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Sayeed S, Reeves BC, Theriault BC, Hengartner AC, Ahsan N, Sadeghzadeh S, Elsamadicy EA, DiLuna M, Elsamadicy AA. Reduced racial disparities among newborns with intraventricular hemorrhage. Childs Nerv Syst 2024; 40:2051-2059. [PMID: 38526575 DOI: 10.1007/s00381-024-06369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Intraventricular hemorrhage (IVH) can ensue permanent neurologic dysfunction, morbidity, and mortality. While previous reports have identified disparities based on patient gender or weight, no prior study has assessed how race may influence in neonatal or infantile IVH patients. The aim of this study was to investigate the impact of race on adverse event (AE) rates, length of stay (LOS), and total cost of admission among newborns with IVH. METHODS Using the 2016-2019 National Inpatient Sample database, newborns diagnosed with IVH were identified using ICD-10-CM codes. Patients were stratified based on race. Patient characteristics and inpatient outcomes were assessed. Multivariate logistic regression analyses were used to identify the impact of race on extended LOS and exorbitant cost. RESULTS Of 1435 patients, 650 were White (45.3%), 270 African American (AA) (18.8%), 300 Hispanic (20.9%), and 215 Other (15.0%). A higher percentage of AA and Other patients than Hispanic and White patients were < 28 days old (p = 0.008). Each of the cohorts had largely similar presenting comorbidities and symptoms, although AA patients did have significantly higher rates of NEC (p < 0.001). There were no observed differences in rates of AEs, rates of mortality, mean LOS, or mean total cost of admission. Similarly, on multivariate analysis, no race was identified as a significant independent predictor of extended LOS or exorbitant cost. CONCLUSIONS Our study found that in newborns with IVH, race is not associated with proxies of poor healthcare outcomes like prolonged LOS or excessive cost. Further studies are needed to validate these findings.
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Affiliation(s)
- Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Brianna C Theriault
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Nabihah Ahsan
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Sina Sadeghzadeh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Emad A Elsamadicy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Vanderbilt University, Nashville, TN, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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Vesoulis ZA, Diggs S, Brackett C, Sullivan B. Racial and geographic disparities in neonatal brain care. Semin Perinatol 2024:151925. [PMID: 38897830 DOI: 10.1016/j.semperi.2024.151925] [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] [Indexed: 06/21/2024]
Abstract
In this review, we explore race-based disparities in neonatology and their impact on brain injury and neurodevelopmental outcomes. We discuss the historical context of healthcare discrimination, focusing on the post-Civil War era and the segregation of healthcare facilities. We highlight the increasing disparity in infant mortality rates between Black and White infants, with premature birth being a major contributing factor, and emphasize the role of prenatal factors such as metabolic syndrome and toxic stress in affecting neonatal health. Furthermore, we examine the geographic and historical aspects of racial disparities, including the consequences of redlining and limited access to healthcare facilities or nutritious food options in Black communities. Finally, we delve into the higher incidence of brain injuries in Black neonates, as well as disparities in adverse neurodevelopmental outcome. This evidence underscores the need for comprehensive efforts to address systemic racism and provide equitable access to healthcare resources.
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Affiliation(s)
- Zachary A Vesoulis
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Stephanie Diggs
- Department of Pediatrics, Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Cherise Brackett
- Department of Pediatrics, Division of Neonatology, University of Virginia, USA
| | - Brynne Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia, USA
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El-Dib I, Farghaly MAA, Saker F, Abu-Shaweesh JM, Alzayyat S, Mohamed MA, Aly H. Chorioamnionitis, Cesarean Deliveries, and Racial Disparities in the USA. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01884-z. [PMID: 38048042 DOI: 10.1007/s40615-023-01884-z] [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: 09/24/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Studies showed disparities in management and outcomes of African American when compared to Caucasian population. The presence of chorioamnionitis may affect the decision to have a cesarean delivery (CD); however, it is not known if such a decision is affected by the mothers' race/ethnicity. OBJECTIVE To assess the interaction between African American race/ethnicity and CD in women with chorioamnionitis. METHODS Utilizing the National Inpatient Sample dataset, we examined the association of CD with chorioamnionitis in the overall population and within Caucasian and African American. Logistic regression models were used to control for confounders. RESULTS The study included 6,648,883 women who delivered 6,925,920 infants. The prevalence of chorioamnionitis was 0.78 and 1.1 in Caucasian and African American, respectively. CD with and without chorioamnionitis was 41.2% and 32.4%, respectively (aOR 1.46 (1.43-1.49), p < 0.001), in Caucasian population and 45.0% and 36.6% in African American population aOR 1.42 (1.37-1.47), p < 0.001. African American population had significantly higher CD after controlling for chorioamnionitis and other confounding variables (aOR of 1.18 (1.17-1.18), p < 0.001). CONCLUSION Chorioamnionitis is associated with increased rate of CD. Ethnic disparities exist in CD rates regardless of the chorioamnionitis status. Such findings warrant further investigation to explore factors associated with this discrepancy.
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Affiliation(s)
- Injy El-Dib
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
- School of Biomedical Engineering, Brown University, Providence, RI, USA
| | - Mohsen A A Farghaly
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA.
| | - Firas Saker
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
| | | | - Sarah Alzayyat
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
- Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Mohamed A Mohamed
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
| | - Hany Aly
- Cleveland Clinic Children's, 9500 Euclid Avenue #M31, Cleveland, OH, 44195, USA
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Kumar P, Polavarapu M. A simple scoring system for prediction of IVH in very-low-birth-weight infants. Pediatr Res 2023; 94:2033-2039. [PMID: 37479747 DOI: 10.1038/s41390-023-02744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND To develop a simple scoring system to predict either any or severe IVH in VLBW infants. METHODS In this retrospective cohort study, 923 VLBW infants were randomly divided into derivation (n = 431) and validation (n = 492) cohorts. After stepwise multivariable logistic regression analyses, a risk score was assigned to independent predictors. RESULTS The overall rates of any and severe IVH were 22.9% and 9.9%. Gestational age, maternal race, location of birth and sex were independent predictors of any IVH (AUC 0.75 in derivation cohort and 0.69 for validation cohort). Birth weight, Apgar score at 1 minute, location of birth and sex were independent predictors of severe IVH (AUC 0.84 in derivation cohort and 0.77 for validation cohort). For any IVH, infants in the high-risk category (total score 4 or 5) had > 50% likelihood of any IVH with a negative predictive value of 82.6%. For severe IVH, the total risk score ranged from 0-8, and infants in high-risk category (total score 6-8) had 30% likelihood of severe IVH with a negative predictive value of 94.9%. CONCLUSION We report an easy to calculate, validated scoring system with a high NPV to identify VLBW infants at highest risk of IVH. IMPACT We report a simple validated scoring system with a high NPV for prediction of IVH in VLBW infants. The variables in the proposed model are available at birth and unlikely to be influenced by provider bias. This scoring system can identify infants at risk of any and severe IVH, while most previous models predict only severe IVH. This scoring system does not require access to web-based resources. This scoring system can help in employing prevention strategies only for infants at highest risk of IVH and thus eliminate the risks of interventions in a large majority of VLBW infants.
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Affiliation(s)
- Praveen Kumar
- Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
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Wege M, von Blanckenburg P, Maier RF, Seifart C. Does Educational Status Influence Parents' Response to Bad News in the NICU? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1729. [PMID: 38002820 PMCID: PMC10670369 DOI: 10.3390/children10111729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023]
Abstract
Communication in neonatal intensive care units and the relationship between families and staff have been reported to influence parental mental well-being. Research has also shown an impact of parental educational level on their well-being. However, whether different educational levels result in different reactions to breaking bad news (BBN) by physicians remains unanswered so far. We therefore examined the impact of parental level of education on their mental state after a BBN conversation and their relation to physicians. A prospective quantitative survey was conducted amongst 54 parents whose preterm or term infants were hospitalized in three German neonatal units. Parental education was classified as low (lower secondary/less (1), n: 23) or high (higher secondary/more (2), n: 31). Parents answered questions about certain aspects of and their mental state after BBN and their trust in physicians. The two groups did not differ significantly in their mental condition after BBN, with both reporting high levels of exhaustion and worries, each (median (min;max): (1): 16 (6;20) vs. (2): 14 (5;20), (scaling: 5-20)). However, lower-educated parents reported a lower trust in physicians (median (min;max): (1): 2 (0;9) vs. (2): 1 (0;6), p < 0.05 (scaling: 0-10)) and felt less safe during BBN (median (min;max): (1): 15 (9;35) vs. (2): 13 (9;33), p < 0.05). Only among higher-educated parents was trust in physicians significantly correlated with the safety and orientation provided during BBN (r: 0.583, p < 0.05, r: 0.584, p < 0.01). Concurrently, only among less-educated parents was safety correlated with the hope conveyed during BBN (r: 0.763, p < 0.01). Therefore, in BBN discussions with less-educated parents, physicians should focus more on giving them hope to promote safety.
