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Marom D, Mory A, Reytan-Miron S, Amir Y, Kurolap A, Cohen JG, Morhi Y, Smolkin T, Cohen L, Zangen S, Shalata A, Riskin A, Peleg A, Lavie-Nevo K, Mandel D, Chervinsky E, Fisch CF, Fleisher Sheffer V, Falik-Zaccai TC, Rips J, Shlomai NO, Friedman SE, Shporen CH, Ben-Yehoshua SJ, Simmonds A, Yaacobi RG, Bauer-Rusek S, Omari H, Weiss K, Hochwald O, Koifman A, Globus O, Batzir NA, Yaron N, Segel R, Morag I, Reish O, Eliyahu A, Leibovitch L, Schwartz ME, Abramsky R, Hochberg A, Oron A, Banne E, Portnov I, Samra NN, Singer A, Baris Feldman H. National Rapid Genome Sequencing in Neonatal Intensive Care. JAMA Netw Open 2024; 7:e240146. [PMID: 38386321 PMCID: PMC10884880 DOI: 10.1001/jamanetworkopen.2024.0146] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance National implementation of rapid trio genome sequencing (rtGS) in a clinical acute setting is essential to ensure advanced and equitable care for ill neonates. Objective To evaluate the feasibility, diagnostic efficacy, and clinical utility of rtGS in neonatal intensive care units (NICUs) throughout Israel. Design, Setting, and Participants This prospective, public health care-based, multicenter cohort study was conducted from October 2021 to December 2022 with the Community Genetics Department of the Israeli Ministry of Health and all Israeli medical genetics institutes (n = 18) and NICUs (n = 25). Critically ill neonates suspected of having a genetic etiology were offered rtGS. All sequencing, analysis, and interpretation of data were performed in a central genomics center at Tel-Aviv Sourasky Medical Center. Rapid results were expected within 10 days. A secondary analysis report, issued within 60 days, focused mainly on cases with negative rapid results and actionable secondary findings. Pathogenic, likely pathogenic, and highly suspected variants of unknown significance (VUS) were reported. Main Outcomes and Measures Diagnostic rate, including highly suspected disease-causing VUS, and turnaround time for rapid results. Clinical utility was assessed via questionnaires circulated to treating neonatologists. Results A total of 130 neonates across Israel (70 [54%] male; 60 [46%] female) met inclusion criteria and were recruited. Mean (SD) age at enrollment was 12 (13) days. Mean (SD) turnaround time for rapid report was 7 (3) days. Diagnostic efficacy was 50% (65 of 130) for disease-causing variants, 11% (14 of 130) for VUS suspected to be causative, and 1 novel gene candidate (1%). Disease-causing variants included 12 chromosomal and 52 monogenic disorders as well as 1 neonate with uniparental disomy. Overall, the response rate for clinical utility questionnaires was 82% (107 of 130). Among respondents, genomic testing led to a change in medical management for 24 neonates (22%). Results led to immediate precision medicine for 6 of 65 diagnosed infants (9%), an additional 2 (3%) received palliative care, and 2 (3%) were transferred to nursing homes. Conclusions and Relevance In this national cohort study, rtGS in critically ill neonates was feasible and diagnostically beneficial in a public health care setting. This study is a prerequisite for implementation of rtGS for ill neonates into routine care and may aid in design of similar studies in other public health care systems.
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Affiliation(s)
- Daphna Marom
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sivan Reytan-Miron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yam Amir
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Julia Grinshpun Cohen
- Community Genetics Department, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Yocheved Morhi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tatiana Smolkin
- Department of Neonatalogy, Baruch Padeh Medical Center, Tzafon Medical Center, Tiberias, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - Lior Cohen
- Genetics Unit, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Shmuel Zangen
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Barzilai University Medical Center, Ashkelon, Israel
| | - Adel Shalata
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Bnai Zion Medical Center, Haifa, Israel
| | - Arieh Riskin
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Peleg
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Carmel Medical Center, Haifa, Israel
| | - Karen Lavie-Nevo
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Carmel Medical Center, Haifa, Israel
| | - Dror Mandel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Elana Chervinsky
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- The Genetics Institute and Center of Rare Diseases, Emek Medical Center, Afula, Israel
| | - Clari Felszer Fisch
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Emek Medical Center, Afula, Israel
| | - Vered Fleisher Sheffer
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Galilee Medical Center, Naharia, Israel
| | - Tzipora C Falik-Zaccai
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Genetics Institute, Galilee Medical Center, Naharia, Israel
| | - Jonathan Rips
- Department of Genetics, Hadassah Medical Organization, Jerusalem, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Hadassah Medical Organization, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Hadassah Medical Organization, Jerusalem, Israel
| | - Calanit Hershkovich Shporen
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Kaplan Medical Center, Rehovot, Israel
| | - Sagie Josefsberg Ben-Yehoshua
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Genetics Institute, Kaplan Medical Center, Rehovot, Israel
| | - Aryeh Simmonds
- Department of Neonatalogy, Laniado Hospital, Netanya, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Racheli Goldfarb Yaacobi
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Meir Medical Center, Kefar-Sava, Israel
| | - Sofia Bauer-Rusek
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Meir Medical Center, Kefar-Sava, Israel
| | - Hussam Omari
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Saint Vincent Hospital (French Hospital), Nazareth, Israel
| | - Karin Weiss
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Genetics Institute, Rambam Medical Center, Haifa, Israel
| | - Ori Hochwald
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, Rambam Medical Center, Haifa, Israel
| | - Arie Koifman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Genetics Institute, Samson Assuta University Medical Center, Ashdod, Israel
| | - Omer Globus
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Samson Assuta University Medical Center, Ashdod, Israel
| | - Nurit Assia Batzir
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Naveh Yaron
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Department of Neonatalogy, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reeval Segel
- Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
- Medical Genetics Institute, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Iris Morag
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Shamir Medical Center, Zerifin, Israel
| | - Orit Reish
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Shamir Medical Center, Zerifin, Israel
| | - Aviva Eliyahu
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Leah Leibovitch
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Neonatology Department, Sheba Medical Center, Tel-Hashomer, Israel
| | - Marina Eskin Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Genetics Institute, Soroka University Medical Center, Be'er Sheva, Israel
| | - Ramy Abramsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
- Department of Neonatalogy, Soroka University Medical Center, Be'er Sheva, Israel
| | - Amit Hochberg
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatalogy, The Hillel Yaffe Medical Center, Hadera, Israel
| | - Anat Oron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neonatalogy, Wolfson Medical Center, Holon, Israel
| | - Ehud Banne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute, Wolfson Medical Center, Hadera, Israel
| | - Igor Portnov
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Department of Neonatalogy, Ziv Medical Center Sefat, Tsfat, Israel
| | - Nadra Nasser Samra
- Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
- Genetics Institute, Ziv Medical Center, Safed, Israel
| | - Amihood Singer
- Community Genetics Department, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Halevi Hochwald I, Green G, Sela Y, Radomyslsky Z, Nissanholtz-Gannot R, Hochwald O. Converting qualitative data into quantitative values using a matched mixed-methods design: A new methodological approach. J Adv Nurs 2023; 79:4398-4410. [PMID: 36938982 DOI: 10.1111/jan.15649] [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: 12/05/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Quantifying qualitative data as part of mixed-methods research (MMR) can add to the study results' analysis. Comparable results may reinforce the conclusions, while differences hold an opportunity for an in-depth discussion. To date, there is little guidance for researchers seeking to quantify their qualitative data. OBJECTIVES Describing conversion of qualitative data to quantitative values, comparison with matched questionnaire results, discussing the benefits of this process and the matched MMR design. METHODS We describe in detail how qualitative data from 46 interviews were converted into quantitative values (i.e., quantitative-qualitative values, QQVs) using MMR design, enabling a comparison of results from interviews and questionnaires obtained from the same participants. This process was embedded in a larger MMR study on family-caregivers caring for people-with-end-stage-dementia conducted between the years 2020-2021. RESULTS A QQV was generated for three main themes and compared to the questionnaires' scores regarding the same topics. There were no significant differences between the scores regarding 'satisfaction with nurses and physicians care', and 'discussion with nurses and physicians about end-of-life care'. However, for 'burden', the QQV score was significantly higher than the questionnaires' score. DISCUSSION We described how to use a matched MMR design to produce and compare QQV from interviews with questionnaire scores. This methodology may allow further valuable discussion if the results are either similar or not, and for better integration and easier presentation of the results. Comparable results can reinforce the conclusions from both parts of the MMR study, while differences hold an opportunity for an in-depth discussion regarding their meaning and context. Although we claim that this methodology can be embedded in the MMR structure and contribute significantly to the discussion's depth, it by no means replaces the traditional MMR design. PATIENT AND PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Gizell Green
- Nursing Department, Ariel University, Ariel, Israel
| | - Yael Sela
- Nursing Department, Faculty of Social and Community Sciences, Ruppin Academic Center, Emeq-Hefer, Israel
| | - Zorian Radomyslsky
- Maccabi Healthcare Services, Tel-Aviv, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
| | | | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Mimouni M, Ben-Haim LN, Naaman E, Bebin A, Ron Y, Mezer E, Hochwald O, Borenstein-Levin L, Zayit-Soudry S. Is there room for prompt routine ophthalmic examination in neonates with congenital cytomegalovirus (CMV) infection during the neonatal period? Int Ophthalmol 2023; 43:3667-3672. [PMID: 37415020 DOI: 10.1007/s10792-023-02775-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To establish the clinical necessity of routine targeted ophthalmic examination of newborns with congenital cytomegalovirus (CMV) infection during the neonatal period. METHODS This retrospective study included consecutive neonates that were referred for ophthalmological screening within the context of a proven congenital CMV infection. The presence of CMV-related ocular and systemic findings was determined. RESULTS Among the 91 patients included in this study, 72 (79.12%) were symptomatic with one or more of the following manifestations: abnormal brain ultrasound (42; 46.15%), small for gestational age (29; 31.87%), microcephaly (23; 25.27%), thrombocytopenia (14; 15.38%), sensory neural hearing loss (13; 14.29%), neutropenia (12; 13.19%), anemia (4; 4.4%), skin lesions (4; 4.4%), hepatomegaly (3; 3.3%), splenomegaly (3; 3.3%), direct hyperbilirubinemia (2; 2.2%). Not one single neonate in this cohort had any of the ocular findings surveyed. CONCLUSION The presence of ophthalmological findings among neonates with congenital CMV infection during the neonatal period is infrequent, suggesting that routine ophthalmological screening may be safely deferred for the post-neonatal period.
