138 results on '"Oei JL"'
Search Results
2. Outcomes of delivery room resuscitation of bradycardic preterm infants: A retrospective cohort study of randomised trials of high vs low initial oxygen concentration and an individual patient data analysis
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Kapadia V, Oei JL, Finer N, Rich W, Rabi Y, Wright IM, Rook D, Vermeulen MJ, Tarnow-Mordi WO, Smyth JP, Lui K, Brown S, Saugstad OD, and Vento M
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Death ,Oxygen ,Neonatal Resuscitation Program ,Intraventricular hemorrhage ,Oxygen saturation ,Heart rate ,Bradycardia ,Systematic review ,Neonatal resuscitation ,Mortality ,Newborn ,Bronchopulmonary dysplasia ,International Liaison Committee on Resuscitation - Abstract
Objective: To determine whether hospital mortality (primary outcome) is associated with duration of bradycardia without chest compressions during delivery room (DR) resuscitation in a retrospective cohort study of randomized controlled trials (RCTs) in preterm infants assigned low versus high initial oxygen concentration. Methods: Medline and EMBASE were searched from 01/01/1990 to 12/01/2020. RCTs of low vs high initial oxygen concentration which recorded serial heart rate (HR) and oxygen saturation (SpO(2)) during resuscitation of infants = 2 min. Individual patient data analysis and pooled data analysis were conducted. Results: Data were collected from 720 infants in 8 RCTs. Neonates with PB had higher odds of hospital death before [OR 3.8 (95% CI 1.5, 9.3)] and after [OR 1.7 (1.2, 2.5)] adjusting for potential confounders. Bradycardia occurred in 58% infants, while 38% had PB. Infants with bradycardia were more premature and had lower birth weights. The incidence of bradycardia in infants resuscitated with low (= 60%) oxygen was similar. Neonates with both, PB and SpO(2) < 80% at 5 min after birth had higher odds of hospital mortality. [OR 18.6 (4.3, 79.7)]. Conclusion: In preterm infants who did not receive chest compressions in the DR, prolonged bradycardia is associated with hospital mortality.
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- 2021
3. Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO 2 < 0.3) or higher (FiO 2 > 0.6) initial oxygen levels. An individual patient meta-analysis
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Oei JL, Kapadia V, Rabi Y, Saugstad OD, Rook D, Vermeulen MJ, Boronat N, Thamrin V, Tarnow-Mordi W, Smyth J, Wright IM, Lui K, van Goudoever JB, Gebski V, and Vento M
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neonatology, resuscitation - Abstract
To determine the effects of lower (=0.3) versus higher (=0.6) initial fractional inspired oxygen (FiO 2 ) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants
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- 2021
4. Oxygen saturation (SpO2) targeting for newborn infants at delivery: Are we reaching for an impossible unknown?
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Bhushan Gottimukkala S, Xavier Sotiropoulos J, Lorenzo-Pozo S, Monti Sharma A, Vento M, Saugstad OD, and Oei JL
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Delivery resuscitation, Newborn infant, Oxygen, SpO(2) - Abstract
For more than 200 years, pure oxygen was given ad libitum to newborn infants requiring resuscitation. Due to oxidative stress and injury concerns, a paradigm shift towards using "less" oxygen, including air (21% oxygen) instead of pure (100%) oxygen, occurred about twenty years ago. A decade later, clinicians were advised to adjust fractional inspired oxygen (FiO 2 ) to target oxygen saturations (SpO 2 ) that were derived from spontaneously breathing, healthy, mature infants. Whether these recommendations are achievable, beneficial, harmful or redundant is uncertain. The underlying pathology leading to resuscitation varies between infants and may considerably alter an infant's response to supplemental oxygen. In this review, we summarize available evidence for the use of SpO 2 monitoring at delivery for newborn infants, elucidate existing knowledge and service gaps, and suggest future research recommendations that will lead to the safest clinical strategies for this standard and important practice.
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- 2021
5. Oxygen therapy of the newborn from molecular understanding to clinical practice
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Saugstad, OD, Oei, JL, Lakshminrusimha, S, and Vento, M
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Oxygen is one of the most critical components of life. Nature has taken billions of years to develop optimal atmospheric oxygen concentrations for human life, evolving from very low, peaking at 30% before reaching 20.95%. There is now increased understanding of the potential toxicity of both too much and too little oxygen, especially for preterm and asphyxiated infants and of the potential and lifelong impact of oxygen exposure, even for a few minutes after birth. In this review, we discuss the contribution of knowledge gleaned from basic science studies and their implication in the care and outcomes of the human infant within the first few minutes of life and afterwards. We emphasize current knowledge gaps and research that is needed to answer a problem that has taken Nature a considerably longer time to resolve.
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- 2019
6. Is There a 'Right' Amount of Oxygen for Preterm Infant Stabilization at Birth?
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Oei JL and Vento M
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outcomes, oxygen, preterm infant, resuscitation, review - Abstract
The amount of oxygen given to preterm infants within the first few minutes of birth is one of the most contentious issues in modern neonatology. Just two decades ago, pure oxygen (FiO 2 1.0) was standard of care and oximetry monitoring was not routine. Due to concerns about oxidative stress and injury, clinicians rapidly adopted the practice of using less oxygen for the respiratory support of all infants, regardless of gestational maturity and pulmonary function. There is now evidence that initial starting fractional inspired oxygen may not be the only factor involved in providing optimum oxygenation and that the amount of oxygen given to babies within the first 10 min of life is a crucial factor in determining outcomes, including death and neurodevelopmental injury. In addition, evolving practice, such as non-invasive respiratory support and delayed cord clamping, need to be taken into consideration when considering oxygen delivery to preterm infants. This review will discuss evidence to date and address the major knowledge gaps that need to be answered in this pivotal aspect of neonatal practice.
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- 2019
7. Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO 2 0.21 or 1.0
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Thamrin, V, Saugstad, OD, Tarnow-Mordi, W, Wang, YA, Lui, K, Wright, IM, De Waal, K, Travadi, J, Smyth, JP, Craven, P, McMullan, R, Coates, E, Ward, M, Mishra, P, See, KC, Cheah, IGS, Lim, CT, Choo, YM, Kamar, AA, Cheah, FC, Masoud, A, and Oei, JL
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Male ,Resuscitation ,Oxygen Inhalation Therapy ,Infant, Newborn ,Gestational Age ,Pediatrics ,Oxygen ,Aptitude Tests ,Neurodevelopmental Disorders ,Child, Preschool ,Humans ,Female ,Infant, Premature ,Follow-Up Studies - Abstract
© 2018 Elsevier Inc. Objective: To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children
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- 2018
8. What does the world think of ankyloglossia?
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Jin, RLR, Sutcliffe, A, Vento, M, Miles, C, Travadi, J, Kishore, K, Suzuki, K, Todd, D, Wooderson, S, Kamar, AA, Ma, L, Smyth, J, and Oei, JL
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stomatognathic diseases ,Opinion ,Frenectomy ,Survey ,Ankyloglossia - Abstract
Aim: The diagnosis of tongue-tie (or ankyloglossia) has increased more than 10-fold in some countries. Whether this is a global phenomenon or related to cultural and professional differences is uncertain. Methods: An online survey in English, Japanese, Chinese and Spanish was disseminated between May and November 2016 via 27 international professional bodies to >30 clinical professions chosen a priori to represent occupations involved in the management of neonatal ankyloglossia. Results: A total of 1721 responses came from nursing (51%), medical (40%), dental (6%) and allied health (4%) clinicians. Nurses (40%) and allied health (34%) professionals were more likely than doctors (8%) to consider ankyloglossia as important for lactation problems, as were western (83%) compared to Asian (52%) clinicians. Referrals to clinicians for ankyloglossia management originated mainly from parents (38%). Interprofessional referrals were not clearly defined. Frenectomies were most likely to be performed by surgeons (65%) and dentists (35%), who were also less likely to be involved in lactation support. Clinicians performing frenectomies were more likely to consider analgesia as important compared to those not performing frenectomies. Conclusion: The diagnosis and treatment of ankyloglossia vary considerably around the world and between professions. Efforts to standardise management are required.
