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Appelhans BM, French SA, Bradley LE, Lui K, Janssen I, Richardson D. CHECK: A randomized trial evaluating the efficacy and cost-effectiveness of home visitation in pediatric weight loss treatment. Contemp Clin Trials 2019; 88:105891. [PMID: 31740429 DOI: 10.1016/j.cct.2019.105891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Socioeconomically-disadvantaged households have a high prevalence of pediatric overweight/obesity, and also face barriers to accessing weight loss treatment in healthcare settings. Delivering family-based pediatric weight loss treatment in the home setting may enhance its efficacy by facilitating treatment attendance, enabling more tailored treatment recommendations informed by observations of the home environment, and increasing accountability. This paper describes the design of the Creating Health Environments for Chicago Kids (CHECK) Trial, which evaluates the efficacy, cost-effectiveness, and mechanisms of home visitation in family-based pediatric weight loss treatment for children in low-income households. DESIGN CHECK is a two-arm, parallel group, randomized controlled trial that is enrolling N = 266 children, ages 6-12 y, who have overweight/obesity (BMI percentile ≥85) and live in a low-income household. Participants are randomized in a 1:1 ratio to either standard of care family-based weight loss treatment delivered in the home, or the identical intervention delivered in an academic medical center. The primary outcome is change in child BMI z-score from baseline to 12 months. Program delivery costs are rigorously documented to enable cost-effectiveness analyses from the societal and payer perspectives. Objectively-documented changes to the home environment and aspects of intervention delivery (e.g., hours of in-person contact received, quantity of behavioral goals set per session) will be tested as hypothesized treatment mechanisms. IMPLICATIONS Findings will inform the design of future interventions, and treatment dissemination decisions by public health agencies and third-party payers. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03195790.
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Affiliation(s)
- B M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, United States of America; Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America.
| | - S A French
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, United States of America
| | - L E Bradley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, United States of America
| | - K Lui
- Department of Pediatrics, Rush University Medical Center, United States of America
| | - I Janssen
- Department of Preventive Medicine, Rush University Medical Center, United States of America
| | - D Richardson
- Department of Preventive Medicine, Rush University Medical Center, United States of America; Department of Mathematics and Computer Science, Lake Forest College, United States of America
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Rasul R, Ward M, Clews S, Falconer J, Feller J, Lui K, Oei J. Retrospective study found that outpatient care for infants exposed to drugs during pregnancy was sustainable and safe. Acta Paediatr 2019; 108:654-661. [PMID: 30030933 DOI: 10.1111/apa.14509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/02/2017] [Revised: 06/10/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
AIM We determined the safety, feasibility and sustainability of an outpatient model of care for infants exposed to intra-uterine drugs. METHODS This was a retrospective chart review of 774 drug-exposed infants born between 1998 and 2016 at the Royal Hospital for Women, Sydney, Australia. RESULTS Most (86%) of the mothers used multiple drugs, including opioids (58%). More than three-quarters (78%) of the infants were born full term at a mean gestation of 38 weeks and hospitalised for a median of seven days. This rose to 14 days if they were medicated for neonatal abstinence syndrome (NAS). Most of the NAS patients (83%) were discharged on medication, namely morphine, and the median duration of NAS treatment was 76 (interquartile range 35-120). Three medication errors occurred: two extra doses of phenobarbitone and one infant weaned off morphine faster than prescribed. No infants were rehospitalised for NAS. Four died from sudden infant death syndrome at 2.2-5.8 months after discharge and one drowned at 15 months. None were medicated at the time of death. CONCLUSION Outpatient care for drug-exposed infants was sustainable and had low complication rates, even for those with NAS. The optimum duration of follow-up and impact on hospital costs should be examined.
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Affiliation(s)
- R Rasul
- School of Women's and Children's Health; University of New South Wales; Kensington NSW Australia
| | - M Ward
- School of Women's and Children's Health; University of New South Wales; Kensington NSW Australia
- The Royal Hospital for Women; Randwick NSW Australia
| | - S Clews
- The Langton Centre; Surry Hills NSW Australia
| | - J Falconer
- The Langton Centre; Surry Hills NSW Australia
| | - J Feller
- Sydney Children's Hospital; Randwick NSW Australia
| | - K Lui
- School of Women's and Children's Health; University of New South Wales; Kensington NSW Australia
- The Royal Hospital for Women; Randwick NSW Australia
| | - J Oei
- School of Women's and Children's Health; University of New South Wales; Kensington NSW Australia
- The Royal Hospital for Women; Randwick NSW Australia
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Kelly LE, Shah PS, Håkansson S, Kusuda S, Adams M, Lee SK, Sjörs G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi N. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 2017; 37:762-768. [PMID: 28383541 DOI: 10.1038/jp.2017.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/22/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK. RESULTS All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified. CONCLUSIONS Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.
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Affiliation(s)
- L E Kelly
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - S Håkansson
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - M Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - G Sjörs
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - M Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - F Rusconi
- Unit of Epidemiology, TIN Toscane Online, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - L Lehtonen
- Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - B A Darlow
- Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand
| | - K Lui
- National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - L S Feliciano
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - L Gagliardi
- Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy
| | - D Bassler
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - N Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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Sanderson E, Yeo KT, Wang AY, Callander I, Bajuk B, Bolisetty S, Lui K. Dwell time and risk of central-line-associated bloodstream infection in neonates. J Hosp Infect 2017; 97:267-274. [PMID: 28651859 DOI: 10.1016/j.jhin.2017.06.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 12/21/2016] [Accepted: 06/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Umbilical venous catheters (UVCs) or peripherally inserted central catheters (PICCs), widely used in high-risk neonates, may have a threshold dwell time for subsequent increased risk of central-line-associated bloodstream infection (CLABSI). AIM To evaluate the CLABSI risks in neonates having either UVC, PICC, or those having both sequentially. METHODS The study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional neonatal intensive care units: 1392 having UVC only (group 1), 1317 PICC only (group 2), and 1276 both UVC and PICC (group 3). FINDINGS There were 403 CLABSIs among 6000 venous catheters inserted, totalling 43,302 catheter-days. CLABSI rates were higher in group 3 infants who were of lowest gestation (16.9 per 1000 UVC-days and 12.5 per 1000 PICC-days; median: 28 weeks) when compared with group 1 (3.3 per 1000 UVC-days; 37 weeks) and group 2 (4.8 per 1000 PICC-days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed that UVC CLABSI rate increased stepwise to 42 per 1000 UVC-days by day 10, with the highest rate in group 3 (85 per 1000 UVC-days). PICC CLABSI rates remained relatively stable at 12-20 per 1000 PICC-days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk than late replacement. CONCLUSION There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 might be considered.
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Affiliation(s)
- E Sanderson
- University of New South Wales, Sydney, Australia
| | - K T Yeo
- Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia; Department of Neonatology, KK Women's & Children's Hospital, Singapore
| | - A Y Wang
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - I Callander
- Department of Newborn Care, Liverpool Hospital, Sydney, New South Wales, Australia
| | - B Bajuk
- New South Wales Pregnancy and Newborn Services Network, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - S Bolisetty
- Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - K Lui
- University of New South Wales, Sydney, Australia; Division of Newborn Care, Royal Hospital for Women, Sydney, New South Wales, Australia.
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Small A, Lipsky M, Mlynarczyk C, Weinberg A, Lui K, Valenzuela R. 183 Implementation of an Adjustable Penile Support for Patients Undergoing Placement of Inflatable Penile Prosthesis: The VALKIN. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.12.172] [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: 10/20/2022]
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Gemmell L, Martin L, Murphy KE, Modi N, Håkansson S, Reichman B, Lui K, Kusuda S, Sjörs G, Mirea L, Darlow BA, Mori R, Lee SK, Shah PS, Shah PS. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation. J Perinatol 2016; 36:1067-1072. [PMID: 27583388 DOI: 10.1038/jp.2016.133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.
