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Blakely ML, Krzyzaniak A, Dassinger MS, Pedroza C, Weitkamp JH, Gosain A, Cotten M, Hintz SR, Rice H, Courtney SE, Lally KP, Ambalavanan N, Bendel CM, Bui KCT, Calkins C, Chandler NM, Dasgupta R, Davis JM, Deans K, DeUgarte DA, Gander J, Jackson CCA, Keszler M, Kling K, Fenton SJ, Fisher KA, Hartman T, Huang EY, Islam S, Koch F, Lainwala S, Lesher A, Lopez M, Misra M, Overbey J, Poindexter B, Russell R, Stylianos S, Tamura DY, Yoder BA, Lucas D, Shaul D, Ham PB, Fitzpatrick C, Calkins K, Garrison A, de la Cruz D, Abdessalam S, Kvasnovsky C, Segura BJ, Shilyansky J, Smith LM, Tyson JE. Effect of Early vs Late Inguinal Hernia Repair on Serious Adverse Event Rates in Preterm Infants: A Randomized Clinical Trial. JAMA 2024; 331:1035-1044. [PMID: 38530261 DOI: 10.1001/jama.2024.2302] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Importance Inguinal hernia repair in preterm infants is common and is associated with considerable morbidity. Whether the inguinal hernia should be repaired prior to or after discharge from the neonatal intensive care unit is controversial. Objective To evaluate the safety of early vs late surgical repair for preterm infants with an inguinal hernia. Design, Setting, and Participants A multicenter randomized clinical trial including preterm infants with inguinal hernia diagnosed during initial hospitalization was conducted between September 2013 and April 2021 at 39 US hospitals. Follow-up was completed on January 3, 2023. Interventions In the early repair strategy, infants underwent inguinal hernia repair before neonatal intensive care unit discharge. In the late repair strategy, hernia repair was planned after discharge from the neonatal intensive care unit and when the infants were older than 55 weeks' postmenstrual age. Main Outcomes and Measures The primary outcome was occurrence of any prespecified serious adverse event during the 10-month observation period (determined by a blinded adjudication committee). The secondary outcomes included the total number of days in the hospital during the 10-month observation period. Results Among the 338 randomized infants (172 in the early repair group and 166 in the late repair group), 320 underwent operative repair (86% were male; 2% were Asian, 30% were Black, 16% were Hispanic, 59% were White, and race and ethnicity were unknown in 9% and 4%, respectively; the mean gestational age at birth was 26.6 weeks [SD, 2.8 weeks]; the mean postnatal age at enrollment was 12 weeks [SD, 5 weeks]). Among 308 infants (91%) with complete data (159 in the early repair group and 149 in the late repair group), 44 (28%) in the early repair group vs 27 (18%) in the late repair group had at least 1 serious adverse event (risk difference, -7.9% [95% credible interval, -16.9% to 0%]; 97% bayesian posterior probability of benefit with late repair). The median number of days in the hospital during the 10-month observation period was 19.0 days (IQR, 9.8 to 35.0 days) in the early repair group vs 16.0 days (IQR, 7.0 to 38.0 days) in the late repair group (82% posterior probability of benefit with late repair). In the prespecified subgroup analyses, the probability that late repair reduced the number of infants with at least 1 serious adverse event was higher in infants with a gestational age younger than 28 weeks and in those with bronchopulmonary dysplasia (99% probability of benefit in each subgroup). Conclusions and Relevance Among preterm infants with inguinal hernia, the late repair strategy resulted in fewer infants having at least 1 serious adverse event. These findings support delaying inguinal hernia repair until after initial discharge from the neonatal intensive care unit. Trial Registration ClinicalTrials.gov Identifier: NCT01678638.
