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Bitar L, Stonestreet BS, Lim YP, Qiu J, Chen X, Mir IN, Chalak LF. Association between decreased cord blood inter-alpha inhibitor levels and neonatal encephalopathy at birth. Early Hum Dev 2024; 193:106036. [PMID: 38733833 DOI: 10.1016/j.earlhumdev.2024.106036] [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: 03/29/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Inter-alpha inhibitor proteins (IAIPs) are structurally related proteins found in the systemic circulation with immunomodulatory anti-inflammatory properties. Reduced levels are found in inflammatory related conditions including sepsis and necrotizing enterocolitis, and in neonatal rodents after exposure to hypoxia ischemia. In the current study, cord blood IAIP levels were measured in neonates with and without exposure to hypoxic-ischemic encephalopathy (HIE). METHODS This is a prospective cohort study including infants born ≥36 weeks over a one-year period. Term pregnancies were divided into two groups: a "reference control" (uncomplicated term deliveries), and "moderate to severe HIE" (qualifying for therapeutic hypothermia). IAIPs were quantified using a sensitive ELISA on the cord blood samples. RESULTS The study included 57 newborns: Reference control group (n = 13) and moderate/severe HIE group (n = 44). Measurement of IAIP cord blood concentrations in moderate to severe HIE group [278.2 (138.0, 366.0) μg/ml] revealed significantly lower IAIP concentrations compared with the control group [418.6 (384.5, 445.0) μg/ml] (p = 0.002). CONCLUSIONS These findings suggest a potential role for IAIPs as indicators of neonates at risk for HIE. IAIP levels could have diagnostic implications in the management of HIE. Future research is required to explore the relationship between HIE and IAIPs as biomarkers for disease severity. CATEGORY OF STUDY Translational.
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Affiliation(s)
- Lynn Bitar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Barbara S Stonestreet
- The Alpert Medical School of Brown University, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - Yow-Pin Lim
- ProThera Biologics, Inc., Providence, RI, United States of America; The Alpert Medical School of Brown University, Department of Pathology and Laboratory Medicine, Providence, RI, United States of America
| | - Joseph Qiu
- ProThera Biologics, Inc., Providence, RI, United States of America
| | - Xiaodi Chen
- The Alpert Medical School of Brown University, Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - Imran N Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
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Leon RL, Bitar L, Sharma K, Mir IN, Chalak LF. Postnatal Cerebral Hemodynamics and Placental Vascular Malperfusion Lesions in Neonates With Congenital Heart Disease. Pediatr Neurol 2024; 156:72-78. [PMID: 38733857 DOI: 10.1016/j.pediatrneurol.2024.03.028] [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: 05/11/2023] [Revised: 02/11/2024] [Accepted: 03/31/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Neonates with congenital heart disease (CHD) have smaller brain volume at birth. High rates of placental vascular malperfusion lesions may play a role in disrupted brain development. METHODS This is a single-center retrospective cohort study of infants born between 2010 and 2019 who were diagnosed with a major cardiac defect requiring surgery in the first year of life. Doppler ultrasound RI of the middle cerebral artery (MCA) and anterior cerebral artery were calculated within the first 72 hours of life. Placentas were evaluated using a standardized approach. RESULTS Over the study period, there were 52 patients with hypoplastic left heart syndrome (HLHS), 22 with single-ventricle right ventricular outflow tract obstruction (SV-RVOTO), 75 with a two-ventricle cardiac defect (2V), and 25 with transposition of the great arteries (TGA). MCA Doppler RI were significantly higher for all subgroups of CHD compared with control subjects (0.68 ± 0.11 in control subjects compared with 0.78 ± 0.13 in HLHS, P = 0.03; 0.77 ± 0.10 in SV-RVOTO, P = 0.002; 0.78 ± 0.13 in 2V, P = 0.03; and 0.80 ± 0.14 in TGA; P = 0.001) with the highest average MCA RI in the TGA group. In subgroup analyses, placental fetal vascular malperfusion in the 2V group was associated with higher MCA RI, but this relationship was not present in other subgroups, nor in regards to maternal vascular malperfusion. CONCLUSIONS Major forms of CHD are associated with significantly higher cerebral artery RI postnatally, but placental vascular malperfusion lesions may not contribute to this hemodynamic adaptation.
