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Song AY, Bulka CM, Niemiec SS, Kechris K, Boyle KE, Marsit CJ, O’Shea TM, Fry RC, Lyall K, Fallin MD, Volk HE, Ladd-Acosta C. Accelerated epigenetic age at birth and child emotional and behavioura development in early childhood: a meta-analysis of four prospective cohort studies in ECHO. Epigenetics 2023; 18:2254971. [PMID: 37691382 PMCID: PMC10496525 DOI: 10.1080/15592294.2023.2254971] [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: 02/15/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023] Open
Abstract
Background: 'Epigenetic clocks' have been developed to accurately predict chronologic gestational age and have been associated with child health outcomes in prior work.Methods: We meta-analysed results from four prospective U.S cohorts investigating the association between epigenetic age acceleration estimated using blood DNA methylation collected at birth and preschool age Childhood Behavior Checklist (CBCL) scores.Results: Epigenetic ageing was not significantly associated with CBCL total problem scores (β = 0.33, 95% CI: -0.95, 0.28) and DSM-oriented pervasive development problem scores (β = -0.23, 95% CI: -0.61, 0.15). No associations were observed for other DSM-oriented subscales.Conclusions: The meta-analysis results suggest that epigenetic gestational age acceleration is not associated with child emotional and behavioural functioning for preschool age group. These findings may relate to our study population, which includes two cohorts enriched for ASD and one preterm birth cohort.; future work should address the role of epigenetic age in child health in other study populations.Abbreviations: DNAm: DNA methylation; CBCL: Child Behavioral Checklist; ECHO: Environmental Influences on Child Health Outcomes; EARLI: Early Autism Risk Longitudinal Investigation; MARBLES: Markers of Autism Risk in Babies - Learning Early Signs; ELGAN: Extremely Low Gestational Age Newborns; ASD: autism spectrum disorder; BMI: body mass index; DSM: Diagnostic and Statistical Manual of Mental Disorders.
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Affiliation(s)
- Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sierra S. Niemiec
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katerina Kechris
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kristen E. Boyle
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carmen J. Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Rebecca C. Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | | | - Heather E. Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christine Ladd-Acosta
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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2
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Song AY, Kauffman EM, Hamra GB, Dickerson AS, Croen LA, Hertz-Picciotto I, Schmidt RJ, Newschaffer CJ, Fallin MD, Lyall K, Volk HE. Associations of prenatal exposure to a mixture of persistent organic pollutants with social traits and cognitive and adaptive function in early childhood: Findings from the EARLI study. Environ Res 2023; 229:115978. [PMID: 37116678 PMCID: PMC10314748 DOI: 10.1016/j.envres.2023.115978] [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] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/03/2023] [Accepted: 04/22/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Literature suggests that maternal exposure to persistent organic pollutants (POPs) may influence child neurodevelopment. Evidence linking prenatal POPs and autism spectrum disorder has been inconclusive and few studies have examined the mixture effect of the POPs on autism-related traits. OBJECTIVE To evaluate the associations between prenatal exposure to a mixture of POPs and autism-related traits in children from the Early Autism Risk Longitudinal Investigation study. METHODS Maternal serum concentrations of 17 POPs (11 polychlorinated biphenyls [PCBs], 4 polybrominated diphenyls [PBDEs], and 2 persistent pesticides) in 154 samples collected during pregnancy were included in this analysis. We examined the independent associations of the natural log-transformed POPs with social, cognitive, and behavioral traits at 36 months of age, including Social Responsiveness Scale (SRS), Mullen Scales of Early Learning-Early Learning Composite (MSEL-ELC), and Vineland Adaptive Behavior Scales (VABS) scores, using linear regression models. We applied Bayesian kernel machine regression and quantile g-computation to examine the joint effect and interactions of the POPs. RESULTS Higher ln-PBDE47 was associated with greater deficits in social reciprocity (higher SRS score) (β = 6.39, 95% CI: 1.12, 11.65) whereas higher ln-p,p'-DDE was associated with lower social deficits (β = -8.34, 95% CI: -15.32, -1.37). Positive associations were observed between PCB180 and PCB187 and cognitive (MSEL-ELC) scores (β = 5.68, 95% CI: 0.18, 11.17; β = 4.65, 95% CI: 0.14, 9.17, respectively). Adaptive functioning (VABS) scores were positively associated with PCB170, PCB180, PCB187, PCB196/203, and p,p'-DDE. In the mixture analyses, we did not observe an overall mixture effect of POPs on the quantitative traits. Potential interactions between PBDE99 and other PBDEs were identified in association with MSEL-ELC scores. CONCLUSIONS We observed independent effects of PCB180, PCB187, PBDE47, and p,p' DDE with ASD-related quantitative traits and potential interactions between PBDEs. Our findings highlight the importance of assessing the effect of POPs as a mixture.
