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Everett SS, Bomback M, Sahni R, Wapner RJ, Tolia VN, Clark RH, Lyford A, Hays T. Prevalence and Clinical Significance of Commonly Diagnosed Genetic Disorders in Preterm Infants. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.14.23292662. [PMID: 37503109 PMCID: PMC10370234 DOI: 10.1101/2023.07.14.23292662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background and Objectives Preterm infants (<34 weeks' gestation) experience high rates of morbidity and mortality before hospital discharge. Genetic disorders substantially contribute to morbidity and mortality in related populations. The prevalence and clinical impact of genetic disorders is unknown in this population. We sought to determine the prevalence of commonly diagnosed genetic disorders in preterm infants, and to determine the association of disorders with morbidity and mortality. Methods This was a retrospective multicenter cohort study of infants born from 23 to 33 weeks' gestation between 2000 and 2020. Genetic disorders were abstracted from diagnoses present in electronic health records. We excluded infants transferred from or to other health care facilities prior to discharge or death when analyzing clinical outcomes. We determined the adjusted odds of pre-discharge morbidity or mortality after adjusting for known risk factors. Results Of 320,582 infants, 4196 (1.3%) had genetic disorders. Infants with trisomy 13, 18, 21, or cystic fibrosis had greater adjusted odds of severe morbidity or mortality. Of the 17,427 infants who died, 566 (3.2%) had genetic disorders. Of the 65,968 infants with a severe morbidity, 1319 (2.0%) had genetic disorders.ConclusionsGenetic disorders are prevalent in preterm infants, especially those with life-threatening morbidities. Clinicians should consider genetic testing for preterm infants with severe morbidity and maintain a higher index of suspicion for life-threatening morbidities in preterm infants with genetic disorders. Prospective genomic research is needed to clarify the prevalence of genetic disorders in this population, and the contribution of genetic disorders to preterm birth and subsequent morbidity and mortality. Article Summary Genetic disorders were found in 1.3% of preterm infants and at a higher rate (2.0%) in infants who died or developed severe morbidity. What’s Known on This Subject Previous research described the prevalence and associated short-term morbidity and mortality of trisomy 13, 18, and 21 in preterm infants. The prevalence of other commonly diagnosed genetic disorders and associated short-term morbidity and mortality in preterm infants is unknown. What This Study Adds In a multicenter, retrospective cohort of 320,582 preterm (<34 weeks' gestation) infants, we found that 1.3% had genetic disorders diagnosed through standard care. Multiple disorders were associated with increased adjusted odds of morbidities or mortality prior to hospital discharge. Contributors Statement Page Selin S. Everett conceptualized and designed the study, conducted analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript.Dr. Thomas Hays conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript.Miles Bomback conceptualized and designed the study and critically reviewed and revised the manuscript.Drs. Veeral N. Tolia and Reese H. Clark coordinated and supervised data collection and critically reviewed and revised the manuscript.Dr. Rakesh Sahni conceptualized and designed the study and critically reviewed and revised the manuscript.Dr. Alex Lyford conducted analyses and critically reviewed and revised the manuscript. Dr. Ronald J. Wapner reviewed and critically revised the manuscript.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Nakashima Y, Mori Y, Sugiura H, Hirose E, Toyoshima K, Masutani S, Tanaka Y, Yoda H. Very low birth weight infants with congenital heart disease: A multicenter cohort study in Japan. J Cardiol 2022; 80:344-350. [PMID: 35725946 DOI: 10.1016/j.jjcc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/04/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The frequency, mortality, and morbidity of very low birth weight (VLBW) infants with congenital heart disease (CHD) in Asian countries are limited. In addition, little is known about the risk factors of death in these infants. METHODS A retrospective, multicenter cohort study was conducted. VLBW infants with CHD born between 2006 and 2010, and followed to 5 years of age, were included in the analysis. Multiple logistic regression