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Sewell E, Cohen S, Zaniletti I, Couture D, Dereddy N, Coghill CH, Flanders TM, Foy A, Heuer GG, Jano E, Kemble N, Lee S, Ling CY, Malaeb S, Mietzsch U, Ocal E, Padula MA, Welch CD, White B, Wilson D, Flibotte J. Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327084. [PMID: 38697810 DOI: 10.1136/archdischild-2024-327084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH). DESIGN Cohort study of the Children's Hospitals Neonatal Database from 2010 to 2022. SETTING 41 referral neonatal intensive care units (NICUs) in North America. PATIENTS Infants born before 32 weeks' gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage. INTERVENTIONS (1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS). MAIN OUTCOME MEASURES Mortality and meningitis. RESULTS Of 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving ventricular access device placement differed by centre, ranging from 4% to 79% (p<0.001). Median chronological and postmenstrual age at time of TD placement were similar between infants with only TD and those with TD-PS. Infants with TD-PS were older and larger than those with only PS at time of PS placement. Death before NICU discharge occurred in 12% of infants, usually due to redirection of care. Meningitis occurred in 11% of the cohort. CONCLUSIONS There was significant intercentre variation in rate of intervention, which may reflect variability in care or referral patterns. Rate of PS placement in infants with TDs was 66%.
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Affiliation(s)
- Elizabeth Sewell
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Susan Cohen
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Dan Couture
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Narendra Dereddy
- AdventHealth for Children, Orlando, Florida, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Carl H Coghill
- Children's of Alabama, Birmingham, Alabama, USA
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Tracy M Flanders
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Foy
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Gregory G Heuer
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eni Jano
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nicole Kemble
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Lee
- University of Iowa Health Care, Iowa City, Iowa, USA
| | - Con Yee Ling
- The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Shadi Malaeb
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ulrike Mietzsch
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eylem Ocal
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael A Padula
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cherrie D Welch
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Diane Wilson
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Flibotte
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Padula MA, Naing K, Wenger TL, Ahmad I, Coghill CH, Wild KT, Rottgers SA, Resnick CM, Goldstein J, Ehsan Z, Watkins D, Deptula N, Lai KC, Lioy J, Gogcu S, Cielo CM. Spectrum of Disease in Hospitalized Newborns with Congenital Micrognathia: A Cohort of 3,236 Infants at North American Tertiary-Care Intensive Care Units. J Pediatr 2024; 265:113799. [PMID: 37879601 PMCID: PMC10872910 DOI: 10.1016/j.jpeds.2023.113799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/15/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To describe the spectrum of disease and burden of care in infants with congenital micrognathia from a multicenter cohort hospitalized at tertiary care centers. STUDY DESIGN The Children's Hospitals Neonatal Database was queried from 2010 through 2020 for infants diagnosed with micrognathia. Demographics, presence of genetic syndromes, and cleft status were summarized. Outcomes included death, length of hospitalization, neonatal surgery, and feeding and respiratory support at discharge. RESULTS Analysis included 3,236 infants with congenital micrognathia. Cleft palate was identified in 1266 (39.1%). A genetic syndrome associated with micrognathia was diagnosed during the neonatal hospitalization in 256 (7.9%). Median (IQR) length of hospitalization was 35 (16, 63) days. Death during the hospitalization (n = 228, 6.8%) was associated with absence of cleft palate (4.4%, P < .001) and maternal Black race (11.6%, P < .001). During the neonatal hospitalization, 1289 (39.7%) underwent surgery to correct airway obstruction and 1059 (32.7%) underwent gastrostomy tube placement. At the time of discharge, 1035 (40.3%) were exclusively feeding orally. There was significant variability between centers related to length of stay and presence of a feeding tube at discharge (P < .001 for both). CONCLUSIONS Infants hospitalized with congenital micrognathia have a significant burden of disease, commonly receive surgical intervention, and most often require tube feedings at hospital discharge. We identified disparities based on race and among centers. Development of evidence-based guidelines could improve neonatal care.