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Affiliation(s)
- Ashley Y Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Wendy Klag Center for Autism & Developmental Disabilities, Baltimore, MD, USA.
| | | | - Ghassan B Hamra
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aisha S Dickerson
- Wendy Klag Center for Autism & Developmental Disabilities, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, USA
| | - Craig J Newschaffer
- College of Health and Human Development, Pennsylvania State University, State College, PA, USA
| | - M Daniele Fallin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
| | - Heather E Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Wendy Klag Center for Autism & Developmental Disabilities, Baltimore, MD, USA
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Keane OA, Zamora AK, Ourshalimian S, Mahdi EM, Song AY, Kim E, Lakshmanan A, Kim ES, Kelley-Quon LI. Opioid and Methadone Use for Infants With Surgically Treated Necrotizing Enterocolitis. JAMA Netw Open 2023; 6:e2318910. [PMID: 37347485 PMCID: PMC10288332 DOI: 10.1001/jamanetworkopen.2023.18910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/22/2023] [Accepted: 05/02/2023] [Indexed: 06/23/2023] Open
Abstract
Importance Necrotizing enterocolitis (NEC) requiring surgical intervention is the most common reason for surgical procedures in preterm neonates. Opioids are used to manage postoperative pain, with some infants requiring methadone to treat physiologic opioid dependence or wean from nonmethadone opioid treatment during recovery. Objective To describe postoperative opioid use and methadone treatment for infants with surgically treated NEC and evaluate postoperative outcomes. Design, Setting, and Participants A cohort study of infants with surgically treated NEC admitted from January 1, 2013, to December 31, 2022, to 48 Children's Hospital Association hospitals contributing data to the Pediatric Health Information System (PHIS) was performed. Infants who received methadone preoperatively, were aged 14 days or less at the time of the operation, had a congenital heart disease-related operation, or died within 90 days of the operation were excluded. Mixed-effects multivariable logistic regression was used to evaluate thresholds for duration of opioid use after the operation associated with methadone treatment and clinical outcomes associated with methadone use were enumerated. Exposure Postoperative administration of nonmethadone opioids. Main Outcomes and Measures Methadone use and postoperative length of stay, ventilator days, and total parenteral nutrition (TPN) days. Results Of the 2037 infants with surgically treated NEC identified, the median birth weight was 920 (IQR, 700.0-1479.5) g; 1204 were male (59.1%), 911 were White (44.7%), and 343 were Hispanic (16.8%). Infants received nonmethadone opioids for a median of 15 (IQR, 6-30) days after the operation and 231 received methadone (11.3%). The median first day of methadone use was postoperative day 18 (IQR, days 9-64) and continued for 28 days (IQR, 14-73). Compared with infants who received nonmethadone opioids for 1 to 5 days, infants receiving 16 to 21 days of opioids were most likely to receive methadone treatment (odds ratio, 11.45; 95% CI, 6.31-20.77). Methadone use was associated with 21.41 (95% CI, 10.81-32.02) more days of postoperative length of stay, 10.80 (95% CI, 3.63-17.98) more ventilator days, and 16.21 (95% CI, 6.34-26.10) more TPN days. Conclusions and Relevance In this cohort study of infants with surgically treated NEC, prolonged use of nonmethadone opioids after the operation was associated with an increased likelihood of methadone treatment and increased postoperative length of stay, ventilation, and TPN use. Optimizing postoperative pain management for infants requiring an operation may decrease the need for methadone treatment and improve health care use.
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Affiliation(s)
- Olivia A. Keane
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Abigail K. Zamora
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Shadassa Ourshalimian
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Elaa M. Mahdi
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eugene Kim
- Department of Anesthesia, Children’s Hospital Los Angeles, Los Angeles, California
| | - Ashwini Lakshmanan
- Division of Neonatology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
| | - Eugene S. Kim
- Department of Surgery, Cedars-Sinai Health System, Los Angeles, California
| | - Lorraine I. Kelley-Quon
- Division of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
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4
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Yieh L, Song AY, Gong CL, Shah K, Li Y, Lakshmanan A. Sociodemographic characteristics and healthcare utilization of infants with SARS-CoV-2 in the U.S. J Perinatol 2023; 43:673-674. [PMID: 37002494 PMCID: PMC10064626 DOI: 10.1038/s41372-023-01659-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Leah Yieh
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.
| | - Ashley Y Song
- Department of Mental Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cynthia L Gong
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Kshama Shah
- Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Yijie Li
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, CA, USA
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Song AY, Bakulski K, Feinberg JI, Newschaffer C, Croen LA, Hertz-Picciotto I, Schmidt RJ, Farzadegan H, Lyall K, Fallin MD, Volk HE, Ladd-Acosta C. Associations between accelerated parental biologic age, autism spectrum disorder, social traits, and developmental and cognitive outcomes in their children. Autism Res 2022; 15:2359-2370. [PMID: 36189953 PMCID: PMC9722613 DOI: 10.1002/aur.2822] [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: 03/09/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
Parental age is a known risk factor for autism spectrum disorder (ASD), however, studies to identify the biologic changes underpinning this association are limited. In recent years, "epigenetic clock" algorithms have been developed to estimate biologic age and to evaluate how the epigenetic aging impacts health and disease. In this study, we examined the relationship between parental epigenetic aging and their child's prospective risk of ASD and autism related quantitative traits in the Early Autism Risk Longitudinal Investigation study. Estimates of epigenetic age were computed using three robust clock algorithms and DNA methylation measures from the Infinium HumanMethylation450k platform for maternal blood and paternal blood specimens collected during pregnancy. Epigenetic age acceleration was defined as the residual of regressing chronological age on epigenetic age while accounting for cell type proportions. Multinomial logistic regression and linear regression models were completed adjusting for potential confounders for both maternal epigenetic age acceleration (n = 163) and paternal epigenetic age acceleration (n = 80). We found accelerated epigenetic aging in mothers estimated by Hannum's clock was significantly associated with lower cognitive ability and function in offspring at 12 months, as measured by Mullen Scales of Early Learning scores (β = -1.66, 95% CI: -3.28, -0.04 for a one-unit increase). We also observed a marginal association between accelerated maternal epigenetic aging by Horvath's clock and increased odds of ASD in offspring at 36 months of age (aOR = 1.12, 95% CI: 0.99, 1.26). By contrast, fathers accelerated aging was marginally associated with decreased ASD risk in their offspring (aOR = 0.83, 95% CI: 0.68, 1.01). Our findings suggest epigenetic aging could play a role in parental age risks on child brain development.