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Affiliation(s)
- Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel.
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Liron Naftali Ben-Haim
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Efrat Naaman
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alex Bebin
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yonina Ron
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eedy Mezer
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Liron Borenstein-Levin
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Borenstein-Levin L, Avishay N, Soffer O, Arnon S, Riskin A, Dinur G, Lavie-Nevo K, Gover A, Kugelman A, Hochwald O. Transcutaneous CO 2 Monitoring in Extremely Low Birth Weight Premature Infants. J Clin Med 2023; 12:5757. [PMID: 37685823 PMCID: PMC10488371 DOI: 10.3390/jcm12175757] [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] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Extremely low birth weight (ELBW) premature infants are particularly susceptible to hypocarbia and hypercarbia, which are associated with brain and lung morbidities. Transcutaneous CO2 (TcCO2) monitoring allows for continuous non-invasive CO2 monitoring during invasive and non-invasive ventilation and is becoming more popular in the NICU. We aimed to evaluate the correlation and agreement between CO2 levels measured by a TcCO2 monitor and blood gas CO2 (bgCO2) among ELBW infants. This was a prospective observational multicenter study. All infants < 1000 g admitted to the participating NICUs during the study period were monitored by a TcCO2 monitor, if available. For each bgCO2 measured, a simultaneous TcCO2 measurement was documented. In total, 1828 pairs of TcCO2-bgCO2 values of 94 infants were collected, with a median (IQR) gestational age of 26.4 (26.0, 28.3) weeks and birth weight of 800 (702, 900) g. A moderate correlation (Pearson: r = 0.64) and good agreement (bias (95% limits of agreement)):(2.9 [-11.8, 17.6] mmHg) were found between the TcCO2 and bgCO2 values in the 25-70 mmHg TcCO2 range. The correlation between the TcCO2 and bgCO2 trends was moderate. CO2 measurements by TcCO2 are in good agreement (bias < 5 mmHg) with bgCO2 among premature infants < 1000 g during the first week of life, regardless of day of life, ventilation mode (invasive/non-invasive), and sampling method (arterial/capillary/venous). However, wide limits of agreement and moderate correlation dictate the use of TcCO2 as a complementary tool to blood gas sampling, to assess CO2 levels and trends in individual patients.
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Affiliation(s)
- Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Noa Avishay
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Orit Soffer
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
| | - Shmuel Arnon
- Department of Neonatology, Meir Medical Center, Kfar-Saba 4428164b, Israel;
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Bnai Zion Medical Center, Haifa 32000, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Karen Lavie-Nevo
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel
| | - Ayala Gover
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
- Department of Neonatology, Carmel Medical Center, Haifa 3436212, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa 3109601, Israel; (O.S.); (G.D.); (A.K.); (O.H.)
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel; (N.A.); (A.R.); (K.L.-N.); (A.G.)
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Borenstein-Levin L, Haj A, Riskin A, Dinur G, Littner Y, Hochwald O, Kugelman A. Oxygenation Instability during Bolus versus Continuous Feeding among Very Low Birth Weight Premature Infants, Supported by Noninvasive Ventilation: A Randomized Prospective Study. Am J Perinatol 2023. [PMID: 37494585 DOI: 10.1055/s-0043-1771257] [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: 07/28/2023]
Abstract
OBJECTIVE This study aimed to compare oxygenation instability, as documented by the oxygen saturation (SpO2) histograms, during bolus (over 30 minutes) versus continuous (over 2 hours) feeding among very low birth weight (VLBW) premature infants, supported with noninvasive ventilation (NIV). STUDY DESIGN This was a randomized prospective study. VLBW infants supported with NIV received three consecutive feeds in a random order of bolus-continuous-bolus or continuous-bolus-continuous. During each feed, 30 minutes and 2 hours histograms were documented. RESULTS Twenty-four infants (birth weight [mean ± standard deviation, SD] 820 ± 168 g, gestational age [mean ± SD] 27.0 ± 1.6 weeks) were included in our study (12 infants started with bolus feeding and 12 with continuous feeding) and 72 histograms were obtained (36 during bolus feeding and 36 during continuous feeding). No differences in mean fraction of inspired oxygen (FiO2), and number of apnea events were observed between the two feeding modes. Oxygenation instability as assessed by time spent in different SpO2 ranges and histogram types (stable or unstable) was comparable during bolus and continuous feedings. Changing feeding mode from bolus to continuous or vice versa did not significantly change the oxygenation instability of the group, though individual infants did show a consistence response to feeding length changes. CONCLUSION Among VLBW infants supported with NIV, oxygenation instability, as documented by SpO2 histograms, was comparable between bolus and continuous feedings. Individual infants may benefit from specific feeding length, and this can be easily demonstrated by the SpO2 histograms. KEY POINTS · Feeding length did not affect oxygenation instability of preterm infants on noninvasive respiratory Support.. · Oxygen saturation histograms allow objective quantification of oxygenation instability at the bedside.. · Individual infants benefit from specific feeding length, as demonstrated by SpO2 histograms..
