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Rustogi D, Yusuf K. Use of Albumin in the NICU: An Evidence-based Review. Neoreviews 2022; 23:e625-e634. [PMID: 36047753 DOI: 10.1542/neo.23-9-e625] [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: 06/15/2023]
Abstract
Albumin is the most abundant protein in human blood with distinctive functions throughout the human body. Low albumin levels are a predictor of mortality as well as disease outcome in children and adults. However, the clinical significance of hypoalbuminemia and the role of albumin infusions in NICUs remain unclear and controversial.
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Affiliation(s)
- Deepika Rustogi
- Department of Neonatology & Pediatrics, Yashoda Superspeciality Hospital, Kaushambi, Ghaziabad, UP, India
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kamran Yusuf
- Section of Neonatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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van Leeuwen B, Smeets P, Bovet J, Nave G, Stieglitz J, Whitehouse A. Do sex hormones at birth predict later-life economic preferences? Evidence from a pregnancy birth cohort study. Proc Biol Sci 2020; 287:20201756. [PMID: 33352071 PMCID: PMC7779492 DOI: 10.1098/rspb.2020.1756] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/27/2020] [Indexed: 12/12/2022] Open
Abstract
Economic preferences may be shaped by exposure to sex hormones around birth. Prior studies of economic preferences and numerous other phenotypic characteristics use digit ratios (2D : 4D), a purported proxy for prenatal testosterone exposure, whose validity has recently been questioned. We use direct measures of neonatal sex hormones (testosterone and oestrogen), measured from umbilical cord blood (n = 200) to investigate their association with later-life economic preferences (risk preferences, competitiveness, time preferences and social preferences) in an Australian cohort (Raine Study Gen2). We find no significant associations between testosterone at birth and preferences, except for competitiveness, where the effect runs opposite to the expected direction. Point estimates are between 0.05-0.09 percentage points (pp) and 0.003-0.14 s.d. We similarly find no significant associations between 2D : 4D and preferences (n = 533, point estimates 0.003-0.02 pp and 0.001-0.06 s.d.). Our sample size allows detecting effects larger than 0.11 pp or 0.22 s.d. for testosterone at birth, and 0.07 pp or 0.14 s.d. for 2D : 4D (α = 0.05 and power = 0.90). Equivalence tests show that most effects are unlikely to be larger than these bounds. Our results suggest a reinterpretation of prior findings relating 2D : 4D to economic preferences, and highlight the importance of future large-sample studies that permit detection of small effects.
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Affiliation(s)
- Boris van Leeuwen
- Department of Economics, Tilburg University, Tilburg, The Netherlands
| | - Paul Smeets
- Department of Finance, Maastricht University, Maastricht, The Netherlands
| | - Jeanne Bovet
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Gideon Nave
- Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Stieglitz
- Institute for Advanced Study in Toulouse, University of Toulouse 1 Capitole, Toulouse, France
| | - Andrew Whitehouse
- Telethon Kids Institute, University of Western Australia, Crawley, Western Australia, Australia
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3
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Low serum albumin concentration predicts the need for surgical intervention in neonates with necrotizing enterocolitis. J Pediatr Surg 2020; 55:2625-2629. [PMID: 32771214 DOI: 10.1016/j.jpedsurg.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/22/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate whether serum albumin (SA) concentration can predict the need for surgical intervention in neonates with necrotizing enterocolitis (NEC). METHODS Retrospective review of all cases with NEC Bell's stage 2 and 3 that were treated in a single center between 2009 and 2015. Data on patient demographics, clinical parameters, laboratory findings and surgical status were recorded. Receiver operating characteristics analysis was used to evaluate optimal cutoffs and predictive values. RESULTS Overall, 151 neonates with NEC were identified. Of these, 132 (87.4%) had confirmed NEC Bell's stage 2. The median gestational age was 28.4 (range, 23.1-39.0) weeks and 69 (52.3%) had a birth weight of ≤1000 g. Sixty-eight (51.5%) underwent surgery, showing a sustained reduction in SA over time with significantly lower median SA levels compared to 64 (48.5%) cases that responded well to medical treatment (18.3 ± 3.7 g/L vs. 26.0 ± 2.0 g/L; P < 0.001). SA concentration of ≤20 g/L on day 2 of NEC diagnosis was a significant predictor for surgery (OR 3.41; P = 0.019) with a positive predictive value of 71.4%. CONCLUSIONS An SA concentration of ≤20 g/L on day 2 of the NEC disease process is associated with a higher likelihood for surgical intervention in neonates with NEC Bell's stage 2. SA, in combination with other clinical parameters and serological markers, may be a useful predictive tool for surgery in NEC. LEVEL OF EVIDENCE II.
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Bolisetty S, Osborn D, Schindler T, Sinn J, Deshpande G, Wong CS, Jacobs SE, Phad N, Pharande P, Tobiansky R, Luig M, Trivedi A, Mcintosh J, Josza E, Opie G, Downe L, Andersen C, Bhatia V, Kumar P, Malinen K, Birch P, Simmer K, McLeod G, Quader S, Rajadurai VS, Hewson MP, Nair A, Williams M, Xiao J, Ravindranathan H, Broadbent R, Lui K. Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017. BMC Pediatr 2020; 20:59. [PMID: 32035481 PMCID: PMC7007668 DOI: 10.1186/s12887-020-1958-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. METHODS A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. RESULTS Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. CONCLUSIONS The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.