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Affiliation(s)
- Mirjam Wege
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, 35032 Marburg, Germany;
| | - Rolf Felix Maier
- Children’s Hospital, University Hospital, Philipps University of Marburg, 35033 Marburg, Germany;
| | - Carola Seifart
- Faculty of Medicine, Deans Office, Research Group Medical Ethics, Philipps University of Marburg, 35033 Marburg, Germany;
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Singh N, Malhotra N, Mahey R, Patel G, Saini M. In vitro fertilization as an independent risk factor for perinatal complications: Single-center 10 years cohort study. JBRA Assist Reprod 2023; 27:197-203. [PMID: 37014951 PMCID: PMC10279444 DOI: 10.5935/1518-0557.20220041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Assisted Reproductive Technology (ART) has made great strides in the past forty-years, but no medical treatment comes without side effects. Despite several studies reporting high incidences of perinatal complications, the association is inconclusive. Also, the effect of racially and ethnically distinguished Asian population undergoing ART on perinatal outcomes is not well studied. Therefore, this study attempts to compare various perinatal outcome parameters in ART, and spontaneously conceived singleton pregnancies from a single high-volume tertiary care center. METHODS This is a retrospective cohort study from a single tertiary infertility center, carried out from January 2011 to September 2020. The study included 1,125 IVF conceived babies (AB group) and 7,193 spontaneous conceived babies (SB group). The groups were compared using the Pearson Chi-square test and adjusted odds ratio, calculated using the multivariate analysis. RESULTS Most of the perinatal complications, such as preterm birth (PTB), early preterm birth, low birth weight (LBW), extremely low birth weight, small for gestational age, large for gestational age babies, neonatal intensive care unit (NICU) admission, need for surfactant, meconium aspiration syndrome, neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and patent ductus arteriosus was significantly increased in the AB group when compared to the SB group (p<0.05). In-vitro fertilization (IVF) independently increases the risk of LBW (aOR 2.530; 95% CI 2.194-2.917), PTB (aOR 4.004; 95% CI 3.496-4.587), NICU admission (aOR 2.003; 95% CI 1.610-2.492) and neonatal seizures (aOR 9.805; 95% CI 5.755-16.706).Conclusions: All ART-conceived pregnant patients should receive antenatal counselling regarding perinatal complications and should deliver at a tertiary care center with appropriate NICU support.
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Affiliation(s)
- Neeta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Reeta Mahey
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Patel
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Monika Saini
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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Chawla S, Natarajan G, Laptook AR, Chowdhury D, Bell EF, Ambalavanan N, Carlo WA, Gantz M, Das A, Tapia JL, Harmon HM, Shankaran S. Model for severe intracranial hemorrhage and role of early indomethacin in extreme preterm infants. Pediatr Res 2022; 92:1648-1656. [PMID: 35301420 PMCID: PMC9481746 DOI: 10.1038/s41390-022-02012-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND To develop a model for prediction of severe intracranial hemorrhage (ICH) or death based on variables from the first 12 h of age and to compare mortality and morbidities with and without exposure to early indomethacin. METHODS This retrospective cohort study included extreme preterm (220/7-266/7 weeks) infants born at National Institute of Child Health and Human Development Neonatal Research Network sites. Primary outcome was a composite of severe ICH and/or death. RESULTS Of 4624 infants, 1827 received early indomethacin. Lower gestation, lack of antenatal steroids exposure, lower 1-min Apgar, male sex, and receipt of epinephrine were associated with severe ICH or death. Early indomethacin was associated with a lower risk of patent ductus arteriosus, bronchopulmonary dysplasia, and higher risk of spontaneous intestinal perforation. CONCLUSIONS A model for early prediction of severe ICH/death was developed and validated. Early indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of spontaneous intestinal perforation. CLINICAL TRIAL REGISTRATION Not applicable. IMPACT Modern data on severe ICH and neonatal morbidities in relation to prophylactic indomethacin are scarce in the published literature. Prophylactic indomethacin was associated with a lower risk of patent ductus arteriosus and bronchopulmonary dysplasia and a higher risk of intestinal perforation. A risk estimator for severe intracranial hemorrhage/death was developed in a large cohort of extremely preterm infants. The risk estimator developed based on a large cohort of patients provides an estimate of severe intracranial bleeding for an individual infant.
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Affiliation(s)
- Sanjay Chawla
- Department of Pediatrics, Wayne State University, Detroit, MI, USA.
- Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
- Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - Abbot R Laptook
- Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA
| | - Dhuly Chowdhury
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | | | - Waldemar A Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marie Gantz
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Rockville, MD, USA
| | - Jose L Tapia
- Departamento de Neonatologia, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Heidi M Harmon
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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Karvonen KL, Goronga F, McKenzie-Sampson S, Rogers EE. Racial disparities in the development of comorbid conditions after preterm birth: A narrative review. Semin Perinatol 2022; 46:151657. [PMID: 36153273 DOI: 10.1016/j.semperi.2022.151657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Faith Goronga
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
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Paturu M, Triplett RL, Thukral S, Alexopoulos D, Smyser CD, Limbrick DD, Strahle JM. Does ventricle size contribute to cognitive outcomes in posthemorrhagic hydrocephalus? Role of early definitive intervention. J Neurosurg Pediatr 2022; 29:10-20. [PMID: 34653990 PMCID: PMC8743027 DOI: 10.3171/2021.4.peds212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Posthemorrhagic hydrocephalus (PHH) is associated with significant morbidity, smaller hippocampal volumes, and impaired neurodevelopment in preterm infants. The timing of temporary CSF (tCSF) diversion has been studied; however, the optimal time for permanent CSF (pCSF) diversion is unknown. The objective of this study was to determine whether cumulative ventricle size or timing of pCSF diversion is associated with neurodevelopmental outcome and hippocampal size in preterm infants with PHH. METHODS Twenty-five very preterm neonates (born at ≤ 32 weeks' gestational age) with high-grade intraventricular hemorrhage (IVH), subsequent PHH, and pCSF diversion with a ventriculoperitoneal shunt (n = 20) or endoscopic third ventriculostomy (n = 5) were followed until 2 years of age. Infants underwent serial cranial ultrasounds from birth until 1 year after pCSF diversion, brain MRI at term-equivalent age, and assessment based on the Bayley Scales of Infant and Toddler Development, Third Edition, at 2 years of age. Frontooccipital horn ratio (FOHR) measurements were derived from cranial ultrasounds and term-equivalent brain MRI. Hippocampal volumes were segmented and calculated from term-equivalent brain MRI. Cumulative ventricle size until the time of pCSF diversion was estimated using FOHR measurements from each cranial ultrasound performed prior to permanent intervention. RESULTS The average gestational ages at tCSF and pCSF diversion were 28.9 and 39.0 weeks, respectively. An earlier chronological age at the time of pCSF diversion was associated with larger right hippocampal volumes on term-equivalent MRI (Pearson's r = -0.403, p = 0.046) and improved cognitive (r = -0.554, p = 0.047), motor (r = -0.487, p = 0.048), and language (r = -0.414, p = 0.021) outcomes at 2 years of age. Additionally, a smaller cumulative ventricle size from birth to pCSF diversion was associated with larger right hippocampal volumes (r = -0.483, p = 0.014) and improved cognitive (r = -0.711, p = 0.001), motor (r = -0.675, p = 0.003), and language (r = -0.618, p = 0.011) outcomes. There was no relationship between time to tCSF diversion or cumulative ventricle size prior to tCSF diversion and neurodevelopmental outcome or hippocampal size. Finally, a smaller cumulative ventricular size prior to either tCSF diversion or pCSF diversion was associated with a smaller ventricular size 1 year after pCSF diversion (r = 0.422, p = 0.040, R2 = 0.178 and r = 0.519, p = 0.009, R2 = 0.269, respectively). CONCLUSIONS In infants with PHH, a smaller cumulative ventricular size and shorter time to pCSF diversion were associated with larger right hippocampal volumes, improved neurocognitive outcomes, and reduced long-term ventriculomegaly. Future prospective randomized studies are needed to confirm these findings.
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Affiliation(s)
- Mounica Paturu
- Department of Neurological Surgery, Washington University in St. Louis, Missouri
| | | | - Siddhant Thukral
- Department of Neurological Surgery, Washington University in St. Louis, Missouri
| | | | - Christopher D. Smyser
- Department of Neurology, Washington University in St. Louis, Missouri
- Department of Pediatrics, Washington University in St. Louis, Missouri
- Department of Radiology, Washington University in St. Louis, Missouri
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University in St. Louis, Missouri
| | - Jennifer M. Strahle
- Department of Neurological Surgery, Washington University in St. Louis, Missouri
- Department of Pediatrics, Washington University in St. Louis, Missouri
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10
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Otun A, Morales DM, Garcia-Bonilla M, Goldberg S, Castaneyra-Ruiz L, Yan Y, Isaacs AM, Strahle JM, McAllister JP, Limbrick DD. Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity. Fluids Barriers CNS 2021; 18:62. [PMID: 34952604 PMCID: PMC8710025 DOI: 10.1186/s12987-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00295-8.
