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DeFreitas MJ, Griffin R, Sanderson K, Nada A, Charlton JR, Jetton JG, Kent AL, Guillet R, Askenazi D, Abitbol CL. Maternal Hypertension Disorders and Neonatal Acute Kidney Injury: Results from the AWAKEN Study. Am J Perinatol 2024; 41:649-659. [PMID: 35196719 PMCID: PMC10981551 DOI: 10.1055/a-1780-2249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to examine the association between maternal hypertension (HTN) exposure and neonatal acute kidney injury (AKI). STUDY DESIGN Retrospective cohort study of 2,162 neonates admitted to 24 neonatal intensive care units (NICUs). Neonates were classified into the following exposure groups: any maternal HTN, chronic maternal HTN, preeclampsia/eclampsia, both, or neither. Demographics, clinical characteristics, and AKI status were compared using Chi-square and analysis of variance. General estimating logistic regression was used to estimate adjusted odds ratios and included a stratified analysis for site of delivery. RESULT Neonates exposed to any maternal HTN disorder had a tendency toward less overall and early AKI. When stratified by inborn versus outborn, exposure to both maternal HTN disorders was associated with a significantly reduced odds of early AKI only in the inborn neonates. CONCLUSION Exposure to maternal HTN, especially preeclampsia/eclampsia superimposed on chronic HTN, was associated with less likelihood of early AKI in the inborn group. KEY POINTS · Maternal HTN is associated with less neonatal AKI.. · Maternal HTN category is variably associated with AKI.. · Inborn status is an important contributor to this association..
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Affiliation(s)
- Marissa J. DeFreitas
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children’s Hospital, Miami, Florida
| | - Russell Griffin
- Department of Epidemiology, University of Alabama Birmingham, Birmingham, Alabama
| | - Keia Sanderson
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina
| | - Arwa Nada
- Department of Pediatrics, Division of Nephrology & Hypertension Le Bonheur Children’s Hospital, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer R. Charlton
- Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Jennifer G. Jetton
- Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa Stead Family Children’s Hospital, Iowa City, Iowa
| | - Alison L. Kent
- Department of Pediatrics, University of Rochester, Rochester, New York
- Department of Pediatrics, Australian National University, ACT, Australia
| | - Ronnie Guillet
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - David Askenazi
- Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, Birmingham, Alabama
| | - Carolyn L. Abitbol
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami/Holtz Children’s Hospital, Miami, Florida
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Haynes N, Bell J, Griffin R, Askenazi DJ, Jetton J, Kent AL. Receipt of high-frequency ventilation is associated with acute kidney injury in very preterm neonates. Pediatr Nephrol 2024; 39:579-587. [PMID: 37594576 DOI: 10.1007/s00467-023-06077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND High-frequency ventilation (HFV) is frequently used in critically ill preterm neonates. We aimed to determine the incidence of acute kidney injury (AKI) in neonates less than 29 weeks gestation who received HFV in the first week of life and to determine if the rates of AKI differed in those who received other forms of respiratory support. METHODS This retrospective cohort study of 24 international, level III/IV neonatal intensive care units (NICUs) included neonates less than 29 weeks gestation from the AWAKEN study database. Exclusion criteria included the following: no intravenous fluids ≥ 48 h, admission ≥ 14 days of life, congenital heart disease requiring surgical repair at < 7 days of life, lethal chromosomal anomaly, death within 48 h, severe congenital kidney abnormalities, inability to determine AKI status, insufficient data on ventilation, and when the diagnosis of early AKI was unable to be made. Subjects were grouped into three groups based on ventilation modes (CPAP/no ventilation, conventional ventilation, and HFV). RESULTS The incidence of AKI was highest in the CPAP/no ventilation group, followed by HFV, followed by conventional ventilation (CPAP/no ventilation 48.5% vs. HFV 42.6% vs. conventional ventilation 28.4% (p = 0.009). An increased risk for AKI was found for those on HFV compared to CPAP/no ventilation (HR = 2.65; 95% CI:1.22-5.73). CONCLUSIONS HFV is associated with AKI in the first week of life. Neonates on HFV should be screened for AKI. The reasons for this association are not clear. Further studies should evaluate the relationship between ventilator strategies and AKI in premature neonates. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Nicholas Haynes
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Jeremiah Bell
- Pediatric and Infant Center for Acute Nephrology, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Russel Griffin
- Pediatric and Infant Center for Acute Nephrology, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David J Askenazi
- Pediatric and Infant Center for Acute Nephrology, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Jetton
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alison L Kent
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
- University of Adelaide Medical School, Women's and Children's Hospital, Adelaide, SA, Australia.
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia.
- Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14624, USA.
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de Barros Medeiros P, Liley H, Andrews C, Gordon A, Heazell AE, Kent AL, Leisher SH, Flenady V. Current approach and attitudes toward neonatal near-miss and perinatal audits: An exploratory international survey. Aust N Z J Obstet Gynaecol 2023; 63:352-359. [PMID: 36447356 PMCID: PMC10952158 DOI: 10.1111/ajo.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/06/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Combined with perinatal mortality review, neonatal near-miss (NNM) audit has the potential to inform strategies to better prevent adverse perinatal outcomes. Nonetheless, there is lack of standardised definitions of NNM and limited evidence of implementation of NNM audits. AIM To describe definitions of NNM and assess current approaches and attitudes toward perinatal mortality and morbidity audit. MATERIALS AND METHODS Online survey from December 2021 to February 2022, with a mix of Likert scales, polar, pool, multi-choice, and open-ended questions, disseminated through national and international organisations to perinatal healthcare workers from high-income countries. RESULTS One hundred and twenty participants came from Australia (n = 86), New Zealand (n = 18), Canada (n = 7), USA (n = 4), Netherlands (n = 2), other countries (n = 3). Neonatologists (35%), midwives (21.7%), obstetricians (12.5%), neonatal nurse practitioners (11.7%) and others (23.3%) responded. Most respondents thought the main characteristics to define NNM were birth asphyxia needing therapeutic hypothermia (68.3%), unexpected resuscitation at birth (67.5%), need for intubation/chest compression/adrenaline (65.0%) and metabolic acidosis at birth (60.0%). There were 97.5% of participants who considered NNM important for identifying cases for perinatal morbidity audits. However, only 10.0% of their institutions used a NNM definition. Overall, 98.4% of participants considered perinatal mortality and morbidity audits important to prevent adverse outcomes. CONCLUSION Neonatal near-miss audit is viewed as a valuable tool to reduce adverse neonatal outcomes. There was reasonable consensus that NNM encompassed evidence of birth asphyxia and/or advanced neonatal resuscitation. Data from this international survey identifies a starting point for a consensus definition of NNM, which can be used for perinatal audits to identify opportunities for improvement.
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Affiliation(s)
- Poliana de Barros Medeiros
- Centre of Research Excellence in StillbirthMater Research Institute, The University of QueenslandBrisbaneQueenslandAustralia
- Department of Paediatrics and NeonatologySunshine Coast University HospitalSunshine CoastQueenslandAustralia
| | - Helen Liley
- Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- Department of NeonatologyMater Mothers' HospitalBrisbaneQueenslandAustralia
| | - Christine Andrews
- Centre of Research Excellence in StillbirthMater Research Institute, The University of QueenslandBrisbaneQueenslandAustralia
| | - Adrienne Gordon
- Centre of Research Excellence in StillbirthMater Research Institute, The University of QueenslandBrisbaneQueenslandAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Alexander E.P. Heazell
- Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Department of Obstetrics, Saint Mary's HospitalManchester University NHS Foundation TrustManchesterUK
- International Stillbirth AllianceMillburnNew JerseyUSA
| | - Alison L. Kent
- Department of PaediatricsUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
- Australian National University, College of Health and MedicineCanberraAustralian Capital TerritoryAustralia
| | - Susannah H. Leisher
- Centre of Research Excellence in StillbirthMater Research Institute, The University of QueenslandBrisbaneQueenslandAustralia
- International Stillbirth AllianceMillburnNew JerseyUSA
| | - Vicki Flenady
- Centre of Research Excellence in StillbirthMater Research Institute, The University of QueenslandBrisbaneQueenslandAustralia
- International Stillbirth AllianceMillburnNew JerseyUSA
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Abadeer M, Swartz MF, Martin SD, Groves AM, Kent AL, Schwartz GJ, Brophy P, Alfieris GM, Cholette JM. Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery. Pediatr Cardiol 2023; 44:855-866. [PMID: 36637459 DOI: 10.1007/s00246-022-03080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 12/16/2022] [Indexed: 01/14/2023]
Abstract
Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. Serum Cystatin C (CysC) is a novel biomarker synthesized by all nucleated cells that may act as an early indicator of AKI following infant CPB. Prospective observational study of infants (< 1 year) requiring CPB during cardiac surgery. CysC was measured at baseline and 12, 24, 48, and 72 h following CPB initiation. Each post-op percent difference in CysC (e.g. %CysC12h) from baseline was calculated. Clinical variables along with urine output (UOP) and serum creatinine (SCr) were followed. Subjects were divided into two groups: AKI and non-AKI based upon the Kidney Disease Improving Global Outcomes (KDIGO) classification. AKI occurred in 41.9% (18) of the 43 infants enrolled. Patient demographics and baseline CysC levels were similar between groups. CysC levels were 0.97 ± 0.28 mg/L over the study period, and directly correlated with SCr (R = 0.71, p < 0.0001). Although absolute CysC levels were not significant between groups, the %CysC12h was significantly greater in the AKI group (AKI: - 16% ± 22% vs. Non-AKI - 28% ± 9% mg/L; p = 0.003). However, multivariate analysis demonstrated that a lower UOP (Odds Ratio:0.298; 95% CI 0.073, 0.850; p = 0.02) but not %CysC12h was independently associated with AKI. Despite a significant difference in the %CysC12h, only UOP was independently associated with AKI. Larger studies of a more homogenous population are needed to understand these results and to explore the variability in this biomarker seen across institutions.
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Affiliation(s)
- Maher Abadeer
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Michael F Swartz
- Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Susan D Martin
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Angela M Groves
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Alison L Kent
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.,College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - George J Schwartz
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Patrick Brophy
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - George M Alfieris
- Department of Surgery, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jill M Cholette
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
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Roy B, Webb A, Walker K, Morgan C, Badawi N, Nunez C, Eslick G, Kent AL, Hunt RW, Mackay MT, Novak I. Prevalence & Risk Factors for Perinatal Stroke: A Population-Based Study. Child Neurol Open 2023; 10:2329048X231217691. [PMID: 38116020 PMCID: PMC10729630 DOI: 10.1177/2329048x231217691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/23/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
Objectives The study objective was to calculate the birth prevalence of perinatal stroke and examine risk factors in term infants. Some risk factors are present in healthy infants, making it difficult to determine at-risk infants. Study Design Prospective population-based perinatal stroke data were compared to the Australian general population data using chi-squared and Fisher's exact tests and multivariable logistic regression analysis. Results Sixty perinatal stroke cases were reported between 2017 and 2019. Estimated stroke prevalence was 9.6/100,000 live births/year including 5.8 for neonatal arterial ischemic stroke and 2.9 for neonatal hemorrhagic stroke. Eighty seven percent had multiple risk factors. Significant risk factors were cesarean section (p = 0.04), 5-min Apgar score <7 (p < 0.01), neonatal resuscitation (p < 0.01) and nulliparity (p < 0.01). Conclusions Statistically significant independent risk factors do not fully explain the cause of perinatal stroke, because they are not a direct causal pathway to stroke. These data now require validation in a case-control study.