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Affiliation(s)
- Srinivas Bolisetty
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
- Conjoint Lecturer, University of New South Wales, Sydney, Australia
| | - David Osborn
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Tim Schindler
- Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - John Sinn
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | | | | | - Susan E. Jacobs
- Deputy Clinical Director and Neonatal Paediatrician, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Nilkant Phad
- John Hunter Children’s Hospital, Newcastle, Australia
| | | | | | | | - Amit Trivedi
- The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Eszter Josza
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
| | - Gillian Opie
- Head and Neonatal Paediatrician, Mercy Hospital for Women, Heidelberg, Victoria Australia
| | | | - Chad Andersen
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | - Vineesh Bhatia
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | | | - Katri Malinen
- PGCert Clinical Education, PGDip Child Health (associate), Advanced Pharmacist, Townsville Hospital, Townsville, Australia
| | - Pita Birch
- Gold Coast University Hospital, Southport, Australia
| | - Karen Simmer
- King Edward Memorial Hospital for Women, Subiaco, Australia
| | - Gemma McLeod
- King Edward Memorial and Princess Margaret Hospitals, Subiaco, Australia
| | - Suzanne Quader
- The Sydney Children’s Hospital Network, Sydney, Australia
| | | | | | - Arun Nair
- Waikato Hospital, Hamilton, New Zealand
| | | | | | | | | | - Kei Lui
- University of New South Wales, Sydney, Australia
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Allegaert K, van den Anker J. Neonates are not just little children and need more finesse in dosing of antibiotics. Acta Clin Belg 2019; 74:157-163. [PMID: 29745792 DOI: 10.1080/17843286.2018.1473094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Neonates are not just little children. They need more finesse in decisions on when to treat, which antibiotics to use and how to dose these antibiotics. METHODS Representative compounds of three major classes of antibiotics (beta-lactams, aminoglycosides, glycopeptides) are discussed in a narrative review to illustrate the recent progress in the knowledge on PK and its covariates (how to dose). RESULTS This knowledge can subsequently be converted to targeted exposure dosing regimens. This is because it is reasonable to postulate that pharmacodynamics (PD) of antibiotics are similar in neonates to that in other populations if a similar concentration-time profile and targeted exposure are attained. However, this approach has its limitations, since the clinical response may be different in neonates because of maturational differences in innate immunity or toxicity. These dosing regimens should at least be validated. CONCLUSION Relevant information on the PK of antibiotics and its covariates have been generated, but the next steps are to validate the dosing regimens suggested, and consider more sophisticated dosing regimens. This approach should subsequently pave the way to conduct comparative studies to assess the efficacy and safety of these commonly used drugs in neonates.
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Affiliation(s)
- Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Neonatology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Development and Regeneration, KU, Leuven, Belgium
| | - John van den Anker
- Intensive Care and Department of Pediatric Surgery, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Paediatric Pharmacology and Pharmacometrics, University of Basel Children’s Hospital, Basel, Switzerland
- Division of Clinical Pharmacology, Children’s National Health System, Washington, DC, USA
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Osborn DA, Schindler T, Jones LJ, Sinn JKH, Bolisetty S. Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Cochrane Database Syst Rev 2018; 3:CD005949. [PMID: 29505664 PMCID: PMC6494253 DOI: 10.1002/14651858.cd005949.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sick newborn and preterm infants frequently are not able to be fed enterally, necessitating parenteral fluid and nutrition. Potential benefits of higher parenteral amino acid (AA) intake for improved nitrogen balance, growth, and infant health may be outweighed by the infant's ability to utilise high intake of parenteral AA, especially in the days after birth. OBJECTIVES The primary objective is to determine whether higher versus lower intake of parenteral AA is associated with improved growth and disability-free survival in newborn infants receiving parenteral nutrition.Secondary objectives include determining whether:• higher versus lower starting or initial intake of amino acids is associated with improved growth and disability-free survival without side effects;• higher versus lower intake of amino acids at maximal intake is associated with improved growth and disability-free survival without side effects; and• increased amino acid intake should replace non-protein energy intake (glucose and lipid), should be added to non-protein energy intake, or should be provided simultaneously with non-protein energy intake.We conducted subgroup analyses to look for any differences in the effects of higher versus lower intake of amino acids according to gestational age, birth weight, age at commencement, and condition of the infant, or concomitant increases in fluid intake. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (2 June 2017), MEDLINE (1966 to 2 June 2017), Embase (1980 to 2 June 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 June 2017). We also searched clinical trials databases, conference proceedings, and citations of articles. SELECTION CRITERIA Randomised controlled trials of higher versus lower intake of AAs as parenteral nutrition in newborn infants. Comparisons of higher intake at commencement, at maximal intake, and at both commencement and maximal intake were performed. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed trial quality, and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs) and assessed the quality of evidence using the GRADE approach. MAIN RESULTS Thirty-two studies were eligible for inclusion. Six were short-term biochemical tolerance studies, one was in infants at > 35 weeks' gestation, one in term surgical newborns, and three yielding no usable data. The 21 remaining studies reported clinical outcomes in very preterm or low birth weight infants for inclusion in meta-analysis for this review.Higher AA intake had no effect on mortality before hospital discharge (typical RR 0.90, 95% CI 0.69 to 1.17; participants = 1407; studies = 14; I2 = 0%; quality of evidence: low). Evidence was insufficient to show an effect on neurodevelopment and suggest no reported benefit (quality of evidence: very low). Higher AA intake was associated with a reduction in postnatal growth failure (< 10th centile) at discharge (typical RR 0.74, 95% CI 0.56 to 0.97; participants = 203; studies = 3; I2 = 22%; typical RD -0.15, 95% CI -0.27 to -0.02; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 4 to 50; quality of evidence: very low). Subgroup analyses found reduced postnatal growth failure in infants that commenced on high amino acid intake (> 2 to ≤ 3 g/kg/day); that occurred with increased amino acid and non-protein caloric intake; that commenced on intake at < 24 hours' age; and that occurred with early lipid infusion.Higher AA intake was associated with a reduction in days needed to regain birth weight (MD -1.14, 95% CI -1.73 to -0.56; participants = 950; studies = 13; I2 = 77%). Data show varying effects on growth parameters and no consistent effects on anthropometric z-scores at any time point, as well as increased growth in head circumference at discharge (MD 0.09 cm/week, 95% CI 0.06 to 0.13; participants = 315; studies = 4; I2 = 90%; quality of evidence: very low).Higher AA intake was not associated with effects on days to full enteral feeds, late-onset sepsis, necrotising enterocolitis, chronic lung disease, any or severe intraventricular haemorrhage, or periventricular leukomalacia. Data show a reduction in retinopathy of prematurity (typical RR 0.44, 95% CI 0.21 to 0.93; participants = 269; studies = 4; I2 = 31%; quality of evidence: very low) but no difference in severe retinopathy of prematurity.Higher AA intake was associated with an increase in positive protein balance and nitrogen balance. Potential biochemical intolerances were reported, including risk of abnormal blood urea nitrogen (typical RR 2.77, 95% CI 2.13 to 3.61; participants = 688; studies = 7; I2 = 6%; typical RD 0.26, 95% CI 0.20 to 0.32; number needed to treat for an additional harmful outcome (NNTH) 4; 95% CI 3 to 5; quality of evidence: high). Higher amino acid intake in parenteral nutrition was associated with a reduction in hyperglycaemia (> 8.3 mmol/L) (typical RR 0.69, 95% CI 0.49 to 0.96; participants = 505; studies = 5; I2 = 68%), although the incidence of hyperglycaemia treated with insulin was not different. AUTHORS' CONCLUSIONS Low-quality evidence suggests that higher AA intake in parenteral nutrition does not affect mortality. Very low-quality evidence suggests that higher AA intake reduces the incidence of postnatal growth failure. Evidence was insufficient to show an effect on neurodevelopment. Very low-quality evidence suggests that higher AA intake reduces retinopathy of prematurity but not severe retinopathy of prematurity. Higher AA intake was associated with potentially adverse biochemical effects resulting from excess amino acid load, including azotaemia. Adequately powered trials in very preterm infants are required to determine the optimal intake of AA and effects of caloric balance in parenteral nutrition on the brain and on neurodevelopment.
