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Preeti S, Kadam A, Kadam S, Vaidya U, Kumar P, Bhagat I, Pandit A, Chouthai NS. Anthropometric measures as biomarkers of neurodevelopmental outcomes of newborns with moderate to severe hypoxic ischemic encephalopathy. J Neonatal Perinatal Med 2019; 12:127-134. [PMID: 30741696 DOI: 10.3233/npm-17151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal asphyxia is a prominent cause of neonatal mortality in the developing world. Growth in head circumference is associated with improved neurodevelopment. Previous studies found a positive correlation between additional dietary supplementation and growth in head circumference among newborns with perinatal brain injury. This study aims to evaluate the association between anthropometric parameters and developmental outcomes in newborns with hypoxic ischemic encephalopathy (HIE). METHODS Newborns at ≥36 weeks gestation with moderate to severe HIE were included in the study and growth parameters were monitored. Newborns with life-threatening anomalies were excluded. None of the study participants received therapeutic hypothermia (TH). Developmental Assessment Scale for Indian Infants (DASII) was used to evaluate neurodevelopmental outcomes at 1 year of age. RESULTS Of 76 study participants, 46 were followed for 12 months, 28 died, and 2 were lost to follow-up. HIE stage III, Apgar score <5 at 5 minutes of age, pH ≤ 7.1 on first blood gas and base deficit > - 16 was associated with death or disability at 1 year of age. All anthropometric parameters were significantly lower in presence of death or disability. pH ≤ 7.1 at birth (odds ratio: 11.835, 95% CI 2.273-61.629, p = 0.003) and weight gain at one year (odds ratio 1.001, 95% CI 1.000-1.002, p = 0.03) were significantly associated with death and disability. CONCLUSION pH > 7.1 at birth, and weight gain were associated with better neurodevelopmental outcomes at 1 year of age. Thus, in addition to TH, nutritional interventions may potentially improve outcomes among newborns with HIE.
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Affiliation(s)
- S Preeti
- Department of Pediatrics, KEM Hospital, Pune, India
| | - A Kadam
- Department of Pediatrics, KEM Hospital, Pune, India
| | - S Kadam
- Department of Pediatrics, KEM Hospital, Pune, India
| | - U Vaidya
- Department of Pediatrics, KEM Hospital, Pune, India
| | - P Kumar
- Division of Neonatal-Perinatal Medicine, Wayne State University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, MI, USA
| | - I Bhagat
- Division of Neonatal-Perinatal Medicine, Wayne State University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, MI, USA
| | - A Pandit
- Department of Pediatrics, KEM Hospital, Pune, India
| | - N S Chouthai
- Division of Neonatal-Perinatal Medicine, Wayne State University, Children's Hospital of Michigan and Hutzel Women's Hospital, Detroit, MI, USA
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Kumar S, Archak S, Tyagi RK, Kumar J, Vk V, Jacob SR, Srinivasan K, Radhamani J, Parimalan R, Sivaswamy M, Jayaprakash P, Tyagi S, Yadav M, Rani J, Sharma S, Bhagat I, Meeta M, Bains NS, Chowdhury AK, Saha BC, Bhattacharya PM, Kumari J, Singh MC, Gangwar OP, Prasad P, Bharadwaj SC, Gogoi R, Sharma JB, Gm SK, Saharan MS, Singh AK, Khan Z, Bag M, Roy A, Prasad TV, Sharma RK, Dutta M, Sharma I, Bansal KC. Correction: Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases. PLoS One 2017; 12:e0175610. [PMID: 28384321 PMCID: PMC5383313 DOI: 10.1371/journal.pone.0175610] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kumar S, Archak S, Tyagi RK, Kumar J, VK V, Jacob SR, Srinivasan K, Radhamani J, Parimalan R, Sivaswamy M, Tyagi S, Yadav M, Kumari J, Deepali, Sharma S, Bhagat I, Meeta M, Bains NS, Chowdhury AK, Saha BC, Bhattacharya PM, Kumari J, Singh MC, Gangwar OP, Prasad P, Bharadwaj SC, Gogoi R, Sharma JB, GM SK, Saharan MS, Bag M, Roy A, Prasad TV, Sharma RK, Dutta M, Sharma I, Bansal KC. Evaluation of 19,460 Wheat Accessions Conserved in the Indian National Genebank to Identify New Sources of Resistance to Rust and Spot Blotch Diseases. PLoS One 2016; 11:e0167702. [PMID: 27942031 PMCID: PMC5153299 DOI: 10.1371/journal.pone.0167702] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/20/2016] [Indexed: 11/21/2022] Open
