498 results on '"Alan Leviton"'
Search Results
2. Systemic inflammation as a biomarker of seizure propensity and a target for treatment to reduce seizure propensity
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Coral Stredny, Alexander Rotenberg, Alan Leviton, and Tobias Loddenkemper
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biomarkers ,closed‐loop ,epilepsy ,inflammation ,responsive ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract People with diabetes can wear a device that measures blood glucose and delivers just the amount of insulin needed to return the glucose level to within bounds. Currently, people with epilepsy do not have access to an equivalent wearable device that measures a systemic indicator of an impending seizure and delivers a rapidly acting medication or other intervention (e.g., an electrical stimulus) to terminate or prevent a seizure. Given that seizure susceptibility is reliably increased in systemic inflammatory states, we propose a novel closed‐loop device where release of a fast‐acting therapy is governed by sensors that quantify the magnitude of systemic inflammation. Here, we review the evidence that patients with epilepsy have raised levels of systemic indicators of inflammation than controls, and that some anti‐inflammatory drugs have reduced seizure occurrence in animals and humans. We then consider the options of what might be incorporated into a responsive anti‐seizure system.
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- 2023
- Full Text
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3. Editorial: Brain development and the attention spectrum: volume II
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Itai Berger, Alan Leviton, and Yael Leitner
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ADHD ,diabetes mellitus ,electric stimulation ,kidney ,autism spectrum disorder ,epilepsy ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Published
- 2023
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4. Prediction of Seizure Recurrence. A Note of Caution
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William J. Bosl, Alan Leviton, and Tobias Loddenkemper
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electroencephalography ,machine learning ,chaos & non-linearity ,dynamical systems ,seizure prediction ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Great strides have been made recently in documenting that machine-learning programs can predict seizure occurrence in people who have epilepsy. Along with this progress have come claims that appear to us to be a bit premature. We anticipate that many people will benefit from seizure prediction. We also doubt that all will benefit. Although machine learning is a useful tool for aiding discovery, we believe that the greatest progress will come from deeper understanding of seizures, epilepsy, and the EEG features that enable seizure prediction. In this essay, we lay out reasons for optimism and skepticism.
- Published
- 2021
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5. Socioeconomic status and early blood concentrations of inflammation-related and neurotrophic proteins among extremely preterm newborns.
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Alan Leviton, Elizabeth N Allred, Olaf Dammann, Robert M Joseph, Raina N Fichorova, T Michael O'Shea, and Karl C K Kuban
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Medicine ,Science - Abstract
The main objective of this study was to evaluate the relationship between mother's socioeconomic disadvantage and blood concentrations of inflammation-related proteins among extremely preterm newborns (
- Published
- 2019
- Full Text
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6. Characteristics of Future Models of Integrated Outpatient Care
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Alan Leviton, Julia Oppenheimer, Madeline Chiujdea, Annalee Antonetty, Oluwafemi William Ojo, Stephanie Garcia, Sarah Weas, Eric Fleegler, Eugenia Chan, and Tobias Loddenkemper
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consumer health informatics ,E-health ,mobile apps ,outpatient follow-up ,patient portal ,patient-reported outcomes ,Medicine - Abstract
Replacement of fee-for-service with capitation arrangements, forces physicians and institutions to minimize health care costs, while maintaining high-quality care. In this report we described how patients and their families (or caregivers) can work with members of the medical care team to achieve these twin goals of maintaining—and perhaps improving—high-quality care and minimizing costs. We described how increased self-management enables patients and their families/caregivers to provide electronic patient-reported outcomes (i.e., symptoms, events) (ePROs), as frequently as the patient or the medical care team consider appropriate. These capabilities also allow ongoing assessments of physiological measurements/phenomena (mHealth). Remote surveillance of these communications allows longer intervals between (fewer) patient visits to the medical-care team, when this is appropriate, or earlier interventions, when it is appropriate. Systems are now available that alert medical care providers to situations when interventions might be needed.
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- 2019
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7. The dazed and confused identity of Agassiz’s land tortoise, Gopherus agassizii (Testudines: Testudinidae) with the description of a new species and its consequences for conservation
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Robert Murphy, Kristin Berry, Taylor Edwards, Alan Leviton, Amy Lathrop, and J. Daren Riedle
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Lectotype ,Xerobates ,Gopherus lepidocephalus ,desert tortoise ,recovery units ,California ,Arizona ,Mexico ,Zoology ,QL1-991 - Abstract
We investigate a cornucopia of problems associated with the identity of the desert tortoise, Gopherus agassizii Cooper. The date of publication is found to be 1861, rather than 1863. Only one of the three original cotypes exists, and it is designated as the lectotype of the species. Another cotype is found to have been destroyed in the 1906 San Francisco earthquake and subsequent fire. The third is lost. The lectotype is genetically confirmed to be from California, and not Arizona, USA as sometimes reported. Maternally, the holotype of G. lepidocephalus Ottley et Velázques Solis, 1989 from the Cape Region of Baja California Sur, Mexico is also from the Mojavian population of the desert tortoise, and not from Tiburon Island, Sonora, Mexico as previously proposed. A suite of characters serve to diagnose tortoises west and north of the Colorado River, the Mojavian population, from those east and south of the river in Arizona, USA and Sonora and Sinaloa, Mexico, the Sonoran population. Species recognition is warranted and because G. lepidocephalus is from the Mojavian population no names are available for the Sonoran species. Thus, a new species, Gopherus morafkai sp. n., is named and this action reduces the distribution of G. agassizii to only 30% of its former range. This reduction has important implications for the conservation and protection of G. agassizii, which may deserve a higher level of protection.
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- 2011
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8. Biases Inherent in Studies of Coffee Consumption in Early Pregnancy and the Risks of Subsequent Events
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Alan Leviton
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epidemiology ,bias ,causation ,coffee ,pregnancy ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Consumption of coffee by women early in their pregnancy has been viewed as potentially increasing the risk of miscarriage, low birth weight, and childhood leukemias. Many of these reports of epidemiologic studies have not acknowledged the potential biases inherent in studying the relationship between early-pregnancy-coffee consumption and subsequent events. I discuss five of these biases, recall bias, misclassification, residual confounding, reverse causation, and publication bias. Each might account for claims that attribute adversities to early-pregnancy-coffee consumption. To what extent these biases can be avoided remains to be determined. As a minimum, these biases need to be acknowledged wherever they might account for what is reported.
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- 2018
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9. Elevated endogenous erythropoietin concentrations are associated with increased risk of brain damage in extremely preterm neonates.
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Steven J Korzeniewski, Elizabeth Allred, J Wells Logan, Raina N Fichorova, Stephen Engelke, Karl C K Kuban, T Michael O'Shea, Nigel Paneth, Mari Holm, Olaf Dammann, Alan Leviton, and ELGAN study investigators
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Medicine ,Science - Abstract
BackgroundWe sought to determine, in very preterm infants, whether elevated perinatal erythropoietin (EPO) concentrations are associated with increased risks of indicators of brain damage, and whether this risk differs by the co-occurrence or absence of intermittent or sustained systemic inflammation (ISSI).MethodsProtein concentrations were measured in blood collected from 786 infants born before the 28th week of gestation. EPO was measured on postnatal day 14, and 25 inflammation-related proteins were measured weekly during the first 2 postnatal weeks. We defined ISSI as a concentration in the top quartile of each of 25 inflammation-related proteins on two separate days a week apart. Hypererythropoietinemia (hyperEPO) was defined as the highest quartile for gestational age on postnatal day 14. Using logistic regression and multinomial logistic regression models, we compared risks of brain damage among neonates with hyperEPO only, ISSI only, and hyperEPO+ISSI, to those who had neither hyperEPO nor ISSI, adjusting for gestational age.ResultsNewborns with hyperEPO, regardless of ISSI, were more than twice as likely as those without to have very low (< 55) Mental (OR 2.3; 95% CI 1.5-3.5) and/or Psychomotor (OR 2.4; 95% CI 1.6-3.7) Development Indices (MDI, PDI), and microcephaly at age two years (OR 2.4; 95%CI 1.5-3.8). Newborns with both hyperEPO and ISSI had significantly increased risks of ventriculomegaly, hemiparetic cerebral palsy, microcephaly, and MDI and PDI < 55 (ORs ranged from 2.2-6.3), but not hypoechoic lesions or other forms of cerebral palsy, relative to newborns with neither hyperEPO nor ISSI.ConclusionhyperEPO, regardless of ISSI, is associated with elevated risks of very low MDI and PDI, and microcephaly, but not with any form of cerebral palsy. Children with both hyperEPO and ISSI are at higher risk than others of very low MDI and PDI, ventriculomegaly, hemiparetic cerebral palsy, and microcephaly.
