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Talej M, Smith ER, Lauria ME, Chitale R, Ferguson K, He S. Responsive Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188648. [PMID: 35921679 DOI: 10.1542/peds.2022-057092f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Responsive feeding may improve health outcomes in preterm and low birth weight (LBW) infants. Our objective was to assess effects of responsive compared with scheduled feeding in preterm and LBW infants. METHODS Data sources include PubMed, Scopus, Web of Science, CINAHL, LILACS, and MEDICUS. Randomized trials were screened. Primary outcomes were mortality, morbidity, growth, neurodevelopment. Secondary outcomes were feed intolerance and duration of hospitalization. Data were extracted and pooled with random-effects models. RESULTS Eleven eligible studies were identified, and data from 8 randomized control trials with 455 participants were pooled in the meta-analyses. At discharge, the mean difference in body weight between the intervention (responsive feeding) and comparison (scheduled feeding) was -2.80 g per day (95% CI -3.39 to -2.22, I2 = 0%, low certainty evidence, 4 trials, 213 participants); -0.99 g/kg per day (95% CI -2.45 to 0.46, I2 = 74%, very low certainty evidence, 5 trials, 372 participants); -22.21 g (95% CI -130.63 to 86.21, I2 = 41%, low certainty evidence, 3 trials, 183 participants). The mean difference in duration of hospitalization was -1.42 days (95% CI -5.43 to 2.59, I2 = 88%, very low certainty evidence, 5 trials, 342 participants). There were no trials assessing other growth outcomes (eg, length and head circumference) mortality, morbidity or neurodevelopment. Limitations include a high risk of bias, heterogeneity, and small sample size in included studies. CONCLUSIONS Overall, responsive feeding may decrease in-hospital weight gain. Although the evidence is very uncertain, responsive feeding may slightly decrease the duration of hospitalization. Evidence was insufficient to understand the effects of responsive compared with scheduled feeding on mortality, morbidity, linear growth, and neurodevelopmental outcomes in preterm and LBW infants.
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Affiliation(s)
- Megan Talej
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia.,ICF International, Rockville, Maryland
| | - Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
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Chitale R, Ferguson K, Talej M, Yang WC, He S, Edmond KM, Smith ER. Early Enteral Feeding for Preterm or Low Birth Weight Infants: a Systematic Review and Meta-analysis. Pediatrics 2022; 150:188642. [PMID: 35921673 DOI: 10.1542/peds.2022-057092e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early enteral feeding has been associated with adverse outcomes such as necrotizing enterocolitis in preterm and low birth weight infants. OBJECTIVES To assess effects of early enteral feeding initiation within the first days after birth compared to delayed initiation. DATA SOURCES Medline, Scopus, Web of Science, CINAHL from inception to June 30, 2021. STUDY SELECTION Randomized trials (RCTs) were included. Primary outcomes were mortality, morbidity, growth, neurodevelopment, feed intolerance, and duration of hospitalization. DATA EXTRACTION Data were extracted and pooled with random-effects models. RESULTS We included 14 randomized controlled trials with 1505 participants in our primary analysis comparing early (<72 hours) to delayed (≥72 hours) enteral feeding initiation. Early initiation likely decreased mortality at discharge and 28 days (1292 participants, 12 trials, relative risk 0.69, 95% confidence interval [95% CI] 0.48-0.99, moderate certainty evidence) and duration of hospitalization (1100 participants, 10 trials, mean difference -3.20 days, 95%CI -5.74 to -0.66, moderate certainty evidence). The intervention may also decrease sepsis and weight at discharge. Based on low certainty evidence, early feeding may have little to no effect on necrotizing enterocolitis, feed intolerance, and days to regain birth weight. The evidence is very uncertain regarding the effect of initiation time on intraventricular hemorrhage, length, and head circumference at discharge. CONCLUSIONS Enteral feeding within 72 hours after birth likely reduces the risk of mortality and length of hospital stay, may reduce the risk of sepsis, and may reduce weight at discharge.
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Affiliation(s)
- Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Megan Talej
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Karen M Edmond
- World Health Organization, Department of Maternal, Child, Adolescent Health and Aging, Geneva, Switzerland
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, DC
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Ghia CJ, Horn EK, Rambhad G, Perdrizet J, Chitale R, Wasserman MD. Estimating the Public Health and Economic Impact of Introducing the 13-Valent Pneumococcal Conjugate Vaccine or 10-Valent Pneumococcal Conjugate Vaccines into State Immunization Programs in India. Infect Dis Ther 2021; 10:2271-2288. [PMID: 34313958 PMCID: PMC8572948 DOI: 10.1007/s40121-021-00498-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Although the pneumococcal conjugate vaccine (PCV) has been introduced into select state immunization programs (SIPs) in India, many children remain unvaccinated. Recently, India’s Advisory Committee on Vaccines & Immunization Practices recommended PCV on the pediatric immunization schedule nationally. This study estimates the public health and economic impact of introducing either Pfizer’s 13-valent PCV (PCV13-PFE), GlaxoSmithKline’s 10-valent PCV (PCV10-GSK), or Serum Institute of India’s 10-valent PCV (PCV10-SII) into every pediatric SIP. Methods A model was developed to predict the disease cases, deaths, and costs associated with implementing PCV13-PFE, PCV10-GSK, or PCV10-SII in SIPs compared to no vaccination program across a 5-year period (2021–2025). State and national-level uptake rate and clinical and economic input parameters were collected from published literature. Disease outcomes included invasive pneumococcal disease, inpatient and outpatient pneumonia, and otitis media. Costs were estimated as vaccine-related costs and direct medical costs incurred to the healthcare system. Results were reported by individual state and aggregated nationally.