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Affiliation(s)
- Bithi Roy
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The University of Notre Dame Australia, Sydney, Australia
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Karen Walker
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- RPA Newborn Care, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Catherine Morgan
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Sydney, Australia
| | - Carlos Nunez
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Australian Paediatric Surveillance Unit, Sydney, Australia
| | - Guy Eslick
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Australian Paediatric Surveillance Unit, Sydney, Australia
| | - Alison L Kent
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
- Australian National University College of Health and Medicine, Canberra, ACT, Australia
| | - Rod W Hunt
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Dept of Paediatrics, Monash University, Melbourne, Australia
- Monash Newborn, Monash Health, Melbourne, Australia
| | - Mark T Mackay
- Department of Neurology, Royal Children's Hospital, Parkville, Australia
- Neuroscience Research, Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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Groves AM, Johnston CJ, Beutner GG, Dahlstrom JE, Koina M, O'Reilly MA, Porter G, Brophy PD, Kent AL. Neonatal hypoxic ischemic encephalopathy increases acute kidney injury urinary biomarkers in a rat model. Physiol Rep 2022; 10:e15533. [PMID: 36541220 PMCID: PMC9768655 DOI: 10.14814/phy2.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
Hypoxic ischemic encephalopathy (HIE) is associated with acute kidney injury (AKI) in neonates with birth asphyxia. This study aimed to utilize urinary biomarkers to characterize AKI in an established neonatal rat model of HIE. Day 7 Sprague-Dawley rat pups underwent HIE using the Rice-Vannucci model (unilateral carotid ligation followed by 120 mins of 8% oxygen). Controls included no surgery and sham surgery. Weights and urine for biomarkers (NGAL, osteopontin, KIM-1, albumin) were collected the day prior, daily for 3 days post-intervention, and at sacrifice day 14. Kidneys and brains were processed for histology. HIE pups displayed histological evidence of kidney injury including damage to the proximal tubules, consistent with resolving acute tubular necrosis, and had significantly elevated urinary levels of NGAL and albumin compared to sham or controls 1-day post-insult that elevated for 3 days. KIM-1 significantly increased for 2 days post-HIE. HIE did not significantly alter osteopontin levels. Seven days post-start of experiment, controls were 81.2% above starting weight compared to 52.1% in HIE pups. NGAL and albumin levels inversely correlated with body weight following HIE injury. The AKI produced by the Rice-Vannucci HIE model is detectable by urinary biomarkers, which can be used for future studies of treatments to reduce kidney injury.
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Affiliation(s)
- Angela M. Groves
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- Department of Radiation OncologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Carl J. Johnston
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Gisela G. Beutner
- Division of CardiologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Jane E. Dahlstrom
- Department of Anatomical Pathology, ACT PathologyCanberra Health ServicesCanberraAustralia
- College of Health and MedicineAustralian National UniversityCanberraAustralia
| | - Mark Koina
- Department of Anatomical Pathology, ACT PathologyCanberra Health ServicesCanberraAustralia
- College of Health and MedicineAustralian National UniversityCanberraAustralia
| | - Michael A. O'Reilly
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - George Porter
- Division of CardiologyUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
| | - Patrick D. Brophy
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- Division of Nephrology, University of Rochester School of Medicine and DentistryGolisano Children's Hospital at University of Rochester Medical CenterNew YorkRochesterUSA
| | - Alison L. Kent
- Department of PediatricsUniversity of Rochester School of Medicine and DentistryNew YorkRochesterUSA
- College of Health and MedicineAustralian National UniversityCanberraAustralia
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Broom M, Youseman ME, Kent AL. Impact of introducing a lactation consultant into a neonatal unit. J Paediatr Child Health 2022; 58:636-640. [PMID: 34713946 DOI: 10.1111/jpc.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
AIM Benefits of mothers' own milk (MOM) for premature and sick neonates are well documented. To increase access, many neonatal units have a lactation consultant (LC) on staff. This study aimed to assess the impact of a permanent LC on (i) maternal access to LC support; (ii) staff confidence in providing Breast Feeding (BF) education and (iii) provision of MOM. METHODS Study included a staff survey and chart audit. Questions provided feedback on access to lactation support and meeting maternal needs. Audit data included: gestational age, birthweight, intention to breastfeed, documentation of LC appointment, provision of MOM at 12 hours, days 3, 7, 28 and discharge. Student's t-tests were used for numerical data and chi-squared tests for categorical variables. RESULTS Ninety-one staff surveys were returned, (pre 35/75 (47%), post 56/85 (66%) with staff reporting organising an LC appointment was significantly easier (P < 0.0001). Staff perceived maternal lactation needs and confidence to breastfeed post-discharge had significantly improved post-LC. The chart audit showed a significant increase in maternal access to LC appointments (15% vs. 80%; P < 0.01), breast pump education by day 3 (65% vs. 81%; P < 0.01), and an increase in MOM provision by 12 h (46% vs. 61%; P < 0.01) post-LC but not at days 7, 28 or discharge. CONCLUSION A dedicated LC increases staff and maternal access to lactation education and support, improving provision of early MOM. Further research is required to assess the effect of LCs in improving breastfeeding rates in neonatal units.
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Affiliation(s)
- Margaret Broom
- Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,SYNERGY: Nursing and Midwifery Research Centre, University of Canberra and ACT Health, Canberra, Australian Capital Territory, Australia
| | - Mary-Ellen Youseman
- Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- University of Rochester, Dept of Pediatrics, Golisano Children's Hospital, Rochester, New York, United States.,Australian National University, College of Health and Medicine, Canberra, Australian Capital Territory, Australia
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Abstract
Understanding physiologic water balance and homeostasis mechanisms in the neonate is critical for clinicians in the NICU as pathologic fluid accumulation increases the risk for morbidity and mortality. In addition, once this process occurs, treatment is limited. In this review, we will cover fluid homeostasis in the neonate, explain the implications of prematurity on this process, discuss the complexity of fluid accumulation and the development of fluid overload, identify mitigation strategies, and review treatment options.
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Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Katja M Gist
- Division of Cardiology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | - Trina S Hemmelgarn
- Division of Pharmacology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Pharmacy, Cincinnati, OH
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Alison L Kent
- Department of Pediatrics, University of Rochester, NY, and Australian National University Medical School, Canberra, ACT, Australia
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Parker MA, Kent AL, Sneddon A, Wang J, Shadbolt B. The Menstrual Disorder of Teenagers (MDOT) Study No. 2: Period ImPact and Pain Assessment (PIPPA) Tool Validation in a Large Population-Based Cross-Sectional Study of Australian Teenagers. J Pediatr Adolesc Gynecol 2022; 35:30-38. [PMID: 34171477 DOI: 10.1016/j.jpag.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/09/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To validate the Period ImPact and Pain Assessment (PIPPA) self-screening tool for menstrual disturbance in teenagers. DESIGN Cross-sectional study. SETTING Three senior high schools in the Australian Capital Territory (ACT), Australia. PARTICIPANTS A total of 1066 girls between 15 and 19 years of age. INTERVENTIONS AND MAIN OUTCOME MEASURES A quantitative paper survey collected self-reports of menstrual bleeding patterns, typical and atypical symptoms, morbidities, and interference with daily activities. Multiple correspondence analysis was used to examine associations between PIPPA questions. Generalized linear models compared total score and subscores by validation criteria: pain, school absence, and body mass index (BMI). Receiver operating characteristic curves were used to evaluate the predictiveness of menstrual disturbance indicators by total PIPPA score. RESULTS Reports of pain, interference, and concern within the PIPPA items and between both the MDOT and PIPPA questionnaires were significantly correlated (P < .0001). The indicator "missing school" was highly associated (P < .0001) with pain and interference. Obesity (BMI ≥30) was associated with higher PIPPA scores, as was underweight (BMI≤18.4). Where 0 = no disturbance, 5 = high disturbance, aggregated PIPPA scores found 75% scoring 0-2 (out of 5) and 25% scoring 3-5 (257/1037). High scores of 4 or 5 (out of 5) were 7% (72/1037) and 3.7% (38/1037), respectively. CONCLUSION PIPPA is a valid screening tool for pain-related menstrual disturbance that affects functioning in young women. PIPPA subdomains of pain/interference have good validity relative to indicators of pain and interference and are responsive to age, BMI, and school absence differences.
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Affiliation(s)
- M A Parker
- Canberra Endometriosis Centre, Department of Obstetrics and Gynaecology, ACT Health, Canberra, ACT, Australia.
| | - A L Kent
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, New York; Australian National University, College of Health and Medicine, Canberra, ACT, Australia
| | - A Sneddon
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - J Wang
- Ocular Genomics Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - B Shadbolt
- ACT Centre for Health and Medical Research, ACT Health, Canberra, ACT, Australia
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Starr MC, Charlton JR, Guillet R, Reidy K, Tipple TE, Jetton JG, Kent AL, Abitbol CL, Ambalavanan N, Mhanna MJ, Askenazi DJ, Selewski DT, Harer MW. Advances in Neonatal Acute Kidney Injury. Pediatrics 2021; 148:peds.2021-051220. [PMID: 34599008 DOI: 10.1542/peds.2021-051220] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/14/2023] Open
Abstract
In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. New evidence highlights the importance of the kidney in "crosstalk" between other organs and how AKI likely plays a critical role in other organ development and injury, such as intraventricular hemorrhage and lung disease. New technology has resulted in advancement in prevention and improvements in the current management in neonates with severe AKI. With specific continuous renal replacement therapy machines designed for neonates, this therapy is now available and is being used with increasing frequency in NICUs. Moving forward, biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, and other new technologies, such as monitoring of renal tissue oxygenation and nephron counting, will likely play an increased role in identification of AKI and those most vulnerable for chronic kidney disease. Future research needs to be focused on determining the optimal follow-up strategy for neonates with a history of AKI to detect chronic kidney disease.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jennifer R Charlton
- Division of Nephrology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Kimberly Reidy
- Division of Pediatric Nephrology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Trent E Tipple
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Jennifer G Jetton
- Division of Nephrology, Dialysis, and Transplantation, Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Alison L Kent
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.,College of Health and Medicine, The Australian National University, Canberra, Australia Capitol Territory, Australia
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, Department of Pediatrics, Miller School of Medicine, University of Miami and Holtz Children's Hospital, Miami, Florida
| | | | - Maroun J Mhanna
- Department of Pediatrics, Louisiana State University Shreveport, Shreveport, Louisiana
| | - David J Askenazi
- Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Selewski
- Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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11
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Abstract
The study of neonatal acute kidney injury (AKI) has transitioned from small, single-center studies to the development of a large, multicenter cohort. The scope of research has expanded from assessment of incidence and mortality to analysis of more specific risk factors, novel urinary biomarkers, interplay between AKI and other organ systems, impact of fluid overload, and quality improvement efforts. The intensification has occurred through collaboration between the neonatology and nephrology communities. This review discusses 2 case scenarios to illustrate the clinical presentation of neonatal AKI, important risk factors, and approaches to minimize AKI events and adverse long-term outcomes.
