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Zhang X, Zhu S, Zhang F, Zhao G, Zhang X, Zhu W, Li D. Utilizing daily excessive concentration hours to estimate small for gestational age infants attributable to fine particulate matter in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-12. [PMID: 38576314 DOI: 10.1080/09603123.2024.2337835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
Limited studies in China have explored the association between gravidae exposure to PM2.5 and small for gestational age infants (SGA), yielding inconsistent results. This study in Wuhan utilized daily excessive concentration hours (DECH) as a novel measure to assess PM2.5's impact on SGA. Data on air pollutants and pregnant women were collected from the Wuhan Municipal Ecology and Environmental Bureau and Wuhan Children's Hospital, respectively. Logistic regression models were employed to evaluate the contribution of PM2.5-DECH and PM2.5-mean to SGA. Significant correlations were observed between PM2.5-mean and SGA during the second trimester [OR = 1.23 (95% CI: 1.14-1.32)] and the entire pregnancy [OR = 1.15 (95% CI: 1.07-1.24)]. Similar correlations were found between PM2.5-DECH and SGA. These findings suggest that increased PM2.5 exposure is associated with a higher risk of SGA, and DECH may be used as a prospective substitute indicator for daily average concentration in similar studies.
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Affiliation(s)
- Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Dejia Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
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Parikh S, Reichman B, Kusuda S, Adams M, Lehtonen L, Vento M, Norman M, San Feliciano L, Isayama T, Hakansson S, Helenius K, Bassler D, Yang J, Shah PS. Trends, Characteristic, and Outcomes of Preterm Infants Who Received Postnatal Corticosteroid: A Cohort Study from 7 High-Income Countries. Neonatology 2023; 120:517-526. [PMID: 37166345 PMCID: PMC10614478 DOI: 10.1159/000530128] [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: 01/22/2023] [Accepted: 03/07/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Our objective was to evaluate the temporal trend of systemic postnatal steroid (PNS) receipt in infants of 24-28 weeks' gestational age, identify characteristics associated with PNS receipt, and correlate PNS receipt with the incidence of bronchopulmonary dysplasia (BPD) and BPD/death from an international cohort included in the iNeo network. METHODS We conducted a retrospective study using data from 2010 to 2018 from seven international networks participating in iNeo (Canada, Finland, Israel, Japan, Spain, Sweden, and Switzerland). Neonates of 24 and 28 weeks' gestational age who survived 7 days and who received PNS were included. We assessed temporal trend of rates of systemic PNS receipt and BPD/death. RESULTS A total of 47,401 neonates were included. The mean (SD) gestational age was 26.4 (1.3) weeks and birth weight was 915 (238) g. The PNS receipt rate was 21% (12-28% across networks) and increased over the years (18% in 2010 to 26% in 2018; p < 0.01). The BPD rate was 39% (28-44% across networks) and remained unchanged over the years (35.2% in 2010 to 35.0% in 2018). Lower gestation, male sex, small for gestational age status, and presence of persistent ductus arteriosus (PDA) were associated with higher rates of PNS receipt, BPD, and BPD/death. CONCLUSION The use of PNS in extremely preterm neonates increased, but there was no correlation between increased use and the BPD rate. Research is needed to determine the optimal timing, dose, and indication for PNS use in preterm neonates.