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Affiliation(s)
- Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Seth Goldberg
- Department of Nephrology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | | | - Yan Yan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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11
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Law JB, Wood TR, Gogcu S, Comstock BA, Dighe M, Perez K, Puia-Dumitrescu M, Mayock DE, Heagerty PJ, Juul SE. Intracranial Hemorrhage and 2-Year Neurodevelopmental Outcomes in Infants Born Extremely Preterm. J Pediatr 2021; 238:124-134.e10. [PMID: 34217769 PMCID: PMC8551011 DOI: 10.1016/j.jpeds.2021.06.071] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/26/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine the incidence, timing, progression, and risk factors for intracranial hemorrhage (ICH) in infants 240/7 to 276/7 weeks of gestational age and to characterize the association between ICH and death or neurodevelopmental impairment (NDI) at 2 years of corrected age. STUDY DESIGN Infants enrolled in the Preterm Erythropoietin Neuroprotection Trial had serial cranial ultrasound scans performed on day 1, day 7-9, and 36 weeks of postmenstrual age to evaluate ICH. Potential risk factors for development of ICH were examined. Outcomes included death or severe NDI as well as Bayley Scales of Infant and Toddler Development, 3rd Edition, at 2 years of corrected age. RESULTS ICH was identified in 38% (n = 339) of 883 enrolled infants. Multiple gestation and cesarean delivery reduced the risk of any ICH on day 1. Risk factors for development of bilateral Grade 2, Grade 3, or Grade 4 ICH at day 7-9 included any ICH at day 1; 2 or more doses of prenatal steroids decreased risk. Bilateral Grade 2, Grade 3, or Grade 4 ICH at 36 weeks were associated with previous ICH at day 7-9. Bilateral Grade 2, any Grade 3, and any Grade 4 ICH at 7-9 days or 36 weeks of postmenstrual age were associated with increased risk of death or severe NDI and lower Bayley Scales of Infant and Toddler Development, 3rd Edition, scores. CONCLUSIONS Risk factors for ICH varied by timing of bleed. Bilateral and increasing grade of ICH were associated with death or NDI in infants born extremely preterm.
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Affiliation(s)
- Janessa B Law
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Thomas R. Wood
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Semsa Gogcu
- Division of Neonatology, Department of Pediatrics, Wake
Forest School of Medicine, NC
| | | | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle,
WA
| | - Krystle Perez
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Mihai Puia-Dumitrescu
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | - Dennis E. Mayock
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
| | | | - Sandra E. Juul
- Division of Neonatology, Department of Pediatrics,
University of Washington, Seattle, WA
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12
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Glazer KB, Zeitlin J, Egorova NN, Janevic T, Balbierz A, Hebert PL, Howell EA. Hospital Quality of Care and Racial and Ethnic Disparities in Unexpected Newborn Complications. Pediatrics 2021; 148:peds.2020-024091. [PMID: 34429339 PMCID: PMC9708325 DOI: 10.1542/peds.2020-024091] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate racial and ethnic differences in unexpected, term newborn morbidity and the influence of hospital quality on disparities. METHODS We used 2010-2014 birth certificate and discharge abstract data from 40 New York City hospitals in a retrospective cohort study of 483 834 low-risk (term, singleton, birth weight ≥2500 g, without preexisting fetal conditions) neonates. We classified morbidity according to The Joint Commission's unexpected newborn complications metric and used multivariable logistic regression to compare morbidity risk among racial and ethnic groups. We generated risk-standardized complication rates for each hospital using mixed-effects logistic regression to evaluate quality, ranked hospitals on this measure, and assessed differences in the racial and ethnic distribution of births across facilities. RESULTS The unexpected complications rate was 48.0 per 1000 births. Adjusted for patient characteristics, morbidity risk was higher among Black and Hispanic infants compared with white infants (odds ratio: 1.5 [95% confidence interval 1.3-1.9]; odds ratio: 1.2 [95% confidence interval 1.1-1.4], respectively). Among the 40 hospitals, risk-standardized complications ranged from 25.3 to 162.8 per 1000 births. One-third of Black and Hispanic women gave birth in hospitals ranking in the highest-morbidity tertile, compared with 10% of white and Asian American women (P < .001). CONCLUSIONS Black and Hispanic women were more likely to deliver in hospitals with high complication rates than were white or Asian American women. Findings implicate hospital quality in contributing to preventable newborn health disparities among low-risk, term births. Quality improvement targeting routine obstetric and neonatal care is critical for equity in perinatal outcomes.
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Affiliation(s)
- Kimberly B. Glazer
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Zeitlin
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center of Research in Epidemiology and Statistics Sorbonne Paris Cité, Université de Paris and Institut National de la Santé et de la Recherche Médicale, Institut National de la Recherche Agronomique, Paris, France
| | - Natalia N. Egorova
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Teresa Janevic
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy Balbierz
- Departments of Population Health Science and Policy, and Obstetrics, Gynecology and Reproductive Science, and Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York;,Grossman School of Medicine, New York University, New York, New York
| | - Paul L. Hebert
- School of Public Health, University of Washington, Seattle, Washington
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Weydig HM, Rosenfeld CR, Jaleel MA, Burchfield PJ, Frost MS, Brion LP. Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension. J Perinatol 2021; 41:1660-1668. [PMID: 34035455 DOI: 10.1038/s41372-021-01090-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/14/2021] [Accepted: 04/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Randomized trials of antenatal steroids (ANS) included women at 24-33 weeks gestational age (GA); however, few women had preeclampsia and women with diabetes mellitus (DM) were excluded. METHODS Cohort study including preterm births at 230/7-286/7 weeks GA before (Epoch-1) and after (Epoch-2) expansion of ANS administration to women with DM and hypertensive disorders (HTN). We compared Group-A (neither DM nor HTN) and Group-B (DM and/or HTN). RESULTS Among 747 neonates the adjusted odds ratio (aOR) for surfactant administration, in-hospital mortality, severe intraventricular hemorrhage (IVH) and death or severe IVH were lower in ANS-exposed neonates than unexposed neonates. In Group-B, ANS administration was independently associated with less severe IVH and less death or severe IVH, but not less surfactant use or mortality. CONCLUSIONS Increased ANS administration in women with DM and/or HTN was independently associated with less severe IVH and less death or severe IVH but without decrease in surfactant administration.
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Affiliation(s)
- Heather M Weydig
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles R Rosenfeld
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mambarambath A Jaleel
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patti J Burchfield
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mackenzie S Frost
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luc P Brion
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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14
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Chawla S, Chock VY, Lakshminrusimha S. Intraventricular hemorrhage and white matter injury: is persistent cerebral desaturation a missing link? Pediatr Res 2021; 89:727-729. [PMID: 33247218 DOI: 10.1038/s41390-020-01294-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Sanjay Chawla
- Central Michigan University, Children's Hospital of Michigan, 3901 Beaubien, Detroit, MI, 48201, USA.
| | - Valerie Y Chock
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, 750 Welch Road, Suite 315, Palo Alto, CA, 94304, USA
| | - Satyan Lakshminrusimha
- Department of Pediatrics-Neonatology, University of California Davis, 2516 Stockton Blvd, Sacramento, CA, 95817, USA
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15
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Elevated supine midline head position for prevention of intraventricular hemorrhage in VLBW and ELBW infants: a retrospective multicenter study. J Perinatol 2021; 41:278-285. [PMID: 32901115 DOI: 10.1038/s41372-020-00809-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/03/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the impact of elevated supine midline head position on intraventricular hemorrhage (IVH) in very-low-birth-weight (VLBW) infants. STUDY DESIGN We reviewed data from four Level III/IV units. Two of these units (mid-line group) cared for infants in midline position and the other two (routine care group) provided routine care. We compared incidence of any and severe IVH in two groups using multivariate logistic regression analyses. RESULTS Of 2201 VLBW infants, 1041 were extremely-low-birth-weight (ELBW). Odds of any IVH were not different either for VLBW or ELBW infants. Odds of severe IVH were higher for VLBW infants in mid-line group (OR 1.43, 95% CI 1.007-2.02; p value 0.046) but not for ELBW infants (OR 0.9, 95% CI 0.6-1.4; p value 0.73). CONCLUSIONS The incidence of any IVH was similar in the two groups but the incidence of severe IVH was higher in VLBW infants in mid-line group.
