1
|
Pugh CP, Zaniletti I, Miquel-Verges F, Nghiem-Rao TH, Downey LC, Hightower H, Grover T, Murthy K, Riddle S, Acharya K. A multicenter matched-cohort analysis of gastroschisis outcomes in infants born before 32 weeks gestation. J Perinatol 2024:10.1038/s41372-024-01974-8. [PMID: 38744936 DOI: 10.1038/s41372-024-01974-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To examine neonatal outcomes of infants with gastroschisis born <32 weeks' gestation compared to matched infants without gastroschisis. STUDY DESIGN Retrospective matched-cohort analysis of infants with gastroschisis born <32 weeks' gestation at Children's Hospitals Neonatal Consortium (CHNC) NICUs from 2010 to 2022 compared to gestational age-matched controls. RESULTS The study included 119 infants with gastroschisis and 357 matched infants; 60% of infants born 29-32 weeks, 23% born 26-28 weeks, and 16% born < 25 weeks. Mortality was not significantly different between groups (11% vs. 9%, p = 0.59). Preterm co-morbidities such as IVH, BPD, ROP, and PVL were similar, as were rates of surgical NEC. Infants with gastroschisis had longer hospital stays (92 vs. 67 days), higher CLABSI and UTIs, and were more likely to need feeding support at discharge. CONCLUSION Compared to infants without gastroschisis, infants <32 weeks' gestation with gastroschisis had similar risks for inpatient mortality, NEC, and other preterm co-morbidities.
Collapse
Affiliation(s)
- C Preston Pugh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | - L Corbin Downey
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hannah Hightower
- UAB Heersink School of Medicine and Children's of Alabama, Birmingham, AL, USA
| | - Theresa Grover
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Karna Murthy
- Feinberg School of Medicine, Northwestern University; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Stefanie Riddle
- Cincinnati Children's Hospital and University of Cincinnati Department of Pediatrics, Cincinnati, OH, USA
| | | |
Collapse
|
2
|
Wojcik MH, Callahan KP, Antoniou A, Del Rosario MC, Brunelli L, ElHassan NO, Gogcu S, Murthy K, Rumpel JA, Wambach JA, Suhrie K, Fishler K, Chaudhari BP. Provision and availability of genomic medicine services in Level IV neonatal intensive care units. Genet Med 2023; 25:100926. [PMID: 37422715 PMCID: PMC10592224 DOI: 10.1016/j.gim.2023.100926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE To describe variation in genomic medicine services across level IV neonatal intensive care units (NICUs) in the United States and Canada. METHODS We developed and distributed a novel survey to the 43 level IV NICUs belonging to the Children's Hospitals Neonatal Consortium, requesting a single response per site from a clinician with knowledge of the provision of genomic medicine services. RESULTS Overall response rate was 74% (32/43). Although chromosomal microarray and exome or genome sequencing (ES or GS) were universally available, access was restricted for 22% (7/32) and 81% (26/32) of centers, respectively. The most common restriction on ES or GS was requiring approval by a specialist (41%, 13/32). Rapid ES/GS was available in 69% of NICUs (22/32). Availability of same-day genetics consultative services was limited (41%, 13/32 sites), and pre- and post-test counseling practices varied widely. CONCLUSION We observed large inter-center variation in genomic medicine services across level IV NICUs: most notably, access to rapid, comprehensive genetic testing in time frames relevant to critical care decision making was limited at many level IV Children's Hospitals Neonatal Consortium NICUs despite a significant burden of genetic disease. Further efforts are needed to improve access to neonatal genomic medicine services.
Collapse
Affiliation(s)
- Monica H Wojcik
- Divisions of Newborn Medicine and Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA; Neonatal Genomics Program, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA.
| | - Katharine P Callahan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Division of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Austin Antoniou
- Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH
| | - Maya C Del Rosario
- Neonatal Genomics Program, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Luca Brunelli
- Division of Neonatology, University of Utah Health and Primary Children's Hospital, Salt Lake City, UT
| | - Nahed O ElHassan
- Division of Neonatology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Semsa Gogcu
- Wake Forest School of Medicine, Department of Pediatrics, Winston-Salem, NC
| | - Karna Murthy
- Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University, Chicago, IL; Children's Hospitals Neonatal Consortium, Dover, DE
| | - Jennifer A Rumpel
- Division of Neonatology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Jennifer A Wambach
- Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO
| | - Kristen Suhrie
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, and Department of Medical and Molecular Genetics, Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, IN
| | - Kristen Fishler
- Munroe-Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE
| | - Bimal P Chaudhari
- Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH; Divisions of Neonatology and Genetics and Genomic Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| |
Collapse
|
3
|
Machut KZ, Gilbart C, Murthy K, Michelson KN. A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care. Adv Neonatal Care 2023; 23:467-477. [PMID: 37499687 PMCID: PMC10544817 DOI: 10.1097/anc.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Families and staff in neonatal intensive care units (NICUs) value continuity of care (COC), though definitions, delivery, and impacts of COC are incompletely described. Previously, we used parental perspectives to define and build a conceptual model of COC provided by neonatologists. Nursing perspectives about COC remain unclear. PURPOSE To describe nursing perspectives on neonatologist COC and revise our conceptual model with neonatal nurse input. METHODS This was a qualitative study interviewing NICU nurses. The investigators analyzed transcripts with directed content analysis guided by an existing framework of neonatologist COC. Codes were categorized according to previously described COC components, impact on infants and families, and improvements for neonatologist COC. New codes were identified, including impact on nurses, and codes were classified into themes. RESULTS From 15 nurses, 5 themes emerged: (1) nurses validated parental definitions and benefits of COC; (2) communication is nurses' most valued component of COC; (3) neonatologist COC impact on nurses; (4) factors that modulate the delivery of and need for COC; (5) conflict between the need for COC and the need for change. Suggested improvement strategies included optimizing staffing and transition processes, utilizing clinical guidelines, and enhancing communication at all levels. Our adapted conceptual model describes variables associated with COC. IMPLICATIONS FOR PRACTICE AND RESEARCH Interdisciplinary NICU teams need to develop systematic strategies tailored to their unit's and patients' needs that promote COC, focused to improve parent-clinician communication and among clinicians. Our conceptual model can help future investigators develop targeted interventions to improve COC.
Collapse
Affiliation(s)
- Kerri Z. Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
| | | | - Karna Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
| | - Kelly N. Michelson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University (Chicago, IL)
- Ann & Robert H. Lurie Children’s Hospital of Chicago (Chicago, IL)
| |
Collapse
|
4
|
Weems MF, Grover TR, Seabrook R, DiGeronimo R, Gien J, Keene S, Rintoul N, Daniel JM, Johnson Y, Guner Y, Zaniletti I, Murthy K. Analgesia, Sedation, and Neuromuscular Blockade in Infants with Congenital Diaphragmatic Hernia. Am J Perinatol 2023; 40:415-423. [PMID: 34044457 DOI: 10.1055/s-0041-1729877] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to describe the use, duration, and intercenter variation of analgesia and sedation in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN This is a retrospective analysis of analgesia, sedation, and neuromuscular blockade use in neonates with CDH. Patient data from 2010 to 2016 were abstracted from the Children's Hospitals Neonatal Database and linked to the Pediatric Health Information System. Patients were excluded if they also had non-CDH conditions likely to affect the use of the study medications. RESULTS A total of 1,063 patients were identified, 81% survived, and 30% were treated with extracorporeal membrane oxygenation (ECMO). Opioid (99.8%), sedative (93.4%), and neuromuscular blockade (87.9%) use was common. Frequency of use was higher and duration was longer among CDH patients treated with ECMO. Unadjusted duration of use varied 5.6-fold for benzodiazepines (median: 14 days) and 7.4-fold for opioids (median: 16 days). Risk-adjusted duration of use varied among centers, and prolonged use of both opioids and benzodiazepines ≥5 days was associated with increased mortality (p < 0.001) and longer length of stay (p < 0.001). Use of sedation or neuromuscular blockade prior to or after surgery was each associated with increased mortality (p ≤ 0.01). CONCLUSION Opioids, sedatives, and neuromuscular blockade were used commonly in infants with CDH with variable duration across centers. Prolonged combined use ≥5 days is associated with mortality. KEY POINTS · Use of analgesia and sedation varies across children's hospital NICUs.. · Prolonged opioid and benzodiazepine use is associated with increased mortality.. · Postsurgery sedation and neuromuscular blockade are associated with mortality..
Collapse
Affiliation(s)
- Mark F Weems
- Division of Neonatology, Department of Pediatrics, Le Bonheur Children's Hospital and the University of Tennessee Health Science Center, Memphis, Tennessee
| | - Theresa R Grover
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | | | - Robert DiGeronimo
- Seattle Children's Hospital and University of Washington, Seattle, Washington
| | - Jason Gien
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah Keene
- Department of Pediatrics, Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia
| | - Natalie Rintoul
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - John M Daniel
- Department of Pediatrics, Children's Mercy Hospitals & Clinics, University of Missouri Kansas, Kansas City, Missouri
| | - Yvette Johnson
- Department of Neonatology, Cook Children's Hospital, Fort Worth, Texas
| | - Yigit Guner
- Children's Hospital of Orange County and University of California Irvine, Orange, California
| | | | - Karna Murthy
- Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | |
Collapse
|
5
|
Porta NFM, Naing K, Keene S, Grover TR, Hedrick H, Mahmood B, Seabrook R, Daniel Iv J, Harrison A, Weems MF, Yoder BA, DiGeronimo R, Haberman B, Dariya V, Guner Y, Rintoul NE, Murthy K. Variability for Age at Successful Extubation in Infants with Congenital Diaphragmatic Hernia. J Pediatr 2023; 253:129-134.e1. [PMID: 36202240 DOI: 10.1016/j.jpeds.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/30/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to characterize clinical factors associated with successful extubation in infants with congenital diaphragmatic hernia. STUDY DESIGN Using the Children's Hospitals Neonatal Database, we identified infants with congenital diaphragmatic hernia from 2017 to 2020 at 32 centers. The main outcome was age in days at the time of successful extubation, defined as the patient remaining extubated for 7 consecutive days. Unadjusted Kaplan-Meier and multivariable Cox proportional hazards ratio equations were used to estimate associations between clinical factors and the main outcome. Observations occurred through 180 days after birth. RESULTS There were 840 eligible neonates with a median gestational age of 38 weeks and birth weight of 3.0 kg. Among survivors (n = 693), the median age at successful extubation was 15 days (interquartile range [IQR]: 8-29 days, 95th percentile: 71 days). For nonsurvivors (n = 147), the median age at death was 21 days (IQR: 11-39 days, 95th percentile: 110 days). Center (adjusted hazards ratio: 0.22-15, P < .01), low birth weight, intrathoracic liver position, congenital heart disease, lower 5-minute Apgar score, lower pH upon admission to Children's Hospitals Neonatal Database center, and use of extracorporeal support were independently associated with older age at successful extubation. Tracheostomy was associated with multiple failed extubations. CONCLUSION Our findings suggest that infants who have not successfully extubated by about 3 months of age may be candidates for tracheostomy with chronic mechanical ventilation or palliation. The variability of timing of successful extubation among our centers supports the development of practice guidelines after validating clinical criteria.
Collapse
Affiliation(s)
- Nicolas F M Porta
- Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospitals of Chicago, Chicago, IL.
| | - Khatija Naing
- School of Public Health, University of Illinois at Chicago, Chicago, IL; Children's Hospitals Neonatal Consortium, Dover, DE
| | - Sarah Keene
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Theresa R Grover
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Holly Hedrick
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Burhan Mahmood
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ruth Seabrook
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | - John Daniel Iv
- Children's Mercy Hospitals and Clinics and University of Missouri -Kansas City, Kansas City, MO
| | - Allen Harrison
- Neonatal Intensive Care Unit, Arkansas Children's Hospital, Little Rock, AR
| | - Mark F Weems
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Bradley A Yoder
- University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, UT
| | - Robert DiGeronimo
- University of Washington and Seattle Children's Hospital, Seattle, WA
| | - Beth Haberman
- Cincinnati Children's Hospital Medical Center and the University of Cincinnati School of Medicine
| | - Vedanta Dariya
- University of Texas Southwestern Medical Center, Children's Medical Center, Dallas, TX
| | - Yigit Guner
- Division of Pediatric Surgery Children's Hospital of Orange County and Department of Surgery University of California Irvine, Orange, CA
| | - Natalie E Rintoul
- Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Karna Murthy
- Children's Hospitals Neonatal Consortium, Dover, DE; Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospitals of Chicago, Chicago, IL
| | | |
Collapse
|
6
|
Vyas-Read S, Jensen EA, Bamat N, Lagatta JM, Murthy K, Patel RM. Correction to: Chronic lung disease-related mortality in the US from 1999-2017: trends and racial disparities. J Perinatol 2022; 42:1558. [PMID: 36127396 DOI: 10.1038/s41372-022-01508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shilpa Vyas-Read
- Emory University/Children's Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.
| | - Erik A Jensen
- University of Pennsylvania/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicolas Bamat
- University of Pennsylvania/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanne M Lagatta
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Karna Murthy
- Northwestern University/Ann & Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Ravi M Patel
- Emory University/Children's Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA
| |
Collapse
|
7
|
Grover TR, Weems MF, Brozanski B, Daniel J, Haberman B, Rintoul N, Walden A, Hedrick H, Mahmood B, Seabrook R, Murthy K, Zaniletti I, Keene S. Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia. Am J Perinatol 2022; 29:1524-1532. [PMID: 33535242 DOI: 10.1055/s-0041-1722941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm. STUDY DESIGN Infants with CDH were identified in the Children's Hospital's Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use. RESULTS A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14-39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy. CONCLUSION Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients. KEY POINTS · Central line placement near universal in congenital diaphragmatic hernia infants.. · Mean of three lines placed per patient; total duration 22 days.. · Clinical patient characteristics affect risk..
