1601
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Hundalani SG, Richards-Kortum R, Oden M, Kawaza K, Gest A, Molyneux E. Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi. Arch Dis Child Fetal Neonatal Ed 2015; 100:F332-6. [PMID: 25877290 PMCID: PMC4484369 DOI: 10.1136/archdischild-2014-308082] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/19/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Low-cost bubble continuous positive airway pressure (bCPAP) systems have been shown to improve survival in neonates with respiratory distress, in developing countries including Malawi. District hospitals in Malawi implementing CPAP requested simple and reliable guidelines to enable healthcare workers with basic skills and minimal training to determine when treatment with CPAP is necessary. We developed and validated TRY (T: Tone is good, R: Respiratory Distress and Y=Yes) CPAP, a simple algorithm to identify neonates with respiratory distress who would benefit from CPAP. OBJECTIVE To validate the TRY CPAP algorithm for neonates with respiratory distress in a low-resource setting. METHODS We constructed an algorithm using a combination of vital signs, tone and birth weight to determine the need for CPAP in neonates with respiratory distress. Neonates admitted to the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi, were assessed in a prospective, cross-sectional study. Nurses and paediatricians-in-training assessed neonates to determine whether they required CPAP using the TRY CPAP algorithm. To establish the accuracy of the TRY CPAP algorithm in evaluating the need for CPAP, their assessment was compared with the decision of a neonatologist blinded to the TRY CPAP algorithm findings. RESULTS 325 neonates were evaluated over a 2-month period; 13% were deemed to require CPAP by the neonatologist. The inter-rater reliability with the algorithm was 0.90 for nurses and 0.97 for paediatricians-in-training using the neonatologist's assessment as the reference standard. CONCLUSIONS The TRY CPAP algorithm has the potential to be a simple and reliable tool to assist nurses and clinicians in identifying neonates who require treatment with CPAP in low-resource settings.
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Affiliation(s)
- Shilpa G Hundalani
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,Department of Bioengineering, Rice University, Houston, Texas, USA
| | | | - Maria Oden
- Department of Bioengineering, Rice University, Houston, Texas, USA
| | - Kondwani Kawaza
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alfred Gest
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth Molyneux
- Department of Pediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi,University of Malawi, College of Medicine, Blantyre, Malawi
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1602
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Numerato D, Fattore G, Tediosi F, Zanini R, Peltola M, Banks H, Mihalicza P, Lehtonen L, Sveréus S, Heijink R, Klitkou ST, Fletcher E, van der Heijden A, Lundberg F, Over E, Häkkinen U, Seppälä TT. Mortality and Length of Stay of Very Low Birth Weight and Very Preterm Infants: A EuroHOPE Study. PLoS One 2015; 10:e0131685. [PMID: 26121647 PMCID: PMC4488246 DOI: 10.1371/journal.pone.0131685] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/04/2015] [Indexed: 11/19/2022] Open
Abstract
The objective of this paper was to compare health outcomes and hospital care use of very low birth weight (VLBW), and very preterm (VLGA) infants in seven European countries. Analysis was performed on linkable patient-level registry data from seven European countries between 2006 and 2008 (Finland, Hungary, Italy (the Province of Rome), the Netherlands, Norway, Scotland, and Sweden). Mortality and length of stay (LoS) were adjusted for differences in gestational age (GA), sex, intrauterine growth, Apgar score at five minutes, parity and multiple births. The analysis included 16,087 infants. Both the 30-day and one-year adjusted mortality rates were lowest in the Nordic countries (Finland, Sweden and Norway) and Scotland and highest in Hungary and the Netherlands. For survivors, the adjusted average LoS during the first year of life ranged from 56 days in the Netherlands and Scotland to 81 days in Hungary. There were large differences between European countries in mortality rates and LoS in VLBW and VLGA infants. Substantial data linkage problems were observed in most countries due to inadequate identification procedures at birth, which limit data validity and should be addressed by policy makers across Europe.
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Affiliation(s)
- Dino Numerato
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
- * E-mail:
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Fabrizio Tediosi
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Rinaldo Zanini
- Dipartimento Materno Infantile, Ospedale "A Manzoni", Lecco, Italy
| | - Mikko Peltola
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Helen Banks
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | | | - Liisa Lehtonen
- Turku University Hospital and Turku University, Turku, Finland
| | - Sofia Sveréus
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Richard Heijink
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Søren Toksvig Klitkou
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eilidh Fletcher
- Lothian Analytical Services, NHS Lothian, Edinburgh, Scotland
| | - Amber van der Heijden
- The EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Fredrik Lundberg
- Department of Neonatology, Linköping University Hospital, Linköping, Sweden
| | - Eelco Over
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Unto Häkkinen
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo T. Seppälä
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
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1603
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Schmalisch G, Wilitzki S, Bührer C, Fischer HS. The lung clearance index in young infants: impact of tidal volume and dead space. Physiol Meas 2015; 36:1601-13. [DOI: 10.1088/0967-3334/36/7/1601] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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1604
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Cain MD, Siebert JR, Iriabho E, Gruneberg A, Almeida JS, Faye-Petersen OM. Development of novel software to generate anthropometric norms at perinatal autopsy. Pediatr Dev Pathol 2015; 18:203-9. [PMID: 25634794 DOI: 10.2350/14-11-1578-oa.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fetal and infant autopsy yields information regarding cause of death and the risk of recurrence, and it provides closure for parents. A significant number of perinatal evaluations are performed by general practice pathologists or trainees, who often find them time-consuming and/or intimidating. We sought to create a program that would enable pathologists to conduct these examinations with greater ease and to produce reliable, informative reports. We developed software that automatically generates a set of expected anthropometric and organ weight ranges by gestational age (GA)/postnatal age (PA) and a correlative table with the GA/PA that best matches the observed anthropometry. The program highlights measurement and organ weight discrepancies, enabling users to identify abnormalities. Furthermore, a Web page provides options for exporting and saving the data. Pathology residents utilized the program to determine ease of usage and benefits. The average time using conventional methods (ie, reference books and Internet sites) was compared to the average time using our Web page. Average time for novice and experienced residents using conventional methods was 26.7 minutes and 15 minutes, respectively. Using the Web page program, these times were reduced to an average of 3.2 minutes (P < 0.046 and P < 0.02, respectively). Participants found our program simple to use and the corrective features beneficial. This novel application saves time and improves the quality of fetal and infant autopsy reports. The software allows data exportation to reports and data storage for future analysis. Finalization of our software to enable usage by both university and private practice groups is in progress.
