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The aim of this study was to explore factors contributing to compassion fatigue (CF), burnout (BO), and compassion satisfaction (CS) during the severe acute respiratory syndrome coronavirus-2 pandemic in pediatric subspecialists. The Compassion Fatigue and Satisfaction Self-Test (CFST) and a questionnaire of personal/professional characteristics were distributed electronically to pediatric subspecialists. There were no significant differences in pre- and early-pandemic CF, BO, and CS scores. Nearly 40% of respondents felt their contributions to the pandemic were not valued by their institutions. Higher CF scores were significantly associated with: higher BO score; “I have put myself at increased risk through my work”; working in one’s specialty >50% of time; distress about mental health and/or future uncertainty. Higher BO scores were significantly associated with: higher CF score; “Self-care is not a priority”; emotional depletion. Higher CS scores were significantly associated with: “My institution values my contribution to the COVID-19 crisis”; workplace debriefs; pet therapy. The pandemic has only increased the need for physicians to receive social/emotional support from their institution and to feel their workplace contributions are valued. Successful pre-pandemic workplace interventions may not adequately support physicians during the pandemic. Further study is needed to identify supports that best counter the pandemic’s unprecedented challenges.

Objective To identify the prevalence of renal insufficiency (RI) in children with a history of prematurity and acute kidney injury (AKI). Study design This prospective cohort study evaluated renal function in children born preterm at 5-9 years of age. Univariable analyses compared perinatal and follow-up data from subjects with and without AKI history, and with and without current RI. Regression analyses were attempted to model RI as a function of AKI and other clinical risk factors. Results Fifteen of 43 (35%) participants had previously undiagnosed RI. Only children with no AKI history or neonatal stage 1 AKI presented for follow-up. Children born preterm with a history of stage 1 AKI had higher serum creatinine (sCr) at follow-up, but were not more likely to have RI compared to children without stage 1 AKI history (RI prevalence 30% and 36% in AKI and non-AKI group, respectively). Conclusion The high prevalence of RI in this preterm cohort at middle childhood follow-up highlights the need for routine kidney health assessments in this population. Large multicenter studies are needed to further characterize the impact of premature birth and mild AKI on renal function throughout childhood.

Background While institution-sponsored wellness programs may be effective, little is known about their availability and utilization in pediatric subspecialists, and about programs physicians wish were available. Methods A survey of perceptions about, and availability and utilization of institutional wellness activities, was distributed electronically to pediatric subspecialists nationally. Bivariate analyses were performed using χ2 tests or independent t tests. Multivariable logistic regression models for categories of institution-sponsored programming as a function of potential predictors of program utilization were performed. Qualitative content analysis was performed for free-text survey answers. Results Approximately 60% of respondents participated in institution-sponsored wellness opportunities. Debriefs, Schwartz Center Rounds, mental health services, and team building events were the most available institution-sponsored wellness activities, whereas debriefs, team building, Schwartz Center Rounds, and pet therapy were most frequently utilized. Respondents desired greater social/emotional support, improved leadership, enhanced organizational support, and modifications to the physical work environment, with no significant differences across subspecialties for "wish list" items. Conclusions Physician wellness requires more than a "one-size-fits-all" initiative. Our data highlight the importance of encouraging and normalizing self-care practices, and of listening to what physicians articulate about their needs. Pre-implementation needs assessment allows a "bottom-up" approach where physician voices can be heard.

Compassion fatigue (CF) is distress experienced by caregivers from ongoing contact with patients who are suffering. Burnout (BO) is occupational stress directly related to dissonance between job demands and available resources. Compassion satisfaction (CS) is professional fulfillment experienced through helping others. CF in physicians is not well studied. Neonatologists may be at particular risk for CF by virtue of recurrent exposure to distress in patients and their families. The objectives of this study were to determine the prevalence of CF, BO and CS, and to identify potential predictors for these phenomena in neonatologists. A modified Compassion Fatigue and Satisfaction Self-Test and a questionnaire of professional details and personal characteristics were distributed electronically to neonatologists nationally. Multivariable logistic and linear regression models for CF, BO and CS as a function of potential predictors were constructed. The survey response rate was 47%. The prevalence of CF, BO and CS was 15.7, 20.8 and 21.9%, respectively. Female gender, emotional depletion, distress from ‘a clinical situation’, ‘co-workers’, ‘personal health issues’ and ‘not talking about distressing issues’ were each significant determinants of CF. Emotional depletion, distress from the ‘physical work environment’ and ‘co-workers’, and ‘not talking about distressing issues’ were significant determinants of BO. Self-identification as Hispanic; ‘not currently feeling distressed’; talking about distressing issues; and utilization of pediatric palliative care services were significant determinants of higher CS. CF and BO may impact emotional well-being and professional performance of neonatologists. Enhancement of CS is a potential target for intervention.

To determine risk factors for acute kidney injury (AKI) in preterm infants as a function of time of onset. In this 5 1/2-year, single-center, retrospective study, incidence and timing of AKI was determined using modified Acute Kidney Injury Network criteria. Characteristics of newborns with and without AKI were compared by chi square and t-tests. Logistic regression was used to examine risk factors for AKI as a function of time of onset and potential confounders. AKI occurred in 30.3% of 357 neonates; 72.2% was stage 1. Gestational ages (GA), initial Cr, maternal magnesium and volume resuscitation were associated with early AKI (days 0 to 1). Volume resuscitation, umbilical arterial line and receipt of non-steroidal anti-inflammatory drug (NSAID) for patent ductus arteriosus were associated with intermediate AKI (days 2 to 5). GA, steroids for early hypotension, necrotizing enterocolitis and sepsis were associated with late AKI (⩾day 6). Stage 1 AKI is a common morbidity in our population. Risk factors for AKI in our population differed with time of onset.

