Papers by Dominic Fitzgerald
World Journal of Pediatrics
Background Since 2010, most tertiary care hospitals in Australia have changed how they care for e... more Background Since 2010, most tertiary care hospitals in Australia have changed how they care for extremely premature infants. However, in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs, especially respiratory outcomes. This study examined the trend in outcomes since these changes were introduced, particularly the prevalence of chronic neonatal lung disease (CLD). Methods This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units’ (NICUS) database of all perinatal intensive care units in New South Wales and the Australian Capital Territory, including infants born at ≥ 24 and ≤ 28 weeks of gestational age in tertiary perinatal units between January 1, 2010, and December 31, 2020. Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models. Results This study included 3258 infants. We saw significant changes in antenatal magn...
Vaccines
Mycobacterium abscessus is a nontuberculous mycobacterium (NTM) of particular concern in individu... more Mycobacterium abscessus is a nontuberculous mycobacterium (NTM) of particular concern in individuals with obstructive lung diseases such as cystic fibrosis (CF). Treatment requires multiple drugs and is characterised by high rates of relapse; thus, new strategies to limit infection are urgently required. This study sought to determine how Bacille Calmette-Guérin (BCG) vaccination may impact NTM infection, using a murine model of Mycobacterium abscessus infection and observational data from a non-BCG vaccinated CF cohort in Sydney, Australia and a BCG-vaccinated CF cohort in Cape Town, South Africa. In mice, BCG vaccination induced multifunctional antigen-specific CD4+ T cells circulating in the blood and was protective against dissemination of bacteria to the spleen. Prior infection with M. abscessus afforded the highest level of protection against M. abscessus challenge in the lung, and immunity was characterised by a greater frequency of pulmonary cytokine-secreting CD4+ T cells c...
Paediatric Respiratory Reviews
The COVID-19 precautions of social distancing, school closures and community lockdowns have impac... more The COVID-19 precautions of social distancing, school closures and community lockdowns have impacted adversely upon children's mental health. The pandemic has compounded the already disadvantaged situations of children in areas affected by conflict. Having schoolchildren at home full-time is traumatic for children, puts stress on families and increases the risk of domestic violence. Grief is characterised by a heaviness, hardship, burden, sorrow, sense of grievance and protest that the world is what it is.
BMJ Paediatrics Open, 2021
Objective To determine the practices of neonatologists in managing high-risk neonates believed to... more Objective To determine the practices of neonatologists in managing high-risk neonates believed to be at risk of sleep disordered breathing (SDB). Design An electronic web-based questionnaire assessing awareness of and current practices for managing neonates predisposed to SDB with conditions like craniofacial anomalies, neuromuscular disorders or airway problems was emailed to 232 neonatologists and neonatal fellows working in Australia and New Zealand (NZ). Additionally, neonatologists were approached directly during the annual Australia and NZ perinatal conference in 2019. Results 93 neonatologists (40%) responded to the survey. The majority (85%) of the respondents stated that there were no written protocols/criteria for sleep consultation in their unit. We found considerable variations in the threshold for performing tests including oximetry or referring for polysomnography. Most respondents would perform oximetry before referring for a sleep consultation. However, the duration ...
Pediatric Pulmonology, 2020
Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and manageme... more Childhood asthma is a huge global health burden. The spectrum of disease, diagnosis, and management vary depending on where children live in the world and how their community can care for them. Global improvement in diagnosis and management has been unsatisfactory, despite ever more evidence‐based guidelines. Guidelines alone are insufficient and need supplementing by government support, changes in policy, access to diagnosis and effective therapy for all children, with research to improve implementation. We propose a worldwide charter for all children with asthma, a roadmap to better education and training which can be adapted for local use. It includes access to effective basic asthma medications. It is not about new expensive medications and biologics as much can be achieved without these. If implemented carefully, the overall cost of care is likely to fall and the global future health and life chance of children with asthma will greatly improve. The key to success will be commun...
