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Rath CP, Athalye-Jape G, Nathan E, Doherty D, Rao S, Patole S. Benefits of routine probiotic supplementation in preterm infants. Acta Paediatr 2023; 112:2352-2358. [PMID: 37505925 DOI: 10.1111/apa.16924] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023]
Abstract
AIM We introduced routine probiotic supplementation (RPS) of preterm infants in June 2012. We previously reported that RPS reduced the incidence of necrotising enterocolitis (NEC) and mortality in such infants. In this study, we assessed if the benefits of RPS were sustained for infants in the current era. METHOD We compared the outcomes of preterm infants in recent epoch 3 (RPS, 1st June 2014 to 31st December 2019) versus epoch 2 (RPS, 1st June 2012 to 31st May 2014) and epoch 1 (no RPS, 1st December 2008 to 30th November 2010). Multiple logistic and Cox regression models were used to compare the outcomes. RESULTS There were 645 infants in epoch 1, 712 in epoch 2 and 1715 in epoch 3. Age at full feeds was significantly lower in epoch 3 vs. 2 and epoch 3 vs. 1 in infants <28 weeks of gestation. NEC and late-onset sepsis (LOS) were significantly lower in epoch 3 vs. 1 in infants <28 weeks. LOS and age at full feeds were significantly lower in epoch 3 vs. 2 and epoch 3 vs. 1 in infants with gestation 28 to 32 weeks. CONCLUSION The benefits associated with RPS were sustained during epoch 3.
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Affiliation(s)
- C P Rath
- Neonatology Directorate, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - G Athalye-Jape
- Neonatology Directorate, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - E Nathan
- Biostatistics, Women and Infants Research Foundation, Subiaco, Western Australia, Australia
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, Western Australia, Australia
| | - D Doherty
- Biostatistics, Women and Infants Research Foundation, Subiaco, Western Australia, Australia
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, Western Australia, Australia
| | - S Rao
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Neonatal Directorate, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - S Patole
- Neonatology Directorate, King Edward Memorial Hospital for Women, Subiaco, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
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Desai S, Athalye-Jape G, Madhala S, Tee W, Sharp M, Nathan E, Shrestha D, Patole S. Comparison of Papile versus Laterality-Based Al-Abdi System to Predict Neurodevelopmental Impairment in Extreme Preterm Infants after Severe Germinal Matrix Hemorrhage-Intraventricular Hemorrhage: A Retrospective Comparative Observational Study. AJNR Am J Neuroradiol 2022; 43:486-492. [PMID: 35210279 PMCID: PMC8910795 DOI: 10.3174/ajnr.a7434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/01/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The traditional Papile classification system for severe germinal matrix hemorrhage-intraventricular hemorrhage is limited in objectivity and interrater variability for accurate prediction of neurodevelopmental impairment in extremely preterm infants. Many extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage are still offered "redirection of care" in spite of the recent evidence suggesting that many of these infants can have normal outcomes. Therefore, it is important to consider the laterality and extent of brain hemisphere involvement while classifying severe germinal matrix hemorrhage-intraventricular hemorrhage to predict neurodevelopmental impairment. The aim of the present study was to compare the Al-Abdi system with the Papile system for their accuracy in predicting neurodevelopmental impairment in extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage. MATERIALS AND METHODS This is a retrospective study of extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage admitted to a tertiary neonatal intensive care unit (2006-2016). Cranial sonograms were independently re-reviewed by 2 radiologists as per the Al-Abdi system. The prognostic statistical indices for both systems to predict neurodevelopmental impairment were calculated. RESULTS A total of 91 infants with severe germinal matrix hemorrhage-intraventricular hemorrhage survived, and 83 (median gestational age, 26.3 weeks; and median birth weight, 890 g) completed developmental assessment. The receiver operating characteristic areas under the curve to predict neurodevelopmental impairment by the Papile versus Al-Abdi systems were 0.702 versus 0.723, respectively (P = .474). Corresponding Al-Abdi cutoff scores of 19, 20, 21, and 22 demonstrated increased specificity (76.36%-85.45%) and correct classification (69.88%-72.29%) to predict moderate-to-severe neurodevelopmental impairment. CONCLUSIONS The Al-Abdi system is comparable with the Papile system for predicting neurodevelopmental impairment for extremely preterm infants with severe germinal matrix hemorrhage-intraventricular hemorrhage, with higher Al-Abdi scores being more specific. This finding may prove useful for neonatal health care providers and parents in their decision regarding "continuation of care." Future multicentric studies are warranted to ascertain the validity of individual Al-Abdi scores.
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Affiliation(s)
- S. Desai
- From the Neonatal Directorate (S.D., G.A.-J., M.S., D.S., S.P.),Perth Children’s Hospital (D.S, S.M., W.T., M.S.), Perth, Western Australia, Australia
| | - G. Athalye-Jape
- From the Neonatal Directorate (S.D., G.A.-J., M.S., D.S., S.P.),School of Medicine (G.A.-J., M.S., S.P.)
| | - S. Madhala
- Department of Radiology (S.M., W.T.),Perth Children’s Hospital (D.S, S.M., W.T., M.S.), Perth, Western Australia, Australia
| | - W. Tee
- Department of Radiology (S.M., W.T.),Perth Children’s Hospital (D.S, S.M., W.T., M.S.), Perth, Western Australia, Australia
| | - M. Sharp
- From the Neonatal Directorate (S.D., G.A.-J., M.S., D.S., S.P.),Perth Children’s Hospital (D.S, S.M., W.T., M.S.), Perth, Western Australia, Australia,School of Medicine (G.A.-J., M.S., S.P.)
| | - E. Nathan
- Women and Infants Research Foundation (E.N.), King Edward Memorial Hospital for Women, Perth, Western Australia, Australia,Division of Obstetrics and Gynaecology (E.N.), University of Western Australia, Perth, Western Australia, Australia
| | - D. Shrestha
- From the Neonatal Directorate (S.D., G.A.-J., M.S., D.S., S.P.)
| | - S. Patole
- From the Neonatal Directorate (S.D., G.A.-J., M.S., D.S., S.P.),School of Medicine (G.A.-J., M.S., S.P.)
