Does angiotensin-1 converting enzyme genotype influence motor or cognitive development after pre-term birth?

BACKGROUND: Raised activity of the renin-angiotensin system (RAS) may both amplify inflammatory and free radical responses and decrease tissue metabolic efficiency and thus enhance cerebral injury in the preterm infant. The angiotensin-converting enzyme (ACE) DD genotype is associated with raised ACE and RAS activity as well as potentially adverse stimuli such as inflammation. The DD genotype has been associated with neurological impairments in the elderly, and thus may be also associated with poorer motor or cognitive development amongst children born preterm prematurely. METHODS: The association of DD genotype with developmental progress amongst 176 Caucasian children born at less than 33 weeks gestation (median birthweight 1475 g, range 645–2480 g; gestation 30 weeks, range 22–32; 108 male) was examined at 2 and 5 1/2 years of age. Measured neuro-cognitive outcomes were cranial ultrasound abnormalities, cerebral palsy, disability, Griffiths Developmental Quotient [DQ] at 2 yrs, and General Cognitive Ability [British Ability Scales-11] and motor performance [ABC Movement], both performed at 5 1/2 yrs. All outcomes were correlated with ACE genotype. RESULTS: The DD genotype was not associated with lower developmental quotients even after accounting for important social variables. CONCLUSION: These data do not support either a role for ACE in the development of cognitive or motor function in surviving infants born preterm or inhibition of ACE as a neuroprotective therapy

Determinants of Infant Mortality in Older ASEAN Economies

Infant mortality in the Association of Southeast Asian Nations (ASEAN) has been declining, yet disparities remain between the nations. This paper therefore explores the determinants of infant mortality in the older ASEAN-4 economies, Malaysia, Thailand, Indonesia and the Philippines using an Autoregressive Distributed Lag (ARDL) Error Correction Model framework. The key findings of the study are: First, there is evidence of long-run relationships among infant mortality, education, female fertility, income and access to healthcare. Second, the determinants of infant mortality vary between countries. Female fertility emerged as the main determinant of infant mortality in Malaysia, while access to healthcare matter for infant mortality in Indonesia, and to a lesser extent for the Philippines. The income effect is significant for reducing infant mortality in Malaysia, while female education is important for Indonesia and Thailand. Third, the speed of adjustment of infant mortality rate is comparatively low in ASEAN-4

Development of a treatment model for mothers with borderline personality disorder at a new mother and baby unit in Perth, Western Australia

RANZCP Keynote Abstract Background: Emotional dysregulation secondary to borderline personality disorder (BPD) can be exacerbated in the postnatal period, related to the developmental tasks of motherhood. In addition, infants of mothers with BPD often show a pattern of disorganized attachment that can further amplify maternal distress. There is limited research describing treatment models for BPD in the postnatal period. The Fiona Stanley Hospital Mother and Baby Unit (FSH MBU) is a new unit, offering multi-disciplinary psychiatric treatment for a broad range of mental health problems, in an inpatient setting, for women referred with their babies under the age of 1 year. Objectives: To examine the rate of referral and admission of mothers with BPD in comparison with mothers with other diagnoses admitted to the FSH MBU and to describe the development of an evidence-informed treatment model of care for this patient group. Methods: Retrospective case note audit of all admissions to the FSH MBU in its first 12 months (February 2015–2016), to examine psychosocial needs and outcomes and to correlate these with standardized screening tools. Furthermore, identification of treatment goals and treatment pathways for mothers with BPD will also be examined. Findings: Mothers with BPD are frequently referred for admission to the FSH MBU due to emotional dysregulation, comorbid depressive or anxiety disorders or complex social problems impacting their ability to cope with the care of their infants. They often face multifaceted challenges that require comprehensive assessment and care. Conclusions: Data collected and analysed will be essential to the understanding of the needs of these women and their families as well as necessary service provision. Collaboration between Australian MBUs with regard to further research and to refine current treatment models for this patient group is needed

Influence of driving pressure on raised-volume forced expiration in infants

The raised-volume forced-expiration technique measures infant lung function over an extended volume range. To improve comparisons between individuals and populations, we investigated the influence of jacket pressure on outcome variables in 21 infants. To quantify pressure transmitted from the jacket to the pleural space at a given lung volume, the jacket was inflated against an occluded airway, and the increase in pressure at the mouth was measured. Flow-volume curves were recorded at transmitted pressure (Ptrans) values ranging from 0 to 41.9 cm H2O. The effect of Ptrans on the FEV measures of FEV05%, FEV0.75 and FVC, and on the forced expiratory flow measures of FEF25% , FEF50%, and FEF75% was assessed. At Ptrans values between 0 to 20 cm H2O, a significant positive relationship existed between transmitted pressure (Ptrans) and all outcome variables except FVC. At higher Ptrans values, all outcome variables demonstrated pressure independence, with the exception of FEF25% (which remained positive) and FVC (which was negative in a subgroup of wheezy infants). FEF75%, values tended to decrease at Ptrans values > 25 cm H2O. At Ptrans values between 20 and 25 cm H2O, most outcome variables are pressure independent. This range is therefore the most suitable for use with the raised-volume forced expiration technique