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Murata T, Isogami H, Imaizumi K, Fukuda T, Kyozuka H, Yasuda S, Yamaguchi A, Sato A, Ogata Y, Shinoki K, Hosoya M, Yasumura S, Hashimoto K, Nishigori H, Fujimori K. Tocolytic treatment and maternal characteristics, obstetric outcomes, and offspring childhood outcomes among births at and after 37 weeks of gestation: the Japan environment and children's study. Arch Gynecol Obstet 2024; 310:1089-1098. [PMID: 37831176 DOI: 10.1007/s00404-023-07203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE To evaluate differences in maternal characteristics and obstetric and offspring childhood outcomes between births at and after 37 weeks of gestation (referred to as term and post-term births) according to the use of tocolytic treatment. METHODS Data for 63,409 women with singleton births at and after 37 weeks of gestation were analyzed using data from the Japan Environment and Children's Study (JECS). We compared maternal characteristics, obstetric outcomes, and offspring childhood outcomes between term and post-term births exposed and not exposed to tocolytic treatment. Additionally, multivariable logistic regression models were used to calculate adjusted odds ratios for offspring childhood outcomes with significant between-group differences in the univariable analysis, with term and post-term births without tocolytic agents as the reference group. RESULTS We observed differences in maternal characteristics and obstetric outcomes between term and post-term births exposed and not exposed to tocolytic treatment. The incidence of offspring childhood developmental disorders showed no significant between-group differences. However, participants exposed to tocolytic agents had higher incidence of offspring childhood allergic disorders. The adjusted odds ratio for any of the offspring childhood allergic disorders in term and post-term births with tocolytic agents was 1.08 (95% confidence interval, 1.03-1.13). CONCLUSION This study found no significant difference in the incidence of offspring developmental disorders between term and post-term births exposed and not exposed to tocolytic treatment. However, tocolytic treatment was associated with differences in maternal characteristics and obstetric outcomes, along with a marginal increase in the incidence of childhood allergic disorders in offspring.
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Affiliation(s)
- Tsuyoshi Murata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Hirotaka Isogami
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Karin Imaizumi
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Toma Fukuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hyo Kyozuka
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shun Yasuda
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Yamaguchi
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Akiko Sato
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuka Ogata
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kosei Shinoki
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuaki Hosoya
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiji Yasumura
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Public Health, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Hashimoto
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Pediatrics, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hidekazu Nishigori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Fukushima Medical Center for Children and Women, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Fukushima Regional Center for the Japan Environment and Children's Study, 1 Hikarigaoka, Fukushima, 960-1295, Japan
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Feddahi N, Hartmann L, Felderhoff-Müser U, Roy S, Lampe R, Maiti KS. Neonatal Exhaled Breath Sampling for Infrared Spectroscopy: Biomarker Analysis. ACS OMEGA 2024; 9:30625-30635. [PMID: 39035909 PMCID: PMC11256302 DOI: 10.1021/acsomega.4c02635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
Monitoring health conditions in neonates for early therapeutic intervention in case deviations from physiological conditions is crucial for their long-term development. Due to their immaturity preterm born neonates are dependent on particularly careful physical and neurological diagnostic methods. Ideally, these should be noninvasive, noncontact, and radiation free. Infrared spectroscopy was used to analyze exhaled breath from 71 neonates with a special emphasis on preterm infants, as a noninvasive, noncontact, and radiation-free diagnostic tool. Passive sample collection was performed by skilled clinicians. Depending on the mode of respiratory support of infants, four different sampling procedures were adapted to collect exhaled breath. With the aid of appropriate reference samples, infrared spectroscopy has successfully demonstrated its effectiveness in the analysis of breath samples of neonates. The discernible increase in concentrations of carbon dioxide, carbon monoxide, and methane in collected samples compared to reference samples served as compelling evidence of the presence of exhaled breath. With regard to technical hurdles and sample analysis, samples collected from neonates without respiratory support proved to be more advantageous compared to those obtained from intubated infants and those with CPAP (continuous positive airway pressure). The main obstacle lies in the significant dilution of exhaled breath in the case of neonates receiving respiratory support. Metabolic analysis of breath samples holds promise for the development of noninvasive biomarker-based diagnostics for both preterm and sick neonates provided an adequate amount of breath is collected.
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Affiliation(s)
- Nadia Feddahi
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Lea Hartmann
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Ursula Felderhoff-Müser
- Center
for Translational and Neurobehavioural Sciences CTNBS, Department
of Pediatrics I, Neonatology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany
| | - Susmita Roy
- Research
Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Pediatric
Neuroorthopaedics, Department of Orthopaedics and Sports Orthopaedics,
TUM School of Medicine and Health, University Hospital Rechts der
Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Renée Lampe
- Research
Unit of the Buhl-Strohmaier Foundation for Cerebral Palsy and Pediatric
Neuroorthopaedics, Department of Orthopaedics and Sports Orthopaedics,
TUM School of Medicine and Health, University Hospital Rechts der
Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
- Markus
Würth Professorship, Technical University
of Munich, Ismaninger
Straße 22, 81675 Munich, Germany
| | - Kiran Sankar Maiti
- TUM
School of Natural Sciences, Department of Chemistry, Technical University of Munich, 85748 Garching, Germany
- Max-Planck-Institut
für Quantenoptik, Hans-Kopfermann-Straße 1, 85748 Garching, Germany
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Tan J, Liu C, Yang M, Xiong Y, Huang S, Qi Y, Chen M, Thabane L, Liu X, He L, Sun X. Investigation of statistical methods used in prognostic prediction models for obstetric care: A 10 year-span cross-sectional study. Acta Obstet Gynecol Scand 2024; 103:611-620. [PMID: 38140844 PMCID: PMC10867372 DOI: 10.1111/aogs.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Obstetric care is a highly active area in the development and application of prognostic prediction models. The development and validation of these models often require the utilization of advanced statistical techniques. However, failure to adhere to rigorous methodological standards could greatly undermine the reliability and trustworthiness of the resultant models. Consequently, the aim of our study was to examine the current statistical practices employed in obstetric care and offer recommendations to enhance the utilization of statistical methods in the development of prognostic prediction models. MATERIAL AND METHODS We conducted a cross-sectional survey using a sample of studies developing or validating prognostic prediction models for obstetric care published in a 10-year span (2011-2020). A structured questionnaire was developed to investigate the statistical issues in five domains, including model derivation (predictor selection and algorithm development), model validation (internal and external), model performance, model presentation, and risk threshold setting. On the ground of survey results and existing guidelines, a list of recommendations for statistical methods in prognostic models was developed. RESULTS A total of 112 eligible studies were included, with 107 reporting model development and five exclusively reporting external validation. During model development, 58.9% of the studies did not include any form of validation. Of these, 46.4% used stepwise regression in a crude manner for predictor selection, while two-thirds made decisions on retaining or dropping candidate predictors solely based on p-values. Additionally, 26.2% transformed continuous predictors into categorical variables, and 80.4% did not consider nonlinear relationships between predictors and outcomes. Surprisingly, 94.4% of the studies did not examine the correlation between predictors. Moreover, 47.1% of the studies did not compare population characteristics between the development and external validation datasets, and only one-fifth evaluated both discrimination and calibration. Furthermore, 53.6% of the studies did not clearly present the model, and less than half established a risk threshold to define risk categories. In light of these findings, 10 recommendations were formulated to promote the appropriate use of statistical methods. CONCLUSIONS The use of statistical methods is not yet optimal. Ten recommendations were offered to assist the statistical methods of prognostic prediction models in obstetric care.
