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1. Proceedings of the 13th International Newborn Brain Conference: Fetal and/or neonatal brain development, both normal and abnormal

Author

Khadar Abdi, Ramy Abramsky, Nickie Andescavage, Jephté Bambi, Sudeepta Basu, Cynthia Bearer, Eric J. Benner, Thérèse Biselele, Nikolay Bliznyuk, Jeroen Breckpot, Galen Carey, Agnes Chao, Line Iadsatian Christiansen, Silvia Comani, Pierpaolo Croce, Maarten De Vos, Anneleen Dereymaeker, Laura Dubois, Amelia J. Eisch, Adrian Epstein, Neta Geva, Yael Geva, Marc Gewillig, Sheyenne Gillis, Ronald N. Goldberg, Magnus Gram, Simon Gregory, Danielle Guez-Barber, Masahiro Hayakawa, Nicole Lind Henriksen, Tim Hermans, Reli Hershkovitz, Kristine Holgersen, Bo Holmqvist, Vaibhav Jain, Katrien Jansen, Vinay Kandula, Kushal Kapse, Masahiro Kawaguchi, Abdulhafeez Khair, Mohammad Khazaei, Hiroyuki Kidokoro, Frederico C. Kiffer, Katherine Kisilewicz, Sumire Kumai, Helene Lacaille, David Ley, Catherine Limperopoulos, Sandy Ebba Hallengreen Lindholm, Prosper Lukusa, Rebecca Lundberg, Peter MacFarlane, Pavle Matak, Laetitia Mavinga, Catherine Mayer, Gloire Mbayabo, Takamasa Mitsumatsu, Gerrye Mubungu, Jonathan Murnick, Tomohiko Nakata, Hajime Narita, Parvathi Nataraj, Jun Natsume, Gunnar Naulaers, Rahul Nikam, Niklas Ortenlöf, Katherine Ottolini, Xiaoyu Pan, Stanislava Pankratova, Kelly Pegram, Anna A. Penn, Subechhya Pradhan, Khadijeh Raeisi, Nicholas Rickman, Blaire Rikard, Reut Rotem, Per Torp Sangild, Yoshiaki Sato, Fumi Sawamura, Eilon Shany, Ilan Shelef, Anna Shiraki, Laura Smets, Livia Sura, Ryosuke Suzui, Takeshi Suzuki, Bruno-Paul Tady, Gentaro Taga, Gabriella Tamburro, Liesbeth Thewissen, J. Will Thompson, Thomas Thymann, Cansu Tokat, Claire-Marie Vacher, Cyndi Valdes, Suvi Vallius, Sergei Vatolin, Hama Watanabe, Adi Yehuda Weintraub, Michael Weiss, Hiroyuki Yamamoto, Salem Shimrit Yaniv, Noelle Younge, Sanghee Yun, and Filippo Zappasodi

Subjects
Pediatrics, Perinatology and Child Health
Published
2022
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2. Early-Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm

Author

Jane E. Brumbaugh, Betty R. Vohr, Edward F. Bell, Carla M. Bann, Colm P. Travers, Elisabeth C. McGowan, Heidi M. Harmon, Waldemar A. Carlo, Andrea F. Duncan, Susan R. Hintz, Alan H. Jobe, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Barbara Alksninis, Carmena Bishop, Robert T. Burke, Melinda Caskey, Laurie Hoffman, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Vita Lamberson, Teresa M. Leach, Emilee Little, Bonnie E. Stephens, Elisa Vieira, Lucille St. Pierre, Suzy Ventura, Victoria E. Watson, Anna Maria Hibbs, Michele C. Walsh, Deanne E. Wilson-Costello, Nancy S. Newman, Monika Bhola, Allison H. Payne, Bonnie S. Siner, Gulgun Yalcinkaya, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Scott, Prabhu S. Parimi, Lisa Gaetano, Brenda B. Poindexter, Kurt Schibler, Suhas G. Kallapur, Edward F. Donovan, Stephanie Merhar, Cathy Grisby, Kimberly Yolton, Barbara Alexander, Traci Beiersdorfer, Kate Bridges, Tanya E. Cahill, Juanita Dudley, Estelle E. Fischer, Teresa L. Gratton, Devan Hayes, Jody Hessling, Lenora D. Jackson, Kristin Kirker, Holly L. Mincey, Greg Muthig, Sara Stacey, Jean J. Steichen, Stacey Tepe, Julia Thompson, Sandra Wuertz, C. Michael Cotten, Ronald N. Goldberg, Ricki F. Goldstein, William F. Malcolm, Deesha Mago-Shah, Patricia L. Ashley, Joanne Finkle, Kathy J. Auten, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Melody B. Lohmeyer, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Jennifer Talbert, Diane Warner, Andrea Trembath, T. Michael O'Shea, Janice Wereszczak, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Donna White, Ravi M. Patel, David P. Carlton, Barbara J. Stoll, Ellen C. Hale, Yvonne C. Loggins, Ira Adams-Chapman, Ann Blackwelder, Diane I. Bottcher, Sheena L. Carter, Salathiel Kendrick-Allwood, Judith Laursen, Maureen Mulligan LaRossa, Colleen Mackie, Amy Sanders, Irma Seabrook, Gloria Smikle, Lynn C. Wineski, Rosemary D. Higgins, Andrew A. Bremer, Stephanie Wilson Archer, Gregory M. Sokol, Anna M. Dusick, Lu Ann Papile, Susan Gunn, Faithe Hamer, Dianne E. Herron, Abbey C. Hines, Carolyn Lytle, Lucy C. Miller, Heike M. Minnich, Leslie Richard, Lucy Smiley, Leslie Dawn Wilson, Jon E. Tyson, Kathleen A. Kennedy, Amir M. Khan, Andrea Duncan, Ricardo Mosquera, Emily K. Stephens, Georgia E. McDavid, Nora I. Alaniz, Elizabeth Allain, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Elizabeth Eason, Patricia W. Evans, Carmen Garcia, Charles Green, Donna Hall, Beverly Foley Harris, Margarita Jiminez, Janice John, Patrick M. Jones, M. Layne Lillie, Anna E. Lis, Karen Martin, Sara C. Martin, Carrie M. Mason, Shannon McKee, Brenda H. Morris, Kimberly Rennie, Shawna Rodgers, Saba Khan Siddiki, Maegan C. Simmons, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Jonathan L. Slaughter, Keith O. Yeates, Sarah Keim, Nathalie L. Maitre, Christopher J. Timan, Patricia Luzader, Erna Clark, Christine A. Fortney, Julie Gutentag, Courtney Park, Julie Shadd, Margaret Sullivan, Melanie Stein, Mary Ann Nelin, Julia Newton, Kristi Small, Stephanie Burkhardt, Jessica Purnell, Lindsay Pietruszewski, Katelyn Levengood, Nancy Batterson, Pamela Morehead, Helen Carey, Lina Yoseff-Salameh, Rox Ann Sullivan, Cole Hague, Jennifer Grothause, Erin Fearns, Aubrey Fowler, Jennifer Notestine, Jill Tonneman, Krystal Hay, Michelle Chao, Kyrstin Warnimont, Laura Marzec, Bethany Miller, Demi R. Beckford, Hallie Baugher, Brittany DeSantis, Cory Hanlon, Jacqueline McCool, Abhik Das, Marie G. Gantz, Dennis Wallace, Margaret M. Crawford, Jenna Gabrio, David Leblond, Jamie E. Newman, Carolyn M. Petrie Huitema, Jeanette O'Donnell Auman, W. Kenneth Poole, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, Valerie Y. Chock, David K. Stevenson, Marian M. Adams, M. Bethany Ball, Barbara Bentley, Elizabeth Bruno, Alexis S. Davis, Maria Elena DeAnda, Anne M. DeBattista, Lynne C. Huffman, Magdy Ismael, Jean G. Kohn, Casey Krueger, Janice Lowe, Ryan E. Lucash, Andrew W. Palmquist, Jessica Patel, Melinda S. Proud, Elizabeth N. Reichert, Nicholas H. St. John, Dharshi Sivakumar, Heather L. Taylor, Natalie Wager, R. Jordan Williams, Hali Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Anne Furey, Ellen Nylen, Paige T. Church, Cecelia E. Sibley, Ana K. Brussa, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Kathleen G. Nelson, Kirstin J. Bailey, Fred J. Biasini, Stephanie A. Chopko, Monica V. Collins, Shirley S. Cosby, Kristen C. Johnston, Mary Beth Moses, Cryshelle S. Patterson, Vivien A. Phillips, Julie Preskitt, Richard V. Rector, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Tarah T. Colaizy, John A. Widness, Michael J. Acarregui, Karen J. Johnson, Diane L. Eastman, Claire A. Goeke, Mendi L. Schmelzel, Jacky R. Walker, Michelle L. Baack, Laurie A. Hogden, Megan Broadbent, Chelsey Elenkiwich, Megan M. Henning, Sarah Van Muyden, Dan L. Ellsbury, Donia B. Campbell, Tracy L. Tud, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Sylvia Fajardo-Hiriart, Arielle Rigaud, Maria Calejo, Silvia M. Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L. Watterberg, Janell Fuller, Robin K. Ohls, Sandra Sundquist Beauman, Conra Backstrom Lacy, Mary Hanson, Carol Hartenberger, Elizabeth Kuan, Jean R. Lowe, Rebecca A. Thomson, Sara B. DeMauro, Eric C. Eichenwald, Barbara Schmidt, Haresh Kirpalani, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Christine Catts, Noah Cook, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Sarvin Ghavam, Hallam Hurt, Jonathan Snyder, Saritha Vangala, Kristina Ziolkowski, Carl T. D'Angio, Dale L. Phelps, Ronnie Guillet, Gary J. Myers, Michelle Andrews-Hartley, Julie Babish Johnson, Kyle Binion, Melissa Bowman, Elizabeth Boylin, Erica Burnell, Kelly R. Coleman, Cait Fallone, Osman Farooq, Julianne Hunn, Diane Hust, Rosemary L. Jensen, Rachel Jones, Jennifer Kachelmeyer, Emily Kushner, Deanna Maffett, Kimberly G. McKee, Joan Merzbach, Constance Orme, Diane Prinzing, Linda J. Reubens, Daisy Rochez, Mary Rowan, Premini Sabaratnam, Ann Marie Scorsone, Holly I.M. Wadkins, Kelley Yost, Lauren Zwetsch, Satyan Lakshminrusimha, Anne Marie Reynolds, Michael G. Sacilowski, Stephanie Guilford, Emily Li, Ashley Williams, William A. Zorn, Myra H. Wyckoff, Luc P. Brion, Walid A. Salhab, Charles R. Rosenfeld, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Lijun Chen, Maria M. De Leon, Francis Eubanks, Alicia Guzman, Gaynelle Hensley, Elizabeth T. Heyne, Lizette E. Lee, Melissa H. Leps, Linda A. Madden, E. Rebecca McDougald, Nancy A. Miller, Janet S. Morgan, Lara Pavageau, Pollieanna Sepulveda, Kristine Tolentino-Plata, Cathy Twell Boatman, Azucena Vera, Jillian Waterbury, Bradley A. Yoder, Mariana Baserga, Roger G. Faix, Sarah Winter, Stephen D. Minton, Mark J. Sheffield, Carrie A. Rau, Shawna Baker, Karie Bird, Jill Burnett, Susan Christensen, Laura Cole-Bledsoe, Brandy Davis, Jennifer O. Elmont, Jennifer J. Jensen, Manndi C. Loertscher, Jamie Jordan, Trisha Marchant, Earl Maxson, Kandace M. McGrath, Karen A. Osborne, D. Melody Parry, Brixen A. Reich, Susan T. Schaefer, Cynthia Spencer, Michael Steffen, Katherine Tice, Kimberlee Weaver-Lewis, Kathryn D. Woodbury, Karen Zanetti, Robert G. Dillard, Lisa K. Washburn, Barbara G. Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G. Sood, Girija Natarajan, Athina Pappas, Katherine Abramczyk, Prashant Agarwal, Monika Bajaj, Rebecca Bara, Elizabeth Billian, Sanjay Chawla, Kirsten Childs, Lilia C. De Jesus, Debra Driscoll, Melissa February, Laura A. Goldston, Mary E. Johnson, Geraldine Muran, Bogdan Panaitescu, Jeannette E. Prentiss, Diane White, Eunice Woldt, John Barks, Stephanie A. Wiggins, Mary K. Christensen, Martha D. Carlson, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, Joanne Williams, and Elaine Romano

Subjects
Pediatrics, Perinatology and Child Health
Published
2023
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3. The Use of Supplemental Hydrocortisone in the Management of Persistent Pulmonary Hypertension of the Newborn

Author

Cliff Robbins, Daniel K. Benjamin, Nicholas Paredes, Kanecia O. Zimmerman, Samia Aleem, Brianna Murphy, Veeral N. Tolia, Ronald N. Goldberg, Rachel G. Greenberg, Christiana Akinyemi, and Stephen Elliott

Subjects
Hydrocortisone, medicine.medical_treatment, Hypertension, Pulmonary, Nitric Oxide, Persistent Fetal Circulation Syndrome, Article, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Administration, Inhalation, Meconium aspiration syndrome, medicine, Humans, 030212 general & internal medicine, Prospective cohort study, Mechanical ventilation, business.industry, Infant, Newborn, Obstetrics and Gynecology, Infant, Odds ratio, medicine.disease, Confidence interval, Meconium Aspiration Syndrome, Anesthesia, Pediatrics, Perinatology and Child Health, Cohort, business, medicine.drug, Cohort study
Abstract

Objective: Characterize association between hydrocortisone receipt and hospital outcomes of infants with persistent pulmonary hypertension of the newborn (PPHN). Study design: Cohort study of infants ≥34 weeks with PPHN who received inhaled nitric oxide at

Published
2021

4. A Provider’s Guide to Vascular Disease, Dyslipidemia, and Glycemic Dysregulation in Chronic Spinal Cord Injury

Author

Michael D. Stillman, Ronald N. Goldberg, Savalan Babapoor-Farrokhran, and David R. Gater

Subjects
Blood Glucose, medicine.medical_specialty, Physical Therapy, Sports Therapy and Rehabilitation, Disease, Paralysis, Humans, Medicine, Vascular Diseases, Clinical care, Intensive care medicine, Spinal cord injury, Spinal Cord Injuries, Dyslipidemias, Glycemic, business.industry, Vascular disease, Rehabilitation, Cardiometabolic Risk Factors, Articles, medicine.disease, Combined Modality Therapy, Etiology, Neurology (clinical), medicine.symptom, business, Dyslipidemia
Abstract

Individuals with chronic spinal cord injury (SCI) are predisposed to accelerated atherogenesis, dyslipidemia, and glycemic dysregulation, although not enough is known about the etiologies or clinical consequences of these secondary effects of paralysis. While guidelines for the detection and treatment of cardiometabolic disease in SCI have recently been published, there has been a historical paucity of data-driven approaches to these conditions. This article will describe what is and not known about the cardiovascular disease and glycemic dysregulation that frequently attend SCI. It will conclude with a review of both guideline-driven and informal recommendations addressing the clinical care of people living with SCI.

Published
2020
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5. Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia

Author

Kristi L, Watterberg, Michele C, Walsh, Lei, Li, Sanjay, Chawla, Carl T, D'Angio, Ronald N, Goldberg, Susan R, Hintz, Matthew M, Laughon, Bradley A, Yoder, Kathleen A, Kennedy, Georgia E, McDavid, Conra, Backstrom-Lacy, Abhik, Das, Margaret M, Crawford, Martin, Keszler, Gregory M, Sokol, Brenda B, Poindexter, Namasivayam, Ambalavanan, Anna Maria, Hibbs, William E, Truog, Barbara, Schmidt, Myra H, Wyckoff, Amir M, Khan, Meena, Garg, Patricia R, Chess, Anne M, Reynolds, Mohannad, Moallem, Edward F, Bell, Lauritz R, Meyer, Ravi M, Patel, Krisa P, Van Meurs, C Michael, Cotten, Elisabeth C, McGowan, Abbey C, Hines, Stephanie, Merhar, Myriam, Peralta-Carcelen, Deanne E, Wilson-Costello, Howard W, Kilbride, Sara B, DeMauro, Roy J, Heyne, Ricardo A, Mosquera, Girija, Natarajan, Isabell B, Purdy, Jean R, Lowe, Nathalie L, Maitre, Heidi M, Harmon, Laurie A, Hogden, Ira, Adams-Chapman, Sarah, Winter, William F, Malcolm, Rosemary D, Higgins, and Marian, Willinger

Subjects
Hydrocortisone, Infant, Newborn, Oxygen Inhalation Therapy, General Medicine, Respiration, Artificial, Double-Blind Method, Neurodevelopmental Disorders, Infant, Extremely Premature, Airway Extubation, Humans, Glucocorticoids, Infant, Premature, Bronchopulmonary Dysplasia, Follow-Up Studies
Abstract

Bronchopulmonary dysplasia is a prevalent complication after extremely preterm birth. Inflammation with mechanical ventilation may contribute to its development. Whether hydrocortisone treatment after the second postnatal week can improve survival without bronchopulmonary dysplasia and without adverse neurodevelopmental effects is unknown.We conducted a trial involving infants who had a gestational age of less than 30 weeks and who had been intubated for at least 7 days at 14 to 28 days. Infants were randomly assigned to receive either hydrocortisone (4 mg per kilogram of body weight per day tapered over a period of 10 days) or placebo. Mandatory extubation thresholds were specified. The primary efficacy outcome was survival without moderate or severe bronchopulmonary dysplasia at 36 weeks of postmenstrual age, and the primary safety outcome was survival without moderate or severe neurodevelopmental impairment at 22 to 26 months of corrected age.We enrolled 800 infants (mean [±SD] birth weight, 715±167 g; mean gestational age, 24.9±1.5 weeks). Survival without moderate or severe bronchopulmonary dysplasia at 36 weeks occurred in 66 of 398 infants (16.6%) in the hydrocortisone group and in 53 of 402 (13.2%) in the placebo group (adjusted rate ratio, 1.27; 95% confidence interval [CI], 0.93 to 1.74). Two-year outcomes were known for 91.0% of the infants. Survival without moderate or severe neurodevelopmental impairment occurred in 132 of 358 infants (36.9%) in the hydrocortisone group and in 134 of 359 (37.3%) in the placebo group (adjusted rate ratio, 0.98; 95% CI, 0.81 to 1.18). Hypertension that was treated with medication occurred more frequently with hydrocortisone than with placebo (4.3% vs. 1.0%). Other adverse events were similar in the two groups.In this trial involving preterm infants, hydrocortisone treatment starting on postnatal day 14 to 28 did not result in substantially higher survival without moderate or severe bronchopulmonary dysplasia than placebo. Survival without moderate or severe neurodevelopmental impairment did not differ substantially between the two groups. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01353313.).

