Gehan Roberts

University of Melbourne, Melbourne, Victoria, Australia

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Publications (39)130.08 Total impact

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    ABSTRACT: Extremely preterm (EP; <28 weeks) birth and extremely low birth weight (ELBW; <1000 g) are risk factors for poor cognitive outcomes, including in executive function (EF; higher-order cognitive skills necessary for goal-directed, adaptive functioning and important for academic and behavioral-emotional outcomes). We aimed to (1) extend the limited data on EF in EP/ELBW survivors in adolescence compared with normal birth weight controls, and (2) determine changes in EF between ages 8 and 17 years in both groups. Two hundred twenty-eight EP/ELBW and 166 control adolescents (mean age, 17 years) from a prospective geographical cohort were assessed with multiple EF tasks, and parent- and self-ratings of behavioral EF. The Rey Complex Figure and Behavior Rating Inventory of Executive Function parent report were also administered at age 8 years, enabling examination of change in scores between childhood and adolescence. EP/ELBW adolescents performed more poorly than controls in verbal processing speed, attentional control, cognitive flexibility, and goal-setting (effect sizes, -0.7 to -0.2 SD), but not psychomotor reaction time. Group differences were of similar magnitude across tasks. From childhood to late adolescence, EP/ELBW children improved their accuracy of the Rey Complex Figure copy more than controls. According to parents, executive behaviors were largely stable over time in both groups. Adolescents born EP/ELBW have poorer EF skills across multiple domains than controls. From childhood to late adolescence, different aspects of EF improved, but others did not, underscoring the need for multidomain, longitudinal assessments in this high-risk population. Copyright © 2015 by the American Academy of Pediatrics.
    PEDIATRICS 03/2015; DOI:10.1542/peds.2014-3188 · 5.30 Impact Factor
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    ABSTRACT: Low working memory (WM) is strongly linked with poor academic outcomes. WM capacity increases across childhood but how exposure to school is associated with WM development is not known. We aimed to determine extent to which chronological age and schooling duration are associated with WM at the population level. In 2012, children in Grade 1 (the second year of formal schooling in Victoria, Australia) from 44 schools in metropolitan Melbourne were recruited. Assessments occurred over the entire school year, with schools quasi-randomly allocated to one of the 4 school terms. WM (primary outcome) was measured using 2 subtests from the computerized Automated Working Memory Assessment: Backwards Digit Recall (verbal) and Mister X (visuospatial). Linear regression was used to examine relationships of WM with time in school and age. Of the 1765 who provided consent, 1727 children (97.9%) had WM assessed throughout the 2012 school year. WM scores became steadily higher over the course of the year. Thus, scores were .77 and .53 SDs higher in Term 4 than Term 1 for verbal and visuospatial WM, respectively (p values for trend for both scores <.001); conclusions were unchanged when adjusted for age and potential confounders. Conversely, age associations attenuated fully once adjusted for school duration. Our results demonstrate, for the first time, that the developmental increases in WM are strongly associated with time spent in the classroom, above and beyond chronological age.
    Journal of developmental and behavioral pediatrics: JDBP 01/2015; DOI:10.1097/DBP.0000000000000121 · 2.12 Impact Factor
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    ABSTRACT: Poor sleep and working memory difficulties are both associated with learning difficulties, but it is not known whether they are linked with each other in childhood. We aimed to determine, in a population-based sample of grade 1 children, whether poor sleep is associated with reduced working memory capacity. Cross-sectional population-based study. All grade 1 children in 44 elementary schools in metropolitan Melbourne, Australia; 1749 children were included (participation rate 65%, mean age 6.9 years). Parents completed a written questionnaire at home, after which researchers administered one-on-one child computerized assessments at school. Predictor measures were parent-reported 1) perceptions of poor sleep, 2) regularity of bedtime, 3) sleep duration, and 4) sleep onset latency. Outcome measures were backward digit recall (verbal working memory) and Mister X (visuospatial working memory) subtests of the Automated Working Memory Assessment (AWMA). Associations were examined using linear regression, adjusted for duration of schooling, gender, age, and social status. Increasing poor sleep (P = .03), less regularity of bedtime (P < .001), and shorter sleep duration (P = .03) were all associated with poorer verbal working memory, with effect sizes ranging from 0.3 to 1.2. Poor sleep was not associated with visuospatial working memory. At a population level, poor sleep in early school-age children is associated with poorer verbal working memory, an important predictor of academic difficulties. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
    Academic Pediatrics 01/2015; 15(1):111-116. DOI:10.1016/j.acap.2014.06.021 · 2.23 Impact Factor
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    ABSTRACT: Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted.
