J D Kennedy

Publications (22)69.6 Total impact

• Article: Postnatal depression mediates the relationship between infant and maternal sleep disruption and family dysfunction.

  A M Piteo, R M Roberts, T Nettelbeck, N Burns, K Lushington, A J Martin, J D Kennedy
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  ABSTRACT: BACKGROUND: Previous research has linked family sleep disruption and dysfunction in children; however, the mechanism is unknown. AIMS: This study examined whether maternal sleep and postnatal depression (PND) mediate the relationship between infant sleep disruption and family dysfunction. STUDY DESIGN AND PARTICIPANTS: Mothers of infants aged 12months old (N=111; 48% male) completed infant and parent sleep surveys, the Edinburgh Postnatal Depression Scale and the Family Assessment Device. RESULTS: Poor infant sleep was related to poor maternal sleep, which was associated with higher PND and higher level of family dysfunction. CONCLUSIONS: Results are consistent with the proposition that identification of both infant and maternal sleep problems during infancy can be relevant to reduction of PND and improved family functioning.
  Early human development 08/2012; · 2.12 Impact Factor
• Article: Parent versus teacher report of daytime behavior in snoring children.

  Mark J Kohler, J D Kennedy, A J Martin, K Lushington
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  ABSTRACT: PURPOSE: Problematic behavior is widely reported in children with sleep-disordered breathing (SDB). Daytime behavior is an important component in the evaluation of clinical history in SDB; however, there is a reliance on parental report alone, and it is unclear whether reports by teachers will aid diagnosis. METHODS: We assessed sleep and behavior reported by both parents and teachers in 19 children with SDB and 27 non-snoring controls. All children were screened for prior diagnoses of other medical and/or behavior and learning disorders and underwent polysomnography and both parental and teacher assessment of behavior. RESULTS: Both parents and teachers report greater problematic behavior in SDB children, predominantly of an internalizing nature. Despite this consistency and moderate correlation between informants, the agreement between parent and teacher reports of individual child behavior was poor when assessed using Bland-Altman plots. CONCLUSIONS: Clinicians should be mindful that the behavioral history of a child being evaluated for SDB may vary depending on whether parent or teacher report is being discussed as this may influence clinical decision making.
  Sleep And Breathing 07/2012; · 1.84 Impact Factor
• Article: Psychometric properties of an omnibus sleep problems questionnaire for school-aged children.

  S N Biggs, J D Kennedy, A J Martin, C J van den Heuvel, K Lushington
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  ABSTRACT: There is a paucity of sleep questionnaires that have been psychometrically validated for use in school-aged children. Due to the limitation regarding the psychometric properties and the great variety in question design, there remains a need for a robust omnibus questionnaire that assesses sleep problems in community populations. This study aimed to develop such a questionnaire for school-aged children by assessing the construct validity and reliability of a questionnaire based on a combination of children's sleep domains from two frequently used and validated questionnaires (Habits Questionnaire and Sleep Disorders Scale for Children) and author devised questions. Parents of 1904 children aged 5-10 years (mean 7.7 ± 1.7 years) from 32 elementary schools in Adelaide, South Australia, completed the questionnaire. Principal axis factoring revealed six unique sub-scales--Sleep Routine, Bedtime Anxiety, Morning Tiredness, Night Arousals, Sleep Disordered Breathing, and Restless Sleep--containing a total of 26 items. Internal consistency for sub-scales were moderate to strong (range α = 0.6-0.8) and test-retest reliability was adequate (>0.4). T-score cut-offs were devised for age and sex. The new questionnaire provides a robust set of sleep problem sub-scales which can be used for assessment of sleep concerns in a community sample as well as provide for optimal analysis of associations with other measures of childhood daytime functioning such as neurocognition and behaviour.
  Sleep Medicine 02/2012; 13(4):390-5. · 3.40 Impact Factor
• Article: Snoring and cognitive development in infancy.