- Published
- 2015
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10. Early Blood Gas Predictors of Bronchopulmonary Dysplasia in Extremely Low Gestational Age Newborns
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Sudhir Sriram, Joy Condie, Michael D. Schreiber, Daniel G. Batton, Bhavesh Shah, Carl Bose, Matthew Laughon, Linda J. Van Marter, Elizabeth N. Allred, and Alan Leviton
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Pediatrics ,RJ1-570 - Abstract
Aim. To determine among infants born before the 28th week of gestation to what extent blood gas abnormalities during the first three postnatal days provide information about the risk of bronchopulmonary dysplasia (BPD). Methods. We studied the association of extreme quartiles of blood gas measurements (hypoxemia, hyperoxemia, hypocapnea, and hypercapnea) in the first three postnatal days, with bronchopulmonary dysplasia, among 906 newborns, using multivariable models adjusting for potential confounders. We approximated NIH criteria by classifying severity of BPD on the basis of the receipt of any O2 on postnatal day 28 and at 36 weeks PMA and assisted ventilation. Results. In models that did not adjust for ventilation, hypoxemia was associated with increased risk of severe BPD and very severe BPD, while infants who had hypercapnea were at increased risk of very severe BPD only. In contrast, infants who had hypocapnea were at reduced risk of severe BPD. Including ventilation for 14 or more days eliminated the associations with hypoxemia and with hypercapnea and made the decreased risk of very severe BPD statistically significant. Conclusions. Among ELGANs, recurrent/persistent blood gas abnormalities in the first three postnatal days convey information about the risk of severe and very severe BPD.
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- 2014
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11. Biases in Electronic Health Records Data for Generating Real-World Evidence: An Overview.
- Author
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Ban Al-Sahab, Alan Leviton, Tobias Loddenkemper, Nigel Paneth, and Bo Zhang
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- 2024
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12. Early nutrition and weight gain in preterm newborns and the risk of retinopathy of prematurity.
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Deborah K VanderVeen, Camilia R Martin, Reshma Mehendale, Elizabeth N Allred, Olaf Dammann, Alan Leviton, and ELGAN Study Investigators
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Medicine ,Science - Abstract
To identify nutritional and weight gain limitations associated with retinopathy of prematurity (ROP) severity among very preterm newborns.1180 infants
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- 2013
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13. Reply to 'Adequate Vitamin D during Pregnancy Reduces the Risk of Premature Birth by Reducing Placental Colonization by Bacterial Vaginosis Species'
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Raina N. Fichorova, Andrew B. Onderdonk, Hidemi Yamamoto, Mary L. Delaney, Andrea M. DuBois, Elizabeth Allred, and Alan Leviton
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Microbiology ,QR1-502 - Published
- 2011
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14. Maternal Microbe-Specific Modulation of Inflammatory Response in Extremely Low-Gestational-Age Newborns
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Raina N. Fichorova, Andrew B. Onderdonk, Hidemi Yamamoto, Mary L. Delaney, Andrea M. DuBois, Elizabeth Allred, and Alan Leviton
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Microbiology ,QR1-502 - Abstract
ABSTRACT The fetal response to intrauterine inflammatory stimuli appears to contribute to the onset of preterm labor as well as fetal injury, especially affecting newborns of extremely low gestational age. To investigate the role of placental colonization by specific groups of microorganisms in the development of inflammatory responses present at birth, we analyzed 25 protein biomarkers in dry blood spots obtained from 527 newborns delivered by Caesarean section in the 23rd to 27th gestation weeks. Bacteria were detected in placentas and characterized by culture techniques. Odds ratios for having protein concentrations in the top quartile for gestation age for individual and groups of microorganisms were calculated. Mixed bacterial vaginosis (BV) organisms were associated with a proinflammatory pattern similar to those of infectious facultative anaerobes. Prevotella and Gardnerella species, anaerobic streptococci, peptostreptococci, and genital mycoplasmas each appeared to be associated with a different pattern of elevated blood levels of inflammation-related proteins. Lactobacillus was associated with low odds of an inflammatory response. This study provides evidence that microorganisms colonizing the placenta provoke distinctive newborn inflammatory responses and that Lactobacillus may suppress these responses. IMPORTANCE Despite improved intensive care, preterm and especially extremely low-gestation-age neonates continue to be at a considerably increased risk of morbidity, mortality, and developmental problems. The fetal inflammatory response appears to contribute to the onset of preterm labor, fetal injury, and complications, underlying lifetime health challenges facing these children. This study provides evidence that bacterial colonization of the very preterm placenta is associated with distinct microorganism-specific inflammatory protein profiles in the newborn blood specimens. We also provide evidence that Lactobacillus reduces inflammatory responses in newborns. Our data support the concept that targeting of placental colonization by specific drugs or probiotics during early pregnancy holds promise for preventing not only preterm birth but also subsequent and long-lasting, inflammation-provoked late sequelae.
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- 2011
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15. Extremely Preterm Birth and its Consequences: The ELGAN Study
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Olaf Dammann, Alan Leviton, T. Michael O'Shea, Nigel Paneth and Olaf Dammann, Alan Leviton, T. Michael O'Shea, Nigel Paneth
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- 2020
16. Self-management education for children with epilepsy and their caregivers. A scoping review
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Alan Leviton, Anup D. Patel, and Tobias Loddenkemper
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Behavioral Neuroscience ,Neurology ,Neurology (clinical) - Published
- 2023
17. Systemic inflammation as a biomarker of seizure propensity and a target for treatment to reduce seizure propensity
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Coral Stredny, Alexander Rotenberg, Alan Leviton, and Tobias Loddenkemper
- Subjects
Neurology ,Neurology (clinical) - Abstract
People with diabetes can wear a device that measures blood glucose and delivers just the amount of insulin needed to return the glucose level to within bounds. Currently, people with epilepsy do not have access to an equivalent wearable device that measures a systemic indicator of an impending seizure and delivers a rapidly acting medication or other intervention (e.g., an electrical stimulus) to terminate or prevent a seizure. Given that seizure susceptibility is reliably increased in systemic inflammatory states, we propose a novel closed-loop device where release of a fast-acting therapy is governed by sensors that quantify the magnitude of systemic inflammation. Here, we review the evidence that patients with epilepsy have raised levels of systemic indicators of inflammation than controls, and that some anti-inflammatory drugs have reduced seizure occurrence in animals and humans. We then consider the options of what might be incorporated into a responsive anti-seizure system.
- Published
- 2022
18. Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm: a prospective cohort
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Jean A. Frazier, Raina N. Fichorova, Kartik K. Venkatesh, Laurie M. Douglass, Thomas M. O'Shea, Hudson P. Santos, Kck Kuban, Robert M. Joseph, Alan Leviton, and Rebecca C. Fry
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Male ,Pediatrics ,medicine.medical_specialty ,Passive smoking ,medicine.disease_cause ,Cerebral palsy ,Cohort Studies ,Pregnancy ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,Epilepsy ,business.industry ,Cerebral Palsy ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,United States ,Infant, Extremely Premature ,Prenatal Exposure Delayed Effects ,Relative risk ,Gestation ,Female ,Tobacco Smoke Pollution ,business ,Body mass index - Abstract
OBJECTIVE To determine the association between prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm (
- Published
- 2021
19. Neonatal Cranial Ultrasound Findings Among Infants Born Extremely Preterm: Associations With Neurodevelopmental Outcomes at Ten Years of Age
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Irina L. Mokrova, Jennifer Check, Karl C.K. Kuban, Stephen R. Hooper, Lynn A. Fordham, Elizabeth N. Allred, T. Michael O'Shea, Alan Leviton, Hongyu Ru, Rebecca C. Fry, Hudson P. Santos, Heather Campbell, Nigel Paneth, Hernan Jara, Laurie M. Douglass, Jean A. Frazier, Robert M. Joseph, and Kyle Roell
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Male ,Pediatrics ,medicine.medical_specialty ,Critical Care ,Infant, Premature, Diseases ,Article ,Cerebral palsy ,Cohort Studies ,03 medical and health sciences ,Epilepsy ,0302 clinical medicine ,Leukoencephalopathies ,030225 pediatrics ,Medicine ,Humans ,030212 general & internal medicine ,Cognitive impairment ,Child ,Cerebral Intraventricular Hemorrhage ,business.industry ,Extremely preterm ,Age Factors ,Infant, Newborn ,medicine.disease ,Echoencephalography ,United States ,Hospitalization ,Cranial ultrasound ,Intraventricular hemorrhage ,Increased risk ,Neurodevelopmental Disorders ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Female ,business ,Birth cohort - Abstract
OBJECTIVE: To examine the association between neonatal cranial ultrasound abnormalities among infants born extremely preterm and neurodevelopmental outcomes at ten years of age. STUDY DESIGN: In a multi-center birth cohort of infants born at < 28 weeks’ gestation, 889 of 1198 survivors were evaluated for neurological, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal cranial ultrasound findings were classified as: intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD. RESULTS: WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes. CONCLUSIONS: Among children born extremely preterm, cranial ultrasound abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.
