Anne Greenough's research while affiliated with NIHR Oxford Biomedical Research and other places

Publications (613)

Article
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Objective To assess the association of short-term neonatal outcomes with cross-site working of multiple healthcare professional teams between a level 3 and a level 1 neonatal unit. Design Retrospective cohort study. Setting A level 1 neonatal unit in London. Patients All infants admitted to the neonatal unit, between 2010 and 2021. Intervention...
Article
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Background Neonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal units during the pandemic. Methods Parents of infants admitted to each neonatal unit were asked to complete a questionnaire regarding their experi...
Article
Premature birth is a risk factor for bronchopulmonary dysplasia (BPD); both of which are associated with obstructive airway disease throughout childhood. Impulse oscillometry (IOS) is an effort-independent, passive measure of tidal breathing, which could have benefits in assessing lung function amongst younger patients unable to perform valid spiro...
Article
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Objectives: To assess if a previous diagnosis of BPD was associated with poorer lung function at 16 to 19 years of age, regardless of whether postnatal corticosteroids had been administered. Working hypothesis: Infants with BPD will have poorer lung function at 16 to 19 years of age. Study design: Prospective follow-up study PATIENT-SUBJECT SE...
Article
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The forced oscillation technique (FOT) is a non-volitional assessment that is used during tidal breathing. A variant of FOT uses a pseudorandom noise (PRN) signal which we postulated might have utility in assessing lung function in prematurely born children. We, therefore, undertook a systematic review to evaluate the evidence regarding PRN FOT. A...
Article
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The use of inhaled nitric oxide (iNO) in treating pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH) is controversial. Our aims were to identify factors associated with survival in CDH infants and whether this was influenced by the response to iNO. Results of CDH infants treated in a tertiary surgical and medical perinatal...
Article
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Objectives To assess the incidence of acute kidney injury (AKI) in infants with congenital diaphragmatic hernia (CDH), including those who had fetoscopic endoluminal tracheal occlusion (FETO), and the effect of AKI on mortality and length of stay. Study design Ten-year retrospective review of infants admitted with CDH to a tertiary perinatal centr...
Article
Chronic respiratory morbidity is unfortunately common in childhood, particularly in those born very prematurely or with congenital anomalies affecting pulmonary development and those with sickle cell disease. Our research group, therefore, has focused on the early origins of chronic respiratory disease. This has included assessing antenatal diagnos...
Article
Antenatal diagnosis of abnormal pulmonary development has improved significantly over recent years due to progress in imaging techniques. 2D ultrasound is the mainstay of investigation of pulmonary pathology during pregnancy, providing good prognostication in conditions such as congenital diaphragmatic hernia; however, it is less validated in other...
Article
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Objectives Newborns with congenital diaphragmatic hernia (CDH) can have complex respiratory problems which are worsened by ventilatory induced lung injury. Neurally adjusted ventilator assist (NAVA) is a potentially promising ventilation mode for this population, as it can result in improved patient-ventilator interactions and provision of adequate...
Article
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Background: Hypoxia can adversely affect cognition, while socioeconomic deprivation has also been associated with impaired neurodevelopment in the newborn. We aimed to assess the impact of hypoxia and socioeconomic deprivation on the neurodevelopmental outcomes of preterm infants. Methods: Retrospective cohort study at a tertiary neonatal unit b...
Article
Background: A small group of extremely preterm infants survive to 36 weeks postmenstrual age (PMA), but die before discharge from neonatal care. Aims: To investigate which epidemiological and clinical parameters were related to death after 36 weeks PMA in extremely preterm infants. Study design: Retrospective whole-population study. Subjects:...
Article
Objectives To describe the importance of comprehensive assessment to determine the underlying diagnosis and the role of physiological pulmonary measurements in the management of congenital bilateral eventration of the diaphragm. Case presentation A female infant born at 34 weeks gestation required intubation and ventilation at birth. Chest radiogr...
Article
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Congenital diaphragmatic hernia (CDH) results in varying degrees of pulmonary hypoplasia. Volume targeted ventilation (VTV) is a lung protective strategy but the optimal target tidal volume in CDH infants has not previously been studied. The aim of this study was to test the hypothesis that low targeted volumes would be better in CDH infants as det...
Article
Objectives A greater proportion of non-pregnant smokers attempted to stop smoking during compared to before the COVID-19 pandemic. The objective of this study was to determine if a greater proportion of pregnant women also attempted to stop smoking during the pandemic rather than before. Methods The use of antenatal smoking cessation services and...