  A M Piteo, J D Kennedy, R M Roberts, A J Martin, T Nettelbeck, M J Kohler, K Lushington
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  ABSTRACT: This study aimed to assess the influence of snoring and sleep duration on developmental outcomes in 6 month old infants. As part of a longitudinal study of snoring in infancy, we identified 16 children (13 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 months of age and 88 healthy infant controls who were reported never to snore in the absence of a cold (36 males). Infants were assessed at 6 months of age with the Bayley Scales of Infant and Toddler Development Edition III, and parents completed demographic, sleep, and developmental surveys. Cognitive development was reduced in infants who snored frequently (mean=95.3; SD=4.3) from the first month of life compared to control infants (mean=100.6; SD=3.9) (F [1, 99]=23.8, p<.01; η(p)(2)=.21). Snoring during the first 6 months of life was associated with lower cognitive development scores. It is unknown whether these infants will continue to snore through childhood and, if so, whether the associated neurocognitive deficits will become worse with time.
  Sleep Medicine 11/2011; 12(10):981-7. · 3.40 Impact Factor
• Article: Parental-reported snoring from the first month of life and cognitive development at 12 months of age.

  A M Piteo, K Lushington, R M Roberts, A J Martin, T Nettelbeck, M J Kohler, J D Kennedy
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  ABSTRACT: The aim of the present study was to evaluate the effect of persistent snoring in the first year of life on developmental outcomes. As part of a longitudinal study of snoring and sleep in infancy, we identified 13 children (10 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 and 12 months of age and 78 controls (31 males) who were reported by parents to never snore in the absence of a cold. Infants were assessed with the Bayley Scales of Infant and Toddler Development Edition III and parents completed demographic and sleep questionnaires. Infants reported to snore frequently from the first month of life and who continued to snore frequently until 12 months of age had significantly lower cognitive development scores (mean=94.2; SD=3.9) compared to controls (mean=100.6; SD=3.7) (F (1, 96)=40 6, p<0.001; η(p)(2)=0.32). Persistent frequent snoring from the first month of life was associated with lower cognitive development scores at 12 months of age. It is possible that this deficit will become worse with age.
  Sleep Medicine 09/2011; 12(10):975-80. · 3.40 Impact Factor
• Article: Prevalence of snoring and associated factors in infancy.

  A M Piteo, K Lushington, R M Roberts, C J van den Heuvel, T Nettelbeck, M J Kohler, A J Martin, J D Kennedy
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  ABSTRACT: In children aged 3-12 years snoring is associated with significant neurocognitive and behavioural deficits; however, there are few studies that have considered both the prevalence of snoring in infants and associated factors that may influence the development of snoring. The goal of the present study was to examine sleep, snoring and associated factors in a community sample of 0-3 month olds. Previously validated infant sleep and parent sleep questionnaires were completed by parents of 457 term infants aged 1-13.9 weeks old (mean age=4.6 weeks; SD=2.7; 45% males) during a home-based nurse visit. Approximately 9% of infants were reported to snore habitually (snoring ≥ 3 nights/week). Habitual snoring was significantly associated with exclusive formula feeding (OR: 28.87; p<.01), maternal concern about child's breathing during sleep (OR: 3.91; p=.01) and restless sleep ≥ 3 nights/week (OR: 17.76; p<.001). These results show that snoring is as common in infants as it is in older children. Given the known relationships between Sleep Disordered Breathing (SDB) and neurocognitive development, the effect of SDB developing early in childhood may have important consequences on future developmental outcomes.
  Sleep Medicine 08/2011; 12(8):787-92. · 3.40 Impact Factor
• Article: Sleep-disordered breathing in Prader-Willi syndrome and its association with neurobehavioral abnormalities.

