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Afifi J, Leijser LM, de Vries LS, Shah PS, Mitra S, Brouwer MJ, Walling S, McNeely PD. Variability in the diagnostic and management practices of post-hemorrhagic ventricular dilatation in very preterm infants across Canadian centers and comparison with European practices. J Neonatal Perinatal Med 2022; 15:721-729. [PMID: 36463462 DOI: 10.3233/npm-221071] [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] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To investigate the variability in diagnostic and therapeutic approaches to posthemorrhagic ventricular dilatation (PHVD) among Canadian neonatal centers, and secondary exploration of differences in approaches between Canadian and European practices. METHODS We conducted a survey among Canadian tertiary neonatal centers on their local practices for managing very preterm infants with PHVD. The survey covered questions on the diagnostic criteria, timing and type of interventions and resources utilization (transfer to neurosurgical sites and neurodevelopmental follow-up). In a secondary exploration, Canadian responses were compared with responses to the same survey from European centers. RESULTS 23/30 Canadian centers (77%) completed the survey. There was no consensus among Canadian centers on the criteria used for diagnosing PHVD or to initiate intervention. The therapeutic interventions also vary, both for temporizing procedures or permanent shunting. Compared to European practices, the Canadian approach relied less on the sole use of ultrasound criteria for diagnosing PHVD (43 vs 94%, p < 0.0001) or timing intervention (26 vs 63%, p = 0.007). Majority of European centers intervened early in the development of PHVD based on ultrasound parameters, whereas Canadian centers intervened based on clinical hydrocephalus, with fewer centers performing serial lumbar punctures prior to neurosurgical procedures (40 vs 81%, p = 0.003). CONCLUSION Considerable variability exists in diagnosis and management of PHVD in preterm infants among Canadian tertiary centers and between Canadian and European practices. Given the potential implications of the inter-center practice variability on the short- and long-term outcomes of preterm infants with PHVD, efforts towards evidence-based Canada-wide practice standardization are underway.
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Affiliation(s)
- J Afifi
- Department of Pediatrics, Neonatal Perinatal Medicine, Dalhousie University, Halifax, Canada
| | - L M Leijser
- Department of Pediatrics, Division of Neonatology, University of Calgary, Calgary, Canada
| | - L S de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - S Mitra
- Department of Pediatrics, Neonatal Perinatal Medicine, Dalhousie University, Halifax, Canada
| | - M J Brouwer
- Department of Neonatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Walling
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - P D McNeely
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Canada
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2
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El-Rabbany M, Blanas N, Sutherland S, Shah PS, Lam DK, Azarpazhooh A. Development and evaluation of the clinimetric properties of the Medication-Related Osteonecrosis of the Jaw Quality of Life Questionnaire (MRONJ-QoL). Int J Oral Maxillofac Surg 2021; 51:768-775. [PMID: 34924268 DOI: 10.1016/j.ijom.2021.11.007] [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] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to develop a self-administered questionnaire (MRONJ-QoL) to assess the quality of life (QoL) of patients with medication-related osteonecrosis of the jaw (MRONJ). A prospective study was performed to develop and evaluate the questionnaire. The MRONJ-QoL was formulated through a review of the literature and interviews of experts and patients. Following development, it was administered to 60 patients with a diagnosis of MRONJ. The sensibility of the questionnaire was assessed by evaluating feasibility (via interviews of patients), face validity (via interviews of patients and experts), and content validity (via evaluation of internal consistency, floor/ceiling effects, and factor analysis). Reliability was evaluated by measuring intra-rater reliability. Construct validity of the questionnaire was evaluated by both cross-sectional and longitudinal comparisons, including comparing scores of the MRONJ-QoL to disease resolution at 6 months. The final MRONJ-QoL questionnaire consisted of 14 questions, demonstrating high internal consistency (Cronbach's alpha of 0.85) and good reliability (weighted kappa score of 0.65). At the 6-month follow-up, disease resolution was found to be significantly associated with improved MRONJ-QoL scores, suggesting validity of the questionnaire (P < 0.01). Therefore, this is a sensible, reliable, and valid questionnaire for evaluating the QoL of patients with MRONJ.
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Affiliation(s)
- M El-Rabbany
- Florida Craniofacial Institute, Tampa, Florida, USA
| | - N Blanas
- Department of Dentistry, Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - S Sutherland
- Department of Dentistry, Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Institute of Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - D K Lam
- Department of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Stony Brook, New York, USA; Department of Surgery, Stony Brook School of Medicine, Stony Brook, New York, USA; Stony Brook Cancer Center, Stony Brook, New York, USA
| | - A Azarpazhooh
- Department of Dentistry, University of Toronto, Toronto, Ontario, Canada; Divisions of Endodontics and Research, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
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3
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Baczynski M, Kharrat A, Zhu F, Ye XY, Shah PS, Weisz DE, Jain A. Factors associated with antibiotic administration delay among preterm infants with late-onset bloodstream infection. J Hosp Infect 2021; 120:31-35. [PMID: 34800611 DOI: 10.1016/j.jhin.2021.09.026] [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] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/25/2022]
Abstract
Early antibiotic administration is an important modifiable factor in reducing mortality from late-onset bloodstream infections in preterm infants. In a cohort study including 142 infants with non-coagulase negative staphylococcus bloodstream infection at two tertiary neonatal intensive care units, we identified typical practice-related factors that may be targeted to prevent delays in antibiotic administration. Collection of cerebrospinal fluid or urine sample before administering antibiotics, a longer time taken to site a peripheral intravenous catheter among those without pre-existing access, and a longer time taken to administer fluid boluses were associated with a longer than median time to antibiotic administration.
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Affiliation(s)
- M Baczynski
- Department of Respiratory Therapy, Mount Sinai Hospital, Toronto, ON, Canada
| | - A Kharrat
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - F Zhu
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - X Y Ye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - P S Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - D E Weisz
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Newborn and Developmental Paediatrics, Sunnybrook Health Science Center, Toronto, ON, Canada
| | - A Jain
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada.
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4
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Alagarasu K, Patil JA, Kakade MB, More AM, Yogesh B, Newase P, Jadhav SM, Parashar D, Kaur H, Gupta N, Vijay N, Narayan J, Shah PS. Serotype and genotype diversity of dengue viruses circulating in India: a multi-centre retrospective study involving the Virus Research Diagnostic Laboratory Network in 2018. Int J Infect Dis 2021; 111:242-252. [PMID: 34428547 DOI: 10.1016/j.ijid.2021.08.045] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES A retrospective study was undertaken to investigate the circulating dengue virus (DENV) serotypes and genotypes in India in 2018. METHODS In total, 4963 samples referred to virus research diagnostic laboratories (n=21), the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV) and ICMR-NIV field units (n=2) for diagnosis of dengue in 2018 were tested using a real-time reverse transcription polymerase chain reaction assay for the presence of DENV serotypes. Representative samples were sequenced for the envelope (E) gene. RESULTS Regional diversity was observed with regard to the dominant circulating serotypes. DENV-2 was found to be the most common serotype in many states. Thrombocytopenia, petechiae and malaise were associated with DENV-2 infection. Phylogenetic analyses of DENV E gene sequences revealed the circulation of genotypes I and V of DENV-1, two lineages of DENV-2 genotype IV, DENV-3 genotype III and DENV-4 genotype I. CONCLUSIONS This study found regional differences in the prevalence of circulating DENV serotypes in India, and provides baseline data for continuous molecular surveillance. Molecular surveillance may have implications for predicting large-scale outbreaks of dengue if regional shifts in the predominantly circulating serotypes and genotypes are detected during the early phase of the dengue season.
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Affiliation(s)
- K Alagarasu
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India.
| | - J A Patil
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M B Kakade
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - A M More
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - B Yogesh
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - P Newase
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - S M Jadhav
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - D Parashar
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - H Kaur
- Virology Unit, Indian Council of Medical Research, New Delhi, India
| | - N Gupta
- Virology Unit, Indian Council of Medical Research, New Delhi, India
| | - N Vijay
- Virology Unit, Indian Council of Medical Research, New Delhi, India
| | - J Narayan
- Virology Unit, Indian Council of Medical Research, New Delhi, India
| | - P S Shah
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
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5
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Alagarasu K, Kakade MB, Bachal RV, Bote M, Parashar D, Shah PS. Use of whole blood over plasma enhances the detection of dengue virus RNA: possible utility in dengue vaccine trials. Arch Virol 2020; 166:587-591. [PMID: 33245437 DOI: 10.1007/s00705-020-04892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/04/2020] [Indexed: 11/26/2022]
Abstract
In the present study, the utility of viral RNA isolated from whole blood over plasma for detection of dengue virus (DENV) was investigated in 80 samples referred for serotyping by DENV serotype-specific one-step real-time RT-PCR. DENV RNA was detected in 71.25% of the whole blood samples compared to 46.25% in the corresponding plasma samples. In secondary infections, DENV RNA was detected in 83.3% of whole blood samples, while it was detected in 40.5% of plasma samples (P = 0.0001). Non-structural protein 1 (NS1) antigen was detected in only 54.8% of the secondary infections. The detection rate of DENV RNA in whole blood is higher than in plasma. We suggest that one-step real-time RT-PCR using RNA from whole blood combined with an NS1 ELISA should be the choice for dengue diagnosis in dengue vaccine trials.
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Affiliation(s)
- K Alagarasu
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India.
| | - M B Kakade
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India
| | - R V Bachal
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India
| | - M Bote
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India
| | - D Parashar
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India
| | - P S Shah
- Dengue and Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, 411001, India
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Melamed N, Murphy K, Barrett J, Asztalos E, McDonald SD, Yoon EW, Shah PS. Benefit of antenatal corticosteroids by year of birth among preterm infants in Canada during 2003-2017: a population-based cohort study. BJOG 2020; 128:521-531. [PMID: 32936996 DOI: 10.1111/1471-0528.16511] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the changes in the associations of antenatal corticosteroids (ACS) with neonatal mortality and severe neurological injury over time (2003-17). DESIGN National, population-representative, retrospective cohort study. SETTING Level III neonatal intensive care units participating in the Canadian Neonatal Network. POPULATION All infants born at 230/7 -336/7 weeks of gestation (n = 43 456). METHODS We estimated the associations between exposure to ACS and neonatal outcomes by year of birth. Year of birth was considered both continuously and categorically as three consecutive epochs. MAIN OUTCOME MEASURE Neonatal mortality and severe neurological injury. RESULTS The absolute rates of neonatal mortality and severe neurological injury decreased during the study period in both the ACS and No ACS groups. For infants born at 230/7 -306/7 weeks of gestation, ACS was associated with similar reductions in neonatal mortality across the three epochs (9.0% versus 18.1%, adjusted relative risk [aRR] 0.54, 95% CI 0.47-0.61 in 2003-09; 7.6% versus 19.6%, aRR 0.51, 95% CI 0.44-0.59 in 2010-13; and 7.3% versus 14.5%, aRR 0.56, 95% CI 0.46-0.68 in 2014-17) and in severe neurological injury (13.2% versus 25.8%, aRR 0.57, 95% CI 0.50-0.64 in 2003-09; 7.4% versus 17.4%, aRR 0.53, 95% CI 0.43-0.66 in 2010-14; and 7.2% versus 14.8%, aRR 0.59, 95% CI 0.48-0.74 in 2014-17). CONCLUSION Despite the ongoing improvements in neonatal care of preterm infants, as reflected by the gradual decrease in the absolute rates of neonatal mortality and severe neurological injury, the association of ACS treatment with neonatal mortality and severe neurological injury among extremely preterm infants born at 23-30 weeks of gestation has remained stable throughout the study period of 15 years. TWEETABLE ABSTRACT Despite the gradual decrease in the rates of neonatal mortality and severe neurological injury, antenatal corticosteroids remain an important intervention in the current era of neonatal care.
