114 results for 2000, Harding, Jane, Journal article

  • Multi-nutrient fortification of human milk for preterm infants

    Brown, JVE; Embleton, ND; Harding, Jane; McGuire, W (2016)

    Journal article
    The University of Auckland Library

    Exclusively breast milk-fed preterm infants may accumulate nutrient deficits leading to extrauterine growth restriction. Feeding preterm infants with multi-nutrient fortified human breast milk rather than unfortified breast milk may increase nutrient accretion and growth rates and may improve neurodevelopmental outcomes. Objectives To determine whether multi-nutrient fortified human breast milk improves important outcomes (including growth and development) over unfortified breast milk for preterm infants without increasing the risk of adverse effects (such as feed intolerance and necrotising enterocolitis). Search methods We used the standard search strategy of the Cochrane Neonatal Review Group. This included electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 2), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until February 2016), as well as conference proceedings and previous reviews. Selection criteria Randomised and quasi-randomised controlled trials that compared feeding preterm infants with multi-nutrient (protein and energy plus minerals, vitamins or other nutrients) fortified human breast milk versus unfortified (no added protein or energy) breast milk. Data collection and analysis We extracted data using the standard methods of the Cochrane Neonatal Review Group. We separately evaluated trial quality, data extracted by two review authors and data synthesised using risk ratios (RRs), risk differences and mean differences (MDs). We assessed the quality of evidence at the outcome level using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Main results We identified 14 trials in which a total of 1071 infants participated. The trials were generally small and weak methodologically. Meta-analyses provided low-quality evidence that multi-nutrient fortification of breast milk increases in-hospital rates of growth (MD 1.81 g/kg/d, 95% confidence interval (CI) 1.23 to 2.40); length (MD 0.12 cm/wk, 95% CI 0.07 to 0.17); and head circumference (MD 0.08 cm/wk, 95% CI 0.04 to 0.12). Only very limited data are available for growth and developmental outcomes assessed beyond infancy, and these show no effects of fortification. The data did not indicate other potential benefits or harms and provided low-quality evidence that fortification does not increase the risk of necrotising enterocolitis in preterm infants (typical RR 1.57, 95% CI 0.76 to 3.23; 11 studies, 882 infants). Authors' conclusions Limited available data do not provide strong evidence that feeding preterm infants with multi-nutrient fortified breast milk compared with unfortified breast milk affects important outcomes, except that it leads to slightly increased in-hospital growth rates.

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  • Oral dextrose gel to improve survival in less vigorous newborn triplet lambs: a randomised controlled trial

    Hegarty, Joanne; Harding, Jane; Oliver, Mark; Gamble, Gregory; Dickson, JL; Chase, G; Jaquiery, Anne (2016-10-23)

    Journal article
    The University of Auckland Library

    Triplet lambs have reduced survival and most deaths occur due to starvation and exposure, but there are a few simple and safe interventions. We hypothesised that buccal dextrose gel would increase blood glucose concentration, vigour, survival and early feeding in less vigorous triplet lambs. Triplet lambs meeting criteria for decreased vigour were randomised to 40% dextrose or placebo gel 1???mL/kg via the buccal mucosa at 1 hour of age. Primary outcome was survival at 3 hours. An additional study exploring the effect of gel on interstitial glucose concentrations was assessed by continuous glucose monitoring in twin lambs. Lambs randomised to dextrose gel did not have higher blood glucose concentrations or better survival than those randomised to placebo. Low temperature at 1 hour after birth, rather than birthweight or blood glucose concentrations, was associated with decreased survival. Interventions to address hypothermia rather than hypoglycaemia may be most effective in improving survival in less vigorous triplet lambs.

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  • Maternal undernutrition and endocrine development

    Harding, Jane; Behrensdorf Derraik, Jose; Bloomfield, Francis (2010)

    Journal article
    The University of Auckland Library

    Maternal undernutrition, whether it occurs before conception, throughout gestation or during lactation, may lead to physiological adaptations in the fetus that will affect the health of the offspring in adult life. The timing, severity, duration and nature of the maternal nutritional insult may affect the offspring differently. Other factors determining outcome following maternal undernutrition are fetal number and gender. Importantly, effects of maternal undernutrition may be carried over into subsequent generations. This review examines the endocrine pathways disrupted by maternal undernutrition that affect the long-term postnatal health of the offspring. Maternal and childhood undernutrition are highly prevalent in low- and middle-income countries, and, in developed countries, unintentional undernutrition may arise from maternal dieting. It is, therefore, important that we better understand the mechanisms driving the long-term effects of maternal undernutrition, as well as identifying treatments to ameliorate the associated mortality and morbidity.

