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Nes E, Chugh PV, Keefe G, Culbreath K, Morrow KA, Ehret DEY, Soll RF, Horbar JD, Harting MT, Lally KP, Modi BP, Jaksic T, Edwards EM. Predictors of Mortality in Very Low Birth Weight Neonates With Congenital Diaphragmatic Hernia. J Pediatr Surg 2024; 59:818-824. [PMID: 38368194 DOI: 10.1016/j.jpedsurg.2024.01.032] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Limited data exists regarding the mortality of very low birth weight (VLBW) neonates with congenital diaphragmatic hernia (CDH). This study aims to quantify and determine predictors of mortality in VLBW neonates with CDH. METHODS This analysis of 829 U.S. NICUs included VLBW [birth weight ≤1500g] neonates, born 2011-2021 with and without CDH. The primary outcome was in-hospital mortality. A generalized estimating equation regression model determined the adjusted risk ratio (ARR) of mortality. RESULTS Of 426,140 VLBW neonates, 535 had CDH. In neonates with CDH, 48.4% had an additional congenital anomaly vs 5.5% without. In-hospital mortality for neonates with CDH was 70.4% vs 12.6% without. Of those with CDH, 73.3% died by day of life 3. Of VLBW neonates with CDH, 38% were repaired. A subgroup analysis was performed on 60% of VLBW neonates who underwent delivery room intubation or mechanical ventilation, as an indicator of active treatment. Mortality in this group was 62.7% for neonates with CDH vs 16.4% without. Higher Apgars at 1 min and repair of CDH were associated with lower mortality (ARR 0.91; 95%CI 0.87,0.96 and ARR 0.28; 0.21,0.39). The presence of additional congenital anomalies was associated with higher mortality (ARR 1.14; 1.01,1.30). CONCLUSION These benchmark data reveal that VLBW neonates with CDH have an extremely high mortality. Almost half of the cohort have an additional congenital anomaly which significantly increases the risk of death. This study may be utilized by providers and families to better understand the guarded prognosis of VLBW neonates with CDH. TYPE OF STUDY Level II. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Priyanka V Chugh
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Gregory Keefe
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | | | | | - Danielle E Y Ehret
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Roger F Soll
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Matthew T Harting
- McGovern Medical School at UTHealth and Children's Memorial Hermann Hospital Houston, Congenital Diaphragmatic Hernia Study Group, Houston, TX, USA
| | - Kevin P Lally
- McGovern Medical School at UTHealth and Children's Memorial Hermann Hospital Houston, Congenital Diaphragmatic Hernia Study Group, Houston, TX, USA
| | - Biren P Modi
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA; University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA.
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Nes E, Edwards EM, Jaksic T. Reply to Letter to the Editor by Gowda S, et al. J Pediatr Surg 2024:S0022-3468(24)00203-3. [PMID: 38616468 DOI: 10.1016/j.jpedsurg.2024.03.049] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA
| | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
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Nes E, Jaksic T, Edwards EM. Reply to Letter to the Editor by Lohmann P, et al. J Pediatr Surg 2024:S0022-3468(24)00202-1. [PMID: 38616469 DOI: 10.1016/j.jpedsurg.2024.03.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
| | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA
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Chugh PV, Nes E, Culbreath K, Keefe G, Edwards EM, Morrow KA, Ehret D, Soll RF, Modi BP, Horbar JD, Jaksic T. Comparing Healthcare Needs in Extremely Low Birth Weight Infants With NEC and Spontaneous Intestinal Perforation. J Pediatr Surg 2024:S0022-3468(24)00157-X. [PMID: 38561308 DOI: 10.1016/j.jpedsurg.2024.03.006] [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: 11/29/2023] [Revised: 02/21/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) affect 6-8% of extremely low birth weight (ELBW) infants. SIP has lower mortality than NEC, but with similar short-term morbidity in length of stay, growth failure, and supplemental oxygen requirements. Comparative long-term neurodevelopmental