Results Estimated over 5 years, implementing PCV13-PFE in SIPs could avert 12.1 million cases and save 626,512 lives among children under 5 years old compared to no vaccination. This corresponds to net national cost savings of over $1.0 billion. Both lower-valent PCVs are estimated to provide less economic savings than PCV13-PFE inclusive of vaccine-related costs. Compared with PCV13-PFE, implementing PCV10-GSK or PCV10-SII nationally is estimated to have a smaller public health impact, with PCV10-GSK averting 8.4 million cases (436,577 deaths) and PCV10-SII preventing 10.3 million cases (531,545 deaths) in India compared to no vaccination, respectively. Conclusion Implementation of PCV13-PFE throughout India is estimated to provide greater public health and economic benefits than PCV10-GSK or PCV10-SII SIPs. Our analysis highlights the substantial disease cases, deaths, and health system cost savings that may be realized from implementing PCV programs throughout India. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00498-4.
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Affiliation(s)
- Canna J Ghia
- Pfizer Inc., Medical Affairs, Mumbai, India. .,Pfizer Limited, The Capital, 1802, 18th Floor, Plot No. C-70, 'G Block', Bandra Kurla Complex, Bandra East, Mumbai, 400051, India.
| | - Emily K Horn
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | | | - Johnna Perdrizet
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Ramaa Chitale
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
| | - Matt D Wasserman
- Pfizer Inc., Health Economics and Outcomes Research, New York, USA
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Wang BC, Chaiyakunapruk N, Zhu S, Babigumira JB, Furnback W, Chitale R, Gamil A, Zhao K, Wasserman M. A systematic literature review of economic evaluations of pneumococcal conjugate vaccines in east and southeast Asia (2006-2019). Expert Rev Vaccines 2021; 21:885-898. [PMID: 33682584 DOI: 10.1080/14760584.2021.1894933] [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: 10/22/2022]
Abstract
INTRODUCTION Pneumococcal infections can lead to serious invasive diseases such as meningitis, septicemia and pneumonia, as well as milder but more common illnesses such as sinusitis and otitis media. The World Health Organization (WHO) recommends the inclusion of pneumococcal conjugate vaccines (PCVs) in infant National Immunization Program (NIP) programs worldwide. Decision-makers in Asian countries planning to introduce PCVs in their respective NIP will need a comprehensive evidence of effectiveness of PCVs at the population level and economic evidence including cost-effectiveness. AREAS COVERED A systematic literature review (from 1/1/2016 to 10/11/2019) of PCVs in East and Southeast Asia to understand (1) the contributing factors to cost-effectiveness results of PCVs and (2) whether gaps in evidence exist suggesting why the region may have yet to implement full NIPs. EXPERT OPINION In East and Southeast Asia, vaccination with PCVs was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccination. Study assumptions, specifically vaccine local acquisition, the inclusion or exclusion of indirect effects (serotype replacement and herd effect), cross-protection, and protection against nontypeable haemophilus influenzae and serotype 3, were the main drivers of cost-effectiveness.