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Affiliation(s)
- Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
- Wendy Klag Center for Autism and Developmental
Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kelly Bakulski
- Department of Epidemiology, University of Michigan, Ann
Arbor, MI
| | - Jason I. Feinberg
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
- Wendy Klag Center for Autism and Developmental
Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Craig Newschaffer
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
- College of Health and Human Development, Pennsylvania State
University, State College, PA
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences and The MIND
Institute, School of Medicine, University of California-Davis, Davis, CA
| | - Rebecca J. Schmidt
- Department of Public Health Sciences and The MIND
Institute, School of Medicine, University of California-Davis, Davis, CA
| | - Homayoon Farzadegan
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
| | - Kristen Lyall
- A.J. Drexel Autism Institute, Drexel University,
Philadelphia, PA
| | - M. Daniele Fallin
- Rollins School of Public Health, Emory University, Atlanta,
Georgia, USA
| | - Heather E. Volk
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
- Wendy Klag Center for Autism and Developmental
Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christine Ladd-Acosta
- Department of Mental Health, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
- Wendy Klag Center for Autism and Developmental
Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD
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6
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Muniraman HK, Kibe R, Namjoshi A, Song AY, Lakshmanan A, Ramanathan R, Biniwale M. Evaluation of Correlation and Agreement between SpO2/FiO2 ratio and PaO2/FiO2 ratio in Neonates. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1756716] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objectives This article evaluates correlation and agreement between oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) (SF) ratio and partial pressure of oxygen (PaO2)/FiO2 (PF) ratio. It also derives and validates predictive PF ratio from noninvasive SF ratio measurements for clinically relevant PF ratios and derives SF ratio equivalent of PF ratio cutoffs used to define acute lung injury (ALI, PF < 300) and acute respiratory distress syndrome (ARDS, PF < 200).
Methods Retrospective cohort study including neonates with respiratory failure over a 6-year study period. Correlation and agreement between PF ratio with SF ratio was analyzed by Pearson's correlation coefficient and Bland–Altman analysis. Generalized estimating equation was used to derive PF ratio from measured PF ratio and derive corresponding SF ratio for PF ratio cutoffs for ALI and ARDS.
Results A total of 1,019 paired measurements from 196 neonates with mean 28 (± 4.7) weeks' gestational age and 925 (± 1111) g birth weight were analyzed. Strong correlation was noted between SF ratio and PF ratio (r = 0.90). Derived PF ratios from regression (1/PF = –0.0004304 + 2.0897987/SF) showed strong accuracy measures for PF ratio cutoffs < 200 (area under the curve [AUC]: 0.85) and < 100 (AUC: 0.92) with good agreement. Equivalent SF ratio to define ALI was < 450, moderate ARDS was < 355, and severe ARDS was < 220 with strong accuracy measures (AUC > 0.81, 0.84, and 0.93, respectively).
Conclusion SF ratio correlated strongly with PF ratio with good agreement between derived PF ratio from noninvasive SpO2 source and measure PF ratio. Derived PF ratio may be useful to reliably assess severity of respiratory failure in neonates. Further studies are needed to validate SF ratio with clinical illness severity and outcomes.
