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7. Development of a Prediction Model for Surgery or Early Mortality at the Time of Initial Assessment for Necrotizing Enterocolitis.

Author

Nayak, Sujir P., Sánchez-Rosado, Mariela, Reis, Jordan D., Brown, L. Steven, Mangona, Kate L., Sharma, Priya, Nelson, David B., Wyckoff, Myra H., Pandya, Samir, Mir, Imran N., and Brion, Luc P.

Subjects
PREDICTION models, RECEIVER operating characteristic curves, RETROSPECTIVE studies, PNEUMOPERITONEUM, SEVERITY of illness index, NEONATAL necrotizing enterocolitis, LONGITUDINAL method, INTRA-abdominal hypertension, SEPSIS, GESTATIONAL age, BIRTH weight, COMPARATIVE studies
Abstract

Objective No available scale, at the time of initial evaluation for necrotizing enterocolitis (NEC), accurately predicts, that is, with an area under the curve (AUC) ≥0.9, which preterm infants will undergo surgery for NEC stage III or die within a week. Study Design This is a retrospective cohort study (n = 261) of preterm infants with <33 weeks' gestation or <1,500 g birth weight with either suspected or with definite NEC born at Parkland Hospital between 2009 and 2021. A prediction model using the new HASOFA score (Hyperglycemia, Hyperkalemia, use of inotropes for Hypotension during the prior week, Acidemia, Neonatal Sequential Organ Failure Assessment [nSOFA] score) was compared with a similar model using the nSOFA score. Results Among 261 infants, 112 infants had NEC stage I, 68 with NEC stage II, and 81 with NEC stage III based on modified Bell's classification. The primary outcome, surgery for NEC stage III or death within a week, occurred in 81 infants (surgery in 66 infants and death in 38 infants). All infants with pneumoperitoneum or abdominal compartment syndrome either died or had surgery. The HASOFA and the nSOFA scores were evaluated in 254 and 253 infants, respectively, at the time of the initial workup for NEC. Both models were internally validated. The HASOFA model was a better predictor of surgery for NEC stage III or death within a week than the nSOFA model, with greater AUC 0.909 versus 0.825, respectively, p < 0.001. Combining HASOFA at initial assessment with concurrent or later presence of abdominal wall erythema or portal gas improved the prediction surgery for NEC stage III or death with AUC 0.942 or 0.956, respectively. Conclusion Using this new internally validated prediction model, surgery for NEC stage III or death within a week can be accurately predicted at the time of initial assessment for NEC. Key Points No available scale, at initial evaluation, accurately predicts which preterm infants will undergo surgery for NEC stage III or die within a week. In this retrospective cohort study of 261 preterm infants with either suspected or definite NEC we developed a new prediction model (HASOFA score). The HASOFA-model had high discrimination (AUC: 0.909) and excellent calibration and was internally validated. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Correlation of placental pathology with the postoperative outcomes and white matter injury in preterm infants following necrotizing enterocolitis

Author

Garg, Parvesh Mohan, Paschal, Jaslyn L., Ansari, Md Abu Yusuf, Ware, Jennifer, Adams, Kristin, Taylor, Charlotte, Reddy, Kartik, Rosenfeld, Charles R., and Mir, Imran N.

