Infants In Australia Research Articles

Perinatal outcomes of Australian buprenorphine‐exposed mothers and their newborn infants

To determine the short-term outcomes of Australian buprenorphine-exposed mother/infant dyads. Retrospective record review of drug-exposed mothers and infants in Australia. Groups were based on drug exposure: buprenorphine (55, 3.8%), non-buprenorphine opiates (O, 686, 48.6%) and non-opiates (NO, 671, 47.5%). More than 30% of buprenorphine mothers continued to use heroin (21, 38%) and benzodiazepines (16, 29%). They were more likely to have child at risk concerns (29, 52.7%, P = 0.019) and have previous children placed in out-of-home care (9, 16.3%, P = 049). Buprenorphine babies were less likely to be preterm (16% vs. 25% (O), P = 0.001 and 23% (NO), P = 0.004) and had higher birthweights (median: 3165 g vs. 2842.5 g (O), P < 0.001 and 2900 g (NO), P = 0.004). Buprenorphine and non-buprenorphine opioid babies had similar maximum Finnegan scores (median 10 vs. 11(O), P = 0.144). The number of babies needing abstinence treatment (45% vs. 51% (O), P = 0.411) and length of hospital stay (median days 9 vs. 11(O), P = 0.067) were similar, but buprenorphine infants required lower maximum morphine doses (mg/kg/day) (median 0.4 mg vs. 0.5 mg (O), P = 0.009). Short-term medical outcomes of infants of buprenorphine-using mothers are similar to those of non-buprenorphine opiate-using mothers, but interpretation of these results is confounded by the high rates of polydrug exposure in the buprenorphine group. This and other social concerns noted in buprenorphine mothers and infants warrant further study.

Introducing Solids and Water to Australian Infants

Recommendations for the introduction of solids and fluids to an infant's diet have changed over the past decade. Since these changes, there has been minimal research to determine patterns in the introduction of foods and fluids to infants. This retrospective cohort study surveyed mothers who birthed in Queensland, Australia, from February 1 to May 31, 2010, around 4 months postpartum. Frequencies of foods and fluids given to infants at 4, 8, 13, and 17 weeks were described. Logistic regression determined associations between infant feeding practices, the introduction of other foods and fluids at 17 weeks, and sociodemographic characteristics. Response rate was 35.8%. At 17 weeks, 68% of infants were breastfed and 33% exclusively breastfed. Solids and water had been introduced in 8.6% and 35.0% of infants, respectively. The introduction of solids by 17 weeks was associated with younger maternal age and the infant being given water and infant formula at 4 weeks. The infant being given water at 17 weeks was associated with younger maternal age, the infant being given infant formula at 4 weeks, level of education, relative socioeconomic disadvantage, parity, and birth facility. Over the past decade, there has been a significant reduction in the proportion of infants in Australia who have been given solids by 17 weeks. Sociodemographic characteristics and formula feeding practices at 4 weeks were associated with the introduction of solids and water by 17 weeks. Further research should examine these barriers to improve compliance with current infant feeding recommendations.

Motor trajectories from 4 to 18 months corrected age in infants born at less than 30 weeks of gestation

BackgroundPreterm infants are recognised as developing at a significantly slower rate than their full-term peers and with different movement quality. AimThis study aimed to describe the longitudinal gross motor trajectories of these infants in the first 18months of (corrected) age and investigate factors associated with gross motor development. Study designA longitudinal study was conducted with convenience samples of 58 preterm infants born ≤29weeks of gestation and 52 control full-term infants in Australia. Outcome measuresThe infants were assessed at 4, 8, 12 and 18months of (corrected) age using the Alberta Infant Motor Scale (AIMS). ResultsForty-six preterm and 48 control infants completed all four assessments. The preterm group scored significantly lower on various sub-scores at all age levels. Almost half of the preterm infants demonstrated less progression in the sit sub-scale from 4 to 8months (corrected) age, possibly due to an imbalance between flexor and extensor strength in the trunk. At 12 and 18months of (corrected) age, lack of rotation and fluency in their movements were evident in some preterm infants. Presence of intra-ventricular haemorrhage and chronic lung disease were associated with poor motor performance at 4months and use of postnatal steroids was associated with poor motor performance at 4, 8 and 18months of corrected age. ConclusionThe imbalance between flexor and extensor muscle strength in preterm infants had a stronger impact on motor development than usually expected. The AIMS appears to be a sensitive assessment tool to demonstrate the unique movement characteristics in this preterm cohort.

