Edmond N Kelly

Mount Sinai Hospital, Toronto · Department of Paediatrics

Background and objectives: We examined associations of white matter injury (WMI) and periventricular hemorrhagic infarction (PVHI) volume and location with 18-month neurodevelopment in very preterm infants. Methods: A total of 254 infants born <32 weeks' gestational age were prospectively recruited across 3 tertiary neonatal intensive care units...

Importance Early-life exposure to painful procedures has been associated with altered brain maturation and neurodevelopmental outcomes in preterm infants, although sex-specific differences are largely unknown. Objective To examine sex-specific associations among early-life pain exposure, alterations in neonatal structural connectivity, and 18-mont...

Objectives We determined whether (1) major surgery is associated with an increased risk for brain injury and adverse neurodevelopment and (2) brain injury modifies associations between major surgery and neurodevelopment in very preterm infants. Methods Prospectively enrolled infants across three tertiary NICUs underwent early-life and/or term-equi...

Availability of time for supporting professional activity for a Paediatric trainee as recommended by the RCPCH Trainee charter and changes pre- and post Covid.

Background Invasive fungal infection (IFI) is associated with significant mortality and morbidity among preterm infants but there has been no population-based study of long-term neurodevelopmental outcomes. The objective of this study was to examine population-based incidence trends as well as mortality, short term in-hospital morbidity and long-te...

Malformations of cortical development (MCD) are a rare group of disorders with heterogeneous clinical, neuroimaging, and genetic features. MCDs consist of disruptions in the development of the cerebral cortex secondary to genetic, metabolic, infectious or vascular etiologies. MCDs are typically classified by stage of disrupted cortical development...

Background: We assessed variability of analgesic use across three tertiary neonatal intensive care units (NICUs) accounting for early-life pain, quantified as number of invasive procedures. We also determined whether analgesia exposure modifies associations between early-life pain and neurodevelopment. Methods: Multicenter prospective study of 2...

Objective: The aim of this study was to evaluate the neurodevelopmental outcome at 18-24 months in surviving preterm infants with grades I-IV intraventricular hemorrhages (IVHs) compared to those with no IVH. Study design: We included preterm survivors <29 weeks' GA admitted to the Canadian Neonatal Network's NICUs from April 2009 to September 2...

Importance: Very preterm neonates (24-32 weeks' gestation) remain at a higher risk of morbidity and neurodevelopmental adversity throughout their lifespan. Because the extent of prematurity alone does not fully explain the risk of adverse neonatal brain growth or neurodevelopmental outcomes, there is a need for neonatal biomarkers to help estimate...

The aim of this retrospective cohort study was to study the clinical burden associated with cardio-pulmonary critical decompensations (CPCDs) in preterm neonates and factors associated with mortality. Through the Canadian Neonatal Network (30 tertiary NICUs, 2010–2017), we identified infants < 32-week gestational age with CPCDs, defined by “signifi...

Our objective was to assess the effect of maternal intravenous immunoglobulin (IVIG) administration for severe red blood cell (RBC) alloimmunisation on fetal outcomes. This is a case–control study. Women with a history of severe early onset alloimmunisation resulting in fetal loss in a previous pregnancy and high anti‐D or anti‐K antibody titres re...

Objective: To describe the incidence, trends, management's variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD). Methods: We reviewed infants <33 weeks' gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristi...

Red blood cell (RBC) alloimmunisation with anti‐D and anti‐K comprise the majority of cases of fetal haemolytic disease requiring intrauterine red cell transfusion (IUT). Few studies have investigated which haematological parameters can predict adverse fetal or neonatal outcomes. The aim of the present study was to identify predictors of adverse ou...

OBJECTIVE: We report the outcome of pregnancies treated with intravenous immunoglobulin (IVIG) for severe red blood cell alloimmunization, evaluating whether IVIG defers the development of severe fetal anaemia and its consequences. BACKGROUND: Although fetal anemia can be treated very successfully with intrauterine transfusion (IUT), procedures be...