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Affiliation(s)
- Martin L Blakely
- Department of Surgery, Institute for Clinical Research and Learning Healthcare and Institute for Implementation Science, University of Texas Health Science Center, Houston
| | | | - Melvin S Dassinger
- Division of Pediatric Surgery, University of Arkansas for Medical Sciences, Little Rock
| | - Claudia Pedroza
- Department of Pediatrics, Institute for Clinical Research and Learning Healthcare, University of Texas Health Science Center, Houston
| | | | - Ankush Gosain
- Division of Pediatric Surgery, University of Colorado, Aurora
| | - Michael Cotten
- Division of Neonatology, Duke University, Durham, North Carolina
| | - Susan R Hintz
- Division of Neonatology, Stanford University, Palo Alto, California
| | - Henry Rice
- Division of Pediatric Surgery, Duke University, Durham, North Carolina
| | - Sherry E Courtney
- Division of Neonatology, University of Arkansas for Medical Sciences, Little Rock
| | - Kevin P Lally
- Department of Pediatric Surgery, University of Texas Health Science Center, Houston
| | | | | | - Kim Chi T Bui
- Division of Neonatology, Kaiser Permanente, Los Angeles, California
| | - Casey Calkins
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jonathan M Davis
- Division of Neonatology, Tufts Medical Center, Boston, Massachusetts
| | - Katherine Deans
- Department of Pediatric Surgery, Nemours Children's Hospital, Wilmington, Delaware
| | - Daniel A DeUgarte
- Division of Pediatric Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Jeffrey Gander
- Division of Pediatric Surgery, University of Virginia, Charlottesville
| | - Carl-Christian A Jackson
- Division of Pediatric Surgery, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Martin Keszler
- Division of Neonatology, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Karen Kling
- Rady Children's Hospital and Division of Pediatric Surgery, University of California, San Diego
| | - Stephen J Fenton
- Division of Pediatric Surgery, University of Utah, Salt Lake City
| | | | - Tyler Hartman
- Division of Neonatology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Eunice Y Huang
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saleem Islam
- Division of Pediatric Surgery, University of Florida, Gainesville
- Department of Surgery, Aga Khan University, Sindh, Pakistan
| | - Frances Koch
- Division of Neonatology, Medical University of South Carolina, Charleston
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children's Medical Center, Hartford
| | - Aaron Lesher
- Division of Pediatric Surgery, Medical University of South Carolina, Charleston
| | - Monica Lopez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meghna Misra
- Pediatric Surgery, Elliot Hospital, Manchester, New Hampshire
| | - Jamie Overbey
- Division of Neonatology, Naval Medical Center, San Diego, California
| | - Brenda Poindexter
- Division of Neonatology, School of Medicine, Emory University, Atlanta, Georgia
| | - Robert Russell
- Division of Pediatric Surgery, University of Alabama at Birmingham
| | - Steven Stylianos
- Division of Pediatric Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, New York
| | - Douglas Y Tamura
- Division of Pediatric Surgery, Valley Children's Hospital, Madera, California
| | | | - Donald Lucas
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Division of Pediatric Surgery, Naval Medical Center, San Diego, California
| | - Donald Shaul
- Division of Pediatric Surgery, Kaiser Permanente, Los Angeles, California
| | - P Ben Ham
- Division of Pediatric Surgery, University at Buffalo, Buffalo, New York
| | - Colleen Fitzpatrick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York
| | - Kara Calkins
- Division of Neonatology, David Geffen School of Medicine, University of California, Los Angeles
| | - Aaron Garrison
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Diomel de la Cruz
- Division of Neonatology, School of Medicine, University of Florida, Gainesville
| | - Shahab Abdessalam
- Division of Neonatology, University of Nebraska Medical Center, Omaha
| | | | - Bradley J Segura
- Division of Pediatric Surgery, M Health Fairview University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Joel Shilyansky
- Department of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City
| | | | - Jon E Tyson
- Department of Pediatrics, Institute for Clinical Research and Learning Healthcare, University of Texas Health Science Center, Houston
