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Peisah C, Sheppard A, Benbow SM, Loughran-Fowlds A, Grayson S, Gunton JE, Kataria A, Lai R, Lele K, Quadrio C, Wright D, McLean L. Operationalising the Family-Friendly Medical Workplace and the Development of FAM-MED, a Family-Friendly Self-Audit Tool for Medical Systems: A Delphi Consensus. Healthcare (Basel) 2023; 11:1679. [PMID: 37372796 DOI: 10.3390/healthcare11121679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Globally, the call for Family-Friendly (FF) workplaces is loud and clear. However, this call is inaudible in medical workplaces, despite both well-established benefits of FF workplaces across businesses and well-known effects of work-family conflict on the well-being and practice of doctors. We aimed to use the Delphi consensus methodology to: (i) operationalise the Family-Friendly medical workplace and (ii) develop a Family-Friendly Self-Audit tool for medical workplaces. The expert medical Delphi panel was deliberatively recruited to capture a breadth of professional, personal, and academic expertise, diversity of age (35-81), life stage, family contexts and lived experience of dual commitments to work and family, and diversity of work settings and positions. Results reflected the inclusive and dynamic nature of the doctor's family and the need to adopt a family life cycle approach to FF medical workplaces. Key processes for implementation include holding firms to zero discrimination; flexibility and openness to dialogue and feedback; and a mutual commitment between the doctor and the department lead to best meet the doctor's individualised needs while still ensuring optimal patient care and team support and cohesion. We hypothesise that the Department Head may be the key to implementation but recognise the workforce constraints to realising these aspirational systemic shifts. It is time we acknowledge that doctors have families, to narrow the gap between identifying as a partner, mother, father, daughter, son, grandparent, and identifying as a doctor. We affirm the right to be both good doctors and good family members.
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Affiliation(s)
- Carmelle Peisah
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | | | - Susan Mary Benbow
- Centre for Ageing and Mental Health, Faculty of Health and Social Care, University of Chester, Chester CH1 4BJ, UK
| | | | | | - Jenny E Gunton
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Westmead Hospital, Sydney, NSW 2145, Australia
- Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Anuradha Kataria
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Rosalyn Lai
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
- Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Kiran Lele
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Carolyn Quadrio
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Danette Wright
- Blacktown Hospital, Sydney, NSW 2148, Australia
- School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia
| | - Loyola McLean
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Westmead Psychotherapy Programme for Complex Traumatic Disorders, Cumberland Hospital, Sydney, NSW 2145, Australia
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2
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Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, de Vries LS, Dusing S, Einspieler C, Eliasson AC, Ferriero D, Fehlings D, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Mak C, Maitre N, McIntyre S, Mei C, Morgan A, Kakooza-Mwesige A, Romeo DM, Sanchez K, Spittle A, Shepherd R, Thornton M, Valentine J, Ward R, Whittingham K, Zamany A, Novak I. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; 175:846-858. [PMID: 33999106 PMCID: PMC9677545 DOI: 10.1001/jamapediatrics.2021.0878] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
IMPORTANCE Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation. Our recommendations apply primarily to children at high risk of CP or with a diagnosis of CP, aged 0 to 2 years. OBJECTIVE To systematically review the best available evidence about CP-specific early interventions across 9 domains promoting motor function, cognitive skills, communication, eating and drinking, vision, sleep, managing muscle tone, musculoskeletal health, and parental support. EVIDENCE REVIEW The literature was systematically searched for the best available evidence for intervention for children aged 0 to 2 years at high risk of or with CP. Databases included CINAHL, Cochrane, Embase, MEDLINE, PsycInfo, and Scopus. Systematic reviews and randomized clinical trials (RCTs) were appraised by A Measurement Tool to Assess Systematic Reviews (AMSTAR) or Cochrane Risk of Bias tools. Recommendations were