Center for Perinatal Medicine

Bedford Park, Australia

Center for Perinatal Medicine

Bedford Park, Australia
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Miller J.,Womens and Childrens Health Research Institute | Miller J.,University of Adelaide | Makrides M.,Womens and Childrens Health Research Institute | Makrides M.,University of Adelaide | And 9 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: Preterm human milk-fed infants often experience suboptimal growth despite the use of human milk fortifier (HMF). The extra protein supplied in fortifiers may be inadequate to meet dietary protein requirements for preterm infants. Objective: We assessed the effect of human milk fortified with a higher-protein HMF on growth in preterm infants. Design: This is a randomized controlled trial in 92 preterm infants born at <31 wk gestation who received maternal breast milk that was fortified with HMF containing 1.4 g protein/100 mL (higher-protein group) or 1.0 g protein/100 mL (current practice) until discharge or estimated due date, whichever came first. The HMFs used were isocaloric and differed only in the amount of protein or carbohydrate. Length, weight, and head-circumference gains were assessed over the study duration. Results: Length gains did not differ between the higher- and standard-protein groups (mean difference: 0.06 cm/wk; 95% CI: -0.01, 0.12 cm/wk; P = 0.08). Infants in the higher-protein group achieved a greater weight at study end (mean difference: 220 g; 95% CI: 23, 419 g; P = 0.03). Secondary analyses showed a significant reduction in the proportion of infants who were less than the 10th percentile for length at the study end in the higher-protein group (risk difference: 0.186; 95% CI: 0.370, 0.003; P = 0.047). Conclusions: A higher protein intake results in less growth faltering in human milk-fed preterm infants. It is possible that a higher-protein fortifier than used in this study is needed. This trial was registered with the Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au/) as ACTRN12606000525583. © 2012 American Society for Nutrition.


Collins C.T.,Womens and Childrens Health Research Institute | Collins C.T.,University of Adelaide | Makrides M.,Womens and Childrens Health Research Institute | Makrides M.,University of Adelaide | And 11 more authors.
British Journal of Nutrition | Year: 2011

The effect of the dietary n-3 long-chain PUFA, DHA (22:6n-3), on the growth of pre-term infants is controversial. We tested the effect of higher-dose DHA (approximately 1% dietary fatty acids) on the growth of pre-term infants to 18 months corrected age compared with standard feeding practice (0•20•3 % DHA) in a randomised controlled trial. Infants born < 33 weeks gestation (n 657) were randomly allocated to receive breast milk and/or formula with higher DHA or standard DHA according to a concealed schedule stratified for sex and birth-weight ( < 1250 and 1250 g). The dietary arachidonic acid content of both diets was constant at approximately 0•4 % total fatty acids. The intervention was from day 2 to 5 of life until the infant's expected date of delivery (EDD). Growth was assessed at EDD, and at 4, 12 and 18 months corrected age. There was no effect of higher DHA on weight or head circumference at any age, but infants fed higher DHA were 0•7 cm (95 % CI 0•1, 1•4 cm; P = 0•02) longer at 18 months corrected age. There was an interaction effect between treatment and birth weight strata for weight (P = 0•01) and length (P = 0•04). Higher DHA resulted in increased length in infants born weighing 1250 g at 4 months corrected age and in both weight and length at 12 and 18 months corrected age. Our data show that DHA up to 1 % total dietary fatty acids does not adversely affect growth. © 2011 The Authors.


Adelson P.L.,University of Adelaide | Wedlock G.R.,Womens and Childrens Hospital | Wilkinson C.S.,Womens and Childrens Hospital | Howard K.,University of Sydney | And 2 more authors.
Australian Health Review | Year: 2013

Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of 319 per woman (95% CI -104 to 742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of 433 (95% CI -282 to 1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to 156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to 'ripen' can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E2. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation. © 2013 AHHA.


Anderson J.,Center for Perinatal Medicine | Noori K.,Center for Perinatal Medicine | Morris S.A.,Center for Perinatal Medicine
Journal of Paediatrics and Child Health | Year: 2013

Aim To describe the outcome of the 4-month immunisation in a cohort of extremely preterm babies who had clinically significant apnoea after their 2-month immunisation. Method A retrospective audit was conducted from January 2001 to January 2011 at Flinders Medical Centre (FMC). Suspected apnoeic reactions to the 2-month immunisation in preterm infants ≤28 weeks + 6 days gestation were identified from the Neonatal Unit database. The medical records of babies with reactions then reviewed. We classified apnoeic reactions using predefined criteria into likely, possible or unlikely. The outcomes for subsequent immunisations were determined either when babies were specifically readmitted to FMC for immunisation and cardiorespiratory monitoring, or from the SA Health Immunisation Unit database. Results There were 203 extremely preterm babies at FMC over the study period who received their 2-month immunisation as inpatients. Clinically significant apnoea post immunisation occurred in 17 (8.4%) babies (likely in 12 and possible 5). The subsequent (4-month) immunisation was given with inpatient cardiorespiratory monitoring in nine babies (seven with likely and two with possible reactions), and no instability was identified. There were eight babies not readmitted to FMC for the subsequent immunisation. No reported adverse events were recorded on the SA Health Immunisation Unit database for these babies. Conclusions Apnoea following the 2-month immunisation in extremely preterm infants is not likely to be repeated with the subsequent immunisation. Prospective surveillance using standardised case definitions and monitoring protocols in this population are required to guide uniform practice. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).


PubMed | Center for Perinatal Medicine
Type: Journal Article | Journal: Journal of paediatrics and child health | Year: 2013

To describe the outcome of the 4-month immunisation in a cohort of extremely preterm babies who had clinically significant apnoea after their 2-month immunisation.A retrospective audit was conducted from January 2001 to January 2011 at Flinders Medical Centre (FMC). Suspected apnoeic reactions to the 2-month immunisation in preterm infants 28 weeks + 6 days gestation were identified from the Neonatal Unit database. The medical records of babies with reactions then reviewed. We classified apnoeic reactions using predefined criteria into likely, possible or unlikely. The outcomes for subsequent immunisations were determined either when babies were specifically readmitted to FMC for immunisation and cardiorespiratory monitoring, or from the SA Health Immunisation Unit database.There were 203 extremely preterm babies at FMC over the study period who received their 2-month immunisation as inpatients. Clinically significant apnoea post immunisation occurred in 17 (8.4%) babies (likely in 12 and possible 5). The subsequent (4-month) immunisation was given with inpatient cardiorespiratory monitoring in nine babies (seven with likely and two with possible reactions), and no instability was identified. There were eight babies not readmitted to FMC for the subsequent immunisation. No reported adverse events were recorded on the SA Health Immunisation Unit database for these babies.Apnoea following the 2-month immunisation in extremely preterm infants is not likely to be repeated with the subsequent immunisation. Prospective surveillance using standardised case definitions and monitoring protocols in this population are required to guide uniform practice.

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