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Pantalone JM, Liu S, Olaloye OO, Prochaska EC, Yanowitz T, Riley MM, Buland JR, Brozanski BS, Good M, Konnikova L. Gestational Age-Specific Complete Blood Count Signatures in Necrotizing Enterocolitis. Front Pediatr 2021; 9:604899. [PMID: 33718296 PMCID: PMC7952609 DOI: 10.3389/fped.2021.604899] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: Necrotizing enterocolitis (NEC) is characterized by peripheral cell abnormalities, yet few studies have analyzed the complete blood count (CBC) specifically by gestational age (GA). Our objective was to describe GA-specific immune abnormalities in NEC through a comprehensive analysis of the CBC differential. Methods: Using a cohort of 246 infants (177 cases, 69 controls) admitted to neonatal intensive care units at a single institution, we retrospectively analyzed CBCs around illness onset in NEC cases compared with controls. Cases included surgical NEC (S-NEC, 34.5%) and medical NEC (M-NEC, 65.5%). Infants were divided into those born at GA <33 and ≥33 weeks. Differences in CBC values were described as absolute and percent changes at NEC onset from baseline and at antibiotic completion after NEC. We used machine learning algorithms based on the CBC at NEC to generate predictive models for diagnosis. Results: At NEC onset, there was an acute drop in monocytes and lymphocytes along with a rise in bands in S-NEC infants born <33 weeks compared with M-NEC. In comparison, both M-NEC and S-NEC ≥33 weeks had a percent drop in neutrophils at diagnosis compared with controls. At antibiotic completion, monocytes in S-NEC <33 weeks significantly rose compared with M-NEC, yet for S-NEC ≥33 weeks, bands significantly dropped compared with M-NEC. Predictive modeling was able to accurately predict S-NEC from M-NEC and controls. Conclusion: There are discrete leukocyte patterns in NEC based on GA. The CBC at diagnosis may be useful in identifying patients who will require surgery.
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Affiliation(s)
- Julia M Pantalone
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Silvia Liu
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oluwabunmi O Olaloye
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States
| | - Erica C Prochaska
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Toby Yanowitz
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Melissa M Riley
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Justin R Buland
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Beverly S Brozanski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Misty Good
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
| | - Liza Konnikova
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, United States.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States
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2
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Haslbeck FB, Bucher HU, Bassler D, Hagmann C, Natalucci G. Creative Music Therapy and Neurodevelopmental Outcomes in Pre-term Infants at 2 Years: A Randomized Controlled Pilot Trial. Front Pediatr 2021; 9:660393. [PMID: 34222141 PMCID: PMC8249730 DOI: 10.3389/fped.2021.660393] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Impaired neurodevelopment is increasingly recognized as a major health issue in children born prematurely. Creative music therapy (CMT) intends to prevent and or reduce neurobehavioral deficits in pre-term infants using musical stimulation and socio-emotional co-regulation. We conducted a randomized, clinical pilot CMT trial to test feasibility and to examine long-term neurodevelopmental outcomes in pre-term infants (NCT02434224: https://clinicaltrials.gov/ct2/show/NCT02434224). Eighty-two pre-term infants were randomized either to CMT or standard care. A specially trained music therapist provided family-integrating CMT via infant-directed singing during hospitalization. Fifty-six infants underwent follow-up at 2 years of corrected age. No significant beneficial nor adverse effects of CMT were identified in routine clinical neurodevelopmental measures (Bayley-III Scales of Infant and Toddler Development and the standardized neurological examination). Longer term follow-up (5 years) and larger future studies are recommended to elucidate possible long-term effects of music in relation to more sensitive outcomes including executive function, detailed language processing and social-emotional development.
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Affiliation(s)
| | - Hans Ulrich Bucher
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Giancarlo Natalucci
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, Zurich, Switzerland.,Larsson-Rosenquist Foundation Centre for Neurodevelopment, Growth and Nutrition of the Newborn, University Hospital Zurich, Zurich, Switzerland
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3
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Bedetti L, Lugli L, Marrozzini L, Baraldi A, Leone F, Baroni L, Lucaccioni L, Rossi C, Roversi MF, D'Amico R, Iughetti L, Berardi A. Safety and Success of Lumbar Puncture in Young Infants: A Prospective Observational Study. Front Pediatr 2021; 9:692652. [PMID: 34211946 PMCID: PMC8240589 DOI: 10.3389/fped.2021.692652] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants. Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO2 < 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO2 desaturation or failure of LP. Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO2 desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP (p < 0.001), non-invasive respiratory support (p 0.007) and mechanical ventilation (p 0.004) were associated with SpO2 desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated. Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.