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Brown J, Chang X, Matson A, Lainwala S, Chen MH, Cong X, Casavant SG. Health disparities in preterm births. Front Public Health 2023; 11:1275776. [PMID: 38162611 PMCID: PMC10757361 DOI: 10.3389/fpubh.2023.1275776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Black African American (B/AA) women have a 2-fold to 3-fold elevated risk compared with non-Hispanic White (W) women for preterm birth. Further, preterm birth is the leading cause of mortality among B/AA infants, and among survivors, preterm infant adverse health outcomes occur disproportionately in B/AA infants. Racial inequities in maternal and infant health continue to pose a public health crisis despite the discovery >100 years ago. The purpose of this study was to expand on reported preterm infant outcome disparities. A life-course approach, accumulation of lifelong stress, including discrimination, may explain social factors causing preterm birth rate and outcome inequities in B/AA mothers. Methods Anthropometric measures and clinical treatment information for 197 consented participants were milled from electronic health records across 4 years. The Neonatal Infant Stressor Scale was used to tally acute and chronic painful/stressful procedures. Neurobehavioral differences were investigated using the Neonatal Intensive Care Unit (NICU) Network Neurobehavioral Scale. Results B/AA mothers gave birth to preterm infants earlier than W mothers. NICU hospitalization stays were extended more than 2 weeks for the significantly smaller B/AA preterm infants in comparison to the age-matched W preterm infants. A higher number of chronic lifesaving procedures with demonstrated altered stress response patterns were recorded for B/AA preterm infants. Discussion This cross-sectional analysis of preterm birth rates and preterm infant developmental and neurodevelopmental outcomes are presented in the context of NICU stress and pain, with attendant implications for infant mortality and future health disparities. Preterm birth rate and outcome inequities further support the need to develop interventions and policies that will reduce the impact of discrimination and improve social determinants of health for Black, Indigenous, and other People of Color.
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Affiliation(s)
- Judy Brown
- Institute for Systems Genomics, University of Connecticut, Storrs, CT, United States
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - Xiaolin Chang
- Department of Statistics, University of Connecticut, Storrs, CT, United States
| | - Adam Matson
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, United States
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT, United States
| | - Xiaomei Cong
- Institute for Systems Genomics, University of Connecticut, Storrs, CT, United States
- Yale University School of Nursing, Orange, CT, United States
| | - Sharon G. Casavant
- Institute for Systems Genomics, University of Connecticut, Storrs, CT, United States
- School of Nursing, University of Connecticut, Storrs, CT, United States
- Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, United States
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Zhao T, Starkweather AR, Matson A, Lainwala S, Xu W, Cong X. Nurses’ experiences of caring for preterm infants in pain: A meta-ethnography. Int J Nurs Sci 2022; 9:533-541. [PMID: 36285076 PMCID: PMC9587390 DOI: 10.1016/j.ijnss.2022.09.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit (NICU) hospitalization. Despite advancements in pain alleviation, nurses remain challenged to provide timely and effective pain management for preterm infants. Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population. The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’ experiences of taking care of preterm infants in pain. Methods An extensive literature search in PubMed, CINAHL, PsycINFO, Scopus, BIOSIS and ProQuest Dissertation and Theses Database was conducted, including studies within the past 10 years. Two nursing researchers conducted data extraction and analysis independently. Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants. Studies published in a language other than English, articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’ experiences were excluded. Critical Appraisal Skills Programme was used for literature quality evaluation. Results Eight studies remained after further screening according to inclusion and exclusion criteria. These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran, Canada, the United States, Finland, Sweden, Switzerland, and Australia. Five themes emerged on the nurses’ perspectives of taking care of preterm infants in pain: 1) They sense the neonatal pain; 2) Adverse consequences of unrelieved pain; 3) Barriers of managing pain; 4) Concerns of available approaches for pain relief; 5) Failure to work with parents. Conclusions This meta-ethnography identified nurses’ understanding of pain in preterm infants that can be assessed, and they acknowledged that unrelieved pain could cause developmental deficits in infants. The barriers are lack of training and support on pain assessment and intervention in preterm infants. Optimizing workload and environment, developing age-specified pain assessment and intervention, receiving emotional support and training, and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.
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Affiliation(s)
- Tingting Zhao
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | | | - Adam Matson
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Wanli Xu
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
- Corresponding author. School of Nursing, University of Connecticut, Storrs, CT, USA.
