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Guillén Ú, Zupancic JAF, Litt JS, Kaempf J, Fanaroff A, Polin RA, Martin R, Eichenwald E, Wilson-Costello D, Edwards AD, Hallman M, Bührer C, Fanaroff J, Albersheim S, Embleton ND, Shah PS, Dennery PA, Discenza D, Jobe AH, Kirpalani H. Community Considerations for Aggressive Intensive Care Therapy for Infants <24+0 Weeks of Gestation. J Pediatr 2024; 268:113948. [PMID: 38336203 DOI: 10.1016/j.jpeds.2024.113948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/20/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Affiliation(s)
| | - John A F Zupancic
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jonathan S Litt
- Division of Newborn Medicine, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA
| | - Joseph Kaempf
- Women and Children's Services, Providence St. Vincent Medical Center, Portland, OR
| | - Avroy Fanaroff
- Emeritus, Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | | | - Richard Martin
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Eric Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - A David Edwards
- Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Mikko Hallman
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
| | - Christoph Bührer
- Department of Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Fanaroff
- Department of Pediatrics, UH Rainbow Babies & Children's Hospital, Cleveland, OH
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia, Vancouver, BC, Canada
| | | | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Phyllis A Dennery
- Warren Alpert School of Medicine of Brown University, Providence, RI
| | | | - Alan H Jobe
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, and University of Cincinnati, Cincinnati, OH
| | - Haresh Kirpalani
- Emeritus, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, and Emeritus Department Pediatrics, McMaster University, Hamilton, ON, Canada
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Pillai A, Albersheim S, Niknafs N, Maugo B, Rasmussen B, Lam M, Grewal G, Albert A, Elango R. Human Milk Calorie Guide: A Novel Color-Based Tool to Estimate the Calorie Content of Human Milk for Preterm Infants. Nutrients 2023; 15:nu15081866. [PMID: 37111084 PMCID: PMC10146985 DOI: 10.3390/nu15081866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of preterm infants. Commercial human milk analyzers (HMA) to individually fortify HM are unavailable in most centers. We describe the development and validation of a bedside color-based tool called the 'human milk calorie guide'(HMCG) for differentiating low-calorie HM using commercial HMA as the gold standard. Mothers of preterm babies (birth weight ≤ 1500 g or gestation ≤ 34 weeks) were enrolled. The final color tool had nine color shades arranged as three rows of three shades each (rows A, B, and C). We hypothesized that calorie values for HM samples would increase with increasing 'yellowness' predictably from row A to C. One hundred thirty-one mother's own milk (MOM) and 136 donor human milk (DHM) samples (total n = 267) were color matched and analyzed for macronutrients. The HMCG tool performed best in DHM samples for predicting lower calories (<55 kcal/dL) (AUC 0.87 for category A DHM) with modest accuracy for >70 kcal/dL (AUC 0.77 for category C DHM). For MOM, its diagnostic performance was poor. The tool showed good inter-rater reliability (Krippendorff's alpha = 0.80). The HMCG was reliable in predicting lower calorie ranges for DHM and has the potential for improving donor HM fortification practices.
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Affiliation(s)
- Anish Pillai
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Neonatology, Surya Hospitals, Mumbai 400054, India
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Susan Albersheim
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Nikoo Niknafs
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Brian Maugo
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi 00100, Kenya
| | - Betina Rasmussen
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Mei Lam
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Gurpreet Grewal
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Rajavel Elango
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 3V4, Canada
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Choi S, Casey L, Albersheim S, Van Oerle R, Irvine MA, Piper HG. Urine sodium to urine creatinine ratio as a marker of total body sodium in infants with intestinal failure. J Pediatr Surg 2022; 57:937-940. [PMID: 35078592 DOI: 10.1016/j.jpedsurg.2021.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Urine sodium (UNa) is a measure of total body sodium in infants with intestinal failure (IF) but can be misleading as it does not reflect volume status. Urine sodium to urine creatinine ratio (UNa:UCr) may offer a more accurate measure, but is not routinely used. This study compares UNa:UCr to UNa as a maker of sodium status in infants with IF. METHODS A retrospective review of infants with IF, from a single center, from 2018 to 2020 was conducted (REB H20-00,816). IF etiology, intestinal anatomy, nutritional intake, urine electrolytes and anthropometrics were collected. Linear mixed effects models adjusting for repeated measures were used to associate UNa and UNa:UCr with weight gain and sodium intake. RESULTS Twenty-two infants with a median gestational age of 31 weeks were included. IF etiology included gastroschisis (41%), necrotizing enterocolitis (23%), and intestinal perforation (14%). Infants had an average of 3 paired UNa and UNa:UCr measures for a total of 74 paired measurements. UNa:UCr more strongly correlated with sodium intake compared to UNa (R = 0.25, p = 0.032 vs. R = 0.10, p = 0.38). Overall, neither UNa (p = 0.21) nor UNa:UCr (p = 0.16) were significantly correlated with weight gain. However, for infants receiving ≤50% nutrition enterally, weight gain correlated with UNa (p = 0.01) and UNa:UCr (p = 0.01). UNa:UCr >35 predicted adequate growth regardless of enteral intake (92% sensitivity, 59% specificity). CONCLUSION UNa:UCr is a measure of total body sodium that correlates with sodium intake in infants with IF. Our study indicates UNa:UCr >35 is associated with adequate growth and can be used to guide further validation studies.
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Affiliation(s)
- Seungwon Choi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Michael A Irvine
- BC Centre for Disease Control, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Hannah G Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Peters FB, Bone JN, Van Oerle R, Albersheim S, Casey L, Piper H. The Importance of the ileocecal valve and colon in achieving intestinal independence in infants with short bowel syndrome. J Pediatr Surg 2022; 57:117-121. [PMID: 34696920 DOI: 10.1016/j.jpedsurg.2021.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Infants with short bowel syndrome (SBS) wean from parenteral nutrition (PN) support at variable rates. Small bowel length is a predictor, but the importance of the ileocecal valve (ICV) and colon are unclear. We aim to determine if the ICV and/or colon predict enteral autonomy. METHODS Infants from a single intestinal rehabilitation program were retrospectively reviewed. Etiology of SBS, intestinal anatomy, and duration of nutritional support were collected for three years. The primary outcome was time to full enteral nutrition. ANCOVA and Cox proportional hazards model were used, with p < 0.05 significant. RESULTS 55 infants with SBS were included. After accounting for the effect of small bowel, PN duration was shorter for infants with the ICV compared to those without (mean 218 vs. 538 days, p = 0.003), and had a more significant effect on infants with ≤50% of small bowel. Increased small bowel length was a positive predictor of weaning. Patients with ≤50% of colon spent less time on PN with the ICV, compared to without (mean 220 vs 715 days, p = 0.009). CONCLUSIONS Preservation of the ICV was associated with shorter duration of PN support, while colon was not. Small bowel length is a positive predictor of enteral autonomy. LEVEL OF EVIDENCE Level III retrospective comparative study TYPE OF STUDY: Retrospective review.