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Affiliation(s)
- Michael A Padula
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Khatija Naing
- School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Tara L Wenger
- Division of Genetic Medicine, University of Washington, Seattle, WA
| | - Irfan Ahmad
- Division of Neonatology, Children's Hospital of Orange County, Orange, CA
| | - Carl H Coghill
- Division of Neonatology, Children's of Alabama, Birmingham, AL
| | - K Taylor Wild
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - S Alex Rottgers
- Division of Plastic & Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Cory M Resnick
- Department of Plastic & Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Jeffrey Goldstein
- Department of Plastic & Reconstructive Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Zarmina Ehsan
- Section of Pulmonary and Sleep Medicine, Children's Mercy Hospital, Kansas City, MO
| | - Donna Watkins
- Division of Neonatology, Riley Hospital for Children IU Health Physicians, Indianapolis, IN
| | - Nicole Deptula
- Division of Newborn Medicine, Washington University School of Medicine, St. Louis, MO
| | - Kuan-Chi Lai
- Division of Neonatology, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Janet Lioy
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Semsa Gogcu
- Division of Neonatology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Christopher M Cielo
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
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3
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Resnick CM, Rottgers SA, Wright JM, Vyas RM, Goldstein JA, Swanson JW, Padula MA, Coghill CH, Ahmad I, Molter DW, Menezes MD, Naing KW, Cielo CM. Surgical outcome and treatment trends in 1289 infants with micrognathia: a multicenter cohort. Plast Reconstr Surg 2023:00006534-990000000-01863. [PMID: 37184511 DOI: 10.1097/prs.0000000000010639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Studies of infants with micrognathia, especially Robin Sequence (RS), are limited by its rarity and both phenotypic and diagnostic variability. Most knowledge of this condition is sourced from small, single-institution samples. METHODS This is a cross-sectional study including infants with micrognathia admitted to 38 Children's Hospital Neonatal Consortium centers from 2010-2020. Predictor variables included demographic data, birth characteristics, cleft and syndrome status. Outcome variables included length of stay (LOS), death, feeding or respiratory support, and secondary airway operations. RESULTS 1289 infants with micrognathia had a surgery to correct upper airway obstruction. Mean age and weight at operation were 34.8±1.8 weeks and 3515.4±42 grams, respectively. A syndromic diagnosis was made in 150 (11.6%) patients, with Stickler (5.4%) and Treacher Collins Syndromes (2.2%) most common. Operations included: mandibular distraction osteogenesis (MDO), 66.3%; tracheostomy, 25.4%; and tongue-lip adhesion (TLA), 8.3%. Tracheostomy patients had a lower birth weight, head circumference, gestational age, and APGAR scores. MDO patients were less likely to need a second airway operation compared to TLA patients (3.5%vs17.8%,p<0.001). The proportion of infants feeding exclusively orally at hospital discharge differed significantly, from most to least: MDO, TLA, tracheostomy. Hospital LOS was not statistically different for patients that had MDO and TLA, but was longer for those with primary tracheostomy. Mortality was low for all operations (0.5%). CONCLUSION In this 1289 surgical patient cohort, MDO was associated with shorter hospital stay, improved oral feeding, and lower rates of secondary airway operations. Prospective multi-center studies are necessary to support these conclusions.
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Affiliation(s)
- Cory M Resnick
- Department of Plastic & Oral Surgery, Boston Children's Hospital; Boston, MA
| | - S Alex Rottgers
- Division of Plastic & Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL
| | - Joshua M Wright
- Division of Plastic & Reconstructive Surgery, Johns Hopkins All Children's Hospital; St. Petersburg, FL
| | - Raj M Vyas
- Department of Aesthetic & Plastic Surgery, University of California Irvine; Orange, CA
| | - Jeffrey A Goldstein
- Department of Plastic & Reconstructive Surgery, Children's Mercy Hospital; Kansas City, MO
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia; Philadelphia, PA
| | - Michael A Padula
- Department of Plastic & Oral Surgery, Boston Children's Hospital; Boston, MA
| | - Carl H Coghill
- Division of Neonatology, Children's of Alabama; Birmingham, AL
| | - Irfan Ahmad
- Division of Neonatology, Children's Hospital of Orange County; Orange, CA
| | - David W Molter
- Department of Otolaryngology, St. Louis Children's Hospital; St. Louis, MO
| | | | - Khatija W Naing
- School of Public Health, University of Illinois Chicago; Chicago, IL
| | - Christopher M Cielo
- Division of Pulmonary and Sleep Medicine, Children's Hospital of Philadelphia; Philadelphia, PA
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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.
