Publications by authors named "Alison Loughran-Fowlds"

Globally, the call for Family-Friendly (FF) workplaces is loud and clear. However, this call is inaudible in medical workplaces, despite both well-established benefits of FF workplaces across businesses and well-known effects of work-family conflict on the well-being and practice of doctors. We aimed to use the Delphi consensus methodology to: (i) operationalise the Family-Friendly medical workplace and (ii) develop a Family-Friendly Self-Audit tool for medical workplaces.

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Purpose: To investigate the risk of developmental coordination disorder (DCD) and motor impairment for children aged 8 to 9 years following newborn surgery.

Methods: Prospective longitudinal cohort study. Motor proficiency and risk of DCD were assessed using the Movement Assessment Battery for Children (second edition) for children born 37 weeks of gestation and older who had undergone newborn cardiac surgery (CS) or non-cardiac surgery (NCS).

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Importance: Cerebral palsy (CP) is the most common childhood physical disability. Early intervention for children younger than 2 years with or at risk of CP is critical. Now that an evidence-based guideline for early accurate diagnosis of CP exists, there is a need to summarize effective, CP-specific early intervention and conduct new trials that harness plasticity to improve function and increase participation.

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Background: Developmentally supportive environments are known to improve medical outcomes for hospitalized neonates and are considered the overarching philosophy for practice in the neonatal setting. Developmental rounds are a strategy incorporated by multidisciplinary teams to support development within and beyond the neonatal unit. Typically, they consist of bedside consultations and individualized developmentally supportive recommendations for families and clinicians.

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Introduction: The second edition of the Movement Assessment Battery for Children (M ABC-2) is a standardised, norm referenced assessment that is frequently used by therapists to identify children with motor difficulties. The norms for the M ABC-2 were derived from a sample of children in the United Kingdom (UK) and are combined across the age groups for boys and girls. The aims of this research were to investigate gender differences in the performance of 8- and 9-year-old Australian children and if the norms in our cohort differed from UK-based M ABC-2 norms.

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Advances in neonatal care have improved survival of premature and critically ill infants; and while rates of some long-term neurodevelopmental problems in survivors have improved, such as cerebral palsy, there are others such as learning and behavioural difficulties that have not. The goal of improving long term neurodevelopmental morbidity has led to an increased focus on improving developmental care not only in neonatal long term follow- up clinics but within the NICU itself to capture the period of earliest brain neuroplasticity. The application of a systematic approach to improve practice is considered the most effective strategy for implementing neuroprotective developmentally supportive care.

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Article Synopsis
  • * This study followed 202 infants who underwent major surgery, assessing their GMs at three months old, with outcomes tracked up to three years; it found that infants without fidgety movements were significantly more likely to have abnormal outcomes.
  • * Specifically, 9% of infants lacked fidgety movements, with many later diagnosed with CP or other developmental disabilities, highlighting the GMs assessment's predictive value and the need for its use in routine follow-up care.
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  • - Neurodevelopmental disability (NDD) is frequently seen in newborns who have complex surgeries for congenital heart disease (CHD), but the long-term effects of this disability are unclear.
  • - There are several critical questions that remain unanswered regarding NDD and CHD, highlighting the need for further research to improve patient care and intervention strategies.
  • - The article identifies current knowledge gaps related to NDD in CHD and suggests potential future research directions to enhance outcomes for individuals affected by CHD across their lifespan.
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Background: Management of hypoplastic left heart syndrome (HLHS) presents many challenges. We describe our institutional outcomes for management of patients with HLHS over the past 12 years and highlight our strategy for those with highly restrictive/intact interatrial septum (R/I-IAS).

Methods: Eighty-eight neonates with HLHS underwent surgical treatment, divided equally into Era-I (n = 44, April 2006 to February 2013) and Era-II (n = 44, March 2013 to June 2018).

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Purpose: The study compared neurodevelopmental outcome at 3 years of age of infants with infantile hypertrophic pyloric stenosis (IHPS) who underwent pyloromyotomy with healthy control infants in New South Wales, Australia.

Methods: Infants with IHPS as well as controls were recruited between August 2006 and July 2008. Developmental assessments were performed using the Bayley scales of infant and toddler development (version III) (BSITD-III) at 1 and 3 years of age.

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Article Synopsis
  • Up to 20% of children with congenital heart disease (CHD) who undergo surgery experience neurodevelopmental disabilities (NDD), with some showing lasting effects; genetic research has linked CHD to NDD.
  • In this study, researchers used a gene panel to analyze genetic variants in three groups: 15 children with both CHD and NDD, 15 with only CHD, and 15 healthy controls, finding significant differences in rare variants between these groups.
  • The results suggest a correlation between novel and rare genetic variants in CHD patients and the development of NDD, highlighting specific genetic pathways related to brain function; however, further research is needed to translate these findings into clinical practices.
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Background: Previous predictive research has predominantly focussed on infants who are preterm, low birth weight, who have a specific condition or who have undergone a specific procedure.