Subjects
Pediatrics, Perinatology and Child Health, Article
Abstract

BACKGROUND: To determine the association of placental pathologic lesions with postoperative outcomes, survival, and white matter injury (WMI) in preterm infants with NEC. METHODS: A retrospective chart review of 107 neonates with NEC (Bell stage > IIa) from Jan 2013- June 2020 was completed. Demographic, clinical, and outcome data were compared between infants with or without placental pathologic lesions. RESULTS: In this cohort, 59/107 (55%) infants had medical NEC, and 48 (45%) had surgical NEC. The infants had a mean gestational age of 28.1±3.7 weeks and a birth weight of 1103±647 g. Maternal vascular malperfusion (82/107, 76.6%) and acute histological chorioamnionitis (42, 39.3%) were the most common pathological placental lesions. Acute histologic chorioamnionitis with fetal inflammatory response was more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). The NEC Infants with WMI on brain MRI scans had a significantly higher incidence of acute histological chorioamnionitis (52% vs. 27.8%; P = 0.04). No significant differences in mortality, length of stay and postoperative outcomes in neonates with and without acute histologic chorioamnionitis with fetal inflammatory response were noted. On unadjusted logistic regression, acute histologic chorioamnionitis without fetal inflammatory response was also associated with higher odds of WMI (OR 2.81; 95% CI 1.05–7.54; p = 0.039). CONCLUSION: Acute histological chorioamnionitis without fetal inflammatory response was associated with higher odds of WMI in infants with NEC, with no significant impact on mortality and other postoperative outcomes.

Published
2023

17. Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study

Author

Garg, Parvesh Mohan, primary, Paschal, Jaslyn L., additional, Ansari, Md Abu Yusuf, additional, Billington, Lauren, additional, Ware, Jennifer, additional, Adams, Kristin, additional, Hamda, Youssef Al, additional, Oshunbade, Adebamike, additional, Rosenfeld, Charles R., additional, and Mir, Imran N., additional

Published
2022
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18. Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study.

Author

Garg, Parvesh Mohan, Paschal, Jaslyn L., Ansari, Md Abu Yusuf, Billington, Lauren, Ware, Jennifer, Adams, Kristin, Hamda, Youssef Al, Oshunbade, Adebamike, Rosenfeld, Charles R., and Mir, Imran N.

Subjects
ENTEROCOLITIS, PREMATURE infants, PLACENTA, CASE-control method, PUERPERIUM, GESTATIONAL age
Abstract

To determine the association of placental pathology with the severity of necrotizing enterocolitis (NEC) in preterm infants. This single-center matched case-control study included infants with NEC (n = 107) and gestational age and birth weight-matched controls (n = 130), born between 2013 and 2020. Placentas were evaluated according to the Amsterdam Placental Workshop Group Consensus Statement. Acute histologic chorioamnionitis with the fetal response was significantly more common in infants with surgical NEC vs. medical NEC (35.4% vs. 15.3%; p = 0.02). On regression model, infants with multiple placental pathologies (OR 2.16; 95% CI 1.01 − 4.73; p = 0.04) and maternal vascular malperfusion (OR 2.2; 95% CI 1.12 − 4.51; p = 0.02) had higher odds of either medical or surgical NEC than controls. Infants with multiple placental lesions, including placental inflammatory and vascular lesions, were at higher risk of medical or surgical NEC in the postnatal period. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Contributors