The study protocol for a randomized controlled trial of a family-centred tobacco control program about environmental tobacco smoke (ETS) to reduce respiratory illness in Indigenous infants.

BackgroundAcute respiratory illness (ARI) is the most common cause of acute presentations and hospitalisations of young Indigenous children in Australia and New Zealand (NZ). Environmental tobacco smoke (ETS) from household smoking is a significant and preventable contributor to childhood ARI. This paper describes the protocol for a study which aims to test the efficacy of a family-centred tobacco control program about ETS to improve the respiratory health of Indigenous infants in Australia and New Zealand. For the purpose of this paper 'Indigenous' refers to Australia's Aboriginal and Torres Strait Islander peoples when referring to Australian Indigenous populations. In New Zealand, the term 'Indigenous' refers to Māori.Methods/DesignThis study will be a parallel, randomized, controlled trial. Participants will be Indigenous women and their infants, half of whom will be randomly allocated to an 'intervention' group, who will receive the tobacco control program over three home visits in the first three months of the infant's life and half to a control group receiving 'usual care' (i.e. they will not receive the tobacco control program). Indigenous health workers will deliver the intervention, the goal of which is to reduce or eliminate infant exposure to ETS. Data collection will occur at baseline (shortly after birth) and when the infant is four months and one year of age. The primary outcome is a doctor-diagnosed, documented case of respiratory illness in participating infants.DiscussionInterventions aimed at reducing exposure of Indigenous children to ETS have the potential for significant benefits for Indigenous communities. There is currently a dearth of evidence for the effect of tobacco control interventions to reduce children's exposure to ETS among Indigenous populations. This study will provide high-quality evidence of the efficacy of a family-centred tobacco control program on ETS to reduce respiratory illness. Outcomes of our study will be important and significant for Indigenous tobacco control in Australia and New Zealand and prevention of respiratory illness in children.Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12609000937213)

The comparison of health status and health services utilisation between Indigenous and non‐Indigenous infants in Australia

To examine the differences in health services utilisation and the associated risk factors between Indigenous and non-Indigenous infants at a national level in Australia. We analysed data from a national representative longitudinal study, the Longitudinal Study for Australian Children (LSAC) starting in 2004. We used survey logistic regression and survey multiple linear regression to examine the factors associated with health services utilisation. Health status of Indigenous infants was poorer than that of non-Indigenous. In comparison to non-Indigenous infants, in the previous 12-month period, the Indigenous infants were significantly less likely to use the following health services: maternal and child health centre or help lines (OR=0.35, 95%CI: 0.24-0.49); maternal and child health nurse visits (OR=0.45, 95%CI: 0.32-0.63); general practitioners (GPs) (OR=0.45, 95%CI: 0.31-0.64); and paediatrician (OR=0.52, 95%CI: 0.35-0.77). In contrast, they were more likely to visit a hospital outpatient clinic (OR=1.82, 95%CI: 1.16-2.85). Mothers' age, education and marital status were associated with certain health services use. Financial status and residential location were the important predictors of the use of health services. The rates of health services utilisation by Indigenous infants were lower and were associated with mothers' characteristics and socio-economic status. The gaps in health services utilisation between Indigenous and non-Indigenous infant requires immediate policy initiatives. Further research is needed to explore the causal pathways between health status, health services utilisation and multiple risk factors at different levels.

Effectiveness of 7-valent pneumococcal conjugate vaccine against radiologically diagnosed pneumonia in indigenous infants in Australia.