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Affiliation(s)
- Rachel L Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Lynn Bitar
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kavita Sharma
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imran N Mir
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lina F Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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Nayak SP, Sánchez-Rosado M, Reis JD, Brown LS, Mangona KL, Sharma P, Nelson DB, Wyckoff MH, Pandya S, Mir IN, Brion LP. Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis. Am J Perinatol 2024. [PMID: 38272063 DOI: 10.1055/a-2253-8656] [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: 01/27/2024]
Abstract
OBJECTIVE No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week. STUDY DESIGN This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birthweight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA SCORE (H: yperglycemia, H: yperkalemia, use of inotropes for H: ypotension during the prior week, A: cidemia, Neonatal S: equential O: rgan F: ailure A: ssessment [nSOFA: ] score) was compared with a similar model using the nSOFA score. RESULTS Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively. CONCLUSION Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC. KEY POINTS · No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week.. · In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score).. · The HASOFA-model had high discrimination (AUC 0.909) and excellent calibration and was internally validated..
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Affiliation(s)
- Sujir P Nayak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mariela Sánchez-Rosado
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Division of Neonatology, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Jordan D Reis
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Baylor Scott and White, Dallas, Texas
| | - L Steven Brown
- Department of Research, Parkland Health and Hospital System, Dallas, Texas
| | - Kate L Mangona
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Priya Sharma
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Pediatrics, Baylor Scott and White, Dallas, Texas
| | - David B Nelson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, and Parkland Health, Dallas, Texas
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samir Pandya
- Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Imran N Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
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Vacher CM, Bonnin A, Mir IN, Penn AA. Editorial: Advances and perspectives in neuroplacentology. Front Endocrinol (Lausanne) 2023; 14:1206072. [PMID: 37274324 PMCID: PMC10236794 DOI: 10.3389/fendo.2023.1206072] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Affiliation(s)
- Claire-Marie Vacher
- Department of Pediatrics, NewYork Presbyterian Hospital, New York, NY, United States
- Columbia University Irving Medical Center, Columbia University, New York, NY, United States
| | - Alexandre Bonnin
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Imran N. Mir
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Anna A. Penn
- Department of Pediatrics, NewYork Presbyterian Hospital, New York, NY, United States
- Columbia University Irving Medical Center, Columbia University, New York, NY, United States
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Garg PM, Paschal JL, Ansari MAY, Billington L, Ware J, Adams K, Hamda YA, Oshunbade A, Rosenfeld CR, Mir IN. Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants - A Matched Case-Control Study. Fetal Pediatr Pathol 2023; 42:187-197. [PMID: 35979839 PMCID: PMC9938086 DOI: 10.1080/15513815.2022.2110340] [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] [Received: 02/21/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association of placental pathology with the severity of necrotizing enterocolitis (NEC) in preterm infants. METHODS This single-center matched case-control study included infants with NEC (n = 107) and gestational age and birth weight-matched controls (n = 130), born between 2013 and 2020. Placentas were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. RESULTS Acute histologic chorioamnionitis with the fetal response was significantly more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). On regression model, infants with multiple placental pathologies (OR 2.16; 95% CI 1.01 - 4.73; p = 0.04) and maternal vascular malperfusion (OR 2.2; 95% CI 1.12 - 4.51; p = 0.02) had higher odds of either medical or surgical NEC than controls. CONCLUSION Infants with multiple placental lesions, including placental inflammatory and vascular lesions, were at higher risk of medical or surgical NEC in the postnatal period.
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Affiliation(s)
- Parvesh Mohan Garg
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jaslyn L Paschal
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Md Abu Yusuf Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Lauren Billington
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jennifer Ware
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Kristin Adams
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Youssef Al Hamda
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adebamike Oshunbade
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Charles R Rosenfeld
- Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Imran N Mir
- Department of Pediatrics/Neonatology, UT Southwestern Medical Center, Dallas, Texas, USA
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Garg PM, Paschal JL, Ansari MAY, Ware J, Adams K, Taylor C, Reddy K, Rosenfeld CR, Mir IN. Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis. J Neonatal Perinatal Med 2023; 16:93-103. [PMID: 36744350 DOI: 10.3233/npm-221105] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05-7.54; p = 0.039). CONCLUSION Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.