Published
2022

6. Proceedings of the 13th International Newborn Brain Conference: Fetal and/or neonatal brain development, both normal and abnormal

Author

Khadar, Abdi, Ramy, Abramsky, Nickie, Andescavage, Jephté, Bambi, Sudeepta, Basu, Cynthia, Bearer, Eric J, Benner, Thérèse, Biselele, Nikolay, Bliznyuk, Jeroen, Breckpot, Galen, Carey, Agnes, Chao, Line Iadsatian, Christiansen, Silvia, Comani, Pierpaolo, Croce, Maarten, De Vos, Anneleen, Dereymaeker, Laura, Dubois, Amelia J, Eisch, Adrian, Epstein, Neta, Geva, Yael, Geva, Marc, Gewillig, Sheyenne, Gillis, Ronald N, Goldberg, Magnus, Gram, Simon, Gregory, Danielle, Guez-Barber, Masahiro, Hayakawa, Nicole Lind, Henriksen, Tim, Hermans, Reli, Hershkovitz, Kristine, Holgersen, Bo, Holmqvist, Vaibhav, Jain, Katrien, Jansen, Vinay, Kandula, Kushal, Kapse, Masahiro, Kawaguchi, Abdulhafeez, Khair, Mohammad, Khazaei, Hiroyuki, Kidokoro, Frederico C, Kiffer, Katherine, Kisilewicz, Sumire, Kumai, Helene, Lacaille, David, Ley, Catherine, Limperopoulos, Sandy Ebba Hallengreen, Lindholm, Prosper, Lukusa, Rebecca, Lundberg, Peter, MacFarlane, Pavle, Matak, Laetitia, Mavinga, Catherine, Mayer, Gloire, Mbayabo, Takamasa, Mitsumatsu, Gerrye, Mubungu, Jonathan, Murnick, Tomohiko, Nakata, Hajime, Narita, Parvathi, Nataraj, Jun, Natsume, Gunnar, Naulaers, Rahul, Nikam, Niklas, Ortenlöf, Katherine, Ottolini, Xiaoyu, Pan, Stanislava, Pankratova, Kelly, Pegram, Anna A, Penn, Subechhya, Pradhan, Khadijeh, Raeisi, Nicholas, Rickman, Blaire, Rikard, Reut, Rotem, Per Torp, Sangild, Yoshiaki, Sato, Fumi, Sawamura, Eilon, Shany, Ilan, Shelef, Anna, Shiraki, Laura, Smets, Livia, Sura, Ryosuke, Suzui, Takeshi, Suzuki, Bruno-Paul, Tady, Gentaro, Taga, Gabriella, Tamburro, Liesbeth, Thewissen, J Will, Thompson, Thomas, Thymann, Cansu, Tokat, Claire-Marie, Vacher, Cyndi, Valdes, Suvi, Vallius, Sergei, Vatolin, Hama, Watanabe, Adi Yehuda, Weintraub, Michael, Weiss, Hiroyuki, Yamamoto, Salem Shimrit, Yaniv, Noelle, Younge, Sanghee, Yun, and Filippo, Zappasodi

Subjects
Fetus, Pregnancy, Infant, Newborn, Brain, Humans, Female, Prenatal Care, Head
Abstract

ispartof: J Neonatal Perinatal Med vol:15 issue:2 pages:411-426 ispartof: location:Netherlands status: published

Published
2022

7. Inadequate oral feeding as a barrier to discharge in moderately preterm infants

Author

Shampa Saha, Ronald N. Goldberg, Pablo J. Sánchez, Edward F. Bell, Laura F. Edwards, Abhik Das, C. Michael Cotten, Barbara J. Stoll, Seetha Shankaran, Waldemar A. Carlo, Michele C. Walsh, P. Brian Smith, Betty R. Vohr, Sara B. DeMauro, Carl T. D'Angio, William F. Malcolm, Abbot R. Laptook, and Krisa P. Van Meurs

Subjects
Male, medicine.medical_specialty, Pediatrics, Logistic regression, Article, Feeding Methods, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Feeding behavior, 030225 pediatrics, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Respiratory Distress Syndrome, Newborn, business.industry, Infant, Newborn, Postmenstrual Age, Infant, Obstetrics and Gynecology, Feeding Behavior, medicine.disease, Patient Discharge, Bottle Feeding, Breast Feeding, Logistic Models, Pediatrics, Perinatology and Child Health, Female, Outcomes research, Energy Intake, business, Breast feeding, Infant, Premature, Oral feeding
Abstract

The objectives describe the frequency that inadequate oral feeding (IOF) is the reason why moderately preterm (MPT) infants remain hospitalized and its association with neonatal morbidities. Prospective study using the NICHD Neonatal Research Network MPT Registry. Multivariable logistic regression was used to describe associations between IOF and continued hospitalization at 36 weeks postmenstrual age (PMA). A total of 6017 MPT infants from 18 centers were included. Three-thousand three-seventy-six (56%) remained hospitalized at 36 weeks PMA, of whom 1262 (37%) remained hospitalized due to IOF. IOF was associated with RDS (OR 2.02, 1.66–2.46), PDA (OR 1.86, 1.37–2.52), sepsis (OR 2.36, 95% 1.48–3.78), NEC (OR 16.14, 7.27–35.90), and BPD (OR 3.65, 2.56–5.21) compared to infants discharged and was associated with medical NEC (OR 2.06, 1.19–3.56) and BPD (OR 0.46, 0.34–0.61) compared to infants remaining hospitalized for an alternative reason. IOF is the most common barrier to discharge in MPT infants, especially among those with neonatal morbidities.

Published
2019
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8. A Polygenic Lipodystrophy Genetic Risk Score Characterizes Risk Independent of BMI in the Diabetes Prevention Program

Author

Marie-France Hivert, Ling Chen, Jose C. Florez, Shylaja Srinivasan, Maegan Harden, Edward J. Boyko, Kathleen A. Jablonski, George A. Bray, William C. Knowler, Josep M. Mercader, Edward S. Horton, Ronald N. Goldberg, Samuel Dagogo-Jack, and Steven E. Kahn

Subjects
obesity, medicine.medical_specialty, Waist, Diabetes, Pancreatic and Gastrointestinal Hormones, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Context (language use), Type 2 diabetes, 03 medical and health sciences, 0302 clinical medicine, Insulin resistance, insulin resistance, Diabetes mellitus, Internal medicine, medicine, Clinical Research Articles, 030304 developmental biology, Glycemic, 2. Zero hunger, 0303 health sciences, business.industry, fungi, lifestyle intervention, medicine.disease, Obesity, 3. Good health, type 2 diabetes, Lipodystrophy, metformin, business
Abstract

Context There is substantial heterogeneity in insulin sensitivity, and genetics may suggest possible mechanisms by which common variants influence this trait. Objectives We aimed to evaluate an 11-variant polygenic lipodystrophy genetic risk score (GRS) for association with anthropometric, glycemic and metabolic traits in the Diabetes Prevention Program (DPP). In secondary analyses, we tested the association of the GRS with cardiovascular risk factors in the DPP. Design In 2713 DPP participants, we evaluated a validated GRS of 11 common variants associated with fasting insulin-based measures of insulin sensitivity discovered through genome-wide association studies that cluster with a metabolic profile of lipodystrophy, conferring high metabolic risk despite low body mass index (BMI). Results At baseline, a higher polygenic lipodystrophy GRS was associated with lower weight, BMI, and waist circumference measurements, but with worse insulin sensitivity index (ISI) values. Despite starting at a lower weight and BMI, a higher GRS was associated with less weight and BMI reduction at one year and less improvement in ISI after adjusting for baseline values but was not associated with diabetes incidence. A higher GRS was also associated with more atherogenic low-density lipoprotein peak-particle-density at baseline but was not associated with coronary artery calcium scores in the Diabetes Prevention Program Outcomes Study. Conclusions In the DPP, a higher polygenic lipodystrophy GRS for insulin resistance with lower BMI was associated with diminished improvement in insulin sensitivity and potential higher cardiovascular disease risk. This GRS helps characterize insulin resistance in a cohort of individuals at high risk for diabetes, independent of adiposity.

Published
2019
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9. Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit

Author

Rachel G. Greenberg, Lawrence Ku, Chi D. Hornik, Margarita Bidegain, Catherine Simmons, Ronald N. Goldberg, Kimberley A. Fisher, P B Smith, and C. Michael Cotten

Subjects
Male, Neonatal intensive care unit, Midazolam, Sedation, medicine.medical_treatment, Vital signs, Ophthalmologic Surgical Procedures, Pain, Procedural, Peripherally inserted central catheter, Fentanyl, 03 medical and health sciences, 0302 clinical medicine, Respiratory Rate, Risk Factors, Intensive Care Units, Neonatal, 030225 pediatrics, Catheterization, Peripheral, Bradycardia, Intubation, Intratracheal, medicine, Humans, Hypnotics and Sedatives, Intubation, Arterial Pressure, Retinopathy of Prematurity, Mortality, Thoracic Wall, Administration, Intranasal, Retrospective Studies, Respiratory Distress Syndrome, Newborn, 030219 obstetrics & reproductive medicine, business.industry, Infant, Newborn, Magnetic Resonance Imaging, Analgesics, Opioid, Procedural sedation and analgesia, Anesthesia, Pediatrics, Perinatology and Child Health, Female, Hypotension, medicine.symptom, business, medicine.drug
Abstract

Background The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). Methods We retrospectively identified all infants receiving intranasal midazolam or fentanyl in the NICU from 2009 to 2015. We recorded indication for use and vital signs and determined the proportion of infants experiencing the following adverse events: death within 24 hours, hypotension, bradycardia, worsening respiratory status, and chest wall rigidity. Vital signs 4 hours before and after each dose were compared using the Wilcoxon signed-rank test. Results We identified 17 infants (gestational ages 23- 41 weeks) receiving 25 intranasal doses. None of the infants died or developed hypotension, bradycardia, or chest wall rigidity. Intranasal delivery was most commonly used for sedation during magnetic resonance imaging studies. Other indications include analgesia or sedation for retinopathy of prematurity surgery, intubation, and peripherally inserted central catheter placement. One infant receiving intranasal midazolam experienced worsening respiratory status. Vital signs before and after dosing were not significantly different. Conclusions Intranasal midazolam and fentanyl use in term and preterm infants appeared safe and well-tolerated in this small cohort of infants. Larger, prospective studies evaluating the safety and efficacy of intranasal midazolam and fentanyl use in infants are warranted.

Published
2019
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10. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary

Author

Salim S. Virani, Nuria Lopez-Pajares, Laurence S. Sperling, Daniel E. Forman, Paul A. Heidenreich, Donald M. Lloyd-Jones, Sidney C. Smith, Ronald N. Goldberg, Joseph Faiella-Tommasino, Joseph J. Saseen, Carmen A. Peralta, Craig A. Beam, Sarah D. de Ferranti, Chiadi E Ndumele, Lynne T. Braun, Kim K. Birtcher, Alison L. Bailey, Daniel W. Jones, Joseph Yeboah, Scott M. Grundy, Carl E. Orringer, Mark A. Hlatky, Roger S. Blumenthal, and Neil J. Stone

Subjects
Ldl cholesterol, Secondary prevention, Oncology, medicine.medical_specialty, Coronary artery calcium score, business.industry, Guideline, Internal medicine, Primary prevention, Blood cholesterol, Medicine, Cardiology and Cardiovascular Medicine, business, Patient compliance
Published
2019
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11. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

Author

Daniel E. Forman, Joseph Faiella-Tommasino, Carmen A. Peralta, Mark A. Hlatky, Craig A. Beam, Carl E. Orringer, Roger S. Blumenthal, Sarah D. de Ferranti, Ronald N. Goldberg, Lynne T. Braun, Kim K. Birtcher, Sidney C. Smith, Neil J. Stone, Scott M. Grundy, Daniel W. Jones, Chiadi E Ndumele, Joseph Yeboah, Laurence S. Sperling, Paul A. Heidenreich, Donald M. Lloyd-Jones, Joseph J. Saseen, Alison L. Bailey, Salim S. Virani, and Nuria Lopez-Pajares

Subjects
Ldl cholesterol, Secondary prevention, biology, business.industry, Coronary artery calcium score, Guideline, Pharmacology, Proliferating cell nuclear antigen, Primary prevention, Blood cholesterol, biology.protein, Medicine, Cardiology and Cardiovascular Medicine, business, Patient compliance
Published
2019
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12. Copper in Glucose Intolerance, Cognitive Decline, and Alzheimer Disease

Author

Mariacristina Siotto, Rosanna Squitti, Ronald N. Goldberg, Armando J. Mendez, and Camillo Ricordi

Subjects
medicine.medical_specialty, Type 2 diabetes, medicine.disease_cause, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Alzheimer Disease, Glycation, Internal medicine, Diabetes mellitus, Glucose Intolerance, medicine, Humans, Cognitive Dysfunction, 030212 general & internal medicine, Prediabetes, Cognitive decline, business.industry, Brain, Ceruloplasmin, medicine.disease, Oxidative Stress, Psychiatry and Mental health, Clinical Psychology, Endocrinology, Diabetes Mellitus, Type 2, chemistry, Advanced glycation end-product, Geriatrics and Gerontology, Alzheimer's disease, business, Gerontology, Copper, 030217 neurology & neurosurgery, Oxidative stress
Abstract

Trace metal dyshomeostasis has been linked to loss of cognitive performance. In particular, a disturbance in the regulation of copper (Cu), characterized by an increase in circulating Cu not bound to ceruloplasmin (non-Cp Cu), is thought to play a role in the development of Alzheimer disease (AD) and other neurodegenerative diseases in the aging population. Non-Cp Cu is redox active and its toxicity is thought to result from its ability to accelerate oxidative stress and advanced glycation endproduct (AGE) formation, leading to extracellular matrix damage in tissues including the brain. Cognitive loss is increasingly recognized to be a feature of type 2 diabetes and the increased AGE formation characteristic of diabetes may play a role in the development of this complication. There also is evidence for copper dyshomeostasis in type 2 diabetes, and therefore this could contribute to the cognitive deterioration associated with this disease. Demonstrating that disturbances of copper homeostasis correlate with an increased rate of cognitive decline in type 2 diabetes patients, and that they correlate with an increased rate of conversion from prediabetes to diabetes would bring almost immediate benefits in the clinical community in terms of treatment efficacy, AD prevention, and cost savings.

Published
2019
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13. Augmented Reality–Assisted Video Laryngoscopy and Simulated Neonatal Intubations: A Pilot Study

Author

Rachel G. Greenberg, David T. Tanaka, Ronald N. Goldberg, Patricia L. Dias, and Kimberley A. Fisher

Subjects
Novel technique, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Laryngoscopy, Pilot Projects, Nursing Staff, Hospital, Manikins, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Intensive care, Intubation, Intratracheal, Humans, Medicine, Intubation, Prospective cohort study, Simulation Training, Augmented Reality, medicine.diagnostic_test, business.industry, Video laryngoscopy, Pediatrics, Perinatology and Child Health, Physical therapy, Smart Glasses, Augmented reality, Clinical Competence, business, Airway
Abstract

BACKGROUND: For novice providers, achieving competency in neonatal intubation is becoming increasingly difficult, possibly because of fewer intubation opportunities. In the present study, we compared intubation outcomes on manikins using direct laryngoscopy (DL), indirect video laryngoscopy (IVL) using a modified disposable blade, and augmented reality–assisted video laryngoscopy (ARVL), a novel technique using smart glasses to project a magnified video of the airway into the intubator’s visual field. METHODS: Neonatal intensive care nurses (n = 45) with minimal simulated intubation experience were randomly assigned (n = 15) to the following 3 groups: DL, IVL, and ARVL. All participants completed 5 intubation attempts on a manikin using their assigned modalities and received verbal coaching by a supervisor, who viewed the video while assisting the IVL and ARVL groups. The outcome and time of each attempt were recorded. RESULTS: The DL group successfully intubated on 32% of attempts compared to 72% in the IVL group and 71% in the ARVL group (P < .001). The DL group intubated the esophagus on 27% of attempts, whereas there were no esophageal intubations in either the IVL or ARVL groups (P < .001). The median (interquartile range) time to intubate in the DL group was 35.6 (22.9–58.0) seconds, compared to 21.6 (13.9–31.9) seconds in the IVL group and 20.7 (13.2–36.5) seconds in the ARVL group (P < .001). CONCLUSIONS: Simulated intubation success of neonatal intensive care nurses was significantly improved by using either IVL or ARVL compared to DL. Future prospective studies are needed to explore the potential benefits of this technology when used in real patients.

Published
2021
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14. Defining abdominal obesity as a risk factor for coronary heart disease in the US: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Author

Diana A. Chirinos, Linda C. Gallo, Maria M. Llabre, Jianwen Cai, Marc D. Gellman, Marta Daviglus, Armando J. Mendez, Daniela Sotres-Alvarez, Neil Schneiderman, and Ronald N. Goldberg

Subjects
Research design, Adult, Male, Waist, Adolescent, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Coronary Disease, Cohort Studies, Diagnostic Techniques, Endocrine, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Reference Values, Risk Factors, Terminology as Topic, Internal Medicine, medicine, Prevalence, Humans, 030212 general & internal medicine, Risk factor, Epidemiology/Health Services Research, Abdominal obesity, Aged, Advanced and Specialized Nursing, Metabolic Syndrome, business.industry, Hispanic or Latino, Middle Aged, medicine.disease, Obesity, United States, Obesity, Abdominal, Community health, Female, Metabolic syndrome, medicine.symptom, Waist Circumference, business, Demography, Cohort study
Abstract

OBJECTIVE Various organizations have highlighted the need to examine whether abdominal obesity cut points are appropriate for identification of cardiovascular risk among ethnic minority adults, particularly Hispanic/Latino adults living in Western societies. This study aimed 1) to establish optimal definitions for abdominal obesity among Hispanics/Latinos and 2) to determine the level of agreement between the presence of metabolic syndrome diagnosed by the current Joint Interim Statement (JIS) definition and an updated definition with optimal abdominal obesity cut points. RESEARCH DESIGN AND METHODS The sample included 16,289 adults who self-identified as Hispanic/Latino ages 18–74 years enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Receiver operating characteristic curves were used to derive sensitivity and specificity values. The largest sum of sensitivity plus specificity was used to determine appropriate cut points. RESULTS Among U.S. Hispanic/Latino adults, waist circumference cut points of >102 cm in men (in line with current JIS criteria) and >97 cm (9 points higher than JIS criteria) in women provide optimal discrimination for cardiovascular risk as judged by the presence of coronary heart disease. When using these cut points to create an updated metabolic syndrome definition among women, we found disagreement between our updated definition and the current JIS criteria. The prevalence of the metabolic syndrome was overestimated by ∼5 percentage points among women based on JIS criteria in comparison with our definition. CONCLUSIONS Our results suggest that the current recommendations for waist circumference cut points may not be appropriate for U.S. Hispanic/Latino women.