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Affiliation(s)
- Matthew D. Cain
- Department of Pathology, University of Alabama at Birmingham, WP 210, 619 South 19th Street, Birmingham, AL 35233-7331, USA
| | - Joseph R. Siebert
- Departments of Pathology and Pediatrics, Seattle Children's Hospital and University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Egiebade Iriabho
- Department of Pathology, University of Alabama at Birmingham, WP 210, 619 South 19th Street, Birmingham, AL 35233-7331, USA
| | - Alexander Gruneberg
- Department of Pathology, University of Alabama at Birmingham, WP 210, 619 South 19th Street, Birmingham, AL 35233-7331, USA
| | - Jonas S. Almeida
- Department of Pathology, University of Alabama at Birmingham, WP 210, 619 South 19th Street, Birmingham, AL 35233-7331, USA
| | - Ona Marie Faye-Petersen
- Department of Pathology, University of Alabama at Birmingham, NP 3547, 619 South 19th Street, Birmingham, AL 35233-7331, USA
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1605
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Serum creatinine concentration in very-low-birth-weight infants from birth to 34-36 wk postmenstrual age. Pediatr Res 2015; 77:696-702. [PMID: 25675426 PMCID: PMC4407015 DOI: 10.1038/pr.2015.25] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 10/27/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Serum creatinine (s[Cr]) reference ranges for very-low-birth-weight (VLBW) infants must account for physiologic changes in the first months of life. METHODS We retrospectively identified a sample of 218 appropriate-for-gestational age (GA) VLBW infants without risk factors for renal impairment, and classified into one of three GA groups: 25-27, 28-29, and 30-33 wk. We observed three phases of s[Cr] change (initial, decline, and equilibrium), whose characteristics varied by GA group. We used mixed-effects regression models to estimate mean and upper 95th prediction interval of s[Cr] for each GA group from birth to 34-36 wk post menstrual age (PMA). RESULTS In phase I, s[Cr] increased after birth, then returned slowly to baseline. The duration of phase I and the magnitude of s[Cr] rise decreased with increasing GA. In phase II, s[Cr] declined abruptly at a rate that increased with GA. A gradual transition to phase III, a steady-state equilibrium with similar s[Cr] among GA groups, began at approximately 34-36 wk PMA. We constructed GA group-specific nomograms depicting s[Cr] behaviour across the three phases. CONCLUSION The reference ranges derived from a sample of infants without risk factors for renal impairment provide a context for quantitative interpretation of s[Cr] trends in VLBW infants.
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1606
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Abstract
PURPOSE OF REVIEW To outline new evidence published from 2013 to 2014 about breast milk fortification in preterm infants. RECENT FINDINGS Breast milk is the feeding choice for preterm infants because of its immunoprotective properties. However, breast milk's nutrient content is not sufficient for preterm infants, and interindividual variation is high. The variation challenges standard fortification, which assumes a standard breast milk composition. Two new fortification strategies (adjustable fortification and target fortification) optimize macronutrient intake and improve growth. Adjustable fortification uses blood urea nitrogen levels to adjust fortifier strength. Target fortification analyzes breast milk and fortifies macronutrients individually to achieve targeted intake. Its feasibility is shown in clinical routine. Current breast milk analyzers used for target fortification achieve acceptable precision for protein and fat but not for lactose and energy. Evidence of benefits for postdischarge breast milk fortification is lacking. Eliminating cow's milk products and feeding exclusively breast milk may decrease the occurrence of feeding intolerance and necrotizing enterocolitis. To facilitate exclusively breast milk diets, a collaboration of prenatal, nutrition and lactation stakeholders is key. Fortification increases osmolality; however, safety cutoffs to prevent necrotizing enterocolitis are unclear. There is also new evidence that composition and structure of various macronutrients and micronutrients affect growth and development, and might play a role in future fortification concepts. SUMMARY Recent research focuses on the variability of breast milk composition, its impact on postnatal growth patterns and the usefulness of target fortification. As well, diets exclusively composed of human milk are a promising approach to improve feeding tolerance. For safe fortification, osmolality cutoff levels are needed.
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Affiliation(s)
- Niels Rochow
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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1607
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Rice MS, Valentine CJ. Neonatal Body Composition: Measuring Lean Mass as a Tool to Guide Nutrition Management in the Neonate. Nutr Clin Pract 2015; 30:625-32. [PMID: 25908606 DOI: 10.1177/0884533615578917] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Neonatal nutrition adequacy is often determined by infant weight gain. The aim of this review is to summarize what is currently known about neonatal body composition and the use of body composition as a measure for adequate neonatal nutrition. Unlike traditional anthropometric measures of height and weight, body composition measurements account for fat vs nonfat mass gains. This provides a more accurate picture of neonatal composition of weight gain. Providing adequate neonatal nutrition in the form of quantity and composition can be a challenge, especially when considering the delicate balance of providing adequate nutrition to preterm infants for catch-up growth. Monitoring weight gain as fat mass and nonfat mass while documenting dietary intake of fat, protein, and carbohydrate in formulas may help provide the medical community the tools to provide optimal nutrition for catch-up growth and for improved neurodevelopmental outcomes. Tracking body composition in term and preterm infants may also provide critical future information concerning the nutritional state of infants who go on to develop future disease such as obesity, hypertension, and hyperlipidemia as adolescents or adults.
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Affiliation(s)
- Melissa S Rice
- Division of Neonatology, Perinatal and Pulmonary Biology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio Parkview Regional Medical Center, Fort Wayne, Indiana. Dr Valentine is now employed by Mead Johnson Nutrition, Evansville, Indiana
| | - Christina J Valentine
- Division of Neonatology, Perinatal and Pulmonary Biology, Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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1608
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Association of birth parameters with refractive status in a sample of caucasian children aged 4-17 years. J Ophthalmol 2015; 2015:635682. [PMID: 25949820 PMCID: PMC4407624 DOI: 10.1155/2015/635682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/17/2015] [Accepted: 04/01/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the association of birth parameters with refractive status in different age groups of Caucasian children. Materials and Methods. This cross-sectional study included 564 eyes of 282 children aged 4 to 17 years. All children underwent complete ophthalmologic examination. The children were divided into three groups according to their refractive status (emmetropia,myopia, and hyperopia), ages (4-7, 8-9, 10-12, and 13-17), and appropriateness for gestational age, respectively. Results. The mean age of the children was 9.2 ± 2.8 (age range 4-17 years). The mean spheric equivalent was +0.3 ± 1.7 (range: (-10.0)-(+10.0) diopters). The mean birth weight and gestational age were 2681.1 ± 930.8 grams (750-5000 grams) and 37.2 ± 3.7 weeks (25-42 weeks). According to multinominal logistic regression analysis, children with myopia were more likely to have higher birth weights than emmetropic children (OR: 1.0, 95% CI: 1.000-1.001, and P = 0.028). The hypermetropes were found to be significantly small for gestational age between 13 and 17 years of age. Conclusion. Birth weight and appropriateness for gestational age as birth parameters may have an impact on development of all types of refractive errors. The hypermetropic children tended to be small for gestational age.
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1609
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Rochow N, Fusch G, Zapanta B, Ali A, Barui S, Fusch C. Target fortification of breast milk: how often should milk analysis be done? Nutrients 2015; 7:2297-310. [PMID: 25835073 PMCID: PMC4425145 DOI: 10.3390/nu7042297] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/16/2015] [Accepted: 03/18/2015] [Indexed: 01/24/2023] Open
Abstract
Target fortification (TFO) reduces natural macronutrient variation in breast milk (BM). Daily BM analysis for TFO increases neonatal intensive care unit work load by 10-15 min/patient/day and may not be feasible in all nurseries. The variation of macronutrient intake when BM analysis is done for various schedules was studied. In an observational study, we analyzed 21 subsequent samples of native 24-h BM batches, which had been prepared for 10 healthy infants (gestational age 26.1 ± 1.3 weeks, birth weight: 890 ± 210 g). Levels of protein and fat (validated near-infrared milk analyzer), as well as lactose (UPLC-MS/MS) generated the database for modelling TFO to meet recommendations of European Society for Paediatric Gastroenterology Hepatology and Nutrition. Intake of macronutrients and energy were calculated for different schedules of BM measurements for TFO (n = 1/week; n = 2/week; n = 3/week; n = 5/week; n = 7/week) and compared to native and fixed dose fortified BM. Day-to-day variation of macronutrients (protein 20%, carbohydrate 13%, fat 17%, energy 10%) decreased as the frequency of milk analysis increased and was almost zero for protein and carbohydrate with daily measurements. Measurements two/week led to mean macronutrient intake within a range of ± 5% of targeted levels. A reduced schedule for macronutrient measurement may increase the practical use of TFO. To what extent the day-to-day variation affects growth while mean intake is stable needs to be studied.
