Objective To determine whether neurally adjusted ventilatory assist (NAVA), a new method of mechanical ventilation that delivers pressure assistance that is proportional to the electrical activity of ...the diaphragm (EAdi), could lower the inspiratory pressure and respiratory muscle load in preterm infants supported with ventilators. Study design Twenty-six mechanically ventilated preterm infants were randomized to crossover ventilation with NAVA and synchronized intermittent mandatory ventilation (SIMV) with pressure support (PS) for 4 hours each in a randomized order. A 1-hour interval for washout was provided between the 2 modes of ventilation. The ventilator settings were adjusted to maintain similar levels of end-tidal partial pressure of CO2 . The ventilator parameters, vital signs, and gas exchange effects under the 2 ventilatory modes were compared. Results Nineteen infants completed the 9-hour crossover comparison protocol. Peak inspiratory pressure (PIP), work of breathing, and peak EAdi with NAVA were lower than those in SIMV with PS. Calculated tidal volume to peak EAdi ratio and PIP to peak EAdi ratio were higher with NAVA. There were no significant differences in mean airway pressure, inspiratory oxygen fraction, and blood gas values. The measurements of vital signs did not differ significantly between the 2 modes. Conclusion NAVA lowered PIP and reduced respiratory muscle load in preterm infants at equivalent inspiratory oxygen fraction and partial pressure of CO2 of capillary blood in comparison with SIMV with PS.
There has been conflicting evidence for the association between antenatal factors and the development of symptomatic patent ductus arteriosus (PDA) or failure of pharmacologic treatment, especially ...for maternal pregnancy–induced hypertension (PIH) or chorioamnionitis. We assessed the perinatal risk factors of symptomatic PDA in preterm infants and those of secondary ligation in infants with pharmacologic treatment for symptomatic PDA using a national cohort.
A total of 2961 infants with 22–29 weeks of gestation with symptomatic PDA or no PDA were included from the Korean Neonatal Network database. To identify significant perinatal risk factors associated with symptomatic PDA or secondary ligation, all perinatal factors were included in the univariate and multivariate generalized estimating equation analysis and final model was selected using backward elimination method based on Quasi-likelihood Information Criterion.
Lower gestational age (GA), female gender, maternal PIH and surfactant use were significant risk factors of symptomatic PDA. Antenatal corticosteroid use decreased the risk of symptomatic PDA. For secondary ligation, lower GA and cesarean section were significant risk factors. Adjusted odds ratio (aOR) of PIH as a risk factor of symptomatic PDA was 1.56 95% confidence interval 1.17–2.08. In the subgroup analysis according to the GA, lower GA, female gender, multiple pregnancy, maternal PIH and surfactant use increased the risk of symptomatic PDA, and histologic chorioamnionitis and antenatal corticosteroid use decreased the risk of symptomatic PDA only in GA 26–29 weeks group.
Lower GA increased the risk of symptomatic PDA and secondary ligation. Maternal PIH and surfactant use increased the risk of symptomatic PDA; however, antenatal corticosteroid use decreased it. Close observation of the clinical symptoms of PDA is needed in preterm infants with maternal PIH.
The study aimed to identify factors associated with compliance to follow-up (FU) appointments among infants following their discharge from the neonatal intensive care unit (NICU).
This retrospective ...cohort study reviewed 657 infants (birth weight <1500 g or gestational age GA <32 weeks), born between 2011 and 2015. A total of 525 eligible infants were classified into two groups: the compliant group (n = 360), who attended clinics from 18 to 24 months, and the non-compliant group (n = 165), who were lost to FU before 18 months.
The non-compliant group was more likely to have higher usage rate of assisted reproductive technology (p = 0.023), GA (p < 0.001), weight (p < 0.001), height (p < 0.001), and head circumference (p < 0.001) at birth. The sibling number was higher in the non-compliant group (p = 0.011). Moreover, the non-compliant group demonstrated higher Apgar scores at 1 min and 5 min (p = 0.002 and p = 0.031, respectively). The compliant group was more likely to live in metropolitan or larger cities with a borderline significance (p = 0.056).
Furthermore, the non-compliant group was less likely to suffer from respiratory distress syndrome (p < 0.001), patent ductus arteriosus (p = 0.002), retinopathy of prematurity (p = 0.007), necrotizing enterocolitis (p = 0.019), and bronchopulmonary dysplasia (p < 0.001). Moreover, it demonstrated lower postmenstrual age at discharge (p = 0.005) and a shorter length of stay in the NICU (p < 0.001). The compliance with FU appointment varied with the assigned doctor (p < 0.001).
The multivariate regression analysis mentioned that the birth weight (OR = 0.903), residence in metropolitan or larger cities (OR = 1.495), and an experience of magnetic resonance imaging (OR = 1.920) were associated with compliance. The compliance to FU appointments was different according to the assigned doctor at admission (OR = 0.357).
The birth weight, residence in metropolitan or larger cities, an experience of MRI, and the assigned doctors were associated with compliance to FU at a corrected age of 18–24 months.
