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Mercier E, Pisharody L, Guy F, Wan S, Hegazy N, D'Aoust PM, Kabir MP, Nguyen TB, Eid W, Harvey B, Rodenburg E, Rutherford C, Mackenzie AE, Willmore J, Hui C, Paes B, Delatolla R, Thampi N. Corrigendum: Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada. Front Public Health 2024; 12:1354693. [PMID: 38333738 PMCID: PMC10850862 DOI: 10.3389/fpubh.2024.1354693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fpubh.2023.1261165.].
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Affiliation(s)
- Elisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Lakshmi Pisharody
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Fiona Guy
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Shen Wan
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Nada Hegazy
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Patrick M. D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Md Pervez Kabir
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Tram Bich Nguyen
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Walaa Eid
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Bart Harvey
- Hamilton Public Health Services, Hamilton, ON, Canada
| | | | | | - Alex E. Mackenzie
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Charles Hui
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Paes B, Lanari M, Rodgers-Gray B, Fullarton J, Carbonell-Estrany X. Opinion: The optimal use of risk factors to guide palivizumab prophylaxis against severe respiratory syncytial virus infection in moderate-to-late preterm infants. Front Pediatr 2024; 12:1343960. [PMID: 38283631 PMCID: PMC10811053 DOI: 10.3389/fped.2024.1343960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS-Policlinico Ospedaliero-Universitario di Bologna, Bologna, Italy
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Thampi N, Mercier E, Paes B, Edwards JO, Rodgers-Gray B, Delatolla R. Perspective: the potential of wastewater-based surveillance as an economically feasible game changer in reducing the global burden of pediatric respiratory syncytial virus infection. Front Public Health 2024; 11:1316531. [PMID: 38283294 PMCID: PMC10816218 DOI: 10.3389/fpubh.2023.1316531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024] Open
Abstract
Respiratory syncytial virus (RSV) is the leading viral cause of childhood bronchiolitis and pneumonia causing over 3 million hospitalizations and 100,000 deaths in children under 5 years of age annually. Wastewater-based surveillance (WBS) has proven an effective early warning system for high-consequence pathogens, including SARS-CoV-2, polio, mpox, and influenza, but has yet to be fully leveraged for RSV surveillance. A model predicated on the Canadian province of Ontario demonstrates that implementation of a WBS system can potentially result in significant cost savings and clinical benefits when guiding an RSV preventive program with a long-acting monoclonal antibody. A network of integrated WBS initiatives offers the opportunity to help minimize the devastating global burden of RSV in children by optimizing the timing of preventive measures and we strongly advocate that its benefits continue to be explored.
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Affiliation(s)
- Nisha Thampi
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Elisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | | | | | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
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Amawat J, Wirayannawat W, Boonyanunt P, Paes B, Kitsommart R. Effects of antenatal dexamethasone on postnatal serum cortisol levels in late preterm infants. J Matern Fetal Neonatal Med 2023; 36:2224491. [PMID: 37322821 DOI: 10.1080/14767058.2023.2224491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To explore whether antenatal dexamethasone impacts postnatal serum cortisol levels in stable late preterm (LPT) infants. Secondary outcomes were to identify short-term hospital outcomes related to antenatal dexamethasone exposure. METHODS A prospective cohort study of serial serum cortisol levels in LPT infants within 3 h of birth, and at 1, 3, and 14 postnatal days. Serum cortisol levels were compared between infants exposed to antenatal dexamethasone >3 h and <14 days prior to delivery (aDex) and those who either did not receive dexamethasone or were exposed < 3 h or >14 days prior to delivery (no-aDex). RESULTS Thirty-two LPT infants (aDex) were compared with 29 infants (no-aDEX). Group demographic characteristics were similar. Serum cortisol levels were identical between the groups at all 4-time points. Cumulative antenatal dexamethasone exposure ranged from 0 to 12 doses. Post-hoc analysis of the 24-hour serum cortisol levels indicated a significant difference between 1 to 3 cumulative doses versus 4 or more doses (p = .01). Only 1 infant in the aDex group had a cortisol level <3rd percentile of the reference value. Rates of hypoglycemia (absolute difference [95% CI] - 1.0 [-16.0,15.0]; p = .90) and mechanical ventilation were similar in both groups (absolute difference [95%CI] - 0.3 [-9.3,8.7]; p = .94). No deaths occurred. CONCLUSION Antenatal dexamethasone administered 14 days prior to delivery did not affect serum cortisol levels and short-term hospital outcomes in stable LPT infants. Exposure to low cumulative doses of dexamethasone resulted in transient low serum cortisol levels compared to 4 or more doses only at 24-hours.
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Affiliation(s)
- Jutharat Amawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wariphan Wirayannawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakamas Boonyanunt
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Mercier E, Pisharody L, Guy F, Wan S, Hegazy N, D’Aoust PM, Kabir MP, Nguyen TB, Eid W, Harvey B, Rodenburg E, Rutherford C, Mackenzie AE, Willmore J, Hui C, Paes B, Delatolla R, Thampi N. Wastewater-based surveillance identifies start to the pediatric respiratory syncytial virus season in two cities in Ontario, Canada. Front Public Health 2023; 11:1261165. [PMID: 37829087 PMCID: PMC10566629 DOI: 10.3389/fpubh.2023.1261165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Detection of community respiratory syncytial virus (RSV) infections informs the timing of immunoprophylaxis programs and hospital preparedness for surging pediatric volumes. In many jurisdictions, this relies upon RSV clinical test positivity and hospitalization (RSVH) trends, which are lagging indicators. Wastewater-based surveillance (WBS) may be a novel strategy to accurately identify the start of the RSV season and guide immunoprophylaxis administration and hospital preparedness. Methods We compared citywide wastewater samples and pediatric RSVH in Ottawa and Hamilton between August 1, 2022, and March 5, 2023. 24-h composite wastewater samples were collected daily and 5 days a week at the wastewater treatment facilities in Ottawa and Hamilton, Ontario, Canada, respectively. RSV WBS samples were analyzed in real-time for RSV by RT-qPCR. Results RSV WBS measurements in both Ottawa and Hamilton showed a lead time of 12 days when comparing the WBS data set to pediatric RSVH data set (Spearman's ρ = 0.90). WBS identify early RSV community transmission and declared the start of the RSV season 36 and 12 days in advance of the provincial RSV season start (October 31) for the city of Ottawa and Hamilton, respectively. The differing RSV start dates in the two cities is likely associated with geographical and regional variation in the incidence of RSV between the cities. Discussion Quantifying RSV in municipal wastewater forecasted a 12-day lead time of the pediatric RSVH surge and an earlier season start date compared to the provincial start date. These findings suggest an important role for RSV WBS to inform regional health system preparedness, reduce RSV burden, and understand variations in community-related illness as novel RSV vaccines and monoclonal antibodies become available.
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Affiliation(s)
- Elisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Lakshmi Pisharody
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Fiona Guy
- Hamilton Health Sciences, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Shen Wan
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Nada Hegazy
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Patrick M. D’Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Md Pervez Kabir
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Tram Bich Nguyen
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Walaa Eid
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Bart Harvey
- Hamilton Public Health Services, Hamilton, ON, Canada
| | | | | | - Alex E. Mackenzie
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Charles Hui
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, ON, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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Kitsommart R, Limrungsikul A, Tongsawang N, Thamwiriyakul N, Deesomchok A, Pithakton N, Paes B. Impact of level of neonatal care on phlebotomy and blood transfusion in extremely low birthweight infants: a prospective, multicenter, observational study. Front Pediatr 2023; 11:1238402. [PMID: 37724088 PMCID: PMC10505442 DOI: 10.3389/fped.2023.1238402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 09/20/2023] Open
Abstract
Objectives To explore the level of neonatal care on cumulative phlebotomy loss (cPL) and red cell transfusions in extremely low birthweight [ELBW; birthweight (BW) <1,000 g] infants, up to 40 weeks post-conceptual age (PCA). The secondary objective was to determine the associations between cPL and number of transfusions and between transfusions and hospital outcomes. Methods A prospective, comparative, observational study was conducted in two level IV and two level III neonatal intensive care units (NICUs) in Thailand. Daily cPL volume and number of blood tests were recorded. Descriptive data are reported as frequency and percentage for categorical variables and median [25th percentile (P25), 75th percentile (P75)] for continuous data according to the data distribution. A p-value <0.05 was considered statistically significant. Results 210 ELBW infants were included; 99 and 111 were admitted to level IV and level III NICUs, respectively. Birth weight of level IV infants was lower 780.0 [660.0, 875.0] vs. 865.0 [723.0, 930.0] g; p < 0.001]. Initial group hematocrits were similar (43.1% vs. 44.0%, p = 0.47). cPL for each infant was 28.1 [16.5, 46.4] ml. Level IV infants had more tests (n = 89 [54, 195] vs. 59 [37, 88], p < 0.001). Counterintuitively, there was a lower cPL trend in level IV infants, but this was insignificant (19.6 [12.3, 52.3] vs. 28.9 [19.3, 45.3] ml; p = 0.06). The number of transfusions in both NICUs was similar 4 [2, 6], with a strong correlation between cPL and number of transfusions (r = 0.79, p < 0.001). Transfusions were significantly associated with bronchopulmonary dysplasia [BPD; adjusted RR (95% CI): 2.6 (1.2, 5.3), p = 0.01]. Conclusions Level IV NICUs conducted more blood tests in ELBW infants without a difference in cPL, and number of transfusions. Cumulative PL correlated with number of transfusions and was associated with BPD risk. Minimizing cPL by point-of-care tests and restrictive transfusion criteria, may reduce need for transfusion.
