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Muntean M, Prelipcean I, Racean MA, Cucerea M, Fagarasan A, David CT, Marginean C, Suciu LM. Optimally Controlled Diabetes and Its Influence on Neonatal Outcomes at a Level II Center: A Study on Infants Born to Diabetic Mothers. Medicina (Kaunas) 2023; 59:1768. [PMID: 37893486 PMCID: PMC10607977 DOI: 10.3390/medicina59101768] [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] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: We investigated the effect of optimal maternal glycemic control on neonatal outcomes among infants born to mothers with diabetes. Materials and Methods: In this prospective study, we assessed 88 eligible mothers admitted to the obstetrics department for pregnancy evaluation. Our analysis included 46 infants born to diabetic mothers (IDMs) and 138 infants born to unaffected mothers, all admitted to the Level II Neonatal Intensive Care Unit (NICU). Results: Mothers affected by diabetes were generally older and exhibited a higher body mass index (BMI) and a greater number of gestations, although parity did not differ significantly. Cesarean section emerged as the most frequently chosen mode of delivery. A significantly higher proportion of infants in the affected group presented with respiratory disease (3% vs. 19.5%), which required NICU admission (4.3% vs. 23.9%), phototherapy (18.1% vs. 43.5%), and had congenital heart defects or myocardial hypertrophy (15.2% and 26% vs. 3% and 4.3%) compared to matched controls (p < 0.05). Conclusions: This study underscores the persistence of adverse neonatal outcomes in IDMs, even when maternal glycemic control is optimized. It calls for further investigation into potential interventions and strategies aimed at enhancing neonatal outcomes in this population.
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Affiliation(s)
- Mihai Muntean
- Department of Obstetrics and Gynecology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania; (M.M.); (C.M.)
| | - Irina Prelipcean
- Department of Neonatology, University of Rochester Medical Center Golisano Children’s Hospital at Strong, Rochester, NY 14642, USA
| | - Maria-Andreea Racean
- Department of Neonatology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania; (M.-A.R.); (M.C.)
| | - Manuela Cucerea
- Department of Neonatology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania; (M.-A.R.); (M.C.)
| | - Amalia Fagarasan
- Department of Pediatric Cardiology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania;
| | - Carmen Tamara David
- Faculty of Medicine, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania;
| | - Claudiu Marginean
- Department of Obstetrics and Gynecology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania; (M.M.); (C.M.)
| | - Laura Mihaela Suciu
- Department of Neonatology, University of Medicine Pharmacy Science and Technology George Emil Palade of Târgu Mures, 540142 Târgu Mures, Romania; (M.-A.R.); (M.C.)
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Suciu LM, Prelipcean I, Făgărășan A, Giesinger RE, McNamara PJ. Normative echocardiography data of myocardial adaptation to extrauterine life: a review of prospective studies. Front Pediatr 2023; 11:1192618. [PMID: 37397152 PMCID: PMC10312083 DOI: 10.3389/fped.2023.1192618] [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: 03/23/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Recent research has increased focus and interest in characterizing the physiology of the transition circulation using echocardiography. Critique of published normative neonatal echocardiography data among healthy term neonates has not been performed. We have performed a comprehensive literature review using the key terms: cardiac adaptation, hemodynamics, neonatal transition, term newborns. Studies were included if they had reported echocardiography indices of cardiovascular function in the presence of maternal diabetes, intrauterine growth restricted newborns and prematurity and had a comparison group of healthy term newborns within first seven postnatal days. Sixteen published studies evaluating transitional circulation in healthy newborns were included. There was marked heterogeneity in the methodologies used; specifically, inconsistency in time of evaluation and imaging techniques used makes it challenging to determine specific trends of expected physiologic changes. Some studies revealed nomograms for echocardiography indices, though limitations persist in terms of sample size, number of reported parameters and consistency of measurement technique. A comprehensive standardized echocardiography framework which includes consistent techniques for assessment dimensions, function, blood flow, pulmonary/systemic vascular resistance, and shunts pattern is warranted to ensure consistency in the use of echocardiography to guide care of healthy and sick newborns.
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Affiliation(s)
- Laura Mihaela Suciu
- Department of Pediatrics, University of Medicine Pharmacy Science and Technology George Emil Palade of Targu Mures, Targu Mures, Romania
| | - Irina Prelipcean
- Department of Neonatology, University of Rochester Medical Center Golisano Children’s Hospital at Strong, Rochester, NY, United States
| | - Amalia Făgărășan
- Department of Pediatrics, University of Medicine Pharmacy Science and Technology George Emil Palade of Targu Mures, Targu Mures, Romania
| | - Regan E. Giesinger
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, United States
| | - Patrick J. McNamara
- Department of Pediatrics, University of Iowa Stead Family Children’s Hospital, Iowa City, IA, United States
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Lin J, Chen J, Lyu H, Khodak I, Chhabra D, Richardson CLD, Prelipcean I, Dylag AM, Luo J. Predicting Adverse Neonatal Outcomes for Preterm Neonates with Multi-Task Learning. ArXiv 2023:2303.15656. [PMID: 37033459 PMCID: PMC10081339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Diagnosis of adverse neonatal outcomes is crucial for preterm survival since it enables doctors to provide timely treatment. Machine learning (ML) algorithms have been demonstrated to be effective in predicting adverse neonatal outcomes. However, most previous ML-based methods have only focused on predicting a single outcome, ignoring the potential correlations between different outcomes, and potentially leading to suboptimal results and overfitting issues. In this work, we first analyze the correlations between three adverse neonatal outcomes and then formulate the diagnosis of multiple neonatal outcomes as a multi-task learning (MTL) problem. We then propose an MTL framework to jointly predict multiple adverse neonatal outcomes. In particular, the MTL framework contains shared hidden layers and multiple task-specific branches. Extensive experiments have been conducted using Electronic Health Records (EHRs) from 121 preterm neonates. Empirical results demonstrate the effectiveness of the MTL framework. Furthermore, the feature importance is analyzed for each neonatal outcome, providing insights into model interpretability.
