114 results for Harding, Jane, Journal article

  • 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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  • 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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  • 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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  • Brief neonatal nutritional supplementation has sex-specific effects on glucose tolerance and insulin regulating genes in juvenile lambs

    Jaquiery, Anne; Park, SS; Phua, HH; Berry, MJ; Meijler, D; Harding, Jane; Oliver, Mark; Bloomfield, Francis (2016-12)

    Journal article
    The University of Auckland Library

    BACKGROUND: The nutritional plane and composition during fetal life can impact upon growth and epigenetic regulation of genes affecting pancreatic ??-cell development and function. However, it is not clear whether ??-cell development can be altered by nutritional factors or growth rate after birth. We therefore investigated the effect of neonatal nutritional supplements on growth, glucose tolerance, and pancreatic development in lambs. METHODS: Newborn lambs were randomized to daily nutritional supplements, calculated to increase macronutrient intake to a similar degree as human breast milk fortifier, or an equivalent volume of water, for 2???wk while continuing to suckle ewe milk. Intravenous glucose tolerance test (IVGTT) was performed at 4 mo of age, and pancreata collected for molecular analysis. RESULTS: Supplemented lambs had slower weight gain than controls. In supplemented lambs, insulin response to IVGTT was increased in males but decreased in females, compared to same sex controls, and was unrelated to growth rate. mRNA expression of key genes in ??-cell development showed sexually dimorphic effects. Epigenetic change occurred in the promotor region of PDX1 gene with decreased suppression and increased activation marks in supplemented lambs of both sexes. CONCLUSION: Nutritional interventions in early life have long-term, sex-specific effects on pancreatic function.Pediatric Research (2016); doi:10.1038/pr.2016.168.

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  • Oral dextrose gel for the prevention of hypoglycaemia in newborn infants

    Hegarty, Joanne; Harding, Jane; Crowther, CA; Brown, Julie; Alsweiler, Jane (2016)

    Journal article
    The University of Auckland Library

    This is the protocol for a review and there is no abstract. The objectives are as follows: To assess whether oral dextrose gel in infants at risk of neonatal hypoglycaemia is more effective than placebo or no treatment or other active therapies (such as antenatal expression of colostrum, early initiation of breastfeeding, supplementation or substitution of breastfeeding with formula milk) in: ??? preventing hypoglycaemia in newborn infants; ??? reducing developmental impairments at childhood follow-up.

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  • Re: Antenatal corticosteroids: a time for more careful scrutiny of the indications? The most reliable evidence is reassuring

    Harding, Jane; Dalziel, SR (2016-09)

    Journal article
    The University of Auckland Library

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  • Relationship between measures of neonatal glycemia, neonatal illness, and 2-year outcomes in very preterm infants

    Tottman, Anna; Alsweiler, Jane; Bloomfield, Francis; Pan, M; Harding, Jane (2017-09)

    Journal article
    The University of Auckland Library

    Objectives: To investigate relationships between early neonatal glycemia, neonatal characteristics, neonatal illness, and developmental outcomes in very preterm infants. Study design: A retrospective, observational cohort study of 443 infants born weighing < 1500 g or < 30 weeks of gestation, and admitted within 24 hours to National Women's Hospital, Auckland, New Zealand. Glucose variability was defined as the standard deviation around the mean after log transformation of all blood glucose concentrations. Absolute glycemic excursions in the first week were used to divide the infants into 4 groups: normoglycemic; hypoglycemic; hyperglycemic, and unstable. Results: Compared with normoglycemic infants, hypoglycemic and unstable infants had lower birth weight z-scores, and hyperglycemic and unstable infants were of lower birth weight. Hypoglycemic infants had similar outcomes to normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neonatal morbidity and less likely to survive without neurodevelopmental impairment at 2 years of age. Higher mean blood glucose concentration was seen in the hyperglycemic and unstable groups, and was associated with worse neonatal and 2-year outcomes. Greater glucose variability was seen in the hypoglycemic and unstable groups, and was associated with worse neonatal illness but not outcome at 2 years. No associations between measures of neonatal glycemia and neonatal or 2-year outcomes remained after correction for gestation, birth weight z-score, and socioeconomic status. Conclusions: In very preterm infants, measures of neonatal glycemia are markers of gestational age and intrauterine growth, and are not independent predictors of neonatal illness or outcomes at 2 years of age.