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16
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Gillam-Krakauer M, Slaughter JC, Cotton RB, Robinson BE, Reese J, Maitre NL. Outcomes in infants < 29 weeks of gestation following single-dose prophylactic indomethacin. J Perinatol 2021; 41:109-118. [PMID: 32948814 PMCID: PMC7499931 DOI: 10.1038/s41372-020-00814-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/05/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prophylactic indomethacin (3 doses) decreases patent ductus arteriosus (PDA) and intraventricular hemorrhage (IVH) in preterm infants. The study aim was to determine whether single-dose indomethacin (SD-INDO) decreases PDA, IVH, and improves motor function. METHODS A retrospective cohort (2007-2014) compared infants born < 29 weeks who did (n = 299) or did not (n = 85) receive SD-INDO and estimated outcomes association with ordinal logistic regression, adjusting for multiple variables using propensity scores. RESULTS Infants who received SD-INDO were more premature (p < 0.001) but had lower odds of PDA (OR 0.26 [0.15, 0.44], p < 0.005), PDA receiving treatment (OR 0.12 [0.03, 0.47], p < 0.005), death (OR 0.41 [0.20, 0.86], p = 0.02), and CP severity (OR 0.33 [0.12, 0.89], p = 0.03). There was less IVH (OR 0.58 [0.36, 0.94], p = 0.03) when adjusted for gestational age. CONCLUSIONS SD-INDO is associated with decreased PDA and CP severity and improved survival.
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Affiliation(s)
- Maria Gillam-Krakauer
- Mildred T. Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - James C. Slaughter
- grid.412807.80000 0004 1936 9916Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Robert B. Cotton
- grid.412807.80000 0004 1936 9916Mildred T. Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Blaine E. Robinson
- grid.412807.80000 0004 1936 9916Vanderbilt University Medical Center, Nashville, TN USA
| | - Jeff Reese
- grid.412807.80000 0004 1936 9916Mildred T. Stahlman Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN USA ,grid.412807.80000 0004 1936 9916Department of Cell and Developmental Biology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Nathalie L. Maitre
- grid.240344.50000 0004 0392 3476Department of Pediatrics Nationwide Children’s Hospital, Columbus, OH USA ,grid.412807.80000 0004 1936 9916Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN USA
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17
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Travers CP, Carlo WA, McDonald SA, Das A, Ambalavanan N, Bell EF, Sánchez PJ, Stoll BJ, Wyckoff MH, Laptook AR, Van Meurs KP, Goldberg RN, D’Angio CT, Shankaran S, DeMauro SB, Walsh MC, Peralta-Carcelen M, Collins MV, Ball MB, Hale EC, Newman NS, Profit J, Gould JB, Lorch SA, Bann CM, Bidegain M, Higgins RD. Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016. JAMA Netw Open 2020; 3:e206757. [PMID: 32520359 PMCID: PMC7287569 DOI: 10.1001/jamanetworkopen.2020.6757] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. OBJECTIVE To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. MAIN OUTCOMES AND MEASURES Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. RESULTS In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. CONCLUSIONS AND RELEVANCE Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.
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Affiliation(s)
- Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Scott A. McDonald
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, Maryland
| | | | | | - Pablo J. Sánchez
- Nationwide Children’s Hospital, Department of Pediatrics, The Ohio State University, Columbus
| | - Barbara J. Stoll
- Children’s Healthcare of Atlanta, Grady Memorial Hospital, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Abbot R. Laptook
- Women and Infants’ Hospital, Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | | | - Carl T. D’Angio
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Sara B. DeMauro
- The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Michele C. Walsh
- Rainbow Babies and Children’s Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | | | - Monica V. Collins
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - M. Bethany Ball
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Ellen C. Hale
- Children’s Healthcare of Atlanta, Grady Memorial Hospital, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy S. Newman
- Rainbow Babies and Children’s Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey B. Gould
- Division of Neonatal and Developmental Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Scott A. Lorch
- The Children’s Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia
| | - Carla M. Bann
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina
| | | | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
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18
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Murosko D, Passerella M, Lorch S. Racial Segregation and Intraventricular Hemorrhage in Preterm Infants. Pediatrics 2020; 145:e20191508. [PMID: 32381625 DOI: 10.1542/peds.2019-1508] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, we investigated the association between RRS and IVH. METHODS A retrospective cohort of neonates born between 24 and 32 weeks' gestation was constructed by using birth certificates linked to medical records from California, Missouri, and Pennsylvania between 1995 and 2009. Dissimilarity, a measure of RRS indicating the proportion of minorities in the census tract of the mother in comparison to the larger metropolitan area, was linked to patient data, yielding a cohort of 70 775 infants. Propensity score analysis matched infants born to mothers living in high segregation to those living in less segregated areas on the basis of race, sociodemographic factors, and medical comorbidities to compare the risk of developing IVH. RESULTS Infants born to mothers in the most segregated quartile had a greater risk of developing IVH compared with those in the lowest quartile (12.9% vs 10.4%; P < .001). In 17 918 pairs matched on propensity scores, the risk of developing IVH was greater in the group exposed to a segregated environment (risk ratio = 1.08, 95% confidence interval: 1.01-1.15). This effect was stronger for black infants alone (risk ratio = 1.16; 95% confidence interval: 1.03-1.30). CONCLUSIONS RRS is associated with an increased risk of IVH in preterm neonates, but the effect size varies by race. This association persists after balancing for community factors and birth weight, representing a novel risk factor for IVH.
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Affiliation(s)
- Daria Murosko
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - Molly Passerella
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
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19
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Wu Y, Song J, Wang Y, Wang X, Culmsee C, Zhu C. The Potential Role of Ferroptosis in Neonatal Brain Injury. Front Neurosci 2019; 13:115. [PMID: 30837832 PMCID: PMC6382670 DOI: 10.3389/fnins.2019.00115] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/30/2019] [Indexed: 01/08/2023] Open
Abstract
Ferroptosis is an iron-dependent form of cell death that is characterized by early lipid peroxidation and different from other forms of regulated cell death in terms of its genetic components, specific morphological features, and biochemical mechanisms. Different initiation pathways of ferroptosis have been reported, including inhibition of system Xc -, inactivation of glutathione-dependent peroxidase 4, and reduced glutathione levels, all of which ultimately promote the production of reactive oxygen species, particularly through enhanced lipid peroxidation. Although ferroptosis was first described in cancer cells, emerging evidence now links mechanisms of ferroptosis to many different diseases, including cerebral ischemia and brain hemorrhage. For example, neonatal brain injury is an important cause of developmental impairment and of permanent neurological deficits, and several types of cell death, including iron-dependent pathways, have been detected in the process of neonatal brain damage. Iron chelators and erythropoietin have both shown neuroprotective effects against neonatal brain injury. Here, we have summarized the potential relation between ferroptosis and neonatal brain injury, and according therapeutic intervention strategies.
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Affiliation(s)
- Yanan Wu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juan Song
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yafeng Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carsten Culmsee
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Changlian Zhu
- Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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20
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SHARIAT M, MOHAGHEGHI P, FARAHANI Z, KHALESI N, NAKHOSTIN M. Comparison of Risk Factors Related to Intraventricular Hemorrhage between Preterm Infants Born After Normal and in Vitro Fertilization Conceptions. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:71-78. [PMID: 30598675 PMCID: PMC6296703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 11/22/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aimed to compare the level of significance of risk factors related Intraventricular hemorrhage (IVH) between preterm infants born after IVF and non-IVF conceptions. MATERIALS & METHODS This historical cohort study was done in four Iranian Hospitals in 2013-2014. Overall, 155 preterm newborns were divided into case (IVF) and control (normal conception) groups. Both groups' demographic data were extracted and recorded. The incidence of IVH and its grades were compared between case and control groups. Significant related risk factors were also considered. RESULTS No differences were observed between 2 groups except for gestational age and mode of delivery. The incidence of IVH especially grades II and III were significantly higher in the case group (P=0.003). Results showed no correlations between Gestational age (GA), birth weight and number of gestations with the incidence of IVH in the case group (0.059, 0.85 and 0.49, respectively). On the other hand, among GA, birth weight and number of gestations; multi gestations (P=0.0001) was an effective risk factor for IVH occurrence in the controls. CONCLUSION The incidence of IVH in the IVF group was significantly higher than in the non-IVF group. IVF as an independent risk factor may cause high-grade IVH; however, in the controls, multi gestational pregnancy (P=0.0001) was an effective risk factor for IVH occurrence.