To examine the relationship between maternal and neonatal creatinine (Cr) in preterm infants in the context of antenatal and intrapartum maternal and neonatal factors. In this 5½-year, single-center, retrospective study, paired maternal and neonatal Cr were compared by t-test. Linear regression for correlated outcomes employing generalized estimating equations was used to examine neonatal Cr as a function of antenatal maternal Cr and potential confounders. A total of 157 neonates of 124 mothers met study criteria. Neonatal Cr values in the first 24 h of life were significantly higher than antenatal maternal values. Linear regression modeling showed that maternal Cr, neonatal lactate, hypoxic–ischemic villous changes on placental pathology and multiple gestation were each significant determinants of the first neonatal Cr. No neonatal Cr was less than its paired maternal value. Maternal Cr, neonatal lactate, hypoxic–ischemic villous changes in the placenta and multiple gestation were each significantly associated with neonatal Cr.

To examine the relationship between blood urea nitrogen (BUN) during the first 3 weeks of life and protein intake and creatinine (Cr) and to quantify the effect of protein intake on postnatal growth in preterm infants.This is a 4-year, single-center, retrospective cohort study. We used multivariable linear regression models to examine the relationships between mean weekly BUN and protein intake adjusted for mean weekly Cr and potential confounders. We used additional regression models to examine the effect of protein intake on growth during this period.Overall, 249 infants met study criteria. As protein intake increased over the first 3 weeks of life, both BUN and Cr decreased significantly. Linear regression models showed protein intake and Cr were each significantly associated with mean BUN for each study week.Protein intake and Cr were each significantly associated with BUN. Significant amelioration of growth failure was seen with higher protein intake.

Objective: To determine whether an association exists between antenatal antibiotic exposure and incidence of necrotizing enterocolitis (NEC) in low birth weight infants. Study Design: A retrospective case-control study was performed on all infants with a diagnosis of NEC born at our institition between 1988 and 2006. Medical histories of all infants with a diagnosis of NEC ≤Bell's stage IIA and matched controls without NEC were reviewed. Maternal and neonatal characteristics were compared using the Mantel-Haenszel chi-square procedure, and logistic regression models were constructed to account for confounding. Result: Clinical data for 97 matched pairs were analyzed. The adjusted odds ratio (OR) for antenatal exposure to ampicillin was significantly greater for infants who developed NEC (OR 2.3, 95% confidence interval 1.1, 4.8, P=0.003) than for control infants. Conclusion: Infants who developed NEC were more likely to have a history of in utero exposure to ampicillin in the immediate antepartum period than infants who did not develop NEC. © 2012 Nature America, Inc. All rights reserved.

Human placentation requires modulation of proliferative cytotrophoblasts to an invasive phenotype to create the intervillous space. Preeclampsia is characterized by failed trophoblast invasion and remodeling of the maternal spiral arteries. OPN is a secreted extracellular matrix protein found in many tissues including human trophoblast, and has been implicated in cell adhesion, invasion, spreading, and migration. To investigate gestational age-specific expression of OPN, immunohistochemical staining of post-partum placental tissue from 13 healthy women was performed using a monoclonal antibody against OPN (MPIIIB10-1). OPN protein was localized to the cytoplasm of invasive extravillous trophoblast from 24-28 wks (N=7). After 28 wks (N=6), OPN was undetectable in the extravillous trophoblast, and was not identified in non-invasive intravillous cytotrophoblast and syncytiotrophoblast at any gestational age (N=13). To investigate the role of OPN in uteroplacental vascular pathology, immunohistochemical staining of post-partum placentas from pregnancies complicated by preeclampsia (N=6) or intrauterine growth retardation (N=2) was performed using MPIIIB10-1 and compared to staining of placentas from gestational age-matched controls without pregnancy-induced maternal vascular disease (N=13). In the preecclampsia group, there was prominent proliferation of cytotrophoblast in the basal plate with intense OPN staining, in association with morphologic evidence of compromised uteroplacental perfusion. This staining pattern was identified in all preeclamptic placentas at 24-40 wks. In contrast, the normal and IUGR placentas did not display prominent cytotrophoblast proliferation or evidence of decreased uteroplacental perfusion: OPN staining was limited to the invasive extravillous cytotrophoblast and detected only until 28 wks. The data suggests a role for OPN in trophoblast invasion of the maternal vasculature and extracellular matrix during normal placentation, where OPN may serve as a marker for uteroplacental vascular remodeling in the human fetus. In the preeclamptic pregnancy, extravillous cytotrophoblast continues to express OPN even at advanced gestational ages, which supports the speculation that intervillous fibrin/fibrinoid may be actively involved in the remodeling of the intervillous space. OPN may be critical in this process, the successful maintenance of which may necessary for fetal compensation.

FAILURE OF VASCULAR SMOOTH MUSCLE CELL (VSMC) ATTACHMENT TO COLLAGEN MATRICES RESULTS IN PROLONGED GROWTH ARREST • 150