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Affiliation(s)
- L Gemmell
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - L Martin
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - N Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - S Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - K Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - G Sjörs
- Swedish Neonatal Quality Register, Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - L Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B A Darlow
- Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - R Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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Dinham GK, Henry A, Lowe SA, Nassar N, Lui K, Spear V, Shand AW. Twin pregnancies complicated by gestational diabetes mellitus: a single centre cohort study. Diabet Med 2016; 33:1659-1667. [PMID: 26802478 DOI: 10.1111/dme.13076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Accepted: 01/19/2016] [Indexed: 11/29/2022]
Abstract
AIMS In women with a twin pregnancy, to determine the incidence of, risk factors for and outcomes of women with gestational diabetes mellitus, and assess how these have changed with a change in gestational diabetes screening. METHODS Retrospective cohort study of women with a twin pregnancy attending an Australian tertiary hospital, 2002-2013. Information on gestational diabetes status, gestational diabetes risk factors and pregnancy outcomes was ascertained. Pregnancy outcomes included hypertensive disorders, twin birthweight centile and a composite adverse pregnancy outcome. Analysis was stratified pre/post screening protocol change (epoch 1: 2002-2009, epoch 2: 2010-2013) and by gestational diabetes status. RESULTS Gestational diabetes was diagnosed in 86/982 (8.8%) women, increasing from 4.4% to 14.7% between epochs (P = 0.0001). The proportion of women with hypertensive disorders increased (11.7% vs. 13.4%, P = 0.009), but the proportion of infant's birthweight > 90th centile decreased (11.0% vs. 7.6%, P = 0.02) between epochs. Overall, 33.6% of women had ≥ 1 risk factors for gestational diabetes. Three-quarters (73.7%) of women overall had an adverse pregnancy outcome, with a slightly higher proportion in women with gestational diabetes compared with those with no gestational diabetes (79.7% vs. 73.1%, P = 0.06). The rate of the adverse pregnancy outcome did not change by epoch, after adjusting for maternal and pregnancy risk factors (adjusted odds ratio = 0.96, 95% confidence interval 0.73-1.26). CONCLUSIONS Almost 1 in 10 women with a twin pregnancy were diagnosed with gestational diabetes, with the incidence of gestational diabetes increasing threefold with a new screening protocol. The pregnancy outcomes of women with a twin pregnancy did not change with increased detection and treatment for gestational diabetes.
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Affiliation(s)
- G K Dinham
- School of Women's and Children's Health, University New South Wales Medicine, Kensington, NSW, Australia
| | - A Henry
- School of Women's and Children's Health, University New South Wales Medicine, Kensington, NSW, Australia
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
- Women's and Children's Health, St George Hospital, Kogarah, NSW, Australia
| | - S A Lowe
- School of Women's and Children's Health, University New South Wales Medicine, Kensington, NSW, Australia
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
| | - N Nassar
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia
| | - K Lui
- School of Women's and Children's Health, University New South Wales Medicine, Kensington, NSW, Australia
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
| | - V Spear
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
| | - A W Shand
- School of Women's and Children's Health, University New South Wales Medicine, Kensington, NSW, Australia
- Department of Obstetrics, Royal Hospital for Women, Randwick, NSW, Australia
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia
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Hwang Y, Lui K, Lin Y, Tsai H. SU-F-I-74: Dose Evaluation Based On Monte Carlo Simulation of Three-Dimensional Rotational Angiography During Hepatic Transarterial Chemoembolization Procedures. Med Phys 2016. [DOI: 10.1118/1.4955902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Tataranno ML, Oei JL, Perrone S, Wright IM, Smyth JP, Lui K, Tarnow-Mordi WO, Longini M, Proietti F, Negro S, Saugstad OD, Buonocore G. Resuscitating preterm infants with 100% oxygen is associated with higher oxidative stress than room air. Acta Paediatr 2015; 104:759-65. [PMID: 25966608 DOI: 10.1111/apa.13039] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 12/06/2014] [Revised: 01/24/2015] [Accepted: 04/17/2015] [Indexed: 11/26/2022]
Abstract
AIM The starting fraction of inspired oxygen for preterm resuscitation is a matter of debate, and the use of room air in full-term asphyxiated infants reduces oxidative stress. This study compared oxidative stress in preterm infants randomised for resuscitation with either 100% oxygen or room air titrated to internationally recommended levels of preductal oxygen saturations. METHODS Blood was collected at birth, two and 12 hours of age from 119 infants <32 weeks of gestation randomised to resuscitation with either 100% oxygen (n = 60) or room air (n = 59). Oxidative stress markers, including advanced oxidative protein products (AOPP) and isoprostanes (IsoP), were measured with high-performance liquid chromatography and mass spectrometry. RESULTS Significantly higher levels of AOPP were found at 12 hours in the 100% oxygen group (p < 0.05). Increases between two- and 12-hour AOPP (p = 0.004) and IsoP (p = 0.032) concentrations were significantly higher in the 100% oxygen group. CONCLUSION Initial resuscitation with room air versus 100% oxygen was associated with lower protein oxidation at 12 hour and a lower magnitude of increase in AOPP and IsoP levels between two and 12 hours of life. Correlations with clinical outcomes will be vital to optimise the use of oxygen in preterm resuscitation.
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Affiliation(s)
- ML Tataranno
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - JL Oei
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - S Perrone
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - IM Wright
- School of Paediatrics; University of Wollongong; Wollongong NSW Australia
| | - JP Smyth
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - K Lui
- School of Women's and Children's Health; University of New South Wales; Sydney NSW Australia
- Department of Newborn Care; The Royal Hospital for Women; Randwick NSW Australia
| | - WO Tarnow-Mordi
- Australia Westmead International Network for Neonatal Education and Research; The University of Sydney; Camperdown NSW Australia
| | - M Longini
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - F Proietti
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - S Negro
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
| | - OD Saugstad
- Department of Pediatric Research; Oslo University Hospital; University of Oslo; Oslo Norway
| | - G Buonocore
- Department of Molecular and Developmental Medicine; University of Siena; Siena Italy
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Martin L, Mirea L, Modi N, Lui K, Adams M, Shah P, Reichman B, Mori R, San Feliciano L, Sjors G, Hakansson S, Shah P. 93: Birth Weight for Gestational Age: Impact of Using Different Growth References on the Comparison of Neonatal Outcomes Between the Countries in iNeo. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e67b] [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: 11/14/2022] Open
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Shah P, Sjors G, Reichman B, Morisaki N, Modi N, Mirea L, Lui K, Adams M, Bassler D, San Feliciano L, Santhakumaran S, Lee S. 94: Variations in Mortality of Very Preterm Neonates Between Eight National Neonatal Databases: The iNeo Experience. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e68] [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: 11/12/2022] Open
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Martin L, Modi N, Reichman B, Sjors G, Hakansson S, Darlow B, Lui K, Adams M, San Feliciano L, Kusuda S, Lee S, Shah P. 98: The Organization of Health Services for VLBW/VPT Neonates: Between-Country Comparisons. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e69b] [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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Shah P, Mirea L, Yang J, Lui K, Darlow B, Sjors G, Hakansson S, Reichman B, Kusuda S, Mori R, Adams M, San Feliciano L, Modi N, Bassler D, Santhakumaran S, Lee S. 96: Comparison of Mortality and Major Morbidity of Very Preterm Neonates Using Data from Eight National Neonatal Databases: The iNeo Experience. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e69] [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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McIntosh J, Meriki N, Joshi A, Biggs V, Welsh AW, Challis D, Lui K. Long term developmental outcomes of pre-school age children following laser surgery for twin-to-twin transfusion syndrome. Early Hum Dev 2014; 90:837-42. [PMID: 25463829 DOI: 10.1016/j.earlhumdev.2014.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 12/28/2013] [Revised: 07/04/2014] [Accepted: 08/09/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Laser therapy is now a well recognised treatment for twin-to-twin transfusion syndrome (TTTS). We investigated the early childhood neurodevelopmental outcome of children post laser treatment for TTTS in our centre. METHODS Children of women who had laser therapy for TTTS between March 2006 and June 2008 were assessed at 30-69 months of age with WPPSI-III and a general health questionnaire. Major neurodevelopmental impairment (NDI) was reported as IQ<70 or cerebral palsy (CP). Borderline cognitive impairment was defined by IQ 70-79. RESULTS Amongst the 37 pregnancies treated, 62 infants were discharged home and the overall foetal survival rate was 84%. A total of 50 children (84%) from 31 pregnancies were assessed. Average age at assessment was 47 months. Two children with late treatment of congenital hypothyroidism were excluded. The majority of pregnancies were Quintero Stage III (74%). There was a significant trend for worse outcome with higher Quintero stage. The average gestational age at birth was 32 weeks. The majority (39, 78%) of children were found to be neurodevelopmentally normal; 9 (18%) had borderline cognitive development; and 2 (4%) had a major NDI, including one with cerebral palsy (2%). CONCLUSIONS There was a modest level of neurocognitive impairment post laser therapy for TTTS, mainly borderline cognitive development, lesser so major NDI. There was a low incidence of cerebral palsy. Routine developmental and neurological follow-up of these children is recommended.
