Showing papers by "Barbara J. Stoll published in 2017"
TL;DR: The incidence of Late-onset sepsis (LOS) decreased over time, and birth year was a significant predictor of LOS on adjusted analysis, with birth years 2000–2009 having a significantly higher odds of Los than the reference year 2011.
Abstract: Background:Late-onset sepsis (LOS) is an important cause of death and neurodevelopmental impairment in premature infants. The purpose of this study was to assess overall incidence of LOS, distribution of LOS-causative organisms and center variation in incidence of LOS for extremely premature infants
112 citations
University of Texas at Austin1, Research Triangle Park2, Brown University3, National Institutes of Health4, University of Utah5, University of Virginia6, University of Texas Health Science Center at Houston7, University of Texas Medical Branch8, Emory University9, University of Texas Health Science Center at San Antonio10, Columbia University Medical Center11
TL;DR: The patterns of association between placental abnormalities, fetal growth, and stillbirth provide insights into the mechanism of impaired placental function and still Birth and suggest implications for clinical care, especially for placental findings amenable to prenatal diagnosis using ultrasound that may be associated with term stillbirths.
Abstract: Worldwide, stillbirth is one of the leading causes of death. Altered fetal growth and placental abnormalities are the strongest and most prevalent known risk factors for stillbirth. The aim of this study was to identify patterns of association between placental abnormalities, fetal growth, and stillbirth.
87 citations
Children's Hospital of Philadelphia1, University of Pennsylvania2, Research Triangle Park3, Duke University4, University of Texas Health Science Center at Houston5, Nationwide Children's Hospital6, University of Iowa7, RTI International8, Brown University9, Stanford University10, Lucile Packard Children's Hospital11, University of Texas Southwestern Medical Center12
TL;DR: Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of early-onset sepsis, and recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.
Abstract: BACKGROUND: Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS. METHODS: Study infants were born at 22 to 28 weeks’ gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at ≤72 hours age. Infants were hypothesized as “low risk” for EOS when delivered via cesarean delivery, with membrane rupture at delivery, and absence of clinical chorioamnionitis. Frequency of prolonged antibiotics (≥5 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight. RESULTS: Of 15 433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving >12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16–0.36]). Low-risk infants also had significantly lower combined risk of EOS or death ≤12 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS. CONCLUSIONS: Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.
76 citations
Case Western Reserve University1, University of Iowa2, United States Environmental Protection Agency3, University of Alabama at Birmingham4, University of Rochester5, Brown University6, Nationwide Children's Hospital7, Emory University8, Wayne State University9, Stanford University10, University of Pennsylvania11, National Institutes of Health12, Cincinnati Children's Hospital Medical Center13, Duke University14, Indiana University15, University of New Mexico16, Children's Mercy Hospital17
TL;DR: Moderately preterm neonates are an understudied group of high-risk infants that experience morbidity and prolonged hospitalization, and such morbidity deserves focused research to improve therapeutic and prevention strategies.
Abstract: BackgroundExtremely preterm infants (EPT, <29 weeks' gestation) represent only 0.9% of births in the United States; yet these infants are the focus of most published research. Moderately preterm neonates (MPT, 29-336/7 weeks) are an understudied group of high-risk infants.MethodsTo determine the neonatal outcomes of MPT infants across the gestational age spectrum, and to compare these with EPT infants. A prospective observational cohort was formed in 18 level 3-4 neonatal intensive care units (NICUs) in the Eunice Kennedy Shriver NICHD Neonatal Research Network. Participants included all MPT infants admitted to NICUs and all EPT infants born at sites between January 2012 and November 2013. Antenatal characteristics and neonatal morbidities were abstracted from records using pre-specified definitions by trained neonatal research nurses.ResultsMPT infants experienced morbidities similar to, although at lower rates than, those of EPT infants. The main cause of mortality was congenital malformation, accounting for 43% of deaths. Central Nervous System injury occurred, including intraventricular hemorrhage. Most MPT infants required respiratory support, but sequelae such as bronchopulmonary dysplasia were rare. The primary contributors to hospitalization beyond 36 weeks' gestation were inability to achieve adequate oral intake and persistent apnea.ConclusionsMPT infants experience morbidity and prolonged hospitalization. Such morbidity deserves focused research to improve therapeutic and prevention strategies.