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Affiliation(s)
- Francesca Bell Peters
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T1Z3, Canada.
| | - Jeffrey N Bone
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rhonda Van Oerle
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia/BC Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Linda Casey
- Department of Pediatrics, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada
| | - Hannah Piper
- Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC, Canada.
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Que J, Van Oerle R, Albersheim S, Panczuk J, Piper H. The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight. Can J Surg 2021; 64:E644-E649. [PMID: 34853053 PMCID: PMC8648346 DOI: 10.1503/cjs.016920] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants. The role of prophylactic probiotics in its prevention is unclear. This study evaluates the effect of routine probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight in the neonatal intensive care unit. Methods: This retrospective cohort study compared infants cared for at a single institution before and after implementation of routine probiotic administration (2014– 2018). Babies born after July 2016 received probiotics containing Bifidobacterium and Lactobacillus daily until 35 weeks corrected gestational age. Baseline characteristics, necrotizing enterocolitis incidence and severity, infections, mortality, and length of stay were compared between groups. Results: Of the 665 infants included in the study, 310 received probiotics and 355 did not. The 2 groups did not differ with regard to gestational age, birth anthropometrics, mode of delivery, comorbidities, and type of enteral feed. The incidence of necrotizing enterocolitis (Bell’s stage 2 of 3) was similar between groups (4% v. 5%, p = 0.35), as was its severity (p = 0.10). In addition, there were no significant differences in mortality and length of stay between the groups. Significantly fewer infants receiving probiotics developed infections (27% v. 34%, p = 0.046), with the rate of urinary tract infections having the largest reduction. Conclusion: The routine use of Bifidobacterium and Lactobacillus probiotics in infants with very low birth weight did not significantly affect the incidence and severity of necrotizing enterocolitis. However, the use of probiotics was associated with fewer overall infections.
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Affiliation(s)
- Jessica Que
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Rhonda Van Oerle
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Susan Albersheim
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Julia Panczuk
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper)
| | - Hannah Piper
- From the Faculty of Medicine, University of British Columbia, Vancouver, BC (Que); the BC Women's Hospital and Health Centre, Vancouver, BC (Van Oerle); the Department of Pediatrics, Faculty of Medicine, University of British Columbia/BC Children's Hospital, Vancouver, BC (Albersheim, Panczuk); and the Division of Pediatric Surgery, University of British Columbia/BC Children's Hospital, Vancouver, BC (Piper).
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Williams N, Synnes A, O'Brien C, Albersheim S. An alternative approach to developing guidelines for the management of an anticipated extremely preterm infant. J Perinat Med 2020; 48:751-756. [PMID: 32726290 DOI: 10.1515/jpm-2019-0444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/02/2020] [Indexed: 11/15/2022]
Abstract
Objectives To identify the probability of survival and severe neurodevelopmental impairment (sNDI) at which perinatal physicians would or would not offer or recommend resuscitation at birth for extremely preterm infants. Methods A Delphi process consisting of five rounds was implemented to seek consensus (>80% agreement) amongst British Columbia perinatal physicians. The first-round consisted of neonatal and maternal-fetal-medicine Focus Groups. Rounds two to five surveyed perinatal physicians, building upon previous rounds. Draft guidelines were developed and agreement sought. Results Based on 401 responses across all rounds, consensus was obtained that resuscitation should not be offered if survival probability <5%, not recommended if survival probability 5 to <10%, resuscitation recommended if survival without sNDI probability >70 to 90% and resuscitation standard care if survival without sNDI >90%. Conclusions This physician consensus-based, objective framework for the management of an anticipated extremely preterm infant is a transparent alternative to existing guidelines, minimizing gestational-ageism and allowing for individualized management utilizing up-to-date data. Further input from other key stakeholders will be required prior to guideline implementation.
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Affiliation(s)
- Nicholas Williams
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Anne Synnes
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
| | - Claire O'Brien
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Susan Albersheim
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
- Division of Neonatology, British Columbia Women's Hospital, Vancouver, BC, Canada
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Dhaliwal K, Albersheim S, Casey L. 33 NeoCHIRP: A Collaborative Care Model for Intestinal Rehabilitation in the NICU. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Many children with intestinal failure (IF) start their course in the NICU with medical or surgical conditions limiting enteral feeding. Multidisciplinary intestinal rehabilitation teams have improved outcomes in pediatric IF patients, but this is not well described in neonates.
Objectives
NeoCHIRP represents a unique IR Team; this study describes its roles in collaborating neonatal and IR care.
Design/Methods
Retrospective descriptive chart review of neonates at risk for IF in one NICU, of patients admitted between April 1, 2013 and March 31, 2019. All neonates at risk for IF were evaluated weekly by a multidisciplinary Neonatal Children’s IR program in the NICU (NeoCHIRP) that is composed of surgeons, dieticians, neonatologists, IR paediatrician, nurses and patient families, to evaluate nutritional status, and provide recommendations. Data collected included weight, patient characteristics, number of NeoCHIRP visits, type of recommendations, cholestasis interventions, successful oral tolerance, and survival.