outcomes have not been clarified. METHODS Data were prospectively collected from 59 North American neonatal units, regarding ELBW infants (401-1000 g or 22-27 weeks gestational age) born between 2011 and 2018 and evaluated again at 16-26 months corrected age. Outcomes were collected from infants with laparotomy-confirmed NEC, laparotomy-confirmed SIP, and those without NEC or SIP. The primary outcome was severe neurodevelopmental disability. Secondary outcomes were weight <10th percentile, medical readmission, post-discharge surgery and medical support at home. Adjusted risk ratios (ARR) were calculated. RESULTS Of 13,673 ELBW infants, 6391 (47%) were followed including 93 of 232 (40%) with NEC and 100 of 235 (42%) with SIP. There were no statistically significant differences in adjusted risk of any outcomes when directly comparing NEC to SIP (ARR 2.35; 95% CI 0.89, 6.26). However, infants with NEC had greater risk of severe neurodevelopmental disability (ARR 1.43; 1.09-1.86), rehospitalization (ARR 1.46; 1.17-1.82), and post-discharge surgery (ARR 1.82; 1.48-2.23) compared to infants without NEC or SIP. Infants with SIP only had greater risk of post-discharge surgery (ARR 1.64; 1.34-2.00) compared to infants without NEC or SIP. CONCLUSIONS ELBW infants with NEC had significantly increased risk of severe neurodevelopmental disability and post-discharge healthcare needs, consistent with prior literature. We now know infants with SIP also have increased healthcare needs. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- Priyanka V Chugh
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | | | - Gregory Keefe
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Erika M Edwards
- University of Vermont, Department of Mathematics and Statistics, Burlington, VT, USA; Vermont Oxford Network, Burlington, VT, USA
| | | | - Danielle Ehret
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Roger F Soll
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Biren P Modi
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, USA; University of Vermont Larner College of Medicine and University of Vermont Medical Center, Burlington, VT, USA
| | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery, Boston, MA, USA.
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Nes E, Knell J, Keefe G, Culbreath K, Han SM, McGivney M, Staffa SJ, Modi BP, Carey AN, Jaksic T, Duggan CP. Factors associated with D-lactic acidosis in pediatric intestinal failure: A case-control study. J Pediatr Gastroenterol Nutr 2024; 78:217-222. [PMID: 38374557 PMCID: PMC10883598 DOI: 10.1002/jpn3.12075] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND D-lactic acidosis (DLA) is a serious complication of short bowel syndrome (SBS) in children with intestinal failure (IF). Malabsorbed carbohydrates are metabolized by bacteria in the intestine to D-lactate which can lead to metabolic acidosis and neurologic symptoms. METHODS A retrospective chart review was performed in children ≤18 years old with SBS who had one of the following criteria: unexplained metabolic acidosis, neurologic signs or symptoms, history of antibiotic therapy for small bowel bacterial overgrowth, or high clinical suspicion of DLA. Cases had serum D-lactate concentration >0.25 mmol/L; controls with concentrations ≤0.25 mmol/L. RESULTS Of forty-six children, median age was 3.16 (interquartile range (IQR): 1.98, 5.82) years, and median residual bowel length was 40 (IQR: 25, 59) cm. There were 23 cases and 23 controls. Univariate analysis showed that cases had significantly lower median bicarbonate (19 vs. 24 mEq/L, p = 0.001), higher anion gap (17 vs. 14 mEq/L, p < 0.001) and were less likely to be receiving parenteral nutrition, compared with children without DLA. Multivariable analysis identified midgut volvulus, history of intestinal lengthening procedure, and anion gap as significant independent risk factors. Midgut volvulus was the strongest independent factor associated with DLA (adjusted odds ratio = 17.1, 95% CI: 2.21, 133, p = 0.007). CONCLUSION DLA is an important complication of pediatric IF due to SBS. Patients with IF, particularly those with history of midgut volvulus, having undergone intestinal lengthening, or with anion gap acidosis, should be closely monitored for DLA.