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Affiliation(s)
- David A Osborn
- University of SydneyCentral Clinical School, Discipline of Obstetrics, Gynaecology and NeonatologySydneyNSWAustralia2050
| | - Tim Schindler
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
| | - Lisa J Jones
- University of SydneyCentral Clinical School, Discipline of Obstetrics, Gynaecology and NeonatologyCamperdownNSWAustralia
| | - John KH Sinn
- Royal North Shore Hospital, The University of SydneyDepartment of NeonatologySt. Leonard'sSydneyNew South WalesAustralia2065
| | - Srinivas Bolisetty
- Royal Hospital for WomenNewborn CareBarker StreetRandwickNSWAustralia2031
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Prevalence of Hypoalbuminemia and Elevated Bilirubin/Albumin Ratios in a Large Cohort of Infants in the Neonatal Intensive Care Unit. J Pediatr 2017; 188:280-286.e4. [PMID: 28669611 DOI: 10.1016/j.jpeds.2017.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/28/2017] [Accepted: 06/01/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To provide descriptive data on serum albumin levels and the bilirubin to albumin (B/A) ratio in neonates admitted to the neonatal intensive care unit, assess the effect of gestational and chronological age on serum albumin and the B/A ratio, and evaluate the association between extreme values and mortality. STUDY DESIGN Using a retrospective cohort design, we queried the Pediatrix clinical data warehouse for all infants born between 23 and 41 weeks of gestation from 1997 to 2014 who had a report of both a serum albumin and total serum bilirubin (TSB) level on the same day between birth and 14 days of life. RESULTS There were 382 190 paired albumin and bilirubin levels across 164 401 neonates (15% of the 1 072 682 infants in the clinical data warehouse). Both gestational age and postnatal age were independent factors that influenced the values for serum albumin, TSB, and B/A ratio (ANOVA; P < .0001). TSB and B/A ratios values above birth weight-specific thresholds for exchange transfusions were uncommon (<6% of infants). Hypoalbuminemia (<2.5 mg/dL) was common (29% of infants). Neonates with serum albumin levels <2.5 g/dL or with B/A ratio levels exceeding exchange thresholds were at higher risk of death compared with infants who did not exceed these levels. This association was independent of other risk factors (estimated gestational age, birth weight, sex, and the presence of a major anomaly). CONCLUSION Both gestational age and postnatal age influence TSB, albumin, and B/A ratios; hypoalbuminemia and extreme B/A ratios are associated with an increased risk of death.
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Jamnadass ESL, Keelan JA, Russell-Smith SN, Hickey M, Maybery MT, Whitehouse AJO. Umbilical cord androgens and estrogens in relation to verbal and nonverbal abilities at age 10 in the general population. PLoS One 2017; 12:e0173493. [PMID: 28278304 PMCID: PMC5344490 DOI: 10.1371/journal.pone.0173493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/21/2017] [Indexed: 11/18/2022] Open
Abstract
Sex differences in verbal and nonverbal abilities are a contentious area of research. Prenatal steroids have been shown to have masculinizing effects on the brain that may affect the development of nonverbal and verbal abilities in later life. The current study examined a wide range of biologically active sex steroids (both androgens and estrogens) in umbilical cord blood at birth in a large pregnancy cohort in relation to performance on nonverbal (Raven's Coloured Progressive Matrices) and verbal (Clinical Evaluation of Language Fundamentals-3 and the Peabody Picture Vocabulary Test-III) measures at age 10 years. Overall, Androgen and Estrogen composites in cord blood were not found to be predictive of performance on verbal and nonverbal measures at age 10. These data suggest that late gestation sex steroids do not exert a major effect on nonverbal and verbal abilities in middle childhood.
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Affiliation(s)
- Esha S. L. Jamnadass
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Jeffrey A. Keelan
- School of Women’s and Infant’s Health, University of Western Australia, Perth, Western Australia, Australia
| | | | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Melbourne, Victoria, Australia
| | - Murray T. Maybery
- School of Psychology, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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9
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Buzanovskii VA. Determination of proteins in blood. Part 1: Determination of total protein and albumin. ACTA ACUST UNITED AC 2017. [DOI: 10.1134/s2079978017010010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Whitehouse AJO, Gilani SZ, Shafait F, Mian A, Tan DW, Maybery MT, Keelan JA, Hart R, Handelsman DJ, Goonawardene M, Eastwood P. Prenatal testosterone exposure is related to sexually dimorphic facial morphology in adulthood. Proc Biol Sci 2016; 282:20151351. [PMID: 26400740 DOI: 10.1098/rspb.2015.1351] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Prenatal testosterone may have a powerful masculinizing effect on postnatal physical characteristics. However, no study has directly tested this hypothesis. Here, we report a 20-year follow-up study that measured testosterone concentrations from the umbilical cord blood of 97 male and 86 female newborns, and procured three-dimensional facial images on these participants in adulthood (range: 21-24 years). Twenty-three Euclidean and geodesic distances were measured from the facial images and an algorithm identified a set of six distances that most effectively distinguished adult males from females. From these distances, a 'gender score' was calculated for each face, indicating the degree of masculinity or femininity. Higher cord testosterone levels were associated with masculinized facial features when males and females were analysed together (n = 183; r = -0.59), as well as when males (n = 86; r = -0.55) and females (n = 97; r = -0.48) were examined separately (p-values < 0.001). The relationships remained significant and substantial after adjusting for potentially confounding variables. Adult circulating testosterone concentrations were available for males but showed no statistically significant relationship with gendered facial morphology (n = 85, r = 0.01, p = 0.93). This study provides the first direct evidence of a link between prenatal testosterone exposure and human facial structure.