- Published
- 2021
20. Neurocognitive and social-communicative function of children born very preterm at 10 years of age: Associations with microorganisms recovered from the placenta parenchyma
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Timothy Heeren, Hudson P. Santos, Martha Scott Tomlinson, Jill R. Stewart, Andrew B. Onderdonk, Rebecca C. Fry, T. Michael O'Shea, Robert M. Joseph, Karl C.K. Kuban, and Alan Leviton
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Male ,Lactobacillus sp ,Placenta ,Intelligence ,Physiology ,Neuropsychological Tests ,Lower risk ,Article ,Social Skills ,03 medical and health sciences ,Executive Function ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Parenchyma ,Odds Ratio ,Medicine ,Humans ,Child ,030304 developmental biology ,0303 health sciences ,business.industry ,Learning Disabilities ,Extremely preterm ,Obstetrics and Gynecology ,Odds ratio ,Very preterm ,Lactobacillus ,medicine.anatomical_structure ,Risk factors ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Female ,business ,Infection ,Neurocognitive ,Child Language ,Follow-Up Studies - Abstract
Objective Infection of the placenta has been associated with preterm birth as well as neurocognitive impairment. This study aimed to determine whether specific bacterial species in the placenta of extremely preterm pregnancies are associated with neurological deficits later in life. Study Design Using data from 807 children in the ELGAN study the risks of a low score on six neurological assessments in relation to 15 different microbes were quantified with odds ratios. Results The presence of certain microbial species in the placenta was associated with lower scores on numerical and oral language assessments. Lactobacillus sp. was associated with decreased risk of a low oral language score and a composite measure of IQ and executive function. Conclusion Placental microorganisms were associated with neurocognitive, but not social-communicative, outcomes at age 10. In contrast, the presence of the anti-inflammatory Lactobacillus sp. in the placenta was associated with a lower risk of impaired neurocognitive functions.
- Published
- 2019
21. Early Postnatal IGF-1 and IGFBP-1 Blood Levels in Extremely Preterm Infants: Relationships with Indicators of Placental Insufficiency and with Systemic Inflammation
- Author
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Raina N. Fichorova, Deborah K. VanderVeen, T. Michael O'Shea, Karl C.K. Kuban, Olaf Dammann, Elizabeth N. Allred, and Alan Leviton
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medicine.medical_specialty ,medicine.medical_treatment ,Infant, Premature, Diseases ,Placental insufficiency ,Systemic inflammation ,Article ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,Placenta ,Humans ,Medicine ,Insulin-Like Growth Factor I ,Inflammation ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,biology ,business.industry ,Extremely preterm ,Growth factor ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Blood Proteins ,Placental Insufficiency ,medicine.disease ,Insulin-Like Growth Factor Binding Protein 1 ,Endocrinology ,medicine.anatomical_structure ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,biology.protein ,Gestation ,Female ,medicine.symptom ,business ,Neurotrophin - Abstract
Objective To evaluate to what extent indicators of placenta insufficiency are associated with low concentrations of insulin-like growth factor 1 (IGF-1) and IGF-1–binding protein-1 (IGFBP-1) in neonatal blood, and to what extent the concentrations of these growth factors are associated with concentrations of proteins with inflammatory, neurotrophic, or angiogenic properties. Study Design Using multiplex immunoassays, we measured the concentrations of IGF-1 and IGFBP-1, as well as 25 other proteins in blood spots collected weekly from ≥ 880 infants born before the 28th week of gestation, and sought correlates of concentrations in the top and bottom quartiles for gestational age and day the specimen was collected. Results Medically indicated delivery and severe fetal growth restriction (sFGR) were associated with low concentrations of IGF-1 on the first postnatal day and with high concentrations of IGFBP-1 on almost all days. Elevated concentrations of IGF-1 and IGFBP-1 were accompanied by elevated concentrations of many other proteins with inflammatory, neurotrophic, or angiogenic properties. Conclusion Disorders associated with impaired placenta implantation and sFGR appear to account for a relative paucity of IGF-1 on the first postnatal day. Elevated concentrations of IGF-1 and especially IGFBP-1 were associated with same-day elevated concentrations of inflammatory, neurotrophic, and angiogenic proteins.
- Published
- 2019
22. Neurocognitive function of 10 year-old multiples born less than 28 weeks gestational age
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Timothy Heeren, Elizabeth N. Allred, Kuban Kck, Robert M. Joseph, Alan Leviton, J W Logan, Michael E. Msall, and Michael O'Shea Tt
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neurocognitive function ,Male ,Pediatrics ,medicine.medical_specialty ,Intelligence ,functional development ,multi-fetal pregnancy ,Gestational Age ,Academic achievement ,Article ,03 medical and health sciences ,Executive Function ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Psychological testing ,Language Development Disorders ,030212 general & internal medicine ,Prospective Studies ,Child ,Twin Pregnancy ,Psychological Tests ,business.industry ,Singleton ,Obstetrics and Gynecology ,Gestational age ,twin pregnancy ,medicine.disease ,United States ,Motor Skills Disorders ,academic achievement ,Logistic Models ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Pregnancy, Twin ,Visual Perception ,Gestation ,Educational Status ,Female ,Pregnancy, Multiple ,business ,Cognition Disorders ,Neurocognitive - Abstract
INTRODUCTION: Few studies have examined the relationship between birth plurality and neurocognitive function among children born extremely preterm. STUDY DESIGN: We compared rates of Z-scores ≤ −2 on 18 tests of neurocognitive function and academic achievement at age 10 years in 245 children arising from twin pregnancies, 55 from triplet pregnancies, and 6 from a septuplet pregnancy to that of 568 singletons, all of whom were born before the 28th week of gestation. RESULTS: 874 children were evaluated at age 10-years. After adjusting for confounders, children of multifetal pregnancies performed significantly better on one of 6 subtests of executive function than their singleton peers. Performance was similar on all other assessments of intelligence, language, academic achievement, processing speed, visual perception, and fine motor skills. CONCLUSION: We found no evidence that children born of multifetal pregnancies had worse scores than their singleton peers on assessments of neurocognitive and academic function.
- Published
- 2018
23. Authors' reply re: Prenatal tobacco smoke exposure and neurological impairment at 10 years of age among children born extremely preterm
- Author
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Kartik K. Venkatesh, Alan Leviton, and Michael O'Shea
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Obstetrics and Gynecology - Published
- 2022
24. Identifying cerebral palsy phenotypes objectively
- Author
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Alan Leviton
- Subjects
business.industry ,Cerebral Palsy ,MEDLINE ,Bioinformatics ,medicine.disease ,Phenotype ,Cerebral palsy ,Developmental Neuroscience ,Pediatrics, Perinatology and Child Health ,Medicine ,Humans ,Neurology (clinical) ,business - Published
- 2020
25. Neonatal white matter damage and the fetal inflammatory response
- Author
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Floyd H. Gilles and Alan Leviton
- Subjects
Pathology ,medicine.medical_specialty ,Inflammatory response ,Leukomalacia, Periventricular ,Inflammation ,Hypoxemia ,White matter ,03 medical and health sciences ,0302 clinical medicine ,White matter pathology ,Fetus ,Pregnancy ,030225 pediatrics ,medicine ,Humans ,Periventricular leukomalacia ,business.industry ,Infant, Newborn ,medicine.disease ,White Matter ,medicine.anatomical_structure ,Brain Injuries ,Pediatrics, Perinatology and Child Health ,Nerve Degeneration ,Female ,medicine.symptom ,Abnormality ,business - Abstract
In 1962 a long-recognized pathologic abnormality in neonatal brains characterized by multiple telencephalic focal white matter necroses was renamed periventricular leukomalacia (PVL) and the authors inappropriately asserted that their entity was caused by anoxia. They also failed to include three other white matter histologic abnormalities. In this essay, we identify the breadth of white matter pathology, especially in very preterm newborns, and show that none of the four histologic expressions of white matter damage, including focal necrosis, are associated with hypoxemia or correlates as hypotension, but are instead associated with markers of fetal or perinatal inflammation, particularly in preterm babies. We begin with the background needed to evaluate the evidence.