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Affiliation(s)
- Luca Bedetti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy.,Pediatrics, Women's, and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Lucia Marrozzini
- Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Baraldi
- Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Federica Leone
- Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, Reggio Emilia, Italy
| | - Laura Lucaccioni
- Pediatrics, Women's, and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Cecilia Rossi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Maria F Roversi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy
| | - Roberto D'Amico
- Unit of Statistics, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatrics, Women's, and Children's Health Department, University Hospital of Modena, Modena, Italy.,Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, University Hospital of Modena, Modena, Italy.,Pediatric Post-graduate School, University Hospital of Modena and Reggio Emilia, Modena, Italy
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Lehmann GC, Levy PT, Patel MD, Sekarski T, Gu H, Choudhry S, Hamvas A, Singh GK. Maturational patterns of left ventricular rotational mechanics in pre-term infants through 1 year of age. Cardiol Young 2020; 30:1238-46. [PMID: 32665043 DOI: 10.1017/S1047951120001912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pre-mature birth impacts left ventricular development, predisposing this population to long-term cardiovascular risk. The aims of this study were to investigate maturational changes in rotational properties from the neonatal period through 1 year of age and to discern the impact of cardiopulmonary complications of pre-maturity on these measures. METHODS Pre-term infants (<29 weeks at birth, n = 117) were prospectively enrolled and followed to 1-year corrected age. Left ventricular basal and apical rotation, twist, and torsion were measured by two-dimensional speckle-tracking echocardiography and analysed at 32 and 36 weeks post-menstrual age and 1-year corrected age. A mixed random effects model with repeated measures analysis was used to compare rotational mechanics over time. Torsion was compared in infants with and without complications of cardiopulmonary diseases of pre-maturity, specifically bronchopulmonary dysplasia, pulmonary hypertension, and patent ductus arteriosus. RESULTS Torsion decreased from 32 weeks post-menstrual age to 1-year corrected age in all pre-term infants (p < 0.001). The decline from 32 to 36 weeks post-menstrual age was more pronounced in infants with cardiopulmonary complications, but was similar to healthy pre-term infants from 36 weeks post-menstrual age to 1-year corrected age. The decline was due to directional and magnitude changes in apical rotation over time (p < 0.05). CONCLUSION This study tracks maturational patterns of rotational mechanics in pre-term infants and reveals torsion declines from the neonatal period through 1 year. Cardiopulmonary diseases of pre-maturity may negatively impact rotational mechanics during the neonatal period, but the myocardium recovers by 1-year corrected age.
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Zurita-Cruz J, Gutierrez-Gonzalez A, Manuel-Apolinar L, Fernández-Gárate JE, Arellano-Flores ML, Correa Gonzalez RA, Vázquez-Rosales G, Pérez Vieyra P, Sanchez-Armas R, Cisneros-González N. The Impact of a History of Pre-maturity on Viral Respiratory Infections in Children Under 2 Years of Age: A Propensity Score-Matching Analysis of in-hospital Complications and Mortality. Front Pediatr 2020; 8:499013. [PMID: 33072667 PMCID: PMC7531324 DOI: 10.3389/fped.2020.499013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/13/2020] [Indexed: 10/27/2022] Open
Abstract
Introduction: A history of pre-maturity may be a risk factor for complications in patients under 24 months of age hospitalized for viral respiratory infections (VRIs). Objective: To identify the impact of a history of pre-maturity on in-hospital complications and mortality in patients under 24 months of age who were hospitalized for VRIs over a period of 5 years. Material and Methods: This was a propensity score-matched study. The database was compiled by physicians, electronically validated by engineers, and analyzed by statisticians. Patients diagnosed with VRIs (based on International Classification of Diseases [ICD-10]) codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219, J22X, and J189) from 2013 to 2017 were enrolled in the study. The subjects were classified into two groups according to the absence or presence of a history of pre-maturity (P070, P072, P073). Patients with congenital heart disease (CHD) (Q20-Q26) were excluded. Length of hospital stay, in-hospital complications, surgical procedures, and mortality were analyzed. Statistical Analysis: Patients were matched according to age. For comparisons between groups, Student's t-tests and chi2 tests were applied. A logistic regression model was constructed to identify factors related to in-hospital complications and mortality. Results: In total, 5,880 patients were eligible for inclusion in the analysis. The average patient age was 14.25 weeks. The presence of pre-maturity (coefficient = 1.16), male sex, bronchopulmonary dysplasia (BPD), in-hospital infectious complications (coefficient = 11.31), and invasive medical procedures (coefficient = 18.4) increased the number of days of hospitalization. Invasive medical procedures (OR = 6.13), a history of pre-maturity (OR = 2.54), and male sex (OR = 1.78) increased the risk for in-hospital complications. In-hospital infectious complications (OR = 84.2) and invasive medical procedures (OR = 58.4) were risk factors for mortality. Conclusions: A history of pre-maturity increased the length of hospital stay and the rate of in-hospital complications but did not increase mortality in patients under 24 months of age hospitalized for VRIs.
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Affiliation(s)
- Jessie Zurita-Cruz
- Facultad de Medicina Universidad Nacional de México, Hospital Infantil de México Federico Gómez, Unit of Research in Medical Nutrition, Pediatric Hospital "Centro Médico Nacional Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Leticia Manuel-Apolinar
- Endocrine Research Unit, Centro Médico Nacional, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Patricia Pérez Vieyra
- Unit of Inhalation Therapy, Pediatric Hospital, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Rocio Sanchez-Armas
- Unit of Research in Medical Nutrition, Pediatric Hospital "Centro Médico Nacional Siglo XXI", Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Nelly Cisneros-González
- Epidemiological Surveillance Coordination, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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