analysis was performed to identify the risk factors of death. RESULTS Among 3247 VLBW infants, 126 various CHDs (3.9 %) were identified. The most common lesions were ventricular septal defect, tetralogy of Fallot (TOF), and coarctation of the aorta/interrupted aortic arch, in that order. The proportions of left-sided and right-sided outflow obstruction (TOF, pulmonary stenosis) were 15.1 % and 15.9 %, respectively. Trisomy 18 and trisomy 13 were present in 32 (25.4 %) of 126 VLBW infants with CHD. Nine patients were lost to follow-up. Overall, 45 patients (35.7 %) died up to 5 years of age. Serious CHD [odds ratio (OR), 19.2; 95 % confidential interval (CI), 3.94-93.11; p < 0.0001], sepsis (OR, 42.3; 95 % CI, 5.39-332.22; p < 0.0001), chromosomal /named anomalies (OR, 7.50; 95%CI, 2.09-26.94; p = 0.001), and no-invasive treatments (OR, 9.89; 95%CI, 2.28-42.91; p = 0.001) were associated with death. On excluding chromosomal anomalies, twelve of 71 patients (16.9 %) died, and only sepsis (OR, 35.5, 95%CI, 2.63-477.1; p = 0.0008) was an independent risk factor. CONCLUSIONS Trisomy 18 and trisomy 13 of chromosomal anomalies are frequently associated with VLBW infants with CHD. The mortality of VLBW infants with CHD is high, even when chromosomal anomalies are excluded. Sepsis has a significant impact on death in VLBW infants with CHD.
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Affiliation(s)
- Yasumi Nakashima
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshiki Mori
- Division of Pediatric Cardiology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.
| | - Hiroshi Sugiura
- Division of Neonatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Etsuko Hirose
- Division of Neonatology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasuhiko Tanaka
- Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Hitoshi Yoda
- Department of Neonatology, Toho-University Oomori Medical Center, Tokyo, Japan
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Vakalopoulos A, Dharmage SC, Dharmaratne S, Jayasinghe P, Lall O, Ambrose I, Weerasooriya R, Bui DS, Yasaratne D, Heyworth J, Bowatte G. Household Air Pollution from Biomass Fuel for Cooking and Adverse Fetal Growth Outcomes in Rural Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041878. [PMID: 33671963 PMCID: PMC7918999 DOI: 10.3390/ijerph18041878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/23/2022]
Abstract
The aim of this study was to investigate the impact of biomass fuel for cooking on adverse fetal growth outcomes in Sri Lanka. A cross-sectional study of mothers recruited at maternity clinics in rural communities in Sri Lanka’s Central Province was undertaken. Data pertaining to household air pollution and fetal growth parameters were collected using an interviewer-administered questionnaire. Logistic regression models, adjusted for potential confounders, were used to evaluate the impact of biomass fuel for cooking on low birth weight (LBW) and small for gestational age (SGA) parameters. Findings showed that exposure to biomass cooking fuels during pregnancy was associated with an increased risk of LBW adjusted odds ratio (aOR) 2.74 (95% CI 1.08–6.96) and SGA (aOR: 1.87, 95% CI 1.03–3.41) compared with the use of clean energy. The risk of LBW was highest for traditional biomass stoves compared to improved biomass stoves (aOR: 3.23, 95% 1.17–8.89) and biomass use in kitchens without a chimney compared to kitchens with a chimney (aOR: 4.63, 95% 1.54–13.93). Similar trends were observed for SGA.
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Affiliation(s)
- Alicia Vakalopoulos
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
- Correspondence:
| | - Samath Dharmaratne
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka;
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Pasan Jayasinghe
- Department of Health Services, Central Province, Kandy 20000, Sri Lanka;
| | - Olivia Lall
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
| | - Isabella Ambrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
| | - Rohan Weerasooriya
- National Institute of Fundamental Studies, Hantana Road, Kandy 20000, Sri Lanka;
| | - Dinh S. Bui
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
| | - Duminda Yasaratne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Jane Heyworth
- School of Population and Public Health, Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, WA 6009, Australia;
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC 3053, Australia; (A.V.); (O.L.); (I.A.); (D.S.B.); (G.B.)