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  • Repeat prenatal corticosteroid doses do not alter neonatal blood pressure or myocardial thickness: Randomized controlled trial

    Mildenhall, L; Battin, Malcolm; Bevan, Coila; Kuschel, Carl; Harding, Jane (2009-04-01)

    Journal article
    The University of Auckland Library

    OBJECTIVE. The goal was to determine whether repeat prenatal corticosteroid treatment alters blood pressure and myocardial wall thickness in neonates. METHODS.A randomized, double-blind, placebo-controlled trial was performed in a tertiary perinatal center. Mothers with a singleton, twin, or triplet pregnancy, at a gestational age of 95th percentile. CONCLUSION. Exposure to repeat prenatal corticosteroid treatment did not increase neonatal blood pressure or myocardial wall thickness in infants who remained at risk of very preterm birth ???7 days after an initial course of corticosteroid treatment.

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  • Effects of sex, litter size and periconceptional ewe nutrition on the ewe-lamb bond.

    Hernandez Verduzco, CE; Matthews, LR; Oliver, Mark; Bloomfield, Francis; Harding, Jane (2009)

    Journal article
    The University of Auckland Library

    Undernutrition restricted to the time around conception in sheep alters endocrine and metabolic responses in the offspring. Studies in rats suggest that such an early insult can also alter the behaviour of the offspring. We studied the effects of mild maternal periconceptional undernutrition (10-15% body weight reduction) on the lamb's response to separation from and reunion with the mother, and on the ewe-lamb bond, evaluated as the preference for each other over an alien ewe/lamb in a test enclosure, at 24 h 1 and 4 weeks of age. Lamb birth weight was not affected by maternal nutrition. Maternal periconceptional undernutrition did not affect the lambs' responses to separation and reunion (number of vocalisations, times to leave pen and achieve proximity with ewes) or the bond between ewes and lambs (percentage of time spent near their own dam/lamb). However, there were effects of sex, litter size and time on lambs' responses to separation and reunion and on the ewe-lamb bond. Female lambs vocalised more during separation (P <= 0.001). We conclude that periconceptional undernutrition does not affect offspring response to separation from the mother or the bond between ewes and lambs, but that these behaviours are affected by sex and litter size for up to 4 weeks after birth.

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  • Cot-side electroencephalography for outcome prediction in preterm infants: Observational study

    West, CR; Harding, Jane; Williams, CE; Nolan, M; Battin, Malcolm (2011-03)

    Journal article
    The University of Auckland Library

    Objective: To assess the use of two-channel electroencephalographical (EEG) recordings for predicting adverse neurodevelopmental outcome (death or Bayley II mental developmental index/psychomotor developmental index < 70) in extremely preterm infants and to determine the relationship between quantitative continuity measures and a specialist neurophysiologist assessment of the same EEG segment for predicting outcome. Design: Observational study. Setting: The study was conducted in a neonatal intensive care unit. Patients: Preterm infants born s assessment was a better predictor of adverse outcome than the continuity measures (positive predictive value 95% CI 75 (54% to 96%) vs 41 (22% to 60) at 25-??V threshold, negative predictive value 88 (80% to 96%) vs 84 (74% to 94%) and positive likelihood ratio 9.0 (3.2 to 24.6) vs 2.0 (1.2 to 3.6)). All the infants with definite seizures identified by the neurophysiologist had poor outcomes. Conclusions: Modified cot-side EEG has potential to assist with identification of extremely preterm infants at risk for adverse neurodevelopmental outcomes. However, analysis by a neurophysiologist performed better than the currently available continuity analyses.