Background: despite advances in perinatal care, periventricular/intraventricular hemorrhage (IVH) continues to remain high in neonatal intensive care units (NICUs) worldwide. Studies have demonstrated the benefits of implementing interventions during the antenatal period, stabilization after birth (golden hour management) and postnatally in the fi...

Objectives:We sought to investigate alterations in fetal growth andfetal brain growth in the setting of late-onset IUGR, and examinetheir relationship with placental function, fetal hemodynamics andneurodevelopmental outcomes.Methods:We performed an observational study in 98 fetusesenriched for low estimated fetal weight, using cine phase-contrastM...

Objective To examine whether the family integrated care (FICare) programme, a multifaceted approach which enables parents to be engaged as primary caregivers in the neonatal intensive care unit, impacts infant neurodevelopment and growth at 18 months’ corrected age. Design/Methods Prospective cohort study of infants born <29 weeks’ gestational age...

To compare neurodevelopmental outcomes of large and appropriate for gestational age (LGA, AGA) infants <29 weeks’ gestation at 18–24 months of corrected age. Retrospective cohort study using the Canadian Neonatal Network and Canadian Neonatal Follow-Up Network databases. Primary outcome was a composite of death or significant neurodevelopmental imp...

Objective: Fetal thoraco-amniotic shunts (TASs) can dislodge in utero, migrating internally into the fetal thorax or externally into the amniotic cavity. Our objective was to evaluate the perinatal and long-term outcome of fetuses with TAS dislodgement and conduct a review of the literature. Methods: This is a retrospective review of all TAS ins...

Objective The primary objective was to compare neurodevelopmental (ND) outcomes at 18–24 months in preterm infants <29 weeks gestational age (GA) who received versus those who did not receive inotropes in the first week of life. The secondary objective was to assess ND outcomes according to the duration of inotropic support in the first week of lif...

Our findings illustrate late on-set IUGR newborns have impaired brain growth in utero. This appears to only impact gross size and not microscopic parameters found on magnetic resonance spectroscopy and diffusion tensor imaging. However, we did notice the brains of our IUGR newborns were smoother, suggesting delayed cortical gyrification. The relati...

Background There is limited data on management strategies for chronic pulmonary hypertension (cPH) in chronic lung disease (CLD) of prematurity. Our objective was to evaluate clinical outcomes following a standardized policy, wherein only cPH with right‐ventricular (RV) dilatation was treated and diuretics were employed as first‐line therapy; cPH w...

Background: The rhesus (Rh) and Kell blood group systems are the most common of over 50 different antigens capable of causing maternal red blood cell (RBC) alloimmunization and severe fetal hemolytic disease. Anti-K and anti-D are responsible for a significant proportion of fetal anemia requiring intrauterine transfusion (IUT). Whilst IUT of packed...

To compare neurodevelopmental outcomes of extremely preterm children who received soy-medium chain triglycerides-olive-fish oil-containing lipid emulsion (SMOF-LE) vs soy-based LE. We conducted a pre-post comparative cohort study of children born < 29 weeks’ gestation who received > 7 days of LE. Outcomes were mortality/significant neurodevelopment...

Objective Fetal myelomeningocele closure results in better infant outcomes than postnatal closure at the cost of potential prematurity and maternal morbidity. Our aim is to describe the setup of a fetal myelomeningocele closure program in Canada and document its outcomes. Methods We conducted a retrospective review of all open fetal myelomeningoce...

Objectives With improved access to intrauterine transfusion (IUT), more fetuses with haemoglobin Bart’s hydrops fetalis (HBHF; homozygous α ⁰ -thalassaemia) will survive. Design To evaluate the long-term outcomes of affected fetuses with and without IUT in Ontario, Canada, we retrospectively collected data on IUTs and pregnancy outcomes in all cas...

