Australia's persistently high rate of early-term prelabour Caesarean delivery.

Objective To compare the incidence of prelabour Caesarean delivery (PCD) at early term (37 weeks and 0 days (370) to 38 weeks and 6 days (386) of gestation) between Australian states and hospital sectors over time and to compare these rates with those of England and the United States of America (USA). Method A population-based descriptive study of 556040 singleton PCDs at term (370-406 weeks) in all public and private hospitals in Australian states, 2005-16, was performed. The primary outcome was the early-term PCD rate, defined as early-term PCDs as a percentage of all term PCDs.

Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis.

Objective: To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices.

Design: Retrospective cohort study.

Setting: A metropolitan tertiary centre encompassing public and private hospitals.

Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term.

Background: Prelabour caesarean section (CS) at early term (37 -38  weeks) is associated with higher rates of adverse short-term neonatal outcomes and higher costs than those performed at full term (39 -40  weeks). Prelabour CS is more common in private than in public hospitals in Australia, particularly at early term.

Aims: To evaluate the impact of hospital sector (public or private) and timing of delivery on short-term neonatal outcomes following prelabour CS at term.

Classification of causes and associated conditions for stillbirths and neonatal deaths.

Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps.

eRegistries: indicators for the WHO Essential Interventions for reproductive, maternal, newborn and child health.

Background: Electronic health registries - eRegistries - can systematically collect relevant information at the point of care for reproductive, maternal, newborn and child health (RMNCH). However, a suite of process and outcome indicators is needed for RMNCH to monitor care and to ensure comparability between settings. Here we report on the assessment of current global indicators and the development of a suite of indicators for the WHO Essential Interventions for use at various levels of health care systems nationally and globally.

Newborn hearing screening in Queensland 2009-2011: Comparison of hearing screening and diagnostic audiological assessment between term and preterm infants.

Aim: This study compares rates and timing of newborn hearing screening outcomes, audiological assessment and hearing loss diagnosis between infants of different gestational age groups. Early identification and management of sensorineural hearing loss (SNHL), ideally by 3-6 months of age, facilitates speech and language optimisation. Literature stratifying hearing screening and diagnostic audiology assessment by gestational age groups is lacking.

The timing of elective caesarean deliveries and early neonatal outcomes in singleton infants born 37-41 weeks' gestation.

Background: Births by elective caesarean section (CS) are rising, particularly before 39 weeks' gestation, which may be associated with unacceptably high risk of adverse neonatal outcomes. The optimal timing of these deliveries needs to be determined with recent recommendations to delay births by elective CS until 39 weeks.

Aims: To evaluate the association between gestational age (GA) at delivery and neonatal outcomes after elective CS between 37 and 41 weeks.

Risk determinants in early intervention use during the first postnatal year in children born very preterm.

Background: Early interventions (EI) are recognised for their potential risk-reduction capacity. Although developmental delay is common in children born very preterm reports continue to suggest poor uptake of EI services. This study examined the risk determinants of EI in Australian children born less than 32 weeks gestation during the first year of life.

Nutritional requirements and feeding recommendations for small for gestational age infants.

We define the small for gestational age (SGA) infant as an infant born ≥ 35 weeks' gestation and <10th percentile on the Fenton Growth Chart. Policy statements from many organizations recommend mother's own milk for SGA infants because it meets most of their nutritional requirements and provides short- and long-term benefits. Several distinct patterns of intrauterine growth restriction are identified among the heterogeneous grouping of SGA infants; each varies with regard to neonatal morbidities, requirements for neonatal management, postnatal growth velocities, neurodevelopmental progress, and adult health outcomes.

Nutritional needs of the micropreterm infant.

We have used an expansive definition of a micropreterm infant as <30 weeks' gestation to provide a global perspective to a "high risk" group of preterm infants for which there are little published data to guide nutritional management. Consensus nutritional guidelines for preterm infants have been developed for infants >1000 g birth weight and >28 weeks' gestational age. Micropreterm infants have greater nutritional deficits at birth than more mature preterm infants and accumulate greater postnatal deficits.

Human milk and the nutritional needs of preterm infants.

Key principles underpinning feeding guidelines for preterm infants include support for developmental care, breastfeeding, milk expression, and creating feeding plans. Early trophic feeding with colostrum and transitional milk improves immune protection and promotes gut maturation. Studies of preterm infants demonstrate that feeding mother's milk (MM) decreases the incidence of infection and necrotizing enterocolitis and improves neurodevelopmental outcome but may decrease ponderal and linear growth.

Australasian neonatal intensive care enteral nutrition survey: implications for practice.

