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Garcia-Bonilla M, Yahanda AT, Isaacs AM, Baksh B, Akbari SHA, Botteron H, Morales DM, Han RH, McAllister Ii JP, Mathur AM, Strahle JM, Smyser CD, Limbrick DD. Pro-inflammatory cerebrospinal fluid profile of neonates with intraventricular hemorrhage: clinical relevance and contrast with CNS infection. Fluids Barriers CNS 2024; 21:17. [PMID: 38383424 PMCID: PMC10880312 DOI: 10.1186/s12987-024-00512-0] [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: 07/16/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Interpretation of cerebrospinal fluid (CSF) studies can be challenging in preterm infants. We hypothesized that intraventricular hemorrhage (IVH), post-hemorrhagic hydrocephalus (PHH), and infection (meningitis) promote pro-inflammatory CSF conditions reflected in CSF parameters. METHODS Biochemical and cytological profiles of lumbar CSF and peripheral blood samples were analyzed for 81 control, 29 IVH grade 1/2 (IVH1/2), 13 IVH grade 3/4 (IVH3/4), 15 PHH, 20 culture-confirmed bacterial meningitis (BM), and 27 viral meningitis (VM) infants at 36.5 ± 4 weeks estimated gestational age. RESULTS PHH infants had higher (p < 0.02) CSF total cell and red blood cell (RBC) counts compared to control, IVH1/2, BM, and VM infants. No differences in white blood cell (WBC) count were found between IVH3/4, PHH, BM, and VM infants. CSF neutrophil counts increased (p ≤ 0.03) for all groups compared to controls except IVH1/2. CSF protein levels were higher (p ≤ 0.02) and CSF glucose levels were lower (p ≤ 0.003) for PHH infants compared to all other groups. In peripheral blood, PHH infants had higher (p ≤ 0.001) WBC counts and lower (p ≤ 0.03) hemoglobin and hematocrit than all groups except for IVH3/4. CONCLUSIONS Similarities in CSF parameters may reflect common pathological processes in the inflammatory response and show the complexity associated with interpreting CSF profiles, especially in PHH and meningitis/ventriculitis.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA.
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - Alexander T Yahanda
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
| | - Albert M Isaacs
- Department of Neurosurgery, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Brandon Baksh
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Hassan A Akbari
- John Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg,, FL, USA
| | - Haley Botteron
- Medical School, University of Kansas, Kansas City, KS, USA
| | - Diego M Morales
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
| | - Rowland H Han
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
| | - James P McAllister Ii
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
| | - Amit M Mathur
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Christopher D Smyser
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine, One Children's Place, Suite 420, St. Louis, MO, USA
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Sharma S, Patel NR, Hanudel MR, Ix JH, Salusky IB, Nguyen KL. Plasma FGF23 is associated with left atrial remodeling in children on hemodialysis. Pediatr Nephrol 2022:10.1007/s00467-022-05812-x. [PMID: 36508050 DOI: 10.1007/s00467-022-05812-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND FGF23 mediates cardiac fibrosis through the activation of pro-fibrotic factors in in vitro models and is markedly elevated in kidney disease. Left atrial global longitudinal strain (LA GLS) derived by echocardiographic speckle-tracking measures longitudinal shortening of the LA walls, quantifies atrial performance and may enable detection of early LA remodeling in the setting of normal ventricular function. We hypothesized that LA GLS is abnormal in children on hemodialysis (HD) compared to healthy controls of comparable age/sex distribution and that, among HD patients, greater FGF23 levels are associated with abnormal LA GLS. METHODS Clinical and echocardiographic data from 29 children receiving HD and 13 healthy controls were collected in a cross-sectional single-center study. Plasma FGF23 concentrations were measured using ELISA. The primary outcome was LA GLS measured using 2D speckle-tracking strain analysis. Linear regression analysis was used to investigate predictors of LA GLS in HD. RESULTS Median dialysis vintage was 1.5 (IQR 0.5-4.3) years. Median intact FGF23 levels were substantially higher in the HD vs. control group (1206 [215, 4707] vs. 51 [43, 66.5] pg/ml; P = 0.0001), and LA GLS was 39.9% SD 11.6 vs. 32.8% SD 5.7 (P = 0.04). Among HD patients, higher FGF23 was associated with lower LA GLS (β per unit Ln-FGF23: - 2.7; 95% CI slope - 5.4, - 0.1; P = 0.04 after adjustment for age, body size, and HD vintage. FGF23 was not associated with LA phasic reservoir, conduit, or contractile strain. CONCLUSIONS In children on HD and preserved left ventricular ejection fraction, greater FGF23 is associated with lower LA GLS (indicative of impaired atrial performance). A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Shilpa Sharma
- Division of Nephrology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Room 6030, Los Angeles, CA, 90073, USA.
| | - Nisha R Patel
- Stritch School of Medicine, Loyola University Chicago, IL, Maywood, USA
| | - Mark R Hanudel
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Isidro B Salusky
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Division of Cardiology, David Geffen School of Medicine at UCLA, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Kivisto AJ, Mills S, Elwood LS. Racial Disparities in Pregnancy-associated Intimate Partner Homicide. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP10938-NP10961. [PMID: 33527866 DOI: 10.1177/0886260521990831] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention's National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.
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BÜYÜKFIRAT E, DEMİR A, DÖRTERLER ME, GÜNENDİ T. Etiology and Mortality Investigation in Neonates that Underwent Surgery. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1024822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Garcia-Bonilla M, McAllister JP, Limbrick DD. Genetics and Molecular Pathogenesis of Human Hydrocephalus. Neurol India 2021; 69:S268-S274. [PMID: 35102976 DOI: 10.4103/0028-3886.332249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy-Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Ceravolo G, Macchia TL, Cuppari C, Dipasquale V, Gambadauro A, Casto C, Ceravolo MD, Cutrupi M, Calabrò MP, Borgia P, Piccolo G, Mancuso A, Albiero R, Chimenz R. Update on the Classification and Pathophysiological Mechanisms of Pediatric Cardiorenal Syndromes. CHILDREN-BASEL 2021; 8:children8070528. [PMID: 34206173 PMCID: PMC8305733 DOI: 10.3390/children8070528] [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: 05/07/2021] [Revised: 06/09/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Cardiorenal syndrome (CRS) is defined as a disorder resulting from the abnormal interaction between the heart and kidney, in which acute or chronic dysfunction of one organ may lead to acute and/or chronic dysfunction of the other. The functional interplay between the heart and kidney is characterized by a complex bidirectional symbiotic interaction, regulated by a wide array of both genetic and environmental mechanisms. There are at least five known subtypes of CRS, based on the severity of clinical features and the degree of heart/renal failure. The fourth subtype (cardiorenal syndrome type 4 (CRS4)) is characterized by a primary chronic kidney disease (CKD), which in turn leads to a decreased cardiac function. Impairment of renal function is among the most important pathophysiological factors contributing to heart failure (HF) in the pediatric age group, and cardiovascular complications could be one of the most important causes of mortality in pediatric patients with advanced CKD. In this context, a loss of glomerular filtration rate directly correlates with both the progression of cardiovascular complications in CRS and the risk of HF. This review describes the interaction pathways between the heart and kidney and the recently identified pathophysiological mechanisms underlying pediatric CRS, with a special focus on CRS4, which encompasses both primary CKD and cardiovascular disease (CVD).
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Affiliation(s)
- Giorgia Ceravolo
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Tommaso La Macchia
- Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy;
| | - Caterina Cuppari
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Valeria Dipasquale
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Antonella Gambadauro
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Celeste Casto
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Maria Domenica Ceravolo
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Maricia Cutrupi
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Maria Pia Calabrò
- Unit of Pediatric Cardiology, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy;
| | - Paola Borgia
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (P.B.); (G.P.)
| | - Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy; (P.B.); (G.P.)
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessio Mancuso
- Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy; (G.C.); (C.C.); (V.D.); (A.G.); (C.C.); (M.D.C.); (M.C.); (A.M.)
| | - Remo Albiero
- Department of Cardiology, Sondrio General Hospital, 23100 Sondrio, Italy;
| | - Roberto Chimenz
- Unit of Pediatric Nephrology, and Rheumatology with Dialysis, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, “G. Martino” Policlinic, 98124 Messina, Italy
- Correspondence: ; Tel.: +39-3479962816
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Querfeld U. Cardiovascular disease in childhood and adolescence: Lessons from children with chronic kidney disease. Acta Paediatr 2021; 110:1125-1131. [PMID: 33080082 DOI: 10.1111/apa.15630] [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: 09/04/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
Children suffering from chronic kidney disease (CKD) have the apparent highest risk for the development of cardiovascular disease (CVD) at a young age. While symptoms of CVD are characteristically absent in childhood and adolescence, remodelling of the myocardium, medium and large-sized arteries and of the microcirculation is clinically significant and can be assessed with non-invasive technology. Kidney disease and its progression are the driver of CVD, mediated by an unparalleled accumulation of risk factors converging on several comorbid conditions including hypertension, anaemia, dyslipidaemia, disturbed mineral metabolism and chronic persistent inflammation. Large prospective paediatric cohorts studies have provided valuable insights into the pathogenesis and the progression of CKD-induced cardiovascular comorbidity and have characterised the cardiovascular phenotype in young patients. They have also provided the rationale for close monitoring of risk factors and have defined therapeutic targets. Recently discovered new biomarkers could help identify the individual risk for CVD. Prevention of CVD by aggressive therapy of modifiable risk factors is essential to enable long-term survival of young patients with CKD.