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Affiliation(s)
- Shalin Parikh
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Center (Mi-Care), Sinai Health System, Toronto, ON, Canada
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Satoshi Kusuda
- Department of Pediatrics, Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Laura San Feliciano
- Division of Neonatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Stellan Hakansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Junmin Yang
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Center (Mi-Care), Sinai Health System, Toronto, ON, Canada
| | - Prakesh S. Shah
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Center (Mi-Care), Sinai Health System, Toronto, ON, Canada
| | - on behalf of International Network for Evaluation of Outcomes (iNeo) of neonates investigators
- Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, ON, Canada
- Maternal-Infant Care Research Center (Mi-Care), Sinai Health System, Toronto, ON, Canada
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
- Department of Pediatrics, Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Division of Neonatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
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Zhang F, Zhang X, Zhong Y, Zhu S, Zhao G, Zhang X, Li T, Zhang Y, Zhu W. Joint Exposure to Ambient Air Pollutants Might Elevate the Risk of Small for Gestational Age (SGA) Infants in Wuhan: Evidence From a Cross-Sectional Study. Int J Public Health 2023; 67:1605391. [PMID: 36686387 PMCID: PMC9849243 DOI: 10.3389/ijph.2022.1605391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: To investigate the effect of exposure to multiple ambient air pollutants during pregnancy on the risk of children being born small for gestational age (SGA). Methods: An Air Pollution Score (APS) was constructed to assess the effects of being exposed to six air pollutants simultaneously, PM2.5, PM10, SO2, NO2, CO, and O3 (referred to as joint exposure). A logistic regression model was applied to estimate the associations of APS and SGA. Results: The adjusted odds ratios (ORs) of SGA per 10 ug/m3 increased in APS during the first and second trimesters and the entire pregnancy were 1.003 [95% confidence intervals (CIs): 1.000, 1.007], 1.018 (1.012, 1.025), and 1.020 (1.009, 1.031), respectively. The ORs of SGA for each 10 μg/m3 elevated in APS during the whole pregnancy were 1.025 (1.005, 1.046) for mothers aged over 35 years old vs. 1.018 (1.005, 1.031) for mothers aged under 35 years old. Women who were pregnant for the first time were more vulnerable to joint ambient air pollution. Conclusion: In summary, the results of the present study suggested that joint exposure to ambient air pollutants was associated with the increment in the risks of SGA.
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Affiliation(s)
- Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Yuanyuan Zhong
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, China
| | - Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Tianzhou Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Yan Zhang, ; Wei Zhu,
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Yan Zhang, ; Wei Zhu,
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Seaton SE, Draper ES, Adams M, Kusuda S, Håkansson S, Helenius K, Reichman B, Lehtonen L, Bassler D, Lee SK, Vento M, Darlow BA, Rusconi F, Beltempo M, Isayama T, Lui K, Norman M, Yang J, Shah PS, Modi N. Variations in Neonatal Length of Stay of Babies Born Extremely Preterm: An International Comparison Between iNeo Networks. J Pediatr 2021; 233:26-32.e6. [PMID: 33600820 DOI: 10.1016/j.jpeds.2021.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. RESULTS Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (-4.8 days less than reference, 95% CI -7.3 to -2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI -12.3 to -11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. CONCLUSIONS We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
| | - Kjell Helenius
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's Hospital, Florence, Italy
| | | | - Tetsuya Isayama
- Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Lui
- School of Women's and Children's Health, University of New South Wales, Australia
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Junmin Yang
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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He H, Miao H, Liang Z, Zhang Y, Jiang W, Deng Z, Tang J, Liu G, Luo X. Prevalence of small for gestational age infants in 21 cities in China, 2014-2019. Sci Rep 2021; 11:7500. [PMID: 33820960 PMCID: PMC8021546 DOI: 10.1038/s41598-021-87127-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Infants who are small for gestational age (SGA) are at increased risk of neonatal and infant death, non-communicable diseases and growth retardation. However, the epidemiological characteristics of SGA remain unclear. We aim to explore the prevalence of SGA and to examine its socioeconomic associations by using data from 21 cities. 10,515,494 single live birth records between 2014 and 2019 from the Guangdong Women and Children Health Information System were included in the study. Descriptive statistical methods were used to analyze the prevalence trend of SGA and its distribution. We also analyze the associations between the prevalence of SGA and per-capita GDP. The prevalence of SGA in Guangdong Province from the years 2014-2019 was 13.17%, 12.96%, 11.96%, 12.72%, 11.45%, 11.30% respectively, and the overall prevalence was 12.28%. The prevalence of term SGA infants in Guangdong Province was 12.50%, which was much higher than that of preterm SGA (7.71%). There was a significant negative correlation between the SGA prevalence and per-capita GDP in 21 cities of Guangdong Province. The level of economic development may affect the prevalence of SGA. The prevalence of SGA in full term infants is significantly higher than in premature infants, suggesting that most SGA infants may be born at a later gestational age.
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Affiliation(s)
- Hui He
- Guangdong Women and Children Hospital of Guangzhou Medical University, Guangzhou, 511442, China
| | - Huazhang Miao
- Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Zhijiang Liang
- Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Ye Zhang
- Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Wei Jiang
- Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Zhi Deng
- Guangdong Women and Children Hospital, Guangzhou, 511442, China
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 511436, China
| | - Guocheng Liu
- Guangdong Women and Children Hospital, Guangzhou, 511442, China.
| | - Xianqiong Luo
- Guangdong Women and Children Hospital, Guangzhou, 511442, China.