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  • Effects of periconceptional undernutrition on the initiation of parturition in sheep

    Kumarasamy, Vasumathy; Mitchell, Murray; Bloomfield, Francis; Oliver, Mark; Campbell, ME; Challis, JRG; Harding, Jane (2005-01)

    Journal article
    The University of Auckland Library

    In sheep, parturition is initiated by increased fetal hypothalamic-pituitary-adrenal axis ( HPAA) activity leading to PGE(2) and PGF(2alpha) production and a rise in the 17beta-estradiol-progesterone (E-2/P-4) ratio. Uteroplacental PG production can also increase fetal HPAA activity. Periconceptional maternal undernutrition accelerates fetal HPAA maturation resulting in preterm labor. We determined whether preterm labor was preceded by an increase in PG concentrations and E-2/P-4 ratio and whether these increases preceded or followed the corresponding rise in cortisol concentrations. Singleton-bearing ewes were nourished ad libitum (N, n = 9) or undernourished (UN, n = 10) to reduce maternal weight by 15% from - 61 days (d) to + 30 d after mating with ad libitum intake thereafter. Paired maternal and fetal blood samples were collected from 126 d until delivery. Half the UN group delivered prematurely ( > 2 SD below mean gestation for the flock). PG and cortisol concentrations and E-2/P-4 ratio increased before delivery in the same way in both groups. However, the increases occurred 7 - 10 d earlier in UN than in N animals. In both UN and N fetuses cortisol concentrations rose before fetal and maternal PG concentrations and maternal E-2/P-4 ratio. Periconceptional maternal undernutrition induces preterm delivery in sheep by advancing the expected prepartum rise in cortisol and PG concentrations and E-2/P-4 ratio. The rise in fetal cortisol concentration precedes the rise in fetal and maternal PG concentrations and maternal E-2/P-4 ratio, suggesting that the underlying mechanism is likely to be acceleration of fetal HPAA maturation, resulting in initiation of the normal process of parturition.

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  • A periconceptional nutritional origin for noninfectious preterm birth

    Bloomfield, Francis; Oliver, Mark; Hawkins, Paul; Campbell, M; Phillips, DJ; Gluckman, Peter; Challis, JRG; Harding, Jane (2003-04-25)

    Journal article
    The University of Auckland Library

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  • Chronic pulsatile infusion of growth hormone to growth-restricted fetal sheep increases circulating fetal insulin-like growth factor-I levels but not fetal growth

    Bauer, MK; Breier, Bernhard; Bloomfield, Francis; Jensen, EC; Gluckman, Peter; Harding, Jane (2003-04)

    Journal article
    The University of Auckland Library

    Intra-uterine growth restriction (IUGR) is a major cause of perinatal mortality and morbidity. Postnatally, growth hormone (GH) increases growth, increases circulating insulin-like growth factor (IGF)-I levels, and alters metabolism. Our aim was to determine if GH infusion to IUGR fetal sheep would alter fetal growth and metabolism, and thus provide a potential intra-uterine treatment for the IUGR fetus. We studied three groups of fetuses: control, IUGR+ vehicle and IUGR+GH (n=5 all groups). IUGR was induced by repeated embolisation of the placental vascular bed between 110 and 116 days of gestation (term=145 days). GH (3.5 mg/kg/day) or vehicle was infused in a pulsatile manner from 117 to 127 days of gestation. Embolisation reduced fetal growth rate by 25% (P<0.04). Both returned to pre-embolisation levels after embolisation stopped, but blood glucose concentrations declined steadily in IUGR+vehicle fetuses. GH treatment maintained fetal blood glucose concentrations at control levels. Our study shows that GH infusion to the IUGR fetal sheep restores fetal IGF-I levels but does not improve fetal growth, and further reduces the fetal kidney and intestine weights. Thus, fetal GH therapy does not seem a promising treatment stratagem for the IUGR fetus.