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- 2018
9. Oxygen and preterm infant resuscitation: what else do we need to know?
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Oei, JL, Saugstad, OD, and Vento, M
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resuscitation ,outcomes ,preterm ,oxygen - Abstract
Purpose of reviewTo evaluate current evidence for the use of lower or higher oxygen strategies for preterm infant resuscitationRecent findingsThe equipoise for using higher fraction of inspired oxygen (FiO(2)) (>0.4) to initiate preterm infant respiratory stabilization has been lost. Recent meta-analyses of randomized controlled trials assessing outcomes after using higher (FiO(2)0.6) vs. lower (FiO(2)0.3) oxygen strategies to initiate preterm resuscitation shows no difference in the rates of death or major morbidities. However, not achieving pulse oximetry saturations of at least 80% by 5min of age, whether it was due to iatrogenic oxygen insufficiency or poor infant pulmonary function, was associated with lower heart rates (mean difference -8.37, 95% confidence interval: -15.73, -1.01) and major intraventricular hemorrhage. There remains scarce neurodevelopmental data in this area and information about the impact of oxygen targeting strategies in low resourced areas. These knowledge gaps are research priorities that must be addressed in large, well designed randomized controlled trials.SummaryMost clinicians now use lower oxygen strategies to initiate respiratory support for all infants, including preterm infants with significant lung disease. However, the impact of such strategies, particularly for neurodevelopmental outcomes and for lower resourced areas, remains uncertain and must be urgently addressed.
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- 2018
10. Dwell time and risk of central-line-associated bloodstream infection in neonates
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Sanderson, E, Yeo, KT, Wang, AY, Callander, I, Bajuk, B, Bolisetty, S, Lui, K, Bowen, J, Sedgley, S, Carlisle, H, Kent, A, Smith, J, Craven, P, Cruden, L, Argomand, A, Rieger, I, Malcolm, G, Lutz, T, Reid, S, Stack, J, Medlin, K, Marcin, K, Shingde, V, Chin, MF, Bonzer, K, Badawi, N, Halliday, R, Karskens, C, Paradisis, M, Kluckow, M, Jacobs, C, Numa, A, Williams, G, Young, J, Luig, M, Baird, J, Oei, JL, and Cameron, D
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Male ,Catheterization, Central Venous ,Time Factors ,Epidemiology ,Sepsis ,Incidence ,Catheter-Related Infections ,Infant, Newborn ,Humans ,Female ,Prospective Studies ,Risk Assessment ,Retrospective Studies - Abstract
© 2017 The Healthcare Infection Society Background Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). Aim To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. Methods The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). Findings There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan–Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12–20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. Conclusion There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.
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- 2017
11. What initial oxygen is best for preterm infants in the delivery room?-A response to the 2015 neonatal resuscitation guidelines
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Vento, M, Schmolzer, G, Cheung, PY, Finer, N, Solevag, AL, Oei, JL, and Saugstad, OD
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- 2016
12. A review of international clinical practice guidelines for the use of oxygen in the delivery room resuscitation of preterm infants
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Wilson, A, primary, Vento, M, additional, Shah, PS, additional, Saugstad, O, additional, Finer, N, additional, Rich, W, additional, Morton, RL, additional, Rabi, Y, additional, Tarnow-Mordi, W, additional, Suzuki, K, additional, Wright, IM, additional, and Oei, JL, additional
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- 2017
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13. Resuscitating preterm infants with 100% oxygen is associated with higher oxidative stress than room air
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Tataranno, ML, primary, Oei, JL, additional, Perrone, S, additional, Wright, IM, additional, Smyth, JP, additional, Lui, K, additional, Tarnow-Mordi, WO, additional, Longini, M, additional, Proietti, F, additional, Negro, S, additional, Saugstad, OD, additional, and Buonocore, G, additional
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- 2015
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14. The associations between ethnicity and outcomes of infants in neonatal intensive care units.
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Ruan S, Abdel-Latif ME, Bajuk B, Lui K, Oei JL, and NSW and the ACT Neonatal Intensive Care Units (NICUs) Group
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OBJECTIVE: To determine the associations between maternal ethnicity and outcomes of infants born between 22 and 31 weeks' gestation and admitted to neonatal intensive care units in New South Wales and the Australian Capital Territory, Australia, between 1995 and 2006. DESIGN AND PATIENTS: De-identified perinatal and neonatal outcome data for 10 267 infants were examined. There were 8629 (84.0%) Caucasian, 922 (9.0%) Asian, 439 (4.3%) indigenous, 127 (1.2%) Polynesian and Maori (PAM) and 150 (1.5%) infants of other maternal ethnicities (excluded from study). Caucasians were the referent for all comparisons. RESULTS: Infants of indigenous mothers were less likely to receive antenatal steroids and three times as likely to be born in non-tertiary hospitals (OR 3.28, 95% CI 2.59 to 4.16, p<0.001). PAM infants were more likely to have Apgar scores <7 at 5 min of age (1.76, 95% CI 1.16 to 2.67, p<0.01). Asian infants had lower birth weight (mean±SD 44.7±27.9, p<0.001) and head circumference percentiles (47.8±29.0, p<0.001), were more likely to be small for gestational age (1.53, 95% CI 1.25 to 1.88, p<0.001), less likely to have hyaline membrane disease (0.78, 95% CI 0.68 to 0.90, p<0.001) but had a higher risk of severe retinopathy of prematurity (1.52, 95% CI 1.11 to 2.07, p<0.01). Ethnicity did not influence infant mortality. CONCLUSIONS: Neonatal growth characteristics and morbidity but not mortality are influenced by maternal ethnicity. Of concern is the risk of low Apgar scores in PAM infants and non-tertiary births of indigenous infants. Review of perinatal care for certain vulnerable ethnic populations is recommended due to the rapidly changing ethnic compositions of many countries around the world. [ABSTRACT FROM AUTHOR]
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- 2012
15. The use of oxygen for delivery room resuscitation of newborn infants in non-Western countries.
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Koh J, Yeo CL, Wright I, Lui K, Saugstad O, Tarnow-Mordi W, Smyth J, Oei JL, Koh, Jeremy, Yeo, Cheo Lian, Wright, Ian, Lui, Kei, Saugstad, Ola, Tarnow-Mordi, William, Smyth, John, and Oei, Ju Lee
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Background: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available.Objective: To determine current neonatal resuscitation practices and availability of oxygen blending equipment in non-Western hospitals.Design: 196 email addresses were obtained through perinatal societies representing 45 hospitals in 14 countries in Asia, Africa and the Middle East.Results: 68 (34.6%) responses were received from all 14 countries. The majority (90%, n=61) of respondents were aware of recent guideline changes but continued to resuscitate with PO because of the lack of equipment and uncertainty about international guidelines (61%, n=41 for term, 44%, n=30 for preterm). Most (81%, n=55) believed that PO caused adverse effects in term neonates. The availability of oxygen blending equipment correlated significantly with the country's gross domestic product.Conclusion: The majority of the practitioners we surveyed in non-Western countries are aware of the most recent recommendations regarding oxygen use in neonatal resuscitation. However, lack of oxygen blending equipment remains a hindrance to the use of blended gas at resuscitation in low resource, non-western countries. Global guidelines from developed countries must take into account the resource limitations and implementation difficulties faced by countries with restricted resources, where the majority of the high-risk infants are born. [ABSTRACT FROM AUTHOR]- Published
- 2012
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16. Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood.
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Lee E, Schofield D, Dronavalli M, Lawler K, Uebel H, Burns L, Bajuk B, Page A, Gu Y, Eastwood J, Dickson M, Green C, Dicair L, and Oei JL
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- Humans, Female, Pregnancy, Retrospective Studies, Infant, Adolescent, Infant, Newborn, Child, Preschool, Young Adult, Child, Male, New South Wales epidemiology, Health Care Costs statistics & numerical data, Health Services Needs and Demand economics, Adult, Hospitalization economics, Hospitalization statistics & numerical data, Pregnancy Complications economics, Pregnancy Complications epidemiology, Substance-Related Disorders economics, Substance-Related Disorders epidemiology, Prenatal Exposure Delayed Effects economics, Prenatal Exposure Delayed Effects epidemiology
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Importance: Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain., Objective: To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years., Design, Setting, and Participants: This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021., Main Outcomes: Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care., Results: Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02., Conclusion and Relevance: Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.
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- 2024
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17. Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks' Gestation: A Systematic Review and Individual Participant Data Network Meta-Analysis.