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Affiliation(s)
- Hemananda K. Muniraman
- Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
- Department of Pediatrics, Creighton University School of Medicine, Phoenix, Arizona, United States
| | - Rutuja Kibe
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Abhijeet Namjoshi
- Division of Neonatology, Department of Child Health, Phoenix Children's Hospital, University of Arizona, Phoenix, Arizona, United States
| | - Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
| | - Ashwini Lakshmanan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
- Fetal and Neonatal Institute, Division of Neonatology, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Rangasamy Ramanathan
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
| | - Manoj Biniwale
- Division of Neonatology, Department of Pediatrics, LAC+ USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Song AY, Feinberg JI, Bakulski KM, Croen LA, Fallin MD, Newschaffer CJ, Hertz-Picciotto I, Schmidt RJ, Ladd-Acosta C, Volk HE. Prenatal Exposure to Ambient Air Pollution and Epigenetic Aging at Birth in Newborns. Front Genet 2022; 13:929416. [PMID: 35836579 PMCID: PMC9274082 DOI: 10.3389/fgene.2022.929416] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
In utero air pollution exposure has been associated with adverse birth outcomes, yet effects of air pollutants on regulatory mechanisms in fetal growth and critical windows of vulnerability during pregnancy are not well understood. There is evidence that epigenetic alterations may contribute to these effects. DNA methylation (DNAm) based age estimators have been developed and studied extensively with health outcomes in recent years. Growing literature suggests environmental factors, such as air pollution and smoking, can influence epigenetic aging. However, little is known about the effect of prenatal air pollution exposure on epigenetic aging. In this study, we leveraged existing data on prenatal air pollution exposure and cord blood DNAm from 332 mother-child pairs in the Early Autism Risk Longitudinal Investigation (EARLI) and Markers of Autism Risk in Babies-Learning Early Signs (MARBLES), two pregnancy cohorts enrolling women who had a previous child diagnosed with autism spectrum disorder, to assess the relationship of prenatal exposure to air pollution and epigenetic aging at birth. DNAm age was computed using existing epigenetic clock algorithms for cord blood tissue-Knight and Bohlin. Epigenetic age acceleration was defined as the residual of regressing chronological gestational age on DNAm age, accounting for cell type proportions. Multivariable linear regression models and distributed lag models (DLMs), adjusting for child sex, maternal race/ethnicity, study sites, year of birth, maternal education, were completed. In the single-pollutant analysis, we observed exposure to PM2.5, PM10, and O3 during preconception period and pregnancy period were associated with decelerated epigenetic aging at birth. For example, pregnancy average PM10 exposure (per 10 unit increase) was associated with epigenetic age deceleration at birth (weeks) for both Knight and Bohlin clocks (β = -0.62, 95% CI: -1.17, -0.06; β = -0.32, 95% CI: -0.63, -0.01, respectively). Weekly DLMs revealed that increasing PM2.5 during the first trimester and second trimester were associated with decelerated epigenetic aging and that increasing PM10 during the preconception period was associated with decelerated epigenetic aging, using the Bohlin clock estimate. Prenatal ambient air pollution exposure, particularly in early and mid-pregnancy, was associated with decelerated epigenetic aging at birth.
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Affiliation(s)
- Ashley Y. Song
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jason I. Feinberg
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kelly M. Bakulski
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente, Oakland, CA, United States
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Craig J. Newschaffer
- College of Health and Human Development, Pennsylvania State University, State College, PA, United States
| | - Irva Hertz-Picciotto
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, United States
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, UC Davis, Davis CA and the UC Davis MIND Institute, Sacramento, CA, United States
| | - Christine Ladd-Acosta
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Heather E. Volk
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Joyce EE, Chavarro JE, Rando J, Song AY, Croen LA, Fallin MD, Hertz‐Picciotto I, Schmidt RJ, Volk H, Newschaffer CJ, Lyall K. Prenatal exposure to pesticide residues in the diet in association with child autism-related traits: Results from the EARLI study. Autism Res 2022; 15:957-970. [PMID: 35261202 PMCID: PMC9090949 DOI: 10.1002/aur.2698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/31/2022]
Abstract
Prior work has suggested associations between prenatal exposure to several classes of pesticides and child autism spectrum disorder (ASD). We examined a previously developed pesticide residue burden score (PRBS) and intake of high pesticide residue foods in association with ASD-related traits. Participants were drawn from the Early Autism Risk Longitudinal Investigation (EARLI) (n = 256), a cohort following mothers who previously had a child with ASD through a subsequent pregnancy and that child's development. ASD-related traits were captured according to total Social Responsiveness Scale (SRS) scores at age 3 (mean raw total SRS score = 35.8). Dietary intake was assessed through a food frequency questionnaire collected during pregnancy. We also incorporated organic intake and fatty foods in modified versions of the PRBS. Associations between high-residue fruit and vegetable intake, the overall PRBS and modified versions of it, and SRS scores were assessed using multivariable linear regression. Overall, we did not observe associations between pesticide residues in foods and ASD-related outcomes, and modified versions of the PRBS yielded similar findings. However, reductions in ASD-related traits were observed with higher overall fruit and vegetable intake (adjusted estimates for Q4 vs. Q1: β -12.76, 95%CI -27.8, 2.3). Thus, findings from this high familial probability cohort did not suggest relationships between pesticide residues in the diet according to the PRBS and ASD-related traits. Beneficial effects of fruit and vegetable intake may influence these relationships. Future work should consider fruit and vegetable intake in association with ASD-related outcomes. LAY SUMMARY: Diet is the main source of exposure to most pesticides in use today. In this study, we examined the relationship between pesticide exposure from residues in the diet during pregnancy and child autism-related traits. We found that these pesticide residues from the diet were not related to child autism-related outcomes at age three. However, higher prenatal fruit and vegetable intake was associated with reductions in child autism-related traits.