    BMC Pediatrics 11/2014; 14(1):279. DOI:10.1186/1471-2431-14-279 · 1.92 Impact Factor
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    ABSTRACT: Extremely preterm (EP, <28 weeks) and/or extremely low birth weight (ELBW, <1000 g) infants are at high risk of aberrant neurodevelopment. Sulcogyral folding patterns of the orbitofrontal cortex (OFC) are determined during the third trimester, however little is known about OFC patterning in EP/ELBW cohorts, for whom this gestational period is disturbed. This study investigated whether the distribution of OFC pattern types and frequency of intermediate and/or posterior orbital sulci (IOS/POS) differed between EP/ELBW and control adolescents. This study also investigated whether OFC pattern type was associated with mental illness or executive function outcome in adolescence. Magnetic resonance images of 194 EP/ELBW and 147 full term (>37 completed weeks) and/or normal birth weight (>2500 g) adolescents were acquired, from which the OFC pattern of each hemisphere was classified as Type I, II, or III. Compared with controls, more EP/ELBW adolescents possessed a Type II in the left hemisphere (P = 0.019). The EP/ELBW group had fewer IOS (P = 0.024) and more POS (P = 0.021) in the left hemisphere compared with controls. OFC pattern type was not associated with mental illness, however in terms of executive functioning, Type III in the left hemisphere was associated with better parent-reported metacognition scores overall (P = 0.008) and better self-reported behavioral regulation scores in the control group (P = 0.001) compared with Type I. We show, for the first time that EP/ELBW birth is associated with changes in orbitofrontal development, and that specific patterns of OFC folding are associated with executive function at age 18 years in both EP/ELBW and control subjects. Hum Brain Mapp, 2014. © 2014 Wiley Periodicals, Inc.
    Human Brain Mapping 11/2014; 36(3). DOI:10.1002/hbm.22692 · 6.92 Impact Factor
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    ABSTRACT: Objectives To compare brain volumes in adolescents who were born extremely preterm (<28 weeks gestation) who had received postnatal dexamethasone, and to determine if there was a postnatal dexamethasone dose–response effect on brain volumes. Study design Geographical cohort study of extremely preterm adolescents born in 1991-1992 in Victoria, Australia. T1-weighted magnetic resonance imaging was performed at 18 years of age. Segmented and parcellated brain volumes were calculated using an automated segmentation method (FreeSurfer) and compared between groups, with and without adjustment for potential confounders. The relationships between total postnatal dexamethasone dose and brain volumes were explored using linear regression. Results Of the 148 extremely preterm participants, 55 (37%) had received postnatal dexamethasone, with a cumulative mean dose of 7.7 mg/kg. Compared with participants who did not receive postnatal dexamethasone, those who did had smaller total brain tissue volumes (mean difference −3.6%, 95% CI [−7.0%, −0.3%], P value = .04) and smaller white matter, thalami, and basal ganglia volumes (all P < .05). There was a trend of smaller total brain and white matter volumes with increasing dose of postnatal dexamethasone (regression coefficient −7.7 [95% CI −16.2, 0.8] and −3.2 [−6.6, 0.2], respectively). Conclusions Extremely preterm adolescents who received postnatal dexamethasone in the newborn period had smaller total brain tissue volumes than those who did not receive postnatal dexamethasone, particularly white matter, thalami, and basal ganglia. Vulnerability of brain tissues or structures associated with postnatal dexamethasone varies by structure and persists into adolescence.