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Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Anchalee Limrungsikul
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Numtip Tongsawang
- Department of Pediatric Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Areeya Deesomchok
- Department of Pediatrics, Buddhachinaraj Hospital, Phitsanulok, Thailand
| | - Nuttanan Pithakton
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
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Wirayannawat W, Amawat J, Yamsiri N, Paes B, Kitsommart R. Comparison of the SenSmart™ and the INVOS™ neonatal cerebral near-infrared spectrometry devices. Front Pediatr 2023; 11:1243977. [PMID: 37691777 PMCID: PMC10485771 DOI: 10.3389/fped.2023.1243977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives To determine the correlation and agreement between the SenSmart™ and the INVOS™ devices of neonatal cerebral regional oxygen saturation (CrSO2) measurements using neonatal sensors. The secondary objective was to develop a regression model that predicts CrSO2-INVOS values using CrSO2-SenSmart indices and determine whether the values between the devices are interchangeable. Methods A prospective, cross-sectional study was conducted in infants during the first 4 weeks of life. Simultaneous, bilateral CrSO2 was measured using the SenSmart™X100 (CrSO2-SenSmart) or INVOS™ 5100C (CrSO2-INVOS) device in each frontoparietal area for 2 h. Five-minute CrSO2 values were extracted for analysis. Results Thirty infants were recruited with 720 pairwise measurements and 26 (84%) were evaluated in the first week of life. Mean gestational age of the preterm and term infants was [30.9 ± 2.8 (n = 14) and 38.8 ± 1.1 (n = 16)] weeks, respectively. Overall CrSO2- was 77.08 ± 9.70% and 71.45 ± 12.74% for the SenSmart and INVOS, respectively (p < 0.001). The correlation coefficient (r) between the CrSO2-SenSmart and INVOS was 0.20 (p < 0.001). The mean difference between the CrSO2-SenSmart and INVOS was 5.63 ± 13.87% with -21.6% to 32.8% limits of agreement. The r and mean difference was 0.39 (p < 0.001) and 8.87 ± 12.58% in preterm infants, and 0.06 (p = 0.27) and 2.79 ± 14.34 in term infants. Conclusion The CrSO2-SenSmart tended to read higher than the CrSO2-INVOS device. There was no correlation between the CrSO2-SenSmart and the CrSO2-INVOS in term infants and it was weak in preterms. Due to imprecise agreement, the CrSO2-SenSmart values are not interchangeable with those of the CrSO2-INVOS.
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Affiliation(s)
- Wariphan Wirayannawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jutharat Amawat
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattaya Yamsiri
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Fullarton J, Keary I, Paes B, Tarride JE, Carbonell-Estrany X, Rodgers-Gray B. Accurately Assessing the Expected Impact of Universal First Respiratory Syncytial Virus (RSV) Season Immunization With Nirsevimab Against RSV-Related Outcomes and Costs Among All US Infants. J Infect Dis 2023; 227:1333-1334. [PMID: 36520978 DOI: 10.1093/infdis/jiac488] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2024] Open
Affiliation(s)
| | - Ian Keary
- Violicom Medical Limited, Aldermaston, United Kingdom
| | - Bosco Paes
- McMaster University, Hamilton, Ontario, Canada
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Mosalli R, Aboumoustafa GA, Khayyat W, Bokhari AN, Almatrafi MA, Ghazi M, Paes B. Assessment of Nurses' Knowledge and Confidence Regarding Tracheostomy Care in a Pediatric Long Term Care Hospital in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:1809-1821. [PMID: 36171869 PMCID: PMC9512020 DOI: 10.2147/rmhp.s374730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement. Methods A cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value <0.05 calculated by t-Test, was considered significant. Results Among 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P <0.05). Conclusion Deficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Gamal A Aboumoustafa
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia
| | - Wed Khayyat
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aziza N Bokhari
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohammed Ghazi
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Division of Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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10
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Mosalli R, Alqarni SA, Khayyat WW, Alsaidi ST, Almatrafi AS, Bawakid AS, Paes B. Respiratory syncytial virus nosocomial outbreak in neonatal intensive care: A review of the incidence, management, and outcomes. Am J Infect Control 2022; 50:801-808. [PMID: 34736992 DOI: 10.1016/j.ajic.2021.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND The main objective was to determine the incidence, management, and outcomes of respiratory syncytial virus nosocomial infection (RSVNI) outbreaks in neonatal intensive care units. METHODS A comprehensive search of RSVNI in 9 databases was conducted from January 1, 2000 to May 1, 2021, of which the Cochrane Library comprised the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. Two hundred and twenty-eight articles were retrieved and 17 were retained. A descriptive analysis was performed, and frequencies are reported as mean, median, and range where pertinent. RESULTS One hundred and seventeen infants were analyzed and comprised preterms (88.1%) and those with pre-existing co-morbidities. The estimated proportional incidence of RSVNI was 23.8% (177/744) infants. Outbreaks were principally managed by conventional protective measures, neonatal intensive care unit closure, and visitor restriction. Palivizumab was used to control RSVNI in 10 studies. RSVNI-related mortality was 8.5% (15/177) and 8.0% (7/87) among infants where infection control was solely employed. CONCLUSION RSVNI is associated with significant morbidity and mortality. The use of palivizumab should be a multidisciplinary decision, based on rapidly spreading infection. Prospective studies are essential to determine the cost-benefit of palivizumab versus standard prevention control for an RSVNI outbreak.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia; Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia.
| | - Sarah A Alqarni
- Medical College, Umm Al Qura University, Mecca, Saudi Arabia
| | - Wed W Khayyat
- Medical College, Umm Al Qura University, Mecca, Saudi Arabia
| | | | | | - Afnan S Bawakid
- Medical College, Umm Al Qura University, Mecca, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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11
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Bhatia K, Solanki S, Paes B, Chan AKC, Bhatt MD. Risk factors for neonatal thrombosis: A retrospective study conducted in a single Canadian intensive care unit. Pediatr Blood Cancer 2022; 69:e29668. [PMID: 35289485 DOI: 10.1002/pbc.29668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/10/2022]
Abstract
Among children, neonates have the highest incidence of thrombosis. We conducted a retrospective review of neonatal thrombosis, in a single intensive care unit (ICU) over 4.5 years. Among 4860 ICU admissions to our center, identified through the Canadian Neonatal Network database, 186 were associated with arterial and venous thrombosis involving 195 thrombotic sites. The neonatal thrombosis incidence was 38 per 1000 neonatal ICU admissions. We assessed patient characteristics and compared the association between risk factors and thrombosis. In the multivariate analysis, central venous catheters, sepsis, and respiratory distress syndrome were significant predictors of neonatal thrombosis.
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Affiliation(s)
- Kulsajan Bhatia
- Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York.,Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Smeet Solanki
- Psychology, Neuroscience and Behavior, McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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12
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Paes B, Chan AKC, Shaik M, Patel D, Bhatt MD. Epidemiology, diagnosis and management of neonatal thrombosis: a single-center cohort study. Blood Coagul Fibrinolysis 2022; 33:83-89. [PMID: 35001043 DOI: 10.1097/mbc.0000000000001110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The incidence of neonatal venous and arterial thrombosis ranges from 6.9 to 15/1000 neonatal ICU (NICU) admissions, and is likely an underestimate based on population demographics, frequency of surveillance and vascular catheterization. This retrospective study involving 234 infants reviewed the epidemiology, diagnosis, and management of neonatal thrombosis in a single, tertiary care institution over more than 10 years. The incidence of thrombosis was 25/1000 NICU admissions, with a preterm to term infant ratio of 1.5 : 1 and a slightly higher proportion of male sex (55.1%). The mean (range) gestational age and birth weight was 33.8 weeks (23-41.6) and 2360 g (512-5890). The median age (IQR) of thrombus diagnosis was 7 (3-17) days. Portal vein thrombosis was most prevalent (59.4%) compared with other sites of thrombosis. Almost three-quarter (171/234; 73.1%) of the thrombotic episodes were line-related, while infection and surgery were associated with 19.7% (46/234) and 10.7% (25/234), respectively. Twenty patients (8.3%) were screened for thrombophilia and 3 were positive; 2 for antithrombin deficiency, 1 for factor V Leiden gene mutation. Subjects were followed with imaging for 3 months with a treatment duration, mean (IQR) of 33.5 (10.8-42.5) days. Complete clot resolution was significantly higher in the anticoagulation group (48%; 17%; P = 0.03) compared with untreated patients. No group difference was noted for partial thrombus resolution (33.3%; 12.4%; P = 0.313). Anticoagulation halted thrombus progression (2.6 versus 12.4%; P = 0.025) and fewer treated patients failed to attend follow-up visits (6.5 versus 18.6%; P = 0.022). Well designed, multicenter prospective studies with larger sample sizes are required to confirm these findings.
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Affiliation(s)
- Bosco Paes
- Division of Neonatology, Department of Pediatrics
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
| | | | - Dhiman Patel
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital
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Mosalli R, Al Matrafi A, Alqarni S, Khayyat W, Paes B. Are multiple births at greater risk for RSV-related hospitalisation compared with singletons? Arch Dis Child 2022; 107:193-197. [PMID: 34728463 DOI: 10.1136/archdischild-2021-322856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia .,Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
| | | | - Sarah Alqarni
- Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
| | - Wed Khayyat
- Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Butt M, Elliott L, Guy F, Symington A, Paes B. Comparison of the Canadian vs. the international risk scoring tool for respiratory syncytial virus prophylaxis in moderate-to-late preterm infants. Front Pediatr 2022; 10:997349. [PMID: 36683806 PMCID: PMC9851620 DOI: 10.3389/fped.2022.997349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
AIM The study objective was to compare the Pediatric Investigators Collaborative Network on Infections in Canada risk scoring tool (CRST) that determines need for respiratory syncytial virus (RSV) prophylaxis in infants 33-35 weeks gestational age during the RSV season, with the newly developed international risk scoring tool (IRST). METHODS Children 33-35 weeks gestational age born during the 2018-2021 RSV seasons were prospectively identified following birth and scored with the validated CRST and IRST, that comprises seven and three variables respectively, into low- moderate- and high-risk groups that predict RSV-related hospitalization. Correlations between total scores on the two tools, and cut-off scores for the low-, moderate- and high-risk categories were conducted using the Spearman rank correlation. RESULTS Over a period of 3 RSV seasons, 556 infants were scored. Total risk scores on the CRST and the IRST were moderately correlated (rs = 0.64, p < 0.001). A significant relationship between the risk category rank on the CRST and the risk category rank on the IRST (rs = 0.53; p < 0.001) was found. The proportion of infants categorized as moderate risk for RSV hospitalization by the CRST and IRST were 19.6% (n = 109) and 28.1% (n = 156), respectively. CONCLUSION The IRST may provide a time-efficient scoring alternative to the CRST with three vs. seven variables, and it selects a larger number of infants who are at moderate risk for RSV hospitalization for prophylaxis. A cost-utility analysis is necessary to justify country-specific use of the IRST, while in Canada a cost comparison is necessary between the IRST vs. the currently approved CRST prior to adoption.
