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Liang J, He X, Wang Y. Cardiomyocyte proliferation and regeneration in congenital heart disease. PEDIATRIC DISCOVERY 2024; 2:e2501. [PMID: 39308981 PMCID: PMC11412308 DOI: 10.1002/pdi3.2501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/25/2024] [Indexed: 09/25/2024]
Abstract
Despite advances in prenatal screening and a notable decrease in mortality rates, congenital heart disease (CHD) remains the most prevalent congenital disorder in newborns globally. Current therapeutic surgical approaches face challenges due to the significant rise in complications and disabilities. Emerging cardiac regenerative therapies offer promising adjuncts for CHD treatment. One novel avenue involves investigating methods to stimulate cardiomyocyte proliferation. However, the mechanism of altered cardiomyocyte proliferation in CHD is not fully understood, and there are few feasible approaches to stimulate cardiomyocyte cell cycling for optimal healing in CHD patients. In this review, we explore recent progress in understanding genetic and epigenetic mechanisms underlying defective cardiomyocyte proliferation in CHD from development through birth. Targeting cell cycle pathways shows promise for enhancing cardiomyocyte cytokinesis, division, and regeneration to repair heart defects. Advancements in human disease modeling techniques, CRISPR-based genome and epigenome editing, and next-generation sequencing technologies will expedite the exploration of abnormal machinery governing cardiomyocyte differentiation, proliferation, and maturation across diverse genetic backgrounds of CHD. Ongoing studies on screening drugs that regulate cell cycling are poised to translate this nascent technology of enhancing cardiomyocyte proliferation into a new therapeutic paradigm for CHD surgical interventions.
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Affiliation(s)
- Jialiang Liang
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Xingyu He
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Yigang Wang
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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Snoep MC, Nijman M, DeRuiter MC, Bekker MN, Aliasi M, Breur JMPJ, Ten Harkel ADJ, Benders MJNL, van der Meeren LE, Haak MC. Placenta histology related to flow and oxygenation in fetal congenital heart disease. Early Hum Dev 2024; 195:106079. [PMID: 39047634 DOI: 10.1016/j.earlhumdev.2024.106079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Fetuses with congenital heart defects (CHD) show delayed neurodevelopment, fetal growth restriction (FGR) and placenta related complications. The neurodevelopmental delay may be, partly, attributed to placental factors. AIM As both placental development and fetal aortic flow/oxygenation influence neurodevelopment, placentas were compared within fetal CHD groups based on aortic oxygenation and flow, aiming to unravel the true effects in the developmental processes. STUDY DESIGN Placental tissues of pregnancies with fetal CHD and healthy controls were selected from biobanks of two Dutch academic hospitals (LUMC, UMCU). Additionally, biometry and Dopplers were assessed. SUBJECTS CHD cases with reduced oxygenation (RO) towards the fetal brain were compared to cases with reduced flow (RF) in the aortic arch and healthy controls. Genetic abnormalities, termination of pregnancy, fetal demise and/or multiple pregnancies were excluded. OUTCOME MEASURES Histological outcomes were related to fetal Dopplers and biometry. A placenta severity score was used to assess the severity of placental abnormalities per case. RESULTS In CHD, significantly more delayed maturation, maternal vascular malperfusion, fetal hypoxia and higher placenta severity scores (median 14 in RO, 14 in RF, 5 in controls, p < 0.001) were observed. Doppler abnormalities (PI UA > p90, PI MCA < p10, CPR < p10) and FGR were more often found in CHD. There were no differences in placental abnormalities, fetal growth and fetal Dopplers between cases with RO and RF. CONCLUSION Fetal hemodynamics in the ascending aorta could not be related to placenta characteristics. We hypothesize that placental development influences neurodevelopment in excess of hemodynamics in CHD cases.
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Affiliation(s)
- Maartje C Snoep
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, the Netherlands.
| | - Maaike Nijman
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Fetal Medicine, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Moska Aliasi
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arend D J Ten Harkel
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Manon J N L Benders
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands; Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Monique C Haak
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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Liu J, Zeng B, Chen X. Heart and great vessels segmentation in congenital heart disease via CNN and conditioned energy function postprocessing. Int J Comput Assist Radiol Surg 2024; 19:1597-1605. [PMID: 38814529 DOI: 10.1007/s11548-024-03182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The segmentation of the heart and great vessels in CT images of congenital heart disease (CHD) is critical for the clinical assessment of cardiac anomalies and the diagnosis of CHD. However, the diverse types and abnormalities inherent in CHD present significant challenges to comprehensive heart segmentation. METHODS We proposed a novel two-stage segmentation approach, integrating a Convolutional Neural Network (CNN) with a postprocessing method with conditioned energy function for pulmonary and aorta. The initial stage employs a CNN enhanced by a gated self-attention mechanism for the segmentation of five primary heart structures and two major vessels. Subsequently, the second stage utilizes a conditioned energy function specifically tailored to refine the segmentation of the pulmonary artery and aorta, ensuring vascular continuity. RESULTS Our method was evaluated on a public dataset including 110 3D CT volumes, encompassing 16 CHD variants. Compared to prevailing segmentation techniques (U-Net, V-Net, Unetr, dynUnet), our approach demonstrated improvements of 1.02, 1.04, and 1.41% in Dice Coefficient (DSC), Intersection over Union (IOU), and the 95th percentile Hausdorff Distance (HD95), respectively, for heart structure segmentation. For the two great vessels, the enhancements were 1.05, 1.07, and 1.42% in these metrics. CONCLUSION The outcomes on the public dataset affirm the efficacy of our proposed segmentation method. Precise segmentation of the entire heart and great vessels can significantly aid in the diagnosis and treatment of CHD, underscoring the clinical relevance of our findings.
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Affiliation(s)
- Jiaxuan Liu
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bolun Zeng
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, 200240, China.
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Shibuya S, Paraboschi I, Giuliani S, Tsukui T, Matei A, Olivos M, Inoue M, Clarke SA, Yamataka A, Zani A, Eaton S, De Coppi P. Comprehensive meta-analysis of surgical procedure for congenital diaphragmatic hernia: thoracoscopic versus open repair. Pediatr Surg Int 2024; 40:182. [PMID: 38980431 PMCID: PMC11233350 DOI: 10.1007/s00383-024-05760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE Previous studies have shown a higher recurrence rate and longer operative times for thoracoscopic repair (TR) of congenital diaphragmatic hernia (CDH) compared to open repair (OR). An updated meta-analysis was conducted to re-evaluate the surgical outcomes of TR. METHODS A comprehensive literature search comparing TR and OR in neonates was performed in accordance with the PRISMA statement (PROSPERO: CRD42020166588). RESULTS Fourteen studies were selected for quantitative analysis, including a total of 709 patients (TR: 308 cases, OR: 401 cases). The recurrence rate was higher [Odds ratio: 4.03, 95% CI (2.21, 7.36), p < 0.001] and operative times (minutes) were longer [Mean Difference (MD): 43.96, 95% CI (24.70, 63.22), p < 0.001] for TR compared to OR. A significant reduction in the occurrence of postoperative bowel obstruction was observed in TR (5.0%) compared to OR (14.8%) [Odds ratio: 0.42, 95% CI (0.20, 0.89), p = 0.02]. CONCLUSIONS TR remains associated with higher recurrence rates and longer operative times. However, the reduced risk of postoperative bowel obstruction suggests potential long-term benefits. This study emphasizes the importance of meticulous patient selection for TR to mitigate detrimental effects on patients with severe disease.
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Affiliation(s)
- Soichi Shibuya
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK.
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan.
| | - Irene Paraboschi
- Department of Biomedical and Clinical Science, University of Milano, Milan, Italy
| | - Stefano Giuliani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Takafumi Tsukui
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan
| | - Andreea Matei
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Mikihiro Inoue
- Department of Pediatric Surgery, Fujita Health University, Aichi, Japan
| | - Simon A Clarke
- Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo City, Tokyo, 113-8431, Japan
| | - Augusto Zani
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Simon Eaton
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK
| | - Paolo De Coppi
- Stem Cell and Regenerative Medicine Section, Developmental Biology and Cancer Research & Teaching Department, Zayed Centre for Research Into Rare Disease in Children, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1E, UK.
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
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Belza C, Cohen E, Orkin J, Fayed N, Major N, Quartarone S, Moretti M. Out-of-pocket expenses reported by families of children with medical complexity. Paediatr Child Health 2024; 29:216-223. [PMID: 39045474 PMCID: PMC11261824 DOI: 10.1093/pch/pxad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2024] Open
Abstract
Objectives Due to their medical and technology dependence, families of children with medical complexity (CMC) have significant costs associated with care. Financial impact on families in general have been described, but detailed exploration of expenses in specific categories has not been systematically explored. Our objective was to describe out-of-pocket (OOP) expenses incurred by caregivers of CMC and to determine factors associated with increased expenditures. Methods This is a secondary observational analysis of data primary caregiver-reported OOP expenses as part of a randomized control trial conducted in Ontario, Canada. Caregivers completed questionnaires reporting OOP costs. Descriptive statistics were utilized to report OOP expenses and a linear regression model was conducted. Results 107 primary caregivers of CMC were included. The median (IQR) age of participants was 34.5 years (30.5 to 40.5) and 83.2% identified as the mother. The majority were married or common-law (86.9%) and 50.5% were employed. The participant's children [median (IQR) age 4.5 (2.2 to 9.7); 57.9% male] most commonly had a neurological/neuromuscular primary diagnosis (46.1%) and 88% utilized medical technology. Total OOP expenses were $8,639 CDN annually (IQR = $4,661 to $31,326) with substantial expenses related to childcare/homemaking, travel to appointments, hospitalizations, and device costs. No factors associated with greater likelihood of OOP expenses were identified. A P-value of <0.05 was considered significant. Conclusion Caregivers of CMC incur significant OOP expenses related to the care of their children resulting in financial burden. Future exploration of the financial impact on caregiver productivity, employment, and identification of resources to mitigate OOP expenses will be important for this patient population.
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Affiliation(s)
- Christina Belza
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Nathalie Major
- Division of Pediatric Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Samantha Quartarone
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myla Moretti
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Katlaps I, Ronai C, Garg B, Mandelbaum A, Ghafari-Saravi A, Caughey AB, Madriago E. The Ongoing Relationship Between Offspring Congenital Heart Disease and Preeclampsia Across Pregnancies. JACC. ADVANCES 2024; 3:101009. [PMID: 39130014 PMCID: PMC11313037 DOI: 10.1016/j.jacadv.2024.101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 08/13/2024]
Abstract
Background Prior literature has described an association between preeclampsia and offspring congenital heart disease (CHD), while suggesting there may be a stronger relationship in individuals with early preeclampsia. Objectives The authors sought to explore the relationship between offspring CHD and preeclampsia among pregnancies in a population-based study. Methods Retrospective cohort study all singleton pregnancies delivered in the state of California 2000 to 2012. We included singleton births with gestational ages of 23 to 42 weeks and excluded pregnancies complicated by pre-existing diabetes or identified fetal chromosomal anomalies. We used multivariable logistic regression to estimate ORs for associations between offspring CHD and preeclampsia. Further subanalyses examined the relationships in deliveries <34 weeks and >34 weeks to analyze if there was a difference according to timing of preeclampsia development. Results Preeclampsia was strongly associated with offspring CHD (aOR: 1.38; 99% CI: 1.29-1.49) in the same pregnancy. Among patients with preeclampsia in the index pregnancy, there was an increased risk of fetal CHD in the subsequent pregnancy (aOR: 1.39; 99% CI: 1.20-1.61). Among patients with offspring CHD in the index pregnancy, there was an increased risk of preeclampsia in the subsequent pregnancy (aOR: 1.39; 99% CI: 1.15-1.68). In all 3 analyses, results remained significant when stratified by <34 weeks and ≥34 weeks. Conclusions Our findings suggest a need for further investigation into the etiology of preeclampsia and its relationship to embryologic development of cardiovascular structures.
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Affiliation(s)
- Isabel Katlaps
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Christina Ronai
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ava Mandelbaum
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Erin Madriago
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
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Chen ZY, Tao J, Xu WL, Gao YY, Li WY, Liu Z, Zhou JY, Dai L. Epidemiology of congenital diaphragmatic hernia among 24 million Chinese births: a hospital-based surveillance study. World J Pediatr 2024; 20:712-722. [PMID: 38070097 PMCID: PMC11269495 DOI: 10.1007/s12519-023-00774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/12/2023] [Indexed: 07/25/2024]
Abstract
BACKGROUND The prevalence of congenital diaphragmatic hernia (CDH) varies across countries, with limited information available on its epidemiology in China. Our study aimed to investigate the prevalence, time trends, and perinatal outcomes of CDH in China, as well as its associated malformations and potential associations with maternal and infant characteristics. METHODS This study included all birth and CDH cases from the Chinese Birth Defects Monitoring Network between 2007 and 2019, with CDH cases classified as either isolated or associated. We employed the joinpoint regression model to calculate the trends of prevalence and the annual percent change, with Poisson regression used for adjusted prevalence rate ratios. A P value ≤ 0.05 was considered statistically significant. RESULTS A total of 4397 CDH cases were identified among 24,158,029 births in the study period, yielding prevalence rates of 1.82, 1.13 and 0.69 per 10,000 for overall, isolated, and associated CDH, respectively. The prevalence of each type of CDH increased over time. The prevalence of overall CDH varied significantly by infant sex (male vs. female, 1.91/10,000 vs. 1.63/10,000), maternal residence (urban vs. rural, 2.13/10,000 vs. 1.45/10,000), maternal age (< 20 years, 1.31/10,000; 20-24 years, 1.63/10,000; 25-29 years, 1.80/10,000; 30-34 years, 1.87/10,000; ≥ 35 years, 2.22/10,000), and geographic region (central, 1.64/10,000; east, 2.45/10,000; west, 1.37/10,000). Cardiovascular anomalies were the most common malformations associated with CDH. Infants with associated CDH had a higher risk of premature birth and perinatal death than those with isolated CDH. CONCLUSION The increasing prevalence and high perinatal mortality rate of CDH highlight the need for further etiological, epidemiological, and clinical studies among the Chinese population. Video Abstract.
