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Biomedical subjects

D I Tudehope

Publications and source records attributed to D I Tudehope.

At least 19 recordsLinked to original sources
PubMed2005

Routine neonatal postextubation chest physiotherapy: a randomized controlled trial.

OBJECTIVE: To test the effects of a neonatal postextubation programme on the incidence of postextubation collapse and adverse outcomes. METHODS: A randomized controlled trial was carried out at the Mater Mothers' Hospital, Brisbane. Mechanically ventilated infants were randomized into one of two groups, physiotherapy group--which involved a regimen of chest wall percussion and oropharyngeal suctioning and control group - which involved suctioning without the percussion unless indicated. Chest X-rays were taken at 6 h and at 24 h postextubation. The primary outcome measure was postextubation collapse as determined by a paediatric radiologist blinded to the group allocation. RESULTS: One hundred and seventy-seven neonates were enrolled in the trial between 1997 and 1999. After an interim analysis, the trial was stopped early. No statistically significant difference was shown in the rate of postextubation collapse (15 of 87 (17.2%) physiotherapy group and 17 of 86 (19.8%) control group (P = 0.85)). No differences were shown between the groups in the number of apnoeic or bradycardic events, duration of requirement for supplemental oxygen or the need for re-intubation within 24 h postextubation. CONCLUSION: The results of this trial suggest that a routine neonatal postextubation chest physiotherapy programme for all infants is not indicated. There was no evidence that chest physiotherapy is associated with any adverse outcomes.

Data Collection↗
PubMed2004

Classification of perinatal deaths: development of the Australian and New Zealand classifications.

Classifications of perinatal deaths have been undertaken for surveillance of causes of death, but also for auditing individual deaths to identify suboptimal care at any level, so that preventive strategies may be implemented. This paper describes the history and development of the paired obstetric and neonatal Perinatal Society of Australia and New Zealand (PSANZ) classifications in the context of other classifications. The PSANZ Perinatal Death Classification is based on obstetric antecedent factors that initiated the sequence of events leading to the death, and was developed largely from the Aberdeen and Whitfield classifications. The PSANZ Neonatal Death Classification is based on fetal and neonatal factors associated with the death. The classifications, accessible on the PSANZ website (http://www.psanz.org), have definitions and guidelines for use, a high level of agreement between classifiers, and are now being used in nearly all Australian states and New Zealand.

Australia↗
PubMed2003

Immunoglobulins in saliva of preterm and full-term infants.

The aim of this longitudinal study was to determine salivary levels of total IgA, IgG and IgM in 84 preterm and 214 full-term infants, from birth to 18 months of age. Unstimulated whole saliva was collected from each infant at birth, and subsequently at 3-monthly intervals. Immunoglobulin levels were estimated using an ELISA technique. At birth, IgA was detected in 147/214 (69%) full-term infants but only 47/84 (56%) preterm infants (P < 0.01). In the case of IgG, 61% of full-term and 56% of preterm infants showed detectable levels, whereas IgM was found in 71% and 73%, respectively. Levels of IgA and IgG rose from birth to 18 months, whereas IgM levels did not change significantly. Increases in salivary levels of IgA were associated with introduction of solid foods (P < 0.001), as well as tooth eruption (P < 0.001). Our results indicate that the majority of full-term and preterm infants are orally immunocompetent at birth.

Chi-Square Distribution↗
PubMed2003

A longitudinal study of Streptococcus mutans colonization in infants after tooth eruption.

We previously reported that, before tooth eruption, over one-half of infants aged 6 mos were already infected with Streptococcus mutans. The aim of this investigation was to determine the colonization of S. mutans after tooth eruption in the same cohort of 111 infants (35 pre-term, 76 full-term). Our results showed that S. mutans colonization increased with increasing age, so that by 24 mos of age, 84% harbored the bacteria (p < 0.01). The mean and median ages of S. mutans colonization in dentate infants were 15.7 mos and 16.0 mos, respectively. Factors associated with S. mutans colonization were sweetened fluids taken to bed (p < 0.01), frequent sugar exposure (p < 0.03) and snacking (p < 0.03), sharing of foods with adults (p < 0.03), and maternal S. mutans levels of > 10(5) CFU/mL (p < 0.02). In contrast, non-colonization of S. mutans was associated with toothbrushing (p < 0.03) and multiple courses of antibiotics (p < 0.001). Analysis of our data establishes the timing of S. mutans colonization in children from birth to 24 mos of age.