Published
2020
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15. Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016

Author

Jeffrey B. Gould, Myra H. Wyckoff, Pablo J. Sánchez, Namasivayam Ambalavanan, Barbara J. Stoll, Abbot R. Laptook, Ronald N. Goldberg, Rosemary D. Higgins, Waldemar A. Carlo, Nancy S. Newman, Scott A. Lorch, Monica V. Collins, Carl T. D'Angio, Myriam Peralta-Carcelen, Sara B. DeMauro, Abhik Das, Colm P. Travers, Jochen Profit, Margarita Bidegain, Seetha Shankaran, Carla M. Bann, M. Bethany Ball, Michele C. Walsh, Scott A. McDonald, Krisa P. Van Meurs, Ellen C. Hale, and Edward F. Bell

Subjects
Pediatrics, medicine.medical_specialty, Birth weight, Ethnic group, Gestational Age, Prenatal care, Cohort Studies, Adrenal Cortex Hormones, Pregnancy, Ethnicity, Medicine, Birth Weight, Humans, Hospital Mortality, Prospective Studies, Healthcare Disparities, Birth Year, Original Investigation, business.industry, Cesarean Section, Research, Postmenstrual Age, Child Health, Infant, Newborn, Gestational age, Prenatal Care, General Medicine, United States, Online Only, Neurodevelopmental Disorders, Case-Control Studies, Infant, Extremely Premature, Gestation, Female, Morbidity, business, Cohort study
Abstract

Key Points Question Are racial/ethnic disparities in care practices and major outcomes increasing or decreasing among extremely preterm infants in the US? Findings In this cohort study of 20 092 extremely preterm infants, racial/ethnic disparities in rates of antenatal corticosteroids and cesarean delivery decreased over time. Changes in rates of mortality and most major morbidities did not differ among white, black, and Hispanic infants, and while mortality decreased over time from 2002 to 2016, rates of moderate-severe neurodevelopmental impairment increased over time in all groups. Meaning Racial/ethnic disparities in rates of potentially life-saving care practices decreased over time in the US, with reductions in mortality but increases in neurodevelopmental impairment in all racial/ethnic groups., Importance Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. Objective To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. Design, Setting, and Participants This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks’ gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months’ postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. Main Outcomes and Measures Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. Results In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. Conclusions and Relevance Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery., This cohort study evaluates whether racial/ethnic disparities in key care practices and major outcomes changed among extremely preterm infants from 2002 to 2016 at centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Published
2020

16. Survival, Morbidities, and Developmental Outcomes among Low Birth Weight Infants with Congenital Heart Defects

Author

David T. Tanaka, Kimberley A. Fisher, Ronald N. Goldberg, Kathryn E. Gustafson, William F. Malcolm, Rick Pittman, Laura Sullivan, Karan R. Kumar, Mihai Puia-Dumitrescu, Christoph P. Hornik, and Andrew J. Lodge

Subjects
Heart Defects, Congenital, medicine.medical_specialty, Pediatrics, Heart disease, Birth weight, Hospital mortality, Comorbidity, Infant, Premature, Diseases, Kaplan-Meier Estimate, 03 medical and health sciences, 0302 clinical medicine, medicine, Birth Weight, Humans, Hospital Mortality, Cardiac Surgical Procedures, 030219 obstetrics & reproductive medicine, business.industry, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Low Birth Weight, medicine.disease, Cardiac surgery, Low birth weight, Infant, Extremely Low Birth Weight, Pediatrics, Perinatology and Child Health, Infant, Small for Gestational Age, medicine.symptom, business, Infant, Premature, Follow-Up Studies
Abstract

Prematurity and low birth weight (LBW) are risk factors for increased morbidity and mortality in infants with congenital heart defects (CHDs). We sought to describe survival, inhospital morbidities, and 2-year neurodevelopmental follow-up in LBW infants with CHD.We included infants with birth weight (BW)2,500 g diagnosed with CHD (except isolated patent ductus arteriosus) admitted January 2013 to March 2016 to a single level-IV academic neonatal intensive care unit. We reported CHD prevalence by BW and gestational age; selected in-hospital morbidities and mortality by infant BW, CHD type, and surgical intervention; and developmental outcomes by Bayley's scales of infant and toddler development, third edition (BSID-III) scores at age 2 years.Among 420 infants with CHD, 28 (7%) underwent cardiac surgery. Median (25th and 75th percentiles) gestational age was 30 (range: 27-33) weeks and BW was 1,258 (range: 870-1,853) g. There were 134 of 420 (32%) extremely LBW (1,000 g) infants, 82 of 420 (20%) were small for gestational age, and 51 of 420 (12%) multiples. Most common diagnosis: atrial septal defect (260/420, 62%), followed by congenital anomaly of the pulmonary valve (75/420, 18%). Most common surgical procedure: pulmonary artery banding (5/28, 18%), followed by the tetralogy of Fallot corrective repair (4/28, 14%). Survival to discharge was 88% overall and lower among extremely LBW (1,000 g, 81%) infants and infants undergoing surgery (79%). Comorbidities were common (35%); retinopathy of prematurity and bronchopulmonary dysplasia were most prevalent. BSID-III scores were available on 148 of 176 (84%); any scores85 were noted in 73 of 148 (49%), with language being most commonly affected.Among LBW infants with congenital heart disease, hospital mortality varied by BW and cardiac diagnosis.· In low birth weight infants with congenital heart disease, survival varied by birth weight and cardiac diagnosis.. · Overall survival was higher than previously reported.. · There were fewer morbidities than previously reported.. · Bayley's scale-III scores at 2 years of age were85 for nearly half..

Published
2020

17. Outcomes of preterm infants treated with hypothermia for hypoxic-ischemic encephalopathy

Author

Margarita Bidegain, Kathryn E. Gustafson, Carolyn Pizoli, P. Brian Smith, C. Michael Cotten, Kimberley A. Fisher, Tamara I. Herrera, Ricki F. Goldstein, William F. Malcolm, Ronald N. Goldberg, and Laura F. Edwards

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Neonatal encephalopathy, Encephalopathy, Obstetrics and Gynecology, Gestational age, Metabolic acidosis, Retrospective cohort study, Hypothermia, medicine.disease, Hypoxic Ischemic Encephalopathy, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Pediatrics, Perinatology and Child Health, medicine, Coagulopathy, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Background Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and efficacy in preterm infants are scarce. Objective Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia. Methods A retrospective cohort analysis of all preterm infants Results 30 infants with a median gestational age and birthweight of 35 weeks' (range; 33–35) and 2575 g (1850–4840) and a median first postnatal blood pH of 6.81 (6.58–7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54–110), 83 (46–118), and 78 (46–112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes. Conclusion Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.

Published
2018
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18. Prolonged furosemide exposure and risk of abnormal newborn hearing screen in premature infants

Author

P. Brian Smith, Ronald N. Goldberg, Kanecia O. Zimmerman, Laura A Wang, Reese H. Clark, Matthew M. Laughon, Stephen J. Balevic, Rachel G. Greenberg, Daniel K. Benjamin, and Lawrence Ku

Subjects
Male, Pediatrics, medicine.medical_specialty, Hearing loss, Birth weight, Population, Gestational Age, Article, 03 medical and health sciences, 0302 clinical medicine, Ototoxicity, Furosemide, Pregnancy, Intensive Care Units, Neonatal, 030225 pediatrics, Intensive care, Evoked Potentials, Auditory, Brain Stem, medicine, Humans, 030212 general & internal medicine, Diuretics, Hearing Loss, education, Bronchopulmonary Dysplasia, education.field_of_study, business.industry, Hearing Tests, Infant, Newborn, Obstetrics and Gynecology, Gestational age, medicine.disease, Pediatrics, Perinatology and Child Health, Cohort, Female, medicine.symptom, business, Infant, Premature, medicine.drug
Abstract

Background At very high doses, furosemide is linked to ototoxicity in adults, but little is known about the risk of hearing loss in premature infants exposed to furosemide. Aims Evaluate the association between prolonged furosemide exposure and abnormal hearing screening in premature infants. Study design Using propensity scoring, infants with prolonged (≥28 days) exposure to furosemide were matched to infants never exposed. The matched sample was used to estimate the impact of prolonged furosemide exposure on the probability of an abnormal hearing screen prior to hospital discharge. Subjects A cohort of infants 501–1250 g birth weight and 23–29 weeks gestational age discharged home from 210 neonatal intensive care units in the United States (2004–2013). Outcome measures We defined abnormal hearing screen as a result of either “fail” or “refer” for either ear. Results Altogether, 1020 infants exposed to furosemide for ≥28 days were matched to 790 unique infants never exposed, yielding a total of 1042 matches due to sampling with replacement and propensity score ties. Matching resulted in a population similar in baseline characteristics. After adjusting for covariates, the proportion of infants with an abnormal hearing screen in the furosemide-exposed group was not significantly higher than the never-exposed group (absolute difference 3.0% [95% CI −0.2–6.2%], P = 0.07). Conclusions Prolonged furosemide exposure was associated with a positive, but not statistically significant, difference in abnormal hearing screening in premature infants. Additional studies with post-hospital discharge audiology follow-up are needed to further evaluate the safety of furosemide in this population.

Published
2018
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19. Antifungal Susceptibility and Clinical Outcome in Neonatal Candidiasis

Author

Barbara J. Stoll, Nathan P. Wiederhold, Sylvia Tan, C. Michael Cotten, Michael Cohen-Wolkowiez, Ronald N. Goldberg, Julie Autmizguine, P. Brian Smith, Ira Adams-Chapman, and Daniel K. Benjamin

Subjects
Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Antifungal Agents, 030106 microbiology, Gestational Age, Microbial Sensitivity Tests, Drug resistance, Article, Infant, Newborn, Diseases, Cohort Studies, Sepsis, 03 medical and health sciences, Minimum inhibitory concentration, 0302 clinical medicine, Drug Resistance, Fungal, Amphotericin B, Intensive Care Units, Neonatal, 030225 pediatrics, Internal medicine, medicine, Humans, Candidiasis, Invasive, Prospective Studies, Prospective cohort study, Fluconazole, Candida, Neonatal Candidiasis, business.industry, Infant, Newborn, Infant, Gestational age, medicine.disease, Low birth weight, Treatment Outcome, Infectious Diseases, Infant, Extremely Low Birth Weight, Neurodevelopmental Disorders, Pediatrics, Perinatology and Child Health, Micafungin, Female, medicine.symptom, business, Cohort study
Abstract

BACKGROUND: Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW

Published
2018
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20. Depressive Symptoms, Antidepressant Medication Use, and Inflammatory Markers in the Diabetes Prevention Program

Author

William C. Knowler, Kieren J. Mather, Todd Doyle, Yong Ma, David W. Price, David G. Marrero, Mary de Groot, Ronald N. Goldberg, Frank L. Schwartz, and Lisa Mele

Subjects
Adult, Male, medicine.medical_specialty, Comorbidity, Placebo, Article, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Diabetes mellitus, Outcome Assessment, Health Care, medicine, Humans, Hypoglycemic Agents, Program Development, Psychiatry, Applied Psychology, Inflammation, biology, Depression, Interleukin-6, business.industry, C-reactive protein, Beck Depression Inventory, Middle Aged, medicine.disease, Antidepressive Agents, Metformin, 030227 psychiatry, Psychiatry and Mental health, C-Reactive Protein, Diabetes Mellitus, Type 2, biology.protein, Female, business, Risk Reduction Behavior, Body mass index, 030217 neurology & neurosurgery, medicine.drug
Abstract

Objective Antidepressant medication use (ADM) has been shown to predict diabetes. This article assessed the role of inflammatory markers in this relationship within the Diabetes Prevention Program (DPP). Methods DPP participants randomized to metformin (MET), life-style intervention (ILS), or placebo (PLB) were assessed for depression (Beck Depression Inventory [BDI]) annually, ADM use semiannually, serum inflammatory markers (C-reactive protein [CRP], interleukin 6 [IL-6]) at baseline and year 1, and diagnosis of type 2 diabetes mellitus (T2DM) semiannually (for 3.2 years). Results At baseline (N = 3187), M (SD) body mass index was 34 (6) kg/m and the median (interquartile range) BDI score was 3 (1-7). One hundred eighty-one (5.7%) reported ADM use and 328 (10%) had BDI scores of 11 or higher. CRP and IL-6 levels did not differ by treatment group. Baseline ADM, but not BDI score, was associated with higher levels of baseline CRP adjusted for demographic, anthropometric variables, and other medications (20% higher, p = .01). Year 1 CRP decreased for non-ADM users in the MET (-13.2%) and ILS (-34%) groups and ADM users in the ILS group (-29%). No associations were found with IL-6. CRP and continuous use of ADM predicted incident T2DM in the PLB group. In the ILS group, continuous and intermittent ADM, but not CRP, predicted T2DM. In the MET group, CRP predicted incident T2DM. CRP did not mediate the risk of T2DM with ADM use in any group. Conclusions ADM was significantly associated with elevated CRP and incident T2DM. In the PLB group, ADM and CRP independently predicted onset of T2DM; however, CRP did not significantly mediate the effect of ADM.

Published
2018
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21. Beyond bacteria: a study of the enteric microbial consortium in extremely low birth weight infants.

Author

Mariam Susan LaTuga, Joseph Christopher Ellis, Charles Michael Cotton, Ronald N Goldberg, James L Wynn, Robert B Jackson, and Patrick C Seed

Subjects
Medicine, Science
Abstract

Extremely low birth weight (ELBW) infants have high morbidity and mortality, frequently due to invasive infections from bacteria, fungi, and viruses. The microbial communities present in the gastrointestinal tracts of preterm infants may serve as a reservoir for invasive organisms and remain poorly characterized. We used deep pyrosequencing to examine the gut-associated microbiome of 11 ELBW infants in the first postnatal month, with a first time determination of the eukaryote microbiota such as fungi and nematodes, including bacteria and viruses that have not been previously described. Among the fungi observed, Candida sp. and Clavispora sp. dominated the sequences, but a range of environmental molds were also observed. Surprisingly, seventy-one percent of the infant fecal samples tested contained ribosomal sequences corresponding to the parasitic organism Trichinella. Ribosomal DNA sequences for the roundworm symbiont Xenorhabdus accompanied these sequences in the infant with the greatest proportion of Trichinella sequences. When examining ribosomal DNA sequences in aggregate, Enterobacteriales, Pseudomonas, Staphylococcus, and Enterococcus were the most abundant bacterial taxa in a low diversity bacterial community (mean Shannon-Weaver Index of 1.02 ± 0.69), with relatively little change within individual infants through time. To supplement the ribosomal sequence data, shotgun sequencing was performed on DNA from multiple displacement amplification (MDA) of total fecal genomic DNA from two infants. In addition to the organisms mentioned previously, the metagenome also revealed sequences for gram positive and gram negative bacteriophages, as well as human adenovirus C. Together, these data reveal surprising eukaryotic and viral microbial diversity in ELBW enteric microbiota dominated bytypes of bacteria known to cause invasive disease in these infants.

Published
2011
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22. Growth Rates of Infants Randomized to Continuous Positive Airway Pressure or Intubation After Extremely Preterm Birth

Author

Jean R. Lowe, Yvonne E. Vaucher, Ira Adams-Chapman, Elizabeth F. Bruno, Paul Zlotnik, Kristin M. Zaterka-Baxter, Nancy Close, Alicia Guzman, Susan R. Hintz, Amanda Soong, Wade Rich, Alexandra Stroerger, Seetha Shankaran, Saba Siddiki, Sharon L. Wright, Kimberlee Weaver-Lewis, Gary David Markowitz, Linda Black, Anne M. DeBattista, Donald J. Goldstein, Monika Bhola, Marcia Worley Mersmann, Brenda H. Morris, Vivek Narendran, Patricia L. Ashley, Theresa M. Leach, Barbara J. Stoll, Gail Hounshell, Kim Francis, M. Bethany Ball, Laura A. Goldston, Michele C. Walsh, Amy K. Hutchinson, Tarah T. Colaizy, David K. Stevenson, Lisa K. Washburn, Meghan Lukasik, Abhik Das, Linda J. Reubens, Maureen Mulligan LaRossa, Rene Barbieri-Welge, John M. Fiascone, Ann B. Cook, Jon E. Tyson, Carlos Torres, Renee Bridge, Melinda S. Proud, John A. Widness, Stephanie Wilson Archer, Kathleen G. Nelson, Kristi L. Watterberg, Katherine A. Foy, Abbot R. Laptook, Dan Gingras, Bradley A. Yoder, Michelle Harwood Berkowits, Richard A. Ehrenkranz, Janet Taft, Neil N. Finer, Fred J. Biasini, J. M. DiFiore, James P. Kiley, Anthony J. Piazza, Shahnaz Duara, William F. Malcolm, Lizette E. Torres, Kathy J. Auten, Dianne E. Herron, Mike Steffens, Nancy Peters, Sally Whitley, Nancy S. Newman, Charles R. Rosenfeld, Nancy A. Miller, Sarah Martin, Beverly Foley Harris, Conra Backstrom Lacy, Linda A. Madden, Gloria V. Smikle, Kathy Arnell, Kristen C. Johnston, Anna M. Dusick, Martha G. Fuller, Heike M. Minnich, Vineet Bhandari, Donna Posin, Kate Bridges, Martha R. Leonard, Roy J. Heyne, Noelle Younge, Christine G. Butler, Patricia Gettner, Carolyn M. Petrie Huitema, Sharon F. Freedman, Rachel V. Walden, Helina Pierre, Waldemar A. Carlo, Robert G. Dillard, Joanne Williams, Ellen Nylen, Margarita Jiminez, Victoria E. Watson, Sheena L. Carter, Richard V. Rector, Barbara Alksninis, David Wang, Bill Cashore, Kimberley A. Fisher, Susie Buchter, Michael J. Acarregui, Bonnie E. Stephens, Alexis N. Diaz, W. Kenneth Poole, Ana K. Brussa, Alexis S. Davis, Carolyn Lytle, Jill Burnett, Laura Grau, Bonnie S. Siner, Melissa Whalen Morris, Karen A. Osborne, Melinda Caskey, Cryshelle S. Patterson, Renee P. Pyle, Laura L. Whitely, Harriet Friedman, Sheree York, Kelley Yost, Emily Kushner, Rebecca Bara, Cathy Grisby, Arlene Zadell, Barbara D. Alexander, Ivan D. Frantz, Myriam Peralta-Carcelen, James W. Pickett, Karen J. Johnson, Sheila Greisman, Susan Barnett, Beena G. Sood, Ann M. Blackwelder, Catherine Twell Boatman, Gary J. Myers, Athina Pappas, Ariel A. Salas, Jean G. Kohn, Ayala Ben-Tall, Ellen C. Hale, Brenda B. Poindexter, Rosemary D. Higgins, Elisabeth Dinkins, Elizabeth T. Heyne, Teresa L. Gratton, Kerry Wilder, Jonathan W. Mink, Regina A. Gargus, Deanne E. Wilson-Costello, Rebecca Montman, Charles R. Bauer, Dale L. Phelps, Jamie E. Newman, Leslie Dawn Wilson, Pablo J. Sánchez, Alan H. Jobe, Monica Konstantino, Melody B. Lohmeyer, Monica V. Collins, Charles Green, Hali E. Weiss, Elizabeth Billian, Dorothy B. Gail, Clarence Demetrio, Kurt Schibler, Mary Anne Berberich, Leslie Rodriguez, David K. Wallace, Shabnam Lainwala, Betty R. Vohr, Sobha Fritz, Kasey Hamlin-Smith, William Oh, Deborah Pontillo, David P. Carlton, Cheryl Runyan, Arielle Riguard, Shawna Baker, Avroy A. Fanaroff, Sara Krzywanski, Shirley S. Cosby, Barbara Bentley, Gaynelle Hensley, Walid A. Salhab, Joan Merzbach, Cecelia E. Sibley, James Allen, Elaine Romano, C. Michael Cotten, Maria Hopkins, Vivien Phillips, Kimberly Yolton, Michael S. Caplan, Kathryn E. Gustafson, Andrea Milena Becerra Garcia, Kirstin J. Bailey, Margaret L. Poundstone, Diana M. Vasil, Cherrie D. Welch, Sarah Lillie, Ellen Waldrep, Jeanette O'Donnell Auman, Gulgun Yalcinkaya, Kalida Mehta, Patricia W. Evans, Harris Gelbard, Carroll Peterson, Angelita M. Hensman, Sylvia Hiriart-Fajardo, Edward F. Donovan, Barbara Do, James Wilkes, Marie G. Gantz, Nicholas H. St. John, Elaine O. Mathews, Harris C. Jacobs, Deborah Evans Allred, Rosemary L. Jensen, Suzy Ventura, Kathleen A. Kennedy, Dawn Andrews, Walter Gilliam, Kristen Angela, Mary Johnson, Katharine Johnson, Krisa P. Van Meurs, Barbara G. Jackson, Betty K. Hastings, Holly L. Mincey, Elisabeth C. McGowan, Brenda L. MacKinnon, JoAnn Poulsen, Pat Cervone, Edward F. Bell, T. Michael O'Shea, Janet S. Morgan, Elaine Ito, Julie Rohr, Ruth Everett-Thomas, Patti L. Pierce Tate, Laura Cole, Maria Calejo, Dennis Wallace, Paul Wozniak, Maynard Rasmussen, Robin K. Ohls, Lisa Augostino, Silvia M. Frade Eguaras, Faithe Hamer, Julie Babish Johnson, Karen Zanetti, Roger G. Faix, Maria Elena DeAnda, Ronald N. Goldberg, James A. Lemons, Diane Hust, Stacy Reddoch, Karie Bird, Jody Hessling, Araceli Solis, Carol J. Blaisdell, Raquel Halfond, Erica Burnell, Nirupama Laroia, Georgia E. McDavid, Namasivayam Ambalavanan, Sally S. Adams, Korinne Chiu, Cynthia Spencer, Lucy Noel, Melissa Martin, Nora I. Alaniz, James R. Moore, Ricki F. Goldstein, Janell Fuller, Melissa H. Lepps, Anne Furey, Diane L. Eastman, Jonathan M. Klein, and Anna E. Lis

Subjects
Male, Pediatrics, medicine.medical_specialty, Birth weight, medicine.medical_treatment, Gestational Age, Lower risk, Article, Child Development, Positive airway pressure, Intubation, Intratracheal, medicine, Humans, Intubation, Oximetry, Continuous positive airway pressure, Respiratory Distress Syndrome, Newborn, Continuous Positive Airway Pressure, business.industry, Infant, Newborn, Postmenstrual Age, Gestational age, Pulmonary Surfactants, Neurodevelopmental Disorders, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Gestation, Female, Energy Intake, business
Abstract