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Affiliation(s)
- Zhi-Yu Chen
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Jing Tao
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Wen-Li Xu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Yu-Yang Gao
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Wen-Yan Li
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Zhen Liu
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Jia-Yuan Zhou
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China
| | - Li Dai
- National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, No. 17 Section 3 Renminnanlu, Chengdu 610041, China.
- The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China.
- NHC Key Laboratory of Chronobology, Sichuan University, Chengdu, China.
- Med-X Center for Informatics, Sichuan University, Chengdu, China.
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Chaparro-Zaraza DF, Pinilla-Orejarena AP, Otoya-Castrillón JP, Chacón-Valenzuela D, Quintero-Olarte JJ, Cifuentes-Rincón AB, Quesada-Uribe BF, Durán-Hernandez A, Bermon A, Manrique-Hernandez EF. Evaluating the use of laparoscopic gastrostomy in children with congenital heart disease in Colombia: a retrospective analysis. Front Pediatr 2024; 12:1405793. [PMID: 38938503 PMCID: PMC11208668 DOI: 10.3389/fped.2024.1405793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024] Open
Abstract
Introduction Congenital Heart Disease (CHD) is the most common congenital disorder and a leading cause of infant mortality. Despite improved survival rates, patients with CHD often face malnutrition due to increased metabolic demands, feeding difficulties, and gastrointestinal dysfunction. Malnutrition in CHD is linked to poor short and long-term clinical outcomes. Gastrostomy (GT) is frequently used for long-term enteral support, and laparoscopic GT (LGT) has demonstrated advantages in children without CHD. This study evaluated a modified Georgeson's percutaneous LGT technique and its perioperative complications in children with CHD. Methods We performed an analytical retrospective cohort study from 2018 to 2022, including patients younger than 24 months with a diagnosis of CHD who underwent LGT. The primary outcome evaluated was the presence of complications during surgery and the first thirty postoperative days. Complications were graded using Clavien-Dindo's (CD) classification. Sociodemographic, clinical, and procedure-related variables were collected. A bivariate analysis was performed using STATA 15, and a p < 0.05 was considered statistically significant. Results Seventy-eight patients were eligible (male 56.41%, Median age 129.5 days, weight: 4.83 kg). The median surgery time was 35 min. The complication rate was 24.36%. The most frequent complications were GT site infection (10.26%), followed by leakage (8.97%) and granuloma formation (6.41%). Conversion to open surgery was significantly associated with postoperative complications (p = 0.002). Conclusion This modified technique is well-tolerated in children with CHD, demonstrating a low rate of CD grade 3A/3B complications and no grade 4 or 5 complications.
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Affiliation(s)
| | | | | | - Daniella Chacón-Valenzuela
- Department of Pediatric Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
- School of Medicine, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | | | | | - Alvaro Durán-Hernandez
- Department of Pediatric Intensive Care, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
| | - Anderson Bermon
- Department of Epidemiology, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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Millar K, Rodd C, Rempel G, Cohen E, Sibley KM, Garland A. The Clinical Definition of Children With Medical Complexity: A Modified Delphi Study. Pediatrics 2024; 153:e2023064556. [PMID: 38804054 DOI: 10.1542/peds.2023-064556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with medical complexity (CMC) comprise a subgroup of children with severe chronic diseases. A conceptual definition for CMC has been formulated, but there is no agreement on criteria to fulfill each of the 4 proposed domains: diagnostic conditions, functional limitations, health care use, and family-identified needs. Our objective with this study was to identify a standardized definition of CMC. METHODS Through a scoping review of the CMC literature, we identified potential criteria to fulfill each domain. These were incorporated into an electronic survey that was completed by a geographic and professionally varied panel of 81 American and Canadian respondents with expertise in managing CMC (response rate 70%) as part of a 4-iteration Delphi procedure. Respondents were asked to vote for the inclusion of each criterion in the definition, and for those with quantitative components (eg, hospitalization rates), to generate a consensus threshold value for meeting that criterion. The final criteria were analyzed by a committee and collapsed when situations of redundancy arose. RESULTS Of 1411 studies considered, 132 informed 55 criteria for the initial survey, which was presented to 81 respondents. Consensus for inclusion was reached on 48 criteria and for exclusion on 1 criterion. The committee collapsed those 48 criteria into 39 final criteria, 1 for diagnostic conditions, 2 for functional limitations, 13 for health care use, and 23 for family needs. CONCLUSIONS These results represent the first consensus-based, standardized definition of CMC. Standardized identification is needed to advance understanding of their epidemiology and outcomes, as well as to rigorously study treatment strategies and care models.
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Affiliation(s)
| | | | | | - Eyal Cohen
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Allan Garland
- Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Urichuk M, Zrinyi A, Keijzer R, Lum Min SA. Prevalence of Mental Health Disorders in Individuals With Gastrointestinal Congenital Surgical Anomalies: A Systematic Review and Meta-analysis. J Pediatr Surg 2024; 59:924-929. [PMID: 38388285 DOI: 10.1016/j.jpedsurg.2024.01.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Studies examining functional outcomes and health-related quality of life for patients with congenital surgical anomalies (CSA) are increasingly common. However, the prevalence of mental health disorders in this population has not been determined. The purpose of this review is to summarize the reported prevalence of mental health disorders in children born with gastrointestinal CSA. METHODS A systematic review of the literature was conducted on Medline (OVID), EMBASE (OVID), CINAHL (EbscoHost), and Scopus to identify studies reporting mental health diagnoses in children with a gastrointestinal CSA. A meta-analysis of the prevalence of anxiety disorders and depressive disorders was completed. RESULTS Of 2546 manuscripts, seven met the inclusion criteria. All included manuscripts looked at patients with anorectal malformation (ARM) and/or Hirschsprung disease (HD). No studies assessed other gastrointestinal CSAs. A total of 183 psychiatric diagnoses were reported in 1167 patients. A pooled analysis of ARM patients revealed a 14.0% prevalence of anxiety disorders (N = 208; CI95 = 4.4-23.4%) and an 18.75% prevalence of depressive disorders (N = 48; CI95 = 7.7-29.8%). A pooled analysis of HD patients revealed a 15.8% prevalence of anxiety disorders (N = 19; CI95 = 0.6-32.2%) and a 4.75% prevalence of depressive disorders (N = 758; CI95 = 3.23-6.26%). CONCLUSIONS There is a paucity of evidence on mental health outcomes of individuals born with gastrointestinal CSA. However, the available evidence suggested a high prevalence of mental health diagnoses in individuals born with ARM or HD with 1 in 7 having an anxiety disorder. Additionally, 1 in 5 ARM patients and 1 in 20 HD patients were diagnosed with a depressive disorder. TYPE OF STUDY Systematic review and meta-analysis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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11
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Talamonti G. Reflections upon the intrauterine repair of myelomeningocele. Childs Nerv Syst 2024; 40:1571-1575. [PMID: 38514517 DOI: 10.1007/s00381-024-06365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
The intrauterine repair of myelomeningocele presents certain advantages and has gained widespread acceptance. It significantly reduces the incidence of Chiari-2 anomalies and hydrocephalus, and it is thought to enhance the neurologic outcome. Nevertheless, several issues remain unsettled and there are no negligible disadvantages. After working with patients with myelomeningocele for 30 years, I thought about how we currently treat them. There are ethical, organizational, neurological, obstetrical, and postnatal aspects worth discussing.
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Affiliation(s)
- Giuseppe Talamonti
- Dep. of Neurosurgery, ASST Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
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12
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Urichuk M, Singh C, Zrinyi A, Lum Min SA, Keijzer R. Mental Health Outcomes of Mothers of Children With Congenital Gastrointestinal Anomalies Are Similar to Control Mothers: A Longitudinal Retrospective Cohort Study. J Pediatr Surg 2024; 59:918-923. [PMID: 38365470 DOI: 10.1016/j.jpedsurg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Mothers of infants born with congenital gastrointestinal surgical anomalies experience a unique caregiving role. Whether these challenges result in more mental health diagnoses than the general population is unknown. This study assessed mental health diagnoses in mothers of children born with congenital surgical anomalies (CSA) compared to mothers of children without CSA. METHODS A total of 780 mothers of children with CSA (case-mothers) and 6994 control-mothers were included. Mental health diagnoses were obtained using International Classification of Diseases 9 codes from an administrative database. Multivariate hazard ratios (HR) of mental health diagnoses were determined for mothers following childbirth, controlling for socioeconomic status, mental health diagnoses prior to childbirth, and age at childbirth. Subgroup analyses were completed for anxiety, depression, and post-traumatic stress disorder (PTSD). The association between a woman's mental health history and becoming a case-mother was analyzed using risk ratios (RR). RESULTS Case-mothers were not at increased risk of mental health disorders compared to controls (HR = 1.00; CI95 = 0.92-1.09). In aggregate analysis, no increased risk of anxiety, depression, or PTSD was found. Subgroup analyses revealed that congenital diaphragmatic hernia case-mothers had an increased risk of depression (HR = 1.43; CI95 = 1.08-1.88). No other case-mothers were at increased risk of mental health diagnoses, anxiety, depression, or PTSD. Only omphalocele was associated with mental health diagnoses before childbirth (RR = 1.89; CI95 = 1.58-2.26). CONCLUSIONS Collectively, mothers of children with CSAs did not have a greater risk of a mental health disorder, anxiety, depression, or PTSD compared to control-mothers. Only mothers of children with congenital diaphragmatic hernia had an increased risk of depression. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Matthew Urichuk
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Charanpal Singh
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Anna Zrinyi
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Keijzer
- Division of Pediatric Surgery, Departments of Surgery and Pediatrics & Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
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13
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Urhoj SK, Morris J, Loane M, Ballardini E, Barrachina-Bonet L, Cavero-Carbonell C, Coi A, Gissler M, Given J, Heino A, Jordan S, Neville A, Santoro M, Tan J, Tucker D, Wellesley D, Garne E, Damkjaer M. Higher risk of cerebral palsy, seizures/epilepsy, visual- and hearing impairments, cancer, injury and child abuse in children with congenital anomalies: Data from the EUROlinkCAT study. Acta Paediatr 2024; 113:1024-1031. [PMID: 38324400 DOI: 10.1111/apa.17136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Abstract
AIM The aim is to examine the risk of cerebral palsy, seizures/epilepsy, visual- and hearing impairments, cancer, injury/poisoning and child abuse in children with and without a congenital anomaly up to age 5 and 10 years. METHODS This is a population-based data linkage cohort study linking information from the European Surveillance of Congenital Anomalies network (EUROCAT) and birth registries to hospital discharge databases. We included 91 504 live born children with major congenital anomalies born from 1995 to 2014 from nine EUROCAT registries in five countries and 1 960 727 live born children without congenital anomalies (reference children). Prevalence and relative risk (RR) were estimated for each of the co-morbidities using Kaplan-Meier survival estimates. RESULTS Children with congenital anomalies had higher risks of the co-morbidities than reference children. The prevalences in the reference children were generally very low. The RR was 13.8 (95% CI 12.5-15.1) for cerebral palsy, 2.5 (95% CI 2.4-2.6) for seizures/epilepsy, 40.8 (95% CI 33.2-50.2) for visual impairments, 10.0 (95% CI 9.2-10.9) for hearing loss, 3.6 (95% CI 3.2-4.2) for cancer, 1.5 (95% CI 1.4-1.5) for injuries/poisoning and 2.4 (95% CI 1.7-3.4) for child abuse. CONCLUSION Children with congenital anomalies were more likely to be diagnosed with the specified co-morbidities compared to reference children.
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Affiliation(s)
- Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Joan Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Londonderry, Northern Ireland, UK
| | - Elisa Ballardini
- IMER Registry, Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitario di Ferrara, Ferrara, Italy
| | - Laia Barrachina-Bonet
- Rare Disease Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Clara Cavero-Carbonell
- Rare Disease Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Alessio Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Joanne Given
- Institute of Nursing and Health Research, Ulster University, Londonderry, Northern Ireland, UK
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sue Jordan
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Amanda Neville
- IMER Registry, Centre for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitario di Ferrara, Ferrara, Italy
| | - Michele Santoro
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
| | - David Tucker
- Congenital Anomaly Register and Information Service for Wales (CARIS), Public Health Knowledge and Research, Public Health Wales, Swansea, UK
| | - Diana Wellesley
- Clinical Genetics, University Hospital Southampton, Southampton, UK
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Mads Damkjaer
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
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Cottle B, Schriewer K, Tiwari S, Miller D, Kaza A, Hitchcock R, Sachse FB. 3D models of the cardiac conduction system in healthy neonatal human hearts. Cardiovasc Pathol 2024; 70:107626. [PMID: 38458505 PMCID: PMC11081815 DOI: 10.1016/j.carpath.2024.107626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
Iatrogenic damage to the cardiac conduction system (CCS) remains a significant risk during congenital heart surgery. Current surgical best practice involves using superficial anatomical landmarks to locate and avoid damaging the CCS. Prior work indicates inherent variability in the anatomy of the CCS and supporting tissues. This study introduces high-resolution, 3D models of the CCS in normal pediatric human hearts to evaluate variability in the nodes and surrounding structures. Human pediatric hearts were obtained with an average donor age of 2.7 days. A pipeline was developed to excise, section, stain, and image atrioventricular (AVN) and sinus nodal (SN) tissue regions. A convolutional neural network was trained to enable precise multi-class segmentation of whole-slide images, which were subsequently used to generate high- resolution 3D tissue models. Nodal tissue region models were created. All models (10 AVN, 8 SN) contain tissue composition of neural tissue, vasculature, and nodal tissues at micrometer resolution. We describe novel nodal anatomical variations. We found that the depth of the His bundle in females was on average 304 μm shallower than those of male patients. These models provide surgeons with insight into the heterogeneity of the nodal regions and the intricate relationships between the CCS and surrounding structures.
