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Changing patterns of patent ductus arteriosus surgical ligation in the United States.
Reese J, Scott TA, Patrick SW
(2018) Semin Perinatol 42: 253-261
MeSH Terms: Cerebral Intraventricular Hemorrhage, Cross-Sectional Studies, Ductus Arteriosus, Patent, Enterocolitis, Necrotizing, Female, Humans, Infant, Extremely Low Birth Weight, Infant, Newborn, Infant, Very Low Birth Weight, Ligation, Male, Practice Patterns, Physicians', Retrospective Studies, Treatment Outcome, United States, Vocal Cord Paralysis
Show Abstract · Added November 26, 2018
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
Copyright © 2018 Elsevier Inc. All rights reserved.
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16 MeSH Terms
Inverse Relationship between Soluble RAGE and Risk for Bronchopulmonary Dysplasia.
Benjamin JT, van der Meer R, Slaughter JC, Steele S, Plosa EJ, Sucre JM, Moore PE, Aschner JL, Blackwell TS, Young LR
(2018) Am J Respir Crit Care Med 197: 1083-1086
MeSH Terms: Biomarkers, Bronchopulmonary Dysplasia, California, Female, Gestational Age, Humans, Infant, Low Birth Weight, Infant, Newborn, Infant, Premature, Male, Receptor for Advanced Glycation End Products, Risk Factors
Added March 21, 2018
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12 MeSH Terms
DOHaD at the intersection of maternal immune activation and maternal metabolic stress: a scoping review.
Goldstein JA, Norris SA, Aronoff DM
(2017) J Dev Orig Health Dis 8: 273-283
MeSH Terms: Animals, Case-Control Studies, Cross-Sectional Studies, Female, Humans, Infant, Low Birth Weight, Metabolic Diseases, Pregnancy, Pregnancy Complications, Premature Birth, Prospective Studies, Randomized Controlled Trials as Topic, Retrospective Studies, Stress, Physiological
Show Abstract · Added June 2, 2017
The prenatal environment is now recognized as a key driver of non-communicable disease risk later in life. Within the developmental origins of health and disease (DOHaD) paradigm, studies are increasingly identifying links between maternal morbidity during pregnancy and disease later in life for offspring. Nutrient restriction, metabolic disorders during gestation, such as diabetes or obesity, and maternal immune activation provoked by infection have been linked to adverse health outcomes for offspring later in life. These factors frequently co-occur, but the potential for compounding effects of multiple morbidities on DOHaD-related outcomes has not received adequate attention. This is of particular importance in low- or middle-income countries (LMICs), which have ongoing high rates of infectious diseases and are now experiencing transitions from undernutrition to excess adiposity. The purpose of this scoping review is to summarize studies examining the effect and interaction of co-occurring metabolic or nutritional stressors and infectious diseases during gestation on DOHaD-related health outcomes. We identified nine studies in humans - four performed in the United States and five in LMICs. The most common outcome, also in seven of nine studies, was premature birth or low birth weight. We identified nine animal studies, six in mice, two in rats and one in sheep. The interaction between metabolic/nutritional exposures and infectious exposures had varying effects including synergism, inhibition and independent actions. No human studies were specifically designed to assess the interaction of metabolic/nutritional exposures and infectious diseases. Future studies of neonatal outcomes should measure these exposures and explicitly examine their concerted effect.
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14 MeSH Terms
Surgical necrotizing enterocolitis.
Robinson JR, Rellinger EJ, Hatch LD, Weitkamp JH, Speck KE, Danko M, Blakely ML
(2017) Semin Perinatol 41: 70-79
MeSH Terms: Biomarkers, Drainage, Enterocolitis, Necrotizing, Enterostomy, Fatty Acid-Binding Proteins, Feces, Humans, Infant, Extremely Premature, Infant, Newborn, Infant, Premature, Diseases, Infant, Very Low Birth Weight, Laparotomy, Leukocyte L1 Antigen Complex, Patient Selection, Predictive Value of Tests, S100A12 Protein, Treatment Outcome
Show Abstract · Added January 16, 2017
Although currently available data are variable, it appears that the incidence of surgical necrotizing enterocolitis (NEC) has not decreased significantly over the past decade. Pneumoperitoneum and clinical deterioration despite maximal medical therapy remain the most common indications for operative treatment. Robust studies linking outcomes with specific indications for operation are lacking. Promising biomarkers for severe NEC include fecal calprotectin and S100A12; serum fatty acid-binding protein; and urine biomarkers. Recent advances in ultrasonography make this imaging modality more useful in identifying surgical NEC and near-infrared spectroscopy (NIRS) is being actively studied. Another fairly recent finding is that regionalization of care for infants with NEC likely improves outcomes. The neurodevelopmental outcomes after surgical treatment are known to be poor. A randomized trial near completion will provide robust data regarding neurodevelopmental outcomes after laparotomy versus drainage as the initial operative treatment for severe NEC.