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  • Pre-school screening for developmental and emotional health: Comparison with neurodevelopmental assessment

    Burakevych, N; McKinlay, D; Alsweiler, Jane; Wouldes, Trecia; Harding, Jane (2016-06)

    Journal article
    The University of Auckland Library

    The study aim was to compare detection of and referral for developmental and emotional problems in a school readiness screening programme (New Zealand Before School Check, B4SC) with that of a comprehensive neurodevelopmental assessment.This is a prospective cohort study of children (n???=???274) born at risk of neonatal hypoglycaemia and recruited to a follow-up study of neurodevelopmental outcomes at 4.5???years (Children with Hypoglycaemia and their Later Development (CHYLD) Study). Children identified as of significant concern for developmental and emotional problems, and referrals made, were compared in the B4SC and CHYLD Study. Scores of the parent-completed Strengths and Difficulties Questionnaire used in both assessments were compared.Of the 274 children who underwent clinical neurodevelopmental assessment at a mean (standard deviation) age of 53.3 (1.8) months, 237 had the B4SC developmental and emotional health screening. Of these, 44 (19%) children met B4SC referral criteria, and 15 (6%) were referred, but only 21 (9%) children met CHYLD referral criteria, and 10 (4%) were referred. Twelve children (5%) met both the B4SC and CHYLD referral criteria, and two were referred by both. When assessed twice, 39 (17%) children changed parent-completed Strengths and Difficulties Questionnaire category. Children who did not have B4SC screening had higher mean total difficulties score (10.5 vs. 8.2, P???=???0.009) and were more likely to have cognitive delay than those who were screened (19% vs. 8%, P???=???0.04).More children met referral criteria for the B4SC screening programme than for a more comprehensive neurodevelopmental assessment. Children who did not have screening had a higher incidence of cognitive and behaviour problems than those who did.

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  • Randomised trial of neonatal hypoglycaemia prevention with oral dextrose gel (hPOD): study protocol

    Harding, Jane; Hegarty, Joanne; Crowther, Caroline; Edlin, Richard; Gamble, Gregory; Alsweiler, Jane (2015-09)

    Journal article
    The University of Auckland Library

    Background: Neonatal hypoglycaemia is common, affecting up to 15??% of newborn babies and 50??% of those with risk factors (preterm, infant of a diabetic, high or low birthweight). Hypoglycaemia can cause brain damage and death, and babies born at risk have an increased risk of developmental delay in later life. Treatment of hypoglycaemia usually involves additional feeding, often with infant formula, and admission to Neonatal Intensive Care for intravenous dextrose. This can be costly and inhibit the establishment of breast feeding. Prevention of neonatal hypoglycaemia would be desirable, but there are currently no strategies, beyond early feeding, for prevention of neonatal hypoglycaemia. Buccal dextrose gel is safe and effective in treatment of hypoglycaemia. The aim of this trial is to determine whether 40??% dextrose gel given to babies at risk prevents neonatal hypoglycaemia and hence reduces admission to Neonatal Intensive Care. Methods/Design: Design: Randomised, multicentre, placebo controlled trial. Inclusion Criteria: Babies at risk of hypoglycaemia (preterm, infant of a diabetic, small or large), less than 1??h old, with no apparent indication for Neonatal Intensive Care Unit admission and mother intends to breastfeed. Trial entry & randomisation: Eligible babies of consenting parents will be allocated by online randomisation to the dextrose gel group or placebo group, using a study number and corresponding trial intervention pack. Study groups: Babies will receive a single dose of 0.5??ml/kg study gel at 1??h after birth; either 40??% dextrose gel (200??mg/kg) or 2??% hydroxymethylcellulose placebo. Gel will be massaged into the buccal mucosal and followed by a breast feed. Primary study outcome: Admission to Neonatal Intensive Care. Sample size: 2,129 babies are required to detect a decrease in admission to Neonatal Intensive Care from 10-6??% (two-sided alpha 0.05, 90??% power, 5??% drop-out rate). Discussion: This study will investigate whether admission to Neonatal Intensive Care can be prevented by prophylactic oral dextrose gel; a simple, cheap and painless intervention that requires no special expertise or equipment and hence is applicable in almost any birth setting. Trial registration: Australian New Zealand Clinical Trials Registry - ACTRN 12614001263684 .