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Affiliation(s)
- P M Garg
- Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.,Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J L Paschal
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - M A Y Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - J Ware
- Department of Pediatrics/Neonatology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Adams
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C Taylor
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - K Reddy
- Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - C R Rosenfeld
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - I N Mir
- Department of Pediatrics/Neonatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Mir IN, Uddin N, Liao J, Brown LS, Leon R, Chalak LF, Savani RC, Rosenfeld CR. Placental clearance not synthesis tempers exaggerated pro-inflammatory cytokine response in neonates exposed to chorioamnionitis. Pediatr Res 2023; 93:675-681. [PMID: 35690685 DOI: 10.1038/s41390-022-02147-z] [Citation(s) in RCA: 3] [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] [Received: 01/06/2022] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The source and clearance of cytokines in the fetal circulation in term pregnancies complicated by chorioamnionitis remains unclear as are the contributions of placental transport, synthesis, and clearance. The objectives of the study were to determine (1) fetal and/or placental contributions to synthesis and/or clearance of inflammatory and anti-inflammatory cytokines in term pregnancies complicated by chorioamnionitis and (2) whether this differs in pregnancies further complicated by fetal hypoxia. METHODS Prospective cohort study of pregnancies >37 weeks gestational age that included: Group 1, uncomplicated cesarean delivery without labor (n = 20); Group 2, uncomplicated vaginal delivery (n = 30); Group 3, pregnancies complicated by chorioamnionitis (n = 10); Group 4, complicated by chorioamnionitis + fetal hypoxia (n = 10). Umbilical arterial (UmA) and venous (UmV) blood were assayed for IL-1β, IL-2, IL-6, IL-8, TNFα, and IL-10. RESULTS IL-6 and IL-8 were below assay detection in UmA and UmV blood in Group 1 and increased in Group 2 (P < 0.01), UmA»UmV (P < 0.01). Their concentrations increased further in Groups 3 and 4 (P = 0.003), UmA»UmV. Placental clearance was concentration dependent that approaches saturation in the presence of chorioamnionitis. CONCLUSIONS Marked increases in fetal synthesis of IL-6 and IL-8 occur in chorioamnionitis. Synthesis increase further when complicated by fetal hypoxia. Cytokine removal occurs via placental concentration-dependent mechanisms, potentially contributing to adverse fetal effects. IMPACT The source and role of the placenta in synthesis and/or clearance of inflammatory mediators in term pregnancies complicated by clinical chorioamnionitis are unclear; however, conventional wisdom suggests the placenta is their source. This is the first study demonstrating that circulating concentrations of fetal IL-6 and IL-8 in clinical chorioamnionitis ± birth asphyxia in term pregnancies are of fetal origin. Circulating fetal inflammatory cytokines are cleared by concentration-dependent placental mechanisms that are nearly saturated in chorioamnionitis ± fetal hypoxia. These observations provide additional insight into understanding the fetal immune response in term pregnancies complicated by clinical chorioamnionitis.
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Affiliation(s)
- Imran N Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Naseem Uddin
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jie Liao
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,The Center for Pulmonary & Vascular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Larry S Brown
- Parkland Health and Hospital Systems, Dallas, TX, USA
| | - Rachel Leon
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,The Center for Pulmonary & Vascular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles R Rosenfeld
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Sisman J, Leon RL, Payton BW, Brown LS, Mir IN. Placental pathology associated with lenticulostriate vasculopathy (LSV) in preterm infants. J Perinatol 2022; 43:568-572. [PMID: 36376451 DOI: 10.1038/s41372-022-01557-5] [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] [Received: 06/21/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Our aim was to examine the frequency and type of placental abnormalities in neonates with LSV. STUDY DESIGN We prospectively reviewed cranial ultrasounds (cUS) from neonates born at ≤32 weeks of gestation at Parkland Hospital between 2012 and 2014. Our cohort included neonates with LSV and gestational age and sex matched controls with normal cUS. We retrieved placental pathology reports retrospectively and compared placental abnormalities in both groups. RESULTS We reviewed 1351 cUS from a total of 407 neonates. Placental pathology evaluations were complete for 64/65 (98%) neonates with LSV and 68/70 (97%) matched controls. There were no significant differences for any type of placental abnormities between LSV and control groups. However, infants with highest stage LSV were more likely to have large for gestational age (LGA) placentas (p = 0.01). CONCLUSION The association between LSV and LGA placenta may indicate a shared vascular response to an adverse prenatal environment.
