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Vu-Hoai N, Ly-Phuc D, Duong-Minh N, Tran-Ngoc N, Nguyen-Dang K. Predictive value of neutrophil-to-lymphocyte ratio for adverse outcomes in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease: A retrospective study. Medicine (Baltimore) 2024; 103:e39797. [PMID: 39312330 PMCID: PMC11419426 DOI: 10.1097/md.0000000000039797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) stands as one of the leading causes of mortality worldwide. Acute exacerbations of COPD (AECOPD) lead to rapid respiratory function decline and worsened disease status. Despite recent studies, the ability of the neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in patients with COPD remains controversial. We investigated the predictive value of NLR for adverse outcomes in hospitalized patients with AECOPD. A retrospective study was conducted at the Department of Pulmonary Medicine, Cho Ray Hospital (Vietnam) from November 2019 to November 2021. The study extracted data from patients diagnosed with AECOPD at discharge and met the inclusion criteria. NLR is calculated by dividing the number of neutrophils by the number of lymphocytes in the peripheral blood test. Adverse outcomes are defined as invasive mechanical ventilation, admission to intensive care unit, or in-hospital mortality. Multivariable regression analysis was conducted to identify variables predicting adverse outcomes. The cutoff, sensitivity, specificity, area under the curve, and receiver operating characteristic of NLR were determined for predicting adverse outcomes. Two hundred eighty-seven patients with AECOPD were included in the final analysis, with a mean age of 70.9, and males comprising 92.7%. The rate of adverse outcomes was 15.7%. Multivariable logistic regression identified reduced consciousness at admission (adjusted odds ratio = 0.08, 95% confidence interval [CI]: 0.02-0.38, P = .001) and high NLR (adjusted odds ratio = 1.17, 95% CI: 1.10-1.24, P < .001) as predictors of adverse outcomes. The receiver operating characteristic of NLR's predictive value yielded an area under the curve of 0.877 (95% CI: 0.83-0.93). An NLR cutoff of 11.0 predicted adverse outcomes with a sensitivity of 80.0%, specificity of 77.7%, and an odds ratio of 13.9 (95% CI: 6.3-30.7), P < .001. NLR is a simple, routine, and cost-effective tool for predicting adverse outcomes in hospitalized patients with AECOPD. Future studies should evaluate the kinetics of NLR in predicting treatment response in patients with AECOPD.
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Affiliation(s)
- Nam Vu-Hoai
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pulmonary Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Duc Ly-Phuc
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ngoc Duong-Minh
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pulmonary Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Tran-Ngoc
- Faculty of Medicine, Department of Tuberculosis and Pulmonary Diseases, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Khoa Nguyen-Dang
- Faculty of Medicine, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Pulmonary Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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Bao LK, Khoa ND, Chi LTK, Anh NT. Prevalence and Factors Affecting Appropriate Inhaler Use in Elderly Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study. J Clin Med 2023; 12:4420. [PMID: 37445455 PMCID: PMC10342446 DOI: 10.3390/jcm12134420] [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: 05/21/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) mainly affects individuals aged 60 and older. The proper use of inhalers is crucial for managing COPD. This study aimed to evaluate the prevalence and factors affecting the appropriate use of inhalers among elderly patients with COPD. METHODS We enrolled 91 elderly patients with COPD admitted to the Department of Respiratory, University Medical Center HCMC between October 2020 and May 2021. Patients who were capable of using the inhaler would have their inhaler usage recorded through video footage. Two respiratory experts carefully analyzed 133 video-recorded demonstrations for evaluation purposes. RESULTS 18.7% of the patients demonstrated the correct inhaler technique. Pressurized metered dose inhaler (pMDI) and Turbuhaler had the lowest documented correct usage rates (11.9% and 10.0%, respectively). Two critical steps, namely "holding breath for about five seconds or as long as comfortable" and "breathing out gently," were commonly performed incorrectly when using pMDI, Respimat, Breezhaler, or Turbuhaler. Multivariable logistic regression analysis showed that lower mMRC scores (AOR = 5.3, CI 1.1-25.5, p = 0.037) and receiving inhaler instruction within the past three months (AOR = 5.2, CI 1.3-20.1, p = 0.017) were associated with increased odds of using the inhaler correctly. CONCLUSIONS Our study found that less than 20% of elderly patients with COPD use inhalers correctly. Common errors include inadequate breath-holding and gentle exhalation. mMRC scores and recent inhaler instruction were predictors of proper use. These findings can aid clinicians in improving inhaler management for elderly patients with COPD.
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Affiliation(s)
- Le Khac Bao
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Dang Khoa
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Le Thi Kim Chi
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam; (L.K.B.); (N.D.K.); (L.T.K.C.)
| | - Nguyen Tuan Anh
- Department of Respiratory, University Medical Center Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City 700000, Vietnam
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Alshaikh B, Yusuf K, Dressler-Mund D, Mehrem AA, Augustine S, Bodani J, Yoon E, Shah P. Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm. J Pediatr 2022; 246:26-33.e2. [PMID: 35301017 DOI: 10.1016/j.jpeds.2022.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/15/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.