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Affiliation(s)
- Jing Tan
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Chunrong Liu
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Min Yang
- Department of Epidemiology and Biostatistics, West China School of Public HealthSichuan UniversityChengduChina
- Faculty of Health, Design and ArtSwinburne Technology UniversityMelbourneVictoriaAustralia
| | - Yiquan Xiong
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Shiyao Huang
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Yana Qi
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Meng Chen
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Sun
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
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Chung HW, Chen JC, Chen HL, Ko FY, Ho SY. Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study. BMC Med 2024; 22:68. [PMID: 38360711 PMCID: PMC10870669 DOI: 10.1186/s12916-024-03286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Follow-up visits for very preterm infants (VPI) after hospital discharge is crucial for their neurodevelopmental trajectories, but ensuring their attendance before 12 months corrected age (CA) remains a challenge. Current prediction models focus on future outcomes at discharge, but post-discharge data may enhance predictions of neurodevelopmental trajectories due to brain plasticity. Few studies in this field have utilized machine learning models to achieve this potential benefit with transparency, explainability, and transportability. METHODS We developed four prediction models for cognitive or motor function at 24 months CA separately at each follow-up visits, two for the 6-month and two for the 12-month CA visits, using hospitalized and follow-up data of VPI from the Taiwan Premature Infant Follow-up Network from 2010 to 2017. Regression models were employed at 6 months CA, defined as a decline in The Bayley Scales of Infant Development 3rd edition (BSIDIII) composite score > 1 SD between 6- and 24-month CA. The delay models were developed at 12 months CA, defined as a BSIDIII composite score < 85 at 24 months CA. We used an evolutionary-derived machine learning method (EL-NDI) to develop models and compared them to those built by lasso regression, random forest, and support vector machine. RESULTS One thousand two hundred forty-four VPI were in the developmental set and the two validation cohorts had 763 and 1347 VPI, respectively. EL-NDI used only 4-10 variables, while the others required 29 or more variables to achieve similar performance. For models at 6 months CA, the area under the receiver operating curve (AUC) of EL-NDI were 0.76-0.81(95% CI, 0.73-0.83) for cognitive regress with 4 variables and 0.79-0.83 (95% CI, 0.76-0.86) for motor regress with 4 variables. For models at 12 months CA, the AUC of EL-NDI were 0.75-0.78 (95% CI, 0.72-0.82) for cognitive delay with 10 variables and 0.73-0.82 (95% CI, 0.72-0.85) for motor delay with 4 variables. CONCLUSIONS Our EL-NDI demonstrated good performance using simpler, transparent, explainable models for clinical purpose. Implementing these models for VPI during follow-up visits may facilitate more informed discussions between parents and physicians and identify high-risk infants more effectively for early intervention.
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Affiliation(s)
- Hao Wei Chung
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ju-Chieh Chen
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiu-Lin Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fang-Yu Ko
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Shinn-Ying Ho
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-Devices, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
- College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Demirci GM, Kittler PM, Phan HTT, Gordon AD, Flory MJ, Parab SM, Tsai CL. Predicting mental and psychomotor delay in very pre-term infants using machine learning. Pediatr Res 2024; 95:668-678. [PMID: 37500755 PMCID: PMC10899098 DOI: 10.1038/s41390-023-02713-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/25/2023] [Accepted: 06/15/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Very preterm infants are at elevated risk for neurodevelopmental delays. Earlier prediction of delays allows timelier intervention and improved outcomes. Machine learning (ML) was used to predict mental and psychomotor delay at 25 months. METHODS We applied RandomForest classifier to data from 1109 very preterm infants recruited over 20 years. ML selected key predictors from 52 perinatal and 16 longitudinal variables (1-22 mo assessments). SHapley Additive exPlanations provided model interpretability. RESULTS Balanced accuracy with perinatal variables was 62%/61% (mental/psychomotor). Top predictors of mental and psychomotor delay overlapped and included: birth year, days in hospital, antenatal MgSO4, days intubated, birth weight, abnormal cranial ultrasound, gestational age, mom's age and education, and intrauterine growth restriction. Highest balanced accuracy was achieved with 19-month follow-up scores and perinatal variables (72%/73%). CONCLUSIONS Combining perinatal and longitudinal data, ML modeling predicted 24 month mental/psychomotor delay in very preterm infants ½ year early, allowing intervention to start that much sooner. Modeling using only perinatal features fell short of clinical application. Birth year's importance reflected a linear decline in predicting delay as birth year became more recent. IMPACT Combining perinatal and longitudinal data, ML modeling was able to predict 24 month mental/psychomotor delay in very preterm infants ½ year early (25% of their lives) potentially advancing implementation of intervention services. Although cognitive/verbal and fine/gross motor delays require separate interventions, in very preterm infants there is substantial overlap in the risk factors that can be used to predict these delays. Birth year has an important effect on ML prediction of delay in very preterm infants, with those born more recently (1989-2009) being increasing less likely to be delayed, perhaps reflecting advances in medical practice.
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Affiliation(s)
- Gözde M Demirci
- Computer Science Department, The Graduate Center of the City University of NY, New York, NY, USA
| | - Phyllis M Kittler
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Ha T T Phan
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Anne D Gordon
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Michael J Flory
- Department of Infant Development, NYS Institute for Basic Research in Developmental Disabilities, Staten Island, NY, USA
| | - Santosh M Parab
- Pediatrics, Richmond University Medical Center, Staten Island, NY, USA
| | - Chia-Ling Tsai
- Computer Science Department, Queens College of the City University of NY, Flushing, NY, USA.
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Kojima K, Liu C, Ehrlich S, Kline-Fath BM, Jain S, Parikh NA. Early surgery in very preterm infants is associated with brain abnormalities on term MRI: a propensity score analysis. J Perinatol 2023; 43:877-883. [PMID: 36966211 PMCID: PMC10382249 DOI: 10.1038/s41372-023-01645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To investigate the association between exposure to surgery under general anesthesia and brain abnormalities and neurodevelopmental outcomes in very preterm infants. STUDY DESIGN This prospective observational study includes 392 infants born at or below 32 weeks' gestational age. Participants completed brain MRI at term-equivalent age and Bayley-III assessment at 2 years corrected age. We evaluated the independent effects of surgery on brain MRI abnormalities and neurodevelopmental outcomes after propensity score matching. RESULTS All infants completed brain MRI, and 341 (87%) completed neurodevelopmental testing. Forty-five received surgery. Surgery was associated with worse MRI abnormalities (p < 0.0001) but with none of the developmental outcomes after propensity score matching. The global brain abnormality score was associated with the Bayley Cognitive (p = 0.005) and Motor (p = 0.028) composite scores. CONCLUSIONS Very preterm infants exposed to surgery under general anesthesia were at higher risk of brain abnormalities on MRI at term.
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Affiliation(s)
- Katsuaki Kojima
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Shelley Ehrlich
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Beth M Kline-Fath
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Shipra Jain
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
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7
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Routier L, Querne L, Ghostine-Ramadan G, Boulesteix J, Graïc S, Mony S, Wallois F, Bourel-Ponchel E. Predicting the Neurodevelopmental Outcome in Extremely Preterm Newborns Using a Multimodal Prognostic Model Including Brain Function Information. JAMA Netw Open 2023; 6:e231590. [PMID: 36884252 PMCID: PMC9996404 DOI: 10.1001/jamanetworkopen.2023.1590] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
IMPORTANCE Early assessment of the prognosis of preterm newborns is crucial for accurately informing parents and making treatment decisions. The currently available prognostic models rarely incorporate functional brain information from conventional electroencephalography (cEEG). OBJECTIVE To examine the performance of a multimodal model combining (1) brain function information with (2) brain structure information (cranial ultrasonography), and (3) perinatal and (4) postnatal risk factors for the prediction of death or neurodevelopmental impairment (NDI) in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Preterm newborns (23-28 weeks' gestational age) admitted to the neonatal intensive care unit at Amiens-Picardie University Hospital were retrospectively included (January 1, 2013, to January 1, 2018). Risk factors from the 4 categories were collected during the first 2 weeks post delivery. Neurodevelopmental impairment was assessed at age 2 years with the Denver Developmental Screening Test II. No or moderate NDI was considered a favorable outcome. Death or severe NDI was considered an adverse outcome. Data analysis was performed from August 26, 2021, to March 31, 2022. MAIN OUTCOMES AND MEASURES After the selection of variables significantly associated with outcome, 4 unimodal prognostic models (considering each category of variable independently) and 1 multimodal model (considering all variables simultaneously) were developed. After a multivariate analysis for models built with several variables, decision-tree algorithms were run on each model. The areas under the curve for decision-tree classifications of adverse vs favorable outcomes were determined for each model, compared using bootstrap tests, and corrected for type I errors. RESULTS A total of 109 newborns (58 [53.2% male]) born at a mean (SD) gestational age of 26.3 (1.1) weeks were included. Among them, 52 (47.7%) had a favorable outcome at age 2 years. The multimodal model area under the curve (91.7%; 95% CI, 86.4%-97.0%) was significantly higher than those of the unimodal models (P < .003): perinatal model (80.6%; 95% CI, 72.5%-88.7%), postnatal model (81.0%; 95% CI, 72.6%-89.4%), brain structure model (cranial ultrasonography) (76.6%; 95% CI, 67.8%-85.3%), and brain function model (cEEG) (78.8%; 95% CI, 69.9%-87.7%). CONCLUSIONS AND RELEVANCE In this prognostic study of preterm newborns, the inclusion of brain information in a multimodal model was associated with significant improvement in the outcome prediction, which may have resulted from the complementarity of the risk factors and reflected the complexity of the mechanisms that interfered with brain maturation and led to death or NDI.