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Affiliation(s)
- Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ahmad Haj
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Gil Dinur
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yoav Littner
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Borenstein-Levin L, Poppe JA, van Weteringen W, Taal HR, Hochwald O, Kugelman A, Reiss IKM, Simons SHP. Oxygen saturation histogram classification system to evaluate response to doxapram treatment in preterm infants. Pediatr Res 2023; 93:932-937. [PMID: 35739260 DOI: 10.1038/s41390-022-02158-w] [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: 11/02/2021] [Revised: 04/25/2022] [Accepted: 05/22/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND An oxygen saturation (SpO2) histogram classification system has been shown to enable quantification of SpO2 instability into five types, based on histogram distribution and time spent at SpO2 ≤ 80%. We aimed to investigate this classification system as a tool to describe response to doxapram treatment in infants with severe apnea of prematurity. METHODS This retrospective study included 61 very-low-birth-weight infants who received doxapram. SpO2 histograms were generated over the 24-h before and after doxapram start. Therapy response was defined as a decrease of ≥1 histogram types after therapy start. RESULTS The median (IQR) histogram type decreased from 4 (3-4) before to 3 (2-3) after therapy start (p < 0.001). The median (IQR) FiO2 remained constant before (27% [24-35%]) and after (26% [22-35%]) therapy. Thirty-six infants (59%) responded to therapy within 24 h. In 34/36 (94%) of the responders, invasive mechanical ventilation (IMV) was not required during the first 72 h of therapy, compared to 15/25 (60%) of non-responders (p = 0.002). Positive and negative predictive values of the 24-h response for no IMV requirement within 72 h were 0.46 and 0.94, respectively. CONCLUSIONS Classification of SpO2 histograms provides an objective bedside measure to assess response to doxapram therapy and can serve as a tool to detect changes in oxygenation status around respiratory interventions. IMPACT The SpO2 histogram classification system provides a tool for quantifying response to doxapram therapy. The classification system allowed estimation of the probability of invasive mechanical ventilation requirement, already within a few hours of treatment. The SpO2 histogram classification system allows an objective bedside assessment of the oxygenation status of the preterm infant, making it possible to assess the changes in oxygenation status in response to respiratory interventions.
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Affiliation(s)
- Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Jarinda A Poppe
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem van Weteringen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Rob Taal
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irwin K M Reiss
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Michael T, Levy A, Kohn E, Daniel S, Hazan A, Berkovitch M, Brik A, Hochwald O, Borenstein L, Betser M, Moskovich M, Livne A, Keidar R, Rorman E, Groisman L, Weiner Z, Malkoff A, Solt I. Prenatal exposure to common heavy metals is associated with anogenital distance in newborns. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.429] [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: 01/08/2023]
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8
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Michael T, Kohn E, Daniel S, Hazan A, Berkovitch M, Brik A, Hochwald O, Borenstein-Levin L, Betser M, Moskovich M, Livne A, Keidar R, Rorman E, Groisman L, Weiner Z, Rabin AM, Solt I, Levy A. Prenatal exposure to heavy metal mixtures and anthropometric birth outcomes: a cross-sectional study. Environ Health 2022; 21:139. [PMID: 36581953 PMCID: PMC9798586 DOI: 10.1186/s12940-022-00950-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Numerous studies have suggested significant associations between prenatal exposure to heavy metals and newborn anthropometric measures. However, little is known about the effect of various heavy metal mixtures at relatively low concentrations. Hence, this study aimed to investigate associations between prenatal exposures to a wide range of individual heavy metals and heavy metal mixtures with anthropometric measures of newborns. METHODS We recruited 975 mother-term infant pairs from two major hospitals in Israel. Associations between eight heavy metals (arsenic, cadmium, chromium, mercury, nickel, lead, selenium, and thallium) detected in maternal urine samples on the day of delivery with weight, length, and head circumference at birth were estimated using linear and Bayesian kernel machine regression (BKMR) models. RESULTS Most heavy metals examined in our study were observed in lower concentrations than in other studies, except for selenium. In the linear as well as the BKMR models, birth weight and length were negatively associated with levels of chromium. Birth weight was found to be negatively associated with thallium and positively associated with nickel. CONCLUSION By using a large sample size and advanced statistical models, we could examine the association between prenatal exposure to metals in relatively low concentrations and anthropometric measures of newborns. Chromium was suggested to be the most influential metal in the mixture, and its associations with birth weight and length were found negative. Head circumference was neither associated with any of the metals, yet the levels of metals detected in our sample were relatively low. The suggested associations should be further investigated and could shed light on complex biochemical processes involved in intrauterine fetal development.
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Affiliation(s)
- Tal Michael
- Department of Epidemiology, Biostatistics, and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology Unit, Pediatric Division, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Daniel
- Department of Epidemiology, Biostatistics, and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel
- Clalit Health Services, Southern District, Beer-Sheva, Israel
| | - Ariela Hazan
- Clinical Pharmacology and Toxicology Unit, Pediatric Division, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Pediatric Division, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anna Brik
- Clinical Pharmacology and Toxicology Unit, Pediatric Division, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Rambam Health Care Campus, and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Rambam Health Care Campus, and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Moshe Betser
- Delivery Rooms and Maternity Ward, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Miki Moskovich
- Delivery Rooms and Maternity Ward, Shamir (Assaf Harofeh) Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Livne
- Neonatal Intensive Care Unit, Shamir (Assaf Harofeh) Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rimona Keidar
- Neonatal Intensive Care Unit, Shamir (Assaf Harofeh) Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efrat Rorman
- National Public Health Laboratory, Ministry of Health, Tel-Aviv, Israel
| | - Luda Groisman
- National Public Health Laboratory, Ministry of Health, Tel-Aviv, Israel
| | - Zeev Weiner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, POB 9602, 31096, Haifa, Israel
| | - Adi Malkoff Rabin
- Department of Obstetrics and Gynecology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, POB 9602, 31096, Haifa, Israel
| | - Ido Solt
- Department of Obstetrics and Gynecology, Rambam Health Care Campus and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, POB 9602, 31096, Haifa, Israel.
| | - Amalia Levy
- Department of Epidemiology, Biostatistics, and Community Health Sciences, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel
- Environment and Health Epidemiology Research Center, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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9
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Borenstein-Levin L, Riskin A, Hochwald O, Timstut F, Sendler S, Shoris I, Littner Y, Dinur G, Kugelman A. Continuous versus Bolus Gastric Tube Feeding in Very Low Birth Weight Infants Supported with Noninvasive Respiratory Support: A Randomized, Pilot Study. Am J Perinatol 2022. [PMID: 36096134 DOI: 10.1055/s-0042-1755551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES This study aimed to compare time to full feeding (TFF) between continuous gastric feeding (CGF) and bolus feeding (BF) in very low birth weight (VLBW) infants supported with noninvasive ventilation (NIV) and to evaluate feasibility and identify methodological pitfalls for future large-scale studies. STUDY DESIGN This study is a randomized controlled, prospective, pilot study. VLBW premature infants, supported with NIV, were randomized while still on trophic feeding <20 mL/kg/day to receive feeding over 2 hours of CGF or over 15- to 30-minute BF. The primary outcome was TFF. Analysis was done by intention to treat. RESULTS Overall, 32 infants were included in this analysis, 17 in the CGF group and 15 in the BF group. Infants in the CGF group were significantly younger than the BF group (mean ± standard deviation [SD] gestational age [GA] 26.9 ± 1.2 vs. 28.9 ± 1.5 weeks, respectively). TFF was comparable with median (interquartile range [IQR]) for the two groups, 10.0 (10.0, 19.0) days in the BF group versus 12.0 (9.0, 13.0) days in the CGF group (p = 0.59). Feeding length was not found to significantly affect TFF in multivariate analysis correcting for GA. Groups were comparable in weight gain, gastrointestinal complications, length of NIV, bronchopulmonary dysplasia incidence, and age at discharge. Most infants from both groups (60% of BF and 70% of CGF) required changes in feeding length. CONCLUSION In this pilot study, among VLBW infants supported with NIV, TFF was comparable between the BF and CGF groups. These results should be interpreted with caution due to the small sample size and despite the multivariate analysis correcting for the different GA. Interestingly, most infants required changes in feeding length regardless of their allocation. This feasibility study emphasizes the need for careful attention to randomization and strict feeding protocols including criteria for switching allocation in future large-scale studies aimed at determining the preferred feeding length during NIV in VLBW infants. KEY POINTS · Among infants supported with NIV, length of feeding affects gastric venting.. · BF might increase gastrointestinal reflux, while continuous feeding hinders gastric decompression.. · Among infants supported by NIV, feeding tolerance was comparable between bolus and continuous groups..