    The Journal of pediatrics 04/2014; 164(4):737–743.e1. DOI:10.1016/j.jpeds.2013.10.083 · 4.02 Impact Factor
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    ABSTRACT: Adult preterm survivors from the 1980s have higher blood pressure (BP) than term controls. Survival rates of extremely preterm (gestational age < 28 weeks; EP) infants born after 1990 have increased, but whether they still have higher BP than term controls is unknown. This study compared the BP of contemporary EP survivors with term controls in late adolescence. All EP adolescents and matched term controls born in 1991-92 in Victoria, Australia, were enrolled in a longitudinal study. At age 18 years, 24-h ambulatory BP was measured. Average BP was compared between EP and term groups, and predictors of BP in EP adolescents were examined. BP data were obtained from 136 EP patients and 120 controls. EP patients on average had higher systolic, diastolic and mean BP than controls. The mean systolic difference over 24 h was 3.2 mmHg [95% confidence interval (CI) 0.1-6.4], 3.9 mmHg [95% CI 0.7-7.2] when awake, and 2.0 mmHg (95% CI 1.4-5.5) when asleep. Male sex and change in weight SD score from birth to 2 years were predictive of SBP (regression coefficients 6.2 (95% CI 1.8-10.6), P = 0.006) and 2.0 (95% CI 0.2-3.8), P = 0.032), respectively). SBP at age 8 was associated with BP at age 18 years. Late adolescent EP survivors of the modern era have higher BP compared with term controls. This highlights the importance of long-term cardiovascular surveillance for this increasing group into adulthood.
    Journal of Hypertension 03/2014; 32(3):620-6. DOI:10.1097/HJH.0000000000000055 · 4.22 Impact Factor
  • Gehan Roberts, Jeanie L Y Cheong
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    ABSTRACT: Given the improving survival rates of extremely preterm (EP, gestational age <28 weeks) infants, there is a need to understand their general growth and health outcomes not only in childhood, but also into adulthood. EP children are shorter and lighter compared with term children at term-equivalent age; with time, the weight disadvantage diminishes but the height disadvantage remains relatively unchanged. EP children and young adults also have higher rates of reported health concerns, medical conditions and visual impairment. Hospital readmissions are higher in early childhood, mostly attributed to respiratory illness. Individuals born EP have reduced bone health and are at increased risk for metabolic disorders. Increased rates of conditions such as diabetes or pathological fractures are not reported in the literature, although follow-up studies so far have only tracked EP individuals into young adulthood. Consequently, health care utilization and costs are increased in EP children and young adults. A thorough knowledge of the health risks related to EP birth is essential in planning surveillance and intervention strategies to optimize their health and wellbeing. Despite the increased risk of health problems, EP young adults generally report their quality of life to be similar to that reported in their term counterparts.
    Seminars in Fetal and Neonatal Medicine 11/2013; DOI:10.1016/j.siny.2013.11.003 · 3.13 Impact Factor
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    ABSTRACT: Extremely preterm (EP) survivors have smaller brains, lower IQ, and worse educational achievement than their term-born peers. The contribution of smaller brain size to the IQ and educational disadvantages of EP is unknown. This study aimed (i) to compare brain volumes from multiple brain tissues and structures between EP-born (<28weeks) and term-born (≥37weeks) control adolescents, (ii) to explore the relationships of brain tissue volumes with IQ and basic educational skills and whether this differed by group, and (iii) to explore how much total brain tissue volume explains the underperformance of EP adolescents compared with controls. Longitudinal cohort study of 148 EP and 132 term controls born in Victoria, Australia in 1991-92. At age 18, magnetic resonance imaging-determined brain volumes of multiple tissues and structures were calculated. IQ and educational skills were measured using the Wechsler Abbreviated Scale of Intelligence (WASI) and the Wide Range Achievement Test(WRAT-4), respectively. Brain volumes were smaller in EP adolescents compared with controls (mean difference [95% confidence interval] of -5.9% [-8.0, -3.7%] for total brain tissue volume). The largest relative differences were noted in the thalamus and hippocampus. The EP group had lower IQs(-11.9 [-15.4, -8.5]), spelling(-8.0 [-11.5, -4.6]), math computation(-10.3 [-13.7, -6.9]) and word reading(-5.6 [-8.8, -2.4]) scores than controls; all p-values<0.001. Volumes of total brain tissue and other brain tissues and structures correlated positively with IQ and educational skills, a relationship that was similar for both the EP and controls. Total brain tissue volume explained between 20-40% of the IQ and educational outcome differences between EP and controls. EP adolescents had smaller brain volumes, lower IQs and poorer educational performance than controls. Brain volumes of multiple tissues and structures are related to IQ and educational outcomes. Smaller total brain tissue volume is an important contributor to the cognitive and educational underperformance of adolescents born EP.
