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Ma L, Zou P, Lv J, Wang Z, Xia B, Lin T, Yu J, Cui Y, Zhong W, He Q. Extracorporeal membrane oxygenation for congenital diaphragmatic hernia: how to begin? Minerva Pediatr (Torino) 2024; 76:46-50. [PMID: 32881475 DOI: 10.23736/s2724-5276.20.05833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is critical for congenital diaphragmatic hernia (CDH), who fails to achieve adequate oxygenation with conventional management. We aim to evaluate initial experiences with ECMO support in a tertiary women and children's medical center in mainland China. METHODS We retrospectively reviewed the establishment of ECMO for CDH Program in our center and analysis of five CDH neonates, who underwent repair during ECMO between December 2016 and December 2018. RESULTS The first ECMO for CDH Program in our institution was established and managed by a multidisciplinary team since December 2016. An alert of ECMO was prenatally created for moderate-severe pulmonary hypoplasia. Of sixteen admissions prenatally diagnosed moderate-severe CDH, eight neonates (50%) required ECMO but five (31%) received eventually. Veno-arterial ECMO was established from 3 hours to 41 hours of age (median 20 h). All the five underwent CDH repair after a stabilization period on ECMO, which ranged from 12 h to 122 h (median 58 h). There were no clotting complications, related to coagulating during CDH repair. Bleeding was the most common complication. Cannula malposition was detected in one case. Their median ECMO duration was 437 (range 85-946) hours. Neonatal survival was 80% (4/5) and 3 survived (60%) in the first three months of life. CONCLUSIONS Multidisciplinary teamwork, precise prenatal evaluation and skillful cannulation assist the successful beginning of ECMO for CDH. Our preliminary results would encourage other institutions, whose ECMO is not well-established.
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Affiliation(s)
- Li Ma
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Pengjian Zou
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Junjian Lv
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhe Wang
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bo Xia
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tulian Lin
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiakang Yu
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Zhong
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiuming He
- Department of Neonatal Surgery, Congenital Diaphragmatic Hernia Study and Collaborative Group of Fetal Care Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China -
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Gómez-Sánchez R, García-Carreño J, Martínez-Solano J, Sousa-Casasnovas I, Juárez-Fernández M, Devesa-Cordero C, Sanz-Ruiz R, Gutiérrez-Ibañes E, Elízaga J, Fernández-Avilés F, Martínez-Sellés M. Off-Hours versus Regular-Hours Implantation of Peripheral Venoarterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock. J Clin Med 2023; 12:jcm12051875. [PMID: 36902662 PMCID: PMC10003377 DOI: 10.3390/jcm12051875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND The "weekend effect" has been associated with worse clinical outcomes. Our aim was to compare off-hours vs. regular-hours peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in cardiogenic shock patients. METHODS We analyzed in-hospital and 90-day mortality among 147 consecutive patients treated with percutaneous VA-ECMO for medical reasons between July 1, 2013, and September 30, 2022, during regular-hours (weekdays 8:00 a.m.-10:00 p.m.) and off-hours (weekdays 10:01 p.m.-7:59 a.m., weekends, and holidays). RESULTS The median patient age was 56 years (interquartile range [IQR] 49-64 years) and 112 (72.6%) were men. The median lactate level was 9.6 mmol/L (IQR 6.2-14.8 mmol/L) and 136 patients (92.5%) had a Society for Cardiovascular Angiography and Interventions (SCAI) stage D or E. Cannulation was performed off-hours in 67 patients (45.6%). In-hospital mortality was similar in off-hours and regular hours (55.2% vs. 56.3%, p = 0.901), as was the 90-day mortality (58.2% vs. 57.5%, p = 0.963), length of hospital stay (31 days [IQR 16-65.8 days] vs. 32 days [IQR 18-63 days], p = 0.979), and VA-ECMO related complications (77.6% vs. 70.0%, p = 0.305). CONCLUSIONS Off-hours and regular-hours percutaneous VA-ECMO implantation in cardiogenic shock of medical cause have similar results. Our results support well-designed 24/7 VA-ECMO implantation programs for cardiogenic shock patients.