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Affiliation(s)
- Emily Nes
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jamie Knell
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Keefe
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine Culbreath
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sam M Han
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McGivney
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra N Carey
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Jaksic
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher P Duggan
- Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Culbreath K, Keefe G, Nes E, Edwards EM, Knell J, Morrow KA, Soll RF, Jaksic T, Horbar JD, Modi BP. Association between neurodevelopmental outcomes and concomitant presence of NEC and IVH in extremely low birth weight infants. J Perinatol 2024; 44:108-115. [PMID: 37735208 DOI: 10.1038/s41372-023-01780-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To quantify the association between necrotizing enterocolitis (NEC) and neurodevelopmental disability (NDI) in extremely low birth weight (ELBW) infants with intraventricular hemorrhage (IVH). STUDY DESIGN ELBW survivors born 2011-2017 and evaluated at 16-26 months corrected age in the Vermont Oxford Network (VON) ELBW Follow-Up Project were included. Logistic regression determined the adjusted relative risk (aRR) of severe NDI in medical or surgical NEC compared to no NEC, stratified by severity of IVH. RESULTS Follow-up evaluation occurred in 5870 ELBW survivors. Compared to no NEC, medical NEC had no impact on NDI, regardless of IVH status. Surgical NEC increased risk of NDI in patients with no IVH (aRR 1.69; 95% CI 1.36-2.09), mild IVH (aRR 1.36;0.97-1.92), and severe IVH (aRR 1.35;1.13-1.60). CONCLUSIONS ELBW infants with surgical NEC carry increased risk of neurodevelopmental disability within each IVH severity stratum. These data describe the additive insult of surgical NEC and IVH on neurodevelopment, informing prognostic discussions and highlighting the need for preventative interventions.
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Affiliation(s)
- Katherine Culbreath
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA
| | - Gregory Keefe
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA
| | - Emily Nes
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA
| | | | - Jamie Knell
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA
| | | | | | - Tom Jaksic
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA
| | | | - Biren P Modi
- Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA.
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Culbreath K, Keefe G, Nes E, Staffa SJ, Carey AN, Jaksic T, Goldsmith JD, Modi BP, Ouahed JD, Jimenez L. Factors Associated With Chronic Intestinal Inflammation Resembling Inflammatory Bowel Disease in Pediatric Intestinal Failure: A Matched Case-Control Study. J Pediatr Gastroenterol Nutr 2023; 76:468-474. [PMID: 36720109 DOI: 10.1097/mpg.0000000000003718] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS There is a subset of intestinal failure patients with associated chronic intestinal inflammation resembling inflammatory bowel disease. This study aimed to evaluate factors associated with chronic intestinal inflammation in pediatric intestinal failure. METHODS This was a single-center retrospective case-control study of children <18 years old with intestinal failure. Cases were defined by abnormal amounts of chronic intestinal inflammation on biopsies. Children with diversion colitis, eosinophilic colitis, or isolated anastomotic ulceration were excluded. Cases were matched 1:2 to intestinal failure controls based on sex, etiology of intestinal failure, and duration of intestinal failure. Multivariable conditional logistic regression was used to compare clinical factors between cases and controls, accounting for clustering within matched sets. A subgroup analysis was performed assessing factors associated with escalation of anti-inflammatory therapy. RESULTS Thirty cases were identified and matched to 60 controls. On univariate analysis, longer parenteral nutrition (PN) duration (1677 vs 834 days, P = 0.03), current PN use (33.3% vs 20.0%, P = 0.037), and culture-proven bacterial overgrowth (53.3% vs 31.7%, P = 0.05) were associated with chronic intestinal inflammation. On multivariable analysis, no variable reached statistical significance. On subgroup analysis, duration of intestinal failure, location of inflammation, and worst degree of inflammation on histology were associated with escalation of therapy. CONCLUSIONS PN dependence and intestinal dysbiosis are associated with chronic intestinal inflammation in children with intestinal failure. Severity of inflammation is associated with escalation of therapy. Further analysis is needed to assess these associations and the efficacy of treatments in this population.