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Affiliation(s)
- N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - K Murphy
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - E Asztalos
- Department of Newborn & Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - S D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynaecology, Radiology, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - E W Yoon
- Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - P S Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, ON, Canada
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Kakade MB, Shrivastava N, Patil JA, Parashar D, Shah PS, Alagarasu K. Clinical evaluation of an in-house-developed real-time RT-PCR assay for serotyping of dengue virus. Arch Virol 2020; 165:2311-2315. [PMID: 32638115 DOI: 10.1007/s00705-020-04725-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Abstract
In the present study, an in-house-developed real-time RT-PCR (rRT-PCR) for serotyping of dengue virus (DENV) was evaluated for its performance, using 612 clinical samples. Compared to the composite reference standard, the in-house-developed rRT-PCR had an overall sensitivity of 97.5% and a specificity of 100%. The assay had a sensitivity of 100%, 95.6%. 96.9% and 100% for detecting DENV-1, DENV-2, DENV-3 and DENV-4, respectively. We recommend periodic evaluation of real-time RT-PCR assays for detecting DENV serotypes with a large number of samples and the use of at least two assays that target different regions of DENV genomes.
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Affiliation(s)
- M B Kakade
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India
| | - N Shrivastava
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India
| | - J A Patil
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India
| | - D Parashar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India
| | - P S Shah
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India
| | - K Alagarasu
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, 411001, Maharashtra, India.
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8
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Xu EH, Claveau M, Yoon EW, Barrington KJ, Mohammad K, Shah PS, Wintermark P. Neonates with hypoxic-ischemic encephalopathy treated with hypothermia: Observations in a large Canadian population and determinants of death and/or brain injury. J Neonatal Perinatal Med 2020; 13:449-458. [PMID: 32310192 DOI: 10.3233/npm-190368] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Birth asphyxia in term neonates remains a serious condition that causes significant mortality and long-term neurodevelopmental sequelae despite hypothermia treatment. The objective of this study was to review therapeutic hypothermia practices in a large population of neonates with hypoxic-ischemic encephalopathy (HIE) across Canada and to identify determinants of adverse outcome. METHODS Our retrospective observational cohort study examined neonates≥36 weeks, admitted to the Canadian Neonatal Network NICUs between 2010 and 2014, diagnosed with HIE, and treated with hypothermia. Adverse outcome was defined as death and/or brain injury. Maternal, birth, and postnatal characteristics were compared between neonates with adverse outcome and those without. The association between the variables which were significantly different (p < 0.05) between the two groups and adverse outcome were further tested, while adjusting for gestational age, birth weight, gender, and initial severity of encephalopathy. RESULTS A total of 2187 neonates were admitted for HIE; 52% were treated with hypothermia and 40% developed adverse outcome. Initial severity of encephalopathy (moderate, p = 0.006; severe, p < 0.0001), hypotension treated with inotropes (p = 0.001), and renal failure (p = 0.007) were significantly associated with an increased risk of death and/or brain injury. CONCLUSIONS In asphyxiated neonates treated with hypothermia, not only their initial severity of encephalopathy on admission, but also their cardiac and renal complications during the first days after birth were significantly associated with risk of death and/or brain injury. Careful monitoring and cautious management of these complications is warranted.
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Affiliation(s)
- E H Xu
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - M Claveau
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
| | - E W Yoon
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K J Barrington
- Department of Pediatrics, Division of Neonate Medicine, University of Montreal, Montreal, Québec, Canada
| | - K Mohammad
- Department of Pediatrics, Division of Neonatology, University of Calgary, Calgary, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - P Wintermark
- Department of Pediatrics, Division of Newborn Medicine, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada
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9
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Alagarasu K, Patil JA, Kakade MB, More AM, Bote M, Chowdhury D, Seervi M, Rajesh NT, Ashok M, Anukumar B, Abraham AM, Parashar D, Shah PS. Spatio-temporal distribution analysis of circulating genotypes of dengue virus type 1 in western and southern states of India by a one-step real-time RT-PCR assay. Infect Genet Evol 2019; 75:103989. [PMID: 31376506 PMCID: PMC6832813 DOI: 10.1016/j.meegid.2019.103989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/19/2022]
Abstract
Dengue virus type 1 (DENV-1) Asian and American/African (AM/AF) genotypes were reported to be co-circulating in southern and western states of India based on envelope (E) gene sequencing of few representative samples. The objective of the present study was to develop a one-step real-time RT-PCR to discriminate between Asian and AM/AF genotypes of DENV-1 and investigate the spatio-temporal distribution of the DENV-1 genotypes in southern and western states of India. A one-step real-time RT-PCR to discriminate the Asian and AM/AF genotypes of DENV-1 was developed and validated using 40 samples (17 Asian and 23 AM/AF), for which the envelope (E) gene sequence data was available. DENV-2, DENV-3 and DENV-4 isolates, one each and DENV negative samples (n = 17) were also tested by the assay. Additional 296 samples positive for DENV-1 from selected Southern and Western states of India were genotyped using the real-time RT-PCR assay. Among the samples used for validation, the genotyping results were concordant with sequencing results for 39 samples. In the one discordant sample which was positive for AM/AF by sequencing, the genotyping assay tested positive for both Asian and AM/AF genotype. DENV-2, DENV-3 and DENV-4 isolates were not reactive in the assay. None of the DENV negative samples were positive (sensitivity 100% and specificity 98.2%). A total of 336 samples (40 samples with sequence data and 296 samples without sequence data) were used for spatio-temporal distribution analysis. The results revealed that the Asian genotype was the predominant genotype in Tamil Nadu and Kerala, the southern states. The AM/AF genotype was the predominant genotype in Maharashtra, a western state of India. In Nashik district of Maharashtra, Asian genotype was observed in 32.6% of DENV-1 samples during 2017 while the same decreased to 7.3% during 2018. In Pune district, Asian genotype was observed in 40.0% of DENV-1 samples during 2018 only. To conclude, a one step real-time RT-PCR has been developed for discriminating Asian and AM/AF genotypes of DENV-1. This assay can act as a complement to sequencing but not a substitute and can be utilized in resource limited settings for molecular surveillance of DENV-1. DENV-1 Asian genotype was the dominant genotype in South India while, AM/AF genotype was dominant in Western India.
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Affiliation(s)
- K Alagarasu
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India.
| | - J A Patil
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M B Kakade
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - A M More
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M Bote
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - D Chowdhury
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M Seervi
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - N T Rajesh
- PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - M Ashok
- ICMR-National Institute of Virology, Bangalore Field Unit, Bengaluru, Karnataka, India
| | - B Anukumar
- ICMR-National Institute of Virology, Kerala Field Unit, Alappuzha, Kerala, India
| | - A M Abraham
- Christian Medical College, Vellore, Tamil Nadu, India
| | - D Parashar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - P S Shah
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
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Sudeep AB, Shil P, Charmode MM, Mohandas S, Bansod S, Gokhale MD, Jagtap M, Shah PS. Involvement of dual serotypes during a severe dengue outbreak in Wadi area, Nagpur district, Maharashtra 2017. J Vector Borne Dis 2019; 56:295-302. [PMID: 33269728 DOI: 10.4103/0972-9062.302031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES An outbreak of dengue-like illness was reported from Wadi area within the Nagpur Municipal Corporation during September-October 2017 with five deaths. Major symptoms reported were high fever (103-106 oF), acute joint pains, myalgia, drowsiness, breathlessness, etc. An investigation was conducted to confirm the etiological agent, its characterization and the vectors involved in the outbreak. METHODS Serological analysis was conducted to detect dengue (DEN)/chikungunya IgM antibodies in 158 sera samples. Nested-PCR was carried out to serotype eight ELISA positive samples. Adult and larval mosquito collections were conducted in the affected areas to determine species composition and mosquito density. RESULTS Dengue IgM antibodies were detected in 44 sera samples. Molecular typing revealed involvement of DEN-2 and DEN-3 serotypes. Dengue hemorrhagic fever symptoms were observed in two patients. Aedes aegypti breeding was found rampant with Breteu index and house index ranging from 23 to 70 and 17 to 56, respectively. Major breeding habitats encountered were, used tyres, cement tanks and refrigerator trays. INTERPRETATION & CONCLUSION Clinical symptoms, detection of anti-DEN IgM antibodies in high number of samples and heavy breeding of Ae. aegypti confirmed it was a dengue outbreak.