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Agrawal S, Pestell CF, Granich J, Rao S, Nathan E, Wray JA, Whitehouse AJO, Patole S. Difficulties in developmental follow-up of preterm neonates in a randomised-controlled trial of Bifidobacterium breve M16-V - Experience from Western Australia. Early Hum Dev 2020; 151:105165. [PMID: 32871454 DOI: 10.1016/j.earlhumdev.2020.105165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/04/2020] [Revised: 07/20/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Probiotics may be neuroprotective for preterm neonates due to their anti-inflammatory effects and ability to facilitate nutrition. AIM To assess long-term effects of early probiotic supplementation on neuropsychological development in preterm infants. STUDY DESIGN Follow up study. SUBJECTS Children at age 3 to 5 years who had participated as preterm infants (<33 week) in the randomised controlled trial. OUTCOMES Primary: Continuous early learning composite measure derived from the Mullen's Scale of Early Learning (MSEL). Other outcomes were assessed by the Developmental, Dimensional and Diagnostic Interview, Developmental NEuroPSYchological assessment-2nd Edition, Parental questionnaires using children's communication checklist-2nd edition, social responsiveness scale, and Vineland Adaptive Behavioural Scales-2nd edition. MEASURES Continuous scores derived from all the measures. RESULTS 67 children of the 159 participants (42%) (Probiotic: 36/79, Placebo: 31/80) were followed-up for at least one neuropsychological assessment. All six assessments were completed in 18/31 (58.1%) of the control vs. 11/36 (30.6%) probiotic group children. Multivariable analysis of MSEL composite score showed no evidence of probiotic effect univariately, or after adjustment for gestation, intrauterine growth restriction, Apgar <7 at 5 min and age at assessment (adjusted mean effect in probiotic group: -2.7, 95% CI -8.5-3.0, p = 0.349). CONCLUSION There was no significant effect on neurodevelopment of children assessed at the age of 3 to 5 years who participated as preterm neonates in the RCT of B. breve M-16V. The validity of these results is limited by the reduced sample size due to high rate of loss to follow up.
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Affiliation(s)
- S Agrawal
- Neonatal Directorate, KEM Hospital for Women, 374 Bagot Road, Subiaco, WA, Australia.
| | - C F Pestell
- School of Psychological Science, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - J Granich
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - S Rao
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Neonatal Pediatrics, Perth Children Hospital, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - E Nathan
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Women and Infants Research Foundation, King Edward Memorial Hospital for Women, 374, Bagot Road, Subiaco, Perth, WA, Australia
| | - J A Wray
- School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia; Child Development Centre, 4/16 Rheola St, West Perth, WA 6005, Australia
| | - A J O Whitehouse
- Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA, 6009 Perth, Australia
| | - S Patole
- Neonatal Directorate, KEM Hospital for Women, 374 Bagot Road, Subiaco, WA, Australia; School of Medicine, University of WA, 35 Stirling Highway, Crawley, WA, 6009 Perth, Australia
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Agrawal S, Rao S, Nathan EA, Patole S. Effect of probiotics on C-reactive protein levels in preterm infants: Secondary analysis of a randomized controlled trial. J Neonatal Perinatal Med 2018; 11:165-171. [PMID: 29843270 DOI: 10.3233/npm-181763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 12/12/2022]
Abstract
BACKGROUND Excessive inflammation is associated with adverse outcomes in preterm infants. C- reactive protein (CRP) is a marker of inflammation/infection. Probiotics have anti-inflammatory properties. Randomized controlled trials (RCTs) in preterm infants have not reported effect of probiotics on CRP. AIM To evaluate effect of probiotics on CRP in preterm infants who had participated in a RCT of Bifidobacterium breve (B. breve) m-16v. METHODS Data on all infants (GA <33 weeks, n = 159) enrolled in the RCT was analyzed. For study purpose, CRP <15 mg/L and ≤10 mg/L was considered normal for the first week, and thereafter respectively. Mixed logistic regression modelling was used to assess probiotic effect on CRP levels. RESULTS There were 1579 CRP measurements (Probiotic: 851 vs. Placebo: 728). Baseline characteristics and number [Median (IQR)] of CRP estimations per infant [l0 (5, 20) vs. 10 (6, 17), p = 0.861] were comparable between probiotic vs. placebo group. There was no significant difference in the proportion of infants with high CRP over time (treatment by weekly time points interaction, p = 0.187), and across all time points between probiotic and placebo group (adjusted OR: 1.62, 95% CI: 0.91-2.88, p = 0.102)CONCLUSION:B. breve m-16v did not decrease CRP levels in preterm infants born <33 weeks.
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Affiliation(s)
- S Agrawal
- Department of Neonatal Paediatrics, KEM Hospital, Perth, WA, Australia.,Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, WA, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - S Rao
- Department of Neonatal Paediatrics, KEM Hospital, Perth, WA, Australia.,Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, WA, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - E A Nathan
- Women and Infants Research Foundation, King Edward Memorial Hospital for Women, Perth, WA, Australia.,School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - S Patole
- Department of Neonatal Paediatrics, KEM Hospital, Perth, WA, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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Jasani B, Patole S. Standardized feeding regimen for reducing necrotizing enterocolitis in preterm infants: an updated systematic review. J Perinatol 2017; 37:827-833. [PMID: 28358382 DOI: 10.1038/jp.2017.37] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 10/10/2016] [Revised: 12/31/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE A systematic review (2005) of observational studies has reported 87% reduction in the incidence of necrotizing enterocolitis (NEC) after introducing standardized feeding regimen (SFR) in preterm infants. Considering the many new studies in this field since 2005 and the continued health burden of NEC, we aimed to systematically review the incidence of NEC in preterm infants 'before' vs 'after' implementing a SFR. STUDY DESIGN PubMed, EMBASE, CINAHL and E-abstracts from the Pediatric Academic Society meetings and other pediatric and neonatal conference proceedings were searched in May 2016. Observational studies reporting incidence of NEC before and after implementing a SFR were included. Relevant data were extracted independently by two reviewers. Meta-analysis was conducted using random effects model (REM) and results rechecked with fixed effects model. RESULTS Pooled results from 15 observational studies (N=18 160) using REM showed that SFR significantly reduced the incidence of NEC (risk ratio 0.22; 95% confidence interval 0.13 to 0.36; P<0.00001; I2=74%). The results remained significant after comparing studies in two epochs (1978 to 2003 vs 2004 to 2016). CONCLUSION SFR continues to be an important tool in prevention of NEC in preterm infants.