Article
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Background Premature attempts at extubation and prolonged episodes of ventilatory support in preterm infants have adverse outcomes. The aim of this study was to determine whether measuring the electrical activity of the diaphragm during a spontaneous breathing trial (SBT) could predict extubation failure in preterm infants. Methods When infants we...
Chapter
In the delivery room an absolute indication for intubation is failure to establish adequate spontaneous respiration despite adequate face mask ventilation. Historically, infants with a diaphragmatic hernia were always intubated and ventilated in the delivery suite, but there is non-randomized evidence that in some infants this may not be necessary....
Chapter
Hypoxemia in the neonatal period can result from multiple causes ventilation/perfusion mismatch, increased physiologic dead space and extrapulmonary (right-to-left) shunts. Hypoventilation (reduced alveolar ventilation, reduction in tidal volume and/or frequency) is distinguished by a high PaCO2 in association with hypoxemia. Reduced lung volume, v...
Chapter
I. Definition A. Tissue hypoxia occurs when oxygen transport is reduced below a critical level (i.e., below the metabolic demand), at which point either metabolism must be maintained anaerobically or tissue metabolic rate must be reduced. B. Under experimental conditions, if demands are kept constant, there is a biphasic response in oxygen consumpt...
Article
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Background Many preterm infants require supplemental oxygen in the newborn period but experience frequent fluctuations of their oxygen saturation levels. Intermittent episodes of hypoxia or hyperoxia increase the risk of complications. Compliance with achievement of oxygen saturation targets is variable, and the need for frequent adjustments of the...
Article
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Objective: To examine changes in lung function over time in extremely prematurely born adolescents. Working hypothesis: Changes in lung function during adolescence would vary by ventilation mode immediately after birth. Study design: Longitudinal follow-up study PATIENT SUBJECT SELECTION: Participants from the United Kingdom Oscillation Study...
Article
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Congenital diaphragmatic hernia (CDH) is a rare developmental defect of the lungs and diaphragm, with substantial morbidity and mortality. Although internationally established treatment guidelines have been developed, most recommendations are still expert opinions. Trials in patients with CDH, more in particular randomized controlled trials, are ra...
Article
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Background We aimed to explore the postnatal evolution of ventilation/perfusion ratio ( V A / Q ) and right-to-left shunt in infants with congenital diaphragmatic hernia (CDH) and whether these indices predicted survival to discharge. Methods Retrospective cohort study at King’s College Hospital, London, UK of infants admitted with CDH in 10 years...
Article
Objective: To determine factors which influenced the relationship between blood carbon dioxide (pCO2) and end-tidal carbon dioxide (EtCO2) values in ventilated, newborn infants. Furthermore, to assess whether pCO2 levels could be predicted from continuous EtCO2 monitoring. Approach: An observational study of routinely monitored newborn infants r...
Article
Background Less invasive surfactant administration (LISA) on the neonatal unit reduces the need for mechanical ventilation and bronchopulmonary dysplasia (BPD). Aims To assess the immediate and longer-term efficacy of LISA to prematurely born infants in the delivery-room. Study design A case control study with inborn historical controls matched f...
Article
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Objective To use cluster analysis to identify discrete phenotypic groups of extremely preterm infants. Design Secondary analysis of a retrospective whole population study. Setting All neonatal units in England between 2014 and 2019. Participants Infants live-born at less than 28 weeks of gestation and admitted to a neonatal unit. Interventions...
Article
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Optimisation of respiratory support of infants with congenital diaphragmatic hernia (CDH) is critical. Infants with CDH often have severe lung hypoplasia and abnormal development of their pulmonary vasculature, leading to ventilation perfusion mismatch. It is vital that lung protective ventilation strategies are employed during both initial stabili...
Article
The main respiratory pathophysiological process following premature birth is the delayed or arrested alveolar development which translates to a smaller alveolar surface area (S­ A ). Histological morphometry is the gold standard method to measure the S A but requires invasive tissue sampling or the removal of the whole organ for analysis. Alternati...
Article
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Objectives Pulmonary hypertension (PH) is a complication of bronchopulmonary dysplasia (BPD) and associated with increased mortality and morbidity. Our aim was to identify, in infants with BPD, the effect of PH on health-care utilisation and health related cost of care. Methods An electronic data recording system was used to identify infants ≤32 w...