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Affiliation(s)
- Uwe Querfeld
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Cerebrospinal fluid NCAM-1 concentration is associated with neurodevelopmental outcome in post-hemorrhagic hydrocephalus of prematurity. PLoS One 2021; 16:e0247749. [PMID: 33690655 PMCID: PMC7946285 DOI: 10.1371/journal.pone.0247749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/12/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Efforts directed at mitigating neurological disability in preterm infants with intraventricular hemorrhage (IVH) and post hemorrhagic hydrocephalus (PHH) are limited by a dearth of quantifiable metrics capable of predicting long-term outcome. The objective of this study was to examine the relationships between candidate cerebrospinal fluid (CSF) biomarkers of PHH and neurodevelopmental outcomes in infants undergoing neurosurgical treatment for PHH. STUDY DESIGN Preterm infants with PHH were enrolled across the Hydrocephalus Clinical Research Network. CSF samples were collected at the time of temporizing neurosurgical procedure (n = 98). Amyloid precursor protein (APP), L1CAM, NCAM-1, and total protein (TP) were compared in PHH versus control CSF. Fifty-four of these PHH subjects underwent Bayley Scales of Infant Development-III (Bayley-III) testing at 15-30 months corrected age. Controlling for false discovery rate (FDR) and adjusting for post-menstrual age (PMA) and IVH grade, Pearson's partial correlation coefficients were used to examine relationships between CSF proteins and Bayley-III composite cognitive, language, and motor scores. RESULTS CSF APP, L1CAM, NCAM-1, and TP were elevated in PHH over control at temporizing surgery. CSF NCAM-1 was associated with Bayley-III motor score (R = -0.422, p = 0.007, FDR Q = 0.089), with modest relationships noted with cognition (R = -0.335, p = 0.030, FDR Q = 0.182) and language (R = -0.314, p = 0.048, FDR Q = 0.194) scores. No relationships were observed between CSF APP, L1CAM, or TP and Bayley-III scores. FOHR at the time of temporization did not correlate with Bayley-III scores, though trends were observed with Bayley-III motor (p = 0.0647 and R = -0.2912) and cognitive scores (p = 0.0506 and R = -0.2966). CONCLUSION CSF NCAM-1 was associated with neurodevelopment in this multi-institutional PHH cohort. This is the first report relating a specific CSF protein, NCAM-1, to neurodevelopment in PHH. Future work will further investigate a possible role for NCAM-1 as a biomarker of PHH-associated neurological disability.
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Carles C, Albouy-Llaty M, Dupuis A, Rabouan S, Migeot V. Comparison of the Effect on Fetal Growth of a Mixture of Atrazine and Nitrates in Drinking Water and of Active Tobacco Exposure during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2200. [PMID: 33672371 PMCID: PMC7926764 DOI: 10.3390/ijerph18042200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 11/29/2022]
Abstract
Active tobacco exposure during pregnancy is a known determinant of fetal growth. Nitrates and atrazine metabolites in drinking water may affect fetal growth as a mixture of endocrine disruptors (ED). We aimed to determine whether EDC have an additional effect on fetal growth compared to active tobacco exposure. A historic cohort study was carried out with a sample stratified with regard to the maternity unit, drinking water exposure, and year of birth. The women included were living in Deux-Sèvres, had given birth between 2005 and 2010 in three selected maternity units, and ultrasound data were available in their obstetrical records. Mixed linear models were used to analyze fetal weight evolution from the second trimester to the time of birth according to drinking water exposure to EDC mixture and active tobacco exposure. We included 558 mother-neonate couples, of whom 9% were exposed to high doses of the mixture and 21% to active tobacco smoking. There was no difference in fetal weight evolution according to drinking water mixture exposure (0.97 g; 95% CI [-3.01; 4.94]). We could not show a supplementary effect of mixture exposure in drinking-water on fetal growth as compared to active tobacco exposure. Further research is needed, using more precise methods to estimate EDC exposure.
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Affiliation(s)
- Camille Carles
- Univ. Bordeaux, INSERM UMR 1219, Equipe EPICENE, F33000 Bordeaux, France
- CHU de Bordeaux, Service Santé Travail Environnement, F33000 Bordeaux, France
| | - Marion Albouy-Llaty
- CHU Poitiers, Department of Public Health, F-86021 Poitiers, France; (M.A.-L.); (V.M.)
- INSERM CIC 1402, CHU Poitiers, F-86021 Poitiers, France; (A.D.); (S.R.)
- School of Medicine and Pharmacy of Poitiers, Université de Poitiers, F-86073 Poitiers, France
| | - Antoine Dupuis
- INSERM CIC 1402, CHU Poitiers, F-86021 Poitiers, France; (A.D.); (S.R.)
- School of Medicine and Pharmacy of Poitiers, Université de Poitiers, F-86073 Poitiers, France
- CHU Poitiers, Department of Pharmacy, F-86021 Poitiers, France
| | - Sylvie Rabouan
- INSERM CIC 1402, CHU Poitiers, F-86021 Poitiers, France; (A.D.); (S.R.)
- School of Medicine and Pharmacy of Poitiers, Université de Poitiers, F-86073 Poitiers, France
| | - Virginie Migeot
- CHU Poitiers, Department of Public Health, F-86021 Poitiers, France; (M.A.-L.); (V.M.)
- INSERM CIC 1402, CHU Poitiers, F-86021 Poitiers, France; (A.D.); (S.R.)
- School of Medicine and Pharmacy of Poitiers, Université de Poitiers, F-86073 Poitiers, France
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Bhattacharya S, Mereness JA, Baran AM, Misra RS, Peterson DR, Ryan RM, Reynolds AM, Pryhuber GS, Mariani TJ. Lymphocyte-Specific Biomarkers Associated With Preterm Birth and Bronchopulmonary Dysplasia. Front Immunol 2021; 11:563473. [PMID: 33552042 PMCID: PMC7859626 DOI: 10.3389/fimmu.2020.563473] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/07/2020] [Indexed: 01/11/2023] Open
Abstract
Many premature babies who are born with neonatal respiratory distress syndrome (RDS) go on to develop Bronchopulmonary Dysplasia (BPD) and later Post-Prematurity Respiratory Disease (PRD) at one year corrected age, characterized by persistent or recurrent lower respiratory tract symptoms frequently related to inflammation and viral infection. Transcriptomic profiles were generated from sorted peripheral blood CD8+ T cells of preterm and full-term infants enrolled with consent in the NHLBI Prematurity and Respiratory Outcomes Program (PROP) at the University of Rochester and the University at Buffalo. We identified outcome-related gene expression patterns following standard methods to identify markers for oxygen utilization and BPD as outcomes in extremely premature infants. We further identified predictor gene sets for BPD based on transcriptomic data adjusted for gestational age at birth (GAB). RNA-Seq analysis was completed for CD8+ T cells from 145 subjects. Among the subjects with highest risk for BPD (born at <29 weeks gestational age (GA); n=72), 501 genes were associated with oxygen utilization. In the same set of subjects, 571 genes were differentially expressed in subjects with a diagnosis of BPD and 105 genes were different in BPD subjects as defined by physiologic challenge. A set of 92 genes could predict BPD with a moderately high degree of accuracy. We consistently observed dysregulation of TGFB, NRF2, HIPPO, and CD40-associated pathways in BPD. Using gene expression data from both premature and full-term subjects (n=116), we identified a 28 gene set that predicted the PRD status with a moderately high level of accuracy, which also were involved in TGFB signaling. Transcriptomic data from sort-purified peripheral blood CD8+ T cells from 145 preterm and full-term infants identified sets of molecular markers of inflammation associated with independent development of BPD in extremely premature infants at high risk for the disease and of PRD among the preterm and full-term subjects.
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Affiliation(s)
- Soumyaroop Bhattacharya
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Jared A Mereness
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Andrea M Baran
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Ravi S Misra
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Derick R Peterson
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States
| | - Rita M Ryan
- Department of Pediatrics, University at Buffalo, Buffalo, NY, United States.,Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | | | - Gloria S Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, United States
| | - Thomas J Mariani
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, NY, United States
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Son JH, Stevenson TJ, Bowles MD, Scholl EA, Bonkowsky JL. Dopaminergic Co-Regulation of Locomotor Development and Motor Neuron Synaptogenesis is Uncoupled by Hypoxia in Zebrafish. eNeuro 2020; 7:ENEURO.0355-19.2020. [PMID: 32001551 PMCID: PMC7046933 DOI: 10.1523/eneuro.0355-19.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/10/2020] [Accepted: 01/17/2020] [Indexed: 11/21/2022] Open
Abstract
Hypoxic injury to the developing human brain is a complication of premature birth and is associated with long-term impairments of motor function. Disruptions of axon and synaptic connectivity have been linked to developmental hypoxia, but the fundamental mechanisms impacting motor function from altered connectivity are poorly understood. We investigated the effects of hypoxia on locomotor development in zebrafish. We found that developmental hypoxia resulted in decreased spontaneous swimming behavior in larva, and that this motor impairment persisted into adulthood. In evaluation of the diencephalic dopaminergic neurons, which regulate early development of locomotion and constitute an evolutionarily conserved component of the vertebrate dopaminergic system, hypoxia caused a decrease in the number of synapses from the descending dopaminergic diencephalospinal tract (DDT) to spinal cord motor neurons. Moreover, dopamine signaling from the DDT was coupled jointly to motor neuron synaptogenesis and to locomotor development. Together, these results demonstrate the developmental processes regulating early locomotor development and a requirement for dopaminergic projections and motor neuron synaptogenesis. Our findings suggest new insights for understanding the mechanisms leading to motor disability from hypoxic injury of prematurity.