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Fabrizio V, Trzaski JM, Brownell EA, Esposito P, Lainwala S, Lussier MM, Hagadorn JI. Individualized versus standard diet fortification for growth and development in preterm infants receiving human milk. Cochrane Database Syst Rev 2020; 11:CD013465. [PMID: 33226632 PMCID: PMC8094236 DOI: 10.1002/14651858.cd013465.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Human milk as compared to formula reduces morbidity in preterm infants but requires fortification to meet their nutritional needs and to reduce the risk of extrauterine growth failure. Standard fortification methods are not individualized to the infant and assume that breast milk is uniform in nutritional content. Strategies for individualizing fortification are available; however it is not known whether these are safe, or if they improve outcomes in preterm infants. OBJECTIVES To determine whether individualizing fortification of breast milk feeds in response to infant blood urea nitrogen (adjustable fortification) or to breast milk macronutrient content as measured with a milk analyzer (targeted fortification) reduces mortality and morbidity and promotes growth and development compared to standard, non-individualized fortification for preterm infants receiving human milk at < 37 weeks' gestation or at birth weight < 2500 grams. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 9), in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), on September 20, 2019. We also searched clinical trials databases and the reference lists of retrieved articles for pertinent randomized controlled trials (RCTs) and quasi-randomized trials. SELECTION CRITERIA We considered randomized, quasi-randomized, and cluster-randomized controlled trials of preterm infants fed exclusively breast milk that compared a standard non-individualized fortification strategy to individualized fortification using a targeted or adjustable strategy. We considered studies that examined any use of fortification in eligible infants for a minimum duration of two weeks, initiated at any time during enteral feeding, and providing any regimen of human milk feeding. DATA COLLECTION AND ANALYSIS Data were collected using the standard methods of Cochrane Neonatal. Two review authors evaluated the quality of the studies and extracted data. We reported analyses of continuous data using mean differences (MDs), and dichotomous data using risk ratios (RRs). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Data were extracted from seven RCTs, resulting in eight publications (521 total participants were enrolled among these studies), with duration of study interventions ranging from two to seven weeks. As compared to standard non-individualized fortification, individualized (targeted or adjustable) fortification of enteral feeds probably increased weight gain during the intervention (typical mean difference [MD] 1.88 g/kg/d, 95% confidence interval [CI] 1.26 to 2.50; 6 studies, 345 participants), may have increased length gain during the intervention (typical MD 0.43 mm/d, 95% CI 0.32 to 0.53; 5 studies, 242 participants), and may have increased head circumference gain during the intervention (typical MD 0.14 mm/d, 95% CI 0.06 to 0.23; 5 studies, 242 participants). Compared to standard non-individualized fortification, targeted fortification probably increased weight gain during the intervention (typical MD 1.87 g/kg/d, 95% CI 1.15 to 2.58; 4 studies, 269 participants) and may have increased length gain during the intervention (typical MD 0.45 mm/d, 95% CI 0.32 to 0.57; 3 studies, 166 participants). Adjustable fortification probably increased weight gain during the intervention (typical MD 2.86 g/kg/d, 95% CI 1.69 to 4.03; 3 studies, 96 participants), probably increased gain in length during the intervention (typical MD 0.54 mm/d, 95% CI 0.38 to 0.7; 3 studies, 96 participants), and increased gain in head circumference during the intervention (typical MD 0.36 mm/d, 95% CI 0.21 to 0.5; 3 studies, 96 participants). We are uncertain whether there are differences between individualized versus standard fortification strategies in the incidence of in-hospital mortality, bronchopulmonary dysplasia, necrotizing enterocolitis, culture-proven late-onset bacterial sepsis, retinopathy of prematurity, osteopenia, length of hospital stay, or post-hospital discharge growth. No study reported severe neurodevelopmental disability as an outcome. One study that was published after our literature search was completed is awaiting classification. AUTHORS' CONCLUSIONS We found moderate- to low-certainty evidence suggesting that individualized (either targeted or adjustable) fortification of enteral feeds in very low birth weight infants increases growth velocity of weight, length, and head circumference during the intervention compared with standard non-individualized fortification. Evidence showing important in-hospital and post-discharge clinical outcomes was sparse and of very low certainty, precluding inferences regarding safety or clinical benefits beyond short-term growth.