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  • Effects of sex, litter size and periconceptional ewe nutrition on offspring behavioural and physiological response to isolation

    Hernandez, CE; Matthews, LR; Oliver, Mark; Bloomfield, Francis; Harding, Jane (2010-12-02)

    Journal article
    The University of Auckland Library

    Maternal periconceptional undernutrition alters fetal hypothalamic???pituitary???adrenal (HPA) axis development. However, the effects of this early nutritional insult on postnatal HPA axis function and stress-related behaviours are unknown. We investigated in sheep the effects of different periods of undernutrition, and of sex and litter size, on offspring behavioural and cortisol responses to isolation stress. We studied four nutritional groups: controls well nourished throughout pregnancy (n=39), or ewes undernourished (UN,10???15% body weight reduction) before mating (!60 to 0 d, n=26), after mating (!2 to +30 d, n=20) or both (!60 to +30 d, n=36). At 4 and 18 months of age, offspring were isolated for 5 min, their behaviour video recorded, and plasma cortisol concentrations measured. Offspring of all undernourished groups demonstrated 50% fewer escape attempts than controls at 4 months of age, and offspring of UN!60 +30 ewes had 20% lower plasma cortisol area under the curve in response to isolation at 18 months. Females had higher cortisol concentrations and vocalised more than males at 4 and 18 months, and were more active at 18 months. After isolation, UN!2 +30 males had higher cortisol concentrations than UN!2 +30 females whereas in all other groups males had lower concentrations than females. Singleton males made more escape attempts than females, whereas in twins females made more escape attempts than males. These !ndings suggest that maternal periconceptional undernutrition in sheep can suppress behavioural reactions and cortisol secretion in response to isolation stress in the offspring into adulthood, and that these effects differ between males and females.

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  • Evidence for fetal glucocorticoid excess as a cause of adult cardiovascular disease

    Bloomfield, Francis; Harding, Jane (2006)

    Journal article
    The University of Auckland Library

    Purpose of review: Animal experiments demonstrating associations between birth weight and postnatal phenotypes that may increase the risk of cardiovascular disease, such as hypertension, obesity, anxiety, and increased glucocorticoid activity, support the human epidemiologic findings of an association between reduced size at birth and adult cardiovascular disease. Here we review the evidence for exposure of the fetus to excess glucocorticoid as the key underlying mechanism. Recent findings: Administration of synthetic glucocorticoids to, and undernutrition of, pregnant animals both results in reduced birth weight and the relevant postnatal phenotypes. However, in the latter paradigm direct evidence of fetal exposure to excess endogenous glucocorticoids of often lacking. Thirty-year-old offspring of pregnant women given glucocorticoids for threatened preterm labour have minimal evidence of increased cardiovascular risk factors. Summary: Exposure of the fetus to inappropriate amounts of glucocorticoids can result in a postnatal phenotype that may predispose to cardiovascular disease, although the fact that surrogate endpoints are often studied in animal experiments must be borne in mind. However, assumptions that effects of other interventions, such as maternal undernutrition, are mediated via exposure of the fetus to excess glucocorticoids are often not supported by direct evidence. The value of available human data should not be overlooked.

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  • Cardiovascular risk factors in children after repeat doses of antenatal glucocorticoids: an RCT

    McKinlay, Christopher; Cutfield, Wayne; Battin, Malcolm; Dalziel, SR; NRCGD, User; Harding, Jane (2015-02)

    Journal article
    The University of Auckland Library

    BACKGROUND: Treatment of women at risk for preterm birth with repeat doses of glucocorticoids reduces neonatal morbidity but could have adverse long-term effects on cardiometabolic health in offspring. We assessed whether exposure to repeat antenatal betamethasone increased risk factors for later cardiometabolic disease in children whose mothers participated in the Australasian Collaborative Trial of Repeat Doses of Corticosteroids. METHODS: Women were randomized to betamethasone or placebo treatment, ??? 7 days after an initial course of glucocorticoids, repeated each week that they remained at risk for preterm birth at corrected age for body composition, insulin sensitivity, ambulatory blood pressure, and renal function. RESULTS: Of 320 eligible childhood survivors, 258 were studied (81%; 123 repeat betamethasone group; 135 placebo [single course] group). Children exposed to repeat antenatal betamethasone and those exposed to placebo had similar total fat mass (geometric mean ratio 0.98, 95% confidence interval [CI] 0.78 to 1.23), minimal model insulin sensitivity (geometric mean ratio 0.89, 95% CI 0.74 to 1.08), 24-hour ambulatory blood pressure (mean difference systolic 0 mm Hg, 95% CI -2 to 2; diastolic 0 mm Hg, 95% CI -1 to 1), and estimated glomerular filtration rate (mean difference 1.2 mL/min/1.73 m(2), 95% CI -3.2 to 5.6). CONCLUSIONS: Exposure to repeat doses of antenatal betamethasone compared with a single course of glucocorticoids does not increase risk factors for cardiometabolic disease at early school age.