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Affiliation(s)
- Mamak SHARIAT
- Maternal & Child Health Specialist, Maternal-Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital,Tehran, Iran
| | - Parisa MOHAGHEGHI
- Neonatologist, Pediatrics Department, Ali-Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra FARAHANI
- Maternal & Child Health Specialist, Maternal-Fetal & Neonatal Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital,Tehran, Iran
| | - Nasrin KHALESI
- Neonatologist, Pediatrics Department, Ali-Asghar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam NAKHOSTIN
- Department of Infectious Diseases,Tehran University of Medical Sciences, Tehran, Iran
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21
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Chiriboga N, Cortez J, Pena-Ariet A, Makker K, Smotherman C, Gautam S, Trikardos AB, Knight H, Yeoman M, Burnett E, Beier A, Cohen I, Hudak ML. Successful implementation of an intracranial hemorrhage (ICH) bundle in reducing severe ICH: a quality improvement project. J Perinatol 2019; 39:143-151. [PMID: 30348961 DOI: 10.1038/s41372-018-0257-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/28/2018] [Accepted: 10/04/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Our specific, measurable, attainable, relevant, and time-limited (SMART) aim was to reduce the incidence of severe intracranial hemorrhage (ICH) among preterm infants born <30 weeks' gestation from a baseline of 24% (January 2012-December 2013) to a long-term average of 11% by December 2015. STUDY DESIGN We instituted an ICH bundle consisting of elements of the "golden hour" (delayed cord clamping, optimized cardiopulmonary resuscitation, improved thermoregulation) and provision of cluster care in the neonatal intensive care unit (NICU). We identified key drivers to achieve our SMART aims, and implemented quality improvement (QI) cycles: initiation of the ICH bundle, education of NICU staff, and emphasis on sustained adherence. We excluded infants born outside our facility and those with congenital anomalies. RESULTS Using statistical process control analysis (p-chart), the ICH bundle was associated with successful reduction in severe ICH (grade 3-4) in our NICU from a prebundle rate of 24% (January 2012-December 2013) to a sustained reduction over the next 4 years to an average rate of 9.7% by December 2017. Results during 2016-2017 showed a sustained improvement beyond the goal for 2014-2015. Over the same interval, there was improvement in admission temperatures [median 36.1 °C (interquartile range: 35.3-36.7 °C) vs. 37.1 °C (36.8-37.5 °C), p < 0.01] and a decrease in mortality rate [pre: 16/117 (14%) vs. post: 16/281 (6%), P < 0.01]. CONCLUSION Our multidisciplinary QI initiative decreased severe ICH in our institution from a baseline rate of 24% to a lower rate of 9.7% over the ensuing 4 years. Intensive focus on sustained implementation of an ICH bundle protocol consisting of improved delivery room management, thermoregulation, and clustered care in the NICU was temporally associated with a clinically significant reduction in severe ICH.
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Affiliation(s)
- Nicolas Chiriboga
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Josef Cortez
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.
| | - Adriana Pena-Ariet
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Shiva Gautam
- Center for Health Equity and Quality Research, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Allison Blair Trikardos
- Department of Women's and Children's Nursing Services, Neonatal Intensive Care Unit, University of Florida Health Jacksonville, Jacksonville, FL, USA
| | - Holly Knight
- Department of Rehabilitation Services, Neonatal Intensive Care Unit, University of Florida Health Jacksonville, Jacksonville, FL, USA
| | - Mark Yeoman
- Department of Women's and Children's Nursing Services, Neonatal Intensive Care Unit, University of Florida Health Jacksonville, Jacksonville, FL, USA
| | - Erin Burnett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Alexandra Beier
- Department of Neurosurgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Inbal Cohen
- Department of Radiology, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA
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22
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Randis TM, Rice MM, Myatt L, Tita ATN, Leveno KJ, Reddy UM, Varner MW, Thorp JM, Mercer BM, Dinsmoor MJ, Ramin SM, Carpenter MW, Samuels P, Sciscione A, Tolosa JE, Saade G, Sorokin Y. Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis. J Perinat Med 2018; 46:926-933. [PMID: 29791315 PMCID: PMC6177287 DOI: 10.1515/jpm-2017-0192] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/06/2018] [Indexed: 01/19/2023]
Abstract
Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the "clinical diagnosis" of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as "suspected" or "confirmed" based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Results Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16-5.08)] and confirmed [OR 4.93 (1.65-14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70-2.61)], respiratory distress [OR 3.14 (2.16-4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01-3.60)] and 4-7 [OR 1.71 (1.43-2.04)] and 5 min Apgar score of 4-7 [OR 1.67 (1.17-2.37)] (vs. 8-10). Conclusion Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.
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Affiliation(s)
- Tara M. Randis
- Department of Pediatrics, Columbia University, New York, NewYork
| | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
| | - Alan T. N. Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth J. Leveno
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uma M. Reddy
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Michael W. Varner
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - John M. Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian M. Mercer
- Department of Obstetrics and Gynecology, Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
| | - Mara J Dinsmoor
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Susan M. Ramin
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Philip Samuels
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania
| | - Jorge E. Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - George Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
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23
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Robinson S, Conteh FS, Oppong AY, Yellowhair TR, Newville JC, Demerdash NE, Shrock CL, Maxwell JR, Jett S, Northington FJ, Jantzie LL. Extended Combined Neonatal Treatment With Erythropoietin Plus Melatonin Prevents Posthemorrhagic Hydrocephalus of Prematurity in Rats. Front Cell Neurosci 2018; 12:322. [PMID: 30319361 PMCID: PMC6167494 DOI: 10.3389/fncel.2018.00322] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/06/2018] [Indexed: 12/15/2022] Open
Abstract
Posthemorrhagic hydrocephalus of prematurity (PHHP) remains a global challenge. Early preterm infants (<32 weeks gestation), particularly those exposed to chorioamnionitis (CAM), are prone to intraventricular hemorrhage (IVH) and PHHP. We established an age-appropriate, preclinical model of PHHP with progressive macrocephaly and ventriculomegaly to test whether non-surgical neonatal treatment could modulate PHHP. We combined prenatal CAM and postnatal day 1 (P1, equivalent to 30 weeks human gestation) IVH in rats, and administered systemic erythropoietin (EPO) plus melatonin (MLT), or vehicle, from P2 to P10. CAM-IVH rats developed progressive macrocephaly through P21. Macrocephaly was accompanied by ventriculomegaly at P5 (histology), and P21 (ex vivo MRI). CAM-IVH rats showed impaired performance of cliff aversion, a neonatal neurodevelopmental test. Neonatal EPO+MLT treatment prevented macrocephaly and cliff aversion impairment, and significantly reduced ventriculomegaly. EPO+MLT treatment prevented matted or missing ependymal motile cilia observed in vehicle-treated CAM-IVH rats. EPO+MLT treatment also normalized ependymal yes-associated protein (YAP) mRNA levels, and reduced ependymal GFAP-immunolabeling. Vehicle-treated CAM-IVH rats exhibited loss of microstructural integrity on diffusion tensor imaging, which was normalized in EPO+MLT-treated CAM-IVH rats. In summary, combined prenatal systemic inflammation plus early postnatal IVH caused progressive macrocephaly, ventriculomegaly and delayed development of cliff aversion reminiscent of PHHP. Neonatal systemic EPO+MLT treatment prevented multiple hallmarks of PHHP, consistent with a clinically viable, non-surgical treatment strategy.
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Affiliation(s)
- Shenandoah Robinson
- Division of Pediatric Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Fatu S Conteh
- Division of Pediatric Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Akosua Y Oppong
- Division of Pediatric Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Tracylyn R Yellowhair
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Jessie C Newville
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States.,Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Nagat El Demerdash
- Division of Pediatric Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Christine L Shrock
- Division of Pediatric Neurosurgery, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Jessie R Maxwell
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Stephen Jett
- Department of Cell Biology and Physiology, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Frances J Northington
- Division of Neonatology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Lauren L Jantzie
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States.,Department of Neurosciences, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Villamor-Martinez E, Fumagalli M, Mohammed Rahim O, Passera S, Cavallaro G, Degraeuwe P, Mosca F, Villamor E. Chorioamnionitis Is a Risk Factor for Intraventricular Hemorrhage in Preterm Infants: A Systematic Review and Meta-Analysis. Front Physiol 2018; 9:1253. [PMID: 30271352 PMCID: PMC6142185 DOI: 10.3389/fphys.2018.01253] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/20/2018] [Indexed: 12/29/2022] Open
Abstract
Although chorioamnionitis (CA) is a well-known risk factor for white matter disease of prematurity, the association with intraventricular hemorrhage (IVH) is controversial and has not been yet systematically reviewed. We performed a systematic review and meta-analysis of studies exploring the association between CA and IVH. A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE, from their inception to 1 July 2017. Studies were included if they examined preterm infants and reported primary data that could be used to measure the association between exposure to CA and the presence of IVH. A random-effects model was used to calculate odds ratios (OR) and 95% confidence intervals (CI). We found 1,284 potentially relevant studies, of which 85 met the inclusion criteria (46,244 infants, 13,432 CA cases). Meta-analysis showed that CA exposure was significantly associated with all grades IVH (OR 1.88, 95% CI 1.61-2.19), with grades 1-2 IVH (OR 1.69, 95% CI 1.22-2.34), and with grades 3-4 IVH (OR 1.62, 95% CI 1.42-1.85). Both clinical and histological CA were associated with an increased risk for developing IVH in very preterm infants. In contrast, the presence of funisitis did not increase IVH risk when compared to CA in the absence of funisitis (OR 1.22, 95% CI 0.89-1.67). Further meta-analyses confirmed earlier findings that CA-exposed infants have significantly lower gestational age (GA; mean difference [MD] -1.20 weeks) and lower birth weight (BW; MD -55 g) than the infants not exposed to CA. However, meta-regression and subgroup analysis could not demonstrate an association between the lower GA and BW and the risk of IVH in the CA-exposed infants. In conclusion, our data show that CA is a risk factor for IVH, but also a risk factor for greater prematurity and more clinical instability. In contrast to other complications of prematurity, such as patent ductus arteriosus, retinopathy of prematurity, or bronchopulmonary dysplasia, the effect of CA on IVH appears to be independent of CA as causative factor for very preterm birth.