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Affiliation(s)
- Michelle Butt
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - LouAnn Elliott
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Fiona Guy
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Amanda Symington
- Department of Pediatrics, St. Catharines General Hospital, Niagara Health, St. Catharines, ON, Canada
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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15
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Ting J, Yeung K, Paes B, Chan AKC, Petropoulos JA, Banfield L, Bhatt MD. How to use low-molecular-weight heparin to treat neonatal thrombosis in clinical practice. Blood Coagul Fibrinolysis 2021; 32:531-538. [PMID: 34102656 DOI: 10.1097/mbc.0000000000001052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Among children, neonates have the highest incidence of thrombosis due to risk factors such as catheter instrumentation, an evolving coagulation system and congenital heart disease. Low-molecular-weight heparins (LMWHs) are the most commonly used anticoagulants in neonates. Published guidelines delineate dosing and monitoring protocols for LMWH therapy in newborns. However, challenging clinical situations frequently present that warrant healthcare providers to think critically beyond the range of guidelines, and judiciously resolve specific problems. This review describes the use of LMWH in the neonatal population, including practical aspects such as route and site of administration, preparation from concentrated formulations and methods to minimize pain of subcutaneous injection. It is followed by a discussion on dosing, monitoring and outcomes of LMWH therapy in neonates. The risk of recurrence of thrombosis in neonates after LMWH therapy is approximately 3% based on a pooled analysis of studies reporting this outcome over the last 24 years. The article concludes with an overview of the side-effects of LMWH, including the risk of bleeding which is around 4% based on pooled analyses of more than 30 studies.
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Affiliation(s)
- James Ting
- National University of Ireland, Galway, Ireland
| | - Klement Yeung
- Internal Medicine Residency Program, McMaster University
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University
| | | | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children's Hospital, McMaster University
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16
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Paes B, Li A, Kim D, Lanctot KL, Mitchell I. A Comparison of Respiratory Syncytial Viral Prophylaxis in Multiple Births versus Singletons in the Canadian Registry of Palivizumab. Am J Perinatol 2021; 38:e129-e136. [PMID: 32232817 DOI: 10.1055/s-0040-1708804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to compare respiratory illness-related hospitalization (RIH) and respiratory syncytial virus (RSV)-related hospitalization (RSVH) in multiple births versus singletons, who received palivizumab during the RSV season and participated in the Canadian registry of palivizumab (CARESS). STUDY DESIGN Prospective, observational study of infants aged <2 years recruited across 32 centers over 12 RSV seasons from 2005 to 2017. Demographic data were collected at enrolment and RIH events were recorded monthly. RESULTS A total of 25,003 infants were enrolled of whom 6,949 (27.8%) were of multiple birth, and 18,054 (72.2%) were singletons. A significantly larger proportion of the multiple births were premature (80.2%) compared with the singleton group (56.8%). Multiples had a lower gestational age (mean ± standard deviation): 31.2 ± 3.2 versus 33.2 ± 5.5 weeks and birth weight (mean: 1,590 ± 606.8 vs. 2,069.4 ± 1068.5 g; both p < 0.0005). They were younger at enrolment (4.5 ± 5.0 vs. 6.1 ± 6.8 months), and fewer attended daycare (1.9 vs. 4.6%), and experienced exposure to smoking (24.5 vs. 29.9%), but more lived in a crowded household (36.7 vs. 19.4%); all p < 0.0005. Multiples had a longer length of neonatal stay (51.1 ± 65.9 vs. 47.9 ± 67.8 days), and more required respiratory support (65.7 vs. 57.7%), but for shorter duration (22.6 ± 32.9 vs. 24.7 ± 40.6 days); all p < 0.001. RIH and RSVH rates (%) in multiples versus singletons were 4.7; 7.7 and 1.4; and 1.6, respectively. Cox regression showed that multiples had a lower risk of RIH compared with singletons (hazard ratio [HR] = 0.616, 95% confidence interval [CI]: 0.543-0.698, p < 0.0005), but not RSVH (HR: 0.77, 95% CI: 0.57-1.02, p = 0.071). CONCLUSION Multiple birth infants, who are known to be at greater risk for severe RSVH compared with singletons, are well protected by palivizumab, provided adherence to the monthly injection scheme is guaranteed.
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Affiliation(s)
- Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Abby Li
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Doyoung Kim
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Krista L Lanctot
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ian Mitchell
- Department of Pediatrics, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
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Mitchell I, Wang DY, Troskie C, Loczy L, Li A, Paes B, Lanctôt K. What risk factors for sudden infant death syndrome are preterm and term medically complex infants exposed to at home? Paediatr Child Health 2021; 26:e184-e188. [PMID: 34262631 PMCID: PMC8274542 DOI: 10.1093/pch/pxaa070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 05/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Risk factors for sudden infant death syndrome include premature birth, maternal smoking, prone or side sleeping position, sleeping with blankets, sharing a sleeping surface with an adult, and sleeping without an adult in the room. In this study, we compare parents' responses on sleep patterns in premature and term infants with medical complexity. METHODS Parents of children enrolled in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab were phoned monthly regarding their child's health status until the end of each respiratory syncytial virus season. Baseline data were obtained on patient demographics, medical history, and neonatal course. Responses on adherence to safe sleep recommendations were recorded as part of the assessment. RESULTS A total of 2,526 preterms and 670 term infants with medical complexity were enrolled. Statistically significant differences were found in maternal smoking rates between the two groups: 13.3% (preterm); 9.3% (term) infants (χ 2=8.1, df=1, P=0.004) and with respect to toys in the crib: 12.3% (term) versus 5.8% preterms (χ 2=24.5, df=1, P<0.0005). Preterm infants were also significantly more likely to be placed prone to sleep (8.8%), compared with term infants (3.3%), (χ 2=18.1, df=1, P<0.0005). CONCLUSION All the infants in this study had frequent medical contacts. There is a greater prevalence of some risk factors for sudden infant death syndrome in preterm infants compared to term infants with medical complexity. Specific educational interventions for vulnerable infants may be necessary.
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Affiliation(s)
- Ian Mitchell
- Department of Paediatrics, University of
Calgary, Calgary, Alberta
| | - Daniel Y Wang
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
| | | | - Lisa Loczy
- Department of Paediatrics, University of
Calgary, Calgary, Alberta
| | - Abby Li
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
| | - Bosco Paes
- Department of Paediatrics, McMaster
University, Hamilton, Ontario
| | - Krista Lanctôt
- Medical Outcomes and Research in Economics (MORE®)
Research Group, Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, Ontario
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Paes B, Fullarton JR, Rodgers-Gray BS, Carbonell-Estrany X. Adoption in Canada of an international risk scoring tool to predict respiratory syncytial virus hospitalization in moderate-to-late preterm infants. Curr Med Res Opin 2021; 37:1149-1153. [PMID: 33813989 DOI: 10.1080/03007995.2021.1911974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The advisory board to the Ontario Ministry of Health considered adopting the new three-variable international risk scoring tool (IRST) to guide prophylaxis against respiratory syncytial virus hospitalization (RSVH) in moderate-to-late preterm infants born 32-35 weeks' gestational age (wGA). Canada currently uses a nationally validated, seven-variable RST, to predict RSVH in 33-35 wGA infants. We explored the potential implications of switching from the Canadian to the IRST. METHODS Predictive accuracy (area under the receiver operating characteristic curve [AUROC]) of the two RSTs and correlations (Spearman rank) and number needed to treat (NNT) between cut-off scores for low-, moderate- and high-risk subjects were assessed. RESULTS The RSTs contain many of the same risk factors (birth proximity to the RSV season, smoking, siblings, daycare), with the Canadian RST also including sex, small for GA and familial eczema. Predictive accuracy was similar (AUROC, IRST: 0.773 [sensitivity: 68.9%; specificity: 73.0%] vs Canadian: 0.762 [68.2%; 71.9%]). Significant correlations between cut-off scores (p < .001) and risk categories (p < .001) were apparent, although the correlation coefficients were weak for both (scores: 0.217; categories: 0.055). While the proportion of high-risk infants was similar (IRST: 0.7% vs Canadian: 0.6%), the NNT was lower for the Canadian RST (7.5 vs 14.3), and more infants were assigned moderate risk by the IRST (19.9% vs 9.8%). CONCLUSIONS The IRST can be considered simpler (fewer risk factors) than the Canadian RST and its adoption may reduce the number of RSVHs among moderate-to-late preterm infants; however, the cost-effective implications for RSV prophylaxis warrant further investigation.