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  • Repeat antenatal glucocorticoids for women at risk of preterm birth: a Cochrane Systematic Review

    McKinlay, Christopher; NRCGD, User; Middleton, P; Harding, Jane (2012)

    Journal article
    The University of Auckland Library

    Administration of antenatal glucocorticoids to women at risk of preterm birth has major benefits for infants but the use of repeat dose(s) is controversial. We performed a systematic review of randomized trials, using standard Cochrane methodology, to assess the effectiveness and safety of 1 or more repeat doses given to women at risk of preterm birth 7 or more days after an initial course. Ten trials were included involving over 4730 women and 5700 infants. Treatment with repeat dose(s) compared with no repeat treatment reduced the risk of respiratory distress syndrome (risk ratio, 0.83; 95% confidence interval, 0.75-0.91) and serious neonatal morbidity (risk ratio, 0.84; 95% confidence interval, 0.75-0.94). At 2- to 3-year follow-up (4 trials, 4170 children), there was no evidence of either significant benefit or harm. Repeat doses of glucocorticoids should be considered in women at risk of preterm birth 7 or more days after an initial course, in view of the neonatal benefits.

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  • Outcome at 2 Years after Dextrose Gel Treatment for Neonatal Hypoglycemia: Follow-Up of a Randomized Trial

    Harris, Deborah; Alsweiler, Jane; Ansell, JM; Gamble, Gregory; Thompson, B; Wouldes, Trecia; Yu, Tzu-Ying; Harding, Jane (2016-03)

    Journal article
    The University of Auckland Library

    To determine neurodevelopmental outcome at 2??years' corrected age in children randomized to treatment with dextrose gel or placebo for hypoglycemia soon after birth (The Sugar Babies Study).This was a follow-up study of 184 children with hypoglycemia (<2.6??mM [47??mg/dL]) in the first 48??hours and randomized to either dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were performed at Kahikatea House, Hamilton, New Zealand, and included neurologic function and general health (pediatrician assessed), cognitive, language, behavior, and motor skills (Bayley Scales of Infant and Toddler Development, Third Edition), executive function (clinical assessment and Behaviour Rating Inventory of Executive Function-Preschool Edition), and vision (clinical examination and global motion perception). Coprimary outcomes were neurosensory impairment (cognitive, language or motor score below -1 SD or cerebral palsy or blind or deaf) and processing difficulty (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level.Mean (??SD) birth weight was 3093??????803??g and mean gestation was 37.7??????1.6??weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 38% vs placebo 34%, relative risk 1.11, 95% CI 0.75-1.63). Processing difficulty also was similar between groups (dextrose 10% vs placebo 18%, relative risk 0.52, 95% CI 0.23-1.15).Dextrose gel is safe for the treatment of neonatal hypoglycemia, but neurosensory impairment is common among these children.Australian New Zealand Clinical Trials Registry: ACTRN??12608000623392.

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  • Bayley-III motor scale and neurological examination at 2 years do not predict motor skills at 4.5 years

    Burakevych, N; McKinlay, Christopher; Alsweiler, Jane; Wouldes, Trecia; Harding, Jane (2017-02)

    Journal article
    The University of Auckland Library

    Aim: To determine whether Bayley Scales of Infant and Toddler Development (3rd edition) (Bayley-III) motor scores and neurological examination at 2 years corrected age predict motor difficulties at 4.5 years corrected age. Method: A prospective cohort study of children born at risk of neonatal hypoglycaemia in Waikato Hospital, Hamilton, New Zealand. Assessment at 2 years was performed using the Bayley-III motor scale and neurological examination, and at 4.5 years using the Movement Assessment Battery for Children (2nd edition) (MABC-2). Results: Of 333 children, 8 (2%) had Bayley-III motor scores below 85, and 50 (15%) had minor deficits on neurological assessment at 2 years; 89 (27%) scored less than or equal to the 15th centile, and 54 (16%) less than or equal to the 5th centile on MABC-2 at 4.5 years. Motor score, fine and gross motor subtest scores, and neurological assessments at 2 years were poorly predictive of motor difficulties at 4.5 years, explaining 0 to 7% of variance in MABC-2 scores. A Bayley-III motor score below 85 predicted MABC-2 scores less than or equal to the 15th centile with a positive predictive value of 30% and a negative predictive value of 74% (7% sensitivity and 94% specificity). Interpretation: Bayley-III motor scale and neurological examination at 2 years were poorly predictive of motor difficulties at 4.5 years.

