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Borre Y.E.,Alimentary Pharmabiotic Center | O'Keeffe G.W.,University College Cork | O'Keeffe G.W.,Cork University Maternity Hospital | Clarke G.,Alimentary Pharmabiotic Center | And 7 more authors.
Trends in Molecular Medicine | Year: 2014

Gut microbiota is essential to human health, playing a major role in the bidirectional communication between the gastrointestinal tract and the central nervous system. The microbiota undergoes a vigorous process of development throughout the lifespan and establishes its symbiotic rapport with the host early in life. Early life perturbations of the developing gut microbiota can impact neurodevelopment and potentially lead to adverse mental health outcomes later in life. This review compares the parallel early development of the intestinal microbiota and the nervous system. The concept of parallel and interacting microbial-neural critical windows opens new avenues for developing novel microbiota-modulating based therapeutic interventions in early life to combat neurodevelopmental deficits and brain disorders. © 2014 Elsevier Ltd. Source

Cregan A.,Cork University Maternity Hospital
Irish medical journal | Year: 2013

Venous thromboembolism (VTE) remains one of the leading direct causes of maternal death. Risk factors for VTE and prophylaxis guidelines have been highlighted by the Royal College of Obstetricians and Gynaecologists (RCOG). A cross sectional study was completed in Cork University Maternity Hospital (CUMH) to determine pattern of VTE risk and compliance with 2004 RCOG guidelines. 364 women's charts were reviewed. Forty percent (n = 145) were at risk for VTE, 69% (n = 100) of these received thromboprophylaxis but only 54% (n = 54) received the correct weight adjusted dose. Three of four morbidly obese women in this study received recommended thromboprophylaxis but none at the appropriate dose. Only 67% (n = 245) had a recorded body mass index (BMI). Increased BMI is a significant risk factor for VTE and should be measured and recorded at the booking visit. Awareness of the risks for VTE and the need for appropriate dosing should be improved. Source

Khan R.,Cork University Maternity Hospital
Irish medical journal | Year: 2010

We explored the opinions of healthcare providers on the antenatal management and outcome of preterm delivery at less than 28 weeks gestation. An anonymous postal questionnaire was sent to health care providers. The response rate was 55% (74% Obstetrician, 70% neonatologist). Twenty four weeks is the limit at which most would advocate intervention. At 23 weeks 67% of neonatologists advocate antenatal steroids. 50% of all health care providers advocate cardiotocographic monitoring at 24 weeks gestation. Written information on survival and long-term outcome is provided by 8% of the respondents. Neonatologists (50%) were more likely than obstetrician (40%) to advocate caesarean section at 25 weeks. We conclude that 24 weeks is the limit at which most would advocate intervention. Significant variation exists both between and within each health care group at less than 25 weeks. Establishment and provision of national outcome data may aid decision making at the limits of viability. Source

Zareen Z.,Cork University Maternity Hospital
Archives of disease in childhood. Fetal and neonatal edition | Year: 2013

A variety of suction catheters (type, size and design) are recommended for oropharyngeal suctioning of meconium during newborn resuscitation, but it is not known which performs best. In this study we compared different sizes of soft catheters, the Yankauer (YK) and the portable bulb syringe (BS), in suctioning a solution of varying viscosity. Simulated meconium (SM) was made using commercial canned pea soup in two strengths, full-strength thick-particulate (TP) and 50% strained soup diluted with water, that is, thin-non-particulate (TnP), with saline as a control. A 20 ml aliquot of solution was suctioned over 5 s with each device using an electrical suction pump set at two different pressures, 100 and 150 mm Hg (21 kpa). In addition, the negative pressure of five BSs was measured in order to compare generated pressures with the alternative devices. The YK and BS suctioned almost 100% of saline, while the 6F and 8F catheters suctioned 50% and 75% saline, respectively. The YK suctioned 100% of TnP, saline and 30% of TP. At reduced suction pressures (100 and 50 mm Hg) the YK also suctioned all TnP. The 12F and 14F catheters suctioned a minimal amount of TP, whereas YK was the most efficient, suctioning 30% of TP. The mean negative pressure generated with five BSs was 78 and 71 mm Hg by a male and female operator, respectively. The YK and BS outperform the catheters in suctioning SM. The YK is the best for TP, but all devices perform poorly in suctioning fluid of this consistency. Source

Dempsey E.,Cork University Maternity Hospital
Cochrane database of systematic reviews (Online) | Year: 2011

Screening examinations for retinopathy of prematurity (ROP) are performed routinely in the neonatal intensive care unit and are a recognised cause of pain in the newborn. To determine the effect of instillation of topical anaesthetic eye drops compared with placebo or no treatment on pain in infants undergoing ROP screening. We used the standard search strategy of the Cochrane Neonatal Review Group. This included a search of the Cochrane Neonatal Group register and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 10, 2010). We identified relevant studies by searching the following: (1) computerised bibliographic databases: MEDLINE (1966 to October 2010), EMBASE (1988 to October 2010) and Web of Science (1975 to March 2010; (2) the Oxford Database of Perinatal Trials. We searched electronically abstracts from PAS from 2000 to 2010 and handsearched abstracts from ESPR from 2000 to 2009. All randomised, or quasi-randomised controlled trials, or randomised cross-over trials. We used the standard methods of the Cochrane Neonatal Review Group. We identified two studies for inclusion. Both studies were randomised cross-over trials performed in single centres. Both studies used the Premature Infant Pain Profile (PIPP) score as a measure of pain response. Different methods of evaluating PIPP scores are presented including the absolute PIPP score, a PIPP score > 10 or > 12 and an increase in PIPP ≥ 4 from the baseline value. There is a nonsignificant reduction in pain scores at one minute and a nonsignificant increase at five minutes post insertion of the speculum. PIPP score > 12 at one minute resulted in a statistically significant reduction in the number of patients who experienced pain (typical risk ratio (RR) 0.56, 95% CI 0.36 to 0.89; typical risk difference (RD) -0.23, 95% CI -0.39 to -0.86; number needed to treat to benefit (NNTB) 4). When pain was defined as an increase in PIPP > 4 there was a statistically significant reduction in the absolute number of patients who experienced pain at one minute (typical RR 0.70, 95% CI 0.52 to 0.94; typical RD -0.19, 95% CI -0.34 to -0.04; NNTB 5.3). The administration of topical proparacaine 30 seconds prior to the ophthalmological evaluation was associated with a reduction in pain scores especially at the time of speculum insertion. However, despite treatment, screening remains a painful procedure and the role of nonpharmacological and pharmacological intervention including different local anaesthetic agents should be ascertained in future randomised trials. Source

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