Paediatric Respiratory Reviews, 2020
Paediatric Respiratory Reviews, 2020
The impact of COVID-19 upon countries differed widely across the Asia-Pacific region. Children ex... more The impact of COVID-19 upon countries differed widely across the Asia-Pacific region. Children experienced milder disease as elsewhere in the world. Vietnam, New Zealand and Australia have had incredibly successful initial outcomes in response to COVID-19. Common problems with poor preparedness and a lack of centralised response hampered efforts to fight the pandemic in some countries.
Paediatric Respiratory Reviews, 2020
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Respirology, 2020
ABSTRACTChronic neonatal lung disease (CNLD) is defined as continued need for any form of respira... more ABSTRACTChronic neonatal lung disease (CNLD) is defined as continued need for any form of respiratory support (supplemental oxygen and/or assisted ventilation) beyond 36 weeks PMA. Low‐flow supplemental oxygen facilitates discharge from hospital of infants with CNLD who are hypoxic in air and is widely used despite lack of evidence on the most appropriate minimum mean target oxygen saturations. Furthermore, there are minimal data to guide the home monitoring, titration or weaning of supplemental oxygen in these infants. The purpose of this position statement is to provide a guide for the respiratory management of infants with CNLD, with special emphasis on role and logistics of supplemental oxygen therapy beyond the NICU stay. Reflecting a variety of clinical practices and infant comorbidities (presence of pulmonary hypertension, retinopathy of prematurity and adequacy of growth), it is recommended that the minimum mean target range for SpO2 during overnight oximetry to be 93–95% wi...
Paediatric Respiratory Reviews, 2020
The sobering reality of the COVID-19 pandemic is that it has brought people together at home at a... more The sobering reality of the COVID-19 pandemic is that it has brought people together at home at a time when we want them apart in the community. This will bring both benefits and challenges. It will affect people differently based upon their age, health status, resilience, family support structures, and socioeconomic background. This article will assess the impact in high income countries like Australia, where the initial wave of infection placed the elderly at the greatest risk of death whilst the protective measures of physical distancing, self-isolation, increased awareness of hygiene practices, and school closures with distance learning has had considerable impact on children and families acutely and may have ramifications for years to come.
Critical Care Medicine, 2020
Prediction models aim to use available data to predict a health state or outcome that has not yet... more Prediction models aim to use available data to predict a health state or outcome that has not yet been observed. Prediction is primarily relevant to clinical practice, but is also used in research, and administration. While prediction modeling involves estimating the relationship between patient factors and outcomes, it is distinct from casual inference. Prediction modeling thus requires unique considerations for development, validation, and updating. This document represents an effort from editors at 31 respiratory, sleep, and critical care medicine journals to consolidate contemporary best practices and recommendations related to prediction study design, conduct, and reporting. Herein, we address issues commonly encountered in submissions to our various journals. Key topics include considerations for selecting predictor variables, operationalizing variables, dealing with missing data, the importance of appropriate validation, model performance measures and their interpretation, an...
Respirology, 2019
Background and Aims: Pneumonia is the leading cause of antibiotic use and hospitalisation in Viet... more Background and Aims: Pneumonia is the leading cause of antibiotic use and hospitalisation in Vietnam. There is a need for better prediction of 1) 'unlikely bacterial pneumonia' to improve rational antibiotic use and 2) 'adverse pneumonia outcome' to guide hospital admission. Methods: Prospective enrolment of all children (<5 years) admitted with 'pneumonia' (per clinician assessment) to the Da Nang Hospital for Women and Children over a 12 month period. Children were classified as having 'likely or 'unlikely' bacterial pneumonia using chest radiograph (CXR) appearance and C-reactive protein (CRP). Predictors of 'unlikely bacterial pneumonia' and 'adverse pneumonia outcome' were evaluated.