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Affiliation(s)
- B Jasani
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
| | - S Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, WA, Australia
- Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
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Ofek Shlomai N, Rao S, Patole S. Efficacy of interventions to improve hand hygiene compliance in neonatal units: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2015; 34:887-97. [DOI: 10.1007/s10096-015-2313-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/07/2015] [Indexed: 01/11/2023]
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Shah P, Nathan E, Doherty D, Patole S. Optimising enteral nutrition in growth restricted extremely preterm neonates – a difficult proposition. J Matern Fetal Neonatal Med 2014; 28:1981-4. [DOI: 10.3109/14767058.2014.974538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ofek Shlomai N, Deshpande G, Rao S, Patole S. Probiotics for preterm neonates: what will it take to change clinical practice? Neonatology 2014; 105:64-70. [PMID: 24281648 DOI: 10.1159/000354891] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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] [Received: 02/04/2013] [Accepted: 07/30/2013] [Indexed: 11/19/2022]
Abstract
Necrotizing enterocolitis (NEC) is a major cause of mortality (25%) and morbidity including recurrent sepsis, dependence on parenteral nutrition, need for surgery, and survival with short bowel syndrome in preterm very low birth weight infants. Mortality (45-100%) and morbidity including the risk of long-term neurodevelopmental impairment are higher in extremely preterm infants needing surgery for NEC. Systematic reviews of randomized controlled trials (RCT) indicate that probiotics significantly reduce the risk of NEC (RR 0.39; 95% CI 0.29-0.52; p < 0.00001) and all-cause mortality (RR 0.52; 95% CI 0.40-0.69; p < 0.00001) while facilitating enteral feeds in preterm infants. At present, data from 25 RCT (∼5,000 neonates) and reports on routine use (∼3,000 neonates) indicates that significant adverse effects of probiotics are rare. Despite the robust evidence, there is still reluctance in incorporating routine probiotic prophylaxis in clinical practice. If the goal is to have zero tolerance for NEC, then probiotic prophylaxis must be adopted as soon as possible. Current gaps in knowledge can be addressed by continued research while providing routine probiotic supplementation. We believe that the concept of evidence-based practice of medicine has been stretched too far in this case. Trial sequential analysis has already shown that the evidence for probiotic supplementation was conclusive after 10 trials. Results of the ongoing trials are unlikely to change the conclusions of the systematic reviews significantly. Currently we are at trial number 25; how many more trials do we need? What will it take to change clinical practice?
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Affiliation(s)
- N Ofek Shlomai
- Department of Neonatal Paediatrics, KEM Hospital for Women, Perth, W.A., Australia
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Shah P, Nathan E, Doherty D, Patole S. Prolonged exposure to antibiotics and its associations in extremely preterm neonates - the Western Australian experience. J Matern Fetal Neonatal Med 2013; 26:1710-4. [DOI: 10.3109/14767058.2013.791274] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- S Patole
- Department of Neonatology Kirwan Hospital for Women Townsville Australia
| | - R Muller
- School of Public Health and Tropic Medicine James Cook University Townsville Australia
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12
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Abstract
BACKGROUND The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and linoleic acid (LA) are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants, who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. OBJECTIVES The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to preterm infants. SEARCH STRATEGY Trials were identified by MEDLINE (February 2007), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007) and by checking reference lists of relevant articles and conference proceedings. SELECTION CRITERIA All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. DATA COLLECTION AND ANALYSIS Fifteen randomised trials assessing the clinical effects of feeding formula supplemented with LCPUFA were included in the review. MAIN RESULTS Of the fifteen randomised trials included in the review, four of these were not classified as of high quality, due to low follow-up, uncertainty regarding concealment of patient allocation and randomisation, and problems with assessment methodology. VISUAL ACUITY: Visual acuity over the first year was measured by Teller or Lea acuity cards in eight studies, by VEP in six studies and by ERG in two studies. Most studies found no significant differences in any visual assessment between supplemented and control infants. DEVELOPMENT Most of the trials have used Bayley Scales of Infant Development (BSID) at 12 to 24 months post-term with three out of seven studies reporting some benefit of LCPUFA in different populations of supplemented infants at different postnatal ages. Meta-analysis of BSID of four studies at 12 months (N = 364) and three studies at 18 months (N = 494) post-term showed no significant effect of supplementation on neurodevelopment. Carlson 1992 and Carlson 1996 demonstrated lower novelty preferences (possibly predictive of lower intelligence) in the supplemented compared with the control group. The investigators however concluded that supplemented infants may have more rapid visual information processing given that they had more looks and each look was of shorter duration. GROWTH Four out of thirteen studies reported benefits of LCPUFA on growth of supplemented infants at different postnatal ages. Two trials (Carlson 1992; Carlson 1996) suggested that LCPUFA supplemented infants grow less well than controls, possibly due to a reduction in AA levels that occurs when n-3 supplements are used without n-6 supplements. Recent trials with addition of AA to the supplement have reported no significant negative effect on growth. Fewtrell 2002 reported mild reductions in length and weight z scores at 18 months. Contrary to these results, meta-analysis of five studies (Uauy 1990; Carlson 1996; Hansen 1997; Vanderhoof 1999; Innis 2002) showed increased weight and length at two months post-term in supplemented infants. Meta-analysis of four studies at 12 months (N = 271) and two studies at 18 months (N = 396) post-term showed no significant effect of supplementation on weight, length or head circumference. SIDE EFFECTS Uauy 1992 reported no significant effect of LCPUFA supplementation on bleeding time and red cell membrane fragility. AUTHORS' CONCLUSIONS Infants enrolled in the trials were relatively mature and healthy preterm infants. Assessment schedule and methodology, dose and source of supplementation and fatty acid composition of the control formula varied between trials. When the results of the RCT's are pooled, no clear long-term benefits were demonstrated for infants receiving formula supplemented with LCPUFA. There was no evidence that supplementation of formula with n-3 and n-6 LCPUFA impaired the growth of preterm infants.