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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
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Villagomez AN, Muñoz FM, Peterson RL, Colbert AM, Gladstone M, MacDonald B, Wilson R, Fairlie L, Gerner GJ, Patterson J, Boghossian NS, Burton VJ, Cortés M, Katikaneni LD, Larson JCG, Angulo AS, Joshi J, Nesin M, Padula MA, Kochhar S, Connery AK. Neurodevelopmental delay: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2020; 37:7623-7641. [PMID: 31783983 PMCID: PMC6899448 DOI: 10.1016/j.vaccine.2019.05.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/09/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Adrienne N Villagomez
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Flor M Muñoz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Robin L Peterson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Alison M Colbert
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Rebecca Wilson
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Gwendolyn J Gerner
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jackie Patterson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nansi S Boghossian
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Vera Joanna Burton
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Jennifer C G Larson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Abigail S Angulo
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA
| | - Jyoti Joshi
- Center for Disease Dynamics Economics & Policy, Amity Institute of Public Health, Amity University, India
| | - Mirjana Nesin
- Division of Microbiology and Infectious Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michael A Padula
- Children's Hospital of Philadelphia, Department of Pediatrics, Philadelphia, PA, USA
| | - Sonali Kochhar
- Global Healthcare Consulting, India; University of Washington, Seattle, USA; Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amy K Connery
- University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital of Colorado, Aurora, CO, USA.
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Ekhaguere OA, Padula MA, Jensen EA. Use of Point-of-Care Gastric pH Testing to Assess the Efficacy of Acid Suppression Therapy in the Neonatal Intensive Care Unit. Am J Perinatol 2020; 37:415-420. [PMID: 30780184 DOI: 10.1055/s-0039-1679917] [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: 10/27/2022]
Abstract
OBJECTIVE The use of acid suppression therapies in newborns lacks efficacy and is associated with adverse effects. Point-of-care (POC) assessment of gastric aspirate pH may provide an objective, noninvasive measure of gastric acidity in tube fed infants. We conducted the present study to characterize the POC gastric pH levels in gastric tube fed infants before and after initiation of enteral omeprazole or ranitidine. STUDY DESIGN Retrospective cohort study of infants with gastric aspirate pH levels determined by POC pH strips. Gastric pH levels recorded during 7 days before and 14 days after medication initiation were compared using Wilcoxon's sign-rank tests. RESULTS Among 307 evaluated infants, 284 (92%) had a median gastric pH level ≥4 in 7 days prior to ranitidine or omeprazole. In 14 days after medication initiation, the median gastric pH of infants with pretreatment median gastric pH < 4 increased to 4.5 and 5 (p < 0.01) in the ranitidine and omeprazole groups, respectively. There was no change in infants with pretreatment median gastric pH ≥4. CONCLUSION Among infants receiving gastric tube feedings and enteral omeprazole or ranitidine, only those with a pretreatment gastric pH level <4 demonstrated a significant increase in gastric pH. Validation of our findings against esophageal pH multichannel intraluminal impedance testing is needed.
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Affiliation(s)
- Osayame A Ekhaguere
- Division of Neonatology, Department of Pediatrics, Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - Michael A Padula
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erik A Jensen
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
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7
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MESH Headings
- Administration, Inhalation
- Female
- Hernias, Diaphragmatic, Congenital/blood
- Hernias, Diaphragmatic, Congenital/drug therapy
- Humans
- Hypertension, Pulmonary/blood
- Hypertension, Pulmonary/congenital
- Hypertension, Pulmonary/drug therapy
- Infant, Newborn
- Infant, Newborn, Diseases/blood
- Infant, Newborn, Diseases/drug therapy
- Male
- Nitric Oxide/administration & dosage
- Platelet Count
- Retrospective Studies
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Affiliation(s)
- Christopher S Thom
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Devine
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stacey Kleinman
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erik A Jensen
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michele P Lambert
- Division of Hematology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael A Padula
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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8
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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.