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Affiliation(s)
- Emily E. Joyce
- Dornsife School of Public Health, Department of Epidemiology and BiostatisticsDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Jorge E. Chavarro
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Juliette Rando
- A.J. Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Ashley Y. Song
- Department of Mental HealthJohns HopkinsBaltimoreMarylandUSA
| | - Lisa A. Croen
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCaliforniaUSA
| | | | - Irva Hertz‐Picciotto
- Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
- MIND InstituteSacramentoCAUSA
| | - Rebecca J. Schmidt
- Department of Public Health SciencesUniversity of CaliforniaDavisCaliforniaUSA
- MIND InstituteSacramentoCAUSA
| | - Heather Volk
- Department of Mental HealthJohns HopkinsBaltimoreMarylandUSA
| | - Craig J. Newschaffer
- College of Health and Human DevelopmentPenn State, University Park, State CollegePennsylvaniaUSA
| | - Kristen Lyall
- Dornsife School of Public Health, Department of Epidemiology and BiostatisticsDrexel UniversityPhiladelphiaPennsylvaniaUSA
- A.J. Drexel Autism InstituteDrexel UniversityPhiladelphiaPennsylvaniaUSA
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9
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Lakshmanan A, Song AY, Belfort MB, Yieh L, Dukhovny D, Friedlich PS, Gong CL. The financial burden experienced by families of preterm infants after NICU discharge. J Perinatol 2022; 42:223-230. [PMID: 34561556 PMCID: PMC8460846 DOI: 10.1038/s41372-021-01213-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/27/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe the financial burden and worry that families of preterm infants experience after discharge from the neonatal intensive care unit (NICU). METHODS We surveyed 365 parents of preterm infants in a cross-sectional study regarding socio-demographics, supplemental security income (SSI), and financial worry. We completed a multivariable logistic regression model to examine the adjusted association of financial worry with modifiable factors. RESULTS We found that 53% of participants worried about healthcare costs after NICU discharge. After adjusting for socio-demographic and infant characteristics, we identified that, aOR (95% CI), out-of-pocket costs from the NICU index hospitalization, 3.51 (1.7, 7.26) and durable medical equipment use, 2.41 (1.11, 5.23) was associated with increased financial worry while enrollment in SSI, 0.38 (0.19, 0.76) was associated with decreased financial worry. CONCLUSIONS We identified factors that could contribute to financial burden after NICU discharge that may advise future work to target financial support systems.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Ashley Y. Song
- grid.21107.350000 0001 2171 9311Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Mandy B. Belfort
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Leah Yieh
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Division of Neonatology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR USA
| | - Philippe S. Friedlich
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Cynthia L. Gong
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
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10
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Yeh AM, Song AY, Vanderbilt DL, Gong C, Friedlich PS, Williams R, Lakshmanan A. The association of care transitions measure-15 score and outcomes after discharge from the NICU. BMC Pediatr 2021; 21:7. [PMID: 33397291 PMCID: PMC7780380 DOI: 10.1186/s12887-020-02463-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objectives were (1) to describe Care Transitions Measure (CTM) scores among caregivers of preterm infants after discharge from the neonatal intensive care unit (NICU) and (2) to describe the association of CTM scores with readmissions, enrollment in public assistance programs, and caregiver quality of life scores. METHODS The study design was a cross-sectional study. We estimated adjusted associations between CTM scores (validated measure of transition) with outcomes using unconditional logistic and linear regression models and completed an E-value analysis on readmissions to quantify the minimum amount of unmeasured confounding. RESULTS One hundred sixty-nine parents answered the questionnaire (85% response rate). The majority of our sample was Hispanic (72.5%), non-English speaking (67.1%) and reported an annual income of <$20,000 (58%). Nearly 28% of the infants discharged from the NICU were readmitted within a year from discharge. After adjusting for confounders, we identified that a positive 10-point change of CTM score was associated with an odds ratio (95% CI) of 0.74 (0.58, 0.98) for readmission (p = 0.01), 1.02 (1, 1.05) for enrollment in early intervention, 1.03 (1, 1.05) for enrollment in food assistance programs, and a unit change (95% CI) 0.41 (0.27, 0.56) in the Multicultural Quality of Life Index score (p < 0.0001). The associated E-value for readmissions was 1.6 (CI 1.1) suggesting moderate confounding. CONCLUSION The CTM may be a useful screening tool to predict certain outcomes for infants and their families after NICU discharge. However, further work must be done to identify unobserved confounding factors such as parenting confidence, problem-solving and patient activation.
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Affiliation(s)
- Amy M Yeh
- Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashley Y Song
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Douglas L Vanderbilt
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Cynthia Gong
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roberta Williams
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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11
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Gong CL, Song AY, Horak R, Friedlich PS, Lakshmanan A, Pruetz JD, Yieh L, Ram Kumar S, Williams RG. Impact of Confounding on Cost, Survival, and Length-of-Stay Outcomes for Neonates with Hypoplastic Left Heart Syndrome Undergoing Stage 1 Palliation Surgery. Pediatr Cardiol 2020; 41:996-1011. [PMID: 32337623 DOI: 10.1007/s00246-020-02348-5] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Abstract
The objective of this analysis was to update trends in LOS and costs by survivorship and ECMO use among neonates with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation surgery using 2016 data from the Healthcare Cost and Utilization Project Kids' Inpatient Database. We identified neonates ≤ 28 days old with HLHS undergoing Stage 1 surgery, defined as a Norwood procedure with modified Blalock-Taussig (BT) shunt, Sano modification, or both. Multivariable regression with year random effects was used to compare LOS and costs by hospital region, case volume, survivorship, and ECMO vs. no ECMO. An E-value analysis, an approach for conducting sensitivity analysis for unmeasured confounding, was performed to determine if unmeasured confounding contributed to the observed effects. Significant differences in total costs, LOS, and mortality were noted by hospital region, ECMO use, and sub-analyses of case volume. However, other than ECMO use and mortality, the maximum E-value confidence interval bound was 1.71, suggesting that these differences would disappear with an unmeasured confounder 1.71 times more associated with both the outcome and exposure (e.g., socioeconomic factors, environment, etc.) Our findings confirm previous literature demonstrating significant resource utilization among Norwood patients, particularly those undergoing ECMO use. Based on our E-value analysis, differences by hospital region and case volume can be explained by moderate unobserved confounding, rather than a reflection of the quality of care provided. Future analyses on surgical quality must account for unobserved factors to provide meaningful information for quality improvement.
