• Child Mortality as Predicted by Nutritional Status and Recent Weight Velocity in Children under Two in Rural Africa.

      National Perinatal Epidemiology Center, Anu Research Center, Department of, Obstetrics and Gynecology, Cork University Maternity Hospital, Wilton, Cork,, Ireland. (2012-01-31)
      WHO has released prescriptive child growth standards for, among others, BMI-for-age (BMI-FA), mid-upper arm circumference-for-age, and weight velocity. The ability of these indices to predict child mortality remains understudied, although growth velocity prognostic value underlies current growth monitoring programs. The study aims were first to assess, in children under 2, the independent and combined ability of these indices and of stunting to predict all-cause mortality within 3 mo, and second, the comparative abilities of weight-for-length (WFL) and BMI-FA to predict short-term (<3 mo) mortality. We used anthropometry and survival data from 2402 children aged between 0 and 24 mo in a rural area of the Democratic Republic of Congo with high malnutrition and mortality rates and limited nutritional rehabilitation. Analyses used Cox proportional hazard models and receiver operating characteristic curves. Univariate analysis and age-adjusted analysis showed predictive ability of all indices. Multivariate analysis without age adjustment showed that only very low weight velocity [HR = 3.82 (95%CI = 1.91, 7.63); P < 0.001] was independently predictive. With age adjustment, very low weight velocity [HR = 3.61 (95%CI = 1.80, 7.25); P < 0.001] was again solely retained as an independent predictor. There was no evidence for a difference in predictive ability between WFL and BMI-FA. This paper shows the value of attained BMI-FA, a marker of wasting status, and recent weight velocity, a marker of the wasting process, in predicting child death using the WHO child growth standards. WFL and BMI-FA appear equivalent as predictors.
    • Communication skills in Obstetrics: what can we learn from bereaved parents?

      Nuzum, D; Meaney, S; O’Donoghue, K (Irish Medical Journal, 2017-02)
      Communicating bad news in obstetrics is challenging. This study explores the impact of how bad news was communicated to parents following a diagnosis of stillbirth. Qualitative in-depth interviews were conducted with 12 mothers and 5 fathers, bereaved following stillbirth at a tertiary maternity hospital where the perinatal mortality rate is 5.2/1000. Data were analysed using Interpretative Phenomenological Analysis. How the diagnosis of stillbirth was communicated had a profound and lasting impact on parents. Dominant superordinate themes were Language used, Sensitivity and Diversionary techniques. Parents recalled in detail where and how bad news was broken and language used. Diversionary techniques created a sense of mistrust especially when parents felt information was being withheld. Bereaved parents valued privacy at the time of diagnosis of stillbirth.This study highlights the importance of language, sensitivity and environment where clinicians can learn from the experiences of bereaved parents who value open, sensitive and honest communication. The results of this study highlight the importance of patient-focused communication training for clinicians.
    • Comorbid depression and risk of lower extremity amputation in people with diabetes: systematic review and meta-analysis.

      O'Neill, Sinéad M; Kabir, Zubair; McNamara, Grace; Buckley, Claire Mary (BMJ open diabetes research & care, 2017-08)
      To compare the risk of lower extremity amputation (LEA) in people with diabetes with and without comorbid depression.
    • Comparison of the T-piece resuscitator with other neonatal manual ventilation devices: A qualitative review.

      Department of Neonatology, Cork University Maternity Hospital, Ireland;, Department of Paediatrics and Child Health, University College Cork, Ireland. (2012-01-31)
      AIM: To review the literature surrounding various aspects of T-piece resuscitator use, with particular emphasis on the evidence comparing the device to other manual ventilation devices in neonatal resuscitation. DATA SOURCES: The Medline, EMBASE, Cochrane databases were searched in April 2011. Ongoing trials were identified using www.clinicaltrials.gov and www.controlled-trials.com. Additional studies from reference lists of eligible articles were considered. All studies including T-piece resuscitator use were eligible for inclusion. RESULTS: Thirty studies were included. There were two randomised controlled trials in newborn infants comparing the devices, one of which addressed short and intermediate term morbidity and mortality outcomes and found no difference between the T-piece resuscitator and self inflating bag. From manikin studies, advantages to the T-piece resuscitator include the delivery of inflating pressures closer to predetermined target pressures with least variation, the ability to provide prolonged inflation breaths and more consistent tidal volumes. Disadvantages include a technically more difficult setup, more time required to adjust pressures during resuscitation, a larger mask leak and less ability to detect changes in compliance. CONCLUSIONS: There is a need for appropriately designed randomised controlled trials in neonates to highlight the efficacy of one device over another. Until these are performed, healthcare providers should be appropriately trained in the use of the device available in their departments, and be aware of its own limitations.
    • Compliance with National Institute of Health and Care Excellence risk-based screening for gestational diabetes mellitus in nulliparous women.