- Published
- 2020
26. Executive Dysfunction Early Postnatal Biomarkers among Children Born Extremely Preterm
- Author
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Olaf Dammann, Raina N. Fichorova, T. Michael O'Shea, Alan Leviton, H. Gerry Taylor, Robert M. Joseph, and Elizabeth N. Allred
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Male ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Immunology ,Neuroscience (miscellaneous) ,Inflammation ,Systemic inflammation ,Article ,Executive Function ,03 medical and health sciences ,0302 clinical medicine ,Neurotrophic factors ,Humans ,Immunology and Allergy ,Medicine ,Nerve Growth Factors ,Prospective Studies ,Child ,Intelligence Tests ,Pharmacology ,biology ,Tumor Necrosis Factor-alpha ,business.industry ,Working memory ,Interleukin-8 ,Infant, Newborn ,Neuropsychology ,Intercellular Adhesion Molecule-1 ,Inhibition, Psychological ,030104 developmental biology ,Infant, Extremely Premature ,biology.protein ,Gestation ,Female ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Executive dysfunction ,Neurotrophin - Abstract
OBJECTIVE: To see to what extent executive function limitations at age 10 years among children born extremely preterm (EP) are associated with blood levels of inflammatory and neurotrophic proteins during the first postnatal month. DESIGN: Longitudinal cohort SETTING: Children were enrolled shortly before or after birth. SUBJECTS: 692 children born before the 28(th) week of gestation who had an IQ ≥ 70 at age 10 years. EXPOSURES: Blood concentrations during the first four weeks of proteins with inflammatory and neurotrophic properties. MAIN OUTCOME MEASURES: Z-scores ≤ −1 on the Differential Ability Scales–II working memory (WM) assessment) (N=164), the NEPSY-II (A Developmental NEuroPSYchological Assessment-II) Inhibition-Inhibition assessment) (N=350), the NEPSY-II Inhibition-Switching assessment) (N=345), as well as a Zscore ≤ −1 on all three assessments (identified as the executive dysfunction composite (EDC) (N=104). RESULTS: Increased risks of the EDC associated with high concentrations of inflammatory proteins (IL-8, TNF-α, and ICAM-1) were modulated by high concentrations of neurotrophic proteins. This pattern was also seen for the working memory limitation, but only with high concentrations of IL-8 and TNF-α, and the switching limitation, but only with high concentrations of ICAM-1. CONCLUSIONS: Among children born EP, risks of executive function limitations might be explained by perinatal systemic inflammation in the absence of adequate neurotrophic capability.
- Published
- 2018
27. Histologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants born before 28 weeks of gestation
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Robert M. Joseph, Jean A. Frazier, Kartik K. Venkatesh, Rebecca C. Fry, Julie L. Daniels, T. Michael O'Shea, Laurie M. Douglass, Jonathan L. Hecht, Karl C.K. Kuban, and Alan Leviton
- Subjects
Adult ,medicine.medical_specialty ,Autism Spectrum Disorder ,Chorioamnionitis ,Severity of Illness Index ,Article ,Cerebral palsy ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Fetal Stage ,Pregnancy ,Intellectual Disability ,Medicine ,Humans ,Cognitive Dysfunction ,030212 general & internal medicine ,Prospective Studies ,Child ,030219 obstetrics & reproductive medicine ,Epilepsy ,business.industry ,Obstetrics ,Cerebral Palsy ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Extremely Preterm Infant ,United States ,Neurodevelopmental Disorders ,Infant, Extremely Premature ,Gestation ,Female ,business ,Body mass index - Abstract
Extremely preterm infants whose placenta had histologic evidence of chorioamnionitis have early brain dysfunction, but little is known about neurologic development at 10 years of age.We investigated the association between histologic chorioamnionitis and neurodevelopmental impairment at 10 years among children born28 weeks' gestation (extremely preterm).The multicenter Extremely Low Gestational Age Newborns study enrolled extremely preterm newborns from 2002 to 2004 at 14 hospitals in the United States. Chorioamnionitis was defined by histologic stage (early, moderate, and advanced) and grade (mild/moderate and severe) of chorionic plate and umbilical cord inflammation. The children were examined for cerebral palsy at 2 years and for autism spectrum disorder, cognitive impairment (intelligence quotient2 standard deviations below the mean), and epilepsy at the age of 10 years by blinded evaluators using validated measures. Multivariable logistic regression with generalized estimating equations was used.Among 805 placentas, 43% (347/805) had histologic chorioamnionitis by moderate or advanced maternal stage, 36% (286/805) by severe maternal grade, 18% (132/737) by moderate or advanced fetal stage, and 1% (10/737) by severe fetal grade. The frequencies of impairments were 11% (88/767) for cerebral palsy, 7% (56/773) for autism spectrum disorder, 15% (120/788) for cognitive impairment, and 7% (52/763) for epilepsy. After adjustment for maternal age, body mass index, race, insurance status, maternal education, tobacco use, infant sex, and multiple gestations, the adjusted odds ratio for the association between histologic chorioamnionitis and cerebral palsy years was increased with advanced maternal stage (adjusted odds ratio, 2.5; 95% confidence interval, 1.6-3.9), severe maternal grade (adjusted odds ratio, 2.0; 95% confidence interval, 1.2-3.4), moderate fetal stage (adjusted odds ratio, 2.20; 95% confidence interval, 2.1-2.2), and mild or moderate fetal grade (adjusted odds ratio, 1.5; 95% confidence interval, 1.0-2.2). Similarly, the adjusted odds ratio for the association between histologic chorioamnionitis and epilepsy was increased with advanced maternal stage (adjusted odds ratio, 1.5; 95% confidence interval, 1.3-1.6) and severe fetal grade (adjusted odds ratio, 5.9; 95% confidence interval, 1.9-17.8). In addition, the adjusted odds ratio for the association between histologic chorioamnionitis and autism spectrum disorder was increased with mild or moderate fetal grade (adjusted odds ratio, 1.7; 95% confidence interval, 1.0-2.9). Histologic chorioamnionitis was not associated with cognitive impairment. These findings held after adjustment for gestational age at delivery. In contrast to histologic chorioamnionitis, a clinical diagnosis of chorioamnionitis was not associated with neurodevelopmental impairment.Histologic chorioamnionitis may be associated with some forms of neurodevelopmental impairment at 10 years of life among infants born28 weeks' gestation.
- Published
- 2019
28. Risk factors for chronic lung disease and asthma differ among children born extremely preterm
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Elizabeth N. Allred, Thomas M. O'Shea, Wesley M. Jackson, Alan Leviton, William A. Gower, and Matthew M. Laughon
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Lung Diseases ,Male ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,medicine.drug_class ,Gestational Age ,Infant, Premature, Diseases ,Weight Gain ,Article ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Bronchodilator ,Epidemiology ,medicine ,Humans ,Risk factor ,Child ,Retrospective Studies ,Asthma ,Fetal Growth Retardation ,business.industry ,Infant, Newborn ,Postmenstrual Age ,Infant ,Gestational age ,Odds ratio ,medicine.disease ,respiratory tract diseases ,030228 respiratory system ,Bronchopulmonary dysplasia ,Child, Preschool ,Infant, Extremely Premature ,Chronic Disease ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
OBJECTIVES To evaluate the hypothesis that chronic lung disease of prematurity (CLD) is a risk factor for asthma in children born extremely preterm, and the hypothesis that the risk factors for CLD are similar to those for asthma. METHODS A retrospective analysis was performed using data collected prospectively from 882 children born before the 28th week of gestation between 2002 and 2004 who returned for follow-up at ages 12 and 24 months and 10 years. We created time-oriented logistic regression models to compare risk factors for CLD, defined as need for supplemental oxygen at 36 weeks postmenstrual age, and parent-reported asthma at 10 years of age. RESULTS CLD diagnosed during neonatal admission was associated with bronchodilator use at 12 months and 24 months (P
- Published
- 2018
29. Can a collaborative healthcare network improve the care of people with epilepsy?
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Ketan K. Mane, Tobias Loddenkemper, Alan Leviton, and Ejaz A. Shamim
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Computer science ,Clinical effectiveness ,Decision Making ,Harmonization ,03 medical and health sciences ,Behavioral Neuroscience ,Epilepsy ,0302 clinical medicine ,Health care ,medicine ,Data Mining ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Quality of Health Care ,Data collection ,business.industry ,Data Collection ,Medical record ,food and beverages ,Information technology ,Decision Support Systems, Clinical ,medicine.disease ,Neurology ,Treatment strategy ,Neurology (clinical) ,Medical emergency ,business ,Delivery of Health Care ,030217 neurology & neurosurgery - Abstract
New opportunities are now available to improve care in ways not possible previously. Information contained in electronic medical records can now be shared without identifying patients. With network collaboration, large numbers of medical records can be searched to identify patients most like the one whose complex medical situation challenges the physician. The clinical effectiveness of different treatment strategies can be assessed rapidly to help the clinician decide on the best treatment for this patient. Other capabilities from different components of the network can prompt the recognition of what is the best available option and encourage the sharing of information about programs and electronic tools. Difficulties related to privacy, harmonization, integration, and costs are expected, but these are currently being addressed successfully by groups of organizations led by those who recognize the benefits.