    PLoS ONE 10/2013; 8(10):e77475. DOI:10.1371/journal.pone.0077475 · 3.53 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate attention difficulties in a contemporary geographic cohort of adolescents born extremely preterm (EP, <28 weeks' gestation) or extremely low birth weight (ELBW, birth weight <1000 g). The EP/ELBW group included 228 adolescents (mean age = 17.0 years) born in Victoria, Australia in 1991 and 1992. The control group were 166 adolescents (mean age = 17.4 years) born of normal birth weight (birth weight >2499 g) who were recruited in the newborn period and matched to the EP/ELBW group on date of birth, gender, language spoken and health insurance status. Participants were assessed on measures of selective, sustained, and executive (shift and divided) attention, and parents and participants completed behavioral reports. The EP/ELBW group performed more poorly across tests of selective and executive attention, had greater rates of clinically significant difficulties compared with the control group, and also had greater behavioral attention problems as reported by parents. Neonatal risk factors were weakly associated with attention outcomes. In conclusion, higher rates of attention impairments are observed in individuals born EP/ELBW well into adolescence and may have consequences for their transition to adulthood. (JINS, 2013, 19, 1-12).
    Journal of the International Neuropsychological Society 09/2013; DOI:10.1017/S1355617713001057 · 2.70 Impact Factor
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    ABSTRACT: Very preterm children exhibit difficulties in working memory, a key cognitive ability vital to learning information and the development of academic skills. Previous research suggests that an adaptive working memory training intervention (Cogmed) may improve working memory and other cognitive and behavioural domains, although further randomised controlled trials employing long-term outcomes are needed, and with populations at risk for working memory deficits, such as children born preterm.In a cohort of extremely preterm (<28 weeks' gestation)/extremely low birthweight (<1000 g) 7-year-olds, we will assess the effectiveness of Cogmed in improving academic functioning 2 years' post-intervention. Secondary objectives are to assess the effectiveness of Cogmed in improving working memory and attention 2 weeks', 12 months' and 24 months' post-intervention, and to investigate training related neuroplasticity in working memory neural networks 2 weeks' post-intervention. This double-blind, placebo-controlled, randomised controlled trial aims to recruit 126 extremely preterm/extremely low birthweight 7-year-old children. Children attending mainstream school without major intellectual, sensory or physical impairments will be eligible. Participating children will undergo an extensive baseline cognitive assessment before being randomised to either an adaptive or placebo (non-adaptive) version of Cogmed. Cogmed is a computerised working memory training program consisting of 25 sessions completed over a 5 to 7 week period. Each training session takes approximately 35 minutes and will be completed in the child's home. Structural, diffusion and functional Magnetic Resonance Imaging, which is optional for participants, will be completed prior to and 2 weeks following the training period. Follow-up assessments focusing on academic skills (primary outcome), working memory and attention (secondary outcomes) will be conducted at 2 weeks', 12 months' and 24 months' post-intervention. To our knowledge, this study will be the first randomised controlled trial to (a) assess the effectiveness of Cogmed in school-aged extremely preterm/extremely low birthweight children, while incorporating advanced imaging techniques to investigate neural changes associated with adaptive working memory training, and (b) employ long-term follow-up to assess the potential benefit of improved working memory on academic functioning. If effective, Cogmed would serve as a valuable, available intervention for improving developmental outcomes for this population.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612000124831.