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Affiliation(s)
- Belal Alshaikh
- Neonatal Nutrition and Gastroenterology Program, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Kamran Yusuf
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna Dressler-Mund
- Occupational Therapy, Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Ayman Abou Mehrem
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sajit Augustine
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Section of Neonatology, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Jaya Bodani
- Department of Pediatrics, Regina General Hospital, Regina and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Eugene Yoon
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh Shah
- Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Departments of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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Feldman K, Nitkin CR, Cuna A, Oschman A, Truog WE, Norberg M, Nyp M, Taylor JB, Lewis T. Corticosteroid response predicts bronchopulmonary dysplasia status at 36 weeks in preterm infants treated with dexamethasone: A pilot study. Pediatr Pulmonol 2022; 57:1760-1769. [PMID: 35434928 DOI: 10.1002/ppul.25928] [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: 10/19/2021] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
IMPORTANCE A major barrier to therapeutic development in neonates is a lack of standardized drug response measures that can be used as clinical trial endpoints. The ability to quantify treatment response in a way that aligns with relevant downstream outcomes may be useful as a surrogate marker for new therapies, such as those for bronchopulmonary dysplasia (BPD). OBJECTIVE To construct a measure of clinical response to dexamethasone that was well aligned with the incidence of severe BPD or death at 36 weeks' postmenstrual age. DESIGN Retrospective cohort study. SETTING Level IV Neonatal Intensive Care Unit. PARTICIPANTS Infants treated with dexamethasone for developing BPD between 2010 and 2020. MAIN OUTCOME(S) AND MEASURE(S) Two models were built based on demographics, changes in ventilatory support, and partial pressure of carbon dioxide (pCO2 ) after dexamethasone administration. An ordinal logistic regression and regularized binary logistic model for the composite outcome were used to associate response level to BPD outcomes defined by both the 2017 BPD Collaborative and 2018 Neonatal Research Network definitions. RESULTS Ninety-five infants were treated with dexamethasone before 36 weeks. Compared to the baseline support and demographic data at the time of treatment, changes in ventilatory support improved ordinal model sensitivity and specificity. For the binary classification, BPD incidence was well aligned with risk levels, increasing from 16% to 59%. CONCLUSIONS AND RELEVANCE Incorporation of response variables as measured by changes in ventilatory parameters and pCO2 following dexamethasone administration were associated with downstream outcomes. Incorporating drug response phenotype into a BPD model may enable more rapid development of future therapeutics.
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Affiliation(s)
- Keith Feldman
- Department of Pediatrics, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri, USA.,Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Christopher R Nitkin
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Alain Cuna
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Alexandra Oschman
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - William E Truog
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Michael Norberg
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Michael Nyp
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Jane B Taylor
- Department of Pediatrics, Division of Pulmonology, UPMC - Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tamorah Lewis
- Children's Mercy Kansas City, Center for Infant Pulmonary Disorders, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA.,Department of Pediatrics, Division of Neonatology, Children's Mercy Kansas City, Kansas City, Missouri, USA
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Vagal Tone and Proinflammatory Cytokines Predict Feeding Intolerance and Necrotizing Enterocolitis Risk. Adv Neonatal Care 2021; 21:452-461. [PMID: 34847103 DOI: 10.1097/anc.0000000000000959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) is the leading cause of death due to gastrointestinal disease in preterm neonates; yet, clinicians lack reliable and noninvasive predictive tools. PURPOSE We aimed to test that diminished high-frequency heart rate variability (HF-HRV) and elevated levels of proinflammatory cytokines would have utility in NEC prediction. METHODS In this multisite prospective study, we enrolled 250 preterm (26-34 weeks' postmenstrual age [PMA]) neonates with physiological stability at 72 hours of life. HRV was measured noninvasively using electrocardiograhic data from standardized cardiorespiratory monitors at postnatal week 1 of life and weekly thereafter until 35 weeks' PMA or discharge; blood was collected for cytokines at postnatal weeks 1 and 3. NEC was diagnosed via Modified Bell's Staging Criteria. RESULTS HF-HRV was decreased at weeks 1 and 2 in neonates (47% females) who developed feeding intolerance or stage 2+ NEC. In addition, these neonates displayed elevated levels of IL-8 at week 1 and increased levels of IL-1β, IL-6, TNF-α, and IL-8 at week 3 of life. Low HF-HRV was associated with elevated IL-6 or IL-8 levels at weeks 1 and 3 of life. Logistic regression indicated that only HF-HRV was a significant predictor of feeding intolerance or NEC development. IMPLICATIONS FOR PRACTICE AND RESEARCH HRV is a promising noninvasive modality for NEC risk detection. The association of low HF-HRV with elevated proinflammatory cytokines provides evidence for a putative role of the vagal cholinergic pathway in NEC pathogenesis. Future studies should focus on application of these techniques to test clinical therapeutics.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=54.
