Noel French

Hospital admissions in the first year of life in very preterm infants

Objective: To analyse hospital readmissions to 1 year in infants <33 weeks’ gestation.

Developmental assessment of twenty in vitro fertilization (IVF) infants at their first birthday

The pregnancy details, delivery outcome, and developmental status as measured on the Griffiths Developmental Scales are provided on the first 20 infants reaching their first birthday following in vitro fertilization-embryo transfer (IVF-ET) within the PIVET Programme. An increased rate of preterm delivery. intrauterine growth retardation, and cesarean sections was noted. One significant and two minor abnormalities were detected and only one infant was slightly under the expected developmental assessment at 1 year on the corrected general quotient of the Griffiths Developmental Scales for children.

Objective assessment of pediatric voice disorders with the acoustic voice quality index

OBJECTIVES/HYPOTHESIS Instrumental measures of voice allow practitioners to assess the severity of voice disorders and objectively measure treatment outcomes. Instrumental measures should be calculated on both sustained vowel and connected speech samples to ensure ecological validity. However, there is a lack of appropriate, validated acoustic measurements for use in the pediatric population. The Acoustic Voice Quality Index (AVQI) is a multivariate acoustic measure of dysphonia that has been found to be reliable, valid, and have diagnostic accuracy and response to change in an adult population. This study aimed to evaluate the AVQI in a pediatric population. STUDY DESIGN This study was a prospective observational study of a sample of dysphonic and normophonic children. METHODS Sixty-seven preterm participants (born at less than 25 weeks gestation) aged between 6 and 15 years were recruited. Participants were excluded because of either inability to comply with task requirements or other speech-related factors that affected acoustic measurement. Forty normophonic term-born participants aged between 5 and 15 years were also recruited. AVQI analysis was conducted on a prolonged vowel sample and a sample of continuous speech. RESULTS The AVQI was found to have diagnostic accuracy and specificity in this population of children with and without dysphonia. It was moderately correlated with ratings of severity on the GRBAS (overall grade of hoarseness (G), roughness (R), breathiness (B), aesthenicity (A), and strain (S)), a subjective rating scale. The threshold for pathology of this sample of 3.46 showed strong sensitivity, specificity, and accuracy, with good-to-excellent likelihood ratios. CONCLUSIONS This study found that the AVQI has diagnostic accuracy in a pediatric population, suggesting that it is an appropriate assessment tool to determine the presence and severity of pediatric voice disorders.

The long term neurologic outcome of children from pregnancies complicated by twin-to-twin transfusion syndrome

Objective  To assess long term outcomes of children from pregnancies complicated by twin‐to‐twin transfusion syndrome.

Very preterm birth–a regional study. Part 1: Maternal and obstetric factors

Objective To ascertain the demographic, pregnancy and obstetric factors associated with the delivery of a live born very preterm infant (< 33 weeks of gestation) and to investigate any differences in these factors between identifiable aetiological groups.

Very preterm birth–a regional study. Part 2: The very preterm infant

Objective To ascertain the growth characteristics, delivery room management and hospital mortality of very preterm live born infants (< 33 weeks of gestation) and to identify differences between infants associated with the aetiological factor related to their very preterm delivery.

Long term follow up of high risk children: who, why and how?

BackgroundMost babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted.DiscussionThis paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps.SummaryA substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.

Neurodevelopmental outcomes at 7 years’ corrected age in preterm infants who were fed high-dose docosahexaenoic acid to term equivalent: a follow-up of a randomised controlled trial

Objective To determine if improvements in cognitive outcome detected at 18 months’ corrected age (CA) in infants born <33 weeks’ gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. Design Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. Setting Five Australian tertiary hospitals from 2008 to 2013. Participants 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. Interventions High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2–4 days until term CA. Primary outcome Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. Results 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital −0.3, 95% CI −2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. Conclusions Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2–4 until term CA showed no evidence of benefit at 7 years’ CA. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12606000327583.

Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomes

Aim: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies.

Repeated Antenatal Corticosteroids (CS): Behaviour Outcomes in a Regional Population of Very Preterm (VP,<33w) Infants |[bull]| 1252

BACKGROUND: We have previously shown reduced birthweight and head circumference in singleton VP infants, and in sheep additional reductions in myelination associated with repeated antenatal CS. AIM: This analysis examines behavioural outcomes in relation to antenatal CS in all surviving singleton VP infants in a total geographic population in WA. DESIGN: Prospective cohort study of all liveborn surviving infants 20w - 32w born in WA from Jan 1990 to Jun 1992. MAIN VARIABLES EXAMINED: Maternal demographic and obstetric history, number of completed courses of antenatal CS, neonatal course. Three year assessment included Stanford Binet IQ test, Child Behavior Checklist (CBCL), Parenting Stress Index (PSI), neurologic exam. RESULTS: 262 of 543 singleton VP survivors (48%) received antenatal CS; 67 (12%) had multiple courses. Behaviour problems increased with increasing antenatal CS on both(a)Externalising subscale of CBCLa and (b) Distractibility scale of PSIb. Factors influencing problem behaviour were ≥3 courses of antenatal CS, male sex, low social class, fetal growth restriction, non-exposure to breast milk, and reducing gestational age. Controlling for these factors gives adjusted relative risks for these problem scores from exposure to ≥3 ANCS of 4.05a (95% CI 2.45-6.68) and 4.26b(95%CI 2.69-6.73) respectively. CBCL total and internalising scores were not influenced by antenatal CS.