Biomedical subjects
F J Stanley
Publications and source records attributed to F J Stanley.
Group B streptococcus infection, not birth asphyxia.
This case illustrates 2 main points. Firstly, fetal infection can mimic exactly both the immediate and delayed signs of perinatal asphyxia. Secondly, the placenta may hold the key to the diagnosis of sepsis which may be made difficult in the neonate by labour ward practices such as the use of intrapartum and immediate newborn antibiotics. We strongly support the recommendation that newborn blood and fetal membrane cultures should always be obtained in babies with a diagnosis of 'intrapartum asphyxia and fetal distress' (1). To this we would add the recommendation that placental histology be performed in these circumstances.
Antepartum risk factors for newborn encephalopathy: the Western Australian case-control study.
OBJECTIVE: To ascertain antepartum predictors of newborn encephalopathy in term infants. DESIGN: Population based, unmatched case-control study. SETTING: Metropolitan area of Western Australia, June 1993 to September 1995. SUBJECTS: All 164 term infants with moderate or severe newborn encephalopathy; 400 randomly selected controls. MAIN OUTCOME MEASURES: Adjusted odds ratio estimates. RESULTS: The birth prevalence of moderate or severe newborn encephalopathy was 3.8/1000 term live births. The neonatal fatality was 9.1%. The risk of newborn encephalopathy increased with increasing maternal age and decreased with increasing parity. There was an increased risk associated with having a mother who was unemployed (odds ratio 3.60), an unskilled manual worker (3.84), or a housewife (2.48). Other risk factors from before conception were not having private health insurance (3.46), a family history of seizures (2.55), a family history of neurological disease (2.73), and infertility treatment (4.43). Risk factors during pregnancy were maternal thyroid disease (9.7), severe pre-eclampsia (6.30), moderate or severe bleeding (3.57), a clinically diagnosed viral illness (2.97), not having drunk alcohol (2.91); and placenta described at delivery as abnormal (2.07). Factors related to the baby were birth weight adjusted for gestational age between the third and ninth centile (4.37) or below the third centile (38.23). The risk relation with gestational age was J shaped with 38 and 39 weeks having the lowest risk. CONCLUSIONS: The causes of newborn encephalopathy are heterogeneous and many of the causal pathways start before birth.
Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study.
OBJECTIVE: To identify intrapartum predictors of newborn encephalopathy in term infants. DESIGN: Population based, unmatched case-control study. SETTING: Metropolitan area of Western Australia, June 1993 to September 1995. SUBJECTS: All 164 term infants with moderate or severe newborn encephalopathy; 400 randomly selected controls. MAIN OUTCOME MEASURES: Adjusted odds ratio estimates. RESULTS: The birth prevalence of moderate or severe newborn encephalopathy was 3.8/1000 term live births. The neonatal fatality was 9.1%. Maternal pyrexia (odds ratio 3.82), a persistent occipitoposterior position (4.29), and an acute intrapartum event (4.44) were all risk factors for newborn encephalopathy. More case infants than control infants were induced (41.5% and 30.5%, respectively) and fewer case infants were delivered by caesarean section without labour (3.7% and 14.5%, respectively). Operative vaginal delivery (2.34) and emergency caesarean section (2.17) were both associated with an increased risk. There was an inverse relation between elective caesarean section (0.17) and newborn encephalopathy. After application of a set of consensus criteria for elective caesarean section only three (7%) eligible case mothers compared with 33 (65%) eligible control mothers were sectioned electively. Of all the case infants, 113 (69%) had only antepartum risk factors for newborn encephalopathy identified; 39 (24%) had antepartum and intrapartum factors; eight (5%) had only intrapartum factors; and four (2%) had no recognised antepartum or intrapartum factors. CONCLUSIONS: The causes of newborn encephalopathy are heterogeneous and many relate to the antepartum period. Elective caesarean section has an inverse association with newborn encephalopathy. Intrapartum hypoxia alone accounts for only a small proportion of newborn encephalopathy. These results question the view that most risk factors for newborn encephalopathy lie in the intrapartum period.
The use of medication in children attending childcare in Western Australia.