Abstact Objectives To examine the association between mortality or neurodevelopmental impairment at 18-24 months of corrected age and the Transport Risk Index of Physiologic Stability (TRIPS) score on admission to the neonatal intensive care unit (NICU) in extremely premature infants. Study design Retrospective cohort study of extremely premature...

Objectives: To analyze the survival, neonatal management, neurodevelopmental outcome and outcome predictors for fetal hydrothorax (FHT) treated with thoracoamniotic shunts. Methods: Retrospective analysis of 132 fetuses undergoing thoracoamniotic shunting at our centre between 1992 and 2014. Results: Mean gestational age at presentation was 25...

Background: Coagulase-negative staphylococci (CoNS) frequently causes late-onset sepsis in preterm infants. Vancomycin is the first-line therapy, but the emergence of reduced vancomycin-susceptibility strains has resulted in linezolid use, of which long-term safety in preterm infants is unknown. Objective: Evaluate the association between linezo...

Objective Survivors of extremely preterm birth are at risk of re-hospitalization but risk factors in the Canadian population are unknown. Our objective is to identify neonatal, sociodemographic, and geographic characteristics that predict re-hospitalization in Canadian extremely preterm neonates. Methods This is a retrospective analysis of a prosp...

Background: Kell and Rhesus (Rh) maternal red blood cell (RBC) alloimmunization are the most common causes of severe fetal haemolytic disease. Widespread use of anti-D immune globulin has dramatically reduced the incidence of Rh(D) alloimmunization, leaving K alloimmunization responsible for a significant proportion of cases of fetal anemia requiri...

Objective: To describe the sonographic characteristics of periventricular hemorrhagic infarction (PVHI) and their association with mortality and neurodevelopmental disability in very preterm infants born in 2008-2013. Study design: Retrospective multicenter observational cohort study. Diagonal PVHI size was measured and severity score assessed....

To compare neurodevelopmental and visual outcomes in preterm infants treated with intravitreal bevacizumab (IVB) to laser ablation at 18–24 months corrected age. A retrospective study was performed. The primary outcome was neurodevelopmental impairment (NDI). Secondary neurodevelopmental outcomes were significant NDI (sNDI), cerebral palsy, hearing...

Objectives: To assess the natural evolution of the size of the fetal lateral ventricles throughout pregnancy in fetuses with callosal anomalies. Methods: Cases of fetal callosal anomalies were retrospectively classified as isolated or complex based on the presence of other structural or genetic anomalies. Longitudinal ultrasound studies were rev...

Background: The risk factors determining the frequency of intrauterine transfusions (IUTs) for severely affected red blood cell alloimmunized singleton pregnancies are not well known. Objective: To assess factors associated with IUT frequency and adverse pregnancy outcomes in transfused pregnancies. Methods: Retrospective cohort analysis of 24...

Objectives To determine the outcomes and resource usage of infants born at ≤ 25 weeks gestational age (GA). Methods Retrospective study of infants born between April 2009 and September 2011 at ≤ 25 weeks’ GA in all neonatal intensive care units in Canada with follow-up in the neonatal follow-up clinics. Short-term morbidities, neurodevelopmental i...

Objective To determine whether the spatial extent and location of early-identified punctate white matter injury (WMI) is associated with regionally-specific disruptions in thalamocortical-connectivity in very-preterm born neonates. Methods 37 very-preterm born neonates (median gestational age: 28.1 weeks; interquartile range [IQR]: 27–30) underwen...

Objective: To characterize clinical outcomes of infants born after previable rupture of membranes (pROM, < 23 weeks gestation and latency period ≥ 2 weeks) in relation to refractory hypoxic respiratory failure (rHRF). Study design: pROM neonates categorized as rHRF (FiO2 > 0.6 for ≥ 2 h) and treated (high frequency ventilation + inhaled nitric o...

Background: Inhaled corticosteroids (ICS) offer targeted treatment for bronchopulmonary dysplasia (BPD) with minimal systemic effects compared to systemic steroids. However, dosing of ICS in the management of infants at high-risk of developing BPD is not well established. The objective of this study was to determine an effective dose of ICS for th...