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  • Mid-childhood outcomes of repeat antenatal corticosteroids: A randomized controlled trial

    Crowther, Caroline; Anderson, PJ; McKinlay, Christopher; Harding, Jane; Ashwood, PJ; Haslam, RR; Robinson, JS; Doyle, LW (2016-10)

    Journal article
    The University of Auckland Library

    Objective: To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years corrected age. METHODS: Women at risk for very preterm birth, who had received a course of corticosteroids ???7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Midchildhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability. RESULTS: Of the 1059 eligible long-term survivors, 963 (91%) were included in the primary outcome; 479 (91%) in the repeat corticosteroid group and 484 (91%) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3% repeat versus 77.3% placebo; risk ratio 1.00, 95% confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services. CONCLUSIONS: Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks gestation, ???7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.

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  • An emerging evidence base for the management of neonatal hypoglycaemia

    Harding, Jane; Harris, Deborah; Hegarty, Joanne; Alsweiler, Jane; McKinlay, Christopher (2017-01)

    Journal article
    The University of Auckland Library

    Neonatal hypoglycaemia is common, and screening and treatment of babies considered at risk is widespread, despite there being little reliable evidence upon which to base management decisions. Although there is now evidence about which babies are at greatest risk, the threshold for diagnosis, best approach to treatment and later outcomes all remain uncertain. Recent studies suggest that treatment with dextrose gel is safe and effective and may help support breast feeding. Thresholds for intervention require a wide margin of safety in light of information that babies with glycaemic instability and with low glucose concentrations may be associated with a higher risk of later higher order cognitive and learning problems. Randomised trials are urgently needed to inform optimal thresholds for intervention and appropriate treatment strategies.

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  • Global Motion Perception in 2-Year-Old Children: A Method for Psychophysical Assessment and Relationships With Clinical Measures of Visual Function

    Yu, Tzu-Ying; Jacobs, Robert; Anstice, Nicola; Paudel, Nabin; Harding, Jane; Thompson, Benjamin; CHYLD Study Team (2013-12)

    Journal article
    The University of Auckland Library

    Purpose. We developed and validated a technique for measuring global motion perception in 2-year-old children, and assessed the relationship between global motion perception and other measures of visual function. Methods. Random dot kinematogram (RDK) stimuli were used to measure motion coherence thresholds in 366 children at risk of neurodevelopmental problems at 24 ?? 1 months of age. RDKs of variable coherence were presented and eye movements were analyzed offline to grade the direction of the optokinetic reflex (OKR) for each trial. Motion coherence thresholds were calculated by fitting psychometric functions to the resulting datasets. Test???retest reliability was assessed in 15 children, and motion coherence thresholds were measured in a group of 10 adults using OKR and behavioral responses. Standard age-appropriate optometric tests also were performed. Results. Motion coherence thresholds were measured successfully in 336 (91.8%) children using the OKR technique, but only 31 (8.5%) using behavioral responses. The mean threshold was 41.7 ?? 13.5% for 2-year-old children and 3.3 ?? 1.2% for adults. Within-assessor reliability and test???retest reliability were high in children. Children's motion coherence thresholds were significantly correlated with stereoacuity (LANG I & II test, ?? = 0.29, P < 0.001; Frisby, ?? = 0.17, P = 0.022), but not with binocular visual acuity (?? = 0.11, P = 0.07). In adults OKR and behavioral motion coherence thresholds were highly correlated (intraclass correlation = 0.81, P = 0.001). Conclusions. Global motion perception can be measured in 2-year-old children using the OKR. This technique is reliable and data from adults suggest that motion coherence thresholds based on the OKR are related to motion perception. Global motion perception was related to stereoacuity in children.