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Affiliation(s)
- Niels Rochow
- Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada.
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada.
| | - Bianca Zapanta
- Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada.
| | - Anaam Ali
- Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada.
| | - Sandip Barui
- Department of Mathematics and Statistics, McMaster University, 1280 Main Street West, Hamilton, On L8S4K1, Canada.
| | - Christoph Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, 1280 Main Street West, Room HSC-4 F5, Hamilton, ON L8S4K1, Canada.
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1610
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Lee BS. Nutritional strategy of early amino acid administration in very low birth weight infants. KOREAN JOURNAL OF PEDIATRICS 2015; 58:77-83. [PMID: 25861329 PMCID: PMC4388974 DOI: 10.3345/kjp.2015.58.3.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/16/2015] [Indexed: 01/30/2023]
Abstract
Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.
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Affiliation(s)
- Byong Sop Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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1611
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Olsen IE, Lawson ML, Ferguson AN, Cantrell R, Grabich SC, Zemel BS, Clark RH. BMI curves for preterm infants. Pediatrics 2015; 135:e572-81. [PMID: 25687149 DOI: 10.1542/peds.2014-2777] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Preterm infants experience disproportionate growth failure postnatally and may be large weight for length despite being small weight for age by hospital discharge. The objective of this study was to create and validate intrauterine weight-for-length growth curves using the contemporary, large, racially diverse US birth parameters sample used to create the Olsen weight-, length-, and head-circumference-for-age curves. METHODS Data from 391 681 US infants (Pediatrix Medical Group) born at 22 to 42 weeks' gestational age (born in 1998-2006) included birth weight, length, and head circumference, estimated gestational age, and gender. Separate subsamples were used to create and validate curves. Established methods were used to determine the weight-for-length ratio that was most highly correlated with weight and uncorrelated with length. Final smoothed percentile curves (3rd to 97th) were created by the Lambda Mu Sigma (LMS) method. The validation sample was used to confirm results. RESULTS The final sample included 254 454 singleton infants (57.2% male) who survived to discharge. BMI was the best overall weight-for-length ratio for both genders and a majority of gestational ages. Gender-specific BMI-for-age curves were created (n = 127 446) and successfully validated (n = 126 988). Mean z scores for the validation sample were ∼0 (∼1 SD). CONCLUSIONS BMI was different across gender and gestational age. We provide a set of validated reference curves (gender-specific) to track changes in BMI for prematurely born infants cared for in the NICU for use with weight-, length-, and head-circumference-for-age intrauterine growth curves.
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Affiliation(s)
- Irene E Olsen
- School of Nursing, University of Pennsylvania, Biology and Physics, and
| | - M Louise Lawson
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - A Nicole Ferguson
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Rebecca Cantrell
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Shannon C Grabich
- Statistics and Analytical Sciences, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia; and
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, and Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Departments of
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1612
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Ahlsén AK, Spong E, Kafumba N, Kamwendo F, Wolff K. Born too small: who survives in the public hospitals in Lilongwe, Malawi? Arch Dis Child Fetal Neonatal Ed 2015; 100:F150-4. [PMID: 25516259 PMCID: PMC4345791 DOI: 10.1136/archdischild-2013-305877] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Malawi has the highest estimated preterm birth rate in the world. The survival rate of these babies is not known. The main objective of this study was to demonstrate the short-term survival of infants with birth weight below 2500 g nursed in Bwaila Hospital, a district hospital, and the tertiary level Kamuzu Central Hospital (KCH) in Lilongwe. The specific objectives were to calculate birth weight specific survival rates, compare the two hospitals regarding the chances of survival and review the use of antenatal corticosteroids. DESIGN 1496 babies were included prospectively in the study between June and November 2012. Survival was defined as discharge from the nursery or postnatal ward. RESULTS Survival was 7% for extremely low birth weight infants, 52% for very low birth weight and 90% for low birth weight (1500-2499 g). There was a marked increase in survival from 1100 g. Survival was significantly higher in KCH only for babies weighing below 1200 g. The majority of deaths occurred within the first 3 days of life. Only 98 of the babies had a mother who had received antenatal corticosteroids. CONCLUSIONS With the current resources, we suggest focusing efforts on preventing early neonatal deaths in low birth weight infants above 1100 g in the hospitals in Lilongwe. The coverage of antenatal steroids for mothers at risk of preterm delivery can be improved. Further studies are needed on the quality of the obstetric and neonatal care at the hospitals and how to reduce the high rate of preterm birth in Malawi.
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Affiliation(s)
- Anna Karin Ahlsén
- Department of Obstetrics and Gynaecology, Södertälje Sjukhus, Södertälje, Sweden,Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi,Department of International Collaborations, Oslo University Hospital, Oslo, Norway
| | | | - Nomsa Kafumba
- Department of Obstetrics and Gynaecology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Francis Kamwendo
- Department of Obstetrics and Gynaecology, Queen Elisabeth Central Hospital, Blantyre, Malawi
| | - Kerstin Wolff
- Department of Obstetrics and Gynaecology, Södertälje Sjukhus, Södertälje, Sweden
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1613
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Appleton AA, Lester BM, Armstrong DA, Lesseur C, Marsit CJ. Examining the joint contribution of placental NR3C1 and HSD11B2 methylation for infant neurobehavior. Psychoneuroendocrinology 2015; 52:32-42. [PMID: 25459891 PMCID: PMC4350656 DOI: 10.1016/j.psyneuen.2014.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Infant neurobehavior, a potential sentinel of future mental and behavioral morbidity characterized in part by reflex symmetry, excitability and habituation to stimuli, is influenced by aspects of the intrauterine environment partially through epigenetic alterations of genes involved in the stress response. DNA methylation of two related cortisol response genes, the glucocorticoid receptor (NR3C1), a nuclear receptor to which cortisol binds, and 11-beta hydroxysteroid dehydrogenase (HSD11B2), the enzyme responsible for conversion of cortisol into inactive cortisone, independently associate with infant neurobehavior. Although these factors are part of a common cortisol regulation pathway, the combined effect of DNA methylation of these factors on infant neurobehavior has not been characterized. Therefore, we conducted an examination of the joint contribution of NR3C1 and HSD11B2 DNA methylation on infant neurobehavior. Among 372 healthy term newborns, we tested the interaction between placental NR3C1 and HSD11B2 DNA methylation in association with neurobehavior as assessed with the validated NICU Network Neurobehavioral Scales. Controlling for confounders, interactions between DNA methylation of these genes were detected for distinct domains of neurobehavior (habituation, excitability, asymmetrical reflexes). Moreover, different patterns of DNA methylation across the cortisol regulation pathway associated with different neurobehavioral phenotypes. Those with low NR3C1 methylation but high HSD11B2 methylation had lower excitability scores; those with high NR3C1 methylation but low HSD11B2 methylation had more asymmetrical reflexes; those with high DNA methylation across the entire pathway had higher habituation scores. These results suggest that epigenetic alterations across the cortisol regulation pathway may contribute to different neurobehavioral phenotypes, likely though varying degrees of glucocorticoid exposure during gestation. While the postnatal environment may continue to affect neurobehavioral risk, this study provides novel insights into the molecular basis for fetal origins of mental conditions.