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  • Accuracy of caregivers' recall of hospital admissions: implications for research

    Burakevych, N; McKinlay, Christopher; Alsweiler, Jane; Harding, Jane; CHYLD Study team (2015-11)

    Journal article
    The University of Auckland Library

    AIM: To determine the accuracy of caregivers' recall of hospital admissions in early childhood. METHODS: Prospective cohort study of babies born at risk of neonatal hypoglycaemia at Waikato Hospital, New Zealand, a regional public hospital and sole provider of acute inpatient care to over 100,000 children. Caregivers' recall of children's hospital admissions up to 4.5 years were compared with medical records. Accuracy of recall was related to neonatal and socio-demographic characteristics. RESULTS: Out of 267 children, 179 (67%) visited hospital and 106 (40%) were admitted at least once. The most frequent reasons for admission were for respiratory (29%) and gastrointestinal (18%) problems. Of 106 children admitted to hospital, 27 (25%) caregivers did not recall the admission and only 37 (35%) accurately recalled the number of admissions. The accuracy of recall was lower for gastrointestinal (38%) and surgical (40%) problems, while recall of respiratory (64%) and ear, nose and throat (60%) admissions was more accurate. Low socio-economic status and multiple admissions were associated with less accurate recall of number of admissions. CONCLUSION: Caregivers do not accurately report hospital admissions. Questionnaire data about use of hospital facilities should be interpreted cautiously, and may not be sufficiently accurate for use in research studies.

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  • Neonatal Glycemia and Neurodevelopmental Outcomes at 2 Years.

    McKinlay, Christopher; Alsweiler, Jane; Ansell, JM; Anstice, Nicola; Chase, JG; Gamble, Gregory; Harris, Deborah; Jacobs, Robert; Jiang, Yannan; Paudel, N; Signal, M; Thompson, Benjamin; Wouldes, Trecia; Yu, TY; Harding, Jane (2015-10)

    Journal article
    The University of Auckland Library

    BACKGROUND: Neonatal hypoglycemia is common and can cause neurologic impairment, but evidence supporting thresholds for intervention is limited. METHODS: We performed a prospective cohort study involving 528 neonates with a gestational age of at least 35 weeks who were considered to be at risk for hypoglycemia; all were treated to maintain a blood glucose concentration of at least 47 mg per deciliter (2.6 mmol per liter). We intermittently measured blood glucose for up to 7 days. We continuously monitored interstitial glucose concentrations, which were masked to clinical staff. Assessment at 2 years included Bayley Scales of Infant Development III and tests of executive and visual function. RESULTS: Of 614 children, 528 were eligible, and 404 (77% of eligible children) were assessed; 216 children (53%) had neonatal hypoglycemia (blood glucose concentration, <47 mg per deciliter). Hypoglycemia, when treated to maintain a blood glucose concentration of at least 47 mg per deciliter, was not associated with an increased risk of the primary outcomes of neurosensory impairment (risk ratio, 0.95; 95% confidence interval [CI], 0.75 to 1.20; P=0.67) and processing difficulty, defined as an executive-function score or motion coherence threshold that was more than 1.5 SD from the mean (risk ratio, 0.92; 95% CI, 0.56 to 1.51; P=0.74). Risks were not increased among children with unrecognized hypoglycemia (a low interstitial glucose concentration only). The lowest blood glucose concentration, number of hypoglycemic episodes and events, and negative interstitial increment (area above the interstitial glucose concentration curve and below 47 mg per deciliter) also did not predict the outcome. CONCLUSIONS: In this cohort, neonatal hypoglycemia was not associated with an adverse neurologic outcome when treatment was provided to maintain a blood glucose concentration of at least 47 mg per deciliter. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others.).

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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 doses of prenatal corticosteroids for women at risk of preterm birth for improving neonatal health outcomes

    Crowther, Caroline; McKinlay, Christopher; Middleton, P; Harding, Jane (2015)