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Affiliation(s)
- A B Sudeep
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - P Shil
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M M Charmode
- District Malaria Officer, Malaria Department, Nagpur Division, Nagpur, Maharashtra, India
| | - S Mohandas
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - S Bansod
- District Medical Officer, Vyahad PHC, Wadi, Nagpur, Maharashtra, India
| | - M D Gokhale
- ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - M Jagtap
- State Entomologist, Maharashtra, India
| | - P S Shah
- ICMR-National Institute of Virology, Pune, Maharashtra, India
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Patil JA, Alagarasu K, Kakade MB, More AM, Gadekar KA, Jadhav SM, Parashar D, Shah PS. Emergence of dengue virus type 1 and type 3 as dominant serotypes during 2017 in Pune and Nashik regions of Maharashtra, Western India. Infect Genet Evol 2018; 66:272-283. [PMID: 30366083 DOI: 10.1016/j.meegid.2018.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/05/2018] [Accepted: 10/22/2018] [Indexed: 10/28/2022]
Abstract
India witnessed dengue outbreaks during 2017 in different parts with more than 180000 cases. There is no data on the serotypes/genotypes of dengue virus (DENV) associated with the 2017 outbreak season. The present study investigated DENV circulating in Pune and Nashik regions of Maharashtra, Western India at molecular level. IgM negative samples that were collected before 6th post onset days of illness were tested for DENV RNA and serotyped by real time RT-PCR based methods. Representative samples of each serotype were processed for virus isolation and envelope (E) gene sequencing. Among the 472 samples tested for DENV serotypes from Nashik, DENV-1 was observed in 36.2%, DENV-2 in 12.9%, DENV-3 in 35.4%, DENV-4 in 8.0%, and multiple serotypes in 7.4% of the samples respectively. In Pune region, among the 109 samples tested for DENV serotypes, DENV-1 was observed in 27.5%, DENV-2 in 11.0%, DENV-3 in 52.3%, DENV-4 in 4.6%, and multiple serotypes in 4.6% of the samples respectively. Comparison of serotype distribution from 2009 to 2017 from the Pune region revealed the emergence of DENV-3 as the dominant serotype followed by DENV-1 in 2017. In the Nashik region, both DENV-1 and DENV-3 were predominant in 2017. Phylogenetic analyses revealed co-circulation of American African (AM/AF) and Asian genotypes of DENV-1. DENV-1 Asian genotype was detected for the first time in the region. No genotype changes were observed for DENV-2 (cosmopolitan genotype), DENV-3 (genotype III) and DENV-4 (genotype I). For DENV-3, a unique amino acid substitution (I380T) was observed in the domain III of E protein of 2017 isolates and was not observed in earlier DENV-3 genotype III isolates. To conclude, the results suggest the emergence of DENV-1 with circulation of both Asian and AM/AF genotypes and DENV-3 with unique amino acid substitutions in Pune and Nashik regions. The study underscores the need for continuous molecular monitoring at a large scale to detect the changes in DENV serotypes/genotypes that might have implications for earlier prediction of dengue outbreaks and designing dengue vaccines and predicting its efficacy.
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Affiliation(s)
- J A Patil
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - K Alagarasu
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India.
| | - M B Kakade
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - A M More
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - K A Gadekar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - S M Jadhav
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - D Parashar
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
| | - P S Shah
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune 411001, India
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12
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Wilson A, Vento M, Shah PS, Saugstad O, Finer N, Rich W, Morton RL, Rabi Y, Tarnow-Mordi W, Suzuki K, Wright IM, Oei JL. A review of international clinical practice guidelines for the use of oxygen in the delivery room resuscitation of preterm infants. Acta Paediatr 2018; 107:20-27. [PMID: 28792628 DOI: 10.1111/apa.14012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/06/2017] [Revised: 06/05/2017] [Accepted: 08/03/2017] [Indexed: 01/20/2023]
Abstract
AIM To collate and assess international clinical practice guidelines (CPG) to determine current recommendations guiding oxygen management for respiratory stabilisation of preterm infants at delivery. METHODS A search of public databases using the terms 'clinical practice guidelines', 'preterm', 'oxygen' and 'resuscitation' was made and complemented by direct query to consensus groups, resuscitation expert committees and clinicians. Data were extracted to include the three criteria for assessment: country of origin, gestation and initial FiO2 and target SpO2 for the first 10 minutes of life. RESULTS A total of 45 CPGs were identified: 36 provided gestation specific recommendations (<28 to <37 weeks) while eight distinguished only between 'preterm' and 'term'. The most frequently recommended initial FiO2 were between 0.21 and 0.3 (n = 17). Most countries suggested altering FiO2 to meet SpO2 targets recommended by expert committees, However, specific five-minute SpO2 targets differed by up to 20% (70-90%) between guidelines. Five countries did not specify SpO2 targets. CONCLUSION CPG recommendations for delivery room oxygen management of preterm infants vary greatly, particularly in regard to gestational ages, initial FiO2 and SpO2 targets and most acknowledge the lack of evidence behind these recommendations. Sufficiently large and well-designed randomised studies are needed to inform on this important practice.
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Affiliation(s)
- A Wilson
- Department of Newborn Care; the Royal Hospital for Women; Randwick NSW Australia
| | - M Vento
- Division of Neonatology; University and Polytechnic Hospital La Fe; Valencia Spain
| | - PS Shah
- Department of Pediatrics; Mount Sinai Hospital and University of Toronto; Toronto ON Canada
| | - O Saugstad
- Department of Pediatric Research; the University of Oslo; Oslo University Hospital; Oslo Norway
| | - N Finer
- University of California; San Diego CA USA
| | - W Rich
- University of California; San Diego CA USA
| | - RL Morton
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
| | - Y Rabi
- University of Calgary; Calgary AB Canada
- Alberta Children's Hospital Research Institute; Calgary AB Canada
| | - W Tarnow-Mordi
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
| | - K Suzuki
- Department of Pediatrics; Tokai University School of Medicine; Isehara Kanagawa Japan
| | - IM Wright
- Illawarra Health and Medical Research Institute and Graduate Medicine; The University of Wollongong; Wollongong NSW Australia
| | - JL Oei
- Department of Newborn Care; the Royal Hospital for Women; Randwick NSW Australia
- NHMRC Clinical Trials Centre; University of Sydney; Camperdown NSW Australia
- School of Women's and Children's Health; the University of New South Wales; Kensington NSW Australia
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13
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Razak A, Florendo-Chin A, Banfield L, Abdul Wahab MG, McDonald S, Shah PS, Mukerji A. Pregnancy-induced hypertension and neonatal outcomes: a systematic review and meta-analysis. J Perinatol 2018; 38:46-53. [PMID: 29095432 DOI: 10.1038/jp.2017.162] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/08/2017] [Accepted: 08/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pregnancy-induced hypertension (PIH) is associated with preterm delivery but its independent impact on neonatal outcomes remains unclear. We sought to systematically review and meta-analyze clinical outcomes of preterm infants <37 weeks' gestation born to mothers with and without PIH. STUDY DESIGN Medline, Embase, PsychINFO and CINAHL were searched from January 2000 to October 2016. Studies with low-moderate risk of bias reporting neonatal outcomes based on PIH as primary exposure variable were included. Data were extracted independently by two co-authors. RESULTS PIH was associated with lower mortality (3 studies; adjusted odds ratio (aOR) 0.65; 95% confidence interval (CI) 0.54 to 0.79), lower severe retinopathy of prematurity (ROP) (2 studies; aOR 0.83; 0.72 to 0.96) and lower severe brain injury (2 studies; unadjusted OR (uOR) 0.57; 0.49 to 0.66). No association between PIH and short-term respiratory outcomes, bronchopulmonary dysplasia (BPD) or necrotizing enterocolitis (NEC) was identified. In subgroup analysis among infants <29 weeks' gestation, BPD odds were higher (3 studies; aOR 1.15; 1.06 to 1.26), whereas mortality lower (2 studies; aOR 0.73; 0.69 to 0.77). In subgroup analysis limited to severe PIH, odds of mortality (3 studies; uOR 2.36; 1.07 to 5.22) and invasive ventilation (3 studies; uOR 3.26; 1.11 to 9.61) were higher. In subgroup analysis limited to preeclampsia, odds of BPD (3 studies; uOR 1.21; 95% CI:1.03 to 1.43) and NEC were higher (3 studies; uOR 2.79; 95% CI:1.57 to 4.96). CONCLUSION PIH was associated with reduced odds of mortality and ROP (all infants), but higher odds for BPD (<29 weeks' gestation). The paradoxical reduction in mortality may be due to survival bias and deserves further exploration in future studies.
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Affiliation(s)
- A Razak
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - A Florendo-Chin
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- Faculty of Health Science, Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - M G Abdul Wahab
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - S McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - P S Shah
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - A Mukerji
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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14
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Soraisham AS, Rabi Y, Shah PS, Singhal N, Synnes A, Yang J, Lee SK, Lodha AK, Lodha AK. Neurodevelopmental outcomes of preterm infants resuscitated with different oxygen concentration at birth. J Perinatol 2017; 37:1141-1147. [PMID: 28594395 DOI: 10.1038/jp.2017.83] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 01/05/2017] [Revised: 04/20/2017] [Accepted: 05/04/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the neurodevelopmental outcomes at 18 to 21 months corrected age (CA) of infants born at <29 weeks that received room air, an intermediate oxygen concentration or 100% oxygen at the initiation of resuscitation. STUDY DESIGN In this retrospective cohort study, we compared neonatal and neurodevelopmental outcomes at 18 to 21 months CA among inborn infants born before 29 weeks' gestation that received room air, intermediate oxygen concentration or 100% oxygen at the initiation of resuscitation. RESULTS Of 1509 infants, 445 received room air, 483 received intermediate oxygen concentrations and 581 received 100% oxygen. Compared to infants that received room air, the primary outcome of death or neurodevelopmental impairment (NDI) was not different in intermediate oxygen (adjusted odds ratio (aOR) 1.01; 95% confidence interval (CI) 0.77, 1.34) or 100% oxygen (aOR 1.03; 95% CI 0.78, 1.35). Compared to room air, there was no difference in odds of death or severe NDI in intermediate oxygen (aOR 1.14; 95% CI 0.82, 1.58) or 100% oxygen group (aOR 1.22; 95% CI 0.90, 1.67). The odds of severe NDI among survivors were significantly higher in infants that received 100% oxygen as compared to room air (aOR 1.57, 95% CI 1.05, 2.35). CONCLUSIONS We observed no significant difference in the primary composite outcomes of death or NDI and death or severe NDI at 18 to 21 months CA between infants that received room air, intermediate oxygen concentration or 100% oxygen at the initiation of resuscitation. However, use of 100% oxygen was associated with increased odds of severe NDI among survivors as compared to room air.
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Affiliation(s)
- A S Soraisham
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Foothills Medical Centre, Calgary, AB, Canada
| | - Y Rabi
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Foothills Medical Centre, Calgary, AB, Canada
| | - P S Shah
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - N Singhal
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Foothills Medical Centre, Calgary, AB, Canada
| | - A Synnes
- Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - J Yang
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - S K Lee
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada
| | - A K Lodha
- Department of Paediatrics, Section of Neonatal Perinatal Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Foothills Medical Centre, Calgary, AB, Canada
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15
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Kelly LE, Shah PS, Håkansson S, Kusuda S, Adams M, Lee SK, Sjörs G, Vento M, Rusconi F, Lehtonen L, Reichman B, Darlow BA, Lui K, Feliciano LS, Gagliardi L, Bassler D, Modi N. Perinatal health services organization for preterm births: a multinational comparison. J Perinatol 2017; 37:762-768. [PMID: 28383541 DOI: 10.1038/jp.2017.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo). STUDY DESIGN We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK. RESULTS All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified. CONCLUSIONS Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.