OBJECTIVE: This paper reports on medication use and factors affecting use in a cohort of preschool children attending long daycare in centres and family daycare in homes. METHODOLOGY: A survey of parents representing 846 children under 6 years old in two types of childcare in Perth, Western Australia. The data were analysed using descriptive and logistic regression techniques to elucidate factors associated with use of medication. RESULTS: Seventy-three per cent of the children were reported to have used over-the-counter medication at some time, whilst current regular use of prescribed medication was 11%. This proportion is comparable to the limited available data for children of similar ages in Western Australia. For both medication categories, the use of medication was higher in long daycare than family daycare. In addition, many other characteristics differed between children in long daycare and family daycare. Initial analysis showed a number of significant associations between child and family factors and both categories of medication. Multivariable analyses indicated that the most important associations with medication use were with children's illnesses. There was no significant difference between long daycare and family daycare for use of over-the-counter medication but attending long daycare was significantly associated with increased use of prescribed medication (OR=2.13; 95% CI 1.24-3.67) after illnesses had been taken into account. CONCLUSION: Medication use in children attending childcare is closely related to reported illness in the child.
Immunisation rates in child care children.
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Type of medication used in children attending childcare in western Australia.
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Does periconceptional multivitamin use reduce the risk of neural tube defects associated with other birth defects?
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Prenatal determinants of motor disorders.
Cerebral palsies (CP) are the commonest childhood motor disorders, originating in early childhood as a result of interference in the developing brain. Identifying prenatal factors in CP is a challenge because there is a considerable period of time (years) between the causal event(s) and diagnosis. Four fascinating "natural" situations provided a unique opportunity to identify and measure prenatal exposures in relation to motor disorders, thus establishing the unequivocal role of some factors. However, the majority of studies determining adverse reproductive effects of environmental factors require a retrospective case-control approach, which present considerable problems. Studies based on the Western Australian CP register suggest that prenatal factors singly or in complex sequences are more common as causes than those occurring perinatally or postnatally. In future, better diagnosis of motor disorders, use of sophisticated scientific techniques to identify markers of neuronal development and the accurate linkage of these findings to clinical patterns of motor dysfunction are required.
An analysis of sudden infant death syndrome in aboriginal infants.
The purpose of this case-control study was to identify antenatal and perinatal risk factors for sudden infant death syndrome (SIDS) in Aboriginal infants in Western Australia (WA). Cases were all Aboriginal infants born in WA from 1980 to 1990 inclusive and classified as dying from SIDS in WA. Controls consisted of a matched group and a random group both selected from liveborn Aboriginal infants born from 1980 to 1990. Multivariate modelling showed that SIDS in Aboriginal infants was strongly related to young maternal age (< 20 years, odds ratio (OR) = 2.89), high parity (parity > 3, OR = 4.40) and being small-for-gestational age (OR = 3.36) but was not associated with single marital status (OR = 0.95) or male sex (OR = 0.97). Although the study was based on routinely collected data, results do highlight some important groups for SIDS prevention. To gain further knowledge in terms of SIDS in Aboriginal infants, there is an urgent need to collect information concerning infant care practices in the Aboriginal community.
Trauma in pregnancy and cerebral palsy: is there a link?
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Hospital admissions for lower respiratory tract illness before the age of two years in western Australia.
In this study, hospital admissions for lower respiratory tract illness before two years of age have been documented for all children born in Western Australia in 1986. Admissions data were linked to birth and death records for individual children. Of the total cohort, 5% of non-Aboriginal and 17% of Aboriginal children were hospitalised only once for lower respiratory tract illness; 1% of non-Aboriginal and 11% of Aboriginal children had repeated admissions. Perinatal conditions comprised the greatest proportion of the admissions for non-Aboriginal children, and pneumonia for Aboriginal children. Non-Aboriginal children had decreasing admission rates from the neonatal period onwards, whereas those for Aboriginal children increased. For all children, those of low or high birthweight, male sex and those with young or unmarried mothers or residing in country regions were more likely to be admitted. This research has highlighted potential risk factors for serious respiratory illness in early childhood and has shown the feasibility of using linked data for the total population to formulate and test hypotheses relating to respiratory morbidity.
Sudden infant death syndrome in Australian aboriginal and non-aboriginal infants: an analytical comparison.