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Affiliation(s)
- Julide Sisman
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Rachel L Leon
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brooke W Payton
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L Steven Brown
- Department of Health System Research, Parkland Health and Hospital System, Dallas, TX, USA
| | - Imran N Mir
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Leon RL, Sharma K, Mir IN, Herrera CL, Brown SL, Spong CY, Chalak LF. Placental vascular malperfusion lesions in fetal congenital heart disease. Am J Obstet Gynecol 2022; 227:620.e1-620.e8. [PMID: 35609643 DOI: 10.1016/j.ajog.2022.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Fetuses with congenital heart disease are at increased risk of perinatal morbidity and mortality, which is highly influenced by their prenatal health. Placental function is vital for the health of the fetus, but increased rates of pathologic lesions of the placenta have been observed in pregnancies complicated by fetal congenital heart disease. OBJECTIVE This study aimed to determine the prevalence of both gross and histologic placental pathologies in a cohort of pregnancies complicated by fetal congenital heart disease vs healthy controls using the Amsterdam Placental Workshop Group Consensus Statement sampling and definitions of placental lesions. STUDY DESIGN This single-center retrospective cohort study included placental examinations from pregnancies diagnosed prenatally with fetal congenital heart disease between 2010 and 2019; moreover, control placentas were collected from pregnancies without maternal or fetal complications. Placentas were sampled and evaluated according to the Amsterdam Placental Workshop Group Consensus Statement and gross and histopathologic diagnoses determined. RESULTS Approximately 80% of fetuses diagnosed with congenital heart disease (n=305) had a placental examination for comparison with controls (n=40). Of note, 239 placentas (78%) in the group with fetal congenital heart disease had at least 1 gross or histopathologic lesion compared with 11 placentas (28%) in the control group (P<.01). One-third of placentas complicated by fetal congenital heart disease met the criteria for small for gestational age, and 48% of placentas had one or more chronic lesions, including maternal vascular malperfusion (23% vs 0%; P<.01), villitis of unknown etiology (22% vs 0%; P<.01), fetal vascular malperfusion (20% vs 0%; P<.01), and other chronic lesions (16% vs 0%; P<.01). Acute inflammation was equally present in both the group with fetal congenital heart disease and the control group (28% vs 28%; P=1.00). Although gestational age and birthweight z score were similar between the 2 groups, birth head circumference was 1.5 cm less in pregnancies complicated by fetal congenital heart disease with a significantly lower z score compared with the control group (-0.52±1.22 vs 0.06±0.69; P<.01). CONCLUSION Vascular malperfusion lesions and chronic forms of inflammation occur at markedly higher rates in placentas complicated by fetal congenital heart disease, which may contribute to the decreased head circumference at birth. Further work in neuroplacentology is needed to explore connections among cardiac defects, placental vascular malperfusion lesions, and fetal brain development.
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Leon RL, Kalvacherla V, Andrews MM, Thomas JM, Mir IN, Chalak LF. Placental pathologic lesions associated with stroke in term neonates. Front Endocrinol (Lausanne) 2022; 13:920680. [PMID: 36157451 PMCID: PMC9492924 DOI: 10.3389/fendo.2022.920680] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To determine the birth prevalence of perinatal stroke in term born infants at our high-volume delivery center and assess the frequency of both gross and histologic placental pathologies associated with perinatal stroke using the Amsterdam Placental Workshop Group Consensus Statement guidelines and definitions. STUDY DESIGN A single-center retrospective cohort study spanning 2010-2020. RESULTS There were 129,759 live births at Parkland Hospital during the study period and a total of 18 term born infants leading to a birth prevalence of 1 in 6,829 infants. Perinatal risk factors were found in all but one patient, and 74% presented with seizures. Pathologic placental examination was available in 56% of the cohort and only one patient had normal placental examination. Acute histologic chorioamnionitis was described in five placentas (50%) and an additional two had isolated umbilical and/or chorionic plate vasculitis with or without funisitis compared to a rate of 28% with acute inflammation in a Control group. Chronic inflammation in the form of villitis of unknown etiology was described in three of the acutely inflamed placentas and was high-grade in each of those while none of the placentas from our Control group showed evidence of any chronic lesion. CONCLUSION Both acute and chronic placental inflammation are common in perinatal stroke; placental examination should be considered an essential component to the diagnostic workup.
