Objective To describe characteristics, treatments and clinical outcomes of patients with trisomy 18 and oesophageal atresia, using a nationwide database in Japan. Design Descriptive study using a retrospective cohort. Setting A nationwide inpatient database including 90% of hospitals with neonatal intensive care units in Japan. Patients Patients hospitalised within a day after birth for both oesophageal atresia and trisomy 18 between July 2010 and March 2020. Interventions Radical surgery for oesophageal atresia. Main outcome measures Characteristics, treatment course and outcomes. Results Among 271 patients with both oesophageal atresia and trisomy 18, 70 patients underwent radical surgery for oesophageal atresia. Patients who underwent radical surgery were less likely to have severe cardiac anomalies (17% vs 32%; p=0.020), but more likely to undergo cardiac surgery (21% vs 9.5%; p=0.012) than those who did not. The overall in-hospital mortality was lower (54% vs 79%; p<0.001) and the median age at death was higher (210 days vs 39 days; p<0.001) in patients who underwent radical surgery than the others. Postoperative mortality within 30 days after radical surgery was 5.7%. Patients who underwent radical surgery were likely to be discharged to home (50% vs 18%; p<0.001), whereas the age at home discharge (median 314 days vs 216 days; p=0.19) and the requirement for each home treatment did not differ significantly by radical surgery. Conclusion This study provides information that will aid the clinical decision-making process for patients with oesophageal atresia and trisomy 18. Radical surgery may be a safe and feasible treatment option. No data are available.
目的 利用日本全国性数据库，描述 18 三体综合征合并食道闭锁患者的特征、治疗方法和临床结果。设计 采用回顾性队列进行描述性研究。背景 一个全国性的住院患者数据库，包括日本 90% 设有新生儿重症监护室的医院。患者 2010年7月至2020年3月期间，因食道闭锁和18三体综合征而在出生后一天内住院的患者。干预措施 食管闭锁根治手术。主要结果指标 特征、治疗过程和结果。结果 在271名同时患有食道闭锁和18三体综合征的患者中，70名患者接受了食道闭锁根治手术。与未接受根治手术的患者相比，接受根治手术的患者出现严重心脏畸形的几率较低（17% vs 32%；P=0.020），但接受心脏手术的几率更高（21% vs 9.5%；P=0.012）。与其他患者相比，接受根治性手术的患者院内总死亡率较低（54% vs 79%; p<0.001），中位死亡年龄较高（210天 vs 39天; p<0.001）。根治术后30天内的术后死亡率为5.7%。接受根治性手术的患者有可能出院回家（50% vs 18%; p<0.001），而出院回家的年龄（中位数314天 vs 216天; p=0.19）和每次回家治疗的要求并没有因根治性手术的不同而有显著差异。结论 本研究提供的信息有助于食道闭锁和 18 三体综合征患者的临床决策过程。根治性手术可能是一种安全可行的治疗方案。暂无数据。
{"title":"Treatment courses and outcomes of oesophageal atresia in patients with trisomy 18: a case series of 271 patients from a nationwide database in Japan","authors":"Mai Kutsukake, Takaaki Konishi, Michimasa Fujiogi, Naohiro Takamoto, Kaori Morita, Ikuta Yasuhisa, Yohei Hashimoto, Hiroki Matsui, Kiyohide Fushimi, Jun Fujishiro, Hideo Yasunaga","doi":"10.1136/archdischild-2023-326354","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326354","url":null,"abstract":"Objective To describe characteristics, treatments and clinical outcomes of patients with trisomy 18 and oesophageal atresia, using a nationwide database in Japan. Design Descriptive study using a retrospective cohort. Setting A nationwide inpatient database including 90% of hospitals with neonatal intensive care units in Japan. Patients Patients hospitalised within a day after birth for both oesophageal atresia and trisomy 18 between July 2010 and March 2020. Interventions Radical surgery for oesophageal atresia. Main outcome measures Characteristics, treatment course and outcomes. Results Among 271 patients with both oesophageal atresia and trisomy 18, 70 patients underwent radical surgery for oesophageal atresia. Patients who underwent radical surgery were less likely to have severe cardiac anomalies (17% vs 32%; p=0.020), but more likely to undergo cardiac surgery (21% vs 9.5%; p=0.012) than those who did not. The overall in-hospital mortality was lower (54% vs 79%; p<0.001) and the median age at death was higher (210 days vs 39 days; p<0.001) in patients who underwent radical surgery than the others. Postoperative mortality within 30 days after radical surgery was 5.7%. Patients who underwent radical surgery were likely to be discharged to home (50% vs 18%; p<0.001), whereas the age at home discharge (median 314 days vs 216 days; p=0.19) and the requirement for each home treatment did not differ significantly by radical surgery. Conclusion This study provides information that will aid the clinical decision-making process for patients with oesophageal atresia and trisomy 18. Radical surgery may be a safe and feasible treatment option. No data are available.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"267 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138545914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1136/archdischild-2023-326340
Stefan Kuhle, Mary Margaret Brown, Sanja Stanojevic
