Richard Mupanemunda - Academia.edu (original) (raw)

Papers by Richard Mupanemunda

Fetal cardiac anomalies – antenatal detection rates and perinatal outcome data over a 3 year period at heart of England NHS Trust

Archives of Disease in Childhood-fetal and Neonatal Edition, Apr 1, 2012

Background Antenatal detection rates for fetal cardiac anomalies are difficult to ascertain. A 50... more Background Antenatal detection rates for fetal cardiac anomalies are difficult to ascertain. A 50% detection rate for major cardiac anomalies was acceptable before introduction of outflows tract as part of mid trimester scanning. Method Comprehensive retrospective data collection using multiple sources, including fetal medicine and neonatal databases, and maternity information system. Patients were identified via local fetal medicine referral criteria and cross-referenced against the West Midlands Perinatal Institute. Perinatal data was obtained and cross-referenced against records at the tertiary referral centre, Birmingham Children's Hospital. 267 mothers were identified between August 2007 to July 2010 (36 months) and details inputted to a purpose built Access database. Data was obtained on risk factors, time of diagnosis, cardiac defect, fetal cardiologist referral and diagnosis, and outcomes including, karyotyping, terminations, gestation and mode of delivery, postnatal diagnosis, surgery, and mortality. Result Antenatal detection rates depended on the exclusion criteria applied and ranged between 48% when minor anomalies were included, to up to 60% if only major anomalies were considered and 72% if outflow-only anomalies were also excluded. Main diagnoses missed were isolated ventriculoseptal defects (24), transposition of the great ateries (8), pulmonary stenosis (7) and Tetralogy of Fallot (5). Conclusion Our current detection rates are above satisfactory. Mandatory screening of outflow tracts as part of Fetal Anomaly Screening Programme guideline should lead to improved antenatal detection rates. These had not been introduced at the time this data was collected. A follow-up audit should show improved antenatal detection rates.

456 Patent ductus arteriosus (PDA) scoring to provide targeted PDA management in preterm infants- a quality improvement project

Quality Improvement and Patient Safety

Treatment of new infants with inhaled nitric oxide

Archives of Disease in Childhood 72(2 FETAL AND NEONAT ED), Jan 10, 1995

Managing the newborn infant with a difficult airway

At birth, 5-10% of all infants will require assisted ventilation. The rapid provision of effectiv... more At birth, 5-10% of all infants will require assisted ventilation. The rapid provision of effective positive pressure ventilation is the single most important predictor of successful neonatal resuscitation. Ineffective ventilatory support leads to hypoxia and may result in increased morbidity and mortality. Endotracheal intubation of newborn infants is a skilled procedure performed most often by advanced neonatal nurse practitioners, paediatric trainees and other non-career grade practitioners. Although competency in the intubation of newborn infants, including extremely premature babies and those with congenital malformation, is a requisite for completion of the RCPCH curriculum in neonatal medicine, training in airway management tends to be opportunistic and the individual experience of paediatric trainees is often variable. Furthermore, during the last decade the requirements of Modernising Medical Careers and the European Working Time Directive have combined to reduce both the ti...

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2014

The Collaborative UK ECMO Trial: Follow-up to 1 Year of Age

Pediatrics, 1998

Objective. To evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation... more Objective. To evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation (ECMO), in terms of mortality and morbidity, in the treatment of cardiorespiratory failure in term infants.Methods. The criteria for trial entry were: an oxygenation index of >40 or arterial partial pressure of carbon dioxide (Paco2) >12 kPa for at least 3 hours; gestational age at birth of 35 completed weeks or more; a birth weight of 2 kg or more; <10 days high-pressure ventilation; an age of <28 days; and no contraindication to ECMO such as previous cardiac arrest or intraventricular hemorrhage. Eligible infants were randomized either to be transferred to one of five ECMO centers in the United Kingdom or to continue conventional treatment. The principal outcome was death or severe disability at the age of 1 year. Severe disability was defined as an overall developmental quotient of <50 using the Griffiths Mental Development Scales, or blindness or a level of function s...