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Sotiropoulos JX, Oei JL, Schmölzer GM, Libesman S, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, Dekker J, Vermeulen MJ, Sundaram V, Kumar P, Kaban RK, Rohsiswatmo R, Saugstad OD, and Seidler AL
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- Humans, Infant, Newborn, Infant, Premature, Gestational Age, Oxygen Saturation, Resuscitation methods, Oxygen Inhalation Therapy methods, Network Meta-Analysis, Oxygen administration & dosage
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Importance: Resuscitation with lower fractional inspired oxygen (FiO2) reduces mortality in term and near-term infants but the impact of this practice on very preterm infants is unclear., Objective: To evaluate the relative effectiveness of initial FiO2 on reducing mortality, severe morbidities, and oxygen saturations (SpO2) in preterm infants born at less than 32 weeks' gestation using network meta-analysis (NMA) of individual participant data (IPD)., Data Sources: MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and WHO ICTRP from 1980 to October 10, 2023., Study Selection: Eligible studies were randomized clinical trials enrolling infants born at less than 32 weeks' gestation comparing at least 2 initial oxygen concentrations for delivery room resuscitation, defined as either low (≤0.3), intermediate (0.5-0.65), or high (≥0.90) FiO2., Data Extraction and Synthesis: Investigators from eligible studies were invited to provide IPD. Data were processed and checked for quality and integrity. One-stage contrast-based bayesian IPD-NMA was performed with noninformative priors and random effects and adjusted for key covariates., Main Outcomes and Measures: The primary outcome was all-cause mortality at hospital discharge. Secondary outcomes were morbidities of prematurity and SpO2 at 5 minutes., Results: IPD were provided for 1055 infants from 12 of the 13 eligible studies (2005-2019). Resuscitation with high (≥0.90) initial FiO2 was associated with significantly reduced mortality compared to low (≤0.3) (odds ratio [OR], 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (0.5-0.65) FiO2 (OR, 0.34; 95% CrI, 0.11-0.99; very low certainty). High initial FiO2 had a 97% probability of ranking first to reduce mortality. The effects on other morbidities were inconclusive., Conclusions and Relevance: High initial FiO2 (≥0.90) may be associated with reduced mortality in preterm infants born at less than 32 weeks' gestation compared to low initial FiO2 (low certainty). High initial FiO2 is possibly associated with reduced mortality compared to intermediate initial FiO2 (very low certainty) but more evidence is required.
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- 2024
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18. Aspects on Oxygenation in Preterm Infants before, Immediately after Birth, and Beyond.
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Sotiropoulos JX, Saugstad OD, and Oei JL
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Background: Oxygen is crucial for life but too little (hypoxia) or too much (hyperoxia) may be fatal or cause lifelong morbidity., Summary: In this review, we discuss the challenges of balancing oxygen control in preterm infants during fetal development, the first few minutes after birth, in the neonatal intensive care unit and after hospital discharge, where intensive care monitoring and response to dangerous oxygen levels is more often than not, out of reach with current technologies and services., Key Messages: Appropriate oxygenation is critically important even from before birth, but at no time is the need to strike a balance more important than during the first few minutes after birth, when body physiology is changing at its most rapid pace. Preterm infants, in particular, have a poor control of oxygen balance. Underdeveloped organs, especially of the lungs, require supplemental oxygen to prevent hypoxia. However, they are also at risk of hyperoxia due to immature antioxidant defenses. Existing evidence demonstrate considerable challenges that need to be overcome before we can ensure safe treatment of preterm infants with one of the most commonly used drugs in newborn care, oxygen., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
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- 2024
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19. Preterm infants are not small term infants: Should the resuscitation of a <26-week preterm infant be initiated with 100% oxygen?
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Bowditch SP, Oei JL, and Lakshminrusimha S
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- 2024
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20. School performance in children with prenatal drug exposure and out-of-home care in NSW, Australia: a retrospective population-based cohort study.
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Uebel H, Dronavalli M, Lawler K, Lee E, Bajuk B, Burns L, Page A, Dickson M, Green C, Dicair L, Eastwood J, and Oei JL
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- Humans, Child, Female, New South Wales epidemiology, Adolescent, Male, Retrospective Studies, Pregnancy, Academic Performance statistics & numerical data, Foster Home Care, Prenatal Exposure Delayed Effects
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Background: Prenatal drug exposure (PDE) is a global public health problem that is strongly associated with the need for child protection services, including placement into out-of-home care (OOHC). We aimed to assess school outcomes for children with PDE (both with and without neonatal abstinence syndrome [NAS]) and the association of school performance with OOHC., Methods: Using linked population health, OOHC, and school test data, we compared results on the Australian standardised curriculum-based test, the National Assessment Program-Literacy and Numeracy (NAPLAN), for children with PDE who were born in New South Wales (NSW) between 2001 and 2020 and had completed at least one NAPLAN test between Jan 1, 2008, and June 30, 2021, administered in Year 3 (age 8-9 years), Year 5 (age 10-11 years), Year 7 (age 12-13 years), or Year 9 (age 14-15 years). Linked datasets included NSW Perinatal Data Collection (birth data), NSW Admitted Patient Data Collection (hospital diagnoses), NSW Education Standards Authority (NAPLAN scores), NSW Family and Community Services Dataset-KiDS Data Collection (OOHC information), NSW Mental Health Ambulatory Data Collection, and NSW Registry for Births, Deaths, and Marriages. The primary outcome was scoring above or below the National Minimum Standard (NMS) in any test domain (mathematics, language, writing, and spelling) at each year level, comparing the relative risk of scoring below NMS between children with and without PDE (and with or without NAS within the PDE group), and with and without OOHC contact. The association between OOHC on the likelihood of scoring above NMS was also investigated for PDE and non-PDE cohorts., Findings: The PDE cohort included 3836 children, and the non-PDE cohort included 897 487 children. Within the PDE cohort, 3192 children had a NAS diagnosis and 644 children had no NAS diagnosis. 1755 (45·8%) children with PDE required OOHC compared with 12 880 (1·4%) of 897 487 children without PDE. Children with PDE were more likely than children without PDE to score below NMS in any domain from Year 3 (risk ratio 2·72 [95% CI 2·58-2·76]) to Year 9 (2·36 [2·22-2·50]). Performance was similar regardless of a NAS diagnosis (Year 3: 0·96 [0·84-1·10]; Year 9: 0·98 [0·84-1·15]). The likelihood of scoring above NMS in Year 9 was reduced for children with PDE and without NAS (0·57 [0·45-0·73]) and NAS (0·58 [0·52-0·64]) compared with those without PDE, and also for children who received OOHC (0·60 [0·57-0·64]) compared with those without OOHC, when adjusted for confounders. Among children with PDE, those receiving OOHC had a similar likelihood of scoring above NMS compared with children who did not receive OOHC, from Year 3 (1·01 [0·92-1·11]) to Year 9 (0·90 [0·73-1·10]), when adjusted for confounding factors. By contrast, among children without PDE, those receiving OOHC were less likely to score above NMS than those who did not receive OOHC, from Year 3 (0·78 [0·76-0·80]) to Year 9 (0·58 [0·54-0·61])., Interpretation: Compared with children without PDE, school performance in children with PDE-regardless of whether they were diagnosed with NAS-is poor, and the gap widens with age. The risk of poor performance persists regardless of OOHC status. This finding underscores the need for all children with PDE to receive long-term, culturally sensitive, and proactive support to improve life success., Funding: SPHERE Mindgardens Neuroscience Network, Australian Red Cross, Alpha Maxx Healthcare, Centre for Research Excellence for Integrated Health and Social Care, National Health and Medical Research Council, and University of Sydney., Competing Interests: Declaration of interests JLO declares support for research and travel from Mallinkrodt outside this study. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
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- 2024
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21. Air or Oxygen for Infant Resuscitation: A Prospective Cohort Study of Moderate-Late Preterm Infants Requiring Delivery Room Resuscitation.
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Sotiropoulos JX, Binoy S, Pham TAN, Yates K, Allgood CL, Kunjunju A, Tracy M, Smyth J, and Oei JL
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Introduction: Due to concerns of oxidative stress and injury, most clinicians currently use lower levels of fractional inspired oxygen (FiO2, 0.21-0.3) to initiate respiratory support for moderate to late preterm (MLPT, 32-36 weeks gestation) infants at birth. Whether this practice achieves recommended oxygen saturation (SpO2) targets is unknown., Methods: We aimed to determine SpO2 trajectories of MLPT infants requiring respiratory support at birth. We conducted a prospective, opportunistic, observational study with consent waiver. Preductal SpO2 readings were obtained during the first 10 min of life from infants between 32 and 36 weeks gestation requiring respiratory support in the delivery room. Primary outcome was reaching a minimum SpO2 80% at 5 min of life. The study was prospectively registered (ACTRN12620001252909)., Results: A total of 76 eligible infants were recruited between February 2021 and March 2022 from 5 hospitals in Australia. Most (n = 58, 76%) had respiratory support initiated with FiO2 0.21 (range 0.21-1.0) using CPAP (92%). Median SpO2 at 5 min was 81% (interquartile range [IQR] 67-90) and 93% (IQR 86-96) at 10 min. At 5 min, 18/43 (42%) infants had SpO2 below 80% and only 8/43 (19%) reached SpO2 80-85%., Conclusions: Many MLPT infants requiring respiratory support do not achieve recommended SpO2 targets. In very preterm infants, SpO2 <80% at 5 min of life increases risk of death, intraventricular haemorrhage, and neurodevelopmental impairment. The implications on this practice on the health outcomes of MLPT infants are unclear and require further research., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
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- 2024
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22. The burden of prenatal and early life maternal substance use among children at risk of maltreatment: A systematic review.