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Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | | | | | - Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
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19
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Mosalli R, Khayyat W, Al Qarni S, Al Matrafi A, El Baz M, Paes B. Topical nitroglycerin in newborns with ischemic injuries: A systematic review. Saudi Pharm J 2021; 29:764-774. [PMID: 34400871 PMCID: PMC8347849 DOI: 10.1016/j.jsps.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Arterial catheterization is frequently performed in neonatal intensive care units with an inherent risk of peripheral ischemic injury, especially in preterm infants. The treatment options following vascular damage involve invasive and non-invasive modalities. The primary objective of this systematic review was to evaluate the evidence of the use of topical nitroglycerine (TNG) either alone or as adjunctive therapy. The secondary aim was to develop an approach to the treatment of catheter induced ischemia in infants based on the available evidence. METHODS A comprehensive search was conducted of available databases for relevant articles that involved the treatment of peripheral tissue ischemia in neonates with the use of TNG. Citations were restricted to human subjects. RESULTS Six hundred and eighty-nine articles were identified, and twenty-seven case reports and case series were compatible with the inclusion and exclusion criteria. Sixty-eight infants out of the 76 published cases (89%) experienced a favorable outcome and 79% (n = 60) demonstrated complete recovery with the topical application of TNG to the ischemic site. CONCLUSION The available evidence demonstrates that TNG is effective for the treatment of peripheral ischemia in neonates after standard conservative measures have failed. However, due to the absence of robust evidence for this therapeutic modality, there are no uniform guidelines regarding the frequency, duration, and safety of TNG use. Planning the management of peripheral ischemia in neonates with TNG should be a multidisciplinary decision that includes close surveillance of blood pressure, methemoglobin levels, and follow up cranial ultrasound.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Um Al-Qura University, Makkah, Saudi Arabia
- Departemt of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
| | - Wed Khayyat
- Medical College, Um Al-Qura University, Makkah, Saudi Arabia
| | - Sarah Al Qarni
- Medical College, Um Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohamed El Baz
- Departemt of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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20
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Paes B, Baraldi E, Fauroux B, Carbonell‐Estrany X. Exploring respiratory syncytial virus prophylaxis for children with all grades of bronchopulmonary dysplasia. Acta Paediatr 2021; 110:25-27. [PMID: 32691906 DOI: 10.1111/apa.15482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Bosco Paes
- Department of Pediatrics McMaster University Hamilton ON Canada
| | - Eugenio Baraldi
- Women’s and Children’s Health Department University of Padova Padova Italy
- Respiratory Syncytial Virus Network (ReSViNET) Padova Italy
| | - Brigitte Fauroux
- Pediatric Non‐invasive Ventilation and Sleep Unit Assistance publique – Hôpitaux de Paris Necker University Hospital Paris France
- Équipe d'accueil Vigilance Fatigue Sommeil Paris University Paris France
| | - Xavier Carbonell‐Estrany
- Neonatology Service Hospital Clinic Institut d’Investigacions Biomediques August Pi Suñer Barcelona Spain
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21
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Carbonell-Estrany X, Rodgers-Gray BS, Paes B. Challenges in the prevention or treatment of RSV with emerging new agents in children from low- and middle-income countries. Expert Rev Anti Infect Ther 2020; 19:419-441. [PMID: 32972198 DOI: 10.1080/14787210.2021.1828866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) causes approximately 120,000 deaths annually in children <5 years, with 99% of fatalities occurring in low- and middle-income countries (LMICs). AREAS COVERED There are numerous RSV interventions in development, including long-acting monoclonal antibodies, vaccines (maternal and child) and treatments which are expected to become available soon. We reviewed the key challenges and issues that need to be addressed to maximize the impact of these interventions in LMICs. The epidemiology of RSV in LMICs was reviewed (PubMed search to 30 June 2020 inclusive) and the need for more and better-quality data, encompassing hospital admissions, community contacts, and longer-term respiratory morbidity, emphasized. The requirement for an agreed clinical definition of RSV lower respiratory tract infection was proposed. The pros and cons of the new RSV interventions are reviewed from the perspective of LMICs. EXPERT OPINION We believe that a vaccine (or combination of vaccines, if practicable) is the only viable solution to the burden of RSV in LMICs. A coordinated program, analogous to that with polio, involving governments, non-governmental organizations, the World Health Organization, the manufacturers and the healthcare community is required to realize the full potential of vaccine(s) and end the devastation of RSV in LMICs.
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Affiliation(s)
- Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
| | | | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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22
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Mosalli R, Paes B. Setting realistic goals for feeding infants when their mothers have suspected or confirmed COVID-19. Acta Paediatr 2020; 109:1934-1936. [PMID: 32628783 PMCID: PMC7361856 DOI: 10.1111/apa.15459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics Um Al‐Qura University Makkah Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division) McMaster University Hamilton ON Canada
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23
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Kim D, Saleem M, Paes B, Mitchell I, Lanctôt KL. Respiratory Syncytial Virus Prophylaxis in Infants With Congenital Diaphragmatic Hernia in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab, 2005-2017. Clin Infect Dis 2020; 69:980-986. [PMID: 30517603 PMCID: PMC6735793 DOI: 10.1093/cid/ciy1010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infants with congenital diaphragmatic hernia (CDH) are at an increased risk of respiratory morbidity from recurrent respiratory tract infections including those from respiratory syncytial virus (RSV). Prospective studies on RSV prophylaxis in CDH infants are limited. We determined the risk of respiratory illness- and RSV-related hospitalizations (RIH and RSVH, respectively) among infants prophylaxed for CDH, standard indications (SIs) and those without increased risk (NR). METHODS The prospective Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab (CARESS) registry was searched for infants who received palivizumab during 12 RSV seasons (2005-2017) in Canada. Cox proportional hazards analyses were conducted to compare RIH and RSVH risks across the groups adjusted for potential confounders. RESULTS In total, 21 107 infants (201 CDH, 389 NR, and 20 517 SI) were included. RIH incidences were 10.0% (CDH), 2.1% (NR), and 6.2% (SI). CDH patients had a significantly higher RIH hazard compared with NR (hazard ratio [HR], 3.6 [95% confidence interval {CI}, 1.5-8.8]; P = .005) but not SI (HR, 1.2 [95% CI, .8-2.0]; P = .379). RSVH incidences were 0.6%, 0.3%, and 1.5% for CDH, NR, and SI, respectively. RSVH risk was similar across groups (SI: HR, 0.0, P = .922; NR: HR, 0.0, P = .934). CONCLUSIONS CDH infants had a 3-fold increased risk of RIH compared to NR but not SI infants. RSVH risk was similar with low RSVH incidences across all groups, implying that CDH infants may benefit from palivizumab during the RSV season, similar to other high-risk groups. CLINICAL TRIALS REGISTRATION NCT00420966.
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Affiliation(s)
- Doyoung Kim
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto
| | - Mahwesh Saleem
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Ian Mitchell
- Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Krista L Lanctôt
- Medical Outcomes and Research in Economics Research Group, Sunnybrook Health Sciences Centre, University of Toronto
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Tieu P, Paes B, Ahmed A, Matino D, Chan A, Bhatt M. Inferior vena cava syndrome in neonates: An evidence-based systematic review of the literature. Pediatr Blood Cancer 2020; 67:e28114. [PMID: 31876366 DOI: 10.1002/pbc.28114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 11/11/2022]
Abstract
Neonatal inferior vena cava syndrome (IVCS), though uncommon, is associated with significant morbidity and mortality. Information on risk factors, diagnosis, treatment, and outcomes is limited. This review comprised 61 neonates across 33 reports. Thrombosis occurred in 98% and 42% involved a central venous catheter. Diagnosis was mainly established by ultrasound in 82%. Therapeutically, heparin was employed in 36% and thrombolysis in 18% of the cases. The overall mortality was 23%. An algorithm of clinical signs, investigation, and management is presented. Well-designed prospective studies are needed to establish a concrete investigational approach to neonatal IVCS and institute safe, evidence-based treatment.
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Affiliation(s)
- Paul Tieu
- Bachelor of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Afrah Ahmed
- Department of Clinical Studies, University of Guelph, Guelph, Ontario, Canada
| | - Davide Matino
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Anthony Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada and the Thrombosis and Hemostasis in Newborns (THiN) Group
| | - Mihir Bhatt
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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Kitsommart R, Thammawong N, Sommai K, Yangnoy J, Bowornkitiwong W, Paes B. Impact of meconium consistency on infant resuscitation and respiratory outcomes: a retrospective-cohort study and systematic review. J Matern Fetal Neonatal Med 2020; 34:4141-4147. [PMID: 31900012 DOI: 10.1080/14767058.2019.1706476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To compare short-term outcomes of infants born with thick versus thin meconium stained amniotic fluid (MSAF) and to perform a systematic review of the topic.Methods: A retrospective, single center, cohort study of infants' ≥34 weeks' gestation born with MSAF between 1 June 2013 and 30 September 2016. Birth resuscitation and respiratory outcomes were compared between the groups. A systematic review was conducted of similar studies published between 1 January 2000 and 30 June 2019.Results: 1507 infants were eligible; 464 (30.8%) thick, 1,043 (69.2%) thin MSAF. The thick group required more respiratory support at birth and was 5.5-fold (95% CI: 2.51-11.95) more likely to and have meconium aspiration syndrome (MAS) and 2.1-fold more likely (95% CI: 0.89-4.83) to require either noninvasive respiratory support or intubation than the thin group. The thick group also had significantly higher oxygen supplementation >24 h (p < .001) and pneumothorax (p = .002). Across 12 studies included in the systematic review, infants with thick MSAF required more intensive birth resuscitation, ventilation support, with higher incidences of MAS. Study differences prohibited data comparisons and quantitative outcome evaluations.Conclusion: Infants with thick MSAF required more intensive birth resuscitation and ventilation support. Our findings need confirmation in robust, prospective cohort studies.