Bacterial-induced activation of erythrocyte T-antigen complicating necrotising enterocolitis: A case report

European Journal of Pediatrics, 1993

Erythrocyte Thomsen-Friedenreich crypt antigen (T-antigen) activation is not an uncommon event in... more Erythrocyte Thomsen-Friedenreich crypt antigen (T-antigen) activation is not an uncommon event in infants with severe necrotising enterocolitis (NEC). Transfusion of these infants with blood products containing plasma carries the risk of causing intravascular haemolysis. T-antigen activation is easily detected using a rapid simple lectin agglutination test. Early recognition of T-antigen activation ensures the correct choice of plasma free transfusion therapy. We describe an infant with severe NEC complicated by T-antigen activation and haemolysis.

Early Human Development, 1994

Background: Retinol deficiency may contribute toward the development of chronic lung disease in v... more Background: Retinol deficiency may contribute toward the development of chronic lung disease in very low birth weight (VLBW) infants. We examined the retinol status during early infancy in VLBW infants from birth to 6 weeks 'post-term'. Methods: Concentrations of serum retinol (SR) and its carrier proteins, retinol-binding protein (RBP), and transthyretin (TTR), were determined at birth, then weekly for 8 weeks, and at 4-6 weeks 'post-term' in preterm infants of less than 34 weeks gestation. The SR values of umbilical cord blood at birth from the preterm infants were compared to the maternal SR levels as well as to cord SR levels of term infants. Results: From 24 through 33 weeks gestation, umbilical cord SR at birth was significantly lower than, but did not correlate with, maternal SR (P < 0.01). The cord SR in term infants was also higher than that in preterm infants (262 f 68 vs. 183 + 67 pg/l, P < 0.01). Longitudinal profiles of SR in 18 VLBW infants showed that, despite regular retinol supplementation, there was a decline in SR after birth, reaching a nadir of 128 f 40 rg/l at 5-7 weeks (P < O.OOl), followed by an increase toward levels comparable to those seen in full term infants. At follow-up at the corrected age of 4-6 weeks 'post-term', SR levels in VLBW infant (222 f 74 &l) had returned to within the normal range for term cord SR values. The concentrations of RBP also showed a similar biphasic pattern. Transthyretin levels did not change for 8 weeks but increased significantly at 4-6 weeks 'post-term'. Conclusions: Current practices of retinol supplementation in VLBW infants fail to maintain adequate retinol status in those infants during the neonatal period. Further efforts to improve the reti-no1 status in these infants should be explored.

Archives of Disease in Childhood, 2012

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Archives of Disease in Childhood, 2013

Key Topics in Neonatology

British Journal of Anaesthesia, 1970

Trace Minerals and Vitamins

Key Topics in Neonatology, 1998

BMJ Paediatrics Open, 2021

BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried... more BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT).ObjectiveTo report on our centre’s experience of HPT and its potential benefits.DesignRetrospective observational study performed as a service evaluation.PatientsInfants ≥35 weeks corrected gestational age with a weight of 2 kg and serum bilirubin ≤50 µmol/L above treatment thresholds. Controls were a matched group of infants who received inpatient phototherapy (IPT).SettingThe catchment area of two neonatal intensive care units, one special care unit and a birth centre at four different hospitals that is covered by a single neonatal community outreach nursing team in Birmingham, UK.InterventionHPT was started either in the community or as a continuation of IPT. Controls received IPT.Main outcome measuresThe rate of bilirubin reduction, hospital readmission rates and parental satisfaction.Results100 i...