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Affiliation(s)
- Jong-Hyun Son
- Department of Biology, University of Scranton, Scranton, PA 18510
| | - Tamara J Stevenson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132
| | - Miranda D Bowles
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132
| | - Erika A Scholl
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132
| | - Joshua L Bonkowsky
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132
- Brain and Spine Center, Primary Children's Hospital, Salt Lake City, UT 84108
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Bonkowsky JL, Son JH. Hypoxia and connectivity in the developing vertebrate nervous system. Dis Model Mech 2018; 11:11/12/dmm037127. [PMID: 30541748 PMCID: PMC6307895 DOI: 10.1242/dmm.037127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The developing nervous system depends upon precise regulation of oxygen levels. Hypoxia, the condition of low oxygen concentration, can interrupt developmental sequences and cause a range of molecular, cellular and neuronal changes and injuries. The roles and effects of hypoxia on the central nervous system (CNS) are poorly characterized, even though hypoxia is simultaneously a normal component of development, a potentially abnormal environmental stressor in some settings, and a clinically important complication, for example of prematurity. Work over the past decade has revealed that hypoxia causes specific disruptions in the development of CNS connectivity, altering axon pathfinding and synapse development. The goals of this article are to review hypoxia's effects on the development of CNS connectivity, including its genetic and molecular mediators, and the changes it causes in CNS circuitry and function due to regulated as well as unintended mechanisms. The transcription factor HIF1α is the central mediator of the CNS response to hypoxia (as it is elsewhere in the body), but hypoxia also causes a dysregulation of gene expression. Animals appear to have evolved genetic and molecular responses to hypoxia that result in functional behavioral alterations to adapt to the changes in oxygen concentration during CNS development. Understanding the molecular pathways underlying both the normal and abnormal effects of hypoxia on CNS connectivity may reveal novel insights into common neurodevelopmental disorders. In addition, this Review explores the current gaps in knowledge, and suggests important areas for future studies. Summary: The nervous system's exposure to hypoxia has developmental and clinical relevance. In this Review, the authors discuss the effects of hypoxia on the development of the CNS, and its long-term behavioral and neurodevelopmental consequences.
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Affiliation(s)
- Joshua L Bonkowsky
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA
| | - Jong-Hyun Son
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA.,Department of Biology, University of Scranton, Scranton, PA 18510, USA
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Communication and decision-making regarding children with critical cardiac disease: a systematic review of family preferences. Cardiol Young 2018; 28:1088-1092. [PMID: 30062980 DOI: 10.1017/s1047951118001233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Critical heart disease in the pediatric population is associated with high morbidity and mortality. Research around the most effective communication and decision-making strategies is lacking. This systematic review aims to summarise what is known about parent preference for communication and decision-making in children with critical heart disease. Database searches included key words such as family, pediatric heart disease, communication, and decision-making. A total of 10 studies fit our inclusion criteria: nine were qualitative studies with parent interviews and one study was quantitative with a parent survey. We found three main themes regarding physician-parent communication and decision-making in the context of paediatric heart disease: (1) amount, timing, and content of information provided to parents; (2) helpful physician characteristics and communication styles; and (3) reinforcing the support circle for families.
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Ouh YT, Park JH, Ahn KH, Hong SC, Oh MJ, Kim HJ, Han SW, Cho GJ. Recurrent Risk of Preterm Birth in the Third Pregnancy in Korea. J Korean Med Sci 2018; 33:e170. [PMID: 29892210 PMCID: PMC5990443 DOI: 10.3346/jkms.2018.33.e170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth. METHODS Study data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014. RESULTS Preterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at < 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94-9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at < 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45-6.58). CONCLUSION We found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Sung Won Han
- Division of Industrial Management Engineering, Korea University College of Engineering, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Rivera-Rueda M, Fernández-Carrocera L, Michel-Macías C, Carrera-Muiños S, Arroyo-Cabrales L, Coronado-Zarco I, Cardona-Pérez J. Morbilidad y mortalidad de neonatos < 1,500 g ingresados a la UCIN de un hospital de tercer nivel de atención. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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May R, Thompson J. The Role of Pediatric Palliative Care in Complex Congenital Heart Disease: Three Illustrative Cases. J Palliat Med 2017; 20:1300-1303. [DOI: 10.1089/jpm.2017.0047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rachna May
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jess Thompson
- Department of Cardiothoracic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Wellons JC, Shannon CN, Holubkov R, Riva-Cambrin J, Kulkarni AV, Limbrick DD, Whitehead W, Browd S, Rozzelle C, Simon TD, Tamber MS, Oakes WJ, Drake J, Luerssen TG, Kestle J. Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study. J Neurosurg Pediatr 2017; 20:19-29. [PMID: 28452657 DOI: 10.3171/2017.1.peds16496] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Previous Hydrocephalus Clinical Research Network (HCRN) retrospective studies have shown a 15% difference in rates of conversion to permanent shunts with the use of ventriculosubgaleal shunts (VSGSs) versus ventricular reservoirs (VRs) as temporization procedures in the treatment of hydrocephalus due to high-grade intraventricular hemorrhage (IVH) of prematurity. Further research in the same study line revealed a strong influence of center-specific decision-making on shunt outcomes. The primary goal of this prospective study was to standardize decision-making across centers to determine true procedural superiority, if any, of VSGS versus VR as a temporization procedure in high-grade IVH of prematurity. METHODS The HCRN conducted a prospective cohort study across 6 centers with an approximate 1.5- to 3-year accrual period (depending on center) followed by 6 months of follow-up. Infants with premature birth, who weighed less than 1500 g, had Grade 3 or 4 IVH of prematurity, and had more than 72 hours of life expectancy were included in the study. Based on a priori consensus, decisions were standardized regarding the timing of initial surgical treatment, upfront shunt versus temporization procedure (VR or VSGS), and when to convert a VR or VSGS to a permanent shunt. Physical examination assessment and surgical technique were also standardized. The primary outcome was the proportion of infants who underwent conversion to a permanent shunt. The major secondary outcomes of interest included infection and other complication rates. RESULTS One hundred forty-five premature infants were enrolled and met criteria for analysis. Using the standardized decision rubrics, 28 infants never reached the threshold for treatment, 11 initially received permanent shunts, 4 were initially treated with endoscopic third ventriculostomy (ETV), and 102 underwent a temporization procedure (36 with VSGSs and 66 with VRs). The 2 temporization cohorts were similar in terms of sex, race, IVH grade, head (orbitofrontal) circumference, and ventricular size at temporization. There were statistically significant differences noted between groups in gestational age, birth weight, and bilaterality of clot burden that were controlled for in post hoc analysis. By Kaplan-Meier analysis, the 180-day rates of conversion to permanent shunts were 63.5% for VSGS and 74.0% for VR (p = 0.36, log-rank test). The infection rate for VSGS was 14% (5/36) and for VR was 17% (11/66; p = 0.71). The overall compliance rate with the standardized decision rubrics was noted to be 90% for all surgeons. CONCLUSIONS A standardized protocol was instituted across all centers of the HCRN. Compliance was high. Choice of temporization techniques in premature infants with IVH does not appear to influence rates of conversion to permanent ventricular CSF diversion. Once management decisions and surgical techniques are standardized across HCRN sites, thus minimizing center effect, the observed difference in conversion rates between VSGSs and VRs is mitigated.
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Affiliation(s)
- John C Wellons
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis N Shannon
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard Holubkov
- Data Coordinating Center, University of Utah, Salt Lake City, Utah
| | - Jay Riva-Cambrin
- Division of Neurosurgery, University of Calgary, Alberta, Canada
| | | | - David D Limbrick
- Department of Neurosurgery, Washington University St. Louis, Missouri
| | - William Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Samuel Browd
- Department of Neurosurgery, University of Washington Medical Center, Seattle, Washington
| | - Curtis Rozzelle
- Department of Neurosurgery, University of Alabama-Birmingham, Alabama
| | - Tamara D Simon
- Department of Pediatrics, University of Washington Medical Center, Seattle, Washington
| | - Mandeep S Tamber
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and
| | - W Jerry Oakes
- Department of Neurosurgery, University of Alabama-Birmingham, Alabama
| | - James Drake
- Department of Neurosurgery, University of Toronto, Ontario, Canada
| | - Thomas G Luerssen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - John Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Mahmoud T, Mujaibel K, Attia H, Zakaria Z, Yagan J, Gheith O, Halim MA, Nair P, Al-Otaibi T. Triplet Pregnancy in a Diabetic Mother With Kidney Transplant: Case Report and Review of the Literature. EXP CLIN TRANSPLANT 2017; 15:139-146. [PMID: 28260455 DOI: 10.6002/ect.mesot2016.p23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Triplet and higher-order multiple pregnancies can carry increased fetal and maternal complications. Reports of triplet pregnancies after kidney transplant are scarce and have been associated with perinatal complications. Presence of diabetes in such cases worsens both fetal and maternal outcomes. Here, we present a triplet pregnancy in a kidney transplant recipient with diabetes. We also reviewed the literature for causes, prevalence, and outcomes in association with chronic kidney disease, kidney transplant, and diabetes mellitus. The patient, a 31-year-female who received a living-donor kidney transplant, had a first-time pregnancy 6 years after transplant. Pregnancy was complicated by gestational diabetes, preeclampsia, and miscarriage. She continued to have postpartum-impaired glucose tolerance. She became pregnant again after 6 months but required insulin therapy during her third trimester. Pregnancy was terminated by cesarean section for a viable small boy. Two years later, she had triplet pregnancy after ovulation induction with clomiphene. Glycemic control was maintained using intensive insulin therapy guided by frequent home blood glucose monitoring (HbA1c was 5.8% at 22 wk). Both gynecologic care and nephrologic care were carried out through outpatient follow-up. Pregnancy was complicated by hypertension and mild renal dysfunction without proteinuria and ended in elective premature cesarean section at 32 weeks of gestation. She had 3 male babies with low birth weights (1320, 1380, 1275 g), with the largest baby developing sepsis and requiring an intensive care unit stay and then incubator for 49 days. The other 2 required incubators for 36 days. Their weights after 22 months were 9, 16, and 11 kg. The mother is now normotensive with normal renal function and impaired glucose tolerance. Care of diabetic kidney recipients with triplet pregnancy constitutes a special challenge requiring a multispecialty skilled team to ensure the best outcome.