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Affiliation(s)
- Veronica Fabrizio
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Jennifer M Trzaski
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Elizabeth A Brownell
- School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
- Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas, USA
| | | | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Mary M Lussier
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
| | - James I Hagadorn
- Division of Neonatology, Connecticut Children's, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
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5
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Gehl B, Brownell E, Power K, Feinn R, Haines K, Lussier M, Moore J, Lainwala S. Comparison of Types of Breast Milk Fortification at Discharge from the Neonatal Intensive Care Unit and Breast Milk Feeding Rates and Growth at 4 Months Corrected Age. Breastfeed Med 2020; 15:655-661. [PMID: 32865432 DOI: 10.1089/bfm.2020.0022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Effects of breast milk (BM) enhancement on long-term BM feeding in preterm infants discharged from the neonatal intensive care unit (NICU) have not been examined previously. This study compares any BM feeding rates at 4 months corrected age (CA) in preterm infants discharged from the NICU on BM enhancement by fortification of expressed BM with infant formula additives (BM-F) versus BM supplemented with infant formula feeds (BM-S). Subjects and Methods: We compared infants born between January 1, 2013, and December 31, 2017, with gestational age <32 weeks or birth weight <1500 g, discharged home on BM-F or BM-S from two NICUs and followed at 4 months CA. Multivariate logistic regression with propensity scoring estimated the adjusted associations between nutrition at discharge and any BM feeding at 4 months CA. Results: Two hundred eighty-five infants were followed at 4 months CA. Infants discharged on BM-F were more likely to have mothers with multiple gestation, private insurance and not Caucasian, initiate feeds of human milk, be discharged from NICU-1, and receive any BM at 4 months CA (p < 0.03). No significant difference in growth parameters <10th percentile at 4 months CA was observed between the two groups. After adjusting for confounding factors, discharge from the NICU on BM-F was significantly associated with BM feeding at 4 months CA (odds ratio: 3.89, 95% confidence interval 1.66-9.14, p = 0.002). Conclusion: In this observational study, preterm infants receiving BM fortified with formula powder additives at discharge from the NICU had better BM feeding outcomes without poor growth at 4 months CA relative to those infants receiving BM supplemented with infant formula feeds.
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Affiliation(s)
- Brigitta Gehl
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Elizabeth Brownell
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Department of Pediatrics, School of Nursing, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Kimberly Power
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
| | - Richard Feinn
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - Kathleen Haines
- Department of Clinical Nutrition Services, Connecticut Children's, Hartford, Connecticut, USA
| | - Mary Lussier
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA
| | - James Moore
- Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Shabnam Lainwala
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA.,Division of Neonatology, Connecticut Children's, Hartford, Connecticut, USA.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
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6
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Lainwala S, Kosyakova N, Power K, Hussain N, Moore JE, Hagadorn JI, Brownell EA. Delayed Achievement of Oral Feedings Is Associated with Adverse Neurodevelopmental Outcomes at 18 to 26 Months Follow-up in Preterm Infants. Am J Perinatol 2020; 37:483-490. [PMID: 30822799 DOI: 10.1055/s-0039-1681059] [Citation(s) in RCA: 14] [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] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to compare neurodevelopmental outcomes in preterm infants at 18 to 26 months corrected age (CA) who did versus did not achieve full oral feedings at 40 weeks postmenstrual age (PMA). STUDY DESIGN This retrospective study included infants born between 2010 and 2015 with gestational age <32 weeks and followed between 18 and 26 months CA. Achievement of full oral feedings was defined as oral intake >130 mL/kg/d for >72 hours by 40 weeks PMA. Incidence of cognitive, language, or motor delay, or cerebral palsy at 18 to 26 months CA was compared in multivariable analyses for infants in the two feeding groups. RESULTS Of 372 included infants, those achieving full oral feedings had lower incidence of any adverse neurodevelopmental outcome (p < 0.001) compared with those who did not achieve full oral feedings. In multivariable analyses, achievement of full oral feedings by 40 weeks PMA was associated with decreased odds of cognitive, language, and motor delays, cerebral palsy, and any adverse neurodevelopmental outcome at follow-up. CONCLUSION Achievement of full oral feedings by 40 weeks PMA was associated with better adjusted neurodevelopmental outcomes at 18 to 26 months CA. Inability to fully feed orally at 40 weeks PMA may be a simple, clinically useful marker for risk of adverse neurodevelopmental outcomes.