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Affiliation(s)
- Laura Routier
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- INSERM UMR 1105, Pediatric Neurophysiology Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Laurent Querne
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- Department of Pediatric Neurology, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Ghida Ghostine-Ramadan
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- Neonatal Intensive Care Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Julie Boulesteix
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- Neonatal Intensive Care Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Solène Graïc
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- Neonatal Intensive Care Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Sandrine Mony
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- Neonatal Intensive Care Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Fabrice Wallois
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- INSERM UMR 1105, Pediatric Neurophysiology Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
| | - Emilie Bourel-Ponchel
- INSERM UMR 1105, Research Group on Multimodal Analysis of Brain Function, University of Picardie Jules Verne, Amiens Cedex, France
- INSERM UMR 1105, Pediatric Neurophysiology Unit, Amiens-Picardie University Medical Center, Amiens Cedex, France
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8
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Chebet M, Musaba MW, Mukunya D, Makoko B, Napyo A, Nantale R, Auma P, Atim K, Nahurira D, Lee S, Okello D, Ssegawa L, Bromley K, Burgoine K, Ndeezi G, Tumwine JK, Wandabwa J, Kiguli S. High Burden of Neurodevelopmental Delay among Children Born to Women with Obstructed Labour in Eastern Uganda: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3470. [PMID: 36834165 PMCID: PMC9963417 DOI: 10.3390/ijerph20043470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 05/11/2023]
Abstract
Over 250 million infants in low and middle-income countries do not fulfill their neurodevelopment potential. In this study, we assessed the incidence and risk factors for neurodevelopmental delay (NDD) among children born following obstructed labor in Eastern Uganda. Between October 2021 and April 2022, we conducted a cohort study of 155 children (aged 25 to 44 months), born at term and assessed their neurodevelopment using the Malawi Developmental Assessment Tool. We assessed the gross motor, fine motor, language and social domains of neurodevelopment. The incidence of neurodevelopmental delay by 25 to 44 months was 67.7% (105/155) (95% CI: 59.8-75.0). Children belonging to the poorest wealth quintile had 83% higher risk of NDD compared to children belonging to the richest quintile (ARR (Adjusted Risk Ratio): 1.83; 95% CI (Confidence Interval): [1.13, 2.94]). Children fed the recommended meal diversity had 25% lower risk of neurodevelopmental delay compared to children who did not (ARR: 0.75; 95% CI: [0.60, 0.94]). Children who were exclusively breastfed for the first 6 months had 27% lower risk of neurodevelopmental delay compared to children who were not (ARR: 0.73; 95% CI: [0.56, 0.96]). We recommend that infants born following obstructed labor undergo neurodevelopmental delay screening.
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Affiliation(s)
- Martin Chebet
- Department of Pediatrics and Child Health, Busitema University, Mbale P.O. Box 1460, Uganda
- Department of Global Public Health and Primary Health Care, Centre for International Health, University of Bergen, 5007 Bergen, Norway
| | - Milton W. Musaba
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
- Department of Research, Nikao Medical Center, Kampala P.O. Box 10005, Uganda
| | - Brian Makoko
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Proscovia Auma
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Ketty Atim
- Department of Obstetrics and Gynecology, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Doreck Nahurira
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Seungwon Lee
- Department of Neuroscience, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dedan Okello
- Department of Pediatrics and Child Health, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Lawrence Ssegawa
- Department of Research, Sanyu Africa Research Institute, Mbale P.O. Box 2190, Uganda
| | - Kieran Bromley
- Research Institute for Primary Care and Health Sciences, School of Medicine, Keele University, Newcastle ST5 5BG, UK
| | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale P.O. Box 921, Uganda
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
| | - James K. Tumwine
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
- Department of Pediatrics and Child Health, Kabale University, Kabale P.O. Box 317, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynecology, Busitema University, Mbale P.O. Box 1460, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, Makerere University, Kampala P.O. Box 7062, Uganda
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9
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Bowe AK, Lightbody G, Staines A, Murray DM. Big data, machine learning, and population health: predicting cognitive outcomes in childhood. Pediatr Res 2023; 93:300-307. [PMID: 35681091 PMCID: PMC7614199 DOI: 10.1038/s41390-022-02137-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022]
Abstract
The application of machine learning (ML) to address population health challenges has received much less attention than its application in the clinical setting. One such challenge is addressing disparities in early childhood cognitive development-a complex public health issue rooted in the social determinants of health, exacerbated by inequity, characterised by intergenerational transmission, and which will continue unabated without novel approaches to address it. Early life, the period of optimal neuroplasticity, presents a window of opportunity for early intervention to improve cognitive development. Unfortunately for many, this window will be missed, and intervention may never occur or occur only when overt signs of cognitive delay manifest. In this review, we explore the potential value of ML and big data analysis in the early identification of children at risk for poor cognitive outcome, an area where there is an apparent dearth of research. We compare and contrast traditional statistical methods with ML approaches, provide examples of how ML has been used to date in the field of neurodevelopmental disorders, and present a discussion of the opportunities and risks associated with its use at a population level. The review concludes by highlighting potential directions for future research in this area. IMPACT: To date, the application of machine learning to address population health challenges in paediatrics lags behind other clinical applications. This review provides an overview of the public health challenge we face in addressing disparities in childhood cognitive development and focuses on the cornerstone of early intervention. Recent advances in our ability to collect large volumes of data, and in analytic capabilities, provide a potential opportunity to improve current practices in this field. This review explores the potential role of machine learning and big data analysis in the early identification of children at risk for poor cognitive outcomes.
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Affiliation(s)
- Andrea K. Bowe
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland
| | - Gordon Lightbody
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland ,grid.7872.a0000000123318773Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Anthony Staines
- grid.15596.3e0000000102380260School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Deirdre M. Murray
- grid.7872.a0000000123318773INFANT Research Centre, University College Cork, Cork, Ireland
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10
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Bowe AK, Lightbody G, Staines A, Kiely ME, McCarthy FP, Murray DM. Predicting Low Cognitive Ability at Age 5-Feature Selection Using Machine Learning Methods and Birth Cohort Data. Int J Public Health 2022; 67:1605047. [PMID: 36439276 PMCID: PMC9684182 DOI: 10.3389/ijph.2022.1605047] [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] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/24/2022] [Indexed: 02/10/2024] Open
Abstract
Objectives: In this study, we applied the random forest (RF) algorithm to birth-cohort data to train a model to predict low cognitive ability at 5 years of age and to identify the important predictive features. Methods: Data was from 1,070 participants in the Irish population-based BASELINE cohort. A RF model was trained to predict an intelligence quotient (IQ) score ≤90 at age 5 years using maternal, infant, and sociodemographic features. Feature importance was examined and internal validation performed using 10-fold cross validation repeated 5 times. Results The five most important predictive features were the total years of maternal schooling, infant Apgar score at 1 min, socioeconomic index, maternal BMI, and alcohol consumption in the first trimester. On internal validation a parsimonious RF model based on 11 features showed excellent predictive ability, correctly classifying 95% of participants. This provides a foundation suitable for external validation in an unseen cohort. Conclusion: Machine learning approaches to large existing datasets can provide accurate feature selection to improve risk prediction. Further validation of this model is required in cohorts representative of the general population.
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Affiliation(s)
| | - Gordon Lightbody
- INFANT Research Centre, Cork, Ireland
- Department of Electrical and Electronic Engineering, University College Cork, Cork, Ireland
| | - Anthony Staines
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - Mairead E. Kiely
- INFANT Research Centre, Cork, Ireland
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Fergus P. McCarthy
- INFANT Research Centre, Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Deirdre M. Murray
- INFANT Research Centre, Cork, Ireland
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
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11
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Aubert AM, Costa R, Ådén U, Cuttini M, Männamaa M, Pierrat V, Sarrechia I, van Heijst AF, Zemlin M, Johnson S, Zeitlin J. Movement Difficulties at Age Five Among Extremely Preterm Infants. Pediatrics 2022; 149:188130. [PMID: 35615946 DOI: 10.1542/peds.2021-054920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born extremely preterm (EPT), <28 weeks' gestational age, face higher risks of movement difficulties than their term-born peers. Studies report varying prevalence estimates and prognostic factors identifying children who could benefit from early intervention are inconsistent. This study investigated the prevalence of movement difficulties in children born EPT and associated risk factors. METHODS Data come from a population-based EPT birth cohort in 2011 and 2012 in 11 European countries. Children without cerebral palsy were assessed at 5 years of age (N = 772) with the Movement Assessment Battery for Children-Second Edition, which classifies movement difficulties as none (>15th percentile), at risk (6th-15th percentile) and significant (≤5th percentile). Associations with sociodemographic, perinatal, and neonatal characteristics collected from obstetric and neonatal medical records and parental questionnaires were estimated using multinomial logistic regression. RESULTS We found 23.2% (n = 179) of children were at risk for movement difficulties and 31.7% (n = 244) had significant movement difficulties. Lower gestational age, severe brain lesions, and receipt of postnatal corticosteroids were associated with significant movement difficulties, whereas male sex and bronchopulmonary dysplasia were associated with being at risk and having significant movement difficulties. Children with younger, primiparous, less educated, and non-European-born mothers were more likely to have significant movement difficulties. Differences in prevalence between countries remained after population case-mix adjustments. CONCLUSIONS This study confirms a high prevalence of movement difficulties among EPT children without cerebral palsy, which are associated with perinatal and neonatal risk factors as well as sociodemographic characteristics and country.