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Affiliation(s)
- J McIntosh
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - N Meriki
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - A Joshi
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - V Biggs
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - A W Welsh
- Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - D Challis
- Royal Hospital for Women, Randwick, New South Wales, Australia
| | - K Lui
- Royal Hospital for Women, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
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Hallab JC, Leach ST, Zhang L, Mitchell HM, Oei J, Lui K, Day AS. Molecular characterization of bacterial colonization in the preterm and term infant's intestine. Indian J Pediatr 2013; 80:1-5. [PMID: 22576294 DOI: 10.1007/s12098-012-0753-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 09/14/2011] [Accepted: 04/04/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To further define patterns of colonising intestinal microflora in newborn infants utilising molecular methods. METHODS Ten term and 5 preterm (<32 wk) infants born at the Royal Hospital for Women, Sydney, Australia were enrolled in the present study and followed for 6 mo post partum. Serial stools were collected, DNA was extracted and subjected to PCR-Denaturing Gradient Gel Electrophoresis using a range of primers and sequencing. The effect of gestational length, feeding and delivery method was compared to the pattern of bacterial acquisition. RESULTS Intestinal bacterial diversity was lower in preterm compared with term infants. For term infants, bacterial DNA detection rates were not associated with feeding or delivery method, although Enterobacteria and Clostridia were commonly identified. The detection rate of Bifidobacteria was lower in preterm infants than term infants. Potential pathogens were detected in preterm infant samples. CONCLUSIONS Preterm infants frequently have aberrant bacterial colonization of the intestine. Further research is now required to determine if this may contribute to adverse health outcomes.
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Affiliation(s)
- J C Hallab
- School of Biochemistry and Biotechnology, University of New South Wales, Sydney, Australia
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16
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Loughran-Fowlds AS, Lin JW, Oei J, Michalowski J, Henry R, Lui K. Early postnatal surge of serum Clara cell secretory protein in newborn infants. Neonatology 2012; 101:125-31. [PMID: 21952535 DOI: 10.1159/000329557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 10/21/2010] [Accepted: 05/24/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Clara cell secretory protein (CCSP) is an anti-inflammatory mediator, but its role in neonatal lung adaptation and diseases is uncertain. OBJECTIVE To characterize postnatal changes in serum CCSP in relation to gestation, respiratory disease (RDS) and bronchopulmonary dysplasia (BPD) in comparison with other anti-inflammatory cytokines (IL-4, -10 and -13). METHODS Blood was collected from 76 infants (26 of 23-29 weeks' gestation, 33 of 30-36 weeks' gestation and 17 term infants) at birth (preterm cord blood); on admission; at 12, 24 and 48 h; and on days 3-4 and 7 of life. CCSP was assayed by ELISA and cytokines by Bio-Plex. RESULTS Median serum CCSP in extremely and moderately preterm infants rose from a baseline of 13.6 and 15.9 to 33.4 ng/ml (p = 0.04) and 59.8 ng/ml (p = 0.03) at 12 h of age, respectively. CCSP levels were highest in term infants (80.7 ng/ml at 12 h). CCSP then decreased to 22.5 ng/ml on days 3-4 (p = 0.001). CCSP of 37 RDS infants fell to a lower baseline on days 4 and 7 than that of the 22 non-RDS preterms. The 8 infants who developed BPD had persistently low serum CCSP (12.7 ng/ml at 12 h). In contrast, early postnatal changes were not seen in IL-4, -10 and -13 levels, but low IL-10 and -13 levels were found on day 7 in BPD infants. CONCLUSIONS Serum CCSP levels were characterized by an early postnatal surge. This apparent gestation-influenced surge may represent an initiation of a protective cascade against postnatal lung injury during extrauterine adaptation.
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Affiliation(s)
- A S Loughran-Fowlds
- Leslie Stevens Newborn Research Laboratory, Royal Hospital for Women, Randwick, NSW, Australia
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Abstract
AIM To determine the short-term outcomes of newborn infants and mothers exposed to antenatal amphetamines in the state of New South Wales and the Australian Capital Territory during 2004. METHODS Amphetamine exposure was determined retrospectively using ICD-10 AM morbidity code searches of hospital medical records and from records of local drug and alcohol services. Records were reviewed on site. All public hospitals (n = 101) with obstetric services were included. RESULTS Amphetamines were used by 200 (22.9%) of the 871 identified drug-using mothers. Most women (182, 91%) injected amphetamines intravenously. Compared with the other 669 drug users, amphetamine-using mothers were significantly more likely to use multiple classes of drugs (45.0% vs 7.8%), be subject to domestic violence (32.1% vs 17.5%), be homeless (14.8% vs 4.9%) and be involved with correctional services (19.8% vs 9.7%). The incidence of comorbid psychiatric illnesses were significantly higher (57.4% vs 41.7%) and their infants were more likely to be preterm (29.5% vs 20.4%), notified as children at risk (67.0% vs 32.8%), fostered before hospital discharge (14.5% vs 5.5%) and less likely to be breastfed (27.0% vs 41.6%). CONCLUSIONS Amphetamine-exposed mothers and infants in public hospitals of NSW and the ACT are at significantly higher risk of adverse social and perinatal outcomes even when compared with mothers and infants exposed to other drugs of dependency. Increased vigilance for amphetamine exposure is recommended due to a high prevalence of use, especially in Australia, as a recreational drug.
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Affiliation(s)
- J Oei
- School of Women's and Children's Health, University of New South Wales, Kensington, Sydney, New South Wales, Australia.
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Garg P, Abdel-Latif ME, Bolisetty S, Bajuk B, Vincent T, Lui K. Perinatal characteristics and outcome of preterm singleton, twin and triplet infants in NSW and the ACT, Australia (1994-2005). Arch Dis Child Fetal Neonatal Ed 2010; 95:F20-4. [PMID: 19671532 DOI: 10.1136/adc.2009.157701] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [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: 11/04/2022]
Abstract
OBJECTIVE To compare the perinatal characteristics, neonatal morbidity and mortality of preterm singletons, twins and triplets born at 22-31 weeks' gestation and admitted to neonatal intensive care units (NICU) in New South Wales and Australian Capital Territory between 1994 and 2005. METHODS Perinatal characteristics and neonatal outcome data were obtained from the regional NICUS data collection to test for a priori hypothesis. The 10 068 very premature infants studied included 7304 (72.5%) singletons, 2444 (24.2%) twins and 320 (3.2%) triplets. RESULTS Assisted conception was associated with a higher maternal age and increased twins and triplets admissions into NICU than spontaneous conceptions (twins OR 6.9, 95% CI 6.1 to 8.0; and triplets OR 35.6, 95% CI 27.6 to 45.8). Major neonatal morbidities were similar between the three groups of singletons, twins or triplets. While twins of 22-27 weeks' gestation (adjusted OR 1.39, 95% CI 1.12 to 1.72) had higher mortality compared with singletons, mortality only diverged below 24 weeks' gestation. Mortality was predicted by decreasing gestational age, male gender and lack of antenatal steroids, whereas assisted conception was protective against mortality (adjusted OR 0.69, 95% CI 0.57 to 0.86). CONCLUSIONS Assisted conception contributed to higher very premature NICU admissions of twins and triplets. Preterm twins at the very extreme of viability had higher mortality compared with singletons. The protective effect of assisted conception against mortality requires further research.
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Affiliation(s)
- P Garg
- Department of Newborn Care, Royal Hospital for Women, Locked Bag 2000, Randwick, NSW 2031, Australia
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Abstract
AIMS To determine the prevalence of developmental coordination disorder (DCD) in "apparently normal" extremely premature (<29 weeks) or extremely low birthweight (<1000 g) schoolchildren at 8 years of age and whether motor skill assessments at an earlier age could predict DCD. METHOD From a neonatal intensive care unit cohort, 50 of the 53 eligible children (IQ >84 and without disabilities at age 5 and residing in Sydney metropolitan) and full-term classroom controls matched for gender and age were assessed with the Movement Assessment Battery for Children (MABC) at school. Previous Griffith's Scales (1 and 3 years) and Peabody Motor Scales (3 and 5 years) results were evaluated for prediction. RESULTS The prevalence of DCD (MABC impairment scores >1 SD below the norm) was significantly higher in the study group than controls (42% vs 8%, respectively), and severe DCD (scores >1.5 SD) was also significantly higher (30% vs 0%). DCD was independently associated with prolonged rupture of membranes and retinopathy of prematurity but not with parental education or occupation. Motor assessment using Peabody Fine Motor Scales at 3 years with a cut-off of <27th centile was the best predictor of DCD (areas under curve 78%). CONCLUSIONS Apparently normal high-risk infants are at risk of motor dysfunction into their school years. Most of these could be identified at age 3.