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Affiliation(s)
- L E Kelly
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - S Håkansson
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
| | - M Adams
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, 700 University Avenue, Toronto, ON, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON, Canada
| | - G Sjörs
- Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden
| | - M Vento
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - F Rusconi
- Unit of Epidemiology, TIN Toscane Online, Meyer Children's University Hospital, Regional Health Agency, Florence, Italy
| | - L Lehtonen
- Department of Pediatrics, Finnish Medical Birth Register and Register of Congenital Malformations, Turku University Hospital, Kiinamyllynkatu 4-8, Turku, Finland
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - B A Darlow
- Department of Paediatrics, Australia and New Zealand Neonatal Network, University of Otago, Christchurch, New Zealand
| | - K Lui
- National Perinatal Epidemiology and Statistic Unit, Australian and New Zealand Neonatal Network, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - L S Feliciano
- Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
| | - L Gagliardi
- Division of Pediatrics and Neonatology, Ospedale Versilia, Viareggio, Italy
| | - D Bassler
- Department of Neonatology, Swiss Neonatal Network, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, Switzerland, Switzerland
| | - N Modi
- Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, UK Neonatal Collaborative, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
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16
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Jarde A, Lutsiv O, Park CK, Beyene J, Dodd JM, Barrett J, Shah PS, Cook JL, Saito S, Biringer AB, Sabatino L, Giglia L, Han Z, Staub K, Mundle W, Chamberlain J, McDonald SD. Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis. BJOG 2017; 124:1176-1189. [PMID: 28276151 DOI: 10.1111/1471-0528.14624] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it. OBJECTIVES To compare progesterone, cerclage and pessary, determine their relative effects and rank them. SEARCH STRATEGY We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews. SELECTION CRITERIA We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study. DATA COLLECTION AND ANALYSIS We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT). MAIN RESULTS We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks. CONCLUSIONS Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae. TWEETABLE ABSTRACT Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.
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Affiliation(s)
- A Jarde
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - O Lutsiv
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
| | - C K Park
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J Beyene
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J M Dodd
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
| | - J Barrett
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - P S Shah
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - J L Cook
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON, Canada.,Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, ON, Canada
| | - S Saito
- Department of Obstetrics and Gynaecology, University of Toyama, Toyama, Japan
| | - A B Biringer
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - L Sabatino
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - L Giglia
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Z Han
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - K Staub
- Canadian Premature Babies Foundation, Sherwood Park, AB, Canada
| | - W Mundle
- Maternal Fetal Medicine Clinic, Windsor Regional Hospital, Windsor, ON, Canada
| | - J Chamberlain
- Save the Mothers, Uganda Christian University, Mukono, Uganda
| | - S D McDonald
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada
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17
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Shah PS, Deoshatwar A, Karad S, Mhaske S, Singh A, Bachal RV, Alagarasu K, Padbidri VS, Cecilia D. Seroprevalence of dengue in a rural and an urbanized village: A pilot study from rural western India. J Vector Borne Dis 2017; 54:172-176. [PMID: 28748839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND & OBJECTIVES Dengue is highly prevalent in tropical and subtropical regions. The prevalence of dengue is influenced by number of factors, i.e. host, vector, virus and environmental conditions including urbanization and population density. A cross sectional study was undertaken to determine the seroprevalence of dengue in two selected villages that differed in the level of their urbanization and population density. METHODS Two villages with demographically well-defined populations close to Pune, a metropolitan city of western India, were selected for the study. Age stratified serosurvey was carried out during February to May 2011 in the two villages-a rural village A, located 6 km from the national highway with a population density of 159/km2 ; and an urbanized village B, located along the highway with a population density of 779/km2 . Assuming a low seroposi- tivity of 10%, 702 serum samples were collected from village A. Sample size for village B was calculated on the basis of seropositivity obtained in village A, and 153 samples were collected. Serum samples were tested for the presence of dengue virus (DENV)-specific IgG. Simple proportional analyses were used to calculate and compare the seroprevalence. RESULTS Of the 702 samples collected from village A, 42.8% were found positive for anti-DENV IgG. A significantly higher seropositivity for DENV (58.8%) was found in village B. In village A, there was an age dependent increase in seroprevalence; whereas, in village B, there was a steep increase from 17% positivity in 0-10 yr age group to 72% in the 11-20 yr age group. The seroprevalence was almost similar in the older age groups. INTERPRETATION & CONCLUSION The observations suggested that prevalence of dengue is probably associated with urbanization and host population density. Areas that are in the process of urbanization needs to be monitored for prevalence of dengue and its vector, and appropriate vector control measures may be implemented.
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Affiliation(s)
- P S Shah
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
| | - A Deoshatwar
- Epidemiology Group, ICMR-National Institute of Virology, Pune, India
| | - S Karad
- Vadu Rural Health Program, Pune, India
| | - S Mhaske
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
| | - A Singh
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
| | - R V Bachal
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
| | - K Alagarasu
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
| | | | - D Cecilia
- Dengue/Chikungunya Group, ICMR-National Institute of Virology, Pune, India
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18
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Jarde A, Lutsiv O, Park CK, Barrett J, Beyene J, Saito S, Dodd JM, Shah PS, Cook JL, Biringer AB, Giglia L, Han Z, Staub K, Mundle W, Vera C, Sabatino L, Liyanage SK, McDonald SD. Preterm birth prevention in twin pregnancies with progesterone, pessary, or cerclage: a systematic review and meta-analysis. BJOG 2017; 124:1163-1173. [DOI: 10.1111/1471-0528.14513] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- A Jarde
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - O Lutsiv
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - CK Park
- Department of Clinical Epidemiology and Biostatistics; McMaster University Hamilton, ON Canada
| | - J Barrett
- Sunnybrook Health Sciences Centre; Toronto ON Canada
| | - J Beyene
- Department of Clinical Epidemiology and Biostatistics; McMaster University Hamilton, ON Canada
| | - S Saito
- Department of Obstetrics and Gynecology; University of Toyama; Toyama Japan
| | - JM Dodd
- Department of Obstetrics and Gynecology; University of Adelaide; Adelaide Australia
| | - PS Shah
- Department of Paediatrics; University of Toronto; Toronto ON Canada
| | - JL Cook
- The Society of Obstetricians and Gynaecologists of Canada; Ottawa ON Canada
| | - AB Biringer
- Department of Family and Community Medicine; University of Toronto; Toronto ON Canada
| | - L Giglia
- Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - Z Han
- The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an Shaanxi Province China
| | - K Staub
- Canadian Premature Babies Foundation; Sherwood Park AB Canada
| | - W Mundle
- Maternal Fetal Medicine Clinic; Windsor Regional Hospital; Windsor ON Canada
| | - C Vera
- Division of Obstetrics and Gynecology; Escuela de Medicina; Pontificia Universidad Católica de Chile; Santiago Chile
| | - L Sabatino
- Midwifery Education Program; McMaster University; Hamilton ON Canada
| | - SK Liyanage
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
| | - SD McDonald
- Department of Obstetrics and Gynecology; McMaster University; Hamilton ON Canada
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19
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Gemmell L, Martin L, Murphy KE, Modi N, Håkansson S, Reichman B, Lui K, Kusuda S, Sjörs G, Mirea L, Darlow BA, Mori R, Lee SK, Shah PS, Shah PS. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation. J Perinatol 2016; 36:1067-1072. [PMID: 27583388 DOI: 10.1038/jp.2016.133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.
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Affiliation(s)
- L Gemmell
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - L Martin
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - N Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - S Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - K Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - G Sjörs
- Swedish Neonatal Quality Register, Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - L Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B A Darlow
- Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - R Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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20
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Olivier F, Bertelle V, Shah PS, Drolet C, Piedboeuf B, Piedboeuf B. Association between birth route and late-onset sepsis in very preterm neonates. J Perinatol 2016; 36:1083-1087. [PMID: 27583393 DOI: 10.1038/jp.2016.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 05/01/2016] [Revised: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates. STUDY DESIGN In this observational study, data from 20,038 infants born between 22 and 32 weeks' gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression. RESULTS A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32). CONCLUSION Birth route did not have an impact on LOS, but was associated with CONS-related LOS.
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Affiliation(s)
- F Olivier
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
| | - V Bertelle
- Department of Pediatrics, Université de Sherbrooke, Hôpital Fleurimont, Sherbrooke, Québec, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital, Maternal-Infant Care Research Centre, Toronto, Ontario, Canada
| | - C Drolet
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
| | - B Piedboeuf
- Department of Pediatrics, Université Laval, CHU de Québec, Québec, Québec, Canada
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21
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Afifi J, Vincer M, Shah V, Ye XY, Shah PS, Barrington K, Kelly E, Piedboeuf B, El-Naggar W. Can We Predict Post-Hemorrhagic Ventricular Dilatation in Preterm Infants with Severe Intraventricular Hemorrhage? Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e51a] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: The incidence of post-hemorrhagic ventricular dilatation (PHVD) remains high in preterm infants. Little is known about the risk factors for PHVD in infants with severe intraventricular hemorrhage (IVH).
OBJECTIVES: To determine the predictors of PHVD among preterm infants with severe IVH.
DESIGN/METHODS: We conducted a retrospective review of all pre-term infants (22+0 - 32+6 weeks) who were admitted to NICUs participating in the Canadian Neonatal Network between 2010 and 2014. Infants with severe IVH (IVH with ventricular dilatation or parenchymal bleeding) who survived ≥ 72 hours were included. Perinatal and neonatal risk factors were compared between infants with and without PHVD (lateral ventricles >10 mm).
RESULTS: Of 16600 eligible infants, 1964 (11.8%) developed severe IVH. Of 1815 infants with severe IVH who survived ≥72 hours, 616 (34%) developed PHVD. Factors associated with occurrence of PHVD include: lower gestational age, small for gestational age, low 5 minute Apgar score, SNAPII score>20, surfactant therapy, high frequency oscillatory ventilation (HFOV), inotropes and occurrence of pneumothorax. [table 1]. There were no differences between both groups in relation to antenatal steroids, multiple pregnancy, mode of delivery, birth weight, gender or the proportion received prophylactic indomethacin. Multivariate analysis showed low five-minute Apgar score and HFOV to be independent predictors of PHVD while maternal magnesium sulfate and small for gestation (SGA) to be protective against PHVD.[table 2].
CONCLUSION: Our study identified factors involved in the prediction of PHVD in a national cohort of preterm infants. The mechanisms by which these factors may impact PHVD need further investigation.
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22
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Srinath BK, Shah J, Kumar P, Shah PS. Kangaroo care by fathers and mothers: comparison of physiological and stress responses in preterm infants. J Perinatol 2016; 36:401-4. [PMID: 26674998 DOI: 10.1038/jp.2015.196] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 09/29/2015] [Accepted: 11/05/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare physiological and biochemical responses in stable preterm neonates and their parents following kangaroo mother care (KMC) and kangaroo father care (KFC). STUDY DESIGN We conducted a prospective cross-over design study of stable preterm neonates of <35 weeks gestation in a tertiary Neonatal Unit in Toronto. All neonates received KMC and KFC for 1 h on consecutive days in a random order. Heart rate, temperature, blood pressure, oxygen saturation and salivary cortisol in infants before and after kangaroo care and heart rate, temperature and salivary cortisol in parents before and after kangaroo care were measured. Pairwise comparisons of changes in these measures were analyzed. RESULT Twenty-six sets of neonates and their parents were studied for physiological parameters, of which 19 had adequate samples for salivary cortisol assessment. The infants had a mean birth weight of 1096 g (s.d.=217) and a mean postmenstrual age at study of 32 weeks (s.d.=2). There were no significant differences in the changes in mean heart rate (P=0.51), temperature (P=0.37), oxygen saturation (P=0.50), systolic blood pressure (P=0.32), mean blood pressure (0.10) and salivary cortisol (P=0.50) before and after KMC or KFC in the neonates. The changes in mean heart rate (P=0.62), temperature (P=0.28) and salivary cortisol (P=0.59) before and after kangaroo care were similar between mothers and fathers. CONCLUSION No significant differences in physiological and stress responses were identified following KMC or KFC in preterm neonates. KFC may be as safe and as effective as KMC.