To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) in preventing pneumonia, diagnosed radiologically according to World Health Organization (WHO) criteria, among indigenous infants in the Northern Territory of Australia. We conducted a historical cohort study of consecutive indigenous birth cohorts between 1 April 1998 and 28 February 2005. Children were followed up to 18 months of age. The PCV7 programme commenced on 1 June 2001. All chest X-rays taken within 3 days of any hospitalization were assessed. The primary endpoint was a first episode of WHO-defined pneumonia requiring hospitalization. Cox proportional hazards models were used to compare disease incidence. There were 526 pneumonia events among 10,600 children - an incidence of 3.3 per 1000 child-months; 183 episodes (34.8%) occurred before 5 months of age and 247 (47.0%) by 7 months. Of the children studied, 27% had received 3 doses of vaccine by 7 months of age. Hazard ratios for endpoint pneumonia were 1.01 for 1 versus 0 doses; 1.03 for 2 versus 0 doses; and 0.84 for 3 versus 0 doses. There was limited evidence that PCV7 reduced the incidence of radiologically confirmed pneumonia among Northern Territory indigenous infants, although there was a non-significant trend towards an effect after receipt of the third dose. These findings might be explained by lack of timely vaccination and/or occurrence of disease at an early age. Additionally, the relative contribution of vaccine-type pneumococcus to severe pneumonia in a setting where multiple other pathogens are prevalent may differ with respect to other settings where vaccine efficacy has been clearly established.

Expressed breast milk as 'connection' and its influence on the construction of 'motherhood' for mothers of preterm infants: a qualitative study

BackgroundBreast milk is considered the optimal nutrition for all newborn infants. While there is high initiation of lactation among mothers of preterm infants in Australia, there is a rapid decline of continued lactation. Furthermore, there is an inverse relationship between infant gestation and duration of lactation. To better understand the breastfeeding experience of parents of very low birth weight (VLBW) preterm infants an interpretive phenomenological study was conducted.MethodsThis longitudinal study was conducted using an interpretive phenomenological approach. Data were collected from 17 parents through 45 individual interviews with both mothers and fathers, from birth to 12 months of age. This data was then transcribed verbatim and analysed using thematic analysis.ResultsThe analysis identified six primary themes: the intention to breastfeed naturally; breast milk as connection; the maternal role of breast milk producer; breast milk as the object of attention; breastfeeding and parenting the hospitalised baby and the demise of breastfeeding. This paper reports on the theme of 'breast milk as connection'.Providing expressed breast milk offered one way the mothers could be physiologically and emotionally connected to their preterm infant while they were in the constant care of hospital staff. Indeed, breast milk was considered the only way the new mother could connect her body (or part there of) to her preterm baby in hospital. This sense of connection however, comes at a cost. On the one hand, the breast milk offers a feeling of connection to the baby, but, on the other, this connection comes only after disconnection of the mother and baby and – through breast expression – mother and her milk. This ability of breast milk to connect mother and baby makes the expressed breast milk highly valued, and places unexpected pressure on the mother to produce milk as integral to her sense of motherhood.ConclusionThe findings of this study have implications for healthcare practice. It is evident that the association of breastfeeding success with mothering success only jeopardises some families' self-esteem and sense of parenting ability. These findings suggest it would be beneficial to find alternate ways to connect preterm infants and their parents in the preterm nursery environment, and find more positive ways to support breastfeeding.

Trends in use and outcome of newborn infants treated with high frequency ventilation in Australia and New Zealand, 1996–2003

To examine the use of high frequency ventilation (HFV) to treat newborn infants in Australia and New Zealand and the associated complications and outcomes. Data for all infants receiving HFV were collected from the 28 neonatal intensive care units contributing to the Australian and New Zealand Neonatal Network database between 1996 and 2003, inclusive. For comparison, the same data were gathered on all infants who received conventional mechanical ventilation (CMV) and nasal continuous positive airway pressure. HFV was used to treat 3270 infants (10.1% of all ventilated infants) between 1996 and 2003; uptake doubled during this period from 5.9% to 12.6% of ventilated infants per year. HFV was most frequently applied in the context of extreme prematurity (29.9% of ventilated infants <26 weeks gestation). HFV is being increasingly used to treat complex diseases such as meconium aspiration syndrome and congenital diaphragmatic hernia (12.2% and 10.6% in 1996 to 25.2% and 48.4% in 2003, respectively, chi2 -test for trend, P<0.001). Infants receiving HFV spent longer on respiratory support than infants treated with CMV (median 21 days compared with 7 days, Mann-Whitney test P<0.001) and required a higher initial FiO2 (median 0.8 compared to 0.5, Mann-Whitney test, P<0.001). The use of HFV was associated with a higher mortality than CMV and nasal continuous positive airway pressure (39.7%, 10.1% and 0.4%, chi2 -test, P<0.001). The incidence of death and intraventricular haemorrhage decreased over time in the HFV group (chi2 -test for trend, P<0.001 and P=0.02 respectively). HFV is an established mode of neonatal ventilation in Australia and New Zealand. HFV is being applied to infants at the greatest risk of serious adverse outcomes, most likely as a rescue therapy.