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Is Timing to Surgery an Independent Risk Factor for Complications Following Operative Treatment of Periprosthetic Lower Extremity Fractures? J Orthop Trauma 2021; 35:315-321. [PMID: 33165205 DOI: 10.1097/bot.0000000000001993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify whether timing to surgery was related to major 30-day morbidity and mortality rates in periprosthetic hip and knee fractures [OTA/AO 3 (IV.3, V.3), OTA/AO 4 (V4)]. DESIGN Retrospective database review. SETTING Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. PATIENTS Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007 and 2015. INTERVENTION Surgical management of periprosthetic hip and knee fractures including revision or open reduction internal fixation. MAIN OUTCOME MEASUREMENTS Major 30-day morbidity and mortality after operative treatment of periprosthetic hip or knee fractures. RESULTS A total of 1265 patients, mean age 72, including 883 periprosthetic hip and 382 periprosthetic fractures about the knee were reviewed. Delay in surgery greater than 72 hours is a risk factor for increased 30-day morbidity in periprosthetic hip and knee fractures [relative risk = 2.90 (95% confidence interval: 1.74-4.71); P-value ≤ 0.001] and risk factor for increased 30-day mortality [relative risk = 8.98 (95% confidence interval: 2.14-37.74); P-value = 0.003]. CONCLUSIONS Using NSQIP database to analyze periprosthetic hip and knee fractures, delay to surgery is an independent risk factor for increased 30-day major morbidity and mortality when controlling for patient functional status and comorbidities. Although patient optimization and surgical planning are paramount, minimizing extended delays to surgery is a potentially modifiable risk factor in the geriatric periprosthetic lower extremity fracture patient. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Hayek J, Schneider F, Tueni M, de Vries H. Is Academic Achievement Related to Mediterranean Diet, Substance Use and Social-Cognitive Factors: Findings from Lebanese Adolescents. Nutrients 2020; 12:nu12051535. [PMID: 32466121 PMCID: PMC7284451 DOI: 10.3390/nu12051535] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/17/2022] Open
Abstract
There is substantial evidence that good academic performance significantly enhances the prospects of success for adolescents in terms of employment, social status, quality of life and health. Identifying which factors are correlated to good academic achievement and which factors may need to be addressed by policies is crucial. Despite its importance, there is insufficient data concerning factors associated with academic achievement in the Middle East, particularly Lebanon. This study assessed the association of lifestyle, socio-demographics and motivational factors with academic achievement of Lebanese adolescents. Grade 10 and 11 Lebanese adolescents aged 15 to 18 years (n = 600), from private and public schools in Beirut and the Mount Lebanon area, completed a multi-component questionnaire assessing health behaviors, socio-demographic characteristics and motivational factors. Height and weight were physically measured and, subsequently, Body Mass Index was calculated. Academic achievement was assessed using self-reported grades and was categorized into high and low. Associations between all factors and academic achievement were tested using logistic regression models. Adherence to the Mediterranean diet, high self-efficacy and intention were positively associated with academic achievement, whereas smoking was associated with poor achievement. Our findings support the need for targeting adolescents with an unhealthier lifestyle and focusing on socio-cognitive determinants interventions aimed at enhancing academic achievement.
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Affiliation(s)
- Joyce Hayek
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands; (F.S.); (H.d.V.)
- Department of Biology, Nutrition and Dietetics, Faculty of Sciences II, Lebanese University, POB 90656 Fanar, Lebanon;
- Correspondence:
| | - Francine Schneider
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands; (F.S.); (H.d.V.)
| | - Maya Tueni
- Department of Biology, Nutrition and Dietetics, Faculty of Sciences II, Lebanese University, POB 90656 Fanar, Lebanon;
| | - Hein de Vries
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands; (F.S.); (H.d.V.)
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Chen J, Sun Y, Wang S, Dai X, Huang H, Bai Z, Li X, Wang J, Li Y. The effectiveness of urinary TIMP-2 and IGFBP-7 in predicting acute kidney injury in critically ill neonates. Pediatr Res 2020; 87:1052-1059. [PMID: 31791043 DOI: 10.1038/s41390-019-0698-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/29/2019] [Accepted: 10/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUD Urinary tissue inhibitor of metalloproteinase-2 (TIMP-2), insulin-like growth factor binding protein-7 (IGFBP-7) and the combination of TIMP-2 and IGFBP-7 ([TIMP-2]•[IGFBP7]) are proposed to be predictive biomarkers for acute kidney injury (AKI). The intention of our study was to determine whether there is any significant predictive value of these biomarkers for the occurrence of AKI and severe AKI in critically ill neonates. METHODS Urinary samples were serially collected in 237 neonates during neonatal intensive care unit (NICU) stay for measurements of TIMP-2 and IGFBP-7 in this prospective study. AKI diagnosis was based on KDIGO classification without urine output or serum creatinine >1.2 mg/dL. RESULTS Twenty neonates developed AKI, including 11 with KDIGO stage 1, defined as mild AKI, and 9 with stages 2 and 3, defined as severe AKI. Urinary IGFBP-7 and [TIMP-2]•[IGFBP7] remained associated with AKI after adjustment for gestational age, gender and illness severity. Urinary [TIMP-2]•[IGFBP7] achieved an AUC of 0.71 (P = 0.034) and displayed a sensitivity of 88.9% and a specificity of 50.9% for discriminating severe AKI at the optimal cut-off value of 0.045. CONCLUSION The combination of TIMP-2 and IGFBP-7 had independent discriminative value for severe AKI in critically ill neonates.