Copyright © 2016 Elsevier Inc. All rights reserved.
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17 MeSH Terms
Pulmonary hypertension in the premature infant: a challenging comorbidity in a vulnerable population.
O'Connor MG, Cornfield DN, Austin ED
(2016) Curr Opin Pediatr 28: 324-30
MeSH Terms: Bronchopulmonary Dysplasia, Comorbidity, Echocardiography, Health Services Research, Humans, Hypertension, Pulmonary, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Practice Guidelines as Topic, Vulnerable Populations
Show Abstract · Added February 21, 2017
PURPOSE OF REVIEW - This review is written from the perspective of the pediatric clinician involved in the care of premature infants at risk for pulmonary hypertension. The main objective is to better inform the clinician in the diagnosis and treatment of pulmonary hypertension in premature infants by reviewing the available relevant literature and focusing on the areas for which there is the greatest need for continued research.
RECENT FINDINGS - Continued knowledge regarding the epidemiology of pulmonary hypertension in the premature infant population has aided better diagnostic screening algorithms. Included in this knowledge, is the association of pulmonary hypertension in infants with bronchopulmonary dysplasia (BPD). However, it is also known that beyond BPD, low birth weight and other conditions that result in increased systemic inflammation are associated with pulmonary hypertension. This information has led to the recent recommendation that all infants with BPD should have an echocardiogram to evaluate for evidence of pulmonary hypertension prior to discharge from the neonatal ICU.
SUMMARY - Pulmonary hypertension can be a significant comorbidity for premature infants. This review aims to focus the clinician on the available literature to improve recognition of the condition to allow for more timely interventions.
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13 MeSH Terms
Intrauterine Growth Restriction Alters Mouse Intestinal Architecture during Development.
Fung CM, White JR, Brown AS, Gong H, Weitkamp JH, Frey MR, McElroy SJ
(2016) PLoS One 11: e0146542
MeSH Terms: Animals, Apoptosis, Birth Weight, Cell Proliferation, Female, Fetal Growth Retardation, Gene Expression, Goblet Cells, Humans, Ileum, Infant, Newborn, Mice, Inbred C57BL, Organ Size, Paneth Cells, Pregnancy
Show Abstract · Added April 11, 2016
Infants with intrauterine growth restriction (IUGR) are at increased risk for neonatal and lifelong morbidities affecting multiple organ systems including the intestinal tract. The underlying mechanisms for the risk to the intestine remain poorly understood. In this study, we tested the hypothesis that IUGR affects the development of goblet and Paneth cell lineages, thus compromising the innate immunity and barrier functions of the epithelium. Using a mouse model of maternal thromboxane A2-analog infusion to elicit maternal hypertension and resultant IUGR, we tested whether IUGR alters ileal maturation and specifically disrupts mucus-producing goblet and antimicrobial-secreting Paneth cell development. We measured body weights, ileal weights and ileal lengths from birth to postnatal day (P) 56. We also determined the abundance of goblet and Paneth cells and their mRNA products, localization of cellular tight junctions, cell proliferation, and apoptosis to interrogate cellular homeostasis. Comparison of the murine findings with human IUGR ileum allowed us to verify observed changes in the mouse were relevant to clinical IUGR. At P14 IUGR mice had decreased ileal lengths, fewer goblet and Paneth cells, reductions in Paneth cell specific mRNAs, and decreased cell proliferation. These findings positively correlated with severity of IUGR. Furthermore, the decrease in murine Paneth cells was also seen in human IUGR ileum. IUGR disrupts the normal trajectory of ileal development, particularly affecting the composition and secretory products of the epithelial surface of the intestine. We speculate that this abnormal intestinal development may constitute an inherent "first hit", rendering IUGR intestine susceptible to further injury, infection, or inflammation.
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15 MeSH Terms
The Patent Ductus Arteriosus Problem: Infants Who Still Need Treatment.
Reese J, Laughon MM
(2015) J Pediatr 167: 954-6
MeSH Terms: Cardiac Catheterization, Ductus Arteriosus, Patent, Female, Humans, Infant, Premature, Infant, Premature, Diseases, Infant, Very Low Birth Weight, Male, Patient Discharge
Added February 21, 2016
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9 MeSH Terms
GLI3 Links Environmental Arsenic Exposure and Human Fetal Growth.