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Affiliation(s)
- Adrien M Aubert
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal
| | - Ulrika Ådén
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mairi Männamaa
- Department of Paediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Véronique Pierrat
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
| | - Iemke Sarrechia
- Department of Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Arno F van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Hospital, 66421 Homburg, Germany
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Jennifer Zeitlin
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, F-75004 Paris, France
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12
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Marlow N, Johnson S, Hurst JR. The extremely preterm young adult - State of the art. Semin Fetal Neonatal Med 2022; 27:101365. [PMID: 35710530 DOI: 10.1016/j.siny.2022.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely outcomes in more contemporary cohorts. This review shows the persistence of adverse outcomes through to adult life and includes a range of outcomes including all body systems evaluated. Nonetheless adult outcomes demonstrate that most survivors appear to be free of major disabling conditions and demonstrate good participation in society. Several studies have reported outcomes in the third decade, but subsequent ageing trajectories have not yet been defined. The stability of many of the outcomes evaluated over childhood into adult life and the lack of improvement in prevalence of childhood impairments found in contemporary cohorts indicates persisting levels of risk.
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Affiliation(s)
- Neil Marlow
- Neonatal Medicine, UCL Institute for Women's Health, University College London, London, UK.
| | - Samantha Johnson
- Child Development, Department of Health Sciences, University of Leicester, Leicester, UK
| | - John R Hurst
- Respiratory Medicine, UCL Respiratory, University College London, London, UK
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13
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Colella M, Panfoli I, Doglio M, Cassanello M, Bruschi M, Angelis LCD, Candiano G, Parodi A, Malova M, Petretto A, Morana G, Tortora D, Severino M, Maghnie M, Buonocore G, Rossi A, Baud O, Ramenghi LA. Adenosine Blood Level: A Biomarker of White Matter Damage in Very Low Birth Weight Infants. Curr Pediatr Rev 2022; 18:153-163. [PMID: 35086453 DOI: 10.2174/1573396318666220127155943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Very low birth weight infants are at risk of developing periventricular white matter lesions. We previously reported high blood adenosine levels in premature infants and infants with low birth weight. We asked whether blood adenosine levels could be related to the vulnerability of the maturing white matter to develop lesions. The present study aims at finding a biomarker for the early detection of brain white matter lesions that can profoundly influence the neurodevelopmental outcome, whose pathophysiology is still unclear. METHODS Dried blood spots were prospectively collected for the newborn screening program and adenosine concentration measurements. Fifty-six newborns who tested four times for blood adenosine concentration (at days 3, 15, 30, and 40 post-birth) were included in the program. All infants underwent brain MRI at term equivalent age. Neurodevelopmental outcomes were studied with Griffiths Mental Development Scales (GMDS) at 12 ± 2 months corrected age. RESULTS Blood adenosine concentration increased over time from a median of 0.75 μM at Day 3 to 1.46 μM at Day 40. Adenosine blood concentration >1.58 μM at Day 15 was significantly associated with brain white matter lesions at MRI (OR (95 % CI) of 50.0 (3.6-688.3), p-value < 0.001). A moderate negative correlation between adenosine at 15 days of life and GMDS at 12 ± 2 months corrected age was found. CONCLUSION These findings suggest a potential role for blood adenosine concentration as a biomarker of creberal white matter lesions in very low birth weight infants.
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Affiliation(s)
- Marina Colella
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Pediatrics, The University of Genova, Genoa, Italy
| | - Isabella Panfoli
- Dipartimento di Farmacia-DIFAR, Universitàdi Genova, Genoa, Italy
| | - Matteo Doglio
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Department of Pediatrics, The University of Genova, Genoa, Italy
| | - Michela Cassanello
- LABSIEM-Laboratory for the Study of Inborn Errors of Metabolism, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura C De Angelis
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Parodi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariya Malova
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Petretto
- Laboratory of Mass Spectrometry-Core Facilities, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Department of Pediatric Neuroradiology,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Domenico Tortora
- Department of Pediatric Neuroradiology,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mariasavina Severino
- Department of Pediatric Neuroradiology,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- LABSIEM-Laboratory for the Study of Inborn Errors of Metabolism, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, The University of Siena, Siena, Italy
| | - Andrea Rossi
- Department of Pediatric Neuroradiology,IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Oliver Baud
- Robert Debré hospital, Paris Diderot University, Paris, France
| | - Luca A Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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14
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Definitions of bronchopulmonary dysplasia and long-term outcomes of extremely preterm infants in Korean Neonatal Network. Sci Rep 2021; 11:24349. [PMID: 34934085 PMCID: PMC8692520 DOI: 10.1038/s41598-021-03644-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022] Open
Abstract
New definitions for bronchopulmonary dysplasia (BPD) have recently been suggested, and an accurate diagnosis, including severity classification with proper definition, is crucial to identify high-risk infants for appropriate interventions. To determine whether recently suggested BPD definitions can better predict long-term outcomes of BPD in extremely preterm infants (EPIs) than the original BPD definition, BPD was classified with severity 1, 2, and 3 using three different definitions: definition A (original), National Institute of Child Health and Human Development (NICHD) definition in 2001; definition B, the modified NICHD 2016 definition (graded by the oxygen concentration and the respiratory support at 36 weeks’ postmenstrual age [PMA]); and definition C, the modified Jensen 2019 definition (graded by the respiratory support at 36 weeks’ PMA). We evaluated 1050 EPIs using a national cohort. Whereas EPIs with grade 2 or 3 BPD as per definition A did not show any increase in the risk, EPIs with BPD diagnosed by definition B and C showed significantly increased risk for poor outcomes, such as respiratory mortality and morbidities, neurodevelopmental delay, and growth restriction at 18–24 months of corrected age. The recently suggested definition and severity grading better reflects long-term childhood morbidities than the original definition in EPIs.
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15
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Mukosha M, Kaonga P, Kapembwa KM, Musonda P, Vwalika B, Lubeya MK, Jacobs C. Modelling mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia: a retrospective review of hospital-based records. Pan Afr Med J 2021; 39:69. [PMID: 34422192 PMCID: PMC8363965 DOI: 10.11604/pamj.2021.39.69.27138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction globally, almost half of all deaths in children under five years of age occur among neonates. We investigated the predictors of mortality within 28 days among preterm infants at a tertiary hospital in Lusaka, Zambia. Methods we reviewed admission records linked to birth, mortality, and hospital discharge from 1st January 2018 to 30th September 2019. Information was retrieved with a follow-up period of 28 days post-delivery to discharge/mortality. We used the Weibull hazards regression to establish the best predictor model for mortality among the neonates. Results a total of 3237 case records of women with a median age of 27 years (IQR, 22-33) were included in the study, of which 971 (30%) delivered term infants and 2267 (70%) preterm infants. The overall median survival time of the infants was 98 hours (IQR, 34-360). Preterm birth was not associated with increased hazards of mortality compared to term birth (p=0.078). Being in the Kangaroo Mother Care compared to Neonatal Intensive Care Unit (NICU), and a unit increase in birth weight were independently associated with reduced hazards of mortality. On the other hand, having hypoxic-ischemic encephalopathy, experiencing difficulty in feeding and vaginal delivery compared to caesarean section independently increased the hazards of mortality. Conclusion having hypoxic-ischemic encephalopathy, vaginal delivery, and experiencing difficulty in feeding increases the risk of mortality among neonates. Interventions to reduce neonatal mortality should be directed on these factors in this setting.
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Affiliation(s)
- Moses Mukosha
- Department of Pharmacy, University of Zambia, Lusaka, Zambia.,School of Public Health, University of Zambia, Lusaka, Zambia
| | - Patrick Kaonga
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Patrick Musonda
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Bellington Vwalika
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Mwansa Ketty Lubeya
- Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia.,Young Emerging Scientists Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia
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16
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Daigneault J, White H, Dube A, Shi Q, Gauguet JM, Rhein L. Lack of Progression of Intraventricular Hemorrhage in Premature Infants: Implications for Head Ultrasound Screening. Glob Pediatr Health 2021; 8:2333794X211010729. [PMID: 34046517 PMCID: PMC8138291 DOI: 10.1177/2333794x211010729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/21/2022] Open
Abstract
Very preterm infants are at risk for germinal matrix hemorrhage- intraventricular
hemorrhage (GH-IVH). Severe GH-IVH may cause death or severe neurodevelopmental
disability while mild GH-IVH is considered a static, non-progressive disease.