  F J O'Donoghue, D Camfferman, J D Kennedy, A J Martin, T Couper, L D Lack, K Lushington, R D McEvoy
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  ABSTRACT: To determine the prevalence and type of sleep-disordered breathing among patients with Prader-Willi syndrome (PWS) and its relationship to such neurobehavioral abnormalities as mental retardation, obsessive-compulsive behavior, and conduct disorders. Polysomnography (PSG) studies were conducted in 13 unselected subjects with PWS (age 1.5 to 28 years). PSG results were compared with tests of behavior and cognition (Development Behavior Checklist [DBC], Auditory Continuous Performance Test [ACPT], and Wechsler Intelligence Scale appropriate for age). Nine of 13 (69%) subjects had > 10 apneas and hypopneas per hour of sleep. Apart from a 2-year-old subject with normal body weight who demonstrated severe central hypopnea in rapid eye movement sleep, the sleep-breathing disturbance was due to upper airway obstruction. Age-adjusted body mass index was associated with more severe hypoxemia during sleep (min SaO2, r = -.87, P < .005) and more sleep disruption (arousals/hour of sleep, r = .62, P < .05; sleep efficiency, r = -.66, P < .05). Increasing severity of obstructive sleep apnea (OSA) or sleep disturbance was associated with daytime inactivity/sleepiness and autistic-relating behavior (DBC) and with impulsiveness (ACPT). Unexpectedly, sleep hypoxemia appeared to be predictive of increased performance IQ. OSA is prevalent among subjects with PWS and is associated with increased body mass, daytime inactivity/ sleepiness, and some behavioral disturbances.
  Journal of Pediatrics 12/2005; 147(6):823-9. · 4.11 Impact Factor
• Article: Reduced neurocognition in children who snore.

  J D Kennedy, S Blunden, C Hirte, D W Parsons, A J Martin, E Crowe, D Williams, Y Pamula, K Lushington
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  ABSTRACT: Obstructive sleep apnea syndrome (OSAS) has been associated with reduced neurocognitive performance in children, but the underlying etiology is unclear. The aim of this study was to evaluate the relationship between hypoxemia, respiratory arousals, and neurocognitive performance in snoring children referred for adenotonsillectomy. Thirteen snoring children who were referred for evaluation regarding the need for adenotonsillectomy to a children's hospital otolaryngology/respiratory department underwent detailed neurocognitive and polysomnographic (PSG) evaluation. PSGs were evaluated for respiratory abnormalities and compared with 13 nonsnoring control children of similar age who were studied in the same manner. The snoring children had an obstructive respiratory disturbance index within normal range (mean obstructive apnea/hypopnea index, 0.6/hr). Despite this, several domains of neurocognitive function were reduced in the snoring group. These included mean verbal IQ scores (snorers 92.6 vs. nonsnorers 110.2, P < 0.001), mean global IQ scores (snorers 96.7 vs. nonsnorers 110.2, P < 0.005), mean selective attention scores (snorers 46.4 vs. nonsnorers 11.8, P < 0.001), mean sustained attention scores (snorers 8.0 vs. nonsnorers 2.2, P = 0.001), and mean memory index (snorers 95.2 vs. nonsnorers 112.1, P = 0.001). There was a direct relationship between number of mild oxygen desaturations of > or = 3%, obstructive hypopneas with > or = 3% oxygen desaturations, and respiratory arousals and severity of neurocognitive deficits, with the greatest effect being on memory scores. The disruption of sleep in snoring children produced by relatively mild changes in oxygen saturation or by increases in respiratory arousals may have a greater effect on neurocognitive function than hitherto appreciated. A possible explanation for these neurocognitive deficits may be the combination of the chronicity of sleep disruption secondary to snoring which is occurring at a time of rapid neurological development in the first decade of life. Future studies need to confirm the reversal of these relatively mild neurocognitive decrements post adenotonsillectomy.
  Pediatric Pulmonology 04/2004; 37(4):330-7. · 2.53 Impact Factor
• Source

  Available from: nih.gov

  Article: Late presentation of upper airway obstruction in Pierre Robin sequence.

  A C Wilson, D J Moore, M H Moore, A J Martin, R E Staugas, J D Kennedy
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  ABSTRACT: A retrospective review was carried out of 11 consecutive patients with the Pierre Robin sequence referred to a tertiary paediatric referral centre over a five year period from 1993 to 1998. Ten patients were diagnosed with significant upper airway obstruction; seven of these presented late at between 24 and 51 days of age. Failure to thrive occurred in six of these seven infants at the time of presentation, and was a strong indicator of the severity of upper airway obstruction. Growth normalised on treatment of the upper airway obstruction with nasopharyngeal tube placement. All children had been reviewed by either an experienced general paediatrician or a neonatologist in the first week of life, suggesting that clinical signs alone are insufficient to alert the physician to the degree of upper airway obstruction or that obstruction developed gradually after discharge home. The use of polysomnography greatly improved the diagnostic accuracy in assessing the severity of upper airway obstruction and monitoring the response to treatment. This report highlights the prevalence of late presentation of upper airway obstruction in the Pierre Robin sequence and emphasises the need for close prospective respiratory monitoring in this condition. Objective measures such as polysomnography should be used, as clinical signs alone may be an inadequate guide to the degree of upper airway obstruction.
  Archives of Disease in Childhood 12/2000; 83(5):435-8. · 2.88 Impact Factor
• Article: Effect of immediate versus slow intrauterine reduction of congenital diaphragmatic hernia on lung development in the sheep: a morphometric analysis of term pulmonary structure and maturity.