Collapse
Affiliation(s)
- Theresa R Grover
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark F Weems
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Beverly Brozanski
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - John Daniel
- Children's Mercy Hospitals & Clinics, University of Missouri, Kansas City, Missouri
| | - Beth Haberman
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Natalie Rintoul
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
| | - Alyssa Walden
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Holly Hedrick
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
| | - Burhan Mahmood
- Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ruth Seabrook
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Sarah Keene
- Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia
| | | |
Collapse
|
8
|
Vyas-Read S, Jensen EA, Bamat N, Lagatta JM, Murthy K, Patel RM. Chronic lung disease-related mortality in the US from 1999-2017: trends and racial disparities. J Perinatol 2022; 42:1244-1245. [PMID: 35906284 DOI: 10.1038/s41372-022-01468-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/19/2022] [Accepted: 07/14/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Shilpa Vyas-Read
- Emory University/Children's Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.
| | - Erik A Jensen
- University of Pennsylvania/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicolas Bamat
- University of Pennsylvania/The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joanne M Lagatta
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Karna Murthy
- Northwestern University/Ann & Robert H Lurie Children's Hospital, Chicago, IL, USA
| | - Ravi M Patel
- Emory University/Children's Healthcare of Atlanta, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA
| |
Collapse
|
9
|
Mikhael M, Cleary JP, Zaniletti I, Truog WE, Ibrahim J, DiGeronimo R, Cuna A, Kielt MJ, Coghill CH, Vyas-Read S, Yallapragada S, Engle WA, Savani RC, Murthy K, Lagatta JM. Chronic lung disease in full-term infants: Characteristics and neonatal intensive care outcomes in infants referred to children's hospitals. Pediatr Pulmonol 2022; 57:2082-2091. [PMID: 35578392 DOI: 10.1002/ppul.25983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/03/2022] [Accepted: 05/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe characteristics, outcomes, and risk factors for death or tracheostomy with home mechanical ventilation in full-term infants with chronic lung disease (CLD) admitted to regional neonatal intensive care units. STUDY DESIGN This was a multicenter, retrospective cohort study of infants born ≥37 weeks of gestation in the Children's Hospitals Neonatal Consortium. RESULTS Out of 67,367 full-term infants admitted in 2010-2016, 4886 (7%) had CLD based on receiving respiratory support at either 28 days of life or discharge. 3286 (67%) were still hospitalized at 28 days receiving respiratory support, with higher mortality risk than those without CLD (10% vs. 2%, p < 0.001). A higher proportion received tracheostomy (13% vs. 0.3% vs. 0.4%, p < 0.001) and gastrostomy (30% vs. 1.7% vs. 3.7%, p < 0.001) compared to infants with CLD discharged home before 28 days and infants without CLD, respectively. The diagnoses and surgical procedures differed significantly between the two CLD subgroups. Small for gestational age, congenital pulmonary, airway, and cardiac anomalies and bloodstream infections were more common among infants with CLD who died or required tracheostomy with home ventilation (p < 0.001). Invasive ventilation at 28 days was independently associated with death or tracheostomy and home mechanical ventilation (odds ratio 7.6, 95% confidence interval 5.9-9.6, p < 0.0001). CONCLUSION Full-term infants with CLD are at increased risk for morbidity and mortality. We propose a severity-based classification for CLD in full-term infants. Future work to validate this classification and its association with early childhood outcomes is necessary.
Collapse
Affiliation(s)
- Michel Mikhael
- Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California, USA
| | - John P Cleary
- Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California, USA
| | | | - William E Truog
- Children's Mercy Kansas City, University of Missouri, Kansas City, Missouri, USA
| | - John Ibrahim
- Division of Newborn Medicine, Magee-Women's Hospital of UPMC/Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert DiGeronimo
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Alain Cuna
- Children's Mercy Kansas City, University of Missouri, Kansas City, Missouri, USA
| | - Matthew J Kielt
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Carl H Coghill
- Division of Neonatology, Department of Pediatrics, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shilpa Vyas-Read
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - William A Engle
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rashmin C Savani
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karna Murthy
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joanne M Lagatta
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | |
Collapse
|
10
|
Carpenter RJ, Srdanovic N, Rychlik K, Sen SK, Porta NFM, Hamvas AE, Murthy K, Hauck AL. The association between pulmonary vascular disease and respiratory improvement in infants with type I severe bronchopulmonary dysplasia. J Perinatol 2022; 42:788-795. [PMID: 35397644 DOI: 10.1038/s41372-022-01386-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe the association between echocardiographic measures of pulmonary vascular disease and time to respiratory improvement among infants with Type I severe bronchopulmonary dysplasia (sBPD). STUDY DESIGN We measured the pulmonary artery acceleration time indexed to the right ventricular ejection time (PAAT/RVET) and right ventricular free wall longitudinal strain (RVFWLS) at 34-41 weeks' postmenstrual age. Cox-proportional hazards models were used to estimate the relationship between the PAAT/RVET, RVFWLS, and the outcome: days from 36 weeks' postmenstrual age to room-air or discharge with oxygen (≤0.5 L/min). RESULT For 102 infants, the mean PAAT/RVET and RVFWLS were 0.27 ± 0.06 and -22.63 ± 4.23%. An abnormal measurement was associated with an increased time to achieve the outcome (PAAT/RVET: 51v24, p < 0.0001; RVFWLS; 62v38, p = 0.0006). A normal PAAT/RVET was independently associated with a shorter time to outcome (aHR = 2.04, 1.11-3.76, p = 0.02). CONCLUSION The PAAT/RVET may aid in anticipating timing of discharge in patients with type I severe BPD.
Collapse
Affiliation(s)
- Ryan J Carpenter
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Nina Srdanovic
- Biostatistics Collaboration Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Rychlik
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shawn K Sen
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nicolas F M Porta
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aaron E Hamvas
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karna Murthy
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amanda L Hauck
- Ann & Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
11
|
Bhat R, Kwon S, Zaniletti I, Murthy K, Liem RI. Risk factors associated with venous and arterial neonatal thrombosis in the intensive care unit: a multicentre case-control study. The Lancet Haematology 2022; 9:e200-e207. [DOI: 10.1016/s2352-3026(21)00399-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 02/04/2023]
|
12
|
Vyas-Read S, Logan JW, Cuna AC, Machry J, Leeman KT, Rose RS, Mikhael M, Wymore E, Ibrahim JW, DiGeronimo RJ, Yallapragada S, Haberman BE, Padula MA, Porta NF, Murthy K, Nelin LD, Coghill CH, Zaniletti I, Savani RC, Truog W, Engle WA, Lagatta JM. A comparison of newer classifications of bronchopulmonary dysplasia: findings from the Children's Hospitals Neonatal Consortium Severe BPD Group. J Perinatol 2022; 42:58-64. [PMID: 34354227 PMCID: PMC8340076 DOI: 10.1038/s41372-021-01178-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compare three bronchopulmonary dysplasia (BPD) definitions against hospital outcomes in a referral-based population. STUDY DESIGN Data from the Children's Hospitals Neonatal Consortium were classified by 2018 NICHD, 2019 NRN, and Canadian Neonatal Network (CNN) BPD definitions. Multivariable models evaluated the associations between BPD severity and death, tracheostomy, or length of stay, relative to No BPD references. RESULTS Mortality was highest in 2019 NRN Grade 3 infants (aOR 225), followed by 2018 NICHD Grade 3 (aOR 145). Infants with lower BPD grades rarely died (<1%), but Grade 2 infants had aOR 7-21-fold higher for death and 23-56-fold higher for tracheostomy. CONCLUSIONS Definitions with 3 BPD grades had better discrimination and Grade 3 2019 NRN had the strongest association with outcomes. No/Grade 1 infants rarely had severe outcomes, but Grade 2 infants were at risk. These data may be useful for counseling families and determining therapies for infants with BPD.
Collapse
Affiliation(s)
- Shilpa Vyas-Read
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - J. Wells Logan
- grid.261331.40000 0001 2285 7943The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Alain C. Cuna
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City and Children’s Mercy Hospital, Kansas, MO USA
| | - Joana Machry
- grid.21107.350000 0001 2171 9311Johns Hopkins University and Johns Hopkins All Children’s Hospital, Baltimore, MD USA
| | - Kristin T. Leeman
- grid.2515.30000 0004 0378 8438Harvard University and Boston Children’s Hospital, Cambridge, MA USA
| | - Rebecca S. Rose
- grid.257410.50000 0004 0413 3089Indiana University and Riley Children’s Hospital, Bloomington, IN USA
| | - Michel Mikhael
- grid.19006.3e0000 0000 9632 6718University of California, Irvine and Children’s Hospital of Orange County, Los Angeles, CA USA
| | - Erica Wymore
- grid.266190.a0000000096214564University of Colorado and Children’s Hospital Colorado, Boulder, CO USA
| | - John W. Ibrahim
- grid.239553.b0000 0000 9753 0008University of Pittsburgh and Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Robert J. DiGeronimo
- grid.34477.330000000122986657University of Washington, Seattle and Seattle Children’s Hospital, Seattle, WA USA
| | - Sushmita Yallapragada
- University of Texas, Southwestern and Children’s Medical Center of Dallas, Dallas, TX USA
| | - Beth E. Haberman
- grid.24827.3b0000 0001 2179 9593University of Cincinnati and Cincinnati Children’s Hospital, Cincinnati, OH USA
| | - Michael A. Padula
- grid.239552.a0000 0001 0680 8770University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Nicolas F. Porta
- grid.413808.60000 0004 0388 2248Northwestern University and Ann & Robert H Lurie Children’s Hospital, Evanston, IL USA
| | - Karna Murthy
- grid.413808.60000 0004 0388 2248Northwestern University and Ann & Robert H Lurie Children’s Hospital, Evanston, IL USA
| | - Leif D. Nelin
- grid.261331.40000 0001 2285 7943The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
| | - Carl H. Coghill
- grid.265892.20000000106344187University of Alabama, Birmingham and Children’s of Alabama, Birmingham, AL USA
| | | | - Rashmin C. Savani
- University of Texas, Southwestern and Children’s Medical Center of Dallas, Dallas, TX USA
| | - William Truog
- grid.266756.60000 0001 2179 926XUniversity of Missouri-Kansas City and Children’s Mercy Hospital, Kansas, MO USA
| | - William A. Engle
- grid.257410.50000 0004 0413 3089Indiana University and Riley Children’s Hospital, Bloomington, IN USA
| | - Joanne M. Lagatta
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin and Children’s Wisconsin, Milwaukee, WI USA
| |
Collapse
|
13
|
Friend EJ, Wiener PC, Murthy K, Pressman GS. Morphological features of mitral annular calcification leading to systolic anterior motion of the mitral valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Systolic anterior motion (SAM) of the mitral valve (MV) can develop after mitral valve repair with placement of an annuloplasty ring. It is occasionally seen in patients with mitral annular calcification (MAC) but mechanisms have not been carefully delineated. Using 2-dimensional echocardiography we explored morphologic parameters which may contribute to SAM in patients with MAC.
Hypothesis
We hypothesized that in cases of MAC where SAM is present there would be anterior displacement of the valve by the posterior annular calcification.
Methods
From our echocardiographic database we identified 20 patients with severe MAC who also had SAM with definite septal contact. Each subject was paired with 2 controls free of MAC and 1 control with severe MAC but no SAM. All controls were matched for age, sex, BSA, and septal wall thickness (±1.5 mm). 2-D echocardiographic measurements were taken from the parasternal long-axis (PLAX), apical 3-chamber and apical 4-chamber views.