formed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework and reported according to the Appraisal of Guidelines, Research, and Evaluation (AGREE) II instrument. FINDINGS Sixteen systematic reviews and 27 RCTs met inclusion criteria. Quality varied. Three best-practice principles were supported for the 9 domains: (1) immediate referral for intervention after a diagnosis of high risk of CP, (2) building parental capacity for attachment, and (3) parental goal-setting at the commencement of intervention. Twenty-eight recommendations (24 for and 4 against) specific to the 9 domains are supported with key evidence: motor function (4 recommendations), cognitive skills (2), communication (7), eating and drinking (2), vision (4), sleep (7), tone (1), musculoskeletal health (2), and parent support (5). CONCLUSIONS AND RELEVANCE When a child meets the criteria of high risk of CP, intervention should start as soon as possible. Parents want an early diagnosis and treatment and support implementation as soon as possible. Early intervention builds on a critical developmental time for plasticity of developing systems. Referrals for intervention across the 9 domains should be specific as per recommendations in this guideline.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Lars Adde
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic and Clinical Services, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Roslyn N. Boyd
- The University of Queensland, St Lucia, Queensland, Australia
| | | | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linda S. de Vries
- University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hans Forssberg
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Pisa, Italy
- University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Petra Karlsson
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Catherine Mak
- The University of Queensland, St Lucia, Queensland, Australia
| | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Cristina Mei
- Orygen, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Angela Morgan
- The Royal Children’s Hospital, Melbourne, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - Katherine Sanchez
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Alicia Spittle
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
| | | | - Marelle Thornton
- Cerebral Palsy Alliance Research Institute, Brain Mind Centre, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Valentine
- Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | | | - Koa Whittingham
- The University of Queensland, St Lucia, Queensland, Australia
| | - Alieh Zamany
- Eugene Child Development and Rehabilitation Center, Oregon Health and Science University, Eugene
| | - Iona Novak
- The University of Sydney, Sydney, Australia
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3
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Fairbairn N, Galea C, Wallen M, Walker K, Hodge A, Badawi N, Loughran-Fowlds A. Are boys and girls just different? Gender differences in the Movement Assessment Battery for Children, 2nd edition (M ABC-2) suggests that they are. Aust Occup Ther J 2020; 67:229-236. [PMID: 32030778 DOI: 10.1111/1440-1630.12646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 12/08/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The second edition of the Movement Assessment Battery for Children (M ABC-2) is a standardised, norm referenced assessment that is frequently used by therapists to identify children with motor difficulties. The norms for the M ABC-2 were derived from a sample of children in the United Kingdom (UK) and are combined across the age groups for boys and girls. The aims of this research were to investigate gender differences in the performance of 8- and 9-year-old Australian children and if the norms in our cohort differed from UK-based M ABC-2 norms. METHODS Children aged 8 or 9 years of age who underwent major neonatal cardiac or non-cardiac surgery and healthy controls were assessed using the M ABC-2 as part of the Development After Infant Surgery (DAISy) study. RESULTS There were statistically significant differences in the scores for boys and girls aged 8- and 9-years old on the M ABC-2. Girls performed better than boys in manual dexterity and on total standard scores. Our control group compared to the assessment norms scored significantly poorer in manual dexterity, aiming and catching and total standard scores. CONCLUSION Caution should be used when interpreting the results of the M ABC-2 for Australian 8- and 9-year olds. Contemporary Australian, gender-specific M ABC-2 norms should be considered. Further research is required to investigate gender differences and differences in performance of Australian children compared to the assessment norms in other age groups on the M ABC-2.