  J Lipsett, J C Cool, S C Runciman, W D Ford, D W Parsons, J D Kennedy, A J Martin
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  ABSTRACT: The incidence of congenital diaphragmatic hernia (CDH) is 1:1,200-5, 000, and the condition is associated with high mortality and morbidity attributed principally to associated pulmonary hypoplasia. One treatment approach has been for intrauterine intervention to induce lung growth to a sufficient level to allow survival at birth. Repair of the hernia in utero has been attempted, using a method of immediate reduction and repair of the hernia (patch) compared to a slow reduction method using a silastic "silo" sewn over the diaphragm defect to contain the hernial contents. In animal studies, this second method has been associated with lower fetal morbidity and mortality. This study, utilizing the sheep model of CDH, focuses on analysis of lung structural development and maturation, comparing the efficacy of the immediate vs. slow methods of hernial repair in preventing/reversing pulmonary hypoplasia. We hypothesized that: a) Both the immediate (patch) and slow (silo) methods of hernia repair performed in the lamb model of CDH will stimulate lung growth and structural development and restore lung structure and maturity towards normal levels by term gestation; b) Effects will be detectable by morphometric measurement of the following parameters: lung volume; parenchyma to nonparenchyma tissue ratio; volume density of connective tissue in nonparenchyma; gas exchange tissue to airspace ratio; gas exchange surface area; capillary loading; alveolar/airspace density; and alveolar perimeter; c) Effects will be seen in all lobes of the lung; and d) There will be no significant difference in lung size or structural parameters between the two groups. Forty-four pregnant ewes were allocated randomly to one of four groups. Fetal lambs in three groups (n = 36) underwent CDH creation at days 72-74 of gestation. Of surviving lambs showing an adequate hernia, 9 were not operated on further, 11 underwent "repair" using a silastic chimney around the hernial contents (slow reduction), and 11 underwent "repair" by a silastic patch over the diaphragmatic defect (immediate reduction). The fourth group were normal controls. All surviving lambs (n = 8 in each group) were delivered by Cesarian section at 141-143 days (term = 145-149 days). Lungs were obtained at autopsy, inflation-fixed, divided into lobes, and sampled, and morphometric analysis was performed. Comparisons were made between these groups and with matched normal controls and CDH untreated animals prepared in conjunction and previously reported. The lungs from the CDH animals treated by both methods of fetal hernia repair showed significant lung growth and structural development and maturation, although they remained significantly hypoplastic compared to normal. There were minor differences in the lung parameters between these two groups, with a tendency for the slow method to provide more normal parameter values. An exception was the increase in lung volume that was greater for the immediate (patch) method, particularly in the left lower lobe. In conclusion, intrauterine hernia repair by both methods is capable of partially reversing total lung and lobar structural hypoplasia and immaturity. The slow reduction method, with reduced potential for mortality and morbidity, is at least as good at reversing pulmonary hypoplasia as the immediate method. Alternative intrauterine interventions to prevent or reverse pulmonary hypoplasia are discussed and compared with the hernia repair methods used in this study.
  Pediatric Pulmonology 10/2000; 30(3):228-40. · 2.53 Impact Factor
• Article: Effects of birthweight and oxygen supplementation on lung function in late childhood in children of very low birth weight.