- Published
- 2018
30. Circulating biomarkers in extremely preterm infants associated with ultrasound indicators of brain damage
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T. Michael O'Shea, Alan Leviton, Karl K.C. Kuban, Raina N. Fichorova, Lynn A. Fordham, Elizabeth N. Allred, and Olaf Dammann
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Male ,0301 basic medicine ,Physiology ,Inflammation ,Brain damage ,Article ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Neurotrophic factors ,Intensive care ,medicine ,Humans ,Nerve Growth Factors ,Child ,Ultrasonography ,business.industry ,Ultrasound ,Infant, Newborn ,General Medicine ,medicine.disease ,030104 developmental biology ,Brain Injuries ,Infant, Extremely Premature ,Concomitant ,Pediatrics, Perinatology and Child Health ,Angiogenesis Inducing Agents ,Female ,Neurology (clinical) ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Ventriculomegaly - Abstract
Aim To assess to what extent the blood concentrations of proteins with neurotrophic and angiogenic properties measured during the first postnatal month convey information about the risk of sonographically-identified brain damage among very preterm newborns. Methods Study participants were 1219 children who had a cranial ultrasound scan during their stay in the intensive care nursery and blood specimens collected on 2 separate days at least a week apart during the first postnatal month. Concentrations of selected proteins in blood spots were measured with electrochemiluminescence or with a multiplex immunobead assay and the risks of cranial ultrasound images associated with top-quartile concentrations were assessed. Results High concentrations of multiple inflammation-related proteins during the first 2 postnatal weeks were associated with increased risk of ventriculomegaly, while high concentrations of just 3 inflammation-related proteins were associated with increased risk of an echolucent/hypoechoic lesion (IL-6, IL-8, ICAM-1), especially on day 7. Concomitant high concentrations of IL6R and bFGF appeared to modulate the increased risks of ventriculomegaly and an echolucent lesion associated with inflammation. More commonly high concentrations of putative protectors/repair-enhancers did not appear to diminish these increased risks. Conclusion Our findings provide support for the hypothesis that endogenous proteins are capable of either protecting the brain against damage and/or enhancing repair of damage.
- Published
- 2018
31. A New Species of Long-glanded Coralsnake of the GenusCalliophis(Squamata: Elapidae) from Dinagat Island, with Notes on the Biogeography and Species Diversity of PhilippineCalliophisandHemibungarus
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Utpal Smart, Alan Leviton, Eric N. Smith, and Rafe M. Brown
- Subjects
0106 biological sciences ,0301 basic medicine ,Squamata ,biology ,Phylogenetic tree ,Biogeography ,Species diversity ,Zoology ,Calliophis ,biology.organism_classification ,Southeast asian ,010603 evolutionary biology ,01 natural sciences ,Hemibungarus ,03 medical and health sciences ,030104 developmental biology ,Geography ,Elapidae ,Animal Science and Zoology ,Ecology, Evolution, Behavior and Systematics - Abstract
We describe a new species of coralsnake from northern Dinagat Island, southeastern Philippines. The discovery of this new species comes as a surprise because it is phenotypically distinct from all other Philippine coralsnakes and has a close phylogenetic affinity to the blue coralsnakes of the Sunda Shelf. The new species is distinguished from all Philippine and other Southeast Asian taxa by its large body size and ventral scale counts; its black head and neck; an alternating, broadly banded color pattern of black and off-white; and a bright orange tail. We use DNA sequence data to investigate the phylogenetic placement of the new species and that of several other populations of Philippine coralsnakes with respect to other Southeast Asian and Australasian elapids. Our results corroborate the uniqueness of the new species with respect to all other Philippine and Sundaic taxa, including the species most closely related to it: Calliophis bivirgatus, C. bilineatus, C. philippinus, and C. suluensis. W...
- Published
- 2018
32. Neonatal systemic inflammation and the risk of low scores on measures of reading and mathematics achievement at age 10 years among children born extremely preterm
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T. Michael O'Shea, Karl C.K. Kuban, Raina N. Fichorova, Olaf Dammann, Robert M. Joseph, Elizabeth N. Allred, and Alan Leviton
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Male ,Pediatrics ,medicine.medical_specialty ,Protein profile ,Neuropsychological Tests ,Systemic inflammation ,Article ,Angiopoietin-2 ,03 medical and health sciences ,0302 clinical medicine ,Developmental Neuroscience ,030225 pediatrics ,Angiopoietin-1 ,medicine ,Humans ,Achievement test ,Nerve Growth Factors ,Child ,Retrospective Studies ,Inflammation ,Word reading ,Extremely preterm ,Infant, Newborn ,Wechsler Adult Intelligence Scale ,Intercellular Adhesion Molecule-1 ,Reading ,Quartile ,Infant, Extremely Premature ,Cytokines ,Gestation ,Female ,medicine.symptom ,Mathematics ,030217 neurology & neurosurgery ,Developmental Biology - Abstract
Background Difficulties with reading and math occur more commonly among children born extremely preterm than among children born at term. Reasons for this are unclear. Methods We measured the concentrations of 27 inflammatory-related and neurotrophic/angiogenic proteins (angio-neurotrophic proteins) in multiple blood specimens collected a week apart during the first postnatal month from 660 children born before the 28th week of gestation who at age 10 years had an IQ ≥ 70 and a Wechsler Individual Achievement Test 3rd edition (WIAT-III) assessment. We identified four groups of children, those who had a Z-score ≤ −1 on the Word Reading assessment only, on the Numerical Operations assessment only, on both of these assessments, and on neither, which served as the referent group. We then modeled the risk of each learning limitation associated with a top quartile concentration of each protein, and with high and lower concentrations of multiple proteins. Results The protein profile of low reading scores was confined to the third and fourth postnatal weeks when increased risks were associated with high concentrations of IL-8 and ICAM-1 in the presence of low concentrations of angio-neurotrophic proteins. The profile of low math scores was very similar, except it did not include ICAM-1. In contrast, the profile of low scores on both assessments was present in each of the first four postnatal weeks. The increased risks associated with high concentrations of TNF-α in the first two weeks and of IL-8 and ICAM-1 in the next two weeks were modulated down by high concentrations of angio-neurotrophic proteins. Conclusions High concentrations of angio-neurotrophic proteins appear to reduce/moderate the risk of each learning limitation associated with systemic inflammation. The three categories of limitations have protein profiles with some similarities, and yet some differences, too.
- Published
- 2018
33. Antenatal and Neonatal Antecedents of Executive Dysfunctions in Extremely Preterm Children
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T. Michael O'Shea, H. Gerry Taylor, Elizabeth N. Allred, Karl K.C. Kuban, Robert M. Joseph, and Alan Leviton
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Pediatrics ,medicine.medical_specialty ,Neuropsychological Tests ,Risk profile ,Article ,Executive Function ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Prevalence ,Fetal growth ,medicine ,Humans ,Prospective Studies ,Child ,Prospective cohort study ,Inflammation ,Socioeconomic disadvantage ,Fetal Growth Retardation ,Learning Disabilities ,Working memory ,Extremely preterm ,Follow up studies ,Socioeconomic Factors ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,030217 neurology & neurosurgery ,Follow-Up Studies ,Executive dysfunction - Abstract
To find out why children born extremely preterm are at heightened risk of executive dysfunctions, the authors assessed 716 children who were 10 years old born extremely preterm whose IQ was ≥ 70. A working memory dysfunction (n = 169), an inhibition dysfunction (n = 360), a switching dysfunction (355), and all 3 (executive dysfunction; n = 107) were defined on the basis of Z-scores ≤ –1 on the Differential Ability Scales–II Working Memory composite, and/or on the NEPSY-II Inhibition-Inhibition and Inhibition-Switching subtests. All risk profiles include an indicator of socioeconomic disadvantage. The risk profile of each of the 3 individual dysfunctions includes an indicator of the newborn’s immaturity, and the risk profiles of the inhibition dysfunction and switching dysfunction also include an indicator of inflammation. Only the switching dysfunction was associated with fetal growth restriction. The risk factors for executive dysfunction can be subsumed under the 4 themes of socioeconomic disadvantage, immaturity/vulnerability, inflammation, and fetal growth restriction.
- Published
- 2018
34. 360 Prenatal tobacco smoke and risk of neurological impairment at age 10 among extremely preterm infants
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Karl C.K. Kuban, Raina N. Fichorova, Rebecca C. Fry, Hudson P. Santos, Michael O'Shea, Robert M. Joseph, Jean A. Frazier, Kartik K. Venkatesh, Alan Leviton, and Laurie M. Douglass
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Extremely preterm ,medicine ,Obstetrics and Gynecology ,business ,Neurological impairment ,Tobacco smoke - Published
- 2021
35. Extremely Preterm Birth and Its Consequences: the ELGAN Study
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Olaf Dammann, Alan Leviton, T. Michael O’Shea, Nigel Paneth, Olaf Dammann, Alan Leviton, T. Michael O’Shea, and Nigel Paneth
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- Premature labor, Neonatology, Developmentally disabled children, Premature infants, Prematurely born children
- Abstract
This book reviews important findings from the Extremely Low Gestational Age Newborn Study (ELGAN), the largest cohort study ever completed involving individuals born extremely prematurely. With a focus on pre-, peri-, and post-natal inflammation, this study identified potentially modifiable risk factors and pathways antecedent to a broad range of neurodevelopmental impairments, as well as asthma and obesity, during middle childhood. These findings will be of interest to both practicing neonatologists and developmental paediatricians, as well as researchers interested in the prevention of adverse child health outcomes and promotion of positive health among individuals born extremely preterm.