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Affiliation(s)
- Shabnam Lainwala
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Natalia Kosyakova
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kimberly Power
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Naveed Hussain
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - James E Moore
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - James I Hagadorn
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Elizabeth A Brownell
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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7
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Fabrizio V, Trzaski JM, Brownell EA, Esposito P, Lainwala S, Lussier MM, Hagadorn JI. Targeted or adjustable versus standard diet fortification for growth and development in very low birth weight infants receiving human milk. Hippokratia 2019. [DOI: 10.1002/14651858.cd013465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Veronica Fabrizio
- Connecticut Children's; Division of Neonatology; Hartford CT USA
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington CT USA
| | - Jennifer M Trzaski
- Connecticut Children's; Division of Neonatology; Hartford CT USA
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington CT USA
| | - Elizabeth A Brownell
- University of Texas Health Science Center; School of Nursing; San Antonio TX USA
- University of Texas Health Science Center; Department of Pediatrics; San Antonio Texas USA
| | | | - Shabnam Lainwala
- Connecticut Children's; Division of Neonatology; Hartford CT USA
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington CT USA
| | - Mary M Lussier
- Connecticut Children's; Division of Neonatology; Hartford CT USA
| | - James I Hagadorn
- Connecticut Children's; Division of Neonatology; Hartford CT USA
- University of Connecticut School of Medicine; Department of Pediatrics; Farmington CT USA
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8
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Lainwala S, Kosyakova N, Spizzoucco AM, Herson V, Brownell EA. Clinical and nutritional outcomes of two liquid human milk fortifiers for premature infants. J Neonatal Perinatal Med 2017; 10:393-401. [PMID: 29286933 DOI: 10.3233/npm-16164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/07/2023]
Abstract
BACKGROUND In preterm infants fortification of human milk with human milk fortifiers (HMF) to optimize nutrition and growth is standard practice. We compared clinical, nutrition and growth outcomes in infants receiving two types of liquid HMF (LHMF). METHODS Clinical, nutrition and growth outcomes were compared between infants admitted to a level IV NICU, and born with birth weight less than or equal to 1800 grams, between 10/1/2014-12/31/2014 and received human milk with acidified LHMF (ALHMF) and between 1/1/2015-4/31/2015 and received human milk with heat treated LHMF (HTLHMF). RESULTS Of the 85 qualifying infants, 67 received human milk and LHMF. ALHMF group had significantly higher incidence of metabolic acidosis and lower bicarbonate and base excess levels relative to infants receiving HTLHMF (P < 0.001). There were no significant differences by LHMF status in other clinical outcomes and nutrition and growth outcomes. In multivariate analyses, ALHMF use was associated with metabolic acidosis, and lower base excess and bicarbonate levels. CONCLUSION In our study, the clinical, nutrition and growth outcomes between the two LHMF groups were similar. However, use of ALHMF in preterm infants was associated with increased incidence of metabolic acidosis in our cohort. Further randomized control trials are warranted to evaluate these findings.
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Affiliation(s)
- Shabnam Lainwala
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Ann Marie Spizzoucco
- Department of Nutrition, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Victor Herson
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Elizabeth A Brownell
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
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Abstract
Background Cyclo-oxygenase inhibitors (COX-I) treatment of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants during the early postnatal period is well established, but their use beyond early postnatal period is not well studied. Objective The objective of this study was to determine the effectiveness of postnatal COX-I for PDA treatment beyond 2 weeks of age in VLBW infants. Study Design A retrospective cohort of VLBW infants admitted to two tertiary NICUs between 1990 and 2008 were studied. Infants with symptomatic PDA were treated with COX-I and infants with failed medical treatment were candidates for surgical ligation. Effectiveness of COX-I treatment, measured by the need for surgical ligation, was compared between early (day of life [DOL] < 14, early treatment group [ETG]) and late (DOL ≥ 14, late treatment group [LTG]) treatment groups. Results Of the 1,289 infants with PDA, 1,082 (84%) were treated with COX-I; 1,046 (97%) infants were in ETG and 36 (3%) in LTG. PDA ligation rates after COX-I treatment were 15% in ETG and 14% in LTG (p-value: not significant). There were no significant differences in demographics or morbidities between the two groups. Conclusions In VLBW infants, late treatment of PDA with COX-I was as effective as early treatment. Trial of late COX-I treatment is warranted for symptomatic PDA before surgical treatment.