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Affiliation(s)
- Rachel L. Leon
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- *Correspondence: Rachel L. Leon,
| | | | | | - Jennifer M. Thomas
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Imran N. Mir
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lina F. Chalak
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Herrera CL, Kadari PS, Pruszynski JE, Mir IN. Antepartum acute maternal infection: Is the preterm neonate protected? Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mir IN, White SP, Steven Brown L, Heyne R, Rosenfeld CR, Chalak LF. Autism spectrum disorders in extremely preterm infants and placental pathology findings: a matched case-control study. Pediatr Res 2021; 89:1825-1831. [PMID: 32950030 DOI: 10.1038/s41390-020-01160-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/08/2020] [Revised: 08/17/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prevalence of autism spectrum disorders (ASD) is 5-fold higher in preterm (PT) infants born ≤28 weeks gestational age (GA) as compared to the general population. The relationship between placental pathologic lesions and ASD in PT infants has not been studied. OBJECTIVES The objective of this study was to determine the association of placental pathology with the occurrence of ASD in PT infants born ≤28 weeks GA. STUDY DESIGN A matched case-control study to identify confirmed ASD cases (n = 16) and matched controls (n = 48) born at Parkland Hospital between January 2012 and December 2015. Patients were matched using known variables associated with increased risk of ASD in PT infants. Placental histology from all births was reviewed. RESULTS Children with ASD had 2-fold greater incidence of multiple placental pathologic lesions vs. matched controls [11/16 (69%) vs.16/48 (33%), respectively; P = 0.01]. In contrast, single placental pathologic lesions were not associated with ASD [5/16 (31%) vs. 21/48 (43%), respectively; P = 0.1]. CONCLUSIONS In this study, we have demonstrated an association between the increasing complexity of histologic placental lesions and the later risk for ASD in infants born ≤28 weeks GA. Thus, placental pathology findings may be valuable in further understanding the prenatal pathologic processes underlying ASD in PT infants. IMPACT PT infants with ASD have a 2-fold greater incidence of multiple placental pathologies. This is the first study to report an association between the complexity of histologic placental lesions and later risk of ASD in infant born extremely PT (i.e., ≤28 weeks GA). This study reiterates the importance of examining placental pathologic lesions, since placental evidence of antenatal insults correlates with postnatal morbidities and mortality in PT infants.
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Affiliation(s)
- Imran N Mir
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA.
| | - Stormi P White
- Department of Pediatrics, Division of Autism and Related Disorders, Emory University School of Medicine and Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Roy Heyne
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
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Pazandak C, Mir IN, Brown LS, Chalak LF. Placental Pathology, Cerebral Blood Flow, and Intraventricular Hemorrhage in Preterm Infants: Is There a Link? Pediatr Neurol 2020; 108:65-69. [PMID: 32451157 DOI: 10.1016/j.pediatrneurol.2020.01.001] [Citation(s) in RCA: 1] [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: 09/15/2019] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is growing evidence to support an association between placental inflammation and neurological sequelae of preterm infants. The goal of this study is to evaluate the relationship between placental pathology, post-natal Doppler cerebral resistive indices (RI's), and intraventricular hemorrhage (IVH) in premature infants. METHODS In a retrospective cohort study, preterm infants born between 23 0/7 and 32 6/7 weeks' gestation at Parkland Hospital were examined with placental pathology and serial ultrasound Doppler to evaluate for the primary outcome of IVH and death. RESULTS A total of 255 infants were included, and 166 (65%) had at least one significant placental pathology, most commonly chorioamnionitis. Infants with placental pathologies were significantly more likely to have mothers with clinical chorioamnionitis and to have lower gestational ages. There was no observed association between placental pathology and IVH or death. Secondary analysis demonstrated that resistive indices obtained from the first and second head ultrasounds were not different in infants with IVH. CONCLUSION In this study, we observed a high rate of placental pathologies but no alterations in cerebral indices on ultrasound, or differences in rates of IVH or death. Additional studies are necessary to delineate the relationship between placental pathology, white matter brain injury, and outcomes.
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Affiliation(s)
- Christine Pazandak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas
| | - Imran N Mir
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas
| | - L Steven Brown
- Parkland Health and Hospital Systems, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, Texas.
