Publications by authors named "Mandy Daly"

Importance: Sepsis is one of the leading causes of neonatal mortality. There is heterogeneity in the outcomes measured and reported in studies of neonatal sepsis. To address this challenge, a core outcome set (COS) for research on neonatal sepsis was needed.

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Sepsis is the overwhelming immunological response to infection, which if not treated can lead to multi-organ failure, shock and death. Specifically, neonatal sepsis results in 225,000 neonatal deaths globally per annum. Moreover, Uganda experiences one of the highest materno-fetal death rates (62,000 p.

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Background: Spontaneous preterm birth (sPTB) has a deep immediate impact on patients but also alters their care and experience in subsequent pregnancies. There is an absence of the pregnant patient's voice in the research surrounding pregnancy at risk of sPTB.

Materials/methods: The Preterm Birth Advisory Council was established at the National Maternity Hospital (NMH) in January 2023, to introduce and embed the patient voice in research into sPTB prevention.

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Aim: Immune dysregulation and delayed onset of sleep wake cycling (SWC) are associated with worse outcome in neonatal encephalopathy (NE), however the association between sleep and immune dysfunction in NE remains unclear. Aimed to evaluate association of sleep and systemic inflammation with outcomes in NE.

Methods: Amplitude-integrated electroencephalography (aEEG) recordings were collected on infants undergoing therapeutic hypothermia (TH).

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Article Synopsis
  • Neonatal encephalopathy (NE) is a serious condition impacting newborns, where therapeutic hypothermia is the standard treatment, yet many still face long-term issues; the paper aims to create a Core Outcome Set (COS) for consistent reporting in studies.* -
  • A systematic review of 116 papers identified 386 reported outcomes from NE studies, categorized into 18 domains, highlighting a lack of uniformity as no single outcome was universally reported across studies.* -
  • The findings emphasize the need for standardized outcome measures, including family input, to improve the comparison of treatments and enhance research on NE.*
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Article Synopsis
  • This study looked at how different people, like parents and doctors, feel about the effects of treatments for neonatal sepsis, which is a serious infection in newborns.
  • The researchers found 19 important outcomes that matter to these people, like how the treatment affects parents and their babies' organs.
  • They concluded that it's important to include these personal views in future research to get a full picture of what's important in treating neonatal sepsis, since the views shared were different from what doctors usually report in clinical trials.
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This meta-analysis assessed short-term outcomes after using human milk-derived fortifiers (HMFs) compared with bovine milk fortifiers (BMFs) in preterm infants fed an exclusive human milk (HM) diet, either mother's own milk (MOM) or donor human milk (DHM). We searched PubMed, Embase, Google Scholar, CENTRAL and CINHAL between January 2015 and August 2023 for studies reporting outcomes in infants with ≤28 weeks gestation and/or birthweight ≤ 1500 g on an exclusive human milk diet fortified with HMF versus BMF. The primary outcomes were death and NEC (stage ≥ 2).

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Background: International studies have reported conflicting data about the effects of COVID-19 pandemic policy measures on maternal and neonatal health. A major impact was reported on stillbirth and prematurity. The published literature suggests that the economic setting influenced the effects of imposed mitigation measures with a more severe effect in low-income countries.

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Background: Heterogeneity in outcomes reported in trials of interventions for the treatment of neonatal encephalopathy (NE) makes evaluating the effectiveness of treatments difficult. Developing a core outcome set for NE treatment would enable researchers to measure and report the same outcomes in future trials. This would minimise waste, ensure relevant outcomes are measured and enable evidence synthesis.

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Article Synopsis
  • Neonatal sepsis is a serious illness in newborns, and different studies measure its effects in different ways, making it hard to compare results.
  • Researchers want to create a Core Outcome Set (COS) to standardize what outcomes should be measured for treatments of neonatal sepsis, using input from parents, healthcare workers, and researchers.
  • By getting everyone to agree on what to measure through online surveys and meetings, this project hopes to make research on neonatal sepsis clearer and more useful.
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Background: Delphi surveys are commonly used to prioritise critical outcomes in core outcome set (COS) development. This trial aims to compare a three-round (Multi-Round) Delphi (MRD) with a Real-Time Delphi (RTD) in the prioritisation of outcomes for inclusion in a COS for neonatal encephalopathy treatments and explore whether 'feedback', 'iteration', and 'initial condition' effects may occur in the two survey methods.