Aim: This study investigated the ability of outcomes at one year of age to predict outcomes at three years using the Bayley-III for infants who have undergone early major cardiac surgery (CS) or non-cardiac (NC) surgery and their healthy peers.

Study Design: Participants who were part of the Development After Infant Surgery (DAISy) study who had complete Bayley-III assessments at one and three years of age were included in the analyses.

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Article Synopsis
  • Acute brain injury, particularly white matter injury, occurs in around 75% of neonates undergoing cardiopulmonary bypass (CPB), with a study finding that 12% of these neonates suffer from stroke, more common in those undergoing the Norwood procedure (24% vs. 8%).
  • Key predictors for stroke include the type of procedure (Norwood), lowest operative temperature, and the use of extracorporeal membrane oxygenation, with significant correlations found in subsequent analyses.
  • At 12 months, neurodevelopmental disability (NDD) was more prevalent in neonates who experienced a stroke, with 68% showing NDD in at least one subscale; the Norwood
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Importance: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age.

Objectives: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function.

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  • Previous research found that infants with esophageal atresia (OA) or tracheoesophageal fistula (TOF) had lower expressive language scores at one year compared to control infants.
  • This study reassessed 24 of these infants at three years to evaluate their cognitive and language development, using standardized tests (Bayley Scales).
  • By three years, infants with OA/TOF scored within the normal range on all developmental measures and showed significant improvement, likely due to early intervention services they received.
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Objective: The objective of this study was to determine whether there remain developmental differences between term infants at 3 years of age following major non-cardiac surgery (NCS) and cardiac surgery (CS) compared with healthy control infants in New South Wales (NSW), Australia.

Study Design: Between 2006 and 2008, term infants who required NCS or CS within the first ninety days of life were enrolled in a prospective population-based study. Their developmental outcome was then compared with a cohort of healthy term infants.

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Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.

Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion.

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A 24-day-old boy presented with fever, irritability and poor feeding. Blood culture grew methicillin-resistant Staphylococcus aureus. Cerebrospinal fluid analysis showed pleocytosis, and methicillin-resistant Staphylococcus aureus grew from enrichment broth.

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Background: Standardised developmental tests are now widely used in neurodevelopmental assessments of infants and children. In 2006, the revised and updated version of the Bayley Scales of Infant and Toddler Development (version III) replaced the previous version and is now widely used in neonatal developmental follow-up clinics. Several papers from Australia have highlighted underestimation of developmental impairment up to age 2 using this revised version.

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Aim: The role of granulocyte-specific S100A12, a marker for inflammatory disorders, in newborn lung disease is unknown. We compared postnatal blood S100A12 concentrations against respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD).

Methods: Blood samples from 92 newborns were collected on admission, 12 h, day 1, day 3-4 and day 7, and analysed for S100A12.

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Background: We present six cases of infants with Robin sequence and severe obstructive sleep apnoea who failed treatment with nasal mask continuous positive airway pressure (CPAP). Surgical intervention with mandibular distraction osteoneogenesis with glossopexy meant tracheostomy was avoided. Polysomnography (PSG) was used to document the severity of the obstructive sleep apnoea.

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Aim: To obtain information on the practices and beliefs of junior doctors regarding neonatal pain and to compare this with best evidence.

Methods: A survey was distributed to junior doctors in five tertiary neonatal intensive care units in Sydney. Questions investigated the doctors' knowledge and treatment of pain in neonates, specifically regarding the perception and effects of pain, pain assessment tools, and the safety and efficacy of treatments for both procedural and long-term pain.

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Clara cell secretory protein (CC10) is an important anti-inflammatory mediator in the adult lung, but its role in newborn pulmonary protection is uncertain. We examined the early postnatal behavior of CC10 in newborn serum and tracheal fluid and hypothesized that CC10 production is positively influenced by gestation. Blood from 165 infants from the first, third/fourth, and seventh days of life (gestational ages: 23-29 wk, 30-36 wk, >36 wk) and tracheal fluid (TF) from the first day of life from 32 ventilated infants were analyzed for CC10.

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Scimitar syndrome is a relatively uncommon constellation of cardio-pulmonary anomalies, its typical feature being partial anomalous pulmonary venous connection. It can present in the neonatal period as well as later in life. We present the case of a girl diagnosed in the newborn period, along with a brief review of literature.

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