Karel O'Brien - Academia.edu (original) (raw)

Papers by Karel O'Brien

Children (Basel), May 17, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

PubMed, May 13, 1999

The first trial of alpha1-proteinase inhibitor therapy for the prevention of chronic lung disease... more The first trial of alpha1-proteinase inhibitor therapy for the prevention of chronic lung disease of prematurity was recently completed. Receipt of four intravenous doses of the medication was associated with a trend towards a reduction in respiratory morbidity. A dose-ranging trial is in progress.

Advances in Neonatal Care, Feb 1, 2005

To implement and deliver a respiratory syncytial virus prophylaxis (RSVP) program in response to ... more To implement and deliver a respiratory syncytial virus prophylaxis (RSVP) program in response to the Canadian Pediatric Society recommendations. A novel program was designed to provide inpatient RSVP for at-risk infants cared for in 1 tertiary care newborn intensive care unit (NICU). This inpatient program was part of a coordinated approach to RSVP, designed and implemented by 3 hospitals. An RSVP program logic model was created and used by a multidisciplinary team to evaluate the in-house program and identify areas of program activity requiring improvement. Following the 2000 to 2001 RSV season, a compliance and outcomes audit was performed in the tertiary center; 193 infants were enrolled in the RSVP program and 162 infants had received RSVP in the NICU [Mean = 1.64 doses]. Telephone follow-up with the parents of discharged infants identified that 159 infants (98%) had successfully completed their full course of RSVP. Using the RSVP program logic model, 5 areas for program improvement were identified including infant recruitment, patient transfer/discharge processes, product procurement, preparation/distribution/administration of doses, and healthcare team communication. Interdisciplinary collaboration is an important factor in the success of the RSVP program and has supported a consistent model of care for the delivery of RSVP. The program logic model provided a useful structure to systematically review the RSVP program in this organization.

American Journal of Obstetrics and Gynecology, 2007

Despite advances in perinatal medicine, the incidence of preterm birth continues to increase. The... more Despite advances in perinatal medicine, the incidence of preterm birth continues to increase. The primary goal of tocolytic therapy is to reduce neonatal morbidity and mortality. While studies have demonstrated a prolongation of pregnancy, no tocolytic has been shown to improve neonatal outcomes. The objective of this randomized placebo-controlled trial was to determine the effect of transdermal nitroglycerin on neonatal outcomes in women who present in preterm labor. We randomized 153 women in labor between 24 and 32 weeks to receive either transdermal nitroglycerin or placebo patches. The primary outcome was a composite of neonatal morbidity (chronic lung disease, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis) and mortality. Secondary outcomes included birth within 48 hours, birth before 28, 34, and 37 weeks, number of doses of antenatal corticosteroids received, side effects, and adverse events. Infants born to transdermal nitroglycerin treated mothers (n = 74) had a statistically significantly reduced composite outcome compared to placebo treated mothers (n = 79) (relative risk 0.29 [95% confidence interval 0.08, 1.00] [p = 0.048]; risk difference -0.10 [95% confidence interval -0.19, -0.01); number needed to treat 10 [95% confidence interval 5, 100]). Birth prior to 28 weeks was reduced (relative risk 0.50, 95% confidence interval 0.23, 1.09). Transdermal nitroglycerin caused significantly more maternal side effects (relative risk 1.41, 95% confidence interval 1.06, 1.86). Transdermal nitroglycerin may reduce neonatal morbidity and mortality as a result of decreased risk of birth before 28 weeks.

The Journal of Pediatrics, 2021

on behalf of the Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) Inves... more on behalf of the Canadian Neonatal Network (CNN) and Canadian Preterm Birth Network (CPTBN) Investigators* Objectives To examine rates and determinants of mother's own milk (MOM) feeding at hospital discharge in a cohort of infants born very preterm within the Canadian Neonatal Network (CNN). Study design This was a population-based cohort study of infants born at <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2015, and December 31, 2018. We examined the rates and determinants of MOM use at discharge home among the participating NICUs. We used multivariable logistic regression analysis to identify independent determinants of MOM feeding. Results Among the 6404 infants born very preterm and discharged home during the study period, 4457 (70%) received MOM or MOM supplemented with formula. Rates of MOM feeding at discharge varied from 49% to 87% across NICUs. Determinants associated with MOM feeding at discharge were gestational age 29-32 weeks compared with <26 weeks (aOR 1.56, 95% CI 1.25-1.93), primipara mothers (aOR 2.12, 95% CI 1.86-2.42), maternal diabetes (aOR 0.79, 95% CI 0.66-0.93), and maternal smoking (aOR 0.27, 95% CI 0.19-0.38). Receipt of MOM by day 3 of age was the major predictor of breast milk feeding at discharge (aOR 3.61, 95% CI 3.17-4.12). Conclusions Approximately two-thirds of infants born very preterm received MOM at hospital discharge, and rates varied across NICUs. Supporting mothers to provide breast milk in the first 3 days after birth may be associated with improved MOM feeding rates at discharge.