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Affiliation(s)
- Natalie Fairbairn
- Grace Centre for Newborn Intensive Care, The Children's Hospital Westmead, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
| | - Claire Galea
- Grace Centre for Newborn Intensive Care, The Children's Hospital Westmead, Sydney, NSW, Australia.,Cerebral Palsy Alliance, Sydney, NSW, Australia
| | - Margaret Wallen
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
| | - Karen Walker
- Grace Centre for Newborn Intensive Care, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Antoinette Hodge
- Child Development Unit, The Children's Hospital Westmead, Westmead, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Intensive Care, The Children's Hospital Westmead, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia.,Cerebral Palsy Alliance, Sydney, NSW, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Intensive Care, The Children's Hospital Westmead, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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4
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Salve GG, Datar GM, Perumal G, Singh AAV, Ayer JG, Roberts P, Sholler GF, Cole AD, Pigott N, Loughran-Fowlds A, Weatherall A, Alahakoon TI, Orr Y, Nicholson IA, Winlaw DS. Impact of High-Risk Characteristics in Hypoplastic Left Heart Syndrome. World J Pediatr Congenit Heart Surg 2019; 10:475-484. [PMID: 31307299 DOI: 10.1177/2150135119852319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Management of hypoplastic left heart syndrome (HLHS) presents many challenges. We describe our institutional outcomes for management of patients with HLHS over the past 12 years and highlight our strategy for those with highly restrictive/intact interatrial septum (R/I-IAS). METHODS Eighty-eight neonates with HLHS underwent surgical treatment, divided equally into Era-I (n = 44, April 2006 to February 2013) and Era-II (n = 44, March 2013 to June 2018). Up to 2013, all patients with R/I-IAS were delivered at an adjacent adult hospital and then moved to our hospital for intensive care and management. From 2014, these patients were delivered at a co-located theatre in our hospital with immediate atrial septectomy. The hybrid approach was occasionally used with preference for the Norwood procedure for suitable candidates. RESULTS One-year survival after Norwood procedure was 62.5% and 80% for Era-I and Era-II (P = not significant (ns)), respectively, and 41% of patients were categorized as high risk using conventional criteria. Survival at 1 year differed significantly between high-risk and standard-risk patients (P = 0.01). For high-risk patients, survival increased from 42% to 65% between eras (P = ns). In the R/I-IAS subgroup (n = 15), 11 underwent Norwood procedure after emergency atrial septectomy. Of these, seven born at the adjacent adult hospital had 40% survival to stage II versus 60% for the four born at the colocated theatre. Delivery in a colocated theatre reduced the birth-to-cardiopulmonary bypass median time from 445 (150-660) to 62 (52-71) minutes. CONCLUSION Reported surgical outcomes are comparable to multicenter reports and international databases. Proactive management for risk factors such as R/I-IAS may contribute to improved overall outcomes.
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Affiliation(s)
- Gananjay G Salve
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gauri M Datar
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gopinath Perumal
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Aakansha Ajay Vir Singh
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Julian G Ayer
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Philip Roberts
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gary F Sholler
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew D Cole
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Nick Pigott
- 3 Paediatric Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Alison Loughran-Fowlds
- 2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,4 Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Andrew Weatherall
- 2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,5 Department of Anaesthetics, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - T Indika Alahakoon
- 2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,6 Department of Maternal Fetal Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Yishay Orr
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Nicholson
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David S Winlaw
- 1 Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,2 Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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5
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Verrall CE, Blue GM, Loughran-Fowlds A, Kasparian N, Gecz J, Walker K, Dunwoodie SL, Cordina R, Sholler G, Badawi N, Winlaw D. 'Big issues' in neurodevelopment for children and adults with congenital heart disease. Open Heart 2019; 6:e000998. [PMID: 31354955 PMCID: PMC6615801 DOI: 10.1136/openhrt-2018-000998] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/18/2019] [Accepted: 04/26/2019] [Indexed: 12/12/2022] Open
Abstract
It is established that neurodevelopmental disability (NDD) is common in neonates undergoing complex surgery for congenital heart disease (CHD); however, the trajectory of disability over the lifetime of individuals with CHD is unknown. Several ‘big issues’ remain undetermined and further research is needed in order to optimise patient care and service delivery, to assess the efficacy of intervention strategies and to promote best outcomes in individuals of all ages with CHD. This review article discusses ‘gaps’ in our knowledge of NDD in CHD and proposes future directions.