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Affiliation(s)
- Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, Australia
| | - Syed Zulqarnain Gilani
- School of Computer Science and Software Engineering, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Faisal Shafait
- School of Computer Science and Software Engineering, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia School of Electrical Engineering and Computer Science, National University of Science and Technology, Islamabad, Pakistan
| | - Ajmal Mian
- School of Computer Science and Software Engineering, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Diana Weiting Tan
- Telethon Kids Institute, University of Western Australia, 100 Roberts Road, Subiaco, Perth, Western Australia 6008, Australia Neurocognitive Development Unit, School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Murray T Maybery
- Neurocognitive Development Unit, School of Psychology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Jeffrey A Keelan
- School of Women's and Infants' Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Roger Hart
- School of Women's and Infants' Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, New South Wales 2139, Australia
| | - Mithran Goonawardene
- School of Dentistry/Oral Health Centre of Western Australia, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
| | - Peter Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western Australia 6009, Australia
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Torer B, Hanta D, Yapakci E, Gokmen Z, Parlakgumus A, Gulcan H, Tarcan A. Association of Serum Albumin Level and Mortality in Premature Infants. J Clin Lab Anal 2016; 30:867-872. [PMID: 27074970 DOI: 10.1002/jcla.21949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/10/2015] [Accepted: 01/11/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Hypoalbuminemia has been proven to be a powerful predictor of mortality in adult patients. However, prognostic value of serum albumin in neonates is not clear. OBJECTIVE To assess the relationship between serum albumin level within the first day of life and outcome in preterm infants born before 32 weeks of gestation. METHODS The study was conducted prospectively in Baskent University Hospital between October 2008 and November 2009. Patients were divided by gestational age into two groups as below or of 28 weeks and above 28 weeks. Then serum albumin percentile groups were established within each gestational age group and were defined as <25, 25-75, and >75 percentile groups by combining percentile groups between the two gestational age groups. Three serum albumin percentile groups were compared regarding neonatal outcomes. RESULTS A total of 199 infants with mean birth weight of 1,272 ± 390 g and mean gestational age of 29.2 ± 2.2 weeks were admitted to the study. The mean serum albumin level was 30.6 ± 4.7 g/l for all patients. The mean serum albumin levels were 25.5 ± 3.8, 30.1 ± 2.7, and 35.3 ± 3.7 g/l for <25, 25-75, and >75 percentile groups, respectively. Prevalence of infants with respiratory distress syndrome and prevalence of infants with sepsis and mortality were significantly higher in <25 percentile group. Logistic regression analysis showed that serum albumin <25 percentile and birth weight were independent predictive variables of mortality. Albumin concentrations lower than 27.2 g/l was associated with mortality, with a sensitivity of 71% and a specificity of 86%. CONCLUSION Low serum albumin level within the first day of life is an independent predictor of mortality in preterm infants.
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Affiliation(s)
- Birgin Torer
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey.
| | - Deniz Hanta
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ece Yapakci
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Zeynel Gokmen
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Ayse Parlakgumus
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana, Turkey
| | - Hande Gulcan
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey
| | - Aylin Tarcan
- Department of Neonatology, Baskent University Faculty of Medicine, Adana, Turkey
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Jamnadass ESL, Keelan JA, Hollier LP, Hickey M, Maybery MT, Whitehouse AJO. The perinatal androgen to estrogen ratio and autistic-like traits in the general population: a longitudinal pregnancy cohort study. J Neurodev Disord 2015; 7:17. [PMID: 26085846 PMCID: PMC4470005 DOI: 10.1186/s11689-015-9114-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prenatal androgen exposure has been hypothesized to be linked to autism spectrum disorder (ASD). While previous studies have found a link between testosterone levels in amniotic fluid and autistic-like traits, a similar relationship has not been found for testosterone in umbilical cord blood. However, it may be the net biological activity of multiple androgens and estrogens that influences postnatal effects of prenatal sex steroids. Accordingly, composite levels of androgens (A) and estrogens (E) were investigated, along with their ratio, in relation to autistic-like traits in young adulthood. METHODS Sex steroid data in umbilical cord blood were available from 860 individuals at delivery. Samples were analyzed for androgens (testosterone, androstenedione, and dehydroepiandrosterone) and estrogens (estrone, estradiol, estriol, and estetrol). Levels of bioavailable testosterone, estradiol, and estrone were measured and used to calculate A and E composites and the A to E ratio. Participants were approached in early adulthood to complete the autism-spectrum quotient (AQ) as a self-report measure of autistic-like traits, with 183 males (M = 20.10 years, SD = 0.65 years) and 189 females (M =19.92 years, SD = 0.68 years) providing data. RESULTS Males exhibited significantly higher androgen composites and A to E composite ratios than females. Males also scored significantly higher on the details/patterns subscale of the AQ. Subsequent categorical and continuous analyses, which accounted for covariates, revealed no substantial relationships between the A/E composites or the A to E ratio and the AQ total or subscale scores. CONCLUSIONS The current study found no link between the A/E composites or the A to E ratio in cord blood and autistic-like traits in the population as measured by the AQ. These outcomes do not exclude the possibility that these sex steroid variables may predict other neurodevelopmental traits in early development.
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Affiliation(s)
- Esha S. L. Jamnadass
- />School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
- />Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
| | - Jeffrey A. Keelan
- />School of Women’s and Infant’s Health, University of Western Australia, Perth, Australia
| | - Lauren P. Hollier
- />Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia 6102 Australia
| | - Martha Hickey
- />Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women’s Hospital, Victoria, Australia
| | - Murray T. Maybery
- />School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009 Australia
| | - Andrew J. O. Whitehouse
- />Telethon Kids Institute, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008 Australia
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Guthe HJT, Indrebø M, Nedrebø T, Norgård G, Wiig H, Berg A. Interstitial fluid colloid osmotic pressure in healthy children. PLoS One 2015; 10:e0122779. [PMID: 25853713 PMCID: PMC4390290 DOI: 10.1371/journal.pone.0122779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 02/07/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The colloid osmotic pressure (COP) of plasma and interstitial fluid play important roles in transvascular fluid exchange. COP values for monitoring fluid balance in healthy and sick children have not been established. This study set out to determine reference values of COP in healthy children. Materials and Methods COP in plasma and interstitial fluid harvested from nylon wicks was measured in 99 healthy children from 2 to 10 years of age. Nylon wicks were implanted subcutaneously in arm and leg while patients were sedated and intubated during a minor surgical procedure. COP was analyzed in a colloid osmometer designed for small fluid samples. Results The mean plasma COP in all children was 25.6 ± 3.3 mmHg. Arbitrary division of children in four different age groups, showed no significant difference in plasma or interstitial fluid COP values for patients less than 8 years, whereas patients of 8-10 years had significant higher COP both in plasma and interstitial fluid. There were no gender difference or correlation between COP in interstitial fluid sampled from arm and leg and no significant effect on interstitial COP of gravity. Prolonged implantation time did not affect interstitial COP. Conclusion Plasma and interstitial COP in healthy children are comparable to adults and COP seems to increase with age in children. Knowledge of the interaction between colloid osmotic forces can be helpful in diseases associated with fluid imbalance and may be crucial in deciding different fluid treatment options. Trial Registration ClinicalTrials.gov NCT01044641