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Affiliation(s)
- Keegan J Kavanaugh
- Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, 2015-26 BT, Iowa City, IA 52241, USA
| | - Jennifer G Jetton
- Division of Pediatric Nephrology, Dialysis, and Transplantation, Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, 2029 BT, Iowa City, IA 52241, USA.
| | - Alison L Kent
- Division of Neonatology, Golisano Children's Hospital, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 651, Rochester, NY 14642, USA; College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory 2601, Australia. https://twitter.com/Aussiekidney
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12
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Freebairn L, Atkinson JA, Qin Y, Nolan CJ, Kent AL, Kelly PM, Penza L, Prodan A, Safarishahrbijari A, Qian W, Maple-Brown L, Dyck R, McLean A, McDonnell G, Osgood ND. 'Turning the tide' on hyperglycemia in pregnancy: insights from multiscale dynamic simulation modeling. BMJ Open Diabetes Res Care 2020; 8:8/1/e000975. [PMID: 32475837 PMCID: PMC7265040 DOI: 10.1136/bmjdrc-2019-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/15/2020] [Accepted: 04/06/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Hyperglycemia in pregnancy (HIP, including gestational diabetes and pre-existing type 1 and type 2 diabetes) is increasing, with associated risks to the health of women and their babies. Strategies to manage and prevent this condition are contested. Dynamic simulation models (DSM) can test policy and program scenarios before implementation in the real world. This paper reports the development and use of an advanced DSM exploring the impact of maternal weight status interventions on incidence of HIP. METHODS A consortium of experts collaboratively developed a hybrid DSM of HIP, comprising system dynamics, agent-based and discrete event model components. The structure and parameterization drew on a range of evidence and data sources. Scenarios comparing population-level and targeted prevention interventions were simulated from 2018 to identify the intervention combination that would deliver the greatest impact. RESULTS Population interventions promoting weight loss in early adulthood were found to be effective, reducing the population incidence of HIP by 17.3% by 2030 (baseline ('business as usual' scenario)=16.1%, 95% CI 15.8 to 16.4; population intervention=13.3%, 95% CI 13.0 to 13.6), more than targeted prepregnancy (5.2% reduction; incidence=15.3%, 95% CI 15.0 to 15.6) and interpregnancy (4.2% reduction; incidence=15.5%, 95% CI 15.2 to 15.8) interventions. Combining targeted interventions for high-risk groups with population interventions promoting healthy weight was most effective in reducing HIP incidence (28.8% reduction by 2030; incidence=11.5, 95% CI 11.2 to 11.8). Scenarios exploring the effect of childhood weight status on entry to adulthood demonstrated significant impact in the selected outcome measure for glycemic regulation, insulin sensitivity in the short term and HIP in the long term. DISCUSSION Population-level weight reduction interventions will be necessary to 'turn the tide' on HIP. Weight reduction interventions targeting high-risk individuals, while beneficial for those individuals, did not significantly impact forecasted HIP incidence rates. The importance of maintaining interventions promoting healthy weight in childhood was demonstrated.
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Affiliation(s)
- Louise Freebairn
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
- School of Medicine, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- Population Health, ACT Health, Woden, Australian Capital Territory, Australia
| | - Jo-An Atkinson
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Yang Qin
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Christopher J Nolan
- Endocrinology and Diabetes, ACT Health, Woden, Australian Capital Territory, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- Golisano Children's Hospital at URMC, University of Rochester, Rochester, New York, USA
| | - Paul M Kelly
- Population Health, ACT Health, Woden, Australian Capital Territory, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Luke Penza
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Ante Prodan
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Anahita Safarishahrbijari
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Weicheng Qian
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Endocrinology Department, Royal Darwin Hospital, Casuarina, Northern Territory, Australia
| | - Roland Dyck
- Department of Medicine, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Allen McLean
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Geoff McDonnell
- The Australian Prevention Partnership Centre, Sax Institute, Haymarket, New South Wales, Australia
| | - Nathaniel D Osgood
- Computational Epidemiology and Public Health Informatics Laboratory, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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13
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Lieschke A, Dahlstrom JE, Kent AL, Sethna F. Uncertainty over implications of placental histopathological findings: A survey of Australian and New Zealand neonatologists. J Paediatr Child Health 2020; 56:259-264. [PMID: 31576644 DOI: 10.1111/jpc.14576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/10/2019] [Accepted: 07/06/2019] [Indexed: 01/15/2023]
Abstract
AIM Placental examination is known to provide useful information following an adverse pregnancy outcome. Despite existing literature and guidelines for placental examination; current workplace practices, attitudes towards the value of placental examination and the knowledge of perinatal clinicians regarding placental lesions of significance are unknown. The aim of the study is to explore the current knowledge of neonatologists and maternal fetal medicine specialists on placental histopathological findings and clinical management based on placental pathology. METHODS A total of 280 specialists working in perinatal centres across Australia and New Zealand were invited to complete a 20-question online multiple-choice-based survey addressing work-place placental examination practices, and participant beliefs regarding the utility of histopathological findings and follow-up practices. RESULTS A total of 74 neonatologists participated in the survey (28.2% response rate). Maternal fetal medicine specialists were excluded due to low response rate (2%). A total of 100% of respondents believed placental examination provided useful information regarding recent pregnancy and neonatal outcomes. They reported being aware of the presence of protocols for macroscopic examination of, and indications for histopathological examination of the placenta (55.4 and 54.1%, respectively). Nine neonatologists reported a system for actioning abnormal placental reports. There was no consensus amongst neonatologists as to which specific placental lesions held implications for future pregnancy or neonatal outcomes, and how these findings should be followed. CONCLUSIONS Our findings show placental examination is valued amongst neonatologists in Australia and New Zealand, but highlights the need for better education regarding the significance and utility of the results and what would be best practice for following up reports.
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Affiliation(s)
- Anna Lieschke
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Jane E Dahlstrom
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Anatomical Pathology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Division of Neonatology, University of Rochester, Golisano Children's Hospital at URMC, Rochester, New York, United States
| | - Farah Sethna
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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14
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Kent AL, Abdel-Latif ME, Cochrane T, Broom M, Dahlstrom JE, Essex RW, Shadbolt B, Natoli R. A pilot randomised clinical trial of 670 nm red light for reducing retinopathy of prematurity. Pediatr Res 2020; 87:131-136. [PMID: 31430763 DOI: 10.1038/s41390-019-0520-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Photobiomodulation by 670 nm red light in animal models reduced severity of ROP and improved survival. This pilot randomised controlled trial aimed to provide data on 670 nm red light exposure for prevention of ROP and survival for a larger randomised trial. METHODS Neonates <30 weeks gestation or <1150 g at birth were randomised to receive 670 nm for 15 min (9 J/cm2) daily until 34 weeks corrected age. DATA COLLECTED placental pathology, growth, days of respiratory support and oxygen, bronchopulmonary dysplasia, patent ductus arteriosus, necrotising enterocolitis, sepsis, worst stage of ROP, need for laser treatment, and survival. RESULTS Eighty-six neonates enrolled-45 no red light; 41 red light. There was no difference in severity of ROP (<27 weeks-p = 0.463; ≥27 weeks-p = 0.558) or requirement for laser treatment (<27 weeks-p = 1.00; ≥27 weeks-no laser treatment in either group). Survival in 670 nm red light treatment group was 100% (41/41) vs 89% (40/45) in untreated infants (p = 0.057). CONCLUSION Randomisation to receive 670 nm red light within 24-48 h after birth is feasible. Although no improvement in ROP or survivability was observed, further testing into the dosage and delivery for this potential therapy are required.
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Affiliation(s)
- Alison L Kent
- Division of Neonatology, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA. .,Australian National University Medical School, Canberra, ACT, 2601, Australia.
| | - Mohamed E Abdel-Latif
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, ACT, 2606, Australia
| | - Timothy Cochrane
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, ACT, 2606, Australia
| | - Margaret Broom
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, ACT, 2606, Australia
| | - Jane E Dahlstrom
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, 2606, Australia.,John Curtin School of Medical Research, College of Medicine Biology and Environment, ANU, Canberra, ACT, 2601, Australia
| | - Rohan W Essex
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Department of Ophthalmology, Canberra Hospital, Woden, ACT, 2606, Australia
| | - Bruce Shadbolt
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Clinical Epidemiology, Canberra Hospital, Woden, ACT, 2606, Australia
| | - Riccardo Natoli
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,John Curtin School of Medical Research, College of Medicine Biology and Environment, ANU, Canberra, ACT, 2601, Australia
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15
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Abstract
Preterm birth is associated with adverse renal health outcomes including hypertension, chronic kidney disease, and an increased rate of progression to end-stage renal failure. This review explores the antenatal, perinatal, and postnatal factors that affect the functional nephron mass of an individual and contribute to long-term kidney outcome. Health-care professionals have opportunities to increase their awareness of the risks to kidney health in this population. Optimizing maternal health around the time of conception and during pregnancy, providing kidney-focused supportive care in the NICU during postnatal nephrogenesis, and avoiding accelerating nephron loss throughout life may all contribute to improved long-term outcomes. There is a need for ongoing research into the long-term kidney outcomes of preterm survivors in mid-to-late adulthood as well as a need for further research into interventions that may improve ex utero nephrogenesis.