Age Factors↗
PubMed2002

Non-anaemic iron deficiency identified by ZPP test in extremely premature infants: prevalence, dietary risk factors, and association with neurodevelopmental problems.

INTRODUCTION: The aims of this study were to determine, in a cohort of extremely premature infants, the prevalence of iron deficiency identified by zinc protoporphyrin/heme ratio (ZPP) testing, and its association with neurodevelopmental problems and dietary risk factors for iron deficiency. METHODS: Infants of less than 29 weeks' gestation or less than 1000 g birth weight were studied prospectively at a multidisciplinary follow-up clinic. Assessments were made at a corrected age of either 12 months (n=72) or 2 years (n=69). Physical examination, Griffiths Developmental Scale, and neurosensory-motor assessment were administered, information on diet and behaviour was obtained by questionnaire, and a fingerprick ZPP ratio was performed to identify iron deficiency. RESULTS: 18.4% of infants had positive ZPP tests. There was no significant association between a positive ZPP test result and dietary risk factors, or symptoms of lethargy, irritability or poor attention. In children without cerebral palsy, there was no difference on Griffiths scores or neurosensory-motor assessment between ZPP-positive and ZPP-negative groups. The diagnosis of cerebral palsy (n=12) was significantly associated with both a positive ZPP test and a lower Griffiths general quotient (GQ) score. CONCLUSIONS: Iron deficiency occurs commonly in extremely low birth weight (ELBW) children in early childhood, and is not predicted by dietary risk factors. The prevalence of iron deficiency is increased in ELBW children with cerebral palsy. Non-anaemic iron deficiency (NAID) does not impair development or significantly affect behaviour of ELBW subjects who do not have cerebral palsy.

Child, Preschool↗
PubMed2001

Oral colonization of Streptococcus mutans in six-month-old predentate infants.

We hypothesize that S. mutans colonization occurs more frequently in pre-term children due to their relative immaturity. In this study of 172 predentate, six-month-old infants, we found that 50% of pre-term and 60% of full-term children harbored S. mutans. The colonization was confirmed by repeat sampling. Although there were minor differences, factors associated with S. mutans infection in pre-term and full-term infants were generally similar. In both groups, increased frequency of sugar was ranked the most important factor (p < 0.001), followed by breast-feeding (p < 0.001), and habits which allowed saliva transfer from mother to infant (p < 0.01). By contrast, non-colonization of S. mutans was associated with multiple courses of antibiotics (p < 0.001). Compared with pre-term children, there were higher percentages of full-term who had night feedings and consumed sugar during sleep times. Mothers with infected infants had S. mutans levels > 5 x 10(5) CFU/mL saliva (p < 0.001), poorer oral hygiene, more periodontal disease, and lower socio-economic status (p < 0.02) and snacked frequently (p < 0.001), compared with mothers with non-infected infants.

Anti-Bacterial Agents↗
PubMed1999

The influence of growth on development outcome in extremely low birthweight infants at 2 years of age.

OBJECTIVE: To determine if weight < 3rd and < 10th centile at 2 years in extremely low birthweight (ELBW) infants is associated with problems of development and motor skills, and whether this association is explained by perinatal risk status. METHODOLOGY: One hundred and ninety-eight of 226 (88%) surviving ELBW infants born between January 1987 and December 1992 were assessed at 2 years corrected age. Children were classified as being at low perinatal risk (n = 128) or high perinatal risk (n = 70) for adverse developmental outcome based on perinatal risk factors. Weight at 2 years was classified as < 3rd, 3rd-9th or > or = 10th centile for age and gender. Development was assessed using the Griffiths Mental Developmental Scales and motor skills using the Neurosensory Motor Developmental Assessment (NSMDA). RESULTS: For the total study group weight centile was strongly related to General Quotient (GQ) and motor abilities. For children < 3rd percentile (n = 48) mean (GQ) was 90.4 (SD, 15.9), for children between the 3rd-9th percentile (n = 49) 91.5 (SD, 17.9), and for children > or = 10th percentile (n = 99) mean GQ was 99.8 (SD, 8.6). The association with mean GQ and NSMDA category occurred for the high-risk subgroup and became non-significant in the low-risk subgroup if neurologically abnormal children were excluded. Other perinatal risk factors, exposure to breast milk, level of maternal education, marital status and history of feeding problems or infections over the 2 years did not confound this association. CONCLUSION: Low weight percentile at 2 years was related to adverse developmental outcome in ELBW infants at high perinatal risk or with neurological impairment, though minimal association was present for neurologically normal infants at low perinatal risk.