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Affiliation(s)
- Hans Jørgen Timm Guthe
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- * E-mail:
| | - Marianne Indrebø
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Nedrebø
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Hyperbaric Medical Unit, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Norgård
- Department of Clinical Medicine, Faculty of Medicine, Section for Pediatric heart-, lung- and allergic diseases, University of Oslo, Oslo, Norway
| | - Helge Wiig
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Ansgar Berg
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Hollier LP, Keelan JA, Jamnadass ESL, Maybery MT, Hickey M, Whitehouse AJO. Adult digit ratio (2D:4D) is not related to umbilical cord androgen or estrogen concentrations, their ratios or net bioactivity. Early Hum Dev 2015; 91:111-7. [PMID: 25594498 DOI: 10.1016/j.earlhumdev.2014.12.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/17/2014] [Accepted: 12/28/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ratio of second digit length to fourth digit length (2D:4D) has been extensively used in human and experimental research as a marker of fetal sex steroid exposure. However, very few human studies have measured the direct relationship between fetal androgen or estrogen concentrations and digit ratio. AIMS We investigated the relationships between both androgen and estrogen concentrations in umbilical cord blood and digit ratio in young adulthood. In addition we calculated measures of total serum androgen and total estrogen bioactivity and investigated their relationship to digit ratio. STUDY DESIGN Prospective cohort study. SUBJECTS An unselected subset of the Western Australian Pregnancy Cohort (Raine) Study (159 female; 182 male). OUTCOME MEASURES Cord serum samples were collected immediately after delivery. Samples were assayed for androgen (testosterone, Δ4-androstenedione, dehydroepiandrosterone) and estrogen (estrone, estradiol, estriol, estetrol) concentrations using liquid-chromatography mass-spectrometry. Digit ratio measurements were taken from hand photocopies at age 19-22years. RESULTS For both males and females, there were no significant correlations between digit ratio and any androgen or estrogen concentrations considered individually, the testosterone to estradiol ratio, total androgen bioactivity measure or ratio of androgen to estrogen bioactivity (all p>.05). In males, but not females, total estrogen bioactivity was negatively correlated with left hand digit ratio (r=-.172, p=.02), but this relationship was no longer significant when adjusted for variables known to affect sex steroid concentrations in cord blood. CONCLUSIONS Our findings indicate that digit ratio is not related to fetal androgens or estrogens at late gestation.
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Affiliation(s)
- Lauren P Hollier
- Telethon Kids Institute, University of Western Australia, Australia; Neurocognitive Development Unit, School of Psychology, University of Western Australia, Australia.
| | - Jeffrey A Keelan
- School of Women's and Infant's Health, University of Western Australia, Australia
| | - Esha S L Jamnadass
- Telethon Kids Institute, University of Western Australia, Australia; Neurocognitive Development Unit, School of Psychology, University of Western Australia, Australia
| | - Murray T Maybery
- Neurocognitive Development Unit, School of Psychology, University of Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Victoria, Australia
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Hollier LP, Maybery MT, Keelan JA, Hickey M, Whitehouse AJO. Perinatal testosterone exposure and cerebral lateralisation in adult males: evidence for the callosal hypothesis. Biol Psychol 2014; 103:48-53. [PMID: 25148786 DOI: 10.1016/j.biopsycho.2014.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 10/24/2022]
Abstract
Two competing theories address the influence of foetal testosterone on cerebral laterality: one proposing exposure to high foetal testosterone concentrations is related to atypical lateralisation (Geschwind-Galaburda hypothesis), the other that high foetal testosterone concentrations exaggerate typical lateralisation (callosal hypothesis). The current study examined the relationship between cord testosterone concentrations and cerebral laterality for language and spatial memory in adulthood. Male participants with high (>0.15nmol) and low (<0.10nmol) cord testosterone levels were invited to take part in the study (n=18 in each group). Cerebral laterality was measured using functional Transcranial Doppler ultrasonography, while participants completed word generation and visual short-term memory tasks. Typical left lateralisation of language was more common in the high-testosterone group than in the low-testosterone group, χ(2)=4.50, df=1, p=034. Spatial memory laterality was unrelated to cord testosterone level. Our findings indicate that foetal testosterone exposure is related to language laterality in a direction that supports the callosal hypothesis.
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Affiliation(s)
- Lauren P Hollier
- Telethon Kids Institute, University of Western Australia, Australia; Neurocognitive Development Unit, School of Psychology, University of Western Australia, Australia.
| | - Murray T Maybery
- Neurocognitive Development Unit, School of Psychology, University of Western Australia, Australia
| | - Jeffrey A Keelan
- School of Women's and Infant's Health, University of Western Australia, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and The Royal Women's Hospital, Victoria, Australia
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Robinson M, Whitehouse AJO, Jacoby P, Mattes E, Sawyer MG, Keelan JA, Hickey M. Umbilical cord blood testosterone and childhood internalizing and externalizing behavior: a prospective study. PLoS One 2013; 8:e59991. [PMID: 23573225 PMCID: PMC3613417 DOI: 10.1371/journal.pone.0059991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 02/22/2013] [Indexed: 11/30/2022] Open
Abstract
Antenatal testosterone exposure influences fetal neurodevelopment and gender-role behavior in postnatal life and may contribute to differences in developmental psychopathology during childhood. We prospectively measured the associations between umbilical cord blood testosterone levels at birth and childhood behavioral development in both males and females from a large population based sample. The study comprised 430 females and 429 males from the Western Australian Pregnancy Cohort (Raine) Study where umbilical cord blood had been collected. Total testosterone concentrations were determined by mass spectrometry and bioavailable testosterone (BioT) levels were calculated. At two, five, eight and ten years of age, the participants completed the Child Behavior Checklist (CBCL). Linear regression models were used to analyse the relationship between BioT concentrations (in quartiles) and CBCL scores (total, internalizing, externalizing and selected syndrome). Boys had higher mean CBCL T-scores than girls across all ages of follow-up. There was no significant relationship between cord blood BioT quartiles and CBCL total, internalizing and externalizing T-scores at age two or five to ten combined. In the syndrome score analyses, higher BioT quartiles were associated with significantly lower scores for attention problems for boys at age five, eight and ten, and greater withdrawal symptoms in pre-school girls (age five). We did not identify a consistent relationship between antenatal testosterone exposure and total, internalizing or externalizing behavioral difficulties in childhood. Higher umbilical cord BioT levels were associated with lower scores for attention problems in boys up to 10 years and more withdrawn behavior in 5-year-old girls; however, these findings were not consistent across ages and require further investigation in a larger sample.