- National Institute of Fundamental Studies, Hantana Road, Kandy 20000, Sri Lanka;
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka
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Epidemiology of Birth Defects in Very Low Birth Weight Infants in Japan. J Pediatr 2020; 226:106-111.e10. [PMID: 32634406 DOI: 10.1016/j.jpeds.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the mortality and morbidity of very low birth weight (VLBW) preterm infants with birth defects in Japan. STUDY DESIGN Data were collected prospectively for infants weighing <1501 g and born at <37 weeks of gestation admitted to centers of the Neonatal Research Network of Japan during 2003-2016. We compared outcomes of infants with and without birth defects using Pearson χ2 test, Wilcoxon rank-sum test, log-rank test, nominal logistic regression analysis, and stratified analysis by birth defect subgroups. This study was approved by the Ethics Committee of Kyoto University Graduate School and Faculty of Medicine. RESULTS Among 57 730 VLBW preterm infants, 3557 infants (6.2%) were born with birth defects. Chromosomal abnormalities, congenital heart defects, and congenital malformation of the digestive system were the most common categories. Among diseases, Trisomy 18, Down syndrome, and cleft palate were the most prevalent. There were significant differences between perinatal characteristics of infants with and without birth defects. Most categories of morbidity occurred more frequently in infants with birth defects compared with those without birth defects. The aOR for mortality during the neonatal intensive care unit admission was 10.6 (95% CI 9.5-11.7) for infants with birth defects. A stratified analysis identified birth defect categories with good, moderate, and poor prognoses. CONCLUSIONS This detailed information about mortality and morbidity of preterm VLBW infants with birth defects should be useful for genetic counseling as well as prenatal and neonatal care, with the limitation that we lacked information about the timing of diagnosis, abortion, or stillbirth.
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Vakrilova L, Hitrova-Nikolova S, Bradinova I. Triploidy in a Live-Born Extremely Low Birth Weight Twin: Clinical Aspects. J Pediatr Genet 2020; 11:227-231. [DOI: 10.1055/s-0040-1716828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
AbstractTriploidy is a rare chromosomal aberration characterized by a karyotype with 69 chromosomes. Triploid fetuses usually are miscarried in early pregnancy. We present a case of a triploid twin and a genetically unaffected co-twin, conceived through in vitro fertilization. A discordant growth was registered at 20 weeks of gestation. Cesarean section was performed at 355/7 gestational week. The second twin was extremely growth restricted female (780 g) with oligohydramnios and severe respiratory distress, and died at 20 hours of age. The autopsy revealed unilobar left lung, bilobar right lung, and cysts of the terminal bronchioles. Quantitative fluorescent polymerase chain reaction detected triploidy compatible pattern. So, early intrauterine growth restriction may be a sign of triploidy, which must be proven by pre or postnatal genetic testing.