Results
There were 163 patients, 105 males, 58 females with 1-27 weekly visits (mean= 9.1) and gestational age between 23-43 4/7 weeks (median= 35). There were 153 survivors discharged from the NICU and 10 deaths (3 from IF related complications.) Enteral autonomy was achieved by 139/163 patients (85.3%.) Common recommendations made were enteral feeds (96.3%), parenteral nutrition (95%) or sodium management (93.9%.) Recommendations for oral stimulation were made in 79.1%, of which 40.5% (66/163) were exclusively orally fed and 20.2% partially orally fed by discharge. Cholestasis interventions were made in 66.9% and conjugated bilirubin (CB) <15 at discharge in 93 patients (range 0-123, mean 12.9 median 2) with only 23/163 patients with CB >30 at final visit. Evaluation of patient weights showed increased z-scores in only 23/153 (15%) from birth to discharge versus increased z-scores in 51/141 (36.2%) from NeoCHIRP consult to discharge.
Conclusion
A Multidisciplinary Neonatal Intestinal Failure Team is a useful collaborative model to support NICU medical management, by minimizing poor weight gain, cholestasis and oral aversion. Recommendations made for all NeoCHIRP patients in enteral, parenteral and sodium management resulted in improved weight gain of patients.
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Abstract
Care of the preterm infant has improved tremendously over the last 60 years, with attendant improvement in outcomes. For the extremely preterm infant, <28 weeks' gestation, concerns related to survival as well as neurodevelopmental impairment, have influenced decision-making to a much larger extent than seen in older children. Possible reasons for conferring a different status on extremely preterm infants include: (1) the belief that the brain is a privileged organ, (2) the degree of medical uncertainty in terms of outcomes, (3) the fact that the family will deal with the psychological, emotional, physical, and financial consequences of treatment decisions, (4) that the extremely preterm looks more like a fetus than a term newborn, (5) the initial lack of relational identity, (6) the fact that extremely preterm infants are technology-dependent, and (7) the timing of decision-making around delivery. Treating extremely preterm infants differently does not hold up to scrutiny. They are owed the same respect as other pediatric patients, in terms of personhood, and we have the same duties to care for them. However, the degree of medical uncertainty and the fact that parents will deal with the consequences of decision-making, highlights the importance of providing a wide band of discretion in parental decision-making authority. Ethical principles considered in decision-making include best interest (historically the sine qua non of pediatric decision-making), a reasonable person standard, the "good enough" parent, and the harm principle, the latter two being more pragmatic. To operationalize these principles, potential models for decision-making are the Zone of Parental Discretion, the Not Unreasonable Standard, and a Shared Decision-Making model. In the final analysis shared decision-making with a wide zone of parental discretion, which is based on the harm principle, would provide fair and equitable decision-making for the extremely preterm infant. However, in the rare circumstance where parents do not wish to embark upon intensive care, against medical recommendations, it would be most helpful to develop local guidelines both for support of health care practitioners and to provide consistency of care for extremely preterm infants.
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Affiliation(s)
- Susan Albersheim
- Division of Neonatology, Department of Pediatrics, University of British Columbia, BC Women's Hospital, Vancouver, BC, Canada
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O’Brien C, Synnes A, Albersheim S, Williams N. 144 An Alternative Approach to Developing Guidelines for the Management of Infants Born at the Threshold of Viability. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claire O’Brien
- University of British Columbia, British Columbia Children’s Hospital
| | - Anne Synnes
- Division of Neonatology, University of British Columbia, British Columbia Women’s & Children’s Hospital
| | - Susan Albersheim
- Division of Neonatology, University of British Columbia, British Columbia Women’s & Children’s Hospital
| | - Nick Williams
- Division of Neonatology, British Columbia Women’s & Children’s Hospital; Royal North Shore Hospital, Sydney, Australia
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Abstract
PURPOSE OF REVIEW There is uncertainty regarding optimal dosing for parenteral amino acids in preterm infants and wide variability exists in clinical practice. There is new data from clinical trials trying to address these concerns. We review the recent evidence on parenteral high-dose amino acid intake in very low birth weight (VLBW) neonates with a focus on relevant clinical outcomes. RECENT FINDINGS Preterm infants often receive less protein than intended in the first week of life. Parenteral amino acid administration in doses that exceed requirements, however, leads to increased oxidation and higher blood urea concentrations. Amino acid doses greater than 3.5 g/kg/day have not shown to improve mortality, neonatal morbidities including sepsis, necrotizing enterocolitis, chronic lung disease, growth parameters or neurodevelopmental outcomes at 2 years of age. SUMMARY Parenteral amino acid administration in VLBW infants should be initiated soon after birth at a dose of at least 1.5 g/kg/day to maintain anabolism. The maximum dose for parenteral amino acid should be between 2.5 and 3.5 g/kg/day, with adequate nonprotein calories and micronutrients to ensure efficient protein utilization and growth.
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Affiliation(s)
- Anish Pillai
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
| | - Susan Albersheim
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
| | - Rajavel Elango
- Neonatal-Perinatal Medicine, BC Women's Hospital and Health Centre
- Department of Pediatrics, University of British Columbia
- BC Children's Hospital Research Institute
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Daboval T, Ferretti E, Moussa A, van Manen M, Moore GP, Srinivasan G, Moldovan A, Agarwal A, Albersheim S. Needs assessment of ethics and communication teaching for neonatal perinatal medicine programs in Canada. Paediatr Child Health 2018; 24:e116-e124. [PMID: 31111831 DOI: 10.1093/pch/pxy108] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective To explore ethics education needs in Canadian Neonatal Perinatal Medicine (NPM) training programs. Methods A retrospective review of NPM trainees' performance at the National NPM Objective Structured Clinical Examination (OSCE) was undertaken for 2012 to 2017 and two distinct cross-sectional online surveys were carried out. One survey targeted recently graduated neonatologists (RGNs) who completed 2 years' training in a Canadian NPM program between 2010 and 2015; the other survey was sent to Canadian NPM training program directors (PDs). The domains of interest were: perception of education, ethics and communication topics, educational strategies, assessment of trainees' competencies, and barriers to neonatal ethics education. Results NPM trainees generally performed less well in stations involving ethics and communication relative to other domains on the National OSCE. Forty-seven RGNs (44.3%) and 12 PDs (92.3%) completed the survey. Over 90% of PDs and RGNs agreed on the importance of training in ethics and communication. Both groups highly valued training on topics related to communication. Preferred teaching strategies were experiential: observation and feedback. PDs mentioned the importance of using validated tools to regularly and formally assess trainees. They recognized challenges in regard to financial resources, physical space, and faculty training in patient-physician communication. Conclusions National OSCE results indicate the need to improve neonatal ethics and communication training in Canadian NPM programs. RGNs and PDs identified important topics, as well as teaching and evaluation strategies. These results can be used to develop a training program for ethics and communication in NPM.
