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Staub E. Current and potential methods to assess kidney structure and morphology in term and preterm neonates. Anat Rec (Hoboken) 2023. [PMID: 36883787 DOI: 10.1002/ar.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/25/2023] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.
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Affiliation(s)
- Eveline Staub
- Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Su YT, Chen YS, Yeh LR, Chen SW, Tsai YC, Wu CY, Yang YN, Tey SL, Lin CH. Unnecessary radiation exposure during diagnostic radiography in infants in a neonatal intensive care unit: a retrospective cohort study. Eur J Pediatr 2023; 182:343-352. [PMID: 36352243 PMCID: PMC9829594 DOI: 10.1007/s00431-022-04695-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/26/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
UNLABELLED Unnecessary radiation exposure (URE) during radiographic examination is an issue among infants in neonatal intensive care units (NICUs). The causes of URE have not been fully explored. This study investigated the incidence and identified the causes of URE in infants during diagnostic radiography in a NICU. This was a retrospective cohort study. We retrieved and analysed requests and radiographs taken at a tertiary NICU between September and November 2018. URE was defined as the rate of discordance between requests and images taken (DisBRI) and unnecessary radiation exposure in irrelevant regions (UREIR) during radiography. We compared the rates of URE between very low-birth-weight (VLBW, birth weight < 1500 g) infants and non-VLBW infants. A total of 306 radiographs from 88 infants were taken. The means ± standard deviations (SDs) of gestational age and birth weight were 35.7 ± 3.6 weeks and 2471 ± 816 g, respectively. Each infant underwent an average of 3.5 radiographs. The DisBRI rate was 1.3% and was mostly related to poor adherence to requests. The UREIR rates in thoraco-abdominal babygrams were 89.6% for the head, 14.8% for the elbows and 18.4% for the knee and were mainly related to improper positioning of and collimation in infants while performing radiography. The UREIR rates for the head, knee and ankle were higher in VLBW infants than in non-VLBW infants (94.6% vs. 85.6%, 27.0% vs. 11.5% and 5.4% vs. 0.7%, respectively, p < 0.05). CONCLUSIONS URE during diagnostic radiography is common in sick infants and is mainly related to improper positioning and collimation during examinations. Adherence to protocols when performing radiographic examination or using ultrasonography may be a solution to reduce URE in infants in NICUs. WHAT IS KNOWN • The risk of unnecessary radiation exposure (URE) during radiography has been a common and important issue in sick infants in neonatal intensive care units (NICUs). • The new point-of-care ultrasound (POCUS) technique decreases the need for chest films and prevents radiation exposure in neonates. WHAT IS NEW • In the NICU, URE is still a common issue in critically ill infants during radiographic examinations. The causes of URE during diagnostic radiography are mainly due to improper positioning and collimation during examinations. • The incidence of URE in irrelevant regions is higher in very low-birth-weight (VLBW) infants than in non-VLBW infants.
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Affiliation(s)
- Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shen Chen
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Lee-Ren Yeh
- Department of Radiology, E-Da Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Wen Chen
- Department of Nursing, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Cheng Tsai
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chyi-Her Lin
- Department of Pediatrics, E-Da Hospital, #1, Yi-da Road, Jiaosu Village, Yanchao District, Kaohsiung, 82445, Taiwan.
- School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan.
- Department of Pediatrics, National Cheng-Kung University Hospital, Tainan, Taiwan.
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Persson MSM, Yin W, Döring N, Risnes K, Weiderpass E, Steliarova-Foucher E, Sandin S. Gestational age and cancer risk up to young adulthood in Swedish population born 1974 to 2013: A population-based cohort study. Int J Cancer 2022; 150:1269-1280. [PMID: 34855204 DOI: 10.1002/ijc.33886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022]
Abstract
We examined the association between gestational age and risk of any primary cancer and observed whether the risk patterns differed by sex, birth weight for gestational age categories, cancer site and age of onset. All people live-born in Sweden 1974 to 2013 were prospectively followed up from birth until 2016 using national registers. Gestational age was extracted from the Medical Birth Register and primary malignant cancer diagnoses were from the Swedish cancer register. The adjusted hazard ratios (aHR) for any primary cancer according to weekly gestational age and gestational age categories were determined using cox proportional hazards models adjusted for birth year and parental age. The study included 3 137 691 people; 180 363 (5.8%) born preterm and 254 790 (8.1%) born postterm. They were followed up for 71 691 112 person-years, to a maximum of 43 years and recorded 22 604 new cancers. Although aHRs for the predefined GA categories were only increased for moderate to late preterm delivery (aHR 1.07, 95% CI 1.01-1.14), gestational week-specific aHRs were increased for gestational weeks 30 to 35, with greatest aHR observed for 31 weeks (aHR 1.18, 95% CI 1.05-1.32). Increased cancer risk related to shorter gestational ages were observed particularly for women, those born small for gestational age, childhood cancers and for cancers originating at certain sites (eg, testicular and liver cancer). We provide the first evidence that those born between 30 and 35 weeks gestation may have increased risk of any primary malignant cancer up to young adulthood. Additionally, increasing gestational ages may reduce the risk of testicular and liver cancer.