This paper critically examines ‘kitchen sink regression’, a practice characterised by the manual or automated selection of variables for a multivariable regression model based on p values or model-based information criteria. We highlight the pitfalls of this method, using examples from perinatal/neonatal medicine, and propose more robust alternatives. The concept of directed acyclic graphs (DAGs) is introduced as a tool for describing and analysing causal relationships. We highlight five key issues with ‘kitchen sink regression’: (1) the disregard for the directionality of variable relationships, (2) the lack of a meaningful causal interpretation of effect estimates from these models, (3) the inflated alpha error rate due to multiple testing, (4) the risk of overfitting and model instability and (5) the disregard for content expertise in model building. We advocate for the use of DAGs to guide variable selection for models that aim to examine associations between a putative risk factor and an outcome and emphasise the need for a more thoughtful and informed use of regression models in medical research.
本文对 "厨房水槽回归 "进行了批判性研究。"厨房水槽回归 "的特点是根据 p 值或基于模型的信息标准为多变量回归模型手动或自动选择变量。我们以围产期/新生儿医学为例，强调了这种方法的缺陷，并提出了更稳健的替代方法。介绍了有向无环图（DAG）的概念，作为描述和分析因果关系的工具。我们强调了 "厨房水槽回归 "的五个关键问题：(1) 忽视变量关系的方向性；(2) 对这些模型的效应估计缺乏有意义的因果解释；(3) 多重测试导致α误差率升高；(4) 存在过度拟合和模型不稳定的风险；(5) 在建立模型时忽视内容的专业性。我们主张使用 DAG 来指导旨在检验推定风险因素与结果之间关联的模型的变量选择，并强调在医学研究中需要更周到、更明智地使用回归模型。
{"title":"Building a better model: abandon kitchen sink regression","authors":"Stefan Kuhle, Mary Margaret Brown, Sanja Stanojevic","doi":"10.1136/archdischild-2023-326340","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326340","url":null,"abstract":"This paper critically examines ‘kitchen sink regression’, a practice characterised by the manual or automated selection of variables for a multivariable regression model based on p values or model-based information criteria. We highlight the pitfalls of this method, using examples from perinatal/neonatal medicine, and propose more robust alternatives. The concept of directed acyclic graphs (DAGs) is introduced as a tool for describing and analysing causal relationships. We highlight five key issues with ‘kitchen sink regression’: (1) the disregard for the directionality of variable relationships, (2) the lack of a meaningful causal interpretation of effect estimates from these models, (3) the inflated alpha error rate due to multiple testing, (4) the risk of overfitting and model instability and (5) the disregard for content expertise in model building. We advocate for the use of DAGs to guide variable selection for models that aim to examine associations between a putative risk factor and an outcome and emphasise the need for a more thoughtful and informed use of regression models in medical research.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138546012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1136/archdischild-2023-325652
Roberto Chioma, Daragh Finn, David B Healy, Ita Herlihy, Vicki Livingstone, Jurate Panaviene, Eugene M Dempsey
Objective To assess the haemodynamic consequences of cord clamping (CC) in healthy term infants. Design Cohort study. Setting Tertiary maternity hospital. Patients 46 full-term vigorous infants born by caesarean section. Interventions Echocardiography was performed before CC, immediately after CC and at 5 min after birth. Main outcome measures Pulsed wave Doppler-derived cardiac output and the pulmonary artery acceleration time indexed to the right ventricle ejection time were obtained. As markers of loading fluctuations, the myocardial performance indexes and the velocities of the tricuspid and mitral valve annuli were determined with tissue Doppler imaging. Heart rate was derived from Doppler imaging throughout the assessments. Results Left ventricular output increased throughout the first minutes after birth (mean (SD) 222.4 (32.5) mL/kg/min before CC vs 239.7 (33.6) mL/kg/min at 5 min, p=0.01), while right ventricular output decreased (306.5 (48.2) mL/kg/min before vs 272.8 (55.5) mL/kg/min immediately after CC, p=0.001). The loading conditions of both ventricles were transiently impaired by CC, recovering at 5 min. Heart rate progressively decreased after birth, following a linear trend temporarily increased by CC. The variation in left ventricular output across the CC was directly correlated to the fluctuation of left ventricular preload over the same period (p = 0.03). Conclusions This study illustrates the cardiovascular consequences of CC in term vigorous infants and offers insight into the haemodynamic transition from fetal to neonatal circulation in spontaneously breathing newborns. Strategies that aim to enhance left ventricular preload before CC may prevent complications of perinatal cardiovascular imbalance. Data are available on reasonable request. The data that support the findings of this study are available on request from the authors.