Children

Background: Family involvement is vital to optimize the care of infants in the neonatal intensive... more Background: Family involvement is vital to optimize the care of infants in the neonatal intensive care unit (NICU). Various technologies have been used to support communication with parents in the NICU. The purpose of this study was to evaluate the parent and staff experience and perception of the use of a cloud-based video-messaging service in our NICU. Methods: This study was a single center observational study conducted at Mount Sinai Hospital, Toronto, Canada. Following the implementation of a video-messaging service, parent and staff surveys were distributed to evaluate their experience and perception. Results: Parent responses were positive with respect to how the service helped them feel: closer to their infant (100%) and reassured about their infant’s care (100%). Nursing staff responses indicated that they perceived a benefit to parents (100%) and to their building a relationship with families (79%). However, they also identified time constraints (85%) and the use of the te...

Archives of Disease in Childhood

ObjectiveTo determine the feasibility of adapting Family Integrated Care to a neonatal hospital u... more ObjectiveTo determine the feasibility of adapting Family Integrated Care to a neonatal hospital unit in a low-income country.DesignSingle-centre, pre/post-pilot study of an adapted Family Integrated Care programme in Uganda (UFICare).SettingSpecial Care Nursery at a Ugandan hospital.PatientsSingleton, inborn neonates with birth weight ≥2 kg.InterventionsAs part of UFICare, mothers weighed their infant daily, assessed for severe illness (‘danger signs’) twice daily and tracked feeds.Main outcome measuresFeasibility outcomes included maternal proficiency and completion of monitoring tasks. Secondary outcomes included maternal stress, discharge readiness and post-discharge healthcare seeking.ResultsFifty-three mother–infant dyads and 51 mother–infant dyads were included in the baseline and intervention groups, respectively. Most mothers were proficient in the tasks 2–4 days after training (weigh 43 of 51; assess danger signs 49 of 51; track feeds 49 of 51). Mothers documented their dan...

Paediatrics and Child Health, 2013

Paediatrics and Child Health, 2004

To better inform early identification efforts, we have initiated a prospective study of high-risk... more To better inform early identification efforts, we have initiated a prospective study of high-risk infants, defined as such by having an Abstracts / Résumés

Paediatrics & Child Health, 2002

the day in 30% of children. Only 1 of 10 severe cases presented during the day. Admission rate wa... more the day in 30% of children. Only 1 of 10 severe cases presented during the day. Admission rate was 1.5%. Oral dexamethasone (DEX) treatment occurred in 92.7% of patients. A second dose of DEX, to be taken 12 hours after the first, was given to 53% of children. Low dose DEX (0.15mg/kg) was given to 124 of 305 children. 0.6 mg/kg/dose of DEX was given in 45% of single doses but only 29% of double doses. Inhaled budesonide (BUD) was used in 8.6% of patients at a dose of 2mg. All children who received BUD also received DEX, 70% received 2 doses. Epinephrine was given to 3% of patients. Six per cent of patients received Ventolin. CONCLUSION: The majority of cases of croup, including severe cases, presented during the night. Children who presented during the day were less likely to require significant intervention. The vast majority of croup patients were treated with DEX, most frequently at a low dose of 0.15 mg/kg, with more than half of patients receiving a second dose. Children who received a single dose of DEX were more likely to receive a higher dose. All patients who received inhaled steroid also received oral DEX. Epinephrine continues to be used in a small number of children. These current practices have established a very low admission rate.

Family Integrated Care (FICare) is associated with improved developmental outcomes and decreased ... more Family Integrated Care (FICare) is associated with improved developmental outcomes and decreased parental mental health risks in stable preterm infants. However, less is known about its application in critically ill infants who are at greater risk for adverse outcomes. The objective of this study was to assess the safety and feasibility of implementation of FICare in critically ill infants in the first few weeks of life. In this prospective cohort study, 41 critically ill infants were enrolled: 17 in observational group receiving standard care (SC)and 24 in the FICare Plus group. Resources were developed for staff and parents to support earlier engagement in infant care. Outcomes were assessed using standardized questionnaires. The t-test or Wilcoxon Rank-Sum test were used to compare continuous variables, while Chi-square or Fisher exact test were used for categorical variables, respectively. Baseline maternal and infant characteristics were similar in both groups. The tools and pr...