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Affiliation(s)
- Thierry Daboval
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital - General Campus, Ottawa, Ontario.,The University of Ottawa, Ottawa, Ontario
| | - Emanuela Ferretti
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital - General Campus, Ottawa, Ontario.,The University of Ottawa, Ottawa, Ontario
| | - Ahmed Moussa
- Division of Neonatology, Department of Pediatrics, Hôpital Sainte-Justine, University of Montreal, Montreal, Quebec
| | - Michael van Manen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Alberta
| | - Gregory P Moore
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Division of Newborn Care, Department of Obstetrics and Gynecology, The Ottawa Hospital - General Campus, Ottawa, Ontario.,The University of Ottawa, Ottawa, Ontario
| | - Ganesh Srinivasan
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Alexandru Moldovan
- Children's Hospital of Eastern Ontario, Student University of Ottawa, Ottawa, Ontario
| | - Amisha Agarwal
- Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Susan Albersheim
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Thorne S, Konikoff L, Brown H, Albersheim S. Navigating the Dangerous Terrain of Moral Distress: Understanding Response Patterns in the NICU. Qual Health Res 2018; 28:683-701. [PMID: 29357751 DOI: 10.1177/1049732317753585] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Moral distress is a well-recognized and ubiquitous aspect of health care professional practice in the neonatal intensive care unit (NICU) context. We used interpretive description methodology to guide a critical exploration of the dynamics of moral distress experience as reflected in the accounts of 28 health care professionals working in this setting. We learned about the kinds of clinical scenarios which triggered distressing experiences, and that the organizational and relational context of clinical work constituted a complex and dynamic working environment that profoundly affected both the individual and the collective experiences with moral distress in these situations. These findings shed light on possibilities for supporting NICU practitioners and developing the collaborative team cultures that may reduce the risk of unresolved effects of moral distress to the benefit of patients as well as the professionals who care for them.
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Affiliation(s)
- Sally Thorne
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Konikoff
- 2 Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Helen Brown
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Albersheim
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
- 3 Children's and Women's Hospitals of British Columbia, Vancouver, British Columbia, Canada
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Abstract
Paediatric practitioners interact with industry representatives for many purposes but most often to receive information on new and existing products. While practitioners believe they are immune to the marketing influences exerted by these representatives, research has demonstrated otherwise. The literature suggests that the public is aware of such influences and that most people feel industry influence on practitioners is inappropriate. National guidelines go some way toward regulating practitioner-industry interactions, although they are not always clear or sufficient. The present practice point explores the context for these relationships, raises some ethical issues specific to paediatric practitioners and provides recommendations for maintaining professional integrity in the patient-physician relationship. Paediatric practitioners have a professional duty to ensure that their own interactions with industry are conducted with the best interests of the patient front and centre.
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Affiliation(s)
- Susan Albersheim
- Canadian Paediatric Society, Bioethics Committee, Ottawa, Ontario
| | - Kevin Coughlin
- Canadian Paediatric Society, Bioethics Committee, Ottawa, Ontario
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Albersheim S, Coughlin K. La relation entre les praticiens en pédiatrie et « l’industrie ». Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Susan Albersheim
- Société canadienne de pédiatrie, comité de bioéthique, Ottawa (Ontario)
| | - Kevin Coughlin
- Société canadienne de pédiatrie, comité de bioéthique, Ottawa (Ontario)
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Moukarzel S, Soberanes L, Dyer RA, Albersheim S, Elango R, Innis SM. Relationships among Different Water-Soluble Choline Compounds Differ between Human Preterm and Donor Milk. Nutrients 2017; 9:nu9040369. [PMID: 28387717 PMCID: PMC5409708 DOI: 10.3390/nu9040369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/21/2017] [Accepted: 04/01/2017] [Indexed: 12/31/2022] Open
Abstract
Choline is essential for infant development. Human milk choline is predominately present in three water-soluble choline (WSC) forms: free choline (FC), phosphocholine (PhosC), and glycerophosphocholine (GPC). It is unclear whether mother's own preterm milk and pooled donor milk differ in WSC composition and whether WSC compounds are interrelated. Mother's own preterm milk (n = 75) and donor milk (n = 30) samples from the neonatal intensive care unit, BC Women's Hospital were analyzed for WSC composition using liquid chromatography tandem mass spectrometry (LC-MS/MS). Associations between different WSC compounds were determined using Pearson's correlations, followed by Fischer r-to-z transformation. Total WSC concentration and concentrations of FC, PhosC, and GPC did not significantly differ between mother's own milk and donor milk. FC was negatively associated with PhosC and GPC in mother's own milk (r = -0.27, p = 0.02; r = -0.34, p = 0.003, respectively), but not in donor milk (r = 0.26, p = 0.181 r = 0.37, p = 0.062, respectively). The difference in these associations between the two milk groups were statistically significant (p = 0.03 for the association between PhosC and FC; and p = 0.003 for the association between FC and GPC). PhosC and GPC were positively associated in mother's own milk (r = 0.32, p = 0.036) but not donor milk (r = 0.36, p = 0.062), although the difference in correlation was not statistically significant. The metabolic and clinical implications of these associations on the preterm infant need to be further elucidated.
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Affiliation(s)
- Sara Moukarzel
- Department of Pediatrics, University of California San Diego, San Diego, USA and Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, Health Sciences, University of California, San Diego, CA 92093, USA.
| | - Lynda Soberanes
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
| | - Roger A Dyer
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
| | - Susan Albersheim
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada.
| | - Rajavel Elango
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada.
- Origins of Child Health and Disease, Healthy Starts, BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
| | - Sheila M Innis
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 3V4, Canada.
- Division of Neonatology, BC Women's Hospital and Health Centre, Vancouver, BC V6H 3N1, Canada.