目的 评估健康足月儿脐带夹闭（CC）对血流动力学的影响。设计 队列研究。地点 三级妇产医院患者 46 名剖腹产足月健壮婴儿。干预措施 在脐带钳夹前、脐带钳夹后立即和出生后 5 分钟进行超声心动图检查。主要结果指标 获得脉冲波多普勒心输出量和肺动脉加速时间与右心室射血时间的指数。作为负荷波动的标记，心肌性能指标以及三尖瓣和二尖瓣瓣环的速度是通过组织多普勒成像测定的。在整个评估过程中，心率都是通过多普勒成像得出的。结果 左心室输出量在出生后最初几分钟内一直增加（CC前平均（标清）222.4（32.5）毫升/千克/分钟 vs 5分钟时239.7（33.6）毫升/千克/分钟，p=0.01），而右心室输出量减少（CC前306.5（48.2）毫升/千克/分钟 vs CC后272.8（55.5）毫升/千克/分钟，p=0.001）。CC 会短暂影响两个心室的负荷条件，5 分钟后恢复。出生后心率逐渐下降，呈线性趋势，CC 会暂时增加心率。CC 期间左心室输出量的变化与同期左心室前负荷的波动直接相关（p = 0.03）。结论 该研究说明了 CC 对足月儿心血管的影响，并有助于了解自主呼吸新生儿从胎儿循环到新生儿循环的血流动力学转变。在 CC 之前提高左心室前负荷的策略可预防围产期心血管失衡的并发症。如有合理要求，可提供相关数据。支持本研究结果的数据可向作者索取。
{"title":"Impact of cord clamping on haemodynamic transition in term newborn infants","authors":"Roberto Chioma, Daragh Finn, David B Healy, Ita Herlihy, Vicki Livingstone, Jurate Panaviene, Eugene M Dempsey","doi":"10.1136/archdischild-2023-325652","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325652","url":null,"abstract":"Objective To assess the haemodynamic consequences of cord clamping (CC) in healthy term infants. Design Cohort study. Setting Tertiary maternity hospital. Patients 46 full-term vigorous infants born by caesarean section. Interventions Echocardiography was performed before CC, immediately after CC and at 5 min after birth. Main outcome measures Pulsed wave Doppler-derived cardiac output and the pulmonary artery acceleration time indexed to the right ventricle ejection time were obtained. As markers of loading fluctuations, the myocardial performance indexes and the velocities of the tricuspid and mitral valve annuli were determined with tissue Doppler imaging. Heart rate was derived from Doppler imaging throughout the assessments. Results Left ventricular output increased throughout the first minutes after birth (mean (SD) 222.4 (32.5) mL/kg/min before CC vs 239.7 (33.6) mL/kg/min at 5 min, p=0.01), while right ventricular output decreased (306.5 (48.2) mL/kg/min before vs 272.8 (55.5) mL/kg/min immediately after CC, p=0.001). The loading conditions of both ventricles were transiently impaired by CC, recovering at 5 min. Heart rate progressively decreased after birth, following a linear trend temporarily increased by CC. The variation in left ventricular output across the CC was directly correlated to the fluctuation of left ventricular preload over the same period (p = 0.03). Conclusions This study illustrates the cardiovascular consequences of CC in term vigorous infants and offers insight into the haemodynamic transition from fetal to neonatal circulation in spontaneously breathing newborns. Strategies that aim to enhance left ventricular preload before CC may prevent complications of perinatal cardiovascular imbalance. Data are available on reasonable request. The data that support the findings of this study are available on request from the authors.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138545870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-02DOI: 10.1136/archdischild-2023-326203
Malcolm Battin, Lynn Sadler, Meghan Hill