Birth Weight↗
PubMed1999

Clinical significance of quantitative blood cultures in newborn infants.

AIM: To evaluate quantitative blood culture as a secondary test on a positive blood culture for the diagnosis of sepsis in newborn infants. METHOD: A 15-month prospective study of colony forming units (CFU) on positive blood cultures from newborn infants clinically suspected of having bacterial sepsis. Growth of bacteria in peripheral blood cultures was quantified using the isolater 1.5 microbial tube lysis direct plating culture system. Colony forming units were evaluated against a clinical assessment of infection. RESULTS: Of 137 positive blood cultures, 71 (51.8%) were taken from neonates with clinically defined infection and 66 (48.2%) were from non-infected infants. The clinical and biographical data in these two groups were similar. Coagulase negative staphylococci were the most commonly isolated organisms in each group (60.6% vs 93.9%). Eight deaths from sepsis occurred in the clinically infected group. Eighty-five per cent of sepsis was late onset. Although a CFU count > or = 30/mL predicted sepsis (sensitivity 83%, specificity 60%, positive predictive value 69%, negative predictive value 76%), a CFU count < 30/mL did not rule out serious sepsis. The higher the CFU count the greater the likelihood of sepsis. CONCLUSION: Quantitative blood culture was not shown to be a sensitive secondary test on a positive blood culture to distinguish clinical sepsis from culture contamination. Although a positive threshold of > or = 30 CFU/mL proved to be optimal, improvement in test performance would be expected with a lower incidence of culture contamination.

Bacteremia↗
PubMed1998

Neonatal cranial ultrasound screening for intraventricular haemorrhage.

The cost effectiveness of performing routine neonatal cranial ultrasound scans to diagnose intraventricular haemorrhage (IVH) on cohorts of high risk infants is in question. In the early 1980s cranial ultrasound scans were performed on preterm infants to expand knowledge of the incidence, aetiology, pathogenesis and evolution of IVH. In many neonatal units high risk infants are scanned on days 5-7 and 10-14 and prior to discharge for extremely low birthweight (ELBW) infants. Cranial ultrasound scanning is often used as a surrogate for assessment of neurodevelopmental outcome with information from meta analyses used to counsel parents about the likelihood of subsequent neurosensory disability.

Cerebral Hemorrhage↗
PubMed1998

Varicella-zoster virus infection in Australia.

OBJECTIVE: To determine the epidemiology of varicella-zoster virus (VZV) infection in Australia using currently available data sources. DESIGN: Analysis of national death data (23 years), congenital and neonatal cases (one year) and attendances at sentinel general practices (two years); hospital admissions in NSW and SA (six years); serological studies in 1995 involving antenatal clinics in Sydney and Brisbane and child-care centre staff and refugees in Sydney; and case-ascertainment in 1995 in South Western Sydney among public hospital staff, child-care centre staff and the community. RESULTS: In Australia, there have been an average of 3.5 deaths from chickenpox (mostly children) and 11 from herpes zoster (mostly older people) each year since 1980. The crude death rate for chickenpox has declined (p > 0.05). In 1995, there were 14 cases of neonatal and two of congenital varicella. Average annual admission rates for NSW and SA showed 1,200 hospital bed-days used for chickenpox, more than 20% with complications, and more than 7,300 bed days for zoster; annually more than 880 in-patient admissions were complicated by VZV. Most people encounter the virus in their first 15 years, but some remain susceptible into their 20s; 25% of cases and 37% of hospital admissions for chickenpox occur in people > or = 15 years of age. CONCLUSION: VZV infection involves people of all ages. It causes substantial morbidity and mortality, particularly at the extremes of life. The death rate from chickenpox but not zoster has fallen since the introduction of acyclovir in the 1980s. Surveillance of VZV infection must be given priority once vaccines become available, to monitor changes in morbidity and mortality.

Adolescent↗
PubMed1997

Characteristics at four months follow-up of infants born small for gestational age: a controlled study.