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Affiliation(s)
- Jiao Chen
- Department of Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Yunqing Sun
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Sanfeng Wang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Xiaomei Dai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Hui Huang
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Zhenjiang Bai
- Department of Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China. .,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
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Sotodate G, Oyama K, Matsumoto A, Konishi Y, Toya Y, Takashimizu N. Predictive ability of neonatal illness severity scores for early death in extremely premature infants. J Matern Fetal Neonatal Med 2020; 35:846-851. [PMID: 32098532 DOI: 10.1080/14767058.2020.1731794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The predictive ability of neonatal illness severity scores for mortality or morbidity in extremely premature infants has not been extensively studied. We aimed to evaluate the ability of neonatal illness severity scores [Clinical Risk Index for Babies II (CRIB II), Score for Neonatal Acute Physiology II (SNAP-II), and SNAP-Perinatal Extension II (SNAPPE-II)] in predicting mortality and short-term morbidity of extremely premature infants.Methods: This retrospective study involved 171 infants with gestational age (GA) between 22 and 27 weeks who were admitted to the NICU during 2010-2017. Predictive ability of neonatal illness severity scores for mortality and short-term morbidity (bronchopulmonary dysplasia, retinopathy of prematurity, intraventricular hemorrhage, necrotizing enterocolitis, and gastrointestinal perforation) was assessed by comparing their area under the receiver operating characteristic curve.Results: The overall mortality rate was 11.1%. Mortality at 23 weeks' gestation was higher than that at 24-27 weeks' gestation (p < .01, adjusted residual 4.5). Neonatal illness severity scores were significantly higher in infants who died than in those who survived (p < .01). CRIB II (AUC 0.93, 95% CI 0.85-1.00), SNAP-II (AUC 0.90, 95% CI 0.76-1.00), and SNAPPE-II (AUC 0.95, 95% CI 0.91-0.99) appeared to be excellent predictors and were superior to birth weight (AUC 0.88, 95% CI 0.80-0.95) or GA (AUC 0.84, 95% CI 0.72-0.96) alone in predicting early death (died on <28th postnatal day). CRIB II, SNAP-II, and SNAPPE-II were better predictors of early death than mortality in extremely premature infants. Neonatal illness severity score and short-term morbidity were not strongly associated.Conclusions: The neonatal illness severity scores were excellent predictors of early death in extremely premature infants and might be useful for selecting extremely preterm infants who need intervention.
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Affiliation(s)
- Genichiro Sotodate
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Kotaro Oyama
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Atsushi Matsumoto
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yu Konishi
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Yukiko Toya
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Nao Takashimizu
- Department of Pediatrics, School of Medicine, Iwate Medical University, Iwate, Japan
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10
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Philpot PA, Bhandari V. Predicting the likelihood of bronchopulmonary dysplasia in premature neonates. Expert Rev Respir Med 2019; 13:871-884. [PMID: 31340666 DOI: 10.1080/17476348.2019.1648215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Bronchopulmonary dysplasia (BPD) is the most common serious pulmonary morbidity in premature infants. Despite ongoing advances in neonatal care, the incidence of BPD has not improved. A potential explanation for this phenomenon is the limited ability for accurate early prediction of the risk of BPD. BPD continues to represent a therapeutic challenge and no single effective therapy exists for this condition. Areas covered: Here, we review risk factors of BPD derived from clinical data, biological fluid biomarkers, respiratory management data, and scientific advancements using 'omics' technologies, and their ability to predict the pathogenesis of BPD in preterm neonates. Risk factors and biomarkers were identified via literature search with a focus on the last 5 years of data. Expert opinion: The most accurate predictive tools utilize risk factors that encompass a variety of categories. Numerous predictive models have been proposed but suffer from a lack of adequate validation. An ideal model should include multiple, easily measurable variables validated across a heterogeneous population. In addition to evaluating recent BPD prediction models, we suggest approaches to enhance future models.
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Affiliation(s)
- Patrick A Philpot
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Thomas Jefferson University College of Medicine, Nemours/Alfred I. DuPont Hospital for Children , Philadelphia , PA , USA
| | - Vineet Bhandari
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children , Philadelphia , PA , USA
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Marvin MM, Gardner FC, Sarsfield KM, Travagli RA, Doheny KK. Increased Frequency of Skin-to-Skin Contact Is Associated with Enhanced Vagal Tone and Improved Health Outcomes in Preterm Neonates. Am J Perinatol 2019; 36:505-510. [PMID: 30193382 PMCID: PMC6405324 DOI: 10.1055/s-0038-1669946] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE An estimation of the individual's ability to cope with environmental adversity, that is, stress resiliency, can be extrapolated by measuring cardiac vagal tone, that is, high-frequency heart rate variability (HF-HRV); indeed, higher HF-HRV is associated with health and developmental advantages for preterm neonates. Previous studies show skin-to-skin contact (SSC) improves stress resiliency; however, linkages between SSC and HF-HRV on outcomes have not been assessed. We aimed to test the hypothesis that increased SSC frequency would enhance HF-HRV, reduce neonatal morbidity, and improve developmental outcomes. STUDY DESIGN Weekly electrocardiograms and clinical data were obtained from 101 preterm neonates. SSC frequency was determined from the electronic medical record. RESULTS At postnatal week 1, frequency of SSC and HF-HRV were positively correlated (p =.02); further, multiple stepwise regressions showed higher HF-HRV and SSC predicted reduced days on ventilation and oxygen, and shorter hospital stay (p < 0.001). Higher HF-HRV predicted lower postmenstrual age (PMA) at discharge (p < 0.01). CONCLUSION Higher SSC frequency was associated with increased HF-HRV during the first postnatal week. SSC and HF-HRV uniquely predicted diminished neonatal morbidity throughout hospitalization. Additionally, HF-HRV uniquely predicted earlier PMA at discharge. Augmenting SSC early in life enhances stress resiliency and improves health outcomes.