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Affiliation(s)
- K Simmer
- King Edward Memorial Hospital for Women and Princess Margaret Hospital for Children, Neonatal Clinical Care Unit, Bagot Road, Subiaco, WA, Australia 6008.
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Travadi J, Patole S, Thonell S, Simmer K. Survey of the current practices for neonatal gastrointestinal contrast studies in Australia. Australas Radiol 2007; 51:437-9. [PMID: 17803795 DOI: 10.1111/j.1440-1673.2007.01867.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
A wide range of contrast agents with varying osmolality (290-849 mmol/kg) and iodine content (150-370 mg/mL) are currently available for neonatal gastrointestinal contrast studies. A nationwide survey was hence conducted to identify current practices. A questionnaire was mailed to the 22 Australian neonatal units registered with the Australian and New Zealand Neonatal Network. Seventeen (72%) of the 22 units responded to the questionnaire and 54% had some guidelines for term neonates. No unit had a specific policy for preterm neonates. Seventy-seven per cent of the respondents used a contrast agent with a high osmolality. There was a wide variation in the volume and dilution of contrast used. Guidelines for gastrointestinal contrast studies in high-risk neonates are suggested.
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Affiliation(s)
- J Travadi
- Department of Neonatal Paediatrics, Princess Margaret and King Edward Memorial Hospitals, Perth, Western Australia, Australia
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Abstract
Postnatal growth restriction has been recently identified as a serious problem in preterm, especially extremely low birth weight neonates who are also at the highest risk for necrotizing enterocolitis (NEC). The fear of NEC and the difficulties in interpreting the signs of feed intolerance continue to be responsible for the variations in enteral feeding practices for these neonates. Such variations in clinical practice (e.g. fluid management, feeding regimens) have also been proposed to represent the 'iatrogenic' component of NEC. The findings of a survey (a questionnaire for self-administration and anonymous response) to document the enteral feeding practices of Australian neonatologists for neonates < 32 weeks' gestation are reported. A few controversial feeding practices are discussed in the light of the current evidence. The importance of minimizing variations in nutritional practices is emphasized.
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Affiliation(s)
- S Patole
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Australia
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Abstract
BACKGROUND It often takes several days or even weeks to establish full enteral feeds (FEFs) in preterm, especially extremely low birthweight neonates because of feed intolerance related to gastrointestinal hypomotility. Clinical trials of erythromycin as a prokinetic agent in preterm neonates have reported conflicting results. AIM To systematically review the efficacy and safety of erythromycin as a prokinetic agent in preterm neonates. METHODS Only randomised controlled trials in preterm neonates (gestation < or = 37 weeks) were considered eligible for inclusion. The primary outcome was the time to reach FEFs of 150 ml/kg/day. The secondary outcomes included the incidence of erythromycin related adverse effects such as diarrhoea, cardiac arrhythmias, and hypertrophic pyloric stenosis. No restrictions were applied on the dose (low: 3-12 mg/kg/day; antimicrobial: > or = 12 mg/kg/6-8 hours) and route (oral or intravenous) and mode (prophylactic or rescue) of administration. The standard methodology for systematic reviews was followed. A subgroup analysis was pre-planned based on the dose and mode of drug administration. RESULTS Seven trials (three prophylaxis, four rescue) with various doses, routes and modes of administration, and durations of erythromycin treatment and different results were found to be eligible for inclusion in the analysis. Meta-analysis could not be performed, as specific data were either inadequate or not available. CONCLUSION The conflicting trial results may be explained by differences in dose and route and mode of administration of erythromycin and in gastrointestinal motor responses in the presence of different feeding conditions-for example, fasting v fed state, intermittent v continuous feeds. Gestational and postnatal ages during erythromycin treatment are also important.
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Affiliation(s)
- S Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, University of Western Australia, Perth, Western Australia 6008.
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Abstract
UNLABELLED A standardised feeding regimen was adopted in 1997 for guiding enteral feeding of neonates <32 weeks' gestation during clinical trials (18 months each) involving erythromycin (n=73) as a prokinetic and carboxymethylcellulose (n=70) as a laxative as well as for during 2 years (n=155) without any trials. Most aspects of the feeding regimen (e.g., milk increments-total volume/day, use of breast milk by choice, etc) were not significantly different from current practices. RESULTS 298 neonates <32 weeks' gestation (<28 weeks; n=78) were enterally fed during the 5 years. Their demographic characteristics and median (interquartile) age in days at starting (AST) and days to reach full enteral feeds (FFT) of 150 ml/kg/day were not significantly different during these 5 years: [AST: 5 (3-7.5)], [FFT: 4 (3-7)] Only one case of definite NEC (> or =Stage II) occurred during the 5 years. The time to reach full feeds was also reduced by over 54% (including for neonates <28 weeks gestation) compared with a historical cohort. CONCLUSION Sustained reduction in the time to reach full feeds with virtual elimination of > or =Stage II NEC for 5 years indicates continued benefits of a standardised feeding regimen as a simple preventive strategy to prevent NEC. Whether our specific policy of no enteral feeds in presence of hemodynamic instability associated with PDA requiring indomethacin, and/or sepsis played a role in achieving the significant results needs controlled trials.
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Affiliation(s)
- S Patole
- King Edward Memorial Hospital for Women, Western Australia 6008, Subiaco, Australia.
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Abstract
Congenital microvillous atrophy (CMVA) is the leading cause of neonatal secretory diarrhoea with onset either in the first 72 hours of life (early onset) or at 6-8 weeks after birth (late onset). To date over 30 cases have been reported worldwide. The prognosis for this life threatening condition continues to be poor. Therapeutic agents like somatostatin and epidermal growth factor are either ineffective or of marginal benefit. Overall five year survival after small bowel transplantation is currently approximately 50%. The following brief review is aimed towards helping neonatologists/perinatologists in the early diagnosis, and management of CMVA and in counselling the parents appropriately.