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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
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9
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Zheng Q, Martin-Saavedra JS, Saade-Lemus S, Vossough A, Zuccoli G, Gonçalves FG, Freeman CW, Ouyang M, Singh V, Padula MA, Demauro SB, Flibotte J, Eichenwald EC, Detre JA, Sze RW, Huang H, Hwang M. Cerebral Pulsed Arterial Spin Labeling Perfusion Weighted Imaging Predicts Language and Motor Outcomes in Neonatal Hypoxic-Ischemic Encephalopathy. Front Pediatr 2020; 8:576489. [PMID: 33102411 PMCID: PMC7546822 DOI: 10.3389/fped.2020.576489] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 06/26/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022] Open
Abstract
Rationale and Objectives: To compare cerebral pulsed arterial spin labeling (PASL) perfusion among controls, hypoxic ischemic encephalopathy (HIE) neonates with normal conventional MRI(HIE/MRI⊕), and HIE neonates with abnormal conventional MRI(HIE/MRI⊖). To create a predictive machine learning model of neurodevelopmental outcomes using cerebral PASL perfusion. Materials and Methods: A total of 73 full-term neonates were evaluated. The cerebral perfusion values were compared by permutation test to identify brain regions with significant perfusion changes among 18 controls, 40 HIE/MRI⊖ patients, and 15 HIE/MRI⊕ patients. A machine learning model was developed to predict neurodevelopmental outcomes using the averaged perfusion in those identified brain regions. Results: Significantly decreased PASL perfusion in HIE/MRI⊖ group, when compared with controls, were found in the anterior corona radiata, caudate, superior frontal gyrus, precentral gyrus. Both significantly increased and decreased cerebral perfusion changes were detected in HIE/MRI⊕ group, when compared with HIE/MRI⊖ group. There were no significant perfusion differences in the cerebellum, brainstem and deep structures of thalamus, putamen, and globus pallidus among the three groups. The machine learning model demonstrated significant correlation (p < 0.05) in predicting language(r = 0.48) and motor(r = 0.57) outcomes in HIE/MRI⊖ patients, and predicting language(r = 0.76), and motor(r = 0.53) outcomes in an additional group combining HIE/MRI⊖ and HIE/MRI⊕. Conclusion: Perfusion MRI can play an essential role in detecting HIE regardless of findings on conventional MRI and predicting language and motor outcomes in HIE survivors. The perfusion changes may also reveal important insights into the reperfusion response and intrinsic autoregulatory mechanisms. Our results suggest that perfusion imaging may be a useful adjunct to conventional MRI in the evaluation of HIE in clinical practice.
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Affiliation(s)
| | | | | | - Arastoo Vossough
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - Giulio Zuccoli
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | | | | | - Minhui Ouyang
- Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Varun Singh
- Thomas Jefferson University, Philadelphia, PA, United States
| | - Michael A Padula
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - Sara B Demauro
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - John Flibotte
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - Eric C Eichenwald
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - John A Detre
- University of Pennsylvania, Philadelphia, PA, United States
| | - Raymond Wang Sze
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - Hao Huang
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
| | - Misun Hwang
- Children's Hospital of Philadelphia, Philadelphia, PA, United States.,University of Pennsylvania, Philadelphia, PA, United States
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10
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Costeloe K, Turner MA, Padula MA, Shah PS, Modi N, Soll R, Haumont D, Kusuda S, Göpel W, Chang YS, Smith PB, Lui K, Davis JM, Hudson LD. Sharing Data to Accelerate Medicine Development and Improve Neonatal Care: Data Standards and Harmonized Definitions. J Pediatr 2018; 203:437-441.e1. [PMID: 30293637 DOI: 10.1016/j.jpeds.2018.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Kate Costeloe
- Paediatric Research, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Mark A Turner
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
| | - Michael A Padula
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prakesh S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Lunenfeld Tannebaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Neena Modi
- Neonatal Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, United Kingdom
| | - Roger Soll
- Vermont Oxford Network, Neonatology, University of Vermont College of Medicine, Burlington, VT
| | - Dominique Haumont
- Department of Neonatology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Satoshi Kusuda
- Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Wolfgang Göpel
- Neonatology and Paediatric Intensive Care, University of Lübeck, Department of Paediatrics, Lübeck, Germany
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Kei Lui
- Discipline of Paediatrics, School of Women's and Children's Health, Sydney, New South Wales, Australia
| | - Jonathan M Davis
- Department of Paediatrics, Floating Hospital for Children, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