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Affiliation(s)
- Eduardo Villamor-Martinez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Owais Mohammed Rahim
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Sofia Passera
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pieter Degraeuwe
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
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Incidence Trends and Risk Factor Variation in Severe Intraventricular Hemorrhage across a Population Based Cohort. J Pediatr 2018; 200:24-29.e3. [PMID: 29754865 PMCID: PMC6109595 DOI: 10.1016/j.jpeds.2018.04.020] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/16/2018] [Accepted: 04/10/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To quantify the current burden of severe intraventricular hemorrhage (IVH), describe time trends in severe IVH, identify IVH-associated risk factors, and determine the contribution of mediating factors. STUDY DESIGN The retrospective cohort included infants 220/7-316/7 weeks of gestation without severe congenital anomalies, born at hospitals in the California Perinatal Quality Care Collaborative between 2005 and 2015. The primary study outcome was severe (grade III or IV) IVH. RESULTS Of 44 028 infants, 3371 (7.7%) had severe IVH. The incidence of severe IVH decreased significantly across California from 9.7% in 2005 to 5.9% in 2015. After stratification by gestational age, antenatal steroid exposure was the only factor associated with a decreased odds of severe IVH for all gestational age subgroups. Other factors, including delivery room intubation, were associated with an increased odds of severe IVH, though significance varied by gestational age. Factors analyzed in the mediation analysis accounted for 45.6% (95% CI 38.7%-71.8%) of the reduction in severe IVH, with increased antenatal steroid administration and decreased delivery room intubation mediating a significant proportion of this decrease, 19.4% (95% CI 13.9%-27.5%) and 27.3% (95% CI 20.3%-39.2%), respectively. The unaccounted proportion varied by gestational age. CONCLUSIONS The incidence of severe IVH decreased across California, associated with changes in antenatal steroid exposure and delivery room intubation. Maternal, patient, and delivery room factors accounted for less than one-half of the decrease in severe IVH. Study of other factors, specifically neonatal intensive care unit and hospital-level factors, may provide new insights into policies to reduce severe IVH.
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26
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Natarajan G, Shankaran S, Saha S, Laptook A, Das A, Higgins R, Stoll BJ, Bell EF, Carlo WA, D'Angio C, DeMauro SB, Sanchez P, Van Meurs K, Vohr B, Newman N, Hale E, Walsh M. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants. J Pediatr 2018; 195:66-72.e3. [PMID: 29395186 PMCID: PMC5869095 DOI: 10.1016/j.jpeds.2017.11.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2017] [Accepted: 11/16/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. RESULTS Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. CONCLUSION Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.
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Affiliation(s)
| | | | - Shampa Saha
- RTI International, Research Triangle Park, NC
| | - Abbot Laptook
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Abhik Das
- RTI International, Research Triangle Park, NC
| | - Rosemary Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Barbara J Stoll
- Department of Pediatrics, UT Health McGovern Medical School, Houston, TX
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL
| | - Carl D'Angio
- University of Rochester Medical Center, Rochester, NY
| | - Sara B DeMauro
- Department of Pediatrics, University of Pennsylvania, PA
| | - Pablo Sanchez
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH
| | - Krisa Van Meurs
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA
| | - Betty Vohr
- Women and Infants Hospital of Rhode Island, Providence, RI
| | - Nancy Newman
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
| | | | - Michele Walsh
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH
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27
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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28
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Grisaru-Granovsky S, Boyko V, Lerner-Geva L, Hammerman C, Rottenstreich M, Samueloff A, Schimmel MS, Reichman B. The mortality of very low birth weight infants: the benefit and relative impact of changes in population and therapeutic variables. J Matern Fetal Neonatal Med 2018; 32:2443-2451. [DOI: 10.1080/14767058.2018.1438398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Valentina Boyko
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Liat Lerner-Geva
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Michael S. Schimmel
- Department of Neonatology, Shaare Zedek Medical Center, affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Brian Reichman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Women & Children’s Health Research Unit, Gertner Institute, Tel Hashomer, Israel
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29
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Abstract
OBJECTIVES Determine the prevalence of intraventricular hemorrhage in infants with moderate to severe congenital heart disease, investigate the impact of gestational age, cardiac diagnosis, and cardiac intervention on intraventricular hemorrhage, and compare intraventricular hemorrhage rates in preterm infants with and without congenital heart disease. DESIGN A single-center retrospective review. SETTING A tertiary care children's hospital. PATIENTS All infants admitted to St. Louis Children's Hospital from 2007 to 2012 with moderate to severe congenital heart disease requiring cardiac intervention in the first 90 days of life and all preterm infants without congenital heart disease or congenital anomalies/known genetic diagnoses admitted during the same time period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cranial ultrasound data were reviewed for presence/severity of intraventricular hemorrhage. Head CT and brain MRI data were also reviewed in the congenital heart disease infants. Univariate analyses were undertaken to determine associations with intraventricular hemorrhage, and a final multivariate logistic regression model was performed. There were 339 infants with congenital heart disease who met inclusion criteria and 25.4% were born preterm. Intraventricular hemorrhage was identified on cranial ultrasound in 13.3% of infants, with the majority of intraventricular hemorrhage being low-grade (grade I/II). The incidence increased as gestational age decreased such that intraventricular hemorrhage was present in 8.7% of term infants, 19.2% of late preterm infants, 26.3% of moderately preterm infants, and 53.3% of very preterm infants. There was no difference in intraventricular hemorrhage rates between cardiac diagnoses. Additionally, the rate of intraventricular hemorrhage did not increase after cardiac intervention, with only three infants demonstrating new/worsening high-grade (grade III/IV) intraventricular hemorrhage after surgery. In a multivariate model, only gestational age at birth and African-American race were predictors of intraventricular hemorrhage. In the subset of infants with CT/MRI data, there was good sensitivity and specificity of cranial ultrasound for presence of intraventricular hemorrhage. CONCLUSIONS Infants with congenital heart disease commonly develop intraventricular hemorrhage, particularly when born preterm. However, the vast majority of intraventricular hemorrhage is low-grade and is associated with gestational age and African-American race.
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Washburn LK, Nixon PA, Snively BM, Russell GB, Shaltout HA, South AM, O’Shea TM. Antenatal corticosteroids and cardiometabolic outcomes in adolescents born with very low birth weight. Pediatr Res 2017; 82:697-703. [PMID: 28574979 PMCID: PMC5599338 DOI: 10.1038/pr.2017.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/24/2017] [Indexed: 01/01/2023]
Abstract
BackgroundExposure to antenatal corticosteroids (ANCS) is associated with adverse cardiometabolic outcomes in animal models; however, long-term outcomes in clinical studies are not well characterized. We hypothesized that exposure to ANCS would be associated with markers of increased cardiometabolic risk in adolescents born with very low birth weight (VLBW).MethodsIn an observational cohort of 186 14-year-old adolescents born with VLBW, we measured resting blood pressure (BP), BP response to cold, ambulatory BP, and anthropometrics; performed dual-energy X-ray absorptiometry; and analyzed blood samples for uric acid, cholesterol, glycated hemoglobin, and high-sensitivity C-reactive protein. Multivariate analyses were used to evaluate associations with ANCS, adjusting for race, sex, and maternal hypertensive pregnancy.ResultsThere were no ANCS group differences in BP measures or blood biomarkers. Compared with adolescents unexposed to ANCS, those exposed to ANCS were taller (exposed-unexposed mean difference 3.1 cm (95% confidence interval (CI) 0.7, 5.5)) and had decreased waist-to-height ratio (exposed-unexposed mean difference -0.03 (95% CI -0.058, -0.002)). Males exposed to ANCS had lower total cholesterol (exposed-unexposed mean difference -0.54 mmol/l (95%CI -0.83, -0.06)).ConclusionAmong adolescents born with VLBW, ANCS exposure was not associated with markers of increased cardiometabolic risk.