      Murphy, Nicolai M; McCarthy, Fergus P; Khashan, Ali S; Myers, Jenny E; Simpson, Nigel A B; Kearney, Patricia M; Greene, Richard A; Poston, Lucilla; Kenny, Louise C (European journal of obstetrics, gynecology, and reproductive biology, 2016-04)
      To investigate compliance with risk-based screening for Gestational Diabetes Mellitus (GDM) in a nulliparous cohort.
    • Consent for routine neonatal procedures: A study of practices in Irish neonatal units. How do we compare with the gold standard BAPM guidelines?

      Ryan, M A; Ryan, C A; Dempsey, E; O’Connell, R (Irish Medical Journal, 2017-06)
      The Irish National Consent Policy (NCP)¹ proposes that the legal requirement for consent extends to all forms of interventions, investigations and treatment, carried out on or behalf of the Health Service Executive (HSE). This study employs a quantitative descriptive approach to investigate the practices for obtaining consent for an identified group of routine neonatal procedures in neonatal facilities throughout Ireland. The BAPM (British Association of Perinatal Medicine)² guidelines were identified as ‘gold standard’ for the purposes of this study. The results indicated a lack of consistency between participating units pertaining to the modes of consent utilised and notable variances from ‘gold standard’ guidelines. Unanimity was evident for 3 procedures only (administering BCG, 6-in-1, and donor breast milk to infant). Significant findings related to EEG with video recordings, MRI/CT and gastro intestinal imaging, screening of an infant with suspected substance abuse or retinopathy of prematurity screening (ROP), administration of Vitamin K, and the carrying out of a lumbar puncture.
    • The decline of hysterectomy for benign disease.

      Horgan, R P; Burke, G; The Anu Research Centre, Department of Obstetrics and Gynaecology, University, College Cork, Cork University Maternity Hospital, Wilton, Cork., richard.horgan@ucc.ie (2012-01-31)
      Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.
    • Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives.

      Mc Carthy, Vera J C; Murphy, Ashling; Savage, Eileen; Hegarty, Josephine; Coffey, Alice; Leahy-Warren, Patricia; Horgan, Aine; O'Connell, Rhona; Marsh, Lynne; Drennan, Jonathan (Journal of Nursing Management, 2018-08-31)
      The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items). Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management.
    • A disappearing neonatal skin lesion.

      Hawkes, Colin Patrick; Bourke, John Francis; Fitzgibbon, James; Dempsey, Eugene Michael; Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland. (2012-01-31)
      A preterm baby girl was noted at birth to have a firm, raised, non-tender skin lesion located over her right hip. She developed three similar smaller lesions on her ear, buttock and right knee. All lesions had resolved by 2 months of age.
    • Does caesarean delivery prevent anal incontinence?

      McLoughlin, Geraldine; Catherine McAuley School of Nursing and Midwifery University College Cork, Ireland. (2011-05)
    • Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy.

      Nadeem, Montasser; Murray, Deirdre M; Boylan, Geraldine B; Dempsey, Eugene M; Ryan, Cornelius A; Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland. (2011-02)
      To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy.
    • Early blood glucose profile and neurodevelopmental outcome at two years in neonatal hypoxic-ischaemic encephalopathy.

      Nadeem, Montasser; Murray, Deirdre M; Boylan, Geraldine B; Dempsey, Eugene M; Ryan, Cornelius A; Neonatal Intensive Care Unit, Cork University Maternity Hospital, Cork, Ireland. (2012-01-31)
      BACKGROUND: To examine the blood glucose profile and the relationship between blood glucose levels and neurodevelopmental outcome in term infants with hypoxic-ischaemic encephalopathy. METHODS: Blood glucose values within 72 hours of birth were collected from 52 term infants with hypoxic-ischaemic encephalopathy. Hypoglycaemia [< 46.8 mg/dL (2.6 mmol/L)] and hyperglycaemia [> 150 mg/dL (8.3 mmol/L)] were correlated to neurodevelopmental outcome at 24 months of age. RESULTS: Four fifths of the 468 blood samples were in the normoglycaemic range (392/468:83.8%). Of the remaining 76 samples, 51.3% were in the hypoglycaemic range and (48.7%) were hyperglycaemic. A quarter of the hypoglycaemic samples (28.2%:11/39) and a third of the hyperglycaemic samples (32.4%:12/37) were recorded within the first 30 minutes of life. Mean (SD) blood glucose values did not differ between infants with normal and abnormal outcomes [4.89(2.28) mmol/L and 5.02(2.35) mmol/L, p value = 0.15] respectively. In term infants with hypoxic-ischaemic encephalopathy, early hypoglycaemia (between 0-6 hours of life) was associated with adverse outcome at 24 months of age [OR = 5.8, CI = 1.04-32)]. On multivariate analysis to adjust for grade of HIE this association was not statistically significant. Late hypoglycaemia (6-72 hours of life) was not associated with abnormal outcome [OR = 0.22, CI (0.04-1.14)]. The occurrence of hyperglycaemia was not associated with adverse outcome. CONCLUSION: During the first 72 hours of life, blood glucose profile in infants with hypoxic-ischaemic encephalopathy varies widely despite a management protocol. Early hypoglycaemia (0-6 hours of life) was associated with severe HIE, and thereby; adverse outcome.
    • Early continuous video electroencephalography in neonatal stroke.