Maternal obesity and breastfeeding

There have been studies showing that breastfeeding may be protective against the development of obesity in the child. It has been less clear whether obesity in the mother has an impact on the success and duration of breastfeeding. Oddy et al report on a study of over 1800 mothers and infants in Australia. They found that obese women were more likely to discontinue breastfeeding compared to normal weight women. This relationship remained significant even after controlling for potential confounders. The reasons for a shorter period of breastfeeding among mothers with obesity are not clear; they could be related to physical factors, hormonal differences, or other issues. This suggests that mothers with obesity deserve greater attention and support to achieve better results with breastfeeding.

Primary prevention of neural tube defects with folate in Western Australia: the value of the Western Australian Birth Defects Registry

This paper reviews the role of the Western Australian Birth Defects Registry in the primary prevention of neural tube defects. The Registry provides complete and up-to-date information on all neural tube defects (NTD), including terminations of pregnancy. These data have been used to determine a baseline rate of NTD and to monitor trends in NTD over time, when health promotion of folic acid supplement use and voluntary fortification of food with folate were introduced. The register has also been used to investigate NTD in special populations (Indigenous infants in Australia) and as a sampling frame for case control studies. The data derived from these studies have been used to assist in assessing whether mandatory food fortification in Australia is indicated to prevent NTD.

The Epidemiology of Meconium Aspiration Syndrome: Incidence, Risk Factors, Therapies, and Outcome

We sought to examine, in a large cohort of infants within a definable population of live births, the incidence, risk factors, treatments, complications, and outcomes of meconium aspiration syndrome (MAS). Data were gathered on all of the infants in Australia and New Zealand who were intubated and mechanically ventilated with a primary diagnosis of MAS (MASINT) between 1995 and 2002, inclusive. Information on all of the live births during the same time period was obtained from perinatal data registries. MASINT occurred in 1061 of 2,490,862 live births (0.43 of 1000), with a decrease in incidence from 1995 to 2002. A higher risk of MASINT was noted at advanced gestation, with 34% of cases born beyond 40 weeks, compared with 16% of infants without MAS. Fetal distress requiring obstetric intervention was noted in 51% of cases, and 42% were delivered by cesarean section. There was a striking association between low 5-minute Apgar score and MASINT. In addition, risk of MASINT was higher where maternal ethnicity was Pacific Islander or indigenous Australian and was also increased after planned home birth. Uptake of exogenous surfactant, high-frequency ventilation, and inhaled nitric oxide increased considerably during the study period, with >50% of infants receiving > or =1 of these therapies by 2002. Risk of air leak was 9.6% overall, with an apparent reduction to 5.3% in 2001-2002. The duration of intubation remained constant throughout the study period (median: 3 days), whereas duration of oxygen therapy and length of hospital stay increased. Death related to MAS occurred in 24 infants (2.5% of the MASINT cohort; 0.96 per 100,000 live births). The incidence of MASINT in the developed world is low and seems to be decreasing. Risk of MASINT is significantly greater in the presence of fetal distress and low Apgar score, as well as Pacific Islander and indigenous Australian ethnicity. The increased use of innovative respiratory supports has not altered the duration of mechanical ventilation.

Physician counselling practices and decision‐making for extremely preterm infants in the Pacific Rim

This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability. A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information. Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.