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Affiliation(s)
- Brian Cottle
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Karl Schriewer
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Sarthak Tiwari
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Dylan Miller
- Intermountain Health, 5121 S Cottonwood St. Murray, UT 84107, USA
| | - Aditya Kaza
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA
| | - Frank B Sachse
- Department of Biomedical Engineering, University of Utah, 36 S. Wasatch Drive, MBB 3100, Salt Lake City, UT 84112, USA.
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Korkut DG, Özlü F, Atlı G, Yıldız ŞM, Demir F, Göçen U, Yapıcıoğlu H. Ischemic-Modified Albumin in Neonates with Congenital Heart Defects. Am J Perinatol 2024; 41:e827-e832. [PMID: 36584690 DOI: 10.1055/s-0042-1758488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Ischemia-modified albumin (IMA) is a new biochemical marker of ischemia. We aimed to search blood IMA levels in neonates with congenital heart defects. STUDY DESIGN During the study period, patients diagnosed with congenital heart disease and newborns with a diagnosis of hyperbilirubinemia as a control group were included in the study. IMA level was analyzed using the IMA absorbance unit (ABSU) method. RESULTS In total, 57 newborns with congenital heart disease requiring cardiac operation for the study group and 38 newborns for the control group were included. There was no difference between the two groups in terms of gender, mode of delivery, and weeks of gestation. The average IMA values in the control group were 0.19 ± 0.09 ABSU. The prepostoperative mean IMA values of the patient group were 0.22 ± 0.07 and 0.23 ± 0.07 ABSU, respectively. Comparison of the postoperative IMA with the mean of the control group was statistically significant. Preoperative and postoperative IMA values of patients who have died due to primary heart disease and surgical complications were 0.21 ± 0.07 (0.08-0.32) ABSU and 0.25 ± 0.06 (0.12-0.36) ABSU, respectively. IMA levels were not statistically different between the two groups. CONCLUSION Hypoxia and ischemia in congenital heart disease in the newborn period both preoperatively and postoperatively were important in prognosis. IMA was higher in the postoperative group. Many comprehensive studies are important in terms of preventing complications and decreasing mortality and morbidity by commenting on prognosis. KEY POINTS · IMA is a new biochemical marker of ischemia.. · In the literature, there are no reports about the relation between congenital heart defects and IM.. · The exposure of CHD patients to hypoxia/asphyxia in the preintra and postoperative periods cause neurologic deficits.
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Affiliation(s)
- Didem G Korkut
- Departemnt of Pediatrics, Çukurova University Medical Faculty, Adana, Turkey
| | - Ferda Özlü
- Department of Neonatology, Çukurova University Medical Faculty, Adana, Turkey
| | - Gülizar Atlı
- Department of Biotechnology Centre, Çukurova University Medical Faculty, Adana, Turkey
| | - Şule M Yıldız
- Department of Biotechnology Centre, Çukurova University Medical Faculty, Adana, Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology, Çukurova University Medical Faculty, Adana, Turkey
| | - Uğur Göçen
- Department of Cardiovascular Surgery, Çukurova University Medical Faculty, Adana, Turkey
| | - Hacer Yapıcıoğlu
- Department of Neonatology, Çukurova University Medical Faculty, Adana, Turkey
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Mazur L, Veten A, Ceneviva G, Pradhan S, Zhu J, Thomas NJ, Krawiec C. Characteristics and Outcomes of Intrahospital Transfers from Neonatal Intensive Care to Pediatric Intensive Care Units. Am J Perinatol 2024; 41:e1613-e1622. [PMID: 37037202 DOI: 10.1055/s-0043-1768069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Critically ill children may be transferred from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) for further critical care, but the frequency and outcomes of this patient population are unknown. The aims of this study are to describe the characteristics and outcomes in patients transferred from NICU to PICUs. We hypothesized that a higher-than-expected mortality would be present for patients with respiratory or cardiovascular diagnoses that underwent a NICU to PICU transition and that specific factors (timing of transfer, illness severity, and critical care interventions) are associated with a higher risk of mortality in the cardiovascular group. STUDY DESIGN Retrospective analysis of Virtual Pediatric Systems, LLC (2011-2019) deidentified cardiovascular and respiratory NICU to PICU subject data. We evaluated demographics, PICU length of stay, procedures, disposition, and mortality scores. Pediatric Index of Mortality 2 (PIM2) score was utilized to determine the standardized mortality ratio (SMR). RESULTS SMR of 4,547 included subjects (3,607 [79.3%] cardiovascular and 940 [20.7%] respiratory) was 1.795 (95% confidence interval: 1.62-1.97, p < 0.0001). Multivariable logistic regression analysis demonstrated transfer age (cardiovascular: odds ratio, 1.246 [1.10-1.41], p = 0.0005; respiratory: 1.254 [1.07-1.47], p = 0.0046) and PIM2 scores (cardiovascular: 1.404 [1.25-1.58], p < 0.0001; respiratory: 1.353 [1.08-1.70], p = 0.0095) were significantly associated with increased odds of mortality. CONCLUSION In this present study, we found that NICU to PICU observed deaths were high and various factors, particularly transfer age, were associated with increased odds of mortality. While the type of patients evaluated in this study likely influenced mortality, further investigation is warranted to determine if transfer timing is also a factor. KEY POINTS · NICU patients may be transitioned to the PICU.. · NICU to PICU observed deaths were high.. · Transfer timing may be a factor..
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Affiliation(s)
- Lauren Mazur
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ahmed Veten
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Gary Ceneviva
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
| | - Sandeep Pradhan
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Junjia Zhu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Neal J Thomas
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Conrad Krawiec
- Department of Pediatrics, Pediatric Critical Care Medicine, Penn State Hershey Children's Hospital, Hershey, Pennsylvania
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Wang X, Li S, Huo D, Zhu Z, Wang W, He H, Zhang Q, Li J, Wang X. Nosocomial Infections After Pediatric Congenital Heart Disease Surgery: Data from National Center for Cardiovascular Diseases in China. Infect Drug Resist 2024; 17:1615-1623. [PMID: 38694890 PMCID: PMC11061562 DOI: 10.2147/idr.s457991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
Purpose Infection prevention and control (IPC) has a significant impact on the prognosis after pediatric cardiac surgery. This study aimed to provide surveillance data on the incidence and density of various infections during the COVID-19 epidemic and explore the influence of multi-drug resistant organisms (MDRO) on in-hospital prognosis after congenital heart disease surgery. Methods This single-center retrospective study included pediatric patients who underwent cardiac surgery between 2021 and 2022. The results of the postoperative bacterial and fungal cultures and antimicrobial stewardship were collected. The demographic characteristics (age and weight), operation-related parameters (RACHS-1 grade, duration of cardiopulmonary bypass, and aortic cross clamp), and surgical outcomes (extracorporeal membrane oxygenation, delayed sternal closure, mortality, duration of mechanical ventilation, length of intensive care unit stay and hospital stay, and hospitalization costs) of MDRO and non-MDRO patients were compared. Results A total of 4776 patients were included. There were 101 infectious culture results after the operation, with a nosocomial infection rate of 2.1%. There were 40 MDRO specimens from 36 patients, 50 non-MDRO specimens from 30 patients, and 11 fungal specimens from 10 patients. The incidence of pneumonia was 1.5%, with a ventilator-associated pneumonia incidence density of 7.2/1000 patient-days. The incidence of sepsis was 0.4%, with a catheter-related bloodstream infection incidence density of 0.24/ 1000 patient-days. The incidence density of catheter-associated tract infection was 0.45/ 1000 patient-days. The incidence of surgical site infection was 0.06%. The culture proportion before commencing antibiotics was 93% and the antibiotic consumption intensity was 30.7 DDD/100 bed-days. The length of intensive care unit stay in MDRO infection patients increased compared with that in non-MDRO infection patients, 30 (18,52) vs 17 (7,62) days, p=0.05). Conclusion The IPC performance of Fuwai Hospital achieved satisfactory results. MDRO infection can lead to prolonged intensive care unit stay.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Shuo Li
- Department of Infection Control, Peking University First Hospital, Beijing, People’s Republic of China
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, People’s Republic of China
| | - Zhiyuan Zhu
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Hongxia He
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Qian Zhang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jiantao Li
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Department of Infection Control, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People’s Republic of China
- School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Lytle EE, Holladay LF. Presentation of Complex Congenital Cardiac Anomalies in a Newborn Pediatric Patient: A Case Report. Cureus 2024; 16:e58596. [PMID: 38770493 PMCID: PMC11102869 DOI: 10.7759/cureus.58596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Tricuspid atresia, a critical congenital heart defect (CHD), accounts for approximately 1% of all cases of CHDs. When tricuspid atresia is coupled with numerous other unexpected congenital cardiac anomalies, a patient's condition becomes more serious and more complex. We present a case that demonstrates the stepwise approach to the holistic treatment of congenital tricuspid atresia in the presence of normally related great vessels, a large ventricular septal defect (VSD), atrial septal defect (ASD), and trivial patent ductus arteriosus (PDA). While expanding upon the implementation of chest X-ray imaging, serial transthoracic echocardiogram (TTE) imaging, and the balloon atrial septostomy (BAS) procedure, we also provide insight into the multidisciplinary team-based approach utilized for this patient's case. This case illustrates a rare critical CHD coupled with other, more common congenital anomalies, and suggests that with multidisciplinary management and treatment, it is possible the mortality rates associated with this diagnosis could decline.
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Affiliation(s)
- Erika E Lytle
- Pediatrics, Edward Via College of Osteopathic Medicine, Monroe, USA
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19
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Wang X, Wang S, Lu Z, Wang W, Wang X. Therapeutic effects of treat and repair strategy in pediatric patients with pulmonary arterial hypertension and simple congenital heart defects. Pulm Circ 2024; 14:e12387. [PMID: 38751611 PMCID: PMC11095199 DOI: 10.1002/pul2.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/19/2024] [Accepted: 05/05/2024] [Indexed: 05/18/2024] Open
Abstract
Surgical indications for patients with pulmonary arterial hypertension (PAH) and congenital heart defects are controversial. The treat and repair strategy has demonstrated efficacy in adult populations, but there have been no studies on pediatric patients. This study included pediatric patients with PAH and simple congenital heart defects who underwent corrective repair between 2012 and 2021. According to the preoperative treatment strategies, the patients were divided into a regular strategy group (Group 1) and a treat-and-repair strategy group (Group 2). Postoperative recovery and follow-up results were compared between the two groups. A total of 33 patients were included in this study. Group 1 consisted of 19 patients, whereas Group 2 consisted of 14 patients. The pulmonary vascular resistance index in Group 2 was higher than that in Group 1 (10.9 ± 4.1 vs. 8.2 ± 1.6 WU, p = 0.031). There were no differences in postoperative recovery between the two groups (p > 0.05). During follow-up, five patients were lost (three in Group 1 and two in Group 2). The median follow-up period was 59 months. One patient died in Group 1, and two patients died in Group 2. There was no significant difference in the survival curve (p = 0.39). At the last follow-up, another seven patients had experienced a non-low-risk condition, with a total of three non-low-risk patients in Group 1 and seven in Group 2, including one patient in each group who had a history of ICU admission. According to the ROC curve, a preoperative PVRi <8.2 WU×m2 can predict postoperative persistent low-risk state, PVRi <5.2 WU×m2 can avoid postoperative death and/or ICU administration. In pediatric patients with PAH and simple congenital heart defects, the treat and repair strategies may provide surgery opportunities, PVRi should be <8 WU×m2, and <5.2 WU×m2 is the best choice.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shilin Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhongyuan Lu
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease, FuWai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Kim KM, Farkas DK, Wong V, Hjorth CF, Horváth-Puhó E, Cahan E, Cohen E, Shah NR, Sørensen HT, Milstein A. Association between maternal employment status and presence of children with major congenital anomalies in Denmark. BMC Public Health 2024; 24:715. [PMID: 38443822 PMCID: PMC10916273 DOI: 10.1186/s12889-024-18190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
IMPORTANCE The burden of caring for children with complex medical problems such as major congenital anomalies falls principally on mothers, who in turn suffer a variety of potentially severe economic consequences. As well, health consequences of caregiving often further impact the social and economic prospects of mothers of children with major congenital anomalies (MCMCAs). Evaluating the long-term economic consequences of extensive in-home caregiving among MCMCAs can inform strategies to mitigate these effects. OBJECTIVE To assess whether MCMCAs face reduced employment and increased need for disability benefits over a 20-year period. DESIGN A population-based matched cohort study. SETTING Denmark. PARTICIPANTS All women who gave birth to a singleton child with a major congenital anomaly in Denmark between January 1, 1997 and December 31, 2017 (n = 23,637) and a comparison cohort of mothers matched by maternal age, parity, and infant's year of birth (n = 234,586). EXPOSURES Liveborn infant with a major congenital anomaly. MAIN OUTCOMES AND MEASURES The primary outcome was mothers' employment status, stratified by their child's age. Employment status was categorized as employed, outside the workforce (on temporary leave, holding a flexible job, or pursuing education), or unemployed; the number of weeks in each category was measured over time. The secondary outcome was time to receipt of a disability pension, which in Denmark implies permanent exit from the labor market. We used a negative binomial regression model to estimate the number of weeks in each employment category, stratified by the child's age (i.e., 0-1 year, > 1-6 years, 7-13 years, 14-18 years). A Cox proportional hazards regression model was used to compute hazard ratios as a measure of the relative risk of receiving a disability pension. Rate ratios and hazard ratios were adjusted for maternal demographics, pregnancy history, health, and infant's year of birth. RESULTS During 1-6 years after delivery, MCMCAs were outside the workforce for a median of 50 weeks (IQR, 6-107 weeks), while members of the comparison cohort were outside the workforce for a median of 48 weeks (IQR, 4-98 weeks), corresponding to an adjusted rate ratio [ARR] of 1.05 (95% confidence interval [CI], 1.04-1.07). During the first year after delivery, MCMCAs were more likely to be employed than mothers in the comparison cohort (ARR, 1.08; 95% CI, 1.06-1.10). At all timepoints thereafter, MCMCAs had a lower rate of workforce participation. The rate of being outside the workforce was 5% higher than mothers in the comparison cohort during 1-6 years after delivery (ARR, 1.05; 95% CI, 1.04-1.07), 9% higher during 7-13 years after delivery (ARR, 1.09; 95% CI, 1.06-1.12), and 12% higher during 14-18 years after delivery (ARR, 1.12; 95% CI, 1.07-1.18). Overall, MCMCAs had a 20% increased risk of receiving a disability pension during follow-up than mothers in the matched comparison cohort [incidence rates 3.10 per 1000 person-years (95% CI, 2.89-3.32) vs. 2.34 per 1000 person-years (95% CI, 2.29-2.40), adjusted hazard ratio, 1.20; 95% CI, 1.11-1.29]. CONCLUSION AND RELEVANCE MCMCAs were less likely to participate in the Danish workforce, less likely to be employed, and more likely to receive disability pensions than mothers of unaffected children. The rate of leaving the workforce intensified as their affected children grew older. The high demands of caregiving among MCMCAs may have long-term employment consequences even in nations with comprehensive and heavily tax-supported childcare systems, such as Denmark.