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16
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Davies B, Steele R, Krueger G, Albersheim S, Baird J, Bifirie M, Cadell S, Doane G, Garga D, Siden H, Strahlendorf C, Zhao Y. Best Practice in Provider/Parent Interaction. Qual Health Res 2017; 27:406-420. [PMID: 27557925 DOI: 10.1177/1049732316664712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In this 3-year prospective grounded theory study in three pediatric settings, we aimed to develop a conceptualization of best practice health care providers (BPHCPs) in interaction with parents of children with complex, chronic, life-threatening conditions. Analysis of semistructured interviews with 34 parents and 80 health care professionals (HCPs) and 88 observation periods of HCP/parent interactions indicated that BPHCPs shared a broad worldview; values of equity, family-centered care, and integrity; and a commitment to authentic engagement. BPHCPs engaged in direct care activities, in connecting behaviors, and in exquisitely attuning to particularities of the situation in the moment, resulting in positive outcomes for parents and HCPs. By focusing on what HCPs do well, findings showed that not only is it possible for HCPs to practice in this way, but those who do so are also recognized as being the best at what they do. We provide recommendations for practice and initial and ongoing professional education.
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Affiliation(s)
- Betty Davies
- 1 University of Victoria, Victoria, British Columbia, Canada
| | | | - Guenther Krueger
- 3 Retired NVivo Computer Software Consultant, Burnaby, British Columbia, Canada
| | - Susan Albersheim
- 4 Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michelle Bifirie
- 6 University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Cadell
- 7 University of Waterloo, Waterloo, Ontario, Canada
| | - Gweneth Doane
- 1 University of Victoria, Victoria, British Columbia, Canada
| | - Deepshikha Garga
- 4 Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Harold Siden
- 4 Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Caron Strahlendorf
- 4 Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
| | - Yuan Zhao
- 3 Retired NVivo Computer Software Consultant, Burnaby, British Columbia, Canada
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Albersheim S, Everett B, Arnold K. Unconventional Treatment Requests: Should Requests for Female-Only Care Providers Be Accommodated? Journal of Obstetrics and Gynaecology Canada 2016; 38:651-4. [DOI: 10.1016/j.jogc.2016.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
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Sur A, Manraj H, Lavoie PM, Lim K, Courtemanche D, Brooks P, Albersheim S. Multiple Successful Angioembolizations for Refractory Cardiac Failure in a Preterm with Rapidly Involuting Congenital Hemangioma. AJP Rep 2016; 6:e99-e103. [PMID: 26929881 PMCID: PMC4737636 DOI: 10.1055/s-0035-1570342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/22/2015] [Indexed: 11/06/2022] Open
Abstract
Rapidly involuting congenital hemangiomas (RICH) are the commonest variety of congenital hemangioma, often diagnosed antenatally as high-flow arteriovenous shunts causing hemodynamic compromise to the fetus. The postnatal management of such patients is often challenging. We present the case of an infant boy who was delivered prematurely at 29 weeks of gestation due to fetal compromise by a RICH, with features of high-output cardiac failure and major systemic hemodynamic steal from peripheral organs. Two early angioembolizations were required to manage his high-output cardiac failure. To our knowledge, this infant is the smallest and earliest newborn case of successful angioembolization for a complex, life-threatening vascular anomaly. We discuss the interventional dilemmas regarding the optimal timing of delivery and early embolization.
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Affiliation(s)
- Amitava Sur
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Heran Manraj
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Interventional Radiology, University of British Columbia, Vancouver, Canada
| | - Pascal M Lavoie
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ken Lim
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Maternal and Fetal Medicine, University of British Columbia, Vancouver, Canada
| | - Douglas Courtemanche
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Paul Brooks
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Susan Albersheim
- Children's and Women's Health Centre of British Columbia, Vancouver, Canada; Department of Pediatrics, University of British Columbia, Vancouver, Canada
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Mahon P, Albersheim S, Holsti L. The Fathers' Support Scale: Neonatal Intensive Care Unit (FSS:NICU): Development and initial content validation. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2014.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Ting J, Butterworth S, Strahlendorf C, Oviedo A, Albersheim S. A baby girl with distended abdomen and unusual course of umbilical catheter. Indian J Pediatr 2014; 81:1272-3. [PMID: 24777625 DOI: 10.1007/s12098-014-1453-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 04/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Joseph Ting
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada,
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Stanger J, Zwicker K, Albersheim S, Murphy JJ. Human milk fortifier: an occult cause of bowel obstruction in extremely premature neonates. J Pediatr Surg 2014; 49:724-6. [PMID: 24851756 DOI: 10.1016/j.jpedsurg.2014.02.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human milk fortifier (HMF) is used in neonatal units throughout North America to facilitate growth of preterm infants. Little data is available on the gastrointestinal side effects and potential adverse events. The purpose of this paper was to present a series of infants presenting with bowel obstruction associated with HMF. METHODS Cases of HMF obstruction were collected between January 2010 and December 2012. Charts were reviewed and relevant data was collected. RESULTS During the study period, 7 premature infants presented with bowel obstruction secondary to intestinal concretions of HMF. All babies were premature with gestational ages from 25 to 27 weeks. Birth weight was less than 1000 grams in all patients. Patients presented with feeding intolerance, bilious aspirates, abdominal distension, and obstipation. Four of the patients presented with acute deterioration and required urgent surgical intervention. CONCLUSIONS HMF is an important source of nutritional support in infants, which is felt to be safe. We present a series of infants where its use has resulted in significant complications. HMF should be used with caution in infants, especially those with a history of necrotizing enterocolitis. Further research should examine the calcium, protein, and fatty acid concentration tolerable in the gastrointestinal tract of infants.