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Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narongrit Thammawong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokwan Sommai
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jittiyaporn Yangnoy
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Walaiporn Bowornkitiwong
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Canada
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Kitsommart R, Wongsinin T, Swasee U, Paes B. Accuracy of Using a Point-of-Care Glucometer for Cerebrospinal Fluid Glucose Screening in Resource-Limited Countries. Hosp Pediatr 2019; 9:665-672. [PMID: 31434686 DOI: 10.1542/hpeds.2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To explore the accuracy of using a point-of-care (POC) glucometer for cerebrospinal fluid (CSF) glucose screening. METHODS A cross-sectional study was conducted. A glucose analysis of CSF samples collected from infants <90 days with suspected meningitis was paired between tests by using a POC glucometer (POC-CSF glucose) and a laboratory glucose analysis (laboratory-CSF glucose). Accuracy and limits of agreement were compared, as well as the glucometer performance to detect a laboratory-CSF glucose level <45 and 60 mg/dL. RESULTS Seventy-three CSF samples were analyzed. Subjects' mean gestational age was 32.2 (SD 4.0) weeks, the mean weight was 1947.7 (SD 814.5) g, and the median age was 8 (interquartile range: 2 to 19.5) days. POC-CSF glucose levels ranged from 26 to 126 mg/dL. The mean (±1.96 SD) difference between POC-CSF and laboratory-CSF glucose levels was -1.6 (interquartile range: -12.6 to 9.4) mg/dL. A POC-CSF glucose level <45 mg/dL has a sensitivity and negative predictive value (NPV) to detect a laboratory-CSF glucose level <45 mg/dL of 82% and 94%, respectively. For a laboratory-CSF glucose level <60 mg/dL, a POC glucose level <60 mg/dL provides a sensitivity and NPV of 96% and 90%, respectively, whereas sensitivity and NPV reach 100% at a POC glucose level <70 mg/dL. CONCLUSIONS A POC glucometer for CSF glucose can detect a potential abnormal glucose level with an appropriate cutoff level. This may facilitate rapid decisions for empirical antibiotics in suspected meningitis, pending laboratory results in limited-resource settings, but requires robust validation in future studies before implementation.
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Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;
| | - Thananjit Wongsinin
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Pediatrics, Bhumibol Hospital, Bangkok, Thailand; and
| | - Uraporn Swasee
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Paes B, Mitra S. Palivizumab for children with Down syndrome: is the time right for a universal recommendation? Arch Dis Child 2019; 104:719-721. [PMID: 30591428 DOI: 10.1136/archdischild-2018-316408] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Souvik Mitra
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University and IWK Health Center, Halifax, Nova Scotia, Canada
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Mitchell I, Saleem M, Li A, Lanctot K, Paes B. 72 Use of Palivizumab in Canada; Data from the CARESS registry 2005–2017. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Abby Li
- Sunnybrook Health Sciences Centre
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Mitchell I, Saleem M, Li A, Lanctot K, Paes B. 73 Changes in Palivizumab usage in Canada 2005–2017 (Data from CARESS registry). Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Paes B, Saleem M, Kim D, Lanctôt KL, Mitchell I. Respiratory illness and respiratory syncytial virus hospitalization in infants with a tracheostomy following prophylaxis with palivizumab. Eur J Clin Microbiol Infect Dis 2019; 38:1561-1568. [DOI: 10.1007/s10096-019-03588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
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Bhatt MD, Patel V, Butt ML, Chan AKC, Paes B. Outcomes following neonatal portal vein thrombosis: A descriptive, single-center study and review of anticoagulant therapy. Pediatr Blood Cancer 2019; 66:e27572. [PMID: 30520242 DOI: 10.1002/pbc.27572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Neonatal portal vein thrombosis (PVT) is uncommon with potentially serious complications that may manifest in infancy and childhood. OBJECTIVE The primary aim of our study was to describe the short-term and long-term outcomes of neonatal PVT. METHODS A retrospective chart review was conducted from 2008 to 2016 of neonates diagnosed with PVT. A systematic review was also performed from 2000 to 2018 to evaluate anticoagulant therapy (ACT) in neonatal PVT. RESULTS Forty-four premature and 30 term infants (mean gestational age 30.7 vs 39.1 weeks, respectively) had PVT. Sixty-eight involved the left portal vein, one involved only the main portal vein, and 5 involved ≥1 vein. PVT was catheter associated in 46 (62%); none of the 7 neonates tested had thrombophilia. Of 74 neonates, 19 (26%) received ACT and 55 (74%) were untreated. The mean follow-up duration was 16.6 months (SD = 17.62; range, 0-89.6); 59.5% were followed for ≥6 months. On last ultrasound examination, thrombus resolution was documented in treated (ACT; n = 19) and nontreated (n = 55) neonates: 12 (63%) versus 32 (58%) with complete resolution, 1 (5%) versus 6 (11%) partial, 0 versus 1 (2%) extension, and 6 (32%) versus 16 (29%) had nonprogressive lesions, respectively. Seventy-one (96%) had no complications. Seventy-one articles met inclusion criteria for the systematic review and 19 were retained for analysis after assessment. CONCLUSIONS PVT resolution rate was similar to previous reports. Although a low complication rate was detected, longer follow-up is necessary to determine the need for early treatment and the precise incidence of outcomes such as portal hypertension.
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Affiliation(s)
- Mihir D Bhatt
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Vishal Patel
- Life Sciences Program, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Michelle L Butt
- School of Nursing, and Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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Paes B, Kim D, Saleem M, Wong S, Mitchell I, Lanctot KL. Respiratory syncytial virus prophylaxis in infants with congenital airway anomalies compared to standard indications and complex medical disorders. Eur J Pediatr 2019; 178:377-385. [PMID: 30610419 DOI: 10.1007/s00431-018-03308-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/23/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
An observational study was conducted of children < 2 years who received ≥ 1 dose of palivizumab in 32 Canadian institutions from 2005 to 2017. We compared respiratory illness (RIH) and respiratory syncytial virus-related hospitalization (RSVH) hazards in children with a congenital airway anomaly (CAA) versus those prophylaxed for standard indications (SI) and serious medical disorders (SMD). Data were assembled on neonatal course, demographics, palivizumab utilization and adherence, and respiratory illness events, and analyzed using ANOVA, chi-square tests and Cox proportional hazards. Twenty-five thousand three children (1219 CAA, 3538 SMD, and 20,246 SI) were enrolled. Palivizumab adherence was 74.8% overall and similar across groups. For 2054 respiratory-related events, 1724 children were hospitalized. RIH rates were 13.6% (CAA), 9.6% (SMD), and 6.0% (SI). RSVH rates were 2.4% (CAA), 1.6% (SMD), and 1.5% (SI). After adjustment for demographic and neonatal differences, children with a CAA had a significantly increased RIH and RSVH hazard relative to SI (RIH, HR = 1.6, 95% CI 1.2-2.2, p = 0.002; RSVH, HR = 2.1, 95% CI 1.0-4.4, p = 0.037) but similar to SMD (RIH, HR = 1.3, 95% CI 0.9-1.9, p = 0.190; RSVH, HR = 1.7, 95% CI 0.7-4.1, p = 0.277).Conclusion: Children with a CAA experience higher RIH risk. RSVH hazard was similar between CAA and SMD but higher for CAA compared to SI, implying that this population requires surveillance for RSV prophylaxis. What is Known: • Children with congenital airway anomalies (CAA) are at risk for respiratory tract illness and respiratory syncytial virus-related hospitalization (RSVH) with accompanying morbidity and mortality • RSV prophylaxis may be useful in children with a CAA, but is not routinely recommended What is New: • Children with a CAA had a 1.6-2.3 fold greater risk of respiratory-related hospitalization and RSVH compared to those prophylaxed for standard, approved indications and serious medical disorders. • RSVH risk in children aged < 2 years with either upper or lower airway anomalies is similar. Children with a CAA require careful surveillance during the RSV season and prophylaxis may be appropriate.
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Affiliation(s)
- Bosco Paes
- Department of Pediatrics - HSC-3A, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Doyoung Kim
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mahwesh Saleem
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sophie Wong
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ian Mitchell
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Krista L Lanctot
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Paes B, Carbonell-Estrany X. Respiratory syncytial virus prophylaxis for children with chronic lung disease: have we got the criteria right? Expert Rev Anti Infect Ther 2019; 17:211-222. [DOI: 10.1080/14787210.2019.1581062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suner (IDIBAPS), Barcelona, Spain
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Lim A, Butt ML, Dix J, Elliott L, Paes B. Respiratory syncytial virus (RSV) infection in children with medical complexity. Eur J Clin Microbiol Infect Dis 2018; 38:171-176. [PMID: 30374685 DOI: 10.1007/s10096-018-3409-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
Abstract
Children with medical complexity (CMC) are vulnerable to respiratory illness hospitalization (RIH) and respiratory syncytial virus (RSV)-related hospitalization (RSVH) due to multisystem disorders and compromised airways. It is unknown whether RSV prophylaxis is effective, or if RSVH is associated with significant morbidities in CMC. The study objectives were to (1) determine the incidence of RSV-related infection in prophylaxed CMC during the first 3 years of life and (2) assess the burden of illness following RSVH. A single tertiary center, retrospective study, was conducted of CMC who received palivizumab during the 2012-2016 RSV seasons. Fifty-four subjects were enrolled; most received one (38.9%, n = 21) or two (57.4%, n = 31) seasons of prophylaxis (mean = 4.2 [SD = 1.24], palivizumab doses per season). The cohort comprised children with multiple medical conditions (n = 22, 40.8%), tracheostomy (n = 18, 33.3%), and invasive (n = 10, 18.5%) or non-invasive (n = 4, 7.4%) ventilation. Of the CMC, 24 were hospitalized 47 times for a viral-related respiratory illness. RSV incidence in the first 3 years of life was 7.4%. Viral-related RIH and RSVH rates were 44.4% (n = 24/54) and 1.9% (n = 1/54), respectively. Of the four RSV-positive children, one was ventilated for 9 days, two acquired nosocomial RSV that was managed on the ward, and one was discharged home under close complex care supervision. All four RSV-positive cases required additional oxygen during their illness. CMC experience a high viral-related RIH rate and palivizumab likely minimizes RSV-related events and associated morbidities. The efficacy of palivizumab in CMC, especially in those ≤ 3 years, should be prospectively evaluated.