    Journal article
    The University of Auckland Library

    BACKGROUND: It has been unclear whether repeat dose(s) of prenatal corticosteroids are beneficial. OBJECTIVES: To assess the effectiveness and safety of repeat dose(s) of prenatal corticosteroids. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 January 2015), searched reference lists of retrieved studies and contacted authors for further data. SELECTION CRITERIA: Randomised controlled trials of women who had already received a single course of corticosteroids seven or more days previously and considered still at risk of preterm birth. DATA COLLECTION AND ANALYSIS: We assessed trial quality and extracted data independently. MAIN RESULTS: We included 10 trials (a total of 4733 women and 5700 babies) with low to moderate risk of bias. Treatment of women who remain at risk of preterm birth seven or more days after an initial course of prenatal corticosteroids with repeat dose(s), compared with no repeat corticosteroid treatment, reduced the risk of their infants experiencing the primary outcomes respiratory distress syndrome (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.75 to 0.91, eight trials, 3206 infants, number needed to treat to benefit (NNTB) 17, 95% CI 11 to 32) and serious infant outcome (RR 0.84, 95% CI 0.75 to 0.94, seven trials, 5094 infants, NNTB 30, 95% CI 19 to 79).Treatment with repeat dose(s) of corticosteroid was associated with a reduction in mean birthweight (mean difference (MD) -75.79 g, 95% CI -117.63 to -33.96, nine trials, 5626 infants). However, outcomes that adjusted birthweight for gestational age (birthweight Z scores, birthweight multiples of the median and small-for-gestational age) did not differ between treatment groups.At early childhood follow-up, no statistically significant differences were seen for infants exposed to repeat prenatal corticosteroids compared with unexposed infants for the primary outcomes (total deaths; survival free of any disability or major disability; disability; or serious outcome) or in the secondary outcome growth assessments. In women, for the two primary outcomes, there was no increase in infectious morbidity of chorioamnionitis or puerperal sepsis, and the likelihood of a caesarean birth was unchanged. AUTHORS' CONCLUSIONS: The short-term benefits for babies of less respiratory distress and fewer serious health problems in the first few weeks after birth support the use of repeat dose(s) of prenatal corticosteroids for women still at risk of preterm birth seven days or more after an initial course. These benefits were associated with a small reduction in size at birth. The current available evidence reassuringly shows no significant harm in early childhood, although no benefit.Further research is needed on the long-term benefits and risks for the woman and baby. Individual patient data meta-analysis may clarify how to maximise benefit and minimise harm.

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  • The ProVIDe study: The impact of protein intravenous nutrition on development in extremely low birthweight babies

    Bloomfield, Francis; Crowther, Caroline; Harding, Jane; Conlon, CA; Jiang, Yannan; Cormack, Barbara (2015-08-26)

    Journal article
    The University of Auckland Library

    Background Preterm birth and very small size at birth have long-term effects on neurodevelopment and growth. A relatively small percentage of extremely low birthweight babies suffer from severe neurological disability; however, up to 50 % experience some neurodevelopmental or learning disability in childhood. Current international consensus is that increased protein intake in the neonatal period improves both neurodevelopment and growth, but the quantum of protein required is not known. This trial aims to assess whether providing an extra 1 to 2 g.kg -1 .d -1 protein in the first 5 days after birth will improve neurodevelopmental outcomes and growth in extremely low birthweight babies. Methods/Design The ProVIDe study is a multicentre, two-arm, double-blind, parallel, randomised, controlled trial. In addition to standard intravenous nutrition, 430 babies with a birthweight of less than 1000 g who have an umbilical arterial line in situ will be randomised in 1:1 ratio to receive either an amino acid solution (TrophAmine??) or placebo (saline) administered through the umbilical arterial catheter for the first 5 days. Exclusion criteria are admission to neonatal intensive care more than 24 h after birth; multiple births of more than 2 babies; known chromosomal or genetic abnormality, or congenital disorder affecting growth; inborn error of metabolism, and in danger of imminent death. Primary outcome: Survival free from neurodevelopmental disability at 2 years??? corrected age, where neurodevelopmental disability is defined as cerebral palsy, blindness, deafness, developmental delay (standardised score more than 1 SD below the mean on the cognitive, language or motor subscales of the Bayley Scales of Infant Development Edition 3), or Gross Motor Function Classification System score ???1. Secondary outcomes: Growth, from birth to 36 weeks??? corrected gestational age, at neonatal intensive care discharge and at 2 years??? corrected age; body composition at 36 to 42 weeks??? corrected postmenstrual age and at 2 years??? corrected age; neonatal morbidity, including length of stay; nutritional intake. Discussion This trial will provide the first direct evidence of the effects of giving preterm babies a higher intake of intravenous protein in the first week after birth on neurodevelopmental outcomes at 2 years corrected age. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612001084875.