Thorax, 2018
Asthma is the most common chronic condition in children worldwide. It affects daytime activities,... more Asthma is the most common chronic condition in children worldwide. It affects daytime activities, sleep and school attendance and causes anxiety to parents, families and other carers. The quality of asthma diagnosis and management globally still needs substantial improvement. From infancy to the teenage years, there are age-specific challenges, including both underdiagnosis and overdiagnosis with stigma-related barriers to treatment in some cultures and in adolescents. Guidelines are increasingly evidence based, but their impact on improving outcomes has been negligible in many parts of the world, often due to lack of implementation. New thinking is needed to enable substantial improvements in outcomes. The disease varies globally and plans will need to differ for individual countries or places where region-specific barriers prevent optimal care. A wide selection of educational activities is needed, including community-targeted initiatives, to engage with families. The Paediatric As...
The American journal of clinical nutrition, 2002
Oxidative stress and depleted antioxidant defenses occur in stable cystic fibrosis patients. Duri... more Oxidative stress and depleted antioxidant defenses occur in stable cystic fibrosis patients. During acute infection, the balance between oxidants and antioxidants may be further disturbed. We examined the oxidative stress during acute infection in cystic fibrosis patients by measuring 8-iso-prostaglandin F(2 alpha) (8-iso-PGF(2 alpha)) and antioxidant defenses in relation to dietary intake, fatty acid status, immune function, and clinical status. Plasma concentrations of total 8-iso-PGF(2 alpha), vitamins E and C, beta-carotene, zinc, selenium, and copper; plasma fatty acid compositions; erythrocyte glutathione concentrations; glutathione peroxidase and superoxide dismutase activity; sputum glutathione and 8-iso-PGF(2 alpha) concentrations; lung function; clinical symptoms; and dietary intake were measured in 15 cystic fibrosis patients before and after 10-14 d of intravenous antibiotic treatment for a pulmonary exacerbation. After treatment, respiratory status improved (percentage ...
The American journal of clinical nutrition, 2003
Oxidative stress, as measured by 8-iso-prostaglandin F(2)(alpha) (8-iso-PGF(2)(alpha)), and deple... more Oxidative stress, as measured by 8-iso-prostaglandin F(2)(alpha) (8-iso-PGF(2)(alpha)), and depleted antioxidant defenses were shown in stable cystic fibrosis (CF) patients. The plasma fatty acid status of CF patients was linked to oxidative stress after respiratory exacerbations. We examined changes in plasma 8-iso-PGF(2)(alpha), antioxidant defenses, plasma fatty acid status, and clinical markers resulting from short-term antioxidant supplementation. Forty-six CF patients were randomly assigned to either group A [low dose of supplement (10 mg vitamin E and 500 micro g vitamin A)] or group B [high dose of supplement (200 mg vitamin E, 300 mg vitamin C, 25 mg beta-carotene, 90 micro g Se, and 500 micro g vitamin A)]. Plasma concentrations of 8-iso-PGF(2)(alpha), vitamins E and C, beta-carotene, zinc, selenium, and copper; plasma fatty acid composition; erythrocyte glutathione peroxidase (EC 1.11.1.9) and superoxide dismutase (EC 1.15.1.1) activities; lung function; and dietary intak...