Objective: To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. Study design: Literature review of severe NDI definitions and application of these definitions were performed in t...

Objective: To compare neurodevelopmental outcomes of preterm infants with and without intervention for posthemorrhagic ventricular dilatation (PHVD) managed with an "early approach" (EA), based on ventricular measurements exceeding normal (ventricular index [VI] <+2 SD/anterior horn width <6 mm) with initial temporizing procedures, followed, if ne...

Objective: To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs). Study design: Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of ges...

A retrospective cohort study of neonates born extremely preterm with persistent patent ductus arteriosus after unsuccessful pharmacologic closure compared outcomes between 166 surgically ligated and 142 nonligated neonates. After adjustment for confounders, ligation was not associated with the composite outcome of death or neurodevelopmental impair...

Objectives: To compare death and/or neurodevelopmental outcomes of preterm infants exposed to inhaled and/or systemic steroids with those without exposure, and examine the impact of timing of exposure. Methods: Retrospective study of infants born <29 weeks gestation and assessed at 18–21 months corrected age (CA). Neurodevelopmental impairment (NDI...

Objective: To describe short-term and long-term outcomes of preterm neonates with severe acute pulmonary hypertension (aPHT) in relation to response to rescue inhaled nitric oxide (iNO) therapy. Design: Retrospective cohort studyover a 6 year period. Setting: Tertiary neonatal intensive care unit. Patients: 89 neonates <35 weeks gestational...

Importance: Observational studies have associated patent ductus arteriosus (PDA) ligation among preterm infants with adverse neonatal outcomes and neurodevelopmental impairment in early childhood, with a resultant secular trend away from surgical treatment. However, to our knowledge, studies have inadequately addressed sources of residual bias, in...

Importance For many very low-birth-weight (VLBW) infants, there is insufficient mother’s milk, and a supplement of pasteurized donor human milk or preterm formula is required. Awareness of the benefits of mother’s milk has led to an increase in use of donor milk, despite limited data evaluating its efficacy. Objective To determine if nutrient-enri...

BACKGROUND: The incidence of post-hemorrhagic ventricular dilatation (PHVD) remains high in preterm infants. Little is known about the risk factors for PHVD in infants with severe intraventricular hemorrhage (IVH). OBJECTIVES: To determine the predictors of PHVD among preterm infants with severe IVH. DESIGN/METHODS: We conducted a retrospective rev...

BACKGROUND: Conflicting evidence exists in regards to outcomes of infants with mild IVH [subependymal hemorrhage (SEH) and IVH without ventricular dilatation (VD)] with recent reports suggesting poor outcomes. OBJECTIVES: To compare 1) neurodevelopmental (ND) outcomes of infants < 29 wks GA with normal head ultrasound scan findings (Group 1: no IVH...

BACKGROUND: Severe intraventricular hemorrhage (IVH) is a common cause of neonatal morbidity and mortality .The incidence and management of post-hemorrhagic ventricular dilatation (PHVD) vary among different centres. OBJECTIVES: To assess the incidence, temporal trend, management and associated outcomes of PHVD in Canadian NICUs. DESIGN/METHODS: We...

Background and objective: Bevacizumab intravitreal injection, a vascular endothelial growth factor inhibitor, is used to treat retinopathy of prematurity (ROP). However, concerns have been raised regarding its systemic absorption and effect on developing tissues including brain. This study compared neurodevelopment at 18 months' corrected age in p...

Background: Late-onset intrauterine growth restriction (IUGR) results from failure of the placenta to supply adequate nutrients and oxygen to the rapidly growing late gestation fetus. Limitations in current monitoring methods present the need for additional techniques for more accurate diagnosis of IUGR in utero. New magnetic resonance imaging (MR...

The association between low birth weight and premature cardiovascular disease has led to the "prenatal origin of adult disease-hypothesis". We postulated that fetal growth restriction is associated with cardiovascular changes detectable at birth and in early infancy. Fifty-two appropriately grown fetuses (AGA) and 60 growth-restricted fetuses (FGR)...