In neonatal encephalopathy (NE), establishing the history includes scrutiny of the perinatal events contributing to the infant’s condition. For births initially considered ‘low risk’ but resulting in peripartum hypoxia, it is crucial to perform interdisciplinary case review. The neonatal perspective (although retrospective) is valuable, but the denominator of healthy babies is not reviewed, only the injured, so hindsight bias should be recognised. Nevertheless, we must consider potential opportunities to act differently and mitigate, particularly if clear risk factors were underappreciated at the time. In Aotearoa New Zealand, the Perinatal and Maternal Mortality Review Committee (PMMRC) collects national data on NE.1 Annual reports include clinical and demographic factors, which facilitate case review to document contributing factors and potential preventability.2 The PMMRC report1 documents …
{"title":"Recognising risk of neonatal encephalopathy with advancing gestation in nulliparous women is crucial for case review","authors":"Malcolm Battin, Lynn Sadler, Meghan Hill","doi":"10.1136/archdischild-2023-326203","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326203","url":null,"abstract":"In neonatal encephalopathy (NE), establishing the history includes scrutiny of the perinatal events contributing to the infant’s condition. For births initially considered ‘low risk’ but resulting in peripartum hypoxia, it is crucial to perform interdisciplinary case review. The neonatal perspective (although retrospective) is valuable, but the denominator of healthy babies is not reviewed, only the injured, so hindsight bias should be recognised. Nevertheless, we must consider potential opportunities to act differently and mitigate, particularly if clear risk factors were underappreciated at the time. In Aotearoa New Zealand, the Perinatal and Maternal Mortality Review Committee (PMMRC) collects national data on NE.1 Annual reports include clinical and demographic factors, which facilitate case review to document contributing factors and potential preventability.2 The PMMRC report1 documents …","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"469 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-29DOI: 10.1136/archdischild-2023-326049
Marie-Coralie Cornet, Yvonne W Wu, Heather Forquer, Lyndsay A Avalos, Achyuth Sriram, Aaron W Scheffler, Thomas B Newman, Michael W Kuzniewicz
Objective Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. Design, setting and patients Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011–2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. Exposure Dispensed maternal SSRI prescription after 20 weeks of pregnancy. Main outcome measures Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). Results 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. Conclusions Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship. Data are available upon reasonable request. The datasets generated for this study are stored at the KPNC Division of Research. Deidentified data can be provided upon reasonable request to the corresponding author, and with permission from the KPNC Institutional Review Board.
