Melissa Luig - Academia.edu (original) (raw)

Papers by Melissa Luig

World Journal of Pediatrics

Background Systemic postnatal corticosteroid use in extremely preterm infants poses a risk of adv... more Background Systemic postnatal corticosteroid use in extremely preterm infants poses a risk of adverse neurodevelopmental outcomes. This study explores their use beyond seven days of age with early neurodevelopmental assessments during the fidgety period (9–20 weeks postterm age). Methods This retrospective single-center cohort study included inborn extremely preterm infants from 1 January 2014 to 31 December 2018. Outborn infants, those with congenital or genetic abnormalities, and those who received postnatal corticosteroids for nonrespiratory reasons were excluded. The cohort was dichotomized based on the status of corticosteroid receipt. Early neurodevelopmental outcomes were reported using Prechtl’s General Movements Assessment. Results Of the 282 infants, 67 (23.75%) received corticosteroids. Of these, 34 (50.75%) received them for dependency on invasive ventilation (intermittent positive-pressure ventilation), and the remainder received them for dependency on non-invasive vent...

Journal of neonatal-perinatal medicine, 2014

To audit clinical practice during transport of very preterm infants (<32 weeks) with acute res... more To audit clinical practice during transport of very preterm infants (<32 weeks) with acute respiratory distress syndrome (RDS) receiving nasal continuous positive airway pressure (NCPAP). Retrospective cohort study. Twenty-seven infants were receiving NCPAP before transport team's arrival, and 23 were commenced on NCPAP after team's arrival. Six infants (12%) failed NCPAP before transfer, 2 infants (4.5%) failed NCPAP less than 24 hours, and 5 infants (11.3%) failed more than 24 hours - 7 days following admission. None died or developed pneumothorax during, or 7 days after admission. We did not observe NCPAP failure during transfer. There was a statistically significant difference between the NCPAP success and NCPAP failure groups for FiO2 at admission (p < 0.05), and the duration of NCPAP (p < 0.05). NCPAP is a potentially safe and effective mode of respiratory support for very preterm infants during ground, and air transports.

Human Mutation, 2020

LARS2 variants are associated with Perrault syndrome, characterised by premature ovarian failure ... more LARS2 variants are associated with Perrault syndrome, characterised by premature ovarian failure and hearing loss, and with an infantile lethal multi-system disorder: hydrops, lactic acidosis, sideroblastic anemia (HLASA) in one individual. Recently we reported LARS2 deafness with (ovario) leukodystrophy. Here we describe five patients with a range of phenotypes, in whom we identified biallelic LARS2 variants: three patients with a HLASA-like phenotype, an individual with Perrault syndrome whose affected siblings also had leukodystrophy, and an individual with a reversible mitochondrial myopathy, lactic acidosis and developmental delay.

Objectives To evaluate adherence to and experience of a state-wide guideline for therapeutic hypo... more Objectives To evaluate adherence to and experience of a state-wide guideline for therapeutic hypothermia using whole body cooling for newborns from non-tertiary birth hospitals with suspected moderate or severe hypoxic ischaemic encephalopathy (HIE) who are referred to the NETS NSW. Methods A retrospective review of all newborns > 35 weeks gestation referred to NETS with the diagnosis of HIE between July 2009 - September 2010. The NETS database identified the population of interest. The four eligibility criteria within the guideline informed the variables described below. Results Data from 30 infants analysed to date. 28 of the 30 infants referred were cooled and transferred for higher level care. Of these, 21 had an Apgar score < 6 at 10 mins, 17 had a pH < 7 and 20 had a base excess less than -12. 22 infants were intubated and 7 received inotropes. An acute hypoxic ischemic event was evident in 21 cases. Level of encephalopathy was not assessed in 21 cases. Three infants ...

Journal of Paediatrics and Child Health

Therapeutic drug monitoring, 2022

BACKGROUND Therapeutic drug monitoring (TDM) is routinely used for optimization of vancomycin the... more BACKGROUND Therapeutic drug monitoring (TDM) is routinely used for optimization of vancomycin therapy, due to exposure-related efficacy and toxicity, in addition to significant variability in pharmacokinetics, which leads to unpredictable drug exposure. OBJECTIVE The aim of this study was to evaluate target attainment and TDM of vancomycin in neonates. METHOD The authors conducted a retrospective study and collected data from medical records of all neonates who received vancomycin therapy in the neonatal intensive care unit between January 2019 and December 2019. The primary outcome was the proportion of vancomycin courses that reached target trough concentrations of 10-20 mg/L based on appropriate TDM samples collection. Secondary outcomes included proportion of courses with appropriate dose and dose frequency, and proportion of patients who achieved target concentrations after the first dose adjustment. RESULTS In total, 69 patients were included, with 129 vancomycin courses. The ...