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The effect of influenza virus infection on pregnancy outcomes: A systematic review and meta-analysis of cohort studies. Int J Infect Dis 2021; 105:567-578. [PMID: 33647509 DOI: 10.1016/j.ijid.2021.02.095] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adverse pregnancy outcomes are risk factors for neonatal mortality and morbidity. While some studies have demonstrated notable associations between influenza and adverse pregnancy outcomes, the findings have contrasted with other studies. This meta-analysis was conducted to assess the effect of influenza infection on pregnancy outcomes. METHODS We searched PubMed, Embase, Cochrane Library and Web of Science from inception to 4 November 2020. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects or fixed-effects models. RESULTS A total of 17 studies involving 2,351,204 participants were included. Influenza infection increased the risk of stillbirth (RR = 3.62, 95% CI: 1.60-8.20), with no significant effect on preterm birth (RR = 1.17, 95%CI: 0.95-1.45), fetal death (RR = 0.93, 95%CI: 0.73-1.18), small for gestational age (SGA) (RR = 1.10, 95%CI: 0.98-1.24) and low birth weight (LBW) (RR = 1.88, 95%CI: 0.46-7.66). In a subgroup analysis of LBW, the association was evident in studies conducted during the 2009 H1N1 pandemic (RR = 2.28, 95%CI: 1.81-2.87), with no evidence of an association in pre-pandemic or post-pandemic studies. CONCLUSIONS Influenza virus infection was associated with an increased risk of stillbirth, but its effect on preterm birth, fetal death, SGA and LBW is still uncertain.
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Gagliardi L, Rusconi F, Reichman B, Adams M, Modi N, Lehtonen L, Kusuda S, Vento M, Darlow BA, Bassler D, Isayama T, Norman M, Håkansson S, Lee SK, Lui K, Yang J, Shah P. Neonatal outcomes of extremely preterm twins by sex pairing: an international cohort study. Arch Dis Child Fetal Neonatal Ed 2021; 106:17-24. [PMID: 32451356 DOI: 10.1136/archdischild-2020-318832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/09/2020] [Accepted: 04/23/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Infant boys have worse outcomes than girls. In twins, the 'male disadvantage' has been reported to extend to female co-twins via a 'masculinising' effect. We studied the association between sex pairing and neonatal outcomes in extremely preterm twins. DESIGN Retrospective cohort study SETTING: Eleven countries participating in the International Network for Evaluating Outcomes of Neonates. PATIENTS Liveborn twins admitted at 23-29 weeks' gestation in 2007-2015. MAIN OUTCOME MEASURES We examined in-hospital mortality, grades 3/4 intraventricular haemorrhage or cystic periventricular leukomalacia (IVH/PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity requiring treatment and a composite outcome (mortality or any of the outcomes above). RESULTS Among 20 924 twins, 38% were from male-male pairs, 32% were from female-female pairs and 30% were sex discordant. We had no information on chorionicity. Girls with a male co-twin had lower odds of mortality, IVH/PVL and the composite outcome than girl-girl pairs (reference group): adjusted OR (aOR) (95% CI) 0.79 (0.68 to 0.92), 0.83 (0.72 to 0.96) and 0.88 (0.79 to 0.98), respectively. Boys with a female co-twin also had lower odds of mortality: aOR 0.86 (0.74 to 0.99). Boys from male-male pairs had highest odds of BPD and composite outcome: aOR 1.38 (1.24 to 1.52) and 1.27 (1.16 to 1.39), respectively. CONCLUSIONS Sex-related disparities in outcomes exist in extremely preterm twins, with girls having lower risks than boys and opposite-sex pairs having lower risks than same-sex pairs. Our results may help clinicians in assessing risk in this large segment of extremely preterm infants.