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Affiliation(s)
- Amanda Dyson
- Centenary Hospital for Women and Children and Department of Neonatology, Canberra Hospital, Woden, Australia
- Australian National University, Canberra, Australia
| | - Alison L Kent
- University of Rochester and Division of Neonatology, Golisano Children's Hospital at URMC, Rochester, NY
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16
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Hogan S, Lui K, Kent AL. Perceptions of Australian and New Zealand clinicians caring for neonates born at the borderline of viability have changed since the 2005 consensus guideline. J Paediatr Child Health 2019; 55:1429-1436. [PMID: 30920065 DOI: 10.1111/jpc.14434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
Abstract
AIM To determine whether clinician and consumer considerations have changed regarding the resuscitation and support of neonates born at the borderlines of viability since the 2005 New South Wales (NSW) and Australian Capital Territory (ACT) consensus guidelines were developed. METHODS A prospective survey based on the hypotheses and scenarios developed in the original NSW and ACT consensus workshop on perinatal care at the borderlines of viability was sent to neonatologists, fetal medicine specialists, clinical midwife and clinical neonatal consultants and consumer representatives in Australia and New Zealand. Four scenarios and 16 questions were used to explore the respondent's views towards different aspects of the management of neonates born at the borderlines of viability. Australian and New Zealand Neonatal Network data from 2013 or NSW/ACT Neonatal Intensive Care Units (NICUS) data from 1998 to 2004 were used to provide outcome data for each scenario. RESULTS A total of 87% or more of respondents advocated for resuscitation of neonates at 24 and 25 weeks' gestation in 2015. Only 29% (49/169) would agree to parental request not to resuscitate at 25 weeks and only 10% (17/170) at 260-6 weeks. The number of perinatal clinical care providers considering resuscitation at 235 weeks' gestation increased from 23% in 2005 to more than 50% in 2015. CONCLUSION These findings support the development of updated guidelines for the management of neonates in Australia and New Zealand born at the borderlines of viability to reflect the changes in clinical perceptions and management.
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Affiliation(s)
- Sara Hogan
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Kei Lui
- Department of Neonatology, Royal Women's Hospital, Sydney, New South Wales, Australia
| | - Alison L Kent
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
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17
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Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Smith A, Starr M, Kent AL. Incidence and Risk Factors of Early Onset Neonatal AKI. Clin J Am Soc Nephrol 2019. [PMID: 34497098 DOI: 10.2215/cjn.03670318.2019.2.test] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization. RESULTS Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata. CONCLUSIONS AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), NCT02443389.
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Affiliation(s)
| | - Louis Boohaker
- University of Alabama at Birmingham, Birmingham, Alabama
| | - David Askenazi
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick D Brophy
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Carl D'Angio
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Mamta Fuloria
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Gien
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | - Sangeeta Hingorani
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Ayesa Mian
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Robin K Ohls
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Mary Revenis
- Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC
| | - Subrata Sarkar
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and
| | | | - Michelle Starr
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Alison L Kent
- Golisano Children's Hospital, University of Rochester, Rochester, New York
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18
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Sutherland MR, Chatfield MD, Davison B, Vojisavljevic D, Kent AL, Hoy WE, Singh GR, Black MJ. Renal dysfunction is already evident within the first month of life in Australian Indigenous infants born preterm. Kidney Int 2019; 96:1205-1216. [PMID: 31563332 DOI: 10.1016/j.kint.2019.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 01/13/2023]
Abstract
Antecedents of the high rates of chronic kidney disease in Australian Indigenous peoples may originate early in life. Fourteen percent of Australian Indigenous infants are born preterm (under 37 weeks gestation) and, therefore, at risk. Here, our observational cohort study sought to determine the impact of preterm birth on renal function in Australian Indigenous and non-Indigenous infants. Renal function was assessed between 4-29 days postnatally in 60 Indigenous and 42 non-Indigenous infants born at 24-36 weeks gestation. Indigenous ethnicity was associated with impaired renal function, with significantly higher serum creatinine (geometric mean ratio (GMR) 1.15 [1.06, 1.25]), fractional excretion of sodium (GMR 1.21 [1.04, 1.39]), and urine albumin (GMR 1.57 [1.05, 2.34]), β-2 microglobulin (GMR 1.82 [1.11, 2.98]) and cystatin C (GMR 3.27 [1.54, 6.95]) when controlling for gestational/postnatal age, sex and birth weight Z-score. Renal injury, as indicated by high urine neutrophil gelatinase-associated lipocalin levels, was associated with maternal smoking and postnatal antibiotic exposure. Indigenous infants appeared to be most susceptible to the adverse impact of antibiotics. These findings show that preterm Australian Indigenous infants are highly vulnerable to renal dysfunction. Preterm birth may contribute to their increased risk of chronic kidney disease. Thus, we recommended that renal function should be closely monitored life-long in Indigenous children born preterm.
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Affiliation(s)
- Megan R Sutherland
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia.
| | - Mark D Chatfield
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Belinda Davison
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Danica Vojisavljevic
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Alison L Kent
- Department of Neonatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Wendy E Hoy
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - Gurmeet R Singh
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Mary Jane Black
- Biomedicine Discovery Institute and the Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
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19
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Abstract
Hypertension is encountered in up to 3% of neonates and occurs more frequently in neonates requiring hospitalization in the neonatal intensive care unit (NICU) than in neonates in newborn nurseries or outpatient clinics. Former NICU neonates are at higher risk of hypertension secondary to invasive procedures and disease-related comorbidities. Accurate measurement of blood pressure (BP) remains challenging, but new standardized methods result in less measurement error. Multiple factors contribute to the rapidly changing BP of a neonate: gestational age, postmenstrual age (PMA), birth weight, and maternal factors are the most significant contributors. Given the natural evolution of BP as neonates mature, a percentile cutoff of 95% for PMA has been the most common definition used; however, this is not based on outcome data. Common causes of neonatal hypertension are congenital and acquired renal disease, history of umbilical arterial catheter placement, and bronchopulmonary dysplasia. The treatment of neonatal hypertension has mostly been off-label, but as evidence accumulates, the safety of medical management has increased. The prognosis of neonatal hypertension remains largely unknown and thankfully most often resolves unless secondary to renovascular disease, but further research is needed. This review discusses important factors related to neonatal hypertension including BP measurement, determinants of BP, and management of neonatal hypertension.
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Affiliation(s)
- Matthew W Harer
- Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alison L Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, P.O. Box 11, Woden, ACT, 2606, Australia. .,Australian National University Medical School, Canberra, Australia.
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20
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Charlton JR, Boohaker L, Askenazi D, Brophy PD, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Starr M, Kent AL. Late onset neonatal acute kidney injury: results from the AWAKEN Study. Pediatr Res 2019; 85:339-348. [PMID: 30546043 PMCID: PMC6438709 DOI: 10.1038/s41390-018-0255-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Most studies of neonatal acute kidney injury (AKI) have focused on the first week following birth. Here, we determined the outcomes and risk factors for late AKI (>7d). METHODS The international AWAKEN study examined AKI in neonates admitted to an intensive care unit. Late AKI was defined as occurring >7 days after birth according to the KDIGO criteria. Models were constructed to assess the association between late AKI and death or length of stay. Unadjusted and adjusted odds for late AKI were calculated for each perinatal factor. RESULTS Late AKI occurred in 202/2152 (9%) of enrolled neonates. After adjustment, infants with late AKI had higher odds of death (aOR:2.1, p = 0.02) and longer length of stay (parameter estimate: 21.9, p < 0.001). Risk factors included intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection. CONCLUSIONS Late AKI is common, independently associated with poor short-term outcomes and associated with unique risk factors. These should guide the development of protocols to screen for AKI and research to improve prevention strategies to mitigate the consequences of late AKI.
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Affiliation(s)
| | - Louis Boohaker
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Askenazi
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick D Brophy
- Golisano Children's Hospital, University of Rochester School of Medicine, Rochester, NY, USA
| | - Mamta Fuloria
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason Gien
- University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | | | | | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, HI, USA
| | - Ayesa Mian
- Golisano Children's Hospital, University of Rochester School of Medicine, Rochester, NY, USA
| | | | | | | | - Mary Revenis
- Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC, USA
| | - Subrata Sarkar
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Starr
- Seattle Children's Hospital/University of Washington, Seattle, WA, USA
| | - Alison L Kent
- Golisano Children's Hospital, University of Rochester School of Medicine, Rochester, NY, USA
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Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Smith A, Starr M, Kent AL. Incidence and Risk Factors of Early Onset Neonatal AKI. Clin J Am Soc Nephrol 2019; 14:184-195. [PMID: 31738181 PMCID: PMC6390916 DOI: 10.2215/cjn.03670318] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization. RESULTS Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata. CONCLUSIONS AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course.
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Affiliation(s)
| | - Louis Boohaker
- University of Alabama at Birmingham, Birmingham, Alabama
| | - David Askenazi
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick D Brophy
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Carl D'Angio
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Mamta Fuloria
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Gien
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | - Sangeeta Hingorani
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Ayesa Mian
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Robin K Ohls
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Mary Revenis
- Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC
| | - Subrata Sarkar
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and
| | | | - Michelle Starr
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Alison L Kent
- Golisano Children's Hospital, University of Rochester, Rochester, New York
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Affiliation(s)
| | - John A Callary
- Psychiatry Registrar, Department of Psychiatry Repatriation General Hospital, Daw Park, SA 5041
| | - Alison L Kent
- Medical Student Flinders University of South Australia Bedford Park, SA 5042
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23
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Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL. Correction: Incidence of neonatal hypertension from a large multicentre study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]. Pediatr Res 2018; 84:314. [PMID: 30089887 DOI: 10.1038/s41390-018-0107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Text for Correction.
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Affiliation(s)
- Emily J Kraut
- Australian National University Medical School, Canberra, ACT, 2601, Australia
| | - Louis J Boohaker
- Department of Pediatrics, Division of Nephrology, University of Alabama, Birmingham, AL, USA
| | - David J Askenazi
- Department of Pediatrics, Division of Nephrology, University of Alabama, Birmingham, AL, USA
| | - Jeffery Fletcher
- Australian National University Medical School, Canberra, ACT, 2601, Australia.,Department of Pediatrics, Centenary Hospital for Women and Children, Woden, ACT, 2606, Australia
| | - Alison L Kent
- Australian National University Medical School, Canberra, ACT, 2601, Australia. .,Department of Neonatology, Centenary Hospital for Women and Children, Woden, ACT, 2606, Australia.
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Kent AL, Charlton JR, Guillet R, Gist KM, Hanna M, El Samra A, Fletcher J, Selewski DT, Mammen C. Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management. Am J Perinatol 2018; 35:1-9. [PMID: 28709164 DOI: 10.1055/s-0037-1604260] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI. METHODS A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices. RESULTS Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up. CONCLUSION Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.
