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Thomas L Spray - One of the best experts on this subject based on the ideXlab platform.
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effect of congenital heart disease on 4 year neurodevelopment within Multiple Gestation births
The Journal of Thoracic and Cardiovascular Surgery, 2017Co-Authors: Amy H Schultz, Richard F Ittenbach, Marsha Gerdes, Gail P Jarvik, Gil Wernovsky, Judy Bernbaum, Cynthia Solot, Robert R Clancy, Susan C Nicolson, Thomas L SprayAbstract:Abstract Objectives We sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at 4 years of age, while matching for Gestational age, socioeconomic status, maternal Gestational conditions, home environment, and parental intelligence by studying Multiple-Gestation births. Methods We performed within-family comparison of 14 Multiple-Gestation births in which 1 child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age. Between 4 and 5 years of age, a comprehensive neurodevelopmental assessment was performed. Paired comparisons were conducted between siblings with and without heart defects using a series of nonparametric tests. Results On average, the children qualified as late preterm (mean Gestational age 35.4 ± 2.6 weeks). At an average age of 4.8 ± 0.1 years, children with congenital heart disease weighed less than their siblings (median weight for age z score −0.4 vs 0.1, P = .02) and had worse performance for cognition (median full-scale IQ 99 vs 109, P = .02) and fine motor skills (median Wide Range Assessment of Visual Motor Ability, Fine Motor score 94.5 vs 107.5, P Conclusions After controlling for socioeconomic status, home environment, parental intelligence, and Gestational factors by using Multiple-Gestation births, congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age is associated with lower weight, cognitive abilities and fine motor skills at 4 years of age.
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effect of congenital heart disease on neurodevelopmental outcomes within Multiple Gestation births
The Journal of Thoracic and Cardiovascular Surgery, 2005Co-Authors: Amy H Schultz, Marsha Gerdes, Gail P Jarvik, Gil Wernovsky, Judy Bernbaum, Robert R Clancy, Susan C Nicolson, Jo Ann Dagostino, Donna M Mcdonaldmcginn, Thomas L SprayAbstract:Objectives We sought to assess the effect of congenital heart disease requiring surgical intervention with cardiopulmonary bypass at 6 months of age or less on developmental outcomes and growth at 1 year of age while controlling for socioeconomic status, prematurity, home environment, and parental intelligence. Methods We performed within-family comparison of 11 Multiple-Gestation births in which one child had congenital heart disease. At 1 year of age, the Bayley Scales of Infant Development II were administered, and growth parameters were assessed. Paired comparisons were made by using fixed effects regression conditioned on family. Results The Multiple-Gestation subjects were mildly premature on average (mean Gestational age, 35.4 ± 3.0 weeks). At 1 year of age, children with congenital heart disease scored lower on the Mental Development Index (85.0 ± 19.3 vs 93.9 ± 16.0, P = .037) and the Psychomotor Development Index (76.6 ± 16.9 vs 91.3 ± 14.9, P = .015) on the Bayley Scales of Infant Development II than did their siblings without congenital heart disease. There were no differences between siblings in weight, height, or head circumference. Conclusions The presence of congenital heart disease requiring surgical intervention with cardiopulmonary bypass at 6 months of age or less is associated with a deficit in developmental achievement at 1 year of age, as measured by using the Bayley Scales of Infant Development II.
Kei Lui - One of the best experts on this subject based on the ideXlab platform.