Renal and Urinary Tract Disorders – Nephrology

Key Topics in Neonatology, 1998

Key Topics in Neonatology, 1998

Assessment of Gestational Age

Key Topics in Neonatology, 1998

Meconium Aspiration Syndrome

Key Topics in Neonatology, 1998

Inherited Metabolic Disease – Investigation and Management

Key Topics in Neonatology, 1998

Fetal cardiac anomalies – antenatal detection rates and perinatal outcome data over a 3 year period at heart of England NHS Trust

Archives of Disease in Childhood-fetal and Neonatal Edition, Apr 1, 2012

Background Antenatal detection rates for fetal cardiac anomalies are difficult to ascertain. A 50... more Background Antenatal detection rates for fetal cardiac anomalies are difficult to ascertain. A 50% detection rate for major cardiac anomalies was acceptable before introduction of outflows tract as part of mid trimester scanning. Method Comprehensive retrospective data collection using multiple sources, including fetal medicine and neonatal databases, and maternity information system. Patients were identified via local fetal medicine referral criteria and cross-referenced against the West Midlands Perinatal Institute. Perinatal data was obtained and cross-referenced against records at the tertiary referral centre, Birmingham Children's Hospital. 267 mothers were identified between August 2007 to July 2010 (36 months) and details inputted to a purpose built Access database. Data was obtained on risk factors, time of diagnosis, cardiac defect, fetal cardiologist referral and diagnosis, and outcomes including, karyotyping, terminations, gestation and mode of delivery, postnatal diagnosis, surgery, and mortality. Result Antenatal detection rates depended on the exclusion criteria applied and ranged between 48% when minor anomalies were included, to up to 60% if only major anomalies were considered and 72% if outflow-only anomalies were also excluded. Main diagnoses missed were isolated ventriculoseptal defects (24), transposition of the great ateries (8), pulmonary stenosis (7) and Tetralogy of Fallot (5). Conclusion Our current detection rates are above satisfactory. Mandatory screening of outflow tracts as part of Fetal Anomaly Screening Programme guideline should lead to improved antenatal detection rates. These had not been introduced at the time this data was collected. A follow-up audit should show improved antenatal detection rates.

456 Patent ductus arteriosus (PDA) scoring to provide targeted PDA management in preterm infants- a quality improvement project

Quality Improvement and Patient Safety

Treatment of new infants with inhaled nitric oxide

Archives of Disease in Childhood 72(2 FETAL AND NEONAT ED), Jan 10, 1995

Managing the newborn infant with a difficult airway

At birth, 5-10% of all infants will require assisted ventilation. The rapid provision of effectiv... more At birth, 5-10% of all infants will require assisted ventilation. The rapid provision of effective positive pressure ventilation is the single most important predictor of successful neonatal resuscitation. Ineffective ventilatory support leads to hypoxia and may result in increased morbidity and mortality. Endotracheal intubation of newborn infants is a skilled procedure performed most often by advanced neonatal nurse practitioners, paediatric trainees and other non-career grade practitioners. Although competency in the intubation of newborn infants, including extremely premature babies and those with congenital malformation, is a requisite for completion of the RCPCH curriculum in neonatal medicine, training in airway management tends to be opportunistic and the individual experience of paediatric trainees is often variable. Furthermore, during the last decade the requirements of Modernising Medical Careers and the European Working Time Directive have combined to reduce both the ti...

Archives of Disease in Childhood - Fetal and Neonatal Edition, 2014

The Collaborative UK ECMO Trial: Follow-up to 1 Year of Age

Pediatrics, 1998

Objective. To evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation... more Objective. To evaluate the clinical effectiveness of neonatal extracorporeal membrane oxygenation (ECMO), in terms of mortality and morbidity, in the treatment of cardiorespiratory failure in term infants.Methods. The criteria for trial entry were: an oxygenation index of >40 or arterial partial pressure of carbon dioxide (Paco2) >12 kPa for at least 3 hours; gestational age at birth of 35 completed weeks or more; a birth weight of 2 kg or more; <10 days high-pressure ventilation; an age of <28 days; and no contraindication to ECMO such as previous cardiac arrest or intraventricular hemorrhage. Eligible infants were randomized either to be transferred to one of five ECMO centers in the United Kingdom or to continue conventional treatment. The principal outcome was death or severe disability at the age of 1 year. Severe disability was defined as an overall developmental quotient of <50 using the Griffiths Mental Development Scales, or blindness or a level of function s...