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Affiliation(s)
- A L Kent
- Department of Neonatology, Canberra and Australian National University, Canberra, Australia
| | - J R Charlton
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - R Guillet
- Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, New York
| | - K M Gist
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - M Hanna
- Department of Pediatrics, University of Kentucky, Lexington, Kentucky
| | - A El Samra
- Department of Pediatrics and Neonatology, Franciscan St. Elizabeth Health, East Lafayette, Indiana
| | - J Fletcher
- Department of Paediatrics, Canberra and Australian National University, Canberra, Australia
| | - D T Selewski
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - C Mammen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Inati V, Matic M, Phillips C, Maconachie N, Vanderhook F, Kent AL. A survey of the experiences of families with bereavement support services following a perinatal loss. Aust N Z J Obstet Gynaecol 2017; 58:54-63. [DOI: 10.1111/ajo.12661] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Violet Inati
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Mara Matic
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Christine Phillips
- Academic Unit of General Practice and Community Health; Australian National University; Canberra Australian Capital Territory Australia
| | | | - Fiona Vanderhook
- SIDS and Kids ACT; Weston Creek Australian Capital Territory Australia
| | - Alison L. Kent
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Department of Neonatology; Canberra Hospital; Woden Australian Capital Territory Australia
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26
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Flenady V, Wojcieszek AM, Ellwood D, Leisher SH, Erwich JJHM, Draper ES, McClure EM, Reinebrant HE, Oats J, McCowan L, Kent AL, Gardener G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, Gordijn S, Pettersson K, Masson V, Pattinson R, Gardosi J, Khong TY, Frøen JF, Silver RM. Classification of causes and associated conditions for stillbirths and neonatal deaths. Semin Fetal Neonatal Med 2017; 22:176-185. [PMID: 28285990 DOI: 10.1016/j.siny.2017.02.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Accurate and consistent classification of causes and associated conditions for perinatal deaths is essential to inform strategies to reduce the five million which occur globally each year. With the majority of deaths occurring in low- and middle-income countries (LMICs), their needs must be prioritised. The aim of this paper is to review the classification of perinatal death, the contemporary classification systems including the World Health Organization's International Classification of Diseases - Perinatal Mortality (ICD-PM), and next steps. During the period from 2009 to 2014, a total of 81 new or modified classification systems were identified with the majority developed in high-income countries (HICs). Structure, definitions and rules and therefore data on causes vary widely and implementation is suboptimal. Whereas system testing is limited, none appears ideal. Several systems result in a high proportion of unexplained stillbirths, prompting HICs to use more detailed systems that require data unavailable in low-income countries. Some systems appear to perform well across these different settings. ICD-PM addresses some shortcomings of ICD-10 for perinatal deaths, but important limitations remain, especially for stillbirths. A global approach to classification is needed and seems feasible. The new ICD-PM system is an important step forward and improvements will be enhanced by wide-scale use and evaluation. Implementation requires national-level support and dedicated resources. Future research should focus on implementation strategies and evaluation methods, defining placental pathologies, and ways to engage parents in the process.
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Affiliation(s)
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK.
| | - Aleena M Wojcieszek
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK; School of Medicine, Griffith University & Gold Coast University Hospital, Gold Coast, Australia
| | - Susannah Hopkins Leisher
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jan Jaap H M Erwich
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester Centre for Medicine, Leicester, UK
| | - Elizabeth M McClure
- International Stillbirth Alliance, Bristol, UK; Department of Maternal and Child Health, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Hanna E Reinebrant
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Alison L Kent
- International Stillbirth Alliance, Bristol, UK; Australian National University Medical School, Canberra, Australia; Centenary Hospital for Women and Children, Canberra, Australia
| | - Glenn Gardener
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia; International Stillbirth Alliance, Bristol, UK; Mater Health Services, Brisbane, Australia
| | | | - David Tudehope
- Mater Research Institute, The University of Queensland (MRI-UQ), Brisbane, Australia
| | - Dimitrios Siassakos
- International Stillbirth Alliance, Bristol, UK; University of Bristol, School of Social and Community Medicine, Obstetrics and Gynaecology, Southmead Hospital, Bristol, UK
| | | | - Jane Zuccollo
- Auckland DHB LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jane E Dahlstrom
- Australian National University Medical School, Canberra, Australia; Anatomical Pathology, ACT Pathology, The Canberra Hospital, Garran, Australia
| | - Katherine J Gold
- International Stillbirth Alliance, Bristol, UK; Department of Family Medicine and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Sanne Gordijn
- International Stillbirth Alliance, Bristol, UK; University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Robert Pattinson
- Department of Obstetrics and Gynaecology, University of Pretoria, Pretoria, South Africa
| | | | - T Yee Khong
- SA Pathology, University of Adelaide, Adelaide, Australia
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway; Centre for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK; University of Utah Health Sciences Center, Salt Lake City, UT, USA
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27
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Matić M, Inati V, Abdel-Latif ME, Kent AL. Maternal hypertensive disorders are associated with increased use of respiratory support but not chronic lung disease or poorer neurodevelopmental outcomes in preterm neonates at <29 weeks of gestation. J Paediatr Child Health 2017; 53:391-398. [PMID: 28121046 DOI: 10.1111/jpc.13430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/21/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
Abstract
AIM To assess whether maternal hypertensive disorders in pregnancies result in higher respiratory requirements, risk of chronic lung disease (CLD) and poorer neurodevelopmental outcome in <29-week premature neonates. METHODS This is a multicentre, retrospective cohort study, within a geographically defined area in Australia, served by a network of 10 neonatal intensive care units (NICUs), consisting of infants <29 weeks of gestational age who were admitted to NICUs between 1998 and 2004. Outcome measures included hospital survival, perinatal complications and functional disability at 2-3 years follow-up. RESULTS A total of 2549 mothers and infants were included in the study; 379 (14.9%) mothers had hypertensive disorders during pregnancy. Follow-up data were obtained for 1473 (74.8%) infants at 2-3 years. Infants exposed to pre-eclampsia had a higher need for supplemental surfactant therapy (odds ratio (OR): 2.004, 95% confidence interval (CI): 1.51-2.66), longer duration of mechanical ventilation (7.0 days vs. 4.0 days), were associated with a higher incidence of CLD (OR: 1.40, 95% CI: 1.12-1.76) and received post-natal steroids for CLD (OR: 1.82, 95% CI: 1.43-2.31) and home oxygen (OR: 1.47, 95% CI: 1.11-1.95). Multivariable analysis showed that hypertensive disease of pregnancy was not significantly associated with the development of CLD in this cohort (OR: 1.103, 95% CI: 0.845-1.441). Multivariable analysis of long-term neurodevelopmental data available for the 1473 follow-up infants showed no significant difference in outcomes with or without exposure to maternal hypertensive disease. CONCLUSION Maternal hypertensive disease of pregnancy does not increase the risk of CLD or long-term neurodevelopmental complications in infants born at <29 weeks of gestation.
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Affiliation(s)
- Mara Matić
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Violet Inati
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Mohamed E Abdel-Latif
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
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28
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Gardiner PA, Kent AL, Rodriguez V, Wojcieszek AM, Ellwood D, Gordon A, Wilson PA, Bond DM, Charles A, Arbuckle S, Gardener GJ, Oats JJ, Erwich JJ, Korteweg FJ, Duc THN, Leisher SH, Kishore K, Silver RM, Heazell AE, Storey C, Flenady V. Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). BMC Pregnancy Childbirth 2016; 16:376. [PMID: 27887578 PMCID: PMC5124291 DOI: 10.1186/s12884-016-1173-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stillbirths and neonatal deaths are devastating events for both parents and clinicians and are global public health concerns. Careful clinical management after these deaths is required, including appropriate investigation and assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An educational programme for health care professionals working in maternal and child health has been designed to address these needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth and is delivered as six interactive skills-based stations. We aimed to determine participants' pre- and post-programme knowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme. We also aimed to determine suitability for international use. METHODS The IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian states and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the assistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation with local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme evaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well as a satisfaction questionnaire. RESULTS Over the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758 participants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement between pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of satisfaction in all settings. CONCLUSIONS The IMPROVE programme has been well received in Australia and in three different international settings and is now being made available through ISA. Future research is required to determine whether the immediate improvements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical practice and improvement in parents' experiences with care. The suitability for this programme in low-income countries also needs to be established.
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Affiliation(s)
- Paul A Gardiner
- Mater Research Institute, The University of Queensland, Level 2 Aubigny Place, South Brisbane, QLD 4101, Australia
| | - Alison L Kent
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Medical School, Australian National University, Canberra, Australia.,Centenary Hospital for Women and Children, Canberra, Australia
| | - Viviana Rodriguez
- Mater Research Institute, The University of Queensland, Level 2 Aubigny Place, South Brisbane, QLD 4101, Australia
| | - Aleena M Wojcieszek
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia
| | - David Ellwood
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,School of Medicine, Griffith University, Brisbane, Australia.,Gold Coast University Hospital, Southport, Australia
| | - Adrienne Gordon
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, Australia.,Newborn Care, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Diana M Bond
- Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Newborn Care, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia.,Kolling Institute, The University of Sydney, Sydney, Australia
| | - Adrian Charles
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia
| | - Susan Arbuckle
- Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Children's Hospital at Westmead, Sydney, Australia
| | - Glenn J Gardener
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Mater Health Services, Brisbane, Australia
| | - Jeremy J Oats
- International Stillbirth Alliance, Bristol, UK.,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jan Jaap Erwich
- International Stillbirth Alliance, Bristol, UK.,University of Groningen, Groningen, The Netherlands
| | - Fleurisca J Korteweg
- International Stillbirth Alliance, Bristol, UK.,Department of Obstetrics and Gynecology, Martini Hospital, Groningen, The Netherlands
| | - T H Nguyen Duc
- Institute for Reproductive and Family Health, Hanoi, Vietnam
| | | | - Kamal Kishore
- College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Robert M Silver
- International Stillbirth Alliance, Bristol, UK.,Health Services Center, University of Utah, Salt Lake City, USA
| | - Alexander E Heazell
- International Stillbirth Alliance, Bristol, UK.,Maternal and Fetal Health Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Vicki Flenady
- International Stillbirth Alliance, Bristol, UK. .,Perinatal Society of Australia and New Zealand Stillbirth and Neonatal Death Alliance, Monington, Australia.
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Griffin J, Heald A, Davidson L, Kent AL. A prospective audit of adherence to safe sleeping guidelines in a general paediatric ward and special care nursery. J Paediatr Child Health 2016; 52:529-33. [PMID: 27329907 DOI: 10.1111/jpc.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 10/09/2015] [Accepted: 12/16/2015] [Indexed: 11/30/2022]
Abstract
AIM Sudden Infant Death Syndrome (SIDS) remains one of the largest causes of infant mortality worldwide, and despite widespread educational campaigns compliance to safe sleeping guidelines remains low in many areas. Hospital staff play a significant role in educating parents on safe sleeping recommendations and providing appropriate sleeping environments for infants. The aim of the study was to evaluate adherence to safe sleeping guidelines in a special care nursery (SCN) and general paediatric ward (GPW). METHODS A prospective audit of sleeping environments in a SCN and GPW with data collected on 10 safe sleeping compliance rules, based on national and international guidelines. RESULTS Two hundred eleven sleeping environments were observed (161 in SCN, 50 in GPW). Supine sleeping compliance was high in both wards (83% SCN, 82% GPW). Overall the median compliance score was significantly lower in the GPW (7, IQR = 6-7) compared to the SCN (8, IQR = 7-9) (Mann Whitney U test, P < 0.001). Lowest compliance rates were seen in respect to removing soft items from the crib and infant positioning within the crib. CONCLUSIONS Compliance with supine sleeping was high; however, nurses and parents may not be aware, or do not implement, the full suite of safe sleeping guidelines. Further research is required to determine specific reasons for poor compliance and on the effectiveness of educational programmes in improving hospital infant sleeping environments.