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Affiliation(s)
- Tarek Mahmoud
- Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait
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Drommelschmidt K, Serdar M, Bendix I, Herz J, Bertling F, Prager S, Keller M, Ludwig AK, Duhan V, Radtke S, de Miroschedji K, Horn PA, van de Looij Y, Giebel B, Felderhoff-Müser U. Mesenchymal stem cell-derived extracellular vesicles ameliorate inflammation-induced preterm brain injury. Brain Behav Immun 2017; 60:220-232. [PMID: 27847282 DOI: 10.1016/j.bbi.2016.11.011] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/04/2016] [Accepted: 11/12/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Preterm brain injury is a major cause of disability in later life, and may result in motor, cognitive and behavioural impairment for which no treatment is currently available. The aetiology is considered as multifactorial, and one underlying key player is inflammation leading to white and grey matter injury. Extracellular vesicles secreted by mesenchymal stem/stromal cells (MSC-EVs) have shown therapeutic potential in regenerative medicine. Here, we investigated the effects of MSC-EV treatment on brain microstructure and maturation, inflammatory processes and long-time outcome in a rodent model of inflammation-induced brain injury. METHODS 3-Day-old Wistar rats (P3) were intraperitoneally injected with 0.25mg/kg lipopolysaccharide or saline and treated with two repetitive doses of 1×108 cell equivalents of MSC-EVs per kg bodyweight. Cellular degeneration and reactive gliosis at P5 and myelination at P11 were evaluated by immunohistochemistry and western blot. Long-term cognitive and motor function was assessed by behavioural testing. Diffusion tensor imaging at P125 evaluated long-term microstructural white matter alterations. RESULTS MSC-EV treatment significantly ameliorated inflammation-induced neuronal cellular degeneration reduced microgliosis and prevented reactive astrogliosis. Short-term myelination deficits and long-term microstructural abnormalities of the white matter were restored by MSC-EV administration. Morphological effects of MSC-EV treatment resulted in improved long-lasting cognitive functions INTERPRETATION: MSC-EVs ameliorate inflammation-induced cellular damage in a rat model of preterm brain injury. MSC-EVs may serve as a novel therapeutic option by prevention of neuronal cell death, restoration of white matter microstructure, reduction of gliosis and long-term functional improvement.
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Affiliation(s)
- Karla Drommelschmidt
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Meray Serdar
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ivo Bendix
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Josephine Herz
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Frederik Bertling
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sebastian Prager
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Matthias Keller
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Anna-Kristin Ludwig
- Institute of Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vikas Duhan
- Institute of Immunology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Stefan Radtke
- Institute of Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; Clinical Research Division, Fred Hutchinson Cancer Research Centre, Seattle, WA 98109, USA
| | - Kyra de Miroschedji
- Institute of Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Peter A Horn
- Institute of Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yohan van de Looij
- Division of Child Growth and Development, Department of Paediatrics, University of Geneva, Geneva, Switzerland; Laboratory of Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bernd Giebel
- Institute of Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
| | - Ursula Felderhoff-Müser
- Department of Paediatrics I/Neonatology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Šuláková T, Feber J, Strnadel J, Pavlíček J, Obermannová B, Petruželková L, Seeman T, Šumník Z. The importance of pulse wave velocity measurement in paediatric population with an increased risk of cardiovascular diseases - Type 1 diabetes and chronic kidney disease. COR ET VASA 2016. [DOI: 10.1016/j.crvasa.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Effect of Creating Opportunities for Parent Empowerment Program on Parent’s Mental Health: A Systematic Review. IRANIAN JOURNAL OF PEDIATRICS 2016. [DOI: 10.5812/ijp.5704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kim DH, Jeon J, Park CG, Sriram S, Lee KS. Neonatal and Infant Mortality in Korea, Japan, and the U.S.: Effect of Birth Weight Distribution and Birth Weight-Specific Mortality Rates. J Korean Med Sci 2016; 31:1450-4. [PMID: 27510390 PMCID: PMC4974188 DOI: 10.3346/jkms.2016.31.9.1450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/29/2016] [Indexed: 11/20/2022] Open
Abstract
Difference in crude neonatal and infant mortality rates (NMR and IMR) among different countries is due to the differences in its two determinants: birth weight distribution (BWD) and birth weight-specific mortality rates (BW-SMRs). We aimed to determine impact of BWD and BW-SMRs on differences in crude NMR and IMR among Korea, Japan, and the U.S. Our study used the live birth data of the period 2009 through 2010. Crude NMR/IMR are the lowest in Japan, 1.1/2.1, compared to 1.8/3.2, in Korea, and 4.1/6.2, in the U.S., respectively. Japanese had the best BW-SMRs of all birth weight groups compared to the Koreans and the U.S. The U.S. BWD was unfavorable with very low birth weight (< 1,500 g) rate of 1.4%, compared to 0.6% in Korea, and 0.8% in Japan. If Koreans and Japanese had the same BWD as in the U.S., their crude NMR/IMR would be 3.9/6.1 for the Koreans and 1.5/2.5 for the Japanese. If both Koreans and Japanese had the same BW-SMRs as in the U.S., the crude NMR/IMR would be 2.0/3.8 for the Koreans and 2.7/5.0 for the Japanese. In conclusion, compared to the U.S., lower crude NMR or IMR in Japan is mainly attributable to its better BW-SMRs. Koreans had lower crude NMR and IMR, primarily from its favorable BWD. Comparing crude NMR or IMR among different countries should include further exploration of its two determinants, BW-SMRs reflecting medical care, and BWD reflecting socio-demographic conditions.
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Affiliation(s)
- Do Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jihyun Jeon
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
| | - Chang Gi Park
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Sudhir Sriram
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
| | - Kwang Sun Lee
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, USA
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Management of post-haemorrhagic hydrocephalus in premature infants. J Clin Neurosci 2016; 31:30-4. [DOI: 10.1016/j.jocn.2016.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/29/2016] [Indexed: 11/23/2022]
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Intracranial Hypertension and Cerebral Hypoperfusion in Children With Severe Traumatic Brain Injury: Thresholds and Burden in Accidental and Abusive Insults. Pediatr Crit Care Med 2016; 17:444-50. [PMID: 27028792 PMCID: PMC4856573 DOI: 10.1097/pcc.0000000000000709] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The evidence to guide therapy in pediatric traumatic brain injury is lacking, including insight into the intracranial pressure/cerebral perfusion pressure thresholds in abusive head trauma. We examined intracranial pressure/cerebral perfusion pressure thresholds and indices of intracranial pressure and cerebral perfusion pressure burden in relationship with outcome in severe traumatic brain injury and in accidental and abusive head trauma cohorts. DESIGN A prospective observational study. SETTING PICU in a tertiary children's hospital. PATIENTS Children less than18 years old admitted to a PICU with severe traumatic brain injury and who had intracranial pressure monitoring. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A pediatric traumatic brain injury database was interrogated with 85 patients (18 abusive head trauma) enrolled. Hourly intracranial pressure and cerebral perfusion pressure (in mm Hg) were collated and compared with various thresholds. C-statistics for intracranial pressure and cerebral perfusion pressure data in the entire population were determined. Intracranial hypertension and cerebral hypoperfusion indices were formulated based on the number of hours with intracranial pressure more than 20 mm Hg and cerebral perfusion pressure less than 50 mm Hg, respectively. A secondary analysis was performed on accidental and abusive head trauma cohorts. All of these were compared with dichotomized 6-month Glasgow Outcome Scale scores. The models with the number of hours with intracranial pressure more than 20 mm Hg (C = 0.641; 95% CI, 0.523-0.762) and cerebral perfusion pressure less than 45 mm Hg (C = 0.702; 95% CI, 0.586-0.805) had the best fits to discriminate outcome. Two factors were independently associated with a poor outcome, the number of hours with intracranial pressure more than 20 mm Hg and abusive head trauma (odds ratio = 5.101; 95% CI, 1.571-16.563). As the number of hours with intracranial pressure more than 20 mm Hg increases by 1, the odds of a poor outcome increased by 4.6% (odds ratio = 1.046; 95% CI, 1.012-1.082). Thresholds did not differ between accidental versus abusive head trauma. The intracranial hypertension and cerebral hypoperfusion indices were both associated with outcomes. CONCLUSIONS The duration of hours of intracranial pressure more than 20 mm Hg and cerebral perfusion pressure less than 45 mm Hg best discriminated poor outcome. As the number of hours with intracranial pressure more than 20 mm Hg increases by 1, the odds of a poor outcome increased by 4.6%. Although abusive head trauma was strongly associated with unfavorable outcome, intracranial pressure/cerebral perfusion pressure thresholds did not differ between accidental and abusive head trauma.
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Brooten D, Youngblut JM, Caicedo C, Seagrave L, Cantwell GP, Totapally B. Cause of Death of Infants and Children in the Intensive Care Unit: Parents' Recall vs Chart Review. Am J Crit Care 2016; 25:235-42. [PMID: 27134230 DOI: 10.4037/ajcc2016233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND More than 55 000 children die annually in the United States, most in neonatal and pediatric intensive care units. Because of the stress and emotional turmoil of the deaths, the children's parents have difficulty comprehending information. OBJECTIVES To compare parents' reports and hospital chart data on cause of death and examine agreement on cause of death according to parents' sex, race, participation in end-of-life decisions, and discussion with physicians; deceased child's age; unit of care (neonatal or pediatric); and hospital and intensive care unit lengths of stay. METHODS A descriptive, correlational design was used with a structured interview of parents 1 month after the death and review of hospital chart data. Parents whose children died in intensive care were recruited from 4 South Florida hospitals and from Florida Department of Health death records. RESULTS Among 230 parents, 54% of mothers and 40% of fathers agreed with the chart cause of death. Agreement did not differ significantly for mothers or fathers by race/ethnicity, participation in end-of-life decisions, discussions with physicians, or mean length of hospital stay. Agreement was better for mothers when the stay in the intensive care unit was the shortest. Fathers' agreement with chart data was best when the deceased was an infant and death was in the pediatric intensive care unit. CONCLUSIONS Death of a child is a time of high stress when parents' concentration, hearing, and information processing are diminished. Many parents have misconceptions about the cause of the death 1 month after the death.