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Affiliation(s)
- T-A Goyen
- Department of Newborn Care, Royal Hospital for Women, Barker Street, Randwick, New South Wales, Australia 2031
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Tavake-Pasi E, Nash I, Lui K, Ralls B, Stinner W, Bullough R, Rasmussen C. Links between risk factors and adverse pregnancy outcomes among Utah mothers with gestational diabetes. Can J Diabetes 2009. [DOI: 10.1016/s1499-2671(09)33195-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- M E Abdel-Latif
- Department of Newborn Care, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 NSW, Australia
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Abdel-Latif ME, Bajuk B, Oei J, Vincent T, Sutton L, Lui K. Does rural or urban residence make a difference to neonatal outcome in premature birth? A regional study in Australia. Arch Dis Child Fetal Neonatal Ed 2006; 91:F251-6. [PMID: 16428354 PMCID: PMC2672724 DOI: 10.1136/adc.2005.090670] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [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: 11/04/2022]
Abstract
BACKGROUND Patients living in rural areas may be at a disadvantage in accessing tertiary health care. AIM To test the hypothesis that very premature infants born to mothers residing in rural areas have poorer outcomes than those residing in urban areas in the state of New South Wales (NSW) and the Australian Capital Territory (ACT) despite a coordinated referral and transport system. METHODS "Rural" or "urban" status was based on the location of maternal residence. Perinatal characteristics, major morbidity and case mix adjusted mortality were compared between 1879 rural and 6775 urban infants <32 weeks gestational age, born in 1992-2002 and admitted to all 10 neonatal intensive care units in NSW and ACT. RESULTS Rural mothers were more likely to be teenaged, indigenous, and to have had a previous premature birth, prolonged ruptured membrane, and antenatal corticosteroid. Urban mothers were more likely to have had assisted conception and a caesarean section. More urban (93% v 83%) infants were born in a tertiary obstetric hospital. Infants of rural residence had a higher mortality (adjusted odds ratio (OR) 1.26, 95% confidence interval (CI) 1.07 to 1.48, p = 0.005). This trend was consistently seen in all subgroups and significantly for the tertiary hospital born population and the 30-31 weeks gestation subgroup. Regional birth data in this gestational age range also showed a higher stillbirth rate among rural infants (OR 1.20, 95% CI 1.09 to 1.32, p<0.001). CONCLUSIONS Premature births from rural mothers have a higher risk of stillbirth and mortality in neonatal intensive care than urban infants.
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Affiliation(s)
- M E Abdel-Latif
- Department of Newborn Care, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 NSW, Australia
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Chen S, Phung S, Kwok S, Ye J, Hur G, Oh S, Smith D, Yuan YC, Karlsberg K, Lui K. Chemopreventive Properties of Mushrooms Against Breast Cancer and Prostate Cancer. Int J Med Mushrooms 2005. [DOI: 10.1615/intjmedmushrooms.v7.i3.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maclean K, Rasiah VS, Kirk EPE, Carpenter K, Cooper S, Lui K, Oei J. Pulmonary haemorrhage and cardiac dysfunction in a neonate with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. Acta Paediatr 2005; 94:114-6. [PMID: 15858970 DOI: 10.1111/j.1651-2227.2005.tb01797.x] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED We report on a favourable case of MCAD deficiency (homozygous 985A > G) that presented as lethargy, poor feeding, pulmonary haemorrhage and cardiac arrest without hypoglycaemia. The cessation of intralipid and the commencement of carnitine supplementation were associated with a rapid clinical improvement. CONCLUSION Mild carnitine depletion and secondary impairment of long-chain fatty acid metabolism may have contributed to post-asphyxial myocardial dysfunction and ventricular arrhythmias. Metabolic disorders must be kept in mind as a differential diagnosis in acutely ill infants, but it must also be emphasized that carnitine therapy is not uniformly effective in all MCAD patients.
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Affiliation(s)
- K Maclean
- Department of Medical Genetics, Sydney Children's Hospital, Sydney, Australia
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Abstract
Congenital chylothorax is the accumulation of lymphatic fluid within the pleural space. Cases unresponsive to conservative management usually require surgery. Octreotide has been used successfully to treat post-traumatic chylothoraces in the paediatric and adult population. Its exact mode of action is uncertain but it is believed to reduce lymphatic drainage by a direct action on splanchnic lymph flow. We report a case of congenital chylothorax where surgery was avoided with the compassionate trial of the somatostatin analogue, octreotide. Treatment was associated with prompt respiratory improvement prior to cessation of pleural drainage. Further studies are required to ascertain its true value in congenital chylothorax.
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Affiliation(s)
- S V Rasiah
- Department of Newborn Care, Royal Hospital for Women, Sydney, NSW 2031, Australia
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Gill AC, Oei J, Lewis NL, Younan N, Kennedy I, Lui K. Strabismus in infants of opiate-dependent mothers. Acta Paediatr 2003; 92:379-85. [PMID: 12725555] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
AIM At a follow-up clinic for infants of opiate-dependent mothers it was noted that more infants than expected developed strabismus. This study aimed to assess the prevalence of strabismus and the need for active strabismus surveillance in this population. METHODS Consecutive infants of opiate-dependent mothers born over an 18 mo period were recalled for ophthalmological assessment by an ophthalmologist and orthoptist. Those unable to attend were surveyed by telephone using a questionnaire. RESULTS 49 (69%) of the 71 eligible infants were recalled at a mean age of 21 mo (range 6-39); 29 had a full ophthalmological examination and the remaining 20 completed the questionnaire only. Seven (14%) of the 49 recalled infants had strabismus on examination; 4 needed glasses or patching. A further seven (14%) had a history of intermittent strabismus but declined formal examination. Another child had significant hypermetropia without strabismus. The mean age at which strabismus was observed was 8.3 mo (range birth to 19 mo). The presence of strabismus was not significantly influenced by conditions at birth, maternal drug doses, family history or need for or duration of abstinence treatment. CONCLUSION The rate of strabismus in infants of opiate-dependent mothers was at least 10 times that in the general population. As attendance at follow-up is often poor, paediatricians should be aware of the association to encourage opportunistic assessment and ophthalmological surveillance of this population.
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Affiliation(s)
- A C Gill
- Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia
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Abstract
OBJECTIVE To explore the opinions of non-tertiary obstetricians towards the care and outcome of extremely premature infants. METHODS A structured questionnaire was mailed nationally to 232 obstetricians affiliated to maternity facilities with Level II nurseries. RESULTS The overall response rate was 75% (n = 174) after two mailings. This included 14 obstetricians who declined to participate. The median birthweight and gestation for active resuscitation was 500 g (350-800) and 24 weeks (22-26), respectively. Factors influencing decision to transfer were: better outcomes for infants born at perinatal centres (74%), paediatric advice (10%), personal beliefs (5%), parental wishes (4%), hospital policy (3%), legal repercussions (2.5%) and past history of infertility (2%). Obstetricians in Victoria and Western Australia (WA) would transfer at 22 weeks whilst the median gestation for transfer in other states was 24 weeks (P = 0.001). Most respondents underestimated intact and infant survival rates but WA and Victorian obstetricians were less pessimistic. CONCLUSIONS Most obstetricians in non-tertiary facilities who responded to our survey considered 500 g and 24 weeks to be the median birthweight and gestation for active resuscitation. This is similar to recent surveys of neonatologists and obstetricians in perinatal centres. There is significant underestimation of intact and infant survival at the extremes of prematurity when compared to available Australian data. Differences towards antenatal transfer between States may represent influences of local perinatal centres.
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Affiliation(s)
- A Gooi
- Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
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Kwong J, Lui K, Chan PSF, Ho SM, Wong YC, Xuan JW, Chan FL. Expression study of three secretory proteins (prostatic secretory protein of 94 amino acids, probasin, and seminal vesicle secretion II) in dysplastic and neoplastic rat prostates. Prostate 2003; 56:81-97. [PMID: 12746832 DOI: 10.1002/pros.10228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
BACKGROUND Prostatic secretory protein of 94 amino acids (PSP94), probasin, and seminal vesicle secretion II (SVSII) are the three major proteins secreted by the lateral lobe of the rat prostate gland. Among these proteins, rodent PSP94 but not probasin and SVSII has a human homologue and it is also a major secretory protein of the human prostate, in addition to prostatic acid phosphatase and prostate-specific antigen. METHODS In this study, we examined and compared the mRNA expression of these three secretory markers in three rat models of prostate cancer including the sex steroid-induced dysplasia (prostatic intraepithelial neoplasia or PIN) in Noble (Nb) rat model, an androgen-independent Nb rat prostatic tumor (AIT) and Dunning rat prostatic adenocarcinomas (both androgen-dependent and -independent) by in situ hybridization (ISH), reverse transcriptase-polymerase chain reaction (RT-PCR), and immunohistochemistry. RESULTS The transcripts for the three markers were highly expressed in the secretory epithelium of normal lateral prostate (LP). Their hybridization signals became reduced in the epithelial cells in the low-grade PINs and significantly weakened or lost in the high-grade PINs induced in the LP. Interestingly, we observed that some dysplastic cells located at the basal compartment of the PIN lesions, and nests of outpouching epithelial cells in the vicinity of PINs, expressed positive hybridization signals of three markers. In the adenocarcinoma, signals of probasin but not PSP94 and SVSII were detected. No hybridization signals were detected in both Dunning and AIT tumors. By RT-PCR, transcripts for these proteins were still detected but significantly reduced in the Dunning tumors, whereas in the AIT tumor, only SVSII transcripts were detected. Immunohistochemistry of PSP94 also showed a reduced staining in the PIN lesions, but no immunoreactivity was seen in the rat prostatic tumors. CONCLUSIONS The mRNA expression of the three prostatic secretory markers were decreased in the hormone-induced PINs and in two rat prostatic tumors, indicating that the androgen-regulated secretory differentiation was impaired during the development of the premalignant lesion and further reduced in advanced tumors. The abnormal expression pattern of these secretory markers and androgen receptor (AR) in the basal compartment of the PIN lesions suggests that there is a population of cell types with secretory phenotype appearing in the basal cell layer during the early malignant transformation of the prostatic epithelium.