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MESH Headings
- Atrophy/etiology
- Atrophy/pathology
- Atrophy/therapy
- Dehydration/etiology
- Dehydration/therapy
- Diarrhea, Infantile/congenital
- Diarrhea, Infantile/pathology
- Diarrhea, Infantile/therapy
- Humans
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/pathology
- Infant, Newborn, Diseases/therapy
- Intestinal Mucosa/ultrastructure
- Microvilli/ultrastructure
- Prognosis
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Affiliation(s)
- N Pecache
- Princess Margaret and King Edward Memorial Hospitals, Neonatal Clinical Care Unit, Subiaco, Western Australia
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18
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Singh M, Patole S, Rane A, Naidoo D, Buettner P. Maternal intravaginal prostaglandin E2 gel before elective caesarean section at term to induce catecholamine surge in cord blood: randomised, placebo controlled study. Arch Dis Child Fetal Neonatal Ed 2004; 89:F131-5. [PMID: 14977896 PMCID: PMC1756045 DOI: 10.1136/adc.2002.025957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that the application of intravaginal prostaglandin E(2) gel before elective caesarean section (ECS) will induce a catecholamine surge in umbilical arterial blood. DESIGN Randomised, double blind, placebo controlled trial. SETTING A regional perinatal referral centre. PATIENTS Mothers booked for ECS at or above 38 weeks gestation. INTERVENTIONS Thirty six consenting mothers were randomly allocated to receive either 2 mg intravaginal prostaglandin E(2) gel (study group; n = 18) or an equal volume of K-Y jelly as a placebo (control group; n = 18) 60 minutes before the ECS. Computer generated random numbers contained in coded, sealed envelopes were used for allocation. The obstetric and neonatal teams were blinded to the randomisation status of enrolled mothers. MAIN OUTCOME MEASURES Catecholamine concentrations in the umbilical arterial blood samples collected at delivery. RESULTS The median (interquartile range) neonatal gestation and birth weight were 271 (269-274) days and 3605 (3072-3970) g for the study group and 271 (270-273) days and 3340 (3000-3622) g for the control group. Median (interquartile range) noradrenaline (norepinephrine) concentrations in the umbilical arterial blood were significantly higher in the study group than the control group (15.9 (9.8-28.92) v 4.6 (1.65-14.4) ng/l, p = 0.03). Adrenaline (epinephrine) concentrations did not differ significantly between the two groups (1.6 (< 0.5-3.1) v 1.4 (< 0.5-2.75) ng/l, p = 0.6). No treatment related complications occurred. CONCLUSION A labour related catecholamine surge could be simulated by intravaginal prostaglandin E(2) gel.
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Affiliation(s)
- M Singh
- Department of Obstetrics, The Townsville Hospital, Douglas, Queensland, Australia
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19
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McGlone L, Devlin L, Doherty DA, Patole S. Use of magnifying lens to aid neonatal umbilical arterial catheter insertion. Indian Pediatr 2004; 41:250-4. [PMID: 15064512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
We conducted this trial to test the hypothesis that use of a magnifying lens would facilitate umbilical arterial catheter (UA C) insertion in neonates. Neonates <33 weeks' gestation requiring a UA C were randomized to conventional method of catheter insertion or an experimental method using a 2.0 X magnifying lens mounted on a headband. A total of 44 neonates (Conventional = 23, Experimental = 21) with comparable demographic characteristics completed the study. The time taken for (primary outcome) and rate of successful UAC insertion (secondary outcome) were not significantly different between the two groups (median times: conventional: 88 seconds,experimental: 70 seconds, P = 0. 734) (Success rate: conventional: 19/23 (83%) vs experimental:13/21 (63%), P = 0. 1791 Thus, our hypothesis was rejected.
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Affiliation(s)
- L McGlone
- Department of Neonatal Pediatrics, King Edward Memorial Hospital for Women, Bagot Rad, Subiaco, Western Australia 6008
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20
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Abstract
Genital prolapse is a rare condition in neonates. It is most commonly associated with neural tube defects such as spina bifida. A preterm, growth restricted neonate with genital prolapse without an associated central nervous system anomaly is reported. The risk factors, management and outcome of neonatal genital prolapse are reviewed. The importance of in utero undernutrition as a predisposing factor is emphasized.
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Affiliation(s)
- L McGlone
- Department of Neonatal Paediatrics, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia
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21
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Abstract
BACKGROUND The n-3 and n-6 essential fatty acids alpha linolenic acid (ALA) and linoleic acid (LA) are the precursors of the n-3 and n-6 longchain polyunsaturated fatty acids (LCPUFA). Controversy exists over whether LCPUFA are essential nutrients for preterm infants who may not be able to synthesise sufficient amounts of LCPUFA to satisfy the needs of the developing brain and retina. OBJECTIVES The aim of this review is to assess whether supplementation of formula with LCPUFA is safe and of benefit to preterm infants. SEARCH STRATEGY Trials were identified by MEDLINE (October 2003), Oxford Database of Perinatal Trials, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003) and by checking reference lists of relevant articles and conference proceedings. SELECTION CRITERIA All randomised trials of formula supplemented with LCPUFA and with clinical endpoints were reviewed. DATA COLLECTION AND ANALYSIS Eleven randomised trials assessing the clinical effects of feeding formula supplemented with LCPUFA were included in the review. MAIN RESULTS Of the eleven randomised trials included in the review, two of these were not classified as of high quality despite blinded assessment and complete follow-up, due to problems with assessment methodology. VISUAL ACUITY: Visual acuity over the first year was measured by Teller acuity cards in six studies, by VEP in four studies and by ERG in two studies. Most studies found no significant differences in any visual assessment between supplemented and control infants. DEVELOPMENT Most of the trials have used Bayley Scales of Infant Development (BSID) at 12 to 24 months postterm and shown no significant effect following supplementation. Meta-analysis of BSID of three studies (Fewtrell 2002, O'Connor 2001, van Wezel 2002) shows no significant effect of supplementation on development. Carlson 1993 and Carlson 1996 demonstrated lower novelty preferences (possibly predictive of lower intelligence) in the supplemented compared with the control group. The investigators however concluded that supplemented infants may have more rapid visual information processing given that they had more looks and each look was of shorter duration. GROWTH Most trials have reported no significant effect of LCPUFA supplementation on growth of preterm infants. Two trials (Carlson 1993, Carlson 1996) suggest that LCPUFA supplemented infants grow less well than controls, possibly due to a reduction in AA levels which occurs when n-3 supplements are used without n-6 supplements. Recent trials with addition of AA to the supplement have reported no significant effect on growth. Fewtrell 2002 reported mild reductions in length and weight z scores at 18 months. Contrary to these results, the meta-analysis of five studies (Uauy 1992, Carlson 1996, Hansen 1997, Vanderhoof 1999, Innis 2002) showed increased weight and length at two months post-term in supplemented infants. SIDE EFFECTS Uauy 1992 reported no significant effect of LCPUFA supplementation on bleeding time and red cell membrane fragility. REVIEWER'S CONCLUSIONS Infants enrolled in the trials were relatively mature and healthy preterm infants. Assessment schedule and methodology, dose and source of supplementation and fatty acid composition of the control formula varied between trials. No long-term benefits were demonstrated for infants receiving formula supplemented with LCPUFA. There was no evidence that supplementation of formula with n-3 and n-6 LCPUFA impaired the growth of preterm infants.