Management of the Umbilical Cord

After completing this article, readers should be able to: 1. Describe the most serious infection that may result from inappropriate management of the umbilical cord and potential sources. 2. Describe the relationship between infant bacterial colonization and postpartum infection. 3. List the most common neonatal staphylococcal infections. 4. List the factors that affect the timing of cord separation. 5. Delineate the probable causes of drainage from the umbilical stump. This review addresses several aspects of the care of the umbilical cord: how to ligate and cut it, what (if anything) to apply to it, the problems that may be associated with ligation and cutting, and the natural history of cord separation. The traditional method of ligating the umbilical cord was to use string or twine to tie the cord before cutting it. In Southern Sudan, fine stringlike roots are used to tie the cord. More recently in the United States, special cotton tape (umbilical tape) was used and still is found on most trays used for insertion of catheters into umbilical blood vessels. Because the umbilical cord tends to shrink after birth, these types of ligature proved somewhat unreliable in preventing hemorrhage. Although the umbilical arteries tend to constrict rapidly after birth because of the muscular walls, this does not occur with the umbilical vein. Consequently, more efficient and effective methods of ligation were sought in the middle of the 20th century. The first method was to use constricting rubber bands, which were effective, but somewhat difficult to apply. This method recently found favor in a developing country (Ethiopia). However, the more usual method in developed countries currently is plastic or metal clamps, which produce safe, reliable constriction. In particular, the plastic Hollister® clamp (Double-Grip Umbilical Cord Clamp, Hollister, Libertyville, IL) has been very successful in preventing bleeding from the cord. These devices are removed …

Choice of formula and human milk supplement for preterm infants in Australia.

Human milk (HM) is considered to be the optimal feed of choice for neonates, however, for preterm infants, HM fortifiers are often added to increase growth. If HM is unavailable, preterm formula is the next best option for preterm infants. Choosing which fortifier, if any, to use or which formula can be confusing. In this paper, the composition of milk feeds available in Australia and New Zealand is reviewed with the aim of assisting paediatricians to decide which feed is most appropriate for their patients.

Neonatology for the generalist: human milk banks and evidence-based medicine.

Human milk (HM) banks provide pasteurised milk from screened donors for infants in many countries but not in Australia. There are potential benefits and risks from feeding donor milk with the benefits most likely for preterm infants. A randomized clinical trial is required to provide conclusive evidence. Promotion of breast-feeding with the establishment of HM banks may prove to be an important primary health care activities for infants in Australia.

Evaluation of neurodevelopmental outcome in highrisk infants in Australia

An understanding of the neurodevelopmental outcome of long-term survivors of neonatal intensive care is essential for the informed management of preterm or high risk infants. This annotation looks at the current status of neonatal follow-up services in Australasia and highlights problems in the collection and interpretation of data. It suggests that we should work towards achieving a consensus on standard definitions and test regimes and on national data collection.

Recreating the village: the development of groups to improve social relationships among mothers of newborn infants in Australia

There is a clear link between social relationships and health in terms of both morbidity and mortality. The study was conducted during 1989 and 1990 among mothers of newborn infants from a middle-ranking socioeconomic status suburb in Sydney (Ryde). Thirty-four per cent of the study group had a moderate level of social isolation and 16 per cent had a high level of social isolation. These mothers strongly valued participation in the groups: virtually all original participants remained with the group both during a five-week formal period with a nursing staff member as the leader and during months and up to five years of continued meetings. The outcomes appear to be favourable in terms of the development and continuation of strong interpersonal relationships among members of the group and by improved confidence and knowledge about infant rearing. The development of groups of mothers adds no cost to the provision of health services and provides a sound and practical way of reducing social isolation and increasing mothercraft skills in an Australian suburb.

Serum IgE antibodies in sudden infant death syndrome

MANY THEORIES have been advanced to explain sudden infant death syndrome; some hypothesize that the deaths may have an immunologic basis. Parish et al 1 suggested in 1960 that anaphylactic reactions to cow milk may be responsible. In 1972, Mulvey~.reported a greater prevalence of house dust mites (Dermatophagoides t)tero nyssinus) in the homes of SIDS victims than in the homes of control infants in Australia. Stimulated by this observation, Turner et al e. ' measured serum IgE antibodies to D. pteronyssinus, Aspergillus fumigatus, and/3-1actoglobulin from cow milk in SIDS victims and in control infants. Their findings suggested an elevation in IgE antibodies to these allergens in a greater proportion of SIDS victims than in controls, particularly with respect to D. pteronyssinus. In an effort to confirm these findings, we measured IgE antibodies to the s,ame three allergens in sera of SIDS victims and of control infants.