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Affiliation(s)
- Kyung Mi Kim
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
- Office of Research Patient Care Services, Stanford Health Care, Menlo Park, CA, USA.
- Department of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, USA.
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Venus Wong
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Cathrine Fonnesbech Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Eli Cahan
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Eyal Cohen
- Edwin S.H. Leong Centre for Healthy Children, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nirav R Shah
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Henrik Toft Sørensen
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Arnold Milstein
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
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Stieren ES, Sankaran D, Lakshminrusimha S, Rottkamp CA. Comorbidities and Late Outcomes in Neonatal Pulmonary Hypertension. Clin Perinatol 2024; 51:271-289. [PMID: 38325946 PMCID: PMC10850767 DOI: 10.1016/j.clp.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Long-term outcomes of persistent pulmonary hypertension of newborn (PPHN) depend on disease severity, duration of ventilation, and associated anomalies. Congenital diaphragmatic hernia survivors may have respiratory morbidities and developmental delay. The presence of PPHN is associated with increased mortality in hypoxic-ischemic encephalopathy, though the effects on neurodevelopment are less clear. Preterm infants can develop pulmonary hypertension (PH) early in the postnatal course or later in the setting of bronchopulmonary dysplasia (BPD). BPD-PH is associated with higher mortality, particularly within the first year. Evidence suggests that both early and late PH in preterm infants are associated with neurodevelopmental impairment.
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MESH Headings
- Infant
- Infant, Newborn
- Humans
- Nitric Oxide
- Infant, Premature
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/therapy
- Bronchopulmonary Dysplasia/epidemiology
- Bronchopulmonary Dysplasia/therapy
- Hernias, Diaphragmatic, Congenital/complications
- Hernias, Diaphragmatic, Congenital/epidemiology
- Hernias, Diaphragmatic, Congenital/therapy
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Affiliation(s)
- Emily S Stieren
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA.
| | - Deepika Sankaran
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA
| | | | - Catherine A Rottkamp
- Division of Neonatology, Department of Pediatrics, University of California, Davis, USA
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22
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Çaylan N, Yalçin SS, Tezel B, Üner O, Aydin Ş, Kara F. Investigation of infant deaths associated with critical congenital heart diseases; 2018-2021, Türkiye. BMC Public Health 2024; 24:441. [PMID: 38347475 PMCID: PMC10860226 DOI: 10.1186/s12889-024-17966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/03/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The aim of this study was to examine the characteristics of infant mortality associated with critical congenital heart disease (CCHD). METHODS In a cross-sectional study, data for the study were obtained through Death Notification System, Birth Notification System and Turkish Statistical Institute birth statistics. RESULTS Of all infant deaths, 9.8% (4083) were associated with CCHD, and the infant mortality rate specific to CCHD was 8.8 per 10,000 live births. CCHD-related infant deaths accounted for 8.0% of all neonatal deaths, while the CCHD specific neonatal death rate was 4.6 per 10,000 live births. Of the deaths 21.7% occurred in the early neonatal, 30.3% in the late neonatal and 48.0% in the post neonatal period. Group 1 diseases accounted for 59.1% (n = 2415) of CCHD related infant deaths, 40.5% (n = 1652) were in Group 2 and 0.4% (n = 16) were in the unspecified group. Hypoplastic left heart syndrome was the most common CCHD among infant deaths (n = 1012; 24.8%). The highest CCHD related mortality rate was found in infants with preterm birth and low birth-weight while multiparity, maternal age ≥ 35 years, twin/triplet pregnancy, male gender, maternal education in secondary school and below, and cesarean delivery were also associated with higher CCHD related infant mortality rate. There was at least one non-cardiac congenital anomaly/genetic disorder in 26.1% of all cases. CONCLUSION CCHD holds a significant role in neonatal and infant mortality in Türkiye. To mitigate CCHD-related mortality rates, it is crucial to enhance prenatal diagnosis rates and promote widespread screening for neonatal CCHD.
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Affiliation(s)
- Nilgün Çaylan
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
- Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Hacettepe University, Ankara, 06100, Turkey
| | - Sıddika Songül Yalçin
- Faculty of Medicine, Department of Pediatrics, Division of Social Pediatrics, Hacettepe University, Ankara, 06100, Turkey.
| | - Başak Tezel
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Oben Üner
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Şirin Aydin
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Fatih Kara
- Faculty of Medicine, Department of Public Health, Selçuk University, Konya, Turkey
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23
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Wang X, Li S, Huo D, Wang S, Wang W, He H, Zhang Q, Li J, Wang X. Healthcare associated infection management in 62 intensive care units for patients with congenital heart disease in China, a survey study. Int J Surg 2024; 110:01279778-990000000-01027. [PMID: 38320095 PMCID: PMC11020057 DOI: 10.1097/js9.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES All patients with congenital heart disease (CHD) receive postoperative management in ICUs. Infection prevention and control (IPC) has a significant impact on prognosis. This study provides a preliminary understanding of the fundamental aspects of IPC in ICUs following CHD surgery in China. METHODS From September to October 2023, we initiated a survey on HAI management in hospitals that perform CHD surgeries independently. The questionnaires were jointly completed by the ICU physicians and IPC personnel. Duplicate or unqualified questionnaires were excluded from the study. The contents of our questionnaires covered hospital and ICU capacity, performance of the infection control department, HAI surveillance, implementation of IPC measures, and antimicrobial stewardship (AMS). Qualified questionnaires were compared according to the volume of annual CHD surgeries performed in different ICUs. Group 1 was defined as volume > 300 cases and group 2 was defined as volume ≤300 cases. RESULTS 62 of the 118 questionnaires were completed, with a response rate of 53%. The CHD surgical volume in 2022 of the 62 hospitals was 36342, accounting for 52% of the annual CHD surgical volume (69672) across the country. The postoperative infection rates obtained from the 15 ICUs varied from 1.3% to 15%, with a median rate of 4.5%. A total of 16 ICUs provided data on drug-resistant bacteria, Klebsiella pneumoniae exhibiting the highest frequency. More than 95% of ICUs have established complete HAI management systems. Information-based HAI surveillance was conducted in 89% of ICUs. Approximately 67% of ICUs stopped prophylactic antibiotics within 48 hours after surgery. In complex cases, carbapenems were administered empirically in 89% of ICUs. Group 1 had an advantage over group 2 in preventing multidrug-resistant organisms (all instruments should be used alone 100% vs. 86%, P=0.047; cleaning and disinfection of environmental surfaces, 100% vs. 81%, P=0.035; antibiotic consumption control 85% vs. 61%, P=0.044) and in preventing surgical site infections (perioperative blood glucose monitoring, 88% vs. 67%, P=0.048). However, Group 1 did not perform well in preventing catheter-related bloodstream infection (delayed catheter removal due to convenience of laboratory tests, 31% vs. 6%, P=0.021) and catheter-associated urinary tract infection (delayed catheter removal due to muscle relaxant administration, 88% vs. 58%, P=0.022). CONCLUSIONS A relatively complete HAI management system has been established throughout the country in ICUs for CHD patients. Information-based surveillance of HAI needs to be promoted, and actions should be taken to facilitate the implementation of IPC measures and AMS bundles. Training and feedback are critical for implementing IPC measures.
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Affiliation(s)
- Xiaofeng Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shuo Li
- Department of Infection Control, Peking University First Hospital
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Shilin Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Wenlong Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hongxia He
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Qian Zhang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jiantao Li
- Department of Infection Control, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Xu Wang
- Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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24
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Marcati E, Meccariello G, Mastino L, Picano M, Giorgi PD, Talamonti G. Myelomeningocele: Long-Term Neurosurgical Management. Adv Tech Stand Neurosurg 2024; 49:95-122. [PMID: 38700682 DOI: 10.1007/978-3-031-42398-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Open spina bifida, also known as myelomeningocele (MMC), is the most challenging and severe birth defect of the central nervous system compatible with life and it is due to a failure in the dorsal fusion of the nascent neural tube during embryonic development. MMC is often accompanied by a constellation of collateral conditions, including hydrocephalus, Arnold - Chiari II malformation, brainstem disfunction, hydrosyringomyelia, tethered cord syndrome and scoliosis. Beyond early surgical repair of the dorsal defect, MMC requires lifelong cares. Several additional surgical procedures are generally necessary to improve the long-term outcomes of patients affected by MMC and multidisciplinary evaluations are crucial for early identification and management of the various medical condition that can accompany this pathology. In this chapter, the most common pathological entities associated with MMC are illustrated, focusing on clinical manifestations, treatment strategies and follow up recommendations.
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Affiliation(s)
- E Marcati
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - G Meccariello
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - L Mastino
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - M Picano
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - P D Giorgi
- Department of Orthopedics, ASST Niguarda Hospital, Milan, Italy
| | - G Talamonti
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
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25
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Singh S, Mane S, Jain S, Bajaj A. Clinical presentation and outcomes of neonates born with neural tube defects- an experience from a level III B NICU in Western India. Childs Nerv Syst 2024; 40:163-170. [PMID: 37452861 DOI: 10.1007/s00381-023-06078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Neural tube defects (NTDs) are one of the most common congenital anomalies and a cause of chronic disability. The study was done to study outcomes of neural tube defects admitted at a tertiary level neonatal intensive care unit (NICU) from 2018 to 2022, a period of 4 years that also coincided with the COVID pandemic. The secondary outcome was to study the clinical presentation, associated anomalies and epidemiological features. METHODS It was a retrospective observational study; data of infants was obtained from medical records and analysis was done. RESULTS Thirty-four neonates were enrolled, of which there were 16 (47%) males and 18 (53%) females. History of pre-pregnancy maternal folate intake was present in 4 (11.7%) cases. 33 (97%) babies were diagnosed with meningomyelocele (MMC) and one each had anencephaly, iniencephaly and encephalocele, of which one had frontal and two had occipital encephalocele. The median age of surgery was 16 days of life with primary repair being the most common procedure followed by MMC repair with VP shunt. Twenty babies (58.8%) were discharged successfully, while 9 (26.5%) expired and 5 (14.7%) were discharged against medical advice; which can be attributed to the financial problems of the patients in a developing country. The overall deaths in our series were four (26.5%) which is slightly higher than other studies which may be due to the fact that this study was conducted during the COVID era with lesser rates of folate supplementation, reduced access to prenatal diagnosis coupled with poor follow-up and compliance of patients post-surgical repair. CONCLUSION This study emphasizes the importance of periconceptional folic acid supplementation, prenatal diagnosis, early surgery and meticulous follow-up as being pivotal to improving outcomes in children with NTDs.