Winterbottom EF, Fei DL, Koestler DC, Giambelli C, Wika E, Capobianco AJ, Lee E, Marsit CJ, Karagas MR, Robbins DJ
(2015) EBioMedicine 2: 536-43
MeSH Terms: Adolescent, Adult, Arsenic, Birth Weight, Child Health, Environmental Exposure, Female, Fetal Development, Gene Expression Profiling, Groundwater, Humans, Kruppel-Like Transcription Factors, Maternal Exposure, Middle Aged, Nerve Tissue Proteins, Octamer Transcription Factor-3, Placenta, Pregnancy, Prenatal Exposure Delayed Effects, Signal Transduction, Water Pollutants, Chemical, Water Pollution, Young Adult, Zinc Finger Protein Gli3
Show Abstract · Added November 2, 2015
Although considerable evidence suggests that in utero arsenic exposure affects children's health, these data are mainly from areas of the world where groundwater arsenic levels far exceed the World Health Organization limit of 10 μg/L. We, and others, have found that more common levels of in utero arsenic exposure may also impact children's health. However, the underlying molecular mechanisms are poorly understood. To address this issue, we analyzed the expression of key developmental genes in fetal placenta in a birth cohort of women using unregulated water supplies in a US region with elevated groundwater arsenic. We identified several genes whose expression associated with maternal arsenic exposure in a fetal sex-specific manner. In particular, expression of the HEDGEHOG pathway component, GLI3, in female placentae was both negatively associated with arsenic exposure and positively associated with infant birth weight. This suggests that modulation of GLI3 in the fetal placenta, and perhaps in other fetal tissues, contributes to arsenic's detrimental effects on fetal growth. We showed previously that arsenic-exposed NIH3T3 cells have reduced GLI3 repressor protein. Together, these studies identify GLI3 as a key signaling node that is affected by arsenic, mediating a subset of its effects on developmental signaling and fetal health.
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24 MeSH Terms
Comparison of new modeling methods for postnatal weight in ELBW infants using prenatal and postnatal data.
Porcelli PJ, Rosenbloom ST
(2014) J Pediatr Gastroenterol Nutr 59: e2-8
MeSH Terms: Algorithms, Birth Weight, Body Weight, Electronic Health Records, Enteral Nutrition, Female, Fluid Therapy, Forecasting, Gestational Age, Growth Charts, Humans, Infant, Extremely Low Birth Weight, Infant, Extremely Premature, Infant, Newborn, Linear Models, Male, Neural Networks (Computer), Nutritional Status, Parenteral Nutrition
Show Abstract · Added January 26, 2016
OBJECTIVES - Postnatal infant weight curves are used to assess fluid management and evaluate postnatal nutrition and growth. Traditionally, postnatal weight curves are based on birth weight and do not incorporate postnatal clinical information. The aim of the present study was to compare the accuracy of birth weight-based weight curves with weight curves created from individual patient records, including electronic records, using 2 predictive modeling methods, linear regression (LR) and an artificial neural network (NN), which apply mathematical relations between predictor and outcome variables.
METHODS - Perinatal demographic and postnatal nutrition data were collected for extremely-low-birth-weight (ELBW; birth weight <1000 g) infants. Static weight curves were generated using published algorithms. The postnatal predictive models were created using the demographic and nutrition dataset.
RESULTS - Birth weight (861 ± 83 g, mean ± 1 standard deviation [SD]), gestational age (26.2 ± 1.4 weeks), and the first month of nutrition data were collected from individual health records for 92 ELBW infants. The absolute residual (
measured-predicted
) for weight was 84.8 ± 74.4 g for the static weight curves, 60.9 ± 49.1 g for the LR model, and 12.9 ± 9.2 g for the NN model, analysis of variance: both LR and NN P<0.01 versus static curve. NPO (nothing by mouth) infants had greater weight curve discrepancies.
CONCLUSIONS - Compared with birth weight-based and logistic regression-generated weight curves, NN-generated weight curves more closely approximated ELBW infant weight curves, and, using the present electronic health record systems, may produce weight curves better reflective of the patient's status.
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19 MeSH Terms
Superior mesenteric artery blood flow velocities following medical treatment of a patent ductus arteriosus.
Yanowitz TD, Reese J, Gillam-Krakauer M, Cochran CM, Jegatheesan P, Lau J, Tran VT, Walsh M, Carey WA, Fujii A, Fabio A, Clyman R
(2014) J Pediatr 164: 661-3
MeSH Terms: Blood Flow Velocity, Cyclooxygenase Inhibitors, Ductus Arteriosus, Patent, Enteral Nutrition, Female, Humans, Ibuprofen, Indomethacin, Infant, Newborn, Infant, Premature, Infant, Very Low Birth Weight, Male, Mesenteric Artery, Superior, Ultrasonography, Doppler
Show Abstract · Added April 9, 2015
We examined superior mesenteric artery blood flow velocity in response to feeding in infants randomized to trophic feeds (n = 16) or nil per os (n = 18) during previous treatment for patent ductus arteriosus. Blood flow velocity increased earlier in the fed infants, but was similar in the 2 groups at 30 minutes after feeding.
Copyright © 2014 Mosby, Inc. All rights reserved.
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14 MeSH Terms