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Affiliation(s)
- Charlotte E Verrall
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gillian M Blue
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Alison Loughran-Fowlds
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.,Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Nadine Kasparian
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Jozef Gecz
- Faculty of Health and Medical Sciences, University of Adelaide School of Medicine, Adelaide, South Australia, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sally L Dunwoodie
- Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculties of Medicine and Science, University of New South Wales, Sydney, NSW, Australia
| | - Rachael Cordina
- Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Discipline of Medicine, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Gary Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia.,Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Health and Medicine, University of Sydney, Sydney, NSW, Australia
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6
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Blue GM, Ip E, Walker K, Kirk EP, Loughran-Fowlds A, Sholler GF, Dunwoodie SL, Harvey RP, Giannoulatou E, Badawi N, Winlaw DS. Genetic burden and associations with adverse neurodevelopment in neonates with congenital heart disease. Am Heart J 2018; 201:33-39. [PMID: 29910053 DOI: 10.1016/j.ahj.2018.03.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 03/28/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Up to 20% of children with congenital heart disease (CHD) undergoing cardiac surgery develop neurodevelopmental disabilities (NDD), with some studies reporting persistent impairment. Recent large-scale studies have demonstrated shared genetic mechanisms contributing to CHD and NDD. In this study, a targeted approach was applied to assess direct clinical applicability of this information. METHODS A gene panel comprising 148 known CHD and/or NDD genes was used to sequence 15 patients with CHD + NDD, 15 patients with CHD, and 15 healthy controls. The number and types of variants between the 3 groups were compared using Poisson log-linear regression, and the SNP-set (Sequence) Kernel Association Test-Optimized was used to conduct single-gene and gene-pathway burden analyses. RESULTS A significant increase in rare (minor allele frequency < 0.01) and novel variants was identified between the CHD + NDD cohort and controls, P < .001 and P = .001, respectively. There was also a significant increase in rare variants in the CHD cohort compared with controls (P = .04). Rare variant burden analyses implicated pathways associated with "neurotransmitters," "axon guidance," and those incorporating "RASopathy" genes in the development of NDD in CHD patients. CONCLUSIONS These findings suggest that an increase in novel and rare variants in known CHD and/or NDD genes is associated with the development of NDD in patients with CHD. Furthermore, burden analyses point toward rare variant burden specifically in pathways related to brain development and function as contributors to NDD. Although promising variants and pathways were identified, further research, utilizing whole-genome approaches, is required prior to demonstrating clinical utility in this patient group.
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Affiliation(s)
- Gillian M Blue
- Kids Heart Research, The Children's Hospital at Westmead, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Eddie Ip
- Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, Australia
| | - Karen Walker
- Sydney Medical School, University of Sydney, Sydney, Australia; Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Edwin P Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alison Loughran-Fowlds
- Sydney Medical School, University of Sydney, Sydney, Australia; Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, Australia
| | - Gary F Sholler
- Kids Heart Research, The Children's Hospital at Westmead, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sally L Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Richard P Harvey
- Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, University of New South Wales, Kensington, Sydney, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, Australia; St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Nadia Badawi
- Sydney Medical School, University of Sydney, Sydney, Australia; Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, Australia; Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - David S Winlaw
- Kids Heart Research, The Children's Hospital at Westmead, Sydney, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia.
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7
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Verrall CE, Walker K, Loughran-Fowlds A, Prelog K, Goetti R, Troedson C, Ayer J, Egan J, Halliday R, Orr Y, Sholler GF, Badawi N, Winlaw DS. Contemporary incidence of stroke (focal infarct and/or haemorrhage) determined by neuroimaging and neurodevelopmental disability at 12 months of age in neonates undergoing cardiac surgery utilizing cardiopulmonary bypass†. Interact Cardiovasc Thorac Surg 2017; 26:644-650. [DOI: 10.1093/icvts/ivx375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte E Verrall
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance, Sydney, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kristina Prelog
- Department of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | - Robert Goetti
- Department of Medical Imaging, The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Julian Ayer
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jonathan Egan
- Sydney Medical School, University of Sydney, Sydney, Australia
- Paediatric Intensive Care Unit, The Children's Hospital at Westmead, Sydney, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
| | - Yishay Orr
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance, Sydney, Australia
| | - David S Winlaw