OBJECTIVE: To evaluate the effects of early treatment with CPAP on nutritional intake and in-hospital growth rates of extremely preterm (EPT) infants. STUDY DESIGN: EPT infants (24–0/7 to 27–6/7 weeks of gestation) enrolled in the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT) were included. EPT infants who died before 36 weeks’ postmenstrual age (PMA) were excluded. The growth rates from birth to 36 weeks’ PMA and follow-up outcomes at 18–22 months’ corrected age of EPT infants randomized at birth to either early CPAP (intervention group) or early intubation for surfactant administration (control group) were analyzed. RESULTS: 810 of 1316 infants enrolled in SUPPORT (414 in intervention group, 396 in control group) had growth data analyzed. Median gestational age was 26 weeks and mean birthweight was 839 grams. Baseline characteristics, total nutritional intake, and in-hospital comorbidities were not significantly different between groups. In a regression model, growth rates between birth and 36 weeks’ PMA as well as growth rates during multiple intervals from birth to day 7, day 7 to14, day 14 to 21, day 21 to 28, day 28 to 32 weeks’ PMA, and 32 weeks’ PMA to 36 weeks’ PMA did not differ between treatment groups. Independent of treatment group, higher growth rates from day 21 to day 28 were associated with a lower risk of Bayley III cognitive score

Published
2021
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23. Genome-wide association study of sepsis in extremely premature infants

Author

Lakshmi, Srinivasan, Grier, Page, Haresh, Kirpalani, Jeffrey C, Murray, Abhik, Das, Rosemary D, Higgins, Waldemar A, Carlo, Edward F, Bell, Ronald N, Goldberg, Kurt, Schibler, Beena G, Sood, David K, Stevenson, Barbara J, Stoll, Krisa P, Van Meurs, Karen J, Johnson, Joshua, Levy, Scott A, McDonald, Kristin M, Zaterka-Baxter, Kathleen A, Kennedy, Pablo J, Sánchez, Shahnaz, Duara, Michele C, Walsh, Seetha, Shankaran, James L, Wynn, C Michael, Cotten, and Geraldine, Muran

Subjects
Male, 0301 basic medicine, medicine.medical_specialty, Genotype, Genome-wide association study, Single-nucleotide polymorphism, Logistic regression, Bioinformatics, Polymorphism, Single Nucleotide, Ion Channels, Article, Cohort Studies, Sepsis, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, Endopeptidases, medicine, Humans, Adaptor Proteins, Signal Transducing, business.industry, GTPase-Activating Proteins, Microfilament Proteins, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Forkhead Transcription Factors, General Medicine, medicine.disease, Surgery, 030104 developmental biology, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Cohort, ATP-Binding Cassette Transporters, Female, business, Genome-Wide Association Study, Cohort study
Abstract

Objective To identify genetic variants associated with sepsis (early-onset and late-onset) using a genome-wide association (GWA) analysis in a cohort of extremely premature infants. Study design Previously generated GWA data from the Neonatal Research Network9s anonymised genomic database biorepository of extremely premature infants were used for this study. Sepsis was defined as culture-positive early-onset or late-onset sepsis or culture-proven meningitis. Genomic and whole-genome-amplified DNA was genotyped for 1.2 million single-nucleotide polymorphisms (SNPs); 91% of SNPs were successfully genotyped. We imputed 7.2 million additional SNPs. p Values and false discovery rates (FDRs) were calculated from multivariate logistic regression analysis adjusting for gender, gestational age and ancestry. Target statistical value was p −5 . Secondary analyses assessed associations of SNPs with pathogen type. Pathway analyses were also run on primary and secondary end points. Results Data from 757 extremely premature infants were included: 351 infants with sepsis and 406 infants without sepsis. No SNPs reached genome-wide significance levels (5×10 −8 ); two SNPs in proximity to FOXC2 and FOXL1 genes achieved target levels of significance. In secondary analyses, SNPs for ELMO1, IRAK2 (Gram-positive sepsis), RALA, IMMP2L (Gram-negative sepsis) and PIEZO2 (fungal sepsis) met target significance levels. Pathways associated with sepsis and Gram-negative sepsis included gap junctions, fibroblast growth factor receptors, regulators of cell division and interleukin-1-associated receptor kinase 2 (p values Conclusions No SNPs met genome-wide significance in this cohort of extremely low birthweight infants; however, areas of potential association and pathways meriting further study were identified.

Published
2017
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24. Survival and Neurodevelopmental Outcomes among Periviable Infants

Author

Abhik Das, Betty R. Vohr, Ricki F. Goldstein, Ravi Mangal Patel, P. Brian Smith, Carla Bann, Andrea F. Duncan, C. Michael Cotten, Noelle Younge, Rosemary D. Higgins, Edward F. Bell, Ronald N. Goldberg, Matthew A. Rysavy, and Susan R. Hintz

Subjects
Male, Pediatrics, medicine.medical_specialty, Clinical Trials and Supportive Activities, Vision Disorders, Diseases, Extremely Premature, Reproductive health and childbirth, Neuropsychological Tests, Low Birth Weight and Health of the Newborn, Medical and Health Sciences, Child health, 03 medical and health sciences, 0302 clinical medicine, Corrected Age, Preterm, Clinical Research, General & Internal Medicine, 030225 pediatrics, Infant Mortality, medicine, Humans, 030212 general & internal medicine, EPOCH (chemotherapy), Early childhood, Hearing Loss, Premature, Survival rate, Pediatric, business.industry, Cerebral Palsy, Incidence, Incidence (epidemiology), Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Neurosciences, Infant, General Medicine, Perinatal Period - Conditions Originating in Perinatal Period, Newborn, United States, Survival Rate, Good Health and Well Being, Neurodevelopmental Disorders, Relative risk, Gestation, Female, business, Maternal Age
Abstract

BackgroundData reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes.MethodsWe compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008-2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death.ResultsData on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P

Published
2017
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25. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial

Author

Abhik Das, Seetha Shankaran, Richard A. Ehrenkranz, David P. Carlton, Lina F. Chalak, Claudia Pedroza, Valerie Y. Chock, Brenda B. Poindexter, Kristi L. Watterberg, Jon E. Tyson, Rosemary D. Higgins, Pablo J. Sánchez, Heidi M. Harmon, Roger G. Faix, Myra H. Wyckoff, Ronald N. Goldberg, William E. Truog, Michele C. Walsh, Elisabeth C. McGowan, Angelita M. Hensman, Nehal A. Parikh, Uday Devaskar, Edward F. Bell, Athina Pappas, Anna Maria Hibbs, Shannon E. G. Hamrick, Abbot R. Laptook, Krisa P. Van Meurs, Namasivayam Ambalavanan, Gregory M. Sokol, Aasma S. Chaudhary, Jane E. Brumbaugh, Breda Munoz, Ivan D. Frantz, Ronnie Guillet, and C. Michael Cotten

Subjects
Pediatrics, medicine.medical_specialty, Randomization, business.industry, Encephalopathy, Obstetrics and Gynecology, Posterior risk, General Medicine, Hypothermia, medicine.disease, Hypoxic Ischemic Encephalopathy, law.invention, Randomized controlled trial, law, medicine, Gestation, Risk of death, medicine.symptom, business
Abstract

Importance Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. Results Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. Trial Registration clinicaltrials.gov Identifier:NCT00614744

Published
2018
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26. A Genocentric Approach to Discovery of Mendelian Disorders

Author

Edward C. Smith, Liwen Wang, Shalini N. Jhangiani, B. Kim Andrews, Alexander C. Allori, Adam W. Hansen, Sherry S. Ross, Sarah Ellestad, Brita Boyd, Joanne Kurtzberg, Fritz J. Sedlazeck, V. Reid Sutton, Eric Boerwinkle, Erica E. Davis, Jill A. Rosenfeld, Aniko Sabo, Jennifer E. Posey, C. Michael Cotten, Jeffrey R. Marcus, Yezmin Perilla, James R. Lupski, Richard A. Gibbs, Mohammed Mikati, John S. Wiener, Heidi L. Cope, Michael M. Khayat, Pengfei Liu, Misha Angrist, Sara H. Katsanis, Sujay Kansagra, Stephen Miller, William Gallentine, Amanda French, Nicholas Katsanis, Mullai Murugan, Eileen Chambers, Allison E. Ashley-Koch, Theresa Curington, Amy P. Murtha, He Li, Patricia L. Ashley, Donna M. Muzny, Kimberley A. Fisher, Zeynep Coban Akdemir, Kevin D. Hill, Azita Sadeghpour, Margarita Bidegain, Todd Purves, Michael F. Wangler, Carolyn Pizoli, Christine M. Eng, Yaping Yang, Ronald N. Goldberg, and Marie T. McDonald

Subjects
0301 basic medicine, Candidate gene, Disease, Computational biology, Biology, Article, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Databases, Genetic, Exome Sequencing, Genetics, medicine, Humans, Exome, Genetic Predisposition to Disease, Family history, Gene, Genetics (clinical), Exome sequencing, Genetic Diseases, Inborn, Genetic Variation, Genomics, medicine.disease, Phenotype, Pedigree, Developmental disorder, 030104 developmental biology, Mendelian inheritance, symbols, 030217 neurology & neurosurgery
Abstract

The advent of inexpensive, clinical exome sequencing (ES) has led to the accumulation of genetic data from thousands of samples from individuals affected with a wide range of diseases, but for whom the underlying genetic and molecular etiology of their clinical phenotype remains unknown. In many cases, detailed phenotypes are unavailable or poorly recorded and there is little family history to guide study. To accelerate discovery, we integrated ES data from 18,696 individuals referred for suspected Mendelian disease, together with relatives, in an Apache Hadoop data lake (Hadoop Architecture Lake of Exomes [HARLEE]) and implemented a genocentric analysis that rapidly identified 154 genes harboring variants suspected to cause Mendelian disorders. The approach did not rely on case-specific phenotypic classifications but was driven by optimization of gene- and variant-level filter parameters utilizing historical Mendelian disease-gene association discovery data. Variants in 19 of the 154 candidate genes were subsequently reported as causative of a Mendelian trait and additional data support the association of all other candidate genes with disease endpoints.

Published
2019

27. Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision

Author

Elisabeth C. McGowan, Abbot. R. Laptook, Jean Lowe, Myriam Peralta-Carcelen, Dhuly Chowdhury, Rosemary D. Higgins, Susan R. Hintz, Betty R. Vohr, Richard A. Polin, Abbott R. Laptook, Martin Keszler, Angelita M. Hensman, Barbara Alksninis, Kristin M. Basso, Robert Burke, Melinda Caskey, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Emilee Little, Elisa Vieira, Victoria E. Watson, Suzy Ventura, Michele C. Walsh, Avroy A. Fanaroff, Anna Marie Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Allison H. Payne, Bonnie S. Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Edward F. Donovan, Cathy Grisby, Kate Bridges, Barbara Alexander, Estelle E. Fischer, Holly L. Mincey, Jody Hessling, Teresa L. Gratton, Lenora Jackson, Kristin Kirker, Greg Muthig, Jean J. Steichen, Stacey Tepe, Kimberly Yolton, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, Patricia L. Ashley, William F. Malcolm, Kathy J. Auten, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Melody B. Lohmeyer, Joanne Finkle, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Cindy Clark, Linda Manor, Diane Warner, Janice Wereszczak, David P. Carlton, Barbara J. Stoll, Ira Adams-Chapman, Ellen C. Hale, Yvonne Loggins, Stephanie Wilson Archer, Gregory M. Sokol, Brenda B. Poindexter, Anna M. Dusick, Lu-Ann Papile, Susan Gunn, Faithe Hamer, Dianne E. Herron, Abbey C. Hines, Carolyn Lytle, Heike M. Minnich, Lucy Smiley, Leslie Dawn Wilson, Pablo J. Sanchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Abhik Das, Dennis Wallace, Marie G. Gantz, W. Kenneth Poole, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret M. Crawford, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Alexis S. Davis, Andrew W. Palmquist, Melinda S. Proud, Barbara Bentley, Elizabeth Bruno, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Jean G. Kohn, Casey Krueger, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Anne Furey, Ellen Nylen, Waldemar A. Carlo, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Fred J. Biasini, Kristen C. Johnston, Kathleen G. Nelson, Cryshelle S. Patterson, Vivien A. Phillips, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Edward F. Bell, Tarah T. Colaizy, Michael J. Acarregui, Dan L. Ellsbury, John A. Widness, Karen J. Johnson, Donia B. Campbell, Diane L. Eastman, Jacky R. Walker, Jane E. Brumbaugh, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Sylvia Fajardo-Hiriart, Arielle Rigaud, Maria Calejo, Silvia M. Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L. Watterberg, Jean R. Lowe, Janell F. Fuller, Robin K. Ohls, Conra Backstrom Lacy, Andrea F. Duncan, Rebecca Montman, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Dale L. Phelps, Ronnie Guillet, Satyan Lakshminrusimha, Julie Babish Johnson, Linda J. Reubens, Cassandra A. Horihan, Diane Hust, Rosemary L. Jensen, Emily Kushner, Joan Merzbach, Gary J. Myers, Mary Rowan, Holly I.M. Wadkins, Melissa Bowman, Julianne Hunn, Stephanie Guilford, Deanna Maffett, Farooq Osman, Diane Prinzing, Anne Marie Reynolds, Michael G. Sacilowski, Ashley Williams, Karen Wynn, Kelley Yost, William Zorn, Lauren Zwetsch, Kathleen A. Kennedy, Jon E. Tyson, Georgia E. McDavid, Nora I. Alaniz, Julie Arldt-McAlister, Katrina Burson, Patricia W. Evans, Carmen Garcia, Charles Green, Beverly Foley Harris, Margarita Jiminez, Janice John, Patrick M. Jones, Layne M. Lillie, Anna E. Lis, Karen Martin, Sara C. Martin, Brenda H. Morris, M. Layne Poundstone, Peggy Robichaux, Shawna Rodgers, Saba Siddiki, Maegan C. Simmons, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Walid A. Salhab, Charles R. Rosenfeld, Diana M. Vasil, Lijun Chen, Alicia Guzman, Gaynelle Hensley, Melissa H. Leps, Nancy A. Miller, Janet S. Morgan, Sally S. Adams, Catherine Twell Boatman, Elizabeth T. Heyne, Linda A. Madden, Lizette E. Torres, Roger G. Faix, Bradley A. Yoder, Karen A. Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, Shawna Baker, Karie Bird, Jill Burnett, Michael Steffen, Jennifer J. Jensen, Sarah Winter, Karen Zanetti, T. Michael O'Shea, Robert G. Dillard, Lisa K. Washburn, Barbara G. Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Athina Pappas, John Barks, Rebecca Bara, Laura A. Goldston, Girija Natarajan, Mary Christensen, Stephanie A. Wiggins, Diane White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, Joanne Williams, and Elaine Romano

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Time Factors, Birth weight, Gestational Age, Prenatal care, Article, 03 medical and health sciences, 0302 clinical medicine, Child Development, stomatognathic system, Pregnancy, 030225 pediatrics, medicine, Hospital discharge, Humans, 030212 general & internal medicine, School education, Retrospective Studies, business.industry, Extremely preterm, Child Protective Services, Infant, Newborn, Infant, Cognition, Prenatal Care, Patient Discharge, United States, stomatognathic diseases, Foster care, Increased risk, Child, Preschool, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, business, Follow-Up Studies
Abstract

OBJECTIVE: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. STUDY DESIGN: For infants born at

Published
2019

28. Behavior Profiles at 2 Years for Children Born Extremely Preterm with Bronchopulmonary Dysplasia

Author

Jane E. Brumbaugh, Edward F. Bell, Scott F. Grey, Sara B. DeMauro, Betty R. Vohr, Heidi M. Harmon, Carla M. Bann, Matthew A. Rysavy, J. Wells Logan, Tarah T. Colaizy, Myriam A. Peralta-Carcelen, Elisabeth C. McGowan, Andrea F. Duncan, Barbara J. Stoll, Abhik Das, Susan R. Hintz, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Emilee Little, Robert T. Burke, Bonnie E. Stephens, Barbara Alksninis, Carmena Bishop, Mary L. Keszler, Teresa M. Leach, Victoria E. Watson, Andrea M. Knoll, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Deanne E. Wilson-Costello, Allison Payne, Monika Bhola, Gulgun Yalcinkaya, Bonnie S. Siner, Harriet G. Friedman, Elizabeth Roth, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Brenda B. Poindexter, Stephanie Merhar, Kimberly Yolton, Teresa L. Gratton, Cathy Grisby, Kristin Kirker, Sandra Wuertz, David P. Carlton, Ira Adams-Chapman, Ellen C. Hale, Yvonne C. Loggins, Diane I. Bottcher, Colleen Mackie, Sheena L. Carter, Maureen Mulligan LaRossa, Lynn C. Wineski, Gloria V. Smikle, Angela Leon-Hernandez, Salathiel Kendrick-Allwood, C. Michael Cotten, Ronald N. Goldberg, Ricki F. Goldstein, William F. Malcolm, Patricia L. Ashley, Joanne Finkle, Kimberley A. Fisher, Sandra Grimes, Kathryn E. Gustafson, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Diane Warner, Janice Wereszczak, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Lu Ann Papile, Abbey C. Hines, Dianne E. Herron, Susan Gunn, Lucy Smiley, Kathleen A. Kennedy, Jon E. Tyson, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Patricia W. Evans, Carmen Garcia, Margarita Jiminez, Janice John, Patrick M. Jones, M. Layne Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shawna Rodgers, Saba Khan Siddiki, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, Marie G. Gantz, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret Crawford, Jenna Gabrio, David Leblond, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, Valerie Y. Chock, David K. Stevenson, Marian M. Adams, M. Bethany Ball, Barbara Bentley, Maria Elena DeAnda, Anne M. Debattista, Beth Earhart, Lynne C. Huffman, Magdy Ismael, Casey E. Krueger, Andrew W. Palmquist, Melinda S. Proud, Elizabeth N. Reichert, Meera N. Sankar, Nicholas H. St. John, Heather L. Taylor, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Brenda L. MacKinnon, Ellen Nylen, Anne Furey, Cecelia E. Sibley, Ana K. Brussa, Waldemar A. Carlo, Namasivayam Ambalavanan, Kirstin J. Bailey, Fred J. Biasini, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, Yvonne E. Vaucher, David Kaegi, Maynard R. Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Wade Rich, Radmila West, Michelle L. Baack, Dan L. Ellsbury, Laurie A. Hogden, Jonathan M. Klein, John M. Dagle, Karen J. Johnson, Tracy L. Tud, Chelsey Elenkiwich, Megan M. Henning, Megan Broadbent, Mendi L. Schmelzel, Jacky R. Walker, Claire A. Goeke, Kristi L. Watterberg, Robin K. Ohls, Conra Backstrom Lacy, Sandra Brown, Janell Fuller, Carol Hartenberger, Jean R. Lowe, Sandra Sundquist Beauman, Mary Ruffner Hanson, Tara Dupont, Elizabeth Kuan, Barbara Schmidt, Haresh Kirpalani, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Ronnie Guillet, Gary J. Myers, Satyan Lakshminrusimha, Anne Marie Reynolds, Michelle E. Hartley-McAndrew, Holly I.M. Wadkins, Michael G. Sacilowski, Linda J. Reubens, Rosemary L. Jensen, Joan Merzbach, William Zorn, Osman Farooq, Deanna Maffett, Ashley Williams, Julianne Hunn, Stephanie Guilford, Kelley Yost, Mary Rowan, Diane M. Prinzing, Karen Wynn, Cait Fallone, Ann Marie Scorsone, Myra H. Wyckoff, Luc P. Brion, Roy J. Heyne, Diana M. Vasil, Sally S. Adams, Lijun Chen, Maria M. De Leon, Frances Eubanks, Alicia Guzman, Elizabeth T. Heyne, Linda A. Madden, Nancy A. Miller, Lizette E. Lee, Lara Pavageau, Pollieanna Sepulveda, Cathy Twell Boatman, Roger G. Faix, Bradley A. Yoder, Mariana Baserga, Karen A. Osborne, Shawna Baker, Karie Bird, Jill Burnett, Susan Christensen, Brandy Davis, Jennifer O. Elmont, Jennifer J. Jensen, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Stephen D. Minton, D. Melody Parry, Carrie A. Rau, Susan T. Schaefer, Mark J. Sheffield, Cynthia Spencer, Mike Steffen, Kimberlee Weaver-Lewis, Sarah Winter, Kathryn D. Woodbury, Karen Zanetti, Seetha Shankaran, Sanjay Chawla, Beena G. Sood, Athina Pappas, Girija Natarajan, Monika Bajaj, Rebecca Bara, Mary E. Johnson, Laura Goldston, Stephanie A. Wiggins, Mary K. Christensen, Martha Carlson, John Barks, Diane F. White, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, and Elaine Romano

Subjects
Male, Pediatrics, medicine.medical_specialty, CBCL, behavioral disciplines and activities, Language Development, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Cognition, 030225 pediatrics, mental disorders, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Child Behavior Checklist, Motor skill, Bronchopulmonary Dysplasia, Problem Behavior, business.industry, Confounding, Postmenstrual Age, Infant, Newborn, medicine.disease, Bronchopulmonary dysplasia, Motor Skills, Child, Preschool, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Infant Behavior, Gestation, Female, business
Abstract

To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).We studied children born at 22-26 weeks of gestation and assessed at 22-26 months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36 weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P .001) and pervasive developmental problems (P .001) increased with worsening BPD grade. Sleep problems (P = .008) and aggressive behavior (P = .023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values .05).BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.