Results
MAC+SAM vs MAC no-SAM. Three notable differences were observed: MAC+SAM patients, as compared with MAC no-SAM, had a smaller left ventricular outflow tract (LVOT), longer anterior mitral leaflet, and greater displacement of the MV coaptation point towards the interventricular septum (Figure 1). Median values for these 3 factors were determined using the no-MAC controls; each MAC subject was then scored for number of factors exceeding those values. MAC+SAM patients had a mean score of 2.7 vs 1.1 for MAC no-SAM patients. By combining anterior mitral leaflet length and coaptation point-septal distance as a ratio we could effectively separate MAC+SAM vs MAC no-SAM when >0.9 with one exception (Figure 2). We also observed a smaller anteroposterior annular dimension in the MAC+SAM group.
MAC no-SAM vs no-MAC. Comparing these groups there were no differences in LVOT diameter or coaptation-septal distance; effective anterior mitral leaflet length was smaller in MAC no-SAM subjects vs no-MAC controls while anteroposterior dimension of the annulus was larger.
Conclusions
SAM develops in a subset of patients with severe calcification of the mitral annulus. These patients have a smaller anteroposterior annular dimension, possibly due to severe MAC. Other notable differences characterize MAC patients with SAM from those without. The LVOT is smaller, the effective anterior mitral leaflet length is longer, and the point of leaflet coaptation is displaced towards the septum. Using the ratio of anterior mitral leaflet length/coaptation point-septal distance in this study sample effectively separated those MAC patients with SAM from those without.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Collapse
Affiliation(s)
- E J Friend
- Einstein Medical Center Philadelphia, Cardiology, Philadelphia, United States of America
| | - P C Wiener
- Einstein Medical Center Philadelphia, Cardiology, Philadelphia, United States of America
| | - K Murthy
- Einstein Medical Center Philadelphia, Cardiology, Philadelphia, United States of America
| | - G S Pressman
- Einstein Medical Center Philadelphia, Cardiology, Philadelphia, United States of America
| |
Collapse
|
14
|
Cuna A, Lagatta JM, Savani RC, Vyas-Read S, Engle WA, Rose RS, DiGeronimo R, Logan JW, Mikhael M, Natarajan G, Truog WE, Kielt M, Murthy K, Zaniletti I, Lewis TR. Association of time of first corticosteroid treatment with bronchopulmonary dysplasia in preterm infants. Pediatr Pulmonol 2021; 56:3283-3292. [PMID: 34379886 PMCID: PMC8453128 DOI: 10.1002/ppul.25610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/13/2021] [Accepted: 07/31/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the association between the time of first systemic corticosteroid initiation and bronchopulmonary dysplasia (BPD) in preterm infants. STUDY DESIGN A multi-center retrospective cohort study from January 2010 to December 2016 using the Children's Hospitals Neonatal Database and Pediatric Health Information System database was conducted. The study population included preterm infants <32 weeks' gestation treated with systemic corticosteroids after 7 days of age and before 34 weeks' postmenstrual age. Stepwise multivariable logistic regression was used to assess the association between timing of corticosteroid initiation and the development of Grade 2 or 3 BPD as defined by the 2019 Neonatal Research Network criteria. RESULTS We identified 598 corticosteroid-treated infants (median gestational age 25 weeks, median birth weight 760 g). Of these, 47% (280 of 598) were first treated at 8-21 days, 25% (148 of 598) were first treated at 22-35 days, 14% (86 of 598) were first treated at 36-49 days, and 14% (84 of 598) were first treated at >50 days. Infants first treated at 36-49 days (aOR 2.0, 95% CI 1.1-3.7) and >50 days (aOR 1.9, 95% CI 1.04-3.3) had higher independent odds of developing Grade 2 or 3 BPD when compared to infants treated at 8-21 days after adjusting for birth characteristics, admission characteristics, center, and co-morbidities. CONCLUSIONS Among preterm infants treated with systemic corticosteroids in routine clinical practice, later initiation of treatment was associated with a higher likelihood to develop Grade 2 or 3 BPD when compared to earlier treatment.
Collapse
Affiliation(s)
- Alain Cuna
- Children's Mercy Kansas City, University of Missouri, Kansas, Missouri, USA
| | - Joanne M Lagatta
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Rashmin C Savani
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shilpa Vyas-Read
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - William A Engle
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rebecca S Rose
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert DiGeronimo
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - J Wells Logan
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michel Mikhael
- Neonatal-Perinatal Medicine Division, Children's Hospital of Orange County, Orange, California, USA
| | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Detroit, Missouri, USA
| | - William E Truog
- Children's Mercy Kansas City, University of Missouri, Kansas, Missouri, USA
| | - Matthew Kielt
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Tamorah R Lewis
- Children's Mercy Kansas City, University of Missouri, Kansas, Missouri, USA
| | | |
Collapse
|
15
|
Seabrook RB, Grover TR, Rintoul N, Weems M, Keene S, Brozanski B, DiGeronimo R, Haberman B, Hedrick H, Gien J, Ali N, Chapman R, Daniel J, Harrison HA, Johnson Y, Porta NFM, Uhing M, Zaniletti I, Murthy K. Treatment of pulmonary hypertension during initial hospitalization in a multicenter cohort of infants with congenital diaphragmatic hernia (CDH). J Perinatol 2021; 41:803-813. [PMID: 33649432 DOI: 10.1038/s41372-021-00923-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/26/2020] [Revised: 11/02/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Describe inpatient pulmonary hypertension (PH) treatment and factors associated with therapy at discharge in a multicenter cohort of infants with CDH. METHODS Six years linked records from Children's Hospitals Neonatal Database and Pediatric Health Information System were used to describe associations between prenatal/perinatal factors, clinical outcomes, echocardiographic findings and PH medications (PHM), during hospitalization and at discharge. RESULTS Of 1106 CDH infants from 23 centers, 62.8% of infants received PHM, and 11.6% of survivors were discharged on PHM. Survivors discharged on PHM more frequently had intrathoracic liver, small for gestational age, and low 5 min APGARs compared with those discharged without PHM (p < 0.0001). Nearly one-third of infants discharged without PHM had PH on last inpatient echo. CONCLUSIONS PH medication use is common in CDH. Identification of infants at risk for persistent PH may impact ongoing management. Post-discharge follow-up of all CDH infants with echocardiographic evidence of PH is warranted.
Collapse
Affiliation(s)
- Ruth B Seabrook
- Nationwide Children's Hospital and the Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Theresa R Grover
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Natalie Rintoul
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Weems
- LeBonheur Children's Hospital and the University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sarah Keene
- Children's Healthcare of Atlanta at Egleston, Emory Children's Pediatric Institute, and Emory University School of Medicine, Atlanta, GA, USA
| | - Beverly Brozanski
- St Louis Children's Hospital and the Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Robert DiGeronimo
- Seattle Children's Hospital and University of Washington, Seattle, WA, USA
| | - Beth Haberman
- Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Holly Hedrick
- Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Gien
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Rachel Chapman
- Children's Hospital Los Angeles and the Fetal & Neonatal Institute, Department of Pediatrics. USC Keck School of Medicine, Los Angeles, CA, USA
| | - John Daniel
- Children's Mercy Hospitals & Clinics, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | | | - Nicolas F M Porta
- Ann & Robert H Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Uhing
- Children's Hospital of Wisconsin and Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Karna Murthy
- Ann & Robert H Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | |
Collapse
|
16
|
Chaudhry PM, Ball MK, Hamrick SEG, Levy PT, Asselin J, Brozanski B, Durand D, Dykes F, Evans J, Grover T, Murthy K, Padula M, Pallotto E, Piazza A, Reber K, Short B. Premature congenital heart disease: building a comprehensive database to evaluate risks and guide intervention. J Pediatr 2021; 230:272-273.e1. [PMID: 33253730 DOI: 10.1016/j.jpeds.2020.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Paulomi M Chaudhry
- Division of Neonatology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Shannon E G Hamrick
- Division of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School and Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Yallapragada S, Savani RC, Mūnoz-Blanco S, Lagatta JM, Truog WE, Porta NFM, Nelin LD, Zhang H, Vyas-Read S, DiGeronimo R, Natarajan G, Wymore E, Haberman B, Machry J, Potoka K, Murthy K. Qualitative indications for tracheostomy and chronic mechanical ventilation in patients with severe bronchopulmonary dysplasia. J Perinatol 2021; 41:2651-2657. [PMID: 34349231 PMCID: PMC8331995 DOI: 10.1038/s41372-021-01165-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2021] [Accepted: 07/13/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND The decision to pursue chronic mechanical ventilation involves a complex mix of clinical and social considerations. Understanding the medical indications to pursue tracheostomy would reduce the ambiguity for both providers and families and facilitate focus on appropriate clinical goals. OBJECTIVE To describe potential indications to pursue tracheostomy and chronic mechanical ventilation in infants with severe BPD (sBPD). STUDY DESIGN We surveyed centers participating in the Children's Hospitals Neonatal Consortium to describe their approach to proceed with tracheostomy in infants with sBPD. We requested a single representative response per institution. Question types were fixed form and free text responses. RESULTS The response rate was high (31/34, 91%). Tracheostomy was strongly considered when: airway malacia was present, PCO2 ≥ 76-85 mmHg, FiO2 ≥ 0.60, PEEP ≥ 9-11 cm H2O, respiratory rate ≥ 61-70 breaths/min, PMA ≥ 44 weeks, and weight <10th %ile at 44 weeks PMA. CONCLUSIONS Understanding the range of indications utilized by high level NICUs around the country to pursue a tracheostomy in an infant with sBPD is one step toward standardizing consensus indications for tracheostomy in the future.
Collapse
Affiliation(s)
| | - Rashmin C. Savani
- grid.267313.20000 0000 9482 7121UT Southwestern Medical Center, Dallas, TX USA
| | - Sara Mūnoz-Blanco
- grid.267313.20000 0000 9482 7121UT Southwestern Medical Center, Dallas, TX USA
| | - Joanne M. Lagatta
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
| | - William E. Truog
- grid.239559.10000 0004 0415 5050Children’s Mercy-Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO USA
| | - Nicolas F. M. Porta
- grid.413808.60000 0004 0388 2248Northwestern University & Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Leif D. Nelin
- grid.240344.50000 0004 0392 3476Nationwide Children’s Hospital, Columbus, OH USA
| | - Huayan Zhang
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Shilpa Vyas-Read
- grid.189967.80000 0001 0941 6502Emory University, Atlanta, GA USA
| | - Robert DiGeronimo
- grid.240741.40000 0000 9026 4165Seattle Children’s Hospital/University of Washington, Seattle, WA USA
| | - Girija Natarajan
- grid.414154.10000 0000 9144 1055Children’s Hospital of Michigan, Detroit, MI USA
| | - Erica Wymore
- grid.430503.10000 0001 0703 675XUniversity of Colorado, Aurora, CO USA
| | - Beth Haberman
- grid.239573.90000 0000 9025 8099Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Joana Machry
- grid.413611.00000 0004 0467 2330Johns Hopkins All Children’s Hospital, St. Petersburg, FL USA
| | - Karin Potoka
- grid.413473.60000 0000 9013 1194Akron Children’s Hospital, Akron, OH USA
| | | | - Karna Murthy
- grid.413808.60000 0004 0388 2248Northwestern University & Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| |
Collapse
|
18
|
Bathgate JR, Rigassio Radler D, Zelig R, Lagoski M, Murthy K. Nutrition Interventions Associated With Favorable Growth in Infants With Congenital Diaphragmatic Hernia. Nutr Clin Pract 2020; 36:406-413. [PMID: 32621640 DOI: 10.1002/ncp.10547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Nutrition complications are common in survivors of congenital diaphragmatic hernia (CDH). Infants diagnosed with CDH may demonstrate poor growth despite receiving enteral tube feedings and gastroesophageal reflux treatment. This literature review was conducted to determine nutrition interventions resulting in favorable growth, which may improve outcomes in these infants. Results indicate that early nutrition support, including supplemental parenteral nutrition with provisions of ≥125 kcal/kg/d and ≥2.3 g/kg/d protein (which are higher than dietary reference intakes for infants), may have a positive impact on growth, potentially impacting neurological development.