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Affiliation(s)
- Joseph Kwong
- Department of Anatomy, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Abstract
OBJECTIVE To investigate the hypothesis that preterm infants who are more susceptible to lung damage have decreased neutrophil apoptosis, and to explore its relation to interleukin 10 (IL10) concentration. DESIGN Prospective cohort design. PATIENTS One hundred tracheal fluid specimens from 50 week-1 ventilated infants were examined for IL10 (by enzyme linked immunosorbent assay) and neutrophil apoptosis (by light microscopy). RESULTS Neutrophil apoptosis was absent or less than 0.22% (median 0%) in the 11 infants with chronic lung disease (CLD) (24-31 weeks gestation) during the first 4 days of life. This was significantly lower than that of the 20 preterm infants without CLD (27-31 weeks gestation; median 0.47%, range 0-1.25%) and 19 term infants (median 0.5%, range 0-2.25%). There was an increase in apoptosis in infants with CLD (median 0.44%, p = 0.046) during days 5-7. Few infants without CLD were intubated beyond 4 days. Median apoptosis on days 5-7 was 0.26% and 2.78% for non-CLD preterm and term infants, but differences were not significant. IL10 concentration in tracheal fluid of infants with CLD was less than 5 pg/ml. None of the infants with IL10 greater than 5 pg/ml developed CLD. The range of IL10 concentrations in tracheal fluid from infants without CLD was wide (0-938 pg/ml). There was no apparent correlation between IL10 levels and percentage neutrophil apoptosis in infants without CLD. CONCLUSION Preterm infants with low levels of IL10 and neutrophil apoptosis may be predisposed to disordered lung repair. Further studies into the method of disposal of senescent neutrophils within preterm lungs are required.
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Affiliation(s)
- J Oei
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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Abstract
UNLABELLED The inability to balance pulmonary injury with healing may predispose preterm infants to chronic lung disease (CLD). It is postulated that the production of interleukin (IL)-10, an anti-inflammatory cytokine, is gestationally influenced and that CLD-prone infants may have a reduced ability to produce IL-10. METHODS Tracheal fluid (TF) was collected at least twice weekly from 48 mechanically ventilated infants within the first 7 d of life while intubated. RESULTS A total of 87 TF specimens were obtained. None of the 11 CLD infants (24-31 wk of gestation) had TF IL-10 levels above 4 pg/ml (0/20 TF specimens), while 14 (70%) of the 20 non-CLD preterm infants (27-36 wk of gestation) had IL-10 levels above 5 pg/ml in one or more of their TF specimens (18/48 TF specimens, p < 0.001). Only the 5 term infants who were ventilated for severe lung disease had raised IL-10 levels (17 infants, 5/19 TF specimens). IL-10 levels, if detected, (range 6-938 pg/ml) tended to be higher with increasing gestation (Spearman's rho coefficient = 0.43; p = 0.003). TF IL-10 detection was not associated with hyaline membrane disease, antenatal steroids or influenced by TF sample volume. Overall IL-8 levels were wide ranging but towards the end of week 1 the levels were significantly higher in CLD infants (CLD: median 34 184 ng/ml, preterm non-CLD: median 699 ng/ml, p < 0.001, term: 2961 ng/ml, p = 0.028). CONCLUSION A gestationally influenced low IL-10 may predispose preterm infants to persistent pulmonary inflammation of CLD.
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Affiliation(s)
- J Oei
- School of Women's and Children's Health, The University of New South Wales, Randwick, Australia
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Lui K, Vest M, Berlowitz P, Akhter S, Kung HH. Desorption of zinc from zinc oxide single-crystal surfaces during temperature programmed decomposition of methanol, formic acid, and 2-propanol. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100405a027] [Citation(s) in RCA: 32] [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: 11/28/2022]
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Akhter S, Lui K, Kung HH. Comparison of the chemical properties of the zinc-polar, the oxygen-polar, and the nonpolar surfaces of zinc oxide. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100256a029] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES To determine if premedication reduces the time and number of attempts by junior medical staff to achieve nasotracheal intubation in neonates. The experimental design was a non-blinded randomized controlled pilot trial. The setting was a perinatal centre in a university teaching hospital. METHODS Twenty infants (within the ranges of 25-40 weeks gestation, 650-3660 g and 1 h to 81 days of age) requiring semi-urgent intubation were randomized to either premedication with morphine, atropine and suxamethonium, or to awake intubation. RESULTS There were no significant differences between the two groups in regard to prior intubation experience of the staff or infant weight or gestation. The intubation procedure, including intervening events, to completion was significantly faster in premedicated infants (median 60 s vs 595 s; P = 0.002) who were intubated at a younger postnatal age. It took twice as many attempts to intubate a conscious infant (median 2 vs 1; P = 0.010). There was a greater decrease in heart rate from the baseline in the unpremedicated group (mean 68 b.p.m. vs 29 b.p.m.; P = 0.017), but decreases in oxygen saturation were not different. Blood was observed in the oral and nasal passages after intubation in five of the awake infants and in one of the premedicated infants. CONCLUSIONS The use of premedication reduces the total time and number of attempts taken to achieve successful nasotracheal intubation of neonates by junior medical staff under supervision.
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Affiliation(s)
- J Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, Australia
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Abstract
UNLABELLED The aim of this study was to assess the efficacy of erythromycin, a motilin agonist, in promoting enteral feed tolerance in preterm infants of < or = 32 wk gestation. Eligible infants were randomized to receive either low-dose (2.5 mg kg(-1) per dose 6 hourly) oral erythromycin ethylsuccinate or placebo for 10 d from the time of the first oral feed. The data from 22 erythromycin and 21 placebo infants were analysed. Birthweights (erythromycin 1,216 +/- 380 g, placebo 1,355 +/- 228 g, p = 0.25), gestation (erythromycin 28.6 +/- 2.2 wk, placebo 29.3 +/- 1.7 wk, p = 0.24) and other clinical variables were not different between the groups. Almost all infants were fed expressed breast milk. Erythromycin infants had significantly fewer episodes of large residual gastric aspirates (>30% of the previous 6 h worth of feeds) over 10 d (erythromycin 1.1 +/- 1.9, placebo 3.6 +/- 2.2 episodes, p = 0.0007). Infants in the erythromycin group achieved full oral feeds more quickly (6.0 +/- 2.3 vs 7.9 +/- 3.5 d, p = 0.04). There were no significant differences between the groups with regard to the number of days on total parenteral nutrition or to the time needed to regain birthweight. One enrolled infant from each group died of necrotizing enterocolitis. CONCLUSION Low-dose erythromycin promoted gastric emptying and feed tolerance in premature infants at a lower gestational age than previously reported. Increased exposure to broad-spectrum antibiotics may not be free of risk. Further studies are recommended to assess its efficacy in premature infants with established feed intolerance.