Published
2019

29. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Author

Alison L. Bailey, Joseph J. Saseen, Sidney C. Smith, Scott M. Grundy, Roger S. Blumenthal, Joseph Yeboah, Lynne T. Braun, Kim K. Birtcher, Craig A. Beam, Daniel W. Jones, Daniel E. Forman, Laurence S. Sperling, Salim S. Virani, Carl E. Orringer, Joseph Faiella-Tommasino, Mark A. Hlatky, Carmen A. Peralta, Nuria Lopez-Pajares, Neil J. Stone, Chiadi E Ndumele, Paul A. Heidenreich, Donald M. Lloyd-Jones, Sarah D. de Ferranti, and Ronald N. Goldberg

Subjects
medicine.medical_specialty, Consensus, Cardiology, Hyperlipidemias, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Physiology (medical), Internal medicine, Primary prevention, medicine, Humans, 030212 general & internal medicine, Patient compliance, Ldl cholesterol, Secondary prevention, Evidence-Based Medicine, Task force, business.industry, Anticholesteremic Agents, Guideline, Clinical Practice, Cholesterol, Treatment Outcome, Cardiovascular Diseases, Blood cholesterol, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract

Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [‡‡‡][1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, PharmD, MS, AACC Biykem Bozkurt, MD, PhD

Published
2019
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30. Disrupted Maturation of the Microbiota and Metabolome among Extremely Preterm Infants with Postnatal Growth Failure

Author

John F. Rawls, Patricia L. Ashley, Noelle Younge, Thomas M. O’Connell, Robert Stevens, C. Michael Cotten, Patrick C. Seed, James R. Bain, Christopher B. Newgard, Ronald N. Goldberg, and Michael J. Muehlbauer

Subjects
Adult, Male, 0301 basic medicine, Postnatal growth failure, Veillonella, lcsh:Medicine, Physiology, Gestational Age, Paediatric research, medicine.disease_cause, Article, Feces, 03 medical and health sciences, 0302 clinical medicine, Enterobacteriaceae, Pregnancy, RNA, Ribosomal, 16S, Metabolome, medicine, Humans, Metabolomics, Lipolysis, lcsh:Science, Adverse effect, Beta oxidation, 2. Zero hunger, Multidisciplinary, Bacteria, biology, Extremely preterm, lcsh:R, Infant, Newborn, Infant, Pathogenic bacteria, biology.organism_classification, Gastrointestinal Microbiome, 3. Good health, 030104 developmental biology, Infant, Extremely Premature, lcsh:Q, Female, Microbiome, 030217 neurology & neurosurgery
Abstract

Growth failure during infancy is a major global problem that has adverse effects on long-term health and neurodevelopment. Preterm infants are disproportionately affected by growth failure and its effects. Herein we found that extremely preterm infants with postnatal growth failure have disrupted maturation of the intestinal microbiota, characterized by persistently low diversity, dominance of pathogenic bacteria within the Enterobacteriaceae family, and a paucity of strictly anaerobic taxa including Veillonella relative to infants with appropriate postnatal growth. Metabolomic profiling of infants with growth failure demonstrated elevated serum acylcarnitines, fatty acids, and other byproducts of lipolysis and fatty acid oxidation. Machine learning algorithms for normal maturation of the microbiota and metabolome among infants with appropriate growth revealed a pattern of delayed maturation of the microbiota and metabolome among infants with growth failure. Collectively, we identified novel microbial and metabolic features of growth failure in preterm infants and potentially modifiable targets for intervention.

Published
2019
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31. Umbilical Cord Milking vs Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants

Author

Jennifer O. Elmont, Holly I.M. Wadkins, M. Bethany Ball, Michele C. Walsh, Satyan Lakshminrusimha, Susan T. Schaefer, Toni Mancini, Melody Parry, Haresh Kirpalani, Jon E. Tyson, Gennie Bose, Namasivayam Ambalavanan, Megan M. Henning, Ann Marie Scorsone, Sanjay Chawla, Marie G. Gantz, Carl L. Bose, Seetha Shankaran, Kimberlee Weaver-Lewis, Diane I. Bottcher, John D.E. Barks, Rosemary D. Higgins, Leif D. Nelin, Kathryn D. Woodbury, Karen J. Johnson, Jennifer Donato, Stephanie Wilson Archer, Dennis Wallace, David Leblond, Tracy L. Tud, Chelsey Elenkiwich, Stephen D. Minton, Prabhu S. Parimi, Sandra Sundquist Beauman, Meena Garg, Andrew A. Bremer, Constance Orme, Anna Maria Hibbs, Mary Hanson, Joanne Finkle, Pablo J. Sánchez, Michael G. Sacilowski, Courtney Park, Laurie A. Hogden, Elizabeth Kuan, Diane F. White, Mendi L. Schmelzel, Deanna Maffett, Kathleen A. Kennedy, Sarvin Ghavam, Brandy Davis, Edward F. Bell, Martin Keszler, David P. Carlton, Emily Li, Jacky R. Walker, Elizabeth N. Reichert, Sharon L. Wright, Claire A. Goeke, Elizabeth Eason, Tara McNair, Sara B. DeMauro, Brenda B. Poindexter, Colleen Mackie, Eugenia K. Pallotto, Rachel Geller, Yvonne Loggins, Carol Hartenberger, Daisy Rochez, Waldemar A. Carlo, Frances Eubanks, Hallie Baugher, Barry Eggleston, Diane Prinzing, Teresa Chanlaw, Kandace McGrath, Carrie A. Rau, Barbara Schmidt, Stephanie Guilford, Kristin Kirker, Melinda S. Proud, Kristin M. Zaterka-Baxter, Ginger Rhodes-Ryan, Premini Sabaratnam, Georgia E. McDavid, Pollieanna Sepulvida, Cathy Grisby, Ronnie Guillet, Soraya Abbasi, Gregory M. Sokol, Mary Rowan, Abbot R. Laptook, Patricia Luzader, Myra H. Wyckoff, Luc P. Brion, Melanie Stein, Bogdan Panaitescu, Sara C. Handley, Karen Martin, Carl T. D'Angio, William E. Truog, Elisa Vieira, Kristi L. Watterberg, Allison Knutson, Cheri Gauldin, Manndi C. Loertscher, Rachel A. Jones, Jacqueline McCool, Lisa Gaetano, Bradley A. Yoder, Monica V. Collins, Ronald N. Goldberg, Michelle L. Baack, Julie C. Shadd, John M. Dagle, Mariana Baserga, Jill Burnett, Anne Marie Reynolds, Sudarshan R. Jadcherla, Emily K. Stephens, Anne Holmes, Earl Maxson, Ravi Mangal Patel, Kimberley A. Fisher, Jonathan Snyder, Rosemary L. Jensen, Jeanette O'Donnell Auman, Kirsten Childs, Stephanie L. Merhar, Angelita M. Hensman, Neha Kumbhat, Jane E. Brumbaugh, R. Jordan Williams, Eric C. Eichenwald, Maria M. DeLeon, Carla Bann, Krisa P. Van Meurs, Mark J. Sheffield, Trisha Marchant, Christine Catts, Robin K. Ohls, Claudia Pedrozza, Amir M. Khan, Conra Backstrom Lacy, Shirley S. Cosby, C. Michael Cotten, Aasma S. Chaudhary, Diana M. Vasil, Donna Hall, Janice Bernhardt, Alexis S. Davis, Kurt Schibler, Valerie Y. Chock, Erna Clark, Kyle Binion, Jonathan M. Klein, Dan L. Ellsbury, Richard A. Polin, Janell Fuller, Abhik Das, Julie Gutentag, Susan Christensen, Dianne E. Herron, Jenna Gabrio, Megan Broadbent, Lucille St. Pierre, Donna White, Cindy Clark, Elizabeth E. Foglia, Matthew M. Laughon, Stephen D. Kicklighter, Tarah T. Colaizy, David K. Stevenson, Girija Natarajan, and Uday Devaskar

Subjects
Male, medicine.medical_specialty, Gestational Age, Umbilical cord, Article, Umbilical Cord, Milking, 03 medical and health sciences, 0302 clinical medicine, Primary outcome, 030225 pediatrics, medicine, Humans, Hospital Mortality, 030212 general & internal medicine, Cerebral Intraventricular Hemorrhage, Retrospective Studies, Extremely premature, Obstetrics, business.industry, Infant, Newborn, Retrospective cohort study, medicine.disease, Constriction, medicine.anatomical_structure, Intraventricular hemorrhage, Hospital outcomes, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, Cord clamping, business
Abstract

OBJECTIVE: To compare in-hospital outcomes after umbilical cord milking versus delayed cord clamping among infants

Published
2021
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32. DIABETES HISTORY AND INCIDENT HEART FAILURE: THE ATHEROSCLEROSIS RISK IN COMMUNITIES (ARIC) STUDY

Author

Gary Gerstenblith, James S. Pankow, Elizabeth Selvin, Vijay Nambi, Chiadi E Ndumele, Justin B. Echouffo Tcheugui, Roberta Florido, Christie M. Ballantyne, Ronald N. Goldberg, Roger S. Blumenthal, Sui Zhang, Carine E. Hamo, Wendy S. Post, Josef Coresh, and Erin D. Michos

Subjects
Gerontology, Atherosclerosis Risk in Communities, business.industry, Diabetes mellitus, Heart failure, medicine, Cardiology and Cardiovascular Medicine, medicine.disease, business, Aric study
Published
2021
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33. Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic–Ischemic Encephalopathy in the Late Hypothermia Trial

Author

Abbot R. Laptook, Seetha Shankaran, Patrick Barnes, Nancy Rollins, Barbara T. Do, Nehal A. Parikh, Shannon Hamrick, Susan R. Hintz, Jon E. Tyson, Edward F. Bell, Namasivayam Ambalavanan, Ronald N. Goldberg, Athina Pappas, Carolyn Huitema, Claudia Pedroza, Aasma S. Chaudhary, Angelita M. Hensman, Abhik Das, Myra Wyckoff, Amir Khan, Michelle C. Walsh, Kristi L. Watterberg, Roger Faix, William Truog, Ronnie Guillet, Gregory M. Sokol, Brenda B. Poindexter, Rosemary D. Higgins, Michael S. Caplan, Richard A. Polin, Martin Keszler, William Oh, Betty R. Vohr, Elizabeth C. McGowan, Barbara Alksninis, Kristin Basso, Joseph Bliss, Carmena Bishop, Robert T. Burke, William Cashore, Melinda Caskey, Dan Gingras, Nicholas Guerina, Katharine Johnson, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Martha R. Leonard, Emilee Little, Bonnie E. Stephens, Elisa Vieira, Victoria E. Watson, Anna Maria Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Beau Batton, Monika Bhola, Juliann M. Di Fiore, Harriet G. Friedman, Bonnie S. Siner, Eileen K. Stork, Gulgun Yalcinkaya, Arlene Zadell, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Kimberly Yolton, Cathy Grisby, Teresa L. Gratton, Stephanie Merhar, Sandra Wuertz, C. Michael Cotten, Kimberley A. Fisher, Sandra Grimes, Joanne Finkle, Ricki F. Goldstein, Kathryn E. Gustafson, William F. Malcolm, Patricia L. Ashley, Kathy J. Auten, Melody B. Lohmeyer, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Diane D. Warner, Janice Wereszcsak, Sofia Aliaga, David P. Carlton, Barbara J. Stoll, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Colleen Mackie, Maureen Mulligan LaRossa, Ira Adams-Chapman, Lynn C. Wineski, Sheena L. Carter, Stephanie Wilson Archer, Heidi M. Harmon, Lu-Ann Papile, Anna M. Dusick, Susan Gunn, Dianne E. Herron, Abbey C. Hines, Darlene Kardatzke, Carolyn Lytle, Heike M. Minnich, Leslie Richard, Lucy C. Smiley, Leslie Dawn Wilson, Kathleen A. Kennedy, Elizabeth Allain, Carrie M. Mason, Julie Arldt-McAlister, Katrina Burson, Allison G. Dempsey, Andrea F. Duncan, Patricia W. Evans, Carmen Garcia, Charles E. Green, Margarita Jimenez, Janice John, Patrick M. Jones, M. Layne Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shannon McKee, Patti L. Pierce Tate, Shawna Rodgers, Saba Khan Siddiki, Daniel K. Sperry, Sharon L. Wright, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Christine A. Fortney, Jennifer L. Grothause, Dennis Wallace, Marie G. Gantz, Kristin M. Zaterka-Baxter, Margaret M. Crawford, Scott A. McDonald, Jamie E. Newman, Jeanette O'Donnell Auman, Carolyn M. Petrie Huitema, James W. Pickett, Patricia Yost, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Barbara Bentley, Valerie Y. Chock, Elizabeth F. Bruno, Alexis S. Davis, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Jean G. Kohn, Casey E. Krueger, Melinda S. Proud, William D. Rhine, Nicholas H. St. John, Heather Taylor, Hali E. Weiss, Waldemar A. Carlo, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Richard V. Rector, Sally Whitley, Tarah T. Colaizy, Jane E. Brumbaugh, Karen J. Johnson, Diane L. Eastman, Michael J. Acarregui, Jacky R. Walker, Claire A. Goeke, Jonathan M. Klein, Nancy J. Krutzfield, Jeffrey L. Segar, John M. Dagle, Julie B. Lindower, Steven J. McElroy, Glenda K. Rabe, Robert D. Roghair, Lauritz R. Meyer, Dan L. Ellsbury, Donia B. Campbell, Cary R. Murphy, Vipinchandra Bhavsar, Robin K. Ohls, Conra Backstrom Lacy, Sandra Sundquist Beauman, Sandra Brown, Erika Fernandez, Andrea Freeman Duncan, Janell Fuller, Elizabeth Kuan, Jean R. Lowe, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Kevin C. Dysart, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl D'Angio, Satyan Lakshminrusimha, Nirupama Laroia, Gary J. Myers, Kelley Yost, Stephanie Guilford, Rosemary L. Jensen, Karen Wynn, Osman Farooq, Anne Marie Reynolds, Holly I.M. Wadkins, Ashley Williams, Joan Merzbach, Patrick Conway, Melissa Bowman, Michele Hartley-McAndrew, William Zorn, Cait Fallone, Kyle Binion, Constance Orme, Ann Marie Scorsone, Luc P. Brion, Lina F. Chalak, Roy J. Heyne, Lijun Chen, Diana M. Vasil, Sally S. Adams, Catherine Twell Boatman, Alicia Guzman, Elizabeth T. Heyne, Lizette E. Lee, Melissa H. Leps, Linda A. Madden, Nancy A. Miller, Emma Ramon, Bradley A. Yoder, Karen A. Osborne, Cynthia Spencer, R. Edison Steele, Mike Steffen, Karena Strong, Kimberlee Weaver-Lewis, Shawna Baker, Sarah Winter, Karie Bird, Jill Burnett, Beena G. Sood, Rebecca Bara, Kirsten Childs, Lilia C. De Jesus, Bogdan Panaitescu, Sanjay M.D. Chawla, Jeannette E. Prentice, Laura A. Goldston, Eunice Hinz Woldt, Girija Natarajan, Monika Bajaj, John Barks, Mary Christensen, and Stephanie A. Wiggins

Subjects
Male, Pediatrics, medicine.medical_specialty, Developmental Disabilities, Subgroup analysis, Severity of Illness Index, Article, Hypoxic Ischemic Encephalopathy, 03 medical and health sciences, 0302 clinical medicine, Hypothermia, Induced, Predictive Value of Tests, 030225 pediatrics, Multicenter trial, medicine, Humans, 030212 general & internal medicine, medicine.diagnostic_test, Neonatal encephalopathy, business.industry, Infant, Newborn, Area under the curve, Infant, Magnetic resonance imaging, Hypothermia, medicine.disease, Magnetic Resonance Imaging, Hypoxia-Ischemia, Brain, Pediatrics, Perinatology and Child Health, Gestation, Female, medicine.symptom, business, Infant, Premature
Abstract

Objective To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia–ischemia. Trial registration Clinicaltrials.gov: NCT00614744 .