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Affiliation(s)
- Srijan Singh
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India.
| | - Sushant Mane
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Suhani Jain
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Aditi Bajaj
- Department of Pediatrics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Çaylan N, Yalçın SS, Tezel B, Üner O, Aydin Ş, Kara F. Evaluation of critical congenital heart disease from 2018 to 2020 in Turkey: a retrospective cohort study. BMC Pregnancy Childbirth 2023; 23:871. [PMID: 38104075 PMCID: PMC10724899 DOI: 10.1186/s12884-023-06193-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the features of critical congenital heart disease (CCHD). METHODS The study was planned as a retrospective cohort study. Data for the study were obtained through national data collection systems and 2018-2020 CCHD cohort was established. In this study, we divided the patients into two groups: Group 1 included seven primary target diseases of the newborn CCHD screening program and Group 2 included secondary target diseases. RESULTS There were 9884 CCHD cases, with a prevalence of 27.8 per 10,000 live births. Of the cases 44.4% were in Group 1 (12.3 per 10,000) and 54.8% were in Group 2 (15.2 per 10,000). Of all cases 55.5% were male and the female/male ratio was 1/1.2. While 21.8% of the cases were premature, 23.0% were babies with low birth weight (LBW), 4.8% were born from multiple pregnancies. The highest prevalence of CCHD was found in LBW (84.8 per 10,000), premature infants (57.8 per 10,000) (p < 0.001). The fatality rate in the cohort was 16.6% in the neonatal period, 31.6% in the first year of life respectively. The mean estimated survival time in the birth cohort was 40.0 months (95% CI: 39.5-40.6). The mean survival time for Group 1 diseases was 33.4 months (95% CI: 32.5-34.2), while it was 45.4 months (95% CI: 44.7-46.0) for Group 2 diseases (p < 0.001). Preterm birth, LBW, maternal age and region were evaluated as factors associated with mortality risk. CONCLUSION This study showed that CCHDs are common in Turkey and mortality rates are high. There are regional differences in CCHD both prevalence and survival. Improving prenatal diagnosis rates and expanding neonatal CCHD screening are of key importance.
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Affiliation(s)
- Nilgün Çaylan
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey
| | - Sıddika Songül Yalçın
- Department of Social Pediatrics, Hacettepe University Institute of Child Health, Ankara, Turkey.
| | - Başak Tezel
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Oben Üner
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Şirin Aydin
- Child and Adolescent Health Department, Ministry of Health, General Directorate of Public Health, Ankara, Turkey
| | - Fatih Kara
- Department of Public Health, Selçuk University Faculty of Medicine, Konya, Turkey
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27
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Virlan SV, Froelich MF, Thater G, Rafat N, Elrod J, Boettcher M, Schoenberg SO, Weis M. Radiomics-Assisted Computed Tomography-Based Analysis to Evaluate Lung Morphology Characteristics after Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:7700. [PMID: 38137769 PMCID: PMC10744187 DOI: 10.3390/jcm12247700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/09/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Purpose: Children with congenital diaphragmatic hernia suffer from long-term morbidity, including lung function impairment. Our study aims to analyze lung morphology characteristics via radiomic-assisted extraction of lung features in patients after congenital diaphragmatic hernia repair. Materials and Methods: 72 patients were retrospectively analyzed after approval by the local research ethics committee. All the image data were acquired using a third-generation dual-source CT (SOMATOM Force, Siemens Healthineers, Erlangen, Germany). Dedicated software was used for image analysis, segmentation, and processing. Results: Radiomics analysis of pediatric chest CTs of patients with status after CDH was possible. Between the ipsilateral (side of the defect) and contralateral lung, three shape features and two higher-order texture features were considered statistically significant. Contralateral lungs in patients with and without ECMO treatment showed significant differences in two shape features. Between the ipsilateral lungs in patients with and without the need for ECMO 1, a higher-order texture feature was depicted as statistically significant. Conclusions: By adding quantitative information to the visual assessment of the radiologist, radiomics-assisted feature analysis could become an additional tool in the future to assess the degree of lung hypoplasia in order to further improve the therapy and outcome of CDH patients.
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Affiliation(s)
- Silviu-Viorel Virlan
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (M.F.F.); (G.T.); (S.O.S.)
| | - Matthias F. Froelich
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (M.F.F.); (G.T.); (S.O.S.)
| | - Greta Thater
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (M.F.F.); (G.T.); (S.O.S.)
| | - Neysan Rafat
- Department of Neonatology, Center for Children, Adolescent and Women’s Medicine, Olgahospital, Clinic of Stuttgart, 70174 Stuttgart, Germany;
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.E.); (M.B.)
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (J.E.); (M.B.)
| | - Stefan O. Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (M.F.F.); (G.T.); (S.O.S.)
| | - Meike Weis
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany; (M.F.F.); (G.T.); (S.O.S.)
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Tan J, Glinianaia SV, Rankin J, Pierini A, Santoro M, Coi A, Garne E, Loane M, Given JE, Brigden J, Ballardini E, Cavero-Carbonell C, de Walle HEK, García-Villodre L, Gatt M, Gissler M, Heino A, Jordan S, Khoshnood B, Klungsoyr K, Lelong N, Lutke RL, Neville AJ, Tucker D, Urhoj SK, Wellesley D, Morris JK. Risk factors for mortality in infancy and childhood in children with major congenital anomalies: A European population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:679-690. [PMID: 37817457 DOI: 10.1111/ppe.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/25/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Preterm birth and young maternal age are known risk factors for infant and childhood mortality. There is limited knowledge of the impact of these risk factors in children born with major congenital anomalies (CAs), who have inherently higher risks of death compared with other children. OBJECTIVES To investigate the risk factors for mortality up to age 10 years in children born with specific major CAs. METHODS This population-based cohort study involved 150,198 livebirths from 1995 to 2014 in 13 European CA registries linked to mortality data. Cox proportional hazards models estimated the association of gestational age, maternal age and child's sex with death <1 year and 1-9 years for the whole cohort and by CA subgroup. Hazard ratios (HR) from each registry were pooled using multivariate meta-analysis. RESULTS Preterm birth had a dose-response association with mortality; compared with infants born at 37+ weeks gestation, those born at <28, 28-31 and 32-36 weeks had 14.88 (95% CI 12.57, 17.62), 8.39 (95% CI 7.16, 9.85) and 3.88 (95% CI 3.40, 4.43) times higher risk of death <1 year, respectively. The corresponding risks at 1-9 years were 4.99 (95% CI 2.94, 8.48), 3.09 (95% CI 2.28, 4.18) and 2.04 (95% CI 1.69, 2.46) times higher, respectively. Maternal age <20 years (versus 20-34 years) was a risk factor for death <1 year (HR 1.30, 95% CI 1.09, 1.54) and 1-9 years (HR 1.58, 95% CI 1.19, 2.10). Females had 1.22 (95% CI 1.07, 1.39) times higher risk of death between 1 and 9 years than males. CONCLUSION Preterm birth was associated with considerably higher infant and childhood mortality in children with CAs, comparable to estimates reported elsewhere for the background population. Additional risk factors included young maternal age and female sex. Information on risk factors could benefit clinical care and guide counselling of parents following CA diagnoses.
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Affiliation(s)
- Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | | | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Joanne E Given
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Joanna Brigden
- Population Health Research Institute, St George's University of London, London, UK
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura García-Villodre
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Tal-Pietà, Malta
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Babak Khoshnood
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Nathalie Lelong
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Renée L Lutke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), Center for Clinical and Epidemiological Research, University of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS), Public Health Knowledge and Research, Public Health Wales, Swansea, UK
| | - Stine K Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Diana Wellesley
- University of Southampton and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
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Turial S, Stimming F, Lux A, Koehn A, Rissmann A. Prevalence and One-Year Survival of Selected Major Congenital Anomalies in Germany: A Population-Based Cohort Study. Eur J Pediatr Surg 2023; 33:403-413. [PMID: 36577437 DOI: 10.1055/s-0042-1758829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Congenital anomalies play an important role in infant mortality worldwide. The present study aims to present the current data on the prevalence rates and the 1-year survival rates for selected major congenital anomalies in Saxony-Anhalt, Germany. MATERIALS AND METHODS The data were collected systematically by the Malformation Monitoring Centre Saxony-Anhalt. Cohort from 2000 to 2017 was retrospectively analyzed to determine the prevalence rates and the survival rates of nine major congenital anomalies. The survival analysis was conducted, including all pregnancy outcomes and various risk factors. RESULTS In total, 1,012 cases of the selected congenital anomalies were registered. The total prevalence rates ranged from 2.5 (congenital diaphragmatic hernia [CDH]) to 5.8 (spina bifida [SB]) per 10,000. The live birth prevalence was lower. In total, 88.3% of live-born cases survived the first year. The 1-year survival rate of all cases, including fetal losses, was merely 61.7%. There was no continual improvement in survival during the study period noted. The 1-year survival rate was 35.7% for "genetic" malformations, 57.6% for "multiple congenital anomalies," and 68.6% for "isolated" cases, with 44.6% for prenatally detected anomalies and 85.2% for postnatally identified anomalies. Gestational age less than 31 weeks and birth weight below 1,000 g affected the survival rate adversely. CONCLUSION The survival rate of infants suffering from congenital anomalies in Saxony-Anhalt is comparable to that reported by national and international studies. Registering all pregnancy outcomes irrespective of whether they result in a live birth, stillbirth, or fetal loss in a malformation register seems to be important as it affects the statistical survival analysis in general.
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Affiliation(s)
- Salmai Turial
- Division of Pediatric Surgery, Pediatric Trauma Surgery and Pediatric Urology, University Medical Centre Magdeburg, Magdeburg, Germany
| | - Friederike Stimming
- Division of Pediatric Surgery, Pediatric Trauma Surgery and Pediatric Urology, University Medical Centre Magdeburg, Magdeburg, Germany
| | - Anke Lux
- Medical Faculty Otto-von-Guericke-University Magdeburg, Institute for Biometrics and Medical Informatics, Magdeburg, Germany
| | - Andrea Koehn
- Medical Faculty Otto-von-Guericke-University Magdeburg, Malformation Monitoring Centre of Saxony-Anhalt, Magdeburg, Germany
| | - Anke Rissmann
- Medical Faculty Otto-von-Guericke-University Magdeburg, Malformation Monitoring Centre of Saxony-Anhalt, Magdeburg, Germany
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Bassam K, Farhat A, El-Rassi I, Bitar F, Arabi M. Combined tricuspid atresia- AV septal defect-a rare congenital cardiac abnormality. Echocardiography 2023; 40:1094-1098. [PMID: 37641570 DOI: 10.1111/echo.15684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Congenital heart diseases (CHDs) are one of the most common birth defects worldwide with a prevalence of 1%. CHDs can be classified into cyanotic and acyanotic diseases based on the presence or absence of the characteristic bluish discoloration of skin and mucus membranes. A subset of cyanotic diseases is single ventricle malformations. This group of disorders comprises 1% of all CHDs. A remarkable yet rare and underreported entity of single ventricle malformations is combined tricuspid atresia (TA) and atrioventricular (AV) septal defect which is characterized by the anatomical features of both entities. Combined TA-AV septal malformation was first anatomically described in 1953 and further explored through echocardiography and cardiac catheterization in 1987 and then 1991. Since then, no studies have been documented in the literature prompting us to share our findings. METHODS Herein we are describing a rare and underreported cardiac lesion based of a retrospective revision of medical charts at the American University of Beirut Medical Center (AUBMC) Children's Heart Center, a tertiary medical center in the Middle East RESULTS: Out of 200 cases with confirmed single ventricle physiology, we identified a few patients with characteristics of combined TA-AV septal defect. Our patients exhibited characteristic echocardiographic findings of primum ASD, VSD, atretic RAVV, and clefted LAVV. CONCLUSION In short, TA-AV septal defect is a rare, underreported congenital malformation. Tracking our patients' clinical profiles will help improve our understanding of the prognosis of this entity. Our findings may also improve treatment modalities since replacing the left-sided valve is often overlooked if the defect is inaccurately diagnosed. In addition, such findings can help shed light on the embryological development of the rarely encountered variation of AV septal malformation.
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Affiliation(s)
- Khalil Bassam
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Aziz Farhat
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Issam El-Rassi
- Department of Surgery, Al Jalila Children's Specialty Hospital, Dubai, UAE
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Bowman RM, Lee JY, Yang J, Kim KH, Wang KC. Myelomeningocele: the evolution of care over the last 50 years. Childs Nerv Syst 2023; 39:2829-2845. [PMID: 37417984 DOI: 10.1007/s00381-023-06057-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE Myelomeningocele (MMC) is one of the representative anomalies in the field of pediatric neurosurgery. During the 50 years of ISPN history, MMC had a tremendous changes in its incidence, clinical management and outcome with advanced understanding of its pathogenesis. We reviewed the changes in MMC during the period. METHODS We reviewed the literature review and collected our experiences. RESULTS During the 50 years, major changes happened in many aspects of MMC including incidence, pathoembryogenesis, folate deficiency, prevention, prenatal diagnosis, mode of delivery, treatment policy with ethical considerations, clinical treatment including fetal surgery, latex allergy, retethering, management outcome, multidisciplinary team approach, and socioeconomic and family issues. CONCLUSIONS There was a great advance in the management and research of MMC during the 50 years. It is a monumental achievement of pediatric neurosurgeons and colleagues of the related fields.
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Affiliation(s)
- Robin M Bowman
- Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; Neurosurgery Department, Northwestern University, Chicago, IL, USA
| | - Ji Yeoun Lee
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeyul Yang
- Department of Neurosurgery, Myongji Hospital, Goyang, Korea
| | - Kyung Hyun Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea
| | - Kyu-Chang Wang
- Center for Rare Cancers, Neuro-oncology Clinic, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Kyounggi-do, 10408, Republic of Korea.
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Majdalany DS. Congenital Heart Disease: A Growing Population with Challenges to Patients and Providers. J Pers Med 2023; 13:1442. [PMID: 37888053 PMCID: PMC10607886 DOI: 10.3390/jpm13101442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Congenital heart disease (CHD) is the most frequent disorder encountered in the newborn period and the most frequent cause of infant mortality [...].