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Affiliation(s)
- Megan M. Marvin
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Fumiyuki C. Gardner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Kristin M. Sarsfield
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - R. Alberto Travagli
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Kim K. Doheny
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
- Department of Neural and Behavioral Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
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Fang F, Hu X, Dai X, Wang S, Bai Z, Chen J, Pan J, Li X, Wang J, Li Y. Subclinical acute kidney injury is associated with adverse outcomes in critically ill neonates and children. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:256. [PMID: 30305134 PMCID: PMC6180629 DOI: 10.1186/s13054-018-2193-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/13/2018] [Indexed: 12/15/2022]
Abstract
Background Research on acute kidney injury (AKI) has focused on identifying early biomarkers. However, whether AKI could be diagnosed in the absence of the classic signs of clinical AKI and whether the condition of subclinical AKI, identified by damage or functional biomarkers in the absence of oliguria or increased serum creatinine (sCr) levels, is clinically significant remains to be elucidated in critically ill children. The aims of the study were to investigate the associations between urinary cystatin C (uCysC) levels and AKI and mortality and to determine whether uCysC-positive subclinical AKI is associated with adverse outcomes in critically ill neonates and children. Methods In this prospective cohort study, uCysC levels were serially measured during the first week after intensive care unit (ICU) admission in a heterogeneous group of patients (n = 510) presenting to a tertiary neonatal and pediatric ICU. The diagnosis of neonatal AKI that developed during the first week after admission was based on neonatal KDIGO criteria or sCr >1.5 mg/dL, and pediatric AKI was based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The term “uCysC(−)” or “uCysC(+)”, indicating the absence or presence of tubular injury, was defined by the optimal peak uCysC cutoff value for predicting ICU mortality. Results The initial and peak uCysC levels were significantly associated with AKI and mortality, and had an area under the receiver operating characteristic curve of 0.76 and 0.81, respectively, for predicting mortality. At the optimal cutoff value of 1260 ng/mg uCr, the peak uCysC displayed sensitivity of 79.2% and specificity of 72.3% for predicting mortality. Among all patients, 130 (25.5%) developed uCysC(+)/AKI(−) status during the first week after admission. The adjusted odds ratio for patients with uCysC(+)/AKI(−) status in association with an increased risk of mortality compared with that for patients with uCysC(−)/AKI(−) was 9.34 (P < 0.001). Patients with uCysC(+)/AKI(−) spent 2.8 times as long in the ICU as those with uCysC(−)/AKI(−) (P < 0.001). Conclusions Both initial and peak uCysC levels are associated with AKI and mortality and are independently predictive of mortality in critically ill neonates and children. Subclinical AKI may occur without detectable loss of kidney function, and uCysC-positive subclinical AKI is associated with worse clinical outcomes in this population. Electronic supplementary material The online version of this article (10.1186/s13054-018-2193-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fang Fang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Xiaohan Hu
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Xiaomei Dai
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Sanfeng Wang
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Zhenjiang Bai
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Jiao Chen
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Jian Pan
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Xiaozhong Li
- Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China
| | - Yanhong Li
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, JiangSu province, China. .,Department of Nephrology, Children's Hospital of Soochow University, Suzhou, JiangSu province, China.
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13
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Park JH, Chang YS, Ahn SY, Sung SI, Park WS. Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels. PLoS One 2018; 13:e0192232. [PMID: 29438382 PMCID: PMC5811008 DOI: 10.1371/journal.pone.0192232] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/19/2018] [Indexed: 11/22/2022] Open
Abstract
We explored GA, BW, Apgar score, CRIB II score, and serum albumin levels as univariate predictors of mortality in extremely low birth weight infants. Medical records of 564 extremely low birth weight infants were reviewed retrospectively. The infants were grouped as survivors (group I), expired ≤ 7th postnatal day (group II), and expired > 7th postnatal day (group III). The predictive value for mortality of gestational age, birth weight, Apgar scores at 1 and 5 min, clinical risk index for babies II score, and first and lowest serum albumin levels was assessed by calculating the associated area under the curve (AUC) in receiver operating characteristic (ROC) curves. The overall survival and mortality rates of groups I, II, and III were 81.0% (457/564), 7.6% (43/564), and 11.4% (64/564), respectively. Birth weight, Apgar scores at 1 and 5 min, and first serum albumin levels were significantly higher, while the clinical risk index for babies II score was significantly lower in group I when compared to groups II and III. Gestational age and lowest serum albumin level in group I were significantly higher than group III, but not group II. However, gestational age, birth weight, and clinical risk index for babies II score showed gestational age dependent variations regardless of survival or mortality. Apgar score at 5 min (0.756) and lowest serum albumin level (0.771) demonstrated the highest AUC of the ROC curve in predicting mortality in group II and III, respectively. In conclusion, Apgar score at 5 min and lowest serum albumin level were the most effective predictors for mortality in extremely low birth weight infants during ≤ 7th and > 7th postnatal days, respectively.