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Affiliation(s)
- K Simmer
- Neonatal Clinical Care Unit, King Edward Memorial Hospital for Women and Princess Margaret Hospital for Children, Bagot Road, Subiaco, WA, Australia
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22
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Abstract
The frequency of diagnosis of congenital scoliosis in the neonatal period is expected to rise given the increasing survival of high risk neonates in the surfactant era and their frequent exposure to x rays. Considering its significant long term implications a neonatologist cannot afford to ignore the diagnosis of congenital scoliosis in a neonate as close surveillance, early detection, and treatment may prevent/minimise the wide spectrum of potentially serious deformities that can affect the developing spine. The review provides general guidelines to help the neonatologists in counselling the parents and in planning the multidisciplinary follow up for management of congenital scoliosis.
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Affiliation(s)
- S Jog
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia
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23
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Abstract
The fetus and the neonate are particularly vulnerable to injury caused directly by immunologic mechanisms or inflicted by infectious agents that take advantage of their relatively immature and inexperienced immune system. With increasing survival of high-risk neonates in the surfactant era, prevention/treatment of sepsis and chronic lung disease (CLD) has emerged as an area of priority in neonatal research. Considering the role of inflammatory mediators in the pathogenesis of sepsis and CLD, the clinical application of immunomodulator therapy to neonatology is perhaps more important at present than ever. Advances in molecular biology and immunology have led to development of newer immune modulator therapies that are directed towards specific cells or cytokines rather than resulting in a general suppression of the immune response. Failure of promising, newer immunomodulator therapies in sepsis trials in adults has, however, clearly documented the difficulties in diagnosing/correcting the imbalance between pro- and anti-inflammatory responses. As in the case of sepsis, development of a single magic bullet for prevention/management of a multi-factorial illness like CLD may be difficult, as prevention of prematurity - the single most important high-risk factor for CLD - is an unachievable goal at present. As new frontiers are being explored, older, well-established therapies like antenatal anti-D immunoglobulin prophylaxis continue to emphasize the tremendous potential of immunomodulator therapy in neonatology/perinatology. The current immunomodulators/immunotherapeutic agents with established/potential clinical applications in the perinatal period are reviewed.
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MESH Headings
- Adjuvants, Immunologic/physiology
- Adjuvants, Immunologic/therapeutic use
- Chronic Disease
- Cromolyn Sodium/immunology
- Cromolyn Sodium/therapeutic use
- Female
- Glucocorticoids/immunology
- Glucocorticoids/therapeutic use
- Hematopoietic Cell Growth Factors/immunology
- Hematopoietic Cell Growth Factors/therapeutic use
- Humans
- Immunoglobulins/immunology
- Immunoglobulins/therapeutic use
- Immunoglobulins, Intravenous/immunology
- Immunoglobulins, Intravenous/therapeutic use
- Infant, Newborn
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/immunology
- Lung Diseases/drug therapy
- Lung Diseases/immunology
- Methylene Blue/therapeutic use
- Milk, Human/immunology
- Neutrophils/immunology
- Neutrophils/transplantation
- Pentoxifylline/immunology
- Pentoxifylline/therapeutic use
- Pregnancy
- Rho(D) Immune Globulin/immunology
- Rho(D) Immune Globulin/therapeutic use
- Sepsis/drug therapy
- Sepsis/immunology
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Affiliation(s)
- S Patole
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia
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24
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Panaretto KS, Whitehall JF, McBride G, Patole S, Whitehall JS. Sudden infant death syndrome in Indigenous and non-Indigenous infants in north Queensland, 1990-1998. J Paediatr Child Health 2002; 38:135-9. [PMID: 12030993 DOI: 10.1046/j.1440-1754.2002.00760.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/20/2022]
Abstract
OBJECTIVE To compare the epidemiology of sudden infant death syndrome (SIDS) in Indigenous and non-Indigenous infants in north Queensland, and to assess the quality of data recorded for SIDS deaths. METHODS Records were obtained for SIDS cases from all coronial courts in north Queensland from 1990 to 1998. Demographic characteristics, ethnicity, age at death, sleeping and feeding patterns, smoking incidences and autopsy findings were compared. Incidences, medians and univariate associations were generated where appropriate. RESULTS There were 83 248 live births for the 9-year period; 71 389 non-Indigenous and 11 859 Indigenous births. There were 69 SIDS deaths (0.83 per 1000 live births). Overall, recording of demographic and death scene data was poor. Thirty-eight autopsies (55%) were performed by specialist pathologists. There were 22 (32%) non-Indigenous and 22 (32%) Indigenous SIDS deaths (25 ethnicity unknown), giving an estimated relative risk of 2.82 (95% CI 2, 4). Median age at death was 13.1 weeks (range 1-83 weeks) with 14% of deaths occurring in the neonatal period for both groups. Sleeping position was not recorded in 42% of cases and co-sleeping was not recorded in 27% of cases. Bed sharing was more common amongst Indigenous infants. Fifty-two per cent of SIDS cases occurred in the wet season and 48% in the dry season. CONCLUSIONS Data recorded for SIDS deaths in north Queensland are poor, preventing specific conclusions concerning SIDS risk factors. However, SIDS rates may be up to three-fold higher in the Indigenous population. A uniform system of post-mortem and death scene data reporting is needed urgently.