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Affiliation(s)
- Cynthia L Gong
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA. .,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.
| | - Ashley Y Song
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Robin Horak
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Department of Anesthesia and Critical Care, Children's Hospital Los Angeles, Los Angeles, USA
| | - Philippe S Friedlich
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA
| | - Ashwini Lakshmanan
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Jay D Pruetz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
| | - Leah Yieh
- Division of Neonatology, Department of Pediatrics, Fetal & Neonatal Institute, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, Los Angeles, USA.,Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA
| | - S Ram Kumar
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiothoracic Surgery, Department of Surgery, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta G Williams
- Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.,Division of Cardiology, Department of Pediatrics, Heart Institute, Children's Hospital Los Angeles, Los Angeles, USA
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12
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Lakshmanan A, Song AY, Flores-Fenlon N, Parti U, Vanderbilt DL, Friedlich PS, Williams R, Kipke M. Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants. Clin Pediatr (Phila) 2020; 59:53-61. [PMID: 31672064 PMCID: PMC8345225 DOI: 10.1177/0009922819884583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 12/15/2022]
Abstract
The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Ashley Y. Song
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nicole Flores-Fenlon
- USC/LAC+USC Neonatal-Perinatal Medicine Fellowship Program, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Urvashi Parti
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Douglas L. Vanderbilt
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Division of General Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Philippe S. Friedlich
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roberta Williams
- Division of Cardiology, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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13
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Haghnazarian E, Hu J, Song AY, Friedlich PS, Lakshmanan A. The association of Trisomy 13 and 18 and hospital discharge outcomes among neonates in California: A retrospective cohort study. Pediatr Neonatol 2019; 60:617-622. [PMID: 30935949 PMCID: PMC7062359 DOI: 10.1016/j.pedneo.2019.02.007] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 02/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite Trisomy 13 and 18 being among the most fatal congenital anomalies, limited information exists about resource utilization and factors associated with length of stay (LOS) and total hospital charges (THC) for these anomalies. METHODS We studied data sets of the patient discharge data set from the California Office of Statewide Health Planning and Development from 2006 to 2010, to determine differences in resource utilization for survivors and non-survivors and identify the predictors of LOS and total hospital charges. Descriptive statistics were assessed for demographic and clinical characteristics. General linear regression models were used to identify predictors of LOS and THC. RESULTS Seventy-six Trisomy 13 and 115 Trisomy 18 patients were identified, for whom inpatient mortality was 27.6% and 20.9%, respectively. In patients with Trisomy 13, after adjusting for gender, ethnicity, advanced directive (DNR), insurance and co-morbidities on multivariate analysis, the provision of more than 96 h of mechanical ventilation was associated with significantly increased LOS (standard error, SE) by 18.0 ± 5.3 days and THC (SE) by $399,000 ± $85,000. In terms of insurance type, patients with private coverage had 10.8 ± 4.9 days more than patients with Medicaid. In patients with Trisomy 18, on multivariate analysis, after adjusting for gender, ethnicity, DNR, insurance and co-morbidities, more than 96 h of mechanical ventilation was associated with increased LOS (SE) by 36.8 ± 6.8 days and THC (SE) by $365,000 ± $59,000. CONCLUSION Understanding predictors that are associated with longer LOS and higher THC may be associated in hospital resource allocation for this vulnerable population of infants.
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Affiliation(s)
- Edith Haghnazarian
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Jiaqi Hu
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashley Y Song
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, United States; USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States.
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14
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Flores-Fenlon N, Song AY, Yeh A, Gateau K, Vanderbilt DL, Kipke M, Friedlich P, Lakshmanan A. Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge. Clin Pediatr (Phila) 2019; 58:903-911. [PMID: 31088122 PMCID: PMC8362840 DOI: 10.1177/0009922819848080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.