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Affiliation(s)
- Dorothy Brooten
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida.
| | - JoAnne M Youngblut
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida
| | - Carmen Caicedo
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida
| | - Lynn Seagrave
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida
| | - G Patricia Cantwell
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida
| | - Balagangadhar Totapally
- Dorothy Brooten is a professor, JoAnne M. Youngblut is the Dr Herbert and Nicole Wertheim Professor, Carmen Caicedo is an assistant professor, and Lynn Seagrave is a project manager, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, Florida. G. Patricia Cantwell is division chief, Pediatric Critical Care Medicine, University of Miami School of Medicine, Miami, Florida. Balagangadhar Totapally is a clinical professor, Herbert Wertheim College of Medicine, Florida International University, and medical director, Pediatric Intensive Care Unit, Miami Children's Hospital, Miami, Florida
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Koshida S, Yanagi T, Ono T, Tsuji S, Takahashi K. Possible Prevention of Neonatal Death: A Regional Population-Based Study in Japan. Yonsei Med J 2016; 57:426-9. [PMID: 26847296 PMCID: PMC4740536 DOI: 10.3349/ymj.2016.57.2.426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/06/2015] [Accepted: 07/06/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The neonatal mortality rate in Japan has currently been at the lowest level in the world. However, it is unclear whether there are still some potentially preventable neonatal deaths. We, therefore, aimed to examine the backgrounds of neonatal death and the possibilities of prevention in a region of Japan. MATERIALS AND METHODS This is a population-based study of neonatal death in Shiga Prefecture of Japan. RESULTS The 103 neonatal deaths in our prefecture between 2007 and 2011 were included. After reviewing by a peer-review team, we classified the backgrounds of these neonatal deaths and analyzed end-of-life care approaches associated with prenatal diagnosis. Furthermore, we evaluated the possibilities of preventable neonatal death, suggesting specific recommendations for its prevention. We analyzed 102 (99%) of the neonatal deaths. Congenital malformations and extreme prematurity were the first and the second most common causes of death, respectively. More than half of the congenital abnormalities (59%) including malformations and chromosome abnormality had been diagnosed before births. We had 22 neonates with non-intensive care including eighteen cases with congenital abnormality and four with extreme prematurity. Twenty three cases were judged to have had some possibility of prevention with one having had a strong possibility of prevention. Among specific recommendations of preventable neonatal death, more than half of them were for obstetricians. CONCLUSION There is room to reduce neonatal deaths in Japan. Prevention of neonatal death requires grater prenatal care by obstetricians before birth rather than improved neonatal care by neonatologists after birth.
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Affiliation(s)
- Shigeki Koshida
- Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan.
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuo Ono
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Kentaro Takahashi
- Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan
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Landrigan PJ, Sly JL, Ruchirawat M, Silva ER, Huo X, Diaz-Barriga F, Zar HJ, King M, Ha EH, Asante KA, Ahanchian H, Sly PD. Health Consequences of Environmental Exposures: Changing Global Patterns of Exposure and Disease. Ann Glob Health 2016; 82:10-9. [PMID: 27325064 DOI: 10.1016/j.aogh.2016.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Environmental pollution is a major cause of disease and death. Exposures in early life are especially dangerous. Patterns of exposure vary greatly across countries. In low-income and lower middle income countries (LMICs), infectious, maternal, neonatal, and nutritional diseases are still major contributors to disease burden. By contrast, in upper middle income and high-income countries noncommunicable diseases predominate. To examine patterns of environmental exposure and disease and to relate these patterns to levels of income and development, we obtained publically available data in 12 countries at different levels of development through a global network of World Health Organization Collaborating Centres in Children's Environmental Health. Pollution exposures in early life contribute to both patterns. Chemical and pesticide pollution are increasing, especially in LMICs. Hazardous wastes, including electronic waste, are accumulating. Pollution-related chronic diseases are becoming epidemic. Future Global Burden of Disease estimates must pay increased attention to the short- and long-term consequences of environmental pollution.
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Affiliation(s)
| | - J Leith Sly
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia
| | | | | | - Xia Huo
- Shantou University Medical College, Shantou, China
| | | | - Heather J Zar
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Malcolm King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Eun-Hee Ha
- Ewah Womans University, Seoul, Republic of South Korea
| | | | | | - Peter D Sly
- Children's Health and Environment Program, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
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Hawthorne DM, Youngblut JM, Brooten D. Parent Spirituality, Grief, and Mental Health at 1 and 3 Months After Their Infant's/Child's Death in an Intensive Care Unit. J Pediatr Nurs 2016; 31:73-80. [PMID: 26320884 PMCID: PMC4975148 DOI: 10.1016/j.pedn.2015.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The death of an infant/child is one of the most devastating experiences for parents and immediately throws them into crisis. Research on the use of spiritual/religious coping strategies is limited, especially with Black and Hispanic parents after a neonatal (NICU) or pediatric intensive care unit (PICU) death. PURPOSE The purpose of this longitudinal study was to test the relationships between spiritual/religious coping strategies and grief, mental health (depression and post-traumatic stress disorder) and personal growth for mothers and fathers at 1 (T1) and 3 (T2) months after the infant's/child's death in the NICU/PICU, with and without control for race/ethnicity and religion. RESULTS Bereaved parents' greater use of spiritual activities was associated with lower symptoms of grief, mental health (depression and post-traumatic stress), but not post-traumatic stress in fathers. Use of religious activities was significantly related to greater personal growth for mothers, but not fathers. CONCLUSION Spiritual strategies and activities helped parents cope with their grief and helped bereaved mothers maintain their mental health and experience personal growth.
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Affiliation(s)
- Dawn M Hawthorne
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL.
| | - JoAnne M Youngblut
- Dr. Herbert & Nicole Wertheim Professor in Prevention and Family Health, Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing & Health Sciences, Florida International University, Miami, FL
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Chow S, Chow R, Popovic M, Lam M, Popovic M, Merrick J, Stashefsky Margalit RN, Lam H, Milakovic M, Chow E, Popovic J. A Selected Review of the Mortality Rates of Neonatal Intensive Care Units. Front Public Health 2015; 3:225. [PMID: 26501049 PMCID: PMC4595739 DOI: 10.3389/fpubh.2015.00225] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Newborn babies in need of critical medical attention are normally admitted to the neonatal intensive care unit (NICU). These infants tend to be preterm, have low birth weight, and/or have serious medical conditions. Neonatal survival varies, but progress in perinatal and neonatal care has notably diminished mortality rates. In this selected review, we examine and compare the NICU mortality rates and etiologies of death in different countries. METHODS A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, and EMBASE. The primary endpoint was the mortality rates in NICUs. Secondary endpoints included the reasons for death and the correlation between infant age and mortality outcome. For the main analysis, we examined all infants admitted to NICUs. Subgroup analyses included extremely low birth weight infants (based on the authors' own definition), very low birth weight infants, very preterm infants, preterm infants, preterm infants with a birth weight of ≤1,500 g, and by developed and developing countries. RESULTS The literature search yielded 1,865 articles, of which 20 were included. The total mortality rates greatly varied among countries. Infants in developed and developing countries had similar ages at death, ranging from 4 to 20 days and 1 to 28.9 days, respectively. The mortality rates ranged from 4 to 46% in developed countries and 0.2 to 64.4% in developing countries. CONCLUSION The mortality rates of NICUs vary between nations but remain high in both developing and developed countries.
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Affiliation(s)
- Selina Chow
- Toronto East General Hospital , Toronto, ON , Canada
| | - Ronald Chow
- Toronto East General Hospital , Toronto, ON , Canada
| | - Mila Popovic
- Toronto East General Hospital , Toronto, ON , Canada
| | - Michael Lam
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | - Marko Popovic
- Toronto East General Hospital , Toronto, ON , Canada
| | - Joav Merrick
- Health Services, Division for Intellectual and Developmental Disabilities, National Institute of Child Health and Human Development, Ministry of Social Affairs , Jerusalem , Israel
| | - Ruth Naomi Stashefsky Margalit
- MSR Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer National Education Center , Ramat Gan , Israel
| | - Henry Lam
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | | | - Edward Chow
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
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Maternal/neonatal vitamin D deficiency: a risk factor for bronchopulmonary dysplasia in preterms? J Perinatol 2015; 35:813-7. [PMID: 26226242 DOI: 10.1038/jp.2015.88] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/23/2015] [Accepted: 06/02/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the possible association between maternal/neonatal 25-hydroxy vitamin D (25-OHD) levels and development of bronchopulmonary dysplasia. STUDY DESIGN One hundred and thirty-two preterm infants ⩽32 weeks of gestation who were diagnosed with respiratory distress syndrome were enrolled. 25-OHD levels were determined in maternal/neonatal blood samples that were obtained at the time of admission to the neonatal intensive care unit. RESULT A total of 100 infants were included and 31 (31%) developed bronchopulmonary dysplasia (BPD). Both maternal and neonatal 25-OHD levels in the BPD group were significantly lower compared with those in the no-BPD group (P=0.0001). A positive correlation was detected between maternal and neonatal 25-OHD levels. All of the infants with BPD had a 25-OHD level <10 ng ml(-1), which represented severe deficiency. Univariate logistic regression analysis revealed that maternal/neonatal vitamin D levels were a significant predictor of BPD (odds ratio (OR): 0.76 and 0.61, respectively, P<0.001). CONCLUSION We demonstrated for the first time that lower maternal and neonatal vitamin 25-OHD levels were associated with BPD development in preterm infants. However, further studies with larger sample sizes are needed to delineate the possible link between vitamin D deficiency and BPD.
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Abstract
PURPOSE OF REVIEW To provide an overview of the literature regarding medical and developmental risks for moderate to late preterm infants (32-36 weeks gestation), with particular attention to the pediatrician's role in care during both inpatient and outpatient periods. RECENT FINDINGS Although the risks of medical issues and developmental delays decrease with increasing gestational age, research suggests that infants born after 32 weeks' gestation often exhibit significant morbidities associated with prematurity. These infants, often referred to as 'macro preemies', have been found to be at a greater risk for medical complications secondary to immature organ systems including impairments in temperature regulation, respiratory functioning, feeding coordination, bilirubin excretion, glucose control, and infection susceptibility. Recent studies of macro preemies also suggest a higher incidence of significant deficits noted in gross and fine motor skills, speech and communication, and learning and behavior compared to their full-term counterparts. Without careful attention from birth, macro preemie infants could be susceptible to both medical issues and developmental delays. SUMMARY Physicians should be aware of the research regarding increased medical and developmental risks for all infants born before term in order to provide their patients with comprehensive medical and neurodevelopmental follow-up care.