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Affiliation(s)
- Liliya Vakrilova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- Neonatology Clinic, University Hospital of Obstetrics and Gynecology “Maichin Dom,” Sofia, Bulgaria
| | - Stanislava Hitrova-Nikolova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- Neonatology Clinic, University Hospital of Obstetrics and Gynecology “Maichin Dom,” Sofia, Bulgaria
| | - Irena Bradinova
- Department of Obstetrics and Gynecology, Medical University of Sofia, Sofia, Bulgaria
- National Genetic Laboratory, University Hospital of Obstetrics and Gynecology “Maichin dom,” Sofia, Bulgaria
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Shitara Y, Oida N, Kondo U, Kushima R, Omori I. Non-surgical intervention for open myelomeningocele in an infant with trisomy 18. Pediatr Int 2020; 62:496-497. [PMID: 32212200 DOI: 10.1111/ped.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Yoshihiko Shitara
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Noriyasu Oida
- Department of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Utako Kondo
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Reiko Kushima
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Isaku Omori
- Department of Neonatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Chung SH, Kim CY, Lee BS. Congenital Anomalies in Very-Low-Birth-Weight Infants: A Nationwide Cohort Study. Neonatology 2020; 117:584-591. [PMID: 32772029 DOI: 10.1159/000509117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/31/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Management of newborn infants with congenital anomalies is challenging and requires a multidisciplinary approach. The prevalence of congenital anomalies in very-low-birth-weight infants (VLBWIs; birth weight <1,500 g) has been rarely reported. OBJECTIVES The aim of this study was to investigate the epidemiology of congenital anomalies in VLBWIs and the association with early mortality and major morbidities. STUDY DESIGN A prospective cohort study was performed using data collected from 70 centers registered in the Korean Neonatal Network. Data from the VLBWIs with major congenital anomalies (n = 289) and the controls (n = 867), selected by 1:3 frequency matching for gestational age, were compared. RESULTS The overall prevalence of major congenital anomalies in VLBWIs was 34.9 per 1,000 live births (289/8,156). The top 2 ranked subgroups of congenital anomalies were the digestive system (31.7%) and congenital heart defects (27.7%), followed by chromosomal anomalies, genitourinary tract defect, central nervous system, other anomalies, undefined, and respiratory system. The group with congenital anomalies had a higher mortality (40.7%) than the control group (11.1%). Each subgroup of congenital anomalies, except for chromosomal anomalies, increased the risk of mortality, with the highest odds ratio associated with "other" anomalies, which includes hydrops fetalis and congenital diaphragmatic hernia. In the multivariate analysis, congenital anomaly was a risk factor for mortality, bronchopulmonary dysplasia, and severe-grade intraventricular hemorrhage. VLBWIs with congenital anomaly demonstrated impaired in-hospital growth as compared with the control group. CONCLUSION Congenital anomaly increased the risk of in-hospital mortality and was associated with short-term neonatal morbidities in the VLBWIs.
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Affiliation(s)
- Sung-Hoon Chung
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chae Young Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Byong Sop Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea,
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Różdżyńska-Świątkowska A, Tylki-Szymańska A. The importance of anthropological methods in the diagnosis of rare diseases. J Pediatr Endocrinol Metab 2019; 32:311-320. [PMID: 30917104 DOI: 10.1515/jpem-2018-0433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/29/2019] [Indexed: 11/15/2022]
Abstract
Most of inborn errors of metabolism (IEMs) and rare endocrine-metabolic diseases (REMD) are rare diseases. According to the European Commission on Public Health, a rare disease is defined, based on its prevalence, as one affecting one in 2000 people. Many IEMs affect body stature, cause craniofacial abnormalities, and disturb the developmental process. Therefore, body proportion, dysmorphic characteristics, and morphological parameters must be assessed and closely monitored. This can be achieved only with the help of an anthropologist who has adequate tools. This is why the role of an anthropologist in collaboration with the physician in the diagnostic process is not to be underestimated. Clinical anthropologists contribute to assessing physical development and improve our understanding of the natural history of rare metabolic diseases. This paper presents anthropometric techniques and methods, such as analysis of demographic data, anthropometric parameters at birth, percentile charts, growth patterns, bioimpedance, somatometric profiles, craniofacial profiles, body proportion indices, and mathematical models of growth curves used in certain rare diseases. Contemporary anthropological methods play an important role in the diagnostic process of rare genetic diseases.