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11
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Tramper J, Zhang H, Foglia EE, Dysart KC, Padula MA, Sullivan KV, Jensen EA. The Association between Positive Tracheal Aspirate Cultures and Adverse Pulmonary Outcomes in Preterm Infants with Severe Bronchopulmonary Dysplasia. Am J Perinatol 2017; 34:96-104. [PMID: 27285471 DOI: 10.1055/s-0036-1584541] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective Bacterial colonization of the airway may contribute to the development of bronchopulmonary dysplasia. Whether airway colonization increases risk for later adverse respiratory outcomes is less clear. We described tracheal aspirate culture results obtained from preterm infants receiving mechanical ventilation at 36 weeks postmenstrual age (PMA) and evaluated the association between bacteria type and the risk for prolonged supplemental oxygen use. Study Design We conducted a retrospective, single-center cohort study comparing infants (1) with and without a tracheal aspirate culture that grew a Gram-negative rod (GNR) and (2) with and without a culture that grew a Gram-positive cocci (GPC). Results Among 121 infants, 65 (53.7%) and 51 (42.2%) had a tracheal aspirate culture that grew a potentially pathogenic GNR and GPC prior to 36 weeks PMA, respectively. GNR were associated with increased risk for death or use of supplemental oxygen at discharge (adjusted odds ratio [aOR], 6.2; 95% confidence interval [CI], 1.8-21.1), and use of supplemental oxygen at discharge among survivors (aOR, 5.5; 95% CI, 1.6-19.0). GPC did not affect the risk for any study outcomes. Conclusion GNR but not GPC in the airways of preterm infants receiving mechanical ventilation at 36 weeks PMA is associated with increased risk for prolonged supplemental oxygen use.
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Affiliation(s)
- Jacobus Tramper
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Huayan Zhang
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Elizabeth E Foglia
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kevin C Dysart
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Michael A Padula
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kaede V Sullivan
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Erik A Jensen
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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12
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Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, Pool V, Pourmalek F, Varricchio F, Kochhar S, Cutland CL. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6027-6037. [PMID: 27449077 PMCID: PMC5139812 DOI: 10.1016/j.vaccine.2016.03.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/20/2022]
Abstract
More than 40% of all deaths in children under 5 years of age occur during the neonatal period: the first month of life. Immunization of pregnant women has proven beneficial to both mother and infant by decreasing morbidity and mortality. With an increasing number of immunization trials being conducted in pregnant women, as well as roll-out of recommended vaccines to pregnant women, there is a need to clarify details of a neonatal death. This manuscript defines levels of certainty of a neonatal death, related to the viability of the neonate, who confirmed the death, and the timing of the death during the neonatal period and in relation to immunization of the mother.
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Affiliation(s)
- Jayani Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Flor M Muñoz
- Departments of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Niranjan Bhat
- Program for Appropriate Technology in Health (PATH), Seattle, USA
| | - Tara Harris
- Immunization and Vaccine Preventable Diseases, Public Health Ontario, Canada
| | - Ambujam Kapoor
- Immunization Technical Support Unit - Ministry of Health and Family Welfare, Public Health Foundation of India, New Delhi, India
| | - Daniel L Keene
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Michael A Padula
- Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania, USA
| | - Stephen L Pande
- Ministry of Health Uganda, Soroti Regional Referral Hospital, Uganda
| | | | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | | | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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13
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Pathirana J, Muñoz FM, Abbing-Karahagopian V, Bhat N, Harris T, Kapoor A, Keene DL, Mangili A, Padula MA, Pande SL, Pool V, Pourmalek F, Varricchio F, Kochhar S, Cutland CL. Neonatal death: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016. [PMID: 27449077 DOI: 10.1016/jzvaccine.2016.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
More than 40% of all deaths in children under 5 years of age occur during the neonatal period: the first month of life. Immunization of pregnant women has proven beneficial to both mother and infant by decreasing morbidity and mortality. With an increasing number of immunization trials being conducted in pregnant women, as well as roll-out of recommended vaccines to pregnant women, there is a need to clarify details of a neonatal death. This manuscript defines levels of certainty of a neonatal death, related to the viability of the neonate, who confirmed the death, and the timing of the death during the neonatal period and in relation to immunization of the mother.