Published
2021
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34. Survival and Neurodevelopmental Outcomes Among Periviable Infants

Author

P B Smith, Noelle Younge, Susan R. Hintz, Carla M. Bann, Andrea F. Duncan, Betty R. Vohr, Rosemary D. Higgins, Matthew A. Rysavy, C M Cotten, Ricki F. Goldstein, Abhik Das, Edward F. Bell, Ronald N. Goldberg, and Ravi Mangal Patel

Subjects
03 medical and health sciences, Pediatrics, medicine.medical_specialty, 0302 clinical medicine, business.industry, Medicine, Obstetrics and Gynecology, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business
Published
2017
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35. Genetic Variants Associated with Patent Ductus Arteriosus in Extremely Preterm Infants

Author

Ronald N. Goldberg, Joshua Levy, Edward F. Bell, Kelli K. Ryckman, Cassandra N. Spracklen, Seetha Shankaran, Grier P. Page, Richard A. Ehrenkranz, C. Michael Cotten, Waldemar A. Carlo, John M. Dagle, Jeffrey C. Murray, Barbara J. Stoll, Jon E. Tyson, and Allison M. Momany

Subjects
Male, Candidate gene, Pediatrics, medicine.medical_specialty, congenital, hereditary, and neonatal diseases and abnormalities, Genotype, health care facilities, manpower, and services, education, Single-nucleotide polymorphism, Polymorphism, Single Nucleotide, Article, 03 medical and health sciences, 0302 clinical medicine, Polymorphism (computer science), 030225 pediatrics, Ductus arteriosus, health services administration, Genetic variation, medicine, Humans, 030212 general & internal medicine, Ductus Arteriosus, Patent, Ligation, business.industry, Case-control study, Infant, Newborn, Obstetrics and Gynecology, medicine.anatomical_structure, Logistic Models, Case-Control Studies, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Cohort, Multivariate Analysis, Female, business
Abstract

OBJECTIVE. Patent ductus arteriosus (PDA) is a commonly observed condition in preterm infants. Prior studies have suggested a role for genetics in determining spontaneous ductal closure. Using samples from a large neonatal cohort we tested the hypothesis that common genetic variations are associated with PDA in extremely preterm infants. STUDY DESIGN. Preterm infants (n=1013) enrolled at NICHD Neonatal Research Network sites were phenotyped for PDA. DNA was genotyped for 1634 single nucleotide polymorphisms (SNPs) from candidate genes. Analyses were adjusted for ancestral eigenvalues and significant epidemiologic variables. RESULT. SNPs in several genes were associated with the clinical diagnosis of PDA and with surgical ligation in extremely preterm neonates diagnosed with PDA (p

Published
2018

36. Weaning of Moderately Preterm Infants from the Incubator to the Crib: A Randomized Clinical Trial

Author

Seetha Shankaran, Edward F. Bell, Abbot R. Laptook, Shampa Saha, Nancy S. Newman, S. Nadya J. Kazzi, John Barks, Barbara J. Stoll, Rebecca Bara, Jenna Gabrio, Kirsten Childs, Abhik Das, Rosemary D. Higgins, Waldemar A. Carlo, Pablo J. Sánchez, David P. Carlton, Lara Pavageau, William F. Malcolm, Carl T. D'Angio, Robin K. Ohls, Brenda B. Poindexter, Gregory M. Sokol, Krisa P. Van Meurs, Tarah T. Colaizy, Ayman Khmour, Karen M. Puopolo, Meena Garg, Michele C. Walsh, Richard A. Polin, Martin Keszler, Angelita M. Hensman, Elisa Vieira, Anna Marie Hibbs, Bonnie S. Siner, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G. Kallapur, Cathy Grisby, Barbara Alexander, Estelle E. Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, C. Michael Cotten, Ronald N. Goldberg, Theresa Roach, Joanne Finkle, Kimberley A. Fisher, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Stephanie Wilson Archer, Heidi Harmon, Dianne E. Herron, Shirley I. Wright-Coltart, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Julie Gutentag, Courtney Park, Julie C. Shadd, Margaret Sullivan, Jennifer L. Grothause, Melanie Stein, Erna Clark, Rox Ann Sullivan, Dennis Wallace, Kristin M. Zaterka-Baxter, Margaret Crawford, Jeanette O'Donnell Auman, David K. Stevenson, Lou Ann Herfert, M. Bethany Ball, Gabrielle T. Goodlin, Melinda S. Proud, R. Jordan Williams, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Teresa Chanlaw, Rachel Geller, Dan L. Ellsbury, Jane E. Brumbaugh, Karen J. Johnson, Donia B. Campbell, Jacky R. Walker, Kristi Watterberg, Conra Backstrom Lacy, Sandy Sundquist Beauman, Carol Hartenberger, Haresh Kirpalani, Eric C. Eichenwald, Sara B. DeMauro, Noah Cook, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Satyan Lakshminrusimha, Ronnie Guillet, Ann Marie Scorsone, Julianne Hunn, Rosemary Jensen, Holly I.M. Wadkins, Stephanie Guilford, Ashley Williams, Myra Wyckoff, Luc P. Brion, Diana M. Vasil, Lijun Chen, Lizette E. Torres, Athina Pappas, Bogdan Panaitescu, Shelley Handel, Diane F. White, Mary Christensen, and Stephanie A. Wiggins

Subjects
Male, Pediatrics, Incubators, Infant, and Human Development Neonatal Research Network, Reproductive health and childbirth, Low Birth Weight and Health of the Newborn, Infant Equipment, law.invention, incubator, Incubators, 0302 clinical medicine, Randomized controlled trial, law, Neonatal, Infant Mortality, 030212 general & internal medicine, Pediatric, Obstetrics, weaning, Incubator, General Medicine, Patient Discharge, Intensive Care Units, Gestation, Female, Patient Safety, medicine.symptom, Infant, Premature, medicine.medical_specialty, Clinical Trials and Supportive Activities, MEDLINE, Weaning, Article, Child health, Paediatrics and Reproductive Medicine, moderately preterm infants, 03 medical and health sciences, Preterm, Clinical Research, 030225 pediatrics, Intensive Care Units, Neonatal, medicine, Humans, Trial registration, Adverse effect, Premature, business.industry, Body Weight, Infant, Newborn, Infant, temperature, Human Movement and Sports Sciences, Perinatal Period - Conditions Originating in Perinatal Period, Length of Stay, Newborn, Eunice Kennedy Shriver National Institute of Child Health, Good Health and Well Being, randomized controlled trial, Pediatrics, Perinatology and Child Health, business, Weight gain
Abstract

ObjectiveTo assess whether length of hospital stay is decreased among moderately preterm infants weaned from incubator to crib at a lower vs higher weight.Study designThis trial was conducted in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants with gestational ages 29-33 weeks, birthweight

Published
2018

37. Behavioral Deficits at 18-22 Months of Age Are Associated with Early Cerebellar Injury and Cognitive and Language Performance in Children Born Extremely Preterm

Author

Andrea F. Duncan, Carla M. Bann, Allison Dempsey, Myriam Peralta-Carcelen, Susan Hintz, Alan H. Jobe, Michael S. Caplan, Abbot R. Laptook, Betty R. Vohr, William Oh, Angelita M. Hensman, Barbara Alksninis, Dawn Andrews, Kristen Angela, Susan Barnett, Bill Cashore, Melinda Caskey, Kim Francis, Dan Gingras, Katharine Johnson, Theresa M. Leach, Bonnie E. Stephens, Victoria E. Watson, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Deanne E. Wilson-Costello, Bonnie S. Siner, Arlene Zadell, Julie DiFiore, Monika Bhola, Harriet G. Friedman, Gulgun Yalcinkaya, Dorothy Bulas, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, Patricia Ashley, Kathy J. Auten, Kimberley A. Fisher, Katherine A. Foy, Sharon F. Freedman, Kathryn E. Gustafson, Melody B. Lohmeyer, William F. Malcolm, David K. Wallace, David P. Carlton, Barbara J. Stoll, Ira Adams-Chapman, Susie Buchter, Anthony J. Piazza, Sheena Carter, Sobha Fritz, Ellen C. Hale, Amy K. Hutchinson, Maureen Mulligan LaRossa, Rosemary D. Higgins, Stephanie Wilson Archer, Gregory M. Sokol, Brenda B. Poindexter, Anna M. Dusick, James A. Lemons, Leslie D. Wilson, Faithe Hamer, Ann B. Cook, Dianne E. Herron, Carolyn Lytle, Heike M. Minnich, Mary Anne Berberich, Carol J. Blaisdell, Dorothy B. Gail, James P. Kiley, Abhik Das, Marie G. Gantz, Jamie E. Newman, Helen Cheng, Betty K. Hastings, Elizabeth M. McClure, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, W. Kenneth Poole, James W. Pickett, Dennis Wallace, Lisa A. Wrage, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Patrick D. Barnes, Barbara Bentley, Elizabeth F. Bruno, Maria Elena DeAnda, Anne M. DeBattista, Jean G. Kohn, Melinda S. Proud, Renee P. Pyle, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Elisabeth C. McGowan, Anne Furey, Brenda L. MacKinnon, Ellen Nylen, Ana Brussa, Cecelia Sibley, Waldemar A. Carlo, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Kirstin J. Bailey, Fred J. Biasini, Maria Hopkins, Kristen C. Johnston, Kathleen G. Nelson, Cryshelle S. Patterson, Richard V. Rector, Leslie Rodriguez, Amanda Soong, Sally Whitley, Sheree York, Neil N. Finer, Maynard R. Rasmussen, Paul R. Wozniak, Yvonne E. Vaucher, Wade Rich, Kathy Arnell, Rene Barbieri-Welge, Ayala Ben-Tall, Renee Bridge, Clarence Demetrio, Martha G. Fuller, Elaine Ito, Meghan Lukasik, Deborah Pontillo, Donna Posin, Cheryl Runyan, James Wilkes, Paul Zlotnik, Edward F. Bell, John A. Widness, Michael J. Acarregui, Jonathan M. Klein, Tarah T. Colaizy, Karen J. Johnson, Diane L. Eastman, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Maria Calejo, Alexis N. Diaz, Silvia M. Frade Eguaras, Andrea Garcia, Kasey Hamlin-Smith, Michelle Harwood Berkowits, Sylvia Hiriart-Fajardo, Elaine O. Mathews, Helina Pierre, Arielle Riguard, Alexandra Stroerger, Kristi L. Watterberg, Robin K. Ohls, Janell Fuller, Julie Rohr, Conra Backstrom Lacy, Jean Lowe, Rebecca Montman, Sandra Brown, Nirupama Laroia, Dale L. Phelps, Gary J. Myers, Gary D. Markowitz, Linda J. Reubens, Diane Hust, Lisa Augostino, Julie Babish Johnson, Erica Burnell, Harris Gelbard, Rosemary L. Jensen, Emily Kushner, Joan Merzbach, Jonathan Mink, Carlos Torres, David Wang, Kelley Yost, Pablo J. Sánchez, Charles R. Rosenfeld, Walid A. Salhab, Roy J. Heyne, Sally S. Adams, James Allen, Laura Grau, Alicia Guzman, Gaynelle Hensley, Elizabeth T. Heyne, Jackie F. Hickman, Melissa H. Leps, Linda A. Madden, Melissa Martin, Nancy A. Miller, Janet S. Morgan, Araceli Solis, Lizette E. Torres, Catherine Twell Boatman, Diana M. Vasil, Kathleen A. Kennedy, Jon E. Tyson, Patricia W. Evans, Esther G. Akpa, Nora I. Alaniz, Beverly Foley Harris, Charles Green, Margarita Jiminez, Anna E. Lis, Sarah Martin, Georgia E. McDavid, Brenda H. Morris, Margaret L. Poundstone, Stacy Reddoch, Saba Siddiki, Patti L. Pierce Tate, Sharon L. Wright, Bradley A. Yoder, Roger G. Faix, Shawna Baker, Karie Bird, Anna E. Bullwinkle, Jill Burnett, Laura Cole, Karen A. Osborne, Cynthia Spencer, R. Edison Steele, Michael Steffen, Kimberlee Weaver-Lewis, T. Michael O'Shea, Robert G. Dillard, Lisa K. Washburn, Nancy J. Peters, Barbara G. Jackson, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Beena G. Sood, Thomas L. Slovis, Athina Pappas, Rebecca Bara, Elizabeth Billian, Laura A. Goldston, and Mary Johnson

Subjects
Male, Pediatrics, medicine.medical_specialty, Ultrasonography, Doppler, Transcranial, Neuroimaging, Neuropsychological Tests, Bayley Scales of Infant Development, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Child Development, Cerebellar Diseases, 030225 pediatrics, Medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Competence (human resources), business.industry, Brain, Infant, Cognition, Child development, Magnetic Resonance Imaging, Language development, Neurodevelopmental Disorders, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, business, Cohort study
Abstract

Objective To investigate associations in toddlers born extremely preterm ( Study design Cohort analysis from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network Surfactant Positive Airway Pressure and Pulse Oximetry Trial Neuroimaging and Neurodevelopmental Outcomes Study of infants born extremely preterm. Subjects underwent cranial ultrasonography and near-term magnetic resonance imaging (MRI). At 18-22 months of corrected age, the assessment included the Brief Infant Toddler Social Emotional Assessment (BITSEA) Problem and Competence Scale scores and the Bayley Scales of Infant Development, Third Edition (Bayley-III). The BITSEA Problem Scale assesses dysregulation; the Competence Scale assesses social-emotional competence. We examined associations of Problem and Competence scores and positive screen rates with cranial ultrasonography and near-term MRI. Mean BITSEA and Bayley-III scores were compared using ANOVA and positive screen rates with the χ2 test. We computed correlations between BITSEA and Bayley-III scores. Results Of the 397 children, positive BITSEA screens were found in 34% for the Problem score and 26% for the Competence score. Presence of lesions on near-term MRI that included cerebellar lesions were significantly associated with lower BITSEA Competence but not with Problem scores; Competence scores were inversely related to the presence/significance of lesions. Positive screens on Competence scores and on both Competence and Problem scores were significantly associated with Bayley-III cognitive and language scores Conclusions Social–emotional competence contributes to deficits in cognitive and language development. Presence of injury on near-term MRI that includes cerebellar lesions is associated with later social–emotional competence and may be a useful predictor to guide early assessment and intervention. Trial registration ClinicalTrials.gov : NCT00063063 and NCT00233324 .

Published
2018

38. Intranasal Midazolam and Fentanyl for Analgesia and Sedation in Infants in the Neonatal Intensive Care Unit

Author

Rachel G. Greenberg, Ronald N. Goldberg, Chi D. Hornik, Brian Smith, Catherine Simmons, Lawrence Ku, Kimberley A. Fisher, Margarita Bidegain, and C. Michael Cotten

Subjects
Neonatal intensive care unit, genetic structures, business.industry, Sedation, Pain management, Fentanyl, Electronic health record, Anesthesia, mental disorders, medicine, Midazolam, heterocyclic compounds, medicine.symptom, Intranasal midazolam, business, psychological phenomena and processes, medicine.drug
Abstract

Purpose: The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for use in infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). Methods: Using electronic health record data, we identified all infants receiving intranasal midazolam or fentanyl …

Published
2018
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39. Definitions of Cardiovascular Insufficiency and Relation to Outcomes in Critically Ill Newborn Infants

Author

Abhik Das, Richard A. Ehrenkranz, Edward F. Bell, Ivan D. Frantz, Pablo J. Sánchez, Douglas E. Kendrick, Kristi L. Watterberg, Roger G. Faix, Conra Backstrom Lacy, Ronald N. Goldberg, Bradley A. Yoder, Brenda B. Poindexter, Barbara J. Stoll, Karen A. Osborne, Rosemary D. Higgins, Krisa P. Van Meurs, Kurt Schibler, Erika Fernandez, Michele C. Walsh, Seetha Shankaran, Abbot R. Laptook, Kathleen A. Kennedy, and Waldemar A. Carlo

Subjects
Male, Pediatrics, medicine.medical_specialty, Critical Illness, Blood Pressure, Gestational Age, Infant, Premature, Diseases, Article, law.invention, law, Intensive Care Units, Neonatal, medicine, Late preterm, Humans, Prospective Studies, Prospective cohort study, Perinatal Mortality, business.industry, Critically ill, Incidence (epidemiology), Infant, Newborn, Infant, Obstetrics and Gynecology, Gestational age, Respiration, Artificial, Intensive care unit, Patient Discharge, Blood pressure, Cardiovascular Diseases, Pediatrics, Perinatology and Child Health, Linear Models, Gestation, Female, business, Infant, Premature
Abstract

Background We previously reported on the overall incidence, management, and outcomes in infants with cardiovascular insufficiency (CVI). However, there are limited data on the relationship of the specific different definitions of CVI to short-term outcomes in term and late preterm newborn infants. Objective This study aims to evaluate how four definitions of CVI relate to short-term outcomes and death. Study Design The previously reported study was a multicenter, prospective cohort study of 647 infants ≥ 34 weeks gestation admitted to a Neonatal Research Network (NRN) newborn intensive care unit (NICU) and mechanically ventilated (MV) during their first 72 hours. The relationship of five short-term outcomes at discharge and four different definitions of CVI were further analyzed. Results All the four definitions were associated with greater number of days on MV and days on O 2 . The definition using a threshold blood pressure (BP) measurement alone was not associated with days of full feeding, days in the NICU or death. The definition based on the treatment of CVI was associated with all the outcomes including death. Conclusions The definition using a threshold BP alone was not consistently associated with adverse short-term outcomes. Using only a threshold BP to determine therapy may not improve outcomes.

Published
2015
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40. Human Umbilical Cord Blood Cells Ameliorate Motor Deficits in Rabbits in a Cerebral Palsy Model

Author

Matthew Derrick, Elizabeth T. Tracy, Rugang Jiang, Tracy Gentry, Joanne Kurtzberg, Kehuan Luo, Zhongjie Shi, C. Michael Cotten, Ronald N. Goldberg, Sidhartha Tan, and Alexander Drobyshevsky

Subjects
Ischemia, Cord Blood Stem Cell Transplantation, Motor Activity, Umbilical cord, Article, Cerebral palsy, Developmental Neuroscience, Pregnancy, Paracrine Communication, medicine, Animals, Humans, Progenitor cell, Dystonia, Behavior, Animal, business.industry, Cerebral Palsy, medicine.disease, Disease Models, Animal, medicine.anatomical_structure, Neurology, Anesthesia, Hypoxia-Ischemia, Brain, Gestation, Female, Rabbits, Righting reflex, business
Abstract

Cerebral palsy (CP) has a significant impact on both patients and society, but therapy is limited. Human umbilical cord blood cells (HUCBC), containing various stem and progenitor cells, have been used to treat various brain genetic conditions. In small animal experiments, HUCBC have improved outcomes after hypoxic-ischemic (HI) injury. Clinical trials using HUCBC are underway, testing feasibility, safety and efficacy for neonatal injury as well as CP. We tested HUCBC therapy in a validated rabbit model of CP after acute changes secondary to HI injury had subsided. Following uterine ischemia at 70% gestation, we infused HUCBC into newborn rabbit kits with either mild or severe neurobehavioral changes. Infusion of high-dose HUCBC (5 × 106 cells) dramatically altered the natural history of the injury, alleviating the abnormal phenotype including posture, righting reflex, locomotion, tone, and dystonia. Half the high dose showed lesser but still significant improvement. The swimming test, however, showed that joint function did not restore to naïve control function in either group. Tracing HUCBC with either MRI biomarkers or PCR for human DNA found little penetration of HUCBC in the newborn brain in the immediate newborn period, suggesting that the beneficial effects were not due to cellular integration or direct proliferative effects but rather to paracrine signaling. This is the first study to show that HUCBC improve motor performance in a dose-dependent manner, perhaps by improving compensatory repair processes.