- Heart Centre for Children, The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 2017; 171:897-907. [PMID: 28715518 PMCID: PMC9641643 DOI: 10.1001/jamapediatrics.2017.1689] [Citation(s) in RCA: 754] [Impact Index Per Article: 107.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. OBJECTIVES To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. EVIDENCE REVIEW This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. FINDINGS Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. CONCLUSIONS AND RELEVANCE Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Cathy Morgan
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Lars Adde
- Norwegian University of Science and Technology, St Olavs University Hospital, Trondheim
| | - James Blackman
- Cerebral Palsy Alliance Research Foundation, New York, New York
| | | | | | - Giovanni Cioni
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simona Fiori
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | | | | | - Andrea Guzzetta
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Petra Karlsson
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | | | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Garey Noritz
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alicia J. Spittle
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Marelle Thornton
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Jane Valentine
- Princess Margaret Hospital, University of Western Australia, Perth
| | - Karen Walker
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia22Children’s Hospital Westmead, The University of Sydney, Sydney, Australia
| | - Robert White
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia22Children’s Hospital Westmead, The University of Sydney, Sydney, Australia
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Verrall C, Ross J, Walker K, Loughran-Fowlds A, Cole A, Sholler G, Badawi N, Winlaw D. The Brain-Heart Axis: Rates of Neurological and Neurodevelopmental Morbidity in Contemporary Neonatal Cardiac Surgery. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Walker K, Loughran-Fowlds A, Halliday R, Badawi N, Stewart J, Holland AJA. Developmental outcomes at three years of age of infants with esophageal atresia. J Pediatr Surg 2016; 51:249-51. [PMID: 26653948 DOI: 10.1016/j.jpedsurg.2015.10.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/AIMS Previous work assessing early developmental outcomes of infants at one year of age following surgery for esophageal atresia (OA) and/or tracheoesophageal fistula (TOF) found a significantly lower score in expressive language compared with control infants. The purpose of this study was to determine whether these differences were still evident at three years of age. METHODS Between August 2006 and July 2008, infants who required surgical correction of OA/TOF were prospectively enrolled as part of a large study which examined developmental outcomes following surgery. Patients were reassessed using the Bayley Scales of Infant and Toddler Development Version III. Cognition, expressive and receptive language, fine motor and gross motor skills scores were compared with both the standardized norms and also with contemporaneous control infants. RESULTS 24 of the 31 infants (77%) assessed at one year were reassessed at three years of age. There was no significant difference between the Bayley scores of the infants with OA/TOF and the standardized norms of the tests in four of the subsets: cognition, expressive language, fine and gross motor skills. Infants with OA scored higher than normative values for the receptive language subscale (P=0.001). When compared with the controls, there were no significant differences in any of the subscales. CONCLUSION Compared with the outcomes at one year, infants with OA/TOF have improved and were scoring within the normal range for the assessment at three years. This may in part be because of the early intervention services which many of these children were provided.
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Affiliation(s)
- Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia; Sydney Medical School, The University of Sydney, Australia; Cerebral Palsy Alliance, Sydney, Australia
| | - Jan Stewart
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Andrew J A Holland
- Sydney Medical School, The University of Sydney, Australia; Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney, Australia.
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Walker K, Loughran-Fowlds A, Halliday R, Holland AJA, Stewart J, Sholler GF, Winlaw DS, Badawi N. Developmental outcomes at 3 years of age following major non-cardiac and cardiac surgery in term infants: A population-based study. J Paediatr Child Health 2015; 51:1221-5. [PMID: 26081460 DOI: 10.1111/jpc.12943] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to determine whether there remain developmental differences between term infants at 3 years of age following major non-cardiac surgery (NCS) and cardiac surgery (CS) compared with healthy control infants in New South Wales (NSW), Australia. STUDY DESIGN Between 2006 and 2008, term infants who required NCS or CS within the first ninety days of life were enrolled in a prospective population-based study. Their developmental outcome was then compared with a cohort of healthy term infants. Infants initially assessed at 1 year of age were then re-assessed at 3 years of age using the Bayley scales of infant and toddler development (version- III) RESULTS Of the 539 term infants assessed at 1 year of age, 417 returned for the 3-year assessment, with 378 complete assessments. The mean scores for the infants who underwent CS (P < 0.001) were significantly lower in all subscales of the assessment compared with the controls, while the mean scores for the infants who underwent NCS were significantly lower in three of the subscales (P < 0.05). The infants who underwent CS scored significantly lower in four of the subscales (P < 0.05), compared with the infants who underwent NCS. CONCLUSION The second phase of this unique population-based study provides further data on the outcomes of infants who underwent major NCS and CS. Major surgery in infants continues to be associated with developmental delay at 3 years of age compared with control infants; however the majority of the delay is mild. The risk remains higher in CS group with the pattern and severity of delay similar to that observed in the first study.