This retrospective study aimed to determine if infants with no GH-IVH or mild
GH-IVH on initial screening head ultrasound (HUS) advanced to severe GH-IVH. A
total of 353 eligible infants with birth gestational age ≤32 0/7 weeks who
received a HUS during hospitalization were identified. Of the 343 (97%) infants
who had mild GH-IVH (grade II or less) on initial screening, only 4 (1.2%)
progressed to severe (grade III or IV). Each of these infants required
mechanical ventilation for at least 40 days. Therefore, premature infants who
have no GH-IVH or mild GH-IVH on initial routine screening HUS without other
risk factors may not require follow-up HUSs. Infants with prolonged mechanical
ventilation may require further screening despite reassuring initial HUS
findings.
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Affiliation(s)
| | - Heather White
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandra Dube
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Qiming Shi
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Lawrence Rhein
- University of Massachusetts Medical School, Worcester, MA, USA
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17
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Quarshie ENB, Fobi D, Acheampong EK, Honu-Mensah CM, Fobi J, Appau O, Andoh-Arthur J, Oppong Asante K. Suicidal behaviours among deaf adolescents in Ghana: a cross-sectional study. J Public Health (Oxf) 2021; 44:e10-e19. [PMID: 33823043 PMCID: PMC8904192 DOI: 10.1093/pubmed/fdab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/30/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022] Open
Abstract
Background A growing global concern is that suicide research has paid little attention to young people with disabilities, particularly, in low- and middle-income countries (LAMICs). We aimed to estimate the 12-month prevalence of suicidal ideation and attempt and describe some associations among deaf adolescents in Ghana. Methods This is a cross-sectional anonymous self-report survey involving a nationally representative random sample of 450 school-going deaf adolescents. Data analysis included bivariate and multivariable approaches. Results The overall 12-month prevalence of suicidal ideation was 19·3% (95% confidence interval [CI] = 15·8–23·3) and suicidal attempt was 15·6% (95% CI = 12·3–19·2). Although alcohol use and parental divorce were strongly associated with increased odds of both suicidal ideation and attempt, high subjective mental well-being was associated with reduced odds of both suicidal ideation and attempt. Living with no parents and being a final year student were associated with suicidal ideation, while male gender was associated with suicidal attempt. Conclusions The prevalence of suicidal behaviours among school-going deaf adolescents in this study compares with estimates among in-school non-deaf adolescents in Ghana and other LAMICs in Africa, and also highlights the need for prevention efforts against the onset of suicidal ideation and possible transition to attempt and suicide among deaf adolescents.
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Affiliation(s)
- E N B Quarshie
- School of Psychology, University of Leeds, Woodhouse, LS2 9JT, Leeds, UK.,Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana
| | - D Fobi
- School of Education, University of Leeds, Woodhouse, LS2 9JT, Leeds, UK
| | - E K Acheampong
- Department of Special Education, University of Education, P.O Box 25, Winneba, Ghana
| | - C M Honu-Mensah
- Department of Special Education, University of Education, P.O Box 25, Winneba, Ghana
| | - J Fobi
- Department of Special Education, University of Education, P.O Box 25, Winneba, Ghana
| | - O Appau
- Department of Special Education, University of Education, P.O Box 25, Winneba, Ghana
| | - J Andoh-Arthur
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana
| | - K Oppong Asante
- Department of Psychology, University of Ghana, P.O. Box LG 84, Legon, Accra, Ghana
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Hilaire M, Andrianou XD, Lenglet A, Ariti C, Charles K, Buitenhuis S, Van Brusselen D, Roggeveen H, Ledger E, Denat RS, Bryson L. Growth and neurodevelopment in low birth weight versus normal birth weight infants from birth to 24 months, born in an obstetric emergency hospital in Haiti, a prospective cohort study. BMC Pediatr 2021; 21:143. [PMID: 33761917 PMCID: PMC7988959 DOI: 10.1186/s12887-021-02605-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birthweight (LBW) infants are at higher risk of mortality and morbidity (growth, chronic disease and neurological problems) during their life. Due to the high incidence of (pre-) eclampsia in Haiti, LBW infants are common. We assessed the anthropometric growth (weight and length) and neurodevelopmental delay in LBW and normal birthweight (NBW) infants born at an obstetric emergency hospital in Port au Prince, Haiti, between 2014 and 2017. METHODS Infants were followed at discharge and 3, 6, 12, 15, 18, 21 and 24 months of corrected gestational age. At each visit they underwent a physical checkup (weight, length, physical abnormalities, identification of morbidities). At 6, 12, 18 and 24 months they underwent a neurodevelopmental assessment using the Bayley Scale III (motor, cognitive and communication skills). We modelled the trajectories between birth and 24 months of age of NBW compared to LBW infants for weight, length, and raw scores for Bayley III assessments using mixed linear models. RESULTS In total 500 LBW and 210 NBW infants were recruited of which 333 (46.7%) were followed up for 24 months (127 NBW; 60.5% and 206 LBW; 41.2%) and 150 died (LBW = 137 and NBW = 13). LBW and NBW babies gained a mean 15.8 g and 11.4 g per kg of weight from discharge per day respectively. The speed of weight gain decreased rapidly after 3 months in both groups. Both groups grow rapidly up to 6 months of age. LBW grew more than the NBW group during this period (22.8 cm vs. 21.1 cm). Both groups had WHZ scores <- 2 up to 15 months. At 24 months NBW babies scored significantly higher on the Bayley scales for gross motor, cognitive and receptive and expressive communication skills. There was no difference between the groups for fine motor skills. CONCLUSION LBW babies that survive neonatal care in urban Haiti and live up to 24 months of age, perform similar to their NBW for weight, length and fine motor skills. LBW babies are delayed in gross motor, cognitive and communication skills development. Further research on the clinical significance of these findings and long term implications of this neurodevelopmental delay is needed.
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Affiliation(s)
| | - Xanthi D Andrianou
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018DD, Amsterdam, The Netherlands
| | - Annick Lenglet
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018DD, Amsterdam, The Netherlands. .,Department of Medical Microbiology, Radboudumc, Nijmegen, Netherlands.
| | - Cono Ariti
- Centre for Trials Research, Cardiff University Medical School, Cardiff, UK
| | | | | | - Daan Van Brusselen
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018DD, Amsterdam, The Netherlands
| | - Harriet Roggeveen
- Médecins Sans Frontières, Plantage Middenlaan 14, 1018DD, Amsterdam, The Netherlands
| | - Elizabeth Ledger
- Médecins Sans Frontières, Port au Prince, Haiti.,Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine (LSHTM), London, UK
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Predicting the outcomes of preterm neonates beyond the neonatal intensive care unit: What are we missing? Pediatr Res 2021; 89:426-445. [PMID: 32428926 PMCID: PMC7276948 DOI: 10.1038/s41390-020-0968-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/13/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
Preterm infants are a population at high risk for mortality and adverse health outcomes. With recent improvements in survival to childhood, increasing attention is being paid to risk of long-term morbidity, specifically during childhood and young-adulthood. Although numerous tools for predicting the functional outcomes of preterm neonates have been developed in the past three decades, no studies have provided a comprehensive overview of these tools, along with their strengths and weaknesses. The purpose of this article is to provide an in-depth, narrative review of the current risk models available for predicting the functional outcomes of preterm neonates. A total of 32 studies describing 43 separate models were considered. We found that most studies used similar physiologic variables and standard regression techniques to develop models that primarily predict the risk of poor neurodevelopmental outcomes. With a recently expanded knowledge regarding the many factors that affect neurodevelopment and other important outcomes, as well as a better understanding of the limitations of traditional analytic methods, we argue that there is great room for improvement in creating risk prediction tools for preterm neonates. We also consider the ethical implications of utilizing these tools for clinical decision-making. IMPACT: Based on a literature review of risk prediction models for preterm neonates predicting functional outcomes, future models should aim for more consistent outcomes definitions, standardized assessment schedules and measurement tools, and consideration of risk beyond physiologic antecedents. Our review provides a comprehensive analysis and critique of risk prediction models developed for preterm neonates, specifically predicting functional outcomes instead of mortality, to reveal areas of improvement for future studies aiming to develop risk prediction tools for this population. To our knowledge, this is the first literature review and narrative analysis of risk prediction models for preterm neonates regarding their functional outcomes.
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20
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Test of Infant Motor Performance for Infants in Brazil: Unidimensional Model, Item Difficulty, and Motor Function. Pediatr Phys Ther 2020; 32:390-397. [PMID: 32991567 DOI: 10.1097/pep.0000000000000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a need for appropriate tests to identify developmental delays early in life. OBJECTIVE This study investigates the Test of Infant Motor Performance (TIMP) unidimensional model and its ability to explain variance in items response, hierarchic order of the items, levels of difficulty, and the extent to which the items were appropriate to distinguish different levels of function for infants in Brazil. METHODS Six hundred fifty-five infants were assessed. Families provided sociodemographic information. RESULTS Appropriate items reliability (0.99), infit (mean = 0.99; SD = 0.46), outfit (mean = 1.34; SD = 1.58), and point-biserial correlations (-0.36 to 0.92) were obtained. The model explains 74.3% of the variance, and 76.2% of the items had adequate factor relationship. CONCLUSION The TIMP measures a single construct, has items with different levels of difficulty, and is sensitive to detect differences in the performance of distinct groups for infants in Brazil.