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MESH Headings
- Enterocolitis, Necrotizing/complications
- Female
- Food, Fortified/adverse effects
- Humans
- Infant Formula
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/surgery
- Infant, Very Low Birth Weight
- Intestinal Obstruction/etiology
- Intestinal Obstruction/surgery
- Male
- Milk, Human
- Retrospective Studies
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Affiliation(s)
- Jennifer Stanger
- Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kelley Zwicker
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Susan Albersheim
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James J Murphy
- Department of Surgery, Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
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Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B. Outcome of patients with gastroschisis managed with and without multidisciplinary teams in Canada. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.3.128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ayala Gover
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Susan Albersheim
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Rebecca Sherlock
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Jennifer Claydon
- Division of Neonatology, Pediatrics, BC Women's Hospital and Health Centre, BC Children's Hospital
| | - Sonia Butterworth
- Division of Pediatric General Surgery, Surgery, Children's Hospital of British Columbia
| | - Boris Kuzeljevic
- Clinical Research Support Unit, Child and Family Research Institute, Vancouver, British Columbia
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Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B. Outcome of patients with gastroschisis managed with and without multidisciplinary teams in Canada. Paediatr Child Health 2014; 19:128-132. [PMID: 24665222 PMCID: PMC3959971] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2013] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE To describe the outcomes of gastroschisis (GS) patients managed with and without a multidisciplinary team during the postoperative period in Canada. METHOD The Canadian Pediatric Surgery Network (CAPSNet) collects patient data from all Canadian tertiary perinatal centres. The outcomes of 396 GS patients born between 2005 and 2009 who were managed with and without a multidisciplinary team were analyzed. RESULTS Significantly more parenteral nutrition (PN) days (P=0.003) and longer lengths of stay (P=0.018) were observed among patients in centres with multidisciplinary teams. Higher mortality rate and earlier death were observed in centres without multidisciplinary teams, especially for high-risk patients, although this was not statistically significant. With regard to low-risk patients, those in centres with multidisciplinary teams had significantly more PN days (P=0.019). CONCLUSIONS GS patients managed by multidisciplinary teams had significantly more PN days and longer lengths of stay compared with patients who were not managed by multidisciplinary teams. This difference may be due to improved survival of high-risk patients in centres with multidisciplinary teams, and a uniform feeding approach for all patients.
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Affiliation(s)
- Ayala Gover
- Division of Neonatology, Pediatrics, BC Women’s Hospital and Health Centre, BC Children’s Hospital
| | - Susan Albersheim
- Division of Neonatology, Pediatrics, BC Women’s Hospital and Health Centre, BC Children’s Hospital
| | - Rebecca Sherlock
- Division of Neonatology, Pediatrics, BC Women’s Hospital and Health Centre, BC Children’s Hospital
| | - Jennifer Claydon
- Division of Neonatology, Pediatrics, BC Women’s Hospital and Health Centre, BC Children’s Hospital
| | - Sonia Butterworth
- Division of Pediatric General Surgery, Surgery, Children’s Hospital of British Columbia
| | - Boris Kuzeljevic
- Clinical Research Support Unit, Child and Family Research Institute, Vancouver, British Columbia
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24
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Ting JY, Manhas D, Innis SM, Albersheim S. Elevated Triglycerides Levels in Two Infants With Hypoxic-ischemic Encephalopathy Undergoing Therapeutic Hypothermia and Receiving Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2013; 38:758-60. [DOI: 10.1177/0148607113497758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 06/22/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph Y. Ting
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Deepak Manhas
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sheila M. Innis
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Susan Albersheim
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abstract
E-mail has become a commonplace 'procedure' in medical practice because it is efficient and inexpensive. However, there are potential misuses and abuses of this form of written communication, with clinical and ethical implications.Common uses of e-mail in paediatics include general communication with colleagues in a professional setting; electronic formal consultation, in which patient confidentiality is paramount; electronic 'curb-side' consultation, which may be perceived as a formal consultation; electronic discussion groups, which lack peer review; communication with current patients or their parents, which should be limited to simple, nonurgent issues; and communication with individuals seeking medical advice who are not patients, which is generally ill-advised.The present practice point offers a few practical suggestions including e-mail etiquette, security measures to ensure confidentiality, development of an e-mail policy for patients and parents, and separation of personal from professional e-mail.
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Gover A, Albersheim S, Sherlock R, Claydon J, Butterworth S, Kuzeljevic B. Impact Of A Multidisciplinary Team on the Outcome of Gastroschisis. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.18ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - A Gover
- BC Childrens and Womens Hospital, Vancouver, British Columbia
| | - S Albersheim
- BC Childrens and Womens Hospital, Vancouver, British Columbia
| | - R Sherlock
- BC Childrens and Womens Hospital, Vancouver, British Columbia
| | - J Claydon
- BC Childrens and Womens Hospital, Vancouver, British Columbia
| | - S Butterworth
- BC Childrens and Womens Hospital, Vancouver, British Columbia
| | - B Kuzeljevic
- BC Childrens and Womens Hospital, Vancouver, British Columbia
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Lalari V, Gover A, Sherlock R, Butterworth S, Singh A, Albersheim S. Does A Multidisciplinary Nutrition Team Improve the Outcomes of Infants With Simple or Complex Gastroschisis? Paediatr Child Health 2010. [DOI: 10.1093/pch/15.suppl_a.38ab] [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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Abstract
OBJECTIVE There is great debate regarding the extent of intensive care interventions for extremely premature newborns. In this report, we describe Canadian neonatologists' attitudes towards delivery room resuscitation decisions in neonates at the threshold of viability. METHODS We interviewed neonatologists (N = 121) practising in Canadian tertiary care neonatal units between June 2004 and April 2005, and asked whether they would support a parental request not to initiate resuscitation for newborns of 23 to 26 weeks' gestation. Bivariate analyses were performed to identify sociodemographic or cultural factors that might affect resuscitation decisions. RESULTS Most Canadian neonatologists would support a parental request not to initiate resuscitation of an infant at 23 and 24 weeks' gestation (98% and 80%, respectively). However, we observed heterogeneity across the country in attitudes primarily at 25 weeks, but also at 24 weeks' gestation. At 24 weeks' gestation, decisions also appear to be significantly related to personal experience with a disabled close friend or relative. For newborns of 25 weeks' gestation, neonatologists are divided: a majority (76%) would strongly advocate resuscitation and/or resuscitate a "viable" fetus against parental wishes, and a minority (24%) would agree not to initiate treatment. At 26 weeks' gestation, more than 97% would not support a request not to initiate resuscitation. CONCLUSION Attitudes of Canadian neonatologists towards resuscitation of newborns at the threshold of viability primarily differ at 25 weeks and to a lesser extent at 24 weeks of gestation. Our findings highlight important nuances in relation to existing national guidelines.