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Affiliation(s)
| | - Anna Tylki-Szymańska
- Department of Pediatric, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
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NICU management and outcomes of infants with trisomy 21 without major anomalies. J Perinatol 2018; 38:1068-1073. [PMID: 29795453 PMCID: PMC6335104 DOI: 10.1038/s41372-018-0136-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To describe how trisomy 21 affects neonatal intensive care management and outcomes of full-term infants without congenital anomalies. STUDY DESIGN Retrospective cohort of full-term infants without anomalies with and without trisomy 21 admitted to Pediatrix NICUs from 2005 to 2012. We compared diagnoses, management, length of stay, and discharge outcomes. RESULTS In all, 4623 infants with trisomy 21 and 606 770 infants without trisomy 21 were identified. One-third of infants in the NICU with and without trisomy 21 were full term without major anomalies. Trisomy 21 infants had more respiratory distress, thrombocytopenia, feeding problems, and pulmonary hypertension. They received respiratory support for a longer period of time and had a longer length of stay. CONCLUSION One-third of infants with trisomy 21 admitted to the NICU are full term without major anomalies. Common diagnoses and greater respiratory needs place infants with trisomy 21 at risk for longer length of stay.
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Birth weight, length and head circumference: Progression and impact over the outcome of patients with congenital heart disease. Int J Cardiol 2017; 243:194-196. [PMID: 28539208 DOI: 10.1016/j.ijcard.2017.05.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are few studies assessing the birth measures of patients with congenital heart disease (CHD). Our aim to evaluate their progression and impact over the outcome. METHODS The cases consisted of patients with CHD during their first hospitalization in a reference cardiac and pediatric intensive care unit (ICU) from Southern Brazil. Controls were composed of patients with no clinical evidence of CHD hospitalized soon after cases. The cases underwent high-resolution karyotype and fluorescence in situ hybridization (FISH) for 22q11 microdeletion. We analyzed birth weight, length and head circumference of patients of both groups. For CHD patients, we evaluated their progression and impact until hospitalization at ICU. RESULTS Our sample was composed of 198 cases and controls. We observe a difference in birth weight of CHD patients only in relation to general population. There was a significant increase in children with CHD and weight below the lower limit from birth until the hospitalization at ICU, and this occurred more in those without complex CHD. Syndromic patients and with an extracardiac malformation also presented a greater difficulty to maintain not only the weight but also the length/height until the hospitalization. Individuals with weight below the lower limit at hospitalization who died had a tendency to present longer stay at ICU. CONCLUSIONS Some CHD patients, especially without complex defects, and with syndromic aspect and a major extracardiac malformation, present a higher difficult to maintain their weight and growth, and, therefore, may be at risk and should be more closely monitored.
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Acharya K, Leuthner S, Clark R, Nghiem-Rao TH, Spitzer A, Lagatta J. Major anomalies and birth-weight influence NICU interventions and mortality in infants with trisomy 13 or 18. J Perinatol 2017; 37:420-426. [PMID: 28079873 PMCID: PMC5738241 DOI: 10.1038/jp.2016.245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe neonatal intensive care unit (NICU) medical interventions and NICU mortality by birth weight and major anomaly types for infants with trisomy 13 (T13) or 18 (T18). STUDY DESIGN Retrospective cohort analysis of infants with T13 or T18 from 2005 to 2012 in the Pediatrix Medical Group. We classified infants into three groups by associated anomaly type: neonatal surgical, non-neonatal surgical and minor. Outcomes were NICU medical interventions and mortality. RESULTS 841 infants were included from 186 NICUs. NICU mortality varied widely by anomaly type and birth weight, from 70% of infants <1500 g with neonatal surgical anomalies to 31% of infants ⩾2500 g with minor anomalies. Infants ⩾1500 g without a neonatal surgical anomaly comprised 66% of infants admitted to the NICU; they had the lowest rates of NICU medical interventions and NICU mortality. CONCLUSIONS Risk stratification by anomaly type and birth weight may help provide more accurate family counseling for infants with T13 and T18.