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Affiliation(s)
- Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Fanny Timstut
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Sofia Sendler
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Irit Shoris
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel
| | - Yoav Littner
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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10
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Borenstein-Levin L, Taha R, Riskin A, Hafner H, Cohen-Vaizer A, Gordin A, Littner Y, Dinur G, Hochwald O, Kugelman A. Effects of neurodevelopmental risk factors on brainstem maturation in premature infants. Pediatr Res 2022; 92:168-173. [PMID: 34789841 DOI: 10.1038/s41390-021-01849-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/26/2020] [Revised: 10/16/2021] [Accepted: 10/31/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Interpeak latencies (IPL), as measured by the auditory brainstem-evoked responses (ABR) test, represent the conduction time, and therefore the maturation of the brainstem auditory pathway. We aimed to study the effect of various risk factors for the neurodevelopmental delay on the conduction time in the auditory pathway among normal hearing premature infants, at term postmenstrual age (PMA). METHODS Retrospective analysis of 239 premature infants (gestational age 32.5 ± 2.1 weeks, birth weight 1827 ± 483 g). Interpeak latencies, demographic data, and risk factors were recorded. RESULTS Sex, PMA at ABR test, being small for gestational age (SGA), intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL), and days of invasive ventilation were found to significantly affect the IPL's in the auditory pathway in a univariate analysis. Multivariable regression analysis revealed that male sex and less advanced PMA at the examination were independent factors associated with prolonged IPL's, while bronchopulmonary dysplasia, IVH or PVL and being SGA shortened the IPL's. Non-invasive mechanical ventilation, did not affect the caudal part of the auditory pathway, despite its high noise level. CONCLUSIONS Among various risk factors for the neurodevelopmental delay, male sex was associated with delayed, while IVH or PVL, BPD and SGA could be associated with accelerated auditory brainstem maturation. IMPACT Auditory brainstem-evoked response (ABR) test, among normal hearing infants, can serve as a clinical tool to assess brainstem auditory maturation. Different neurodevelopmental risk factors could have different effects on the maturity of the auditory pathway. Male sex is significantly associated with prolonged interpeak latencies (IPL) among preterm and term infants, while intraventricular hemorrhage or periventricular leukomalacia, bronchopulmonary dysplasia, and being small for gestation age may be associated with shortened IPL The corrected age at ABR testing is of significance, among preterm and term infants.
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Affiliation(s)
- L Borenstein-Levin
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.
| | - R Taha
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - A Riskin
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - H Hafner
- Laboratory of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - A Cohen-Vaizer
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of ENT, Rambam Health Care Campus, Haifa, Israel
| | - A Gordin
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of ENT, Rambam Health Care Campus, Haifa, Israel
| | - Y Littner
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - G Dinur
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - O Hochwald
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - A Kugelman
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
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11
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Nof E, Artzy‐Schnirman A, Bhardwaj S, Sabatan H, Waisman D, Hochwald O, Gruber M, Borenstein‐Levin L, Sznitman J. Ventilation‐induced epithelial injury drives biological onset of lung trauma in vitro and is mitigated with prophylactic anti‐inflammatory therapeutics. Bioeng Transl Med 2021; 7:e10271. [PMID: 35600654 PMCID: PMC9115701 DOI: 10.1002/btm2.10271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/25/2023] Open
Abstract
Mortality rates among patients suffering from acute respiratory failure remain perplexingly high despite the maintenance of blood oxygen homeostasis during ventilatory support. The biotrauma hypothesis advocates that mechanical forces from invasive ventilation trigger immunological mediators that spread systemically. Yet, how these forces elicit an immune response remains unclear. Here, a biomimetic in vitro three‐dimensional (3D) upper airways model allows to recapitulate lung injury and immune responses induced during invasive mechanical ventilation in neonates. Under such ventilatory support, flow‐induced stresses injure the bronchial epithelium of the intubated airways model and directly modulate epithelial cell inflammatory cytokine secretion associated with pulmonary injury. Fluorescence microscopy and biochemical analyses reveal site‐specific susceptibility to epithelial erosion in airways from jet‐flow impaction and are linked to increases in cell apoptosis and modulated secretions of cytokines IL‐6, ‐8, and ‐10. In an effort to mitigate the onset of biotrauma, prophylactic pharmacological treatment with Montelukast, a leukotriene receptor antagonist, reduces apoptosis and pro‐inflammatory signaling during invasive ventilation of the in vitro model. This 3D airway platform points to a previously overlooked origin of lung injury and showcases translational opportunities in preclinical pulmonary research toward protective therapies and improved protocols for patient care.
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Affiliation(s)
- Eliram Nof
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Arbel Artzy‐Schnirman
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Saurabh Bhardwaj
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Hadas Sabatan
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
| | - Dan Waisman
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Carmel Medical Center Haifa Israel
| | - Ori Hochwald
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Ruth Rappaport Children's Hospital, Rambam Healthcare Haifa Israel
| | - Maayan Gruber
- Azrieli Faculty of Medicine Bar‐Ilan University Safed Israel
- Department of Otolaryngology‐Head and Neck Surgery Galilee Medical Center Nahariya Israel
| | - Liron Borenstein‐Levin
- Faculty of Medicine Technion ‐ Israel Institute of Technology Haifa Israel
- Department of Neonatology Ruth Rappaport Children's Hospital, Rambam Healthcare Haifa Israel
| | - Josué Sznitman
- Faculty of Biomedical Engineering Technion ‐ Israel Institute of Technology Haifa Israel
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12
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Littner Y, Volinsky C, Kuint J, Yekutiel N, Borenstein-Levin L, Dinur G, Hochwald O, Kugelman A. Respiratory morbidity in very low birth weight infants through childhood and adolescence. Pediatr Pulmonol 2021; 56:1609-1616. [PMID: 33657277 DOI: 10.1002/ppul.25329] [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: 01/02/2021] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the long-term (up to 18 years of age) respiratory outcomes of children and adolescents born at very low birth weight (VLBW; ≤1500 g) in comparison with that of children born >1500 g. METHODS An observational, longitudinal, retrospective study comparing VLBW infants with matched controls, registered at a large health maintenance organization in Israel. Pulmonary outcomes collected anonymously from the electronic medical files included respiratory illness diagnoses, purchased medications for respiratory problems, office visits with either a pediatric pulmonologist or cardiologist and composite respiratory morbidity combining all these parameters. RESULTS Our study included 5793 VLBW infants and 11,590 matched controls born between 1998 and 2012. The majority (99%) of VLBW infants were premature (born < 37 weeks' gestation), while 93% of controls were born at term. The composite respiratory morbidity was significantly higher in VLBW infants compared with controls in all age groups (relative risk [95% confidence interval]: 1 year: 1.22 [1.19-1.26], <2 years: 1.30 [1.27-1.34], 2-6 years: 1.29 [1.27-1.32], 6-12 years: 1.53 [1.47-1.59], 12-18 years: 1.46 [1.35-1.56]; respectively). Both VLBW infants and controls demonstrated a steady decline in the composite respiratory morbidity with aging. In VLBW infants, lower gestational age was associated with higher respiratory morbidity only until 2 years of age and the morbidity declined in each gestational age group until adolescence. CONCLUSION Our study confirmed a strong association between VLBW and pulmonary morbidity. The higher prevalence of respiratory composite morbidity in VLBW infants persists over the years until adolescence. The respiratory morbidity is most evident in the first year of life and declines afterward.
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Affiliation(s)
- Yoav Littner
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Chen Volinsky
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Kuint
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,K.S.M Research & Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Naama Yekutiel
- K.S.M Research & Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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13
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Dinur G, Borenstein-Levin L, Vider S, Hochwald O, Jubran H, Littner Y, Fleischer-Sheffer V, Kugelman A. Evaluation of audio-voice guided application for neonatal resuscitation: a prospective, randomized, pilot study. J Perinat Med 2021; 49:520-525. [PMID: 33470963 DOI: 10.1515/jpm-2020-0173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/22/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine whether audio-voice guidance application improves adherence to resuscitation sequence and recommended time frames during neonatal resuscitation. METHODS A prospective, randomized, pilot study examining the use of an audio-voice application for guiding resuscitation on newborn mannequins, based on the Neonatal Resuscitation Program (NRP) algorithm. Two different scenarios, with and without voice guidance, were presented to 20 medical personnel (2 midwives, 8 nurses, and 10 physicians) in random order, and their performance videotaped. RESULTS Audio-voice guided resuscitation compared with non-guided resuscitation, resulted in significantly better compliance with NRP order sequence (p<0.01), correct use of oxygen supplementation (p<0.01) and performance of MR SOPA (Mask, reposition, suction, open mouth, pressure, airway) (p<0.01), and shortened the time to "positive pressure ventilation" (p<0.01). CONCLUSIONS In this pilot study, audio-voice guidance application for newborn resuscitation simulation on mannequins, based on the NRP algorithm, improved adherence and performance of NRP guidelines.