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Powell M, Pilkington R, Varney B, Havard A, Lynch J, Dobbins T, Oei JL, Ahmed T, and Falster K
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- Humans, Pregnancy, Female, Risk Factors, Child, Infant, Prevalence, Mothers, Substance-Related Disorders epidemiology, Child Abuse statistics & numerical data, Child Abuse psychology, Prenatal Exposure Delayed Effects epidemiology
- Abstract
Issues: Although maternal substance use is a known risk factor for child maltreatment, evidence on the scale of substance use is needed to inform prevention responses. This systematic review synthesised prevalence estimates of maternal substance use during pregnancy and early life among children at risk of maltreatment. Ovid, Pubmed, CINAHL, PsychInfo and ProQuest databases were searched. We included observational studies that sampled children at risk of maltreatment in high-income countries and reported information on maternal substance use during pregnancy and/or the child's first year of life. We extracted study characteristics and data to calculate prevalence, assessed risk of bias and conducted a narrative synthesis; there were insufficient comparable populations or outcomes to quantitatively synthesise results., Key Findings: Thirty five of 14,084 titles were included. Fifteen studies had adequately sized and representative samples to estimate prevalence. Maternal substance use prevalence ranged from 2.4% to 40.6%. Maternal substance use was highest among infants referred to child protection at birth (40.6%) and children in out-of-home care (10.4% to 37.2%). Prevalence was higher when studies defined substance use more broadly and when maternal substance use was ascertained from both child and mother records., Implications: Supportive, coordinated responses to maternal substance use are needed from health and child protection services, spanning alcohol and other drug treatment, antenatal and postnatal care., Conclusions: Prenatal and early life maternal substance use is common among child maltreatment populations, particularly among younger children and those with more serious maltreatment., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)
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- 2024
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23. 'Joining the Dots: Linking Prenatal Drug Exposure to Childhood and Adolescence' - research protocol of a population cohort study.
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Lawler K, Dronavalli M, Page A, Lee E, Uebel H, Bajuk B, Burns L, Dickson M, Green C, Dicair L, Eastwood J, and Oei JL
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- Adolescent, Child, Female, Humans, Pregnancy, Australia epidemiology, Australian Aboriginal and Torres Strait Islander Peoples, Cohort Studies, New South Wales epidemiology, Data Collection, Health Services, Indigenous, Prenatal Exposure Delayed Effects epidemiology
- Abstract
Introduction: Prenatal drug exposure (PDE) is one of the most important causes of child harm, but comprehensive information about the long-term outcomes of the families is difficult to ascertain. The Joining the Dots cohort study uses linked population data to understand the relationship between services, therapeutic interventions and outcomes of children with PDE., Methods and Analysis: Information from routinely collected administrative databases was linked for all births registered in New South Wales (NSW), Australia between 1 July 2001 and 31 December 2020 (n=1 834 550). Outcomes for seven mutually exclusive groups of children with varying prenatal exposure to maternal substances of addiction, including smoking, alcohol, prescription/illicit drugs and neonatal abstinence syndrome will be assessed. Key exposure measures include maternal drug use type, maternal social demographics or social determinants of health, and maternal physical and mental health comorbidities. Key outcome measures will include child mortality, academic standardised testing results, rehospitalisation and maternal survival. Data analysis will be conducted using Stata V.18.0., Ethics and Dissemination: Approvals were obtained from the NSW Population and Health Services Research Ethics Committee (29 June 2020; 2019/ETH12716) and the Australian Capital Territory Health Human Research Ethics Committee (11 October 2021; 2021-1231, 2021-1232, 2021-1233); and the Aboriginal Health and Medical Research Council (5 July 2022; 1824/21), and all Australian educational sectors: Board of Studies (government schools), Australian Independent Schools and Catholic Education Commission (D2014/120797). Data were released to researchers in September 2022. Results will be presented in peer-reviewed academic journals and at international conferences. Collaborative efforts from similar datasets in other countries are welcome., Competing Interests: Competing interests: JLO submitted proposals leading to awarding of funding support (Sphere Mindgardens Neuroscience Network, Australian Red Cross, Alpha Maxx Healthcare, National Health and Medical Research Council grant, Medical Research Future Fund and Ross Foundation) that was used to finance data linkage and statistical support, but had no influence on data analysis or publication. JLO has also received support for research and travel from Mallinkrodt, but this was not related to the current manuscript. CG is associated with Alpha Maxx Healthcare, but his link had no bearing on data analysis or publication. There is no relevant financial disclosure to be made for any of the authors in this manuscript., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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24. Interconnections between unintended pregnancy, alcohol and other drug use, and pregnancy, birth, infant, childhood and socioeconomic outcomes: a scoping review.
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McNamara KA, Murnion B, Fotheringham P, Terplan M, Lintzeris N, Oei JL, Bond DM, Nassar N, and Black KI
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Background: Unintended pregnancy (UIP) and substance use disorder share underlying root causes with similar impacts for women and their offspring in pregnancy, birth and beyond. Furthermore, intoxication with alcohol and other drugs (AOD) increases the risk of UIP., Objectives: To assess the available evidence on associations between UIP and health, social and economic outcomes, in women who use AOD., Search Strategy: The review utilised the Joanna Briggs Institute Methodology for Scoping Reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. The search was conducted across multiple databases, including Scopus and Medline, and limited to studies published between January 2000 to June 2023., Selection Criteria: Studies reporting on interactions between AOD use and UIP, and pregnancy, birth, infant, childhood, social or economic outcomes. All patterns and types of AOD use, except isolated use of tobacco, were included. Studies were available in English and conducted in high-income countries., Data Collection and Analysis: Selected articles were reviewed, and data collected by two independent reviewers using a standardised data extraction sheet. Findings were summarised and reported descriptively., Main Results: A total of 2536 titles and abstracts were screened, 97 full texts were reviewed, and three studies were selected for inclusion in the scoping review. There was heterogeneity in types and patterns of AOD use, differences in study design and tools to assess pregnancy intention, and each focused on disparate outcomes. No study assessed or reported on birth outcomes., Conclusion: There is a paucity of data examining the intersection between AOD use and UIP and further research is needed., Competing Interests: Competing interests: NL has received funding for unrelated research projects from Camurus AB, Indivior and the National Health and Medical Research Centre. KMN has received funding from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists; however, no funds were directed to this project. No other authors have disclosures of interest., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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25. International Online Survey on the Management of Patent Ductus Arteriosus.
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Woodford S, Parmar T, Leong E, Zhong J, Oei JL, Suzuki K, Kumar K, Yeo KT, Ma L, De Luca D, Hummler H, Schmölzer G, Vento M, and Schindler T
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- Humans, Infant, Newborn, Surveys and Questionnaires, Infant, Premature, North America, Health Care Surveys, Female, Australasia, Internet, Ductus Arteriosus, Patent therapy, Practice Patterns, Physicians' statistics & numerical data, Intensive Care Units, Neonatal statistics & numerical data
- Abstract
Introduction: There is uncertainty and lack of consensus regarding optimal management of patent ductus arteriosus (PDA). We aimed to determine current clinical practice in PDA management across a range of different regions internationally., Materials and Methods: We surveyed PDA management practices in neonatal intensive care units using a pre-piloted web-based survey, which was distributed to perinatal societies in 31 countries. The survey was available online from March 2018 to March 2019., Results: There were 812 responses. The majority of clinicians (54%) did not have institutional protocols for PDA treatment, and 42% reported variable management within their own unit. Among infants <28 weeks (or <1,000 g), most clinicians (60%) treat symptomatically. Respondents in Australasia were more likely to treat PDA pre-symptomatically (44% vs. 18% all countries [OR 4.1; 95% CI 2.6-6.5; p < 0.001]), and respondents from North America were more likely to treat symptomatic PDA (67% vs. 60% all countries [OR 2.0; 95% CI 1.5-2.6; p < 0.001]). In infants ≥28 weeks (or ≥1,000 g), most clinicians (54%) treat symptomatically. Respondents in North America were more likely to treat PDAs in this group of infants conservatively (47% vs. 38% all countries [OR 2.3; 95% CI 1.7-3.2; p < 0.001]), and respondents from Asia were more likely to treat the PDA pre-symptomatically (21% vs. 7% all countries [OR 5.5; 95% CI 3.2-9.8; p < 0.001])., Discussion/conclusion: There were marked international differences in clinical practice, highlighting ongoing uncertainty and a lack of consensus regarding PDA management. An international conglomeration to coordinate research that prioritises and addresses these areas of contention is indicated., (© 2024 S. Karger AG, Basel.)