Abstract
A comprehensive germplasm evaluation study of wheat accessions conserved in the Indian National Genebank was conducted to identify sources of rust and spot blotch resistance. Genebank accessions comprising three species of wheat-Triticum aestivum, T. durum and T. dicoccum were screened sequentially at multiple disease hotspots, during the 2011-14 crop seasons, carrying only resistant accessions to the next step of evaluation. Wheat accessions which were found to be resistant in the field were then assayed for seedling resistance and profiled using molecular markers. In the primary evaluation, 19,460 accessions were screened at Wellington (Tamil Nadu), a hotspot for wheat rusts. We identified 4925 accessions to be resistant and these were further evaluated at Gurdaspur (Punjab), a hotspot for stripe rust and at Cooch Behar (West Bengal), a hotspot for spot blotch. The second round evaluation identified 498 accessions potentially resistant to multiple rusts and 868 accessions potentially resistant to spot blotch. Evaluation of rust resistant accessions for seedling resistance against seven virulent pathotypes of three rusts under artificial epiphytotic conditions identified 137 accessions potentially resistant to multiple rusts. Molecular analysis to identify different combinations of genetic loci imparting resistance to leaf rust, stem rust, stripe rust and spot blotch using linked molecular markers, identified 45 wheat accessions containing known resistance genes against all three rusts as well as a QTL for spot blotch resistance. The resistant germplasm accessions, particularly against stripe rust, identified in this study can be excellent potential candidates to be employed for breeding resistance into the background of high yielding wheat cultivars through conventional or molecular breeding approaches, and are expected to contribute toward food security at national and global levels.
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Affiliation(s)
- Sundeep Kumar
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Sunil Archak
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - R. K. Tyagi
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Jagdish Kumar
- ICAR-Indian Agricultural Research Institute, Regional Station, Wellington, Tamil Nadu, India
| | - Vikas VK
- ICAR-Indian Agricultural Research Institute, Regional Station, Wellington, Tamil Nadu, India
| | - Sherry R. Jacob
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Kalyani Srinivasan
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - J. Radhamani
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - R. Parimalan
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - M. Sivaswamy
- ICAR-Indian Agricultural Research Institute, Regional Station, Wellington, Tamil Nadu, India
| | - Sandhya Tyagi
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Mamata Yadav
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Jyotisna Kumari
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Deepali
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Sandeep Sharma
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Indoo Bhagat
- Punjab Agricultural University, Regional Station, Gurdaspur, Punjab, India
| | - Madhu Meeta
- Punjab Agricultural University, Ludhiana, Punjab, India
| | - N. S. Bains
- Punjab Agricultural University, Ludhiana, Punjab, India
| | - A. K. Chowdhury
- North Bengal Agricultural University, Cooch Behar, West Bengal, India