Author

Abbasi, Soraya, Afshar, Yalda, Ahn, Sun-Young, Albertine, Kurt H., Allegaert, Karel, Alper, Seth L., Altit, Gabriel, Alvaro, Ruben E., Alvira, Cristina M., Maia Amorim, Natália Carlos, Anbuhl, Kelsey L., Andersen, Claus Yding, Anderson, Richard A., Andrews, Katrina A., Askenazi, David J., Fernandes Assunção, Débora Gabriela, Auten, Richard Lambert, Jr., Autmizguine, Julie, Azhibekov, Timur, Back, Stephen A., Bahr, Timothy M., Baker, Peter Russell, II, Bancalari, Eduardo H., Barichello, Tatiana, Battaglia, Frederick C., Bauer, Andrew J., Baum, Michel, Bavis, Ryan W., Beardsall, Kathryn, Beggs, Simon, Benchimol, Corinne, Benders, Manon J.N.L., Bennet, Laura, Bennett, Phillip R., Berger, Melvin, Bernhard, Wolfgang, Bertram, John F., Bhombal, Shazia, Bhutani, Vinod K., Black, Mary Jane, Bliss, Joseph M., Bolender, David L., Bowdin, Sarah C., Boyd, Scott D., Brandenburg, Joline E., Brown, Laura D., Burrin, Douglas G., Cannon, Barbara, Caplan, Michael, Carlson, Susan E., Carlton, David P., Chaemsaithong, Piya, Chang, Jill, Charlton, Jennifer R., Chemtob, Sylvain, Chheda, Sadhana, Childs, Andrew J., Chu, David H., Chung, Wendy K., Cilio, Maria Roberta, Clark, David A., Clarke, Paul, Cleal, Jane K., Clemente, Ethel G., Clements, John A., Clyman, Ronald I., Cohen, Jennifer L., Cohen, Susan S., Collins, Amélie, Collodel, Allan, Colombo, John, Combes, Alexander N., Copp, Andrew J., Cotten, C. Michael, Crawford, Peter A., Crowe, James E., Jr., Crowther, C.A., Cullen-McEwen, Luise A., Cutfield, Wayne S., Cyr-Depauw, Chanèle, Danielly da S. Ribeiro, Karla, Dauby, Nicolas, Davenport, Patricia, Davidson, Joanne O., Cruz, Diomel de la, Gomes de Oliveira, Priscila, de Vrijer, Barbra, Del Colle, Andrew, Delacourt, Christophe, Diacovo, Thomas G., Disdier, Clémence, Dormans, John P., Duhamel, François, Duong, Minh Dien, Dysart, Kevin, Eichenwald, Eric C., El-Khuffash, Afif F., Ivor Ellis, Peter James, Empey, Kerry M., Ercal, Baris, Erdős, Melinda, Errede, Mariella, Feldman, Brian J., Fidanza, Mario, Fogarty, Matthew J., Friedlich, Philippe S., Fujiwara, Ryoichi, Gallo, Vittorio, Ganguly, Abhrajit, Gao, Yuansheng, Garland, Marianne, Geddes, Donna, Dip (Sci), Post Grad, Georgieff, Michael K., Gien, Jason, Giussani, Dino A., Goldman, Armond S., Gomez-Lopez, Nardhy, Good, Misty, Good, Pamela I., Gordon, Scott M., Green, Lucy R., Greene, Nicholas D.E., Gridneva, Zoya, Grigoriou, Emmanouil, Grimberg, Adda, Grunau, Ruth E., Guignard, Jean-Pierre, Gunn, Alistair J., Gurtunca, Nursen, Gustafson, Kathleen M., Hadchouel, Alice, Haddad, Gabriel G., Hale, Thomas W., Hambidge, K. Michael, Hammerman, Cathy, Ruud Hansen, Thor Willy, Hanson, Mark A., Harbeson, Danny, Harding, J.E., Harding, Richard, Harris, Mary Catherine, Hartmann, Peter, Hartnett, M. Elizabeth, Hasbun, Rodrigo, Haugen, Guttorm, Hawkes, Colin P., Hay, William W., Jr., Heine, Vivi M., Helmrath, Michael A., Hendricks-Muñoz, Karen D., Herrera, Emilio, Hiatt, Michael J., Hooper, Stuart B., Hooven, Thomas A., Iacobelli, Silvia, Inder, Terrie E., Iruela-Arispe, M. Luisa, Jadcherla, Sudarshan Rao, Jain, Deepak, Jetton, Jennifer G., Jobe, Alan H., Jones, Helen, Jose, Pedro A., Jung, Eunjung, Kallapur, Suhas G., Kaplan, Michael, Karumanchi, S. Ananth, Kaskel, Frederick J., Levitt Katz, Lorraine E., Kavus, Haluk, Keeney, Susan E., Kern, Steven E., Khanjani, Shirin, Khlevner, Julie, Kilpatrick, Laurie E., Kim, Chang-Ryul, Kingma, Paul S., Kinsella, John P., Kiserud, Torvid, Koenig, Joyce