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Affiliation(s)
- Gil Dinur
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Shachar Vider
- Department of Orthopedic Surgery, Technion - Israel Institute of Technology, Rambam Health Care Campus, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Yoav Littner
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Vered Fleischer-Sheffer
- Department of Neonatology, Galilee Medical Center, Naharia,Israel.,Bar-Ilan University, Azrieli Faculty of Medicine, Safed, Israel
| | - Amir Kugelman
- Department of Neonatology, Ruth Rapapport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Technion - Israel Institute of Technology, Ruth & Bruce Rappaport Faculty of Medicine, Haifa, Israel
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Hochwald O, Borenstein-Levin L, Dinur G, Kugelman A. Is There a "Direct" Answer: Should We Perform Exchange Transfusion for Neonatal Predominantly Conjugated Hyperbilirubinemia? Clin Pediatr (Phila) 2021; 60:221-225. [PMID: 33853369 DOI: 10.1177/00099228211006686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Gil Dinur
- Rambam Health Care Campus, Haifa, Israel
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15
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Hochwald O, Riskin A, Borenstein-Levin L, Shoris I, Dinur GP, Said W, Jubran H, Littner Y, Haddad J, Mor M, Timstut F, Bader D, Kugelman A. Cannula With Long and Narrow Tubing vs Short Binasal Prongs for Noninvasive Ventilation in Preterm Infants: Noninferiority Randomized Clinical Trial. JAMA Pediatr 2021; 175:36-43. [PMID: 33165539 PMCID: PMC7653541 DOI: 10.1001/jamapediatrics.2020.3579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Use of cannulas with long and narrow tubing (CLNT) has gained increasing popularity for applying noninvasive respiratory support for newborn infants thanks to ease of use, perceived patient comfort, and reduced nasal trauma. However, there is concern that this interface delivers reduced and suboptimal support. OBJECTIVE To determine whether CLNT is noninferior to short binasal prongs and masks (SPM) when providing nasal intermittent positive pressure ventilation (NIPPV) in preterm infants. DESIGN, SETTING, AND PARTICIPANTS This randomized controlled, unblinded, prospective noninferiority trial was conducted between December 2017 and December 2019 at 2 tertiary neonatal intensive care units. Preterm infants born between 24 weeks' and 33 weeks and 6 days' gestation were eligible if presented with respiratory distress syndrome with the need for noninvasive ventilatory support either as initial treatment after birth or after first extubation. Analysis was performed by intention to treat. INTERVENTIONS Randomization to NIPPV with either CLNT or SPM interface. MAIN OUTCOMES AND MEASURES The primary outcome was the need for intubation within 72 hours after NIPPV treatment began. Noninferiority margin was defined as 15% or less absolute difference. RESULTS Overall, 166 infants were included in this analysis, and infant characteristics and clinical condition (including fraction of inspired oxygen, Pco2, and pH level) were comparable at recruitment in the CLNT group (n = 83) and SPM group (n = 83). The mean (SD) gestational age was 29.3 (2.2) weeks vs 29.2 (2.5) weeks, and the mean (SD) birth weight was 1237 (414) g vs 1254 (448) g in the CLNT and SPM groups, respectively. Intubation within 72 hours occurred in 12 of 83 infants (14%) in the CLNT group and in 15 of 83 infants (18%) in the SPM group (risk difference, -3.6%; 95% CI, -14.8 to 7.6 [within the noninferiority margin], χ2 P = .53). Moderate to severe nasal trauma was significantly less common in the CLNT group compared with the SPM group (4 [5%] vs 14 [17%]; P = .01). There were no differences in other adverse events or in the course during hospitalization. CONCLUSIONS AND RELEVANCE In this study, CLNT was noninferior to SPM in providing NIPPV for preterm infants, while causing significantly less nasal trauma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03081611.
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Affiliation(s)
- Ori Hochwald
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Arieh Riskin
- Bnai Zion Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | | | - Irit Shoris
- Bnai Zion Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Gil P. Dinur
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Waseem Said
- Bnai Zion Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Huda Jubran
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Yoav Littner
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Julie Haddad
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Malka Mor
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Fanny Timstut
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - David Bader
- Bnai Zion Medical Center & Rapport Faculty of Medicine, Haifa, Israel
| | - Amir Kugelman
- Rambam Medical Center & Rapport Faculty of Medicine, Haifa, Israel
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Miller-Barmak A, Riskin A, Hochwald O, Haddad J, Dinur G, Vortman R, Kugelman A, Borenstein-Levin L. Oxygenation Instability Assessed by Oxygen Saturation Histograms during Supine vs Prone Position in Very Low Birthweight Infants Receiving Noninvasive Respiratory Support. J Pediatr 2020; 226:123-128. [PMID: 32615194 DOI: 10.1016/j.jpeds.2020.06.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 04/14/2020] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effect of prone vs supine position on the oxygenation instability among very low birth weight (VLBW) infants receiving noninvasive respiratory support, as assessed by the average oxygen saturation (SpO2) histograms. STUDY DESIGN Sixty-nine histograms from 23 VLBW infants were studied prospectively. Each infant was studied during 3 consecutive 3-hour periods of alternating positions; 12 infants started the study while prone and 11 infants started supine, by random order. Histogram classification system was used to quantify oxygenation stability and time spent in different SpO2 ranges. RESULTS The fraction of inspired oxygen values were similar in both positions. Unstable histograms were more common in supine vs prone position (20/34 [59%] vs 10/35 [29%]; P = .02, respectively). Analyzing oxygenation stability as per position change revealed that a change from prone to supine increased oxygenation instability, and supine to prone decreased instability (P = .02). In the supine vs prone position, percent of time spent in SpO2 ≤80% and <90% was higher (5.0 ± 4.2 vs 2.4 ± 3.4 [P < .001] and 24.1 ± 13.7 vs 13.2 ± 10.0 [P < .001], respectively), and percent of time in SpO2 >94% was lower (39.7 ± 26.0 vs 52.4 ± 23.4 [P = .04]). CONCLUSIONS Prone positioning decreased oxygenation instability and resulted in higher oxygenation among VLBW premature infants on noninvasive respiratory support. SpO2 histograms allow easy bedside assessment of oxygenation instability, and quantification of the time spent at different SpO2 ranges.
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Affiliation(s)
- Adi Miller-Barmak
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Arieh Riskin
- Neonatal Intensive Care Unit, Bnai Zion Medical Center, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Julie Haddad
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rita Vortman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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17
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Borenstein-Levin L, Kugelman A, Horani A, Sharif Y, Sharif-Rasslan A, Riskin A, Hochwald O, Dinur G, Amshalom A, Bader D, Sharif D. [ALTERATIONS IN SENSITIVE MEASURES OF CARDIAC FUNCTION IN HEALTHY NEONATES DURING PHOTOTHERAPY]. Harefuah 2020; 159:739-744. [PMID: 33103393] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Phototherapy has been reported to reduce coronary blood flow in neonates but without affecting gross measures of cardiac function. The aim of our current study was to evaluate earlier, more sensitive changes in cardiac function during phototherapy. METHODS Nineteen neonates with jaundice treated with phototherapy had Doppler echocardiographic evaluation, before, during and after phototherapy and were compared to 25 matched controls. Sensitive measures for cardiac performance in this study included left ventricular dimension, ventricular Doppler parameters and regional function assessment. RESULTS Phototherapy was associated with a significant increase in heart rate. In addition, atrioventricular valve closure to opening interval decreased significantly during phototherapy while ventricular ejection times tended to decrease. However, left and right ventricular filling parameters and outflow velocity parameters, longitudinal tissue-Doppler annular velocities and myocardial performance indices were not affected by phototherapy and were similar to those in controls. Coronary blood velocities and integrals decreased significantly during phototherapy. CONCLUSIONS Our study found no differences in early and sensitive measures of cardiac performance including the diastolic and systolic function, despite modestly lower flow in coronary arteries among healthy neonates during phototherapy.