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Mir IN, Chalak LF, Brown LS, Johnson-Welch S, Heyne R, Rosenfeld CR, Kapadia VS. Impact of multiple placental pathologies on neonatal death, bronchopulmonary dysplasia, and neurodevelopmental impairment in preterm infants. Pediatr Res 2020; 87:885-891. [PMID: 31812153 PMCID: PMC7223700 DOI: 10.1038/s41390-019-0715-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the association of placental pathology, including multiple placental lesions, with the occurrence and severity of bronchopulmonary dysplasia (BPD), death, and neurodevelopmental impairment (NDI) in preterm infants. METHOD A retrospective cohort study of neonates <29 weeks gestational age (GA) born at Parkland Hospital from 08/2009 to 08/2012. Infants were stratified as follows: Group 1: no significant placental pathology; Group 2: single significant placental lesion; and Group 3: ≥2 placental lesions (multiple lesions). Primary outcome was death and/or BPD. Two-year neurodevelopmental follow-up was compared. RESULTS In all, 42% (100/241) of infants had one placental lesion, and 34% (82/241) ≥2 lesions. As the number of the pathologic lesions increased (no lesions vs. 1 vs. ≥2), the occurrence of death or BPD increased (25%, 37%, and 52%, respectively; P = 0.004). Moreover, infants with multiple pathologic lesions were more likely to have NDI (29%, 29%, and 46%, respectively; P = 0.03). After logistic regression, infants with multiple pathologic lesions were more likely to develop moderate-to-severe BPD [P < 0.01; OR 3.9 (1.5-10.1)] but not NDI. CONCLUSION(S) Neonates <29 weeks GA with multiple placental pathologic lesions have an increased risk for developing BPD, suggesting an interaction between placental inflammation and vascular pathology and the pathogenesis of BPD; however, the risk of NDI is not increased.
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Affiliation(s)
- Imran N. Mir
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Lina F. Chalak
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - L. Steven Brown
- 0000 0000 9482 7121grid.267313.2Parkland Health and Hospital Systems, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Sarah Johnson-Welch
- 0000 0000 9482 7121grid.267313.2Department of Pathology, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Roy Heyne
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Charles R. Rosenfeld
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
| | - Vishal S. Kapadia
- 0000 0000 9482 7121grid.267313.2Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical School, Dallas, TX 75390 USA
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Mir IN, Steven Brown L, Rosenfeld CR, Chalak LF. Placental clearance/synthesis of neurobiomarkers GFAP and UCH-L1 in healthy term neonates and those with moderate-severe neonatal encephalopathy. Pediatr Res 2019; 86:500-504. [PMID: 31132788 DOI: 10.1038/s41390-019-0439-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/06/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Fetal concentrations of GFAP and UCH-L1 are elevated in umbilical arterial (UmA) blood of neonates with birth asphyxia plus neonatal encephalopathy (NE), but their source and role of placental clearance/synthesis is unknown. METHODS Prospective cohort study of term neonates to (a) determine UmA and venous (UmV) blood concentrations of GFAP and UCH-L1 in term uncomplicated pregnancies and their placental synthesis and/or clearance and (b) compare UmA concentrations in uncomplicated pregnancies with those complicated by fetal hypoxia-asphyxia+NE. Three term groups were studied: uncomplicated cesarean delivery without labor (Group 1, n = 15), uncomplicated vaginal delivery with labor (Group 2, n = 15), and perinatal hypoxia-asphyxia+NE (Group 3, n = 8). RESULTS UmA GFAP concentrations were lower in Group 1 vs. 2 (P = 0.02) and both demonstrated 100% placental clearance. In contrast, UmA and UmV UCH-L1 concentrations were not unaffected by labor. Group 3 UmA GFAP concentrations were 30- and 8-fold higher than Groups 1 and 2, respectively, P = 0.02, whereas UmA UCH-L1 concentrations were similar in all groups. CONCLUSIONS UmA GFAP is derived from the fetus, and circulating levels, which are modulated by placental clearance, increase during uncomplicated labor and more so in the presence of fetal hypoxia-asphyxia+NE, providing a better biomarker than UCH-L1 for hypoxia-asphyxia+NE.
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Affiliation(s)
- Imran N Mir
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, UT Southwestern Medical, Dallas, TX, USA.