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Boss RD, Hutton N, Griffin PL, Wieczorek BH, Donohue PK. Novel legislation for pediatric advance directives: surveys and focus groups capture parent and clinician perspectives. Palliat Med 2015; 29:346-53. [PMID: 25670471 DOI: 10.1177/0269216315571020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Legislative measures increasingly require consideration of pediatric inpatients for Medical Orders for Life-Sustaining Treatment. AIM To explore pediatric clinicians' experiences with life-sustaining treatments prior to the Medical Orders for Life-Sustaining Treatment mandate and to describe clinician and family concerns and preferences regarding pediatric Medical Orders for Life-Sustaining Treatment. DESIGN Clinician surveys and clinician and parent focus groups. SETTING/PARTICIPANTS Pediatric clinicians and parents from one of Maryland's largest health systems. RESULTS Of 96 survey respondents, 72% were physicians and 28% were nurse practitioners. A total of 73% of physicians and 34% of nurse practitioners felt able to lead discussions about limiting therapies "most" or "all" of the time. A total of 75% of physicians and 37% of nurse practitioners led such a discussion in the prior year. A total of 55% of physicians and 96% of nurse practitioners had written no order to limit therapies in the past year. Only for children predicted to die within 30 days did >80% of clinicians agree that limitation discussions were warranted. A total of 100% of parent focus group participants, but 17% of physicians and 33% of nurse practitioners, thought that all pediatric inpatients warranted Medical Orders for Life-Sustaining Treatment discussions. Parents felt that universal Medical Orders for Life-Sustaining Treatment would decrease the stigma of limitation discussions. Participants believed that Medical Orders for Life-Sustaining Treatment would clarify decision making and increase utilization of palliative care. Medical Orders for Life-Sustaining Treatment communication skills training was recommended by all. CONCLUSION A minority of clinicians, but all parents, support universal pediatric Medical Orders for Life-Sustaining Treatment. Immediately prior to the Medical Orders for Life-Sustaining Treatment mandate, many clinicians felt unprepared to lead limitation discussions, and few had written relevant orders in the prior year. Communication training is perceived essential to successful Medical Orders for Life-Sustaining Treatment conversations.
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Affiliation(s)
- Renee D Boss
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Nancy Hutton
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela L Griffin
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Beth H Wieczorek
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pamela K Donohue
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lake ET, Staiger D, Horbar J, Kenny MJ, Patrick T, Rogowski JA. Disparities in perinatal quality outcomes for very low birth weight infants in neonatal intensive care. Health Serv Res 2015; 50:374-97. [PMID: 25250882 PMCID: PMC4369214 DOI: 10.1111/1475-6773.12225] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics. DATA SOURCES Nurse survey and VLBW infant registry data. STUDY DESIGN Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk. DATA COLLECTION Primary nurse survey (N = 5,773, 77 percent response rate). PRINCIPAL FINDINGS VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities. CONCLUSIONS Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country.
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Affiliation(s)
- Eileen T Lake
- Address correspondence to Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania, 302 Claire M. Fagin Hall, Philadelphia, PA 19104; e-mail:
| | - Douglas Staiger
- Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania302 Claire M. Fagin Hall, Philadelphia, PA 19104
- Douglas Staiger, Ph.D., is with the Department of Economics, Dartmouth CollegeHanover, NH
- Jeffrey Horbar, M.D., is with the Department of Pediatrics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Michael J. Kenny, M.S., is with the Department of Medical Biostatistics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Thelma Patrick, Ph.D., R.N., is with the College of Nursing, The Ohio State UniversityColumbus, OH
- Jeannette A. Rogowski, Ph.D., is with the Department of Health Systems and Policy, School of Public Health, Rutgers, The State University of New JerseyPiscataway, NJ
| | - Jeffrey Horbar
- Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania302 Claire M. Fagin Hall, Philadelphia, PA 19104
- Douglas Staiger, Ph.D., is with the Department of Economics, Dartmouth CollegeHanover, NH
- Jeffrey Horbar, M.D., is with the Department of Pediatrics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Michael J. Kenny, M.S., is with the Department of Medical Biostatistics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Thelma Patrick, Ph.D., R.N., is with the College of Nursing, The Ohio State UniversityColumbus, OH
- Jeannette A. Rogowski, Ph.D., is with the Department of Health Systems and Policy, School of Public Health, Rutgers, The State University of New JerseyPiscataway, NJ
| | - Michael J Kenny
- Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania302 Claire M. Fagin Hall, Philadelphia, PA 19104
- Douglas Staiger, Ph.D., is with the Department of Economics, Dartmouth CollegeHanover, NH
- Jeffrey Horbar, M.D., is with the Department of Pediatrics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Michael J. Kenny, M.S., is with the Department of Medical Biostatistics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Thelma Patrick, Ph.D., R.N., is with the College of Nursing, The Ohio State UniversityColumbus, OH
- Jeannette A. Rogowski, Ph.D., is with the Department of Health Systems and Policy, School of Public Health, Rutgers, The State University of New JerseyPiscataway, NJ
| | - Thelma Patrick
- Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania302 Claire M. Fagin Hall, Philadelphia, PA 19104
- Douglas Staiger, Ph.D., is with the Department of Economics, Dartmouth CollegeHanover, NH
- Jeffrey Horbar, M.D., is with the Department of Pediatrics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Michael J. Kenny, M.S., is with the Department of Medical Biostatistics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Thelma Patrick, Ph.D., R.N., is with the College of Nursing, The Ohio State UniversityColumbus, OH
- Jeannette A. Rogowski, Ph.D., is with the Department of Health Systems and Policy, School of Public Health, Rutgers, The State University of New JerseyPiscataway, NJ
| | - Jeannette A Rogowski
- Eileen T. Lake, Ph.D., R.N., Center for Health Outcomes and Policy Research, School of Nursing, Department of Sociology, Leonard Davis Institute of Health Economics, University of Pennsylvania302 Claire M. Fagin Hall, Philadelphia, PA 19104
- Douglas Staiger, Ph.D., is with the Department of Economics, Dartmouth CollegeHanover, NH
- Jeffrey Horbar, M.D., is with the Department of Pediatrics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Michael J. Kenny, M.S., is with the Department of Medical Biostatistics, University of Vermont, Vermont Oxford NetworkBurlington, VT
- Thelma Patrick, Ph.D., R.N., is with the College of Nursing, The Ohio State UniversityColumbus, OH
- Jeannette A. Rogowski, Ph.D., is with the Department of Health Systems and Policy, School of Public Health, Rutgers, The State University of New JerseyPiscataway, NJ
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Tucker Edmonds B, Mogul M, Shea JA. Understanding low-income African American women's expectations, preferences, and priorities in prenatal care. FAMILY & COMMUNITY HEALTH 2015; 38:149-157. [PMID: 25739062 DOI: 10.1097/fch.0000000000000066] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We aimed to explore factors affecting prenatal care attendance and preferences for prenatal care experiences among low-income black women by conducting a focus group study using a community-based participatory research framework and nominal group technique. Discussions were audiorecorded, transcribed, and coded by trained reviewers. Friends/family and baby's health were the top attendance motivators. Greatest barriers were insurance, transportation, and ambivalence. Facilitators included transportation services, social support, and resource education. In a "perfect system," women wanted continuity of care, personal connection, and caring/respect from providers. Relationship-centered maternity care models may mitigate disparities. Group prenatal care may provide the continuity and support system desired.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Indiana University School of Medicine, Obstetrics & Gynecology, Indianapolis (Dr Tucker Edmonds); Maternity Care Coalition, Philadelphia, Pennsylvania (Dr Mogul); and University of Pennsylvania School of Medicine (Dr Shea)
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Abstract
The analysis of uterine EMG (electrohysterogram-EHG) records may help solve the problem of predicting pre-term labor. We investigated the adaptive autoregressive (AAR) method to estimate the EHG signal spectrograms and sample entropy, to separate and classify sets of term and pre-term delivery records, using the Term-Preterm EHG Database. The database contains four sets of records divided according to the time of delivery (term or pre-term: ⩾37 or < 37 weeks of gestation, respectively) and according to the time of recording (early or later: before or after the 26th week of gestation, respectively). Using the AAR method the term and pre-term delivery records recorded early can be separated (p = 0.002), as well as all term and pre-term delivery records (p < 0.001). Using the sample entropy, the results showed that all term and pre-term delivery records can be separated (p = 0.022). The spectra of the signals for term delivery records have the tendency of moving to lower frequencies as the time of pregnancy increases. We investigated a few classifiers to classify records between term and pre-term delivery sets. Using median frequency measurements and additional clinical information with the synthetic minority over-sampling technique, the quadratic discriminant analysis classifier achieved a 97% classification accuracy for the records recorded early, and 86% for all records regardless of the time of recording; while for the sample entropy measurements, for the same sets of records, using the support vector machine classifier, the classification accuracies were 80% and 87%, respectively.
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Affiliation(s)
- A Smrdel
- Faculty of Computer and Information Science, University of Ljubljana, Večna pot 113, 1000 Ljubljana, Slovenia
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Wogu AF, Loffredo CA, Bebu I, Luta G. Mediation analysis of gestational age, congenital heart defects, and infant birth-weight. BMC Res Notes 2014; 7:926. [PMID: 25515761 PMCID: PMC4320577 DOI: 10.1186/1756-0500-7-926] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 12/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study we assessed the mediation role of the gestational age on the effect of the infant's congenital heart defects (CHD) on birth-weight. METHODS We used secondary data from the Baltimore-Washington Infant Study (1981-1989). Mediation analysis was employed to investigate whether gestational age acted as a mediator of the association between CHD and reduced birth-weight. We estimated the mediated effect, the mediation proportion, and their corresponding 95% confidence intervals (CI) using several methods. RESULTS There were 3362 CHD cases and 3564 controls in the dataset with mean birth-weight of 3071 (SD = 729) and 3353 (SD = 603) grams, respectively; the mean gestational age was 38.9 (SD = 2.7) and 39.6 (SD = 2.2) weeks, respectively. After adjusting for covariates, the estimated mediated effect by gestational age was 113.5 grams (95% CI, 92.4-134.2) and the mediation proportion was 40.7% (95% CI, 34.7%-46.6%), using the bootstrap approach. CONCLUSIONS Gestational age may account for about 41% of the overall effect of heart defects on reduced infant birth-weight. Improved prenatal care and other public health efforts that promote full term delivery, particularly targeting high-risk families and mothers known to be carrying a fetus with CHD, may therefore be expected to improve the birth-weight of these infants and their long term health.