Journal of Paediatrics and Child Health, 2022

AIM Hypothermia is associated with increased morbidity and mortality in preterm infants. A local ... more AIM Hypothermia is associated with increased morbidity and mortality in preterm infants. A local audit revealed 60% preterm infants ≤32 weeks gestation and/or very low birth weight (VLBW) infants (<1500 g) had an abnormal body temperature at admission. This study compares thermoregulatory outcomes before and after the implementation of a thermoregulation bundle in the birthing environment. METHODS This retrospective cohort study reviewed thermoregulatory data for all inborn preterm (≤32 weeks) and/or VLBW infants for a period of 30 months before (Group 1: 1st January 2013 to 30 June 2015) and after changes to thermoregulation practice (Group 2: 1st July 2015 to 31 December 2017). The key practice changes included: improved anticipation and staff preparedness, wrapping infant in a polyethylene sheet, using a polyethylene lined bonnet, using servo-control mode at birth and during transport. RESULTS There were 282 and 286 infants in group 1 and group 2 respectively, with similar baseline characteristics. A clinically and statistically significant improvement was observed in the proportion of infants with normothermia (33% in group 1 to 60% in group 2, P < 0.0001) including the sub-group of extremely preterm (<28 weeks gestation) infants (38 to 60%, P = 0.0083). A higher mean admission temperature was observed for group 2 (36.10°C ± 0.78 in group 1 vs 36.52°C ± 0.61 in group 2, P < 0.0001). Moderate hypothermia was reduced by two-thirds in group 2 (41-12%, P = <0.0001). CONCLUSIONS The introduction of a thermoregulation bundle improved admission temperature, improved the proportion of normothermia and reduced moderate hypothermia in preterm infants.

Additional file 1 Table S1. 2017 consensus formulations and comparison to recommended parenteral ... more Additional file 1 Table S1. 2017 consensus formulations and comparison to recommended parenteral nutrient intakes in preterm neonates. Values are per kg per day, unless otherwise indicated. Table S2. 2017 consensus formulations and comparison to recommended parenteral nutrient intakes in term neonates. Values are per kg per day, unless otherwise indicated. Table S3. Suggested routine PN biochemistry orders.

International Journal of Antimicrobial Agents, 2022

Neonatal infections caused by Gram-positive bacteria are commonly treated with vancomycin. There ... more Neonatal infections caused by Gram-positive bacteria are commonly treated with vancomycin. There is a lack of agreement on the optimal vancomycin dosing regimen and corresponding vancomycin exposure to correlate with efficacy and toxicity. The objective of this review is to evaluate dosing of vancomycin in neonates, therapeutic target attainment and clinical toxicity and efficacy outcomes. Two electronic databases Embase and PubMed (Medline) were systematically searched between (1995-2020). Studies that reported dosing regimens, drug concentrations, toxicity, and efficacy of vancomycin in neonates were eligible for inclusion. Descriptive analysis and a narrative synthesis were performed. The systematic review protocol was registered with the PROSPERO International Prospective Register of Systematic reviews in 2020 (registration number: CRD42020219568). Twenty-four studies were included for final analysis. Overall, the data from the included studies showed a great degree of heterogeneity. Therapeutic drug monitoring (TDM) practices were different between institutions. Although most studies used trough concentration with a target range of 10-20 mg/L target attainment was different across the studies. The probability of target attainment was less than 80% in all tested dosing algorithms. Only a few studies reported on vancomycin efficacy and toxicity. This is a comprehensive overview of dosing strategies of vancomycin in neonates. There is inadequate evidence to propose an optimal therapeutic regimen in the newborn population based on the data obtained due to the heterogeneity in the design and objectives of included studies. Consistent and homogeneous comparative RCTs are needed to identify a dosing regimen with a probability of target attainment (PTA) of >90% without toxicity.

The Journal of Pediatrics, 2021

OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted ... more OBJECTIVE To compare length of stay (LOS) in neonatal care for extremely preterm babies admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks' gestational age (n= 28,204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birthweight z-score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI: 19.3 to 22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI: -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI: -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI: 2.0 to 3.2) and 2.1 (95% CI: 1.6 to 2.6) days, respectively.results CONCLUSIONS: We identified between-network differences in LOS of up to three weeks for extremely preterm babies. Some of these may be partly explained by differences in mortality, but unexplained variations may also be related to differences in clinical care practices and healthcare systems between countries. CONCLUSION

Frontiers in Pediatrics, 2021

Background: The administration of live microbiota (probiotic) via enteral route to preterm infant... more Background: The administration of live microbiota (probiotic) via enteral route to preterm infants facilitates intestinal colonization with beneficial bacteria, resulting in competitive inhibition of the growth of pathogenic bacteria preventing gut microbiome dysbiosis. This dysbiosis is linked to the pathogenesis of necrotizing enterocolitis (NEC), an acquired multi-factorial intestinal disease characterized by microbial invasion of the gut mucosa, particularly affecting preterm infants. Probiotic prophylaxis reduces NEC; however, variations in strain-specific probiotic effects, differences in administration protocols, and synergistic interactions with the use of combination strains have all led to challenges in selecting the optimal probiotic for clinical use.Aim: To compare any differences in NEC rates, feeding outcomes, co-morbidities in preterm infants receiving single or two-strain probiotics over a 4-year period. The two-strain probiotic prophylaxis was sequentially switched ...