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21
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Pascal A, Naulaers G, Ortibus E, Oostra A, De Coen K, Michel S, Cloet E, Casaer A, D'haese J, Laroche S, Jonckheere A, Plaskie K, Van Mol C, Delanghe G, Bruneel E, Van Hoestenberghe MR, Samijn B, Govaert P, Van den Broeck C. Neurodevelopmental outcomes of very preterm and very-low-birthweight infants in a population-based clinical cohort with a definite perinatal treatment policy. Eur J Paediatr Neurol 2020; 28:133-141. [PMID: 32788055 DOI: 10.1016/j.ejpn.2020.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With constant changes in neonatal care practices, recent information is valuable for healthcare providers and for parental counselling. The aim of the study was to describe the neurodevelopmental outcome in a cohort of very preterm (VPT)/very-low-birthweight (VLBW) infants at 2 years corrected age (CA). MATERIAL AND METHODS This is a population-based cohort study of all infants born with a GA <31 weeks and/or BW < 1500 g between 2014 and 2016 admitted to the Flemish (Belgium) neonatal intensive care units. Infants had routine clinical follow-up around 2 years CA. The diagnosis of cerebral palsy (CP), visual and hearing impairments were recorded. Motor, cognitive and language outcomes were assessed using the Bayley-III. Neurodevelopmental impairment (NDI) was classified as mild (<1 standard deviation [SD]) or moderate-severe (<2SD) based on the defined categories of motor, cognitive, hearing, and vision impairments. RESULTS Of the 1941 admissions, 92% survived to discharge and follow-up data were available for 1089 infants (61.1%). Overall, 19.3%, 18.9% and 41.8% of infants had a motor, cognitive and language delay, respectively. CP was diagnosed in 4.3% of the infants. Mild and moderate-to-severe NDI was observed in 25.2% and 10.9% of the infants, respectively. The number of infants with a normal outcome increased from nearly 40% in the category of GA<26 weeks to 70% for infants in the category of 30─31 weeks GA. CONCLUSION At 2 years CA, 64% were free from NDI and 90% were free from moderate-to-severe NDI. However, a lower GA and BW are associated with higher rates of adverse neurodevelopmental outcomes at 2 years CA.
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Affiliation(s)
- Aurelie Pascal
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium. http://
| | - Gunnar Naulaers
- Department of Neonatology, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Els Ortibus
- Centre for Developmental Disorders, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
| | - Ann Oostra
- Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Kris De Coen
- Department of Neonatology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Sonnaert Michel
- Department of Neonatology, University Hospital Brussels, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Eva Cloet
- Department of Pediatric Neurology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Belgium.
| | - Alexandra Casaer
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium; Centre for Developmental Disorders, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - James D'haese
- Department of Neonatology, AZ Sint-Jan, Brugge, Ruddershove 10, 8000, Brugge, Belgium.
| | - Sabrina Laroche
- Department of Neonatology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium; Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - An Jonckheere
- Centre for Developmental Disorders, University Hospital Antwerp, Wilrijkstraat 10, 2650, Antwerp, Belgium.
| | - Katleen Plaskie
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Christine Van Mol
- Department of Neonatology, GasthuisZusters Antwerpen, Oosterveldlaan 24, Antwerp, Belgium.
| | - Gwenda Delanghe
- Department of Neonatology, Algemeen Ziekenhuis Middelheim, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Els Bruneel
- Department of Neonatology, Algemeen Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.
| | | | - Bieke Samijn
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Paul Govaert
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Christine Van den Broeck
- Department of Rehabilitation Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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Levinson M, Parvez B, Aboudi D, Shah S. Impact of maternal stressors and neonatal clinical factors on post-partum depression screening scores. J Matern Fetal Neonatal Med 2020; 35:1328-1336. [PMID: 32316772 DOI: 10.1080/14767058.2020.1754394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Higher rates of postpartum depression (PPD) are reported in mothers of neonatal intensive care unit (NICU) hospitalized infants. The relationship of neonatal clinical risk factors and self-reported maternal stress levels to positive PPD screening is not well characterized.Objective: To determine the feasibility of postpartum depression screening in a regional perinatal center, and assess the association of NICU-specific comorbidities and maternal stress levels with PPD screening scores.Design/Methods: Prospective study of mothers of NICU-hospitalized infants conducted between 21and 30 days of their infant's life. Mothers completed the Edinburgh Postpartum Depression scale (EPDS) and the Parental Stressor Scale: NICU (PSS: NICU) in the environmental, infant behavior and parental domains. Total EPDS scores and positive PPD screening were correlated with NICU comorbidities, demographic factors and PSS: NICU scores.Results: The incidence of positive PPD screening was 19% (25/135). In bivariate analysis, positive PPD screen was associated with exclusive breastfeeding (67% vs, 35%, p < .05) and maternal age <35 years (32% vs. 12%, p < .05). No observed differences in maternal and infant demographic factors or neonatal comorbidities were seen in mothers with positive PPD screening. Mean PPD screening scores were higher in infants with intraventricular hemorrhage of any grade and necrotizing enterocolitis. In adjusted analysis, overall and domain-specific PSS: NICU scores were associated with positive PPD screening.Conclusion: Cumulatively and within each PSS: NICU domain, parental stress correlated with positive PPD screening but was unrelated to NICU comorbidities. Reducing modifiable factors which exacerbate parental stress may impact the incidence of positive PPD screening among NICU mothers.
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Affiliation(s)
- Michelle Levinson
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - Boriana Parvez
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - David Aboudi
- New York City Department of Health and Mental Hygiene, Division of Mental Health Statistics, New York, NY, USA
| | - Shetal Shah
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY, USA
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23
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Kratimenos P, Christidis P, Kehinde F, Koutroulis I, Santana S, Mossabeb R, Fleishman R. Association between hemoglobin concentrations at discharge from the neonatal intensive care unit with markers of neurodevelopmental outcomes in premature neonates. J Neonatal Perinatal Med 2019; 12:221-230. [PMID: 30829622 DOI: 10.3233/npm-1822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Premature neonates are often subjected to multiple transfusions with red blood cells during their hospitalization in the neonatal intensive care unit (NICU). The hemoglobin threshold for transfusion prior to discharge from the NICU varies significantly among different centers. The aim of the present study is to investigate the association between hemoglobin concentration at discharge with neurodevelopmental outcomes in premature neonates. METHODS Retrospective observation study with regression analysis was performed with follow up assessment in the neuro-developmental outpatient clinic at 30 months of adjusted age. RESULTS Data from 357 neonates born at less than 37 weeks' gestation were analyzed. Sensory and motor neurodevelopment at 30 months of adjusted age, were not associated with the hemoglobin concentration at discharge (p=0.5891 and p=0.4575, respectively). There was no association between the hemoglobin concentration at discharge with fine or gross motor development (p=0.1582 and p=0.3805, respectively). Hemoglobin concentration at discharge was not associated with poor neurodevelopmental outcomes up until 30 months of adjusted age. CONCLUSIONS The data of the present study indicate that the hemoglobin concentration of premature neonates at the time of discharge is not associated with poorer markers of neurodevelopmental outcomes at 30 months of adjusted age. Comorbidities such as BPD and IVH that are present to premature neonates were identified as potential risk factors for certain aspects of the neurodevelopment.
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Affiliation(s)
- Panagiotis Kratimenos
- Drexel University College of Medicine, St. Christopher's Hospital for Children and Temple University Hospital, Philadelphia, PA, USA.,Department of Pediatrics, Division of Neonatology, Children's National Medical Center, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Folasade Kehinde
- Drexel University College of Medicine, St. Christopher's Hospital for Children and Temple University Hospital, Philadelphia, PA, USA
| | - Ioannis Koutroulis
- Department of Pediatrics, Division of Emergency Medicine, Children's National Medical Center, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephanie Santana
- Nemours/AI DuPont Hospital for Children, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, USA
| | - Roschanak Mossabeb
- Drexel University College of Medicine, St. Christopher's Hospital for Children and Temple University Hospital, Philadelphia, PA, USA
| | - Rachel Fleishman
- Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Marchman VA, Ashland MD, Loi EC, Adams KA, Fernald A, Feldman HM. Predictors of early vocabulary growth in children born preterm and full term: A study of processing speed and medical complications. Child Neuropsychol 2019; 25:943-963. [PMID: 30714476 DOI: 10.1080/09297049.2019.1569608] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Delays in expressive vocabulary may be harbingers of long-term language difficulties. In toddlers born full term (FT), individual differences in language processing speed are associated with variation in expressive vocabulary growth. Children born preterm (PT) are at increased risk for persistent language deficits. Here, we evaluate predictors of early vocabulary growth in PT toddlers in relation to two sources of variability: language processing speed and medical complications of prematurity. Vocabulary growth from 16 to 30 months (adjusted for degree of prematurity) was modeled longitudinally using parent reports in English-speaking FT (n = 63; ≥37 weeks, ≥2495 g) and PT (n = 69; ≤32 weeks, <1800 g) children, matched on sex and socioeconomic status. Children were tested in the "looking-while-listening task" at 18 months to derive a measure of language processing speed. Each PT child was assessed for number of medical complications (13 maximum), based on medical chart reviews. PT and FT children displayed similar vocabulary trajectories; however, birth group disparities began to emerge by 30 months. PT children were slower in language processing speed than FT children. Critically, language processing speed predicted expressive vocabulary size at 30 months; interactions with birth group were not significant (all p > .20). In PT children, faster language processing speed predicted stronger outcomes regardless of number of medical complications; slower processing speed and more medical complications predicted poorer outcomes. Faster processing speed reflected favorable neuropsychological processes associated with faster expressive vocabulary growth that overrode the impact of medical complications on language outcomes in PT children.