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Affiliation(s)
- A Lim
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - M L Butt
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.,School of Nursing, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - J Dix
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - L Elliott
- McMaster Children's Hospital, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - B Paes
- Department of Pediatrics, McMaster University, HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Kitsommart R, Nakornchai K, Yangthara B, Jiraprasertwong R, Paes B. Positive end-expiratory pressure during resuscitation at birth in very-low birth weight infants: A randomized-controlled pilot trial. Pediatr Neonatol 2018; 59:448-454. [PMID: 29289490 DOI: 10.1016/j.pedneo.2017.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/16/2017] [Accepted: 12/06/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is limited evidence of the effect of positive end-expiratory pressure (PEEP) during resuscitation soon after birth. Premature neonates may experience respiratory distress from surfactant insufficiency and providing PEEP after the very first breath, may improve outcomes following appropriate resuscitation. The objective of this study was to evaluate the short term respiratory outcomes after positive pressure ventilation (PPV) with PEEP in preterm infants at birth. METHODS A prospective randomized-controlled, pilot trial was conducted. Premature neonates ≤ 32 weeks gestational age or birth weight < 1500 g were recruited. Subjects were allocated to either PEEP of 5 cm H2O (PEEP-5) or no PEEP (PEEP-0) if PPV was administered. Pre-ductal, peripheral capillary oxygen saturation (SpO2) and fraction of inspired oxygen concentration (FiO2) were monitored at 1, 3, 5, 10, 15, and 20 min after birth. FiO2 was adjusted to achieve targeted SpO2 using the 2010 neonatal resuscitation protocol guidelines. RESULTS 56% (14/25; PEEP-0) and 50% (13/26; PEEP-5) infants received PPV. Mean gestational age was 30 (PEEP-0) vs 31 (PEEP-5) weeks. The mean [SD] birthweight (g) of PEEP-0 was significantly lower than PEEP-5 (1050.4 [262.7] vs 1218.8 [236.8], p = 0.02). Pre-ductal SpO2, FiO2 delivered at each time point, and rates of pneumothorax, surfactant administration and oxygen dependency at 36 weeks postmenstrual age or death was similar. CONCLUSION Due to the small sample size and potential bias accrued through random allocation of higher birthweight infants to the PEEP-5 group, the results did not confirm differences in outcomes between the groups, despite evidence favoring postnatal ventilation with PEEP. A further randomized, controlled clinical trial with a larger sample size is warranted to determine the utility and safety of PEEP during the resuscitation of premature infants immediately after birth.
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Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Kittaya Nakornchai
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Buranee Yangthara
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ratchada Jiraprasertwong
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Yangthara B, Horrasith S, Paes B, Kitsommart R. Predictive factors for intensive birth resuscitation in a developing-country: a 5-year, single-center study. J Matern Fetal Neonatal Med 2018; 33:570-576. [PMID: 29973079 DOI: 10.1080/14767058.2018.1497602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To identify risk factors outlined in the International Liaison Committee on Resuscitation (ILCOR) 2010 guideline and requirement for high-intensity resuscitation.Study design: A retrospective cross-sectional study of infants born to high-risk mothers from 2011 to 2015.Results: Totally 11,446 infants were analyzed; 37% were preterm, 36% were low-birth weight infants or less. 1506 infants required respiratory support; 82 (0.7%) and 61 (0.5%) infants needed chest compression and/or epinephrine. Very-preterm infants received more intensive resuscitation than moderate preterm or term infants. Breech presentation, maternal infection and maternal diabetes were significantly associated with need for respiratory support. Fetal anomalies, breech presentation, oligohydramnios, and multiple gestation were significantly associated with need for hemodynamic support.Conclusion: Most infants defined in the ILCOR 2010 guideline required nonintensive ventilation. Very-preterm infants, fetal anomalies, and breech presentation necessitate neonatal attendance at delivery. In developing countries, maternal infection and diabetes remain high-risk criteria despite deletion from the ILCOR 2016 guideline.
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Affiliation(s)
- Buranee Yangthara
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Siriluck Horrasith
- Department of Obstetrics and Gynaecology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Department of Pediatrics, Division of Neonatology, McMaster University, Hamilton, Hamilton, Canada
| | - Ratchada Kitsommart
- Department of Pediatrics, Division of Neonatology, Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
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Nossair F, Schoettler P, Starr J, Chan AKC, Kirov I, Paes B, Mahajerin A. Pediatric superior vena cava syndrome: An evidence-based systematic review of the literature. Pediatr Blood Cancer 2018; 65:e27225. [PMID: 29781569 DOI: 10.1002/pbc.27225] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/03/2018] [Accepted: 04/03/2018] [Indexed: 11/07/2022]
Abstract
Superior vena cava syndrome (SVCS) results in vascular, respiratory, and neurologic compromise. A systematic search was conducted to determine the prevalence of pediatric SVCS subtypes and identify clinical characteristics/treatment strategies that may influence overall outcomes. Data from 101 case reports/case series (142 patients) were analyzed. Morbidity (30%), mortality (18%), and acute complications (55%) were assessed as outcomes. Thrombosis was present in 36%, with multi-modal anticoagulation showing improved outcome by >50% (P = 0.004). Infant age (P = 0.04), lack of collaterals (P = 0.007), acute complications (P = 0.005), and clinical presentation may have prognostic utility that could influence clinical decisions and surveillance practices in pediatric SVCS.
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Affiliation(s)
- Fadi Nossair
- Division of Oncology, CHOC Children's, Orange, California
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Peter Schoettler
- Department of Pediatrics, University of California-Irvine, Irvine, California
- Department of Pediatrics, CHOC Children's, Orange, California
| | - Joanne Starr
- Division of Cardiothoracic Surgery, CHOC Children's, Orange, California
| | - Anthony K C Chan
- Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Kirov
- Division of Oncology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Arash Mahajerin
- Division of Hematology, CHOC Children's, Orange, California
- Department of Pediatrics, University of California-Irvine, Irvine, California
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Andrew M, Brooker L, Leaker M, Paes B, Weitz J. Fibrin Clot Lysis by Thrombolytic Agents Is Impaired in Newborns due to a Low Plasminogen Concentration. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1656374] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryAlthough thrombolytic drugs have been extensively used in adults, there is sparse information on their effectiveness in newborns whose fibrinolytic system differs significantly from adults. The purpose of this study was to determine if low plasma levels of plasminogen in cord plasma limited the therapeutic effectiveness of thrombolytic agents. Urokinase (UK), streptokinase (SK) and tissue plasminogen activator (TPA) were compared for their ability to lyse washed 125I-labelled adult or cord fibrin clots suspended in cord or adult plasma. 125I-labelled fibrin clots were prepared by recalcifying cord or adult plasma spiked with labelled fibrinogen and then placed into cord or adult plasma which contained either saline or differing amounts of a specific thrombolytic agent. After a 60 min incubation, the remaining 125I-fibrin in clots released 125I-fibrin fragments, and concentrations of fibrinogen, α2-antiplasmin, and plasminogen in the bathing plasma were measured and compared to starting values. Cord fibrin clots were more resistant than adult fibrin clots to all thrombolytic drugs tested (p <0.001). On average, the cord system retained 27% more 125I-fibrin in clots, and released 32% less 125I-fibrin fragments into plasma. Fibrinogenolysis was also decreased in cord plasmas compared to adult plasmas. The degree of fibrinolysis and fibrinogenolysis in cord plasma increased to adult values when plasminogen concentrations were increased in the bathing plasma. Thus, cord fibrin clots have an impaired response to thrombolytic agents secondary to low levels of plasminogen. We speculate that the clinical response of newborns to thrombolytic agents is also impaired and will not be enhanced by increasing doses of thrombolytic agents but may be enhanced by increasing the concentration of plasminogen.
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Affiliation(s)
- M Andrew
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - L Brooker
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - M Leaker
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - B Paes
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - J Weitz
- The Departments of Pediatrics and Medicine, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
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Andrew M, Schmidt B, Mitchell L, Paes B, Ofosu F. Thrombin Generation in Newborn Plasma Is Critically Dependent on the Concentration of Prothrombin. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1645680] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe ability to generate thrombin is decreased and delayed in plasma from the healthy newborn infant compared to the adult. Only 30 to 50% of peak adult thrombin activity can be produced in neonatal plasma. To test whether this observation can be explained by the low neonatal levels of the contact or vitamin K dependent factors, we measured neonatal thrombin generation after raising the concentration of these factors to adult values. We also determined whether the addition of a variety of blood products to neonatal plasma improved thrombin generation. An amidolytic method was used to quantitate intrinsic (APTT) and extrinsic (PT) pathway thrombin generation in defibrinated pooled cord plasma from healthy term infants. Added individually, factors VII, IX, X or the contact factors (CF) failed to alter the rate or the total amount of thrombin generated in neonatal plasma. In contrast, the addition of prothrombin increased the total amount of thrombin generated to above adult values in both the APTT and the PT systems but did not alter the rate of thrombin generation. The rate of thrombin generation in cord plasma shortened after a combination of II, IX, X and CF was added to the APTT system or II, VII and X to the PT system. In both systems, the total amount of thrombin generated was linearly related to the initial prothrombin concentration. Each of fresh frozen plasma, cryoprecipitate, plasma from platelet concentrates, or factor IX concentrate (in amounts used therapeutically) caused an increase in the total amount of thrombin generated which was related to the increase in prothrombin concentration. Thus, the total amount of thrombin generated in newborn plasma is critically dependent on the prothrombin concentration whereas the rate at which thrombin is generated is dependent on the levels of many other coagulation proteins in combination.