| | - B. C. Saha
- North Bengal Agricultural University, Cooch Behar, West Bengal, India
| | | | - Jyoti Kumari
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - M. C. Singh
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - O. P. Gangwar
- ICAR-Indian Institute of Wheat and Barley Research, Regional Station, Flowerdale, Himachal Pradesh, India
| | - P. Prasad
- ICAR-Indian Institute of Wheat and Barley Research, Regional Station, Flowerdale, Himachal Pradesh, India
| | - S. C. Bharadwaj
- ICAR-Indian Institute of Wheat and Barley Research, Regional Station, Flowerdale, Himachal Pradesh, India
| | - Robin Gogoi
- ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - J. B. Sharma
- ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Sandeep Kumar GM
- ICAR-Indian Agricultural Research Institute, Regional Station, Katrain, Himachal Pradesh, India
| | - M. S. Saharan
- ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India
| | - Manas Bag
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Anirban Roy
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - T. V. Prasad
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - R. K. Sharma
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - M. Dutta
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
| | - Indu Sharma
- ICAR-Indian Institute of Wheat and Barley Research, Karnal, Haryana, India
| | - K. C. Bansal
- ICAR-National Bureau of Plant Genetic Resources, Pusa Campus, New Delhi, India
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Sarkar S, Barks JD, Bapuraj JR, Bhagat I, Dechert RE, Schumacher RE, Donn SM. Does phenobarbital improve the effectiveness of therapeutic hypothermia in infants with hypoxic-ischemic encephalopathy? J Perinatol 2012; 32:15-20. [PMID: 21527909 DOI: 10.1038/jp.2011.41] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether phenobarbital (PB) given before therapeutic hypothermia to infants with hypoxic-ischemic encephalopathy (HIE) augments the neuroprotective efficacy of hypothermia. STUDY DESIGN Records of 68 asphyxiated infants of 36 weeks' gestation, who received hypothermia for moderate or severe HIE were reviewed. Some of these infants received PB prophylactically or for clinical seizures. All surviving infants had later brain magnetic resonance imaging (MRI). The composite primary outcome of neonatal death related to HIE with worsening multiorgan dysfunction despite maximal treatment, and the presence of post-hypothermia brain MRI abnormalities consistent with hypoxic-ischemic brain injury, were compared between the infants who received PB before initiation of hypothermia (PB group, n=36) and the infants who did not receive PB before or during hypothermia (No PB group, n=32). Forward logistic regression analysis determined which of the pre-hypothermia clinical and laboratory variables predict the primary outcome. RESULT The two groups were similar for severity of asphyxia as assessed by Apgar scores, initial blood pH and base deficit, early neurologic examination, and presence of an intrapartum sentinel event. The composite primary outcome was more frequent in infants from the PB group (PB 78% versus No PB 44%, P=0.006, odds ratio 4.5, 95% confidence interval 1.6 to 12.8). Multivariate analysis identified only the PB receipt before initiation of hypothermia (P=0.002, odds ratio 9.5, 95% confidence interval 2.3 to 39.5), and placental abruption to be independently associated with a worse primary outcome. CONCLUSION PB treatment before cooling did not improve the composite outcome of neonatal death or the presence of an abnormal post-hypothermia brain MRI, but the long-term outcomes have not yet been evaluated.
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Affiliation(s)
- S Sarkar
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Health System, CS Mott Children's Hospital, Ann Arbor, MI, USA.