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Affiliation(s)
| | - Melanie D Ashland
- a Stanford University , Stanford , CA , USA.,b School of Medicine , Stanford University , Stanford , CA , USA
| | - Elizabeth C Loi
- b School of Medicine , Stanford University , Stanford , CA , USA.,c University of Oregon , Eugene , OR , USA
| | - Katherine A Adams
- a Stanford University , Stanford , CA , USA.,d New York University , New York , NY , USA
| | | | - Heidi M Feldman
- b School of Medicine , Stanford University , Stanford , CA , USA
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25
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Nguyen TNN, Spencer-Smith M, Haebich KM, Burnett A, Scratch SE, Cheong JLY, Doyle LW, Wiley JF, Anderson PJ. Language Trajectories of Children Born Very Preterm and Full Term from Early to Late Childhood. J Pediatr 2018; 202:86-91.e1. [PMID: 30054166 DOI: 10.1016/j.jpeds.2018.06.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/10/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To identify distinct language trajectories of children born very preterm and full term from 2 to 13 years of age and examine predictors for the identified trajectories. STUDY DESIGN A cohort of 224 children born very preterm and 77 full term controls recruited at birth were followed up at ages 2, 5, 7, and 13 years. The number of distinct language trajectories was examined using latent growth mixture modeling allowing for linear and quadratic time trends. Potential predictors in the neonatal period (eg, birth group, sex, and medical risk) and at 2 years (ie, social risk and use of allied health services) for the language trajectories were tested using multinomial logistic regression. RESULTS Five distinct language trajectories were identified across childhood: stable normal (32% of study cohort), resilient development showing catch-up (36%), precocious language skills (7%), stable low (17%), and high-risk (5%) development. The very preterm group was 8 times more likely to have a language trajectory that represented poorer language development compared with full term controls (very preterm, 40%; full term, 6%). Greater social risk and use of allied health services were associated with poorer language development. CONCLUSIONS Variable language trajectories were observed, with a substantial proportion of children born very preterm exhibiting adverse language development. These findings highlight the need for monitoring language skills in children born very preterm before school entry and across middle childhood.
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Affiliation(s)
- Thi-Nhu-Ngoc Nguyen
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Megan Spencer-Smith
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Kristina M Haebich
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Alice Burnett
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada; Department of Pediatrics, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Jeanie L Y Cheong
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, Melbourne, Australia
| | - Lex W Doyle
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia; Newborn Research, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynecology, Royal Women's Hospital, Melbourne, Australia
| | - Joshua F Wiley
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia
| | - Peter J Anderson
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
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Fiabilidad y validez del cuestionario observacional de las conductas de alimentación en neonatos prematuros (COCANP). ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rlfa.2018.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Piccoli GB, Zakharova E, Attini R, Ibarra Hernandez M, Covella B, Alrukhaimi M, Liu ZH, Ashuntantang G, Orozco Guillen A, Cabiddu G, Li PKT, Garcia-Garcia G, Levin A. Acute Kidney Injury in Pregnancy: The Need for Higher Awareness. A Pragmatic Review Focused on What Could Be Improved in the Prevention and Care of Pregnancy-Related AKI, in the Year Dedicated to Women and Kidney Diseases. J Clin Med 2018; 7:jcm7100318. [PMID: 30275392 PMCID: PMC6210235 DOI: 10.3390/jcm7100318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/14/2022] Open
Abstract
Pregnancy-related acute kidney injury (pAKI), preeclampsia (PE), and the hypertensive disorders of pregnancy are closely related conditions, which are, in turn, frequently linked to pre-existing and often non-diagnosed chronic kidney disease (CKD). The current literature and research mainly underline the effects of pregnancy complications on the offspring; this review strongly emphasizes the maternal health as well. These conditions not only negatively affect pregnancy outcomes, but have a relevant effect on the future health of affected mothers and their children. Therefore, dedicated diagnostic and follow-up programs are needed, for optimizing materno-foetal health and reducing the impact of pregnancy-related problems in the mothers and in the new generations. This narrative review, performed on the occasion of the 2018 World Kidney Day dedicated to women’s health, focuses on three aspects of the problem. Firstly, the risk of AKI in the hypertensive disorders of pregnancy (the risk is the highest in developing countries; however PE is the main cause of pregnancy related AKI worldwide). Secondly, the effect of AKI and the hypertensive disorders of pregnancy on the development of CKD in the mother and offspring: long-term risks are increased; the entity and the trajectories are still unknown. Thirdly, the role of CKD in the pathogenesis of AKI and the hypertensive disorders of pregnancy: CKD is a major risk factor and the most important element in the differential diagnosis; pregnancy is a precious occasion for early diagnosis of CKD. Higher awareness on the importance of AKI in pregnancy is needed to improve short and long term outcomes in mothers and children.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, 10100 Torino, Italy.
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, 101000 Moscow, Russia.
- Nephrology, Moscow State University of Medicine and Dentistry, 101000 Moscow, Russia.
- Nephrology, Russian Medical Academy of Continuous Professional Education, 101000 Moscow, Russia.
| | - Rossella Attini
- Obstetrics, Department of Surgery, University of Torino, 10100 Torino, Italy.
| | - Margarita Ibarra Hernandez
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Bianca Covella
- Néphrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, P.O. Box 20170, Dubai, UAE.
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210000, China. zhihong--
| | - Gloria Ashuntantang
- Yaounde General Hospital & Faculty of Medicine and Biomedical Sciences, University of Yaounde I, P.O. Box 337, Yaounde, Cameroon.
| | | | | | - Philip Kam Tao Li
- Prince of Wales Hospital, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong.
| | - Gulliermo Garcia-Garcia
- Nephrology Service, Hospital Civil de Guadalajara "Fray Antonio Alcalde", University of Guadalajara Health Sciences Center, 44100 Guadalajara Jal, Mexico.
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada.
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Piccoli GB, Alrukhaimi M, Zhi-Hong L, Zakharova E, Levin A. [What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day]. TERAPEVT ARKH 2018; 90:4-14. [PMID: 32598653 DOI: 10.26442/terarkh20189064-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Indexed: 11/22/2022]
Abstract
On behalf of the World Kidney Day Steering Committee Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- G B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology department, Centre Hospitalier Le Mans, Le Mans, France
| | - M Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - L Zhi-Hong
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E Zakharova
- Nephrology department, S.P. Botkin Moscow City Hospital, Moscow, Russia.,Department of Nephrology, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia
| | - A Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Haslam MD, Lisonkova S, Creighton D, Church P, Yang J, Shah PS, Joseph KS, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Fajardo C, Aziz K, Toye J, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Mukerji A, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Kovacs L, Barrington K, Drolet C, Piedboeuf B, Riley SP, Claveau M, Faucher D, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Andrews W, Deshpandey A, McMillan D, Afifi J, Kajetanowicz A, Lee SK, Pillay T, Sauvé R, Hendson L, Reichert A, Bodani J, Sankaran K, Moddemann D, Nwaesei C, Daboval T, Dow K, Lee D, Ly L, Kelly E, el Helou S, Pelausa E, Riley SP, Lefebvre F, Demers C, Bélanger S, Canning R, Monterrosa L, Makary H, Vincer M, Murphy P. Severe Neurodevelopmental Impairment in Neonates Born Preterm: Impact of Varying Definitions in a Canadian Cohort. J Pediatr 2018; 197:75-81.e4. [PMID: 29398054 DOI: 10.1016/j.jpeds.2017.12.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/18/2017] [Accepted: 12/08/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. STUDY DESIGN Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI. RESULTS The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, employment status, antenatal corticosteroid treatment, and gestational age were not associated consistently with severe NDI. Although maternal substance use, sex, score of neonatal acute physiology >20, late-onset sepsis, bronchopulmonary dysplasia, and brain injury were consistently associated with severe NDI irrespective of definition, the strength of the associations varied. CONCLUSIONS The definition of severe NDI significantly influences the incidence and the associations between risk factors and severe NDI. A standardized definition would facilitate site comparisons and scientific communication.