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Affiliation(s)
- Josh Griffin
- Australian National University Medical School, Canberra, Australian Capital Territory
| | - Alicia Heald
- Australian National University Medical School, Canberra, Australian Capital Territory
| | - Lucy Davidson
- Australian National University Medical School, Canberra, Australian Capital Territory
| | - Alison L Kent
- Australian National University Medical School, Canberra, Australian Capital Territory.,Department of Neonatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Jetton JG, Guillet R, Askenazi DJ, Dill L, Jacobs J, Kent AL, Selewski DT, Abitbol CL, Kaskel FJ, Mhanna MJ, Ambalavanan N, Charlton JR. Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study. Front Pediatr 2016; 4:68. [PMID: 27486571 PMCID: PMC4950470 DOI: 10.3389/fped.2016.00068] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/20/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) affects ~30% of hospitalized neonates. Critical to advancing our understanding of neonatal AKI is collaborative research among neonatologists and nephrologists. The Neonatal Kidney Collaborative (NKC) is an international, multidisciplinary group dedicated to investigating neonatal AKI. The AWAKEN study (Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates) was designed to describe the epidemiology of neonatal AKI, validate the definition of neonatal AKI, identify primary risk factors for neonatal AKI, and investigate the contribution of fluid management to AKI events and short-term outcomes. METHODS AND ANALYSIS The NKC was established with at least one pediatric nephrologist and neonatologist from 24 institutions in 4 countries (USA, Canada, Australia, and India). A Steering Committee and four subcommittees were created. The database subcommittee oversaw the development of the web-based database (MediData Rave™) that captured all NICU admissions from 1/1/14 to 3/31/14. Inclusion and exclusion criteria were applied to eliminate neonates with a low likelihood of AKI. Data collection included: (1) baseline demographic information; (2) daily physiologic parameters and care received during the first week of life; (3) weekly "snapshots"; (4) discharge information including growth parameters, final diagnoses, discharge medications, and need for renal replacement therapy; and (5) all serum creatinine values. ETHICS AND DISSEMINATION AWAKEN was proposed as human subjects research. The study design allowed for a waiver of informed consent/parental permission. NKC investigators will disseminate data through peer-reviewed publications and educational conferences. DISCUSSION The purpose of this publication is to describe the formation of the NKC, the establishment of the AWAKEN cohort and database, future directions, and a few "lessons learned." The AWAKEN database includes ~325 unique variables and >4 million discrete data points. AWAKEN will be the largest, most inclusive neonatal AKI study to date. In addition to validating the neonatal AKI definition and identifying risk factors for AKI, this study will uncover variations in practice patterns related to fluid provision, renal function monitoring, and involvement of pediatric nephrologists during hospitalization. The AWAKEN study will position the NKC to achieve the long-term goal of improving the lives, health, and well-being of newborns at risk for kidney disease.
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Affiliation(s)
- Jennifer G Jetton
- Stead Family Department of Pediatrics, Division of Nephrology, Dialysis and Transplantation, University of Iowa Children's Hospital , Iowa City, IA , USA
| | - Ronnie Guillet
- Department of Pediatrics, Division of Neonatology, University of Rochester Medical Center , Rochester, NY , USA
| | - David J Askenazi
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Lynn Dill
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Judd Jacobs
- Data Management Center, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center , Cincinnati, OH , USA
| | - Alison L Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School , Canberra, ACT , Australia
| | - David T Selewski
- Department of Pediatrics and Communicable Diseases, Division of Nephrology, C.S. Mott Children's Hospital, University of Michigan , Ann Arbor, MI , USA
| | - Carolyn L Abitbol
- Department of Pediatrics, Division of Nephrology, Holtz Children's Hospital, University of Miami , Miami, FL , USA
| | - Fredrick J Kaskel
- Department of Pediatrics, Division of Nephrology, Children's Hospital at Montefiore, Albert Einstein , Bronx, NY , USA
| | - Maroun J Mhanna
- Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, Case Western Reserve University , Cleveland, OH , USA
| | - Namasivayam Ambalavanan
- Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham , Birmingham, AL , USA
| | - Jennifer R Charlton
- Department of Pediatrics, Division of Nephrology, University of Virginia , Charlottesville, VA , USA
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Abstract
In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates <1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.
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Affiliation(s)
- David T Selewski
- Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Jennifer R Charlton
- Division of Nephrology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia;
| | - Jennifer G Jetton
- Division of Nephrology, Dialysis and Transplantation, Stead Family Department of Pediatrics, University of Iowa Children's Hospital, Iowa City, Iowa
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Maroun J Mhanna
- Division of Neonatology, Department of Pediatrics, Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio
| | - David J Askenazi
- Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; and
| | - Alison L Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Australian Capital Territory, Australia
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Kent AL, Broom M, Parr V, Essex RW, Abdel-Latif ME, Dahlstrom JE, Valter K, Provis J, Natoli R. A safety and feasibility study of the use of 670 nm red light in premature neonates. J Perinatol 2015; 35:493-6. [PMID: 25695843 DOI: 10.1038/jp.2015.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina affecting extremely preterm or low birth weight infants The aim of this study was to assess the feasibility and safety of 670 nm red light use in a neonatal intensive care unit. STUDY DESIGN Neonates <30 weeks gestation and <1150 g were enrolled within 48 h of birth. Data collected included cause of preterm delivery, Apgar scores and birthweight. 670 nm red light was administered for 15 min per day from a distance of 25 cm, delivering 9 J cm(-)(2), from the time of inclusion in the study until 34 weeks postmenstrual age. Infants were assessed daily for the presence of any skin burns or other adverse signs. RESULT Twenty-eight neonates were enrolled, seven 24 to 26 weeks and twenty-one 27 to 29 weeks gestation. The most common cause for preterm delivery was preterm labor (14/28) with five of these having evidence of chorioamnionitis. There were no skin burns or other documented adverse events. Entry into the study was readily achieved and treatment was well accepted by parents and nursing staff. CONCLUSION 670 nm red light appears to be a safe and feasible treatment for further research in respect to ROP.
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Affiliation(s)
- A L Kent
- 1] Department of Neonatology, Canberra Hospital, Woden, ACT, Australia [2] Australian National University Medical School, Canberra, ACT, Australia
| | - M Broom
- Department of Neonatology, Canberra Hospital, Woden, ACT, Australia
| | - V Parr
- Department of Neonatology, Canberra Hospital, Woden, ACT, Australia
| | - R W Essex
- 1] Australian National University Medical School, Canberra, ACT, Australia [2] Department of Ophthalmology, Canberra Hospital, Woden, ACT, Australia
| | - M E Abdel-Latif
- 1] Department of Neonatology, Canberra Hospital, Woden, ACT, Australia [2] Australian National University Medical School, Canberra, ACT, Australia
| | - J E Dahlstrom
- 1] Australian National University Medical School, Canberra, ACT, Australia [2] Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia
| | - K Valter
- 1] Australian National University Medical School, Canberra, ACT, Australia [2] John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - J Provis
- 1] Australian National University Medical School, Canberra, ACT, Australia [2] John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - R Natoli
- 1] Australian National University Medical School, Canberra, ACT, Australia [2] John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
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Phad N, Dahlstrom JE, Ellwood D, Kent AL. The effect of pregnancy-induced hypertensive disorders on placental growth along short and long axes and neonatal outcomes. Aust N Z J Obstet Gynaecol 2015; 55:239-44. [PMID: 26084195 DOI: 10.1111/ajo.12308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 12/14/2014] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of pregnancy-induced hypertensive disorders on the growth of the placenta on the short and long axes and neonatal outcomes. MATERIALS AND METHODS A retrospective cohort study of gross and histological characteristics of placentas and the fetal outcomes of normotensive and hypertensive pregnancies over a three-year period from January 2009 to December 2011 at a tertiary teaching hospital in ACT, Australia. RESULTS Placentas and neonatal outcomes from 100 pregnancies complicated with pregnancy-induced hypertension/pre-eclampsia were studied and compared with 51 gestational age-matched placentas and neonatal outcomes from normotensive pregnancies. The median maternal age and smoking history were similar in the two groups (P = 0.894; P = 1.00, respectively). The median pre-pregnancy weight was significantly higher (P < 0.001) and primiparity more common (P = 0.001) in the study group. The median weight of the placenta was significantly lower (P < 0.001) and below the 10th centile (P < 0.001) in the study group. Both the long and short axes of the placental disc were significantly smaller in the study group (P = 0.002; P ≤ 0.001 respectively). Accelerated villous maturation, placental infarcts and decidual vessel vasculopathy were more common in the study group (P < 0.001). The median birthweight and the number of infants with birthweight and length below the 10th centile were significantly higher in the study group (P = 0.008; P < 0.001; P = 0.004, respectively). CONCLUSION This study demonstrates that pregnancy-induced hypertension significantly influences the growth and development of both the placenta and fetus.
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Affiliation(s)
- Neelkanth Phad
- Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Jane E Dahlstrom
- Department of Anatomical Pathology, Canberra Hospital, Woden, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - David Ellwood
- Department of Fetal Medicine, Gold Coast University Hospital, Southport, Queensland, Australia.,Griffith University, Southport, Queensland, Australia
| | - Alison L Kent
- Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia.,Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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Affiliation(s)
- Ranga Panagoda
- Department of Neonatal Registrar, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Natalie De Cure
- Department of Obstetric Registrar, Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Ruth McCuaig
- Department of Obstetric Registrar, Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Alison L Kent
- Department of Senior Staff Specialist, Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
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Kent AL, Koina ME, Gubhaju L, Cullen-McEwen LA, Bertram JF, Lynnhtun J, Shadbolt B, Falk MC, Dahlstrom JE. Indomethacin administered early in the postnatal period results in reduced glomerular number in the adult rat. Am J Physiol Renal Physiol 2014; 307:F1105-10. [PMID: 25186294 DOI: 10.1152/ajprenal.00328.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Indomethacin and ibuprofen are administered to close a patent ductus arteriosus (PDA) during active glomerulogenesis. Light and electron microscopic glomerular changes with no change in glomerular number were seen following indomethacin and ibuprofen treatment during glomerulogenesis at 14 days after birth in a neonatal rat model. This present study aimed to determine whether longstanding renal structural changes are present at 30 days and 6 mo (equivalent to human adulthood). Rat pups were administered indomethacin or ibuprofen antenatally on days 18-20 (0.5 mg·kg(-1)·dose(-1) indomethacin; 10 mg·kg(-1)·dose(-1) ibuprofen) or postnatally intraperitoneally from day 1 to 3 or day 1 to 5 (0.2 mg·kg(-1)·dose(-1) indomethacin; 10 mg·kg(-1)·dose(-1) ibuprofen). Control groups received no treatment or normal saline intraperitoneally. Pups were killed at 30 days of age and 6 mo of age. Tissue blocks from right kidneys were prepared for light and electron microscopic examination, while total glomerular number was determined in left kidneys using unbiased stereology. Eight pups were included in each group from 14 maternal rats. At 30 days and 6 mo, there were persistent electron microscopy abnormalities of the glomerular basement membrane in those receiving postnatal indomethacin and ibuprofen. There were no significant light microscopy findings at 30 days or 6 mo. At 6 mo, there were significantly fewer glomeruli in those receiving postnatal indomethacin but not ibuprofen (P = 0.003). In conclusion, indomethacin administered during glomerulogenesis appears to reduce the number of glomeruli in adulthood. Alternative options for closing a PDA should be considered including ibuprofen as well as emerging therapies such as paracetamol.