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Affiliation(s)
- J Oei
- Department of Newborn Care, Royal Hospital for Women and the School of Paediatrics, University of New South Wales, Sydney, Australia
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Bolisetty S, Naidoo D, Lui K, Koh THHG, Watson D, Montgomery R, Whitehall J. Postnatal changes in maternal and neonatal plasma antioxidant vitamins and the influence of smoking. Arch Dis Child Fetal Neonatal Ed 2002; 86:F36-40. [PMID: 11815546 PMCID: PMC1721361 DOI: 10.1136/fn.86.1.f36] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the postnatal changes in the plasma concentrations of fat soluble antioxidant vitamins and malondialdehyde (MDA) in mothers and their newborns and their relation to smoking. DESIGN Prospective cohort study. SETTING Tertiary perinatal centre. SUBJECTS Eighteen non-smoking and 14 smoking mothers and 33 infants. MAIN OUTCOME MEASURES Plasma concentrations of vitamins E, A, and beta-carotene and MDA were measured in mothers and infants at delivery and on day 4 post partum. RESULTS Neonatal plasma levels of vitamins E, A, and beta-carotene were significantly lower than maternal levels both at delivery and on day 4 in both groups. There was a significant postnatal increase in plasma vitamin E levels in smoking mothers and neonates of both groups. A significant postnatal increase in maternal, but not neonatal, plasma vitamin A was noted in both groups. Cord plasma vitamin E levels were significantly lower in infants of smoking mothers (mean 4.7 v 6.5 micromol/l, p = 0.041). Plasma MDA was paradoxically lower in smoking mothers at delivery (3.19 v 4.01 micromol/l, p = 0.03) and on day 4 (1.37 v 3.29 micromol/l, p = 0.005) and in infants of the smoking group on day 4 (2.18 v 3.12 micromol/l, p = 0.014). Also, there was a significant postnatal fall in plasma MDA levels on day 4 in mothers and infants in the smoking group. CONCLUSIONS The postnatal changes in plasma vitamin E were more pronounced in the smoking group. The postnatal changes in plasma vitamins A and beta-carotene were similar in both groups. The rapid decline in plasma MDA in smoking mothers and their infants suggests withdrawal of oxidative stress from smoking around delivery. This coincided with the increase in plasma vitamin E.
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Affiliation(s)
- S Bolisetty
- Kirwan Hospital For Women, Townsville, Queensland, Australia. srinib75@hotmailcom
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Loh M, Osborn DA, Lui K. Outcome of very premature infants with necrotising enterocolitis cared for in centres with or without on site surgical facilities. Arch Dis Child Fetal Neonatal Ed 2001; 85:F114-8. [PMID: 11517205 PMCID: PMC1721305 DOI: 10.1136/fn.85.2.f114] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine if the presence of a neonatal surgical facility on site has any effect on mortality and morbidity of very premature infants with necrotising enterocolitis (NEC). DESIGN AND SETTING Retrospective review of infants of less than 29 weeks gestation cared for in the seven perinatal centres in New South Wales. PATIENTS Between 1992 and 1997, 605 infants were cared for in two centres with in house surgical facilities (group 1) and 1195 in five centres where transfers were required for surgical management (group 2). RESULTS Although use of antenatal steroids was significantly lower in group 1 centres than group 2 centres (74% v. 85% respectively), and the incidence of hyaline membrane disease, pneumothorax, and NEC was higher, mortality was identical (27%). Fifty two (9%) infants in group 1 and 72 (6%) in group 2 of comparable perinatal characteristics and CRIB (Clinical Risk Index for Babies) scores developed radiologically or pathologically proven NEC. The overall mortality of infants with NEC in group 1 was lower but this was not statistically significant (27% v. 35%). Significantly more infants with NEC in group 1 had surgery (69% v. 39%). There were fewer postoperative deaths in group 1 and more deaths without surgery in group 2. The duration of respiratory and nutritional support and hospital stay for the survivors were similar in the two groups. In a multivariate analysis, shorter gestation was the only factor associated with mortality in infants with NEC; the presence of in house surgical facilities was not. CONCLUSIONS There were no significant differences in outcome of premature infants with NEC managed in perinatal centres with or without on site surgical facilities. Early transfers should be encouraged. This finding may have implications for future planning of facilities for neonatal care.
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MESH Headings
- Enterocolitis, Necrotizing/mortality
- Enterocolitis, Necrotizing/surgery
- Female
- General Surgery/organization & administration
- Humans
- Infant Mortality
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/surgery
- Infant, Very Low Birth Weight
- Intensive Care, Neonatal/organization & administration
- Male
- Morbidity
- Multivariate Analysis
- New South Wales/epidemiology
- Patient Transfer
- Retrospective Studies
- Risk Factors
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- M Loh
- Royal Hospital for Women, Randwick, NSW, Australia
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Abstract
OBJECTIVE Concern regarding parental capacity to manage their infant's drug withdrawal traditionally leads to prolonged hospitalization for both mother and infant. This study examines the impact of a multidisciplinary follow-up clinic for infants discharged home on morphine. METHODOLOGY Records of full-term infants born to mothers with narcotic dependency were reviewed retrospectively. Two periods were compared: 1995-1997 (period A) and 1998 to September 1999 with clinic established (period B). RESULTS Twenty-five and 26 mothers were identified in periods A and B, respectively. Almost half had fewer than four antenatal clinic visits and most were on methadone with other substance usage. Despite higher maternal methadone doses (mean 48.5 vs 89.5 mg/day, P = 0.009) and withdrawal rates, the mean length of stay was significantly shorter for period B mothers (7.8 +/- 4.8 vs 5.4 +/- 3.3 days, P = 0.01) and babies (14.8 +/- 9.7 vs 8.7 +/- 7.2, P = 0.01). Median duration of morphine treatment was significantly shorter in period A (17 vs 60 days, P = 0.0001) when only four babies were discharged on morphine. In contrast, 18 treated period B babies were discharged on morphine. No families were lost to follow up. Compliance with clinic attendance was 92%. CONCLUSIONS Hospital stay was reduced with establishment of the clinic. The shorter treatment duration before establishment of the clinic could have been related to a lesser abstinence severity or a perceived need of a more rapid weaning prior to discharge. Further studies are needed to assess the impact of this model of care on the health outcome of the narcotic-dependent mother and infant unit.
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Affiliation(s)
- J Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia.
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Abstract
Despite the availability of surfactant treatment, extremely low birth weight (ELBW) infants continue to be at high risk of developing bronchopulmonray dysplasia (BPD). Evidence suggests that pathologic changes occur within the first few days of life. We hypothesized that the changes in early respiratory system compliance and resistance in ELBW infants with or without hyaline membrane disease (HMD) would correlate with BPD severity and aid in its prediction. Respiratory system compliance (Crs) and resistance (Rrs) were measured at the end of weeks 1, 2, 3, and 4 in 46 infants weighing 1,000 g or less at birth, using the single breath airway occlusion method. Twenty-four infants had HMD and 22 did not. Fifteen infants with and 10 infants without HMD developed BPD with radiological changes and oxygen needs at 28 days. Twelve BPD infants required supplemental oxygen beyond 36 weeks, defined as chronic lung disease (CLD). Irrespective of whether the infant initially had HMD, the week 1 results showed that infants who subsequently developed BPD had a significantly higher respiratory system resistance than those who did not (P = 0.0014). Though week 1 compliance was lower, it was not statistical significant. Multiple logistic models consisting of simple neonatal variables and week 1 respiratory mechanics showed that Rrs was independently associated with subsequent BPD (P = 0.026) and CLD (P = 0.016), while compliance was not. Prediction of CLD improved with the inclusion of Rrs results as compared to prediction using clinical variables alone. Throughout the 4-week study period, Rrs was significantly higher in BPD infants than in those without BPD, and resistance was particularly abnormal in those who had CLD or subsequently required corticosteroid treatment. These observations provide rationale for interventions to prevent BPD within the first week of life. Respiratory mechanics measurements could be useful in the assessment of therapeutics in the current surfactant era.
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Affiliation(s)
- K Lui
- School of Paediatrics, University of New South Wales, Sydney, Australia.
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40
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Abstract
AIM OF THE STUDY The aetiology of necrotizing enterocolitis (NEC) remains poorly understood in infants of all gestation, particularly when it occurs at term. We hypothesize that NEC in term infants is rare but often associated with underlying congenital illnesses. METHOD Records of all term infants hospitalized with radiologically or surgically proven NEC in the 10 tertiary centres of two geographical regions of Australia during a 6.5-y period were reviewed. Regional birth data were obtained and a special care nursery survey was conducted. RESULTS Twenty-nine infants had proven NEC giving a population incidence of 0.05 per 1000 live births. Nineteen (66%) of them had underlying congenital diseases. Five (17%) infants had endocrine disorders, which included panhypopituitarism, hypothyroidism, hypoparathyroidism and congenital adrenal hyperplasia. Ten infants had congenital heart disease, eight being cyanotic. Six of them developed NEC prior to any invasive cardiac procedures. Seven of the other nine infants without any congenital diseases had perinatal risk factors associated with NEC. The severity of illness was not different amongst the three groups. All infants, except two, survived. CONCLUSION NEC in term infants is commonly secondary to or preceded by underlying congenital diseases. A considerable proportion of NEC cases had co-existing endocrine illnesses.