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Affiliation(s)
- Maureen Andrew
- The Department of Pediatrics, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - Barbara Schmidt
- The Department of Pediatrics, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - Lesley Mitchell
- The Department of Pediatrics, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - Bosco Paes
- The Department of Pediatrics, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
| | - Frederick Ofosu
- The Department of Pathology, McMaster University Health Sciences Centre, Chedoke-McMaster Hospitals, Hamilton, Ontario, Canada
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Mitra S, McCord H, El Azrak M, Paes B. DOES PRESENCE OF DOWN SYNDROME INCREASE RESPIRATORY SYNCYTIAL VIRUS (RSV) RELATED HOSPITALIZATION IN CHILDREN LESS THAN 2 YEARS OF AGE? A SYSTEMATIC REVIEW AND META-ANALYSIS. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Down syndrome (DS) is associated with a number of immunologic abnormalities and congenital heart disease (CHD) which increase susceptibility to respiratory syncytial virus (RSV). However current position statements from the American Academy of Pediatrics and the Canadian Paediatric Society do not recommend routine RSV prophylaxis with Palivizumab to all infants with DS,
OBJECTIVES
To conduct a systematic reviewand meta-analysis of observational studies to compare RSV-related hospitalization (RSVH) rates, length of hospital stay(LOS), need for intensive care and assisted ventilation in DS children <2 years of age compared with children without DS.
DESIGN/METHODS
Data Sources:
The authors searched MEDLINE, Embase, CINAHL, reference lists of relevant articles, abstracts and conference proceedings, results of unpublished trials, and contacted the primary authors of relevant studies. Studies were included if data was provided on RSV-related hospitalization in children <2yr of age with and without DS.
Data extraction & Synthesis:
Two reviewers independently screened the search results, applied inclusion criteria and assessed methodological quality using the Newcastle-Ottawa Scale. Data was extracted and checked in duplicate.
Main outcomes & measures:
The primary outcome was RSV-related hospitalization. Secondary outcomes included length of hospital stay, need for intensive care and assisted ventilation. Sensitivity analysis was conducted for the primary outcome comparing DS infants without congenital heart disease (CHD) with non-DS infants.
RESULTS
19 cohort studies met the inclusion criteria. Ten studies involving 1,390,380 children were analyzed. DS-children had significantly higher RSVH compared to non-DS children (Relative Risk, 6.97; 95% CI, 6.01 to 8.08; I2=0%; Figure 1a). Among children hospitalized with RSV, need for assisted ventilation (RR, 5.82; 95% CI, 1.81 to 18.69; I2=84%; Figure 1b) and LOS (Mean difference, 2.28 days; 95% CI, 1.61 to 2.96 days; I2=0%; Figure 1c) were significantly higher in DS-children. The sensitivity analysis also confirmed that DS children without CHD had a significantly higher RSVH rate compared to non-DS children (RR, 6.31; 95% CI, 4.83 to 8.23;I2=0%; Figure 1d).
CONCLUSION
Compared to children without DS, RSV-related hospitalization, need for assisted ventilation and length of RSV-related hospital stay is significantly higher in children with DS in the first 2 years of life. The results of this systematic review should prompt a favorable recommendation for routine RSV prophylaxis in both healthy and medically compromised DS children aged <2years.
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Mitchell I, Wong SK, Paes B, Ruff M, Bjornson C, Li A, Lanctôt KL. Respiratory syncytial virus prophylaxis in cystic fibrosis: the Canadian registry of palivizumab data (2005-2016). Eur J Clin Microbiol Infect Dis 2018; 37:1345-1352. [PMID: 29728782 DOI: 10.1007/s10096-018-3256-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
Respiratory syncytial virus (RSV) may cause severe illness in cystic fibrosis (CF) children, but recommendations vary on prophylaxis. CARESS is a prospective registry of children who received palivizumab in 32 Canadian sites from 2005 to 2016. Demographic data were collected at enrollment and respiratory illness-related events recorded monthly. We reviewed respiratory illness hospitalization (RIH) and RSV hospitalization (RSVH) in CF children aged < 24 months versus those prophylaxed for standard indications (SI; prematurity, chronic lung disease [CLD] and congenital heart disease [CHD]), and complex medical disorders (CM). Of 23,228 children analyzed, 19,452 (83.8%) were SI, 3349 (14.4%) were CM, and 427 (1.8%) were CF. CF children were more likely to be Caucasian, heavier at birth and enrollment, and less likely to have a sibling or live in crowded conditions. CF children were similar to the other groups in daycare attendance, history of atopy, and exposure to smoking. RIH incidences were 4.3% (premature), 13.8% CLD, 11.5% CHD, 11.7% CM, and 6.8% CF. RSVH incidence in CF children was similar to that in the SI and CM groups: 1.1, 1.5, and 2.0% groups respectively. Cox regression analyses showed that compared to CF children, the HRs for RSVH in SI (HR 2.0 95% CI 0.5-8.3, p = 0.3) and CM (HR 2.4, 95% CI 0.6-9.8, p = 0.2) did not differ. CF children are equally at risk for RSVH relative to those prophylaxed for other indications. Pending robust evidence from prospective trials, palivizumab could perhaps be considered in the interim, for young CF patients born early during the RSV season with evidence of serious lung disease.
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Affiliation(s)
- Ian Mitchell
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada.
| | - S K Wong
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG-08, Toronto, Ontario, M4N3M5, Canada
| | - B Paes
- Department of Pediatrics, McMaster University, Room - HSC-3A, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - M Ruff
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - C Bjornson
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada
| | - A Li
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG-08, Toronto, Ontario, M4N3M5, Canada
| | - K L Lanctôt
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG-08, Toronto, Ontario, M4N3M5, Canada
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Blanken MO, Paes B, Anderson EJ, Lanari M, Sheridan‐Pereira M, Buchan S, Fullarton JR, Grubb E, Notario G, Rodgers‐Gray BS, Carbonell‐Estrany X. Risk scoring tool to predict respiratory syncytial virus hospitalisation in premature infants. Pediatr Pulmonol 2018; 53:605-612. [PMID: 29405612 PMCID: PMC6099524 DOI: 10.1002/ppul.23960] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective was to develop a risk scoring tool which predicts respiratory syncytial virus hospitalisation (RSVH) in moderate-late preterm infants (32-35 weeks' gestational age) in the Northern Hemisphere. METHODS Risk factors for RSVH were pooled from six observational studies of infants born 32 weeks and 0 days to 35 weeks and 6 days without comorbidity from 2000 to 2014. Of 13 475 infants, 484 had RSVH in the first year of life. Logistic regression was used to identify the most predictive risk factors, based on area under the receiver operating characteristic curve (AUROC). The model was validated internally by 100-fold bootstrapping and externally with data from a seventh observational study. The model coefficients were converted into rounded multipliers, stratified into risk groups, and number needed to treat (NNT) calculated. RESULTS The risk factors identified in the model included (i) proximity of birth to the RSV season; (ii) second-hand smoke exposure; and (iii) siblings and/or daycare. The AUROC was 0.773 (sensitivity: 68.9%; specificity: 73.0%). The mean AUROC from internal bootstrapping was 0.773. For external validation with data from Ireland, the AUROC was 0.707 using Irish coefficients and 0.681 using source model coefficients. Cut-off scores for RSVH were ≤19 for low- (1.0%), 20-45 for moderate- (3.3%), and 50-56 (9.5%) for high-risk infants. The high-risk group captured 62.0% of RSVHs within 23.6% of the total population (NNT 15.3). CONCLUSIONS This risk scoring tool has good predictive accuracy and can improve targeting for RSVH prevention in moderate-late preterm infants.
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Affiliation(s)
- Maarten O. Blanken
- Division of Pediatric Immunology and Infectious DiseasesUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Bosco Paes
- Neonatal Division, Department of PediatricsMcMaster UniversityHamiltonCanada
| | - Evan J. Anderson
- Departments of Pediatrics and MedicineEmory University School of MedicineAtlantaGeorgia
| | - Marcello Lanari
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Margaret Sheridan‐Pereira
- Department of Paediatrics and Newborn Medicine, Coombe Women and Infants University Hospital and Department of PaediatricsTrinity CollegeDublinIreland
| | | | | | - ElizaBeth Grubb
- Health Economics and Outcomes ResearchAbbVie IncNorth ChicagoIllinois
| | - Gerard Notario
- Formerly Global Pharmaceutical Research and DevelopmentAbbVie IncNorth ChicagoIllinois
| | | | - Xavier Carbonell‐Estrany
- Neonatology Service, Hospital ClinicInstitut d'Investigacions Biomediques August Pi Suñer (IDIBAPS)BarcelonaSpain
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Abstract
Healthy, premature infants ≤35 weeks' gestational age (wGA) are universally recognized to be at an increased risk of perinatal morbidity and mortality. Serious respiratory syncytial virus (RSV) lower respiratory tract infection imposes an additional burden of illness on these infants following hospitalization. Incurred morbidities relative to term infants include longer lengths of hospital stay, admission to intensive care, and need for oxygen and mechanical ventilation, all of which are associated with increased hospital costs. The highest morbidities are experienced by premature infants who are youngest (<3 months' chronological age) and are of lower gestational age. Short- and long-term follow-up indicates that healthy preterm infants both of lower gestational age and who are late preterm have obstructive lung function at baseline, which is further compromised by RSV-related infection during infancy. There is increasing evidence that childhood exposure to an episode of RSV infection may set the stage for an abnormal respiratory function trajectory, which, in adulthood, leads to chronic obstructive pulmonary disease. Healthy premature infants <32 wGA merit RSV prophylaxis based on existing data, whereas moderate- and high-risk preterm infants 32 to 35 wGA should be selectively and cost-effectively targeted for prophylaxis using validated risk scoring tools and country-specific thresholds for funding.