Article
Background Carboxyhaemoglobin (COHb) levels may reflect the level of early oxidative stress which plays a role in mediating free-radical-related diseases in prematurely born infants. Aim To assess the relationship of COHb levels in the first seven days of after birth to the development of bronchopulmonary dysplasia (BPD) and other free-radical-rel...
Article
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Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in in...
Article
Background Nicotine replacement therapy (NRT) and e-cigarettes are recommended to pregnant women who wish to stop smoking. Albeit eliminating other harmful components of cigarettes, those alternatives still expose the developing fetus to nicotine. The lungs may be particularly vulnerable to damage by nicotine as there is widespread nicotinic-acetyl...
Conference Paper
Background Premature infants are at risk of developing bronchopulmonary dysplasia (BPD). Pulmonary hypertension (PH) is a recognised complication of BPD. Objectives To identify the risk factors and outcomes of pulmonary hypertension in infants with BPD in a tertiary neonatal intensive care unit. Methods An electronic data recording system (Badger...
Conference Paper
Background All neonatal units, have implemented policies designed to prevent the spread of COVID-19 infection. Parents of babies admitted to neonatal units have had to make adjustments to comply with such guidance and visiting restrictions. Only one parent could visit their baby at a time and they were required to wear a surgical mask while on the...
Conference Paper
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Background NAVA/NIV-NAVA (Neurally adjusted ventilatory assist/non-invasive NAVA) utilises the electrical activity of the diaphragm to trigger the ventilator. A modified nasogastric feeding tube with a series of electrodes allows monitoring of the diaphragmatic electromyogram (Edi).¹ The waveform of the Edi is used to trigger and control ventilator...
Article
Mechanical ventilation can be life-saving for the premature infant, but is often injurious to immature and underdeveloped lungs. Lung injury is caused by atelectrauma, oxygen toxicity, and volutrauma. Lung protection must include appropriate lung recruitment starting in the delivery suite and throughout mechanical ventilation. Strategies include op...
Article
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Background: We aimed to determine whether the introduction of 24 h cover by resident consultants in a tertiary neonatal unit affected mortality and other clinical outcomes. Methods: Retrospective cohort study in a tertiary medical and surgical neonatal unit between 2010-2020 of all liveborn infants admitted to the neonatal unit. Out of hours cov...
Conference Paper
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Background: During NAVA/NIV (non-invasive) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). This Edi waveform determines the delivered pressure from the ventilator. Our aim was to determine whether, in preterm infants with evolving/ established BPD NAVA/NIV-NAVA had advantages over c...
Article
Non-invasive ventilation (NIV) is being utilised more frequently to reduce the need for invasive ventilation within the neonatal population. An example of one mode of NIV is bi-level continuous positive airway pressure (BiPAP). BiPAP delivers a lower pressure (usually 4–6 cm H2O) interchanging with a higher-level pressure, which is conventionally s...
Article
Carbon dioxide (CO2) monitoring is vital during mechanical ventilation of newborn infants, as morbidity increases when CO2 levels are inappropriate. Our aim was to review the uses and limitations of such noninvasive monitoring methods. Colorimetry is primarily utilized during resuscitation to determine whether successful intubation has occurred. Fa...
Article
Background: Pulmonary outcome of premature neonates has focused more on short-term than long-term respiratory morbidities. Objective: Describe risk factors/biomarkers associated with short-term (bronchopulmonary dysplasia [BPD]) (supplemental oxygen use at 36 weeks postmenstrual age [PMA]) and longer-term (chronic respiratory morbidity [CRM]) (r...
Article
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Objectives: Diuretics are often given to infants with evolving/established bronchopulmonary dysplasia (BPD) with the hope of improving their pulmonary outcomes. We aimed to determine if diuretic use in preterm infants was associated with improved pulmonary outcomes, but poorer weight gain. Methods: An observational study over a 5 year period was...
Article
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Objective To assess whether end-tidal capnography (EtCO2) monitoring reduced the magnitude of difference in carbon dioxide (CO2) levels and the number of blood gases in ventilated infants. Study design A case–control study of a prospective cohort (n = 36) with capnography monitoring and matched historical controls (n = 36). Result The infants had...
Article
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Background Less invasive surfactant administration (LISA) is the preferred mode of surfactant administration for spontaneously breathing preterm babies supported by noninvasive ventilation (NIV). Objective The aim of this study was to determine whether LISA on the neonatal unit or in the delivery suite was associated with reduced rates of bronchopu...