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Nader M, Tasdelen-Teker G, DeStephens AJ, Lampotang S, Prelipcean I, Smith RD, Bortcosh WH, Chiriboga Salazar NR, Martinez Schlurmann NI, Hamdan US, Munoz Pareja JM. Simulation Use in Outreach Setting: A Novel Approach to Building Sustainability. Simul Healthc 2022; 17:e136-e140. [PMID: 33600139 DOI: 10.1097/sih.0000000000000555] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Simulation is a well-studied teaching tool for multidisciplinary teamwork, crisis resource management, and communication skills. These attributes are essential for successful international medical missions, which include healthcare providers with different familiarities with the outreach environment and each team member's role. However, immersive simulation remains underused in similar settings. Our team designed a simulation-based curriculum that focuses on multidisciplinary teamwork and crisis resource management skills. In this commentary, we describe its implementation during high-risk cleft care outreach missions conducted by the Global Smile Foundation. We discuss the importance of a simple, feasible, and flexible platform to successfully overcome the limitations of time and resources inherent to outreach mission work while addressing the clinical and geographic needs specific to each site. We highlight challenges, including unpredictability of the outreach environment, a language barrier, and the short duration of missions. Finally, we offer a roadmap for groups involved in similar global health efforts.
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Affiliation(s)
- Marie Nader
- From the Department of Pediatrics (M.N.), University of Florida College of Medicine, Gainesville, FL; Department of Medical Education and Informatics, Hacettepe University, Ankara, Turkey (G.T.-T.); Center for Safety, Simulation & Advanced Learning Technologies, University of Florida College of Medicine (A.J.D., S.L.); Department of Anesthesiology, University of Florida College of Medicine (A.J.D., S.L.); Office of Educational Affairs/Office of Medical Education (S.L.); Division of Neonatology, University of Florida College of Medicine (I.P.), Department of Pediatrics; Division of Pediatric Critical Care, University of Florida College of Medicine (R.D.S., W.H.B., N.R.C.S., N.I.M.S., J.M.M.P.), Department of Pediatrics; and the Global Smile Foundation (U.S.H.), Norwood, MA
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Prelipcean I, Wynn JL, Thompson L, Burchfield DJ, James-Woodley L, Chase PB, Barnes CP, Bernier A. Absence of relationship between serum cortisol and critical illness in premature infants. Arch Dis Child Fetal Neonatal Ed 2021; 106:408-412. [PMID: 33541918 PMCID: PMC8852370 DOI: 10.1136/archdischild-2020-319970] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Inadequate cortisol production in response to critical illness in extremely preterm infants may exacerbate poor outcomes. Despite commonly measuring cortisol concentration and administering hydrocortisone for presumed adrenal insufficiency, the relationship between serum cortisol concentration and illness severity remains unclear in this unique population. OBJECTIVE To determine the relationship between cortisol concentrations and illness severity as measured by the Score for Neonatal Acute Physiology II, neonatal Sequential Organ Failure Assessment and Vasoactive-Inotropic Score in premature infants. DESIGN/METHODS This retrospective, single-center cohort study included preterm infants born <30 weeks gestational age admitted to a level IV neonatal intensive care unit (NICU) between June 2011 and July 2018, who had a serum cortisol obtained for clinical indications before 36 weeks PMA. Demographic data were collected on infants and mothers. Nine clinical variables were identified a priori that could potentially modify cortisol concentration including critical illness. Univariate and multivariable analyses determined the relationship between cortisol concentration and each of these variables. RESULTS A total of 224 preterm infants with pretreatment serum cortisol concentration met criteria for inclusion. The median (IQR) gestational age at birth was 25 weeks (24, 26) and at cortisol measurement was 26 weeks (25, 28). The median cortisol was 13.3 ug/dL. Non-survivors had the highest values. Cortisol concentration did not correlate with any of the selected illness severity scores. CONCLUSIONS Cortisol concentrations in extremely preterm infants did not correlate with illness severity regardless of gestational age. Further studies are needed to identify clinically useful mediators of adrenal dysfunction and to guide clinical management.
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Affiliation(s)
- Irina Prelipcean
- Pediatrics, University of Rochester, Rochester, New York, USA .,Pediatrics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - James L. Wynn
- Department of Pediatrics, University of Florida, Gainesville, Florida,Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Lindsay Thompson
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | | | | | - Philip B. Chase
- Clinical and Translational Science - Informatics and Technology, University of Florida
| | - Christopher P. Barnes
- Clinical and Translational Science - Informatics and Technology, University of Florida
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida
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