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Affiliation(s)
- Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, Children's and Women's Health Centre of British Columbia, Vancouver, BC
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Abstract
OBJECTIVE This qualitative study aimed at understanding the experiences of fathers of very ill neonates in the NICU. METHODS Sixteen fathers of very ill and/or very preterm infants who had been in the NICU for >30 days were interviewed by a male physician. Fathers were asked about their level of comfort with or concerns about staff communication regarding their infant, about accessing information, and about more general perceptions of their experience in the neonatal intensive care unit. Interviews were audiotaped and transcribed for analysis. Coding used content analysis with construction of themes by 3 researchers. RESULTS The overarching theme for fathers was a sense of lack of control. Their world view, as a "backdrop" theme, provided context for all of the themes. Four other interrelated subthemes were identified, including information; communication, particularly with the health care team; fathers' various roles; and external activities. Fathers reported that relationships with friends/family/health care team, receiving information consistently, and receiving short written materials on common conditions were ways of giving them support. The fathers said that speaking to a male physician was a positive and useful experience. CONCLUSIONS Fathers experience a sense of lack of control when they have an extremely ill infant in the NICU. Specific activities help fathers regain a sense of control and help them fulfill their various roles of protectors, fathers, partners, and breadwinners. Understanding these experiences helps the health care team offer targeted supports for fathers in the NICU.
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Affiliation(s)
- Vincent Arockiasamy
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Waisman D, Kessel I, Ish-Shalom N, Maroun L, Riskin-Mashiah S, Falik-Zaccai T, Weintraub Z, Albersheim S, Rotschild A. The anuric preterm newborn infant with a normal renal ultrasound: a diagnostic and ethical challenge. Prenat Diagn 2006; 26:350-3. [PMID: 16511901 DOI: 10.1002/pd.1417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Diagnosis and treatment of an anuric premature infant with severe respiratory compromise and a normal renal ultrasound (US), is a difficult task that requires a multidisciplinary approach. A 29-week gestation premature male infant, born after 5 weeks of worsening oligohydramnios, was ventilated for respiratory distress and remained anuric. Intensive clinical investigations and pediatric nephrology consultation that predicted very poor prognosis were followed by progressive renal failure, electrolyte imbalance, respiratory failure, ventricular arrhythmia, and finally cardiac arrest and death on day 5. In view of the predicted poor outcome, and after discussion with the parents, a decision was made not to start peritoneal dialysis (PD), and to offer only palliative therapy, with comfort care alone. Pre and postnatal diagnosis lead, in this case, to an ethical challenge that focuses on the question of futility.
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Affiliation(s)
- Dan Waisman
- Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa 34362, Israel.
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Struthers S, Underhill H, Albersheim S, Greenberg D, Dobson S. A comparison of two versus one blood culture in the diagnosis and treatment of coagulase-negative staphylococcus in the neonatal intensive care unit. J Perinatol 2002; 22:547-9. [PMID: 12368970 DOI: 10.1038/sj.jp.7210792] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study compares two versus one blood culture in the diagnosis and treatment of coagulase-negative staphylococcus (CONS) in babies with suspected sepsis. STUDY DESIGN The study was performed at British Columbia's Children's Hospital Neonatal Intensive Care Unit between March 1999 to March 2000. One hundred pairs of cultures were drawn from two percutaneous sites from babies more than 48 hours old at the time of a sepsis screen. CONS cultured from both sites was regarded as evidence of infection. Positive culture from only one of the two sites was regarded as contaminant. The difference in rates of diagnosed CONS infection and reduction in antibiotic usage when using two versus one blood culture was calculated. RESULTS In 5% of babies, cultures from a second site did not substantiate the diagnosis of CONS when compared to the result from a single culture. The resultant reduction in antibiotic use was 8.2%. CONCLUSIONS Two blood cultures reduce the number of children diagnosed with CONS infection and reduce antibiotic usage.
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Affiliation(s)
- Simon Struthers
- Department of Pediatrics, Children's and Women's Health Care Center of British Columbia, University of British Columbia, Vancouver, Canada
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Abstract
The purpose of this study was to review the clinical and ultrasound experience of renal tract abnormalities associated with cocaine exposure in utero. We undertook a 3-year chart review of all infants admitted to British Columbia's Children's Hospital neonatal intensive care unit and Sunny Hill Health Centre for Children in order to identify patients with the diagnostic code for maternal drug or substance use. There were 136 neonates with a positive history or urine drug screen. Renal ultrasound scans had been performed on 79 patients. Ultrasound abnormalities were found in 11 patients (14%) and included horseshoe kidney (2), unilateral abnormal small kidney (1), duplex kidney (1), and renal tract dilation (8). Clinical findings were glandular (2) and juxtaglandular (1) hypospadias with chordee. The patients with hypospadias did not have other abnormalities or abnormal renal ultrasound scans. In our population of infants exposed to cocaine in utero we detected an increased incidence of hypospadias and an increased incidence of renal tract abnormalities. We conclude that cocaine exposure in utero may well be a risk factor for renal tract anomalies. However, a larger, longer-term prospective study is necessary before definitive recommendations can be given for routine screening by ultrasound of all infants exposed to cocaine in utero.
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Affiliation(s)
- M Battin
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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35
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Albersheim S, Rode T. Problem with pulse oximeters. Pediatrics 1991; 87:585. [PMID: 2011445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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36
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Rotschild A, Solimano A, Puterman M, Smyth J, Sharma A, Albersheim S. Increased compliance in response to salbutamol in premature infants with developing bronchopulmonary dysplasia. J Pediatr 1989; 115:984-91. [PMID: 2685221 DOI: 10.1016/s0022-3476(89)80755-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.7] [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: 01/02/2023]
Abstract
We compared the effect of salbutamol and placebo in a double-blind study of preterm infants with bronchopulmonary dysplasia, using a randomized, crossover design with several replicates per subject. Sixty-two tests were performed on 20 ventilator-dependent infants weighing less than 1500 gm. Patients were entered as early as the first week of life and studied for at least 4 weeks or until extubation. Each subject was his own control subject and was randomly assigned to a placebo-salbutamol or salbutamol-placebo sequence administered on 2 consecutive days of each week. Static compliance, expiratory resistance of the respiratory system, and changes in transcutaneous oxygen and carbon dioxide tension were measured. Static compliance improved by 0.240 ml/cm H2O/kg (35.3%) after salbutamol and by 0.010 ml/cm H2O/kg (2.8%) after placebo (p less than 0.0001). The presence of a predetermined decrease in carbon dioxide tension correlated with large changes in static compliance per kilogram and with the need for a high level of fractional inspired oxygen. The magnitude of the clinical and physiologic improvement observed, and the early response suggest that long-term bronchodilator therapy starting as early as the second week of life may be beneficial for very low birth weight infants with early bronchopulmonary dysplasia.