M., Kohli, Rohit, Kollmann, Tobias R., Kolls, Jay K., Konecny, Christina M., Kratimenos, Panagiotis, Krebs, Nancy F., Krutsch, Kaytlin, Kuhn-Riordon, Kara, Kulik, Thomas J., Kumar, T. Rajendra, Kutikov, Jessica Katz, Lakshminrusimha, Satyan, Lasunción, Miguel Angel, Lavoie, Pascal M., Lawrence, Shelley M., Lee, Mark K., Lee, Mary M., Lee, Yvonne K., Leibel, Sandra L., Levy, Ofer, Levy, Philip T., Lewis, Rohan M., Li, Changgong, Lin, Fangming, Lobritto, Steven, Loomis, Cynthia A., MacFarlane, Peter M., MacIntyre, David A., Mahe, Maxime M., Mamsen, Linn Salto, Mankouski, Anastasiya, Mantilla, Carlos B., Marchant, Arnaud, Margolis, Kara Gross, Maródi, László, Maršál, Karel, Martin, Richard J., Martin Carli, Jayne F., Martinez, Hugo R., Matsell, Douglas G., Matthews, Dwight E., McArdle, Harry J., McKinlay, C.J.D., McManaman, James L., McNamara, Patrick J., Meschia, Giacomo, Mestan, Karen, Miller, Steven P., Minoo, Parviz, Mir, Imran N., Mitchell, Lisa J., Mižíková, Ivana, Mizuno, Tomoyuki, Momper, Jeremiah D., Monagle, Paul, Monks, Jenifer, Mortola, Jacopo P., Muglia, Louis J., Munshi, Upender K., Narasimhan, Sumana, Narendran, Vivek, Nedergaard, Jan, Nelin, Leif D., Neu, Josef, Nielsen, Sandra C.A., Nigam, Sanjay K., Nizet, Victor, Nogee, Lawrence M., Noori, Shahab, Norris, Andrew W., O’Brien, Barbara M., O’Brien, Lori L., O’Callaghan, Karen M., Ogilvy-Stuart, Amanda, Ohls, Robin K., Ortega-Senovilla, Henar, O’Sullivan, Justin M., Panitch, Howard B., Penn, Anna A., Penn, Raymond B., Petroff, Margaret G., Philipps, Anthony F., Pisani, Francesco, Pleasure, David, Pomeroy, Scott L., Post, Martin, Prakash, Y.S., Prozialeck, Joshua D., Pysher, Theodore J., Quigley, Raymond, Rabinovitch, Marlene, Raffay, Thomas M., Raj, J. Usha, Ramsey, Laura B., Rana, Sarosh, Randis, Tara M., Ranger, Manon, Regnault, Timothy R.H., Rios, Danielle R., Romero, Roberto, Rosenfeld, Charles R., Ross, A. Catharine, Roth, Daniel E., Rozycki, Henry J., Ryan, Thomas D., Sahni, Rakesh, Sarnat, Harvey B., Satlin, Lisa M., Scafidi, Joseph, Schellpfeffer, Michael A., Schierding, William, Schwartz, George J., Segar, Jeffrey L., Selewski, David T., Seri, Istvan, Shaffer, Thomas H., Shearer, Martin J., Shroyer, Noah F., Sieck, Gary C., Simmons, Rebecca A., Singh, Neel Kamal, Sivieri, Emidio, Smith, Laura, Smyth, Ian M., Sola-Visner, Martha C., Solhaug, Michael J., Sperandio, Markus, Sperling, Mark A., Srinivasan, Lakshmi, Stanescu, Diana E., Stanley, Charles A., Steinhorn, Robin H., Stinson, Lisa, Stonestreet, Barbara S., Strasburger, Janette F., Styne, Dennis M., Sun, Xin, Sussel, Lori, Tam, Emily W.Y., Tan, Libo, te Pas, Arjan B., Ten, Vadim S., Thébaud, Bernard, Thornton, Claire, Tollin, Daniel J., Towbin, Jeffrey A., Truog, William E., III, Uhler, Kristin M., van den Akker, Chris H.P., Nicolaas van den Anker, John, van den Hoff, Maurice J.B., van Goudoever, Johannes (Hans) B., Vickers, Mark H., Vinks, Alexander A., Virgintino, Daniela, Visscher, Marty O., Vonderohe, Caitlin E., Vyas, Neha V., Wacker-Gussmann, Annette, Walch, Abby, Wallace, Megan J., Walsh, Brian H., Wambach, Jennifer A., Wang, Linda X., Warburton, David, Ward, Robert M., Watt, Kevin M., Watterberg, Kristi L., Werner, Lynne A., Wernimont, Sarah A., Wershil, Barry K., Wessels, Andy, Whitsett, Jeffrey A., Willems, Fabienne, Win, Myat Su, Wohlmuth, Christoph, Wolf, Matthias T., Wolfson, Marla R., Wong, Ronald J., Wynn, James L., Yeo, Lami, Yoder, Bradley A., Yuskaitis, Christopher J., Zabinsky, Jennifer, and Zhou, Dan