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- 2024
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26. Prophylaxis of Patent Ductus Arteriosus with Paracetamol in Extremely Low Gestational Age Newborns (ELGANs): A Single-Institution Observational Study in Vietnam.
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Nguyen TT, Nguyen DTN, Pham TTT, and Oei JL
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Introduction: Prophylactic paracetamol for extremely low gestation age neonates (ELGAN, <27 weeks' gestation) with symptomatic patent ductus arteriosus (sPDA) in high-income countries (HIC) reduces medical and surgical interventions. Its effectiveness in low-to-middle-income countries (LMIC) remains uncertain. This study assesses prophylactic paracetamol's impact on sPDA interventions in ELGANs in an LMIC., Methods: This is a retrospective cohort study that compared a historical cohort of ELGANs that were treated with oral ibuprofen or intravenous paracetamol after diagnosis of sPDA ( n = 104) with infants ( n = 76) treated with prophylactic paracetamol (20 mg/kg loading, 7.5 mg/kg qid for 4 days), in a tertiary neonatal intensive care unit (NICU) in Vietnam. Oral ibuprofen or intravenous therapeutic paracetamol were administered if prophylactic paracetamol failed to close sPDA. Surgical ligation was conducted if targeted medical intervention failed, or the infant deteriorated from conditions attributable to sPDA., Results: In the historical cohort, 57 (55%) infants died within 7 days of life compared to 18 (24%) from the prophylactic cohort ( p < 0.01). Of the survivors, 21 (45%) of the historical and 23 (39.7%) of the prophylactic cohort required surgical ligation ( p = 0.6). Duration of hospitalization for survivors was lower in the prophylactic cohort (mean 74 vs. 97 days, p = 0.01). In the prophylactic cohort, 24 (41%) infants did not need further treatment while 34 (59%) required further treatment including ibuprofen and/or paracetamol 28 (48%) and surgical ligation 22 (38%)., Conclusions: Prophylactic paracetamol for ELGAN in LMIC does not reduce the need for surgical ligation, sPDA rates, and other PDA-related morbidities in infants who survive beyond 7 days of age. It may reduce the risk of death and the duration of hospitalization but further study into the reasons behind this need to be determined with larger studies.
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- 2023
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27. A Systematic Review of Clinical Practice Guidelines for Neonatal Abstinence Syndrome.
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Wei Z, Gilbert Y, Thananjeyan A, Cope J, Morton RL, Li A, Pham CT, Ward M, and Oei JL
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Background: The prevalence of neonatal abstinence syndrome is increasing, but the number and quality of clinical practice guidelines available are unknown. This systematic review aimed to identify, appraise and evaluate clinical practice guidelines for neonatal abstinence syndrome., Methods: A systematic search of databases and the grey literature was conducted between 1 June and 1 July 2022. Full-text guidelines published by national or state-wide institutions were included. The recommendations from each guideline were extracted. The AGREE-II instrument was used to assess guideline quality. Sufficient-quality scores were defined as >60 and good-quality scores were >80 for each domain of AGREE-II., Results: A total of 1703 records were identified, and 22 guidelines from the United States, Australia, Canada and the United Kingdom, published between 2012 to 2021, were included. The quality scores were low, with median scores of 37/100 for stakeholder involvement, 33/100 for methodology, 34/100 for applicability and 0 for editorial independence. Scope and purpose scored 72/100, and presentation scored 85/100. Sixteen (73%) guidelines did not meet the cut-offs for clinical use., Conclusion: Many guidelines were of insufficient quality to guide clinical practice for neonatal abstinence syndrome. This emphasises the need for high-quality studies to inform clinical practice guidelines, improve care and reduce the risk of poor outcomes in these high-risk infants.
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- 2023
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28. Editorial: Women in Neonatology 2022.
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Nakstad B and Oei JL
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Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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- 2023
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29. The role of oxygen in the development and treatment of bronchopulmonary dysplasia.
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Sotiropoulos JX and Oei JL
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- Infant, Infant, Newborn, Humans, Oxygen, Morbidity, Causality, Infant, Premature, Bronchopulmonary Dysplasia prevention & control
- Abstract
Oxygen (O
2 ) is crucial for both the development and treatment of one of the most important consequences of prematurity: bronchopulmonary dysplasia (BPD). In fetal life, the hypoxic environment is important for alveolar development and maturation. After birth, O2 becomes a double-edged sword. While O2 is needed to prevent hypoxia, it also causes oxidative stress leading to a plethora of morbidities, including retinopathy and BPD. The advent of continuous O2 monitoring with pulse oximeters has allowed clinicians to recognize the narrow therapeutic margins of oxygenation for the preterm infant, but more knowledge is needed to understand what these ranges are at different stages of the preterm infant's life, including at birth, in the neonatal intensive care unit and after hospital discharge. Future research, especially in innovative technologies such as automated O2 control and remote oximetry, will improve the understanding and treatment of the O2 needs of infants with BPD., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2023
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30. The Future Proofing Study: Design, methods and baseline characteristics of a prospective cohort study of the mental health of Australian adolescents.
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Werner-Seidler A, Maston K, Calear AL, Batterham PJ, Larsen ME, Torok M, O'Dea B, Huckvale K, Beames JR, Brown L, Fujimoto H, Bartholomew A, Bal D, Schweizer S, Skinner SR, Steinbeck K, Ratcliffe J, Oei JL, Venkatesh S, Lingam R, Perry Y, Hudson JL, Boydell KM, Mackinnon A, and Christensen H
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- Humans, Adolescent, Female, Australia epidemiology, Prospective Studies, Surveys and Questionnaires, Mental Health
- Abstract
Objectives: The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort., Methods: The FPS is an Australian school-based prospective cohort study with an embedded cluster-randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self-report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years., Results: The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05)., Conclusions: This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence., (© 2022 The Authors. International Journal of Methods in Psychiatric Research published by John Wiley & Sons Ltd.)
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- 2023
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31. Editorial: The neurology and neurobiology of neonatal abstinence syndrome.
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Clemens KJ, Oei JL, and Jantzie LL
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Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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- 2023
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32. Thermoregulation and golden hour practices in extremely preterm infants: an international survey.
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Jani P, Mishra U, Buchmayer J, Walker K, Gözen D, Maheshwari R, D'Çruz D, Lowe K, Wright A, Marceau J, Culcer M, Priyadarshi A, Kirby A, Moore JE, Oei JL, Shah V, Vaidya U, Khashana A, Godambe S, Cheah FC, Zhou W, Xiaojing H, and Satardien M
- Subjects
- Female, Humans, Infant, Newborn, Male, Pregnancy, Body Temperature Regulation, Intensive Care Units, Neonatal, Polyethylenes, Surveys and Questionnaires, Hypothermia prevention & control, Infant, Extremely Premature
- Abstract
Background: Are thermoregulation and golden hour practices in extremely preterm (EP) infants comparable across the world? This study aims to describe these practices for EP infants based on the neonatal intensive care unit's (NICUs) geographic region, country's income status and the lowest gestational age (GA) of infants resuscitated., Methods: The Director of each NICU was requested to complete the e-questionnaire between February 2019 and August 2021., Results: We received 848 responses, from all geographic regions and resource settings. Variations in most thermoregulation and golden hour practices were observed. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission, and having local protocols were the most consistent practices (>75%). The odds for the following practices differed in NICUs resuscitating infants from 22 to 23 weeks GA compared to those resuscitating from 24 to 25 weeks: respiratory support during resuscitation and transport, use of polyethylene plastic wrap and servo-control mode, commencing ambient humidity >80% and presence of local protocols., Conclusion: Evidence-based practices on thermoregulation and golden hour stabilisation differed based on the unit's region, country's income status and the lowest GA of infants resuscitated. Future efforts should address reducing variation in practice and aligning practices with international guidelines., Impact: A wide variation in thermoregulation and golden hour practices exists depending on the income status, geographic region and lowest gestation age of infants resuscitated. Using a polyethylene plastic wrap, commencing humidity within 60 min of admission and having local protocols were the most consistent practices. This study provides a comprehensive description of thermoregulation and golden hour practices to allow a global comparison in the delivery of best evidence-based practice. The findings of this survey highlight a need for reducing variation in practice and aligning practices with international guidelines for a comparable health care delivery., (© 2022. The Author(s).)