  J D Kennedy, L J Edward, D J Bates, A J Martin, S N Dip, R R Haslam, A J McPhee, R E Staugas, P Baghurst
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  ABSTRACT: Impaired respiratory function has been found frequently in ex-premature children, but it is unclear which specific factors influence this impairment the most. The aim of this study was to determine the importance of the contributions of birth weight, gestational age, neonatal respiratory disease, and its treatment on subsequent childhood lung function at age 11 years in a cohort of children of very low birth weight (VLBW; </=1,500 g). Detailed clinical histories were recorded, and lung function was measured in 60% (102 children) of surviving VLBW infants born 1981/1982, and compared with 82 matched control children (birth weight >2,000 g) of similar age. VLBW children were shorter and lighter than controls (P < 0.0001) at 11 years of age, and had reduced expiratory flows (P < 0.00001) and forced vital capacities (P < 0.001). The residual volume to total lung capacity ratio (RV/TLC ratio) was increased (P < 0.00001), while total lung capacity (TLC) remained unchanged. Those with bronchopulmonary dysplasia (BPD) had the lowest mean expiratory flows. Males had lower expiratory flows than females. On univariate analysis, gestational age by itself accounted for 8.8% of the explained variance in FEV(1) at 11 years of age, but birth weight accounted for 16% on its own; both together accounted for a further 0.2% (16.2%), suggesting that the latter was the dominant factor. On multivariate analysis, the contribution of birth weight and gestational age was small, and the best predictors at 11 years of age, which together explained 43.4% of the total variance in FEV(1), were log days of supplemental oxygen (9.6%) and a reported history of asthma (10.8%). For FEF(25-75), these predictors explained 7.2% and 13.4%, respectively, of the total explained variance of 40.6%. The relation between neonatal oxygen supplementation and childhood FEV(1) was such that up to 20 days of supplemental oxygen had little effect on subsequent FEV(1) at 11 years of age, but each additional week of supplemental oxygen after that time was associated with a progressive reduction in FEV(1) of 3%. These data confirm the significant role of supplemental oxygen in the neonatal period and a history of asthma on the subsequent reduction of expiratory flows in VLBW children. Birth weight was a more important prenatal factor than gestational age, but both were of lesser predictive significance than either supplemental oxygen or a reported history of asthma.
  Pediatric Pulmonology 07/2000; 30(1):32-40. · 2.53 Impact Factor
• Article: Asthma and other atopic diseases in Australian children. Australian arm of the International Study of Asthma and Allergy in Childhood.

  C F Robertson, M F Dalton, J K Peat, M M Haby, A Bauman, J D Kennedy, L I Landau
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  ABSTRACT: To determine the prevalence of asthma, eczema and allergic rhinitis in Australian schoolchildren using the protocol of the International Study of Asthma and Allergy in Childhood (ISAAC). Questionnaire-based survey. Melbourne, Sydney, Adelaide (in winter-spring, 1993) and Perth (in winter-spring, 1994). All children in school years 1 and 2 (ages 6-7 years) or in year 8 (ages 13-14 years), attending a random sample of 272 schools, stratified by age and city. Parent-reported (for 6-7 year olds) or self-reported (for 13-14 year olds) symptoms of atopic disease in the previous 12 months, or ever; treatment of asthma; and country of birth. 10,914 questionnaires were completed for 6-7 year olds and 12,280 for 13-14 year olds (84% and 94% response rates, respectively). Prevalence of wheeze in the past 12 months was 24.6% for the 6-7 year olds and 29.4% for the 13-14 year olds, and, among 6-7 year olds, was significantly higher in boys (27.4%) than girls (21.7%). Children born in Australia were more likely to report current wheeze than those born elsewhere (6-7 year olds: odds ratio [OR], 1.82; 95% confidence interval [CI] 1.55-2.15; and 13-14 year olds: OR, 1.88; 95% CI, 1.68-2.11). Prevalences of current eczema and allergic rhinitis were 10.9% and 12.0%, respectively, for the 6-7 year olds, and 9.7% and 19.6%, respectively, for the 13-14 year olds. Asthma, eczema and rhinitis coexisted in 1.8% of 6-7 year olds and 2.8% of 13-14 year olds. This study provides evidence that asthma prevalence in Australian schoolchildren is continuing to increase and is higher among Australian-born children than among those born elsewhere. Asthma, eczema and allergic rhinitis coexist to a lesser extent than expected. These results form the basis for future Australian and international comparisons.
  The Medical journal of Australia 06/1998; 168(9):434-8. · 2.81 Impact Factor
• Article: Effect of antenatal tracheal occlusion on lung development in the sheep model of congenital diaphragmatic hernia: a morphometric analysis of pulmonary structure and maturity.