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Affiliation(s)
- B K Srinath
- NICU, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Shah
- NICU, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - P Kumar
- NICU, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P S Shah
- NICU, Department of Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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23
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Jiang S, Lyu Y, Ye XY, Monterrosa L, Shah PS, Lee SK. Intensity of delivery room resuscitation and neonatal outcomes in infants born at 33 to 36 weeks' gestation. J Perinatol 2016; 36:100-5. [PMID: 26540242 DOI: 10.1038/jp.2015.156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 06/29/2015] [Revised: 09/20/2015] [Accepted: 10/01/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine the relationship between delivery room resuscitation intensity and mortality, morbidities and resource use in late preterm infants. STUDY DESIGN Retrospective cohort study of inborn infants born at 33 to 36 weeks' gestation and admitted to Canadian neonatal intensive care units during 2010 to 2013. The 13 619 infants were grouped according to delivery room resuscitation intensity: no or minimal resuscitation (64.5%); continuous positive airway pressure (10.2%); bag-mask ventilation (21.7%); endotracheal intubation (3.1%); and cardiopulmonary resuscitation (CPR) (0.6%). RESULTS Overall mortality, early mortality, respiratory distress, pneumothorax, late-onset sepsis and resource use increased with higher intensity resuscitation. Compared with no or minimal resuscitation, intubation and CPR were associated with increased odds of mortality (adjusted odds ratio (95% confidence interval): 50 (20 to 125) and 180 (63 to 518), respectively). CONCLUSIONS Intubation or higher intensity delivery room resuscitation is associated with increased mortality, morbidities and resource use in late preterm infants. Extra intensive care is required for such infants, especially during the first week of life.
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Affiliation(s)
- S Jiang
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Y Lyu
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Child Health Development, Capital Institute of Pediatrics, Beijing, China
| | - X Y Ye
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - L Monterrosa
- Department of Paediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - P S Shah
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - S K Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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24
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Alagarasu K, Bachal RV, Shah PS, Cecilia D. Profile of killer cell immunoglobulin-like receptor and its human leucocyte antigen ligands in dengue-infected patients from Western India. Int J Immunogenet 2015; 42:432-8. [PMID: 26385514 DOI: 10.1111/iji.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 07/10/2015] [Accepted: 07/19/2015] [Indexed: 11/29/2022]
Abstract
Killer cell immunoglobulin-like receptors (KIRs) regulate the activation of natural killer cells (NKs). Qualitative and quantitative differences in the type and the number of KIRs expressed on NK cells affect its activation which would influence the outcome of the disease. In this study, 114 hospitalized cases of dengue [82 dengue fever (DF) and 32 dengue haemorrhagic fever (DHF) cases] and 104 healthy controls (HC) without no known history of hospitalization for dengue-like illness were investigated for their KIR gene profile to find out the association of KIR genes with dengue disease severity. KIR gene profile was investigated using duplex sequence-specific priming polymerase chain reaction-based typing system. The results revealed a higher frequency of KIR3DL1 gene [P = 0.0225; odds ratio (OR) 4.1 95% confidence interval (CI) 1.1-14.8] and lower frequency of KIR3DS1/3DS1 genotype [P = 0.0225; OR 0.24 95% CI (0.068-0.88)] in DF cases compared to HC. Immunoglobulin-like receptor gene frequencies were not different between DHF and DF or HC. The results suggest that KIR3DL1/KIR3DS1 locus might be associated with the risk of developing DF.
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Affiliation(s)
- K Alagarasu
- Dengue/Chikungunya Group, National Institute of Virology (ICMR), Pune, India
| | - R V Bachal
- Dengue/Chikungunya Group, National Institute of Virology (ICMR), Pune, India
| | - P S Shah
- Dengue/Chikungunya Group, National Institute of Virology (ICMR), Pune, India
| | - D Cecilia
- Dengue/Chikungunya Group, National Institute of Virology (ICMR), Pune, India
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25
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Shah PS, Mirea L, Ng E, Solimano A, Lee SK. Association of unit size, resource utilization and occupancy with outcomes of preterm infants. J Perinatol 2015; 35:522-9. [PMID: 25675049 DOI: 10.1038/jp.2015.4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/29/2014] [Revised: 11/28/2014] [Accepted: 12/17/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Assess association of NICU size, and occupancy rate and resource utilization at admission with neonatal outcome. STUDY DESIGN Retrospective cohort study of 9978 infants born at 23-32 weeks gestation and admitted to 23 tertiary-level Canadian NICUs during 2010-2012. Adjusted odds ratios (AOR) were estimated for a composite outcome of mortality/any major morbidity with respect to NICU size, occupancy rate and intensity of resource utilization at admission. RESULTS A total of 2889 (29%) infants developed the composite outcome, the odds of which were higher for 16-29, 30-36 and >36-bed NICUs compared with <16-bed NICUs (AOR (95% CI): 1.47 (1.25-1.73); 1.49 (1.25-1.78); 1.55 (1.29-1.87), respectively) and for NICUs with higher resource utilization at admission (AOR: 1.30 (1.08-1.56), Q4 vs Q1) but not different according to NICU occupancy. CONCLUSION Larger NICUs and more intense resource utilization at admission are associated with higher odds of a composite adverse outcome in very preterm infants.
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Affiliation(s)
- P S Shah
- 1] Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada [2] Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - L Mirea
- 1] Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada [2] Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - E Ng
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - A Solimano
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - S K Lee
- 1] Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada [2] Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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26
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Alagarasu K, Memane RS, Shah PS. Polymorphisms in the retinoic acid-1 like-receptor family of genes and their association with clinical outcome of dengue virus infection. Arch Virol 2015; 160:1555-60. [PMID: 25850761 DOI: 10.1007/s00705-015-2417-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/30/2015] [Indexed: 12/21/2022]
Abstract
Polymorphisms in the DDX58 and IFIH1 genes, which code for the retinoic acid inducible gene-1 protein and myeloid differentiation factor (MDA) 5, were investigated in 120 dengue (DEN) cases (88 dengue fever [DF] cases and 32 dengue hemorrhagic fever [DHF] cases) and 109 healthy controls (HCs) to investigate their association with dengue. The results revealed a lower carrier frequency of the DDX58 rs3205166 G allele in DEN than in HCs and a higher frequency of the DDX58 rs669260 T/C genotype in DHF than in DF cases (P = 0.043, OR with 95 % CI 3.358 [1.038-10.861]). This suggests that polymorphisms in DDX58 gene influence the clinical outcome of DENV infection.
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Affiliation(s)
- K Alagarasu
- Dengue Group, National Institute of Virology (Indian Council of Medical Research), 20A, Dr Ambedkar Road, Pune, Maharashtra, India,
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27
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Esmaeilizand R, Shah PS, Seshia M, Yee W, Yoon EW, Dow K. 64: Antibiotic Exposure and Development of Necrotizing Enterocolitis in Very Preterm Neonates in Canada. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e56b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Alagarasu K, Bachal RV, Tillu H, Mulay AP, Kakade MB, Shah PS, Cecilia D. Association of combinations of interleukin-10 and pro-inflammatory cytokine gene polymorphisms with dengue hemorrhagic fever. Cytokine 2015; 74:130-6. [PMID: 25890879 DOI: 10.1016/j.cyto.2015.03.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 09/26/2014] [Revised: 03/11/2015] [Accepted: 03/31/2015] [Indexed: 12/26/2022]
Abstract
Pro-inflammatory and anti-inflammatory cytokines have been shown to play an important role in dengue disease pathogenesis. In the present study, to find out whether single nucleotide polymorphisms (SNPs) in the pro-inflammatory and anti-inflammatory cytokine genes are associated with dengue disease severity, SNPs in TNF, IFNG, IL1B, IL8, IL0, IL17A and IL17F genes were investigated using polymerase chain reaction based methods in 132 dengue (DEN) cases [87 dengue fever (DF), 45 dengue hemorrhagic fever (DHF) cases] and 108 apparently healthy controls (HC) from Pune, Maharashtra, western India. Under recessive genetic model (C/C vs. T/T+T/C), the TNF rs1799964 C/C genotype was significantly associated with DEN [P=0.014, OR with 95% CI 3.07 (1.18-7.98)]. Frequency of T/C genotype of IL17F rs763780 was significantly lower in DEN group as compared to HC [P=0.033, OR with 95% CI 0.43 (0.19-0.95)]. Under overdominant genetic model (A/T vs. A/A+T/T), IL8 rs4973 A/T genotype was negatively associated with DHF compared to HCs [p=0.029, OR with 95% CI 0.43 (0.20-0.93)]. Under overdominant genetic model, A/G genotype of IL10 rs1800871 was significantly negatively associated with DHF compared to DF cases [p=0.014, OR with 95% CI 0.35 (0.15-0.84)]. Significantly higher frequency of the combined genotype IL10 A/A-IFNG A/T and lower frequency of the combined genotypes IL10 A/G-IL1B A/A, IL10 A/G-IL8 A/T and IL10 A/G-IL17F T/T were observed in DHF cases compared to DF. The results suggest that heterozygous genotypes of IL8 rs4973 and IL10 rs1800871 are associated with reduced risk of DHF. Combinations of IL10 rs1800871 and pro-inflammatory cytokine genotypes influence the risk of DHF.