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Affiliation(s)
- Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Ashraf Horani
- Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel
| | - Yasmin Sharif
- Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel
| | | | - Arieh Riskin
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
| | - Annat Amshalom
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - David Bader
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Dawod Sharif
- Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel
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18
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Borenstein-Levin L, Makhoul S, Ilivitzki A, Zreik M, Hochwald O, Makhoul JS, Kugelman A, Makhoul IR. Neonatal frontal lobe: sonographic reference values and suggested clinical use. Pediatr Res 2020; 87:536-540. [PMID: 31600773 DOI: 10.1038/s41390-019-0605-3] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/14/2019] [Accepted: 09/25/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHHC) remain major problems among premature infants. The need, timing and type of ventricular drainage are based on sonographic ventricular measures, without assessment of the dimensions of the frontal lobe. The aim of our study was to establish new reference values for sonographic frontal lobe cortico-ventricular thickness (FL-CVT) in a large cohort of infants. METHODS All normal head ultrasound scans that were performed in our center during the first 4 days of life between January 2014 and December 2016 were retrospectively evaluated. RESULTS Scans were evaluated and plotted to create a reference range for the thickness of the frontal lobe in normal infants of 24-40 weeks' gestation. The FL-CVT increased significantly during gestation. Calculating the area under the curve of the FL-CVT in 9 infants with post-hemorrhagic-hydrocephalus (PHHC) reveals a 20% mean loss of FL-CVT. The impact of increasing ventricular dilatation and of the various ventricular drainage procedures on the frontal lobe growth were described in two infants demonstrating the potential clinical value of this tool. CONCLUSIONS Head ultrasound provides a simple, non-invasive method for measuring the thickness of the frontal lobe, which grows significantly between 24 and 40 weeks' gestation. In premature infants with PHHC, we suggest the use of the FL-CVT measure, in addition to ventricular size measures, as a direct assessment of the impact of the enlarged ventricles on the surrounding brain parenchyma. This could assist in the management of PHHC and determine the need and optimal timing for intervention.
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Affiliation(s)
- Liron Borenstein-Levin
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,Neonatology, Rambam Health Care Campus, Haifa, Israel.
| | - Shada Makhoul
- Alpha Project for Gifted High School Students, Technion, Haifa, Israel
| | - Anat Ilivitzki
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Pediatric Imaging Unit, Rambam Health Care Campus, Haifa, Israel
| | - Merna Zreik
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Joanne S Makhoul
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Imad R Makhoul
- Research Unit, Nazareth Hospital, Nazareth, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Ramat Gan, Israel
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19
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Borenstein-Levin L, Hochwald O, Ben David S, Kugelman A. Abdominal aortic perforation by an umbilical arterial catheter. Arch Dis Child Fetal Neonatal Ed 2020; 105:40. [PMID: 31467071 DOI: 10.1136/archdischild-2019-317869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/06/2019] [Accepted: 08/18/2019] [Indexed: 11/04/2022]
Affiliation(s)
| | - Ori Hochwald
- Neonatology, Rambam Health Care Campus, Haifa, Israel
| | | | - Amir Kugelman
- Neonatology, Rambam Health Care Campus, Haifa, Israel
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20
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Hochwald O, Borenstein-Levin L, Dinur G, Jubran H, Ben-David S, Kugelman A. Continuous Noninvasive Carbon Dioxide Monitoring in Neonates: From Theory to Standard of Care. Pediatrics 2019; 144:peds.2018-3640. [PMID: 31248940 DOI: 10.1542/peds.2018-3640] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Ventilatory support may affect the short- and long-term neurologic and respiratory morbidities of preterm infants. Ongoing monitoring of oxygenation and ventilation and control of adequate levels of oxygen, pressures, and volumes can decrease the incidence of such adverse outcomes. Use of pulse oximetry became a standard of care for titrating oxygen delivery, but continuous noninvasive monitoring of carbon dioxide (CO2) is not routinely used in NICUs. Continuous monitoring of CO2 level may be crucial because hypocarbia and hypercarbia in extremely preterm infants are associated with lung and brain morbidities, specifically bronchopulmonary dysplasia, intraventricular hemorrhage, and cystic periventricular leukomalacia. It is shown that continuous monitoring of CO2 levels helps in maintaining stable CO2 values within an accepted target range. Continuous monitoring of CO2 levels can be used in the delivery room, during transport, and in infants receiving invasive or noninvasive respiratory support in the NICU. It is logical to hypothesize that this will result in better outcome for extremely preterm infants. In this article, we review the different noninvasive CO2 monitoring alternatives and devices, their advantages and disadvantages, and the available clinical data supporting or negating their use as a standard of care in NICUs.
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Affiliation(s)
- Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel; and.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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21
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Hochwald O, Gil Z, Gordin A, Winer Z, Avrahami R, Abargel E, Khoury A, Lehavi A, Abecassis P, Eldor L, Ben-Izhak O, Borenstein-Levin L, Stienberg R, Kugelman A. Three-step management of a newborn with a giant, highly vascularized, cervical teratoma: a case report. J Med Case Rep 2019; 13:73. [PMID: 30851737 PMCID: PMC6409158 DOI: 10.1186/s13256-019-1976-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background A giant congenital cervical teratoma is often highly vascularized; thus, in addition to a life-threatening airway occlusion at birth it comprises a high risk for significant and lethal blood loss during resection. In the case presented, an endovascular embolization of the carotid artery that supplied a giant congenital cervical teratoma was done as part of a three-stage treatment soon after birth and contributed to an overall good outcome. Embolization in cases of cervical teratomas was not described previously. Case presentation We present a case of a preterm newborn from a Sephardic jewish origin with a giant, highly vascularized, congenital cervical teratoma that was managed successfully in three stages: (1) delivery by an ex utero intrapartum treatment procedure after extensive preoperative planning and followed by tracheostomy, (2) endovascular embolization of the carotid artery that supplied the tumor in order to decrease blood loss during resection, and (3) complete surgical resection. The parents were involved in all the ethical and medical decisions, starting just after the cervical mass was diagnosed prenatally. Conclusion The management of giant congenital cervical teratoma is often challenging from both a medical and ethical prospective. Meticulous perinatal planning and parents’ involvement is crucial. Endovascular embolization of the tumor feeding vessels can significantly improve the resection outcome and overall prognosis.
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Affiliation(s)
- Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel.
| | - Ziv Gil
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Campus, Haifa, Israel
| | - Arie Gordin
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Campus, Haifa, Israel.,The Pediatric ENT service, Rambam Health Campus, Haifa, Israel
| | - Zeev Winer
- The Obstetrics & Gynecology Division, Rambam Health Campus, Haifa, Israel
| | - Ron Avrahami
- The Obstetrics & Gynecology Division, Rambam Health Campus, Haifa, Israel
| | - Eitan Abargel
- Invasive Neuroradiology Unit, Rambam Health Campus, Haifa, Israel
| | - Asaad Khoury
- Department of Pediatric Cardiology & Congenital Heart Disease in Adults, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Amit Lehavi
- The Department of Anesthesiology, Rambam Health Campus, Haifa, Israel
| | | | - Liron Eldor
- The Department of Plastic Surgery, Rambam Health Campus, Haifa, Israel
| | - Ofer Ben-Izhak
- The Department of Pathology, Rambam Health Campus, Haifa, Israel
| | - Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
| | - Ran Stienberg
- The Department of Pediatric Surgery, Rambam Health Campus, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Haifa, Israel
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22
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Hochwald O, Mainzer G, Borenstein-Levin L, Jubran H, Dinur G, Zucker M, Mor M, Khoury A, Kugelman A. Adding Paracetamol to Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm Infants: A Double-Blind, Randomized, Placebo-Controlled Pilot Study. Am J Perinatol 2018; 35:1319-1325. [PMID: 29783269 DOI: 10.1055/s-0038-1653946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The objective of this study was to compare the closure rate of hemodynamically significant patent ductus arteriosus (hsPDA) of intravenous ibuprofen + paracetamol (acetaminophen) versus ibuprofen + placebo, in preterm infants of 24 to 316/7 weeks postmenstrual age. STUDY DESIGN This is a single-center, double-blind, randomized controlled pilot study. Infants were assigned for treatment with either intravenous ibuprofen + paracetamol (n = 12) or ibuprofen + placebo (n = 12). RESULTS There was no statistical difference in baseline characteristics of the two groups. Echocardiography parameters were comparable before treatment in both groups. There was a trend toward higher hsPDA closure rate in the paracetamol group in comparison to the placebo group (83 vs. 42%, p = 0.08). No adverse effects, clinical or laboratory, were associated with adding paracetamol. CONCLUSION Our pilot study was unable to detect a beneficial effect by adding intravenous paracetamol to ibuprofen for the treatment of hsPDA. Larger prospective studies are needed to explore the positive tendency suggested by our results and to assure safety.