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Affiliation(s)
- Luigi Gagliardi
- Division of Neonatology and Pediatrics, Ospedale Versilia, Viareggio, Azienda USL Toscana Nord Ovest, Italy
| | - Franca Rusconi
- Unit of Epidemiology, Anna Meyer Children's University Hospital and Regional Health Agency, Florence, Italy
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Department of Clinical Medicine, University of Turku0, Turku, Finland
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Maximo Vento
- Division of Neonatology, Health Research Institute La Fe, Valencia, Spain
| | - Brian A Darlow
- Department of Paediatrics, University of Otago Christchurch, Canterbury, New Zealand
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umea University, Umea, Sweden
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Kei Lui
- Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, 0, Randwick, New South Wales, Australia
| | - Junmin Yang
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakeshkumar Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Poryo M, Maas S, Gortner L, Geipel M, Zemlin M, Löffler G, Meyer S. Effects of small for gestational age status on mortality and major morbidities in ≤750 g neonates. Early Hum Dev 2020; 144:105040. [PMID: 32325371 DOI: 10.1016/j.earlhumdev.2020.105040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Controversy exists regarding the impact of small for gestational age (SGA = birth weight < 10th percentile) status on mortality and major morbidities. AIM To assess the effects of SGA on mortality and major morbidities in ≤750 gram (g) neonates. STUDY DESIGN Retrospective (01/2005-12/2017), single center study at a tertiary NICU. SUBJECTS SGA neonates ≤ 750 g. OUTCOME Effect of SGA status on mortality and major morbidities. RESULTS 183 infants were enrolled. 103 (56.3%) were non-SGA (mean gestational age 25 + 1 weeks ± 9.9 days, mean birth weight 662.6 ± 75.2 g), and 80 (43.7%) SGA (mean gestational age 26 + 6 weeks ± 14.0 days, mean birth weight 543.9 ± 114.7 g). Mortality was 24.1% (non-SGA: 30/103 (29.1%), SGA: 14/80 (17.5%); p = 0.08). Univariable logistic regression analysis revealed a significant protective effect of SGA status on pneumothoraces (OR 0.28, 95%-CI [0.11-0.69]), IVH (≥3) (OR 0.38; 95%-CI [0.15-0.67]), and seizures (OR 0.09, 95%-CI [0.01-0.76]), but NEC (≥2a) occurred more frequently in SGA neonates (p = 0.024). Multiple logistic regression analysis found SGA status to negatively influence ROP (≥3) (OR 2.87, 95%-CI [1.14-7.23]) and need for home monitoring (OR 2.38, 95%-CI [1.05-5.41]). Other major morbidities (IVH, PVL, RDS, BPD, NEC, FIP, sepsis, hearing impairment) and mortality rates were not significantly affected, but distinct organ-specific patterns were seen. CONCLUSION SGA had negative effects on the rate of severe ROP and the need for home monitoring, but other major morbidities as well as mortality rates were not significantly affected. In the future, it will be important to delineate underlying pathophysiological mechanisms that contribute to this pattern.
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Affiliation(s)
- Martin Poryo
- Deparment of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Sebastian Maas
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Ludwig Gortner
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Martina Geipel
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Michael Zemlin
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Günther Löffler
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany
| | - Sascha Meyer
- Department of Pediatrics and Neonatology, Saarland University Medical Center, Homburg, Germany; Section Neuropediatrics, Saarland University Medical Center, Homburg, Germany.
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Isayama T, Kusuda S, Reichman B, Lee SK, Lehtonen L, Norman M, Adams M, Bassler D, Helenius K, Hakansson S, Yang J, Jain A, Shah PS. Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm. J Pediatr 2020; 220:34-39.e5. [PMID: 32145968 DOI: 10.1016/j.jpeds.2020.01.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/07/2020] [Accepted: 01/31/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess associations between neonatal intensive care unit (NICU)-level patent ductus arteriosus (PDA) treatment rates (pharmacologic or surgical) and neonatal outcomes. STUDY DESIGN This cohort study included infants born at 24-28 weeks of gestation and birth weight <1500 g in 2007-2015 in NICUs caring for ≥100 eligible infants in 6 countries. The ratio of observed/expected (O/E) PDA treatment rates was derived for each NICU by estimating the expected rate using a logistic regression model adjusted for potential confounders and network. The primary composite outcome was death or severe neurologic injury (grades III-IV intraventricular hemorrhage or periventricular leukomalacia). The associations between the NICU-level O/E PDA treatment ratio and neonatal outcomes were assessed using linear regression analyses including a quadratic effect (a square term) of the O/E PDA treatment ratio. RESULTS From 139 NICUs, 39 096 infants were included. The overall PDA treatment rate was 45% in the cohort (13%-77% by NICU) and the O/E PDA treatment ratio ranged from 0.30 to 2.14. The relationship between the O/E PDA treatment ratio and primary composite outcome was U-shaped, with the nadir at a ratio of 1.13 and a significant quadratic effect (P<.001). U-shaped relationships were also identified with death, severe neurologic injury, and necrotizing enterocolitis. CONCLUSIONS Both low and high PDA treatment rates were associated with death or severe neurologic injury, whereas a moderate approach was associated with optimal outcomes.