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Affiliation(s)
- A L Kent
- Department of Neonatology, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - M E Koina
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia
| | - L Gubhaju
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - L A Cullen-McEwen
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - J F Bertram
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia; and
| | - J Lynnhtun
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia
| | - B Shadbolt
- Clinical Epidemiology Unit, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - M C Falk
- Department of Renal Medicine, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
| | - J E Dahlstrom
- Department of Anatomical Pathology, Canberra Hospital, Woden, ACT, Australia; Australian National University Medical School, Canberra, ACT, Australia
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Abstract
The normal development of the kidney may be affected by several factors, including abnormalities in placental function, resulting in fetal growth restriction, exposure to maternal disease states, including hypertension and diabetes, antenatal steroids, chorioamnionitis, and preterm delivery. After preterm birth, several further insults may occur that may influence nephrogenesis and renal health, including exposure to nephrotoxic medications, postnatal growth failure, and obesity after growth restriction. In this review article, common clinical neonatal scenarios are used to highlight these renal risk factors, and the animal and human evidence on which these risk factors are based are discussed.
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Affiliation(s)
- Megan Sutherland
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - Dana Ryan
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - M Jane Black
- Department of Anatomy and Developmental Biology, Monash University, Level 3, Boulevard 76, Wellington Road, Clayton, Victoria 3800, Australia
| | - Alison L Kent
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, PO Box 11, Woden 2606, Australian Capital Territory, Australia; Australian National University Medical School, Canberra 2601, Australian Capital Territory, Australia.
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Gubhaju L, Sutherland MR, Horne RSC, Medhurst A, Kent AL, Ramsden A, Moore L, Singh G, Hoy WE, Black MJ. Assessment of renal functional maturation and injury in preterm neonates during the first month of life. Am J Physiol Renal Physiol 2014; 307:F149-58. [PMID: 24899060 DOI: 10.1152/ajprenal.00439.2013] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Worldwide, approximately 10% of neonates are born preterm. The majority of preterm neonates are born when the kidneys are still developing; therefore, during the early postnatal period renal function is likely reflective of renal immaturity and/or injury. This study evaluated glomerular and tubular function and urinary neutrophil gelatinase-associated lipocalin (NGAL; a marker of renal injury) in preterm neonates during the first month of life. Preterm and term infants were recruited from Monash Newborn (neonatal intensive care unit at Monash Medical Centre) and Jesse McPherson Private Hospital, respectively. Infants were grouped according to gestational age at birth: ≤28 wk (n = 33), 29-31 wk (n = 44), 32-36 wk (n = 32), and term (≥37 wk (n = 22)). Measures of glomerular and tubular function were assessed on postnatal days 3-7, 14, 21, and 28. Glomerular and tubular function was significantly affected by gestational age at birth, as well as by postnatal age. By postnatal day 28, creatinine clearance remained significantly lower among preterm neonates compared with term infants; however, sodium excretion was not significantly different. Pathological proteinuria and high urinary NGAL levels were observed in a number of neonates, which may be indicative of renal injury; however, there was no correlation between the two markers. Findings suggest that neonatal renal function is predominantly influenced by renal maturity, and there was high capacity for postnatal tubular maturation among preterm neonates. There is insufficient evidence to suggest that urinary NGAL is a useful marker of renal injury in the preterm neonate.
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Affiliation(s)
- Lina Gubhaju
- Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Rosemary S C Horne
- Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Alison Medhurst
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia
| | - Alison L Kent
- Department of Neonatology, Canberra Hospital, and the Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Andrew Ramsden
- Monash Newborn, Monash Medical Centre, Clayton, Victoria, Australia
| | - Lynette Moore
- Department of Surgical Pathology, South Australia Pathology, Women's and Children's Hospital, North Adelaide and the University of Adelaide, Adelaide, South Australia, Australia
| | - Gurmeet Singh
- Menzies School of Health Research and the Royal Darwin Hospital, Casuarina, Northern Territory, Australia; and
| | - Wendy E Hoy
- Centre for Chronic Disease, University of Queensland, Brisbane, Queensland, Australia
| | - M Jane Black
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia;
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Saha S, Kent AL. Length of time from extubation to cardiorespiratory death in neonatal intensive care patients and assessment of suitability for organ donation. Arch Dis Child Fetal Neonatal Ed 2014; 99:F59-63. [PMID: 24105623 DOI: 10.1136/archdischild-2013-304704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A common concern for parents when end of life decisions are made is the length of time their baby may take to die. Postcardiac death organ donation is now becoming more common, along with neonatal organ donation. The aim was to determine the length of time from extubation until cardiorespiratory death (CRD) in neonatal intensive care patients and consideration of potential organ donation. DESIGN Retrospective review of medical records of neonates who died in a neonatal intensive care unit between 2000 and 2009. PATIENTS Data collected included gestation at birth, age at death, birth weight, reason for cessation of intensive care, inotrope and ventilation requirements, sedation and muscle relaxation prior to death, time from extubation to documented CRD. An assessment was made for potential suitability for consideration of organ donation with a gestation at birth ≥ 34 weeks and birth weight >2.0 kg. RESULTS 117 neonates were included, median gestation 29 weeks and median birth weight 1220 grams. The median age at death was 4 days of age. The median time from discussing prognosis to death was 137 min. The median time from extubation to CRD was 30 min. Seven (6%) neonates were considered suitable for organ donation, and for these infants the median time from extubation to CRD was 120 min. Two neonates donated heart valves. CONCLUSIONS This provides a guide for grieving parents on time frames for the interval between extubation and CRD. More accurate postextubation CRD times are required to determine likely potential for postcardiac death organ donation.
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Affiliation(s)
- S Saha
- Department of Obstetrics and Gynaecology, Canberra Hospital, , Canberra, Australian Capital Territory, Australia
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Abstract
AIM There is uncertainty about the risk of developmental dysplasia of the hip (DDH) in breech preterm infants and therefore uncertainty about the benefits of using ultrasound screening in this population. The aim of this study was to determine if preterm infants born in the breech position are at risk of DDH. METHODS A retrospective audit of preterm and term infants born in the breech position was performed to determine the incidence of DDH. Group 1 included breech preterm infants (<37 weeks gestational age) born between 2004 and 2008. Group 2 included breech term infants (≥37 weeks gestational age) born between 2005 and 2007. Infants were screened with clinical examination and ultrasound of the hip and were classified into two outcome groups: positive or negative for DDH. RESULTS Three out of 129 (2.3%) preterm infants screened had DDH. For term infants, 3 out of 163 (1.8%) infants screened had DDH. The odds ratio for DDH in breech preterm infants compared with breech term infants was 1.27 (95% confidence interval 0.25 to 6.40). CONCLUSION Preterm infants born in the breech position appear to have a similar incidence of DDH to term infants and thus require similar screening guidelines.
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Affiliation(s)
- Teddy Quan
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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Black MJ, Sutherland MR, Gubhaju L, Kent AL, Dahlstrom JE, Moore L. When birth comes early: Effects on nephrogenesis. Nephrology (Carlton) 2013; 18:180-2. [DOI: 10.1111/nep.12028] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Mary Jane Black
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Megan R Sutherland
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Lina Gubhaju
- Department of Anatomy and Developmental Biology; Monash University; Melbourne; Victoria
| | - Alison L Kent
- Departments of Neonatology; Canberra Hospital and the Australian National University Medical School
| | - Jane E Dahlstrom
- Anatomical Pathology; Canberra Hospital and the Australian National University Medical School; Canberra; Australian Capital Territory
| | - Lynette Moore
- Department of Surgical Pathology; South Australia Pathology; Women's and Children's Hospital, North Adelaide and The University of Adelaide; Adelaide; South Australia; Australia
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Chaudhari T, Robertson M, Ellwood D, Simpson E, Kecskes Z, Kent AL. Maternal ventilation and sedation for H1N1 influenza resulting in fetal bladder rupture and urinary ascites. J Paediatr Child Health 2013; 49:E97-100. [PMID: 22845898 DOI: 10.1111/j.1440-1754.2012.02502.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.
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Affiliation(s)
- Tejasvi Chaudhari
- Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia
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Kent AL. Developmental origins of health and adult disease: what should neonatologists/paediatricians be considering about the long-term health of their patients? J Paediatr Child Health 2012; 48:730-4. [PMID: 22970665 DOI: 10.1111/j.1440-1754.2012.02541.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The developmental origins of health and disease hypothesis is now strongly supported by both animal and human evidence, and as a consequence, obstetricians, neonatologists and paediatricians need to consider the impact that the in utero and early post-natal environment can have on later renal, cardiovascular and metabolic health. Four common clinical scenarios were provided along with animal and human evidence identifying long-term health implications. Suggestions as to how we should translate this growing body of evidence into practice are provided.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, Canberra Hospital, Woden, Australian Capital Territory, Australia.
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Kent AL, Brown L, Broom M, Broomfield A, Dahlstrom JE. Increased urinary podocytes following indomethacin suggests drug-induced glomerular injury. Pediatr Nephrol 2012; 27:1111-7. [PMID: 22415583 DOI: 10.1007/s00467-012-2111-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 01/05/2012] [Accepted: 01/06/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Preterm infants are delivered while glomerulogenesis is ongoing and may be exposed to insults, including medications that may affect renal development. Podocytes detected in the urine are an indicator of glomerular injury. The aims of this study were to determine whether preterm and term infants excrete podocytes in their urine and whether exposure to gentamicin and indomethacin increase podocyte excretion in their urine. METHODS Preterm infants <33 weeks gestation had urine collected each day while receiving either gentamicin or indomethacin. Preterm and term control infants had urine collected for 3 days. The number of casts and podocytes present in the urine of infants receiving indomethacin and gentamicin were compared with preterm and term control infants. RESULTS Forty-two neonates were included in the study. Podocytes were present in small numbers (< 2) in the urine of both preterm and term control neonates. The number of podocytes in the preterm group receiving indomethacin was significantly higher than in all other groups (p=0.02) ,as was urinary albumin (p=0.02). CONCLUSIONS Increased number of podocytes in preterm neonates receiving indomethacin and higher excretion of albumin suggest glomerular injury is occurring. It is unknown whether injury to glomeruli during glomerulogenesis in preterm neonates has long-term sequelae for renal development and function into adulthood.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, Canberra Hospital, PO Box 11, Woden, 2606, ACT, Australia.