    BMC Pediatrics 09/2013; 13(1):144. DOI:10.1186/1471-2431-13-144 · 1.92 Impact Factor
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    ABSTRACT: Using magnetic resonance imaging, this study compared hippocampal volume between 145 very preterm children and 34 children born full-term at 7 years of age. The relationship between hippocampal volume and memory and learning impairments at 7 years was also investigated. Manual hippocampal segmentation and subsequent three-dimensional volumetric analysis revealed reduced hippocampal volumes in very preterm children compared with term peers. However, this relationship did not remain after correcting for whole brain volume and neonatal brain abnormality. Contrary to expectations, hippocampal volume in the very preterm cohort was not related to memory and learning outcomes. Further research investigating the effects of very preterm birth on more extensive networks in the brain that support memory and learning in middle childhood is needed. (JINS, 2013, 19, 1-11).
    Journal of the International Neuropsychological Society 08/2013; DOI:10.1017/S1355617713000891 · 2.70 Impact Factor
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    ABSTRACT: To assess the self-reported quality of life, health status, self-esteem, and functional outcomes at age 18 years of extremely preterm (EP; <28 weeks gestation) or extremely low birth weight (ELBW; birth weight <1000 g) adolescents born in 1991-1992 compared with normal birth weight (birth weight >2499 g) controls, and, within the EP/ELBW cohort, to assess whether these outcomes are related to gestational age or birth weight. Self-reported measures of quality of life, health status, self-esteem, and functional outcomes were obtained at age 18 years from a geographic cohort of all survivors born EP/ELBW in 1991-1992 in the state of Victoria, Australia, along with matched normal birth weight controls. Data were available from 194 EP/ELBW and 148 control adolescents. EP/ELBW adolescents reported similar overall quality of life, health status, and self-esteem as controls (P > .05). Birth at younger gestational age or lower birth weight were not related to poorer quality of life within the EP/ELBW cohort (P > .05). EP/ELBW adolescents reported less physical activity (OR, 0.5; 95% CI, 0.3-0.8; P < .01), sexual activity (OR, 0.6; 95% CI, 0.4-0.9; P = .01), and alcohol intake (OR, 0.5; 95% CI, 0.3-0.8; P = .01) compared with controls. Other aspects of risk-taking behavior were similar in the 2 groups (P > .05). EP/ELBW individuals born after the introduction of exogenous surfactant are transitioning well into young adulthood, despite the fact that more of the tiniest and most immature infants survive than ever before. They report similar quality of life, self-esteem, and social and risk-taking behaviors as controls.
    The Journal of pediatrics 07/2013; 163(4). DOI:10.1016/j.jpeds.2013.05.048 · 4.02 Impact Factor
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    ABSTRACT: OBJECTIVE:Research is required to monitor changes in the nature of neurobehavioral deficits in extremely preterm (EP) or extremely low birth weight (ELBW) survivors. This study examines cognitive, academic, and behavioral outcomes at age 8 years for a regional cohort of EP/ELBW children born in 1997.METHODS:The EP/ELBW cohort comprised all live births with a gestational age <28 weeks (EP) or birth weight <1000 g (ELBW) born in the state of Victoria, Australia, in 1997. Of 317 live births, 201 (63.4%) survived to 2 years of age. A term/normal birth weight (T/NBW) cohort was recruited comprising 199 infants with birth weights <2500 g or gestational age <37 weeks. Measures of intellectual ability, educational achievement, and behavior were administered at age 8.RESULTS:Retention was 94% for the EP/ELBW group and 87% for the T/NBW group. The EP/ELBW group performed poorer than the T/NBW group on measures of IQ, educational achievement, and certain behavioral domains, even after adjustment for sociodemographic factors and exclusion of children with neurosensory impairment. The rate of any neurobehavioral impairment was elevated in the EP/ELBW group (71% vs 42%), and one-half of subjects had multiple impairments. The outcomes for those with <750 g birth weight or <26 weeks' gestational age were similar to those with a birth weight of 750 to 999 g or a gestational age of 26 to 27 weeks, respectively.CONCLUSIONS:Despite ongoing improvements in the management of EP/ELBW infants, the rate of neurobehavioral impairment at school-age remains too high relative to controls.