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trends in morbidity and mortality of extremely preterm Multiple Gestation newborns
Pediatrics, 2015Co-Authors: Kee Thai Yeo, Qin Ying Lee, Wei Shern Quek, Yueping Alex Wang, Srinivas Bolisetty, Kei LuiAbstract:OBJECTIVES: To examine the risk of mortality and major morbidities in extremely preterm Multiple Gestation infants compared with singletons over time. METHODS: This is a retrospective study of 15 402 infants born ≤27 weeks’ Gestation, admitted to NICUs in the Australian and New Zealand Neonatal Network from 1995 to 2009. Mortality and major morbidities were compared between singletons and Multiples across three 5-year epochs. RESULTS: Extreme preterm Multiples were more likely to have lower birth weight; higher maternal age; and higher rates of assisted conception, antenatal steroid use, and cesarean delivery compared with singletons. The mortality rate was significantly higher in Multiples compared with singletons even as there was a trend of decreasing Gestational-age stratified mortality in Multiples over the time period investigated. The rates of major morbidities or composite adverse outcomes were not different between Multiples and singletons across all epochs. The adjusted odds ratio (AOR) for mortality in Multiples was significantly higher in Multiples compared with singletons (AOR 1.20, 95% confidence interval [CI] 1.08–1.34). There were no differences in the adjusted odds for poor outcomes in Multiples compared with singletons in the most recent epoch: mortality (AOR 1.00, 95% CI 0.84–1.19), major morbidity (0.95, 95% CI 0.81–1.10), and composite adverse outcome (0.96, 95% CI 0.83–1.11). CONCLUSIONS: Over the 15-year period, the odds for mortality in extremely preterm NICU infants of Multiple Gestation was significantly higher compared with singletons. The adjusted odds of poor outcomes in Multiples were not significantly different from that of singletons in the most recent epoch.
Seetha Shankaran - One of the best experts on this subject based on the ideXlab platform.
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association of antenatal corticosteroids with mortality morbidity and neurodevelopmental outcomes in extremely preterm Multiple Gestation infants
JAMA Pediatrics, 2016Co-Authors: Nansi S Boghossian, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Scott A Mcdonald, Waldemar A Carlo, Jane E Brumbaugh, Abhik DasAbstract:Importance Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm Multiples. Objective To examine if use of ANS is associated with improvement in major outcomes in extremely preterm Multiples. Design, Setting, and Participants Infants with a Gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Exposure Antenatal corticosteroids. Main Outcomes and Measures In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months’ corrected age or death before assessment. Results A total of 6925 Multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for Gestational age Multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for Gestational age Multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among Multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Conclusions and Relevance Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm Multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for Gestational age Multiples.
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maternal race demography and health care disparities impact risk for intraventricular hemorrhage in preterm neonates
The Journal of Pediatrics, 2014Co-Authors: Seetha Shankaran, Heping Zhang, Aiping Lin, Jill Mallerkesselman, Michael T Oshea, Henrietta S Bada, Jeffrey R Kaiser, Richard P Lifton, Charles R Bauer, Laura R MentAbstract:Objective To determine whether risk factors associated with grade 2-4 intraventricular hemorrhage (IVH) differs between infants of African ancestry and white infants. Study design Inborn, appropriate for Gestational age infants with birth weight 500-1250 g and exposure to at least 1 dose of antenatal steroids were enrolled in 24 neonatal intensive care units. Cases had grade 2-4 IVH and controls matched for site, race, and birth weight range had 2 normal ultrasounds read centrally. Multivariate logistic regression modeling identified factors associated with IVH across African ancestry and white race. Results Subjects included 579 African ancestry or white race infants with grade 2-4 IVH and 532 controls. Mothers of African ancestry children were less educated, and white case mothers were more likely to have more than 1 prenatal visit and Multiple Gestation ( P ≤ .01 for all). Increasing Gestational age ( P = .01), preeclampsia ( P P = .02), cesarean delivery ( P P = .01) were associated with decreased risk for IVH. Chorioamnionitis ( P = .01), 5-minute Apgar score P P P P = .02). Among white infants, Multiple Gestation was associated with increased risk ( P P Conclusion The risk for IVH differs between infants of African ancestry and white infants, possibly attributable to both race and health care disparities.