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Heald A, Abdel-Latif ME, Kent AL. Insulin infusion for hyperglycaemia in very preterm infants appears safe with no effect on morbidity, mortality and long-term neurodevelopmental outcome. J Matern Fetal Neonatal Med 2012; 25:2415-8. [PMID: 22668010 DOI: 10.3109/14767058.2012.699115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND/OBJECTIVE Hyperglycaemia is common in very premature neonates and is associated with increased risk of intraventricular haemorrhage, necrotising enterocolitis, sepsis and death. Administration of insulin may risk hypoglycaemia and associated complications. To determine effects of insulin infusions in very premature infants on morbidity, mortality and long-term neurodevelopmental outcome. METHODS Retrospective audit of 97 infants delivered at <29 weeks gestation and admitted to The Canberra Hospital NICU. Data on insulin treatment, Blood Glucose Levels (BGL's) prior and during insulin therapy, episodes of significant hypoglycaemia and neurodevelopmental outcome at 12 months corrected age was collected. RESULTS 17 (17.5%) neonates received insulin. Episodes of hypoglycaemia were infrequent (1.3%, 95% CI 0.5-2.9). Multiple regression analysis showed that insulin treatment was not associated with an increased risk of retinopathy of prematurity (OR 3.6, 95% CI 0.4-32.3) or mortality (OR 1.2, 95% CI 0.29-5.0). No significant difference in 12 month neurodevelopmental or anthropometric outcomes was detected in infants who received insulin. CONCLUSION Insulin infusions for hyperglycaemia appear to be safe with infrequent episodes of hypoglycaemia, no increased risk of morbidity or mortality and no adverse effect on long-term neurodevelopmental outcome.
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Affiliation(s)
- Alicia Heald
- Australian National University Medical School, Canberra, 2601, ACT, Australia
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Abstract
OBJECTIVES To determine whether male gender has an effect on survival, early neonatal morbidity, and long-term outcome in neonates born extremely prematurely. METHODS Retrospective review of the New South Wales and Australian Capital Territory Neonatal Intensive Care Unit Data Collection of all infants admitted to New South Wales and Australian Capital Territory neonatal intensive care units between January 1998 and December 2004. The primary outcome was hospital mortality and functional impairment at 2 to 3 years follow-up. RESULTS Included in the study were 2549 neonates; 54.7% were male. Risks of grade III/IV intraventricular hemorrhage, sepsis, and major surgery were found to be increased in male neonates. Hospital mortality (odds ratio 1.285, 95% confidence interval 1.035-1.595) and moderate to severe functional disability at 2 to 3 years of age (odds ratio 1.877, 95% confidence interval 1.398-2.521) were more likely in male infants. Gender differences for mortality and long-term neurologic outcome loses significance at 27 weeks gestation. CONCLUSIONS In the modern era of neonatal management, male infants still have higher mortality and poorer long-term neurologic outcome. Gender differences for mortality and long-term neurologic outcome appear to lose significance at 27 weeks gestation.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, Canberra Hospital, PO Box 11, Woden, 2606, ACT, Australia.
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Sutherland MR, Gubhaju L, Moore L, Kent AL, Dahlstrom JE, Horne RSC, Hoy WE, Bertram JF, Black MJ. Accelerated maturation and abnormal morphology in the preterm neonatal kidney. J Am Soc Nephrol 2011; 22:1365-74. [PMID: 21636639 DOI: 10.1681/asn.2010121266] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Nephrogenesis is ongoing at the time of birth for the majority of preterm infants, but whether postnatal renal development follows a similar trajectory to normal in utero growth is unknown. Here, we examined tissue collected at autopsy from 28 kidneys from preterm neonates, whose postnatal survival ranged from 2 to 68 days, including 6 that had restricted intrauterine growth. In addition, we examined kidneys from 32 still-born gestational controls. We assessed the width of the nephrogenic zone, number of glomerular generations, cross-sectional area of the renal corpuscle, and glomerular maturity and morphology. Renal maturation accelerated after preterm birth, with an increased number of glomerular generations and a decreased width of the nephrogenic zone in the kidneys of preterm neonates. Of particular concern, compared with gestational controls, preterm kidneys had a greater percentage of morphologically abnormal glomeruli and a significantly larger cross-sectional area of the renal corpuscle, suggestive of renal hyperfiltration. These observations suggest that the preterm kidney may have fewer functional nephrons, thereby increasing vulnerability to impaired renal function in both the early postnatal period and later in life.
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Affiliation(s)
- Megan R Sutherland
- Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Clayton, Victoria, 3800, Australia
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Chaudhari T, Todd DA, Kent AL, Dopita B, Hallam L, Freckmann ML, Johnston HM. Bilateral subdural hygromas and cephalhaematomas in male twins with severe myotubular myopathy caused by a Novel c.431delT (p.Leu144fs) mutation in MTM1 gene. J Paediatr Child Health 2011; 47:64-5. [PMID: 20500434 DOI: 10.1111/j.1440-1754.2010.01737.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tejasvi Chaudhari
- Department of Neonatology, Canberra Hospital, Woden, Canberra, Australia.
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Kent AL, Jyoti R, Robertson C, Gonsalves L, Meskell S, Shadbolt B, Falk MC. Are renal volumes measured by magnetic resonance imaging and three-dimensional ultrasound in the term neonate comparable? Pediatr Nephrol 2010; 25:913-8. [PMID: 20084401 DOI: 10.1007/s00467-009-1414-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/23/2009] [Accepted: 11/25/2009] [Indexed: 11/30/2022]
Abstract
Renal volume, but not renal length, has been shown to be positively correlated with renal function. Three-dimensional (3D) ultrasound and magnetic resonance imaging (MRI) are two modalities used to assess renal volume. The aim of our study was to determine whether 3D ultrasound measurements of renal volume in the neonate are comparable to those of MRI measurements. Preterm and term neonates had an MRI and 3D ultrasound to determine renal volume at the same time as they had an MRI brain scan for other clinical conditions. The preterm neonates were all term corrected age, and the term neonates were 1-4 weeks of age. None of the kidneys examined were abnormal. There were no significant differences in the weight or length of the preterm and term infants at the time of their MRI scan. The left renal length was significantly longer according to MRI measurements than according to 3D ultrasound measurements (p=0.02). Renal volumes of both the left and right kidney were greater when measured by MRI than by 3D ultrasound (p<0.0001, respectively). Total volumes of the kidneys were greater when measured by MRI than by 3D ultrasound (p=0.008). Renal volume in neonates was significantly less when evaluated by 3D ultrasound than by MRI. These results demonstrate that MRI and 3D ultrasound renal volumes are not comparable in the neonatal population and, therefore, the same radiological modality should be used if repeat volume measurements are to be performed.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, Canberra Hospital, Woden ACT, Australia.
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Kent AL, Dahlstrom JE, Ellwood D, Bourne M. Systematic multidisciplinary approach to reporting perinatal mortality: lessons from a five-year regional review. Aust N Z J Obstet Gynaecol 2010; 49:472-7. [PMID: 19780728 DOI: 10.1111/j.1479-828x.2009.01048.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Because of differences in reporting criteria throughout the world, comparing perinatal mortality rates and identifying areas of concern can be complicated and imprecise. AIMS To detail the systematic approach to reporting perinatal deaths and to identify any significant differences in outcomes in the Australian Capital Territory (ACT). METHODS Review of perinatal deaths from 2001 to 2005 in the ACT using the Australian and New Zealand Antecedent Classification of Perinatal Mortality (ANZACPM) and the Australian and New Zealand Neonatal Death Classification (ANZNDC) systems. RESULTS ACT residents' perinatal mortality rate was 10.6 per 1000 total births, fetal death rate 7.5 per 1000 total births and neonatal death rate 3.2 per 1000 live births. The three leading antecedent causes of perinatal death were congenital anomalies, spontaneous preterm birth and unexplained antepartum death. The three leading causes of neonatal death were extreme prematurity, cardiorespiratory disorders and congenital anomalies. Multiple births attributed to 20% (65 of 321) of perinatal deaths. Perinatal autopsy was performed in 50% of cases, but in only 64% of unexplained antepartum deaths. CONCLUSIONS Causes of perinatal death for the ACT and surrounding New South Wales region are similar to other states using this classification system. The following are considered important lessons to promote accurate perinatal mortality reporting: (i) a universal reporting system for Australia utilising a multidisciplinary team; (ii) a high perinatal autopsy rate, especially in the critical area of antepartum death with no identifiable cause; and (iii) standardised definitions for avoidability. Attention to these areas may prompt further research and changes in practice to further reduce perinatal mortality.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, The Canberra Hospital, Australian National University Medical School, PO Box 11, Woden, ACT 2606, Australia.
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Kent AL, Shadbolt B, Hu E, Meskell S, Falk MC, Dahlstrom JE. Do maternal- or pregnancy-associated disease states affect blood pressure in the early neonatal period? Aust N Z J Obstet Gynaecol 2009; 49:364-70. [PMID: 19694689 DOI: 10.1111/j.1479-828x.2009.01018.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Placental vascular changes associated with maternal disease states may affect fetal vascular development. There is evidence suggesting that being born prematurely is associated with a higher blood pressure (BP) in later life. AIM To determine whether maternal disease state affects BP in the early neonatal period. METHODS Cohort study of neonates admitted to neonatal intensive care unit with exposure to maternal hypertension and diabetes. Inclusion criteria were neonates greater than 27 weeks gestation not ventilated or requiring inotropes for more than 24 h, materna l hypertension (pregnancy induced or essential) or diabetes of any kind requiring treatment, and spontaneous delivery. Exclusion criteria included chromosomal or congenital anomaly and illicit maternal drug use. Oscillometric BP measurements taken until discharge on days 1, 2, 3, 4, 7, 14, 21 and 28. Placental histopathology was performed. RESULTS One hundred and ninety infants enrolled, 104 in the control and 86 in the study group. Sixty-five infants were born between 28-31 weeks and 125 infants between 32-41 weeks gestation. Those born between 28-31 weeks with a history of diabetes had a statistically higher systolic, mean and diastolic BP throughout the first 28 days of life (P = 0.001; P = 0.007; P = 0.02). Those born between 32-41 weeks gestation with placental pathology associated with altered uteroplacental perfusion had a higher systolic BP (P = 0.005). CONCLUSIONS Maternal- or pregnancy-associated disease states appear to influence BP in the early neonatal period. Diabetes and altered placental perfusion were associated with higher BP readings. Clinical significance of these statistically elevated BPs in the early neonatal period is unknown.
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Affiliation(s)
- Alison L Kent
- Department of Neonatology, Canberra Hospital, Australia.
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