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Affiliation(s)
- Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew J A Holland
- Douglas Cohen Department of Pediatric Surgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jan Stewart
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Pediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Notre Dame University, Sydney, New South Wales, Australia
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12
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Janz-Robinson EM, Badawi N, Walker K, Bajuk B, Abdel-Latif ME, Bajuk B, Sedgley S, Carlisle H, Smith J, Craven P, Glover R, Cruden L, Argomand A, Rieger I, Malcolm G, Lutz T, Reid S, Stack J, Callander I, Medlin K, Marcin K, Shingde V, Lampropoulos B, Chin MF, Bonser K, Badawi N, Halliday R, Loughran-Fowlds A, Karskens C, Paradisis M, Kluckow M, Jacobs C, Numa A, Williams G, Young J, Luig M, Baird J, Lui K, Sutton L, Cameron D. Neurodevelopmental Outcomes of Premature Infants Treated for Patent Ductus Arteriosus: A Population-Based Cohort Study. J Pediatr 2015; 167:1025-32.e3. [PMID: 26227439 DOI: 10.1016/j.jpeds.2015.06.054] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/01/2015] [Accepted: 06/25/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes of extremely preterm infants diagnosed with patent ductus arteriosus (PDA) who were treated medically or surgically and those who were not diagnosed with PDA or who did not undergo treatment for PDA. STUDY DESIGN This retrospective population-based cohort study used data from a geographically defined area in New South Wales and the Australian Capital Territory served by a network of 10 neonatal intensive care units. Patients included all preterm infants born at <29 completed weeks of gestation between 1998 and 2004. Moderate/severe functional disability at 2-3 years corrected age was defined as developmental delay, cerebral palsy requiring aids, sensorineural or conductive deafness (requiring bilateral hearing aids or cochlear implant), or bilateral blindness (best visual acuity of <6/60). RESULTS Follow-up information at age 2-3 years was available for 1473 infants (74.8%). Compared with infants not diagnosed with a PDA or who did not receive PDA treatment for PDA, those with medically treated PDA (aOR, 1.622; 95% CI, 1.199-2.196) and those with surgically treated PDA (aOR, 2.001; 95% CI, 1.126-3.556) were at significantly greater risk for adverse neurodevelopmental outcomes at age 2-3 years. CONCLUSION Our results demonstrate that treatment for PDA may be associated with a greater risk of adverse neurodevelopmental outcome at age 2-3 years. This was particularly so among infants born at <25 weeks gestation. These results may support permissive tolerance of PDAs; however, reasons for this association remain to be elucidated through carefully designed prospective trials.
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Affiliation(s)
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, Australia; Cerebral Palsy Alliance Research Foundation, Notre Dame University, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, Australia; Cerebral Palsy Alliance Research Foundation, Notre Dame University, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Barbara Bajuk
- Neonatal Intensive Care Units Data Collection, NSW Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, Australia
| | - Mohamed E Abdel-Latif
- Department of Neonatology, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia; Medical School, College of Medicine, Biology & Environment, Australian National University, Acton, Canberra, Australia.
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13
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Stewart P, Khatami A, Loughran-Fowlds A, Isaacs D. Methicillin-resistant Staphylococcus aureus bacteraemia and epidural abscess in a neonate. J Paediatr Child Health 2015; 51:458-60. [PMID: 25266956 DOI: 10.1111/jpc.12745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
Abstract
A 24-day-old boy presented with fever, irritability and poor feeding. Blood culture grew methicillin-resistant Staphylococcus aureus. Cerebrospinal fluid analysis showed pleocytosis, and methicillin-resistant Staphylococcus aureus grew from enrichment broth. Magnetic resonance imaging revealed an epidural abscess extending from C2-3 to T8-9. Staphylococcal infections of the central nervous system are uncommon in neonates. This case demonstrates the importance of performing a lumbar puncture in isolated staphylococcal bacteraemia. The case also highlights that cerebrospinal fluid pleocytosis may indicate a parameningeal focus of infection.