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Affiliation(s)
- Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Simões EAF, Bont L, Manzoni P, Fauroux B, Paes B, Figueras-Aloy J, Checchia PA, Carbonell-Estrany X. Past, Present and Future Approaches to the Prevention and Treatment of Respiratory Syncytial Virus Infection in Children. Infect Dis Ther 2018; 7:87-120. [PMID: 29470837 PMCID: PMC5840107 DOI: 10.1007/s40121-018-0188-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence - A Geographical Archive of the Literature) series has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This seventh and final publication covers the past, present and future approaches to the prevention and treatment of RSV infection among infants and children. METHODS A systematic review was undertaken of publications between January 1, 1995 and December 31, 2017 across PubMed, Embase and The Cochrane Library. Studies reporting data on the effectiveness and tolerability of prophylactic and therapeutic agents for RSV infection were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. A further nonsystematic search of the published literature and Clinicaltrials.gov on antiviral therapies and RSV vaccines currently in development was also undertaken. RESULTS The systematic review identified 1441 studies of which 161 were included. Management of RSV remains centered around prophylaxis with the monoclonal antibody palivizumab, which has proven effective in reducing RSV hospitalization (RSVH) in preterm infants < 36 weeks' gestational age (72% reduction), children with bronchopulmonary dysplasia (65% reduction), and infants with hemodynamically significant congenital heart disease (53% reduction) (high SOE). Palivizumab has also shown to be effective in reducing recurrent wheezing following RSVH (high SOE). Treatment of RSV with ribavirin has conflicting success (moderate SOE). Antibodies with increased potency and extended half-life are currently entering phase 3 trials. There are approximately 15 RSV vaccines in clinical development targeting the infant directly or indirectly via the mother. CONCLUSION Palivizumab remains the only product licensed for RSV prophylaxis, and only available for high-risk infants. For the general population, there are several promising vaccines and monoclonal antibodies in various stages of clinical development, with the aim to significantly reduce the global healthcare impact of this common viral infection. FUNDING AbbVie.
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Affiliation(s)
- Eric A F Simões
- Center for Global Health, Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
- ReSViNET (Respiratory Syncytial Virus Network), Utrecht, The Netherlands
| | - Paolo Manzoni
- ReSViNET (Respiratory Syncytial Virus Network), Utrecht, The Netherlands
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Chan AKC, Paredes N, Thong B, Chindemi P, Paes B, Berry LR, Monagle P. Binding of heparin to plasma proteins and endothelial surfaces is inhibited by covalent linkage to antithrombin. Thromb Haemost 2017; 91:1009-18. [PMID: 15116263 DOI: 10.1160/th03-06-0365] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryUnfractionated heparin (UFH) and low molecular weight heparin (LMWH) are used for prophylaxis and treatment of thrombosis. However, UFH has a short plasma half-life and variable anticoagulant response in vivo due to plasma or vessel wall protein binding and LMWH has a decreased ability to inactivate thrombin, the pivotal enzyme in the coagulation cascade. Covalent linkage of antithrombin to heparin gave a complex (ATH) with superior anticoagulant activity compared to UFH and LMWH, and longer intravenous half-life compared to UFH. We found that plasma proteins bound more to UFH than ATH, and least to LMWH. Also, UFH bound significantly more to endothelial cells than ATH, with 100% of UFH and 94% of ATH binding being on the cell surface and the remainder was endocytosed. Competition studies with UFH confirmed that ATH binding was likely through its heparin moiety. These findings suggest that differences in plasma protein and endothelial cell binding may be due to available heparin chain length. Although ATH is polydisperse, the covalently-linked antithrombin may shield a portion of the heparin chain from association with plasma or endothelial cell surface proteins. This model is consistent with ATH’s better bioavailability and more predictable dose response.
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Affiliation(s)
- Anthony K C Chan
- Henderson Research Centre, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada.
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Affiliation(s)
- Sophie K. Wong
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Abby Li
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Krista L. Lanctôt
- Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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Manzoni P, Figueras-Aloy J, Simões EAF, Checchia PA, Fauroux B, Bont L, Paes B, Carbonell-Estrany X. Defining the Incidence and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Children with Chronic Diseases. Infect Dis Ther 2017; 6:383-411. [PMID: 28653300 PMCID: PMC5595774 DOI: 10.1007/s40121-017-0160-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION REGAL (RSV Evidence-a Geographical Archive of the Literature) has provided a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This review covers the risk and burden of RSV infection in children with underlying medical conditions or chronic diseases (excluding prematurity and congenital heart disease). METHODS A systematic review of publications between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov was supplemented by papers identified by the authors through March 2017. Studies reporting data for hospital visits/admissions for RSV infection as well as studies reporting RSV-associated morbidity and mortality were included. Study quality and strength of evidence (SOE) were graded. RESULTS A total of 2703 studies were identified and 58 were included. Down syndrome, irrespective of prematurity and congenital heart disease (moderate SOE), immunocompromised children (low SOE), cystic fibrosis (low SOE), and neurologic conditions (low SOE) were associated with a significantly increased risk of RSV hospitalization. A number of other congenital malformations and chronic conditions were also associated with severe RSV disease (low SOE). In general, pre-existing disease was also a predisposing factor for RSV-related mortality (low SOE). CONCLUSION Severe RSV infection in infants and young children with underlying medical conditions or chronic diseases poses a significant health burden. Further studies are needed to fully quantify the epidemiology, burden and outcomes in these populations, in particular RSV-attributable mortality.
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Affiliation(s)
- Paolo Manzoni
- Neonatology and NICU, Sant'Anna Hospital, Turin, Italy
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | - Eric A F Simões
- Center for Global Health, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Louis Bont
- ReSViNET (Respiratory Syncytial Virus Network), Málaga, Spain
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Wong S, Paes B, Li A, Mitchell I, Lanctôt KL. RESPIRATORY ILLNESS AND RESPIRATORY SYNCYTIAL VIRUS (RSV)-RELATED HOSPITALIZATION (RSVH) IN INFANTS WITH CONGENITAL AIRWAY ANOMALIES (CAA) IN THE CARESS REGISTRY (2005-2015). Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fauroux B, Simões EAF, Checchia PA, Paes B, Figueras-Aloy J, Manzoni P, Bont L, Carbonell-Estrany X. The Burden and Long-term Respiratory Morbidity Associated with Respiratory Syncytial Virus Infection in Early Childhood. Infect Dis Ther 2017; 6:173-197. [PMID: 28357706 PMCID: PMC5446364 DOI: 10.1007/s40121-017-0151-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence-a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. The objective of this fifth publication was to determine the long-term respiratory morbidity associated with RSV lower respiratory tract infection (RSV LRTI) in early life. METHODS A systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015. This was supplemented by inclusion of papers published whilst drafting the manuscript. Studies reporting data on the incidence and long-term wheezing and asthma following RSV LRTI in early life were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULTS A total of 2337 studies were identified of which 74 were included. Prospective, epidemiologic studies consistently demonstrated that RSV LRTI is a significant risk factor for on-going respiratory morbidity characterized by transient early wheezing and recurrent wheezing and asthma within the first decade of life and possibly into adolescence and adulthood (high SOE). RSV LRTI was also associated with impaired lung function in these children (high SOE). Respiratory morbidity has been shown to result in reduced quality of life and increased healthcare resource use (moderate SOE). The mechanisms through which RSV contributes to wheezing/asthma development are not fully understood, but appear to relate to the viral injury, preexisting abnormal lung function and/or other factors that predispose to wheezing/asthma, including genetic susceptibility, altered immunology, eosinophilia, and associated risk factors such as exposure to environmental tobacco smoke (high SOE). CONCLUSION There is growing evidence that RSV LRTI in early childhood is associated with long-term wheezing and asthma and impaired lung function. Future research should aim to fully elucidate the pathophysiological mechanisms through which RSV causes recurrent wheezing/asthma.
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Affiliation(s)
- Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Eric A F Simões
- University of Colorado School of Medicine, and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA
| | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | | | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Papneja K, Chan AK, Mondal TK, Paes B. Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality. Pediatr Cardiol 2017; 38:427-441. [PMID: 28238152 DOI: 10.1007/s00246-016-1556-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/23/2016] [Indexed: 01/24/2023]
Abstract
Coronary artery disease is a global problem with high mortality rates and significant residual sequelae that affect long-term quality of life. Myocardial infarction (MI) in neonates is a recognized, uncommon entity, but the incidence and broad spectrum of the disease is unknown and likely underestimated due to limited reporting which in the majority is confined to acute ischemic events. The challenges involve clinical diagnosis which masquerades in the early phase as non-specific symptoms and signs that are commonly found in a host of neonatal disorders. Precise diagnostic criteria for neonatal MI are lacking, and management is driven by clinical presentation and hemodynamic stabilization rather than an attempt to rapidly establish the root cause of the condition. We conducted a review of the published reports of neonatal MI from 2000 to 2014, to establish an approach to the diagnosis and management based on the existing evidence. The overall evidence from 32 scientific articles stemmed from case reports and case series which were graded as low-to-very low quality. Neonatal MI resembles childhood and adult MI with features that involve characteristic ECG changes, raised biomarkers, and diagnostic imaging, but with lack of robust, standardized criteria to facilitate prompt diagnosis and timely intervention. The mortality rate of neonatal MI ranges from 40 to 50% based on inclusion criteria, but the short-term data reflect normal quality of life in survivors. An algorithm for the diagnosis and management of neonatal MI may optimize outcomes, but at the present time is based on limited evidence. Well-designed clinical studies focusing on the definition, diagnosis, and management of neonatal MI, backed by international consensus guidelines, are needed to alter the prognosis of this serious condition.
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Affiliation(s)
- Koyelle Papneja
- Division of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anthony K Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Tapas K Mondal
- Division of Cardiology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Bosco Paes
- Division of Neonatology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. .,Department of Pediatrics, McMaster University, Room HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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