Sepsis is commonly known to affect neonatal outcomes. We assessed how much center-to-center variability of the sepsis rate affects the outcomes of very-low-birth-weight infants (VLBWIs). 7,493 VLBWIs ...registered in the Korean Neonatal Network from 2013 to 2016 were classified into three groups according to the sepsis rate: low sepsis group (LS) < 25
percentile versus intermediate sepsis group (IS) 25
-75
versus high sepsis group (HS) ≥ 75
. The incidence density of sepsis for the LS, IS, and HS groups were 1.17, 3.17, and 8.88 cases/1,000 person-days. After propensity score matching was done for multiple antenatal and perinatal factors, the odds ratio of death, moderate to severe bronchopulmonary dysplasia and/or death, periventricular leukomalacia, and survival without major morbidities for the HS group were 2.0 (95% confidence interval 1.4-2.8), 1.9 (1.5-2.4), 1.5 (1.1-2.3) and 0.7 (0.5-0.8) when compared with the IS group, and 2.2 (1.6-3.2), 2.3 (1.8-2.9), 2.0 (1.3-2.9), and 0.7 (0.6-0.9) when compared with the LS group. There were no significant differences in those outcomes between the LS and IS groups. Hence, nationwide quality improvements to control the sepsis rate especially in units with a high sepsis rate will be helpful to improve the outcomes of VLBWIs.
BACKGROUNDA previous national study found that Korean children who were breastfed for at least one year had lesser weight gain, lower protein, calcium, and iron intake relative to calories, and ...different dietary patterns in the second year of life, compared with children weaned before 12 months of age or those who were never breastfed. Therefore, this study aimed to investigate whether growth status, dietary and nutrient intake patterns differed by prolonged breastfeeding (PBF) experience even in the third year of life, when weaning is considered complete.METHODSThis cross-sectional study was based on the data of children aged 24 to 35 months from the National Health and Nutrition Examination Survey (2010-2020). Data on anthropometry, dietary behavior, food and nutrient intake, maternal education, and household income were extracted to analyze the association between PBF and growth, dietary and nutrient intake patterns.RESULTSIn the final analysis, 31.6% of the 931 children with a birth weight of ≥ 2.5 kg continued to breastfeed for at least 12 months of age, and their mean breastfeeding (BF) duration was 15.9 months. Children with PBF had significantly less postnatal weight gain than those without (P = 0.006). Regarding food group intake, PBF was significantly associated with lower legume and soy product intake (β 95% confidence interval, -10.688 -19.314, -2.062, P = 0.015) and higher fruit intake (32.978 3.349, 62.608, P = 0.029), after adjusting for sex, age in month, total caloric intake, maternal education and household income. Regarding nutrient intake, after adjusting for these variables, PBF had significantly associated with higher dietary fiber (β 95% CI, 1.607 0.218, 2.996, P = 0.023), iron (0.848 0.317, 1.380, P = 0.002) and niacin (0.728 0.222, 1.235, P = 0.005) intake and was significantly associated with lower saturated fatty acid intake (-1.217 -2.364, -0.071, P = 0.037) and percentage of energy from fat (-1.351 -2.666, -0.035, P = 0.044).CONCLUSIONEven in the third year of life, children who have been breastfed for over one year continue to have relatively slow growth. However, they do appear to have better intake of some beneficial nutrients, which may be attributed to healthier dietary intake patterns in children with PBF. The results of this study can be used to support the recommendation of long-term BF for Korean infants and toddlers.
Aims
The purpose of this study was to explore clinical markers reflecting developmental changes in drug clearance by preterm infants.
Methods
Preterm infants administered aminophylline or ...theophylline to treat apnoea of prematurity were enrolled in this study. Trough and one of 2 h, 4 h or 6 h post‐dose blood samples and urine samples were collected during steady state, to determine the concentrations of theophylline and its targeted metabolites. CYP1A2*1C and CYP1A2*1F genotypes were analyzed. Total, renal and nonrenal clearances of theophylline were calculated, and cytochrome P450 1A2 (CYP1A2) activity was obtained from the ratio of 1‐methyluric acid and 3‐methylxanthine to theophylline in urine. Multiple linear regression analysis was performed to evaluate the relationships between theophylline clearance and the clinical characteristics of preterm infants.
Results
A total of 152 samples from 104 preterm infants were analyzed. A strong association between the serum trough and urine theophylline concentrations was found (P < 0.001). Total, renal and nonrenal clearances of theophylline were 0.50 ± 0.29 ml kg−1 min−1, 0.16 ± 0.06 ml kg−1 min−1 and 0.34 ± 0.28 ml kg−1 min−1, respectively. CYP1A2 activity correlated positively with the postnatal age and postmenstrual age. However, CYP1A2 genotype was not associated with CYP1A2 activity, which was significantly associated with nonrenal clearance. CYP1A2 activity, postnatal age , weight and 24‐h urine output were significantly associated with total theophylline clearance.