This prospective study compared 65 small-for-gestational-age (SGA) (birth weight < 3rd centile) and 71 control infants at a corrected age of 4 months. It was hypothesised that differences would exist in growth, development, temperament and minor neurological signs and that these would be predicted by type (proportional/disproportional) of growth restriction at birth and maternal mood disturbance at birth or at 4 months. Infants had a Griffith's developmental test and neuromotor assessment. Maternal mood and infant temperament were surveyed. Few differences were found between SGA and control infants. SGA infants showed catch-up growth with 63% being above the third percentile and 43% being above the tenth percentile for weight. SGA infants had lower Griffith's GQ scores (97 vs. 102, P = 0.02) and they were rated in temperament as more manageable than controls. There were no differences in subtle neuromotor signs. Neither type of SGA nor maternal mood disturbance at birth had prognostic significance for infant catch up growth, neuromotor scores, or temperament though level of maternal stress and anxiety at 4 months were related to lower GQ scores in SGA infants.

Body Height↗
PubMed1997

Aetiology and classification of small for gestational age infants.

OBJECTIVE: To determine important aetiological factors in small gestational age (SGA) infants and the effectiveness of anthropometric indexes in identifying patterns of growth retardation. METHODOLOGY: Eighty-four SGA infants and 81 controls were enrolled. Maternal biological, lifestyle and psychosocial factors were compared for the total group and the term Caucasian subset. Anthropometric indexes were also examined in relation to growth patterns. RESULTS: Decreased maternal size, poor weight gain, previous SGA infant and smoking were significantly associated with SGA status. Poor parental education and unemployment was increased in the study group. Mothers of SGA infants, especially the term Caucasian group, had a greater prevalence of hypertension and depressive and stress symptomatology. Ponderal index failed to identify discreet patterns of disproportionate/proportionate growth retardation. CONCLUSION: Biological, lifestyle and psychosocial differences remain important aetiological factors of intrauterine growth retardation. Identification of specific patterns of growth retardation by ponderal index remains controversial.

Body Height↗
PubMed1997

Infants born to narcotic dependent mothers: physical growth patterns in the first 12 months of life.

OBJECTIVES: To describe the physical growth patterns of infants born to narcotic dependent mothers (INDM) over a 12 months period and, if possible, to relate the growth to drug taking patterns during pregnancy. METHODOLOGY: The growth of a cohort of 43 INDM was measured during the first 12 months of life. Weight and length measurements were compared with percentile charts and converted to Z scores. Questionnaire data about drug taking practices, demographic variables and the neonatal period (including withdrawal scores) were obtained. RESULTS: Twenty-four (55.8%) of INDM had evidence of neonatal drug withdrawal requiring treatment with phenobarbitone. At birth, Z scores for weight and length indicated relative intrauterine growth retardation. By 12 months, there had been some catch up growth, but Z scores for weight and length were still below zero. Persistent weight retardation at 12 months was correlated with methadone dosage during pregnancy, but not the need for phenobarbitone therapy. CONCLUSIONS: The growth patterns of INDM in the first 12 months of life indicated that at birth there was evidence of intrauterine growth retardation, but by 12 months the growth was little different from the rest of the community. There appears to be some influence of narcotic agents taken while pregnant on subsequent growth of INDM.

Adult↗
PubMed1997

Survival and neonatal and neurodevelopmental outcome of 24-29 week gestation infants according to primary cause of preterm delivery.

A total of 189 infants of 24-29 weeks' gestation were born in a regional perinatal centre during a 2-year period. They were divided into groups according to the primary cause of preterm delivery: antepartum haemorrhage (n = 37, 20%), preeclampsia (n = 27), 14%), preterm premature rupture of membranes (n = 64, 34%), preterm labour (n = 27, 14%), chorioamnionitis (n = 16, 8%), other complications (n = 18, 10%). The perinatal mortality rate (PMR) was 286/1,000 of whom 44% were stillbirths. The 'other complication' group had the highest PMR due to a large number of intrauterine deaths, with no differences in neonatal mortality between the groups. Preeclampsia was associated with an increased risk of necrotizing enterocolitis and chorioamnionitis was associated with an increased risk of periventricular haemorrhage. Follow-up to at least 2 years was performed in 122 (97%) of survivors. Cerebral palsy occurred in 7%, while 18% had neurodevelopmental disability. No relationship was found between primary cause of preterm delivery and outcome. This information should be of value in counselling parents when preterm delivery is imminent.

Child Development↗