Published
2022
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36. In Utero Gunshot Wound to the Left Upper Extremity in a Preterm Infant.

Author

Mir, Imran N., Kapadia, Vishal S., Murphy, Joseph T., and Diesen, Diana L.

Subjects
*ARM, *GUNSHOT wounds, *PREMATURE infants, *CESAREAN section, *ACUTE kidney failure, *ACADEMIC medical centers
Abstract

The article describes the case of a preterm infant born at 27 weeks who sustained an open humerus fracture after a 38-magnum gunshot wound to the maternal abdomen. Topics covered include treatment administered to the patient, operative findings, patient outcomes by two weeks of age, and information on injuries to the fetus caused by gunshot wounds to the uterus.

Published
2019

37. Neurodevelopmental outcomes in extremely preterm infants with placental pathologic evidence of fetal inflammatroy response.

Author

Alayli Y, Brown LS, Tolentino-Plata K, Leon R, Heyne R, Chalak LF, and Mir IN

Abstract

Objectives: Neonates born with fetal inflammatory response (FIR) are at increased risk for adverse neonatal outcomes. Our objective was to determine whether FIR and its severity is associated with neurodevelopmental impairment (NDI) at 2 years of age or death among preterm infants., Methods: A retrospective cohort study of prospectively collected data of all infants born <29 weeks gestational age (GA). FIR and its severity were diagnosed according to the Amsterdam Placental Workshop Group Consensus Statement. Neurodevelopmental outcomes among all participants were quantified according to Bayley III., Results: Mothers of infants with FIR were significantly younger (P = 0.04) and had a greater prevalence of antenatal steroid use (P < 0.01), infection during pregnancy (P = 0.01), PPROM (P < 0.01), and clinical chorioamnionitis (P < 0.01). Infants with FIR had longer duration of hospitalization (P < 0.01), days on oxygen (P < 0.01), congenital pneumonia (P = 0.03), moderate/severe bronchopulmonary dysplasia (BPD; P < 0.01). Notably, infants with FIR were not at increased risk of NDI or death (primary outcome). Those with moderate to severe FIR (≥ stage 2 FIR) were at increased risk of developing motor & language impairment or death (P < 0.01)., Conclusion: This is the first report demonstrating an association between the severity of FIR and subsequent NDI in preterm infants born., Impact Statement: Fetal Inflammatory Response (FIR) is not associated Neurodevelopmental Impairement (NDI) or Death in preterm infants However, there is significant relationship between moderate to severe FIR and NDI at 2 years of age in preterm infants. This is the first study demonstrating the impact of progression and severity of FIR on NDI or Death in preterm infants. These observations provide additional insight into understanding the impact of intrauterine exposure to inflammation on the NDI or death in preterm infants., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Published
2024
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