  J Lipsett, J C Cool, S I Runciman, W D Ford, J D Kennedy, A J Martin
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  ABSTRACT: The incidence of congenital diaphragmatic hernia (CDH) is 1:1,207-5,000, and the condition is associated with high mortality and morbidity, attributed principally to associated pulmonary hypoplasia. Repairing the diaphragmatic defect by antenatal surgery has high mortality, mainly due to premature labor. Antenatal tracheal occlusion, which is achievable by less invasive methods, stimulates lung growth (weight and DNA). However, its effectiveness in reversing structural and maturational abnormalities and its optimal timing requires further investigation. We hypothesized that (1) antenatal tracheal occlusion performed in the lamb model of congenital diaphragmatic hernia will stimulate lung growth and structural development and restore lung structure and maturity toward normal levels by term gestation; (2) effects will be detectable by morphometric measurements of the following parameters: lung volume, ratio of parenchyma to nonparenchyma, volume density of connective tissue within nonparenchyma, ratio of gas exchange tissue to airspace in parenchyma, gas exchange surface area, capillary loading, alveolar/airspace density and alveolar perimeter; (3) effects will be seen in all lobes of the lung; and (4) a greater effect will be observed when tracheal occlusion is performed early rather than late in gestation. Fourteen lambs underwent CDH creation at gestation day 72-74 followed by tracheal occlusion at day 101 (n = 7) or 129 (n = 7). They were delivered by Cesarean section at 143 days (term = 145-149). Lungs were obtained at autopsy, inflation fixed, divided into lobes, and sampled; morphometric analysis was performed. Comparisons were made with previously reported results from control lungs of normal lambs and lambs with untreated CDH. In comparison with untreated lungs, antenatal tracheal occlusion at both times resulted in increased volumes for total lung and lobes, increased volume density of parenchyma and of airspace within parenchyma, and increased gas exchange surface areas. Normal values for gas exchange surface area density, and alveolar density and perimeter were attained and the lungs appeared more mature than non-occluded lungs. Tracheal occlusion earlier in gestation produced a greater effect, achieving greater than normal values for lung volumes and volume densities, whereas the capillary loading value was similar to normal lung. Later occlusion achieved less than normal values for lung volumes and volume densities, with a reduced capillary loading value. We conclude that antenatal tracheal occlusion is capable of reversing structural total lung and lobar hypoplasia and immaturity caused by CDH as determined by morphometrically determined parameters. The effect is greater when tracheal occlusion is performed early rather than late in gestation. The results are encouraging for development of treatment methods for humans with antenatally diagnosed CDH.
  Pediatric Pulmonology 05/1998; 25(4):257-69. · 2.53 Impact Factor
• Article: Diagnostic difficulties in cases of sudden death in infants with mandibular hypoplasia.

  R W Byard, J D Kennedy
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  ABSTRACT: Infants with mandibular hypoplasia are at risk of sudden death from cardiorespiratory arrest secondary to upper airway obstruction. To evaluate diagnostic difficulties that may occur at autopsy in such infants, the autopsy files at the Adelaide Children's Hospital (ACH) for 36 years, 1959 to 1994, were reviewed. Eight cases were identified (age range, 2 days to 10 months; mean age, 2.2 months; male/female ratio, 5:3). In all cases, death was considered most likely due to airway obstruction related to mandibular hypoplasia or its treatment. Although death occurred in the hospital in five cases, one infant suddenly collapsed at home while feeding and died, and two infants were unexpectedly found dead in their cribs at home. Three infants had defined genetic syndromes. Although all the infants had histories of antemortem airway obstruction, one infant had normal oxygen saturation studies before hospital discharge, and one infant had a tracheostomy. Acute bronchopneumonia was an exacerbating factor in one case. Assessment of mandibular size is important in any infant who dies unexpectedly; and if hypoplasia is found, careful review of the clinical details for evidence of airway obstruction is necessary to help distinguish these cases from sudden infant death syndrome (SIDS). Sudden death may, however, occur in infants with mandibular hypoplasia in spite of apparent clinical stability before death with no significant recent episodes of oxygen desaturation.
  American Journal of Forensic Medicine & Pathology 10/1996; 17(3):255-9. · 0.88 Impact Factor
• Article: Congenital diaphragmatic hernia: lung compliance after antenatal tracheal obstruction or surgical correction of the defect