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Affiliation(s)
- Phoebe Stewart
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Trivedi A, Walker K, Loughran-Fowlds A, Halliday R, J. A. Holland A, Badawi N. The impact of surgery on the developmental status of late preterm infants - a cohort study. J Neonatal Surg 2015; 4:2. [PMID: 26023526 PMCID: PMC4420401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/25/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population. METHODS Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages. RESULTS Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p less than 0.001). CONCLUSIONS These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.
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Affiliation(s)
- Amit Trivedi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW, Australia
,
Correspondence: Dr. Amit Trivedi, Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Locked Bag 4001, WESTMEAD NSW 2076, Australia. E-mail:
| | - Karen Walker
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW, Australia
,Sydney Medical School, The University of Sydney, Australia
| | - Alison Loughran-Fowlds
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW, Australia
,Sydney Medical School, The University of Sydney, Australia
| | - Robert Halliday
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Andrew J. A. Holland
- Sydney Medical School, The University of Sydney, Australia
,Douglas Cohen Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, NSW, Australia
,Sydney Medical School, The University of Sydney, Australia
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Trivedi A, Walker K, Loughran-Fowlds A, Halliday R, Holland A, Badawi N. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study. J Neonatal Surg 2015. [DOI: 10.47338/jns.v4.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages.Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p<0.001).Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.
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Chinta S, Walker K, Halliday R, Loughran-Fowlds A, Badawi N. A comparison of the performance of healthy Australian 3-year-olds with the standardised norms of the Bayley Scales of Infant and Toddler Development (version-III). Arch Dis Child 2014; 99:621-4. [PMID: 24504506 DOI: 10.1136/archdischild-2013-304834] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Standardised developmental tests are now widely used in neurodevelopmental assessments of infants and children. In 2006, the revised and updated version of the Bayley Scales of Infant and Toddler Development (version III) replaced the previous version and is now widely used in neonatal developmental follow-up clinics. Several papers from Australia have highlighted underestimation of developmental impairment up to age 2 using this revised version. We aimed to ascertain how a cohort of healthy 3-year-old children performed compared to the standardised norms of the Bayley Scales of Infant and Toddler Development (version-III). METHOD Term healthy newborn control infants from the prospective Development after Infant Surgery (DAISy) study were included. At 3 years of age, the mean scores on each of the five subscales for 156 children were compared with the standardised norms. RESULTS At 3 years of age, the mean scores were higher than the standardised norms on four of the subscales, cognition (<0.05), receptive and expressive language and fine motor (p<0.001). There was no significant difference in the gross motor scale (p=0.435). CONCLUSIONS Healthy term Australian children have a statistically significantly higher mean score on the Bayley Scales of Infant and Toddler Development (version-III) compared with the standardised means in four of the subtests, with the greatest difference in receptive language. This has implications for the assessment of children as the test may miss those with a minor delay and not reflect the severity of delay of infants that it does identify. We recommend that consideration ought to be given to re-standardising this assessment on Australian children.
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Abstract
AIM The role of granulocyte-specific S100A12, a marker for inflammatory disorders, in newborn lung disease is unknown. We compared postnatal blood S100A12 concentrations against respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). METHODS Blood samples from 92 newborns were collected on admission, 12 h, day 1, day 3-4 and day 7, and analysed for S100A12. IL-8 and IL-6 were assayed in 52 infants. RESULTS Infants with RDS were significantly more premature (median 27 vs. 34 weeks), more likely to receive antenatal corticosteroids (84% vs. 26%) and have lower neutrophil counts (median 2.4 vs. 3.8 × 10(9) /L) at admission. S100A12 levels peaked during the first day and were significantly lower in preterm infants with RDS compared to those without (median 250 vs. 616 ng/mL at 12 h, 281 vs. 828 ng/mL day 1, respectively). S100A12 levels were low among the 35 very preterm infants (24-29 week gestation) regardless of the presence of BPD (285 vs. 288 ng/mL on day 1). In comparison, IL-8 and IL-6 levels were not different between groups. CONCLUSION Plasma S100A12 is low in infants with RDS, possibly because of gestationally related differences in neutrophil response or to the effects of antenatal corticosteroids. It is therefore not a useful marker of BPD development.