- Published
- 2021
36. Maternal obesity and attention-related symptoms in the preterm offspring
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T. Michael O'Shea, Megan Scott, Jelske W. van der Burg, Scott J. Hunter, Alan Leviton, Margot van de Bor, Robert M. Joseph, Elizabeth T. Jensen, Karl C.K. Kuban, Olaf Dammann, Stephen R. Hooper, Elizabeth N. Allred, E&H: Environmental Health and Toxicology, and AIMMS
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Offspring ,Overweight ,Article ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Pregnancy ,030225 pediatrics ,medicine ,Journal Article ,Humans ,0501 psychology and cognitive sciences ,Attention ,Obesity ,Prospective cohort study ,business.industry ,05 social sciences ,Infant, Newborn ,Obstetrics and Gynecology ,Odds ratio ,medicine.disease ,Confidence interval ,Pregnancy Complications ,Attention Deficit Disorder with Hyperactivity ,Pediatrics, Perinatology and Child Health ,Infant Behavior ,Female ,medicine.symptom ,business ,Body mass index ,Infant, Premature ,050104 developmental & child psychology - Abstract
BACKGROUND: Maternal pre-pregnancy obesity, in term-born children, is associated with an increased risk of attention problems, however this relationship has not been explored among children born extremely preterm.AIM: To estimate the risk of attention problems at age 10years in children born very preterm to overweight (i.e., body mass index (BMI) 25-29kg/m2) and obese (i.e., BMI≥30kg/m2) women relative to the risk among children born to women who were neither overweight nor obese (i.e. BMISTUDY DESIGN: Multi-center prospective cohort study.METHODS: A total of 764 children born before the 28th week of gestation and whose mother's pre-pregnancy height and pre-pregnancy weight were obtained at birth had an IQ≥70 at age 10years when parents and teachers completed Child Symptom Inventory-4 questionnaires that included items about the presence of ADHD.RESULTS: Compared to children whose mother's pre-pregnancy weight was in the normal range (BMICONCLUSION: Maternal overweight and obesity are associated with increased risk of parent-identified ADHD characteristics at 10years of age in children born extremely preterm.
- Published
- 2017
37. Antecedents and early correlates of high and low concentrations of angiogenic proteins in extremely preterm newborns
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Alan Leviton, Raina N. Fichorova, Olaf Dammann, T. Michael O'Shea, Elizabeth N. Allred, Stanthia Ryan, and Karl C.K. Kuban
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Angiogenesis ,Clinical Biochemistry ,Systemic inflammation ,Biochemistry ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Placenta ,Internal medicine ,Humans ,Medicine ,Angiogenic Proteins ,business.industry ,Biochemistry (medical) ,Infant, Newborn ,Gestational age ,Angiopoietins ,General Medicine ,Vascular endothelial growth factor A ,Endocrinology ,medicine.anatomical_structure ,PIGF ,Infant, Extremely Premature ,Immunology ,Gestation ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background To identify the antecedents and very early correlates of low concentrations of angiogenic proteins in the blood of extremely preterm newborns during the first postnatal month. Methods Using multiplex immunoassays we measured the concentrations of vascular endothelial growth factor A (VEGF), VEGF receptor-1 (VEGFR-1), VEGF receptor-2 (VEGFR-2), placenta growth factor (PIGF), and angiopoietins 1 and 2 (Ang-1, Ang-2), as well as 21 other proteins in blood spots collected on postnatal days 1 ( N = 1062), 7 ( N = 1087), 14 ( N = 989), 21 ( N = 940) and 28 ( N = 880) from infants born before the 28th week of gestation. We then sought the protein-concentration correlates of concentrations in the top and bottom quartile for gestational age and day the specimen was collected. Results Children who were delivered for medical indications and those who were severely growth restricted were more likely than others to have low day-1 blood concentrations of VEGF, VEGF-R2, Ang-1, and PIGF. Systemic inflammation accompanied top quartile concentrations of every one of the 6 angiogenic proteins. Conclusions Low day-1 concentrations of most angiogenic proteins are associated with disorders linked to placenta insufficiency/dysfunction. High concentrations, on the other hand, are associated with systemic inflammation throughout the first postnatal month.
- Published
- 2017
38. Both antenatal and postnatal inflammation contribute information about the risk of brain damage in extremely preterm newborns
- Author
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Diana Yanni, Karl C.K. Kuban, Steven J. Korzeniewski, Raina N. Fichorova, Olaf Dammann, Elizabeth N. Allred, T. Michael O'Shea, and Alan Leviton
- Subjects
Pediatrics ,medicine.medical_specialty ,Time Factors ,Placenta ,Physiology ,Gestational Age ,Inflammation ,Article ,Cerebral palsy ,03 medical and health sciences ,0302 clinical medicine ,Spastic cerebral palsy ,Leukoencephalopathies ,Pregnancy ,Risk Factors ,030225 pediatrics ,medicine ,Humans ,biology ,business.industry ,Cerebral Palsy ,C-reactive protein ,Infant, Newborn ,Gestational age ,Intercellular Adhesion Molecule-1 ,medicine.disease ,United States ,3. Good health ,C-Reactive Protein ,Logistic Models ,medicine.anatomical_structure ,Child, Preschool ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Microcephaly ,biology.protein ,Cytokines ,Gestation ,Female ,Inflammation Mediators ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery - Abstract
BackgroundPreterm newborns exposed to intrauterine inflammation are at an increased risk of neurodevelopmental disorders. We hypothesized that adverse outcomes are more strongly associated with a combination of antenatal and postnatal inflammation than with either of them alone.MethodsWe defined antenatal inflammation as histologic inflammation in the placenta. We measured the concentrations of seven inflammation-related proteins in blood obtained on postnatal days 1, 7, and 14 from 763 infants born before 28 weeks of gestation. We defined postnatal inflammation as a protein concentration in the highest quartile on at least 2 days. We used logistic regression models to evaluate the contribution of antenatal and postnatal inflammation to the risk of neurodevelopmental disorders.ResultsThe risk of white matter damage was increased when placental inflammation was followed by sustained elevation of C-reactive protein or ICAM-1. We found the same for spastic cerebral palsy when placental inflammation was followed by elevation of TNF-α or IL-8. The presence of both placental inflammation and elevated levels of IL-6, TNF-α, or ICAM-1 was associated with an increased risk for microcephaly.ConclusionCompared with a single hit, two inflammatory hits are associated with stronger risk for abnormal cranial ultrasound, spastic cerebral palsy, and microcephaly at 2 years.
- Published
- 2017
39. Hypoxia–ischemia is not an antecedent of most preterm brain damage: the illusion of validity
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Floyd H. Gilles, Pierre Gressens, Alan Leviton, and Olaf Dammann
- Subjects
0301 basic medicine ,Encephalopathy ,Ischemia ,Reviews ,Neuropathology ,Brain damage ,Review ,Bioinformatics ,Hypoxemia ,03 medical and health sciences ,0302 clinical medicine ,Developmental Neuroscience ,medicine ,Fetus ,business.industry ,Hypoxia (medical) ,medicine.disease ,3. Good health ,030104 developmental biology ,Pediatrics, Perinatology and Child Health ,Neurology (clinical) ,Animal studies ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Cognitive psychology - Abstract
Brain injury in preterm newborn infants is often attributed to hypoxia–ischemia even when neither hypoxia nor ischemia is documented, and many causative speculations are based on the same assumption. We review human and animal study contributions with their strengths and limitations, and conclude that – despite all the work done in human fetal neuropathology and developmental models in animals – the evidence remains unconvincing that hypoxemia, in the fetus or newborn infant, contributes appreciably to any encephalopathy of prematurity. Giving an inappropriate causal name to a disorder potentially limits the options for change, should our understanding of the etiologies advance. The only observationally‐based title we think appropriate is ‘encephalopathy of prematurity’. Future pathophysiological research should probably include appropriately designed epidemiology studies, highly active developmental processes, infection and other inflammatory stimuli, the immature immune system, long chain fatty acids and their transporters, and growth (neurotrophic) factors. What this paper adds Fetal hypoxemia is rarely documented in brain injury studies.Animal studies fail to consider human–animal fetal anatomical differences.Putative treatments from animal models have not found clinical use.Observational studies constitute the only approach to etiological understanding.No convincing evidence yet that hypoxemia injures preterm brain. Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder.Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder., What this paper adds Fetal hypoxemia is rarely documented in brain injury studies.Animal studies fail to consider human–animal fetal anatomical differences.Putative treatments from animal models have not found clinical use.Observational studies constitute the only approach to etiological understanding.No convincing evidence yet that hypoxemia injures preterm brain. Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder.Encephalopathy of prematurity is preferable to hypoxia‐ischemia as a term for this disorder. This article is commented on by Paneth on page 115 of this issue. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations.