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Affiliation(s)
- K Alagarasu
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India.
| | - R V Bachal
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
| | - H Tillu
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
| | - A P Mulay
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
| | - M B Kakade
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
| | - P S Shah
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
| | - D Cecilia
- Dengue Group, National Institute of Virology, 20 A, Dr Ambedkar Road, Pune 411001, Maharashtra, India
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29
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Mumtaz K, Faisal N, Husain S, Morillo A, Renner EL, Shah PS. Universal prophylaxis or preemptive strategy for cytomegalovirus disease after liver transplantation: a systematic review and meta-analysis. Am J Transplant 2015; 15:472-81. [PMID: 25522141 DOI: 10.1111/ajt.13044] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/24/2014] [Accepted: 09/28/2014] [Indexed: 02/06/2023]
Abstract
We systematically reviewed and meta-analyze the efficacy of universal prophylaxis (UP) and preemptive (PE) strategies (using ganciclovir or valganciclovir) in preventing cytomegalovirus (CMV) disease (CMD) among liver transplant recipients (LTRs). We performed an electronic search of MEDLINE, EMBASE and the Cochrane Database till December 2013. Studies that assessed UP or PE for preventing CMD in LTRs were included. The risk of bias was assessed using the Newcastle-Ottawa scale. The primary outcome was CMD, secondary outcomes being acute cellular rejection (ACR), graft loss (GL) and mortality. Due to the heterogeneity of comparative studies, an indirect comparison was performed. Pooled incidence rates with 95% confidence interval (CI) are calculated for each outcome using a random-effects model. Thirty-two studies involving 2456 LTRs were included. The majority of the studies were of low risk of bias. Irrespective of donor/recipient CMV sero-status, CMD was 10% with UP (95% CI: 6-14; I(2) = 87%; 16 studies, n = 1581) and 7% with PE (95% CI: 3-10; I(2) = 84%; 16 studies, n = 875) (mean difference 2.6; 95% CI: -3.25 to 8.45, p = 0.34). Likewise, ACR and mortality were similar with the two strategies. However, GL was significantly lower in the UP group, regardless of donor/recipient sero-status. In indirect comparison, the incidence of CMD, ACR and mortality in LTRs were similar with two strategies. Trials comparing the two strategies directly are needed.
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Affiliation(s)
- K Mumtaz
- Wexner Medical Center, Gastroenterology, Hepatology and Nutrition Division, The Ohio State University, Columbus, OH
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30
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Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units. J Neonatal Perinatal Med 2015; 8:207-214. [PMID: 26485554 DOI: 10.3233/npm-15814128] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [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: 06/05/2023]
Abstract
OBJECTIVE To identify predictors of severe retinopathy of prematurity (ROP) in a large population-based cohort and to examine risk-adjusted variations across units. STUDY DESIGN Retrospective analysis of Canadian Neonatal Network data on neonates with birth weight <1500 g who were screened for ROP between 2003 and 2010. Characteristics of infants with and without ROP were compared and a risk-adjusted model for severe ROP was developed. Rates of severe ROP were compared between sites. RESULTS 1163 of 9187 (12.7%) infants developed severe ROP. Lower gestational age, male sex, small for gestational age, patent ductus arteriosus, late onset sepsis, more than two blood transfusions, inotrope use, and outborn status were associated with an increased risk of severe ROP. Severe ROP rates varied significantly between units. CONCLUSION Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites.
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Affiliation(s)
- K Thomas
- Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - R Canning
- Department of Pediatrics, Moncton Hospital, Moncton, New Brunswick, Canada
| | - A Harrison
- Department of Pediatrics, Victoria General Hospital, Victoria, British Columbia, Canada
| | - S K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Dow
- Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada
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Shah PS, Hakak H, Mohamed A, Shah J, Young J, Kelly E. Oxygen saturation profile in late-preterm and term infants: a prospective cohort study. J Perinatol 2014; 34:917-20. [PMID: 24901450 DOI: 10.1038/jp.2014.107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 03/14/2014] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine oxygen saturation profile over 6 h monitoring period in healthy late-preterm and term neonates during the first 48 h of age, and to assess the impact of gestational age, birth weight and method of delivery on this profile. STUDY DESIGN Prospective cohort study of measurement of SpO2 over 6 h in 20 late-preterm (35 to 36 weeks gestation) and 40 term infants within 12 to 48 h of birth was conducted. Infants with cardiorespiratory symptoms or need for cardiorespiratory support at birth were excluded. Percentage time spent at SpO2 >90% and ⩽90% was calculated by gestational age and birth weight. RESULT Late-preterm infants and infants born weighing <2.5 kg spent approximately 7% of the time at SpO2 ⩽90%; this time decreased as gestational age and birth weight increased. Time at SpO2 >90% was significantly different between late-preterm and term infants (93% (5%) vs 96% (3%); P =0.002). Time at SpO2 >90% was not significantly different between males and females (95% (5%) vs 95% (4%), both n=30; P =0.72) or between vaginal births and cesarean births (95% (4%), n=32, vs 95% (4%), n=28; P =0.39). Cumulative time with SpO2 <90 was mean (s.d.) of 25 (18) in preterm vs 13 (10) min in term infants. CONCLUSION Over a 6-h period healthy late-preterm and term infants spent significant time at SpO2 ⩽90%. Lower gestation and lower birth weight were associated with higher time at SpO2 ⩽90%.
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Affiliation(s)
- P S Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - H Hakak
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - A Mohamed
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Shah
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - J Young
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - E Kelly
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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D'Souza R, Shah PS. Predicting stillbirths - still a distant reality. BJOG 2014; 122:56. [PMID: 25236962 DOI: 10.1111/1471-0528.13110] [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] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Ayed M, Shah PS, Lodha AK, Scarsgard ED, Lee SK, Moore AM. 43: Outcome of Infants with Necrotising Enterocolitis (NEC): The Impact of Laparotomy Versus Peritoneal Drainage. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Derynck MR, Shah PS, Seshia M, Bouali NR, Yoon EW, Lee SK, Dow K. 51: Inhaled and Systemic Corticosteroid Administration to Preterm Infants Across Canadian NICUs. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Deb-Rinker P, Leon JA, Gilbert NL, Rouleau J, Shah PS, Sauve R, Kramer M, Joseph KS. 169: A Detailed Examination of Infant Mortality Rates in Canada and Selected High Income Countries. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lyu Y, Shah PS, Ye XY, Piedboeuf B, Deshpandey A, Dunn M, Lee SK. 2: Impact of Admission Temperature on Mortality and Major Morbidities in Very Preterm Infants. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Yusuf K, Nair V, Alshaikh B, Hasan SU, Lodha A, Silva OD, Alvaro RE, Lee SK, Shah PS. 95: Neonatal Outcomes in Infants <29 Weeks Gestation in Relation to Maternal Hypertension and Smoking Status. Paediatr Child Health 2014. [DOI: 10.1093/pch/19.6.e35-93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schachtner T, Reinke P, Dorje C, Mjoen G, Midtvedt K, Strom EH, Oyen O, Jenssen T, Reisaeter AV, Smedbraaten YV, Sagedal S, Mjoen G, Fagerland MW, Hartmann A, Thiel S, Zulkarnaev A, Vatazin A, Vincenti F, Harel E, Kantor A, Thurison T, Hoyer-Hansen G, Craik C, Kute VB, Shah PS, Vanikar AV, Modi PR, Shah PR, Gumber MR, Patel HV, Engineer DP, Shah VR, Rizvi J, Trivedi HL, Malheiro J, Dias L, Martins LS, Fonseca I, Pedroso S, Almeida M, Castro-Henriques A, Cabrita A, Costa C, Ritta M, Sinesi F, Sidoti F, Mantovani S, Di Nauta A, Messina M, Cavallo R, Verflova A, Svobodova E, Slatinska J, Slavcev A, Pokorna E, Viklicky O, Yagan J, Chandraker A, Messina M, Diena D, Tognarelli G, Ranghino A, Bussolino S, Fop F, Segoloni GP, Biancone L, Leone F, Mauro MV, Gigliotti P, Lofaro D, Greco F, Perugini D, Papalia T, Perri A, Vizza D, Giraldi C, Bonofilgio R, Luis-Lima S, Marrero D, Gonzalez-Rinne A, Torres A, Salido E, Jimenez-Sosa A, Aldea-Perona A, Gonzalez-Posada JM, Perez-Tamajon L, Rodriguez-Hernandez A, Negrin-Mena N, Porrini E, Mjoen G, Pihlstrom H, Dahle DO, Holdaas H, Von Der Lippe N, Waldum B, Brekke F, Amro A, Reisaeter AV, Os I, Klin P, Sanabria H, Bridoux P, De Francesco J, Fortunato RM, Raffaele P, Kong J, Son SH, Kwon HY, Whang EJ, Choi WY, Yoon CS, Thanaraj V, Theakstone A, Stopper K, Ferraro A, Bhattacharjya S, Devonald M, Williams A, Mella A, Messina M, Gallo E, Fop F, Di Vico MC, Diena D, Pagani F, Gai M, Ranghino A, Segoloni GP, Biancone L, Cho HJ, Nho KW, Park SK, Kim SB, Yoshida K, Ishii D, Ohyama T, Kohguchi D, Takeuchi Y, Varga A, Sandor B, Kalmar-Nagy K, Toth A, Toth K, Szakaly P, Zulkarnaev A, Vatazin A, Kildushevsky A, Fedulkina V, Kantaria R, Staeck O, Halleck F, Rissling O, Naik M, Neumayer HH, Budde K, Khadzhynov D, Bhadauria D, Kaul A, Prasad N, Sharma RK, Sezer S, Bal Z, Erkmen Uyar M, Guliyev O, Erdemir B, Colak T, Ozdemir N, Haberal M, Caliskan Y, Yazici H, Artan AS, Oto OA, Aysuna N, Bozfakioglu S, Turkmen A, Yildiz A, Sever MS, Yagisawa T, Nukui A, Kimura T, Nannmoku K, Kurosawa A, Sakuma Y, Miki A, Damiano F, Ligabue G, De Biasi S, Granito M, Cossarizza A, Cappelli G, Martins LS, Fonseca I, Malheiro J, Henriques AC, Pedroso S, Almeida M, Dias L, Davide J, Cabrita A, Von During ME, Jenssen TG, Bollerslev J, Godang K, Asberg A, Hartmann A, Bachelet