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- 2023
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33. PROspective Meta-analysis Of Trials of Initial Oxygen in preterm Newborns (PROMOTION): Protocol for a systematic review and prospective meta-analysis with individual participant data on initial oxygen concentration for resuscitation of preterm infants.
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Sotiropoulos JX, Schmölzer GM, Oei JL, Libesman S, Hunter KE, Williams JG, Webster AC, Tarnow-Mordi WO, Vento M, Asztalos E, Shah PS, Katheria A, and Seidler AL
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- Infant, Female, Infant, Newborn, Humans, Prospective Studies, Resuscitation methods, Gestational Age, Meta-Analysis as Topic, Infant, Premature, Oxygen
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Background: Clinicians favour low oxygen concentrations when resuscitating preterm infants immediately after birth despite inconclusive evidence to support this practice. Prospective meta-analysis (PMA) is a novel approach where studies are identified as eligible for inclusion in the meta-analysis before their results are known., Aims: To explore whether high (60%) or low (30%) oxygen is associated with greater efficacy and safety for the initial resuscitation (immediately after birth) of preterm infants born at <29 weeks' gestation., Methods: We will conduct a prospective meta-analysis (PMA) with individual participant data (IPD). We will perform a systematic search to identify ongoing RCTs including infants <29 weeks' gestation randomised to high (60%) or low (30%) oxygen for initial resuscitation after birth. IPD will be sought for all infants randomised for the purpose of meta-analysis. We will employ a one-stage random-effects approach to IPD meta-analysis. Potential heterogeneity and the differential effect of high or low oxygen will be explored through subgroup and interaction analyses. The primary outcome of this study is all-cause mortality prior to hospital discharge. There will be a follow-up analysis of neurodevelopmental outcomes once available., Results/conclusion: The results of neonatal outcomes at hospital discharge are expected by 2025, and neurodevelopmental outcomes by 2027., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)
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- 2023
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34. Global variation in skin injures and skincare practices in extremely preterm infants.
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Jani P, Mishra U, Buchmayer J, Maheshwari R, D'Çruz D, Walker K, Gözen D, Lowe K, Wright A, Marceau J, Culcer M, Priyadarshi A, Kirby A, Moore JE, Oei JL, Shah V, Vaidya U, Khashana A, Godambe S, Cheah FC, Zhou WH, Hu XJ, and Satardien M
- Subjects
- Infant, Infant, Newborn, Humans, Intensive Care Units, Neonatal, Skin Care, Logistic Models, Infant, Extremely Premature, Dermatitis
- Abstract
Background: Globally, are skincare practices and skin injuries in extremely preterm infants comparable? This study describes skin injuries, variation in skincare practices and investigates any association between them., Methods: A web-based survey was conducted between February 2019 and August 2021. Quantifying skin injuries and describing skincare practices in extremely preterm infants were the main outcomes. The association between skin injuries and skincare practices was established using binary multivariable logistic regression adjusted for regions., Results: Responses from 848 neonatal intensive care units, representing all geographic regions and income status groups were received. Diaper dermatitis (331/840, 39%) and medical adhesive-related skin injuries (319/838, 38%) were the most common injuries. Following a local skincare guideline reduced skin injuries [medical adhesive-related injuries: adjusted odds ratios (aOR) = 0.63, 95% confidence interval (CI) = 0.45-0.88; perineal injuries: aOR = 0.66, 95% CI = 0.45-0.96; local skin infections: OR = 0.41, 95% CI = 0.26-0.65; chemical burns: OR = 0.46, 95% CI = 0.26-0.83; thermal burns: OR = 0.51, 95% CI = 0.27-0.96]. Performing skin assessments at least every four hours reduced skin injuries (abrasion: aOR = 0.48, 95% CI = 0.33-0.67; pressure: aOR = 0.51, 95% CI = 0.34-0.78; diaper dermatitis: aOR = 0.71, 95% CI = 0.51-0.99; perineal: aOR = 0.52, 95% CI = 0.36-0.75). Regional and resource settings-based variations in skin injuries and skincare practices were observed., Conclusions: Skin injuries were common in extremely preterm infants. Consistency in practice and improved surveillance appears to reduce the occurrence of these injuries. Better evidence regarding optimal practices is needed to reduce skin injuries and minimize practice variations., (© 2022. The Author(s).)
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- 2023
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35. Symptomatic Postnatal Cytomegalovirus Infection in Less than 32-Week Preterm Infants: 13-Year Retrospective Multicenter Case-Control Study.
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Tapawan SJC, Bajuk B, Oei JL, and Palasanthiran P
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- Female, Pregnancy, Humans, Infant, Newborn, Infant, Premature, Glucocorticoids, Dexamethasone therapeutic use, Anti-Inflammatory Agents therapeutic use, Cytomegalovirus, Prospective Studies, Case-Control Studies, Australia epidemiology, Infant, Premature, Diseases diagnosis, Infant, Premature, Diseases epidemiology, Infant, Premature, Diseases drug therapy, Lung Diseases, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections epidemiology
- Abstract
Introduction: Reports on the influence of postnatal cytomegalovirus (pCMV) infection in neonatal outcomes of preterm babies vary while guidance on management including screening is lacking. We aim to determine the association between symptomatic pCMV infection and chronic lung disease (CLD) and mortality in preterm infants born less than 32 weeks gestation., Methods: We used data from the Neonatal Intensive Care Units' (NICUS) population-based prospective data registry of infants in 10 neonatal units in New South Wales and the Australian Capital Territory, Australia. De-identified perinatal and neonatal outcome data for 40,933 infants were examined. We identified 172 infants <32 weeks gestation with symptomatic pCMV infection. Each was matched with one control infant., Results: Infants with symptomatic pCMV infection were 2.7 times more likely to develop CLD (OR 2.7, 95% CI: 1.7-4.5) and spend 25.2 days more in hospital (95% CI: 15.2-35.2). Seventy-five percent (129/172) of infants with symptomatic pCMV were extremely preterm (<28 weeks). The mean age of symptomatic pCMV diagnosis was 62.5 ± 20.5 days or 34.7 ± 3.6 weeks-corrected gestational age. Ganciclovir treatment did not decrease CLD and death. CLD was 5.5 times predictive of death in patients with symptomatic pCMV infection. Symptomatic pCMV infection did not influence mortality nor increase neurologic impairment., Conclusion: Symptomatic pCMV is a modifiable factor affecting extreme preterm infants with significant impact on CLD. Prospective study on screening and treatment will help unveil potential benefits in our already at-risk preterm infants., (© 2023 S. Karger AG, Basel.)
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- 2023
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36. A Narrative Review of the Rationale for Conducting Neonatal Emergency Studies with a Waived or Deferred Consent Approach.
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Katheria A, Schmölzer GM, Janvier A, Kapadia V, Saugstad OD, Vento M, Kushnir A, Tracy M, Rich W, and Oei JL
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- Humans, Infant, Newborn, Infant, Emergency Medicine, Informed Consent, Clinical Trials as Topic
- Abstract
Emergency research studies are high-stakes studies that are usually performed on the sickest patients, where many patients or guardians have no opportunity to provide full informed consent prior to participation. Many emergency studies self-select healthier patients who can be informed ahead of time about the study process. Unfortunately, results from such participants may not be informative for the future care of sicker patients. This inevitably creates waste and perpetuates uninformed care and continued harm to future patients. The waiver or deferred consent process is an alternative model that may be used to enroll sick patients who are unable to give prospective consent to participate in a study. However, this process generates vastly different stakeholder views which have the potential to create irreversible impediments to research and knowledge. In studies involving newborn infants, consent must be sought from a parent or guardian, and this adds another layer of complexity to already fraught situations if the infant is very sick. In this manuscript, we discuss reasons why consent waiver or deferred consent processes are vital for some types of neonatal research, especially those occurring at and around the time of birth. We provide a framework for conducting neonatal emergency research under consent waiver that will ensure the patient's best interests without compromising ethical, beneficial, and informative knowledge acquisition to improve the future care of sick newborn infants., (© 2023 S. Karger AG, Basel.)