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Affiliation(s)
- Allison A. Appleton
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York, USA,Correspondence and reprint requests: Allison A. Appleton, Department of Epidemiology and Biostatistics, University at Albany, State University of New York; phone: 518-402-0402; fax: 518-402-0380;
| | - Barry M. Lester
- Department of Psychiatry and Department of Pediatrics, Brown Center for the Study of Children at Risk, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, Rhode Island, USA
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Carmen J. Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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1614
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Yum SK, Moon CJ, Youn YA, Lee HS, Kim SY, Sung IK. Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre. J Matern Fetal Neonatal Med 2015; 29:338-43. [PMID: 25567562 DOI: 10.3109/14767058.2014.1000853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival. METHODS Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group. RESULTS Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/7 ± 3.610 versus 29 and 3/7 ± 3.530 weeks, p = 0.009) and lower one-minute (2.342 ± 1.493 versus 4.035 ± 2.079, p < 0.001) and five-minute Apgar scores (2.342 ± 1.493 versus 4.035 ± 2.079, p < 0.001) and required aggressive resuscitation (p = 0.003) and a greater number of inotropes (2.195 ± 1.346 versus 1.069 ± 0.704, p < 0.001). Deceased infants were administered increased amounts of fluid during the first 24 h after birth (117.783 ± 32.325 versus 99.379 ± 17.728 mL/kg, p = 0.004). A relatively short prothrombin time impacted survival (p = 0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p = 0.01). CONCLUSION Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.
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Affiliation(s)
- Sook Kyung Yum
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Cheong-Jun Moon
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Young-Ah Youn
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Hyun Seung Lee
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - So-Young Kim
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - In Kyung Sung
- a Division of Neonatology, Department of Pediatrics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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1615
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1616
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Park HJ, Lee HY, Woo HK, Kim SN, Lee J, Yang HR, Kim BI, Choi CW. The Usefulness of Birth Weight Z-Score as a Predictor of Catch Up Growth in Preterm Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Huee Jin Park
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hae Yun Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hae Kyung Woo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Seon Nyo Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Won Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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1617
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Ranke MB, Krägeloh-Mann I, Vollmer B. Growth, head growth, and neurocognitive outcome in children born very preterm: methodological aspects and selected results. Dev Med Child Neurol 2015; 57:23-8. [PMID: 25251724 DOI: 10.1111/dmcn.12582] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Abstract
In light of the growing number of surviving children born very preterm, there is an increasing focus on their long-term outcomes in terms of growth, metabolic status, and neurocognitive development. Therefore, it is of importance to follow such children from birth onwards with the aim of identifying the causes of atypical development, developing preventative measures, and improving outcomes. Since such long-term follow-up needs to be conducted with the least possible burden, clinical investigations such as anthropometry and neurocognitive tests, if conducted rigorously, will continue to have a predominant role. The aim of this review is to discuss the complexity of longitudinal anthropometry in children born very preterm and to provide an overview of the main studies that have examined associations between growth, in particular head growth, and neurocognitive outcomes at around school age.
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1618
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Doğan K, Salihoglu O, Sever N, Tombul T, Sari E, Yaşar L. Do Placental Histopathologic Characteristics Differ with Gestational Ages in Preterm and Term Deliveries? Fetal Pediatr Pathol 2015; 34:365-74. [PMID: 26467259 DOI: 10.3109/15513815.2015.1087610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The study aim is to evaluate the placental histopathological characteristics and maternal risk factors in preterm and term births according to their weeks of gestation. We designed a prospective study involving a patient population (n = 355) composed of pregnant women who delivered preterm (n = 216) and term neonates (n = 139). The preterm births were divided into three groups as extremely (n = 22), moderate (n = 96) and late preterm (n = 98) births. The statistical analyses were performed using SPSS version 15 software. There was significant difference regarding maternal vascular underperfusion and inflammation in the extremely preterm group compared with the other groups (P = 0.001), but fetal vascular obstruction and villitis of unknown etiology were not found significantly different. According to our study results, the careful examination of the placenta of premature babies, particularly those of extremely preterm births, should be part of routine obstetrical management to determine the causes of preterm birth.
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Affiliation(s)
- Keziban Doğan
- a Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
| | - Ozgul Salihoglu
- b Neonatal Intensive Care Unit, Department of Pediatrics , Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
| | - Nurten Sever
- c Pathology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
| | - Tuba Tombul
- a Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
| | - Ergül Sari
- d Department of Pediatrics , Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
| | - Levent Yaşar
- a Obstetrics and Gynecology, Bakirkoy Dr Sadi Konuk Teaching and Research Hospital , Istanbul , Turkey
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1619
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Heo JS, Jung YH, Lee J, Shin SH, Kim EK, Kim HS, Choi JH. Prognosis and Predictive Factors according to Extent of Involvement in Necrotizing Enterocolitis among Very Low Birth Weight Infants. NEONATAL MEDICINE 2015. [DOI: 10.5385/nm.2015.22.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hwa Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Juyoung Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Han Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ee-Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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1620
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Gossai A, Lesseur C, Farzan S, Marsit C, Karagas MR, Gilbert-Diamond D. Association between maternal urinary arsenic species and infant cord blood leptin levels in a New Hampshire Pregnancy Cohort. ENVIRONMENTAL RESEARCH 2015; 136:180-6. [PMID: 25460635 PMCID: PMC4262605 DOI: 10.1016/j.envres.2014.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/03/2014] [Accepted: 10/07/2014] [Indexed: 05/20/2023]
Abstract
Leptin is an important pleiotropic hormone involved in the regulation of nutrient intake and energy expenditure, and is known to influence body weight in infants and adults. High maternal levels of arsenic have been associated with reduced infant birth weight, but the mechanism of action is not yet understood. This study aimed to investigate the association between in utero arsenic exposure and infant cord blood leptin concentrations within 156 mother-infant pairs from the New Hampshire Birth Cohort Study (NHBCS) who were exposed to low to moderate levels of arsenic through well water and diet. In utero arsenic exposure was obtained from maternal second trimester urinary arsenic concentration, and plasma leptin levels were assessed through immunoassay. Results indicate that urinary arsenic species concentrations were predictive of infant cord blood leptin levels following adjustment for creatinine, infant birth weight for gestational age percentile, infant sex, maternal pregnancy-related weight gain, and maternal education level amongst 149 white mother-infant pairs in multivariate linear regression models. A doubling or 100% increase in total urinary arsenic concentration (iAs+MMA+DMA) was associated with a 10.3% (95% CI: 0.8-20.7%) increase in cord blood leptin levels. A 100% increase in either monomethylarsonic acid (MMA) or dimethylarsinic acid (DMA) was also associated with an 8.3% (95% CI: -1.0-18.6%) and 10.3% (95% CI: 1.2-20.2%) increase in cord blood leptin levels, respectively. The association between inorganic arsenic (iAs) and cord blood leptin was of similar magnitude and direction as other arsenic species (a 100% increase in iAs was associated with a 6.5% (95% CI: -3.4-17.5%) increase in cord blood leptin levels), albeit not significant. These results suggest in utero exposure to low levels of arsenic influences cord blood leptin concentration and presents a potential mechanism by which arsenic may impact early childhood growth.