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MESH Headings
- Birth Weight
- Endocrine System Diseases/complications
- Endocrine System Diseases/congenital
- Endocrine System Diseases/epidemiology
- Enterocolitis, Necrotizing/epidemiology
- Enterocolitis, Necrotizing/etiology
- Enterocolitis, Necrotizing/mortality
- Female
- Gestational Age
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/epidemiology
- Humans
- Incidence
- Infant, Newborn
- Infant, Newborn, Diseases/epidemiology
- Infant, Newborn, Diseases/mortality
- Male
- New South Wales/epidemiology
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Survival Rate
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Affiliation(s)
- S Bolisetty
- Royal Hospital for Women, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE To determine whether umbilical cord blood glucose correlates with subsequent hypoglycaemia after birth in infants of well-controlled diabetic mothers. METHODOLOGY Thirty-eight term infants of well-controlled diabetic mothers were enrolled. Five mothers had pre-existing diabetes. Of the 33 gestational diabetic mothers, 16 were managed on insulin and 17 on diet. Maternal blood glucose was maintained between 4 and 8 mmol/L during labour and delivery. Infants' plasma glucose levels were measured from venous cord blood and serially, at less than 30 min, 1 h and 2 h of life by glucose hexokinase method. Blood glucose levels were further monitored by bedside Dextrostix for 24 h. RESULTS Eighteen (47%) infants developed hypoglycaemia (blood glucose level less than 2 mmol/L) during the first 2 h of life. There was no difference in the cord blood glucose levels between infants with or without hypoglycaemia (3.7 +/- 1.1 vs 4.5 +/- 1.1 mmol/L, respectively). Infants of mothers with diabetes diagnosed prior to 28 weeks gestation were at a higher risk of developing hypoglycaemia (8 of 10 vs 10 of 28, OR 7.2, 95%CI 1.3-40.7). Hypoglycaemic infants were of significantly higher birthweight, and were more likely to be born to Caucasian mothers and by Caesarean section. Raised maternal fructosamine blood level, the need for insulin treatment or the infant's haematocrit were not different between infants with or without hypoglycaemia. CONCLUSIONS In well-controlled diabetic mothers, the incidence of early hypoglycaemia in infants is still high, particularly in those mothers who had a longer duration of diabetes. Cord blood glucose level did not identify the infants with hypoglycaemia.
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Affiliation(s)
- R K Agrawal
- Department of Newborn Care, Royal Hospital for Women, Randwick and School of Paediatrics, University of New South Wales, Sydney, Australia
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Abstract
OBJECTIVE This study aims to explore the current attitudes of Australian neonatologists and nurses towards the resuscitation of extremely preterm infants. METHODOLOGY An anonymous questionnaire regarding resuscitation of infants of less than 28 weeks gestation was sent to all neonatologists and three registered nurses in each perinatal centre in Australia. RESULTS One hundred and thirty-three questionnaires were sent. A return rate of 93% and 73% was obtained from neonatologists and nurses, respectively. Twenty-two per cent of neonatologists would 'occasionally' resuscitate at 22 weeks while none of the nurses would. A considerable proportion of neonatologists (23%) but only a few nurses (6%) would 'quite often' resuscitate 23-week infants. The majority of neonatologists (85%) and nurses (88%) would 'almost always' resuscitate 24 week infants. More than half of the respondents would 'occasionally' resuscitate a 400-499 g infant and most would resuscitate infants weighing more than 500 g. Clinicians were not as optimistic of long-term outcome as they were for survival. Typically, only 52% of neonatologists and 38% of nurses thought babies of 25 weeks gestation had a greater than 50% chance of survival without major handicap. Parental wishes and the presence of congenital abnormalities were major influences on decision to resuscitate. Hypothetically, most respondents, more doctors than nurses, would consider initiating resuscitation without parental consent at a median gestation of 25 weeks. CONCLUSIONS The majority of Australian clinicians would resuscitate at a gestation of 24 weeks or greater or at a birth weight of over 500 g despite conservative estimates of intact survival. This survey has brought to light the importance of communication with parents prior to extreme premature birth.
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Affiliation(s)
- J Oei
- Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales Centre for Perinatal Health Services Research, University of Sydney, Australia
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Osborn DA, Lui K, Pussell P, Jana AK, Desai AS, Cole M. T and Tk antigen activation in necrotising enterocolitis: manifestations, severity of illness, and effectiveness of testing. Arch Dis Child Fetal Neonatal Ed 1999; 80:F192-7. [PMID: 10212080 PMCID: PMC1720919 DOI: 10.1136/fn.80.3.f192] [Citation(s) in RCA: 26] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To determine if T or Tk antigen activation is associated with different and more severe manifestations of illness in infants with necrotising enterocolitis (NEC); and if a policy of testing infants with suspected sepsis or NEC for T and Tk antigen activation is effective. METHODS A case-control study of infants with confirmed NEC, born after the introduction of screening, was undertaken:17 activated infants were compared with 28 non-activated controls, matched for gestation and weight. A historical control study compared the outcome of infants before and after the introduction of testing. RESULTS Of 201 infants with confirmed NEC, 27 were T or Tk antigen activated-10 (9%) before and 17 (19%) after the introduction of testing. T or Tk antigen activated infants had a significantly higher mortality (35% vs 7%); more frequent (71% vs 21%) and severe haemolysis, hyperkalaemia, renal impairment, acidosis; and they received more colloid for resuscitation. While only known activated infants in both time periods were managed with the use of low titre T antibody blood products, there was a significant increase in mortality (odds ratios 2.6; 95% CI 1.2, 5.6) and incidence of surgery (OR 2.7; 1.5, 4.9) after the introduction of testing. The increased mortality (OR 2.6; 0.8, 5.2) and incidence of surgery (OR 1.8; 0.9, 3.7) were no longer significant after adjustment for several perinatal risk factors. CONCLUSIONS In a retrospective case-control study, routine testing of at risk infants increased the detection rate of T and Tk antigen activation. The use of low titre T plasma products in these patients did not reduce mortality compared with historical controls. A randomised controlled trial of testing in at risk infants, or of the use of low titre T plasma products in babies with NEC and T activation, is warranted.
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MESH Headings
- Antigens, Tumor-Associated, Carbohydrate/immunology
- Case-Control Studies
- Enterocolitis, Necrotizing/immunology
- Enterocolitis, Necrotizing/mortality
- Female
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/immunology
- Infant, Premature, Diseases/mortality
- Isoantigens
- Male
- Retrospective Studies
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Affiliation(s)
- D A Osborn
- Department of Neonatology, Westmead Hospital, Westmead, Australia
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Abstract
Recent data indicate that the cell surface glycoprotein CD5 functions as a negative regulator of T cell receptor (TCR)-mediated signaling. In this study, we examined the regulation of CD5 surface expression during normal thymocyte ontogeny and in mice with developmental and/or signal transduction defects. The results demonstrate that low level expression of CD5 on CD4(-)CD8(-) (double negative, DN) thymocytes is independent of TCR gene rearrangement; however, induction of CD5 surface expression on DN thymocytes requires engagement of the pre-TCR and is dependent upon the activity of p56(lck). At the CD4(+)CD8(+) (double positive, DP) stage, intermediate CD5 levels are maintained by low affinity TCR-major histocompatibility complex (MHC) interactions, and CD5 surface expression is proportional to both the surface level and signaling capacity of the TCR. High-level expression of CD5 on DP and CD4(+) or CD8(+) (single positive, SP) thymocytes is induced by engagement of the alpha/beta-TCR by (positively or negatively) selecting ligands. Significantly, CD5 surface expression on mature SP thymocytes and T cells was found to directly parallel the avidity or signaling intensity of the positively selecting TCR-MHC-ligand interaction. Taken together, these observations suggest that the developmental regulation of CD5 in response to TCR signaling and TCR avidity represents a mechanism for fine tuning of the TCR signaling response.