T, Martinez C, Bello A, Kejji S, Couzi L, Guidicelli G, Lepreux S, Visentin J, Congy-Jolivet N, Rostaing L, Taupin JL, Kamar N, Merville P, Sezer S, Bal Z, Erkmen Uyar M, Ozdemir H, Guliyev O, Yildirim S, Tutal E, Ozdemir N, Haberal M, Sezer S, Erkmen Uyar M, Bal Z, Guliyev O, Sayin B, Colak T, Ozdemir Acar N, Haberal M, Banasik M, Boratynska M, Koscielska-Kasprzak K, Kaminska D, Bartoszek D, Mazanowska O, Krajewska M, Zmonarski S, Chudoba P, Dawiskiba T, Protasiewicz M, Halon A, Sas A, Kaminska M, Klinger M, Stefanovic N, Cvetkovic T, Velickovic - Radovanovic R, Jevtovic - Stoimenov T, Vlahovic P, Rungta R, Das P, Ray DS, Gupta S, Kolonko A, Szotowska M, Kuczera P, Chudek J, Wiecek A, Sikora-Grabka E, Adamczak M, Szotowska M, Kuczera P, Madej P, Wiecek A, Amanova A, Kendi Celebi Z, Bakar F, Caglayan MG, Keven K, Massimetti C, Imperato G, Zampi G, De Vincenzi A, Fabbri GDD, Brescia F, Feriozzi S, Filipov JJ, Zlatkov BK, Dimitrov EP, Svinarov DA, Poesen R, De Vusser K, Evenepoel P, Kuypers D, Naesens M, Meijers B, Kocak H, Yilmaz VT, Yilmaz F, Uslu HB, Aliosmanoglu I, Ermis H, Dinckan A, Cetinkaya R, Ersoy FF, Suleymanlar G, Fonseca I, Oliveira JC, Santos J, Martins LS, Almeida M, Dias L, Pedroso S, Lobato L, Castro-Henriques A, Mendonca D, Watarai Y, Yamamoto T, Tsujita M, Hiramitsu T, Goto N, Narumi S, Kobayashi T, Dahle DO, Holdaas H, Reisaeter AV, Dorje C, Mjoen G, Line PD, Hartmann A, Housawi A, House A, Ng C, Denesyk K, Rehman F, Moist L, Musetti C, Battista M, Izzo C, Guglielmetti G, Airoldi A, Stratta P, Musetti C, Cena T, Quaglia M, Fenoglio R, Cagna D, Airoldi A, Amoroso A, Stratta P, Palmisano A, Degli Antoni AM, Vaglio A, Piotti G, Cremaschi E, Buzio C, Maggiore U, Lee MC, Hsu BG, Zalamea Jarrin F, Sanchez Sobrino B, Lafuente Covarrubias O, Karsten Alvarez S, Dominguez Apinaniz P, Llopez Carratala R, Portoles Perez J, Yildirim T, Yilmaz R, Turkmen E, Altindal M, Arici M, Altun B, Erdem Y, Dounousi E, Mitsis M, Naka K, Pappas H, Lakkas L, Harisis H, Pappas K, Koutlas V, Tzalavra I, Spanos G, Michalis L, Siamopoulos K, Iwabuchi T, Yagisawa T, Kimura T, Nanmoku K, Kurosawa A, Yasunaru S, Lee MC, Hsu BG, Yoshikawa M, Kitamura K, Fuji H, Fujisawa M, Nishi S, Carta P, Zanazzi M, Buti E, Larti A, Caroti L, Di Maria L, Minetti EE, Shi Y, Luo L, Cai B, Wang T, Zou Y, Wang L, Kim Y, Kim HS, Choi BS, Park CW, Yang CW, Kim YS, Chung BH, Baek CH, Kim M, Kim JS, Yang WS, Han DJ, Park SK, Mikolasevic I, Racki S, Lukenda V, Persic MP, Colic M, Devcic B, Orlic L, Sezer S, Gurlek Demirci B, Guliyev O, Colak T, Say N CB, Ozdemir Acar FN, Haberal M, Vali S, Ismal K, Sahay M, Civiletti F, Cantaluppi V, Medica D, Mazzeo AT, Assenzio B, Mastromauro I, Deambrosis I, Giaretta F, Fanelli V, Mascia L, Musetti C, Airoldi A, Quaglia M, Guglielmetti G, Battista M, Izzo C, Stratta P, Lakkas L, Naka K, Dounousi E, Koutlas V, Gkirdis I, Bechlioulis A, Evangelou D, Zarzoulas F, Kotsia A, Balafa O, Tzeltzes G, Nakas G, Pappas K, Kalaitzidis R, Katsouras C, Michalis L, Siamopoulos K, Tutal E, Erkmen Uyar M, Uyanik S, Bal Z, Guliyev O, Toprak SK, Ilhan O, Sezer S, Bal Z, Ekmen Uyar M, Guliyev O, Sayin B, Colak T, Sezer S, Haberal M, Hernandez Vargas H, Artamendi Larranaga M, Ramalle Gomara E, Gil Catalinas F, Bello Ovalle A, Pimentel Guzman G, Coloma Lopez A, Sierra Carpio M, Gil Paraiso A, Dall Anesse C, Beired Val I, Huarte Loza E, Choy BY, Kwan L, Mok M, Chan TM, Yamakawa T, Kobayashi A, Yamamoto I, Mafune A, Nakada Y, Tannno Y, Tsuboi N, Yamamoto H, Yokoyama K, Ohkido I, Yokoo T, Luque Y, Anglicheau D, Rabant M, Clement R, Kreis H, Sartorius A, Noel LH, Timsit MO, Legendre C, Rancic N, Vavic N, Dragojevic-Simic V, Katic J, Jacimovic N, Kovacevic A, Mikov M, Veldhuijzen NMH, Rookmaaker MB, Van Zuilen AD, Nquyen TQ, Boer WH, Mjoen G, Pihlstrom H, Dahle DO, Holdaas H, Sahtout W, Ghezaiel H, Azzebi A, Ben Abdelkrim S, Guedri Y, Mrabet S, Nouira S, Ferdaws S, Amor S, Belarbia A, Zellama D, Mokni M, Achour A, Viklicky O, Parikova A, Slatinska J, Hanzal V, Fronek J, Orandi BJ, James NT, Montgomery RA, Desai NM, Segev DL, Fontana F, Ballestri M, Magistroni R, Damiano F, Cappelli G. TRANSPLANTATION CLINICAL 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dar S, Lazer T, Shah PS, Librach CL. Neonatal outcomes among singleton births after blastocyst versus cleavage stage embryo transfer: a systematic review and meta-analysis. Hum Reprod Update 2014; 20:439-48. [DOI: 10.1093/humupd/dmu001] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
OBJECTIVE To examine rates, trends, predictive risk factors, and outcomes associated with pneumothorax in neonates. STUDY DESIGN Retrospective analyses were used to estimate rates and assess trends in pneumothorax among early preterm (GA <32 weeks), moderate-late preterm (GA 32-36), and term (GA ≥37 weeks) neonates admitted to neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network™ from 2005 to 2011. For each GA group, multivariable logistic regression models were derived to predict pneumothorax using risk factors with known clinical relevance. Additional logistic regression analyses assessed associations between pneumothorax and mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage. RESULTS The study included 71,237 neonates; of them 16,985 (24%) early preterm, 27,709 (39%) moderate-late preterm, and 26,543 (37%) term neonates. The overall rate of pneumothorax by GA was bimodal with estimates of 4.0%, 2.6%, and 6.7% respectively. No significant temporal trends were detected. Risk factors for pneumothorax included: a) for the overall lpopulation- Score for Neonatal Acute Physiology, version II >20, surfactant use, and respiratory distress syndrome; b) for early preterm infants-chorioamnionitis; c) for moderate-late preterm infants-higher birth weight, male sex, rupture of membranes >24 hours, and outborn status; and d) for term infants- male sex, outborn status, and meconium aspiration in term neonates. In early preterm neonates, pneumothorax was associated with mortality, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged NICU stay. CONCLUSIONS Pneumothorax rates were higher among term and early preterm neonates admitted to the NICU. Predictors of pneumothorax varied between GA groups. Pneumothorax-associated mortality and morbidity were significantly greater in early preterm infants.
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Affiliation(s)
- H Hanh Duong
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
| | - L Mirea
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Maternal-Infant Care (MiCare) Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - P S Shah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada Maternal-Infant Care (MiCare) Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada Department of Pediatrics, University of Toronto, ON, Canada
| | - J Yang
- Maternal-Infant Care (MiCare) Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - S K Lee
- Maternal-Infant Care (MiCare) Research Centre, Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada Department of Pediatrics, University of Toronto, ON, Canada
| | - K Sankaran
- Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada
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Morais M, Mehta C, Murphy K, Shah PS, Giglia L, Smith PA, Bassil K, McDonald SD. How often are late preterm births the result of non-evidence based practices: analysis from a retrospective cohort study at two tertiary referral centres in a nationalised healthcare system. BJOG 2013; 120:1508-14. [DOI: 10.1111/1471-0528.12401] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 12/01/2022]
Affiliation(s)
- M Morais
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
| | - C Mehta
- Department of Obstetrics & Gynecology; University of Toronto; Toronto ON Canada
| | - K Murphy
- Department of Obstetrics & Gynecology; University of Toronto; Toronto ON Canada
| | - PS Shah
- Department of Pediatrics; Division of Neonatology; Department of Health Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - L Giglia
- Department of Pediatrics; McMaster University; Hamilton ON Canada
| | - PA Smith
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
| | - K Bassil
- Department of Epidemiology; Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - SD McDonald
- Department of Obstetrics & Gynecology; Division of Maternal Fetal Medicine; McMaster University; Hamilton ON Canada
- Department of Clinical Epidemiology & Biostatistics; McMaster University; Hamilton ON Canada
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Alagarasu K, Honap T, Damle IM, Mulay AP, Shah PS, Cecilia D. Polymorphisms in the oligoadenylate synthetase gene cluster and its association with clinical outcomes of dengue virus infection. Infect Genet Evol 2013; 14:390-5. [PMID: 23337612 DOI: 10.1016/j.meegid.2012.12.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
Abstract
Oligoadenylate synthetases (OAS) play an important role in the immune response against dengue virus. Single nucleotide polymorphisms (SNPs) in the OAS genes are known to affect OAS activity and are associated with outcome of viral infections. Polymorphisms in the OAS1 (rs1131454 and rs10774671), OAS3 (rs2285932 and rs2072136) and OAS2 (rs15895 and rs1732778) genes were studied using PCR followed by restriction fragment length polymorphism methods in 109 patients hospitalized for dengue (DEN) and 105 healthy controls (HCs) who have no documented evidence of symptomatic dengue. The two locus haplotype of OAS2 G-G was significantly higher in all patient groups [DEN vs. HCs, P=0.0041, P corrected (Pc)=0.012, Odds ratio (OR) 1.73 95% CI 1.16-2.59] while the four locus haplotype of OAS3-OAS2 C-G-A-G was significantly lower in all dengue patient groups [DEN vs. HCs, P=0.0054, Pc=0.0486, OR 0.09, 95% CI 0.00-0.64] compared to controls. When the six locus haplotypes involving OAS1, OAS3 and OAS2 polymorphisms were analyzed and compared, the frequency of the haplotype A-A-C-A-G-G was significantly higher [P=0.0267, Pc=0.486, OR 2.34, 95% CI 1.08-4.91] and the frequency of the haplotype A-A-C-G-G-A was significantly lower in DHF cases [P=0.014, Pc=0.252, OR 0.12, 95% CI 0.01-0.85] compared to healthy controls. The results suggest that OAS1-OAS3-OAS2 haplotypes are associated with differential susceptibility to clinical outcomes of dengue infection.
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Affiliation(s)
- K Alagarasu
- Dengue Group, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune 411 001, Maharashtra, India.