Published
2015
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41. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage

Author

Heike M. Minnich, Ivan D. Frantz, Karen J. Johnson, William E Truog, Sandra Brown, Ronnie Guillet, Myriam Peralta-Carcelen, Rosemary D. Higgins, Haresh Kirpalani, Kathryn E. Gustafson, Leslie Dawn Wilson, Gregory M Sokol, Catherine Twell Boatman, Edward F. Bell, Janet S. Morgan, W. Kenneth Poole, Amanda D. Soong, Jeanette O'Donnell Auman, Avroy A. Fanaroff, Katrina Burson, Gulgun Yalcinkaya, Monica Konstantino, Leif D. Nelin, Bradley A. Yoder, Carin Kiser, Kristin M. Basso, Marian M. Adams, Neil N. Finer, Dennis Wallace, Hali E. Weiss, Deanna Maffett, Hallam Hurt, Fred J. Biasini, Meena Garg, Laura Cole, Kathleen A. Kennedy, Julianne Hunn, Lucy Miller, Anne Holmes, Farooq Osman, Barbara Schmidt, Anna Marie Hibbs, Walid A. Salhab, Karen A. Osborne, M. Bethany Ball, Laura A. Goldston, Silvia M. Frade Eguaras, Faithe Hamer, Julie Babish Johnson, Ruth Everett-Thomas, Patti L. Pierce Tate, Maria Calejo, Michele C. Walsh, Eugenia K. Pallotto, Rachel Geller, Roger G. Faix, Melissa H. Leps, Maria Elena DeAnda, Ronald N. Goldberg, Marie G. Gantz, Sally Whitley, Nehal A. Parikh, Michelle Harwood Berkowits, Seetha Shankaran, Andrew W. Palmquist, Andrea Halbrook, Kimberlee Weaver-Lewis, Theresa M. Leach, Ira Adams-Chapman, Janice Bernhardt, Sarah Ryan, Maynard Rasmussen, Edward F. Donovan, Diana M. Vasil, Carroll Peterson, Jamie E. Newman, Bonnie E. Stephens, Karen A. Wynn, Myra H. Wyckoff, David P. Carlton, Jody Hessling, Barbara Alexander, Katherine A. Foy, Abbot R. Laptook, Michael Steffen, Sudarshan R. Jadcherla, Suzy Ventura, Raquel Halfond, Ana K. Brussa, Charles R. Rosenfeld, Ellen Waldrep, Peggy Robichaux, Donald J. Goldstein, Monika Bhola, Brenda H. Morris, Clarence Demetrio, Erica Burnell, Brenda B. Poindexter, Martha D. Carlson, Sharon L. Wright, Linda A. Madden, Michael S. Caplan, Isabell B. Purdy, Athina Pappas, Barbara Bentley, Carol Hartenberger, Patricia W. Evans, John A. Widness, Marsha Gerdes, Stephanie Wilson Archer, Kimberly Yolton, Christine G. Butler, Roy J. Heyne, Joanne Williams, Gaynelle Hensley, Carl L. Bose, Lu Ann Papile, Richard A. Polin, Brenda L. MacKinnon, JoAnn Poulsen, Anne Marie Reynolds, T. Michael O'Shea, Charles R. Bauer, Gary J. Myers, Joanne Finkle, Maegan C. Simmons, Shahnaz Duara, Arielle Rigaud, Jill Burnett, Jacky R. Walker, Lauren Zwetsch, Ellen Nylen, Margarita Jiminez, Christine A. Fortney, Angelita M. Hensman, Ellen C. Hale, Joan Merzbach, Teresa L. Gratton, Yvonne E. Vaucher, Kathy Arnell, Holly I.M. Wadkins, Sara Kryzwanski, Nancy A. Miller, Susan R. Hintz, Elaine Romano, Betty R. Vohr, Sara B. DeMauro, Donia B. Campbell, Dara M. Cucinotta, Anna Bodnar, Kristy Domnanovich, Angela Argento, Georgia E. McDavid, Kurt Schibler, Patricia L. Ashley, Margaret M. Crawford, Casey E. Krueger, Bonnie S. Siner, Sally S. Adams, Jane E. Brumbaugh, Korinne Chiu, Janice Wereszczak, Satyanarayana Lakshminrusimha, Jon E. Tyson, Carolyn Lytle, Toni Mancini, Nancy Peters, Gennie Bose, Cryshelle S. Patterson, Katharine Johnson, Barbara J. Stoll, Kristin Kirker, Gail Hounshell, Melinda S. Proud, Janet Taft, Dale L. Phelps, Keith Owen Yeates, Kathy Johnson, Dan L. Ellsbury, Martin Keszler, Leslie Rodrigues, Jennifer J. Jensen, Barbara Alksninis, Sandra Grimes, Wade Rich, Stephanie A. Wiggins, Krisa P. Van Meurs, Yvonne Loggins, M. Layne Poundstone, David Kaegi, Elizabeth T. Heyne, Sheena L. Carter, Patricia Cervone, Richard V. Rector, John M. Fiascone, Nora I. Alaniz, Helina Pierre, Waldemar A. Carlo, Kimberley A. Fisher, Elisabeth C. McGowan, Robert G. Dillard, Greg Muthig, Sarah Martin, Carolyn M. Petrie Huitema, Barbara G. Jackson, Brian G. Tang, Melinda Caskey, Vivien Phillips, Soraya Abbasi, Michael J. Acarregui, Andrea Garcia, Robert T. Burke, Aasma S. Chaudhary, Luc P. Brion, Jean G. Kohn, Kelley Yost, Melody B. Lohmeyer, Allison F. Payne, Harriet Friedman, Victoria E. Watson, William Oh, Nancy S. Newman, John Barks, Andrea H. Duncan, Pablo J. Sánchez, Mary Lenore Keszler, Deborah Evans Allred, Rosemary L. Jensen, Karie Bird, Kristin M. Zaterka-Baxter, Ann B. Cook, Alicia Guzman, Holly L. Mincey, Gail E. Besner, Kate Bridges, Sylvia Fajardo-Hiriart, Matthew M. Laughon, Cathy Grisby, Robin K. Ohls, Rebecca Bara, Karen Zanetti, Anne M. DeBattista, Tarah T. Colaizy, William F. Malcolm, Cherrie D. Welch, Judy Bernbaum, Melissa Whalen Morris, Kathleen G. Nelson, Scott A. McDonald, Emily Kushner, Abbey C. Hines, Sheila Greisman, Ashley Williams, Estelle E. Fischer, Lenora Jackson, Harris C. Jacobs, Cheri Gauldin, Alexandra Stoerger, Deanne E. Wilson-Costello, Rebecca Montman, Monica V. Collins, Mary Christensen, Charles Green, Mary Johnson, David K. Stevenson, Lijun Chen, Cecelia E. Sibley, Lisa K. Washburn, Maureen Mulligan LaRossa, Lizette E. Torres, Kathy J. Auten, Chris Henderson, U. Devaskar, Leigh Ann Smith, Janell Fuller, Diane L. Eastman, Anna E. Lis, Dianne E. Herron, Kristen C. Johnston, Anna M. Dusick, Martha G. Fuller, Anne Furey, Howard W. Kilbride, Jean R. Lowe, Elizabeth F. Bruno, Saba Siddiki, Abhik Das, Linda J. Reubens, Richard A. Ehrenkranz, Namasivayam Ambalavanan, Cynthia Spencer, Ricki F. Goldstein, Lynne C. Huffman, Teresa Chanlaw, Patricia Luzader, Carl T. D'Angio, Diane Hust, Radmila West, Beverly Foley Harris, Sarah Winter, Conra Backstrom Lacy, Shawna Baker, Shirley S. Cosby, C. Michael Cotten, and Kristi L. Watterberg

Subjects
Male, Pediatrics, medicine.medical_specialty, Gestational Age, Infant, Premature, Diseases, Bayley Scales of Infant Development, 03 medical and health sciences, 0302 clinical medicine, 030225 pediatrics, medicine, Humans, Longitudinal Studies, Original Investigation, Cerebral Hemorrhage, Retrospective Studies, Ultrasonography, business.industry, Cerebral Palsy, Infant, Newborn, Gestational age, Brain, Gross Motor Function Classification System, Odds ratio, medicine.disease, Prognosis, Intraventricular hemorrhage, Bronchopulmonary dysplasia, Neurodevelopmental Disorders, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Female, business, 030217 neurology & neurosurgery, Ventriculomegaly, Hydrocephalus
Abstract

Importance Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. Objective To characterize the outcomes of extremely preterm neonates younger than 27 weeks’ gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks’ postmenstrual age. Design, Setting, and Participants This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks’ gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks’ postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. Main Outcomes and Measures The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. Results Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ. Conclusions and Relevance Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.

Published
2017

42. Effect of Therapeutic Hypothermia Initiated After 6 Hours of Age on Death or Disability Among Newborns With Hypoxic-Ischemic Encephalopathy: A Randomized Clinical Trial

Author

Angelita M. Hensman, Athina Pappas, Krisa P. Van Meurs, Jane E. Brumbaugh, Aasma S. Chaudhary, Breda Munoz, Ivan D. Frantz, Jon E. Tyson, Ronnie Guillet, William E. Truog, David P. Carlton, Myra H. Wyckoff, Claudia Pedroza, Anna Maria Hibbs, Abhik Das, Richard A. Ehrenkranz, Namasivayam Ambalavanan, Elisabeth C. McGowan, Brenda B. Poindexter, Abbot R. Laptook, Rosemary D. Higgins, Pablo J. Sánchez, Seetha Shankaran, Michele C. Walsh, Nehal A. Parikh, Heidi M. Harmon, Roger G. Faix, Ronald N. Goldberg, Gregory M. Sokol, Lina F. Chalak, Edward F. Bell, C. Michael Cotten, Shannon E. G. Hamrick, Kristi L. Watterberg, Uday Devaskar, and Valerie Y. Chock

Subjects
Male, Randomization, Developmental Disabilities, Encephalopathy, Gestational Age, Hypoxic Ischemic Encephalopathy, Article, law.invention, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Hypothermia, Induced, Pregnancy, 030225 pediatrics, Medicine, Humans, business.industry, Infant, Newborn, Gestational age, Bayes Theorem, General Medicine, Hypothermia, medicine.disease, Pregnancy Complications, Anesthesia, Hypoxia-Ischemia, Brain, Gestation, Female, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

Importance Hypothermia initiated at less than 6 hours after birth reduces death or disability for infants with hypoxic-ischemic encephalopathy at 36 weeks’ or later gestation. To our knowledge, hypothermia trials have not been performed in infants presenting after 6 hours. Objective To estimate the probability that hypothermia initiated at 6 to 24 hours after birth reduces the risk of death or disability at 18 months among infants with hypoxic-ischemic encephalopathy. Design, Setting, and Participants A randomized clinical trial was conducted between April 2008 and June 2016 among infants at 36 weeks’ or later gestation with moderate or severe hypoxic-ischemic encephalopathy enrolled at 6 to 24 hours after birth. Twenty-one US Neonatal Research Network centers participated. Bayesian analyses were prespecified given the anticipated limited sample size. Interventions Targeted esophageal temperature was used in 168 infants. Eighty-three hypothermic infants were maintained at 33.5°C (acceptable range, 33°C-34°C) for 96 hours and then rewarmed. Eighty-five noncooled infants were maintained at 37.0°C (acceptable range, 36.5°C-37.3°C). Main Outcomes and Measures The composite of death or disability (moderate or severe) at 18 to 22 months adjusted for level of encephalopathy and age at randomization. Results Hypothermic and noncooled infants were term (mean [SD], 39 [2] and 39 [1] weeks’ gestation, respectively), and 47 of 83 (57%) and 55 of 85 (65%) were male, respectively. Both groups were acidemic at birth, predominantly transferred to the treating center with moderate encephalopathy, and were randomized at a mean (SD) of 16 (5) and 15 (5) hours for hypothermic and noncooled groups, respectively. The primary outcome occurred in 19 of 78 hypothermic infants (24.4%) and 22 of 79 noncooled infants (27.9%) (absolute difference, 3.5%; 95% CI, −1% to 17%). Bayesian analysis using a neutral prior indicated a 76% posterior probability of reduced death or disability with hypothermia relative to the noncooled group (adjusted posterior risk ratio, 0.86; 95% credible interval, 0.58-1.29). The probability that death or disability in cooled infants was at least 1%, 2%, or 3% less than noncooled infants was 71%, 64%, and 56%, respectively. Conclusions and Relevance Among term infants with hypoxic-ischemic encephalopathy, hypothermia initiated at 6 to 24 hours after birth compared with noncooling resulted in a 76% probability of any reduction in death or disability, and a 64% probability of at least 2% less death or disability at 18 to 22 months. Hypothermia initiated at 6 to 24 hours after birth may have benefit but there is uncertainty in its effectiveness. Trial Registration clinicaltrials.gov Identifier:NCT00614744

Published
2017

43. Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids

Author

Alan H. Jobe, Namasivayam Ambalavanan, Abbot Laptook, Ellen C. Hale, Waldemar A. Carlo, Linda L. Wright, Carl T. D'Angio, Nancy S. Newman, Pablo J. Sánchez, Barbara Schmidt, Seetha Shankaran, Edward F. Bell, M. Bethany Ball, Michele C. Walsh, Scott A. McDonald, Rosemary D. Higgins, Stephanie Wilson Archer, Ronald N. Goldberg, Barbara J. Stoll, Abhik Das, Elizabeth M. McClure, and Colm P. Travers

Subjects
Male, Pediatrics, medicine.medical_specialty, Gestational Age, Article, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, 030225 pediatrics, Infant Mortality, medicine, Humans, Prospective Studies, Glucocorticoids, Bronchopulmonary Dysplasia, Respiratory Distress Syndrome, Newborn, 030219 obstetrics & reproductive medicine, Periventricular leukomalacia, business.industry, Postmenstrual Age, Infant, Newborn, Obstetrics and Gynecology, Gestational age, Infant, Pulmonary Surfactants, medicine.disease, Respiration, Artificial, Confidence interval, Drug Utilization, United States, Bronchopulmonary dysplasia, Infant, Extremely Low Birth Weight, Relative risk, Anesthesia, Infant, Extremely Premature, Prenatal Exposure Delayed Effects, Necrotizing enterocolitis, Female, Pulmonary hemorrhage, business
Abstract

Antenatal corticosteroids are given primarily to induce fetal lung maturation but results from meta-analyses of randomized controlled trials have not shown mortality or pulmonary benefits for extremely preterm infants although these are the infants most at risk of mortality and pulmonary disease.We sought to determine if exposure to antenatal corticosteroids is associated with a lower rate of death and pulmonary morbidities by 36 weeks' postmenstrual age.Prospectively collected data on 11,022 infants 22 0/7 to 28 6/7 weeks' gestational age with a birthweight of ≥401 g born from Jan. 1, 2006, through Dec. 31, 2014, were analyzed. The rate of death and the rate of physiologic bronchopulmonary dysplasia by 36 weeks' postmenstrual age were analyzed by level of exposure to antenatal corticosteroids using models adjusted for maternal variables, infant variables, center, and epoch.Infants exposed to any antenatal corticosteroids had a lower rate of death (2193/9670 [22.7%]) compared to infants without exposure (540/1302 [41.5%]) (adjusted relative risk, 0.71; 95% confidence interval, 0.65-0.76; P.0001). Infants exposed to a partial course of antenatal corticosteroids also had a lower rate of death (654/2520 [26.0%]) compared to infants without exposure (540/1302 [41.5%]); (adjusted relative risk, 0.77; 95% confidence interval, 0.70-0.85; P.0001). In an analysis by each week of gestation, infants exposed to a complete course of antenatal corticosteroids had lower mortality before discharge compared to infants without exposure at each week from 23-27 weeks' gestation and infants exposed to a partial course of antenatal corticosteroids had lower mortality at 23, 24, and 26 weeks' gestation. Rates of bronchopulmonary dysplasia in survivors did not differ by antenatal corticosteroid exposure. The rate of death due to respiratory distress syndrome, the rate of surfactant use, and the rate of mechanical ventilation were lower in infants exposed to any antenatal corticosteroids compared to infants without exposure.Among infants 22-28 weeks' gestational age, any or partial antenatal exposure to corticosteroids compared to no exposure is associated with a lower rate of death while the rate of bronchopulmonary dysplasia in survivors did not differ.

Published
2017

44. Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

Author

Jennifer James, David Munson, Sara B. DeMauro, John C. Langer, April R. Dworetz, Girija Natarajan, Margarita Bidegain, Christine A. Fortney, Ruth Seabrook, Betty R. Vohr, Jon E. Tyson, Edward F. Bell, Brenda B. Poindexter, Seetha Shankaran, Rosemary D. Higgins, Abhik Das, Barbara J. Stoll, Haresh Kirpalani, Michael S. Caplan, Abbot R. Laptook, Angelita M. Hensman, Elisa Vieira, Emilee Little, Robert Burke, Melinda Caskey, Katharine Johnson, Barbara Alksninis, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Elisabeth C. McGowan, Victoria E. Watson, Suzy Ventura, Michele C. Walsh, Avroy A. Fanaroff, Anna Marie Hibbs, Nancy S. Newman, Allison H. Payne, Deanne E. Wilson-Costello, Bonnie S. Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Allison Knutson, Kurt Schibler, Barbara Alexander, Cathy Grisby, Teresa L. Gratton, Jean J. Steichen, Estelle E. Fischer, Lenora Jackson, Kristin Kirker, Greg Muthig, Stacey Tepe, Kimberly Yolton, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, William F. Malcolm, Patricia L. Ashley, Kimberley A. Fisher, Joanne Finkle, Kathryn E. Gustafson, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Janice Wereszczak, David P. Carlton, Ellen C. Hale, Ira Adams-Chapman, Yvonne Loggins, Stephanie Wilson Archer, Gregory M. Sokol, Lu-Ann Papile, Leslie Dawn Wilson, Dianne E. Herron, Susan Gunn, Lucy Smiley, Abbey C. Hines, Leif D. Nelin, Sudarshan R. Jadcherla, Pablo J. Sánchez, Patricia Luzader, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, Marie G. Gantz, Jamie E. Newman, Jeanette O'Donnell Auman, Margaret Crawford, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Susan R. Hintz, Melinda S. Proud, Barbara Bentley, Maria Elena DeAnda, Anne M. DeBattista, Beth Earhart, Lynne C. Huffman, Casey E. Krueger, Hali E. Weiss, Waldemar A. Carlo, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Fred J. Biasini, Kristen C. Johnston, Cryshelle S. Patterson, Vivien A. Phillips, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Dan L. Ellsbury, Tarah T. Colaizy, Jane E. Brumbaugh, John A. Widness, Karen J. Johnson, Jacky R. Walker, Donia B. Campbell, Diane L. Eastman, Kristi L. Watterberg, Jean R. Lowe, Janell F. Fuller, Robin K. Ohls, Conra Backstrom Lacy, Andrea F. Duncan, Barbara Schmidt, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Ronnie Guillet, Satyan Lakshminrusimha, Anne Marie Reynolds, Rosemary L. Jensen, Joan Merzbach, Gary J. Myers, Ashley Williams, Kelley Yost, William Zorn, Karen Wynn, Deanna Maffett, Diane Prinzing, Julianne Hunn, Stephanie Guilford, Farooq Osman, Mary Rowan, Michael G. Sacilowski, Holly I.M. Wadkins, Melissa Bowman, Kathleen A. Kennedy, Julie Arldt-McAlister, Katrina Burson, Andrea Freeman Duncan, Carmen Garcia, Beverly Foley Harris, Janice John, Patrick M. Jones, Layne M. Lillie, Karen Martin, Sara C. Martin, Georgia E. McDavid, Shawna Rodgers, Saba Siddiki, Daniel Sperry, Patti L. Pierce Tate, Sharon L. Wright, Myra Wyckoff, Luc P. Brion, Diana M. Vasil, Lijun Chen, Roy J. Heyne, Sally S. Adams, Linda A. Madden, Elizabeth Heyne, Alicia Guzman, Lizette E. Torres, Catherine Twell Boatman, Athina Pappas, Rebecca Bara, Laura A. Goldston, John Barks, Mary Christensen, Stephanie Wiggins, and Diane White

Subjects
Male, Pediatrics, medicine.medical_specialty, Palliative care, Birth weight, Decision Making, Article, 03 medical and health sciences, 0302 clinical medicine, Early onset sepsis, 030225 pediatrics, Intensive care, Infant Mortality, Outcome Assessment, Health Care, medicine, Humans, 030212 general & internal medicine, Registries, Retrospective Studies, business.industry, Infant, Newborn, Gestational age, Infant, medicine.disease, Life Support Care, Survival Rate, Withholding Treatment, Life support, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Gestation, Female, Morbidity, business, Infant, Premature
Abstract

Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%-29.9%) as did WWLST (5.2%-20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov : NCT00063063 .