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Affiliation(s)
- Matthew D Haslam
- School of Population and Public Health, University of British Columbia, British Columbia, Canada
| | - Sarka Lisonkova
- School of Population and Public Health, University of British Columbia, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianne Creighton
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Paige Church
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Junmin Yang
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - K S Joseph
- School of Population and Public Health, University of British Columbia, British Columbia, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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30
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Piccoli G, Al Rukhaimi M, Liu ZH, Zakharova E, Levin A. What we know and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day. Braz J Med Biol Res 2018; 51:e7315. [PMID: 29791583 PMCID: PMC5972021 DOI: 10.1590/1414-431x20177315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/27/2017] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically women's kidney health on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state in which acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. Various autoimmune and other conditions are more likely to impact women, with profound consequences for child bearing and the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we know and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- G.B. Piccoli
- Department of Clinical and Biological Sciences, University of
Torino, Torino, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - M. Al Rukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United
Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling
Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E. Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow,
Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry,
Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional
Education, Moscow, Russian Federation
| | - A. Levin
- Department of Medicine, Division of Nephrology, University of
British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases: Questions unanswered and answers unquestioned : Reflection on World Kidney Day and International Woman's Day. Pediatr Nephrol 2018; 33:529-540. [PMID: 29497823 DOI: 10.1007/s00467-018-3917-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; Questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day. Physiol Int 2018; 105:1-18. [DOI: 10.1556/2060.105.2018.1.6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic kidney disease (CKD) affects approximately 10% of the world’s adult population; it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, which not only offers an opportunity for diagnosis of kidney disease, but also states where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- GB Piccoli
- 1 Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- 2 Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - M Alrukhaimi
- 3 Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Z-H Liu
- 4 National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - E Zakharova
- 5 Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- 6 Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- 7 Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - A Levin
- 8 Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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33
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Woman's Day. BMC Nephrol 2018; 19:66. [PMID: 29544451 PMCID: PMC5856379 DOI: 10.1186/s12882-018-0864-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 12/30/2022] Open
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly.Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, BC, Canada.
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34
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Can J Kidney Health Dis 2018; 5:2054358118761656. [PMID: 29552348 PMCID: PMC5846917 DOI: 10.1177/2054358118761656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/08/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease affects approximately 10% of the world's adult population: It is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus giving an occasion to reflect on open questions on the importance of kidney health in women for the present and the future generations. OBJECTIVES In this review, we summarize some aspects that are unique to women's kidney health, offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. FINDINGS Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is not only a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for childbearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. CONCLUSION Improving knowledge on women, kidney health, and kidney disease, may be a way to improve outcomes of kidney diseases worldwide.
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Italy
- Nephrology, Centre Hospitalier–Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, Canada
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35
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases: Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women's Day. Indian J Nephrol 2018; 28:87-96. [PMID: 29861556 PMCID: PMC5952463 DOI: 10.4103/ijn.ijn_81_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- G. B. Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- Centre Hospitalier Le Mans, Le Mans, France
| | - M. Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Z. H. Liu
- National Clinical Research Center of Kidney Diseases, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, China
| | - E. Zakharova
- Moscow City Hospital n.a. S.P. Botkin
- Moscow State University of Medicine and Dentistry
- Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - A. Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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36
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. Women and Kidney Diseases: Questions Unanswered and Answers Unquestioned. Kidney Int Rep 2018; 3:225-235. [PMID: 29725625 PMCID: PMC5932302 DOI: 10.1016/j.ekir.2018.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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37
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases - questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman’s Day. Nephrology (Carlton) 2018; 23:199-209. [DOI: 10.1111/nep.13193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences; University of Torino; Torino Italy
- Nephrology; Centre Hospitalier Le Mans; Le Mans France
| | - Mona Alrukhaimi
- Department of Medicine; Dubai Medical College; Dubai United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital; Nanjing University School of Medicine; Nanjing China
| | - Elena Zakharova
- Nephrology Department; Moscow City Hospital n.a. S.P. Botkin; Moscow Russian Federation
- Chair of Nephrology; Moscow State University of Medicine and Dentistry; Moscow Russian Federation
- Chair of Nephrology; Russian Medical Academy of Continuous Professional Education; Moscow Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
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38
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women's Day. Am J Nephrol 2018; 47:103-114. [PMID: 29455210 DOI: 10.1159/000486408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P., Moscow, Russian Federation
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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39
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: reflection on World Kidney Day and International Women's Day. J Nephrol 2018; 31:173-184. [PMID: 29464527 DOI: 10.1007/s40620-018-0474-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 02/08/2023]
Abstract
Chronic Kidney Disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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40
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Blood Purif 2018; 45:364-375. [PMID: 29478067 DOI: 10.1159/000484686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022]
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P., Moscow, Russian Federation.,Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.,Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know About Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman's Day. Am J Hypertens 2018; 31:375-384. [PMID: 29438477 DOI: 10.1093/ajh/hpx218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow, Russian Federation
- Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
- Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What we know and do not know about women and kidney diseases: questions unanswered and answers unquestioned: reflection on World Kidney Day and International Women's Day. Intern Med J 2018; 48:113-123. [PMID: 29415356 DOI: 10.1111/imj.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Giorgina B Piccoli
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy.,Department of Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | - Mona Alrukhaimi
- Department of Medicine, Dubai Medical College, Dubai, United Arab Emirates
| | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Department of Nephrology, Moscow City Hospital S.P. Botkin, Moscow, Russia.,Department of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia.,Department of Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adeera Levin
- Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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Piccoli GB, Alrukhaimi M, Liu ZH, Zakharova E, Levin A. What We Do and Do Not Know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Women's Day. KIDNEY DISEASES (BASEL, SWITZERLAND) 2018; 4:37-48. [PMID: 29594141 PMCID: PMC5848484 DOI: 10.1159/000485269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic kidney disease affects approximately 10$ of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50$ of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to have an impact on women, with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Affiliation(s)
- Giorgina B. Piccoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Zhi-Hong Liu
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Elena Zakharova
- Nephrology, Moscow City Hospital n.a. S.P. Botkin, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia
- Nephrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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What we do and do not know about women and kidney diseases; questions unanswered and answers unquestioned: Reflection on World Kidney Day and International Woman's Day. Nefrologia 2017; 38:114-124. [PMID: 29287946 DOI: 10.1016/j.nefro.2017.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/22/2017] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease affects approximately 10% of the world's adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women's Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women's health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly. Girls and women, who make up approximately 50% of the world's population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants. In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.
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Haile SR, Guerra B, Soriano JB, Puhan MA. Multiple Score Comparison: a network meta-analysis approach to comparison and external validation of prognostic scores. BMC Med Res Methodol 2017; 17:172. [PMID: 29268701 PMCID: PMC5740913 DOI: 10.1186/s12874-017-0433-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/20/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prediction models and prognostic scores have been increasingly popular in both clinical practice and clinical research settings, for example to aid in risk-based decision making or control for confounding. In many medical fields, a large number of prognostic scores are available, but practitioners may find it difficult to choose between them due to lack of external validation as well as lack of comparisons between them. METHODS Borrowing methodology from network meta-analysis, we describe an approach to Multiple Score Comparison meta-analysis (MSC) which permits concurrent external validation and comparisons of prognostic scores using individual patient data (IPD) arising from a large-scale international collaboration. We describe the challenges in adapting network meta-analysis to the MSC setting, for instance the need to explicitly include correlations between the scores on a cohort level, and how to deal with many multi-score studies. We propose first using IPD to make cohort-level aggregate discrimination or calibration scores, comparing all to a common comparator. Then, standard network meta-analysis techniques can be applied, taking care to consider correlation structures in cohorts with multiple scores. Transitivity, consistency and heterogeneity are also examined. RESULTS We provide a clinical application, comparing prognostic scores for 3-year mortality in patients with chronic obstructive pulmonary disease using data from a large-scale collaborative initiative. We focus on the discriminative properties of the prognostic scores. Our results show clear differences in performance, with ADO and eBODE showing higher discrimination with respect to mortality than other considered scores. The assumptions of transitivity and local and global consistency were not violated. Heterogeneity was small. CONCLUSIONS We applied a network meta-analytic methodology to externally validate and concurrently compare the prognostic properties of clinical scores. Our large-scale external validation indicates that the scores with the best discriminative properties to predict 3 year mortality in patients with COPD are ADO and eBODE.
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Affiliation(s)
- Sarah R. Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Beniamino Guerra
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Joan B. Soriano
- Servicio de Neumología, Instituto de Investigación del Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Epidemiology & Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Carlson NS. Current Resources for Evidence-Based Practice, September/October 2017. J Obstet Gynecol Neonatal Nurs 2017; 46:788-793. [DOI: 10.1016/j.jogn.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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