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Affiliation(s)
- K S Panaretto
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia.
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25
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Panaretto KS, Muller R, Patole S, Watson D, Whitehall JS. Is being Aboriginal or Torres Strait Islander a risk factor for poor neonatal outcome in a tertiary referral unit in north Queensland? J Paediatr Child Health 2002; 38:16-22. [PMID: 11869395 DOI: 10.1046/j.1440-1754.2002.00782.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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: 11/20/2022]
Abstract
OBJECTIVE To compare perinatal outcomes for all births, and the morbidity and mortality patterns of babies admitted to neonatal intensive care, for non-Indigenous, Aboriginal and Torres Strait Islander (TSI) people in a major remote urban centre. METHODS A prospective cohort study of all births and consecutive admissions to the Neonatal Intensive Care Unit/Special Baby Care Unit (NICU/SCBU) at Kirwan Hospital for Women (KWH), Townsville (a tertiary referral hospital) was conducted from January 1998 to June 1999. RESULTS There were 2575 births, with 2392 (93%) booked into KWH for delivery. The Aboriginal group differed from the non-Indigenous group only in the prevalence of low-birthweight births. The TSI group had significantly higher perinatal mortality rates, preterm and low-birthweight births than the non-Indigenous group. Seven hundred and fifty-eight babies were admitted to NICU/SCBU: 586 (77%) non-Indigenous, 129 (17%) Aboriginal, 43 (6%) TSI. There were significantly more preterm, lower birthweight and longer stay length Aboriginal and TSI babies. Being Indigenous was not associated with neonatal death. Gestation of less than 28 weeks, congenital anomalies, and high-grade cerebral haemorrhage, but not ethnicity, were independent risk factors for neonatal death. Maternal risk factors, including poor antenatal care attendance, were more prevalent amongst Indigenous women. CONCLUSION Neonatal outcomes for Aboriginal infants were better than expected from national and State reports. Outcomes for Torres Strait Islander infants were worse than expected. Ethnicity was not a risk factor for neonatal death. These findings suggest that outcomes may be further improved by programmes to increase access for Indigenous women to antenatal care services.
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Affiliation(s)
- K S Panaretto
- Townsville Aboriginal and Islander Health Service, Kirwan Hospital for Women, Townsville, Queensland, Australia.
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26
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27
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Abstract
Intrauterine growth retardation and neonatal transient mucocutaneous lesions ("transient Behcet syndrome") have been reported in pregnancies complicated by Behcets disease (BD). Neonatal neurological manifestations have not been reported in such pregnancies. Vascular and neurological involvement is known to worsen the prognosis in adults with BD. The clinical course and outcome of a 34-weeks' gestation neonate born to a mother with BD is reported. Progressive recovery from minimal respiratory distress syndrome was followed by catastrophic presentation on 6th day of life with generalized seizures. Cranial ultrasound revealed multiple hyperechoic lesions in the frontal, parietal, and periventricular regions with a few surrounded by a ring of reduced echogenicity suggesting haemorrhage into ischemic areas. Death occurred after withdrawal of life support on Day 9, after extensive discussions with parents in view of the progressive deterioration in the neonates' general condition and the cranial ultrasound findings. Strong family history of BD, clinical course, and laboratory results (no evidence of disseminated intravascular coagulation, normal levels of protein C and S, absence of factor V Leiden and anticardiolipin antibodies) suggested neurological manifestations of BD as the most probable diagnosis.
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Affiliation(s)
- S Jog
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia
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28
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Patole S. A simplified approach to improve skills of communication with parents of neonates under intensive care: a personal viewpoint. J Paediatr Child Health 2001; 37:415-6. [PMID: 11547777 DOI: 10.1046/j.1440-1754.2001.0720d.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Patole S, Whitehall J. The business of conferences. J Paediatr Child Health 2001; 37:319-20. [PMID: 11468058 DOI: 10.1046/j.1440-1754.2001.0681d.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Abstract
The use of antibiotic coated catheters has been proposed as a means of reducing catheter related sepsis. In this study, an in vitro comparison of bacterial colonisation rates was made between uncoated umbilical venous catheters and catheters coated with rifampicin and minocycline. The following parameters were determined; the direct antimicrobial effect of coated and uncoated catheter segments against a range of organisms associated with line sepsis, the assessment of the decline in antimicrobial activity in coated catheters immersed in plasma and the inhibitory efficacy of the catheters to colonisation over a 28-day period. Minocycline and rifampicin coated umbilical catheters showed a superior inhibitory effect and prevented colonisation with the commoner line-related organisms, when compared with uncoated catheters. The inhibitory effect declined after 14 days in the human plasma. Resistance to colonisation in vitro may not extend beyond 21 days.
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Affiliation(s)
- R E Norton
- Department of Clinical Microbiology, Townsville General Hospital, Qld 4810, Townsville, Australia.
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31
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Affiliation(s)
- S Bolisetty
- Neonatal Intensive Care Unit, Kirwan Hospital for Women, Townsville, Queensland, Australia.
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32
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Patole S, Whitehall J. Publishing case reports--a powerful tool for academic motivation. Postgrad Med J 2000; 76:597. [PMID: 11032534 PMCID: PMC1741729 DOI: 10.1136/pmj.76.899.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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33
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Patole S. "Damned if the parents cry, damned if they don't" by the nurses! Dilemma of a neonatologist. Pediatrics 2000; 106:161-2. [PMID: 10939911 DOI: 10.1542/peds.106.1.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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34
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Abstract
A case of congenital varicella syndrome characterized by intrauterine growth retardation, ocular and neurologic abnormalities, but no cutaneous lesions is reported. This case highlights the risk of embryopathy from varicella infection during pregnancy in non-immune women.