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- 2023
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37. What's in a name? The ethical implications and opportunities in diagnosing an infant with neonatal abstinence syndrome (NAS).
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Oei JL, Blythe S, Dicair L, Didden D, Preisz A, and Lantos J
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- Infant, Infant, Newborn, Humans, Analgesics, Opioid therapeutic use, Neonatal Abstinence Syndrome diagnosis, Neonatal Abstinence Syndrome drug therapy, Opioid-Related Disorders
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- 2023
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38. SIDS is associated with prenatal drug use: a meta-analysis and systematic review of 4 238 685 infants.
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Makarious L, Teng A, and Oei JL
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- Female, Humans, Infant, Pregnancy, Analgesics, Opioid adverse effects, Cocaine adverse effects, Methadone adverse effects, Observational Studies as Topic, Risk Factors, Substance-Related Disorders complications, Substance-Related Disorders epidemiology, Sudden Infant Death epidemiology, Prenatal Exposure Delayed Effects epidemiology
- Abstract
Objective: To conduct a meta-analysis to determine the association between prenatal drug exposure and risk of sudden infant death syndrome (SIDS)., Design: Studies were searched using PubMed, Medline and Embase and restricted to English, with no publication date limit. Selected studies included published cohort, population or case studies comparing the incidence of SIDS among drug-exposed with drug-free controls. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Data were pooled using a random-effects model to evaluate risk ratios (RR)., Setting: High-income countries., Patients: Children with a history of prenatal drug exposure., Interventions: None., Main Outcome Measures: RR of SIDS between drug-exposed and control infants., Results: Sixteen studies (36 730 infants with any prenatal drug exposure, 21 661 exposed to opioids, 21 571 exposed to cocaine, 5031 exposed to methadone compared with 4 201 955 with no exposure). Any prenatal drug exposure was associated with an increased crude risk of SIDS (RR 7.84, 95% CI 5.21 to 11.81). Prenatal opioid exposure had the highest associative crude risk of SIDS (RR 9.76, 95% CI 5.28 to 18.05), followed by methadone (RR 9.52, 95% CI 4.60 to 19.70) and cocaine (RR 4.40, 95% CI 2.52 to 7.67). Increased crude risk persisted after adjusting for socioeconomic factors (RR 4.24, 95% CI 1.39 to 12.88). The incidence of SIDS for this cohort decreased between 1972 and 2020 but remained significantly higher than controls., Conclusion: Exposure to any drug of dependency during pregnancy is associated with an increased risk of SIDS after controlling for socioeconomic factors. Further study to evaluate mechanisms and contribution of other confounders (eg, smoking) is warranted., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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39. The quest for optimum oxygenation during newborn delivery room resuscitation: Is it the baby or is it us?
- Author
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Sotiropoulos JX, Vento M, Saugstad OD, and Oei JL
- Subjects
- Female, Humans, Infant, Infant, Newborn, Oxygen, Pregnancy, Research Design, Delivery Rooms, Resuscitation
- Abstract
Achieving "normal oxygenation" in sick newborn infants requiring resuscitation is one of the most difficult and incompletely informed practices in neonatal care. Suboptimal oxygenation, whether too little or too much, has profound repercussions, including death. In the last two decades, clinicians have lost equipoise for the use of higher oxygen strategies due to concerns of hyperoxia but emerging evidence suggests that lower oxygen strategies may also be as detrimental, especially in infants with pulmonary pathologies such as those born at the cusp of viability. Practice at the coalface using rapidly evolving recommendations has also uncovered continuing complexities in the quest to achieve optimum oxygenation during the first critical minutes of life. There are adjustable factors, such as the practical impediments to acquiring knowledge, equipment and expertise as well as unadjustable factors, such as inherent infant pathology, that necessitates agile clinical manipulation to "first do no harm". This review will address the deficiencies in knowledge that currently impede our quest to determine the best and safest means to deliver oxygen to sick infants during the first critical minutes of life and suggest practical solutions for current practice while awaiting definitive evidence from large scale, well defined, randomized controlled studies., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2022
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40. Neonatal Abstinence Syndrome: Prevention, Management and Outcomes: From Birth to Adulthood.
- Author
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Allegaert K and Oei JL
- Abstract
Neonatal abstinence syndrome (NAS), or-when specifically focused on opioids-neonatal opioid withdrawal syndrome (NOWS) is a withdrawal syndrome in neonates after birth causally related to the in utero exposure to drugs of dependence, and the subsequent acute interruption at delivery [...].
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- 2022
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41. Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO 2 < 0.3) or higher (FiO 2 > 0.6) initial oxygen levels. An individual patient meta-analysis.
- Author
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Oei JL, Kapadia V, Rabi Y, Saugstad OD, Rook D, Vermeulen MJ, Boronat N, Thamrin V, Tarnow-Mordi W, Smyth J, Wright IM, Lui K, van Goudoever JB, Gebski V, and Vento M
- Subjects
- Child, Gestational Age, Humans, Infant, Infant, Newborn, Middle Aged, Oxygen, Resuscitation, Infant, Premature, Infant, Premature, Diseases therapy
- Abstract
Objective: To determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO
2 ) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants <32 weeks' gestation., Design: Meta-analysis of individual patient data from three randomised controlled trials., Setting: Neonatal intensive care units., Patients: 543 children <32 weeks' gestation., Intervention: Randomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2 ., Outcome Measures: Primary: death and/or NDI at 2 years of age.Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2 ) below or at/above 80%., Results: By 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) -0.2%, -7% to 7%, p=0.96) or with cognitive scores <85 (2%, -5% to 9%, p=0.5). Five-minute SpO2 >80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores >85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI., Conclusion: Initial FiO2 was not associated with difference in risk of disability/death at 2 years in infants <32 weeks' gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed., Competing Interests: Competing interests: YR has patents for technology to guide oxygen titration during newborn resuscitation. He did not contribute to any aspects of the manuscript related to the targeting of oxygen saturation., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2022
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42. Population data suggest persistently high risk of pregnancy complications in women with chronic kidney disease.
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Oei JL and Kandasamy Y
- Subjects
- Female, Humans, Pregnancy, Pregnancy Complications epidemiology, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic epidemiology
- Abstract
Competing Interests: Competing interests: None declared.
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- 2022
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43. An economic analysis of the cost of survival of micro preemies: A systematic review.
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Lee E, Schofield D, Owens CEL, and Oei JL
- Subjects
- Cost-Benefit Analysis, Humans, Delivery of Health Care, Outcome Assessment, Health Care
- Abstract
Objective: This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g., Method: We searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists., Results: The search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives., Conclusion: Despite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
- Published
- 2022
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44. Tobacco use during pregnancy.
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Havard A, Chandran JJ, and Oei JL
- Subjects
- Female, Humans, Pregnancy, Smoking therapy, Nicotiana, Tobacco Smoking, Tobacco Use Cessation Devices adverse effects, Electronic Nicotine Delivery Systems, Pregnancy Complications etiology, Pregnancy Complications therapy, Smoking Cessation
- Abstract
The use of tobacco during pregnancy is the leading preventable cause of pregnancy complications and adverse birth outcomes. In high-income countries, around one in 10 pregnant women smokes tobacco, while smokeless tobacco is the primary form of tobacco used in many low- and middle-income countries. Although the risk of tobacco-related harms can be reduced substantially if mothers cease smoking in the first trimester of pregnancy, the proportion of women who successfully quit smoking during pregnancy remains modest. Psychosocial interventions are first-line treatment, with some high-quality evidence showing that counselling is effective in promoting smoking cessation among pregnant women. There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women., (© 2021 Society for the Study of Addiction.)
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- 2022
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45. The micropreemie: Advances and challenges in treating the smallest newborn infants.
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Kusuda S and Oei JL
- Subjects
- Humans, Infant, Infant, Newborn, Infant Care, Infant, Premature
- Published
- 2022
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46. Practical procedures for the delivery room resuscitation of micropreemies.