Methods: We recruited 269 participants (parents/caregivers, healthcare providers and researchers/academics) of which 222 were randomised to either the MRD or the RTD.

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The past decades have seen markedly improved survival of increasingly immature preterm infants, yet major health complications persist. This is particularly true for bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, which has become the most common sequelae of prematurity and a significant predictor of respiratory morbidity throughout childhood as well as adult life, neurodevelopmental disability, cardiovascular disease, and even death. The need for novel approaches to reduce BPD and related complications of prematurity has never been more critical.

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Human milk (HM) fortification has been recommended for the nutritional optimization of very low-birthweight infants. This study analyzed the bioactive components of HM and evaluated fortification choices that could accentuate or attenuate the concentration of such components, with special reference to human milk-derived fortifier (HMDF) offered to extremely premature infants as an exclusive human milk diet. An observational feasibility study analyzed the biochemical and immunochemical characteristics of mothers' own milk (MOM), both fresh and frozen, and pasteurized banked donor human milk (DHM), each supplemented with either HMDF or cow's milk-derived fortifier (CMDF).

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Article Synopsis
  • Preterm birth (PTB) is a major cause of infant mortality globally, and studies show mixed results regarding its rates during COVID-19 lockdowns, with changes ranging from -90% to +30%.
  • Analysis of data from 52 million births in 26 countries indicates modest reductions in PTB rates during the first three months of lockdown, but no significant changes in the fourth month.
  • High-income countries showed an increase in stillbirth risk during the first month of lockdown, with Brazil experiencing increased stillbirth rates throughout the entire lockdown period, highlighting the need for further investigation into these trends.
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Objective: To identify the outcomes considered important to parents or caregivers of infants diagnosed with neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia in high-income and low- to middle-income countries (LMiCs), as part of the outcome-identification process in developing a core outcome set (COS) for the treatment of neonatal encephalopathy.

Design: A qualitative study involving 25 semistructured interviews with parents or other family members (caregivers) of infants who were diagnosed with, and treated for, neonatal encephalopathy, hypoxic ischaemic encephalopathy or birth asphyxia.

Setting: Interviews were conducted in high-income countries (HiCs) (n=11) by Zoom video conferencing software and in LMiCs (n=14) by phone or face to face.

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Introduction: Approximately, one in ten infants is born preterm or requires hospitalization at birth. These complications at birth have long-term consequences that can extend into childhood and adulthood. Timely detection of developmental delay through surveillance could enable tailored support for these babies and their families.

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Article Synopsis
  • The study aimed to define and validate types of pain in critically ill neonates and infants, involving collaboration among researchers and clinicians in neonatal care.
  • Each study stage built upon the previous one, starting with expert panels defining pain, identifying clinical characteristics, creating case scenarios, and finally testing these definitions through an international survey.
  • Results showed significant agreement on definitions and the ability to distinguish between acute and chronic pain in this population, highlighting the need for further research on other pain types.
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Preterm birth is the leading cause of infant death worldwide, but the causes of preterm birth are largely unknown. During the early COVID-19 lockdowns, dramatic reductions in preterm birth were reported; however, these trends may be offset by increases in stillbirth rates. It is important to study these trends globally as the pandemic continues, and to understand the underlying cause(s).

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Background: The Delphi method is used in a wide variety of settings as a method of building consensus on important issues. Traditionally, the Delphi method uses multiple rounds of a survey to allow for feedback of other participants' survey responses in between rounds. By informing participants about how others answer a question or prioritise specific topics, it allows for diverse opinions to inform the consensus process.

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Background: Neonatal encephalopathy is a complex syndrome in infants that predominantly affects the brain and other organs. The leading cause is a lack of oxygen in the blood reaching the brain. Neonatal encephalopathy can result in mortality or complications later in life, including seizures, movement disorders and cerebral palsy.

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Background: Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants.

Methods: Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed.

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Background: Different interventions and treatments are available for growth-restricted newborns to improve neonatal and long-term outcomes. Lack of outcome standardization across trials of feeding interventions limits pooled analysis of intervention effects. This study aimed to develop a core outcome set (COS) and minimum reporting set (MRS) for this research field.

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