Aim: This survey investigated standardised feeding guidelines and nutrition policy in Australasian neonatal intensive care units and compared these with previously published surveys and international consensus nutrition recommendations.

Methods: An electronic survey on enteral nutrition comprising a wide range of questions about clinical practice was e-mailed to all 25 Australasian neonatal intensive care unit directors of tertiary perinatal centres.

Results: Twenty-five surveys were distributed; 24 (96%) were completed.

Twelve-year review of neonatal deaths in the delivery room in a perinatal tertiary centre.

Aim: To describe decisions made for babies who died in the delivery room as a result of clinical practice of non-resuscitation or unsuccessful resuscitation.

Methods: A retrospective study was conducted of neonatal deaths (NNDs) ≥ 400 g and/or ≥20 weeks' gestation born at Mater Mothers' Hospitals 1998-2009 who were not admitted to a neonatal nursery. Deaths were divided into not resuscitated and unsuccessful resuscitation and subdivided by cause of death as extremely preterm, congenital abnormality or 'other'.

Infant formulas for preterm infants: in-hospital and post-discharge.

The availability and composition of preterm and post-discharge formulas (PDFs) have undergone considerable changes over the last decade. Human milk, supplemented with multi-component fortifier, is the preferred feed for very preterm infants as it has beneficial effects for both short- and long-term outcomes compared with formula. If supply of mother's milk or donor milk is inadequate, a breast milk substitute specifically designed for premature infants is the next option.

Growth monitoring of low birthweight infants: what references to use?

Growth charts are the mainstay of monitoring growth in babies who were born small or preterm. A variety of different charts are available, each with specific limitations. Most birthweight centile charts underestimate growth restriction in preterm babies and there are few good charts for monitoring longitudinal growth in preterm babies; it is important to be aware of the limitations of using cross-sectional data for monitoring longitudinal growth.

The use of recombinant tissue plasminogen activator in the management of infective intracardiac thrombi in pre-term infants with thrombocytopaenia.

Bacterial endocarditis complicated by the development of intra-cardiac thrombus presents a difficult management dilemma in the pre-term infant. Here we present our experience with three infants who had this condition, all of whom were successfully managed using therapy with recombinant tissue plasminogen activator (r-TPA). Therapy in one of the infants was particularly instructive, as the condition was further complicated by severe thrombocytopaenia, making the decision to treat using r-TPA difficult.

Decreased use of postnatal corticosteroids in extremely preterm infants without increasing chronic lung disease.

Background: Postnatal corticosteroids are effective in preventing chronic lung disease in preterm infant. There are concerns that corticosteroid use may be associated with an increased risk of impaired neurodevelopment.

Objective: To examine the effect of change in practice with the use of postnatal corticosteroids over an 8-year period in extremely preterm babies on the incidence of chronic lung disease (CLD) and cerebral palsy at 1 year of age.

Measuring sensorineural disability in preterm children using a public health screening strategy: a randomised controlled trial.

Aim: To assess the efficacy of a preterm-targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children born < or =31 weeks gestation at 12-months of age.

Methods: Multi-centred trial involving 202 preterm children randomised to receive the preterm-targeted or NHMRC programme. Primary outcome, correct identification of neurosensory disability by general practitioners assessed against gold standard paediatric assessments.

Orogastric and intravenous indomethacin administration to very premature neonates with patent ductus arteriosus: population pharmacokinetics, absolute bioavailability, and treatment outcome.

A population pharmacokinetic model was developed after administration of orogastric and/or intravenous indomethacin for the treatment of patent ductus arteriosus in preterm infants. Plasma indomethacin concentrations (n=227) were obtained from 90 preterm infants of median gestational age 27 weeks, mean postnatal age of 12 days, and a mean current weight (WT) of 1010 g. Infants received one to three courses of indomethacin (0.

Spin on perinatal testicular torsion.

We describe a recent case of perinatal testicular torsion at our institution. The presentation, management and outcome of perinatal testicular torsion are quite different to testicular torsion in the general paediatric population. The literature describes a variety of management options for perinatal testicular torsion and these are briefly reviewed.

Neonatal neurodevelopmental outcomes following tocolysis with glycerol trinitrate patches.

Objective: The object of this study was to determine the effects of maternal tocolysis with glycerol trinitrate (GTN) patches on the neurodevelopment of infants.

Study Design: This was a randomized, multicenter, controlled trial comparing the efficacy of GTN patches with standard beta2 agonist as tocolytic therapy. The previously reported outcomes of this study indicated no difference in neonatal mortality or morbidity to hospital discharge.