- Published
- 2017
40. Postnatal systemic inflammation and neuro-ophthalmologic dysfunctions in extremely low gestational age children
- Author
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Olaf Dammann, Thomas M. O'Shea, Dordi Austeng, Alan Leviton, Elizabeth N. Allred, Raina N. Fichorova, Karl C.K. Kuban, and Mari Holm
- Subjects
Birth weight ,Vision Disorders ,Physiology ,Systemic inflammation ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Strabismus ,Inflammation ,business.industry ,Infant, Newborn ,Gestational age ,General Medicine ,Odds ratio ,Confidence interval ,Quartile ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Gestation ,Visual Fields ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery - Abstract
AIM Compared to infants born at term, children born very preterm are at increased risk of visual dysfunctions and neonatal systemic inflammation. Here, we explore whether these two propensities are related. METHODS As part of the ELGAN study, the concentrations of 16 mediators of inflammation were measured in blood obtained on postnatal days 1, 7, 14, 21 and 28 from 1062 children born before the 28th week of gestation. Presence of visual field deficit, strabismus and/or impaired visual fixation was recorded at age two. The concentrations of each protein were divided into quartiles within gestational week categories. We calculated odds ratios with 99% confidence intervals for having each disorder comparing children with concentration in the top quartile of each protein to children whose concentration was in the lower quartiles on the corresponding day. Analyses were adjusted for gestational age and birth weight Z-score. RESULTS Only one of 80 assessments (16 proteins on five different days) was significant for visual field deficit, and one for impaired fixation. No association was found between strabismus and any inflammatory mediator. CONCLUSION None of the three neuro-ophthalmologic dysfunctions assessed at two years appears to be associated with systemic inflammation measured the first four postnatal weeks.
- Published
- 2017
41. Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm
- Author
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Christiane E.L. Dammann, J. W. Logan, Thomas M. O'Shea, Elizabeth N. Allred, Kristyn S. Beam, Robert M. Joseph, Karl C.K. Kuban, Olaf Dammann, and Alan Leviton
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Developmental Disabilities ,Gestational Age ,macromolecular substances ,Severity of Illness Index ,Executive Function ,03 medical and health sciences ,Child Development ,0302 clinical medicine ,030225 pediatrics ,Severity of illness ,Humans ,Illness severity ,Maternal fetal ,Medicine ,Prospective Studies ,Child ,Extramural ,business.industry ,Extremely preterm ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Infant newborn ,United States ,Logistic Models ,Multicenter study ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Quality of Life ,Female ,business ,030217 neurology & neurosurgery - Abstract
A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders.An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6).Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.
- Published
- 2017
42. Michele La Clergue Aldrich, historian of geology, 1942–2016
- Author
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Alan Leviton and Mark Aldrich
- Subjects
History and Philosophy of Science ,General Earth and Planetary Sciences ,Art history ,Physical geography - Published
- 2017
43. 1163: Histopathologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants
- Author
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Rebecca C. Fry, Jonathan L. Hecht, Laurie M. Douglass, Michael O'Shea, Robert M. Joseph, Julie L. Daniels, Karl C.K. Kuban, Alan Leviton, Jean A. Frazier, and Kartik K. Venkatesh
- Subjects
medicine.medical_specialty ,business.industry ,Obstetrics ,Extremely preterm ,Obstetrics and Gynecology ,Medicine ,business ,Chorioamnionitis ,medicine.disease - Published
- 2020
44. Antenatal glucocorticoids and neonatal inflammation-associated proteins
- Author
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Raina N. Fichorova, Maheer Faden, Elizabeth N. Allred, Alan Leviton, Mari Holm, and Olaf Dammann
- Subjects
Male ,medicine.medical_specialty ,Immunology ,Biochemistry ,Umbilical cord ,Antenatal steroid ,Article ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,medicine ,Humans ,Immunology and Allergy ,Glucocorticoids ,Molecular Biology ,Inflammation ,Obstetrics ,business.industry ,Infant, Newborn ,Gestational age ,Blood Proteins ,Hematology ,Odds ratio ,Blood proteins ,Confidence interval ,medicine.anatomical_structure ,Quartile ,Gestation ,Female ,business ,Infant, Premature ,030217 neurology & neurosurgery - Abstract
Background To date, studies of the relationship between antenatal glucocorticoids (AGC) and neonatal inflammation in preterm newborns have been largely limited to umbilical cord blood specimens. Aim To explore the association between exposure to antenatal glucocorticoids and concentrations of inflammation-related proteins in whole blood collected from very preterm newborns at multiple times during the first postnatal month. Methods We measured the protein concentrations on postnatal day 1 (N = 1118), day 7 (N = 1138), day 14 (N = 1030), day 21 (N = 936) and day 28 (N = 877) from infants born before the 28th week of gestation and explored the relationship between antenatal steroid receipt and protein concentrations in the highest and lowest quartiles. The creation of multinomial logistic regression models (adjusted for potential confounders) allowed us calculate odds ratios and 95% confidence intervals. Results Twenty of 420 assessments [21 (proteins) × 2 (exposure levels: partial and full) × 2 (quartile levels: top and bottom) × 5 (days)] were statistically significant without any cohesive pattern. Conclusion Among infants born before 28 weeks of gestational age, neither full, nor partial courses of antenatal glucocorticoids have a sustained anti-inflammatory effect.
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- 2016
45. Antecedents of epilepsy and seizures among children born at extremely low gestational age
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Alan Leviton, Hereen Tc, Steve Engelke, Thomas M. O'Shea, Carl E. Stafstrom, Kuban Kck, Bhavesh Shah, Rachana Singh, Laurie M. Douglass, and Elizabeth N. Allred
- Subjects
Pediatrics ,medicine.medical_specialty ,Placenta ,Mothers ,Disease ,Severity of Illness Index ,Infant, Newborn, Diseases ,Article ,Hypoxemia ,03 medical and health sciences ,Epilepsy ,Chronic Disease Indicators ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,Surveys and Questionnaires ,Severity of illness ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Child ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Socioeconomic Factors ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Gestation ,Female ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Objective To identify specific risk factors for epilepsy for individuals born extremely preterm. Study design In a prospective cohort study, at 10-year follow-up, children were classified as having epilepsy or seizures not associated with epilepsy. We evaluated for association of perinatal factors using time-oriented, multinomial logistic regression models. Results Of the 888 children included in the study, 66 had epilepsy and 39 had seizures not associated with epilepsy. Epilepsy was associated with an indicator of low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal exposure to hydrocortisone, cerebral white matter disease and severe bronchopulmonary dysplasia. Seizure without epilepsy was associated with indicators of placental infection and inflammation, and hypoxemia during the first 24 postnatal hours. Conclusions In children born extremely preterm, epilepsy and seizures not associated with epilepsy have different risk profiles. Though both profiles included indicators of infection and inflammation, the profile of risk factors for epilepsy included multiple indicators of endogenous vulnerability.
- Published
- 2018
46. Antecedents of Obesity Among Children Born Extremely Preterm
- Author
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Karl C.K. Kuban, T. Michael O'Shea, Olivia Linthavong, Charles T. Wood, Eliana M. Perrin, Elizabeth N. Allred, and Alan Leviton
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Pediatric Obesity ,Population ,Overweight ,Weight Gain ,Article ,Childhood obesity ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Risk Factors ,030225 pediatrics ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Risk factor ,Child ,education ,education.field_of_study ,business.industry ,Infant, Newborn ,Infant ,Gestational age ,medicine.disease ,Obesity ,Child, Preschool ,Infant, Extremely Premature ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Cohort ,Female ,medicine.symptom ,business ,Weight gain ,Follow-Up Studies ,Demography - Abstract
BACKGROUND: Childhood obesity is a pervasive public health problem with risk factors such as maternal prepregnancy BMI and rapid infant weight gain. Although catch-up weight gain promotes more favorable neurodevelopment among infants born preterm, it is not clear whether faster weight gain early in life, or other correlates of preterm birth, are associated with later obesity in this population. METHODS: We used prospective data from the multicenter, observational Extremely Low Gestational Age Newborn Study. Among 1506 eligible individuals in the initial cohort, 1198 were eligible for follow-up at 10 years of age. We examined BMI in 871 children (58% of the cohort; 74% of survivors) and analyzed relationships between antecedents and overweight or obesity at 10 years of age. A time-oriented approach to multinomial multivariable regression enabled us to calculate odds of overweight and obesity associated with pre- and postnatal antecedents. RESULTS: Prepregnancy maternal BMI ≥25 and top quartile infant weight gain in the first year were associated with increased risk of both overweight and obesity at 10 years of age. Single marital status was a risk factor for later child obesity and exposure to tobacco smoke was a risk factor for later child overweight. CONCLUSIONS: The risk profiles for overweight and obesity at 10 years of age among children born extremely preterm appear to be similar to the risk profiles of overweight and obesity among children born at term.