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Affiliation(s)
- Shabnam Lainwala
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Naveed Hussain
- Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
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Abstract
We review here 7 cases of neonatal transfusion-associated babesiosis at a NICU in the northeast United States. Transfusion from 2 infected units of blood resulted in the 7 cases described. The clinical presentation was highly variable in this cohort; the extremely low birth weight neonates were the most severely affected. Antibiotic therapy was effective in neonates with mild and asymptomatic infection; however, double-volume exchange blood transfusion with prolonged multidrug treatment was required for the 2 most severe cases. The risk of Babesia microti infection is not eliminated through current blood-bank practices. Neonatologists in endemic areas should have a high index of suspicion for babesiosis in premature infants exposed to blood transfusions.
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Affiliation(s)
- Kari A Simonsen
- Pediatric Infectious Diseases, University of Nebraska Medical Center, 982162 Nebraska Medical Center, Omaha, Nebraska 68198-2162, USA.
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11
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Lainwala S, Perritt R, Poole K, Vohr B. Neurodevelopmental and growth outcomes of extremely low birth weight infants who are transferred from neonatal intensive care units to level I or II nurseries. Pediatrics 2007; 119:e1079-87. [PMID: 17403821 DOI: 10.1542/peds.2006-0899] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Transfer of clinically stable infants to level I and II nurseries alleviates demands on NICUs and allows better use of beds and resources. This study compared growth, neurodevelopmental impairments, postdischarge rehospitalization and deaths, and compliance for follow-up assessment at 18 to 22 months' corrected age of extremely low birth weight infants who transferred to level I and II nurseries with those who continued to receive care to discharge in a NICU. METHODS A retrospective analysis of prospectively collected data from the National Institute of Child Health and Human Development Neonatal Research Network was performed. Between January 1998 and June 2002, 4896 infants born with birth weights of 401 to 1000 g and cared for in 19 National Institute of Child Health and Human Development Neonatal Research Network centers were included. The sample consisted of 4392 survivors who received continuing care in the NICU to discharge home and 504 infants who were transferred to level I and II nurseries before discharge home. Demographics, perinatal characteristics, growth, and neurodevelopmental impairments were compared. Bivariate and logistic regression analyses were performed. RESULTS Transfer of infants to level I and II nurseries was associated significantly with white race, private insurance, outborn status, and lower neonatal morbidities and compliance for follow-up compared with the NICU group. After adjusting for known covariates, transfer to level I and II nurseries was not associated with neurodevelopmental impairments or death; however, it was associated with increased postdischarge rehospitalization. CONCLUSIONS Extremely low birth weight infants who are transferred to level I and II nurseries have similar growth and neurodevelopmental outcomes to infants who are discharged from a NICU. They are, however, more likely to be readmitted to the hospital and are less compliant for follow-up. Establishment of consistent guidelines for comprehensive discharge planning for level I and II nurseries may improve follow-up compliance and reduce rehospitalization rates among these infants who are transferred.
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Affiliation(s)
- Shabnam Lainwala
- Department of Pediatrics, Women and Infants Hospital, 101 Dudley St, Providence, RI 02905, USA.
