal outcome.
    • New thresholds for significant intrawin growth discordance, results of the prospective multicenter ESPRIT study

      Breathnach, FM; Carroll, SC; McAuliffe, F; Daly, S; Geary, M; Morrison, JJ; Dornan, J; Higgins, J; Malone, FD (2011-02)
    • Newborn thyroid function tests: too many, too soon

      Gaffney, C; Gallagher, P; Mayne, P; Foran, A (2010)
    • Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography.

      Weisz, Dany E; Jain, Amish; McNamara, Patrick J; EL-Khuffash, Afif (2012)
      Non-invasive cardiac output monitoring is a potentially useful clinical tool in the neonatal setting. Our aim was to evaluate a new method of non-invasive continuous cardiac output (CO) measurement (NICOM™) based on the principle of bioreactance in neonates.
    • Non-invasive cardiac output monitoring in preterm infants undergoing patent ductus arteriosus ligation: a comparison with echocardiography.

      Weisz, Dany E; Jain, Amish; Ting, Joseph; McNamara, Patrick J; El-Khuffash, Afif; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont., Canada. (2014)
      Non-invasive cardiac output monitoring (NICOM; NICOM™) may be useful in the management of extremely premature preterm infants.
    • Novel ETHE1 mutation in a carrier couple having prior offspring affected with ethylmalonic encephalopathy: Genetic analysis, clinical management and reproductive outcome.

      Walsh, David J; Sills, Eric S; Lambert, Deborah M; Gregersen, Nils; Malone, Fergal D; Walsh, Anthony P H; The Sims Institute/Sims International Fertility Clinic, Dublin 14, Ireland. (2010-03)
      Ethylmalonic encephalopathy (EE) is an autosomally recessive inherited disorder with a relentlessly progressive decline in neurological function, usually fatal by the age of ten. It is characterised by generalised hypotonia, psychomotor regression, spastic tetraparesis, dystonia, seizures and, eventually, global neurological failure. Approximately 50 reports have been published worldwide describing this devastating disease, most involving patients of Mediterranean or Arab origin. The fundamental defect in EE likely involves the impairment of a mitochondrial sulphur dioxygenase coded by the ETHE1 gene responsible for the catabolism of sulphide, which subsequently accumulates to toxic levels. A diagnosis of EE should initiate careful genetic evaluation and counselling, particularly if the parents intend to have additional offspring. The present report describes the diagnosis of EE in a reproductive endocrinology context, where both members of a non-consanguineous couple were confirmed to be carriers of an identical A↷G mutation. This previously unknown mutation at nucleotide position c.494 resulted in an amino acid substitution, p.Asp165Gly. Although consideration was given to in vitro fertilisation, embryo biopsy and single gene pre-implantation genetic diagnosis, the couple decided to first utilise a less aggressive therapeutic approach with donor sperm insemination. Pregnancy with a low risk of EE was indeed achieved; however, the infant was affected with a different anomaly (hypoplastic left heart). As this case demonstrates, prior to the initiation of fertility therapy, genetic analysis may be used to provide a confirmatory diagnosis when EE is suspected.
    • Obstetric Anal Sphincter Injuries: A Survey of Clinical Practice and Education among Obstetricians and Gynaecologists in Ireland

      Abdelrahman, M; Geary, M; Eogan, M (Irish Medical Journal, 2019-01)
      This paper summarises results of a survey of obstetricians in Ireland regarding their technique, management, and education on episiotomy and Obstetric Anal Sphincter Injury (OASIS). An anonymous survey was emailed to all obstetricians and gynaecologists in Ireland, including trainees between January and September 2017. The response rate was 45% (155/343) with 111 out of 144 (77%) reported clinical experience as part of their training and 92 (64%) attended an OASIS workshop or classroom teaching. The majority prescribe antibiotics and laxatives post-op, request physiotherapy review and follow-up patients in outpatient settings. We identified that most specialists and trainees practice within guidelines, but some recognise a need for further teaching and exposure to these types of injuries. These results will direct future curriculum and optimise ongoing training for trainees, unify service provision and contribute to patient safety.
    • Obstetric anal sphincter injury, risk factors and method of delivery - an 8-year analysis across two tertiary referral centers.

      Hehir, Mark P; O'Connor, Hugh D; Higgins, Shane; Robson, Michael S; McAuliffe, Fionnuala M; Boylan, Peter C; Malone, Fergal D; Mahony, Rhona; Department of Obstetrics and Gynaecology, National Maternity Hospital, Holles St. Dublin 2 , Ireland (2013-10)
      Obstetric anal sphincter injury (OASIS) represents a major cause of maternal morbidity and is a risk factor for the development of fecal incontinence. We set out to analyze the incidence of OASIS and its association with mode of delivery in two large obstetric hospitals across an 8-year study period.
    • OC15.01: Prenatal determination of placental cord insertion site in monochorionic and dichorionic twin gestations: a predictor of growth discordance?

      Breathnach, F.; McAuliffe, F.; Geary, M.; Daly, S.; Higgins, J.; Dornan, J. J.; Morrison, J. J.; Burke, G.; Higgins, S.; Carroll, S.; et al. (2010-10)