Published
2017

45. Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants

Author

Namasivayam Ambalavanan, Sarah McGregor, Teresa Chanlaw, Abbot R. Laptook, Martin Keszler, Shampa Saha, Sudarshan R. Jadcherla, Stephanie A. Wiggins, Stephanie Guilford, Waldemar A. Carlo, Greg Muthig, Karen Martin, Michele C. Walsh, Patricia Luzader, Nehal A. Parikh, Nancy S. Newman, David P. Carlton, Carl T. D'Angio, Eugenia K. Pallotto, Rachel Geller, Richard A. Polin, Anne Holmes, Satyan Lakshminrusimha, Dennis Wallace, Holly I.M. Wadkins, Anna Marie Hibbs, Carl L. Bose, Jeanette O'Donnell Auman, Cindy Clark, Haresh Kirpalani, Girija Natarajan, Jodi A. Ulloa, Jon E. Tyson, Julie Arldt-McAlister, Barbara J. Stoll, Edward F. Bell, Ronald N. Goldberg, Yvonne Loggins, Marliese Dion Nist, Lenora Jackson, Jacky R. Walker, Jane E. Brumbaugh, Cheri Gauldin, John D.E. Barks, Rosemary L. Jensen, Donia B. Campbell, Rosemary D. Higgins, Bonnie S. Siner, Monica V. Collins, Toni Mancini, Ann Marie Scorsone, Janice Bernhardt, Seetha Shankaran, Kristin M. Zaterka-Baxter, Jennifer Fuller, Lizette E. Torres, Kathy Johnson, Karen J. Johnson, Luc P. Brion, Margaret M. Crawford, Leif D. Nelin, Diane I. Bottcher, Julianne Hunn, Carol Hartenberger, Carmen Garcia, M. Bethany Ball, Shirley S. Cosby, Marissa E. Jones, Matthew M. Laughon, Diane F. White, Barbara Alexander, Pablo J. Sánchez, Meena Garg, Uday Devaskar, Estelle E. Fischer, Ellen C. Hale, Sharon L. Wright, Athina Pappas, Conra Backstrom Lacy, Mary Christensen, Tarah T. Colaizy, David K. Stevenson, Lijun Chen, Shelley Handel, Rebecca Bara, Kristin Kirker, Melinda S. Proud, Dan L. Ellsbury, Betty R. Vohr, Sara B. DeMauro, Cathy Grisby, Robin K. Ohls, Tara Wolfe, Diana M. Vasil, Dara M. Cucinotta, Kimberley A. Fisher, Soraya Abbasi, Stephanie Wilson Archer, Joanne Finkle, Myra H. Wyckoff, Elisa Vieira, Suhas G. Kallapur, Dianne E. Herron, Jenna Gabrio, Howard W. Kilbride, Jennifer Jennings, Abhik Das, Julie Gutentag, Sandy Sundquist Beauman, Greg Sokol, Ashley Williams, Angelita M. Hensman, Krisa P. Van Meurs, Aasma S. Chaudhary, Georgia E. McDavid, Elizabeth Rodgers, and Sandra Wuertz

Subjects
Adult, medicine.medical_specialty, Leukomalacia, Periventricular, Resuscitation, Gestational Age, Antenatal steroid, Article, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Neonatal Screening, Pregnancy, Risk Factors, 030225 pediatrics, medicine, Humans, Prospective Studies, Registries, Obstetrics, business.industry, Cesarean Section, Infant, Newborn, Gestational age, Brain, Infant, Stepwise regression, medicine.disease, Cystic Periventricular Leukomalacia, Chorioamnionitis, Logistic Models, Pediatrics, Perinatology and Child Health, Infant, Small for Gestational Age, Gestation, Small for gestational age, Female, business, Intracranial Hemorrhages, 030217 neurology & neurosurgery, Neonatal resuscitation, Infant, Premature, Ventriculomegaly, Hydrocephalus
Abstract

OBJECTIVES: To describe the frequency and findings of cranial imaging in moderately preterm (MPT) infants (born at 29 0/7–33 6/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN: We used data from the Neonatal Research Network MPT Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age (GA), antenatal steroids and center. RESULTS: Among 7,021 infants, 4,184 (60%) underwent cranial imaging. These infants had lower GAs and birth weights and higher rates of birth weight small-for-gestation, outborn birth, cesarean delivery; neonatal resuscitation and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3–4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%) and ventriculomegaly (6.6%). Histological chorioamnionitis [OR 1.47; 95% C.I.:1.19–1.83], GA [0.95; 95% C.I.: 0.94–0.97], antenatal steroids [OR 0.55; 95% C.I.: 0.41–0.74] and cesarean delivery [OR 0.66; 95% C.I.: 0.53–0.81] were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging [OR 2.08; 95% CI: 1.10–3.92]. On the CART model, cesarean delivery, center, antenatal steroids and chorioamnionitis, in that order, predicted abnormal imaging. CONCLUSIONS: Among the 60% of MPT infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in MPT infants is needed.

Published
2017

46. Admission Temperature and Associated Mortality and Morbidity among Moderately and Extremely Preterm Infants

Author

Abbot R. Laptook, Edward F. Bell, Seetha Shankaran, Nansi S. Boghossian, Myra H. Wyckoff, Sarah Kandefer, Michele Walsh, Shampa Saha, Rosemary Higgins, Richard A. Polin, Martin Keszler, Betty R. Vohr, Angelita M. Hensman, Elisa Vieira, Emilee Little, Avroy A. Fanaroff, Anna Marie Hibbs, Nancy S. Newman, Bonnie S. Siner, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Suhas G. Kallapur, Cathy Grisby, Barbara Alexander, Estelle E. Fischer, Lenora Jackson, Kristin Kirker, Jennifer Jennings, Sandra Wuertz, Greg Muthig, Edward F. Donovan, Jody Hessling, Marcia Worley Mersmann, Holly L. Mincey, C. Michael Cotten, Ronald N. Goldberg, Joanne Finkle, Kimberley A. Fisher, Kathy J. Auten, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Cindy Clark, Barbara J. Stoll, David P. Carlton, Ellen C. Hale, Yvonne Loggins, Diane I. Bottcher, Stephanie Wilson Archer, Linda L. Wright, Elizabeth M. McClure, Brenda B. Poindexter, Gregory M. Sokol, Dianne E. Herron, James A. Lemons, Diana D. Appel, Lucy C. Miller, Pablo J. Sanchez, Leif D. Nelin, Sudarshan R. Jadcherla, Patricia Luzader, Nehal A. Parikh, Marliese Dion Nist, Jennifer Fuller, Julie Gutentag, Marissa E. Jones, Sarah McGregor, Elizabeth Rodgers, Jodi A. Ulloa, Tara Wolfe, Abhik Das, Dennis Wallace, W. Kenneth Poole, Kristin M. Zaterka-Baxter, Margaret Crawford, Jenna Gabrio, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, Betty K. Hastings, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Melinda S. Proud, Waldemar A. Carlo, Namasivayam Ambalavanan, Monica V. Collins, Shirley S. Cosby, Uday Devaskar, Meena Garg, Teresa Chanlaw, Rachel Geller, Tarah T. Colaizy, Dan L. Ellsbury, Jane E. Brumbaugh, Karen J. Johnson, Donia B. Campbell, Jacky R. Walker, Kristi L. Watterberg, Robin K. Ohls, Conra Backstrom Lacy, Sandra Sundquist Beauman, Carol Hartenberger, Barbara Schmidt, Haresh Kirpalani, Noah Cook, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara Cucinotta, Carl T. D'Angio, Ronnie Guillet, Satyan Lakshminrusimha, Dale L. Phelps, Ann Marie Reynolds, Julianne Hunn, Rosemary Jensen, Holly I.M. Wadkins, Stephanie Guilford, Ashley Williams, Michael Sacilowski, Linda Reubens, Erica Burnell, Mary Rowan, Karen Wynn, Deanna Maffett, Luc P. Brion, Diana M. Vasil, Lijun Chen, Lizette E. Torres, Walid A. Salhab, Susie Madison, Gay Hensley, Nancy A. Miller, Alicia Guzman, Kathleen A. Kennedy, Jon E. Tyson, Julie Arldt-McAlister, Carmen Garcia, Karen Martin, Georgia E. McDavid, Sharon L. Wright, Esther G. Akpa, Patty A. Cluff, Anna E. Lis, Claudia I. Franco, Athina Pappas, John Barks, Rebecca Bara, Shelley Handel, Geraldine Muran, Diane F. White, Mary Christensen, and Stephanie A. Wiggins

Subjects
Male, Pediatrics, medicine.medical_specialty, Fever, Hospital mortality, Hypothermia, Infant, Premature, Diseases, Logistic regression, Child health, Article, Body Temperature, 03 medical and health sciences, 0302 clinical medicine, Patient Admission, Risk Factors, 030225 pediatrics, Intensive Care Units, Neonatal, Medicine, Humans, 030212 general & internal medicine, Hospital Mortality, business.industry, Extremely preterm, Infant, Newborn, Infant newborn, United States, Logistic Models, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Female, business
Abstract

To evaluate the temperature distribution among moderately preterm (MPT, 29-33 weeks) and extremely preterm (EPT,29 weeks) infants upon neonatal intensive care unit (NICU) admission in 2012-2013, the change in admission temperature distribution for EPT infants between 2002-2003 and 2012-2013, and associations between admission temperature and mortality and morbidity for both MPT and EPT infants.Prospectively collected data from 18 centers in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network were used to examine NICU admission temperature of inborn MPT and EPT infants. Associations between admission temperature and mortality and morbidity were determined by multivariable logistic regression. EPT infants from 2002-2003 and 2012-2013 were compared.MPT and EPT cohorts consisted of 5818 and 3213 infants, respectively. The distribution of admission temperatures differed between the MPT vs EPT (P .01), including the percentage36.5°C (38.6% vs 40.9%), 36.5°C-37.5°C (57.3% vs 52.9%), and37.5°C (4.2% vs 6.2%). For EPT infants in 2012-2013 compared with 2002-2003, the percentage of temperatures between 36.5°C and 37.5°C more than doubled and the percentage of temperatures37.5°C more than tripled. Admission temperature was inversely associated with in-hospital mortality.Low and high admission temperatures are more frequent among EPT than MPT infants. Compared with a decade earlier, fewer EPT infants experience low admission temperatures but more have elevated temperatures. In spite of a change in distribution of NICU admission temperature, an inverse association between temperature and mortality risk persists.

Published
2017

47. Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

Author

Sanjay Chawla, Girija Natarajan, Seetha Shankaran, Benjamin Carper, Luc P. Brion, Martin Keszler, Waldemar A. Carlo, Namasivayam Ambalavanan, Marie G. Gantz, Abhik Das, Neil Finer, Ronald N. Goldberg, C. Michael Cotten, Rosemary D. Higgins, Alan H. Jobe, Michael S. Caplan, Richard A. Polin, Abbot R. Laptook, William Oh, Angelita M. Hensman, Dan Gingras, Susan Barnett, Sarah Lillie, Kim Francis, Dawn Andrews, Kristen Angela, Michele C. Walsh, Avroy A. Fanaroff, Nancy S. Newman, Bonnie S. Siner, Kurt Schibler, Edward F. Donovan, Vivek Narendran, Kate Bridges, Barbara Alexander, Cathy Grisby, Marcia Worley Mersmann, Holly L. Mincey, Jody Hessling, Kathy J. Auten, Kimberly A. Fisher, Katherine A. Foy, Gloria Siaw, Barbara J. Stoll, Susie Buchter, Anthony Piazza, David P. Carlton, Ellen C. Hale, Stephanie Wilson Archer, Brenda B. Poindexter, James A. Lemons, Faithe Hamer, Dianne E. Herron, Lucy C. Miller, Leslie D. Wilson, Mary Anne Berberich, Carol J. Blaisdell, Dorothy B. Gail, James P. Kiley, W. Kenneth Poole, Margaret Cunningham, Betty K. Hastings, Amanda R. Irene, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W. Pickett, Dennis Wallace, Kristin M. Zaterka-Baxter, Krisa P. Van Meurs, David K. Stevenson, M. Bethany Ball, Melinda S. Proud, Ivan D. Frantz, John M. Fiascone, Anne Furey, Brenda L. MacKinnon, Ellen Nylen, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Maynard R. Rasmussen, Paul R. Wozniak, Wade Rich, Kathy Arnell, Renee Bridge, Clarence Demetrio, Edward F. Bell, John A. Widness, Jonathan M. Klein, Karen J. Johnson, Shahnaz Duara, Ruth Everett-Thomas, Kristi L. Watterberg, Robin K. Ohls, Julie Rohr, Conra Backstrom Lacy, Dale L. Phelps, Nirupama Laroia, Linda J. Reubens, Erica Burnell, Pablo J. Sánchez, Charles R. Rosenfeld, Walid A. Salhab, James Allen, Alicia Guzman, Gaynelle Hensley, Melissa H. Lepps, Melissa Martin, Nancy A. Miller, Araceli Solis, Diana M. Vasil, Kerry Wilder, Kathleen A. Kennedy, Jon E. Tyson, Brenda H. Morris, Beverly Foley Harris, Anna E. Lis, Sarah Martin, Georgia E. McDavid, Patti L. Tate, Sharon L. Wright, Bradley A. Yoder, Roger G. Faix, Jill Burnett, Jennifer J. Jensen, Karen A. Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, T. Michael O'Shea, Nancy J. Peters, Beena G. Sood, Rebecca Bara, Elizabeth Billian, Mary Johnson, Richard A. Ehrenkranz, Harris C. Jacobs, Vineet Bhandari, Pat Cervone, Patricia Gettner, Monica Konstantino, JoAnn Poulsen, and Janet Taft

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Positive pressure, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, 030225 pediatrics, Fraction of inspired oxygen, medicine, Intubation, Humans, 030212 general & internal medicine, Continuous positive airway pressure, Treatment Failure, Respiratory Distress Syndrome, Newborn, business.industry, Infant, Newborn, Gestational age, Pulmonary Surfactants, medicine.disease, Surgery, Bronchopulmonary dysplasia, Anesthesia, Infant, Extremely Premature, Pediatrics, Perinatology and Child Health, Airway Extubation, Apgar score, Female, Morbidity, business, Infant, Premature
Abstract

Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov : NCT00233324 .

Published
2017

48. Factors Affecting the Decline in Incidence of Diabetes in the Diabetes Prevention Program Outcomes Study (DPPOS)

Author

William C. Knowler, John M. Lachin, Mary Beth Murphy, Jill P. Crandall, Steven E. Kahn, Elizabeth M. Venditti, George A. Bray, Ronald N. Goldberg, Jose C. Florez, Costas A. Christophi, Richard F. Hamman, Elizabeth Barrett-Connor, Edward S. Horton, and Sarah E. Fowler

Subjects
Male, medicine.medical_specialty, Diabetes risk, Endocrinology, Diabetes and Metabolism, Placebo, Pathophysiology, Risk Factors, Intervention (counseling), Internal medicine, Diabetes mellitus, Internal Medicine, Humans, Hypoglycemic Agents, Medicine, Genetic risk, Aged, business.industry, Incidence, Incidence (epidemiology), Middle Aged, medicine.disease, Metformin, Diabetes Mellitus, Type 2, Physical therapy, Female, medicine.symptom, business, Weight gain, medicine.drug
Abstract

During the first 7 years of the Diabetes Prevention Program Outcomes Study (DPPOS), diabetes incidence rates, when compared with the Diabetes Prevention Program (DPP), decreased in the placebo (−42%) and metformin (−25%), groups compared with the rates in the intensive lifestyle intervention (+31%) group. Participants in the placebo and metformin groups were offered group intensive lifestyle intervention prior to entering the DPPOS. The following two hypotheses were explored to explain the rate differences: “effective intervention” (changes in weight and other factors due to intensive lifestyle intervention) and “exhaustion of susceptible” (changes in mean genetic and diabetes risk scores). No combination of behavioral risk factors (weight, physical activity, diet, smoking, and antidepressant or statin use) explained the lower DPPOS rates of diabetes progression in the placebo and metformin groups, whereas weight gain was the factor associated with higher rates of progression in the intensive lifestyle intervention group. Different patterns in the average genetic risk score over time were consistent with exhaustion of susceptibles. Results were consistent with exhaustion of susceptibles for the change in incidence rates, but not the availability of intensive lifestyle intervention to all persons before the beginning of the DPPOS. Thus, effective intervention did not explain the lower diabetes rates in the DPPOS among subjects in the placebo and metformin groups compared with those in the DPP.

Published
2014
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49. Serum levels of soluble receptor for advanced glycation end-products and metabolic syndrome: The Northern Manhattan Study

Author

Barry I. Hudson, Ronald N. Goldberg, Ralph L. Sacco, Clinton B. Wright, Tatjana Rundek, Mitchell S.V. Elkind, Chuanhui Dong, and Hannah Gardener

Subjects
Male, medicine.medical_specialty, Waist, Endocrinology, Diabetes and Metabolism, Receptor for Advanced Glycation End Products, Population, Down-Regulation, White People, Article, Body Mass Index, Cohort Studies, Endocrinology, Waist–hip ratio, Interquartile range, Internal medicine, Diabetes mellitus, Prevalence, medicine, Humans, Receptors, Immunologic, education, Aged, Metabolic Syndrome, education.field_of_study, business.industry, Urban Health, Hispanic or Latino, medicine.disease, Obesity, Black or African American, Cross-Sectional Studies, Solubility, Hyperglycemia, Obesity, Abdominal, Hypertension, Female, New York City, Waist Circumference, Metabolic syndrome, business, Body mass index, Biomarkers
Abstract

Recent studies have shown a strong link between serum soluble receptor for advanced glycation end-products (sRAGE) levels and cardiovascular risk factors and disease. What is less clear is the relationship between metabolic risk factors and sRAGE levels. Here, we tested the hypothesis that lower sRAGE levels may be associated with the metabolic syndrome (MetS) in an urban multi ethnic population.From the Northern Manhattan Study (NOMAS), we included 1101 stroke-free participants (mean age: 71 ± 9 years, 60% women, 64% Hispanic, 18% black, 16% white). Serum sRAGE was measured by ELISA. Quantile regression analysis was performed to evaluate the association between sRAGE and MetS components and MetS, after adjusting for sociodemographics, smoking status and kidney function.The median (interquartile) sRAGE was 899 pg/ml (647-1248 pg/ml), 42% had metabolic syndrome. The prevalence of unfavorable metabolic factors was 50% for waist circumference (WC), 81% for blood pressure, 39% for fasting glucose, 35% for reduced high density lipoproteins (HDL), and 23% for triglycerides. After adjustment, the median sRAGE levels were at least 120 pg/ml lower in those who had elevated WC (p0.0001), blood pressure (p=0.0014), and fasting glucose (p0.0001), and those who had 2 or more unfavorable metabolic factors. No relationship was seen between sRAGE levels and elevated triglycerides or reduced HDL levels. Interaction and stratified analyses revealed that the association of sRAGE with MetS was more prominent in Hispanics compared to whites, and displaying no association with components of MetS in blacks.sRAGE levels were mainly associated with MetS factors related to obesity, diabetes and hypertension, and displayed variation with ethnicity in a multi-ethnic population. Further studies of sRAGE, MetS and their relationship to cardiovascular disease are warranted.

Published
2014
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50. Feeding practices and other risk factors for developing transfusion-associated necrotizing enterocolitis

Author

Annadele E. Herman, David T. Tanaka, Mary Lee Campbell, P. Brian Smith, Ronald N. Goldberg, Nicholas Bandarenko, Chris DeRienzo, and C. Michael Cotten

Subjects
Male, Pediatrics, medicine.medical_specialty, Anemia, Gestational Age, Infant, Premature, Diseases, Hematocrit, Article, Cohort Studies, Blood Transfusion, Autologous, Enterocolitis, Necrotizing, Risk Factors, Intensive care, medicine, Humans, Infant, Very Low Birth Weight, Retrospective Studies, medicine.diagnostic_test, Obstetrics, business.industry, Incidence (epidemiology), Infant, Newborn, Obstetrics and Gynecology, Gestational age, Retrospective cohort study, Feeding Behavior, medicine.disease, digestive system diseases, Pediatrics, Perinatology and Child Health, Necrotizing enterocolitis, Female, Erythrocyte Transfusion, business, Cohort study
Abstract

The objective of this study is to determine the incidence of and risk factors for necrotizing enterocolitis (NEC) and transfusion-associated NEC (TANEC) in very-low-birth-weight (VLBW) infants pre/post implementation of a peri-transfusion feeding protocol.A retrospective cohort study was conducted including all inborn VLBW infants admitted to the Duke intensive care nursery from 2002 to 2010. We defined NEC using Bell's modified criteria IIA and higher and TANEC as NEC occurring within 48h of a packed red blood cell (pRBC) transfusion. We compared demographic and laboratory data for TANEC vs. other NEC infants and the incidence of TANEC pre/post implementation of our peri-transfusion feeding protocol. We also assessed the relationship between pre-transfusion hematocrit and pRBC unit age with TANEC.A total of 148/1380 (10.7%) infants developed NEC. Incidence of NEC decreased after initiating our peri-transfusion feeding protocol: 126/939 (12%) to 22/293 (7%), P=0.01. The proportion of TANEC did not change: 51/126 (41%) vs. 9/22 (41%), P0.99. TANEC infants were smaller, more likely to develop surgical NEC, and had lower mean pre-transfusion hematocrits prior to their TANEC transfusions compared with all other transfusions before their NEC episode: 28% vs. 33%, P0.001. Risk of TANEC was inversely related to pre-transfusion hematocrit: odds ratio 0.87 (0.79-0.95).Pre-transfusion hematocrit is inversely related to risk of TANEC, which suggests that temporally maintaining a higher baseline hemoglobin in infants most at risk of NEC may be protective. The lack of difference in TANEC pre-/post-implementation of our peri-transfusion feeding protocol, despite an overall temporal decrease in NEC, suggests that other unmeasured interventions may account for the observed decreased incidence of NEC.

Published
2014
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