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Affiliation(s)
- Katherine Culbreath
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Gregory Keefe
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Emily Nes
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Steven J Staffa
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Alexandra N Carey
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Tom Jaksic
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey D Goldsmith
- the Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Biren P Modi
- From the Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Jodie D Ouahed
- the Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Lissette Jimenez
- the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA
- the Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA
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Culbreath K, Knell J, Keefe G, Nes E, Han SM, Edwards EM, Morrow KA, Soll RF, Jaksic T, Horbar JD, Modi BP. Impact of concomitant necrotizing enterocolitis on mortality in very low birth weight infants with intraventricular hemorrhage. J Perinatol 2023; 43:91-96. [PMID: 35715599 DOI: 10.1038/s41372-022-01434-1] [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] [Received: 03/03/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of necrotizing enterocolitis (NEC) on mortality in very low birth weight (VLBW) infants with intraventricular hemorrhage (IVH). STUDY DESIGN Data were collected on VLBW infants born 2014-2018 at Vermont Oxford Network (VON) centers. NEC and IVH were categorized by severity. Adjusted risk ratios (ARR) for in-hospital mortality were calculated. RESULTS This study included 187 187 VLBW infants. Both medical and surgical NEC increased mortality risk compared to those without NEC. Stratification by IVH severity modified this effect (no IVH: ARR 3.04 (95%CI 2.74-3.38) for medical NEC and 4.17 (3.84-4.52) for surgical NEC; mild IVH: ARR 2.14 (1.88-2.44) for medical NEC and 2.49 (2.24-2.78) for surgical NEC; severe IVH: ARR 1.14 (1.03-1.26) for medical NEC and 1.10 (1.02-1.18) for surgical NEC). CONCLUSION The relative impact of NEC on mortality decreased as IVH severity increased. Given the frequent coexistence of NEC and IVH, these data inform multidisciplinary management of these complex patients.
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Affiliation(s)
- Katherine Culbreath
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jamie Knell
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Gregory Keefe
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Emily Nes
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sam M Han
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | | | - Tom Jaksic
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Biren P Modi
- Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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Nes E, White BAA, Malek AJ, Mata J, Wieters JS, Little D. Building Communication and Conflict Management Awareness in Surgical Education. J Surg Educ 2022; 79:745-752. [PMID: 34952815 DOI: 10.1016/j.jsurg.2021.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A group of surgeons and a medical educator constructed a curriculum to strengthen communication and emotional intelligence skills in the surgical setting. DESIGN The curriculum consisted of a small group discussion series occurring during medical students' eight-week surgery clerkship. The curriculum targeted the following objectives: building team rapport, exploring self-management strategies in team communication, recognizing communication styles, diagnosing conflict, identifying opportunities in professional and personal development, and discussing professionalism in medicine. Students completed pre-post Likert style tests about their knowledge and understanding of the above-mentioned topics. SETTING Texas A&M University College of Medicine, Surgical Clerkship at Baylor Scott and White Medical Center, a level 1 trauma center, in Temple, TX. PARTICIPANTS Twenty-four students in their third year of medical school completed the communication curriculum. RESULTS Wilcoxon sign test was used to analyze the non-parametric data and multiple repeat tests required the significance level (p-Value) be adjusted to 0.003. Students showed significant increase in understanding of conflict management, their ability to communicate effectively, and their awareness of communication preferences (p < 0.001). In addition, they recognized better ways to engage with other students, residents, and staff on their rotation (p = 0.002) and felt more confident in their ability to handle feedback (p = 0.001). Open-ended responses on the post-test had overwhelmingly positive feedback with themes of awareness, psychological safety, and team rapport. Finally, students requested that the curriculum be taught longitudinally throughout their third-year clerkships. CONCLUSIONS Our curriculum enabled students to improve their awareness of communication, conflict management, team dynamics, and professionalism. These important competencies will support students throughout their training and in their practice as future surgeons.