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Affiliation(s)
- Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Gur Mainzer
- Department of Pediatric Cardiology and Congenital Heart Disease in Adults, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel.,Department of Pediatric Cardiology, Baruch Padeh Medical Center, Poriya, Israel
| | - Liron Borenstein-Levin
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Huda Jubran
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Gil Dinur
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Meirav Zucker
- Department of Pediatric Cardiology and Congenital Heart Disease in Adults, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Malka Mor
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Asaad Khoury
- Department of Pediatric Cardiology and Congenital Heart Disease in Adults, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
| | - Amir Kugelman
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Health Campus, Rappoart Faculty of Medicine, Technion, Haifa, Israel
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23
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Kugelman A, Borenstein-Levin L, Jubran H, Dinur G, Ben-David S, Segal E, Haddad J, Timstut F, Stein I, Makhoul IR, Hochwald O. Less is More: Modern Neonatology. Rambam Maimonides Med J 2018; 9:RMMJ.10344. [PMID: 30089091 PMCID: PMC6115478 DOI: 10.5041/rmmj.10344] [Citation(s) in RCA: 6] [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] [Indexed: 02/07/2023] Open
Abstract
Iatrogenesis is more common in neonatal intensive care units (NICUs) because the infants are vulnerable and exposed to prolonged intensive care. Sixty percent of extremely low-birth-weight infants are exposed to iatrogenesis. The risk factors for iatrogenesis in NICUs include prematurity, mechanical or non-invasive ventilation, central lines, and prolonged length of stay. This led to the notion that "less is more." In the delivery room delayed cord clamping is recommended for term and preterm infants, and suction for the airways in newborns with meconium-stained fluid is not performed anymore. As a symbol for a less aggressive attitude we use the term neonatal stabilization rather than resuscitation. Lower levels of oxygen saturations are accepted as normal during the first 10 minutes of life, and if respiratory assistance is needed, we no longer use 100% oxygen but 0.21-0.3 FiO2, depending on gestational age and the level of oxygen saturation. We try to avoid endotracheal ventilation by using non-invasive respiratory support and administering continuous positive airway pressure early on, starting in the delivery room. If surfactant is needed, non-invasive methods of surfactant administration are utilized. Use of central lines is shortened, and early feeding of human milk is the routine. Permissive hypercapnia is allowed, and continuous non-invasive monitoring not only of the O2 but also of CO2 is warranted. "Kangaroo care" and Newborn Individualized Developmental Care and Assessment Program (NIDCAP) together with a calm atmosphere with parental involvement are encouraged. Whether "less is more," or not enough, is to be seen in future studies.
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Affiliation(s)
- Amir Kugelman
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- To whom correspondence should be addressed. E-mail:
| | - Liron Borenstein-Levin
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Huda Jubran
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Gil Dinur
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Shlomit Ben-David
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Elena Segal
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Julie Haddad
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Fanny Timstut
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Iris Stein
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
| | - Imad R. Makhoul
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Ori Hochwald
- Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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Hochwald O, Holsti L, Osiovich H. Salivary Cortisol Based Early ACTH Test for Identifying Adrenal Insufficiency in Low Birth Weight Infants. Indian J Pediatr 2016; 83:1491-1492. [PMID: 27299340 DOI: 10.1007/s12098-016-2177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Ori Hochwald
- Neonatal Intensive Care Unit, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel. .,Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, Canada.
| | - Liisa Holsti
- Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, BC, Canada.,Child and Family Research Institute, Vancouver, BC, Canada
| | - Horacio Osiovich
- Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, Vancouver, Canada
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Hochwald O, Jabr M, Osiovich H, Miller SP, McNamara PJ, Lavoie PM. Preferential cephalic redistribution of left ventricular cardiac output during therapeutic hypothermia for perinatal hypoxic-ischemic encephalopathy. J Pediatr 2014; 164:999-1004.e1. [PMID: 24582011 PMCID: PMC4623763 DOI: 10.1016/j.jpeds.2014.01.028] [Citation(s) in RCA: 45] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 12/04/2013] [Accepted: 01/15/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the relationship between left ventricular cardiac output (LVCO), superior vena cava (SVC) flow, and brain injury during whole-body therapeutic hypothermia. STUDY DESIGN Sixteen newborns with moderate or severe hypoxic-ischemic encephalopathy were studied using echocardiography during and immediately after therapeutic hypothermia. Measures were also compared with 12 healthy newborns of similar postnatal age. Newborns undergoing therapeutic hypothermia also had cerebral magnetic resonance imaging as part of routine clinical care on postnatal day 3-4. RESULTS LVCO was markedly reduced (mean ± SD 126 ± 38 mL/kg/min) during therapeutic hypothermia, whereas SVC flow was maintained within expected normal values (88 ± 27 mL/kg/min) such that SVC flow represented 70% of the LVCO. The reduction in LVCO during therapeutic hypothermia was mainly accounted by a reduction in heart rate (99 ± 13 vs 123 ± 17 beats/min; P < .001) compared with immediately postwarming in the context of myocardial dysfunction. Neonates with brain injury on magnetic resonance imaging had higher SVC flow prerewarming, compared with newborns without brain injury (P = .013). CONCLUSION Newborns with perinatal hypoxic-ischemic encephalopathy showed a preferential systemic-to-cerebral redistribution of cardiac blood flow during whole-body therapeutic hypothermia, which may reflect a lack of cerebral vascular adaptation in newborns with more severe brain injury.
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Affiliation(s)
- Ori Hochwald
- Neonatal Intensive Care Unit, Rambam Medical Center, Haifa, Israel
| | - Mohammed Jabr
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Horacio Osiovich
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Steven P. Miller
- Department of Pediatrics, Division of Neurology Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patrick J. McNamara
- Division of Neonatology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pascal M. Lavoie
- Department of Pediatrics, Division of Neonatology, University of British Columbia, Vancouver, Canada
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Ting J, Hochwald O, Au N, Mercimek-Mahmutoglu S. Blueberry muffin rash and thrombocytopenia in a newborn with mucolipidosis type II (I-cell disease) masquerading as congenital infections. Mol Genet Metab 2011; 104:708-9. [PMID: 21959079 DOI: 10.1016/j.ymgme.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/04/2011] [Indexed: 11/16/2022]
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27
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Hochwald O, Osiovich H. Prenatal Caffey disease. Isr Med Assoc J 2011; 13:113-114. [PMID: 21443040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
MESH Headings
- Amniocentesis
- Female
- Fetal Diseases/diagnostic imaging
- Fetal Diseases/pathology
- Humans
- Hyperostosis, Cortical, Congenital/complications
- Hyperostosis, Cortical, Congenital/diagnostic imaging
- Hyperostosis, Cortical, Congenital/pathology
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/pathology
- Polyhydramnios/etiology
- Pregnancy
- Radiography
- Ultrasonography, Prenatal
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Affiliation(s)
- Ori Hochwald
- Division of Neonatology, Department of Pediatrics, Children's & Women's Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada.
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Gover A, Bader D, Weinger-Abend M, Chystiakov I, Miller E, Riskin A, Hochwald O, Beni-Adani L, Tirosh E, Kugelman A. Head ultrasonograhy as a screening tool in apparently healthy asymptomatic term neonates. Isr Med Assoc J 2011; 13:9-13. [PMID: 21446229] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The rate of brain abnormalities in asymptomatic term neonates varies substantially in previous studies. Some of these rates may justify general screening of healthy newborns by head ultrasound (HUS). OBJECTIVES To assess the incidence of intracranial abnormalities among asymptomatic term newborns with HUS and to detect high-risk populations that might need such screening. METHODS This was a prospective study in 493 term newborns who underwent HUS and a neurological evaluation during the first 3 days of life. The neurological examination results were unknown to the sonographist and the examiner was blinded to the HUS findings. The abnormal HUS findings were classified as significant or non-significant according to the current literature. RESULTS Abnormal HUS was found in 11.2% of the neonates. Significant findings were noted in 3.8% of the infants. There was no association between non-structural HUS findings (hemorrhage or echogenicity) and mode of delivery. There was no relationship between any HUS abnormality and birth weight, head circumference and maternal age, ethnicity, education or morbidity. The rate of abnormal neurological, hearing or vision evaluation in infants with a significant abnormal HUS (5.2%) was comparable to the rate in infants with normal or non-significant findings on HUS (3.1%). CONCLUSIONS There is no indication for routine HUS screening in apparently healthy term neonates due to the relatively low incidence of significant brain abnormalities in these infants in our population.