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Affiliation(s)
- Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - Shoo K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospita, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Mikael Norman
- Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospita, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Stellan Hakansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Junmin Yang
- Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; Maternal-infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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10
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Lui K, Lee SK, Kusuda S, Adams M, Vento M, Reichman B, Darlow BA, Lehtonen L, Modi N, Norman M, Håkansson S, Bassler D, Rusconi F, Lodha A, Yang J, Shah PS. Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries. J Pediatr 2019; 215:32-40.e14. [PMID: 31587861 DOI: 10.1016/j.jpeds.2019.08.020] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/04/2019] [Accepted: 08/08/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate outcome trends of neonates born very preterm in 11 high-income countries participating in the International Network for Evaluating Outcomes of neonates. STUDY DESIGN In a retrospective cohort study, we included 154 233 neonates admitted to 529 neonatal units between January 1, 2007, and December 31, 2015, at 240/7 to 316/7 weeks of gestational age and birth weight <1500 g. Composite outcomes were in-hospital mortality or any of severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia (BPD); and same composite outcome excluding BPD. Secondary outcomes were mortality and individual morbidities. For each country, annual outcome trends and adjusted relative risks comparing epoch 2 (2012-2015) to epoch 1 (2007-2011) were analyzed. RESULTS For composite outcome including BPD, the trend decreased in Canada and Israel but increased in Australia and New Zealand, Japan, Spain, Sweden, and the United Kingdom. For composite outcome excluding BPD, the trend decreased in all countries except Spain, Sweden, Tuscany, and the United Kingdom. The risk of composite outcome was lower in epoch 2 than epoch 1 in Canada (adjusted relative risks 0.78; 95% CI 0.74-0.82) only. The risk of composite outcome excluding BPD was significantly lower in epoch 2 compared with epoch 1 in Australia and New Zealand, Canada, Finland, Japan, and Switzerland. Mortality rates reduced in most countries in epoch 2. BPD rates increased significantly in all countries except Canada, Israel, Finland, and Tuscany. CONCLUSIONS In most countries, mortality decreased whereas BPD increased for neonates born very preterm.
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Affiliation(s)
- Kei Lui
- Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Shoo K Lee
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Satoshi Kusuda
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Neena Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stellan Håkansson
- Department of Clinical Science/Pediatrics, Umeå University, Umeå, Sweden
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Franca Rusconi
- Unit of Epidemiology Meyer Children's University Hospital and Regional Health Agency, Florence, Italy
| | - Abhay Lodha
- Pediatrics & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Sinai Health System, University of Toronto, Ontario, Canada; Maternal-Infant Care Research Centre, Sinai Health System, Toronto, Ontario, Canada
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11
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Modi N. Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database. Transl Pediatr 2019; 8:193-198. [PMID: 31413953 PMCID: PMC6675679 DOI: 10.21037/tp.2019.07.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Technological developments, coupled with strengthened governance and data security have led to increasing recognition of the potential of real-world health data to benefit patient care and health services. Real-world health data are those captured in the course of routine care. Here I describe a mature source of real-world health data, the UK National Neonatal Research Database and provide examples of the many types of uses it supports.