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Affiliation(s)
- Lisa K. Washburn
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - Patricia A. Nixon
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Beverly M. Snively
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Gregory B. Russell
- Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Hossam A. Shaltout
- Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC,Department of Pharmacology and Toxicology, School of Pharmacy, University of Alexandria, Alexandria, Egypt
| | - Andrew M. South
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC,Hypertension and Vascular Research Center, Wake Forest School of Medicine, Winston-Salem, NC
| | - T. Michael O’Shea
- Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
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Wallace ME, Mendola P, Kim SS, Epps N, Chen Z, Smarr M, Hinkle SN, Zhu Y, Grantz KL. Racial/ethnic differences in preterm perinatal outcomes. Am J Obstet Gynecol 2017; 216:306.e1-306.e12. [PMID: 27865977 DOI: 10.1016/j.ajog.2016.11.1026] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Racial disparities in preterm birth and infant death have been well documented. Less is known about racial disparities in neonatal morbidities among infants who are born at <37 weeks of gestation. OBJECTIVE The purpose of this study was to determine whether the risk for morbidity and death among infants who are born preterm differs by maternal race. STUDY DESIGN A retrospective cohort design included medical records from preterm deliveries of 19,325 black, Hispanic, and white women in the Consortium on Safe Labor. Sequentially adjusted Poisson models with generalized estimating equations estimated racial differences in the risk for neonatal morbidities and death, controlling for maternal demographics, health behaviors, and medical history. Sex differences between and within race were examined. RESULTS Black preterm infants had an elevated risk for perinatal death, but there was no difference in risk for neonatal death across racial groups. Relative to white infants, black infants were significantly more likely to experience sepsis (9.1% vs 13.6%), peri- or intraventricular hemorrhage (2.6% vs 3.3%), intracranial hemorrhage (0.6% vs 1.8%), and retinopathy of prematurity (1.0% vs 2.6%). Hispanic and white preterm neonates had similar risk profiles. In general, female infants had lower risk relative to male infants, with white female infants having the lowest prevalence of a composite indicator of perinatal death or any morbidity across all races (30.9%). Differences in maternal demographics, health behaviors, and medical history did little to influence these associations, which were robust to sensitivity analyses of pregnancy complications as potential underlying mechanisms. CONCLUSION Preterm infants were at similar risk for neonatal death, regardless of race; however, there were notable racial disparities and sex differences in rare, but serious, adverse neonatal morbidities.
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Affiliation(s)
- Maeve E Wallace
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Pauline Mendola
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Sung Soo Kim
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Nikira Epps
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Melissa Smarr
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Stefanie N Hinkle
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Yeyi Zhu
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD
| | - Katherine L Grantz
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD.
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Schushan-Eisen I, Maayan-Metzger A, Mazkereth R, Leibovitch L, Strauss T. Risk factors for brain damage among preterm twins. J Matern Fetal Neonatal Med 2017; 31:489-493. [PMID: 28140706 DOI: 10.1080/14767058.2017.1288210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM To evaluate the perinatal and postnatal risk factors for various brain pathologies among preterm twins. METHODS Retrospective data of 104 twin pairs of which one of the siblings had evidence of abnormal head ultrasound (HUS) and its co-twin with normal HUS served as control. RESULTS Abnormal HUS consisted of periventricular echodensities among 69 infants, intraventricular hemorrhage among 28 infants, cystic periventricular leukomalacia among 10 infants, and other parenchymal brain pathologies among 5 infants. Perinatal and postnatal complications were similar between study and controls. Siblings with severe brain pathologies were ventilated for longer time over their co-twins. In 10 out of 11 cases of discordant twins (≥20%) with severe brain pathology, the severe pathology was recorded in the larger sibling. CONCLUSIONS Our study results, which included matched preterm twin pairs for study/control groups to evaluate risk factors for the overall evidence of brain injury, could not determine specific risk factors for these brain pathologies. The finding that severe brain pathologies were more common among the larger co-twin requires further study of and attention to short- and long-term outcomes and the potential conflicts that may arise.
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Affiliation(s)
- Irit Schushan-Eisen
- a Department of Neonatology , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Ayala Maayan-Metzger
- a Department of Neonatology , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Ram Mazkereth
- a Department of Neonatology , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Leah Leibovitch
- a Department of Neonatology , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Tzipora Strauss
- a Department of Neonatology , The Edmond and Lily Safra Children's Hospital, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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Chawla S, Natarajan G, Shankaran S, Pappas A, Stoll BJ, Carlo WA, Saha S, Das A, Laptook AR, Higgins RD. Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids. JAMA Pediatr 2016; 170:1164-1172. [PMID: 27723868 PMCID: PMC5294968 DOI: 10.1001/jamapediatrics.2016.1936] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants. OBJECTIVE To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS. DESIGN, SETTING, AND PARTICIPANTS In this observational cohort study, participants were extremely premature infants (birth weight range, 401-1000 g; gestational age, 22-27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016. MAIN OUTCOMES AND MEASURES Rates of death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness. RESULTS There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65.5%). Additionally, death or neurodevelopmental impairment occurred in 68.1%, 54.4%, and 48.1% of patients in the no, partial, and complete ANS groups, respectively. Logistic regression analysis revealed that complete (odds ratio, 0.63; 95% CI, 0.53-0.76) and partial (odds ratio, 0.77; 95% CI, 0.63-0.95) ANS courses were associated with lower rates of death or neurodevelopmental impairment compared with the no ANS group. The reduction in the rate of death or neurodevelopmental impairment associated with exposure to a complete ANS course may be mediated through a reduction in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia in the neonatal period. CONCLUSIONS AND RELEVANCE Antenatal steroid exposure was associated with a dose-dependent protective effect against death or neurodevelopmental impairment in extremely preterm infants. The effect was partly mediated by ANS-associated reductions in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia. These results support prompt administration of ANS, with the goal of a complete course prior to delivery.
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Affiliation(s)
- Sanjay Chawla
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Seetha Shankaran
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | | | | | - Shampa Saha
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Abhik Das
- Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
| | - Abbot R. Laptook
- Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Abstract
Intraventricular hemorrhage (IVH) is a multifactorial disorder, the most important risk factors of which are prematurity and low birth weight. Disturbances in cerebral blood flow, inherent fragility of the germinal matrix vasculature, and platelet/coagulation disturbances are the 3 major pathogenic mechanisms. In this context, we investigated the role of platelet indices and several maternal and neonatal characteristics in the development of IVH through a retrospective cohort analysis of 130 extremely premature neonates, 24% of whom presented with severe IVH. There was a significant difference in platelet counts between the IVH and the control group on the first day of life (P=0.046). Presence of IVH was linked with lower birth weight (P=0.006) and lower gestational age (P=0.001). Platelet count on the first day of life was positively correlated with survival (P=0.001) and, along with platelet mass, was indicative of the worst IVH grade recorded for each neonate (P=0.002 and 0.007, respectively). Prolonged prothrombin time was also correlated with IVH (P<0.001), but factor analysis supported no prominent role. Maternal medications seem to play a minor role as well. In conclusion, IVH in extremely premature infants cannot be solely explained by platelet parameters, and further studies are required to determine the relationships between IVH, platelet indices, and outcomes.
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Anderson JG, Baer RJ, Partridge JC, Kuppermann M, Franck LS, Rand L, Jelliffe-Pawlowski LL, Rogers EE. Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study. Pediatrics 2016; 138:peds.2015-4434. [PMID: 27302979 DOI: 10.1542/peds.2015-4434] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To assess the rates of mortality and major morbidity among extremely preterm infants born in California and to examine the rates of neonatal interventions and timing of death at each gestational age. METHODS A retrospective cohort study of all California live births from 2007 through 2011 linked to vital statistics and hospital discharge records, whose best-estimated gestational age at birth was 22 through 28 weeks. Major morbidities were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Survival beyond the first calendar day of life and procedure codes were used to assess attempted resuscitation after birth. RESULTS A total of 6009 infants born at 22 through 28 weeks' gestation were included. Survival to 1 year for all live births ranged from 6% at 22 weeks to 94% at 28 weeks. Seventy-three percent of deaths occurred within the first week of life. Major morbidity was present in 80% of all infants, and multiple major morbidities were present in 66% of 22- and 23-week infants. Rates of resuscitation at 22, 23, and 24 weeks were 21%, 64%, and 93%, respectively. Survival after resuscitation was 31%, 42%, and 64% among 22-, 23-, and 24-week infants, respectively. Improved survival was associated with increased birth weight, female sex, and cesarean delivery (P < .01) for resuscitated 22-, 23-, and 24-week infants. CONCLUSIONS In a population-based study of extreme prematurity, infants ≤24 weeks' gestation are at highest risk of death or major morbidity. These data can help inform recommendations and decision-making for extremely preterm births.