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Alagarasu K, Honap T, Mulay AP, Bachal RV, Shah PS, Cecilia D. Association of vitamin D receptor gene polymorphisms with clinical outcomes of dengue virus infection. Hum Immunol 2012; 73:1194-9. [PMID: 22917542 DOI: 10.1016/j.humimm.2012.08.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/06/2012] [Accepted: 08/09/2012] [Indexed: 11/26/2022]
Abstract
Vitamin D is known to affect pathogenesis of dengue through modulation of immune responses. Vitamin D exerts its effects through vitamin D receptor (VDR). The functioning of VDR is affected by the gene polymorphisms in the coding (rs2228570) and 3'untranslated region (UTR) (rs1544410, rs7975232 and rs731236). In the present study, VDR gene polymorphisms were investigated in 112 dengue infected patients (83 dengue fever (DF) and 29 dengue hemorrhagic fever cases (DHF)) and 105 apparently healthy controls (HCs) using polymerase chain reaction based restriction fragment length polymorphisms methods. HCs had no documented evidence of symptomatic dengue. Results revealed significantly lower frequency of 'C' allele of rs7975232 in all dengue patients (DEN) as compared to HCs [(P corrected (Pc)=0.014, Odds ratio (OR) 0.51]. The frequency of C/C genotype of rs7975232 was significantly lower in DEN and DF cases compared to HCs (DEN vs. HCs: Pc=0.0184, OR 0.24; DF cases vs. HCs: Pc=0.028, OR 0.21). The frequency of T allele of rs2228570 in a dominant mode was significantly higher in DHF cases as compared to DF cases (P=0.034 OR 2.58). A significantly lower frequency of the haplotype G-C-T (Pc=0.0135) and higher frequency of the haplotype G-A-T (Pc=0.000085) was observed in DEN and DF cases as compared to HCs. The results suggest that the 3'UTR haplotypes of VDR gene are differentially associated with risk of symptomatic dengue requiring hospitalization. The 'T' allele of rs2228570 polymorphism in a dominant mode of inheritance is associated with DHF.
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Affiliation(s)
- K Alagarasu
- Dengue Group, National Institute of Virology, 20-A Ambedkar Road, Pune 411001, Maharashtra, India.
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Patil JA, Cherian S, Walimbe AM, Bhagat A, Vallentyne J, Kakade M, Shah PS, Cecilia D. Influence of evolutionary events on the Indian subcontinent on the phylogeography of dengue type 3 and 4 viruses. Infect Genet Evol 2012; 12:1759-69. [PMID: 22890284 DOI: 10.1016/j.meegid.2012.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/12/2012] [Accepted: 07/15/2012] [Indexed: 11/19/2022]
Abstract
During 1960-80 dengue disease profile in India was mild despite circulation of all four serotypes of dengue virus (DENV). Increase in disease severity with a concomitant change in the population of DENV-1 and 2 have been reported since then. To determine population dynamics of DENV-3 and 4, the envelope (E) gene sequence was determined for 16 Indian isolates of DENV-3 and 11 of DENV-4 and analyzed together with 97 DENV-3 and 43 DENV-4 global sequences. All Indian DENV-3 isolates belonged to genotype III, lineages C, D, E and F. Lineage F was newly identified and represented non-circulating viruses. Three non-conservative amino acid changes in domain I, II & III were identified during the transition from lineages F/E, associated with mild disease, to A-D, associated with severe disease. For DENV-4, the current viruses clustered in genotype I, lineage C, whilst the isolates from 1960s formed the new genotype V. A 1979 Indian isolate of DENV-4 was found to be an inter-genotypic recombinant of Sri Lankan isolate (1978) of genotype I and Indian isolate (1961) of genotype V. The rates of nucleotide substitution and time to the most recent common ancestor (tMRCA) estimated for DENV-3 (1782-1934) and DENV-4 (1719-1931) were similar to earlier reports. However, the divergence time for genotype III of DENV-3, 1938-1963, was a more accurate estimate with the inclusion of Indian isolates from the 1960s. By phylogeographical analysis it was revealed that DENV-3 GIII viruses emerged from India and evolved through Sri Lanka whilst DENV-4 emerged and dispersed from India. The present study demonstrates the crucial role that India/Sri Lanka have played in the evolution and dispersion of the major genotypes, GIII of DENV-3 and GI of DENV-4 which are more virulent and show higher dissemination potential.
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Affiliation(s)
- J A Patil
- Dengue Group, National Institute of Virology, 20-A, Dr Ambedkar Road, PO Box No 11, Pune 411001, Maharashtra State, India
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Jefferies A, Shah PS, Shah V, Bassil KL, Ye X, Lee SK. Impact of Late Preterm and Term Infants Admitted to Canadian Nicus. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.31a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wong J, Shah PS, Yoon W, Yee W, Lee SK, Dow K. Inotrope use Among Extremely Preterm Infants in Canadian Nicus : Variations and Outcomes. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.34aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shah PS, Sankaran K, Aziz K, Allen AC, Seshia M, Ohlsson A, Lee SK. Outcomes of preterm infants <29 weeks gestation over 10-year period in Canada: a cause for concern? J Perinatol 2012; 32:132-8. [PMID: 21593814 DOI: 10.1038/jp.2011.68] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [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: 11/09/2022]
Abstract
OBJECTIVE To compare risk-adjusted changes in outcomes of preterm infants <29 weeks gestation born in 1996 to 1997 with those born in 2006 to 2007. STUDY DESIGN Observational retrospective comparison of data from 15 units that participated in the Canadian Neonatal Network during 1996 to 1997 and 2006 to 2007 was performed. Rates of mortality and common neonatal morbidities were compared after adjustment for confounders. RESULT Data on 1897 infants in 1996 to 1997 and 1866 infants in 2006 to 2007 were analyzed. A higher proportion of patients in the later cohort received antenatal steroids and had lower acuity of illness on admission. Unadjusted analyses revealed reduction in mortality (unadjusted odds ratio (UAOR): 0.83, 95% confidence interval (CI): 0.63, 0.98), severe retinopathy (UAOR: 0.68, 95% CI: 0.50 to 0.92), but increase in bronchopulmonary dysplasia (UAOR: 1.61, 95% CI: 1.39 to 1.86) and patent ductus arteriosus (UAOR: 1.22, 95% CI: 1.07 to 1.39). Adjusted analyses revealed increases in the later cohort for bronchopulmonary dysplasia (adjusted odds ratio (AOR): 1.88, 95% CI: 1.60 to 2.20) and severe neurological injury (AOR: 1.49, 95% CI: 1.22 to 1.80). However, the ascertainment methods for neurological findings and ductus arteriosus differed between the two time periods. CONCLUSION Improvements in prenatal care has resulted in improvement in the quality of care, as reflected by reduced severity of illness and mortality. However, after adjustment of prenatal factors, no improvement in any of the outcomes was observed and on the contrary bronchopulmonary dysplasia increased. There is need for identification and application of postnatal strategies to improve outcomes of extreme preterm infants.
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Affiliation(s)
- P S Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
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Braga JR, Santos ISO, McDonald M, Shah PS, Ross HJ. Factors associated with the development of cardiac allograft vasculopathy - a systematic review of observational studies. Clin Transplant 2011; 26:E111-24. [DOI: 10.1111/j.1399-0012.2011.01565.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Organisms causing early-onset neonatal sepsis (EONS) have consistently changed over time. The distribution of organisms in EONS helps to influence the appropriate type of antibiotic prophylaxis strategy during labor and the antibiotics used in neonates with suspected sepsis. STUDY DESIGN To compare the organisms distribution for EONS between 2003 and 2008 for infants admitted to neonatal intensive care units (NICUs) in Canada. Data were retrieved from infants with a positive bacterial blood or cerebrospinal fluid culture in the first 72 h after birth who were admitted to NICUs participating in the Canadian Neonatal Network from 2003 to 2008. Comparisons of incidence rate, demographics and causative organisms were carried out between earlier cohort (2003 to 2005) and later cohort (2006 to 2008). RESULT A total of 405 infants had positive blood and/or cerebral spinal fluid cultures over the study period. The EONS rate was 6.8/1000 admissions (n=24969) in the earlier cohort compared with 6.2/1000 admissions (n=37484) in the later cohort (P=0.36). Rate of clinical chorioamnionitis was higher in the later cohort (38 vs 26%; P=0.02). For term infants, coagulase-negative Staphylococcus (CONS) (2.4/1000) followed by group B Streptococcus (GBS) (1.9/1000) were the most common organisms identified. For preterm infants, CONS (2.5/1000) followed by Escherichia coli (2.6/1000) were the most common organisms identified. There was a significant reduction in GBS EONS over time (P<0.01) and a trend toward an increase in other organisms. CONCLUSION Although the rate of EONS among neonates admitted to NICUs has not changed, the pattern of infection has changed over the past 6 years. With the increased use of prophylactic antibiotics to mothers, careful surveillance of the changing trend of bacterial organisms among neonates is warranted.
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Affiliation(s)
- M Sgro
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
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Kingdom JCP, Walker M, Proctor LK, Keating S, Shah PS, McLeod A, Keunen J, Windrim RC, Dodd JM. Unfractionated heparin for second trimester placental insufficiency: a pilot randomized trial. J Thromb Haemost 2011; 9:1483-92. [PMID: 21689371 DOI: 10.1111/j.1538-7836.2011.04407.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To conduct a pilot randomized controlled trial of unfractionated heparin (UFH) in women considered at high risk of placental insufficiency in the second trimester. METHODS Women with either false-positive first trimester (pregnancy-associated placental protein-A [PAPP-A] < 0.35 MoM) or second trimester (alpha-fetoprotein [AFP] > 2.0 MoM, inhibin > 3.0 MoM, human chorionic gonadotropin > 4.0 MoM) serum screening tests or medical/obstetric risk factors were screened for placental insufficiency by sonographic evaluation of the placenta and uterine artery Doppler between 18 and 22 weeks. Thrombophilia screen-negative women with two or three abnormal test categories were randomized by 23+6 weeks to self-administration of subcutaneous unfractionated heparin (UFH) 7500 IU twice daily until birth or 34 weeks, or to standard care. Maternal anxiety and other maternal-infant outcomes were determined. RESULTS Thirty-two out of 41 eligible women consented, with 16 women randomized to UFH and 16 to standard care. There was no statistically significant difference identified between the two treatment groups (standard care vs. UFH) for the following: maternal anxiety score (mean [standard deviation]), 14.2 [± 1.6] vs. 14.0 [± 1.8]; birth weight (median [range]), 1795 [470-3295]g vs. 1860 [730-3050]g; perinatal death, 3 vs. 0; severe preeclampsia, 2 vs. 6; placental weight < 10th percentile, 7 vs. 4; or placental infarction, 4 vs. 3. CONCLUSION Our study design identified women at high risk of adverse maternal-infant outcomes attributable to placental insufficiency. Women with evidence of placental insufficiency were willing to undergo randomization and self-administration of UFH without increased maternal anxiety.
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Affiliation(s)
- J C P Kingdom
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, ON, Canada.
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