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Sarkar S, Bhagat I, Hieber S, Donn SM. Can neutrophil responses in very low birth weight infants predict the organisms responsible for late-onset bacterial or fungal sepsis? J Perinatol 2006; 26:501-5. [PMID: 16761008 DOI: 10.1038/sj.jp.7211554] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine neutrophil counts and various neutrophil indices in preterm very low birth weight (VLBW) newborn infants (birth weight <1500 g) with culture-proven late-onset sepsis to determine whether the neutrophil responses could predict the responsible infectious agent. STUDY DESIGN Neutrophil parameters were examined during episodes of culture-proven sepsis in a cohort of 1026 VLBW infants, born over a 6-year period and admitted to two different neonatal intensive care units. Revised reference ranges of Mouzinho et al. for circulating neutrophil counts in VLBW infants were used to define the abnormal neutrophil indices. RESULTS One hundred sixty-two of 1026 (15.8%) VLBW infants had blood culture-proven late-onset infection. Infections included Gram-positive bacteria (113/162, 70%), Gram-negative bacteria (30/162, 18%) and fungi (19/162, 12%). Of the 162 sepsis episodes, only nine (5.5%) were associated with neutropenia (absolute total neutrophil (ATN) <1100/mm3). Six of the 30 (20%) infants with Gram-negative bacterial sepsis were neutropenic compared to 2.6% infants with Gram-positive bacterial sepsis and none with fungal sepsis (odds ratio: 11; 95% confidence interval: 2.6, 47.3). Neutrophil counts and various neutrophil indices were similar in infants with late-onset Gram-positive bacterial and fungal sepsis; but total white blood cells, and ATN count were significantly lower (P = 0.004 and 0.001, respectively) in infants with late-onset Gram-negative bacterial sepsis. CONCLUSIONS In VLBW infants, common organisms causing infection have different effects on neutrophil responses. Occurrence of neutropenia during evaluation of sepsis in sick VLBW infants is more common with Gram-negative bacterial infection.
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Affiliation(s)
- S Sarkar
- The Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Michigan Health System, Mott Children's Hospital, Ann Arbor, Michigan 48109-0254, USA.
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Abstract
BACKGROUND The optimal number of blood cultures needed to document sepsis in an ill neonate has undergone little critical evaluation. Multiple site cultures may improve pathogen detection if intermittent bacteremia occurs, or if a low density of bacteria is present in the blood. We hypothesized, however, that bacterial clearance is slower and bacteremia more continuous in septic neonates, so that a single site blood culture should be sufficient to accurately document true septicemia. OBJECTIVE To determine the need for multiple site blood cultures in the evaluation of neonates for sepsis. DESIGN/METHODS Clinical data were prospectively collected for 216 neonates who had 269 pairs of blood cultures taken from two different peripheral sites for the evaluation of possible sepsis. A minimum of 1 ml of blood was obtained from the two peripheral sites within 15-30 min of each other. Based on prior retrospective data, we determined that 203 infants would need to have two site blood cultures to demonstrate a significant improvement in pathogen detection at an alpha of 0.05 and a beta of 0.20 (80%) power. RESULTS A total of 186 culture pairs were taken for evaluation of early-onset sepsis in 186 neonates, while 83 pairs were drawn for evaluation of late-onset sepsis in 43 neonates. In all, 21 neonates from the late-onset group were evaluated more than once, and 12 neonates were evaluated for both early- and late-onset sepsis. In all, 20 (9.2%) of 216 neonates had 22 episodes of culture-proven sepsis at a median age of 18 days. All neonates with positive cultures had the same organism with a similar sensitivity pattern obtained from the two different peripheral sites. The other 196 study neonates had negative blood cultures from both sites. The single episode of early-onset sepsis was caused by Listeria monocytogenes, while all remaining episodes were late-onset with the following organisms: Staphylococcus epidermidis (7), methicillin-resistant Staphylococcus aureus (MRSA) (3), combined MRSA and Candida albicans (2), Candida albicans alone (2), late-onset Group B beta-hemolytic Streptococcus (GBS) (2), Klebsiella pneumoniae (2), Enterococcus fecalis (1), Escherichia coli (1), and Serratia marcescens (1). Since no infant grew organisms from only one of the two sites, the data indicate that the diagnosis of sepsis would have been made correctly in all infants with a single site culture. CONCLUSIONS Two site blood cultures for the initial evaluation of neonatal sepsis do not have a better yield in pathogen detection. Sepsis in neonates can be detected with no loss of accuracy with a single site blood culture with blood volume of>or=1 ml.
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Affiliation(s)
- S Sarkar
- Department of Pediatrics, Division of Neonatology, SUNY-Stony Brook, Stony Brook, NY, USA.
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