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Affiliation(s)
- Bruce Cm Wang
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | | | - Shuiqing Zhu
- Health Economics and Outcomes Research, Pfizer Investment Co. Ltd, Shanghai, China
| | | | - Wesley Furnback
- Health Economics and Real World Evidence , Elysia Group, LLC, New York, NY, USA
| | - Ramaa Chitale
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
| | - Amgad Gamil
- Medical and Scientific Affairs, Pfizer Inc, Singapore
| | - Kun Zhao
- Health Technology Assessment, China National Health Development Research Center, National Health Commission of the People's Republic of China
| | - Matt Wasserman
- Health Economics and Outcomes Research, Pfizer Inc, New York, NY, USA
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Wang B, Zhu S, Babigumira J, Furnback W, Chitale R, Yang J, Zhao K, Wasserman M. PIN23 Systematic Review of Economic Evaluations of Pneumococcal Conjugate Vaccines in Mainland China. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.270] [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: 12/01/2022]
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Mistry EA, Mistry AM, Mehta T, Arora N, Starosciak AK, La Rosa FDLR, Siegler JE, Kasner SE, Chitale R, Fusco M, Froehler M, Yaghi S, Schrag M, Khatri P. White Matter Disease and Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2020; 41:639-644. [PMID: 32165366 DOI: 10.3174/ajnr.a6478] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE The increased severity of white matter disease is associated with worse outcomes and an increased rate of intracerebral hemorrhage in patients with ischemic stroke undergoing thrombolytic treatment. However, whether white matter disease is associated with outcomes in patients undergoing endovascular treatment remains unclear. MATERIALS AND METHODS In this prespecified exploratory analysis of our prospective multi-institutional study that enrolled consecutive adult patients with anterior circulation ischemic stroke undergoing endovascular treatment from November 2017 to September 2018, we compared the following outcomes between patients with none-to-minimal (van Swieten score, 0-2) and moderate-to-severe (van Swieten score, 3-4) white matter disease using logistic regression: 90-day mRS 3-6, death, intracerebral hemorrhage, successful recanalization, and early neurologic recovery. RESULTS Of the 485 patients enrolled in the Blood Pressure after Endovascular Stroke Therapy (BEST) study, 389 had white matter disease graded (50% women; median age, 68 years; range, 58-79 years). A van Swieten score of 3-4 (n = 74/389, 19%) was associated with a higher rate of 90-day mRS of 3-6 (45% versus 18%; adjusted OR, 2.73; 95% CI, 1.34-5.93; P = .008). Although the death rate was higher in patients with van Swieten scores of 3-4 (26% versus 15%), the adjusted likelihood was not significantly different (adjusted OR, 1.14; 95% CI, 0.56-2.26; P = .710). Ordered regression revealed a shift toward worse mRS scores with increasing van Swieten scores (adjusted common OR, 3.04; 95% CI, 1.93-4.84; P < .001). No associations between white matter disease severity and intracerebral hemorrhage, successful recanalization, and early neurologic recovery were observed. CONCLUSIONS Moderate-to-severe white matter disease is associated with worse outcomes in patients undergoing endovascular treatment without a significant increase in hemorrhagic complications. Studies comparing patients with and without endovascular treatment are necessary to determine whether the benefit of endovascular treatment is attenuated with greater white matter disease.
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Affiliation(s)
- E A Mistry
- From the Departments of Neurology (E.A.M., M.S.) and
| | - A M Mistry
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - T Mehta
- Department of Neurology and Neurosurgery (T.M.), University of Minnesota, Minneapolis, Minnesota
| | - N Arora
- Department of Neurology (N.A.), University of Missouri, Columbia, Missouri
| | - A K Starosciak
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - F D L R La Rosa
- Baptist Health Neuroscience Center (A.K.S., F.D.L.R.L.R.), Miami, Florida
| | - J E Siegler
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - S E Kasner
- Department of Neurology (J.E.S., S.E.K.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - R Chitale
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Fusco
- Neurosurgery (A.M.M., R.C., M. Fusco), and
| | - M Froehler
- Cerebrovascular Program (M. Froehler), Vanderbilt University Medical Center, Nashville, Tennessee
| | - S Yaghi
- New York University Langone Health (S.Y.), Brooklyn, New York
| | - M Schrag
- From the Departments of Neurology (E.A.M., M.S.) and
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Chalouhi N, Tjoumakaris S, Dumont AS, Gonzalez LF, Randazzo C, Gordon D, Chitale R, Rosenwasser R, Jabbour P. Superior hypophyseal artery aneurysms have the lowest recurrence rate with endovascular therapy. AJNR Am J Neuroradiol 2012; 33:1502-6. [PMID: 22403776 DOI: 10.3174/ajnr.a3004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Given the challenges posed by surgical clipping, endovascular techniques have been increasingly used to treat SHA aneurysms. The purpose of this study was to assess the safety and efficacy of endovascular techniques in the treatment of SHA aneurysms. MATERIALS AND METHODS Medical charts and initial and follow-up angiograms were reviewed retrospectively for all patients treated with endovascular procedures at our institution between January 2006 and February 2011. RESULTS We identified 87 patients with SHA aneurysms who were treated with endovascular techniques. Of these patients, 79 were women and only 8 were men (90.8% female predominance). Thirty-five patients were treated with coil embolization; 45, with stent-assisted coiling; 4, with balloon-assisted coil embolization; and 3, with a flow-diversion technique. Minor complications occurred in 2 patients (2.2%). None of the patients had a major complication. The mortality and permanent morbidity rates related to the procedure were 0%. Imaging follow-up was available for 89.4% of patients (DSA in 65, MRA in 11 patients) at a mean time point of 10.4 months (range, 6-60 months). Of the 76 patients with available follow-up, 3 patients had a recurrence (3.9%) and only 1 required further intervention (1.3%). Stent-assisted coiling was associated with lower recurrence rates than simple coil embolization. CONCLUSIONS SHA aneurysms have the lowest recurrence rate with endovascular treatment compared with aneurysms in other locations by using historical data. Because of its safety and efficacy, endovascular therapy should be considered the procedure of choice for the treatment of SHA aneurysms.
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Affiliation(s)
- N Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA
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