Bacterial-induced activation of erythrocyte T-antigen complicating necrotising enterocolitis: A case report

European Journal of Pediatrics, 1993

Erythrocyte Thomsen-Friedenreich crypt antigen (T-antigen) activation is not an uncommon event in... more Erythrocyte Thomsen-Friedenreich crypt antigen (T-antigen) activation is not an uncommon event in infants with severe necrotising enterocolitis (NEC). Transfusion of these infants with blood products containing plasma carries the risk of causing intravascular haemolysis. T-antigen activation is easily detected using a rapid simple lectin agglutination test. Early recognition of T-antigen activation ensures the correct choice of plasma free transfusion therapy. We describe an infant with severe NEC complicated by T-antigen activation and haemolysis.

Early Human Development, 1994

Background: Retinol deficiency may contribute toward the development of chronic lung disease in v... more Background: Retinol deficiency may contribute toward the development of chronic lung disease in very low birth weight (VLBW) infants. We examined the retinol status during early infancy in VLBW infants from birth to 6 weeks 'post-term'. Methods: Concentrations of serum retinol (SR) and its carrier proteins, retinol-binding protein (RBP), and transthyretin (TTR), were determined at birth, then weekly for 8 weeks, and at 4-6 weeks 'post-term' in preterm infants of less than 34 weeks gestation. The SR values of umbilical cord blood at birth from the preterm infants were compared to the maternal SR levels as well as to cord SR levels of term infants. Results: From 24 through 33 weeks gestation, umbilical cord SR at birth was significantly lower than, but did not correlate with, maternal SR (P < 0.01). The cord SR in term infants was also higher than that in preterm infants (262 f 68 vs. 183 + 67 pg/l, P < 0.01). Longitudinal profiles of SR in 18 VLBW infants showed that, despite regular retinol supplementation, there was a decline in SR after birth, reaching a nadir of 128 f 40 rg/l at 5-7 weeks (P < O.OOl), followed by an increase toward levels comparable to those seen in full term infants. At follow-up at the corrected age of 4-6 weeks 'post-term', SR levels in VLBW infant (222 f 74 &l) had returned to within the normal range for term cord SR values. The concentrations of RBP also showed a similar biphasic pattern. Transthyretin levels did not change for 8 weeks but increased significantly at 4-6 weeks 'post-term'. Conclusions: Current practices of retinol supplementation in VLBW infants fail to maintain adequate retinol status in those infants during the neonatal period. Further efforts to improve the reti-no1 status in these infants should be explored.

Archives of Disease in Childhood, 2012

This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

Archives of Disease in Childhood, 2013

Key Topics in Neonatology

British Journal of Anaesthesia, 1970

Trace Minerals and Vitamins

Key Topics in Neonatology, 1998

BMJ Paediatrics Open, 2021

BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried... more BackgroundIn the UK setting, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT).ObjectiveTo report on our centre’s experience of HPT and its potential benefits.DesignRetrospective observational study performed as a service evaluation.PatientsInfants ≥35 weeks corrected gestational age with a weight of 2 kg and serum bilirubin ≤50 µmol/L above treatment thresholds. Controls were a matched group of infants who received inpatient phototherapy (IPT).SettingThe catchment area of two neonatal intensive care units, one special care unit and a birth centre at four different hospitals that is covered by a single neonatal community outreach nursing team in Birmingham, UK.InterventionHPT was started either in the community or as a continuation of IPT. Controls received IPT.Main outcome measuresThe rate of bilirubin reduction, hospital readmission rates and parental satisfaction.Results100 i...

Renal and Urinary Tract Disorders – Nephrology

Key Topics in Neonatology, 1998

Key Topics in Neonatology, 1998

Assessment of Gestational Age

Key Topics in Neonatology, 1998

Meconium Aspiration Syndrome

Key Topics in Neonatology, 1998

Inherited Metabolic Disease – Investigation and Management

Key Topics in Neonatology, 1998