    PEDIATRICS 03/2013; 131(4). DOI:10.1542/peds.2012-2311 · 5.30 Impact Factor
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    ABSTRACT: OBJECTIVES:To determine changes in height, weight, and BMI of extremely preterm (EPT; gestational age <28 completed weeks) survivors from birth to 18 years of age, compared with term controls.METHODS:Birth, discharge, and follow-up at ages 2, 5, 8, and 18 years of consecutive EPT survivors and contemporaneous term controls born in 1991-1992 in Victoria, Australia. Weight, height, and BMI were converted to z scores and compared between groups. Height z scores at age 2 and midparental height z scores were examined as predictors of height z score at age 18 years.RESULTS:Follow-up rates were >90% until 18 years, when 166 (74%) of 225 EPT subjects and 153 (60%) of 253 controls were assessed. EPT subjects had lower weight z scores than controls at birth, with a much greater difference at discharge, which reduced progressively until age 18 years. EPT children were shorter than controls at all ages, and this difference did not alter greatly over time. BMI z scores were lower in EPT children at younger ages, but by age 18 were similar between groups. Height at age 2 was a better predictor of height at age 18 in EPT participants, compared with midparental height.CONCLUSIONS:EPT survivors were substantially lighter than term controls from birth to late adolescence, although the gap in weight steadily decreased over time from a peak at the time of discharge. The height disadvantage in EPT children compared with controls remained constant over time and BMI scores were similar at age 18 years.
    PEDIATRICS 01/2013; 131(2). DOI:10.1542/peds.2012-1135 · 5.30 Impact Factor
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    ABSTRACT: The hippocampus undergoes rapid growth and development in the perinatal months. Infants born very preterm (VPT) are vulnerable to hippocampal alterations, and can provide a model of disturbed early hippocampal development. Hippocampal shape alterations have previously been associated with memory impairment, but have never been investigated in infants. The aims of this study were to determine hippocampal shape differences between 184 VPT infants (<30weeks' gestation or <1250g at birth) and 32 full-term infants, effects of perinatal factors, and associations between infant hippocampal shape and volume, and 7year verbal and visual memory (California Verbal Learning Test- Children's Version and Dot Locations). Infants underwent 1.5T magnetic resonance imaging at term equivalent age. Hippocampi were segmented, and spherical harmonics-point distribution model shape analysis was undertaken. VPT infants' hippocampi were less infolded than full-term infants, being less curved toward the midline and less arched superior-inferiorly. Straighter hippocampi were associated with white matter injury and postnatal corticosteroid exposure. There were no significant associations between infant hippocampal shape and 7year memory measures. However, larger infant hippocampal volumes were associated with better verbal memory scores. Altered hippocampal shape in VPT infants at term equivalent age may reflect delayed or disrupted development. This study provides further insight into early hippocampal development and the nature of hippocampal abnormalities in prematurity.
    NeuroImage 01/2013; DOI:10.1016/j.neuroimage.2012.12.053 · 6.13 Impact Factor
  • Gehan Roberts, Jeanie L.Y. Cheong
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    ABSTRACT: Given the improving survival rates of extremely preterm (EP, gestational age <28 weeks) infants, there is a need to understand their general growth and health outcomes not only in childhood, but also into adulthood. EP children are shorter and lighter compared with term children at term-equivalent age; with time, the weight disadvantage diminishes but the height disadvantage remains relatively unchanged. EP children and young adults also have higher rates of reported health concerns, medical conditions and visual impairment. Hospital readmissions are higher in early childhood, mostly attributed to respiratory illness. Individuals born EP have reduced bone health and are at increased risk for metabolic disorders. Increased rates of conditions such as diabetes or pathological fractures are not reported in the literature, although follow-up studies so far have only tracked EP individuals into young adulthood. Consequently, health care utilization and costs are increased in EP children and young adults. A thorough knowledge of the health risks related to EP birth is essential in planning surveillance and intervention strategies to optimize their health and wellbeing. Despite the increased risk of health problems, EP young adults generally report their quality of life to be similar to that reported in their term counterparts.