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MESH Headings
- Animals
- Antibodies
- Antigens, CD/analysis
- Antigens, CD/immunology
- CD5 Antigens/immunology
- CD5 Antigens/metabolism
- Cell Differentiation
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/physiology
- Female
- Flow Cytometry
- Gene Rearrangement, T-Lymphocyte/immunology
- Histocompatibility Antigens Class I/genetics
- Histocompatibility Antigens Class I/immunology
- Histocompatibility Antigens Class II/genetics
- Histocompatibility Antigens Class II/immunology
- Lymphocyte Specific Protein Tyrosine Kinase p56(lck)/genetics
- Lymphocyte Specific Protein Tyrosine Kinase p56(lck)/metabolism
- Lymphocyte Subsets/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Transgenic
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
- Receptors, Antigen, T-Cell, alpha-beta/genetics
- Receptors, Antigen, T-Cell, alpha-beta/metabolism
- Signal Transduction
- T-Lymphocytes/cytology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Up-Regulation
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Affiliation(s)
- H S Azzam
- Laboratory of Mammalian Genes and Development, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
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Shores EW, Ono M, Kawabe T, Sommers CL, Tran T, Lui K, Udey MC, Ravetch J, Love PE. T cell development in mice lacking all T cell receptor zeta family members (Zeta, eta, and FcepsilonRIgamma). J Exp Med 1998; 187:1093-101. [PMID: 9529325 PMCID: PMC2212212 DOI: 10.1084/jem.187.7.1093] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The zeta family includes zeta, eta, and FcepsilonRIgamma (Fcgamma). Dimers of the zeta family proteins function as signal transducing subunits of the T cell antigen receptor (TCR), the pre-TCR, and a subset of Fc receptors. In mice lacking zeta/eta chains, T cell development is impaired, yet low numbers of CD4+ and CD8+ T cells develop. This finding suggests either that pre-TCR and TCR complexes lacking a zeta family dimer can promote T cell maturation, or that in the absence of zeta/eta, Fcgamma serves as a subunit in TCR complexes. To elucidate the role of zeta family dimers in T cell development, we generated mice lacking expression of all of these proteins and compared their phenotype to mice lacking only zeta/eta or Fcgamma. The data reveal that surface complexes that are expressed in the absence of zeta family dimers are capable of transducing signals required for alpha/beta-T cell development. Strikingly, T cells generated in both zeta/eta-/- and zeta/eta-/--Fcgamma-/- mice exhibit a memory phenotype and elaborate interferon gamma. Finally, examination of different T cell populations reveals that zeta/eta and Fcgamma have distinct expression patterns that correlate with their thymus dependency. A possible function for the differential expression of zeta family proteins may be to impart distinctive signaling properties to TCR complexes expressed on specific T cell populations.
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MESH Headings
- Animals
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Cells, Cultured
- Cytokines/metabolism
- Dimerization
- Flow Cytometry
- Gene Expression Regulation, Developmental/genetics
- Interferon-gamma/metabolism
- Lymph Nodes/immunology
- Mice
- Mice, Knockout
- Phenotype
- RNA, Messenger/metabolism
- Receptors, Antigen, T-Cell/chemistry
- Receptors, Antigen, T-Cell/deficiency
- Signal Transduction/physiology
- Spleen/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Thymus Gland/immunology
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Affiliation(s)
- E W Shores
- Division of Hematologic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland 20892.
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Abstract
The prevalence and severity of visual-motor deficits and the relation of visual-motor function to visual perception and fine motor skills was examined in a group of 83 neurologically and intellectually normal (IQ >84) very-low-birthweight (VLBW) children at age 5. Fifteen children (17%) had below average visual motor scores (<1SD below mean). While relatively few children (N=9) had below average scores in visual perception (11%), 58 (71%) had below average scores for fine motor skills. Nineteen (23%) were considered impaired (<1.5SD); of these, eight were severely impaired (<2SD). Fine motor scores were significantly lower in children who had been born <28 weeks' gestation, with hyaline membrane disease, or had required a longer period of ventilation. There was significant correlation between visual-motor and fine motor scores (r = 0.50, P < 0.001) and between visual-motor and visual perception scores (r = 0.42, P < 0.001). The implications of these findings and management of these 'normal' children need further research. Previous reports of visual-motor dysfunction in school-age VLBW children could be related to fine motor difficulties.
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Affiliation(s)
- T A Goyen
- Growth and Development Clinic, Perinatal Services, Westmead Hospital, NSW, Australia
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Morgan ME, Lui K, Anderson BD. Microscale titrimetric and spectrophotometric methods for determination of ionization constants and partition coefficients of new drug candidates. J Pharm Sci 1998; 87:238-45. [PMID: 9519160 DOI: 10.1021/js970057s] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study describes the adaptation of conventional titrimetric and spectrophotometric techniques to a microscale for the determination of drug ionization constants (pKa) and partition coefficients (log P). The apparatus for determining pKa and compound purity (or equivalent weight) consists of a three-port conical glass microvial maintained at 25 degrees C, a pH microelectrode, and a microinjection pump equipped with a 10 microL gastight syringe for titrant delivery. Sample mixing and protection from atmospheric CO2, which is particularly important at the microscale, is accomplished using a fine stream of water-saturated N2 bubbles. Simple titrimetric procedures combined with ionic equilibria models which allow the accurate determination of pKa and purity (or equivalent weight) using sample sizes in the microgram range and solution volumes of 10-100 microL were developed and validated using acetic acid and tromethamine. Simultaneous determinations of pKa, purity or equivalent weight, and octanol/water partition coefficient were shown to be possible from a single sample of a test solute by adapting the pH-metric technique to a microscale. Using benzoic acid as a model compound, a pKa of 4.24 and octanol/water partition coefficient of 64 were obtained, in close agreement with the literature values. The principles employed in titrimetric analysis were also applied to demonstrate the spectrophotometric determination of benzoic acid's pKa and partition coefficient using only 6 micrograms of compound. The microscale titration method was then used to determine the two pKa values of an "unknown" diprotic acid containing a carboxyl and an aromatic SH group. The phenyl thiol pKa was confirmed using the microscale spectrophotometric procedure.
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Affiliation(s)
- M E Morgan
- Department of Pharmaceutics and Pharmaceutical Chemistry, College of Pharmacy, University of Utah, Salt Lake City 84124, USA
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Abstract
OBJECTIVE Complications of indwelling central venous access devices (CVAD) were assessed in 63 children with cancer and 35 without cancer. METHODOLOGY Central venous access devices placed surgically in 1991 were reviewed for complications. RESULTS In cancer patients, the median CVAD duration was 211 days (range 9-924), compared to 37 days (range 3-339) in the non-cancer patients. Although significantly more CVAD, 41 of 72 (57%), were infected in the cancer patients compared to 14 of 40 (35%) CVAD in the non-cancer patients (OR = 2.46, 95% CI 1.03-5.93), the rate of line infection in cancer patients was lower: 2.8 per 1000 catheter days compared with 7.6 per 1000 in non-cancer patients (P = 0.0014). Infection was significantly more common in intensive chemotherapy cancer patients (P = 0.0002). CONCLUSIONS Treating infected CVAD with antibiotics or hydrochloric acid (HCl), clearing occluded lines with streptokinase/HCl and repairing fractured lines, when successful, resulted in a considerable gain in the number of days of use for the CVAD.
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Affiliation(s)
- R Tobiansky
- Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia
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Lui K, Jackson M, Sowa MG, Ju H, Dixon IM, Mantsch HH. Modification of the extracellular matrix following myocardial infarction monitored by FTIR spectroscopy. Biochim Biophys Acta 1996; 1315:73-7. [PMID: 8608173 DOI: 10.1016/0925-4439(95)00118-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Comparison of mid- and near-infrared spectra of control and infarcted rat ventricular tissue reveals the presence of absorptions in infarcted tissue which are highly characteristics of collagen, indicating large scale deposition of type I collagen in the myocardium following infarction. These results demonstrate that IR spectroscopy may be used to rapidly monitor the modifications of the extracellular matrix associated with myocardial infarction.
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Affiliation(s)
- K Lui
- Institute for Biodiagnostics, National Research Council Canada, Winnipeg, Manitoba
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50
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Abstract
OBJECTIVE To assess the effect of necrotizing enterocolitis (NEC) on neurodevelopmental outcome. METHODOLOGY Neurodevelopmental outcome of 20 very low birthweight (VLBW) infants who developed NEC requiring surgery was compared with 40 matched infants controlled for gestation, birthweight, and year of admission. Twenty-nine VLBW infants who developed NEC and did not require surgery were also compared. RESULTS Infants with NEC needing surgery were of 26 +/- 2 weeks gestation and weighted 892 +/- 192 g at birth. Infants with NEC managed medically were of higher gestation (27 +/- 2 weeks) but similar birthweights. More infants with NEC requiring surgery required inotropic support. At follow up, NEC surgery infants had a significantly higher incidence of developmental morbidity. 11 of 20 compared with 11 of 40 matched controls (Fisher's exact test P = 0.0493), and six of 29 infants with NEC managed medically (Fisher's exact test P = 0.0174). CONCLUSIONS These findings stress the importance for close follow up for neurodevelopmental sequelae in VLBW infants who have had NEC requiring surgery.
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Affiliation(s)
- R Tobiansky
- Department of Neonatology, Westmead Hospital, New South Wales, Australia
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