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Affiliation(s)
- Emily Nes
- Boston Children's Hospital, Department of Surgery, Boston, Massachusetts; Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Bobbie Ann Adair White
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; MGH Institute of Health Professions, Health Professions Education Program, Boston, Massachusetts; Texas A&M, College of Medicine, Temple, Texas.
| | - Adil Justin Malek
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas
| | - Jonaphine Mata
- Johns Hopkins, Department of Medicine, Baltimore, Maryland; Texas A&M, College of Medicine, Temple, Texas
| | - J Scott Wieters
- Baylor Scott and White Health System, Department of Emergency Medicine, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
| | - Dan Little
- Baylor Scott and White Health System, Department of Surgery, Temple, Texas; Texas A&M, College of Medicine, Temple, Texas
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Wang X, Esquivel C, Charlton M, Stathakis S, Nes E. MO-F-BRA-06: Neutron Dose Equivalent at the Maze Entrance of a Flattening Filter Free Accelerator. Med Phys 2011. [DOI: 10.1118/1.3613001] [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: 11/07/2022] Open
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Nes E, Blough M, Mira J. SU-GG-T-571: A Comparative Study between RapidArc and IMRT Techniques Applied to H&N Cancers. Med Phys 2010. [DOI: 10.1118/1.3468969] [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: 11/07/2022] Open
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Wang X, Esquivel C, Shi C, Nes E, Papanikolaou N, Charlton M. SU-EE-A1-03: The Neutron Dose Evaluation and Shielding at the Maze Entrance of the Varian Clinac 2300EX. Med Phys 2009. [DOI: 10.1118/1.3181095] [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: 11/07/2022] Open
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Manciu M, Vulcan T, Manciu F, Nes E, Waggener R. SU-FF-T-39: A Robust Method for Megavoltage X-Ray Spectra Reconstruction Using Attenuation Measurements. Med Phys 2007. [DOI: 10.1118/1.2760684] [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: 11/07/2022] Open
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Nes E, Esquivel C, Waggener R. SU-FF-T-155: Derivation of Photon Energy Spectra From Transmission Measurements Using Large Fields. Med Phys 2006. [DOI: 10.1118/1.2241079] [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: 11/07/2022] Open
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Solberg JK, McQueen HJ, Ryum N, Nes E. Influence of ultra-high strains at elevated temperatures on the microstructure of aluminium. Part I. ACTA ACUST UNITED AC 1989. [DOI: 10.1080/01418618908213872] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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McQueen HJ, Solberg JK, Ryum N, Nes E. Evolution of flow stress in aluminium during ultra-high straining at elevated temperatures. Part II. ACTA ACUST UNITED AC 1989. [DOI: 10.1080/01418618908213873] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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23
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24
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Marthinsen K, Lohne O, Nes E. The development of recrystallization microstructures studied experimentally and by computer simulation. ACTA ACUST UNITED AC 1989. [DOI: 10.1016/0001-6160(89)90273-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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26
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27
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28
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Saetre T, Hunderi O, Nes E. Computer simulation of primary recrystallisation microstructures: The effects of nucleation and growth kinetics. ACTA ACUST UNITED AC 1986. [DOI: 10.1016/0001-6160(86)90207-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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31
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Solbeeg JK, Nes E. The interaction between vacancy emitting/absorbing precipitates and dislocations in silicon as investigated by transmission electron microscopy. ACTA ACUST UNITED AC 1978. [DOI: 10.1080/01418617808239183] [Citation(s) in RCA: 20] [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] [Indexed: 10/23/2022]
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32
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33
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34
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35
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36
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Nes E, Ryum N. On the formation of fan-shaped precipitates during the decomposition of a highly supersaturated AlZr solid solution. ACTA ACUST UNITED AC 1971. [DOI: 10.1016/0036-9748(71)90142-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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