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Affiliation(s)
- A Rotschild
- Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
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37
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Horbar JD, McAuliffe TL, Adler SM, Albersheim S, Cassady G, Edwards W, Jones R, Kattwinkel J, Kraybill EN, Krishnan V. Variability in 28-day outcomes for very low birth weight infants: an analysis of 11 neonatal intensive care units. Pediatrics 1988; 82:554-9. [PMID: 3273485] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A retrospective study of all infants weighing 701 to 1,500 g born at 11 neonatal intensive care centers during 1983 and 1984 was performed to determine whether two specific 28-day outcomes, survival and survival without the need for supplemental oxygen, varied among the centers. Survival without the need for supplemental oxygen was chosen as a reflection of infants surviving without chronic lung disease. There were 1,776 live-born infants delivered during the 2-year study period. Of these infants, 85% (1,512) survived 28 days, a range of 80% to 92% at the individual centers. A total of 60% (1,056) of the infants were alive without supplemental oxygen on day 28, a range of 51% to 70% at the individual centers. Multivariate analysis demonstrated that both survival on day 28 (chi 2 = 23.9, P less than .01) and survival without supplemental oxygen on day 28 (chi 2 = 44.2, P less than .0001) varied significantly among centers after the effects of birth weight, gender, and race were taken into account. Female gender, nonwhite race, and increased birth weight were factors associated with improved rates of survival and survival without supplemental oxygen. The magnitude of outcome variation among centers was estimated by using the logistic regression models to predict what the outcomes would be if each center were to treat a standardized population consisting of all 1,776 study infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J D Horbar
- Department of Pediatrics, University of Vermont, Burlington
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Lockitch G, Halstead AC, Albersheim S, MacCallum C, Quigley G. Age- and sex-specific pediatric reference intervals for biochemistry analytes as measured with the Ektachem-700 analyzer. Clin Chem 1988; 34:1622-5. [PMID: 3402068] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Using the Ektachem-700 multilayer film analyzer, we defined age- and sex-specific reference intervals for 20 analytes in sera from a healthy population of neonates and children ages one to 19 years. Upper and lower normal reference intervals for each analyte were determined by nonparametric methods as the 0.975 and 0.025 fractiles, respectively. Newborns have lower concentrations of total protein and albumin, and higher concentrations of phosphate, bilirubin, and enzymes in serum than older children do. Concentrations of urea, glucose, calcium, phosphate, and bilirubin change rapidly postnatally. Outside the neonatal period, no significant age- or sex-related difference was found for plasma glucose, serum amylase, conjugated or unconjugated bilirubin, or lipase. There was no sex-related difference in reference intervals for albumin, total protein, calcium, phosphate, or urea. However, concentrations of uric acid and creatine kinase are much higher in postpubertal boys than in girls. Alkaline phosphatase values peak later in boys. Except for lactate dehydrogenase and gamma-glutamyltransferase, the reference intervals defined here do not differ strikingly from data derived with use of other analyzers. The age- and sex-related trends are independent of method. However, each laboratory should determine the degree to which these reference ranges can be directly applied to analyses performed with another analyzer.
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Affiliation(s)
- G Lockitch
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
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39
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Lockitch G, Halstead AC, Albersheim S, MacCallum C, Quigley G. Age- and sex-specific pediatric reference intervals for biochemistry analytes as measured with the Ektachem-700 analyzer. Clin Chem 1988. [DOI: 10.1093/clinchem/34.8.1622] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Using the Ektachem-700 multilayer film analyzer, we defined age- and sex-specific reference intervals for 20 analytes in sera from a healthy population of neonates and children ages one to 19 years. Upper and lower normal reference intervals for each analyte were determined by nonparametric methods as the 0.975 and 0.025 fractiles, respectively. Newborns have lower concentrations of total protein and albumin, and higher concentrations of phosphate, bilirubin, and enzymes in serum than older children do. Concentrations of urea, glucose, calcium, phosphate, and bilirubin change rapidly postnatally. Outside the neonatal period, no significant age- or sex-related difference was found for plasma glucose, serum amylase, conjugated or unconjugated bilirubin, or lipase. There was no sex-related difference in reference intervals for albumin, total protein, calcium, phosphate, or urea. However, concentrations of uric acid and creatine kinase are much higher in postpubertal boys than in girls. Alkaline phosphatase values peak later in boys. Except for lactate dehydrogenase and gamma-glutamyltransferase, the reference intervals defined here do not differ strikingly from data derived with use of other analyzers. The age- and sex-related trends are independent of method. However, each laboratory should determine the degree to which these reference ranges can be directly applied to analyses performed with another analyzer.
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Affiliation(s)
- G Lockitch
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
| | - A C Halstead
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
| | - S Albersheim
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
| | - C MacCallum
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
| | - G Quigley
- Department of Pathology, B.C. Children's Hospital, Vancouver, Canada
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40
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Albersheim S, Boychuk R, Seshia MM, Cates D, Rigatto H. Effects of CO2 on immediate ventilatory response to O2 in preterm infants. J Appl Physiol (1985) 1976; 41:609-11. [PMID: 993147 DOI: 10.1152/jappl.1976.41.5.609] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We wanted to know wheter the paradoxical response to CO2 under various background concentrations of O2 in preterm infants was mediated at the peripheral chemoreceptors. In five preterm infants we estimated peripheral chemoreceptor activity using the immediate change in ventilation (first 30 s) when 15%, 40%, 60%, or 100% O2 was substituted for 21% O2. Potentiation between O2 and CO2 was assessed by comparing the response with and without 4% CO2. CO2 enhanced the immediate hyperventilation with hypoxia (P less than 0.005) and reduced the immediate hypoventilation with hyperoxia (P less than 0.025 for 40% O2). This effect of CO2 increased from .00% to 15% O2 (P less than 0.05). These findings suggest: 1) CO2 interacts with O2 at the peripheral chemoreceptor level, and 2) because this interaction is more pronounced with hypoxia, the flatter CO2 response we observed with hypoxia was probably not mediated through the peripheral chemoreceptors and is likely to be central in origin.
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