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Affiliation(s)
- Neena Modi
- Section of Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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12
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Gagliardi L, Basso O. Maternal hypertension and survival in singletons and twins born at 23-29 weeks: not just one answer…. Pediatr Res 2019; 85:697-702. [PMID: 30763949 DOI: 10.1038/s41390-019-0337-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To describe the association between maternal hypertension (chronic and gestational, MH) and mortality in very preterm singletons and twins, focusing on how estimates depend on gestational age (GA) and size at birth. METHODS We estimated relative risks of in-hospital death in 12,320 singletons (MH: 22.4%) and 4381 twins (MH: 10.6%) born at 23-29 weeks in the Italian Neonatal Network (89 hospitals, 2008-2016). RESULTS Babies with MH had higher GA and were more frequently small-for-gestational age (SGA), especially singletons. In crude analyses, MH was associated with lower mortality in singletons. In multivariable analyses, the effects of GA and size differed between twins and singletons with and without MH. The best-fitting models included continuous birth weight (rather than SGA) and were stratified by GA. In these models, MH was associated with lower mortality in singletons-but not twins-born after week 25. CONCLUSIONS In this cohort of very preterm infants, the association between MH and mortality differed between singletons and twins and across strata of GA at birth. These estimates cannot be interpreted causally, but suggest that, from a descriptive/predictive standpoint, singletons with MH born after week 25 have lower mortality than singletons born to women without MH.
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Affiliation(s)
- Luigi Gagliardi
- Department of Woman and Child Health, Pediatrics and Neonatology Division, Ospedale Versilia, Viareggio, AUSL Toscana Nord Ovest, Pisa, Italy.
| | - Olga Basso
- Department of Obstetrics and Gynecology, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occ. Health, McGill University, Montreal, QC, Canada
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13
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Stockley EL, Ting JY, Kingdom JC, McDonald SD, Barrett JF, Synnes AR, Monterrosa L, Shah PS. Intrapartum magnesium sulfate is associated with neuroprotection in growth-restricted fetuses. Am J Obstet Gynecol 2018; 219:606.e1-606.e8. [PMID: 30240651 DOI: 10.1016/j.ajog.2018.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intrapartum magnesium sulfate administration is recommended for fetal neuroprotection in women with imminent very preterm birth. However, previous studies have not included or separately analyzed the outcomes of pregnancies with fetal growth restriction that were treated with intrapartum magnesium sulfate. OBJECTIVE We sought to evaluate the neonatal and neurodevelopmental outcomes of growth-restricted fetuses born <29 weeks' gestation and exposed to maternal intrapartum magnesium sulfate. STUDY DESIGN We conducted a retrospective cohort study of infants born <29 weeks' gestation from 2010 through 2011, admitted to participating Canadian Neonatal Network units, and followed by the Canadian Neonatal Follow-up Network centers. Growth restriction was defined either as estimated fetal or actual neonatal birthweight <10th percentile according to fetal or neonatal growth standards for gestational age and sex, respectively. Infants exposed to intrapartum magnesium sulfate were compared with unexposed infants. The primary outcome was composite of death or significant neurodevelopmental impairment at 18-36 months' corrected age. Secondary outcomes were death or any neurodevelopmental impairment at 18-36 months' corrected age. Neonatal morbidities were also compared. RESULTS Of the 336 growth-restricted fetuses, 112 (33%) received magnesium sulfate and of the 177 growth-restricted infants, 61 (34%) received magnesium sulfate. Administration of magnesium sulfate was at the discretion of the treating physician. Intrapartum magnesium sulfate was associated with reduced odds of composite of death or significant neurodevelopmental impairment for infants classified according to both fetal standards (adjusted odds ratio, 0.42; 95% confidence interval, 0.22-0.80) and neonatal standards (adjusted odds ratio, 0.44; 95% confidence interval, 0.20-0.98). CONCLUSION Intrapartum administration of magnesium sulfate to women with growth-restricted fetuses born <29 weeks' gestation was associated with reduced odds of composite of death or significant neurodevelopmental impairment.