BACKGROUND Bronchopulmonary dysplasia (BPD) is a major neonatal morbidity associated with adverse neurodevelopmental outcome at 18–24 months of age. Use of postnatal systemic corticosteroids has been shown to facilitate extubation and reduce the severity of BPD; however its use is associated with an increased risk of neurodevelopmental impairment m...

BACKGROUND Gram-negative sepsis (GNS) is associated with increased neonatal mortality and morbidity compared with Gram-positive and fungal sepsis. Limited research has examined the differences in short-term and long-term outcomes of early-onset and late-onset GNS. OBJECTIVES To compare short-term and long-term outcomes of neonates with early-onset...

BACKGROUND Intravitreal injection of bevacizumab, a vascular endothelial growth factor inhibitor (VEGF), is used to treat retinopathy of prematurity (ROP). As bevacizumab can diffuse into the systemic circulation, potential long-term effect on brain development needs to be documented. OBJECTIVES To compare neurodevelopmental outcomes at 18–22 mont...

Fetal infection with human parvovirus B19 (hParvo-B19) has been mainly associated with fetal anemia, while data regarding other fetal hematological effects are limited. Our aim was to assess the rate and consequences of severe fetal thrombocytopenia following fetal hParvo-B19 infection. We conducted a retrospective study of pregnancies complicated...

The Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) showed no benefit in the reduction of major neonatal mortality/morbidity or neurodevelopment at 2 and 5 years of age. Using the data from the randomized controlled trial and its follow-up, the aim of this study was to evaluate the association between gestational ages a...

Objective: To determine the impact of prenatal exposure to maternal anti-Ro antibodies, slow fetal heart rate, and/or prolonged dexamethasone therapy for immune-mediated congenital atrioventricular heart block (CAVB) on the cognitive and academic performance of these children at school age. Methods: We performed a prospective, blinded assessment...

Objective: To determine oxygen saturation profile over 6 h monitoring period in healthy late-preterm and term neonates during the first 48 h of age, and to assess the impact of gestational age, birth weight and method of delivery on this profile. Study design: Prospective cohort study of measurement of SpO2 over 6 h in 20 late-preterm (35 to 36...

To describe the development of an anatomically accurate simulator in order to aid the training of a perinatal team in the insertion and removal of a fetal endoscopic tracheal occlusion (FETO) balloon in the management of prenatally diagnosed congenital diaphragmatic hernia (CDH). An experienced perinatal team collaborated with a medical sulptor to...

Importance A single course of antenatal corticosteroid therapy is recommended for pregnant women at risk of preterm birth between 24 and 33 weeks’ gestational age. However, 50% of women remain pregnant 7 to 14 days later, leading to the question of whether additional courses should be given to women remaining at risk for preterm birth. The Multipl...

Purpose: To evaluate fetal thoraco-amniotic shunting for isolated large macrocystic cystic adenomatoid malformations (CCAM) of the lung. Methods: Retrospective study of 12 fetuses with macrocystic CCAM's, who underwent thoraco-amniotic shunting. Results: Shunts were inserted at 24.6 (17 – 32) wks. All 12 fetuses had very large macrocystic CCAMs w...

To evaluate the impact of implementing a simple, user-friendly eLearning module on hand hygiene (HH) compliance and infection rates. Preintervention and postintervention observational study. All neonates admitted to the neonatal intensive care unit (NICU) over the study period were eligible for participation and were included in the analyses. A tot...

: To estimate obstetric and neonatal outcomes after induction of labor at 37 weeks of gestation compared with expectant management in pregnancies complicated by fetal gastroschisis. : The management of 296 pregnancies involving fetal gastroschisis (1980-2011) was reviewed from a single perinatal center. Ultrasound surveillance and nonstress testing...