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Affiliation(s)
| | - Christopher A Loffredo
- Departments of Oncology and of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, 3800 Reservoir Rd, NW, Washington, DC 20057, USA.
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Balkin EM, Wolfe J, Ziniel SI, Lang P, Thiagarajan R, Dillis S, Fynn-Thompson F, Blume ED. Physician and parent perceptions of prognosis and end-of-life experience in children with advanced heart disease. J Palliat Med 2014; 18:318-23. [PMID: 25493354 DOI: 10.1089/jpm.2014.0305] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about how physician and parent perspectives compare regarding the prognosis and end-of-life (EOL) experience of children with advanced heart disease (AHD). OBJECTIVE The study's objective was to describe and compare parent and physician perceptions regarding prognosis and EOL experience in children with AHD. METHODS This was a cross-sectional survey study of cardiologists and bereaved parents. Study subjects were parents and cardiologists of children with primary cardiac diagnoses who died in a tertiary care pediatric hospital between January 2007 and December 2009. Inclusion required both physician and parent to have completed surveys respective to the same patient. A total of 31 parent/physician pairs formed the analytic sample. Perceptions were measured of cardiologists and bereaved parents regarding the EOL experience of children with AHD. RESULTS Nearly half of parents and physicians felt that patients suffered 'a great deal,' 'a lot,' or 'somewhat' at EOL, but there was no agreement between them. At diagnosis, parents more often expected complete repair and normal lifespan while the majority of physicians expected shortened lifespan without normal quality of life. Parents who expected complete repair with normal life were more likely to report 'a lot' of suffering at EOL (p=0.002). In 43% of cases, physicians reported that the parents were prepared for the way in which their child died, while the parents reported feeling unprepared. CONCLUSION Both parents and physicians perceive suffering at EOL in patients who die of AHD. Moreover, parent expectations at diagnosis may influence perceptions of suffering at EOL. Physicians overestimate the degree of parent preparedness for their child's death.
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Affiliation(s)
- Emily M Balkin
- 1 Department of Pediatrics, UCSF Benioff Children's Hospital , San Francisco, California
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Parry S, Zhang H, Biggio J, Bukowski R, Varner M, Xu Y, Andrews WW, Saade GR, Esplin MS, Leite R, Ilekis J, Reddy UM, Sadovsky Y, Blair IA. Maternal serum serpin B7 is associated with early spontaneous preterm birth. Am J Obstet Gynecol 2014; 211:678.e1-12. [PMID: 24954659 DOI: 10.1016/j.ajog.2014.06.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/31/2014] [Accepted: 06/16/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to identify serum biomarkers of early spontaneous preterm birth (SPTB) using semiquantitative proteomic analyses. STUDY DESIGN This was a nested case-control study of pregnant women with previous SPTB. Maternal serum was collected at 19-24 and 28-32 weeks' gestation, and analyzed by liquid chromatography-multiple reaction monitoring/mass spectrometry. Targeted and shotgun proteomics identified 31 candidate proteins that were differentially expressed in pooled serum samples from spontaneous preterm (cases [<34 weeks]) and term (controls) deliveries. Candidate protein expression was compared in individual serum samples between cases and controls matched by age and race groups, and clinical site. Protein expression was verified by Western blot in the placenta and fetal membranes from cases and controls. RESULTS Serum samples were available for 35 cases and 35 controls at 19-24 weeks, and 16 cases and 16 controls at 28-32 weeks. One protein, serpin B7, yielded serum concentrations that differed between cases and controls. The mean concentration of serpin B7 at 28-32 weeks was 1.5-fold higher in women with subsequent preterm deliveries compared to controls; there was no difference at 19-24 weeks. Higher levels of serpin B7 at both gestational age windows were associated with a shorter interval to delivery, and higher levels of serpin B7 in samples from 28-32 weeks were associated with a lower gestational age at delivery. Western blotting identified serpin B7 protein in placenta, amnion, and chorion from cases and controls. CONCLUSION Targeted and shotgun serum proteomics analyses associated 1 protein, serpin B7, with early SPTB. Our results require validation in other cohorts and analysis of the possible mechanistic role of serpin B7 in parturition.
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Affiliation(s)
- Samuel Parry
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA.
| | - Heping Zhang
- Collaborative Center for Statistics in Science, Yale University School of Public Health, New Haven, CT
| | - Joseph Biggio
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, School of Medicine, Birmingham, AL
| | - Radek Bukowski
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Michael Varner
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Yaji Xu
- Collaborative Center for Statistics in Science, Yale University School of Public Health, New Haven, CT
| | - William W Andrews
- Department of Obstetrics and Gynecology, University of Alabama, Birmingham, School of Medicine, Birmingham, AL
| | - George R Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - M Sean Esplin
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Rita Leite
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - John Ilekis
- Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Uma M Reddy
- Pregnancy and Perinatology Branch, Center for Developmental Biology and Perinatal Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
| | - Yoel Sadovsky
- Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ian A Blair
- Center for Cancer Pharmacology, University of Pennsylvania School of Medicine, Philadelphia, PA
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Wang Y, He C, Li X, Miao L, Zhu J, Liang J. Nationwide study of injury-related deaths among children aged 1-4 years in China, 2000-2008. J Paediatr Child Health 2014; 50:E94-E101. [PMID: 22897239 DOI: 10.1111/j.1440-1754.2012.02525.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. METHODS The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. RESULTS During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year (P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% (P < 0.001; 95% CI: 2.5-7.1%) and 9.9% (P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year (P < 0.001; 95% CI: 2.6-8.0%) and 6.1% (P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years. CONCLUSION Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury.
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Affiliation(s)
- Yanping Wang
- National Office for Maternal and Child Health Surveillance of China, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Liberman DB, Pham PK, Nager AL. Pediatric advance directives: parents' knowledge, experience, and preferences. Pediatrics 2014; 134:e436-43. [PMID: 25002672 DOI: 10.1542/peds.2013-3124] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore parents' and caregivers' experience, knowledge, and preferences regarding advance directives (ADs) for children who have chronic illness. METHODS We conducted a prospective, cross-sectional survey of parents and caregivers of children who have chronic illness. During ambulatory medical visits, participants were asked about previous AD experience and knowledge, future preferences regarding AD discussions, their child's past and current health status, and family demographics. RESULTS Among 307 participants surveyed, previous AD experience was low, with 117 (38.1%) having heard of an AD, 54 (17.6%) having discussed one, and 77 (25.1%) having known someone who had an AD. Furthermore, 27 (8.8%) participants had an AD or living will of their own, and 8 (2.6%) reported that their chronically ill child had an AD. Previous AD knowledge was significantly more likely among parents and caregivers who had a college degree than those who did not have a high school diploma, yet significantly less likely among primarily Spanish-speaking parents and caregivers than those primarily English-speaking. Interest in creating an AD for the child was reported by 151 (49.2%) participants, and was significantly more likely among families who had more frequent emergency department visits over the previous year. CONCLUSIONS The limited AD experience and knowledge of parents and caregivers of children who have chronic illness and their interest in creating an AD suggest an unmet need among families of children who have chronic illness, and an opportunity to enhance communication between families and medical teams regarding ADs and end-of-life care.
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Affiliation(s)
- Danica B Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California; andDepartment of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Phung K Pham
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California; and
| | - Alan L Nager
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Los Angeles, California; andDepartment of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Parental perspectives on suffering and quality of life at end-of-life in children with advanced heart disease: an exploratory study*. Pediatr Crit Care Med 2014; 15:336-42. [PMID: 24583501 DOI: 10.1097/pcc.0000000000000072] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe parent perspectives regarding the end-of-life experience of children with advanced heart disease. DESIGN Cross-sectional multicenter survey study of bereaved parents. SETTING Two tertiary care pediatric hospitals. SUBJECTS Parents of children younger than 21 years with primary cardiac diagnoses who died in the hospital 9 months to 4 years before the survey date. Parents were excluded if they were non-English speakers or had previously denied permission to contact. INTERVENTION The Survey for Caring for Children with Advanced Heart Disease was developed, piloted, and then sent to parents of all children who died at two sites. MEASUREMENTS AND MAIN RESULTS Fifty bereaved parents responded (39% response rate) a mean of 2.7 years after their child's death. Median age at death was 6 months (3.6 d to 20.4 yr). At end-of-life, 86% of children were intubated and 46% were receiving mechanical circulatory support. Seventy-eight percent died during withdrawal of life-sustaining interventions and 16% during resuscitative efforts. Parents realized that their child had no realistic chance of survival a median of 2 days prior to death (0-30 d). According to parents, 47% of children suffered "a great deal," "a lot," or "somewhat" during the end-of-life period. The symptoms parents perceived to be causing the most suffering were breathing and feeding difficulties in children under 2 years and fatigue and sleeping difficulties in older children. Seventy-one percent of parents described the quality of life of their child during the last month of life as "poor" or "fair." Most parents (84%) described the quality of care delivered as "very good" or "excellent." CONCLUSIONS According to their parents, many children with advanced heart disease experience suffering in the end-of-life care period. For most, realization that their child has no realistic chance of survival does not occur until late, some not until death is imminent. Once this realization occurs, however, parents perceive peacefulness, a "good death," and excellent quality of care. Strategies for improved communication around symptom management, quality of life, prognosis, and advance care planning are needed for families of children with advanced heart disease.