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Affiliation(s)
- David S Majdalany
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Baquedano M, de Jesus SE, Rapetto F, Murphy GJ, Angelini G, Benedetto U, Caldas P, Srivastava PK, Uzun O, Luyt K, Gonzalez Corcia C, Taliotis D, Stoica S, Lawlor DA, Bamber AR, Perry A, Skeffington KL, Omeje I, Pappachan J, Mumford AD, Coward RJM, Kenny D, Caputo M. Outcome monitoring and risk stratification after cardiac procedure in neonates, infants, children and young adults born with congenital heart disease: protocol for a multicentre prospective cohort study (Children OMACp). BMJ Open 2023; 13:e071629. [PMID: 37553192 PMCID: PMC10414053 DOI: 10.1136/bmjopen-2023-071629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Congenital heart disease (CHD) represents the most common birth defect, affecting from 0.4% to 1.2% of children born in developed countries. The survival of these patients has increased significantly, but CHD remains one of the major causes of neonatal and childhood death. The aetiology of CHD is complex, with some evidence of both genetic and environmental causes. However, there is still lack of knowledge regarding modifiable risk factors and molecular and genetic mechanisms underlying the development of CHD. This study aims to develop a prospective cohort of patients undergoing cardiac procedures that will bring together routinely collected clinical data and biological samples from patients and their biological mothers, in order to investigate risk factors and predictors of postoperative-outcomes, as well as better understanding the effect of the surgical intervention on the early and long-term outcomes. METHODS AND ANALYSIS Children OMACp (OMACp, outcome monitoring after cardiac procedure in congenital heart disease) is a multicentre, prospective cohort study recruiting children with CHD undergoing a cardiac procedure. The study aims to recruit 3000 participants over 5 years (2019-2024) across multiple UK sites. Routine clinical data will be collected, as well as participant questionnaires collecting sociodemographic, NHS resource use and quality of life data. Biological samples (blood, urine and surgical waste tissue from patients, and blood and urine samples from biological mothers) will be collected where consent has been obtained. Follow-up outcome and questionnaire data will be collected for 5 years. ETHICS AND DISSEMINATION The study was approved by the London-Brent Research Ethics Committee on 30 July 2019 (19/SW/0113). Participants (or their parent/guardian if under 16 years of age) must provide informed consent prior to being recruited into the study. Mothers who wish to take part must also provide informed consent prior to being recruited. The study is sponsored by University Hospitals Bristol and Weston Foundation Trust and is managed by the University of Bristol. Children OMACp is adopted onto the National Institute for Health Research Clinical Research Network portfolio. Findings will be disseminated through peer-reviewed publications, presentation at conference, meetings and through patient organisations and newsletters. TRIAL REGISTRATION NUMBER ISRCTN17650644.
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Affiliation(s)
- Mai Baquedano
- Translational Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Filippo Rapetto
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, NIHR Leicester Biomedical Research Centre Cardiovascular Diseases, Leicester, East Midlands, UK
| | - Gianni Angelini
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Patricia Caldas
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, UK
- NICU, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Avon, UK
| | | | - Demetris Taliotis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Deborah A Lawlor
- Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Andrew R Bamber
- Bristol Medical School, University of Bristol, Bristol, UK
- North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Alison Perry
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Ikenna Omeje
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Andrew D Mumford
- Department of Haematology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Damien Kenny
- Children's Health Ireland at Crumlin, Dublin, Crumlin, Ireland
| | - Massimo Caputo
- Translational Health Sciences, University of Bristol, Bristol, UK
- Bristol Heart Institute, University of Bristol, Bristol, UK
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Smoll NR, Brady Z, Scurrah KJ, Lee C, Berrington de González A, Mathews JD. Computed tomography scan radiation and brain cancer incidence. Neuro Oncol 2023; 25:1368-1376. [PMID: 36638155 PMCID: PMC10326490 DOI: 10.1093/neuonc/noad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Computed tomography (CT) scans make substantial contributions to low-dose ionizing radiation exposures, raising concerns about excess cancers caused by diagnostic radiation. METHODS Deidentified medicare records for all Australians aged 0-19 years between 1985-2005 were linked to national death and cancer registrations to 2012. The National Cancer Institute CT program was used to estimate radiation doses to the brain from CT exposures in 1985-2005, Poisson regression was used to model the dependence of brain cancer incidence on brain radiation dose, which lagged by 2 years to minimize reverse causation bias. RESULTS Of 10 524 842 young Australians, 611 544 were CT-exposed before the age of 20 years, with a mean cumulative brain dose of 44 milligrays (mGy) at an average follow-up of 13.5 years after the 2-year lag period. 4472 were diagnosed with brain cancer, of whom only 237 had been CT-exposed. Brain cancer incidence increased with radiation dose to the brain, with an excess relative risk of 0.8 (95% CI 0.57-1.06) per 100 mGy. Approximately 6391 (95% CI 5255, 8155) persons would need to be exposed to cause 1 extra brain cancer. CONCLUSIONS For brain tumors that follow CT exposures in childhood by more than 2 years, we estimate that 40% (95% CI 29%-50%) are attributable to CT Radiation and not due to reverse causation. However, because of relatively low rates of CT exposure in Australia, only 3.7% (95% CI 2.3%-5.4%) of all brain cancers are attributable to CT scans. The population-attributable fraction will be greater in countries with higher rates of pediatric scanning.
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Affiliation(s)
- Nicolas R Smoll
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| | - Zoe Brady
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
- Department of Radiology and Nuclear Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Katrina J Scurrah
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA
| | - John D Mathews
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street Carlton, VIC, 3053, Australia
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Engwall-Gill AJ, Weller JH, Salvi PS, Penikis AB, Sferra SR, Rhee DS, Solomon DG, Kunisaki SM. Morbidity and Mortality in Neonates with Symptomatic Congenital Lung Malformation. J Am Coll Surg 2023; 236:1139-1146. [PMID: 36786474 DOI: 10.1097/xcs.0000000000000653] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Neonatal resection is the mainstay treatment of children presenting with symptomatic congenital lung malformation (CLM) at birth. The objective of this study was to evaluate risk factors for increased morbidity and mortality after neonatal CLM resection using a large multicenter database. STUDY DESIGN Retrospective review of the Pediatric Health Information System database was performed. Children with a symptomatic CLM managed by lung resection before 30 days of age were included (2016 to 2021). Primary outcomes measures were postoperative respiratory complication and any complication, including death. RESULTS Of 1,791 CLM patients identified, 256 (14%) underwent neonatal resection for symptomatic disease. Pathology included 123 (48%) congenital pulmonary airway malformation, 24 (10%) bronchopulmonary sequestration, 5 (2%) congenital lobar emphysema, 16 (6%) hybrid, and 88 (34%) unclassified lesion. Preoperative mechanical ventilation and extracorporeal membrane oxygenation (ECMO) were employed in 149 (58.2%) and 17 (6.7%) of cases, respectively. The median age at resection was 6.5 days (interquartile range 2 to 23). Postoperatively, 25 (10%) required mechanical ventilation for 48 hours or more, 3 (1%) continued ECMO, and 3 (1%) required ECMO rescue. The overall respiratory complication rate was 34% (87), rate of any complication was 51% (130), median postoperative length of stay was 20 days (interquartile range 9 to 52), and mortality rate was 14.5% (37). Birthweight was inversely correlated with complication risk (incidence rate ratio 0.55, 95% CI 0.36 to 0.83, p = 0.006). Cardiac structural anomaly was associated with a 21-day longer postoperative length of stay (95% CI 6 to 35, p = 0.006) and 2.2 times increased risk of any complication (95% CI 1.18 to 4.02, p = 0.014). CONCLUSIONS In this large multicenter study, ECMO use and mortality are relatively uncommon among neonates undergoing lung resection for a symptomatic CLM. However, postoperative morbidity remains high, particularly in those with cardiac structural disease.
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Affiliation(s)
- Abigail J Engwall-Gill
- From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)
| | - Jennine H Weller
- From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)
| | - Pooja S Salvi
- the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki)
| | - Annalise B Penikis
- From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)
| | - Shelby R Sferra
- From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)
| | - Daniel S Rhee
- From the Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Engwall-Gill, Weller, Penikis, Sferra, Rhee)
| | - Daniel G Solomon
- the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki)
| | - Shaun M Kunisaki
- the Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT (Salvi, Solomon, Kunisaki)
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Engwall-Gill AJ, Zhou AL, Penikis AB, Sferra SR, Jelin AC, Blakemore KJ, Kunisaki SM. Prenatal Sonography in Suspected Proximal Gastrointestinal Obstructions: Diagnostic Accuracy and Neonatal Outcomes. J Pediatr Surg 2023; 58:1090-1094. [PMID: 36907770 PMCID: PMC10866136 DOI: 10.1016/j.jpedsurg.2023.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND The purpose of this study was to assess diagnostic accuracy and neonatal outcomes in fetuses with a suspected proximal gastrointestinal obstruction (GIO). METHODS After IRB approval, a retrospective chart review was conducted on prenatally suspected and/or postnatally confirmed cases of proximal GIO at a tertiary care facility (2012-2022). Maternal-fetal records were queried for presence of a double bubble ± polyhydramnios, and neonatal outcomes were assessed to calculate the diagnostic accuracy of fetal sonography. RESULTS Among 56 confirmed cases, the median birthweight and gestational age at birth were 2550 g [interquartile range (IQR) 2028-3012] and 37 weeks (IQR 34-38), respectively. There was one (2%) false-positive and three (6%) false-negatives by ultrasound. Double bubble had a sensitivity, specificity, positive predictive value, and negative predictive value for proximal GIO of 85%, 98%, 98%, and 83%, respectively. Pathologies included 49 (88%) with duodenal obstruction/annular pancreas, three (5%) with malrotation, and three (5%) with jejunal atresia. The median postoperative length of stay was 27 days (IQR 19-42). Cardiac anomalies were associated with significantly higher complications (45% vs 17%, p = 0.030). CONCLUSIONS In this contemporary series, fetal sonography has high diagnostic accuracy for detecting proximal gastrointestinal obstruction. These data are informative for pediatric surgeons in prenatal counseling and preoperative discussions with families. LEVEL OF EVIDENCE Diagnostic Study, Level III.
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Affiliation(s)
- Abigail J Engwall-Gill
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice L Zhou
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annalise B Penikis
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shelby R Sferra
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angie C Jelin
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karin J Blakemore
- Division of Maternal-Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaun M Kunisaki
- Division of General Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Wu H, Yang Y, Jia J, Guo T, Lei J, Deng Y, He Y, Wang Y, Peng Z, Zhang Y, Zhang H, Wang Q, Shen H, Zhang Y, Yan D, Ma X. Maternal Preconception Hepatitis B Virus Infection and Risk of Congenital Heart Diseases in Offspring Among Chinese Women Aged 20 to 49 Years. JAMA Pediatr 2023; 177:498-505. [PMID: 36912830 PMCID: PMC10012042 DOI: 10.1001/jamapediatrics.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/12/2023] [Indexed: 03/14/2023]
Abstract
Importance Maternal hepatitis B virus (HBV) infection during early pregnancy has been related to congenital heart diseases (CHDs) in offspring. However, no study to date has evaluated the association of maternal preconception HBV infection with CHDs in offspring. Objective To explore the association of maternal preconception HBV infection with CHDs in offspring. Design, Setting, and Participants This retrospective cohort study used nearest-neighbor (1:4) propensity score matching of 2013 to 2019 data from the National Free Preconception Checkup Project (NFPCP), a national free health service for childbearing-aged women who plan to conceive throughout mainland China. Women aged 20 to 49 years who got pregnant within 1 year after preconception examination were included, and those with multiple births were excluded. Data were analyzed from September to December 2022. Exposures Maternal preconception HBV infection statuses, including uninfected, previous, and new infection. Main Outcomes and Measures The main outcome was CHDs, which were prospectively collected from the birth defect registration card of the NFPCP. Logistic regression with robust error variances was used to estimate the association between maternal preconception HBV infection status and CHD risk in offspring, after adjusting for confounding variables. Results After matching with a 1:4 ratio, there were 3 690 427 participants included in the final analysis, where 738 945 women were infected with HBV, including 393 332 women with previous infection and 345 613 women with new infection. Approximately 0.03% (800 of 2 951 482) of women uninfected with HBV preconception and women newly infected with HBV carried an infant with CHDs, whereas 0.04% (141 of 393 332) of women with HBV infection prior to pregnancy carried an infant with CHDs. After multivariable adjustment, women with HBV infection prior to pregnancy had a higher risk of CHDs in offspring compared with women who were uninfected (adjusted relative risk ratio [aRR], 1.23; 95% CI, 1.02-1.49). Moreover, compared with couples who were uninfected with HBV prior to pregnancy (680 of 2 610 968 [0.026%]), previously infected women with uninfected men (93 of 252 919 [0.037%]) or previously infected men with uninfected women (43 of 95 735 [0.045%]) had a higher incidence of CHDs in offspring and were significantly associated with a higher risk of CHDs in offspring (previously infected women with uninfected men: aRR, 1.36; 95% CI, 1.09-1.69; previously infected men with uninfected women: aRR, 1.51; 95% CI, 1.09-2.09) with multivariable adjustment, while no significant association was observed between maternal new HBV infection and CHDs in offspring. Conclusions and Relevance In this matched retrospective cohort study, maternal preconception previous HBV infection was significantly associated with CHDs in offspring. Moreover, among women with HBV-uninfected husbands, significantly increased risk of CHDs was also observed in previously infected women prior to pregnancy. Consequently, HBV screening and getting HBV vaccination-induced immunity for couples prior to pregnancy are indispensable, and those with previous HBV infection prior to pregnancy should also be taken seriously to decrease the CHDs risk in offspring.