Collapse
Affiliation(s)
- Jennifer R Bathgate
- School of Health Professions, Department of Clinical and Preventive, Lurie Children's Hospital, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Diane Rigassio Radler
- School of Health Professions, Department of Clinical and Preventive, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Rena Zelig
- School of Health Professions, Department of Clinical and Preventive, Nutrition Sciences, Rutgers University, Chicago, Illinois, USA
| | - Megan Lagoski
- Feinberg School of Medicine, Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Karna Murthy
- Feinberg School of Medicine, Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| |
Collapse
|
19
|
Slattery SM, Knight DC, Weese‐Mayer DE, Grobman WA, Downey DC, Murthy K. Machine learning mortality classification in clinical documentation with increased accuracy in visual-based analyses. Acta Paediatr 2020; 109:1346-1353. [PMID: 31762098 DOI: 10.1111/apa.15109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022]
Abstract
AIM The role of machine learning on clinical documentation for predictive outcomes remains undefined. We aimed to compare three neural networks on inpatient providers' notes to predict mortality in neonatal hypoxic-ischaemic encephalopathy (HIE). METHODS Using Children's Hospitals Neonatal Database, non-anomalous neonates with HIE treated with therapeutic hypothermia were identified at a single-centre. Data were linked with the initial seven days of documentation. Exposures were derived using the databases and applying convolutional and two recurrent neural networks. The primary outcome was mortality. The predictive accuracy and performance measures for models were determined. RESULTS The cohort included 52 eligible infants. Most infants survived (n = 36, 69%) and 23 had severe HIE (44%). Neural networks performed above baseline and differed in their median accuracy for predicting mortality (P = .0001): recurrent models with long short-term memory 69% (25th , 75th percentile 65, 73%) and gated-recurrent model units 65% (62, 69%) and convolutional 72% (64, 96%). Convolutional networks' median specificity was 81% (72, 97%). CONCLUSION The neural network models demonstrated fundamental validity in predicting mortality using inpatient provider documentation. Convolutional models had high specificity for (excluding) mortality in neonatal HIE. These findings provide a platform for future model training and ultimately tool development to assist clinicians in patient assessments and risk stratifications.
Collapse
Affiliation(s)
- Susan M. Slattery
- Stanley Manne Children’s Research Institute Chicago IL USA
- Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Paediatrics Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago IL USA
| | | | - Debra E. Weese‐Mayer
- Stanley Manne Children’s Research Institute Chicago IL USA
- Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Paediatrics Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago IL USA
| | - William A. Grobman
- Stanley Manne Children’s Research Institute Chicago IL USA
- Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Obstetrics and Gynaecology Feinberg School of Medicine Chicago IL USA
| | | | - Karna Murthy
- Stanley Manne Children’s Research Institute Chicago IL USA
- Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Paediatrics Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago IL USA
| |
Collapse
|
20
|
Fry JT, Matoba N, Datta A, DiGeronimo R, Coghill CH, Natarajan G, Brozanski B, Leuthner SR, Niehaus JZ, Schlegel AB, Shah A, Zaniletti I, Bartman T, Murthy K, Sullivan KM. Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units. J Pediatr 2020; 217:86-91.e1. [PMID: 31831163 DOI: 10.1016/j.jpeds.2019.10.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/12/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). STUDY DESIGN We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. RESULTS Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death. CONCLUSIONS From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.
Collapse
Affiliation(s)
- Jessica T Fry
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| | - Nana Matoba
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ankur Datta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Robert DiGeronimo
- Department of Pediatrics, University of Washington, Seattle, WA; Division of Neonatology, Seattle Children's Hospital, Seattle, WA
| | - Carl H Coghill
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL; Division of Neonatology, Children's of Alabama, Birmingham, AL
| | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Detroit, MI; Division of Neonatology, Children's Hospital of Michigan, Detroit, MI
| | - Beverly Brozanski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA; Division of Newborn Medicine, UPMC Children's Hospital, Pittsburgh, PA
| | - Steven R Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; Division of Neonatology, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Jason Z Niehaus
- Department of Pediatrics, Indiana University, Indianapolis, IN; Division of Neonatology, Riley Hospital for Children, Indianapolis, IN
| | - Amy Brown Schlegel
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
| | - Anita Shah
- Division of Neonatology, Children's Hospital of Orange County, Orange, CA
| | | | - Thomas Bartman
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH
| | - Karna Murthy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Kevin M Sullivan
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Division of Neonatology, Nemours/AI duPont Hospital for Children, Wilmington, DE
| | -
- Children's Hospitals Neonatal Consortium, Kansas City, MO
| |
Collapse
|
21
|
Falciglia GH, Murthy K, Holl JL, Palac HL, Woods DM, Robinson DT. Low prevalence of clinical decision support to calculate caloric and fluid intake for infants in the neonatal intensive care unit. J Perinatol 2020; 40:497-503. [PMID: 31813935 PMCID: PMC7042157 DOI: 10.1038/s41372-019-0546-z] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clinical decision support (CDS) improves nutrition delivery for infants in the neonatal intensive care unit (NICU), however, the prevalence of CDS to support nutrition is unknown. METHODS Online surveys, with telephone and email validation of responses, were administered to NICU clinicians in the Children's Hospital Neonatal Consortium (CHNC). We determined and compared the availability of CDS to calculate calories and fluid received in the prior 24 h, stratified by enteral and parenteral intake, using McNemar's test. RESULTS Clinicians at all 34 CHNC hospitals responded with 98 of 108 (91%) surveys completed. NICUs have considerably less CDS to calculate enteral calories received than enteral fluid received (32% vs. 82%, p < 0.001) and less CDS to calculate parenteral calories received than parenteral fluid received (29% vs. 82%, p < 0.001). DISCUSSION Most CHNC NICUs are unable to reliably and consistently monitor caloric intake delivered to critically ill infants at risk for growth failure.
Collapse
Affiliation(s)
- Gustave H. Falciglia
- 0000 0001 2299 3507grid.16753.36Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL USA ,0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| | - Karna Murthy
- 0000 0001 2299 3507grid.16753.36Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL USA ,0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA ,Children’s Hospital Neonatal Consortium, Kansas City, MO USA
| | - Jane L. Holl
- 0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA ,0000 0001 2299 3507grid.16753.36Center for Health Services & Outcomes Research, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | | | - Donna M. Woods
- 0000 0001 2299 3507grid.16753.36Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL USA ,0000 0001 2299 3507grid.16753.36Center for Health Services & Outcomes Research, Northwestern University, Feinberg School of Medicine, Chicago, IL USA
| | - Daniel T. Robinson
- 0000 0001 2299 3507grid.16753.36Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL USA ,0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, USA
| |
Collapse
|
22
|
Vyas-Read S, Wymore EM, Zaniletti I, Murthy K, Padula MA, Truog WE, Engle WA, Savani RC, Yallapragada S, Logan JW, Zhang H, Hysinger EB, Grover TR, Natarajan G, Nelin LD, Porta NFM, Potoka KP, DiGeronimo R, Lagatta JM. Utility of echocardiography in predicting mortality in infants with severe bronchopulmonary dysplasia. J Perinatol 2020; 40:149-156. [PMID: 31570799 PMCID: PMC7222140 DOI: 10.1038/s41372-019-0508-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the relationship between interventricular septal position (SP) and right ventricular systolic pressure (RVSP) and mortality in infants with severe BPD (sBPD). STUDY DESIGN Infants with sBPD in the Children's Hospitals Neonatal Database who had echocardiograms 34-44 weeks' postmenstrual age (PMA) were included. SP and RVSP were categorized normal, abnormal (flattened/bowed SP or RVSP > 40 mmHg) or missing. RESULTS Of 1157 infants, 115 infants (10%) died. Abnormal SP or RVSP increased mortality (SP 19% vs. 8% normal/missing, RVSP 20% vs. 9% normal/missing, both p < 0.01) in unadjusted and multivariable models, adjusted for significant covariates (SP OR 1.9, 95% CI 1.2-3.0; RVSP OR 2.2, 95% CI 1.1-4.7). Abnormal parameters had high specificity (SP 82%; RVSP 94%), and negative predictive value (SP 94%, NPV 91%) for mortality. CONCLUSIONS Abnormal SP or RVSP is independently associated with mortality in sBPD infants. Negative predictive values distinguish infants most likely to survive.
Collapse
Affiliation(s)
- Shilpa Vyas-Read
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
| | - Erica M Wymore
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael A Padula
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - William E Truog
- Children's Mercy Hospital, University of Missouri, Kansas City, MO, USA
| | - William A Engle
- Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rashmin C Savani
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - J Wells Logan
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Huayan Zhang
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erik B Hysinger
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Theresa R Grover
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Girija Natarajan
- Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA
| | - Leif D Nelin
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Nicolas F M Porta
- Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karin P Potoka
- Department of Pediatrics, Division of Newborn Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Robert DiGeronimo
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Joanne M Lagatta
- Children's Hospital of Wisconsin, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
23
|
Murthy K, Karbownik K, Garfield CF, Falciglia GH, Roth J, Figlio DN. Small-for-Gestational Age Birth Confers Similar Educational Performance through Middle School. J Pediatr 2019; 212:159-165.e7. [PMID: 31301852 DOI: 10.1016/j.jpeds.2019.04.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate the association between small for gestational age (SGA) at birth and educational performance on standardized testing and disability prevalence in elementary and middle school. STUDY DESIGN Through linked birth certificates and school records, surviving infants born at 23-41 weeks of gestation who entered Florida's public schools 1998-2009 were identified. Twenty-three SGA definitions (3rd-25th percentile) were derived. Outcomes were scores on Florida Comprehensive Assessment Test (FCAT) and students' disability classification in grades 3 through 8. A "sibling cohort" subsample included families with at least 2 siblings from the same mother in the study period. Multivariable models estimated independent relationships between SGA and outcomes. RESULTS Birth certificates for 80.2% of singleton infants were matched to Florida public school records (N = 1 254 390). Unadjusted mean FCAT scores were 0.236 SD lower among <10th percentile SGA infants compared with non-SGA infants; this difference declined to -0.086 SD after adjusting for maternal and infant characteristics. When siblings discordant in SGA status were compared within individual families, the association declined to -0.056 SD. For SGA <10th percentile infants, the observed prevalence of school-age disability was 15.0%, 7.7%, and 6.3% for unadjusted, demographics-adjusted, and sibling analyses, respectively. No inflection or discontinuity was detected across SGA definitions from 3rd to 25th percentile in either outcome, and the associations were qualitatively similar. CONCLUSIONS The associations between SGA birth and students' standardized test scores and well-being were quantitatively small but persisted through elementary and middle school. The observed deficits were largely mitigated by demographic and familial factors.
Collapse
Affiliation(s)
- Karna Murthy
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Krzysztof Karbownik
- Department of Economics, Emory University, Atlanta, GA; National Bureau of Economic Research, Cambridge, MA
| | - Craig F Garfield
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Policy Research, Northwestern University, Evanston, IL
| | - Gustave H Falciglia
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey Roth
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - David N Figlio
- National Bureau of Economic Research, Cambridge, MA; Institute for Policy Research, Northwestern University, Evanston, IL; School of Education and Social Policy, Northwestern University, Evanston, IL
| |
Collapse
|
24
|
Yanowitz TD, Sullivan KM, Piazza AJ, Brozanski B, Zaniletti I, Sharma J, DiGeronimo R, Nayak SP, Wadhawan R, Reber KM, Murthy K. Does the initial surgery for necrotizing enterocolitis matter? Comparative outcomes for laparotomy vs. peritoneal drain as initial surgery for necrotizing enterocolitis in infants <1000 g birth weight. J Pediatr Surg 2019; 54:712-717. [PMID: 30765157 DOI: 10.1016/j.jpedsurg.2018.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 11/25/2018] [Accepted: 12/12/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Quantify short-term outcomes associated with initial surgery [laparotomy (LAP) vs. peritoneal drain (PD)] for necrotizing enterocolitis (NEC) in extremely-low-birth-weight (ELBW) infants. METHODS Using the Children's Hospitals Neonatal Database, we identified ELBW infants <32 weeks' gestation with surgical NEC (sNEC). Unadjusted and multivariable regression analyses were used to estimate the associations between LAP (or PD) and death/short bowel syndrome (SBS) and length of stay (LOS). RESULTS LAP was the more common initial procedure for sNEC (n = 359/528, 68%). Infants receiving LAP were older and heavier. Initial procedure was unrelated to death/SBS in both bivariate (LAP: 43% vs PD: 46%, p = 0.573) and multivariable analyses (OR = 0.89, 95% CI = 0.57, 1.38, p = 0.6). LAP was inversely related to mortality (29% vs. 41%, p < 0.007) in bivariate analysis, but not significant in multivariable analysis accounting for markers of preoperative illness severity. However, the association between LAP and SBS (14% vs. 5%, p = 0.012) remained significant in multivariable analyses (adjusted OR = 2.25, p = 0.039). LOS among survivors was unrelated to the first surgical procedure in multivariable analysis. CONCLUSION ELBW infants who undergo LAP as the initial operative procedure for sNEC may be at higher risk for SBS without a clear in-hospital survival advantage or shorter hospitalization. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
| | - Kevin M Sullivan
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Jotishna Sharma
- University of Missouri Kansas City School of Medicine, Kansas City, MO
| | | | | | | | | | | | | |
Collapse
|
25
|
Natarajan G, Mathur A, Zaniletti I, DiGeronimo R, Lee KS, Rao R, Dizon M, Hamrick S, Rudine A, Cook N, Smith D, Flibotte J, Murthy K, Massaro A. Withdrawal of Life-Support in Neonatal Hypoxic-Ischemic Encephalopathy. Pediatr Neurol 2019; 91:20-26. [PMID: 30559002 DOI: 10.1016/j.pediatrneurol.2018.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/13/2018] [Accepted: 08/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We describe the frequency and timing of withdrawal of life-support (WLS) in moderate or severe hypoxic-ischemic encephalopathy (HIE) and examine its associations with medical and sociodemographic factors. PROCEDURES We undertook a secondary data analysis of a prospective multicenter data registry of regional level IV Neonatal Intensive Care Units participating in the Children's Hospitals Neonatal Database. Infants ≥36 weeks gestational age with HIE admitted to a Children's Hospitals Neonatal Database Neonatal Intensive Care Unit between 2010 and 2016, who underwent therapeutic hypothermia were categorized as (1) infants who died following WLST and (2) survivors with severe HIE (requiring tube feedings at discharge). RESULTS Death occurred in 267/1,925 (14%) infants with HIE, 87.6% following WLS. Compared to infants with WLS (n = 234), the survived severe group (n = 74) had more public insurance (73% vs 39.3%, P = 0.00001), lower household income ($37,020 vs $41,733, P = 0.006) and fewer [20.3% vs 35.0%, P = 0.0212] were from the South. Among infants with WLS, electroencephalogram was performed within 24 hours in 75% and was severely abnormal in 64% cases; corresponding rates for MRI were 43% and 17%, respectively. Private insurance was independently associated with WLS, after adjustment for HIE severity and center. CONCLUSIONS In a multicenter cohort of infants with HIE, WLS occurred frequently and was associated with sociodemographic factors. The rationale for decision-making for WLS in HIE require further exploration.