- Author
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Kusuda S, Nakanishi H, and Oei JL
- Subjects
- Female, Humans, Infant, Infant, Newborn, Intermittent Positive-Pressure Ventilation, Intubation, Intratracheal, Positive-Pressure Respiration, Pregnancy, Delivery Rooms, Resuscitation methods
- Abstract
There are no standardized procedures for the resuscitation of micropreemies but respiratory and circulatory stabilization immediately after birth should be prioritized. Without aggressive support by positive pressure ventilation, establishing effective respiration among micropreemies is not possible. The first step in postnatal stabilization is initiated by positive airway pressure with a bag and mask. Once the heart rate increases above 100 beats/m, intratracheal intubation should be achieved because it is unusual for a micropreemie to breathe spontaneously or by non-invasive respiratory support for a protracted duration. Until further information is available, initial FiO
2 should be between 0.3 and 0.6, and titrated to achieve SpO2 obtained from healthy term infants for the first 10 min of life. Temperature control of infants is also critical for successful resuscitation and heat-loss minimizing procedures should be used e.g. with insulating bags. After securing the intratracheal tube, the infants should be transferred to the NICU for further procedures, including pulmonary surfactant installation and umbilical cord catheterization. Procedures in a delivery room under a radiant warmer should be limited to the initial resuscitation. In NICUs, the infants should be placed into a closed incubator to maintain high environmental temperature and humidity as well as decrease exposure to intervention and noise. Increased number of staff will also be needed to stabilize the infants further in the NICU. Finally, appropriate equipment (e.g. appropriate sized laryngoscopes) should be made readily available, along with regular practical training and education, whether in person or through SIM courses which are essential for all staff to achieve competence in successful resuscitation of the newborn micropreemie., (Copyright © 2022 Elsevier Ltd. All rights reserved.)- Published
- 2022
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47. NETwork Meta-analysis Of Trials of Initial Oxygen in preterm Newborns (NETMOTION): A Protocol for Systematic Review and Individual Participant Data Network Meta-Analysis of Preterm Infants <32 Weeks' Gestation Randomized to Initial Oxygen Concentration for Resuscitation.
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Sotiropoulos JX, Oei JL, Schmölzer GM, Hunter KE, Williams JG, Webster AC, Vento M, Kapadia V, Rabi Y, Dekker J, Vermeulen MJ, Sundaram V, Kumar P, Saugstad OD, and Seidler AL
- Subjects
- Female, Gestational Age, Humans, Infant, Infant, Extremely Premature, Infant, Newborn, Network Meta-Analysis, Pregnancy, Randomized Controlled Trials as Topic, Systematic Reviews as Topic, Oxygen, Resuscitation methods
- Abstract
Background: Internationally recognized guidelines recommend the judicious use of low oxygen (21-30%), titrated to peripheral oxygen saturation targets, for the initiation of resuscitation of very and extremely preterm infants (<32 weeks' gestation). However, despite more than 10 randomized controlled trials on this question, the ideal initial oxygen concentration for this group of vulnerable infants remains uncertain., Aims: This study aims to assess the effect of various initial oxygen concentrations on (1) all-cause mortality, chronic lung disease, intraventricular hemorrhage, and retinopathy of prematurity; and (2) reaching the prescribed oxygen saturation targets by 5 min after birth, in preterm infants requiring resuscitation., Methods: We will conduct a systematic review and network meta-analysis using individual participant data. Studies of preterm infants <32 weeks' gestation, randomized to initial oxygen concentration, will be included. We will systematically search medical databases and trial registries for eligible studies (published or unpublished). Records will be screened by two independent reviewers, with conflicts resolved by the inclusion of a third reviewer. Identified initial oxygen concentrations will be grouped into the following nodes: low (≤30%), intermediate (60%), and high (≥90%) oxygen. A two-step random-effects contrast-based network meta-regression will be calculated to compare and rank different oxygen concentrations. Analyses will be intention-to-treat, with the primary outcome of all-cause mortality., Discussion: This is the first individual participant data network meta-analysis of initial oxygen concentrations for the resuscitation of preterm infants. This novel approach may address long-standing uncertainty regarding optimal oxygen supplementation practice for the resuscitation of preterm infants <32 weeks' gestation., (© 2022 S. Karger AG, Basel.)
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- 2022
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48. "Mild'' Hypoxic-Ischaemic Encephalopathy and Therapeutic Hypothermia: A Survey of Clinical Practice and Opinion from 35 Countries.
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Singla M, Chalak L, Kumar K, Hayakawa M, Mehta S, Neoh SH, Kitsommart R, Yuan Y, Zhang H, Shah PS, Smyth J, Wandita S, Yeo KT, Lim G, and Oei JL
- Subjects
- Humans, Infant, Newborn, Hypothermia, Induced, Hypoxia-Ischemia, Brain therapy
- Abstract
Introduction: We aimed to determine global professional opinion and practice for the use of therapeutic hypothermia (TH) for treating infants with mild hypoxic-ischaemic encephalopathy (HIE)., Methods: A web-based survey (REDCap) was distributed via emails, social networking sites, and professional groups from October 2020 to February 2021 to neonatal clinicians in 35 countries., Results: A total of 484 responses were obtained from 35 countries and categorized into low/middle-income (43%, LMIC) or high-income (57%, HIC) countries. Of the 484 respondents, 53% would provide TH in mild HIE on case-to-case basis and only 25% would never cool. Clinicians from LMIC were more likely to routinely offer TH in mild HIE (25% v HIC 16%, p < 0.05), have a unit protocol for providing TH (50% v HIC 26%, p < 0.05), use adjunctive tools, e.g., aEEG (49% v HIC 32%, p < 0.001), conduct an MRI post TH (48% v HIC 40%, p < 0.05) and less likely to use neurological examinations as a HIE severity grading tool (80% v HIC 95%, p < 0.001). The majority of respondents (91%) would support a randomized controlled trial that was sufficiently large to examine neurodevelopmental outcomes in mild HIE after TH., Conclusions: This is the first survey of global opinion for TH in mild HIE. The overwhelming majority of professionals would consider "cooling" an infant with mild HIE, but LMIC respondents were more likely to routinely cool infants with mild HIE and use adjunctive tools for diagnosis and follow-up. There is wide practice heterogeneity and a sufficiently large RCT designed to examine neurodevelopmental outcomes, is urgently needed and widely supported., (© 2022 S. Karger AG, Basel.)
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- 2022
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49. Prenatal methamphetamine-impact on the mother and child-a review.
- Author
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Perez FA, Blythe S, Wouldes T, McNamara K, Black KI, and Oei JL
- Subjects
- Adult, Analgesics, Opioid, Female, Humans, Infant, Infant, Newborn, Mothers, Pregnancy, Pregnancy Outcome, Methamphetamine adverse effects, Prenatal Exposure Delayed Effects epidemiology, Substance-Related Disorders epidemiology
- Abstract
Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug-using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co-existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid-centric with little attention paid to the consequences of prenatal MA exposure., (© 2021 Society for the Study of Addiction.)
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- 2022
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50. Oxygen for the delivery room respiratory support of moderate-to-late preterm infants. An international survey of clinical practice from 21 countries.
- Author
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Sotiropoulos JX, Kapadia V, Vento M, Rabi Y, Saugstad OD, Kumar RK, Schmölzer GM, Zhang H, Yuan Y, Lim G, Kusuda S, Arimitsu T, Nguyen TT, Kitsommart R, Yeo KT, and Oei JL
- Subjects
- Female, Humans, Infant, Infant, Newborn, Infant, Premature, Oximetry, Pregnancy, Resuscitation, Surveys and Questionnaires, Delivery Rooms, Oxygen
- Abstract
Aim: The aim of this study was to determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation., Methods: An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap., Results: Of the 695 respondents, 69% had access to oxygen blenders and 90% had pulse oximeters. Respondents from high-income countries were more likely to have oxygen blenders than those from middle-income countries (72% vs. 66%). Most initiated respiratory support with FiO
2 0.21 (43%) or 0.3 (36%) but only 45% titrated FiO2 to target SpO2 . Most (89%) considered heart rate as a more important indicator of response than SpO2 . Almost all (96%) supported the need for well-designed trials to examine oxygenation in moderate-late preterm resuscitation., Conclusion: Most clinicians resuscitated moderate-late preterm infants with lower initial FiO2 but some cannot/will not target SpO2 or titrate FiO2 . Most consider heart rate as a more important indicator of infant response than SpO2 .Large and robust clinical trials examining oxygen use for moderate-late preterm resuscitation, including long-term neurodevelopmental outcomes, are supported amongst clinicians., (©2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)- Published
- 2021
- Full Text
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