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Affiliation(s)
- Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center affiliated with Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Hochwald O, Osiovich H. High Flow — Low Level of Evidence — What Are We Doing? Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.19a] [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: 11/13/2022] Open
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Hochwald O, Osiovich H. Steroids as First Line Drug Treatment for Hypotension in Preterm in fants. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.46ab] [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: 11/12/2022] Open
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Hochwald O, Bamberger ES, Rubin L, Gershtein R, Srugo I. A pertussis outbreak among daycare children in Northern Israel: who gets sick? Isr Med Assoc J 2010; 12:283-286. [PMID: 20929081] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND An outbreak of pertussis occurred in a daycare center with 87.5% vaccination coverage. OBJECTIVES To assess the effectiveness of the acellular pertussis vaccine and prevention of pertussis after chemoprophylaxis with azithromycin. METHODS We studied 31 daycare children aged 3-5.5 years exposed to a child with pertussis. Nasopharyngeal swabs were obtained for Bordetella pertussis culture and polymerase chain reaction initially, and at days 21 and 60 of follow-up, in cases exhibiting symptoms. RESULTS Of the 31 daycare children 6 (19%) tested positive for 8. pertussis by PCR, 4 of whom had not been vaccinated against the disease. Of the two vaccinated children who contracted pertussis, one had milder symptoms and the other was asymptomatic. The incidence of pertussis was significantly lower in the vaccinated group (2/27) than in the unvaccinated group (4/4) (P = 0.000), with efficacy of the vaccine calculated to be 92.5%. Azithromycin chemoprophylaxis was taken only by 14 of the 25 exposed children (56%). On day 21 follow-up, there was no further laboratory-diagnosed B. pertussis cases in any of the exposed children, regardless of whether or not chemoprophylaxis was taken. CONCLUSIONS Based o the children's clinical manifestations and PCR findings a pertussis outbreak had occurred in the daycare center studied. Our findings support the importance of pertussis vaccination since all the unvaccinated children in the daycare center contracted the infection.
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Affiliation(s)
- Ori Hochwald
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
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Riskin A, Hochwald O, Bader D, Srugo I, Naftali G, Kugelman A, Cohen E, Mor F, Kaufman B, Shaoul R. The effects of lactulose supplementation to enteral feedings in premature infants: a pilot study. J Pediatr 2010; 156:209-14. [PMID: 19879595 DOI: 10.1016/j.jpeds.2009.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [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] [Received: 02/07/2009] [Revised: 07/27/2009] [Accepted: 09/02/2009] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the safety and prebiotic effects of lactulose in preterm infants. STUDY DESIGN This was a prospective, double-blinded, placebo-controlled, single-center study in 23- to 34-weeks premature infants. The study group received 1% lactulose, and control infants received 1% dextrose in all feeds (human milk or formula). RESULTS Twenty-eight infants participated (15 lactulose, 13 placebo). Small doses of lactulose appeared to be safe and did not cause diarrhea. Premature infants on lactulose had more Lactobacilli-positive stool cultures that appeared earlier with larger number of colonies. The lactulose group tended to have less intolerance to enteral feedings, to reach full oral feeds earlier, and to be discharged home earlier. They also tended to have fewer episodes of late-onset sepsis, lower Bell stage necrotizing enterocolitis, and their nutritional laboratory indices were better, especially calcium and total protein. CONCLUSIONS This pilot study supports the safety of supplementing preterm infants' feeds with low doses of lactulose. It also demonstrated trends that may suggest positive prebiotic effects.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Technion, Israel Institute of Technology, 47 Golomb Street, POB 4940, Haifa 31048, Israel.
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Affiliation(s)
- Ori Hochwald
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
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Hochwald O, Bamberger E, Srugo I. The return of pertussis: who is responsible? What can be done? Isr Med Assoc J 2006; 8:301-7. [PMID: 16805225] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Israel Ministry of Health's epidemiology department reported a record number of 1564 new pertussis cases in 2004. This brings the incidence rate to 23 per 100,000 population, indicating a marked increase in the prevalence of pertussis, from 1-3/100,000 in 1998, 9 in 2001, to 14 in 2003. The rate of atypical pertussis presentations in vaccinated patients, the decline in pertussis immunity post-vaccination, and the decreased awareness of potential infections in the adult population make the diagnosis of pertussis difficult and contribute to the rising incidence. In this article we review the current literature in order to increase awareness of the occurrence of pertussis in children as well as adults, discuss the laboratory diagnostic methods being used, and report the currently recommended means of treating the disease.
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Affiliation(s)
- Ori Hochwald
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel.
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Hochwald O, Shaoul R. The missing of missing mandibular frenulum in hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr 2005; 40:101; author reply 100-1. [PMID: 15625440 DOI: 10.1097/00005176-200501000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Affiliation(s)
- O Hochwald
- Paediatric Department, Bnai Zion Medical Center, Haifa, Israel.
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Hochwald O. Hypovitaminosis D among inpatients in sunny country. Isr Med Assoc J 2004; 6:381. [PMID: 15214476] [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: 04/30/2023]
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Hochwald O, Harman-Boehm I, Castel H. Hypovitaminosis D among inpatients in a sunny country. Isr Med Assoc J 2004; 6:82-7. [PMID: 14986463] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND Hypovitaminosis D is an important risk factor for osteoporosis and its complications. Previous studies found that the incidence of hypovitaminosis D among patients in an internal medicine ward reached up to 57%. OBJECTIVE To determine the prevalence and determinants of hypovitaminosis D among patients in internal medicine wards in a sunny country. METHODS We measured 25-hydroxyvitamin D, parathyroid hormone and various other laboratory parameters, and assessed the amount of sun exposure, dietary vitamin D intake and other risk factors for hypovitaminosis D in 296 internal medicine inpatients admitted consecutively to the Soroka University Medical Center, which is situated in a sunny region of Israel. RESULTS We found hypovitaminosis D (serum 25-HO-D < 15 ng/ml) in 77 inpatients (26.27%). The amount of sunlight exposure, serum albumin concentration, being housebound or resident of a nursing home, vitamin D intake, ethnic group, cerebrovascular accident and glucocorticoid therapy were all significantly associated with hypovitaminosis D. Multivariate analysis showed a significant association between hypovitaminosis D and Bedouin origin, sun exposure, vitamin D intake, and stroke. Hypovitaminosis D was also found among inpatients who reported consuming more than the recommended daily amount of vitamin D. Parathyroid hormone levels were significantly higher in patients with 25-OH-D levels below 15 ng/ml. In a subgroup of 74 inpatients under 65 years old with no known risk factors for hypovitaminosis D, we found 20.3% with hypovitaminosis D. CONCLUSIONS Hypovitaminosis D is common in patients hospitalized in internal medicine wards in our region, including patients with no known risk factors for this condition. Based on our findings, we recommend vitamin D supplementation during hospitalization and upon discharge from general internal medicine wards as a primary or secondary preventive measure.
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Affiliation(s)
- Ori Hochwald
- Department of Pediatrics, Bnei Zion Medical Center, Haifa, Israel.
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Hochwald O, Shaoul R. [The neurological manifestations of celiac disease in children]. Harefuah 2003; 142:848-51, 876. [PMID: 14702754] [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] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Neurological manifestations are occasionally associated with celiac disease in both adults and children. In the past these manifestations were related to nutritional deficiencies. However, since neurological manifestations can be demonstrated in patients without nutritional deficiencies, the etiology may be immune or toxic mediated. We present an update on the neurological manifestations of celiac disease, particularly in children.
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Affiliation(s)
- Ori Hochwald
- Pediatric Department, Bnai Zion Medical Center, Haifa, Israel
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