Collapse
Affiliation(s)
- Girija Natarajan
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, Michigan.
| | - Amit Mathur
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital
| | | | - Robert DiGeronimo
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Kyong-Soon Lee
- Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rakesh Rao
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital
| | - Maria Dizon
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - Shannon Hamrick
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta at Egleston, Atlanta
| | - Anthony Rudine
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Noah Cook
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Danielle Smith
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - John Flibotte
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karna Murthy
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - An Massaro
- Department of Pediatrics, Children's National Medical Center, and George Washington University School of Medicine, Washington DC
| | -
- Children's Hospitals Neonatal Consortium, Kansas City, MO
| |
Collapse
|
26
|
Murthy K, Prasad R, Deshpande A. Implant-ADM based breast reconstruction: “A tale of two techniques”. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.326] [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: 10/27/2022] Open
|
27
|
Tolia VN, Murthy K, Bennett MM, Greenberg RG, Benjamin DK, Smith PB, Clark RH. Morphine vs Methadone Treatment for Infants with Neonatal Abstinence Syndrome. J Pediatr 2018; 203:185-189. [PMID: 30220442 DOI: 10.1016/j.jpeds.2018.07.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/13/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To estimate the relationship of initial pharmacotherapy with methadone or morphine and length of stay (LOS) in infants with neonatal abstinence syndrome (NAS) admitted to the neonatal intensive care unit (NICU). STUDY DESIGN From the Pediatrix Clinical Data Warehouse database, we identified all infants born at ≥36 weeks of gestation between 2011 and 2015 who were diagnosed with NAS (International Classification of Diseases, Ninth Revision code 779.5) and treated with methadone or morphine in the first 7 days of life. We used multivariable Cox proportional hazards regression analysis to quantify the association between initial treatment and LOS after adjusting for maternal age, maternal race/ethnicity, maternal drug use, maternal smoking, gestational age, small for gestational age status, inborn status, and discharge year. RESULTS We identified a total of 7667 eligible infants, including 1187 treated with methadone (15%) and 6480 treated with morphine (85%). Birth weight, gestational age, and sex were similar in the 2 groups. Methadone treatment was associated with a 22% shorter median LOS (18 days [IQR, 11-30 days] vs 23 days [IQR, 16-33]; P < .001) and a 19% shorter median NICU stay (17 days [IQR, 10-29 days] vs 21 days [IQR, 14-36 days]; P < .001). After adjustment, methadone was associated with a shorter LOS (hazard ratio for discharge, 1.24; 95% CI, 1.11-1.37; P < .001) CONCLUSION: Among infants born at ≥36 weeks of gestation with NAS, initial methadone treatment was associated with a shorter LOS compared with morphine treatment. Future prospective comparative effectiveness trials to treat infants with NAS are needed to verify this observation.
Collapse
Affiliation(s)
- Veeral N Tolia
- Department of Neonatology, Baylor University Medical Center, Dallas, TX; Pediatrix Medical Group, Baylor Scott & White Health, Dallas, TX.
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, IL; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Monica M Bennett
- Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
| | - Rachel G Greenberg
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Reese H Clark
- Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, SC; Center for Research, Education, and Quality, Mednax, Inc, Sunrise, FL
| |
Collapse
|
28
|
Falciglia GH, Murthy K, Holl JL, Palac HL, Oumarbaeva Y, Woods DM, Robinson DT. Energy and Protein Intake During the Transition from Parenteral to Enteral Nutrition in Infants of Very Low Birth Weight. J Pediatr 2018; 202:38-43.e1. [PMID: 30195557 DOI: 10.1016/j.jpeds.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/18/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the association between nutrition delivery practices and energy and protein intake during the transition from parenteral to enteral nutrition in infants of very low birth weight (VLBW). STUDY DESIGN This was a retrospective analysis of 115 infants who were VLBW from a regional neonatal intensive care unit. Changes in energy and protein intake were estimated during transition phase 1 (0% enteral); phase 2 (>0, ≤33.3% enteral); phase 3 (>33.3, ≤66.7% enteral); phase 4 (>66.7, <100% enteral); and phase 5 (100% enteral). Associations between energy and protein intake were determined for each phase for parenteral nutrition, intravenous lipids, central line, feeding fortification, fluid restriction, and excess non-nutritive fluid intake. RESULTS In phases 2 and 3, infants receiving feeding fortification received less protein than infants who were unfortified (-1.1 and -0.3 g/kg/d, respectively; P < .001). However, this negative association was not observed after adjusting for relevant nutrition delivery practices. Despite greater enteral protein intake during phases 2 and 3 (0.3 and 0.8 g/kg/d, respectively; P < .001), infants with early fortification received less parenteral protein than infants who were unfortified (-1.4 and -1.1 g/kg/d, respectively; P < .001). Similar patterns were observed for energy intake. Protein intake declined during phases 3 and 4. CONCLUSIONS Infants paradoxically received less protein and energy on days with early fortification, suggesting that clinicians may lack easily accessible data to detect the association between nutrition delivery practices and overall nutrition in infants who are VLBW.
Collapse
Affiliation(s)
- Gustave H Falciglia
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Ann & Robert H. Lurie Children's Hospital of Chicago.
| | - Karna Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Ann & Robert H. Lurie Children's Hospital of Chicago; Children's Hospitals Neonatal Consortium, Kansas City, MO
| | - Jane L Holl
- Ann & Robert H. Lurie Children's Hospital of Chicago; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Hannah L Palac
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Yuliya Oumarbaeva
- Department of Pediatrics, Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Donna M Woods
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Daniel T Robinson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Ann & Robert H. Lurie Children's Hospital of Chicago
| |
Collapse
|
29
|
Bhat R, Kumar R, Kwon S, Murthy K, Liem RI. Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit-A Case Control Study. J Pediatr 2018; 195:28-32. [PMID: 29398052 DOI: 10.1016/j.jpeds.2017.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 07/17/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. STUDY DESIGN A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. RESULTS The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P < .01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P = .04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P = .01). CONCLUSIONS The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.
Collapse
Affiliation(s)
- Rukhmi Bhat
- Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Riten Kumar
- Division of Hematology/Oncology, Department of Pediatrics, The Ohio State University, Nationwide Children's Hospital, Columbus, OH
| | - Soyang Kwon
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
30
|
Falciglia GH, Murthy K, Holl J, Palac HL, Oumarbaeva Y, Yadavalli P, Woods D, Robinson DT. Association Between the 7-Day Moving Average for Nutrition and Growth in Very Low Birth Weight Infants. JPEN J Parenter Enteral Nutr 2017; 42:805-812. [PMID: 28800397 DOI: 10.1177/0148607117722927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/17/2017] [Accepted: 06/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants remain at risk for postnatal growth restriction. Clinicians may have difficulty identifying growth patterns resulting from nutrition interventions, impeding prompt management changes intended to increase growth velocity. This study aimed to quantify the association between growth and nutrition intake through 7-day moving averages (SDMAs). METHODS The first 6 weeks of daily nutrition intake and growth measurements were collected from VLBW infants admitted to a level 4 neonatal intensive care unit (2011-2014). The association between SDMA for energy and macronutrients and subsequent 7-day growth velocities for weight, length, and head circumference were determined using mixed effects linear regression. Analyses were adjusted for fluid intake, infant characteristics, and comorbid conditions. RESULTS Detailed enteral and parenteral caloric provisions were ascertained for 115 infants (n = 4643 patient-days). Each 10-kcal/kg/d increase over 7 days was independently associated with increased weight (1.7 g/kg/d), length (0.4 mm/wk), and head circumference (0.9 mm/wk; P < .001, for weight and head circumference; P = .041 for length). Each 1 g/kg/d macronutrient increase was also associated with increased weight (protein, P = .027; fat and carbohydrates, P < .001), increased length (fat, P = .032), and increased head circumference (fat and carbohydrates, P < .001). CONCLUSIONS The SDMA identifies clinically meaningful associations among total energy, macronutrient dosing, and growth in VLBW infants. Whether SDMA is a clinically useful tool for providing clinicians with prompt feedback to improve growth warrants further attention.
Collapse
Affiliation(s)
- Gustave H Falciglia
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Karna Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jane Holl
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Hannah L Palac
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Yuliya Oumarbaeva
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Pratyusha Yadavalli
- Department of Internal Medicine, St Joseph Mercy Health System, Livonia, Michigan, USA
| | - Donna Woods
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel T Robinson
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
31
|
Abstract
IMPORTANCE Survivors of preterm birth often present with medical morbidities; however, variation in their long-term educational performance has not been well described. OBJECTIVE To estimate the association between gestational age and 4 outcomes in school-aged children: readiness to enter kindergarten, scores on standardized tests in elementary and middle school, gifted status, and low performance. DESIGN, SETTING, AND PARTICIPANTS In a retrospective cohort study, children born in Florida between 1992 and 2002 at 23 to 41 weeks' gestation who entered Florida's public schools between 1995 and 2012 were assessed for kindergarten readiness and tested in mathematics and reading in grades 3 through 8. Data analysis was performed from January 12, 2016, to March 1, 2017. EXPOSURES Gestational age at birth. MAIN OUTCOMES AND MEASURES Kindergarten readiness, scores on the Florida Comprehensive Achievement Test (FCAT), classified as gifted, and classified as low performance. RESULTS A total of 1 527 113 singleton infants with gestational ages of 23 to 41 weeks born between 1992 and 2002 were matched to Florida public school records. Of these, 1 301 497 children were included in the analysis; 641 479 (49.3%) were girls. A total of 301 (65.0%) Florida children born at 23 to 24 weeks' gestation were designated as ready to start kindergarten. When the FCAT test scores were adjusted for potentially confounding maternal and infant variables, children born at 23 to 24 weeks' gestation performed 0.66 SD (95% CI, -0.73 to -0.59) lower compared with those born at full term. A total of 123 554 (9.5%) of all Florida-born public school students were considered gifted, including 17 (1.8%) of those born at 23 to 24 weeks' gestation. In comparison, 75 458 (5.8%) of all Florida-born public school students were low performing; 310 (33.5%) of these children had been born at 23 to 24 weeks' gestation. Kindergarten readiness, FCAT scores, and gifted status were positively related to gestational age, whereas low performance was inversely related to gestational age. CONCLUSIONS AND RELEVANCE Although gestational age has long been associated with poor educational performance, a sufficient proportion of children born near the limits of viability performed within expected school norms, warranting further investigation into how and why certain children are able to overcome the educational burdens that may follow preterm birth.