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Affiliation(s)
- Monica S M Persson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Nora Döring
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, New York, USA
- Seaver Autism Center for Research and Treatment at Mount Sinai, New York, New York, USA
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Jadcherla SR, Hasenstab KA, Osborn EK, Levy DS, Ipek H, Helmick R, Sultana Z, Logue N, Yildiz VO, Blosser H, Shah SH, Wei L. Mechanisms and management considerations of parent-chosen feeding approaches to infants with swallowing difficulties: an observational study. Sci Rep 2021; 11:19934. [PMID: 34620898 PMCID: PMC8497609 DOI: 10.1038/s41598-021-99070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Videofluoroscopy swallow studies (VFSS) and high-resolution manometry (HRM) methods complement to ascertain mechanisms of infant feeding difficulties. We hypothesized that: (a) an integrated approach (study: parent-preferred feeding therapy based on VFSS and HRM) is superior to the standard-of-care (control: provider-prescribed feeding therapy based on VFSS), and (b) motility characteristics are distinct in infants with penetration or aspiration defined as penetration-aspiration scale (PAS) score ≥ 2. Feeding therapies were nipple flow, fluid thickness, or no modification. Clinical outcomes were oral-feeding success (primary), length of hospital stay and growth velocity. Basal and adaptive HRM motility characteristics were analyzed for study infants. Oral feeding success was 85% [76-94%] in study (N = 60) vs. 63% [50-77%] in control (N = 49), p = 0.008. Hospital-stay and growth velocity did not differ between approaches or PAS ≥ 2 (all P > 0.05). In study infants with PAS ≥ 2, motility metrics differed for increased deglutition apnea during interphase (p = 0.02), symptoms with pharyngeal stimulation (p = 0.02) and decreased distal esophageal contractility (p = 0.004) with barium. In conclusion, an integrated approach with parent-preferred therapy based on mechanistic understanding of VFSS and HRM metrics improves oral feeding outcomes despite the evidence of penetration or aspiration. Implementation of new knowledge of physiology of swallowing and airway protection may be contributory to our findings.
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Affiliation(s)
- Sudarshan R. Jadcherla
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA ,grid.412332.50000 0001 1545 0811Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Kathryn A. Hasenstab
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Erika K. Osborn
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Deborah S. Levy
- grid.8532.c0000 0001 2200 7498Department of Speech and Language Pathology, Hospital de Clínicas de Porto Alegre, Department of Health and Communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Haluk Ipek
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Roseanna Helmick
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Zakia Sultana
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA
| | - Nicole Logue
- grid.240344.50000 0004 0392 3476The Innovative Infant Feeding Disorders Research Program, Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, OH USA ,grid.240344.50000 0004 0392 3476Division of Neonatology, Nationwide Children’s Hospital, 575 Children’s Crossroads, Columbus, OH 43215 USA
| | - Vedat O. Yildiz
- grid.240344.50000 0004 0392 3476Biostatistics Resource at Nationwide Children’s Hospital (BRANCH), Nationwide Children’s Hospital, Columbus, OH USA ,grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
| | - Hailey Blosser
- grid.240344.50000 0004 0392 3476Division of Clinical Therapies, Nationwide Children’s Hospital, Columbus, OH USA
| | - Summit H. Shah
- grid.240344.50000 0004 0392 3476Department of Radiology, Nationwide Children’s Hospital, Columbus, OH USA
| | - Lai Wei
- grid.261331.40000 0001 2285 7943Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH USA
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