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late onset sepsis in very low birth weight infants from singleton and Multiple Gestation births
The Journal of Pediatrics, 2013Co-Authors: Nansi S Boghossian, Michael C Cotten, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Jeffrey C Murray, Grier P Page, Nancy S NewmanAbstract:Objectives To describe and compare the incidence of late-onset sepsis (LOS) and demographic and clinical characteristics associated with LOS in very low birth weight (VLBW) infants from singleton and Multiple births, and to examine the heritability of susceptibility to LOS among VLBW twins by comparing same-sex and unlike-sex twin pairs. Study design The study group comprised infants with birth weight 401-1500 g seen at clinical centers of the Eunice Kennedy Shriver National Institute of Child and Human Development Neonatal Research Network between 2002 and 2008. Only the first episode of LOS was included in our analysis. Stepwise logistic regression models were fitted separately for singleton and Multiple pregnancies to examine the maternal and neonatal factors associated with LOS. LOS due solely to gram-negative bacteria in singleton and Multiple pregnancies was also examined in separate models. The heritability of LOS was estimated by examining the concordance of LOS in twins from same-sex and unlike-sex pairs. Results LOS occurred in 25.0% (3797 of 15 178) of singleton and 22.6% (1196 of 5294) of Multiple-birth VLBW infants. Coagulase-negative staphylococci were the most common infecting organisms, accounting for 53.2% of all LOS episodes in singletons and 49.2% in Multiples. Escherichia coli and Klebsiella species were the most commonly isolated gram-negative organisms, and Candida albicans was the most commonly isolated fungus. Concordance of LOS did not differ significantly between same-sex and unlike-sex twin pairs. Conclusion LOS remains a common problem in VLBW infants. The incidence of LOS is similar for singleton and Multiple-birth infants. The similar concordance of LOS in same-sex and unlike-sex twin pairs provides no evidence that susceptibility to LOS among VLBW infants is genetically determined.
Nansi S Boghossian - One of the best experts on this subject based on the ideXlab platform.
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association of antenatal corticosteroids with mortality morbidity and neurodevelopmental outcomes in extremely preterm Multiple Gestation infants
JAMA Pediatrics, 2016Co-Authors: Nansi S Boghossian, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Scott A Mcdonald, Waldemar A Carlo, Jane E Brumbaugh, Abhik DasAbstract:Importance Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm Multiples. Objective To examine if use of ANS is associated with improvement in major outcomes in extremely preterm Multiples. Design, Setting, and Participants Infants with a Gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Exposure Antenatal corticosteroids. Main Outcomes and Measures In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months’ corrected age or death before assessment. Results A total of 6925 Multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for Gestational age Multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for Gestational age Multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among Multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Conclusions and Relevance Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm Multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for Gestational age Multiples.
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late onset sepsis in very low birth weight infants from singleton and Multiple Gestation births
The Journal of Pediatrics, 2013Co-Authors: Nansi S Boghossian, Michael C Cotten, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Jeffrey C Murray, Grier P Page, Nancy S NewmanAbstract:Objectives To describe and compare the incidence of late-onset sepsis (LOS) and demographic and clinical characteristics associated with LOS in very low birth weight (VLBW) infants from singleton and Multiple births, and to examine the heritability of susceptibility to LOS among VLBW twins by comparing same-sex and unlike-sex twin pairs. Study design The study group comprised infants with birth weight 401-1500 g seen at clinical centers of the Eunice Kennedy Shriver National Institute of Child and Human Development Neonatal Research Network between 2002 and 2008. Only the first episode of LOS was included in our analysis. Stepwise logistic regression models were fitted separately for singleton and Multiple pregnancies to examine the maternal and neonatal factors associated with LOS. LOS due solely to gram-negative bacteria in singleton and Multiple pregnancies was also examined in separate models. The heritability of LOS was estimated by examining the concordance of LOS in twins from same-sex and unlike-sex pairs. Results LOS occurred in 25.0% (3797 of 15 178) of singleton and 22.6% (1196 of 5294) of Multiple-birth VLBW infants. Coagulase-negative staphylococci were the most common infecting organisms, accounting for 53.2% of all LOS episodes in singletons and 49.2% in Multiples. Escherichia coli and Klebsiella species were the most commonly isolated gram-negative organisms, and Candida albicans was the most commonly isolated fungus. Concordance of LOS did not differ significantly between same-sex and unlike-sex twin pairs. Conclusion LOS remains a common problem in VLBW infants. The incidence of LOS is similar for singleton and Multiple-birth infants. The similar concordance of LOS in same-sex and unlike-sex twin pairs provides no evidence that susceptibility to LOS among VLBW infants is genetically determined.