| | - L Steven Brown
- School and Parkland Health and Hospital Systems, Dallas, TX, USA
| | - Charles R Rosenfeld
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, UT Southwestern Medical, Dallas, TX, USA
| | - Lina F Chalak
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, UT Southwestern Medical, Dallas, TX, USA
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McClain LE, Mir IN, Kapadia VS, Murphy JT, Diesen DL. In Utero Gunshot Wound to the Left Upper Extremity in a Preterm Infant. Am Surg 2019; 85:e282-e283. [PMID: 31267914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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McClain LE, Mir IN, Kapadia VS, Murphy JT, Diesen DL. In Utero Gunshot Wound to the Left Upper Extremity in a Preterm Infant. Am Surg 2019. [DOI: 10.1177/000313481908500604] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lauren E. McClain
- Division of Pediatric Surgery Department of Surgery Children's Medical Center University of Texas Southwestern Dallas, Texas
| | - Imran N. Mir
- Division of Neonatal and Perinatal Medicine Department of Pediatrics Children's Medical Center University of Texas Southwestern Dallas, Texas
| | - Vishal S. Kapadia
- Division of Neonatal and Perinatal Medicine Department of Pediatrics Children's Medical Center University of Texas Southwestern Dallas, Texas
| | - Joseph T. Murphy
- Division of Pediatric Surgery Department of Surgery Children's Medical Center University of Texas Southwestern Dallas, Texas
| | - Diana L. Diesen
- Division of Pediatric Surgery Department of Surgery Children's Medical Center University of Texas Southwestern Dallas, Texas
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Mir IN, Chalak LF, Liao J, Johnson-Welch S, Brown LS, Longoria C, Savani RC, Rosenfeld CR. Fetal-placental crosstalk occurs through fetal cytokine synthesis and placental clearance. Placenta 2018; 69:1-8. [PMID: 30213477 DOI: 10.1016/j.placenta.2018.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/13/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cytokines modulate fetal well-being and contribute to parturition. Their origin in fetal blood, whether maternal, placental or fetal, at the time of parturition remains unclear. OBJECTIVE To determine fetal and placental contributions to circulating fetal cytokines by measuring umbilical arterial (UmA) and venous (UmV) concentration differences in uncomplicated term pregnancies in the absence and presence of labor. METHODS Term uncomplicated pregnancies were assessed: Group 1 were not in labor and delivered by elective cesarean section (n = 20); Group 2 delivered vaginally following uncomplicated pregnancy and labor (n = 30). UmA and UmV blood was collected before delivery of the placenta to measure circulating cytokines. Placental tissue was collected for histology and to determine cytokine contents and localization. RESULTS Group 1 UmA and UmV IL-10 concentrations were similar (504 ± 15 and 468 ± 16 pg/ml, respectively; P ≥ 0.1); other cytokines were below level of detection. During labor, IL-10 concentrations increased 15-34%, but placental contents decreased. Group 2 UmA IL-6 and IL-8 concentrations increased (P < 0.001) to 16.7 ± 1.6 and 18.4 ± 4.3 pg/ml, respectively, but were less (P < 0.001) in UmV, 0.29 ± 0.2 and 0.74 ± 0.3 pg/ml, respectively, demonstrating placental clearances ≥97%. This was associated with >6-fold increases in placental IL-6/IL-8 contents (P < 0.001) and chorioamniotic infiltration of activated maternal neutrophils. IL-6 and IL-10 were localized to villous syncytiotrophoblasts. CONCLUSIONS In uncomplicated term pregnancies fetal circulating IL-10 is likely of placental origin, whereas IL-6/IL-8 are derived from the fetus, increase during parturition, and circulating levels are modulated by non-saturable placental clearance, revealing a novel pathway for fetal-placental crosstalk and signaling.
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Affiliation(s)
- Imran N Mir
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA.
| | - Lina F Chalak
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA
| | - Jie Liao
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA
| | - Sarah Johnson-Welch
- Department of Pediatrics, Department of Pathology, University of Texas Southwestern Medical Center, USA
| | | | - Christopher Longoria
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA
| | - Rashmin C Savani
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA; The Center for Pulmonary & Vascular Biology, University of Texas Southwestern Medical Center, USA
| | - Charles R Rosenfeld
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, USA
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Ahmad MM, Wani MD, Dar HM, Mir IN, Wani HA, Raja AN. An experience of ultrasound-guided hydrostatic reduction of intrussusception at a tertiary care centre. S AFR J SURG 2016; 54:10-13. [PMID: 28240490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Intussusception is an important and one of the most commonly encountered diagnoses of intestinal obstruction in the paediatric age group. Ultrasound-guided hydrostatic reduction is an effective, nonoperative treatment modality for this condition and is associated with a high success rate. In addition, it is simple and safe as the entire procedure is carried out with real-time ultrasound, without the hazard of radiation. The aim of this study was to evaluate the effi cacy and safety of ultrasound-guided hydrostatic reduction in the management of intussusceptions in the paediatric age group. METHOD A case study was carried out on 89 patients diagnosed with intussusception using high-resolution ultrasonography over a period of two years, spanning February 2012 to January 2014. Ultrasound-guided hydrostatic reduction was performed in 78 of these patients, and 11 patients were excluded owing to clinical contraindications. Follow-up ultrasound was performed after 24 hours to rule out recurrence. RESULTS The disease was most prevalent in the age group 6-24 months. The ileocolic type was the most common. Mean duration (hours) was 17.02 ± 20.81 for time to presentation. Complete therapeutic reduction was achieved in 70 of the 78 cases, with a success rate of 90%. Two recurrences occurred in the following 24 hours, which were successfully reduced on the second attempt. Complications and mortality did not occur secondary to the procedure. CONCLUSION Our study found that ultrasound-guided hydrostatic reduction is a simple, safe and effective nonoperative treatment for intussusceptions in the paediatric age group, and should be the fi rst line of management in appropriate patients.