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Affiliation(s)
| | - Rebecca J Baer
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | | | | | - Linda S Franck
- School of Nursing, University of California San Francisco, San Francisco, California; and
| | - Larry Rand
- Obstetrics, Gynecology, and Reproductive Sciences, and
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Ma L, Wen XH, Yang HB, Huang JH, Chen N. [Influencing factors for brain injury in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:471-475. [PMID: 27324531 PMCID: PMC7389088 DOI: 10.7499/j.issn.1008-8830.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the incidence of different types of brain injury in preterm infants and their influencing factors. METHODS The clinical data and head magnetic resonance imaging (MRI) findings of 239 preterm infants were collected, and the influence of antepartum, intrapartum, and postpartum factors on brain injury in preterm infants was analyzed. RESULTS The incidence rate of brain injury in preterm infants was 25.5%; among these infants, 10.5% had hemorrhagic brain injury, 10.5% had ischemic brain injury, and 4.6% and hemorrhagic and ischemic brain injury. The infants with a lower gestational age had higher incidence rates of hemorrhagic brain injury and overall brain injury (P<0.01). The incidence rates of ischemic brain injury and hemorrhagic and ischemic brain injury were not correlated with gestational age (P>0.05). The incidence rates of hemorrhagic, ischemic, and overall brain injury were not correlated with birth weight (P>0.05). Multiparity (OR=0.292, 95%CI 0.088-0.972) and cesarean section (OR=0.075, 95%CI 0.015-0.368) were protective factors against brain injury in infants with a gestational age of <34 weeks; cesarean section (OR=0.296, 95%CI 0.131-0.672) was the protective factor against brain injury in infants with a gestational age of ≤34 weeks, and severe infection (OR=8.176, 95%CI 1.202-55.617) was the risk factor. CONCLUSIONS In order to prevent or reduce the occurrence of brain injury in preterm infants. the gestational age of preterm infants should be prolonged as much as possible and the indications for cesarean section should be grasped. Infections should be prevented and if occurring should be treated actively and effectively.
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Affiliation(s)
- Li Ma
- Department of Pediatrics, Third Affiliated Hospital of Anhui Medical University, Hefei 230061, China.
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A novel method for assessing cerebral autoregulation in preterm infants using transfer function analysis. Pediatr Res 2016; 79:453-9. [PMID: 26571222 PMCID: PMC4821724 DOI: 10.1038/pr.2015.238] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/11/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Autoregulatory dysfunction is an important contributor to brain injury in premature infants, particularly intraventricular hemorrhage (IVH). The autoregulatory system acts as a filter that dampens the systemic blood flow to follow a normal cerebral perfusion profile. METHODS Simultaneous arterial blood pressure and cerebral near-infrared spectroscopy (NIRS) data were collected from infants born before 28 wk estimated gestational age. The resulting data were preprocessed and then divided into nonoverlapping 20-min epochs. The transfer function estimate was calculated to determine dampening ability. RESULTS Sixty-two infants were prospectively recruited with a mean estimated gestational age of 25.4 ± 1.3 wk and birth weight of 832 ± 199 g. 67% were male, 24/62 had IVH, 17/62 received dopamine, 47/62 had antenatal steroid exposure, and 22/62 received fentanyl.Advancing estimated gestational age and birth weight z-score predicted stronger dampening while African-American race and IVH of any grade predicted weaker dampening. CONCLUSION This preliminary report suggests an impairment in dampening ability associated with immaturity, decreased birth weight z-score, and African-American race. Decreased dampening is also associated with IVH, although these results cannot distinguish between decreased dampening as an antecedent or sequela of IVH. These observations should be studied in a larger sample.
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Ment LR, Ådén U, Bauer CR, Bada HS, Carlo WA, Kaiser JR, Lin A, Cotten CM, Murray J, Page G, Hallman M, Lifton RP, Zhang H. Genes and environment in neonatal intraventricular hemorrhage. Semin Perinatol 2015; 39:592-603. [PMID: 26516117 PMCID: PMC4668116 DOI: 10.1053/j.semperi.2015.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Emerging data suggest intraventricular hemorrhage (IVH) of the preterm neonate is a complex disorder with contributions from both the environment and the genome. Environmental analyses suggest factors mediating both cerebral blood flow and angiogenesis contribute to IVH, while candidate gene studies report variants in angiogenesis, inflammation, and vascular pathways. Gene-by-environment interactions demonstrate the interaction between the environment and the genome, and a non-replicated genome-wide association study suggests that both environmental and genetic factors contribute to the risk for severe IVH in very low-birth weight preterm neonates.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Mikko Hallman
- University of Oulu and Oulu University Hospital, FIN-90014 Oulu, Finland
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Abstract
Gene-environment interactions likely account for some degree of the variance in response rates that are clinically observed with antenatal corticosteroids, breast milk prophylaxis, surfactant administration, early recognition and treatment of sepsis, utility of non-invasive ventilation, and judicious exposure to supplemental oxygen. While these therapies and practice guidelines have significantly decreased overall neonatal mortality in the NICU, they have not made a marked impact on the frequency and severity of conditions such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and periventricular leukomalacia. One possible explanation is that genetic factors in the neonate modulate response to external intervention or preventative agents, culminating in variable levels of injury and different degrees of resolution and repair. Gene-environment explanations are supported by the observed heritability of BPD in twin studies, but they do not differentiate the interactions between neonate and offending toxin or pathogen, from interactions between neonate and intervention or therapeutic agent. Likely, both kinds of interactions are important in determining outcome.
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Affiliation(s)
- Vineet Bhandari
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
| | - Jeffrey R Gruen
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Yale Child Health Research Center, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Genetics, Yale University School of Medicine, New Haven, CT; Department of Investigative Medicine, Yale University School of Medicine, New Haven, CT
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Esiaba I, Angeles DM, Holden MS, Tan JBC, Asmerom Y, Gollin G, Boskovic DS. Urinary Allantoin Is Elevated in Severe Intraventricular Hemorrhage in the Preterm Newborn. Transl Stroke Res 2015; 7:97-102. [PMID: 25994284 DOI: 10.1007/s12975-015-0405-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 04/06/2015] [Accepted: 05/08/2015] [Indexed: 11/27/2022]
Abstract
Germinal matrix intraventricular hemorrhage (IVH) is the most common type of intracranial hemorrhage observed in preterm neonates. It is a precursor of poor neurocognitive development, cerebral palsy, and death. The pathophysiology is not well defined, but damage to the fragile germinal matrix vasculature may be due to free radicals generated during inflammation and as a consequence of ischemia followed by reperfusion. Assessment of the oxidative stress status in these infants is therefore important. Urinary allantoin concentration was measured in preterm neonates as a marker of oxidative stress associated with IVH. Urine was collected from 44 preterm neonates at four time points between 24 and 72 hours of life (HOL), and the allantoin content was determined by gas chromatography mass spectrometry (GCMS). Records were retrospectively reviewed, and the incidence and severity of IVH was categorized as follows: no IVH (n = 24), mild (grade 1-2) IVH (n = 13), and severe (grade 3-4) IVH (n = 7). Neonates with severe IVH showed significantly elevated allantoin levels vs subjects with no IVH from 36 HOL (0.098 ± 0.013 μmol and 0.043 ± 0.007 μmol, respectively, p = 0.002). The allantoin concentration remained elevated even at 72 HOL (0.079 ± 0.014 μmol and 0.033 ± 0.008 μmol, respectively, p = 0.021). There were no significant differences in allantoin levels in the no IVH and mild IVH groups. IVH was diagnosed by head imaging on average at about 11th postnatal day. Urinary allantoin levels were significantly elevated during the first 3 days of life in the neonates subsequently diagnosed with severe IVH, suggesting that oxidative stress might be a crucial factor in IVH pathogenesis. Further studies are needed to assess the usefulness of urinary allantoin in early identification of preterm infants at risk for or with severe IVH and monitoring of the response to interventions designed to prevent or treat it.
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Affiliation(s)
- Ijeoma Esiaba
- Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Danilyn M Angeles
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Megan S Holden
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - John B C Tan
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Yayesh Asmerom
- Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Gerald Gollin
- Division of Pediatric Surgery, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Danilo S Boskovic
- Department of Earth and Biological Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA. .,Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA. .,Division of Biochemistry, School of Medicine, Loma Linda University, Loma Linda, CA, 92350, USA.
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Peffer ME, Zhang JY, Umfrey L, Rudine AC, Monaghan AP, DeFranco DB. Minireview: the impact of antenatal therapeutic synthetic glucocorticoids on the developing fetal brain. Mol Endocrinol 2015; 29:658-66. [PMID: 25763611 DOI: 10.1210/me.2015-1042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The life-threatening, emotional, and economic burdens of premature birth have been greatly alleviated by antenatal glucocorticoid (GC) treatment. Antenatal GCs accelerate tissue development reducing respiratory distress syndrome and intraventricular hemorrhage in premature infants. However, they can also alter developmental processes in the brain and trigger adverse behavioral and metabolic outcomes later in life. This review summarizes animal model and clinical studies that examined the impact of antenatal GCs on the developing brain. In addition, we describe studies that assess glucocorticoid receptor (GR) action in neural stem/progenitor cells (NSPCs) in vivo and in vitro. We highlight recent work from our group on two GR pathways that impact NSPC proliferation, ie, a nongenomic GR pathway that regulates gap junction intercellular communication between coupled NSPCs through site-specific phosphorylation of connexin 43 and a genomic pathway driven by differential promoter recruitment of a specific GR phosphoisoform.
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Affiliation(s)
- Melanie E Peffer
- Program in Integrative Molecular Biology (M.E.P., D.B.D.), Department of Pharmacology and Chemical Biology (M.E.P., J.Y.Z., L.U., D.B.D.), and Newborn Medicine Program (A.C.R.), Children's Hospital of Pittsburgh, and Department of Neurobiology (A.P.M.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260
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