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Affiliation(s)
- Roberto Gómez-Sánchez
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jorge García-Carreño
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jorge Martínez-Solano
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Iago Sousa-Casasnovas
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Miriam Juárez-Fernández
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carolina Devesa-Cordero
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jaime Elízaga
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Instituto de Investigación Sanitaria Gregorio Marañon (IiSGM), Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Faculty of Biomedical and Health Sciences, Universidad Europea, 28670 Madrid, Spain
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007 Madrid, Spain
- Correspondence: ; Tel.: +34-915868293
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Steurer MA, Tonna JE, Coyan GN, Burki S, Sciortino CM, Oishi PE. On-Hours Compared to Off-Hours Pediatric Extracorporeal Life Support Initiation in the United States Between 2009 and 2018-An Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Explor 2022; 4:e0698. [PMID: 35620766 PMCID: PMC9113205 DOI: 10.1097/cce.0000000000000698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We aimed to investigate whether there are differences in outcome for pediatric patients when extracorporeal life support (ECLS) is initiated on-hours compared with off-hours. DESIGN Retrospective cohort study. SETTING Ten-year period (2009-2018) in United States centers, from the Extracorporeal Life Support Organization registry. PATIENTS Pediatric (>30 d and <18 yr old) patients undergoing venovenous and venoarterial ECLS. INTERVENTIONS The primary predictor was on versus off-hours cannulation. On-hours were defined as 0700-1859 from Monday to Friday. Off-hours were defined as 1900-0659 from Monday to Thursday or 1900 Friday to 0659 Monday or any time during a United States national holiday. The primary outcome was inhospital mortality. The secondary outcomes were complications related to ECLS and length of hospital stay. MEASUREMENTS AND MAIN RESULTS In a cohort of 9,400 patients, 4,331 (46.1%) were cannulated on-hours and 5,069 (53.9%) off-hours. In the off-hours group, 2,220/5,069 patients died (44.0%) versus 1,894/4,331 (44.1%) in the on-hours group (p = 0.93). Hemorrhagic complications were lower in the off-hours group versus the on-hours group (hemorrhagic 18.4% vs 21.0%; p = 0.002). After adjusting for patient complexity and other confounders, there were no differences between the groups in mortality (odds ratio [OR], 0.95; 95% CI, 0.85-1.07; p = 0.41) or any complications (OR, 1.02; 95% CI, 0.89-1.17; p = 0.75). CONCLUSIONS Survival and complication rates are similar for pediatric patients when ECLS is initiated on-hours compared with off-hours. This finding suggests that, in aggregate, the current pediatric ECLS infrastructure in the United States provides adequate capabilities for the initiation of ECLS across all hours of the day.
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Affiliation(s)
- Martina A Steurer
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health; Salt Lake City, UT
- Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Garrett N Coyan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA
| | - Sarah Burki
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA
| | - Christopher M Sciortino
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center; Pittsburgh, PA
| | - Peter E Oishi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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van der Wal PS, Kraaijeveld AO, van der Heijden JJ, van Laake LW, Platenkamp M, de Heer LM, Braithwaite SA, van Eijk M, Hermens J, Cremer OL, Donker DW, Meuwese CL. Initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock during out of hours versus working hours is not associated with increased mortality. Int J Artif Organs 2022; 45:301-308. [PMID: 35139685 DOI: 10.1177/03913988211073344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Initiation of veno-arterial (VA) Extracorporeal Membrane Oxygenator (ECMO) is associated with severe complications. It is unknown whether these adverse consequences occur more often after initiations during out of hours service compared to working hours. METHODS All patients receiving VA-ECMO for cardiogenic shock between 2009 and 2020 were categorized into a working hours group (between 8 am and 5 pm on weekdays) and an out of hours service group (between 5 pm and 8 am, or between Friday 5 pm and Monday 8 am). Primary outcome was all-cause mortality at 30 days. Secondary outcomes included vascular complications (including limb ischemia and/or bleeding), bloodstream infections and length of ICU stay. Propensity scores were used to adjust for potential confounding effects. RESULTS Among 250 patients (median (IQR) age 56 (42-64) years) receiving VA-ECMO (median duration 3.5 (1.0-9.0) days), 160 (64%) runs were initiated between 5 pm and 8 am whereas the remainder (36%) started during working hours. Characteristic did not differ between the working hours- and out of hours-group. By day 30, 37 (41.1%), and 68 (42.5%) patients in either group had died, respectively (p = 0.831). VA-ECMO support duration and length of stay on the ICU did not differ significantly in both crude and adjusted analyses. More complications occurred during out of hours service (p = 0.039). CONCLUSIONS Out of hours- versus working hours-initiation of VA-ECMO for cardiogenic shock was not associated with higher mortality, longer VA-ECMO support duration, or longer length of stay on the intensive care. Vascular complications were more common in the out of hours group.