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Affiliation(s)
- Jayani Pathirana
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Flor M Muñoz
- Departments of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | | | - Niranjan Bhat
- Program for Appropriate Technology in Health (PATH), Seattle, USA
| | - Tara Harris
- Immunization and Vaccine Preventable Diseases, Public Health Ontario, Canada
| | - Ambujam Kapoor
- Immunization Technical Support Unit - Ministry of Health and Family Welfare, Public Health Foundation of India, New Delhi, India
| | - Daniel L Keene
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | | | - Michael A Padula
- Division of Neonatology, The Children's Hospital of Philadelphia and University of Pennsylvania, USA
| | - Stephen L Pande
- Ministry of Health Uganda, Soroti Regional Referral Hospital, Uganda
| | | | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | | | - Clare L Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg, South Africa; Department of Science and Technology, National Research Foundation, Vaccine Preventable Diseases, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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14
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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.
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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
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15
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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.
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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
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16
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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.
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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
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17
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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.
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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
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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.
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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
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Abstract
Longitudinal observational clinical data on pediatric patients in electronic format is becoming widely available. A new era of multi-institutional data networks that study pediatric diseases and outcomes across disparate health delivery models and care settings are also enabling an innovative collaborative rapid improvement paradigm called the Learning Health System. However, the potential alignment of routine clinical care, observational clinical research, pragmatic clinical trials, and health systems improvement requires a data infrastructure capable of combining information from systems and workflows that historically have been isolated from each other. Removing barriers to integrating and reusing data collected in different settings will permit new opportunities to develop a more complete picture of a patient's care and to leverage data from related research studies. One key barrier is the lack of a common terminology that provides uniform definitions and descriptions of clinical observations and data. A well-characterized terminology ensures a common meaning and supports data reuse and integration. A common terminology allows studies to build upon previous findings and to reuse data collection tools and data management processes. We present the current state of terminology harmonization and describe a governance structure and mechanism for coordinating the development of a common pediatric research terminology that links to clinical terminologies and can be used to align existing terminologies. By reducing the barriers between clinical care and clinical research, a Learning Health System can leverage and reuse not only its own data resources but also broader extant data resources.
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Affiliation(s)
- Michael G. Kahn
- Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - L. Charles Bailey
- Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Christopher B. Forrest
- Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael A. Padula
- Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Steven Hirschfeld
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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20
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Padula MA, Grover TR, Brozanski B, Zaniletti I, Nelin LD, Asselin JM, Durand DJ, Short BL, Pallotto EK, Dykes FD, Reber KM, Evans JR, Murthy K. Therapeutic interventions and short-term outcomes for infants with severe bronchopulmonary dysplasia born at <32 weeks' gestation. J Perinatol 2013; 33:877-81. [PMID: 23828204 DOI: 10.1038/jp.2013.75] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 04/12/2013] [Accepted: 06/04/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the treatments and short-term outcomes in infants with severe bronchopulmonary dysplasia (sBPD) referred to regional neonatal intensive care units. STUDY DESIGN Infants born <32 weeks' gestation with sBPD were identified using the Children's Hospital Neonatal Database. Descriptive outcomes are reported. RESULT A total of 867 patients were eligible. On average, infants were born at 26 weeks' gestation and referred 43 days after birth. Infants frequently experienced lung injury (pneumonia: 24.1%; air leak: 9%) and received systemic corticosteroids (61%) and mechanical ventilation (median duration 37 days). Although 91% survived to discharge, the mean post-menstrual age was 47 weeks. Ongoing care such as supplemental oxygen (66%) and tracheostomy (5%) were frequently needed. CONCLUSION Referred infants with sBPD sustain multiple insults to lung function and development. Because affected infants have no proven, safe or efficacious therapy and endure an exceptional burden of care even after referral, urgent work is required to observe and improve their outcomes.