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Affiliation(s)
- Hanbin Wu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jiajing Jia
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China
| | - Tonglei Guo
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
- NHC Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jueming Lei
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - YuZhi Deng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuan He
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health and Family Planning Commission of the PRC, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resource Center, National Human Reproduction and Health Resource Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
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Mortality in Congenital Diaphragmatic Hernia: A Multicenter Registry Study of Over 5000 Patients Over 25 Years. Ann Surg 2023; 277:520-527. [PMID: 34334632 DOI: 10.1097/sla.0000000000005113] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine if risk-adjusted survival of patients with CDH has improved over the last 25 years within centers that are long-term, consistent participants in the CDH Study Group (CDHSG). SUMMARY BACKGROUND DATA The CDHSG is a multicenter collaboration focused on evaluation of infants with CDH. Despite advances in pediatric surgical and intensive care, CDH mortality has appeared to plateau. Herein, we studied CDH mortality rates amongst long-term contributors to the CDHSG. METHODS We divided registry data into 5-year intervals, with Era 1 (E1) beginning in 1995, and analyzed multiple variables (operative strategy, defect size, and mortality) to assess evolution of disease characteristics and severity over time. For mortality analyses, patients were risk stratified using a validated prediction score based on 5-minute Apgar (Apgar5) and birth weight. A risk-adjusted, observed to expected (O:E) mortality model was created using E1 as a reference. RESULTS 5203 patients from 23 centers with >22years of participation were included. Birth weight, Apgar5, diaphragmatic agenesis, and repair rate were unchanged over time (all P > 0.05). In E5 compared to E1, minimally invasive and patch repair were more prevalent, and timing of diaphragmatic repair was later (all P < 0.01). Overall mortality decreased over time: E1 (30.7%), E2 (30.3%), E3 (28.7%), E4 (26.0%), E5 (25.8%) ( P = 0.03). Risk-adjusted mortality showed a significant improvement in E5 compared to E1 (OR 0.78, 95% CI 0.62-0.98; P = 0.03). O:E mortality improved over time, with the greatest improvement in E5. CONCLUSIONS Risk-adjusted and observed-to-expected CDH mortality have improved over time.
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Advances in Fetal Surgical Repair of Open Spina Bifida. Obstet Gynecol 2023; 141:505-521. [PMID: 36735401 DOI: 10.1097/aog.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023]
Abstract
Spina bifida remains a common congenital anomaly of the central nervous system despite national fortification of foods with folic acid, with a prevalence of 2-4 per 10,000 live births. Prenatal screening for the early detection of this condition provides patients with the opportunity to consider various management options during pregnancy. Prenatal repair of open spina bifida, traditionally performed by the open maternal-fetal surgical approach through hysterotomy, has been shown to improve outcomes for the child, including decreased need for cerebrospinal fluid diversion surgery and improved lower neuromotor function. However, the open maternal-fetal surgical approach is associated with relatively increased risk for the patient and the overall pregnancy, as well as future pregnancies. Recent advances in minimally invasive prenatal repair of open spina bifida through fetoscopy have shown similar benefits for the child but relatively improved outcomes for the pregnant patient and future childbearing.
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Fields D, Fraser LK, Taylor J, Hackett J. What does 'good' palliative care look like for children and young people? A qualitative study of parents' experiences and perspectives. Palliat Med 2023; 37:355-371. [PMID: 36825577 PMCID: PMC10021114 DOI: 10.1177/02692163231154300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Worldwide, around 21 million children would benefit from palliative care and over 7 million babies and children die each year. Whilst provision of paediatric palliative care is advancing, there major gaps between what should be done, and what is being done, in clinical practice. In 2017, the National Institute for Health and Care Excellence (NICE) introduced a quality standard, to standardise and improve children's palliative care in England. However, there is little evidence about what good experiences of palliative care for children are, and how they relate to the quality standard for end-of-life care. AIM This study explored how the NICE quality standard featured in parental experiences of palliative care for children to understand what 'good' palliative care is. DESIGN Qualitative study, employing in-depth, telephone and video-call, semi-structured interviews. Data were analysed using thematic analysis, informed by Appreciative Inquiry. SETTING/PARTICIPANTS Participants were parents of children and young people (aged 0-17 years) in England, who were receiving palliative care, and parents whose child had died. RESULTS Fourteen mothers and three fathers were interviewed. Seven were bereaved. Parents were recruited via four children's hospices, one hospital, and via social media. Good palliative care is co-led and co-planned with trusted professionals; is integrated, responsive and flexible; encompasses the whole family; and enables parents to not only care for, but also to parent their child to end of life. CONCLUSIONS Findings have implications for informing evidence based practice and clinical guidelines, overall improving experiences of care.
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Affiliation(s)
- Diana Fields
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Lorna Katherine Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Jo Taylor
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Julia Hackett
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
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Caggiano S, Pavone M, Cherchi C, Paglietti MG, Schiavino A, Petreschi F, Chiarini Testa MB, Cutrera R. Children with medical complexity and pediatric palliative care: Data by a respiratory intermediate care unit. Pediatr Pulmonol 2023; 58:918-926. [PMID: 36510441 DOI: 10.1002/ppul.26278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
Pediatric palliative care (PPC) is an active and total approach to the care of children with life-limiting conditions and their families. PPC programs provide ongoing treatment for children with medical complexity (CMC), many of whom will reach adulthood. Aim of the study was to describe a population of CMC attendingin six preselected months the Respiratory Intermediate Care Unit of a tertiary referral hospital for southern and central Italy. We enrolled all CMC patients admitted to our unit in six preselected months and registered pathologies and different categories of childhood diseases, devices and needs, hospitalization and home care plan. Among the 275 children admitted to our unit, 130 CMC were included. Median age was 9.9 (0.1-40.0) years. The main pathologies recorded were neuromuscular, neurological, respiratory, metabolic and malformative diseases, genetic syndromes and outcomes of prematurity. Comorbidity due to respiratory, digestive, neurological, cardiac and urological involvement was present in a high percentage of cases. Among our patients, only 46 were not carriers of any medical device. The average length of hospitalization was 7.0 (1.0-270.0) days with 2 (1.0-7.0) admissions per year per patient. Home care activation was not required for 47 out of 130 patients. Children eligible for PPC are increasing and their survival results in a rise of comorbidities and special needs demanding multilevel interventions. Respiratory symptoms are the most recurrent ones observed, thus requiring an expert in PPC with expertise in the respiratory field. Sharing data and knowledge of CMC needs may help improve care coordination.
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Affiliation(s)
- Serena Caggiano
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Martino Pavone
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Claudio Cherchi
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Giovanna Paglietti
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Schiavino
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Francesca Petreschi
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Beatrice Chiarini Testa
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Renato Cutrera
- Academic Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Lu E, Wu L, Chen B, Xu S, Fu Z, Wu Y, Wu Y, Gu H. Maternal Serum tRNA-Derived Fragments (tRFs) as Potential Candidates for Diagnosis of Fetal Congenital Heart Disease. J Cardiovasc Dev Dis 2023; 10:jcdd10020078. [PMID: 36826574 PMCID: PMC9968204 DOI: 10.3390/jcdd10020078] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Congenital heart disease (CHD) is one of the most predominant birth defects that causes infant death worldwide. The timely and successful surgical treatment of CHD on newborns after delivery requires accurate detection and reliable diagnosis during pregnancy. However, there are no biomarkers that can serve as an early diagnostic factor for CHD patients. tRNA-derived fragments (tRFs) have been reported to play an important role in the occurrence and progression of numerous diseases, but their roles in CHD remains unknown. METHODS High-throughput sequencing was performed on the peripheral blood of pregnant women with an abnormal fetal heart and a normal fetal heart, and 728 differentially expressed tRFs/tiRNAs were identified, among which the top 18 tRFs/tiRNAs were selected as predictive biomarkers of CHD. Then, a quantitative reverse transcriptase polymerase chain reaction verified the expression of tRFs/tiRNAs in more clinical samples, and the correlation between tRFs/tiRNAs abnormalities and CHD was analyzed. RESULTS tRF-58:74-Gly-GCC-1 and tiRNA-1:35-Leu-CAG-1-M2 may be promising biomarkers. Through further bioinformatics analysis, we predicted that TRF-58:744-GLy-GCC-1 could induce CHD by influencing biological metabolic processes. CONCLUSIONS Our results provide a theoretical basis for the abnormally expressed tRF-58:74-Gly-GCC-1 in maternal peripheral blood as a new potential biomarker for the accurate diagnosis of CHD during pregnancy.
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Affiliation(s)
- Enkang Lu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Central Laboratory of Jiangsu Provincial Maternal and Child Health Care Hospital, Maternal and Child Branch of the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Lijun Wu
- Department of Ultrasound, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing 210004, China
| | - Bin Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Shipeng Xu
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA
| | - Ziyi Fu
- Central Laboratory of Jiangsu Provincial Maternal and Child Health Care Hospital, Maternal and Child Branch of the First Affiliated Hospital of Nanjing Medical University, Nanjing 210036, China
| | - Yun Wu
- Department of Ultrasound, Nanjing Maternity and Child Health Care Hospital, Women’s Hospital of Nanjing Medical University, Nanjing 210004, China
- Correspondence: (Y.W.); (Y.W.); (H.G.); Tel.: +86-189-0518-0170 (Y.W.); +86-139-5194-5999 (Y.W.); +86-139-0159-2427 (H.G.)
| | - Yanhu Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (Y.W.); (Y.W.); (H.G.); Tel.: +86-189-0518-0170 (Y.W.); +86-139-5194-5999 (Y.W.); +86-139-0159-2427 (H.G.)
| | - Haitao Gu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
- Correspondence: (Y.W.); (Y.W.); (H.G.); Tel.: +86-189-0518-0170 (Y.W.); +86-139-5194-5999 (Y.W.); +86-139-0159-2427 (H.G.)
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Miles KG, Powell AW, Critser PJ, Hardie W, O'Neil M, Cash M, Magness M, Geers E, Mays W, Hirsch R. Long-term exercise and pulmonary function outcomes in a contemporary cohort of children with congenital diaphragmatic hernia. Pediatr Pulmonol 2023; 58:1471-1480. [PMID: 36751101 DOI: 10.1002/ppul.26348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) survivors are at risk for long-term exercise impairment and pulmonary morbidity, but the generalizability of prior reported cohorts are limited by reduced disease severity and older surgical eras. We assessed the mid-childhood exercise and pulmonary function outcomes in a contemporary cohort of CDH survivors. STUDY DESIGN In this retrospective cohort study, we identified 36 consecutive pediatric CDH survivors who underwent cardiopulmonary exercise testing (CPET) and spirometry from 2014 to 2021. Inferential statistics compared survivors with age-, sex-, and size-matched healthy controls; univariate analyses identified factors associated with abnormal testing. RESULTS Maximal effort CPET and resting spirometry were completed by 27/36 (75%) and 31/36 (86%) subjects, respectively (median age: 8.1 years [interquartile range: 7.5, 10]; 16 females [44%]). Abnormal CPET (percent predicted [pp] peak VO2 < 80%) was more common in the CDH cohort (12 vs. 1, p < 0.001) and associated with longer neonatal intensive care unit (NICU) stay (p = 0.02) and oxygen therapy at discharge (p = 0.03). Exercise impairment was mild (pp peak VO2 70%-80%), moderate (60%-70%), and severe (<60%) in 6, 4, and 2 survivors, respectively. Abnormal spirometry was more common in the CDH cohort (21 vs. 3, p < 0.001; obstructive [n = 15], restrictive [n = 6]) and associated with decreased gestational age (p = 0.046), longer mechanical ventilation in the NICU (p = 0.02), and orthopedic abnormalities (p = 0.03). CONCLUSION(S) Exercise capacity was normal or mildly impaired in most CDH survivors, however, approximately two-thirds demonstrated abnormal spirometry. Impaired exercise capacity and lung function were associated with severity of lung disease postnatally. These data support cardiopulmonary follow-up throughout childhood.
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Affiliation(s)
- Kimberley G Miles
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam W Powell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul J Critser
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - William Hardie
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pulmonology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Meredith O'Neil
- Department of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michelle Cash
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa Magness
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth Geers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Wayne Mays
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Russel Hirsch
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Peppa M, De Stavola BL, Loukogeorgakis S, Zylbersztejn A, Gilbert R, De Coppi P. Congenital diaphragmatic hernia subtypes: Comparing birth prevalence, occurrence by maternal age, and mortality in a national birth cohort. Paediatr Perinat Epidemiol 2023; 37:143-153. [PMID: 36441118 PMCID: PMC10099870 DOI: 10.1111/ppe.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Population-based administrative data have rarely been used to compare the birth prevalence, risk factors for occurrence, and mortality of congenital diaphragmatic hernia (CDH) subtypes. OBJECTIVES We used a national birth cohort to identify CDH subtypes and compared their birth prevalence, relationship with maternal age after accounting for sociodemographic factors, and 1-year mortality rates. METHODS Linked hospital admission and death records were used to identify isolated and complex CDH cases (involving additional anomalies) among singleton livebirths in England between 2002 and 2018. The prevalence of each CDH subtype per 10,000 livebirths was estimated overall and by infant, birth and maternal characteristics. The relationship between maternal age and each subtype relative to no CDH was examined using multivariable log-binomial regression to estimate risk ratios (RRs). One-year mortality rates were examined using Kaplan-Meier curves and the hazard ratio (HR) of complex versus isolated CDH was calculated using Cox regression. RESULTS Among 9.5 million livebirths, we identified 1285 with isolated CDH and 1150 with complex CDH. The overall prevalence of isolated and complex CDH was 1.4 (95% confidence interval [CI] 1.3, 1.4) and 1.2 (95% CI 1.1, 1.3) per 10,000 livebirths, respectively. Only complex CDH was associated with maternal age. Compared with maternal age 25-34 years, complex CDH risk was elevated for maternal age < 20 years (RR 1.31, 95% CI 1.00, 1.72). Risk was highest for maternal age ≥ 40 years (RR 1.61, 95% CI 1.21, 2.15) although accounting for chromosomal anomalies attenuated the risk (RR 1.39, 95% CI 1.00, 1.92). The 1-year mortality rate for complex CDH (33.1%, 95% CI 30.5, 35.9) was slightly higher than for isolated CDH (29.7%, 95% CI 27.3, 32.3) (HR 1.10, 95% CI 0.96, 1.27). CONCLUSIONS Mechanisms of occurrence differed between and within CDH subtypes and 1-year mortality of complex CDH was slightly higher than for isolated CDH.