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Affiliation(s)
- Anala Gossai
- Institute of Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Shohreh Farzan
- Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755, USA; Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Carmen Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA; Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Margaret R Karagas
- Institute of Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755, USA; Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA
| | - Diane Gilbert-Diamond
- Institute of Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; Children's Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755, USA; Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA.
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1621
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Lesseur C, Armstrong DA, Paquette AG, Li Z, Padbury JF, Marsit CJ. Maternal obesity and gestational diabetes are associated with placental leptin DNA methylation. Am J Obstet Gynecol 2014; 211:654.e1-9. [PMID: 24954653 DOI: 10.1016/j.ajog.2014.06.037] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE In this study, we aimed to investigate relationships between maternal prepregnancy obesity and gestational diabetes mellitus and placental leptin DNA methylation. STUDY DESIGN This study comprises data on 535 mother-infant dyads enrolled in the Rhode Island Child Health Study, a prospective cohort study of healthy term pregnancies. Prepregnancy body mass index was calculated from self-reported anthropometric measures and gestational diabetes mellitus diagnoses gathered from inpatient medical records. DNA methylation of the leptin promoter region was assessed in placental tissue collected at birth using quantitative bisulfite pyrosequencing. RESULTS In a multivariable regression analysis adjusted for confounders, infants exposed to gestational diabetes mellitus had higher placental leptin methylation (β = 1.89, P = .04), as did those demonstrating prepregnancy obesity (β = 1.17, P = .06). Using a structural equations model, we observed that gestational diabetes mellitus is a mediator of the effects of prepregnancy obesity on placental leptin DNA methylation (β = 0.81, 95% confidence interval, 0.27-2.71). CONCLUSION Our results suggest that the maternal metabolic status before and during pregnancy can alter placental DNA methylation profile at birth and potentially contribute to metabolic programming of obesity and related conditions.
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1622
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Zahnleiter D, Hauer NN, Kessler K, Uebe S, Sugano Y, Neuhauss SC, Giessl A, Ekici AB, Blessing H, Sticht H, Dörr HG, Reis A, Thiel CT. MAP4-Dependent Regulation of Microtubule Formation Affects Centrosome, Cilia, and Golgi Architecture as a Central Mechanism in Growth Regulation. Hum Mutat 2014; 36:87-97. [DOI: 10.1002/humu.22711] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/01/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Diana Zahnleiter
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Nadine N. Hauer
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Kristin Kessler
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Steffen Uebe
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Yuya Sugano
- Institute of Molecular Life Sciences; University of Zurich; Zurich Switzerland
| | | | - Andreas Giessl
- Animal Physiology; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Arif B. Ekici
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Holger Blessing
- Department of Pediatrics and Adolescent Medicine; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Heinrich Sticht
- Institute of Biochemistry; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - Helmuth-Günther Dörr
- Department of Pediatrics and Adolescent Medicine; Friedrich-Alexander Universität Erlangen-Nürnberg; Erlangen Germany
| | - André Reis
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
| | - Christian T. Thiel
- Institute of Human Genetics; Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen Germany
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1623
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Johnson LC, Lieberman E, O'Leary E, Geggel RL. Prenatal and newborn screening for critical congenital heart disease: findings from a nursery. Pediatrics 2014; 134:916-22. [PMID: 25287457 DOI: 10.1542/peds.2014-1461] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Delayed diagnosis of critical congenital heart disease (CCHD) in neonates increases morbidity and mortality. The use of pulse oximetry screening is recommended to increase detection of these conditions. The contribution of pulse oximetry in a tertiary-care birthing center may be different from at other sites. METHODS We analyzed CCHD pulse oximetry screening for newborns ≥ 35 weeks' gestation born at Brigham and Women's Hospital and cared for in the well-infant nursery during 2013. We identified patients with prenatal diagnosis of CCHD. We also identified infants born at other medical centers who were transferred to Boston Children's Hospital for CCHD and determined if the condition was diagnosed prenatally. RESULTS Of 6838 infants with complete pulse oximetry data, 6803 (99.5%) passed the first screening. One infant failed all 3 screenings and had the only echocardiogram prompted by screening that showed persistent pulmonary hypertension. There was 1 false-negative screening in an infant diagnosed with interrupted aortic arch. Of 112 infants born at Brigham and Women's Hospital with CCHD, 111 had a prenatal diagnosis, and none was initially diagnosed by pulse oximetry. Of 81 infants transferred to Boston Children's Hospital from other medical centers with CCHD, 35% were diagnosed prenatally. CONCLUSIONS In our tertiary-care setting, pulse oximetry did not detect an infant with CCHD because of effective prenatal echocardiography screening. Pulse oximetry will detect more infants in settings with a lower prenatal diagnosis rate. Improving training in complete fetal echocardiography scans should also improve timely diagnosis of CCHD.
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Affiliation(s)
- Lise C Johnson
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Ellice Lieberman
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Edward O'Leary
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Departments of Medicine and
| | - Robert L Geggel
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and Cardiology, Boston Children's Hospital, Boston, Massachusetts
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1624
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Wisgrill L, Schüller S, Bammer M, Berger A, Pollak A, Radke TF, Kögler G, Spittler A, Helmer H, Husslein P, Gortner L. Hematopoietic stem cells in neonates: any differences between very preterm and term neonates? PLoS One 2014; 9:e106717. [PMID: 25181353 PMCID: PMC4152327 DOI: 10.1371/journal.pone.0106717] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/07/2014] [Indexed: 01/14/2023] Open
Abstract
Background In the last decades, human full-term cord blood was extensively investigated as a potential source of hematopoietic stem and progenitor cells (HSPCs). Despite the growing interest of regenerative therapies in preterm neonates, only little is known about the biological function of HSPCs from early preterm neonates under different perinatal conditions. Therefore, we investigated the concentration, the clonogenic capacity and the influence of obstetric/perinatal complications and maternal history on HSPC subsets in preterm and term cord blood. Methods CD34+ HSPC subsets in UCB of 30 preterm and 30 term infants were evaluated by flow cytometry. Clonogenic assays suitable for detection of the proliferative potential of HSPCs were conducted. Furthermore, we analyzed the clonogenic potential of isolated HSPCs according to the stem cell marker CD133 and aldehyde dehydrogenase (ALDH) activity. Results Preterm cord blood contained a significantly higher concentration of circulating CD34+ HSPCs, especially primitive progenitors, than term cord blood. The clonogenic capacity of HSPCs was enhanced in preterm cord blood. Using univariate analysis, the number and clonogenic potential of circulating UCB HSPCs was influenced by gestational age, birth weight and maternal age. Multivariate analysis showed that main factors that significantly influenced the HSPC count were maternal age, gestational age and white blood cell count. Further, only gestational age significantly influenced the clonogenic potential of UCB HSPCs. Finally, isolated CD34+/CD133+, CD34+/CD133– and ALDHhigh HSPC obtained from preterm cord blood showed a significantly higher clonogenic potential compared to term cord blood. Conclusion We demonstrate that preterm cord blood exhibits a higher HSPC concentration and increased clonogenic capacity compared to term neonates. These data may imply an emerging use of HSPCs in autologous stem cell therapy in preterm neonates.