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Affiliation(s)
- M M Ahmad
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
| | - M D Wani
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
| | - H M Dar
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
| | - I N Mir
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
| | - H A Wani
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
| | - A N Raja
- Department of Surgery, Government Medical College Srinagar; Karan Nagar, Srinagar, Jammu and Kashmi, India
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Mir IN, Johnson-Welch SF, Nelson DB, Brown LS, Rosenfeld CR, Chalak LF. Placental pathology is associated with severity of neonatal encephalopathy and adverse developmental outcomes following hypothermia. Am J Obstet Gynecol 2015; 213:849.e1-7. [PMID: 26408082 DOI: 10.1016/j.ajog.2015.09.072] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 08/19/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although neonatal encephalopathy (NE) due to perinatal asphyxia accounts for a notable proportion of brain injury, the causal pathway remains largely unexplained. We sought to determine the association of placental pathology with: (1) severity of NE in the first 6 hours postnatal, and (2) abnormal neurodevelopmental outcomes (NDO) in neonates requiring hypothermia therapy. STUDY DESIGN This is a retrospective cohort study of neonates ≥36 weeks' gestation born at Parkland Hospital, Dallas, TX, from January 2006 through November 2011 with NE. Placental histology was reviewed and validated by a pediatric pathologist blinded to outcomes. Abnormal NDO was defined as death or Bayley-III score of <85 at 18-24 months of age. RESULTS Of 86,274 neonates ≥36 weeks' gestation, 120 had evidence of a combination of perinatal acidosis and NE. In all, 47 had mild NE and received no treatment, while 73 had moderate (n = 70) or severe (n = 3) NE and received systemic hypothermia. Nine neonates died and all survivors receiving hypothermia had a Bayley-III assessment at 22 ± 7 (SD) months of age. Chorioamnionitis with or without fetal response and patchy/diffuse chronic villitis were found to be independently associated with severity of NE (P < .001). Univariate logistic regression revealed an association with a diagnosis of major placental pathology (odds ratio, 3.5; 95% confidence interval, 1.1-11.4) and abnormal outcomes following cooling. Specifically, diffuse chronic villitis (odds ratio, 9.29; 95% confidence interval, 1.11-77.73) was the only individual predictor of abnormal NDO following hypothermia therapy. CONCLUSION Placental inflammatory villitis appears to be a harbinger of abnormal outcomes in neonates with NE, spanning to the 18-24 month NDO.
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Abstract
Biomarkers have the potential to enable the clinicians to screen infants for brain injury, monitor progression of disease, identify injured brain regions, assess efficacy of neuroprotective therapies, and offer hope to identify the timing of the injury, thus shedding light on the potential pathophysiology and the most effective therapy. Currently, clinicians do not routinely use biomarkers to care for neonates with Neonatal Encephalopathy (NE) and brain injury due to prenatal hypoxia-asphyxia. This review will cover potential biomarkers of the neurovascular unit in the setting of NE that (i) can help assess the degree or severity of encephalopathy at birth; (ii) can help monitor progression of disease process and efficacy of neuroprotective therapy; (iii) can help assess neurodevelopmental outcome. These biomarkers will be summarized in two categories: 1) Specific biomarkers targeting the neurovascular unit such as glial fibrillary acidic protein (GFAP), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), S100B, and neuron specific enolase (NSE) and 2) general inflammatory cytokines, such as interleukin-6 (IL-6), interleukin-1b (IL-1b), and pNF-H, among others.
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Affiliation(s)
- Imran N Mir
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lina F Chalak
- Dept. of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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