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Affiliation(s)
- Nicole Flores-Fenlon
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ashley Y. Song
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amy Yeh
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kameelah Gateau
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Douglas L. Vanderbilt
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, CA, USA,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Breton CV, Song AY, Xiao J, Kim SJ, Mehta HH, Wan J, Yen K, Sioutas C, Lurmann F, Xue S, Morgan TE, Zhang J, Cohen P. Effects of air pollution on mitochondrial function, mitochondrial DNA methylation, and mitochondrial peptide expression. Mitochondrion 2019; 46:22-29. [PMID: 30980914 DOI: 10.1016/j.mito.2019.04.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 10/26/2018] [Revised: 02/25/2019] [Accepted: 04/01/2019] [Indexed: 12/30/2022]
Abstract
Mitochondrial DNA is sensitive to damage by exogenous reactive oxygen sources, including traffic-related air pollution (TRAP). Given the important role for mitochondria in human disease, we hypothesized that prenatal air pollution exposure may be associated with mitochondrial dysfunction and that mitochondrial-derived peptides (MDPs) might protect against these effects. In in vitro studies, 24-hour exposure to nanoparticulate matter (nPM) increased oxidation of mtDNA, decreased mitochondrial consumption rate (OCR), and decreased mtDNAcn in SH-SY5Y cells. Addition of MDPs rescued these effects to varying degrees. Liver tissue taken from C57Bl/6 males exposed for 10 weeks to nPM had lower OCR, lower mtDNAcn and higher MDP levels, similar to in vitro studies. In newborn cord blood, MDP levels were positively associated with prenatal TRAP exposures. Moreover, DNA methylation of two distinct regions of the D-Loop in the mitochondria genome was associated with levels of several MDPs. Our in vitro and in vivo data indicate that TRAP can directly affect mitochondrial respiratory function and mtDNAcn. Treatment of cells with MDPs can counteract TRAP induced-effects. Lastly, we present evidence that suggests MDPs may be regulated in part by mitochondrial DNA methylation in humans.
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Affiliation(s)
- Carrie V Breton
- Department of Preventive Medicine, Keck School of Medicine USC, 2001 N Soto St., Los Angeles, CA 90032, United States of America.
| | - Ashley Y Song
- Department of Preventive Medicine, Keck School of Medicine USC, 2001 N Soto St., Los Angeles, CA 90032, United States of America
| | - Jialin Xiao
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Su-Jeong Kim
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Hemal H Mehta
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Junxiang Wan
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Kelvin Yen
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Constantinos Sioutas
- USC Viterbi School of Engineering, 3620 South Vermont Ave, Los Angeles, CA 90089, United States of America
| | - Fred Lurmann
- Sonoma Technology, 1450 N. McDowell Blvd., Suite 200, Petaluma, CA 94954, United States of America
| | - Shanyan Xue
- Department of Preventive Medicine, Keck School of Medicine USC, 2001 N Soto St., Los Angeles, CA 90032, United States of America
| | - Todd E Morgan
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
| | - Junfeng Zhang
- Nicholas School of the Enviroment, Duke University, 308 Research Drive LSRC, Durham, NC 27708, United States of America
| | - Pinchas Cohen
- USC Leonard School of Gerontology, 3715 McClintock Ave, Los Angeles, CA 90089, United States of America
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16
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Muniraman HK, Song AY, Ramanathan R, Fletcher KL, Kibe R, Ding L, Lakshmanan A, Biniwale M. Evaluation of Oxygen Saturation Index Compared With Oxygenation Index in Neonates With Hypoxemic Respiratory Failure. JAMA Netw Open 2019; 2:e191179. [PMID: 30924897 PMCID: PMC6450323 DOI: 10.1001/jamanetworkopen.2019.1179] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Oxygenation index (OI), an invasive measurement, is routinely used as a marker of severity of hypoxemic respiratory failure in neonates. Oxygen saturation index (OSI) is a noninvasive measurement and has been shown to be a reliable surrogate marker of OI in children and adults with respiratory failure. OBJECTIVES To evaluate the correlation of OI with OSI and to derive and validate predictive OI from noninvasive OSI measurements for clinically relevant OI values. DESIGN, SETTING, AND PARTICIPANTS For this retrospective cohort study, 220 neonates requiring invasive mechanical ventilation for hypoxic respiratory failure during the first 3 days of admission were recruited from a level III neonatal intensive care unit during a 6-year period, from January 1, 2012, to December 31, 2017. Data were analyzed from January 2017 to December 2017. MAIN OUTCOMES AND MEASURES The primary outcome was correlation of OI with OSI, analyzed using Pearson correlation coefficient. The secondary outcome was derivation and validation of OI from OSI. The data were split into derivative samples, from which a predictive equation for OI was derived using generalized linear model, and a validation sample was used to assess the predictive ability of the derived OI. Bland-Altman plot was used to assess agreement between derived OI and measured OI. RESULTS A total of 1442 paired OI and OSI measurements from 220 infants (190 preterm and 30 term; median [interquartile range] gestational age, 29 [26-33] weeks; mean [SD] birth weight, 1602 [1092] g) were recorded during the study. The median (interquartile range) number of samples was 5 (3-9) per patient. Overall, OI and OSI showed strong correlation (r = 0.89). The correlation was stronger in preterm infants (<28 weeks, r = 0.93; 28-33 weeks, r = 0.93) and within an oxygen saturation range of 85% to 95% (r = 0.94). The predictive derivative equation showed a strong linear association and good agreement in both derivation and validation data sets, with strong accuracy measures of derived OI for OI cutoffs of 5, 10, 15, 20, and 25. CONCLUSIONS AND RELEVANCE A strong correlation of OI with OSI was found. Derived OI from OSI was in good agreement and strongly predictive of clinically relevant OI cutoffs from 5 to 25. Oxygenation index derived from noninvasive sources may be useful to reliably assess severity of respiratory failure and response to therapy on a continuous basis.