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Affiliation(s)
- Lukas Wisgrill
- Dept. of Pediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Medical University of Vienna, Vienna, Austria
| | - Simone Schüller
- Dept. of Pediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Medical University of Vienna, Vienna, Austria
| | - Markus Bammer
- Dept. of Pediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Medical University of Vienna, Vienna, Austria
| | - Angelika Berger
- Dept. of Pediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Medical University of Vienna, Vienna, Austria
| | - Arnold Pollak
- Dept. of Pediatrics and Adolescent Medicine, Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Medical University of Vienna, Vienna, Austria
| | - Teja Falk Radke
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich Heine University Medical Center, Duesseldorf, Germany
| | - Gesine Kögler
- Institute for Transplantation Diagnostics and Cell Therapeutics, Heinrich Heine University Medical Center, Duesseldorf, Germany
| | - Andreas Spittler
- Department of Surgery, Research Labs & Core Facility Flow Cytometry, Medical University of Vienna, Vienna, Austria
| | - Hanns Helmer
- Dept. of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Peter Husslein
- Dept. of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Ludwig Gortner
- Dept. of Pediatrics and Neonatology, Saarland University, Homburg, Saar, Germany
- * E-mail:
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1625
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Abstract
Despite a decreasing trend in premature births, greater numbers of infants born at the limits of viability are surviving to discharge. Most of these infants have complex medical problems requiring multidisciplinary care. These infants are primarily cared for by the general pediatrician, but their needs are quite different from those of a full-term healthy newborn. The paucity of data regarding care for these infants complicates their management after hospital discharge. In this article, the authors present the most current evidence-based practices and provide a guide to the general pediatrician on caring for the complex neonatal intensive care unit graduate.
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1626
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Baltajian K, Hecht JL, Wenger JB, Salahuddin S, Verlohren S, Perschel FH, Zsengeller ZK, Thadhani R, Karumanchi SA, Rana S. Placental lesions of vascular insufficiency are associated with anti-angiogenic state in women with preeclampsia. Hypertens Pregnancy 2014; 33:427-39. [DOI: 10.3109/10641955.2014.926914] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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1627
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Königsbrügge O, Langer M, Hayde M, Ay C, Pabinger I. Oral anticoagulation with rivaroxaban during pregnancy: a case report. Thromb Haemost 2014; 112:1323-4. [PMID: 25055834 DOI: 10.1160/th14-04-0393] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/12/2014] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | - I Pabinger
- Prof. Dr. Ingrid Pabinger, Medical University of Vienna, Department of Medicine I, Clinical Division of Haematology and Haemostaseology, Waehringer Guertel 18-20, A-1090 Vienna, Austria, Tel.: +43 1 40400 44480, Fax: +43 1 40400 40300, E-mail:
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1628
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Proaño A, Aragón RE, Proaño JL. Z‐Score: Fenton 2013. Ten‐year update. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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1629
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Olhager E, Törnqvist C. Body composition in late preterm infants in the first 10 days of life and at full term. Acta Paediatr 2014; 103:737-43. [PMID: 24628453 DOI: 10.1111/apa.12632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/01/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
AIM To investigate changes in body weight, fat-free mass, fat mass and percentage of body fat during early life and at full-term postconceptional age (PCA) in preterm infants born after 32 gestational weeks and before 37. METHODS Twenty-nine late preterm infants underwent growth and body composition assessment by air displacement plethysmography (ADP) at the age of 4 days and at full-term PCA. In 25 of these infants, body composition was assessed three times between days four and nine of life. The preterm infants were compared with 29 full-term infants, matched for gestational age, sex and body weight. RESULTS There was a significant increase in birth weight and fat-free mass between days four and nine of life. Preterm infants had significantly more body fat 382 ± 180 g vs 287 ± 160 g than full-term infants at full-term PCA. Preterm infants showed poor linear growth between birth and full-term PCA. CONCLUSION Weight gain after the initial postnatal weight loss consists of gain in fat-free mass. At full-term PCA, preterm infants were stunted. When compared with full-term new born infants matched for body weight and gestational age, preterm infants had more body fat and a higher percentage of body fat.
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Affiliation(s)
- Elisabeth Olhager
- Division of Paediatrics; Department of Clinical and Experimental Medicine; Faculty of Health Science; Linkoping University; Linköping Sweden
| | - Caroline Törnqvist
- Division of Paediatrics; Department of Clinical and Experimental Medicine; Faculty of Health Science; Linkoping University; Linköping Sweden
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1630
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Author's reply: Z‐Score: Fenton 2013. Ten‐year update. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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1631
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Lima PAT, de Carvalho M, da Costa ACC, Moreira MEL. Author's reply: Z-Score: Fenton 2013. Ten-year update. J Pediatr (Rio J) 2014; 90:427-8. [PMID: 24746810 DOI: 10.1016/j.jped.2014.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 10/25/2022] Open
Affiliation(s)
- Paola Azara Tabicas Lima
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; Clínica Perinatal Laranjeiras, Rio de Janeiro, RJ, Brazil; Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Manoel de Carvalho
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; Clínica Perinatal Laranjeiras, Rio de Janeiro, RJ, Brazil; Universidade Federal Fluminense, Rio de Janeiro, RJ, Brazil
| | - Ana Carolina Carioca da Costa
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Maria Elisabeth Lopes Moreira
- Instituto Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; Clínica Perinatal Laranjeiras, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo, São Paulo, SP, Brazil.
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1632
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Proaño A, Aragón RE, Proaño JL. Z-Score: Fenton 2013. Ten-year update. J Pediatr (Rio J) 2014; 90:426. [PMID: 24746939 DOI: 10.1016/j.jped.2014.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/07/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Alvaro Proaño
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Romina E Aragón
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
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1633
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Abstract
The concept that adequate nutritional status and normal growth are important is well-accepted. How to assess the adequacy of nutrition and how to define appropriate growth remains an area of active debate. Our goal is to review how growth is assessed at birth and during the hospital stay of prematurely born infants, and to offer a standardized approach.
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1634
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Nzegwu NI, Ehrenkranz RA. Post-discharge nutrition and the VLBW infant: To supplement or not supplement?: a review of the current evidence. Clin Perinatol 2014; 41:463-74. [PMID: 24873844 DOI: 10.1016/j.clp.2014.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Due to advancements in neonatology, the survival of very-low-birth-weight infants, especially extremely low-birth-weight infants continues to rise. The goal of nutrition in these preterm infants is to match the intrauterine growth curves of the normally growing fetus. Despite this recommendation from the American Academy of Pediatrics Committee on Nutrition, neonatologists struggle daily to meet this goal, and as a result, postnatal growth failure and restriction are common. This article reviews post-discharge nutrition in the VLBW population, examining different types of post-discharge nutrition, current evidence, and future and remaining questions. In addition, recommendations are provided for post-discharge nutrition in this population.