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Affiliation(s)
- Jae Hyun Park
- Department of Pediatrics, Dongsan Medical Center, Keimyung University, School of Medicine, Daegu, South Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Se In Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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14
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Gardner FC, Adkins CS, Hart SE, Travagli RA, Doheny KK. Preterm Stress Behaviors, Autonomic Indices, and Maternal Perceptions of Infant Colic. Adv Neonatal Care 2018; 18:49-57. [PMID: 29261561 PMCID: PMC5786477 DOI: 10.1097/anc.0000000000000451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND While biological and behavioral stress response systems are intact in early gestation, preterm infants' behaviors are often more subtle and difficult to interpret compared with full-term infants. They are also more vulnerable for regulatory issues (ie, colic) that are known to impact caregiver-infant interactions. Biobehavioral measures such as behavioral responsivity and heart rate variability (HRV), particularly cardiac vagal tone, may help elucidate preterm infants' stress/regulatory systems. PURPOSE To test the hypotheses that preterm infants' consoling behaviors and high-frequency (HF) HRV in the first week of life are significantly associated and they are inverse correlates of future colic risk. METHODS/SEARCH STRATEGY Thirty preterm (mean ± SE = 32.7 ± 0.3 weeks postmenstrual age [PMA]) infants underwent direct NIDCAP (Newborn Individualized Development and Assessment Program) observation during routine care and had HRV measurements during their first week postbirth. Sixty-three percent of mothers completed the Infant Colic Scale at 6 to 8 weeks adjusted postnatal age. Nonparametric tests were used to determine associations among behaviors, HRV, and maternal perceptions of infant colic. FINDINGS/RESULTS Self-consoling behaviors were positively associated with HF-HRV (vagal tone). In addition, stress behaviors were positively associated with low-frequency/high-frequency HRV (sympathetic dominance). Infants who displayed more stress behaviors also demonstrated more self-consoling behaviors. No significant associations were found with colic. IMPLICATIONS FOR PRACTICE HF-HRV provides information on the infant's capacity to modulate stress and is a useful, noninvasive measure when behaviors are more difficult to discern. IMPLICATIONS FOR RESEARCH Further study in a larger sample is needed to determine whether behavioral stress measures and HF-HRV may be useful to determine colic risk.
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Affiliation(s)
- Fumiyuki C. Gardner
- Penn State Hershey Children’s Hospital and Department of Pediatrics, Penn State Hershey, College of Medicine, Hershey, PA
| | - Cherie S. Adkins
- Stabler Department of Nursing, York College of Pennsylvania, York, PA
| | - Sarah E. Hart
- Department of Anesthesia, Critical Care and Pain Management, Deaconess Medical Center, Boston, MA
| | - R. Alberto Travagli
- Department of Neural and Behavioral Sciences, Penn State Hershey, College of Medicine, Hershey PA, USA
| | - Kim Kopenhaver Doheny
- Penn State Hershey Children’s Hospital and Department of Pediatrics, Penn State Hershey, College of Medicine, Hershey, PA
- Department of Neural and Behavioral Sciences, Penn State Hershey, College of Medicine, Hershey PA, USA
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15
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Mohamed I, Elremaly W, Rouleau T, Lavoie JC. Oxygen and parenteral nutrition two main oxidants for extremely preterm infants: 'It all adds up'. J Neonatal Perinatal Med 2016; 8:189-97. [PMID: 26485550 DOI: 10.3233/npm-15814091] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the effect of early exposure to O2 and parenteral nutrition (PN) on oxidative stress at 36 weeks post-menstrual age (PMA) and on bronchopulmonary dysplasia (BPD) in extremely preterm infants. STUDY DESIGN A prospective observational study including 116 infants <29 weeks of gestation. Baseline clinical characteristics, FiO2 on day 7, duration of PN and clinical outcomes data were collected. In 39 infants, whole blood glutathione (GSH) and oxidized glutathione (GSSG) at 36 weeks PMA were measured and the redox potential was calculated using Nernst equation. Student's t-test, Chi-square, Spearman correlation, ANOVA, and logistic regression analyses were used as appropriate. P < 0.05 was considered significant. RESULTS FiO2 ≥25% was associated with higher level of GSSG (0.29 ± 0.04 versus 0.18 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-191 ± 2 versus -198 ± 2 mV) and more BPD (90% versus 45%). PN duration >14 days was also associated with higher level of GSSG (0.26 ± 0.03 versus 0.13 ± 0.02 nmol/mg of protein), a more oxidized redox potential (-193 ± 5 versus -203 ± 2 mV) and more BPD (89% versus 24%). In logistic regression model, each 1% increase in FiO2 and each day increase in PN duration resulted in an increase in the OR for BPD by 1.57 (1.09 -2.28) and 1.17 (1.03 -1.33) respectively. CONCLUSION Early O2 supplement and PN have additive effects that were associated with prolonged oxidative stress and increased risk of BPD. Strategies targeting judicious use of O2 and decreasing the duration or developing a safer formulation of PN can be targeted to decrease BPD.