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Affiliation(s)
- C S Choong
- Department of Neonatology, Kirwan Hospital for Women, Thuringowa, Queensland, Australia
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35
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36
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Almonte RA, Heath DL, Whitehall J, Russell MJ, Patole S, Vink R. Gestational magnesium deficiency is deleterious to fetal outcome. Biol Neonate 1999; 76:26-32. [PMID: 10364636 DOI: 10.1159/000014128] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A number of recent epidemiological findings have implicated magnesium as being essential to fetal well-being. Few studies, however, have examined the relationship between maternal requirements for dietary magnesium and subsequent mortality and morbidity in offspring. The present study uses a rodent model of dietary-induced hypomagnesemia to investigate the effects of magnesium deficiency prior to and during gestation on neonatal morbidity and mortality. Magnesium deficiency during gestation significantly increased neonatal mortality and morbidity. Such increases were associated with a reduced free magnesium concentration in both maternal and offspring blood and an increased incidence of periventricular hemorrhage and edema in newborn pups as observed by magnetic resonance imaging and histology. Animals fed a magnesium-deficient diet before mating but given magnesium supplementation during gestation did not demonstrate a significant change in neonatal mortality and morbidity when compared to control animals. The significant improvement in fetal outcome with dietary magnesium supports the concept of magnesium supplementation during pregnancy.
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Affiliation(s)
- R A Almonte
- Neonatal Care Unit, Kirwan Hospital for Women, James Cook University, Townsville, Qld., Australia
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37
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Almonte R, Patole S, Muller R, Whitehall J. Comparison of two methods of taping peripheral intravenous cannulas. Indian Pediatr 1999; 36:494-8. [PMID: 10728040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- R Almonte
- Neonatal Intensive Care Unit, Kirwan Hospital for Women, Thuringowa, Queensland, Australia 4817
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38
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Patole S, Lee J, Whitehall J. Adenosine infusion in the management of a micropremi neonate with pulmonary hypertension. Indian Pediatr 1999; 36:307-10. [PMID: 10713845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- S Patole
- Department of Neonatology, Kirwan Hospital for Women, Thuringowa, QLD 4817, Australia
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39
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Patole S, Lee J, Whitehall J. Adenosine infusion in the management of a micropremi neonate with pulmonary hypertension. Indian Pediatr 1998; 35:1221-4. [PMID: 10216700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- S Patole
- Department of Neonatology (NICU), Kirwan Hospital for Women, Thuringowa, QLD, Australia
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40
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Patole S, Lee J, Buettner P, Whitehall J. Improved oxygenation following adenosine infusion in persistent pulmonary hypertension of the newborn. Biol Neonate 1998; 74:345-50. [PMID: 9742263 DOI: 10.1159/000014052] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Six consecutive cases of persistent pulmonary hypertension of the newborn (PPHN) were treated with adenosine following failure of conventional therapy, excluding inhaled nitric oxide. A rise in arterial PO2 >20 mm Hg occurred in 5 of 6 cases within 30 min of commencing adenosine infusion. Individual maximal increases in PaO2 ranged from 31 to 131 mm Hg. Three neonates survived and 3 died. Amongst deaths, intensive support was withdrawn in a preterm neonate due to severe arthrogryposis/pulmonary hypoplasia. Of the remaining 2, the improvement in oxygenation persisted until death occurred from causes unrelated to adenosine. Side effects related to adenosine (bradycardia, hypotension, prolonged bleeding time) did not occur. Due to its ease of availability, administration and extremely short half-life, adenosine may be an important therapeutic option in PPHN.
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Affiliation(s)
- S Patole
- Department of Neonatology (NICU), Kirwan Hospital for Women, Thuringowa, Qld, Australia
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41
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Abstract
AIM To assess the efficacy of cisapride in reducing the time required to establish enteral feeds in preterm infants. METHODS A randomised, double blind, placebo controlled trial was conducted of 34 infants of < or = 32 weeks of gestation, assigned to receive either cisapride 0.2 mg/kg/dose four times daily (n = 18) or placebo (n = 16). RESULTS The time taken by the babies to tolerate full enteral feeds was not significantly different between the groups (median 9.5 days vs 10 days). There was a significantly lower incidence of large gastric residuals and regurgitation in the treated group compared with the placebo group. The number of episodes of large gastric residuals per infant was also significantly less. No adverse effects were noted. CONCLUSION The routine use of cisapride in preterm infants cannot be recommended to decrease the time to establish enteral feeds. Its use may be justified for clinically significant gastric stasis or regurgitation.
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Affiliation(s)
- A Enriquez
- Department of Newborn Care, Royal Hospital for Women, Randwick New South Wales, Australia
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42
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Abstract
Using videoconferencing technology, educational programs in neonatology were provided for staff at rural hospitals. The technology was also used to reunite babies with their families and its usefulness in long-distance diagnosis was assessed. Eighty-two educational sessions were delivered over a 9 month period and, despite problems with technology, operation and presentation, were considered worthwhile by the audiences. Family reunions were very successful. Neonatal diagnosis was impossible at the narrow bandwidth used (128 kilobits/s). Valuable lessons were learned regarding optimum use of this medium.
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Affiliation(s)
- J Whitehall
- Kirwan Hospital for Women, Townsville, Queensland, Australia.
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43
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Abstract
A case is presented in which extension of meconium peritonitis through muscular defects in the diaphragm lead to intrathoracic calcifications diagnosed sonographically at 23 weeks of gestation. There were three diaphragmatic defects, two small ones corresponded to foramina of Morgagni and one large posterior defect that did not correspond to the foramen of Bochdelak. There were three additional muscular defects: one in the rectus abdominus and two, bilaterally, in the loins. Despite long-standing fetal ascites and fresh intraperitoneal meconium at laparotomy, postoperative progress was uneventful. The baby did not have other dysmorphic features except for a single palmar crease, the chromosomes were normal, and the baby did not have cystic fibrosis. Follow-up examination at 10 months showed a thriving infant with mild hypotonia and developmental delay, but no respiratory or gastrointestinal problems.
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Affiliation(s)
- S Patole
- Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia
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44
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Daga SR, Patole S, Deokate S, Bhatnagar S. Bartter's syndrome in newborn treated with indomethacin. Indian Pediatr 1989; 26:79-81. [PMID: 2759699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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45
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46
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Abstract
Provision of a thermoneutral environment to the newborns has made an important contribution to improved neonatal survivals. Modern systems which only warm one baby are expensive and their maintenance not very easy. Warming a room with three to four babies by means of simple devices is cost-effective and should be preferred by those to whom cost matters very much.
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