Acta Paediatrica, 2021

While infants with early‐onset sepsis require antibiotics, there is little evidence to support th... more While infants with early‐onset sepsis require antibiotics, there is little evidence to support their routine use in asymptomatic infants exposed to maternal chorioamnionitis. We aimed to ascertain the incidence of culture‐proven sepsis in full‐term infants exposed to chorioamnionitis and to determine whether asymptomatic infants need routine antibiotic treatment.

Journal of the American Heart Association, 2020

Background Very preterm infants are at high risk of death or severe morbidity. The objective was ... more Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights <1500 g. Severe CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation...

Journal of Neonatology, 2018

Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic... more Objectives: Therapeutic hypothermia (TH) is now standard treatment for moderate to severe hypoxic ischemic encephalopathy (HIE), secondary to intrapartum hypoxia, and has been performed in our neonatal unit since 2008. Objectives of this study included the assessment of compliance with the TH protocol and the evaluation of 2-year outcomes. Materials and Methods: Medical records of all the infants who underwent TH (2008-2014) were reviewed and relevant data were extracted. The laboratory database was used to extract blood test results. Follow-up clinic records were reviewed to gather data for 2-year outcomes. Outcome at 2 years was dichotomized as normal (survival with no or mild impairment) and abnormal (death or survival with moderate or severe impairment). Regression analysis was performed to determine the association of perinatal variables with an abnormal outcome. Results: Seventy-seven infants were treated with TH with 40/77 (52%) cooled as per the protocol. Treatment with TH for stage 1 HIE was the most common reason for protocol noncompliance. A total of 71 infants had HIE (n = 26, 24, and 21 with modified Sarnat stages 1, 2, and 3 respectively). Sixteen infants with HIE (22.5%) died; all had stage 3 HIE. Forty-one infants were seen at ≥2 years. Of these, 34 infants (83%) had a normal outcome. The clinical stage of HIE was the strongest predictor of an abnormal outcome. Normal 2-year outcome was seen in 94%, 84%, and 5% of stages 1, 2, and 3 HIE respectively. Conclusions: We noted a high degree of variation from the TH protocol. Clinical staging of HIE remains the strongest predictor of long-term outcome.

International Journal of Clinical Pediatrics, 2020

In extreme preterm infants, early use of continuous positive airway pressure (CPAP) for respirato... more In extreme preterm infants, early use of continuous positive airway pressure (CPAP) for respiratory support reduces the incidence of chronic lung disease. However, as a sequel, inadvertent passage of air into the gastrointestinal tract leads to abdominal distension often with visibly dilated loops. The first description of "CPAP belly syndrome" in 1992, originates from the study in premature infants weighing less than 1,000 g and managed on nasal CPAP. The description of this phenomenon included benign episodic abdominal distension, with no associations to feed intolerance, and no radiological evidence of bowel wall thickening, pneumatosis or free air. With improving perinatal care, lesser gestational age infants are increasingly managed on early CPAP with resultant more frequent occurrence of CPAP belly syndrome. When extreme preterm infants on CPAP develop tense, marked abdominal distension, clinical decisions to cease feeds, administer empiric antibiotics and perform plain abdominal radiographs are all justified to screen for potentially serious causes. With rampant use of non-invasive respiratory support in extreme preterm infants, the occurrence of severe CPAP belly syndrome now extends to include clinical scenario mimicking a "necrotizing enterocolitis (NEC) scare". We present the case of an extreme preterm infant with severe CPAP belly syndrome that required rescue intubation due to a massively distended abdomen. The emergency management included change to invasive ventilation and exclusion of serious intestinal conditions such as NEC. In retrospect, the life-threatening marked abdominal distension was due to severe CPAP belly syndrome, contrary to its well-recognized benign description, three decades ago. The clinical paradigm of CPAP belly syndrome is evolving, and in its severe form in extreme preterm infants, warrants vigilant monitoring to differentiate it from severe progressive intestinal conditions, such as NEC. Further research is required to describe its causes, associated morbidities and the need to evaluate the utility of other diagnostic modalities to reassure clinicians.