      Walsh, Brian H; Low, Evonne; Bogue, Conor O; Murray, Deirdre M; Boylan, Geraldine B; Neonatal Brain Research Group, Cork University Maternity Hospital, Wilton, Cork, , Ireland. Bh.walsh@ucc.ie (2012-01-31)
      Perinatal stroke is the second most common cause of neonatal seizures, and can result in long-term neurological impairment. Diagnosis is often delayed until after seizure onset, owing to the subtle nature of associated signs. We report the early electroencephalographic (EEG) findings in a female infant with a perinatal infarction, born at 41 weeks 2 days and weighing 3.42 kg. Before the onset of seizures, the EEG from 3 hours after delivery demonstrated occasional focal sharp waves over the affected region. After electroclinical seizures, focal sharp waves became more frequent, complex, and of higher amplitude, particularly in 'quiet sleep'. In 'active sleep', sharp waves often disappeared. Diffusion-weighted imaging confirmed the infarct, demonstrating left frontal and parietal diffusion restriction. At 9 months, the infant has had no further seizures, and neurological examination is normal. To our knowledge, this report is the first to describe the EEG findings in perinatal stroke before seizures, and highlights the evolution of characteristic background EEG features.
    • The effect of moderate gestational alcohol consumption during pregnancy on speech and language outcomes in children: a systematic review

      O’Keeffe, Linda M; Greene, Richard A; Kearney, Patricia M (2014-01-02)
      Abstract Background Consensus has not been reached on safe alcohol consumption recommendations during pregnancy. The National Institutes for Care and Health Excellence (NICE) in the UK suggest that one to two drinks not more than twice per week is safe. However, the speech and language effects of even low levels of alcohol use among offspring are unknown. The aim of this study was to review systematically the evidence on studies of the effect of low to moderate levels of alcohol consumption during pregnancy (up to 70 grams of alcohol per week) compared to abstinence on speech and language outcomes in children. Methods Using medical subject headings, PubMed, Web of knowledge, Scopus, Embase, Cinahl and the Cochrane Library were searched from their inception up to March 2012. Case control and cohort studies were included. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality. Results A total of 1,397 titles and abstracts were reviewed of which 51 full texts were retrieved. Three cohort studies totaling 10,642 women met the inclusion criteria. All three studies, (United States (2) and Australia (1)) indicated that language was not impaired as a result of low to moderate alcohol consumption during pregnancy. Two studies were judged to be of low quality based on a six-item bias classification tool. Due to heterogeneity, results could not be meta-analyzed. Conclusion Studies included in this review do not provide sufficient evidence to confirm or refute an association between low to moderate alcohol use during pregnancy and speech and language outcomes in children. High quality, population based studies are required to establish the safety of low to moderate levels of alcohol use such as those set out by the NICE guidelines in the UK.
    • The effects of maternal body mass index on pregnancy outcome.