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Cheng ATL, Corke M, Loughran-Fowlds A, Birman C, Hayward P, Waters KA. Distraction osteogenesis and glossopexy for Robin sequence with airway obstruction. ANZ J Surg 2010; 81:320-5. [DOI: 10.1111/j.1445-2197.2010.05588.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
AIM To obtain information on the practices and beliefs of junior doctors regarding neonatal pain and to compare this with best evidence. METHODS A survey was distributed to junior doctors in five tertiary neonatal intensive care units in Sydney. Questions investigated the doctors' knowledge and treatment of pain in neonates, specifically regarding the perception and effects of pain, pain assessment tools, and the safety and efficacy of treatments for both procedural and long-term pain. RESULTS The survey was completed by 33 junior doctors (77% response rate). Respondents generally had adequate knowledge about the effects of pain in neonates; however, a low proportion of respondents acknowledged the difference in long-term effects between neonates and older children. Less experienced doctors were especially unaware of this. Pain assessment tools were not perceived to be reliable, valid or routinely used, especially by less experienced doctors. Respondents were appropriately unsupportive of the use of topical anaesthetic agents. Participants acknowledged the efficacy breastfeeding and oral sucrose during short-term procedures but skin-to-skin contact and massage were less recognised as useful. Mixed opinions were noted on the benefits and risks of use of opioid analgesics, morphine infusions and midazolam but most agreed that sedation does not necessarily provide adequate pain relief. Disturbingly, doctors who were aware of the Royal Australasian College of Physicians Guidelines were more likely to agree with the routine use of midazolam in neonates. CONCLUSIONS Increased educational programmes should be developed to improve the knowledge of junior doctors regarding neonatal pain.
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Affiliation(s)
- Meleesa Schultz
- Faculty of Medicine, The Children's Hospital at Westmead, Westmead, Australia.
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Loughran-Fowlds A, Oei J, Lui K. Bronchopulmonary Dysplasia: An Imbalance of Inflammation. CRMR 2009. [DOI: 10.2174/157339809788922360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Loughran-Fowlds A, Oei J, Wang H, Xu H, Wimalasundera N, Egan C, Henry R, Lui K. The influence of gestation and mechanical ventilation on serum clara cell secretory protein (CC10) concentrations in ventilated and nonventilated newborn infants. Pediatr Res 2006; 60:103-8. [PMID: 16690962 DOI: 10.1203/01.pdr.0000219388.56608.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clara cell secretory protein (CC10) is an important anti-inflammatory mediator in the adult lung, but its role in newborn pulmonary protection is uncertain. We examined the early postnatal behavior of CC10 in newborn serum and tracheal fluid and hypothesized that CC10 production is positively influenced by gestation. Blood from 165 infants from the first, third/fourth, and seventh days of life (gestational ages: 23-29 wk, 30-36 wk, >36 wk) and tracheal fluid (TF) from the first day of life from 32 ventilated infants were analyzed for CC10. Surfactant proteins A (SPA) and B (SPB) were also analyzed from the blood of a subgroup of infants. Serum CC10 on day 1 was highest in term infants (69.4 ng/mL), followed by moderately preterm (55.8 ng/mL), and then extremely preterm infants (median 42.1 ng/mL). Term infants also had higher tracheal fluid CC10 than preterm infants. (20.152 ng/mL versus 882 ng/mL). Mechanical ventilation increased serum CC10 only in moderately preterm infants, and only on d 1 [68.4 ng/mL versus 42.1 ng/mL (nonventilated moderately preterm infants)]. Serum CC10 decreased progressively by the end of the first week in all infants, in contrast to SPA and SPB, which increased. Our results show that CC10 is detectable in the blood of newborn infants and that a production surge occurs at birth. This surge is more pronounced in term infants and may confer them with superior extrauterine pulmonary protection compared with preterm infants.
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Abstract
Scimitar syndrome is a relatively uncommon constellation of cardio-pulmonary anomalies, its typical feature being partial anomalous pulmonary venous connection. It can present in the neonatal period as well as later in life. We present the case of a girl diagnosed in the newborn period, along with a brief review of literature.
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Affiliation(s)
- Arvind Sehgal
- Grace Neonatal Intensive Care Unit, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
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