Early Human Development, 2019

Background: Transient hypothyroxinaemia of prematurity (THOP) has been associated with neurodevel... more Background: Transient hypothyroxinaemia of prematurity (THOP) has been associated with neurodevelopmental deficits with a paucity of literature leading to variable practice. Aim: Evaluation of the relationship between free T4 (fT4) levels at 2 weeks after birth and early markers of neurodevelopmental outcome. Study design: A retrospective study of prospectively collected data from infants born < 29 weeks' gestation, admitted to NICU between January 2012 and December 2014. The primary outcomes were the relationship between fT4 levels at 2 weeks, Prechtl General Movement Assessment (GMA) at 36 weeks and 3 months postterm age, and Bayley Scales of Infant Development (BSID-III) at 2 years postterm age. Secondary outcomes were survival free of disability and other neonatal morbidities. Results: Of 122 infants, 101 infants had normal fT4 levels (No-THOP) and 21 had fT4 levels > 1SD below the mean (THOP group). There was increased frequency of abnormal GMA in the No-THOP group compared with the THOP group at 36 weeks (abnormal writhing GMs: 43% vs 21%, p = 0.15) and 3 months corrected age (absent fidgety GMs: 7.6% vs 0%, p = 0.36), though not statistically significant. The neurodevelopmental outcome was worse in the No-THOP group compared with the THOP group with significantly lower mean cognitive and motor scores at 2 year of corrected age (90 ± 13.8 vs 100 ± 8.3, p = 0.01 and 91 ± 15.2 vs 100 ± 13.2, p = 0.04 respectively). Conclusions: This is the first report describing General Movements (GMs) in preterm infants with THOP. We found worse neurodevelopmental outcome in No-THOP infants reflected by significantly worse cognitive and motor outcomes at 2 years corrected age.

The Journal of Pediatrics, 2019

Objectives To describe variability in admission volumes and approach to early respiratory support... more Objectives To describe variability in admission volumes and approach to early respiratory support between neonatal intensive care units in the Australian and New Zealand Neonatal Network and to evaluate whether these center-specific factors are associated with death and bronchopulmonary dysplasia. Study design This retrospective cohort study included 19 099 neonates born between 25 and 32 weeks' gestation and admitted to 1 of 25 NICUs from 2007 to 2013. Center-specific factors evaluated were annual admission volume and rate of using continuous positive airway pressure (CPAP) rather than intubation as the first mode of respiratory support. Logistic regression was used to examine any association of these center-specific factors with death, BPD, and death or survival with BPD (death/BPD). Analysis was performed separately for 2 gestation groups (25-28 weeks and 29-32 weeks inclusive). Results Admission volumes and rates of early CPAP use varied widely across centers. Higher admission volumes were associated with lower odds of death or survival with BPD in the 25-28 week group (aOR 0.93, 99% CI 0.88-0.99 per increase of 10 babies per center annually). Centers with higher early CPAP use did not have lower odds of death or BPD than centers that intubated more frequently. Conclusions Higher admission volumes are associated with more favorable outcomes for the more preterm infants in the Australian and New Zealand Neonatal Network. Further investigation is required to explore why the individual benefits of early CPAP do not translate to better outcomes for centers that use this approach most frequently.

Australasian Journal of Ultrasound in Medicine, 2016

Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation. We repor... more Vein of Galen aneurysmal malformation (VGAM) is a rare congenital vascular malformation. We report a case of VGAM being associated with presence of bilateral hydrocephalus, gross cardiomegaly and is unique in two ways. Firstly, clinical presentation was associated with a large discrete cystic swelling along right side of the neck, which has not previously been reported. Secondly, this was a missed diagnosis of VGAM due to omission of colour Doppler study while performing diagnostic fetal cranial ultrasound just prior to delivery, following referral for assessment on a previously identified abnormality.

Journal of paediatrics and child health, Jan 8, 2017

Left vocal cord paralysis (LVCP) is variably reported post ligation of patent ductus arteriosus (... more Left vocal cord paralysis (LVCP) is variably reported post ligation of patent ductus arteriosus (PDA). Our objective was to determine the incidence of LVCP and identify predictive factors and associated morbidities in preterm infants post PDA ligation. This is a retrospective cohort study of infants less than 29 weeks gestational age from 2006 to 2014 who underwent PDA ligation. Infants with laryngeal symptoms underwent flexible fibreoptic nasopharyngolaryngoscopy to evaluate vocal cord function. We compared short- and long-term morbidities among infants with and without symptomatic LVCP. A total of 35 infants underwent PDA ligation in the study period, of which 11 infants (31%) developed symptomatic LVCP. Dysphonia was the presenting symptom in all neonates with LVCP and stridor was present in 46% (5/11) of them. The median (interquartile range) gestation (25 weeks (24-27) vs. 25 weeks (23-28)), birthweight (810 g (550-1180) vs. 825 g (550-1220)) and age at surgery (19 days (9-27) ...