Collapse
Affiliation(s)
- Craig F. Garfield
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois,Institute for Policy Research, Northwestern University, Evanston, Illinois
| | | | - Karna Murthy
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gustave Falciglia
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan Guryan
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - David N. Figlio
- Institute for Policy Research, Northwestern University, Evanston, Illinois,Human Development and Social Policy, Northwestern University School of Education and Social Policy, Evanston, Illinois
| | - Jeffrey Roth
- Department of Pediatrics, University of Florida, Gainesville
| |
Collapse
|
32
|
Murthy K, Porta NFM, Lagatta JM, Zaniletti I, Truog WE, Grover TR, Nelin LD, Savani RC, Savani RC. Inter-center variation in death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol 2017; 37:723-727. [PMID: 28181997 DOI: 10.1038/jp.2016.277] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/21/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the presence and sources of inter-center variation (ICV) in the risk of death or tracheostomy placement (D/T) among infants with severe bronchopulmonary dysplasia (sBPD)Study design:We analyzed the Children's Hospitals Neonatal Database between 2010 and 2013 to identify referred infants born <32 weeks' gestation with sBPD. The association between center and the primary outcome of D/T was analyzed by multivariable modeling. Hypothesized diagnoses/practices were included to determine if these explained any observed ICV in D/T. RESULTS D/T occurred in 280 (20%) of 1383 eligible infants from 21 centers. ICV was significant for D/T (range 2-46% by center, P<0.001) and tracheostomy placement (n=187, range 2-37%, P<0.001), but not death (n=93, range 0-19%, P=0.08). This association persisted in multivariable analysis (adjusted center-specific odds ratios for D/T varied 5.5-fold, P=0.009). CONCLUSIONS ICV in D/T is apparent among infants with sBPD. These results highlight that the indications for tracheostomy (and subsequent chronic ventilation) remain uncertain.
Collapse
Affiliation(s)
- K Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - N F M Porta
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and The Ann &Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - J M Lagatta
- Department of Pediatrics, Medical College of Wisconsin and The Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - I Zaniletti
- Department of Analytics, Children's Hospital Association, Inc, Overland Park, KS &Department of Statistics, University of Missouri, Columbia, MO, USA
| | - W E Truog
- Department of Pediatrics, University of Missouri Kansas City School of Medicine and The Center for Infant Pulmonary Disorders, Children's Mercy Hospitals &Clinics, Kansas City, MO, USA
| | - T R Grover
- Department of Pediatrics, University of Colorado School of Medicine and The Colorado Children's Hospital, Aurora, CO, USA
| | - L D Nelin
- Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and The Nationwide Children's Hospital, Columbus, OH, USA
| | - R C Savani
- Department of Pediatrics, University of Texas Southwestern Medical Center and the Children's Medical Center of Dallas, Dallas, TX, USA
| | | |
Collapse
|
33
|
Gien J, Murthy K, Pallotto EK, Brozanski B, Chicoine L, Zaniletti I, Seabrook R, Keene S, Alapati D, Porta N, Rintoul N, Grover TR. Short-term weight gain velocity in infants with congenital diaphragmatic hernia (CDH). Early Hum Dev 2017; 106-107:7-12. [PMID: 28178582 DOI: 10.1016/j.earlhumdev.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/14/2017] [Accepted: 01/31/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Appropriate post-natal growth remains a mainstay of therapeutic goals for infants with CDH, with the hypothesis that optimizing linear growth will improve survival through functional improvements in pulmonary hypoplasia. However, descriptions of growth and the effect on survival are limited in affected infants. OBJECTIVE Describe in-hospital weight gain related to survival among infants with CDH. DESIGN/METHODS Children's Hospitals Neonatal Database (CHND) identified infants with CDH born ≥34weeks' gestation (2010-14). Exclusion criteria were: admission age>7days, death/discharge age<14days, or surgical CDH repair prior to admission. Weight gain velocity (WGV: g/kg/day) was calculated using an established exponential approximation and the cohort stratified by Q1: <25%ile, Q2-3: 25-75%ile, and Q4: >75%ile. Descriptive measures and unadjusted Kaplan-Meier analyses describe the implications of WGV on mortality/discharge. RESULTS In 630 eligible infants, median WGV was 4.6g/kg/day. After stratification by WGV [Q1: (n=156; <3.1g/kg/day); Q2-3 (n=316; 3.1-5.9g/kg/day), and Q4 (n=158, >5.9g/kg/day)] infants in Q1 had shortest median length of stay, less time on TPN and intervention for gastro-esophageal reflux relative to the other WGV strata (p<0.01 for all). Unadjusted survival estimates revealed that Q1 [hazard ratio (HR)=9.5, 95% CI: 5.7, 15.8] and Q4 [HR=2.9, 95% CI: 1.7, 5.1, p<0.001 for both] WGV were strongly associated with NICU mortality relative to Q2-3 WGV. CONCLUSION Variable WGV is evident in infants with CDH. Highest and lowest WGV appear to be related to adverse outcomes. Efforts are needed to develop nutritional strategies targeting optimal growth.
Collapse
Affiliation(s)
- Jason Gien
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, United States
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Eugenia K Pallotto
- Children's Mercy Hospital and University of Missouri, Kansas City, MO, United States
| | - Beverly Brozanski
- Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Louis Chicoine
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Ruth Seabrook
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Sarah Keene
- Children's Healthcare of Atlanta at Egleston, Atlanta, GA, United States
| | - Deepthi Alapati
- Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
| | - Nicolas Porta
- Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Natalie Rintoul
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, United States
| | - Theresa R Grover
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, United States.
| | | |
Collapse
|
34
|
Tolia VN, Desai S, Qin H, Rayburn PD, Poon G, Murthy K, Ellsbury DL, Chiruvolu A. Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants. Am J Perinatol 2017; 34:105-110. [PMID: 27285470 DOI: 10.1055/s-0036-1584522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. Study Design We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, n = 313) to infants born in the 2 years after (post-ASO, n = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis. Results Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; p < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; p < 0.001). There were no differences in mortality (12.1 vs 10.2%; p = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use. Conclusion Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.
Collapse
Affiliation(s)
- Veeral N Tolia
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
| | - Sujata Desai
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
| | - Huanying Qin
- Department of Quantitative Sciences, Baylor Scott & White Health Care System, Dallas, Texas
| | - Polli D Rayburn
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
| | - Grace Poon
- Department of Pharmacy, Baylor Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and the Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Dan L Ellsbury
- Center for Research, Education and Quality, MEDNAX Services-Pediatrix Medical Group, Sunrise, Florida
| | - Arpitha Chiruvolu
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center and Pediatrix Medical Group, Dallas, Texas
| |
Collapse
|
35
|
Colacci M, Murthy K, DeRegnier RAO, Khan JY, Robinson DT. Growth and Development in Extremely Low Birth Weight Infants After the Introduction of Exclusive Human Milk Feedings. Am J Perinatol 2017; 34:130-137. [PMID: 27322667 DOI: 10.1055/s-0036-1584520] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To estimate associations of exclusive human milk (EHM) feedings with growth and neurodevelopment through 18 months corrected age (CA) in extremely low birth weight (ELBW) infants. Study Design ELBW infants admitted from July 2011 to June 2013 who survived were reviewed. Infants managed from July 2011 to June 2012 were fed with bovine milk-based fortifiers and formula (BOV). Beginning in July 2012, initial feedings used a human milk-based fortifier to provide EHM feedings. Infants were grouped on the basis of feeding regimen. Primary outcomes were the Bayley-III cognitive scores at 6, 12, and 18 months and growth. Results Infants (n = 85; 46% received EHM) were born at 26 ± 1.9 weeks (p = 0.92 between groups) weighing 776 ± 139 g (p = 0.67 between groups). Cognitive domain scores were similar at 6 months (BOV: 96 ± 7; EHM: 95 ± 14; p = 0.70), 12 months (BOV: 97 ± 10; EHM: 98 ± 9; p = 0.86), and 18 months (BOV: 97 ± 16; EHM: 98 ± 14; p = 0.71) CA. Growth velocity prior to discharge (BOV: 12.1 ± 5.2 g/kg/day; EHM: 13.1 ± 4.0 g/kg/day; p = 0.33) and subsequent growth was similar between groups. Conclusion EHM feedings appear to support similar growth and neurodevelopment in ELBW infants as compared with feedings containing primarily bovine milk-based products.
Collapse
Affiliation(s)
- Michael Colacci
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raye-Ann O DeRegnier
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Janine Y Khan
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel T Robinson
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
36
|
Murthy K, Chandrashekar M, McCartney L. 222. L shaped nipple reconstruction: A novel technique to improve patient satisfaction outcomes. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.155] [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: 11/27/2022] Open
|
37
|
Massaro AN, Murthy K, Zaniletti I, Cook N, DiGeronimo R, Dizon MLV, Hamrick SEG, McKay VJ, Natarajan G, Rao R, Richardson T, Smith D, Mathur AM. Intercenter Cost Variation for Perinatal Hypoxic-Ischemic Encephalopathy in the Era of Therapeutic Hypothermia. J Pediatr 2016; 173:76-83.e1. [PMID: 26995699 DOI: 10.1016/j.jpeds.2016.02.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 12/15/2015] [Revised: 01/14/2016] [Accepted: 02/09/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To quantify intercenter cost variation for perinatal hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia across children's hospitals. STUDY DESIGN Prospectively collected data from the Children's Hospitals Neonatal Database and Pediatric Health Information Systems were linked to evaluate intercenter cost variation in total hospitalization costs after adjusting for HIE severity, mortality, length of stay, use of extracorporeal support or nitric oxide, and ventilator days. Secondarily, costs for intensive care unit bed, electroencephalography (EEG), and laboratory and neuroimaging testing were also evaluated. Costs were contextualized by frequency of favorable (survival with normal magnetic resonance imaging) and adverse (death or need for gastric tube feedings at discharge) outcomes to identify centers with relative low costs and favorable outcomes. RESULTS Of the 822 infants with HIE treated with therapeutic hypothermia at 19 regional neonatal intensive care units, 704 (86%) survived to discharge. The median cost/case for survivors was $58 552 (IQR $32 476-$130 203) and nonsurvivors $29 760 (IQR $16 897-$61 399). Adjusting for illness severity and select interventions, intercenter differences explained 29% of the variation in total hospitalization costs. The widest cost variability across centers was EEG use, although low cost and favorable outcome centers ranked higher with regards to EEG costs. CONCLUSIONS There is marked intercenter cost variation associated with treating HIE across regional children's hospitals. Our investigation may help establish references for cost and enhance quality improvement and resource utilization projects related to HIE.
Collapse
Affiliation(s)
- An N Massaro
- Children's National Health System and the Department of Pediatrics, George Washington University School of Medicine, Washington, DC.
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL; Children's Hospitals Neonatal Consortium, Inc
| | | | - Noah Cook
- Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert DiGeronimo
- Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT
| | - Maria L V Dizon
- Ann and Robert H. Lurie Children's Hospital of Chicago and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shannon E G Hamrick
- Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Emory University, Atlanta, GA
| | | | - Girija Natarajan
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI
| | - Rakesh Rao
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
| | | | - Danielle Smith
- Children's Hospital of Colorado and Department of Pediatrics, University of Colorado, Aurora, CO
| | - Amit M Mathur
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO
| | | |
Collapse
|
38
|
Falciglia GH, Grobman WA, Murthy K. Racial/ethnic differences in weekend delivery after induction of labor. J Perinatol 2015; 35:809-12. [PMID: 26156061 DOI: 10.1038/jp.2015.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether the frequency induction of labor (IOL) varies by day of the week based on maternal race/ethnicity. STUDY DESIGN Gravid women in the US from 2007 to 2010 were stratified into <34, 34 to 36, 37 to 38 and ⩾39 weeks. Multivariable analyses estimated the association between weekend delivery, race/ethnicity (categorized as non-Hispanic white, Hispanic white, black and 'other') and their interaction with induction. RESULT After 34 weeks, induction was less likely on the weekend (P<0.01) and less likely in black, Hispanic or 'other' women relative to non-Hispanic whites (P<0.01). However, there was a significant positive interaction between race/ethnicity and weekend delivery (P<0.001). During the late preterm gestation, weekend IOL was greater in black women (odds ratio, 1.08). CONCLUSION The difference in IOL by race/ethnicity increased with gestational age. This difference was least on the weekends.