目的:选择性血清素再摄取抑制剂(SSRI)在妊娠期的应用较为普遍。它与新生儿适应延迟有关。大多数先前的研究没有调整产妇精神健康障碍的严重程度，也没有检查SSRI类型和剂量的影响。我们研究了妊娠后期(20周后)使用SSRIs治疗是否与新生儿适应延迟相关，而不受母亲抑郁和焦虑的影响。设计、环境和患者2011-2019年在北加州15家Kaiser Permanente医院出生的28090名足月婴儿的回顾性人群出生队列。从电子病历中获取个人层面的药房、孕产妇、妊娠和新生儿数据。妊娠20周后配发母亲SSRI处方。新生儿延迟适应定义为5分钟Apgar评分≤5，出生时复苏或进入新生儿重症监护病房接受呼吸支持。次要结局包括主要结局的每个单独组成部分和更严重的新生儿结局(肺动脉高压、缺氧缺血性脑病和癫痫发作)。结果7573例(2.7%)婴儿在妊娠后期暴露于SSRIs。11.2%的暴露婴儿和4.4%的未暴露婴儿发生延迟新生儿适应(相对危险度2.52 (95% CI 2.36 - 2.70))。多变量校正后，SSRI暴露与新生儿延迟适应之间存在关联(校正OR为2.14 (95% CI 1.96 - 2.32))。这种关联是剂量依赖性的。艾司西酞普兰和氟西汀与延迟新生儿适应的最高风险相关。结论:暴露于SSRIs的婴儿延迟适应的风险增加呈类型和剂量依赖关系，表明存在因果关系。如有合理要求，可提供资料。本研究生成的数据集存储在KPNC研究部。在向通讯作者提出合理要求并获得KPNC机构审查委员会许可的情况下，可以提供已识别的数据。
{"title":"Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population-based cohort study","authors":"Marie-Coralie Cornet, Yvonne W Wu, Heather Forquer, Lyndsay A Avalos, Achyuth Sriram, Aaron W Scheffler, Thomas B Newman, Michael W Kuzniewicz","doi":"10.1136/archdischild-2023-326049","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326049","url":null,"abstract":"Objective Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. Design, setting and patients Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011–2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. Exposure Dispensed maternal SSRI prescription after 20 weeks of pregnancy. Main outcome measures Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). Results 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. Conclusions Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship. Data are available upon reasonable request. The datasets generated for this study are stored at the KPNC Division of Research. Deidentified data can be provided upon reasonable request to the corresponding author, and with permission from the KPNC Institutional Review Board.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"475 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.1136/archdischild-2023-326551
Georgina Yan, Annalie Shears, Julia R Dudley, Paddy McMaster, Katy J Fidler
Our recent prospective UK-wide British Paediatric Surveillance Unit (BPSU) cohort study findings echo the increase in incidence of neonatal herpes simplex virus (HSV) described by Dungu et al. 1 We found that the incidence of neonatal HSV infection has tripled over the last three decades in the UK from 1.65/100 000 in 1986–19912 to a minimum of 6/100 000 infants between August 2019 and February 2022.3 General consensus among the UK Paediatric Antimicrobial Stewardship (UK-PAS) network is in agreement with the above authors that not all unwell infants …
{"title":"Response to: ‘Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study’ by Dungu et al","authors":"Georgina Yan, Annalie Shears, Julia R Dudley, Paddy McMaster, Katy J Fidler","doi":"10.1136/archdischild-2023-326551","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326551","url":null,"abstract":"Our recent prospective UK-wide British Paediatric Surveillance Unit (BPSU) cohort study findings echo the increase in incidence of neonatal herpes simplex virus (HSV) described by Dungu et al. 1 We found that the incidence of neonatal HSV infection has tripled over the last three decades in the UK from 1.65/100 000 in 1986–19912 to a minimum of 6/100 000 infants between August 2019 and February 2022.3 General consensus among the UK Paediatric Antimicrobial Stewardship (UK-PAS) network is in agreement with the above authors that not all unwell infants …","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"515 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.1136/archdischild-2023-325732
Pauline E van Beek, Monique Rijken, Lisa Broeders, Hendrik J ter Horst, Corine Koopman-Esseboom, Ellen de Kort, A R C Laarman, S M Mulder - de Tollenaer, Katerina Steiner, Renate M C Swarte, Elke van Westering-Kroon, Guid Oei, Aleid G Leemhuis, Peter Andriessen
Objective After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design Population-based cohort study. Setting All neonatal intensive care units in the Netherlands. Patients All infants born between 240/7 and 266/7 weeks’ gestation who were 5.5 years’ corrected age (CA) in 2018–2020 were included. Main outcome measures Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results In the 3-year period, a total of 632 infants survived to 5.5 years’ CA. Data were available for 484 infants (77%). At 5.5 years’ CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks’ gestation, respectively (p<0.001). Conclusions After lowering the threshold for supporting active treatment from 25 to 24 completed weeks’ gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years’ CA. All data relevant to the study are included in the article or uploaded as supplementary information. Other data may be obtained from a third party and are not publicly available.