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Affiliation(s)
- Maria Peppa
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Bianca L. De Stavola
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Stavros Loukogeorgakis
- Stem Cell and Regenerative MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- Specialist Neonatal and Paediatric Surgery UnitGreat Ormond Street HospitalLondonUK
| | - Ania Zylbersztejn
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Paolo De Coppi
- Stem Cell and Regenerative MedicineUCL Great Ormond Street Institute of Child HealthLondonUK
- Specialist Neonatal and Paediatric Surgery UnitGreat Ormond Street HospitalLondonUK
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Ruan Y, Xie Z, Liu X, He Y. Associated factors for prenatally diagnosed fetal congenital heart diseases. BMC Cardiovasc Disord 2023; 23:52. [PMID: 36707754 PMCID: PMC9883969 DOI: 10.1186/s12872-022-02981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 11/28/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Current studies have suggested that fetal congenital heart diseases (CHDs) are caused by various factors. However, few data in this field is available in China. This study aimed to detect associated factors of prenatally diagnosed fetal CHD in a large sample in China. STUDY DESIGN Pregnant women who underwent fetal echocardiography were recruited in our hospital between May 2018 and September 2019. The maternal sociodemographic and lifestyle characteristics and some fetal factors were obtained. We used forward stepwise logistic regression analysis to assess risk of fetal CHD associated with various factors. RESULTS A total of 5024 subjects were enrolled, of whom 875 had CHD fetuses. Among the fetal CHD group (N = 875), critical CHDs account for 27%, of which Tetralogy of Fallot is the most (7.1%), followed by coarctation of aorta (4.0%), double-outlet right ventricle (2.9%). The forward stepwise logistic regression models revealed that history of spontaneous abortion (OR = 1.59, 95% CI 1.33-1.91, P = 0.000), upper respiratory tract infection during early pregnancy (OR = 1.30, 95% CI 1.04-1.62, P = 0.020), mental stress during early pregnancy (OR = 2.37, 95% CI 1.15-4.91, P = 0.020), single umbilical artery (OR = 2.30, 95% CI 1.18-4.51, P = 0.015), and paternal smoking (OR = 1.21, 95% CI 1.02-1.44, P = 0.027) are positively associated with an increased risk of fetal CHD. CONCLUSION We identified several factors positively associated with fetal CHD. These findings suggest that it is important to strengthen healthcare and prenatal counseling for women with these factors.
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Affiliation(s)
- Yanping Ruan
- grid.24696.3f0000 0004 0369 153XEchocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China ,grid.24696.3f0000 0004 0369 153XMaternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
| | - Zan Xie
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai City, 264000 China
| | - Xiaowei Liu
- grid.24696.3f0000 0004 0369 153XEchocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China ,grid.24696.3f0000 0004 0369 153XMaternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
| | - Yihua He
- grid.24696.3f0000 0004 0369 153XEchocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, China ,grid.24696.3f0000 0004 0369 153XMaternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029 China
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46
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Cicozi K, Smith SM, Grossoehme DH, Hiltunen A, Roth C, Richner G, Kim SS, Friebert S. Pediatric Home-Based Hospice and Palliative Medicine Provider Home Visits: A Multisite Study. J Palliat Med 2023. [PMID: 36695724 DOI: 10.1089/jpm.2022.0480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Pediatric home-based palliative care and/or hospice provider (Physician, Advanced Practice Nurse, or Physician Assistant) home visits are an underexplored subject in the literature with little available descriptive data and limited evidence guiding how best to utilize them. Objectives: Describe the population receiving hospice and palliative medicine (HPM) provider home visits and characterize visit themes. Design: Retrospective chart review of electronic medical record (EMR) data Setting/Subjects: A total of 226 individuals 1 month to 21 years of age, who received an HPM provider home visit from January 1, 2013, to December 31, 2018; two large quaternary medical centers in the Midwest. Measurements: Demographic data, content, and details from home visit abstracted from the EMR. Results: The three most common diagnostic groups receiving HPM provider home visits were neurological (42%), congenital chromosomal (26%), and prematurity-related (14%) conditions. Goals of care (GOC) were discussed at 29% of visits; most commonly, goals related to code status (42%), technology dependence (20%), and nutrition/hydration (15%). A change in GOC occurred in 44% of visits. Forms of anticipatory guidance addressed were nutrition (68%), side effects of treatment (63%), pain assessment (59%), decline/death (32%), and allow natural death/do not resuscitate/advance directives (26%). Conclusion: HPM provider visits are diverse in content and changes in plan of care with potential for proactive identification of GOC and provision of important anticipatory guidance around patient decline and end of life. Further research is indicated to establish which populations benefit most and how to leverage this scarce resource strategically.
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Affiliation(s)
- Kate Cicozi
- Department of Anesthesia, Section of Hospice and Palliative Care, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Steven M Smith
- Department of Anesthesia, Section of Hospice and Palliative Care, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Daniel H Grossoehme
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA.,Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
| | - Audrey Hiltunen
- Department of Anesthesia, Section of Hospice and Palliative Care, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Catherine Roth
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Gwendolyn Richner
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
| | - Stephani S Kim
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Sarah Friebert
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA.,Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, Ohio, USA
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47
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Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118:3272-3287. [PMID: 35150240 DOI: 10.1093/cvr/cvac013] [Citation(s) in RCA: 701] [Impact Index Per Article: 701.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/08/2022] [Indexed: 01/25/2023] Open
Abstract
Heart Failure (HF) is a multi-faceted and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. HF affects more than 64 million people worldwide. Therefore, attempts to decrease its social and economic burden have become a major global public health priority. While the incidence of HF has stabilized and seems to be declining in industrialized countries, the prevalence is increasing due to the ageing of the population, improved treatment of and survival with ischaemic heart disease, and the availability of effective evidence-based therapies prolonging life in patients with HF. There are geographical variations in HF epidemiology. There is substantial lack of data from developing countries, where HF exhibits different features compared with that observed in the Western world. In this review, we provide a contemporary overview on the global burden of HF, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Moritz Becher
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe M C Rosano
- St George's Hospital Medical School, London, UK.,IRCCS San Raffaele Roma, Rome, Italy
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48
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McCallum Z, Delany C, Gillam L. Crossing the line? Ethics of parenteral nutrition in paediatric neurodisability complicated by intestinal failure. Arch Dis Child 2023; 108:11-14. [PMID: 35288420 DOI: 10.1136/archdischild-2021-323500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
Children with severe neurological impairment (such as cerebral palsy or congenital anomalies) are living longer, although medically complex, lives. Feeding intolerance is an increasing problem that is emerging as a new end-of-life issue. Long-term parenteral nutrition (LTPN) is technically feasible in these children. However, clinicians are concerned about whether it is appropriate in these circumstances or whether it constitutes a treatment 'too far'. This narrative review of the literature identifies, categorises and explores the ethical foundations and reasons for clinician hesitancy about the use of LTPN in this population. The categories of reasons are: lack of clear diagnostic criteria for feeding failure; risks of LTPN to the child; burden of LTPN to the family/caregivers; burden of LTPN to the child; difficulty in cessation of LTPN; and the concept that feeding failure may be a preterminal sign. These reasons are all ultimately about risks and burden outweighing the benefits. We argue that the risks of LTPN have decreased over time, the burden for individual children and their parents may be less than imagined, and the benefit is a realistic prospect. Case-by-case consideration, giving due weight to child and parental perspectives, can show that LTPN is ethically justified for some children with severe neurological impairment.
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Affiliation(s)
- Zoe McCallum
- The Department of Neurodevelopment and Disability, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Clare Delany
- Children's Bioethics Centre, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Lynn Gillam
- Children's Bioethics Centre, The Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia
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49
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Szymanski KM, Adams CM, Alkawaldeh MY, Austin PF, Bowman RM, Castillo H, Castillo J, Chu DI, Estrada CR, Fascelli M, Frimberger DC, Gargollo PC, Hamdan DG, Hecht SL, Hopson B, Husmann DA, Jacobs MA, MacNeily AE, McLeod DJ, Metcalfe PD, Meyer T, Misseri R, O'Neil J, Rensing AJ, Routh JC, Rove KO, Sawin KJ, Schlomer BJ, Shamblin I, Sherlock RL, Slobodov G, Stout J, Tanaka ST, Weiss DA, Wiener JS, Wood HM, Yerkes EB, Blount J. Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study. J Pediatr Rehabil Med 2023; 16:605-619. [PMID: 38073338 PMCID: PMC10789326 DOI: 10.3233/prm-220086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/31/2023] [Indexed: 01/01/2024] Open
Abstract
PURPOSE This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD. METHODS A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics. RESULTS Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%). For 261 shunted individuals, leading COD were neurological (21%) and pulmonary (17%), and leading MOD were infections (34%, including shunt infections: 4%) and non-infectious shunt malfunctions (14%). For 32 unshunted individuals, leading COD were pulmonary (34%) and cardiovascular (13%), and leading MOD were infections (38%) and non-infectious pulmonary (16%). COD and MOD varied by shunt status and age (p < = 0.04), not ambulation or birthyear (p > = 0.16). Urology-related deaths (urosepsis, renal failure, hematuria, bladder perforation/cancer: 10%) were more likely in females (p = 0.01), independent of age, shunt, or ambulatory status (p > = 0.40). COD/MOD were independent of bladder augmentation (p = >0.11). Unexplained deaths while asleep (4%) were independent of age, shunt status, and epilepsy (p >= 0.47). CONCLUSION COD varied by shunt status. Leading MOD were infectious. Urology-related deaths (10%) were independent of shunt status; 26% of COD were unknown. Life-long multidisciplinary care and accurate mortality documentation are needed.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Cyrus M Adams
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Paul F Austin
- Division of Urology, Texas Children's Hospital, Houston, TX, USA
| | - Robin M Bowman
- Division of Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Heidi Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Jonathan Castillo
- Section of Developmental Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - Michele Fascelli
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Dominic C Frimberger
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Dawud G Hamdan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah L Hecht
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Betsy Hopson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Micah A Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew E MacNeily
- Division of Pediatric Urology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Daryl J McLeod
- Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Joseph O'Neil
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Adam J Rensing
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | | | - Kyle O Rove
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kathleen J Sawin
- Department of Nursing Research and Evidence-Based Practice, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Bruce J Schlomer
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Isaac Shamblin
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gennady Slobodov
- Department of Urology, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Jennifer Stout
- Surgery Office of Clinical Research, Duke University, Durham, NC, USA
| | - Stacy T Tanaka
- Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University, Durham, NC, USA
| | - Hadley M Wood
- Department of Urology, Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeffrey Blount
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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50
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Li M, Cai Y, Pang S, Yan B. Molecular Genetic Study on HAND2 Gene Promoter in Ventricular Septal Defect. Int Heart J 2023; 64:1140-1147. [PMID: 38030295 DOI: 10.1536/ihj.22-721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Ventricular septal defect (VSD), the most common type of congenital heart disease (CHD), is primarily caused by cardiac dysplasia. Heart and neural crest derivatives expressed 2 (HAND2) participates in developing the right heart. The loss of HAND2 expression in humans is closely connected with ventricular septal defects. We used a case-control study to analyze the genetic variations in the HAND2 promoter region in VSD patients and controls. Some statistical analysis methods were used to analyze the association of single nucleotide polymorphisms (SNPs) with VSD. The dual-luciferase reporter assay and electrophoretic mobility shift assay (EMSA) were used to conduct functional analysis and molecular mechanism study of genetic variations. Through sequencing, we identified nine genetic variants in patients with VSD. The SNP rs2276940 G>T and rs2276941 G>A were associated with an increased risk of VSD. The dual-luciferase reporter assay showed that SNP rs2276940 G>T and rs138531627 C>G decreased the transcriptional activity of the HAND2 promoter. Transcription factors (TFs) predicting suggested that all three SNPs may change the binding of TFs. The result of EMSA showed that rs138531627 C>G may create a new binding site for TFs while rs2276940 G>T enhanced the binding affinity for TFs. These results indicated that genetic variants of the HAND2 promoter may increase the risk of VSD, and the molecular mechanism may be the change of the binding affinity of TFs.
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Affiliation(s)
- Meikun Li
- Cheeloo College of Medicine, Shandong University
| | - Yahui Cai
- Institute of Precision Medicine, Jining Medical University
- College of Basic Medicine, Jining Medical University
| | - Shuchao Pang
- Shandong Provincial Sino-US Cooperation Research Center for Translational Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University
| | - Bo Yan
- Institute of Precision Medicine, Jining Medical University
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