Michele C Walsh - One of the best experts on this subject based on the ideXlab platform.
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delayed interval delivery in Multiple Gestation pregnancies neonatal mortality morbidity and development
Pediatrics, 2021Co-Authors: Nicolas J Bouey, Michele C Walsh, Shampa Saha, Deanne Wilsoncostello, Matthew A Rysavy, Myra H Wyckoff, Anna Maria HibbsAbstract:Background: Delayed-interval delivery (DID) is the delivery of the first fetus in a Multiple Gestation pregnancy without promptly delivering the remaining fetus(es), usually in an attempt to decrease the risk of adverse outcome due to extreme prematurity in the retained fetus(es). Available information on DID is limited, resulting in a knowledge gap of how the benefits of DID in reducing known risks of prematurity are balanced with its complications. Objective: Determine the incidence of DID in the NICHD Neonatal Research Network (NRN) and describe short- and long-term outcomes. Design/Methods: Retrospective cohort study of infants born at …
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association of antenatal corticosteroids with mortality morbidity and neurodevelopmental outcomes in extremely preterm Multiple Gestation infants
JAMA Pediatrics, 2016Co-Authors: Nansi S Boghossian, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Scott A Mcdonald, Waldemar A Carlo, Jane E Brumbaugh, Abhik DasAbstract:Importance Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm Multiples. Objective To examine if use of ANS is associated with improvement in major outcomes in extremely preterm Multiples. Design, Setting, and Participants Infants with a Gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Exposure Antenatal corticosteroids. Main Outcomes and Measures In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months’ corrected age or death before assessment. Results A total of 6925 Multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for Gestational age Multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for Gestational age Multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among Multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Conclusions and Relevance Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm Multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for Gestational age Multiples.
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late onset sepsis in very low birth weight infants from singleton and Multiple Gestation births
The Journal of Pediatrics, 2013Co-Authors: Nansi S Boghossian, Michael C Cotten, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Seetha Shankaran, Edward F. Bell, Jeffrey C Murray, Grier P Page, Nancy S NewmanAbstract:Objectives To describe and compare the incidence of late-onset sepsis (LOS) and demographic and clinical characteristics associated with LOS in very low birth weight (VLBW) infants from singleton and Multiple births, and to examine the heritability of susceptibility to LOS among VLBW twins by comparing same-sex and unlike-sex twin pairs. Study design The study group comprised infants with birth weight 401-1500 g seen at clinical centers of the Eunice Kennedy Shriver National Institute of Child and Human Development Neonatal Research Network between 2002 and 2008. Only the first episode of LOS was included in our analysis. Stepwise logistic regression models were fitted separately for singleton and Multiple pregnancies to examine the maternal and neonatal factors associated with LOS. LOS due solely to gram-negative bacteria in singleton and Multiple pregnancies was also examined in separate models. The heritability of LOS was estimated by examining the concordance of LOS in twins from same-sex and unlike-sex pairs. Results LOS occurred in 25.0% (3797 of 15 178) of singleton and 22.6% (1196 of 5294) of Multiple-birth VLBW infants. Coagulase-negative staphylococci were the most common infecting organisms, accounting for 53.2% of all LOS episodes in singletons and 49.2% in Multiples. Escherichia coli and Klebsiella species were the most commonly isolated gram-negative organisms, and Candida albicans was the most commonly isolated fungus. Concordance of LOS did not differ significantly between same-sex and unlike-sex twin pairs. Conclusion LOS remains a common problem in VLBW infants. The incidence of LOS is similar for singleton and Multiple-birth infants. The similar concordance of LOS in same-sex and unlike-sex twin pairs provides no evidence that susceptibility to LOS among VLBW infants is genetically determined.