  W. D. A. Ford, J. C. Cool, D. Parsons, A. J. Martin, J. D. Kennedy, J. Lipsett, R. W. Byard, A. J. Slater
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  ABSTRACT: Fetal lambs with diaphragmatic herniae (CDH) created surgically at 73 days' gestation were subjected to three different forms of intrauterine correction: silastic patch correction of the diaphragmatic defect plus an abdominal patch at 101 days gestation; an intrathoracic silo at 101 days; and a tracheal plug obstruction at 101 or 129 days. At 143 days' gestation (term 145–149 days), the lambs were delivered by caesarean section and ventilated for 30 min before undergoing respiratory compliance measurements. These results were compared to those of normal lambs and animals with uncorrected herniae. The total respiratory system compliance values in those groups undergoing corrections were remarkably similar: those with any form of correction had a significant improvement (P < 0.05)="" compared="" to="" those="" with="" herniae="" and="" no="" correction="" (patch="1.57" =="" ="" 0.182="" ml/cm="">2O; silo = 1.53 0.179; plug at 101 days = 1.66 0.311; plug at 129 days = 2.00 0,175; without correction = 0.62 0.073). None, however, reached the values of those with normal lungs: 2.72 0.223 (P < 0.05).="" this="" improvement="" in="" compliance="" in="" all="" corrected="" groups="" suggests="" that="" fetal="" tracheal="" obstruction="" is="" as="" effective="" as="" the="" two="" more="" invasive="" forms="" of="" open="" fetal="" surgery="" carried="" out="" in="" this="" study="" and,="" as="" this="" procedure="" lends="" itself="" to="" surgery="" through="" a="" small="" uterine="" incision="" or="">minimally invasive surgery, it may be the procedure of choice to reduce the incidence of preterm labour for those human fetuses undergoing antenatal correction of a CDH.bb
  Pediatric Surgery International 12/1995; 11(8):524-527. · 1.25 Impact Factor
• Source

  Available from: David W Parsons

  Article: Effect of spinal surgery on lung function in Duchenne muscular dystrophy.

  J D Kennedy, A J Staples, P D Brook, D W Parsons, A D Sutherland, A J Martin, L M Stern, B K Foster
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  ABSTRACT: The effect on subsequent respiratory function of spinal stabilisation for scoliosis in Duchenne muscular dystrophy is unclear. In order to clarify this clinical problem, changes in the forced vital capacity of a group of children with Duchenne muscular dystrophy who had undergone spinal surgery were measured and compared with a group of children with Duchenne muscular dystrophy who had not had surgery. In this retrospective study 17 boys with Duchenne muscular dystrophy who underwent spinal stabilisation at a mean age of 14.9 years (surgical group) were compared with 21 boys with Duchenne muscular dystrophy who had not had surgery (non-surgical group). The mean (SD) Cobb angle of the surgical group at 14.9 years was 57 (16.4) degrees, and of the non-surgical group at 15 years was 45 (29.9) degrees. Forced vital capacity expressed as percentage predicted (% FVC) was measured in total over a seven year period in the surgical group and over 6.5 years in the non-surgical group, and regression equations were calculated. Survival curves for both groups were also constructed. No difference was found between spinal stabilisation (surgical group) and the non-surgical group in the rate of deterioration of % FVC which was 3-5% per year. There was no difference in survival in either group. Spinal stabilisation in Duchenne muscular dystrophy does not alter the decline in pulmonary function, nor does it improve survival.
  Thorax 12/1995; 50(11):1173-8. · 6.84 Impact Factor
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  Available from: David W Parsons

  Article: Fetal lung compliance in premature and term lambs after two methods of in utero repair of diaphragmatic hernia.

