Ronald Hagan

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.

Repeated Antenatal Corticosteroids: Growth and Early Childhood Outcome

Aim: To determine the effects of repeated antenatal corticosteroids on size at birth and later growth and development in Very Preterm (<33 weeks) singleton infants. Design: Prospective regional cohort study (n=664). Exclusions: maternal preeclampsia(n=215), no information on steroid use (n=23). Factors Examined: demographic/obstetric history, size at birth, a/n steroids grouped as none(G0, n=233), one (G1, n=93), two (G2, n=76) or three plus courses (G3, n=24), size at 3 years, Stanford Binet IQ test results at 3 yrs. Results: Significantly more infants had birthweight <10% in G2 and G3 (G0=14.6%, G1=10.8%, G2=19.7%, G3=33.3%). Multivariate analysis showed a progressive reduction in birthweight and head circumference with increasing steroid courses. Infants in G3 had a reduction of 122g and 0.87 cm compared to G0. Steroid use did not affect birth length, growth parameters at three years, disability or IQ outcomes. Conclusions: Multiple courses of antenatal steroids are associated with significant reductions in birthweight and head circumference. These factors have the potential to affect long term outcomes though an independent long term effect was not evident in this cohort.

MATERNAL DEPRESSION FOLLOWING VERY PRETERM BIRTH † 1584

Aim: To ascertain the prevalence of depression in mothers following a very preterm (VP < 33weeks) or VLBW delivery and to test if a cognitive behavioural therapy intervention (CBTI) program reduces the prevalence. Design: Randomized single blind control trial; stratified for gestation < 28 weeks and parity. Subjects: English speaking mothers of VP/VLBW infants admitted to KEMH nursery.Intervention: A 6 session CBTI program provided by a research midwife between weeks 3 to 6 after birth. Outcome: Depression and stress disorders assessed by a research clinical psychologist at structured interview, the Schedule for Affective Disorders & Schizophrenia (SADS), using Research Diagnostic Criteria at 2 weeks, 2,6 and 12 months.Results: Of 220 mothers enrolled 21 were depressed at initial interview and not randomized, 199 mothers were randomized (102 CBTI: 97 Control). There were no differences in gestation, parity, previous history of depression or other demographic or obstetric factor between the groups.There was no effect of the CBTI on the prevalence of depression; 25/102 (24.5%) CBTI v 20/97 (20.6%) Control [Relative Risk 1.2 (95% CI 0.71,2.0)]. Overall 66/220(30%) of mothers experienced a minor or major depressive illness in the first 6-12 months. An additional 12 mothers had a diagnosed stress reaction giving a total prevalence of psychiatric disorder of 88/220 (40%).Conclusions: Maternal depression is common after VP delivery. A CBTI program did not reduce this prevalence. Paediatricians have a duty of care to assess maternal psychological well-being during follow-up of these infants. Maternal depression may account for some of the increased behavioural and cognitive problems reported in very preterm or very low birthweight infants.

Repeated Antenatal Corticosteroids (ANC); Effect on Behaviour at 6 years in Very Preterm infants

Repeated Antenatal Corticosteroids (ANC); Effect on Behaviour at 6 years in Very Preterm infants

Repeated Antenatal Corticosteroids (Cs): Early Temperament and Behaviour in Very Preterm Infants

Repeated Antenatal Corticosteroids (Cs): Early Temperament and Behaviour in Very Preterm Infants

Maternal Depression and Child Behaviour in a Regional Cohort of Very Preterm(Vp) infants 82

Maternal Depression and Child Behaviour in a Regional Cohort of Very Preterm(Vp) infants 82