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  • Impact of Retrospective Calibration Algorithms on Hypoglycemia Detection in Newborn Infants Using Continuous Glucose Monitoring

    Signal, M; Le Compte, A; Harris, Deborah; Weston, PJ; Harding, Jane; Chase, JG (2012-10)

    Journal article
    The University of Auckland Library

    Background: Neonatal hypoglycemia is common and may cause serious brain injury. Diagnosis is by blood glucose (BG) measurements, often taken several hours apart. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing the number of BG measurements. Calibration algorithms convert sensor signals into CGM output. Thus, these algorithms directly affect measures used to quantify hypoglycemia. This study was designed to quantify the effects of recalibration and filtering of CGM data on measures of hypoglycemia (BG <2.6 mmol/L) in neonates. Subjects and Methods: CGM data from 50 infants were recalibrated using an algorithm that explicitly recognized the high-accuracy BG measurements available in this study. CGM data were analyzed as (1) original CGM output, (2) recalibrated CGM output, (3) recalibrated CGM output with postcalibration median filtering, and (4) recalibrated CGM output with precalibration median filtering. Hypoglycemia was classified by number of episodes, duration, severity, and hypoglycemic index. Results: Recalibration increased the number of hypoglycemic events (from 161 to 193), hypoglycemia duration (from 2.2% to 2.6%), and hypoglycemic index (from 4.9 to 7.1 ??mol/L). Median filtering postrecalibration reduced hypoglycemic events from 193 to 131, with little change in duration (from 2.6% to 2.5%) and hypoglycemic index (from 7.1 to 6.9 ??mol/L). Median filtering prerecalibration resulted in 146 hypoglycemic events, a total duration of hypoglycemia of 2.6%, and a hypoglycemic index of 6.8 ??mol/L. Conclusions: Hypoglycemia metrics, especially counting events, are heavily dependent on CGM calibration BG error, and the calibration algorithm. CGM devices tended to read high at lower levels, so when high accuracy calibration measurements are available it may be more appropriate to recalibrate the data. ?? Copyright 2012, Mary Ann Liebert, Inc. 2012.

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  • Mothers of babies enrolled in a randomized trial immediately after birth report a positive experience

    Harris, Deborah; Weston, PJ; Harding, Jane (2014)

    Journal article
    The University of Auckland Library

    Objective:Randomized trials are essential for improving outcomes, but researchers can be hesitant about undertaking clinical trials in newborn babies because of perceived vulnerability of the baby and risk of increasing parental anxiety. There is a paucity of evidence about the parental experience. We investigated mothers' experiences of having their newborn baby participate in a randomized double-blind placebo-controlled trial soon after birth.Study Design:Eligible mothers had consented to their baby's participation in the Sugar Babies Study. Mothers of potentially eligible babies were invited to join the study antenatally, but others were approached postnatally. Babies were enrolled in the study soon after birth and remained in the study for 48???h. After 2 weeks the birth mothers were interviewed by phone about their experience.Result:Four hundred and eighty-one mothers were enrolled, of whom 310 (64%) gave consent antenatally. All mothers were contacted and 477 (99%) were interviewed. The majority of mothers (458, 96%) reported they would consent to participating again, if they had another eligible baby, and 460 mothers (96%) reported they would recommend participation to family and friends. Nineteen mothers (4%) reported they did not like the heel lance blood tests, which were part of routine clinical care and not part of the trial protocol.Conclusion:Most mothers reported the experience of having their newborn baby participate in a clinical trial as positive. Most negative responses were related to aspects of routine care rather than the trial protocol.

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  • Antenatal glucocorticoids: where are we after forty years?

    McKinlay, Christopher; Dalziel, SR; Harding, Jane (2015)

    Journal article
    The University of Auckland Library

    Since their introduction more than forty years ago, antenatal glucocorticoids have become a cornerstone in the management of preterm birth and have been responsible for substantial reductions in neonatal mortality and morbidity. Clinical trials conducted over the past decade have shown that these benefits may be increased further through administration of repeat doses of antenatal glucocorticoids in women at ongoing risk of preterm and in those undergoing elective cesarean at term. At the same time, a growing body of experimental animal evidence and observational data in humans has linked fetal overexposure to maternal glucocorticoids with increased risk of cardiovascular, metabolic and other disorders in later life. Despite these concerns, and somewhat surprisingly, there has been little evidence to date from randomized trials of longer-term harm from clinical doses of synthetic glucocorticoids. However, with wider clinical application of antenatal glucocorticoid therapy there has been greater need to consider the potential for later adverse effects. This paper reviews current evidence for the short- and long-term health effects of antenatal glucocorticoids and discusses the apparent discrepancy between data from randomized clinical trials and other studies.

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