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Affiliation(s)
- Monique Robinson
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
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17
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The association between perinatal testosterone concentration and early vocabulary development: A prospective cohort study. Biol Psychol 2013; 92:212-5. [DOI: 10.1016/j.biopsycho.2012.10.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 10/18/2012] [Accepted: 10/30/2012] [Indexed: 11/17/2022]
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Whitehouse AJO, Mattes E, Maybery MT, Dissanayake C, Sawyer M, Jones RM, Pennell CE, Keelan JA, Hickey M. Perinatal testosterone exposure and autistic-like traits in the general population: a longitudinal pregnancy-cohort study. J Neurodev Disord 2012; 4:25. [PMID: 23110806 PMCID: PMC3500651 DOI: 10.1186/1866-1955-4-25] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND Increased prenatal testosterone exposure has been hypothesized as a mechanism underlying autism spectrum disorders (ASD). However, no studies have prospectively measured prenatal testosterone exposure and ASD. The current study sought to determine whether testosterone concentrations in umbilical cord blood are associated with a clinical diagnosis of ASD in a small number of children and with autistic-like traits in the general population. METHODS Umbilical cord blood was collected from 707 children. Samples were analyzed for total (TT) and bioavailable (BioT) testosterone concentrations. Parent report indicated that five individuals had a clinical diagnosis of ASD. Those participants without a diagnosis were approached in early adulthood to complete the Autism-Spectrum Quotient (AQ), a self-report measure of autistic-like traits, with 184 males (M = 20.10 years; SD= 0.65 years) and 190 females (M = 19.92 years; SD=0.68 years) providing data. RESULTS The BioT and TT concentrations of the five children diagnosed with ASD were within one standard-deviation of the sex-specific means. Spearman's rank-order coefficients revealed no significant correlations between TT levels and scores on any AQ scale among males (rho range: -.01 to .06) or females (rho value range: -.07 to .01). There was also no significant association between BioT or TT concentrations and AQ scores among males (rho value range: -.07 to .08) or females (rho value range: -.06 to .12). Males were more likely than females to have 'high' scores (upper decile) on the AQ scale relating pattern and detail processing. However, the likelihood of a high score on this scale was unrelated to BioT and TT concentrations in both males and females. CONCLUSIONS These findings indicate that testosterone concentrations from umbilical cord blood are unrelated to autistic-like traits in the general population. However, the findings do not exclude an association between testosterone exposure in early intrauterine life and ASD.
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Affiliation(s)
- Andrew JO Whitehouse
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, Western Australia, 6008, Australia
| | - Eugen Mattes
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, Western Australia, 6008, Australia
| | - Murray T Maybery
- School of Psychology, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia
| | - Cheryl Dissanayake
- School of Psychological Science, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Michael Sawyer
- Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Rachel M Jones
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, Western Australia, 6008, Australia
| | - Craig E Pennell
- School of Women’s and Infants’ Health, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia
| | - Jeffrey A Keelan
- School of Women’s and Infants’ Health, University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia, 6009, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Cnr of Flemington Road and Grattan Street, Parkville, Victoria, 3052, Australia
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Farrant BM, Mattes E, Keelan JA, Hickey M, Whitehouse AJO. Fetal Testosterone, Socio-Emotional Engagement and Language Development. INFANT AND CHILD DEVELOPMENT 2012. [DOI: 10.1002/icd.1771] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Brad M. Farrant
- Telethon Institute for Child Health Research, Centre for Child Health Research; The University of Western Australia; WA; Australia
| | - Eugen Mattes
- Telethon Institute for Child Health Research, Centre for Child Health Research; The University of Western Australia; WA; Australia
| | - Jeff A. Keelan
- School of Women's and Infants' Health; The University of Western Australia; WA; Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology; University of Melbourne; Victoria; Australia
| | - Andrew J. O. Whitehouse
- Telethon Institute for Child Health Research, Centre for Child Health Research; The University of Western Australia; WA; Australia
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Whitehouse AJO, Mattes E, Maybery MT, Sawyer MG, Jacoby P, Keelan JA, Hickey M. Sex-specific associations between umbilical cord blood testosterone levels and language delay in early childhood. J Child Psychol Psychiatry 2012; 53:726-34. [PMID: 22276678 DOI: 10.1111/j.1469-7610.2011.02523.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preliminary evidence suggests that prenatal testosterone exposure may be associated with language delay. However, no study has examined a large sample of children at multiple time-points. METHODS Umbilical cord blood samples were obtained at 861 births and analysed for bioavailable testosterone (BioT) concentrations. When participating offspring were 1, 2 and 3 years of age, parents of 767 children (males = 395; females = 372) completed the Infant Monitoring Questionnaire (IMQ), which measures Communication, Gross Motor, Fine Motor, Adaptive and Personal-Social development. Cut-off scores are available for each scale at each age to identify children with 'clinically significant' developmental delays. Chi-square analyses and generalized estimating equations examined longitudinal associations between sex-specific quartiles of BioT concentrations and the rate of developmental delay. RESULTS Significantly more males than females had language delay (Communication scale) at age 1, 2 and 3 years (p-values ≤. 01). Males were also more likely to be classified as delayed on the Fine-Motor (p = .04) and Personal-Social (p < .01) scales at age 3 years. Chi-square analyses found a significant difference between BioT quartiles in the rate of language delay (but not Fine-Motor and Personal-Social delay) for males (age 3) and females (age 1 and 3). Generalized estimating equations, incorporating a range of sociodemographic and obstetric variables, found that males in the highest BioT quartile were at increased risk for a clinically significant language delay during the first 3 years of life, with an odds ratio (OR) of 2.47 (95% CI: 1.12, 5.47). By contrast, increasing levels of BioT reduced the risk of language delay among females (Quartile 2: OR = 0.23, 95% CI: 0.09, 0.59; Quartile 4: 0.46, 95% CI: 0.21, 0.99). CONCLUSION These data suggest that high prenatal testosterone levels are a risk factor for language delay in males, but may be a protective factor for females.
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Affiliation(s)
- Andrew J O Whitehouse
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, 100 Roberts Road, Subiaco, WA 6008, Australia.
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Dried blood spots, pharmacokinetic studies and better medicines for children. Bioanalysis 2011; 3:779-86. [PMID: 21452994 DOI: 10.4155/bio.11.19] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Determining circulating drug concentrations in children is an ongoing obstacle to the development of age-appropriate dosing regimens. The requirement for small blood sample volumes in children compared with adults is a significant barrier to obtaining age-specific pharmacokinetic-pharmacodynamic data for this population and hence optimizing the efficacy and safety profile of medicines used by this group. This article discusses the potential for dried blood spot sampling to offer a solution to this issue.