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Affiliation(s)
- P S van der Wal
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J van der Heijden
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W van Laake
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Platenkamp
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L M de Heer
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S A Braithwaite
- Department of Cardioanesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mmj van Eijk
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaj Hermens
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - O L Cremer
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D W Donker
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Cardiovascular and Respiratory Physiology Group, TechMed Centre, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - C L Meuwese
- Departments of Intensive Care and Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Lunz D, Camboni D, Philipp A, Flörchinger B, Terrazas A, Müller T, Schmid C, Diez C. The 'Weekend Effect' in adult patients who receive extracorporeal cardiopulmonary resuscitation after in- and out-of-hospital cardiac arrest. Resusc Plus 2020; 4:100044. [PMID: 34223319 PMCID: PMC8244442 DOI: 10.1016/j.resplu.2020.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/05/2022] Open
Abstract
Aim This study investigates the potentially adverse association between extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest on weekends versus weekdays. Methods Single-centre, retrospective, stratified (weekday versus weekend) analysis of 318 patients who underwent in-hospital ECPR after out-of-hospital and in-hospital cardiac arrest (OHCA/IHCA) between 01/2008 and 12/2018. Weekend was defined as the period between Friday 17:00 and Monday 06:59. Results Seventy-three patients (23%) received ECPR during the weekend and 245 arrests (77%) occurred during the weekday. Whereas survival to discharge did not differ between both groups, long-term survival was significantly lower in the weekend group (p = 0.002). In the multivariate analysis, independent risk factors associated with hospital mortality were no flow time (OR 1.014; 95% CI 1.004–1.023) and serum lactate prior ECPR (OR 1.011; 95% CI 1.006–1.012), whereas each unit serum haemoglobin above average had a protective effect on in-hospital mortality (OR 0.87; 95% CI 0.79–0.96). New onset kidney failure requiring renal replacement therapy occurred more often in the weekend group (30.1% versus 18.4%; p = 0.04). One third of patients experienced complications regardless ECPR was initiated at weekdays or weekends. Conclusion Extracorporeal cardiopulmonary resuscitation at weekends adversely seems to impact long-term survival regardless timing (dayshift/nightshift). Duration of CPR and serum lactate prior ECPR were demonstrated as independent risk factors for in-hospital mortality. As ECPR at weekends could not be shown to be an independent outcome predictor a thorough analysis of clinical events subsequent to this intervention is warranted to understand long-term consequences of ECPR initiation after cardiac arrest.
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Affiliation(s)
- Dirk Lunz
- University Medical Centre Regensburg, Department of Anaesthesiology, 93053 Regensburg, Germany
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, 93053 Regensburg, Germany
| | - Alois Philipp
- Department of Cardiothoracic Surgery, 93053 Regensburg, Germany
| | | | | | - Thomas Müller
- Department of Internal Medicine II Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, 93053 Regensburg, Germany
| | - Claudius Diez
- Department of Cardiothoracic Surgery, 93053 Regensburg, Germany
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Ramsden L, McColgan MP, Rossor T, Greenough A, Clark SJ. Paediatric outcomes and timing of admission. Arch Dis Child 2018; 103:611-617. [PMID: 29545409 DOI: 10.1136/archdischild-2017-314559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/04/2022]
Abstract
Studies of adult patients have demonstrated that weekend admissions compared with weekday admissions had a significantly higher hospital mortality rate. We have reviewed the literature to determine if the timing of admission, for example, weekend or weekday, influenced mortality and morbidity in children. Seventeen studies reported the effect of timing of admission on mortality, and only four studies demonstrated an increase in those admitted at the weekend. Meta-analysis of the results of 15 of the studies demonstrated there was no significant weekend effect. There was, however, considerable heterogeneity in the studies. There were two large UK studies: one reported an increased mortality only for planned weekend admissions likely explained by planned admissions for complex conditions and the other showed no significant weekend effect. Two studies, one of which was large (n=2913), reported more surgical complications in infants undergoing weekend oesophageal atresia and trachea-oesophageal repair. Medication errors have also been reported to be more common at weekends. Five studies reported the effect of length of stay, meta-analysis demonstrated a significantly increased length of stay following a weekend admission, the mean difference was approximately 1 day. Those data, however, should be interpreted with the caveat that there was no adjustment in all of the studies for differences in disease severity. We conclude that weekend admission overall does not increase mortality but may be associated with a longer length of stay and, in certain conditions, with greater morbidity.
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Affiliation(s)
- Louise Ramsden
- Neonatal Unit, Sheffield Teaching Foundation Hospitals Trust, Sheffield, UK
| | | | - Thomas Rossor
- MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Greenough
- Royal College of Paediatrics and Child Health, London, UK.,MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,NIHR Biomedical Centre at Guy's and St Thomas NHS Foundation Trust and King's College London, London, UK
| | - Simon J Clark
- Neonatal Unit, Sheffield Teaching Foundation Hospitals Trust, Sheffield, UK.,Royal College of Paediatrics and Child Health, London, UK
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