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Affiliation(s)
- Hemananda K. Muniraman
- Neonatology Association Limited, Obstetrix Medical Group of Phoenix, Mednax, Phoenix, Arizona
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Ashley Y. Song
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rangasamy Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kathryn L. Fletcher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Rutuja Kibe
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Ashwini Lakshmanan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
- Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Manoj Biniwale
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Los Angeles County+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles
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Alderete TL, Song AY, Bastain T, Habre R, Toledo-Corral CM, Salam MT, Lurmann F, Gilliland FD, Breton C. Prenatal traffic-related air pollution exposures, cord blood adipokines and infant weight. Pediatr Obes 2018; 13:348-356. [PMID: 29098799 PMCID: PMC5934325 DOI: 10.1111/ijpo.12248] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 03/01/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Studies suggest that prenatal exposure to traffic-related air pollution (TRAP) may contribute to childhood obesity. While exact mechanisms for this association are unknown, circulating adipokines are hypothesized to contribute to early-life weight gain. METHODS The Maternal and Child Health Study birth cohort included 136 women from the Los Angeles County + University of Southern California Medical Center. This study estimated prenatal residential TRAP exposure and used linear regression analysis to examine associations between adipokines with TRAP exposure and infant weight change (birth to 6 months). RESULTS A one standard deviation (1-SD: 2 ppb) increase in prenatal non-freeway nitrogen oxides was associated with 33% (P = 0.01) higher leptin and 9% higher high molecular weight adiponectin levels (P = 0.07) in cord blood. Leptin levels were 71% higher in mothers who lived <75 m than those living >300 m from major roadways (P = 0.03). A 1-SD (10 ng mL-1 ) increase in leptin was associated with a significant increase in infant weight change in female infants (0.62 kg, P = 0.02) but not male infants (0.11 kg, P = 0.48). CONCLUSIONS Higher TRAP exposures were associated with higher cord blood levels of leptin and high molecular weight adiponectin. These adipokines were associated with increased infant weight change in female infants, which may have implications for future obesity risk.
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Affiliation(s)
- Tanya L. Alderete
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
| | - Ashley Y. Song
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
| | - Theresa Bastain
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
| | - Rima Habre
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
| | - Claudia M. Toledo-Corral
- California State University, Los Angeles, Department of Public Health, Los Angeles California, USA
| | - Muhammad T. Salam
- Kern Medical, University of Southern California, Los Angeles, California, USC
| | | | - Frank D. Gilliland
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
| | - Carrie Breton
- University of Southern California, Department of Preventive Medicine, Division of Environmental Health, Los Angeles, California, USA
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Song AY, Chen HHA, Chapman R, Govindarajan A, Upperman JS, Burke RV, Stein J, Friedlich PS, Lakshmanan A. Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997-2012. J Pediatr Surg 2017. [PMID: 28622971 DOI: 10.1016/j.jpedsurg.2017.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 10/19/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) remains one of the most intensive therapies for newborns in the United States. However, there is limited information on resource utilization for neonates receiving ECMO. METHODS We conducted a retrospective data analysis of the Kids' Inpatient Database from 1997 to 2012. Bivariate and multivariate analysis was completed to identify predictors of LOS, hospital costs and mortality. Cardiac and non-cardiac diagnoses of neonates receiving ECMO were also included in the bivariate and multivariable analysis. RESULTS Of the 5151 ECMO cases, survival to discharge was 62%. 22% had a principal cardiac diagnosis. After adjusting for covariates, increased mortality was associated with treatment in the midwest compared to the northeast region (aOR=2.0, p<0.01) and decreased among neonates with a non-cardiac diagnosis (aOR=0.4, p<0.01). Living in midwest was associated with longer LOS by 13days and increased hospital costs by 63,000 dollars (p<0.01). When stratified by non-cardiac diagnoses, infants with a diagnosis of congenital diaphragmatic hernia was associated with increased mortality (2.3, p<0.01) and longer LOS (25, p<0.01) and increased costs (11,100, p<0.01). CONCLUSION Neonates who received ECMO in certain regions of the United States were associated with poorer survival outcomes as well as increased LOS and hospital costs. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ashley Y Song
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Hsuan-Hsiu Annie Chen
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Rachel Chapman
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ameish Govindarajan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California
| | - Rita V Burke
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California
| | - James Stein
- Department of Pediatric Surgery, Children's Hospital Los Angeles, University of Southern California
| | - Philippe S Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States.
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Song AY, Jones SE. Vineland social maturity scale norm examined--the Wisconsin experience with 0- to 3-year-old children. Am J Ment Defic 1982; 86:428-31. [PMID: 7072767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Inspection of the Vineland social Maturity Scale scores of a representative sample of 150 nonretarded children between the ages of 2 weeks and 36 months revealed that the social ages of most of these children using the original norm table were consistently higher than their chronological ages. A table of adjusted Vineland ages based on the performance of these children was provided, along with the original Vineland norms. Comparison of the original and adjusted scores suggests that the social ages on the Vineland may be overestimated in the 1- to 2-year range.
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Song AY, Song RH. Visual memory and reading ability of mental retardates. Am J Ment Defic 1969; 73:942-5. [PMID: 5785510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Song AY, Song RH. Prediction of job efficiency of institutionalized retardates in the community. Am J Ment Defic 1969; 73:567-71. [PMID: 5762253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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