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Marete I, Tenge C, Pasha O, Goudar S, Chomba E, Patel A, Althabe F, Garces A, McClure EM, Saleem S, Esamai F, Kodkany B, Belizan J, Derman RJ, Hibberd PL, Hambidge KM, Buekens P, Goldenberg RL, Carlo WA, Wallace D, Moore J, Koso-Thomas M, Wright LL, Liechty EA. Perinatal outcomes of multiple-gestation pregnancies in Kenya, Zambia, Pakistan, India, Guatemala, and Argentina: a global network study. Am J Perinatol 2014; 31:125-32. [PMID: 23512321 PMCID: PMC4013719 DOI: 10.1055/s-0033-1338173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To determine the rates of multiple gestation, stillbirth, and perinatal and neonatal mortality and to determine health care system characteristics related to perinatal mortality of these pregnancies in low- and middle-income countries. METHODS Pregnant women residing within defined geographic boundaries located in six countries were enrolled and followed to 42 days postpartum. RESULTS Multiple gestations were 0.9% of births. Multiple gestations were more likely to deliver in a health care facility compared with singletons (70 and 66%, respectively, p < 0.001), to be attended by skilled health personnel (71 and 67%, p < 0.001), and to be delivered by cesarean (18 versus 9%, p < 0.001). Multiple-gestation fetuses had a relative risk (RR) for stillbirth of 2.65 (95% confidence interval [CI] 2.06, 3.41) and for perinatal mortality rate (PMR) a RR of 3.98 (95% CI 3.40, 4.65) relative to singletons (both p < 0.0001). Neither delivery in a health facility nor the cesarean delivery rate was associated with decreased PMR. Among multiple-gestation deliveries, physician-attended delivery relative to delivery by other health providers was associated with a decreased risk of perinatal mortality. CONCLUSIONS Multiple gestations contribute disproportionately to PMR in low-resource countries. Neither delivery in a health facility nor the cesarean delivery rate is associated with improved PMR.
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Le Gloan L, Mercier LA, Dore A, Marcotte F, Mongeon FP, Ibrahim R, Asgar A, Poirier N, Khairy P. Pregnancy in women with Fontan physiology. Expert Rev Cardiovasc Ther 2014; 9:1547-56. [DOI: 10.1586/erc.11.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Best postpartum breastfeeding practices must address the caloric needs of all infants, including vulnerable infants, while enabling long-term, exclusive breastfeeding. An adequate subsequent milk supply depends on early, frequent and effective colostrum removal. A combination of hand expression of colostrum, spoon-feeding and unrestricted breastfeeding provide more milk for infants and more stimulation for subsequent breast milk production. A sustainable, preventive practice model for low- and high-risk infants depends on elevating staff expertise and shifting the focus of lactation educators to address staff learning needs. We propose a five-step implementation program to achieve this.
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Belfort MB, Gillman MW, Buka SL, Casey PH, McCormick MC. Preterm infant linear growth and adiposity gain: trade-offs for later weight status and intelligence quotient. J Pediatr 2013; 163:1564-1569.e2. [PMID: 23910982 PMCID: PMC3834090 DOI: 10.1016/j.jpeds.2013.06.032] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/01/2013] [Accepted: 06/18/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine trade-offs between cognitive outcome and overweight/obesity in preterm-born infants at school age and young adulthood in relation to weight gain and linear growth during infancy. STUDY DESIGN We studied 945 participants in the Infant Health and Development Program, an 8-center study of preterm (≤37 weeks gestational age), low birth weight (≤2500 g) infants from birth to age 18 years. Adjusting for maternal and child factors in logistic regression, we estimated the odds of overweight/obesity (body mass index [BMI] ≥85th percentile at age 8 or ≥25 kg/m(2) at age 18) and in separate models, low IQ (<85) per z-score changes in infant length and BMI from term to 4 months, from 4 to 12 months, and from 12 to 18 months. RESULTS More rapid linear growth from term to 4 months was associated with lower odds of IQ <85 at age 8 years (OR, 0.82; 95% CI, 0.70-0.96), but higher odds of overweight/obesity (OR, 1.27; 95% CI, 1.05-1.53). More rapid BMI gain in all 3 infant time intervals was also associated with higher odds of overweight/obesity, and BMI gain from 4-12 months was associated with lower odds of IQ <85 at age 8. Results at age 18 were similar. CONCLUSION In these preterm, low birth weight infants born in the 1980s, faster linear growth soon after term was associated with better cognition, but also with a greater risk of overweight/obesity at age 8 years and 18 years. BMI gain over the entire 18 months after term was associated with later risk of overweight/obesity, with less evidence of a benefit for IQ.
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Affiliation(s)
| | - Matthew W. Gillman
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute
| | | | - Patrick H. Casey
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital
| | - Marie C. McCormick
- Department of Society, Human Development, and Health, Harvard School of Public Health
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Abstract
PURPOSE Patients with idiopathic clubfoot are considered at increased risk for having developmental dysplasia of the hips (DDH). However, the studies showing this association have been relatively small. Many clinicians who treat idiopathic clubfoot routinely screen the hips of these patients with ultrasound or radiograph due to the concerns of increased risk of DDH. We evaluated a large clubfoot population to determine the risk of DDH and compare this to a population of children without clubfoot. We also evaluated if the clubfoot patients found to have DDH would have been discovered by standard DDH screening. METHODS We identified infants in 3 states (MA, NY, NC), who were reported to each state's birth defects registry as having a clubfoot. A second cohort of infants without clubfoot was also identified as a control group. Mothers of these children were contacted to be included in the study, and a computer-assisted telephone interview was administered by one of the study nurses, including questions about treatment of DDH. The child's median age at interview was 7 months. Mothers of clubfoot cases were also contacted for follow-up at mean age of 3.3 years. RESULTS Families of 677 patients with clubfoot and 2037 controls were interviewed. A total of 5/677 (0.74%) patients with clubfoot and 5/2037 (0.25%) controls reported having their infant treated with a brace or harness for hip problems (P=0.134). Of the patients with clubfoot, 2 of them did not need treatment for their DDH and 2 would have been discovered by standard hip screening. Follow-up study at 3.3 years of age found no serious late hip dysplasia. CONCLUSIONS Treatment of DDH was uncommon in all children; the higher proportion in infants with clubfoot was not statistically different than controls. Of the patients with clubfoot and DDH, standard hip screening would have been appropriate and others did not need treatment. These data suggest that routine hip ultrasound or radiographic screening of idiopathic clubfoot patients is not necessary unless indicated by the standard infant hip screening. LEVEL OF EVIDENCE Level 3 study.
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Survival rate of extremely low birth weight infants and its risk factors: case-control study in Japan. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:873563. [PMID: 24371528 PMCID: PMC3858981 DOI: 10.1155/2013/873563] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/09/2013] [Indexed: 11/18/2022]
Abstract
Aim. To clarify the effect of perinatal events on the survival of ELBW infants in Japan. Methods. 1,713 ELBW infants, from 92,630 live births in 2001 and 2002, born at 22–36 weeks of gestation were registered. Case was defined as death at discharge. The relevant variables were compared between the cases (n = 366) and the controls (n = 1,347). Results. The total survival rate was 78.6%. There was a significant difference between the survival rate in cesarean and vaginal delivery at 24–31 weeks of gestation. Cesarean delivery in infants with a birth weight >400 g was significantly advantageous to the survival rate of ELBW infants than vaginal delivery. The significant contributing factors were gestational age at delivery (OR: 0.97), Apgar score at 5 min (0.56), antenatal steroid (0.41), and birth weight (0.996). Nonvertex presentation (1.81), vaginal delivery (1.56), and placental abruption (2.50) were found to be significantly associated with neonatal death. Conclusions. Cesarean section might be advantageous for survival in ELBW infants over 24 gestational weeks or 400 grams of birth weight. Nonvertex presentation, vaginal delivery, and placental abruption could be significant risk factors for survival of ELBW infants.
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García-Muñoz-Rodrigo F, Diez Recinos AL, Aponte Contreras O, Pérez Matos C, Gutiérrez García L, García Hernández JA. [Influence of gestational age, type of delivery, and resuscitation, on the incidence of pneumothorax in term neonates]. An Pediatr (Barc) 2013; 80:138-43. [PMID: 24099928 DOI: 10.1016/j.anpedi.2013.06.026] [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: 11/30/2011] [Revised: 05/23/2013] [Accepted: 06/23/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Elective caesarean section before 39 weeks gestational age (GA) has been associated with a higher incidence of iatrogenic respiratory distress and pneumothorax in term newborn babies, probably because of a higher respiratory morbidity and the need for resuscitation. These factors have not been systematically evaluated in our patients. OBJECTIVE To determine whether the gestational age, type of delivery, and intensity of resuscitation, are associated with an increase in the incidence of pneumothorax in term neonates. PATIENTS AND METHODS Full term neonates (≥ 37 weeks GA) born in our maternity unit from January 2006 to December 2010 were studied, along with the type of delivery (vaginal, forceps or caesarean section). Advanced cardiopulmonary resuscitation (CPR) was defined as the need of bag and mask intermittent ventilation, intubation, chest compression, and/or administration of medication. The diagnosis of pneumothorax was clinical and radiological in all cases. RESULTS A total of 32,238 full term newborns were included. Type of delivery: vaginal 76.1%, C-section 12.4%, and forceps 11.5%. The incidence of pneumothorax was 0.316%. It was significantly higher in C-section (0.85%), than in forceps (0.59%), or non-instrumental vaginal deliveries (0.19%) (P<.001), and in infants ≥ 40 weeks GA (0.37%) compared to ≤ 39 weeks GA (0.24%) (P=.033), and in advanced CPR (4.29%) compared to basic CPR (0.18%) (P<.001). CONCLUSIONS A GA ≥ 40 weeks, C-section, or forceps delivery, and advanced CPR immediately after birth were significantly associated with a higher incidence of pneumothorax in full term newborn babies. In our population, we did not observe an increase in pneumothorax among neonates born by elective C-section before 39 weeks of gestation.
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Affiliation(s)
- F García-Muñoz-Rodrigo
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
| | - A L Diez Recinos
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - O Aponte Contreras
- Servicio de Neonatología, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - C Pérez Matos
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - L Gutiérrez García
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - J A García Hernández
- Servicio de Ginecología y Obstetricia, Hospital Universitario Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
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