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Affiliation(s)
- M A Padula
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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21
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Srinivasan L, Shah SS, Padula MA, Abbasi S, McGowan KL, Harris MC. Cerebrospinal fluid reference ranges in term and preterm infants in the neonatal intensive care unit. J Pediatr 2012; 161:729-34. [PMID: 22575245 PMCID: PMC4593309 DOI: 10.1016/j.jpeds.2012.03.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [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: 09/30/2011] [Revised: 02/27/2012] [Accepted: 03/26/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine reference ranges of cerebrospinal fluid (CSF) laboratory findings in term and preterm infants in the neonatal intensive care unit. STUDY DESIGN Data were collected prospectively as part of a multisite study of infants aged <6 months undergoing lumbar puncture for evaluation of suspected sepsis. Infants with a red blood cell count >500 cells/μL or a known cause of CSF pleocytosis were excluded from the analysis. RESULTS A total of 318 infants met the inclusion criteria. Of these, 148 infants (47%) were preterm, and 229 (72%) received antibiotics before undergoing lumbar puncture. The upper reference limit of the CSF white blood cell (WBC) count was 12 cells/μL in preterm infants and 14 cells/μL in term infants. CSF protein levels were significantly higher in preterm infants (upper reference limit, 209 mg/dL vs 159 mg/dL in term infants; P < .001), and declined with advancing postnatal age in both groups (preterm, P = .008; term, P < .001). CSF glucose levels did not differ in term and preterm infants. Antibiotic exposure did not significantly affect CSF WBC, protein, or glucose values. CONCLUSIONS CSF WBC counts are not significantly different in preterm and term infants. CSF protein levels are higher and decline more slowly with postnatal age in preterm infants compared with term infants. This study provides CSF reference ranges for hospitalized preterm and term infants, particularly in the first month of life.
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Affiliation(s)
- Lakshmi Srinivasan
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
| | - Samir S. Shah
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael A. Padula
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Soraya Abbasi
- Division of Newborn Care, Pennsylvania Hospital, Philadelphia, PA
| | - Karin L. McGowan
- Department of Pathology and Laboratory Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Mary C. Harris
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
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Abstract
The observation of orthostatic hypotension in an index case of manganese toxicity lead to this prospective attempt to evaluate cardiovascular autonomic function and cognitive and emotional neurotoxicity in eight manganese alloy welders and machinists. The subjects consisted of a convenience sample consisting of an index case of manganese dementia, his four co-workers in a "frog shop" for gouging, welding, and grinding repair of high manganese railway track and a convenience sample of three mild steel welders with lesser manganese exposure also referred because of cognitive or autonomic symptoms. Frog shop air manganese samples 9.6-10 years before and 1.2-3.4 years after the diagnosis of the index case exceeded 1.0 mg/m3 in 29% and 0.2 mg/m3 in 62%. Twenty-four-hour electrocardiographic (Holter) monitoring was used to determine the temporal variability of the heartrate (RR' interval) and the rates of change at low frequency (0.04-0.15 Hz) and high frequency (0.15-0.40 Hz). MMPI and MCMI personality assessment and short-term memory, figure copy, controlled oral word association, and symbol digit tests were used. The five frog shop workers had abnormal sympathovagal balance with decreased high frequency variability (increased ln LF/ln HF). Seven of the eight workers had symptoms of autonomic dysfunction and significantly decreased heart rate variability (rMSSD) but these did not distinguish the relative exposure. Mood or affect was disturbed in all with associated changes in short-term memory and attention in four of the subjects. There were no significant correlations with serum or urine manganese. Power spectrum analysis of 24-h ambulatory ECG indicating a decrease in parasympathetic high frequency activation of heart rate variability may provide a sensitive index of central autonomic dysfunction reflecting increased exposure to manganese, although the contribution of exposures to solvents and other metals cannot be excluded. Neurotoxicity due to the gouging, welding, and grinding of mild steel and high manganese alloys (11-25%) merits air manganese and neuropsychologic surveillance including autonomic function by Holter monitoring of cardiovagal activation.
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Affiliation(s)
- W W Barrington
- University of Nebraska Medical Center, Omaha 68198-6055, USA
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Affiliation(s)
- Xiaoxin Qiao
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - Michael A. Padula
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - Douglas M. Ho
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - Nancy J. Vogelaar
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - Clarence E. Schutt
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
| | - Robert A. Pascal
- Contribution from the Department of Chemistry, Princeton University, Princeton, New Jersey 08544
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