Collapse
Affiliation(s)
- G H Falciglia
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W A Grobman
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Prentice Women's Hospital, Chicago, IL, USA
| | - K Murthy
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
39
|
Grover TR, Murthy K, Brozanski B, Gien J, Rintoul N, Keene S, Najaf T, Chicoine L, Porta N, Zaniletti I, Pallotto EK. Short-term outcomes and medical and surgical interventions in infants with congenital diaphragmatic hernia. Am J Perinatol 2015; 32:1038-44. [PMID: 25825963 DOI: 10.1055/s-0035-1548729] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to characterize medical and surgical therapies and short-term outcomes in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN Retrospective analysis of CDH infants admitted to 27 children's hospitals submitting data to Children's Hospital Neonatal Database (CHND) from 2010 to 2013, stratified by gestational age, birth weight, and survival. RESULTS A total of 572 infants were identified, 508 (89%) born ≥ 34 weeks' gestation and ≥ 2 kg. More mature infants had higher APGAR scores, shorter duration of mechanical ventilation, and were more likely to receive extracorporeal membrane oxygenation (ECMO). Overall, mortality for the cohort was 29%, with mortality lower in infants born ≥ 34 weeks' gestation and ≥ 2 kg (26 vs. 50%, p < 0.01). Nonsurvivors were more likely to receive treatment with high-frequency oscillatory ventilation (HFOV), vasopressors, pulmonary vasodilators, and ECMO, and to have associated major congenital anomalies than survivors. In hospital morbidity and complications were relatively uncommon among survivors. CONCLUSION Infants with CDH have a high risk of morbidity and mortality, and for preterm infants with CDH those risks are amplified. Patterns of respiratory and circulatory support appeared to be different for survivors. In addition to established data registries, this consortium of regional neonatal intensive care units provides a new collaborative effort to describe short-term outcomes for infants referred with CDH.
Collapse
Affiliation(s)
- Theresa R Grover
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Beverly Brozanski
- Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jason Gien
- Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Natalie Rintoul
- Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Sarah Keene
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Nicolas Porta
- Ann and Robert H. Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Eugenia K Pallotto
- Children's Mercy Hospital and University of Missouri, Kansas City, Missouri
| | | |
Collapse
|
40
|
|
41
|
Abstract
OBJECTIVES To estimate the interhospital differences in induction of labor (IOL) from 34(0/7) to 38(6/7) weeks' gestation by race/ethnicity. METHODS Women between 34 and 42 weeks' gestation during 1995 and 2009 in three states were identified using linked maternal and infant records. Women with prior cesarean delivery, premature rupture of membranes, gestational hypertension, who delivered at hospitals with < 100 annual births, or who had missing data were excluded. The outcomes were inductions at early-term (ETI: between 37(0/7) and 38(6/7) weeks') and late preterm (LPI: from 34(0/7)-36(6/7) weeks') gestations. Cox proportional hazard ratios (HR) were used to estimate the independent associations between race/ethnicity and hospital of delivery on ETI and LPI. RESULTS A total of 6.98 million eligible women delivered at 469 hospitals. ETI and LPI occurred in 3.20 and 0.40% of women, respectively. Non-Hispanic white women (3.99%) received ETI most commonly; conversely, LPI was highest among non-Hispanic black women (0.50%). In multivariable analyses, non-Hispanic black race was protective for ETI (HR = 0.89; p < 0.01) and was a risk factor for LPI (HR = 1.26; p < 0.01) after adjusting for patient factors and the delivery hospital. CONCLUSION Racial differences in ETI and LPI appear to be pervasive. Much of the unaccounted racial/ethnic variation remains seems secondary to within-hospital differences in selecting women for IOL.
Collapse
Affiliation(s)
- Karna Murthy
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Michelle Macheras
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
42
|
Tolia VN, Patrick SW, Bennett MM, Murthy K, Sousa J, Smith PB, Clark RH, Spitzer AR. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N Engl J Med 2015; 372:2118-26. [PMID: 25913111 DOI: 10.1056/nejmsa1500439] [Citation(s) in RCA: 315] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of the neonatal abstinence syndrome, a drug-withdrawal syndrome that most commonly occurs after in utero exposure to opioids, is known to have increased during the past decade. However, recent trends in the incidence of the syndrome and changes in demographic characteristics and hospital treatment of these infants have not been well characterized. METHODS Using multiple cross-sectional analyses and a deidentified data set, we analyzed data from infants with the neonatal abstinence syndrome from 2004 through 2013 in 299 neonatal intensive care units (NICUs) across the United States. We evaluated trends in incidence and health care utilization and changes in infant and maternal clinical characteristics. RESULTS Among 674,845 infants admitted to NICUs, we identified 10,327 with the neonatal abstinence syndrome. From 2004 through 2013, the rate of NICU admissions for the neonatal abstinence syndrome increased from 7 cases per 1000 admissions to 27 cases per 1000 admissions; the median length of stay increased from 13 days to 19 days (P<0.001 for both trends). The total percentage of NICU days nationwide that were attributed to the neonatal abstinence syndrome increased from 0.6% to 4.0% (P<0.001 for trend), with eight centers reporting that more than 20% of all NICU days were attributed to the care of these infants in 2013. Infants increasingly received pharmacotherapy (74% in 2004-2005 vs. 87% in 2012-2013, P<0.001 for trend), with morphine the most commonly used drug (49% in 2004 vs. 72% in 2013, P<0.001 for trend). CONCLUSIONS From 2004 through 2013, the neonatal abstinence syndrome was responsible for a substantial and growing portion of resources dedicated to critically ill neonates in NICUs nationwide.
Collapse
Affiliation(s)
- Veeral N Tolia
- From the Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Pediatrix Medical Group (V.N.T.), and the Office of the Chief Quality Officer, Baylor Scott and White Health (M.M.B.) - all in Dallas; the Mildred Stahlman Division of Neonatology, Department of Pediatrics, and the Vanderbilt Center for Health Services Research and Department of Health Policy, Vanderbilt University School of Medicine, Nashville (S.W.P.); the Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann and Robert H. Lurie Children's Hospital of Chicago - both in Chicago (K.M.); the Department of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton (J.S.), and the Center for Research, Education, and Quality, Mednax, Sunrise (R.H.C., A.R.S.) - both in Florida; the Department of Pediatrics, Duke University School of Medicine, Durham, NC (P.B.S.); and Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, SC (R.H.C.)
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Massaro AN, Murthy K, Zaniletti I, Cook N, DiGeronimo R, Dizon M, Hamrick SEG, McKay VJ, Natarajan G, Rao R, Smith D, Telesco R, Wadhawan R, Asselin JM, Durand DJ, Evans JR, Dykes F, Reber KM, Padula MA, Pallotto EK, Short BL, Mathur AM. Short-term outcomes after perinatal hypoxic ischemic encephalopathy: a report from the Children's Hospitals Neonatal Consortium HIE focus group. J Perinatol 2015; 35:290-6. [PMID: 25393081 DOI: 10.1038/jp.2014.190] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [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: 06/24/2014] [Accepted: 08/18/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To characterize infants affected with perinatal hypoxic ischemic encephalopathy (HIE) who were referred to regional neonatal intensive care units (NICUs) and their related short-term outcomes. STUDY DESIGN This is a descriptive study evaluating the data collected prospectively in the Children's Hospital Neonatal Database, comprised of 27 regional NICUs within their associated children's hospitals. A consecutive sample of 945 referred infants born ⩾36 weeks' gestation with perinatal HIE in the first 3 days of life over approximately 3 years (2010-July 2013) were included. Maternal and infant characteristics are described. Short-term outcomes were evaluated including medical comorbidities, mortality and status of survivors at discharge. RESULT High relative frequencies of maternal predisposing conditions, cesarean and operative vaginal deliveries were observed. Low Apgar scores, profound metabolic acidosis, extensive resuscitation in the delivery room, clinical and electroencephalographic (EEG) seizures, abnormal EEG background and brain imaging directly correlated with the severity of HIE. Therapeutic hypothermia was provided to 85% of infants, 15% of whom were classified as having mild HIE. Electrographic seizures were observed in 26% of the infants. Rates of complications and morbidities were similar to those reported in prior clinical trials and overall mortality was 15%. CONCLUSION Within this large contemporary cohort of newborns with perinatal HIE, the application of therapeutic hypothermia and associated neurodiagnostic studies appear to have expanded relative to reported clinical trials. Although seizure incidence and mortality were lower compared with those reported in the trials, it is unclear whether this represented improved outcomes or therapeutic drift with the treatment of milder disease.
Collapse
Affiliation(s)
- A N Massaro
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA
| | - K Murthy
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | - I Zaniletti
- Children's Hospitals Association, Overland Park, KS, USA
| | - N Cook
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R DiGeronimo
- Department of Pediatrics, University of Utah and the Primary Children's Medical Center, Salt Lake City, UT, USA
| | - M Dizon
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Chicago, IL, USA
| | - S E G Hamrick
- Emory University Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - V J McKay
- All Children's Hospital, St Petersburg, FL, USA
| | - G Natarajan
- Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA
| | - R Rao
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Loius, MO, USA
| | - D Smith
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - R Telesco
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - R Wadhawan
- Florida Hospital for Children, Orlando, FL, USA
| | - J M Asselin
- Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA
| | - D J Durand
- Children's Hospital Oakland & Research Center, Neonatal/Pediatric Research, Oakland, CA, USA
| | - J R Evans
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - F Dykes
- Emory University Department of Pediatrics and Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - K M Reber
- Nationwide Children's Hospital and the Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, USA
| | - M A Padula
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E K Pallotto
- Children's Hospitals Mercy and Clinics and the Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA
| | - B L Short
- Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA
| | - A M Mathur
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| |
Collapse
|
44
|
Abstract
OBJECTIVE To quantify the variation in induction of labor (IOL) over the days of the week for gravid women in the United States. STUDY DESIGN Women who delivered singletons between 24 and 42 weeks' gestation were identified using birth certificate data from 2007 to 2010. Women with pregnancy-associated hypertension, fetal anomalies, previous cesarean delivery, or incomplete records were excluded. The primary outcome was IOL. Women were stratified into four gestational age groups: < 34, 34 to 36, 37 to 38, and ≥ 39 weeks. Frequencies of IOL were determined according to day of the week. Multivariable logistic regression estimated the association between weekend delivery and IOL, adjusting for maternal characteristics and year of delivery. RESULTS There were 11.6 million eligible women. For each gestational age stratum, the frequency of IOL was increased on weekdays compared with weekends (8.0 vs. 7.4%, 16.5 vs. 13.2%, 25.0 vs. 14.8%, and 33.2 vs. 19.3% at < 34, 34-36, 37-38, and ≥ 39 weeks, respectively; p < 0.01 for all). Multivariable analyses demonstrated that weekend IOL was inversely related to gestational age (odds ratios: 0.93, 0.77, 0.52, and 0.48, respectively; p < 0.001 for all). CONCLUSION The frequency of IOL varies according to the day of the week, with the odds of weekend IOL lowest at greater gestational ages.
Collapse
Affiliation(s)
- Gustave H Falciglia
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Prentice Women's Hospital-Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| |
Collapse
|
45
|
Tolia VN, Murthy K, McKinley PS, Bennett MM, Clark RH. The effect of the national shortage of vitamin A on death or chronic lung disease in extremely low-birth-weight infants. JAMA Pediatr 2014; 168:1039-44. [PMID: 25222512 DOI: 10.1001/jamapediatrics.2014.1353] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 11/14/2022]
Abstract
IMPORTANCE Prophylactic vitamin A supplementation has been shown to reduce the incidence of chronic lung disease or death in extremely low-birth-weight infants. Beginning in 2010, a national shortage reduced the supply of vitamin A available. OBJECTIVE To estimate the association between vitamin A supplementation and death or chronic lung disease in the context of the recent drug shortage. Intercenter variability in vitamin A use was assessed secondarily. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 7925 infants with birth weights between 401 and 1000 g who were cared for in US neonatal intensive care units managed by the Pediatrix Medical Group. Infants were discharged between January 1, 2010, and June 30, 2012, and data were collected from the Pediatrix Clinical Data Warehouse. Infants who had major congenital anomalies, died during the first 3 days of life, or had missing data were excluded from the analysis. EXPOSURES Vitamin A supplementation. MAIN OUTCOMES AND MEASURES The primary outcome was either death before hospital discharge or chronic lung disease, defined as receiving any respiratory support at 36 weeks' corrected gestational age. RESULTS Of the 6210 eligible infants, 3011 (48.5%) experienced the primary outcome. Those who received vitamin A were more immature and more likely to receive mechanical ventilation during the first 3 days of life. During the study period, vitamin A supplementation significantly decreased (27.2% to 2.1%); however, the primary outcome was similar (48.4% to 49.5%; P = .40). Vitamin A was unrelated to death or chronic lung disease in unadjusted or multivariable analyses (relative risk [RR], 0.97; 95% CI, 0.91-1.03; P = .32) when demographic and clinical information were considered. After classifying centers by vitamin A use, the center of birth was significantly associated with the outcome, with birth in low- and medium-use centers related to a reduced likelihood of death or chronic lung disease. CONCLUSIONS AND RELEVANCE The occurrence of death or chronic lung disease appears unaffected by the recent shortage of vitamin A. However, the center of birth appears to be an important risk factor for these infants' outcomes.