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- 2018
47. Caffeine exposure during pregnancy: Is it safe?
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Kesha Baptiste-Roberts and Alan Leviton
- Subjects
Pregnancy ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,Health outcomes ,medicine.disease ,03 medical and health sciences ,chemistry.chemical_compound ,Child Development ,0302 clinical medicine ,Caffeine consumption ,chemistry ,Caffeine ,Prenatal Exposure Delayed Effects ,030225 pediatrics ,Environmental health ,Pediatrics, Perinatology and Child Health ,Humans ,Medicine ,Central Nervous System Stimulants ,Female ,Caffeine intake ,business - Abstract
Numerous studies have examined the association between maternal caffeine consumption and infant and childhood health outcomes and the results have been inconsistent. The study of maternal caffeine intake and infant and childhood health outcomes is prone to methodologic challenges. In this review, we examine the existing evidence juxtaposed with the epidemiologic design challenges that color the interpretation of the study results presented. In light of methodologic/interpretation challenges, it seems reasonable to infer that exposure to low levels of caffeine is probably not associated with substantial infant and childhood adversities. However, more research is needed using well designed studies that address methodologic challenges.
- Published
- 2020
48. Prevalence and associated features of autism spectrum disorder in extremely low gestational age newborns at age 10 years
- Author
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Thomas M. O'Shea, Nigel Paneth, Deborah Hirtz, Robert M. Joseph, Timothy Heeren, Karl C.K. Kuban, Alan Leviton, and Elizabeth N. Allred
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education.field_of_study ,Pediatrics ,medicine.medical_specialty ,business.industry ,General Neuroscience ,Population ,Gestational age ,medicine.disease ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Autism spectrum disorder ,030225 pediatrics ,mental disorders ,Intellectual disability ,Cohort ,medicine ,Etiology ,Autism ,Neurology (clinical) ,Population Risk ,business ,education ,030217 neurology & neurosurgery ,Genetics (clinical) - Abstract
We sought to estimate the prevalence of autism spectrum disorder (ASD) in children born extremely preterm relative to the U.S. population risk of 1.5% [CDC, 2014] using the best-available diagnostic procedures and minimizing confounding with other neurodevelopmental impairments. Eight hundred and eighty nine of 966 (92%) 10-year-old children from the Extremely Low Gestational Age Newborn birth cohort, delivered at 23-27 weeks gestation in 2002-2004, participated. Children meeting ASD screening criteria on the Social Communication Questionnaire were evaluated with the Autism Diagnostic Interview-Revised (ADI-R). Those meeting ADI-R criteria were assessed with the Autism Diagnostic Observation Schedule-2 (ADOS-2). A positive ADOS-2 score was the criterion for ASD. Twenty-six participants were not assessed for ASD because of severe sensory or motor impairment. In the remaining sample, 61 children met criteria for ASD, resulting in a prevalence of 7.1% (95% CI = 5.5-9.0). ASD risk decreased with increasing gestational age, from 15.0% (95% CI = 10.0-21.2) for 23-24 weeks, 6.5% (95% CI = 4.2-9.4) for 25-26 weeks, to 3.4% (95% CI = 1.6-6.1) for 27 weeks gestational age, and this association was independent of IQ. Among children with ASD, 40% had intellectual disability. The male-to-female ratio of children with ASD was 2.1:1 (95% CI = 1.2:1-3.5:1), lower than in the general population (4:1). ASD prevalence in the ELGAN cohort was four times higher than in the general population, and was strongly associated with gestational age, underscoring the need for enhanced ASD screening of children born preterm, and suggesting that some risk factors associated with preterm birth may also play a role in the etiology of autism. Autism Res 2017, 10: 224-232. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
- Published
- 2016
49. Systemic endogenous erythropoietin and associated disorders in extremely preterm newborns
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Olaf Dammann, Mari Holm, Alan Leviton, Jon Skranes, Raina N. Fichorova, and Elizabeth N. Allred
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medicine.medical_specialty ,Pediatrics ,Time Factors ,Gestational Age ,Infant, Premature, Diseases ,03 medical and health sciences ,0302 clinical medicine ,Enterocolitis, Necrotizing ,Risk Factors ,030225 pediatrics ,Humans ,Medicine ,Retinopathy of Prematurity ,Prospective Studies ,Neonatology ,Prospective cohort study ,Erythropoietin ,Bronchopulmonary Dysplasia ,Neonatal Disorder ,Respiratory Distress Syndrome, Newborn ,business.industry ,Obstetrics and Gynecology ,Gestational age ,Retinopathy of prematurity ,General Medicine ,medicine.disease ,Quartile ,Bronchopulmonary dysplasia ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Cohort ,business ,030217 neurology & neurosurgery - Abstract
Objective To explore the association between concentrations of endogenous erythropoietin (EPO) in blood the first 2 weeks of life and neonatal disorders in extremely low gestational age newborns (ELGANs). Design Prospective cohort study. Setting Neonatal care units at 14 participating hospitals in the USA. Patients 867 children born before the 28th week of gestation from the ELGAN study cohort. Main outcome measures EPO blood concentrations were measured on postnatal days 1, 7 and 14. The following neonatal characteristics and disorders were registered: blood gases, early and late respiratory dysfunction, pulmonary deterioration, retinopathy of prematurity (ROP), necrotising enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). We calculated the gestational age-adjusted ORs for having each disorder associated with an EPO blood concentration in the highest or lowest quartile, compared with infants whose EPO concentration was in the middle two quartiles on the corresponding day. Results Newborns whose day-1 EPO was in the highest quartile were at increased risk for early and persistent respiratory dysfunction during the first 2 weeks of life, and NEC requiring surgery. The lowest EPO quartile on day 1 was associated with a decreased risk of moderate BPD. The association between low EPO and decreased risk of respiratory complications persisted on day 7. On day 14, being in the highest EPO quartile was associated with increased risk of ROP, and BPD not requiring ventilation assistance. Conclusions EPO blood concentrations in extremely preterm newborns during the first 2 weeks of life convey information about increased risks of bowel, lung and retinal diseases.
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- 2016
50. Systemic inflammation on postnatal days 21 and 28 and indicators of brain dysfunction 2years later among children born before the 28th week of gestation
- Author
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Alan Leviton, Raina N. Fichorova, Elizabeth N. Allred, T. Michael O'Shea, Karl C.K. Kuban, and Olaf Dammann
- Subjects
medicine.medical_specialty ,Systemic inflammation ,Bayley Scales of Infant Development ,Article ,03 medical and health sciences ,Child Development ,0302 clinical medicine ,030225 pediatrics ,Internal medicine ,medicine ,Humans ,Infant, Very Low Birth Weight ,biology ,business.industry ,Obstetrics ,C-reactive protein ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Odds ratio ,Intercellular Adhesion Molecule-1 ,medicine.disease ,C-Reactive Protein ,Endocrinology ,Quartile ,Infant, Extremely Premature ,Pediatrics, Perinatology and Child Health ,Microcephaly ,biology.protein ,Cytokines ,Gestation ,medicine.symptom ,business ,Biomarkers ,030217 neurology & neurosurgery ,Hydrocephalus ,Ventriculomegaly - Abstract
Systemic inflammation during the first two postnatal weeks in extremely preterm newborns (28weeks gestation) has been associated with an increased risk of neurodevelopmental dysfunctions. Little is known, however, about the relationship between systemic inflammation during the third and fourth postnatal weeks and subsequent development.We measured the concentrations of 16 inflammation-related proteins in blood spots collected on postnatal days 21 (N=749) and 28 (N=697) from infants born before the 28th week of gestation and assessed at age 2years. We then sought the developmental correlates of top quartile concentrations for gestational age and day the specimen was collected. Odds ratios and 95% confidence intervals were calculated from regular or multinomial logistic regression models (as appropriate).Top quartile concentrations of CRP, IL-1β, IL-6, IL-6R, TNF-R2, IL-8, ICAM-1, and TSH on both days 21 and 28 were associated with ventriculomegaly (when in the NICU) and microcephaly at age 2years. Top quartile concentrations of CRP, SAA, IL-6, TNF-R2, IL-8, and ICAM-1 were associated with mental development index (MDI) of the Bayley-II55, while top quartile concentrations of CRP, TNF-α (inversely), IL-8, and ICAM-1 were associated with psychomotor development index (PDI)55 CONCLUSION: Extremely preterm newborns who had systemic inflammation during the third and fourth postnatal weeks were at increased risk of ventriculomegaly during the months after birth, and of microcephaly, and low Bayley Scale scores at 2years old.
- Published
- 2016
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