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Affiliation(s)
- Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
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Pardo Vargas RA, Aracena M, Aravena T, Cares C, Cortés F, Faundes V, Mellado C, Passalacqua C, Sanz P, Castillo Taucher S. [Congenital anomalies of poor prognosis. Genetics Consensus Committee]. ACTA ACUST UNITED AC 2016; 87:422-431. [PMID: 27234469 DOI: 10.1016/j.rchipe.2016.04.005] [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: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Genetic Branch of the Chilean Society of Paediatrics, given the draft Law governing the decriminalisation of abortion on three grounds, focusing on the second ground, which considers the "embryo or foetus suffering from a congenital structural anomaly or a genetic disorder incompatible with life outside the womb", met to discuss the scientific evidence according to which congenital anomalies (CA) may be included in this draft law. METHODOLOGY Experts in clinical genetics focused on 10 CA, reviewed the literature evidence, and met to discuss it. RESULTS It was agreed not to use the term "incompatible with life outside the womb", as there are exceptions and longer survivals, and change to "congenital anomaly of poor prognosis (CAPP)". Ten CA were evaluated: serious defects of neural tube closure: anencephaly, iniencephaly and craniorachischisis, pulmonary hypoplasia, acardiac foetus, ectopia cordis, non-mosaic triploidy, "limb body wall" complex, "body stalk" anomaly, trisomy 13, trisomy 18, and bilateral renal agenesis. Findings on the prevalence, natural history, prenatal diagnostic methods, survival, and reported cases of prolonged survival were analysed. Post-natal survival, existence of treatments, and outcomes, as well as natural history without intervention, were taken into account in classifying a CA as a CAPP. CONCLUSION A CAPP would be: anencephaly, severe pulmonary hypoplasia, acardiac foetus, cervical ectopia cordis, non-mosaic triploidy, limb body wall complex, body stalk anomaly, non-mosaic trisomy 13, non-mosaic trisomy 18, and bilateral renal agenesis. For their diagnosis, it is required that all pregnant women have access to assessments by foetal anatomy ultrasound and occasionally MRI, and cytogenetic and molecular testing.
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Affiliation(s)
- Rosa A Pardo Vargas
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile.
| | - Mariana Aracena
- Unidad de Genética, Hospital Luis Calvo Mackenna, Santiago, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Teresa Aravena
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Indisa, Santiago, Chile
| | - Carolina Cares
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Dávila, Santiago, Chile
| | - Fanny Cortés
- Centro de Enfermedades Raras, Clínica Las Condes, Santiago, Chile
| | - Víctor Faundes
- Laboratorio de Genética y Enfermedades Metabólicas, INTA, Universidad de Chile, Santiago, Chile
| | - Cecilia Mellado
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricia Sanz
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Sección Genética, Hospital San Juan de Dios, Santiago, Chile
| | - Silvia Castillo Taucher
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Clínica Alemana, Santiago, Chile
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Boghossian NS, Sicko RJ, Kay DM, Rigler SL, Caggana M, Tsai MY, Yeung EH, Pankratz N, Cole BR, Druschel CM, Romitti PA, Browne ML, Fan R, Liu A, Brody LC, Mills JL. Rare copy number variants implicated in posterior urethral valves. Am J Med Genet A 2016; 170:622-33. [PMID: 26663319 PMCID: PMC6205289 DOI: 10.1002/ajmg.a.37493] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/13/2015] [Indexed: 11/07/2022]
Abstract
The cause of posterior urethral valves (PUV) is unknown, but genetic factors are suspected given their familial occurrence. We examined cases of isolated PUV to identify novel copy number variants (CNVs). We identified 56 cases of isolated PUV from all live-births in New York State (1998-2005). Samples were genotyped using Illumina HumanOmni2.5 microarrays. Autosomal and sex-linked CNVs were identified using PennCNV and cnvPartition software. CNVs were prioritized for follow-up if they were absent from in-house controls, contained ≥ 10 consecutive probes, were ≥ 20 Kb in size, had ≤ 20% overlap with variants detected in other birth defect phenotypes screened in our lab, and were rare in population reference controls. We identified 47 rare candidate PUV-associated CNVs in 32 cases; one case had a 3.9 Mb deletion encompassing BMP7. Mutations in BMP7 have been associated with severe anomalies in the mouse urethra. Other interesting CNVs, each detected in a single PUV case included: a deletion of PIK3R3 and TSPAN1, duplication/triplication in FGF12, duplication of FAT1--a gene essential for normal growth and development, a large deletion (>2 Mb) on chromosome 17q that involves TBX2 and TBX4, and large duplications (>1 Mb) on chromosomes 3q and 6q. Our finding of previously unreported novel CNVs in PUV suggests that genetic factors may play a larger role than previously understood. Our data show a potential role of CNVs in up to 57% of cases examined. Investigation of genes in these CNVs may provide further insights into genetic variants that contribute to PUV.