Objective: The purpose of this study was to compare perinatal outcomes of pregnancies that undergo "early" (<17 weeks' gestation) or "late" (>26 weeks' gestation) fetoscopic laser ablation of placental vascular anastomoses for twin-twin transfusion syndrome (TTTS) with "conventional" cases that were treated at 17-26 weeks' gestation. Study design...

Introduction Untreated, fetal hydrothorax is associated with significant morbidity and a mortality rate of approximately 80–90%. Population 114 fetuses with isolated large pleural effusions underwent pleuroamniotic shunting at our perinatal centre. All had an extensive antenatal work-up including: detailed anatomy, echocardiogram, karyotype, infect...

To evaluate fetal thoracoamniotic shunting for isolated large macrocystic congenital cystic adenomatoid malformations (CCAM) of the lung. This was a retrospective study of 11 fetuses with macrocystic CCAM who underwent thoracoamniotic shunting. This procedure was offered if fetal hydrops or signs of evolving hydrops (such as ascites or polyhydramni...

To estimate the effect of multiple courses of antenatal corticosteroids on neonatal size, controlling for gestational age at birth and other confounders, and to determine whether there was a dose-response relationship between number of courses of antenatal corticosteroids and neonatal size. This is a secondary analysis of the Multiple Courses of An...

The purpose of this study was to monitor developmental progress and identify predictors of developmental outcomes at 2 years after operation in infants who underwent a surgical procedure with cardiopulmonary bypass (CPB) at less than 3 months of age. Patients (N=131 enrolled; N=106 assessed) less than 3 months of age at the time of cardiac operatio...

A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or bir...

A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or bir...

To determine perinatal outcome in pregnancies with early severe red blood cell (RBC) alloimmunization. This was a retrospective analysis of 30 patients requiring their first intrauterine transfusion (IUT) at < 22 weeks of gestation. Timing of the first IUT was based on evaluation of either the middle cerebral artery peak systolic velocity (MCA-PSV)...

The aim of this study was to determine the effects of repeated courses of prenatal corticosteroid therapy versus placebo on death or neurologic impairment among the children enrolled in the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study, at 18 to 24 months of age. A total of 2305 infants were eligible for follow-up evaluation...

Surfactant replacement therapy (SRT) reduces respiratory morbidity and mortality in premature infants. The goal of this study was to characterise the effects of delivery room SRT on the ductus arteriosus and early neonatal haemodynamics. A prospective observational study was conducted in preterm infants of less than 32 weeks' gestation who received...

Our aim was to define the association between early onset intra-uterine growth restriction (IUGR) due to placental insufficiency and hypospadias in males. We prospectively studied a cohort of small-for-gestational age (SGA) male infants with hypospadias managed by a multidisciplinary team over a 5-year period. Thirty SGA male infants were diagnosed...

One course of antenatal corticosteroids reduces the risk of respiratory distress syndrome and neonatal death. Weekly doses given to women who remain undelivered after a single course may have benefits (less respiratory morbidity) or cause harm (reduced growth in utero). We aimed to find out whether multiple courses of antenatal corticosteroids woul...

Background: Maternal parvovirus B19 infection can lead to serious consequences in the fetus including fetal death, non-immune hydrops fetalis and possibly long-term adverse neurodevelopmental outcome. To date, there has been no systematic review of the literature regarding long-term outcomes of these infants and children. Objective: To systematical...

To evaluate perinatal outcome of fetuses with primary pleural effusions following pleuroamniotic shunting. This was a retrospective study of 88 fetuses with large pleural effusions referred to a tertiary fetal medicine unit between 1991 and 2008 which, after a thorough work-up, underwent pleuroamniotic shunting. At presentation, 59 (67.0%) fetuses...

Although a single course of antenatal corticosteroids for women at risk of preterm birth reduces the risk of respiratory distress syndrome (RDS), neonatal mortality and morbidity, the benefits may diminish over time. The effects of weekly doses have been investigated but the benefits are unclear, and there is evidence of decreased fetal growth and...