Orphanet Journal of Rare Diseases, 2014
Background: Rare chronic diseases of childhood are often complex and associated with multiple hea... more Background: Rare chronic diseases of childhood are often complex and associated with multiple health issues. Such conditions present significant demands on health services, but the degree of these demands is seldom reported. This study details the utilisation of hospital services and associated costs in a single case of surfactant protein C deficiency, an example of childhood interstitial lung disease. Methods: Hospital records and case notes for a single patient were reviewed. Costs associated with inpatient services were extracted from a paediatric hospital database. Actual costs were compared to cost estimates based on both disease/procedure-related cost averages for inpatient hospital episodes and a recently implemented Australian hospital funding algorithm (activity-based funding). Results: To age 8 years and 10 months the child was a hospital inpatient for 443 days over 32 admissions. A total of 298 days were spent in paediatric intensive care. Investigations included 58 chest x-rays, 9 bronchoscopies, 10 lung function tests and 11 sleep studies. Comprehensive disease management failed to prevent respiratory decline and a lung transplant was required. Costs of inpatient care at three tertiary hospitals totalled $966,531 (Australian dollars). Disease-and procedure-related cost averages underestimated costs of paediatric inpatient services for this patient by 68%. An activity-based funding algorithm that is currently being adopted in Australia estimated the cost of hospital health service provision with more accuracy. Conclusions: Health service usage and inpatient costs for this case of rare chronic childhood respiratory disease were substantial. This case study demonstrates that disease-and procedure-related cost averages are insufficient to estimate costs associated with rare chronic diseases that require complex management. This indicates that the health service use for similar episodes of hospital care is greater for children with rare diseases than other children. The impacts of rare chronic childhood diseases should be considered when planning resources for paediatric health services.
Neuromuscular Disorders, 2014
Over the past decade there have been major advances in defining the genetic basis of the majority... more Over the past decade there have been major advances in defining the genetic basis of the majority of congenital myopathy subtypes. However the relationship between each congenital myopathy, defined on histological grounds, and the genetic cause is complex. Many of the congenital myopathies are due to mutations in more than one gene, and mutations in the same gene can cause different muscle pathologies. The International Standard of Care Committee for Congenital Myopathies performed a literature review and consulted a group of experts in the field to develop a summary of (1) the key features common to all forms of congenital myopathy and (2) the specific features that help to discriminate between the different genetic subtypes. The consensus statement was refined by two rounds of on-line survey, and a three-day workshop. This consensus statement provides guidelines to the physician assessing the infant or child with hypotonia and weakness. We summarise the clinical features that are most suggestive of a congenital myopathy, the major differential diagnoses and the features on clinical examination, investigations, muscle pathology and muscle imaging that are suggestive of a specific genetic diagnosis to assist in prioritisation of genetic testing of known genes. As next generation sequencing becomes increasingly used as a diagnostic tool in clinical practise, these guidelines will assist in determining which sequence variations are likely to be pathogenic.
Neurology, 2007
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study examined noninvasive ventilation (NIV) in children with severe neuromuscular disorders. NIV was defined as the delivery of ventilatory support via a nasal or face-mask interface without the need for an invasive artificial airway. The comparator appears to have been current practice before the introduction of NIV. Type of intervention Palliative care. Economic study type Cost-effectiveness analysis. Study population The study population comprised children with severe neuromuscular disorders. Setting The study setting was inpatient care. The economic analysis was carried out in Australia.
Journal of Paediatrics and Child Health, 1995
Objectives: In neonatal screening for cystic fibrosis (CF), infants recognised as ΔF508 heterozyg... more Objectives: In neonatal screening for cystic fibrosis (CF), infants recognised as ΔF508 heterozygotes require a sweat test to confirm the diagnosis. However, compound heterozygotes with ΔF508 and the R117H mutation are known to have non‐diagnostic sweat chlorides (<60 mmol/L) at an early age. As genotyping for rare mutations is not readily available in Australia, there is a need to determine whether quantitative pancreatic stimulation tests could facilitate the diagnosis of CF in three infants with the ΔF508/R117H mutation.Methodology Formal sweat testing, genotyping and pancreatic stimulation tests were performed in three subjects heterozygous for ΔF508 who initially had non‐diagnostic sweat chloride results (40‐60 mmol/L) but presented later with persisting chest symptoms and/or signs consistent with CF.Results All three patients were shown to have the ΔF508/R117H genotype with initial sweat chloride results ranging from 40 to 58 mmol/L. Pancreatic stimulation tests demonstrate...
European Respiratory Journal, 2014
Uploads
Papers by Dominic Fitzgerald