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Affiliation(s)
- Nansi S. Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Robert J. Sicko
- Department of Health, Division of Genetics, Wadsworth Center, Albany, New York
| | - Denise M. Kay
- Department of Health, Division of Genetics, Wadsworth Center, Albany, New York
| | - Shannon L. Rigler
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Michele Caggana
- Department of Health, Division of Genetics, Wadsworth Center, Albany, New York
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Edwina H. Yeung
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Nathan Pankratz
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Benjamin R. Cole
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Charlotte M. Druschel
- Department of Health, Congenital Malformations Registry, Albany, New York
- University at Albany School of Public Health, Rensselaer, New York
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa
| | - Marilyn L. Browne
- Department of Health, Congenital Malformations Registry, Albany, New York
- University at Albany School of Public Health, Rensselaer, New York
| | - Ruzong Fan
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Aiyi Liu
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Lawrence C. Brody
- Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - James L. Mills
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Bruns DA, Martinez A. An analysis of cardiac defects and surgical interventions in 84 cases with full trisomy 18. Am J Med Genet A 2015; 170A:337-343. [DOI: 10.1002/ajmg.a.37427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Deborah A. Bruns
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
| | - Alyssa Martinez
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
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15
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Boghossian NS, Hansen NI, Bell EF, Stoll BJ, Murray JC, Carey JC, Adams-Chapman I, Shankaran S, Walsh MC, Laptook AR, Faix RG, Newman NS, Hale EC, Das A, Wilson LD, Hensman AM, Grisby C, Collins MV, Vasil DM, Finkle J, Maffett D, Ball MB, Lacy CB, Bara R, Higgins RD. Mortality and morbidity of VLBW infants with trisomy 13 or trisomy 18. Pediatrics 2014; 133:226-35. [PMID: 24446439 PMCID: PMC3904274 DOI: 10.1542/peds.2013-1702] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Little is known about how very low birth weight (VLBW) affects survival and morbidities among infants with trisomy 13 (T13) or trisomy 18 (T18). We examined the care plans for VLBW infants with T13 or T18 and compared their risks of mortality and neonatal morbidities with VLBW infants with trisomy 21 and VLBW infants without birth defects. METHODS Infants with birth weight 401 to 1500 g born or cared for at a participating center of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network during the period 1994-2009 were studied. Poisson regression models were used to examine risk of death and neonatal morbidities among infants with T13 or T18. RESULTS Of 52,262 VLBW infants, 38 (0.07%) had T13 and 128 (0.24%) had T18. Intensity of care in the delivery room varied depending on whether the trisomy was diagnosed before or after birth. The plan for subsequent care for the majority of the infants was to withdraw care or to provide comfort care. Eleven percent of infants with T13 and 9% of infants with T18 survived to hospital discharge. Survivors with T13 or T18 had significantly increased risk of patent ductus arteriosus and respiratory distress syndrome compared with infants without birth defects. No infant with T13 or T18 developed necrotizing enterocolitis. CONCLUSIONS In this cohort of liveborn VLBW infants with T13 or T18, the timing of trisomy diagnosis affected the plan for care, survival was poor, and death usually occurred early.