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14
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Shah PS, Kusuda S, Håkansson S, Reichman B, Lui K, Lehtonen L, Modi N, Vento M, Adams M, Rusconi F, Norman M, Darlow BA, Lodha A, Yang J, Bassler D, Helenius KK, Isayama T, Lee SK. Neonatal Outcomes of Very Preterm or Very Low Birth Weight Triplets. Pediatrics 2018; 142:peds.2018-1938. [PMID: 30463851 DOI: 10.1542/peds.2018-1938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the neonatal outcomes of very preterm triplets with those of matched singletons using a large international cohort. METHODS A retrospective matched-cohort study of preterm triplets and singletons born between 2007 and 2013 in the International Network for Evaluation of Outcomes in neonates database countries and matched by gestational age, sex, and country of birth was conducted. The primary outcome was a composite of mortality or severe neonatal morbidity (severe neurologic injury, treated retinopathy of prematurity, and bronchopulmonary dysplasia). Unadjusted and adjusted odds ratios with 95% confidence intervals (CIs) were calculated for model 1 (maternal hypertension and birth weight z score) and model 2 (variables in model 1, antenatal steroids, and mode of birth). Models were fitted with generalizing estimating equations and random effects modeling to account for clustering. RESULTS A total of 6079 triplets of 24 to 32 weeks' gestation or 500 to 1499 g birth weight and 18 232 matched singletons were included. There was no difference in the primary outcome between triplets and singletons (23.4% vs 24.0%, adjusted odds ratio: 0.91, 95% CI: 0.83-1.01 for model 1 and 1.00, 95% CI: 0.90-1.11 for model 2). Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. The results were also similar for a subsample of the cohort (1648 triplets and 4944 matched singletons) born at 24 to 28 weeks' gestation. CONCLUSIONS No significant differences were identified in mortality or major neonatal morbidities between triplets who were very low birth weight or very preterm and matched singletons.
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Affiliation(s)
- Prakesh S Shah
- Department of Pediatrics and .,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Departments of Pediatrics and
| | - Satoshi Kusuda
- National Research Network Japan, Department of Pediatrics, Kyorin University, Mitaka, Japan
| | - Stellan Håkansson
- Swedish Neonatal Quality Register, Unit of Pediatrics, Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Brian Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Kei Lui
- Australian and New Zealand Neonatal Network, Department of Newborn Care, Royal Hospital for Women and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London and Chelsea and Westminster Hospital, London, United Kingdom
| | - Maximo Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain
| | - Mark Adams
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - Mikael Norman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand
| | - Abhay Lodha
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; and
| | - Junmin Yang
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Dirk Bassler
- Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kjell K Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital and Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tetsuya Isayama
- Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shoo K Lee
- Department of Pediatrics and.,Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Departments of Pediatrics and.,Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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15
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Nam HK, Lee KH. Small for gestational age and obesity: epidemiology and general risks. Ann Pediatr Endocrinol Metab 2018; 23:9-13. [PMID: 29609444 PMCID: PMC5894562 DOI: 10.6065/apem.2018.23.1.9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 01/08/2023] Open
Abstract
Children born small for gestational age (SGA) have several life-long consequences. Previous epidemiological studies investigated from childhood to adulthood reported that a number of chronic diseases originate in the prenatal period. With the emerging era of obesity epidemic, more concerns are related to being obese than being short-statured in SGA children. The exact mechanisms are uncertain; however, growth hormone-insulin-like growth factor axis disturbance by fetal programming and accelerated postnatal weight gain contributed to central adiposity in SGA children. In this review, we summarized the definitions and prevalence of SGA, epidemiology, and general risks of obesity in SGA children. Early interventions, before and after birth, are needed for healthy catch-up growth to prevent later obesity and related complications.
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Affiliation(s)
- Hyo-Kyoung Nam
- Department of Pediatrics, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea,Address for correspondence: Kee-Hyoung Lee, MD, PhD https://orcid.org/0000-0002-4319-9019 Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5090 Fax: +82-2-922-7476 E-mail:
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16
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Helenius K, Sjörs G, Shah PS, Modi N, Reichman B, Morisaki N, Kusuda S, Lui K, Darlow BA, Bassler D, Håkansson S, Adams M, Vento M, Rusconi F, Isayama T, Lee SK, Lehtonen L. Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics 2017; 140:peds.2017-1264. [PMID: 29162660 DOI: 10.1542/peds.2017-1264] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULTS Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSIONS The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.
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Affiliation(s)
- Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland; .,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Gunnar Sjörs
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, and Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, and National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, Australia
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain; and
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy and Regional Health Agency of Tuscany, Florence, Italy
| | - Tetsuya Isayama
- Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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van Hagen IM, Roos-Hesselink JW, Donvito V, Liptai C, Morissens M, Murphy DJ, Galian L, Bazargani NM, Cornette J, Hall R, Johnson MR. Incidence and predictors of obstetric and fetal complications in women with structural heart disease. Heart 2017; 103:1610-1618. [DOI: 10.1136/heartjnl-2016-310644] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 01/25/2023] Open
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