Article
Objective To report the effect of antenatal corticosteroids (ANS) on mortality, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and the duration of ventilation according to sex in extremely preterm infants. Methods All extremely preterm infants admitted to any neonatal unit in England between 2014 and 2019. Results Eleven thou...
Article
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Objectives Corticosteroids are administered to ventilator dependent infants with bronchopulmonary dysplasia (BPD) to improve respiratory function and facilitating extubation. Acutely, however, growth impairment can occur as a side effect of such therapy. We aimed to determine the effect of corticosteroids on postnatal growth during the entire neona...
Article
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Background Volumetric capnography allows for continuous monitoring of expired tidal volume and carbon dioxide. The slope of the alveolar plateau of the capnogram (S III ) could provide information regarding ventilation homogeneity. We aimed to assess the feasibility of measuring S III during newborn resuscitation and determine if S III decreased af...
Article
Invasive mechanical ventilation in the neonatal setting can be life‐saving, but may lead to chronic respiratory morbidity. As a consequence, there has been a focus on using non‐invasive ventilation techniques (NIV). One NIV mode is bilevel continuous positive airway pressure (BiPAP), during which two alternating levels of pressure are delivered: a...
Article
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Background: Neonates often receive noninvasive respiratory support via continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygen (HHFNC). The decision to change from one mode to the other, however, is not evidence based, hence not standardized and does not consider cost implications. Purpose: To assess the introduction of a ca...
Article
Objectives To use the oxyhaemoglobin dissociation curve (ODC) to non-invasively measure the ventilation perfusion ratio (VA/Q) and right-to-left intrapulmonary vascular shunt before and after liver transplantation (LT) in children with hepatopulmonary syndrome (HPS). To investigate whether the right-to-left shunt derived by ODC correlated with the...
Article
Objectives To assess if intrauterine growth retardation (IUGR) was associated with reduced lung function at 16 to 19 years Working hypothesis Very prematurely born young people who had IUGR would have reduced lung function post‐puberty. Study design Prospective follow‐up study. Patient‐subject selection One hundred and fifty‐nine 16‐19 year olds...
Article
Background Discharge home of preterm infants on supplemental oxygen has significant healthcare, parental psychological and financial implications, but the potential ability of clinical parameters at discharge to predict the duration of home oxygen has not been previously examined. Aims To use clinical and epidemiological parameters available at di...
Article
Objectives: Asylum seekers have been highlighted as a particularly vulnerable group of expectant mothers due to complex medical and psychosocial needs, as well as the difficulties they may face in accessing care. Our aim was to examine if there were differences in the antenatal care and perinatal outcomes for asylum seeking women when compared to...
Article
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Background: Dead space is the volume not taking part in gas exchange and, if increased, could affect alveolar ventilation if there is too low a delivered volume. We determined if there were differences in dead space and alveolar ventilation in ventilated infants with pulmonary disease or no respiratory morbidity. Methods: A prospective study of...
Article
Aim To determine if the duration of invasive ventilation predicted the development of bronchopulmonary dysplasia (BPD) and need for discharge home on supplementary oxygen in extremely preterm infants. Methods Retrospective whole population study of all infants <28 weeks of gestation admitted to a neonatal unit in England between 2014‐2018. BPD dev...
Article
Objectives Infants receiving care from neonatal intensive care unit (NICU) can develop chronic problems and be transferred to a paediatric intensive care unit (PICU) for on-going care. There is concern that such infants may take up a large amount of PICU resource, but this is not evidence based. We determined the impact of such transfers. Methods...
Article
Background On the neonatal unit less invasive surfactant administration (LISA) reduces BPD and the need for mechanical ventilation Aims To evaluate the feasibility of LISA in the delivery suite and to undertake respiratory function physiological monitoring before and after LISA. Study design A prospective, observational cohort study was undertake...
Article
Surfactant administered in the delivery suite might prevent or reduce the severity of subsequent respiratory distress syndrome. This review describes the evidence for surfactant delivery methods with relationship to their relevance in the delivery suite. The techniques include delivery using a thin catheter with the first breath, by the intubation-...
Article
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Introduction: Congenital diaphragmatic hernia (CDH) is one of the most challenging neonatal surgical conditions due to its high mortality and morbidity. A multidisciplinary approach is required regarding the management of affected infants, before birth, during their initial hospitalization and in their long-term follow-up. Areas covered: This revie...