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Affiliation(s)
- Nneka I Nzegwu
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064, USA.
| | - Richard A Ehrenkranz
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520-8064, USA
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1635
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Fusch C, Samiee-Zafarghandy S. Promoting healthy growth and nutrition in preterm infants: a challenge for clinicians and researchers. Clin Biochem 2014; 47:711-3. [PMID: 24858247 DOI: 10.1016/j.clinbiochem.2014.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Christoph Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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1636
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Unger S, Gibbins S, Zupancic J, O’Connor DL. DoMINO: Donor milk for improved neurodevelopmental outcomes. BMC Pediatr 2014; 14:123. [PMID: 24884424 PMCID: PMC4032387 DOI: 10.1186/1471-2431-14-123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/01/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Provision of mother's own milk is the optimal way to feed infants, including very low birth weight infants (VLBW, <1500 g). Importantly for VLBW infants, who are at elevated risk of neurologic sequelae, mother's own milk has been shown to enhance neurocognitive development. Unfortunately, the majority of mothers of VLBW infants are unable to provide an adequate supply of milk and thus supplementation with formula or donor milk is necessary. Given the association between mother's own milk and neurodevelopment, it is important to ascertain whether provision of human donor milk as a supplement may yield superior neurodevelopmental outcomes compared to formula.Our primary hypothesis is that VLBW infants fed pasteurized donor milk compared to preterm formula as a supplement to mother's own milk for 90 days or until hospital discharge, whichever comes first, will have an improved cognitive outcome as measured at 18 months corrected age on the Bayley Scales of Infant Development, 3(rd) ed. Secondary hypotheses are that the use of pasteurized donor milk will: (1) reduce a composite of death and serious morbidity; (2) support growth; and (3) improve language and motor development. Exploratory research questions include: Will use of pasteurized donor milk: (1) influence feeding tolerance and nutrient intake (2) have an acceptable cost effectiveness from a comprehensive societal perspective? METHODS/DESIGN DoMINO is a multi-centre, intent-to-treat, double blinded, randomized control trial. VLBW infants (n = 363) were randomized within four days of birth to either (1) pasteurized donor milk or (2) preterm formula whenever mother's own milk was unavailable. Study recruitment began in October 2010 and was completed in December 2012. The 90 day feeding intervention is complete and long-term follow-up is underway. DISCUSSION Preterm birth and its complications are a leading cause long-term morbidity among Canadian children. Strategies to mitigate this risk are urgently required. As mother's own milk has been shown to improve neurodevelopment, it is essential to ascertain whether pasteurized donor milk will confer the same advantage over formula without undue risks and at acceptable costs. Knowledge translation from this trial will be pivotal in setting donor milk policy in Canada and beyond. TRIAL REGISTRATION ISRCTN35317141; Registered 10 August 2010.
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Affiliation(s)
- Sharon Unger
- Mount Sinai Hospital and the University of Toronto, 600 University Avenue, 19-231, Toronto, Ontario, M5G 1X5, Canada
| | - Sharyn Gibbins
- Trillium Health Partners, 2200 Eglinton Ave West, Mississauga, Ontario, L5M 2 N1, Canada
| | - John Zupancic
- Beth Israel Deaconess Med Center, Neonatology, Rose 318 330 Brookline Ave, Boston, MA 02215, USA
| | - Deborah L O’Connor
- University of Toronto and The Hospital for Sick Children, 327 Fitzgerald Building, 150 College Street, Toronto, Ontario, M5S 3E2, Canada
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1637
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Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014; 133:844-53. [PMID: 24777216 DOI: 10.1542/peds.2013-3285] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To provide an updated US birth weight for gestational age reference corrected for likely errors in last menstrual period (LMP)-based gestational age dating, as well as means and SDs, to enable calculation of continuous and categorical measures of birth weight for gestational age. METHODS From the 2009-2010 US live birth files, we abstracted singleton births between 22 and 44 weeks of gestation with at least 1 nonmissing estimate of gestational age (ie, LMP or obstetric/clinical) and birth weight. Using an algorithm based on birth weight and the concordance between these gestational age estimates, implausible LMP-based gestational age estimates were either excluded or corrected by using the obstetric/clinical estimate. Gestational age- and sex-specific birth weight means, SDs, and smoothed percentiles (3rd, 5th, 10th, 90th, 95th, 97th) were calculated, and the 10th and 90th percentiles were compared with published population-based references. RESULTS A total of 7 818 201 (99% of eligible) births were included. The LMP-based estimate of gestational age comprised 85% of the dataset, and the obstetric/clinical estimate comprised the remaining 15%. Cut points derived from the current reference identified ∼10% of births as ≤10th and ≥90th percentiles at all gestational weeks, whereas cut points derived from previous US-based references captured variable proportions of infants at these thresholds within the preterm and postterm gestational age ranges. CONCLUSIONS This updated US-based birth weight for gestational age reference corrects for likely errors in gestational age dating and allows for the calculation of categorical and continuous measures of birth size.
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Affiliation(s)
| | | | - Alla Sikorskii
- Statistics and Probability, Michigan State University, East Lansing, Michigan; and
| | - Olga Basso
- Departments of Obstetrics and Gynecology, and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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1638
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Lesseur C, Armstrong DA, Murphy MA, Appleton AA, Koestler DC, Paquette AG, Lester BM, Marsit CJ. Sex-specific associations between placental leptin promoter DNA methylation and infant neurobehavior. Psychoneuroendocrinology 2014; 40:1-9. [PMID: 24485470 PMCID: PMC3912462 DOI: 10.1016/j.psyneuen.2013.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/27/2013] [Accepted: 10/21/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Leptin (LEP) is a hormone central for energy homeostasis and has been implicated in neurodevelopment. This adipokine is produced by the placenta and is epigenetically regulated by promoter DNA methylation. Recent evidence has suggested a role for LEP in behavioral development. In this study, we investigated associations between profiles of human newborn neurobehavior and placental LEP DNA methylation. METHODS We determined LEP promoter methylation in 444 placental samples from healthy term infants and measured LEP gene expression in a random subset of these samples. Infant neurobehavior was assessed with the NICU Network Neurobehavioral Scales (NNNS) and we examined the relationship between LEP promoter methylation and profiles of infant neurobehavior derived from these scores generated using a hierarchical model-based clustering method. RESULTS LEP methylation is negatively correlated with gene expression only in placentas from male infants (r=-0.6, P=0.006). A 10% increase in LEP DNA methylation was associated with membership in a profile of infant neurobehavior marked by increased lethargy and hypotonicity (OR=1.9; 95% CI: 1.07-3.4), and consistently with reduced risk of membership in a profile characterized by decreased lethargy and hypotonicity (OR=0.54; 95% CI: 0.3-0.94) only in male infants (n=223). No statistically significant associations were observed amongst female infants. DISCUSSION These results suggest that increased placental LEP DNA methylation, related to reduced expression, may play a role in human newborn neurodevelopment, particularly in reactivity to various stimuli, but that these effects may be sexually dimorphic.
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Affiliation(s)
- Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA.
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Megan A. Murphy
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Allison A. Appleton
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Devin C. Koestler
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - Alison G. Paquette
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Barry M. Lester
- The Brown Center for the Study of Children at Risk, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI 02903, USA
| | - Carmen J. Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA,Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA,Corresponding author at: Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA. Tel.: +1 603 6501825; fax: +1 603 6501129. (C. Lesseur), (C.J. Marsit)
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1639
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Pereira-da-Silva L, Virella D. Is intrauterine growth appropriate to monitor postnatal growth of preterm neonates? BMC Pediatr 2014; 14:14. [PMID: 24438124 PMCID: PMC3915236 DOI: 10.1186/1471-2431-14-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 12/06/2013] [Indexed: 11/10/2022] Open
Abstract
When using the useful 2013 Fenton Chart, data should be interpreted with caution taking into account two aspects: the physiologic loss of body water after birth for the weight curves, and the questionable accuracy of the birth length curves considering the heterogeneity and reliability of the methods used in the original measurements.