      Khashan, A S; Kenny, L C; The Anu Research Centre, Department of Obstetrics and Gynaecology, Cork, University Maternity Hospital, University College Cork, Wilton, Cork, Ireland., a.khashan@ucc.ie (2012-01-31)
      The increasing prevalence of obesity is presenting a critical challenge to healthcare services. We examined the effect of Body Mass Index in early pregnancy on adverse pregnancy outcome. We performed a population register-based cohort study using data from the North Western Perinatal survey (N = 99,403 babies born during 2004-2006), based at The University of Manchester, UK. The main outcome measures were Caesarean section delivery, preterm birth, neonatal death, stillbirth, Macrosomia, small for gestational age and large for gestational age. The risk of preterm birth was reduced by almost 10% in overweight (RR = 0.89, [95% CI: 0.83, 0.95]) and obese women (RR = 0.90, [95% CI: 0.84, 0.97]) and was increased in underweight women (RR = 1.33, [95% CI: 1.16, 1.53]). Overweight (RR = 1.17, [95% CI: 1.09, 1.25]), obese (RR = 1.35, [95% CI: 1.25, 1.45]) and morbidly obese (RR = 1.24, [95% CI: 1.02, 1.52]) women had an elevated risk of post-term birth compared to normal women. The risk of fetal macrosomia and operative delivery increased with BMI such that morbidly obese women were at greatest risk of both (RR of macrosomia = 4.78 [95% CI: 3.86, 5.92] and RR of Caesarean section = 1.66 [95% CI: 1.61, 1.71] and a RR of emergency Caesarean section = 1.59 [95% CI: 1.45, 1.75]). Excessive leanness and obesity are associated with different adverse pregnancy outcomes with major maternal and fetal complications. Overweight and obese women have a higher risk of macrosomia and Caesarean delivery and lower risk of preterm delivery. The mechanism underlying this association is unclear and is worthy of further investigation.
    • An epidemiological study of factors associated with preterm Infant in-hospital mortality

      Lutomski, J; Dempsey, E; Molloy, E (Irish Medical Journal, 2013-01)
    • Evaluation and treatment of hypotension in the preterm infant.

      Dempsey, E M; Barrington, K J; Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland. (2012-01-31)
      A large proportion of very preterm infants receive treatment for hypotension. The definition of hypotension is unclear, and, currently, there is no evidence that treating it improves outcomes or, indeed, which treatment to choose among the available alternatives. Assessment of circulatory adequacy of the preterm infant requires a careful clinical assessment and may also require ancillary investigations. The most commonly used interventions, fluid boluses and dopamine, are problematic: fluid boluses are statistically associated with worse clinical outcomes and may not even increase blood pressure, whereas dopamine increases blood pressure mostly by causing vasoconstriction and may decrease perfusion. For neither intervention is there any reliable data showing clinical benefit. Prospective trials of intervention for hypotension and circulatory compromise are urgently required.
    • The Expression of Inflammatory Mediators in Bladder Pain Syndrome.

      Offiah, Ifeoma; Didangelos, Athanasios; Dawes, John; Cartwright, Rufus; Khullar, Vik; Bradbury, Elizabeth J; O'Sullivan, Suzanne; Williams, Dic; Chessell, Iain P; Pallas, Kenny; et al. (European urology, 2016-08)
      Bladder pain syndrome (BPS) pathology is poorly understood. Treatment strategies are empirical, with limited efficacy, and affected patients have diminished quality of life.
    • Fetal heart rate patterns in neonatal hypoxic-ischemic encephalopathy: relationship with early cerebral activity and neurodevelopmental outcome.

      Murray, Deirdre M; O'Riordan, Mairead N; Horgan, Richard; Boylan, Geraldine; Higgins, John R; Ryan, Cornelius A; Department of Paediatrics and Child Health, University College Cork, Cork, University Maternity Hospital, Cork, Wilton, Cork, Ireland. d.murray@ucc.ie (2012-01-31)
      Despite widespread use of fetal heart rate monitoring, the timing of injury in hypoxic-ischemic encephalopathy (HIE) remains unclear. Our aim was to examine fetal heart rate patterns during labor in infants with clinical and electroencephalographic (EEG) evidence of HIE and to relate these findings to neurodevelopmental outcome. Timing of onset of pathological cardiotocographs (CTGs) was determined in each case by two blinded reviewers and related to EEG grade at birth and neurological outcome at 24 months. CTGs were available in 35 infants with HIE (17 mild, 12 moderate, 6 severe on EEG). Admission CTGs were normal in 24/35 (69%), suspicious in 8/35 (23%), and pathological in 3/35 (8%). All CTGs developed nonreassuring features prior to delivery. Three patterns of fetal heart rate abnormalities were seen: group 1, abnormal CTGs on admission in 11/35 (31%); group 2, normal CTGs on admission with gradual deterioration to pathological in 20/35 cases (57%); and group 3, normal CTGs on admission with acute sentinel events in 4/35 (11.5%). The median (interquartile range) duration between the development of pathological CTGs and delivery was 145 (81, 221) minutes in group 2 and 22 (12, 28) minutes in group 3. There was no correlation between duration of pathological CTG trace and grade of encephalopathy (R = 0.09, P = 0.63) or neurological outcome (P = 0.75). However, the grade of encephalopathy was significantly worse in group 3 (P = 0.001), with a trend to worse outcomes. The majority of infants with HIE have normal CTG traces on admission but develop pathological CTG patterns within hours of delivery. More severe encephalopathy was associated with normal admission CTG and acute sentinel events shortly before delivery.