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Florendo KN, Bellflower B, van Zwol A, Cooke RJ. Growth in preterm infants fed either a partially hydrolyzed whey or an intact casein/whey preterm infant formula. J Perinatol 2009; 29:106-11. [PMID: 18716627 DOI: 10.1038/jp.2008.124] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare feeding tolerance, nutrient intake and growth in preterm infants (< or =32 weeks, < or =1750 g) fed either a standard nonhydrolyzed whey-casein (nHWC) or a partially hydrolyzed whey (pHW) preterm infant formula. STUDY DESIGN In this double-blind randomized controlled trial infants were fed either formula for at least 3 weeks. Intake was monitored daily, serum chemistries and growth weekly. Data were analyzed using analysis of covariance. RESULT A total of 80 infants were enrolled, 72 completed the study. No differences were noted in demographic characteristics. No differences were detected in feeding tolerance, intakes (118+/-21 vs 119+/-14; nHWC vs pHW) or growth weight, 28+/-1.5 vs 28+/-1.6 g per day; length, 1.0+/-0.7 vs 1.0+/-0.6 cm per week; head circumference, 0.9+/-0.4 vs 1.0+/-0.44 cm per week). At the end of study, blood urea nitrogen (5.2+/-3.1 <6.7+/-2.3 mg per 100 ml, nHWC<pHW), total serum proteins (4.7+/-0.4 >4.4+/-0.5 g per 100 ml) and albumin (2.7+/-0.3 >2.6+/-0.4 g per 100 ml) differed. CONCLUSION A pHW preterm infant formula was not associated with improved feeding tolerance, enteral intake or growth but differences in serum chemistries. These are unlikely to be clinically relevant because values were well within normal limits for preterm infants, whereas growth was identical in both groups and paralleled that 'in utero'.
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Affiliation(s)
- K N Florendo
- Division of Neonatology, University of Tennessee Center for Health Sciences, Memphis, TN, USA
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Sinn JKH, Kumar K, Osborn DA, Bolisetty S. Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Hippokratia 2006. [DOI: 10.1002/14651858.cd005949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- John KH Sinn
- Royal North Shore Hospital, The University of Sydney; Department of Neonatology; St. Leonard's Sydney New South Wales Australia 2065
| | - Kiran Kumar
- Women's and Children's Hospital; Neonatal Unit; 72 King William Road North Adelaide South Australia South Australia Australia 5006
| | - David A Osborn
- University of Sydney; Central Clinical School, Discipline of Obstetrics, Gynaecology and Neonatology; Sydney NSW Australia 2050
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Abstract
There are relatively few studies of albumin use in neonates and children, with most showing no consistent benefit compared with the use of crystalloid solutions. Certainly, albumin treatment is not indicated for treatment of hypoalbuminemia alone. Studies also show that albumin is not indicated in neonates for the initial treatment of hypotension, respiratory distress, or partial exchange transfusions. In adults, albumin is not considered to be the initial therapy for hypovolemia, burn injury, or nutritional supplementation. Based on the evidence, albumin should be used rarely in the neonatal ICU. Albumin may be indicated in the treatment of hypovolemia only after crystalloid infusion has failed. In patients with acute hemorrhagic shock, albumin may be used with crystalloids when blood products are not available immediately. Inpatients with acute or continuing losses of albumin and normal capillary permeability and lymphatic function, such as during persistent thoracostomy tube or surgical site drainage, albumin supplementation will prevent the development of hypoalbuminemia, and possibly edema formation. This has not been studied systematically, however. In patients with hypoalbuminemia and increased capillary permeability, albumin supplementation often leads to greater albumin leakage across the capillary membrane, contributing to edema formation without improvement in outcome. As the disease process improves and capillary permeability normalizes, albumin supplementation may accelerate recovery, but long-term benefits of albumin treatment usually cannot be demonstrated. These patients will recover whether or not albumin is administered.
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Affiliation(s)
- Michael R Uhing
- Division of Neonatology, Medical College of Wisconsin, Neonatal Intensive Care Unit, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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Jardine LA, Jenkins-Manning S, Davies MW. Albumin infusion for low serum albumin in preterm newborn infants. Cochrane Database Syst Rev 2004:CD004208. [PMID: 15266522 DOI: 10.1002/14651858.cd004208.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Intravenous albumin infusion to treat hypoalbuminaemia is used in intensive care nurseries. Hypoalbuminaemia occurs in a number of clinical situations including prematurity, the acutely unwell infant, respiratory distress syndrome (RDS), chronic lung disease (CLD), necrotising enterocolitis (NEC), intracranial haemorrhage, hydrops fetalis and oedema. Fluid overload is a potential side effect of albumin administration. Albumin is a blood product and therefore carries the potential risk of infection and adverse reactions. Albumin is also a scarce and expensive resource. OBJECTIVES The primary objective was to assess whether albumin infusions, in preterm neonates with low serum albumin, reduces mortality and morbidity. A secondary objective was to assess whether albumin infusion is associated with significant side effects. SEARCH STRATEGY Searches were made of MEDLINE from 1966 to April 2004, CINAHL from 1982 to April 2004 and the current Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 1, 2004). Previous reviews (including cross references) and abstracts were also searched. SELECTION CRITERIA All randomised controlled trials in which individual patients were allocated to albumin infusion versus control were included. Cross-over studies were excluded. Quasi randomised trials were excluded. Participants were preterm infants who had hypoalbuminaemia. Types of interventions included albumin infusion versus placebo (e.g. crystalloid) or no treatment. DATA COLLECTION AND ANALYSIS The reviewers worked independently to search for trials for inclusion and to assess methodological quality. Studies were assessed using the following key criteria: blinding of randomisation, blinding of intervention, completeness of follow up and blinding of outcome measurement. MAIN RESULTS Only two small studies were found for inclusion in this review and only one reported clinically relevant outcomes - it found no significant differences for our primary outcome measure of death (RR 1.5 [95% confidence interval 0.3 - 7.43]) or secondary outcome measures of intraventricular haemorrhage, patent ductus arteriosus, necrotising enterocolitis, bronchopulmonary dysplasia, duration of mechanical ventilation and duration of oxygen therapy. REVIEWERS' CONCLUSIONS There is a lack of evidence from randomised trials to determine whether the routine use of albumin infusion, in preterm neonates with low serum albumin, reduces mortality or morbidity, and no evidence to assess whether albumin infusion is associated with significant side effects. There is a need for good quality, double-blind randomised controlled trials to assess the safety and efficacy of albumin infusions in preterm neonates with low serum albumin.