  D W Parsons, W D Ford, J C Cool, A J Martin, R E Staugas, J D Kennedy
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  ABSTRACT: In utero surgery was used to correct a surgically induced model of congenital diaphragmatic hernia (CDH) in premature and term lambs, resulting in an improvement in lung mechanics at birth. The differences between the in utero "patch" repair method and the "silo" repair method were assessed in 55 lambs by measuring the static respiratory system compliance (CST,RS) at birth in term (approximately 145 day) and in premature (128 day) animals. Both methods resulted in similar improvements in CST,RS in term lambs, but in premature lambs only the silo method produced an increase in compliance. Comparisons of specific compliance related to length or birth weight did not alter these findings; however, corrections related to lung weight or a measure of lung volume showed there was no difference between any experimental groups in either term or premature lambs. These findings suggest that there was no difference in the intrinsic compliance of the lung tissue between normal, unrepaired and repaired animals, and that the differences in respiratory system compliance measured at birth may be due primarily to differences in lung size. The silo repair method appears to provide an earlier improvement in CST,RS than the patch repair method.
  Thorax 11/1994; 49(10):1015-9. · 6.84 Impact Factor
• Article: Intrathoracic silo for fetal diaphragmatic hernia: lung growth and slow reduction of abdominal viscera.

  W D Ford, A J Martin, J C Cool, D W Parsons, J D Kennedy
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  ABSTRACT: Correction of a left congenital diaphragmatic hernia in a human fetus with a large volume of liver in the chest requires reduction of liver and viscera into the abdomen. This can kink the ductus venosus and cause the death of the fetus. Therefore, we have repaired surgically created diaphragmatic hernias in fetal lambs by leaving viscera in the chest wrapped in a silastic chimney. With fetal growth there is a relative reduction of hernia volume over weeks, potentially avoiding kinking the ductus venosus. In four groups of lambs lung size and static respiratory system compliance at birth were compared. Lambs treated by this new technique (silo, n = 7) were compared with lambs that had undergone immediate complete correction with a flat silastic patch in the diaphragm plus an abdominal patch (patch, n = 8), with lambs with uncorrected hernias (n = 6), and with normals (n = 8). There was no significant difference between total lung weights (131 +/- 6 g v 157 +/- 13 g, mean +/- SEM, silo v patch) and lung displacement volumes (142 +/- 7 mL v 162 +/- 14 mL) in either surgically corrected group. Lungs from those corrected by silo were significantly heavier than those with uncorrected herniae (131 +/- 6 g v 56 +/- 5 g, P < .01), but were not as heavy as normal lungs (131 +/- 6 g v 257 +/- 16 g, P < .01).(ABSTRACT TRUNCATED AT 250 WORDS)
  Journal of Pediatric Surgery 09/1993; 28(8):1006-8. · 1.45 Impact Factor
• Source

  Available from: Irene Hudson

  Article: Effect of bracing on respiratory mechanics in mild idiopathic scoliosis.

  J D Kennedy, C F Robertson, I Hudson, P D Phelan
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  ABSTRACT: The use of a corrective orthopaedic brace is an established form of management for patients with progressive idiopathic scoliosis. Thirteen patients with mild idiopathic scoliosis were studied with and without the corrective brace applied. Lung volumes and the pattern of chest wall and abdominal movement were measured during quiet breathing. Transdiaphragmatic pressures were measured in six of the patients and upper ribcage movement in seven patients. Application of the brace resulted in a significant reduction in vital capacity (14%), functional residual capacity (22%), and total lung capacity (12%). There was no effect on respiratory rate or minute volume. In the erect position the pattern of chest wall movement was altered with a reduction in lower ribcage movement of 46% and abdominal wall of 39% and an increase in upper ribcage movement of 43%. These changes were greater in the supine position. There was at least a twofold increase in end inspiratory and end expiratory gastric pressures during tidal breathing, but oesophageal pressures were not affected by the brace. Transdiaphragmatic pressures showed a similar twofold increase, which implies a substantial increase in the work of breathing. In view of the doubts concerning the influence of bracing on the natural history of idiopathic scoliosis and the substantial functional effect of bracing on the respiratory system, it is suggested that the current practice of bracing in this condition needs to be reviewed.
  Thorax 08/1989; 44(7):548-53. · 6.84 Impact Factor
• Article: Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.

  J D Kennedy, C F Robertson, A Olinsky, D R Dickens, P D Phelan
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  ABSTRACT: The use of bracing in the treatment of mild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence of other disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed.
  Thorax 01/1988; 42(12):959-61. · 6.84 Impact Factor