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Affiliation(s)
- Luis Pereira-da-Silva
- Neonatal Intensive Care Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Rua Jacinta Marto, 1169-045 Lisbon, Portugal.
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1640
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Test-retest reliability of the infant car-seat challenge. J Perinatol 2014; 34:54-8. [PMID: 24135707 PMCID: PMC10016367 DOI: 10.1038/jp.2013.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/15/2013] [Accepted: 08/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate how a single infant car-seat challenge (ICSC) predicts subsequent respiratory physiology in premature infants. STUDY DESIGN Prospective observational study of infants born at <37 weeks gestational age. Subjects underwent three ICSCs and we evaluated clinical characteristics, pass rate, and predictive value of a single ICSC pass. RESULT Completed three ICSCs on 60 subjects. Seven failed initial ICSC (11.7%). Those who failed had lower birth weights. Of the 53 that initially passed, 47 passed two subsequent tests (89%). Those who passed an initial test and failed a subsequent test had lower weights at each ICSC. CONCLUSION Our results indicate that passing an ICSC is highly predictive of passing subsequent ICSCs. Lower weights at birth and at the time of ICSC were associated with increased risk of failure. We recommend including low birth weight as an inclusion criterion for ICSCs.
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1641
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Lesseur C, Armstrong DA, Paquette AG, Koestler DC, Padbury JF, Marsit CJ. Tissue-specific Leptin promoter DNA methylation is associated with maternal and infant perinatal factors. Mol Cell Endocrinol 2013; 381:160-7. [PMID: 23911897 PMCID: PMC3795868 DOI: 10.1016/j.mce.2013.07.024] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/19/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
Leptin a regulator of body weight is involved in reproductive and developmental functions. Leptin promoter DNA methylation (LEP) regulates gene expression in a tissue-specific manner and has been linked to adverse pregnancy outcomes. In non-pathologic human pregnancies, we assessed LEP methylation, genotyped the single nucleotide polymorphism (SNP) rs2167270 in placental (n=81), maternal and cord blood samples (n=60), and examined the association between methylation, genotype, and perinatal factors. Maternal blood LEP methylation was lower in pre-pregnancy obese women (P=0.01). Cord blood LEP methylation was higher in small for gestational age (SGA) (P=4.6×10(-3)) and A/A genotype (P=1.6×10(-4)), lower (-1.47, P=0.03) in infants born to pre-pregnancy obese mothers and correlated (P=0.01) with maternal blood LEP. Gender was associated with placental LEP methylation (P=0.05). These results suggest that LEP epigenetic control may be influenced by perinatal factors including: maternal obesity, infant growth, genotype and gender in a tissue-specific manner and may have multigenerational implications.
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Affiliation(s)
- Corina Lesseur
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - David A. Armstrong
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Alison G. Paquette
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
| | - Devin C. Koestler
- Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
| | - James F. Padbury
- Department of Pediatrics, Women & infants Hospital of RI, Brown University, Box G-WIH, Providence, RI 02905, USA
| | - Carmen J. Marsit
- Department of Pharmacology and Toxicology, Geisel School of Medicine at Dartmouth, 7650 Remsen, Hanover, NH 03755, USA
- Department of Community and Family Medicine, Section of Biostatistics and Epidemiology, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, 7927 Rubin Building, Lebanon, NH 03756, USA
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1642
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Prince A, Groh-Wargo S. Nutrition Management for the Promotion of Growth in Very Low Birth Weight Premature Infants. Nutr Clin Pract 2013; 28:659-68. [DOI: 10.1177/0884533613506752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Allison Prince
- University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Sharon Groh-Wargo
- Case Western Reserve University School of Medicine, Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio
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1643
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1644
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Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013; 13:92. [PMID: 23758808 PMCID: PMC3700759 DOI: 10.1186/1471-2431-13-92] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 06/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current fetal-infant growth references have an obvious growth disjuncture around 40 week gestation overlapping where the fetal and infant growth references are combined. Graphical smoothening of the disjuncture to connect the matching percentile curves has never been validated. This study was designed to compare weight gain patterns of contemporary preterm infants with a fetal-infant growth reference (derived from a meta-analysis) to validate the previous smoothening assumptions and inform the revision of the Fenton chart. METHODS Growth and descriptive data of preterm infants (23 to 31 weeks) from birth through 10 weeks post term age were collected in three cities in Canada and the USA between 2001 and 2010 (n = 977). Preterm infants were grouped by gestational age into 23-25, 26-28, and 29-31 weeks. Comparisons were made between the weight data of the preterm cohort and the fetal-infant growth reference. RESULTS Median weight gain curves of the three preterm gestational age groups were almost identical and remained between the 3rd and the 50th percentiles of the fetal-infant-growth-reference from birth through 10 weeks post term. The growth velocity of the preterm infants decreased in a pattern similar to the decreased velocity of the fetus and term infant estimates, from a high of 17-18 g/kg/day between 31-34 weeks to rates of 4-5 g/kg/day by 50 weeks in each gestational age group. The greatest discrepancy in weight gain velocity between the preterm infants and the fetal estimate was between 37 and 40 weeks; preterm infants grew more rapidly than the fetus. The infants in this study regained their birthweight earlier compared to those in the 1999 National Institute of Child Health and Human Development report. CONCLUSION The weight gain velocity of preterm infants through the period of growth data disjuncture between 37 and 50 weeks gestation is consistent with and thus validates the smoothening assumptions made between preterm and post-term growth references.
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1645
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O'Connor DL, Unger S. Post-discharge nutrition of the breastfed preterm infant. Semin Fetal Neonatal Med 2013; 18:124-128. [PMID: 23706724 DOI: 10.1016/j.siny.2013.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Provision of mother's own milk is the optimal way to nourish infants, including the preterm infant. The importance of mother's own milk during initial hospitalization to improve feeding tolerance, reduce serious infection and necrotizing enterocolitis is well appreciated. As a result, there has been a culture shift in neonatology such that breastfeeding is now encouraged and the majority of mothers of preterm infants attempt to express breastmilk. While more can be done during the hospital stay, nutrient intakes and growth are monitored and lactation support is provided. After hospital discharge, however, nutrient intakes and growth are frequently not monitored in a coordinated fashion and lactation support is often inaccessible. Few data are available to guide the clinician on the best approach to supporting the breastfed infant after discharge and expert guidance is frequently non-existent. This review provides evidence for a 'proactive' rather than a 'reactive' approach to supporting the breastfed preterm infant after discharge in terms of breastfeeding promotion, resolving acquired nutrient deficits, normalizing feeding and promoting optimal growth.
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Affiliation(s)
- Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Professional Practice and Research Institute, The Hospital for Sick Children, Room 8511C, 555 University Avenue, Toronto M5G 1X8, Canada.
| | - Sharon Unger
- Department of Pediatrics, University of Toronto, Department of Neonatology, Mount Sinai Hospital, Toronto, Canada
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