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  • Arginine and mixed amino acids increase protein accretion in the growth-restricted and normal ovine fetus by different mechanisms

    De Boo, Hendrina; Van Zijl, PL; Smith, DEC; Kulik, W; Lafeber, HN; Harding, Jane (2005-08)

    Journal article
    The University of Auckland Library

    Protein metabolism may be perturbed in intrauterine growth restriction (IUGR). Arginine is indispensable for growth and nitrogen balance in young mammals. Fetuses with IUGR therefore may benefit from arginine supplementation. The purpose of this study was to determine 1) the effects of IUGR on protein metabolism in the ovine fetus and 2) the effects of arginine or mixed amino acid (AA) infusion on protein metabolism in these fetuses. Pregnant ewes and their fetuses were catheterized at 110 d gestation and randomly assigned to control or IUGR groups. IUGR was induced by repetitive placental embolization. Parameters of fetal protein metabolism were determined from [ring-H-2(5)]phenylatanine kinetics at baseline and in response to a 4-h infusion of either arginine or an isonitrogenous AA mixture. There were no differences in protein metabolism between control and IUGR groups either at baseline or in response to arginine or AA treatment. Both arginine and AA infusion increased fetal protein accretion in both groups. Arginine did this by decreasing protein turnover, synthesis, and breakdown. AAs increased protein turnover and synthesis while decreasing protein breakdown. AA infusion resulted in a significantly higher increase in protein accretion than arginine infusion. Thus, in the ovine fetus, placental embolization has no clear effect on protein metabolism. Arginine and AAs both stimulate protein accretion but do so in distinctly different ways. Mixed AA infusion has a greater effect on protein accretion than arginine alone and therefore maybe a better strategy for stimulating fetal growth.

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  • Customised birthweight centiles predict SGA pregnancies with perinatal morbidity

    McCowan, Lesley; Harding, Jane; Stewart, Alistair (2005-08)

    Journal article
    The University of Auckland Library

    Objectives To determine the following: (1) the proportion of babies reclassified as small or appropriately grown using customised and population centiles; and (2) the relative risks of perinatal morbidity, including abnormal umbilical Doppler studies, in babies classified as small for gestational age (SGA) and appropriate for gestational age (non-SGA) using the two centile calculations.Design Cohort study in SGA and general hospital populations.Setting National Women's Hospital, Auckland, NZ.Population A cohort of SGA pregnancies (n= 374) and a general obstetric population (n= 12,879).Methods Pregnancy outcomes were compared between 'non-SGA both' (>= 10th% by population and customised centiles) and those who were 'SGA both' (< 10th% by population and customised centiles), 'SGA customised only' (SGA by customised but non-SGA by population centiles) and 'SGA population only' (SGA by population but non-SGA by customised centiles).Main outcome measures Maternal and newborn morbidity and perinatal death.Results In the SGA cohort 271 (72%) babies were 'SGA both', 27 (7%) were 'SGA customised only', 32 (9%) were 'population SGA only' and 44 (12%) were 'non-SGA both'. In the general obstetric population 863 (6.7%) babies were 'SGA both', 445 (3.5%) were 'customised SGA only', 285 (2.2%) were 'population SGA only' and 11,286 (88%) were 'non-SGA both'. Perinatal death and newborn morbidity including nursery admission and long hospital stay were increased and comparable between 'SGA both' and 'customised SGA only' in both study populations. Newborn morbidity was low and comparable between 'population SGA only' and 'non-SGA both'. No perinatal deaths occurred in 'population SGA only' babies. Abnormal Doppler studies were more common in 'SGA both' or 'customised SGA only' but not in 'population SGA only' groups compared with 'non-SGA both'.Conclusions Customised birthweight centiles identified small babies at risk of morbidity and mortality. Use of customised centiles is likely to detect more babies at risk of perinatal morbidity and mortality than would be detected by population centiles.

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  • Cot-side electroencephalography for outcome prediction in preterm infants: observational study.