目的降低妊娠25 ~ 24周积极治疗的荷兰阈值后，极早产活产婴儿的出院生存率提高10%。现在该指南已经实施，需要对学龄期神经发育结果进行准确描述。设计基于人群的队列研究。荷兰所有新生儿重症监护病房。所有2018-2020年出生在240/7周至266/7周的5.5岁矫正年龄(CA)的婴儿都被纳入研究。主要结局指标主要结局指标为5.5岁时的神经发育结局。神经发育结局是一个复合结局，定义为无，轻度或中度至重度损伤(进一步定义为神经发育损伤(NDI))，使用纠正的认知评分(韦氏学前和初级智力量表- iii - nl)，神经学检查和神经感觉功能。此外，运动评分(儿童运动评估电池-2- nl)进行评估。所有评估都是作为全国标准化后续方案的一部分进行的。结果在3年的时间里，共有632名婴儿存活至5.5岁，其中484名婴儿(77%)有数据可查。在5.5岁时，大多数认知和运动(子)量表与标准平均值相比显著降低。总的来说，46%的人没有损伤，36%的人有轻微损伤，18%的人有NDI。妊娠24周、25周和26周的活产患儿无ndi生存率分别为30%、49%和67% (p<0.001)。在降低了支持积极治疗的阈值后，相当一部分幸存的极早产儿在5.5岁时没有任何损害。所有与研究相关的数据都包含在文章中或作为补充信息上传。其他数据可能从第三方获得，不公开提供。
{"title":"Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24–26 weeks’ gestational age: the EPI-DAF study","authors":"Pauline E van Beek, Monique Rijken, Lisa Broeders, Hendrik J ter Horst, Corine Koopman-Esseboom, Ellen de Kort, A R C Laarman, S M Mulder - de Tollenaer, Katerina Steiner, Renate M C Swarte, Elke van Westering-Kroon, Guid Oei, Aleid G Leemhuis, Peter Andriessen","doi":"10.1136/archdischild-2023-325732","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325732","url":null,"abstract":"Objective After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design Population-based cohort study. Setting All neonatal intensive care units in the Netherlands. Patients All infants born between 240/7 and 266/7 weeks’ gestation who were 5.5 years’ corrected age (CA) in 2018–2020 were included. Main outcome measures Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results In the 3-year period, a total of 632 infants survived to 5.5 years’ CA. Data were available for 484 infants (77%). At 5.5 years’ CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks’ gestation, respectively (p<0.001). Conclusions After lowering the threshold for supporting active treatment from 25 to 24 completed weeks’ gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years’ CA. All data relevant to the study are included in the article or uploaded as supplementary information. Other data may be obtained from a third party and are not publicly available.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"498 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-27DOI: 10.1136/archdischild-2023-326102
Ulrike Mietzsch, Sarah E Kolnik, Thomas Ragnar Wood, Niranjana Natarajan, Fernando F Gonzalez, Hannah Glass, Dennis E Mayock, Sonia L Bonifacio, Krisa Van Meurs, Bryan A Comstock, Patrick J Heagerty, Tai-Wei Wu, Yvonne W Wu, Sandra E Juul
Objective To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). Design Secondary analysis of the H igh-dose E rythropoietin for A sphyxia and Encepha L opathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. Setting Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. Patients 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). Interventions Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. Main outcome measures Primary outcome was defined as the composite outcome of death or any NDI at 22–36 months. Results Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. Conclusion Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22–36 months in infants with moderate or severe HIE. Data are available upon reasonable request. Data are available upon request and will be publicly available soon.
