Search

Aim Method Results Interpretation To investigate the impact of severe neonatal brain injury (SNBI) on gestational age‐related trends in neurodevelopmental impairment (NDI) outcome in infants born very preterm.A population‐based cohort study recruited 1091 infants born at a gestational age of less than 31 weeks between 2011 and 2020. The trends in neonatal morbidities, mortality, and 24‐month NDI severity (no/mild, moderate, severe) by epoch (2011–2015, 2016–2020) and gestational age (22–25 weeks, 26–28 weeks, 29–30 weeks) were determined in infants with and without SNBI inclusion.There was increased antenatal steroid use and higher maternal education and socioeconomic status over time. The rates of neonatal morbidities and mortality had no temporal changes. Among 825 infants with follow‐up, those in the 22 to 25 weeks gestational age group had declining trends in cerebral palsy and severe cognitive impairment, with decreased rates of severe NDI from 19% to 8% across epochs, particularly in those without SNBI (from 16% to 2%). Relative to its occurrence in epoch 2011 to 2015, risk of severe NDI was significantly reduced in epoch 2016 to 2020 (adjusted relative risk 0.39, 95% confidence interval 0.16–0.96) for infants born at 22 to 25 weeks gestational age, and the risk dropped even lower in these infants without SNBI (0.12, 0.02–0.84).Infants born at 22 to 25 weeks gestational age had decreased rates of severe NDI in the decade between 2011 and 2020, particularly those without SNBI. The improvement might be attributed to better perinatal/neonatal and after‐discharge care. [ABSTRACT FROM AUTHOR]

Aim: To determine the risk patterns associated with transient hearing impairment (THI) and permanent hearing loss (PHL) of infants born very preterm who failed hearing screenings. Method: We enrolled 646 infants (347 males, 299 females) born at no more than 30 weeks' gestation between 2006 and 2020 who received auditory brainstem response screening at term‐equivalent age. Audiological examinations of infants who failed the screening revealed THI, when hearing normalized, or PHL, defined as a persistent unilateral or bilateral hearing threshold above 20 dB. Principal component analysis (PCA) was used to characterize risk patterns. Results: Among the 646 infants, 584 (90.4%) had normal hearing, 42 (6.5%) had THI, and 20 (3.1%) had PHL. Compared with the group with normal hearing, the THI and PHL groups had significantly higher rates of neurodevelopmental impairment at 24 months corrected age. PCA of risk patterns showed the THI group and especially the PHL group had more severe haemodynamic and respiratory instability. Moreover, severe intraventricular haemorrhage (IVH) was also a risk for PHL. Propensity score matching revealed an association of haemodynamic and respiratory instability with PHL. Interpretation: In infants born preterm, the severity and duration of haemodynamic and respiratory instability are risk patterns for both THI and PHL; severe IVH is an additional risk for PHL. What this paper adds: Neurodevelopmental delay was more common in infants born preterm who failed hearing screening.Principal component analysis revealed the risk patterns associated with hearing impairment.Haemodynamic–respiratory instability was associated with transient and permanent hearing impairment outcomes.Severe haemodynamic–respiratory instability and intraventricular haemorrhage was associated with permanent hearing loss. [ABSTRACT FROM AUTHOR]

Aim: To determine whether early‐life respiratory trajectories are associated with neurodevelopmental impairment (NDI) in infants born very and extremely preterm. Method: The daily type of respiratory supports in the first 8 weeks after birth were analysed in 546 infants (285 males, 261 females; median gestational age = 28.0 weeks, interquartile range = 3 weeks), comprising 301 infants born very preterm (gestation = 28–30 weeks) and 245 infants born extremely preterm (gestation <28 weeks), who survived to discharge from 2004 to 2018 and received follow‐up assessment by Bayley Scales of Infant and Toddler Development at a corrected age of 24 months. NDI included cognition or motor impairment, moderate and severe cerebral palsy, or visual and hearing impairment. Results: Clustering analysis identified three respiratory patterns with increasing severity: improving; slowly improving; and delayed improvement. These were significantly associated with increasing rates of NDI in infants born very and extremely preterm and smaller head circumference in infants born extremely preterm (both p < 0.001). By day 28, the proportion of infants who were under different categories of ventilation support significantly differed according to the three trajectory groups in infants born very and extremely preterm (both p < 0.05). Models that included adverse respiratory trajectories demonstrated more negative impacts on neurodevelopment than those without. Interpretation: An adverse early‐life respiratory trajectory was associated with NDI at follow‐up, especially in infants born extremely preterm, suggesting a lung–brain axis of preterm birth. What this paper adds: Clustering analysis identified three respiratory trajectories with increasing severity in infants born preterm.Increasing severity of respiratory trajectories was associated with increasing rates of neurodevelopmental impairment.Adverse respiratory trajectories had a significantly negative impact on neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Objective: Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ. Design: A retrospective cohort study. Setting: By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1‐21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1‐7 days and 8‐21 days. Participants: Taiwanese patients with head and neck cancer. Main Outcomes Measure: Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ. Results: The overall incidence of ORNJ in the included patients was 1.03% (mean follow‐up duration, 4.07 ± 3.01 years; range, 1.00‐13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] =0.734; P =.312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P <.001). Conclusion: In a mean follow‐up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7‐21 days before RT. [ABSTRACT FROM AUTHOR]

A vector autoregression (VAR) model is powerful for analyzing economic data as it can be used to simultaneously handle multiple time series from different sources. However, in the VAR model, we need to address the problem of substantial coefficient dimensionality, which would cause some computational problems for coefficient inference. To reduce the dimensionality, one could take model structures into account based on prior knowledge. In this paper, group structures of the coefficient matrices are considered. Because of the different types of VAR structures, corresponding Markov chain Monte Carlo algorithms are proposed to generate posterior samples for performing inference of the structure selection. Simulation studies and a real example are used to demonstrate the performances of the proposed Bayesian approaches. [ABSTRACT FROM AUTHOR]

A supersaturated design is a design where all effects cannot be estimated simultaneously due to an insufficient run size. An important goal in analyzing such designs is to screen active effects based on the factor sparsity assumption. In this work, a screening procedure is proposed using an efficient Bayesian variable selection approach. A modified cross-validation method is employed for parameter tuning to improve the selection results. Simulations and several real examples are used to demonstrate the performance of this screening procedure. In the real examples, our procedure identifies models similar to those of previous analysis methods. The simulation results indicate that our new procedure outperforms the other analysis methods in terms of the high true identified rate and the efficient estimation of the model size. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]