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12
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Lainwala S, Brown ER, Weinschenk NP, Blackwell MT, Hagadorn JI. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care 2005; 5:265-72. [PMID: 16202968 DOI: 10.1016/j.adnc.2005.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [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: 11/28/2022]
Abstract
PURPOSE Length of hospital stay (LOS) of infants treated for neonatal abstinence syndrome (NAS) with methadone was compared to LOS of those treated with an oral morphine preparation (OMP, neonatal morphine solution, or deodorized tincture of opium). METHODS A retrospective review of medical records of infants treated for NAS due to in utero exposure to methadone and/or illicit drugs such as heroin or morphine was performed for birthweight, neonatal abstinence scores, infant and maternal illicit drug exposure history, maternal methadone dose (if any), and details of treatment. Length of stay was the primary outcome measure. RESULTS Forty-six infants met the inclusion criteria. The median LOS of infants treated with methadone versus OMP was not significant (P > 0.05). Prolonged LOS was associated with larger pharmacological treatment doses required to control withdrawal symptoms, larger maternal methadone dose, and increased birthweight. After adjusting for these factors, exposure to opioids in utero, maternal nicotine use, hospital of treatment, severity of withdrawal symptoms, and foster care placement were not significantly associated with LOS in univariate or multivariate analyses. CONCLUSIONS These results suggest that infants treated with OMP or methadone have similar LOS. Longer LOS is associated with both higher maternal methadone doses and higher opioid treatment dose requirements after birth. The potential effect of maternal methadone dose on neonatal LOS should be considered when treating expectant mothers on methadone maintenance therapy.
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Affiliation(s)
- Shabnam Lainwala
- Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI 02905, USA.
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Gow JB, Lyerla TA, Lainwala S. Enlarged dysmorphic lysosomes in an established beige (C57BL/6J;bgJ(/bgJ)) mouse mutant fibroblast line: a reversible characteristic. In Vitro Cell Dev Biol Anim 1996; 32:457-61. [PMID: 8889598 DOI: 10.1007/bf02723046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Gow JB, Lainwala S, Lyerla TA. Cellular expression of the beige mouse mutation and its correction in hybrids with control human fibroblasts. In Vitro Cell Dev Biol Anim 1993; 29A:884-91. [PMID: 8167906 DOI: 10.1007/bf02631368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fibroblasts from a beige mouse (C57BL/6J; bgJ bgJ) have been established and maintained in culture for more than 3 yr. At early passages, the mutant cells were distinguishable from C57BL/6J control mouse fibroblasts at the ultrastructural level by the presence of enlarged cytoplasmic granules. After continuous passaging, this distinguishing feature was lost from the mutant cells, correlated with their increased growth rate. Clustered, perinuclear distribution of lysosomes was retained, however, and was quantitatively different at any passage number of the beige cell line from the dispersed distribution of these organelles in control mouse fibroblasts, as analyzed by computer-aided, video-enhanced light microscopy. In somatic cell hybrids between the established beige cell line and a control human diploid fibroblast cell strain, seven uncorrected hybrid lines retained a lysosomal dispersion pattern statistically indistinguishable from that of the beige mouse cell lines. Three corrected hybrid lines had lysosomal dispersion patterns that were significantly different from the beige parent line and indistinguishable from that of the control mouse fibroblast line. Thus, lysosomal dispersion can be used objectively and quantitatively to distinguish mutant beige and control mouse fibroblasts and corrected vs. uncorrected cell hybrids made from the beige/control human somatic cell crosses.
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Affiliation(s)
- J B Gow
- Department of Biology, Clark University, Worcester, Massachusetts 01610
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Rocchi M, Baldini A, Archidiacono N, Lainwala S, Miller OJ, Miller DA. Chromosome-specific subsets of human alphoid DNA identified by a chromosome 2-derived clone. Genomics 1990; 8:705-9. [PMID: 2276742 DOI: 10.1016/0888-7543(90)90258-v] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We have cloned an alphoid DNA fragment, pBS4D, from the DNA of a human-hamster hybrid cell line containing chromosome 2 as its only cytologically detectable human component. Under high stringency conditions, pBS4D hybridized in situ mostly to chromosome 2 and to a lesser extent to chromosomes 18 and 20. Restriction analysis using the DNA from selected somatic hybrid cell lines revealed that the genomic organization of this alphoid DNA differs on each of these three chromosomes.
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Affiliation(s)
- M Rocchi
- Center for Molecular Biology, Wayne State University, Detroit, Michigan 48201
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