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Affiliation(s)
- Nansi S. Boghossian
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Nellie I. Hansen
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | - John C. Carey
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Ira Adams-Chapman
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Michele C. Walsh
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Abbot R. Laptook
- Department of Pediatrics, Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Roger G. Faix
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Nancy S. Newman
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Ellen C. Hale
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Leslie D. Wilson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Angelita M. Hensman
- Department of Pediatrics, Brown University and Women & Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Cathy Grisby
- Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica V. Collins
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Diana M. Vasil
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joanne Finkle
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Deanna Maffett
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - M. Bethany Ball
- Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California; and
| | - Conra B. Lacy
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Rebecca Bara
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Abstract
Congenital birth defects and early/premature birth are common complex conditions affecting populations throughout the world, the interaction of which accounts for a significant proportion of neonatal morbidity and mortality. The relationship between these two conditions is not well understood. Several congenital birth defects can directly lead to early delivery. In addition, certain fetal conditions may necessitate early or premature delivery, several of which are also associated with maternal conditions necessitating early birth. Further understanding of both the incidences and causes of congenital birth defects and of early and premature birth will facilitate establishment of strategies to improve neonatal mortality and morbidity.
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Affiliation(s)
- Jonathan R Swanson
- Department of Pediatrics, University of Virginia Children's Hospital, University of Virginia, Box 800386, Charlottesville, VA 22908, USA
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Adams-Chapman I, Hansen NI, Shankaran S, Bell EF, Boghossian NS, Murray JC, Laptook AR, Walsh MC, Carlo WA, Sánchez PJ, Van Meurs KP, Das A, Hale EC, Newman NS, Ball MB, Higgins RD, Stoll BJ. Ten-year review of major birth defects in VLBW infants. Pediatrics 2013; 132:49-61. [PMID: 23733791 PMCID: PMC3691532 DOI: 10.1542/peds.2012-3111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Birth defects (BDs) are an important cause of infant mortality and disproportionately occur among low birth weight infants. We determined the prevalence of BDs in a cohort of very low birth weight (VLBW) infants cared for at the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers over a 10-year period and examined the relationship between anomalies, neonatal outcomes, and surgical care. METHODS Infant and maternal data were collected prospectively for infants weighing 401 to 1500 g at NRN sites between January 1, 1998, and December 31, 2007. Poisson regression models were used to compare risk of outcomes for infants with versus without BDs while adjusting for gestational age and other characteristics. RESULTS A BD was present in 1776 (4.8%) of the 37 262 infants in our VLBW cohort. Yearly prevalence of BDs increased from 4.0% of infants born in 1998 to 5.6% in 2007, P < .001. Mean gestational age overall was 28 weeks, and mean birth weight was 1007 g. Infants with BDs were more mature but more likely to be small for gestational age compared with infants without BDs. Chromosomal and cardiovascular anomalies were most frequent with each occurring in 20% of affected infants. Mortality was higher among infants with BDs (49% vs 18%; adjusted relative risk: 3.66 [95% confidence interval: 3.41-3.92]; P < .001) and varied by diagnosis. Among those surviving >3 days, more infants with BDs underwent major surgery (48% vs 13%, P < .001). CONCLUSIONS Prevalence of BDs increased during the 10 years studied. BDs remain an important cause of neonatal morbidity and mortality among VLBW infants.
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Affiliation(s)
- Ira Adams-Chapman
- Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, GA, USA.
| | - Nellie I. Hansen
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | | | | | - Abbot R. Laptook
- Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, Rhode Island
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pablo J. Sánchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, Maryland; and
| | - Ellen C. Hale
- Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Nancy S. Newman
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
| | - M. Bethany Ball
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine, and Children’s Healthcare of Atlanta, Atlanta, Georgia
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