Our previous research has shown that the sudden infant death syndrome (SIDS) rate for Aboriginal infants in Western Australia (WA) is markedly higher than that for non-Aboriginal infants. The aim of this study was to identify factors that may be important in explaining this disparity. A case-control study was conducted based on routinely collected data for the population of WA singleton births from 1980 to 1990 inclusive. Cases were infants born and classified as dying from SIDS in WA (Aboriginal n = 88, non-Aboriginal n = 409). Controls were infants born in WA and not classified as dying from SIDS; 2% samples of both Aboriginal and non-Aboriginal infants were included. The risk of dying from SIDS in Aboriginal infants was 3.86 times [95% confidence interval (CI) = 2.98 to 5.02] that in non-Aboriginal infants. Statistically significant univariable risk factors for SIDS in Aboriginal infants were preterm birth, low birthweight and small-for-gestational-age; for non-Aboriginal infants they included these factors as well as single marital status, young maternal age, parity of one or greater and male sex. Comparing Aboriginal with non-Aboriginal controls, most of the risk factors were more common in the Aboriginal population. Multiple logistic regression analysis indicated that Aboriginal infants were 1.43 times [95% CI = 1.04 to 1.95] more likely to die from SIDS than non-Aboriginal infants. Differences in the risk factor profile for Aboriginal and non-Aboriginal infants were sought using interaction terms. The only important differences were that the risk of SIDS in Aboriginal infants, unlike that in non-Aboriginal infants, appeared not to be strongly related to male sex or to single marital status. Thus, the results show that the disparity between the incidence of SIDS in the Aboriginal and non-Aboriginal populations can be explained largely, although not totally, by the high prevalence of routinely recorded risk factors in the Aboriginal population. A limitation of this study is that data on the postnatal risk factors of prone sleeping, maternal smoking and non-breastfeeding were unavailable. The residual excess risk for Aboriginal infants may be a result of these recognised postnatal risk factors and/or other infant care practices that are not routinely recorded in our data base, or to underlying social and economic conditions. Further study of all these potential risk factors is warranted.
Issues in the prevention of spina bifida.
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Technology seduction: lost opportunities in child health?
This report examines the extent to which illness-based individual care and expensive, often unevaluated, technologies in paediatrics have seduced practitioners away from more cost-effective, population-based child health activities and examples of new and unevaluated technologies in perinatology and paediatrics are given. The way in which these technologies are introduced and taken up, by 'creeping incrementalism', is described and a plea is made to implement only those aspects of paediatric care that have been demonstrated to be effective. This would result in only appropriate technologies being used, avoid harm being done to children and ensure that money is available for other effective population-based activities that improve child health.
Singleton and twin confinements associated with infertility treatments.
A cross-sectional sample of 150 singleton and 159 twin confinements delivered in Western Australia in 1991 were randomly sampled in 1993; 63% of the women responded to a postal questionnaire. Thirteen percent of respondents with singletons and 26% of those with twins reported having problems conceiving at some stage in their life. Six percent of those who had singleton confinements and 22% of those women who had twin confinements sought fertility advice prior to the conception of the index pregnancy. One percent (95% CI 0.03%, 5.5%) of women with singletons received infertility treatment compared with 17% (95% CI 10.4%, 26.3%) of those with twins. Overall 82.7% (95% CI 75.2%, 90.1%) of twin confinements followed spontaneous conception, 11.2% (95% CI 5.7%, 19.2%) followed ovarian stimulation treatment alone and 6.1% (95% CI 2.3%, 12.9%) followed IVF or GIFT procedures. The probability of a spontaneous twin confinement was 1 in 95. It was concluded that nearly twice as many twin pregnancies were associated with ovarian stimulation treatment given alone than with IVF and GIFT combined. The routinely collected data about assisted twin conceptions provide an incomplete picture with regard to the role of different infertility treatment modalities.
SIDS and birth defects in Aboriginal infant deaths.
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The role of life events in different categories of preterm birth in a group of women with previous poor pregnancy outcome.
The aim of the present study was to determine whether mothers reporting more life events experience more preterm births following both complicated and uncomplicated pregnancies. A Life Events Inventory was administered prospectively to women at high risk for poor obstetric and neonatal outcomes who took part in the Pregnancy Home Visiting Program (PHVP), a randomized controlled trial of the effect of a programme of antenatal home visits by midwives on the incidence of preterm birth. This study took place in Western Australia in the years 1984-1987. All women in the study had had a previous poor pregnancy outcome. The women were classified into two groups--those with complicated and those with uncomplicated pregnancies. Pregnancies classified as 'complicated' were defined as a pregnancy in which there was antenatal hospital admission(s) for hypertension, antepartum haemorrhage or other medical reason except for preterm birth. Pregnancies classified as 'uncomplicated' refer to all pregnancies without these complications. No significant association was found between life events and preterm birth although the total stress score for women with uncomplicated pregnancies almost reached significance, as did the number of life events for both women with complicated and women with uncomplicated pregnancies considered together. Life events were not shown to have a predictive relationship to preterm birth even when stratified by etiologically different groups. However, although stress was not an important predictor of preterm birth in this group of women at biological risk it may yet be so in a group at social risk.