    Seminars in Fetal and Neonatal Medicine 01/2013; · 3.13 Impact Factor
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    ABSTRACT: OBJECTIVE: Postnatal corticosteroids (PCS) are used to prevent or treat bronchopulmonary dysplasia (BPD) in extremely low birthweight (ELBW; <1000 g) or extremely preterm (EPT; <28 weeks) infants. In the early 2000s, concerns were raised about increased risks of cerebral palsy (CP) in association with PCS, which may have affected prescribing of PCS, and influenced rates of BPD, mortality or long-term neurosensory morbidity. Our aim was to determine the changes over time in the rates of PCS use and 2-year outcomes in ELBW/EPT infants in Victoria, Australia. DESIGN: All ELBW or EPT infants born in Victoria, Australia in three distinct eras (1991-92, 1997 and 2005) who were alive at 7 days were included. Rates of PCS use, rates of BPD (oxygen dependency at 36 weeks' corrected age), death before 2 years of age, CP and major disability (any of moderate/severe CP, developmental quotient <-2 SD, blindness or deafness) were contrasted between cohorts. RESULTS: The rate of PCS use and the dose prescribed diminished significantly in 2005 compared with earlier eras, but the rate of BPD rose. Non-significant changes in the rates of mortality over time were mirrored by non-significant changes in the rates of CP or major disability. Combined outcomes of mortality with either major disability or CP were similar over the three eras. CONCLUSIONS: PCS use decreased in 2005 compared with earlier eras, and was accompanied by a rise in BPD, with no significant changes in mortality or neurological morbidity.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2012; 98(1). DOI:10.1136/fetalneonatal-2011-301355 · 3.86 Impact Factor
  • Gehan Roberts, Anna Price, Frank Oberklaid
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    ABSTRACT: Aim:  Children with learning difficulties are commonly seen in Australian paediatric outpatient settings. The practice patterns of paediatricians in assessing, referring and managing these children are unknown, and there is no consensus on best practice. We thus aimed to examine the consistency between Australian paediatricians': (i) assessment; (ii) referral; and (iii) management of children presenting with learning difficulties. Methods:  All 373 paediatrician members of the Australian Paediatric Research Network were invited to participate in an online survey in 2010. Paediatricians who saw children with learning difficulties were asked questions about their assessment, referral and management practices. Results:  Of 181 (49%) paediatricians to complete the survey, 140 (77%) reported seeing patients with learning difficulties. Most often, paediatricians supplemented their clinical assessments with audiology assessments (75%), teacher or parent questionnaires (60-65%), or teacher contact (51%). Paediatricians used medical investigations (40%), direct assessment tools (27%) or a school visit (4%) less often. Most paediatricians referred children with learning difficulties to educational psychology (84%), special education (61%) or speech therapy (66%) services but less often to occupational therapy (34%) or mental health (15%) services. The most common management strategies were to provide a report to the school (76%) or parents (66%) and to make recommendations around sleep hygiene (75%) and for tutoring (66%). Conclusions:  Australian paediatric practice in this area is diverse, with the greatest variability around management practices. These data provide a case for designing and implementing evidence-based guidelines for the paediatric care of children who struggle to learn in school.
    Journal of Paediatrics and Child Health 05/2012; 48(12). DOI:10.1111/j.1440-1754.2012.02469.x · 1.19 Impact Factor
  • American Thoracic Society 2012 International Conference, May 18-23, 2012 • San Francisco, California; 05/2012

Publication Stats

517 Citations
130.08 Total Impact Points

Institutions

  • 2008–2014
    • University of Melbourne
      • Department of Paediatrics
      Melbourne, Victoria, Australia
  • 2009–2013
    • Murdoch Childrens Research Institute
      Melbourne, Victoria, Australia
  • 2009–2012
    • The Royal Children's Hospital
      • Department of Neonatal Medicine
      Melbourne, Victoria, Australia
  • 2010
    • Royal Hospital for Women
      Sydney, New South Wales, Australia