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Affiliation(s)
- I Mohamed
- Department of Pediatrics-Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - W Elremaly
- Department of Nutrition, University of Montreal, Montreal, Canada
| | - T Rouleau
- Department of Pediatrics-Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada.,Department of Nutrition, University of Montreal, Montreal, Canada
| | - J-C Lavoie
- Department of Pediatrics-Neonatology, CHU Sainte-Justine, University of Montreal, Montreal, Canada.,Department of Nutrition, University of Montreal, Montreal, Canada
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Sullivan BA, McClure C, Hicks J, Lake DE, Moorman JR, Fairchild KD. Early Heart Rate Characteristics Predict Death and Morbidities in Preterm Infants. J Pediatr 2016; 174:57-62. [PMID: 27113378 PMCID: PMC5672906 DOI: 10.1016/j.jpeds.2016.03.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/19/2016] [Accepted: 03/17/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine whether an early heart rate characteristics (HRC) index (HeRO score), measured in the first day and week after birth predicts death and morbidities compared with established illness severity scores. STUDY DESIGN For all very low birth weight infants in a single neonatal intensive care unit from 2004-2014, the average first day HRC index was calculated within 24 hours of birth (aHRC-24h) and the average first week HRC index within 7 days of birth (aHRC-7d). The Score for Neonatal Acute Physiology (SNAP-II) and Clinical Risk Indicator for Babies (CRIB-II) were calculated when data were available. The aHRC was compared with the SNAP-II and CRIB-II for predicting death, late-onset septicemia, necrotizing enterocolitis, bronchopulmonary dysplasia, severe intraventricular hemorrhage, or severe retinopathy of prematurity. RESULTS All 4 scores were associated with death and severe intraventricular hemorrhage (P < .01). The OR and 95% CI for every 1-point increase in aHRC for predicting mortality, adjusted for gestational age, was 1.59 (1.25-2.00) for aHRC-24h and 2.61 (1.58-4.33) for aHRC-7d. High aHRC-7d, SNAP-II, and CRIB-II were associated with bronchopulmonary dysplasia (P < .001). High aHRC-7d was associated with late-onset septicemia (P < .05). None of the scores predicted necrotizing enterocolitis or severe retinopathy of prematurity. CONCLUSIONS HRC assessed in the first day or first week after birth compares favorably to established risk scores to predict death and morbidities in very low birth weight infants.
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Affiliation(s)
- Brynne A. Sullivan
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Christina McClure
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Jamie Hicks
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Douglas E. Lake
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - J. Randall Moorman
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Karen D. Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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17
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Rivera L, Siddaiah R, Oji-Mmuo C, Silveyra GR, Silveyra P. Biomarkers for Bronchopulmonary Dysplasia in the Preterm Infant. Front Pediatr 2016; 4:33. [PMID: 27065351 PMCID: PMC4814627 DOI: 10.3389/fped.2016.00033] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/22/2016] [Indexed: 12/20/2022] Open
Abstract
Bronchopulmonary dysplasia (BPD) is a chronic inflammatory lung disease of very-low-birth-weight (VLBW) preterm infants, associated with arrested lung development and a need for supplemental oxygen. Over the past few decades, the incidence of BPD has significantly raised as a result of improved survival of VLBW infants requiring mechanical ventilation. While early disease detection is critical to prevent chronic lung remodeling and complications later in life, BPD is often difficult to diagnose and prevent due to the lack of good biomarkers for identification of infants at risk, and overlapping symptoms with other diseases, such as pulmonary hypertension (PH). Due to the current lack of effective treatment available for BPD and PH, research is currently focused on primary prevention strategies, and identification of biomarkers for early diagnosis, that could also represent potential therapeutic targets. In addition, novel histopathological, biochemical, and molecular factors have been identified in the lung tissue and in biological fluids of BPD and PH patients that could associate with the disease phenotype. In this review, we provide an overview of biomarkers for pediatric BPD and PH that have been identified in clinical studies using various biological fluids. We also present a brief summary of the information available on current strategies and guidelines to prevent and diagnose BPD and PH, as well as their pathophysiology, risk factors, and experimental therapies currently available.
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Affiliation(s)
- Lidys Rivera
- Department of Pediatrics, The Pennsylvania State University College of Medicine , Hershey, PA , USA
| | - Roopa Siddaiah
- Department of Pediatrics, The Pennsylvania State University College of Medicine , Hershey, PA , USA
| | - Christiana Oji-Mmuo
- Department of Pediatrics, The Pennsylvania State University College of Medicine , Hershey, PA , USA
| | - Gabriela R Silveyra
- Department of Pediatrics, The Pennsylvania State University College of Medicine , Hershey, PA , USA
| | - Patricia Silveyra
- Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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18
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Cecatto SB, Monteiro-Soares M, Henriques T, Monteiro E, Moura CIFP. Derivation of a clinical decision rule for predictive factors for the development of pharyngocutaneous fistula postlaryngectomy. Braz J Otorhinolaryngol 2015; 81:394-401. [PMID: 26145251 PMCID: PMC9442709 DOI: 10.1016/j.bjorl.2014.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/21/2014] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Pharyngocutaneous fistula after larynx and hypopharynx cancer surgery can cause several damages. This study's aim was to derive a clinical decision rule to predict pharyngocutaneous fistula development after pharyngolaryngeal cancer surgery. METHODS A retrospective cohort study was conducted, including all patients performing total laryngectomy/pharyngolaryngectomy (n=171). Association between pertinent variables and pharyngocutaneous fistula development was assessed and a predictive model proposed. RESULTS American Society of Anesthesiologists scale, chemoradiotherapy, and tracheotomy before surgery were associated with fistula in the univariate analysis. In the multivariate analysis, only American Society of Anesthesiologists maintained statistical significance. Using logistic regression, a predictive model including the following was derived: American Society of Anesthesiologists, alcohol, chemoradiotherapy, tracheotomy, hemoglobin and albumin pre-surgery, local extension, N-classification, and diabetes mellitus. The model's score area under the curve was 0.76 (95% CI 0.64-0.87). The high-risk group presented specificity of 93%, positive likelihood ratio of 7.10, and positive predictive value of 76%. Including the medium-low, medium-high, and high-risk groups, a sensitivity of 92%, negative likelihood ratio of 0.25, and negative predictive value of 89% were observed. CONCLUSION A clinical decision rule was created to identify patients with high risk of pharyngocutaneous fistula development. Prognostic accuracy measures were substantial. Nevertheless, it is essential to conduct larger prospective studies for validation and refinement.