    West, CR; Harding, Jane; Williams, CE; Nolan, M; Battin, Malcolm (2010-09-24)

    Journal article
    The University of Auckland Library

    Objective To assess the use of two-channel electroencephalographical (EEG) recordings for predicting adverse neurodevelopmental outcome (death or Bayley II mental developmental index/psychomotor developmental index < 70) in extremely preterm infants and to determine the relationship between quantitative continuity measures and a specialist neurophysiologist assessment of the same EEG segment for predicting outcome. Design Observational study. Setting The study was conducted in a neonatal intensive care unit. Patients Preterm infants born s assessment was a better predictor of adverse outcome than the continuity measures (positive predictive value 95% CI 75 (54% to 96%) vs 41 (22% to 60) at 25-??V threshold, negative predictive value 88 (80% to 96%) vs 84 (74% to 94%) and positive likelihood ratio 9.0 (3.2 to 24.6) vs 2.0 (1.2 to 3.6)). All the infants with definite seizures identified by the neurophysiologist had poor outcomes. Conclusions Modified cot-side EEG has potential to assist with identification of extremely preterm infants at risk for adverse neurodevelopmental outcomes. However, analysis by a neurophysiologist performed better than the currently available continuity analyses.

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  • Effect of periconceptional undernutrition in sheep on late gestation expression of mRNA and protein from genes involved in fetal adrenal steroidogenesis and placental prostaglandin production

    Connor, KL; Bloomfield, Francis; Oliver, Mark; Harding, Jane; Challis, JRG (2009)

    Journal article
    The University of Auckland Library

    In sheep, maternal periconceptional undernutrition precociously activates fetal hypothalamic-pituitary-adrenal function in a high proportion of animals, resulting in preterm birth. We investigated whether the effects of periconceptional undernutrition were mediated through genes encoding enzymes involved in adrenal steroidogenesis and in placental production and metabolism of steroids and prostaglandins. Singleton-bearing ewes were fed ad libitum (control, N) throughout gestation or undernourished from 60 days before until 30 days after mating. Fetal adrenal and placentome tissues were collected on gestational day 131. Fetal adrenal P450C17 protein expression was significantly increased with undernutrition. Placental prostaglandin endoperoxide synthase-2 expression was not different between groups. In undernourished pregnancies, there were significant positive correlations between fetal plasma adrenocorticotrophic hormone and cortisol concentrations and between fetal plasma adrenocorticotrophic hormone concentrations and placental prostaglandin endoperoxide synthase-2 messenger RNA (mRNA) and protein. These studies suggest that periconceptional undernutrition affects fetal adrenal P450C17, consistent with an elevation in plasma cortisol, and this occurs prior to activation of placental prostaglandin endoperoxide synthase-2 expression at gestational day 131.

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  • Do Alterations in Placental 11 beta-Hydroxysteroid Dehydrogenase (11 beta HSD) Activities Explain Differences in Fetal Hypothalamic-Pituitary-Adrenal (HPA) Function Following Periconceptional Undernutrition or Twinning in Sheep?

    Connor, KL; Challis, JRG; van Zijl, P; Rumball, CW; Alix, S; Jaquiery, Anne; Oliver, Mark; Harding, Jane; Bloomfield, Francis (2009-12)

    Journal article
    The University of Auckland Library

    Periconceptional undernutrition (UN) in sheep accelerates fetal hypothalamic-pituitary-adrenal (HPA) axis activation, resulting in preterm birth. In contrast, twin conception suppresses fetal HPA function and delays prepartum HPA activation. We hypothesized that these dissimilar effects on fetal HPA activity result from different influences of maternal glucocorticoid (GC) on maturation of the fetal HPA axis, mediated via different activities of placental 11 beta-hydroxysteroid dehydrogenase (11 beta HSD) isozymes. We examined the effects of twinning and maternal periconceptional UN from 60 days before until 30 days after mating on the ontogeny of placental 11 beta HSD-1 and -2 enzyme activities. At day 85 of gestation, placental 11 beta HSD-2 activity was lower in UN than in normally nourished (N) fetuses (P < .05) and was higher in twins than in singletons (P < .05). Furthermore, placental 11 beta HSD-1 activity was not different between nutritional groups but was higher in twins than in singletons (P = .01). At day 85, fetal plasma cortisol (P < .001) and cortisone (P < .001) concentrations were lower in UN than in N fetuses, but the cortisol to cortisone ratio was higher in UN than in N fetuses (P = .01). There was no effect of fetus number on plasma cortisol or cortisone concentrations or on the ratio of cortisol to cortisone at day 85. Therefore, periconceptional UN and twinning may result in the alterations of placental 11 beta HSD isozyme activities at particular times during gestation. Changes in these activities during critical periods of fetal development could affect transplacental transfer or placental generation of GCs that reach the fetus, potentially influencing the timing of activation of the fetal HPA axis, fetal maturation, and hence the development and health later in life.

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