Conclusions
CYP1A2 activity can be monitored using noninvasive random urine samples, and it can be used to assess developmental changes in theophylline clearance by preterm infants.
The kidney is an important site of xenobiotic-induced toxicity. Because the traditional markers of renal injury indicate only severe renal damage, new biomarkers are needed for a more sensitive and ...reliable evaluation of renal toxicity. This study was designed to identify in vitro noninvasive biomarkers for efficient assessment of nephrotoxicity by using cisplatin as a model of nephrotoxic compounds. To this end, a comparative proteomic analysis of conditioned media from HK-2 human kidney epithelial cells treated with cisplatin was performed. Here, we identified pyruvate kinase M1/M2 isoform M2 (PKM2) and eukaryotic translation elongation factor 1 gamma (EF-1γ) as potential biomarker candidates for evaluation of nephrotoxicity. PKM2 and EF-1γ were increased by cisplatin in a kidney cell-specific manner, most likely due to cisplatin-induced apoptosis. The increase of PKM2 and EF-1γ levels in conditioned media was also observed in the presence of other nephrotoxic agents with different cytotoxic mechanisms such as CdCl2, HgCl2, and cyclosporine A. Rats treated with cisplatin, CdCl2, or HgCl2 presented increased levels of PKM2 and EF-1γ in the urine and kidney tissue. Taken together, this study identified two noninvasive biomarker candidates, PKM2 and EF-1γ, by comparative proteomic analysis. These new biomarkers may offer an alternative to traditional renal markers for efficient evaluation of nephrotoxicity.
Given the potential benefit of medical therapy in patients with non-obstructive coronary artery disease (CAD), there is a need for risk stratification and treatment strategy for these patients. We ...aimed to develop a risk prediction model for non-obstructive CAD patients for risk stratification and guidance of statin and aspirin therapy.
From a cohort of consecutive patients who underwent coronary computed tomography angiography (CCTA) (n = 25,087), we identified patients with non-obstructive CAD of 1–49% diameter-stenosis (n = 6243) and developed a risk prediction model for 5-year occurrence of a composite of all-cause mortality, myocardial infarction, and late coronary revascularization using a derivation cohort (n = 4391).
Age, sex, hypertension, diabetes, anemia, C-reactive protein, and the extent of non-obstructive CAD were incorporated in the prediction model (risk score 0-13, C-index = 0.716). Patients were categorized into 4 groups; risk score of 0–3 (low-risk), 4-6 (intermediate-risk), 7-9 (high-risk), and ≥10 (very high-risk). Patients with very high-risk demonstrated unfavorable outcome comparable to patients with obstructive CAD. The low-risk group exhibited favorable outcome similar to those with no CAD. While statin therapy was associated with better outcomes in high- or very high-risk group (hazard ratio, 0.62; 95% confidence interval, 0.39–0.96; p = 0.033), aspirin use was associated with an increased risk in low-risk group (hazard ratio, 2.57; 95% confidence interval, 1.34–4.90; p = 0.004).
A dedicated risk scoring system for non-obstructive CAD using clinical factors and CCTA findings accurately predicted prognosis. According to our risk prediction model, statin therapy can be beneficial for high-risk patients, whereas aspirin can be harmful for low-risk patients.
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•We developed a risk prediction model for patients with non-obstructive CAD by CCTA.•The prediction model included clinical factors and extent of non-obstructive CAD.•Statin therapy improved outcomes in the high-risk group by the prediction model.•Use of aspirin was associated with worse outcomes in the low-risk group.•The prediction model can guide preventive medical therapy for non-obstructive CAD.
Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the ...radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study.
Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates.
Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients.
Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
Many studies have explored the relationship between short-term weather and its health effects (including pneumonia) based on mortality, although both morbidity and mortality pose a substantial ...burden. In this study, the authors aimed to describe the influence of meteorological factors on the number of emergency room (ER) visits due to pneumonia in Seoul, Korea.
Daily records of ER visits for pneumonia over a 6-year period (2009-2014) were collected from the National Emergency Department Information System. Corresponding meteorological data were obtained from the National Climate Data Service System. A generalized additive model was used to analyze the effects. The percent change in the relative risk of certain meteorological variables, including pneumonia temperature (defined as the change in average temperature from one day to the next), were estimated for specific age groups.
A total of 217 776 ER visits for pneumonia were identified. The additional risk associated with a 1°C increase in pneumonia temperature above the threshold of 6°C was 1.89 (95% confidence interval CI, 1.37 to 2.61). Average temperature and diurnal temperature range, representing within-day temperature variance, showed protective effects of 0.07 (95% CI, 0.92 to 0.93) and 0.04 (95% CI, 0.94 to 0.98), respectively. However, in the elderly (65+ years), the effect of pneumonia temperature was inconclusive, and the directionality of the effects of average temperature and diurnal temperature range differed.
The term 'pneumonia temperature' is valid. Pneumonia temperature was associated with an increased risk of ER visits for pneumonia, while warm average temperatures and large diurnal temperature ranges showed protective effects.
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