目的探讨中重度缺氧缺血性脑病(HIE)患儿在治疗性低温治疗(TH)前后进行Sarnat检查(SE)与2岁预后的关系。设计:高剂量促红细胞生成素用于缺氧和脑病试验的二次分析。基于SE严重程度类别和类别变化构建死亡或神经发育障碍(NDI)的调整ORs (aORs)，并对检查时的镇静进行调整。使用局部估计的散点图平滑曲线比较绝对SE评分及其变化与死亡或NDI风险的相关性。随机、双盲、安慰剂对照的多中心试验，包括美国17个中心。479/500的患者纳入了在TH前有合格SE (qSE)和复温后有合格SE (rSE)的新生儿。干预措施在TH前后各部位采用标准化SE。所有的提供者都接受了标准化的SE培训。主要结局指标主要结局定义为22-36个月死亡或任何NDI的综合结局。结果qSE和rSE均与主要结局相关。值得注意的是，在中度和重度脑病患者中，主要结局的aOR分别为6.2 (95% CI 3.1 - 12.6)和50.3 (95% CI 13.3 - 190)。与改善者相比，持续或恶化的rSE严重程度与主要结局的几率更高相关，即使在qSE严重时也是如此。结论中重度HIE患儿22-36月龄时rSE及qSE与rSE的变化与死亡/NDI的几率密切相关。如有合理要求，可提供资料。数据可应要求提供，并将很快公开。
{"title":"Evolution of the Sarnat exam and association with 2-year outcomes in infants with moderate or severe hypoxic-ischaemic encephalopathy: a secondary analysis of the HEAL Trial","authors":"Ulrike Mietzsch, Sarah E Kolnik, Thomas Ragnar Wood, Niranjana Natarajan, Fernando F Gonzalez, Hannah Glass, Dennis E Mayock, Sonia L Bonifacio, Krisa Van Meurs, Bryan A Comstock, Patrick J Heagerty, Tai-Wei Wu, Yvonne W Wu, Sandra E Juul","doi":"10.1136/archdischild-2023-326102","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326102","url":null,"abstract":"Objective To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). Design Secondary analysis of the H igh-dose E rythropoietin for A sphyxia and Encepha L opathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. Setting Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. Patients 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). Interventions Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. Main outcome measures Primary outcome was defined as the composite outcome of death or any NDI at 22–36 months. Results Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. Conclusion Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22–36 months in infants with moderate or severe HIE. Data are available upon reasonable request. Data are available upon request and will be publicly available soon.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"510 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Newborn infants have unique respiratory physiology compared with older children and adults due to their lungs’ structural and functional immaturity and highly compliant chest wall. To date, ventilation distribution has seldom been studied in this age group. This study aims to assess the effect of body position on ventilation distribution in spontaneously breathing healthy neonates. Design Prospective observational study. Setting Maternity wards of Oulu University Hospital. Patients 20 healthy, spontaneously breathing, newborn infants. Interventions Electrical impedance tomography data were recorded with a 32-electrode belt (Sentec AG, Landquart, Switzerland) in six different body positions in random order. Ventilation distribution was retrospectively assessed 10 minutes after each position change. Main outcome measures In each position, regional tidal impedance variation (ΔZ) and ventral-to-dorsal and right-to-left centre of ventilation were measured. Results The mean global ΔZ was the largest in supine position and it was smaller in prone and lateral positions. Yet, global ΔZ did not differ in supine positions, ventilation distribution was more directed towards the non-dependent lung region in supine tilted position (p<0.001). In prone, a reduction of global ΔZ was observed (p<0.05) corresponding to an amount of 10% of global tidal variation in supine position. In both lateral positions, tidal ventilation was distributed more to the corresponding non-dependent lung region. Conclusions Prone or lateral body positioning in healthy spontaneously breathing newborns leads to a redistribution of ventilation to the non-dependent lung regions and at the same time global tidal volume is reduced as compared with supine. No data are available. Not applicable.
{"title":"Effect of body position on ventilation distribution in healthy newborn infants: an observational study","authors":"Marika Rahtu, Inéz Frerichs, Tytti Pokka, Tobias Becher, Outi Peltoniemi, Merja Kallio","doi":"10.1136/archdischild-2023-325967","DOIUrl":"https://doi.org/10.1136/archdischild-2023-325967","url":null,"abstract":"Objectives Newborn infants have unique respiratory physiology compared with older children and adults due to their lungs’ structural and functional immaturity and highly compliant chest wall. To date, ventilation distribution has seldom been studied in this age group. This study aims to assess the effect of body position on ventilation distribution in spontaneously breathing healthy neonates. Design Prospective observational study. Setting Maternity wards of Oulu University Hospital. Patients 20 healthy, spontaneously breathing, newborn infants. Interventions Electrical impedance tomography data were recorded with a 32-electrode belt (Sentec AG, Landquart, Switzerland) in six different body positions in random order. Ventilation distribution was retrospectively assessed 10 minutes after each position change. Main outcome measures In each position, regional tidal impedance variation (ΔZ) and ventral-to-dorsal and right-to-left centre of ventilation were measured. Results The mean global ΔZ was the largest in supine position and it was smaller in prone and lateral positions. Yet, global ΔZ did not differ in supine positions, ventilation distribution was more directed towards the non-dependent lung region in supine tilted position (p<0.001). In prone, a reduction of global ΔZ was observed (p<0.05) corresponding to an amount of 10% of global tidal variation in supine position. In both lateral positions, tidal ventilation was distributed more to the corresponding non-dependent lung region. Conclusions Prone or lateral body positioning in healthy spontaneously breathing newborns leads to a redistribution of ventilation to the non-dependent lung regions and at the same time global tidal volume is reduced as compared with supine. No data are available. Not applicable.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138543645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-23DOI: 10.1136/archdischild-2023-326333
Gonzalo Solís-García, Sara Elias, Michael Dunn, Bonny Jasani
Objective To systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants. Design PubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age. Results Pooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups. Conclusions Administration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants. PROSPERO registration number CRD42023432463.