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Affiliation(s)
- L A Jardine
- Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland, Australia, 4029
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Erasmus HD, Ludwig-Auser HM, Paterson PG, Sun D, Sankaran K. Enhanced weight gain in preterm infants receiving lactase-treated feeds: a randomized, double-blind, controlled trial. J Pediatr 2002; 141:532-7. [PMID: 12378193 DOI: 10.1067/mpd.2002.127499] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether lactase-treated preterm feeds enhance weight gain and feeding tolerance in premature infants. STUDY DESIGN Prospective, double-blind, randomized, controlled trial involving 130 infants (26-34 weeks postconceptual age). The primary outcome variable was weight gain (g per day). Other outcome measures included gains in length and head circumference, biochemical indexes of nutritional status, feeding intolerance, and incidence of necrotizing enterocolitis. RESULTS On study day 10, weight gain (mean +/- SEM) of the treatment group was significantly greater (P <.05) than that of the control group (20.4 +/- 1.8 g/day vs 15.5 +/- 1.6 g/day). By study end, no significant difference in weight gain between treatment and control groups was observed. The difference in serum albumin level was significant at study day 14, with a value of 29.3 +/- 0.6 g/L in the treatment group compared with 27.1 +/- 0.4 g/L in the control group (P <.01). There were no significant differences in caloric intakes, length gain, head circumference gain, feeding intolerance, and incidence of necrotizing enterocolitis. CONCLUSIONS Weight gain may be enhanced during the period of low functional lactase activity of prematurity by addition of lactase to preterm feeds. No adverse effects on feeding tolerance resulted from this treatment.
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Affiliation(s)
- Helen D Erasmus
- Department of Nutrition Services and Neonatal Intensive Care Unit, Royal University Hospital, and the College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Kenny SE, Pierro A, Isherwood D, Donnell SC, Van Saene HK, Lloyd DA. Hypoalbuminaemia in surgical neonates receiving parenteral nutrition. J Pediatr Surg 1995; 30:454-7. [PMID: 7760241 DOI: 10.1016/0022-3468(95)90054-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aim of this study was to define the prevalence of hypoalbuminaemia (HA), its predisposing factors, and its effect on outcome in infants. Fifty-six consecutive infants receiving parenteral nutrition (PN) for gastrointestinal disease were divided into two groups according to their lowest measured serum albumin level. The reference range (27.9 to 50.9 g/L) for serum albumin was derived from measurements taken in 37 (22 term and 15 preterm) normal enterally fed newborn infants. HA group (serum albumin < 27.9 g/L) included 15 infants (27%); NA group (serum albumin > or = 27.9 g/L) included 41 infants (73%). HA infants received more albumin than NA infants (median 66 versus 14 mL/kg; P = .005). There was no significant difference between HA and NA groups in gestational age, postmenstrual age at time of start of PN, composition of PN, nor mean weight gain. HA was unrelated to biochemical signs of liver dysfunction, C-reactive protein elevation, septicaemic episodes, or time from operation. HA occurred within the first week of starting PN in 10 infants and returned to normal values within 5 days. HA was a recurrent phenomenon in three patients. Mortality was higher in the HA group (33.3%) than in the NA group (4.9%; P = .02) but was apparently causally unrelated to the low serum albumin level. Hypoalbuminaemia is a common finding in neonates on PN despite the administration of exogenous albumin. Monitoring serum albumin levels in surgical infants on PN seems to be of little clinical value.
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Affiliation(s)
- S E Kenny
- Alder Hey Children's Hospital, Liverpool, England
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28
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Kanarek KS, Williams PR, Blair C. Concurrent administration of albumin with total parenteral nutrition in sick newborn infants. JPEN J Parenter Enteral Nutr 1992; 16:49-53. [PMID: 1738219 DOI: 10.1177/014860719201600149] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns (birth weight 1.26 +/- 0.1 kg [mean +/- SEM] and gestational age 30 +/- 0.8 weeks [mean +/- SEM]) compared with a control group of 12 premature newborns (birth weight 1.17 +/- 0.2 kg and gestational age 29 +/- 0.1 weeks) who received total parenteral nutrition. All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation. Albumin supplementation of total parenteral nutrition resulted in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group. Slow albumin infusion had no observed effect on the severity of respiratory distress. Study group infants regained birth weight earlier than control group infants. These data suggest that the concurrent administration of albumin may be clinically beneficial in critically ill newborn infants.
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Affiliation(s)
- K S Kanarek
- Department of Pediatrics, University of South Florida, Tampa
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29
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Dawnay AB, Hirst AD, Perry DE, Chambers RE. A critical assessment of current analytical methods for the routine assay of serum total protein and recommendations for their improvement. Ann Clin Biochem 1991; 28 ( Pt 6):556-67. [PMID: 1776805 DOI: 10.1177/000456329102800604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- A B Dawnay
- Department of Chemical Pathology, St Bartholomew's Hospital, London, UK
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30
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Polberger SK, Fex G, Räihä NC. Concentration of twelve plasma proteins at birth in very low birthweight and in term infants. ACTA PAEDIATRICA SCANDINAVICA 1990; 79:729-36. [PMID: 2239265 DOI: 10.1111/j.1651-2227.1990.tb11547.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Plasma samples obtained at birth from 70 very low birth weight (VLBW) infants (gestational age 24 to 34 weeks) and from 20 term infants were analysed for concentrations of 12 different proteins. The plasma concentrations of albumin, transthyretin (TTR), retinol-binding protein (RBP), vitamin D-binding protein, apolipoprotein A I, fibronectin, orosomucoid and alpha 1-antichymotrypsin were significantly lower in the VLBW infants than in the term infants, whereas the values of alpha-fetoprotein (AFP) were significantly higher in the VLBW infants. No differences were found between the two groups for apolipoprotein A II, apolipoprotein B and transferrin. Birth asphyxia and sex had no influence on the measured plasma protein concentrations. The plasma concentrations of apolipoprotein A I and A II were significantly lower in small-for-gestational age (SGA), VLBW infants compared with appropriate-for-gestational age (AGA), VLBW infants. Possible acute inflammation (defined as raised concentrations of orosomucoid or alpha 1-antichymotrypsin) was associated with significantly higher values of vitamin D-binding protein in both VLBW and term infants, suggesting that this protein may act as an acute phase protein in newborn infants.
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Affiliation(s)
- S K Polberger
- Department of Paediatrics, University of Lund, Malmö General Hospital, Sweden
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31
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Reisman J, Petrou C, Corey M, Stringer D, Durie P, Levison H. Hypoalbuminemia at initial examination in patients with cystic fibrosis. J Pediatr 1989; 115:755-8. [PMID: 2809910 DOI: 10.1016/s0022-3476(89)80657-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J Reisman
- Department of Radiology, Hospital for Sick Children, Toronto, Ontario, Canada
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