Collapse
Affiliation(s)
- Veeral N Tolia
- Pediatrix Medical Group, Baylor Health Care System, Dallas, Texas
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Monica M Bennett
- Department of Quantitative Sciences, Baylor Health Care System, Dallas, Texas
| | - Reese H Clark
- Pediatrix Medical Group, Greenville Memorial Hospital, Greenville, South Carolina7Center for Research, Education, and Quality, Pediatrix Medical Group, Sunrise, Florida
| |
Collapse
|
46
|
Abstract
OBJECTIVE The aim of this study is to assess the influence of parenteral nutrition (PN) on the time to regain birth weight in premature neonates born between 1,500 and 2,499 g. STUDY DESIGN A retrospective analysis stratified premature neonates born between 1,500 and 2,499 g by receipt of PN or intravenous dextrose at ≤ 72 hours of age. The primary outcome was the time to regain birth weight. Secondary measures included preterm-associated morbidities, time to achieve predefined enteral nutrition milestones, and length of stay. Multivariable regression estimated associations between PN and time to achieve nutrition milestones. RESULTS Among 260 eligible neonates, those receiving PN (53%) were less mature, weighed less at birth, had a higher index of illness severity, and higher prevalence of preterm-associated morbidities (p < 0.01). The time to regain birth weight (PN, 9.4 ± 3.5 d; no PN, 9.5 ± 3.4 d) was similar between groups. Regression analysis adjusting for gestational age, illness severity, and sepsis demonstrated that PN exposure was associated with a greater time to achieve nutrition milestones and length of stay (p < 0.05). CONCLUSION Although its impact on growth remains uncertain among premature neonates born between 1,500 and 2,499 g, PN was independently associated with a greater time to achieve nutrition milestones.
Collapse
Affiliation(s)
- Daniel T Robinson
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Shreya Shah
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karna Murthy
- Division of Neonatology, Department of Pediatrics, Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| |
Collapse
|
47
|
Grover TR, Brozanski BS, Barry J, Zaniletti I, Asselin JM, Durand DJ, Short BL, Pallotto EK, Dykes F, Reber KM, Padula MA, Evans JR, Murthy K. High surgical burden for infants with severe chronic lung disease (sCLD). J Pediatr Surg 2014; 49:1202-5. [PMID: 25092076 DOI: 10.1016/j.jpedsurg.2014.02.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 02/21/2014] [Accepted: 02/21/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Infants with severe chronic lung disease (sCLD) may require surgical procedures to manage their medical problems; however, the scope of these interventions is undefined. The purpose of this study was to characterize the frequency, type, and timing of operative interventions performed in hospitalized infants with sCLD. METHODS The Children's Hospital Neonatal Database was used to identify infants with sCLD from 24 children's hospital's NICUs hospitalized over a recent 16-month period. RESULTS 556 infants were diagnosed with sCLD; less than 3% of infants had operations prior to referral and 30% were referred for surgical evaluation. In contrast, 71% of all sCLD infants received ≥1 surgical procedure during the CHND NICU hospitalization, with a mean of 3 operations performed per infant. Gastrostomy insertion (24%), fundoplication (11%), herniorrhaphy (13%), and tracheostomy placement (12%) were the most commonly performed operations. The timing of gastrostomy (PMA 48±10 wk) and tracheostomy (PMA 47±7 wk) insertions varied, and for infants who received both devices, only 33% were inserted concurrently (13/40 infants). CONCLUSIONS A striking majority of infants with sCLD received multiple surgical procedures during hospitalizations at participating NICUs. Further work regarding the timing, coordination, perioperative complications, and clinical outcomes for these infants is warranted.
Collapse
Affiliation(s)
- Theresa R Grover
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Beverly S Brozanski
- University of Pittsburgh School of Medicine and the Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - James Barry
- University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | | | - David J Durand
- Children's Hospital Oakland & Research Center, Oakland, CA
| | - Billie L Short
- George Washington University School of Medicine and Children's National Medical Center, Washington, DC
| | - Eugenia K Pallotto
- University of Missouri School of Medicine and Children's Mercy Hospital, Kansas City, MO
| | | | - Kristina M Reber
- Ohio State University School of Medicine and Nationwide Children's Hospital, Columbus, OH
| | - Michael A Padula
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jacquelyn R Evans
- Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Karna Murthy
- Feinberg School of Medicine, Northwestern University & the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| |
Collapse
|
48
|
Murthy K, Dykes FD, Padula MA, Pallotto EK, Reber KM, Durand DJ, Short BL, Asselin JM, Zaniletti I, Evans JR. The Children's Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care. J Perinatol 2014; 34:582-6. [PMID: 24603454 DOI: 10.1038/jp.2014.26] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [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: 10/04/2013] [Revised: 12/10/2013] [Accepted: 01/13/2014] [Indexed: 02/03/2023]
Abstract
The Children's Hospitals Neonatal Consortium is a multicenter collaboration of leaders from 27 regional neonatal intensive care units (NICUs) who partnered with the Children's Hospital Association to develop the Children's Hospitals Neonatal Database (CHND), launched in 2010. The purpose of this report is to provide a first summary of the population of infants cared for in these NICUs, including representative diagnoses and short-term outcomes, as well as to characterize the participating NICUs and institutions. During the first 2 1/2 years of data collection, 40910 infants were eligible. Few were born inside these hospitals (2.8%) and the median gestational age at birth was 36 weeks. Surgical intervention (32%) was common; however, mortality (5.6%) was infrequent. Initial queries into diagnosis-specific inter-center variation in care practices and short-term outcomes, including length of stay, showed striking differences. The CHND provides a contemporary, national benchmark of short-term outcomes for infants with uncommon neonatal illnesses. These data will be valuable in counseling families and for conducting observational studies, clinical trials and collaborative quality improvement initiatives.
Collapse
Affiliation(s)
- K Murthy
- Ann & Robert H Lurie Children's Hospital of Chicago, Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA
| | - F D Dykes
- Children's Healthcare of Atlanta at Egleston and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - M A Padula
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - E K Pallotto
- Children's Mercy Hospital and Clinics and the Department of Pediatrics, University of Missouri School of Medicine, Kansas City, MO, USA
| | - K M Reber
- Nationwide Children's Hospital and the Department of Pediatrics, Ohio State University School of Medicine, Columbus, OH, USA
| | - D J Durand
- Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA
| | - B L Short
- Children's National Medical Center and the Department of Pediatrics, George Washington University School of Medicine, Washington DC, USA
| | - J M Asselin
- Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA
| | - I Zaniletti
- Children's Hospital Association, Overland Park, KS, USA
| | - J R Evans
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
49
|
Murthy K, Savani RC, Lagatta JM, Zaniletti I, Wadhawan R, Truog W, Grover TR, Zhang H, Asselin JM, Durand DJ, Short BL, Pallotto EK, Padula MA, Dykes FD, Reber KM, Evans JR. Predicting death or tracheostomy placement in infants with severe bronchopulmonary dysplasia. J Perinatol 2014; 34:543-8. [PMID: 24651732 DOI: 10.1038/jp.2014.35] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 10/21/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To estimate the risk of death or tracheostomy placement (D/T) in infants with severe bronchopulmonary dysplasia (sBPD) born < 32 weeks' gestation referred to regional neonatal intensive care units. STUDY DESIGN We conducted a retrospective cohort study in infants born < 32 weeks' gestation with sBPD in 2010-2011, using the Children's Hospital Neonatal Database. sBPD was defined as the need for FiO2 ⩾ 0.3, nasal cannula support >2 l min(-1) or positive pressure at 36 weeks' post menstrual age. The primary outcome was D/T before discharge. Predictors associated with D/T in bivariable analyses (P < 0.2) were used to develop a multivariable logistic regression equation using 80% of the cohort. This equation was validated in the remaining 20% of infants. RESULT Of 793 eligible patients, the mean gestational age was 26 weeks' and the median age at referral was 6.4 weeks. D/T occurred in 20% of infants. Multivariable analysis showed that later gestational age at birth, later age at referral along with pulmonary management as the primary reason for referral, mechanical ventilation at the time of referral, clinically diagnosed pulmonary hypertension, systemic corticosteroids after referral and occurrence of a bloodstream infection after referral were each associated with D/T. The model performed well with validation (area under curve 0.86, goodness-of-fit χ(2), P = 0.66). CONCLUSION Seven clinical variables predicted D/T in this large, contemporary cohort with sBPD. These results can be used to inform clinicians who counsel families of affected infants and to assist in the design of future prospective trials.
Collapse
Affiliation(s)
- K Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University and the Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - R C Savani
- Department of Pediatrics, University of Texas Southwestern Medical Center and the Children's Medical Center of Dallas, Dallas, TX, USA
| | - J M Lagatta
- Department of Pediatrics, Medical College of Wisconsin and the Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - I Zaniletti
- Department of Analytics, Children's Hospital Association, Overland Park, KS, USA
| | - R Wadhawan
- Department of Pediatrics, University of Central Florida and the Florida Hospital for Children, Orlando, FL, USA
| | - W Truog
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine and the Children's Mercy Hospitals & Clinics, Kansas, MO, USA
| | - T R Grover
- University of Colorado School of Medicine and the Colorado Children's Hospital, Aurora, CO, USA
| | - H Zhang
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J M Asselin
- Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA
| | - D J Durand
- Department of Pediatrics, Children's Hospital Oakland & Research Center, Oakland, CA, USA
| | - B L Short
- Department of Pediatrics, George Washington University School of Medicine and Children's National Medical Center, Washington, DC, USA
| | - E K Pallotto
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine and the Children's Mercy Hospitals & Clinics, Kansas, MO, USA
| | - M A Padula
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - F D Dykes
- Department of Pediatrics, Emory University School of Medicine and the Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - K M Reber
- Department of Pediatrics and Center for Perinatal Research, The Ohio State University College of Medicine and the Nationwide Children's Hospital, Columbus, OH, USA
| | - J R Evans
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
50
|
Natarajan G, Johnson YR, Brozanski B, Farrow KN, Zaniletti I, Padula MA, Asselin JM, Durand DJ, Short BL, Pallotto EK, Dykes FD, Reber KM, Evans JR, Murthy K. Postnatal weight gain in preterm infants with severe bronchopulmonary dysplasia. Am J Perinatol 2014; 31:223-30. [PMID: 23690052 PMCID: PMC4451086 DOI: 10.1055/s-0033-1345264] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To characterize postnatal growth failure (PGF), defined as weight < 10th percentile for postmenstrual age (PMA) in preterm (≤ 27 weeks' gestation) infants with severe bronchopulmonary dysplasia (sBPD) at specified time points during hospitalization, and to compare these in subgroups of infants who died/underwent tracheostomy and others. STUDY DESIGN Retrospective review of data from the multicenter Children's Hospital Neonatal Database (CHND). RESULTS Our cohort (n = 375) had a mean ± standard deviation gestation of 25 ± 1.2 weeks and birth weight of 744 ± 196 g. At birth, 20% of infants were small for gestational age (SGA); age at referral to the CHND neonatal intensive care unit (NICU) was 46 ± 50 days. PGF rates at admission and at 36, 40, 44, and 48 weeks' PMA were 33, 53, 67, 66, and 79% of infants, respectively. Tube feedings were administered to > 70% and parenteral nutrition to a third of infants between 36 and 44 weeks' PMA. At discharge, 34% of infants required tube feedings and 50% had PGF. A significantly greater (38 versus 17%) proportion of infants who died/underwent tracheostomy (n = 69) were SGA, compared with those who did not (n = 306; p < 0.01). CONCLUSIONS Infants with sBPD commonly had progressive PGF during their NICU hospitalization. Fetal growth restriction may be a marker of adverse outcomes in this population.
Collapse
Affiliation(s)
- Girija Natarajan
- Department of Pediatrics, Wayne State University, Children’s Hospital of Michigan, Detroit, Michigan
| | - Yvette R. Johnson
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | - Beverly Brozanski
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathryn N. Farrow
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Michael A. Padula
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David J. Durand
- Children’s Hospital Oakland and Research Center, Oakland, California
| | - Billie L. Short
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
| | - Eugenia K. Pallotto
- Department of Pediatrics, University of Missouri School of Medicine, Kansas City, Missouri
| | - Francine D. Dykes
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kristina M. Reber
- Department of Pediatrics and Center for Perinatal Research, Division of Neonatology; Columbus, Ohio
| | - Jacquelyn R. Evans
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karna Murthy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | |
Collapse
|