目的系统回顾和荟萃分析表面活性剂晚期给药与安慰剂在降低早产儿死亡或支气管肺发育不良(BPD)发生率方面的效果。检索PubMed、EMBASE、CINAHL和Cochrane CENTRAL，直到2023年5月30日，以比较48小时后给药表面活性剂与安慰剂对依赖呼吸机的早产儿的随机对照试验(rct)。主要终点是经后36周(PMA)死亡或BPD的发生率。次要结局包括PMA 36周时BPD的发生率、出院前死亡率、产后类固醇的使用、出院后呼吸支持、类固醇治疗或1岁前的住院治疗。结果4项随机对照试验(N=850)的合并分析显示，36周PMA时两组患者的死亡或BPD发生率无统计学差异(相对危险度(RR) 0.99;95% CI 0.90 ~ 1.10;推荐、评估、发展和评估等级(GRADE):中等。晚期给药表面活性剂显著降低1岁矫正年龄前对出院后呼吸支持的需求(2项随机对照试验;N = 522;RR 0.72;95% CI 0.59 ~ 0.89;等级:低)。其他次要结果在两组间无显著差异。结论对于延长呼吸功能不全的早产儿，给予晚期表面活性剂并不能改善36周时的死亡率或BPD。需要更多的充分有力的试验来确定晚期表面活性剂治疗早产儿的疗效。普洛斯彼罗注册号CRD42023432463。如有合理要求，可提供资料。
{"title":"Late surfactant administration after 48 hours of age in preterm neonates with respiratory insufficiency: a systematic review and meta-analysis","authors":"Gonzalo Solís-García, Sara Elias, Michael Dunn, Bonny Jasani","doi":"10.1136/archdischild-2023-326333","DOIUrl":"https://doi.org/10.1136/archdischild-2023-326333","url":null,"abstract":"Objective To systematically review and meta-analyse the effect of late surfactant administration versus placebo in reducing the incidence of death or bronchopulmonary dysplasia (BPD) in preterm infants. Design PubMed, EMBASE, CINAHL and Cochrane CENTRAL were searched until 30 May 2023, for randomised controlled trials (RCTs) comparing administration of surfactant after 48 hours of age versus placebo in preterm ventilator-dependent neonates. The primary outcome was incidence of death or BPD at 36 weeks’ postmenstrual age (PMA). Secondary outcomes included incidence of BPD at 36 weeks PMA, pre-discharge mortality, use of postnatal steroids, post-discharge respiratory support, treatment with steroids or hospitalisation prior to 1-year corrected age. Results Pooled analyses of four RCTs (N=850) showed no statistically significant difference between groups in the incidence of death or BPD at 36 weeks’ PMA (relative risk (RR) 0.99; 95% CI 0.90 to 1.10; Grades of Recommendation, Assessment, Development and Evaluation (GRADE): moderate). Late surfactant administration significantly decreased the need for post-discharge respiratory support prior to 1-year corrected age (two RCTs; N=522; RR 0.72; 95% CI 0.59 to 0.89; GRADE: low). Other secondary outcomes did not differ significantly between the groups. Conclusions Administration of late surfactant does not improve the rates of death or BPD at 36 weeks when administered to preterm infants with prolonged respiratory insufficiency. Additional adequately powered trials are needed to establish the efficacy of late surfactant therapy in preterm infants. PROSPERO registration number CRD42023432463.","PeriodicalId":501153,"journal":{"name":"Fetal & Neonatal","volume":"480 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138510565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：