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Affiliation(s)
- Suzana Boltes Cecatto
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil; Associação Médica Brasileira (AMB), São Paulo, SP, Brazil; Oporto Faculty of Medicine, Oporto, Portugal.
| | - Matilde Monteiro-Soares
- CIDES/CINTESIS, Health Information and Decision Sciences Department, Oporto Faculty of Medicine, Oporto, Portugal
| | - Teresa Henriques
- CIDES/CINTESIS, Health Information and Decision Sciences Department, Oporto Faculty of Medicine, Oporto, Portugal
| | - Eurico Monteiro
- Department of Otorhinolaryngology, Portuguese Institute of Oncology of Porto, Oporto, Portugal
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Wang Q, Li M, Li X, Pan J, Wang J, Feng X, Li Y. Early urinary angiotensinogen excretion in critically ill neonates. J Renin Angiotensin Aldosterone Syst 2015; 16:1010-20. [PMID: 26116142 DOI: 10.1177/1470320315583777] [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: 03/17/2014] [Accepted: 03/12/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Urinary angiotensinogen is considered a reliable biomarker for intrarenal renin-angiotensin system activity. The aims of this study were to assess the urinary angiotensinogen level during the first day of life and to evaluate its correlation with renal function in critically ill neonates. METHODS Urinary angiotensinogen concentration during the first 24 hours of life was measured in 98 critically ill neonates. Neonatal renal function was assessed by urinary levels of cystatin-C, albumin and α1-microglobulin and urinary electrolyte excretion. RESULTS Urinary angiotensinogen level decreased with increasing gestational age and body weight in critically ill neonates (P<0.001). After adjustment for gestational age, urinary angiotensinogen level correlated with urinary fractional excretion of sodium and urinary levels of cystatin-C and α1-microglobulin. Multivariate linear regression identified a significant impact of urinary cystatin-C on urinary angiotensinogen level (P<0.001). Furthermore, urinary angiotensinogen was significantly increased in neonates with a urinary cystatin-C-to-creatinine ratio ⩾2500 ng/mg, which was the optimal cut-off value to predict acute kidney injury in our previous study. CONCLUSIONS The urinary angiotensinogen level correlates with the overall maturity of renal function during the early postnatal period in critically ill neonates and an increased urinary angiotensinogen level might reflect renal injury in immature neonates.
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Affiliation(s)
- Qing Wang
- Department of Neonatology, Children's Hospital affiliated to Soochow University, China
| | - Mengxia Li
- Department of Nephrology, Children's Hospital affiliated to Soochow University, China
| | - Xiaozhong Li
- Department of Nephrology, Children's Hospital affiliated to Soochow University, China
| | - Jian Pan
- Institute of Pediatric Research, Children's Hospital affiliated to Soochow University, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital affiliated to Soochow University, China
| | - Xing Feng
- Department of Neonatology, Children's Hospital affiliated to Soochow University, China
| | - Yanhong Li
- Department of Nephrology, Children's Hospital affiliated to Soochow University, China Institute of Pediatric Research, Children's Hospital affiliated to Soochow University, China
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Abstract
PURPOSE OF REVIEW Advances in medical therapy have increased survival of extremely premature infants and changed the pathology of bronchopulmonary dysplasia (BPD) from one of acute lung injury to a disease of disrupted lung development. With this evolution, new questions emerge regarding the molecular mechanisms that control postnatal lung development, the effect of early disruptions of postnatal lung development on long-term lung function, and the existence of endogenous mechanisms that permit lung regeneration after injury. RECENT FINDINGS Recent data demonstrate that a significant component of alveolarization, the final stage of lung development, occurs postnatally. Further, clinical and experimental studies demonstrate that premature birth disrupts alveolarization, decreasing the gas exchange surface area of the lung and causing BPD. BPD is associated with significant short-term morbidity, and new longitudinal, clinical data demonstrate that survivors of BPD have long-standing deficits in lung function and may be at risk for the development of additional lung disease as adults. Unfortunately, current care is mainly supportive with few effective therapies that prevent or treat established BPD. These studies underscore the need to further elucidate the mechanisms that direct postnatal lung growth and develop innovative strategies to stimulate lung regeneration. SUMMARY Despite significant improvements in the care and survival of extremely premature infants, BPD remains a major clinical problem. Although efforts should remain focused on the prevention of preterm labor and BPD, novel research aimed at promoting postnatal alveolarization offers a unique opportunity to develop effective strategies to treat established BPD.
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