69 citations
Case Western Reserve University1, University of Alabama at Birmingham2, University of California, San Diego3, University of Cincinnati4, University of Chicago5, Columbia University6, Brown University7, Cincinnati Children's Hospital Medical Center8, Duke University9, Grady Memorial Hospital10, National Institutes of Health11, Riley Hospital for Children12, RTI International13, Lucile Packard Children's Hospital14, Floating Hospital for Children15, University of Iowa16, University of Miami17, University of New Mexico18, University of Rochester Medical Center19, University of Texas Southwestern Medical Center20, University of Texas Health Science Center at Houston21, Primary Children's Hospital22, Wake Forest Baptist Medical Center23, Wayne State University24, Boston Children's Hospital25
TL;DR: Infants born SGA had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased intermittent hypoxemia events and lower survival.
46 citations
TL;DR: The only evidence of subgroup effects associated with prophylactic indomethacin were lower odds of death among infants with birth weights above the 10th percentile and those who were not treated for a patent ductus arteriosus after the first day of life.
34 citations
University of Pennsylvania1, RTI International2, University of Iowa3, National Institutes of Health4, University of Alabama at Birmingham5, Duke University6, University of Cincinnati7, Wayne State University8, Stanford University9, Emory University10, University of Texas Health Science Center at Houston11, University of Texas Southwestern Medical Center12, University of Miami13, Case Western Reserve University14, University of Florida15
TL;DR: 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.
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.
26 citations
TL;DR: Women with stillbirth usually delivered vaginally regardless of whether labor was spontaneous or induced or whether they had a prior cesarean delivery, however, 15% underwent cesar delivery, often without a documented obstetric indication.
26 citations
Children's Hospital of Philadelphia1, Research Triangle Park2, Emory University3, Wayne State University4, Duke University5, Nationwide Children's Hospital6, Brown University7, University of Texas at Austin8, University of Iowa9, Cincinnati Children's Hospital Medical Center10, National Institutes of Health11, RTI International12
TL;DR: Wide center variations in postnatal discussions about withdrawal or withholding of life‐sustaining therapy (WWLST) occur, especially at ≤24 weeks GA, and outcomes of infants surviving after WWLST discussions are poor.
24 citations
TL;DR: Childhood neglect is understudied in comparison to abuse and should be included in the future studies of associations between CM and pregnancy outcomes, including stillbirth.
14 citations
University of New Mexico1, Children's Mercy Hospital2, Emory University3, Indiana University4, University of Texas Health Science Center at Houston5, University of Pennsylvania6, United States Environmental Protection Agency7, RTI International8, HealthPartners9, Nationwide Children's Hospital10, Wayne State University11, Women & Children's Hospital of Buffalo12, Duke University13, Stanford University14, Cincinnati Children's Hospital Medical Center15, University of Iowa16, University of Alabama at Birmingham17, University of California, Los Angeles18, University of Texas Southwestern Medical Center19, National Institutes of Health20
TL;DR: An analysis of reasons for low enrollment in a randomized controlled trial of the effect of hydrocortisone for cardiovascular insufficiency on survival without neurodevelopmental impairment in term/late preterm newborns finds Successful RCTs of emergent therapy may require fewer exclusions, a short-term primary outcome, waiver of consent and/or other alternatives.
Abstract: To analyze reasons for low enrollment in a randomized controlled trial (RCT) of the effect of hydrocortisone for cardiovascular insufficiency on survival without neurodevelopmental impairment (NDI) in term/late preterm newborns. The original study was a multicenter RCT. Eligibility: ⩾34 weeks’ gestation, <72 h old, mechanically ventilated, receiving inotrope. Primary outcome was NDI at 2 years; infants with diagnoses at high risk for NDI were excluded. This paper presents an analysis of reasons for low patient enrollment. Two hundred and fifty-seven of the 932 otherwise eligible infants received inotropes; however, 207 (81%) had exclusionary diagnoses. Only 12 infants were randomized over 10 months; therefore, the study was terminated. Contributing factors included few eligible infants after exclusions, open-label steroid therapy and a narrow enrollment window. Despite an observational study to estimate the population, very few infants were enrolled. Successful RCTs of emergent therapy may require fewer exclusions, a short-term primary outcome, waiver of consent and/or other alternatives.
TL;DR: Infants with birth weight z-score -2 to -0.5 are more likely than normally grown infants to require PDA surgery following pharmacologic treatment.
28 Jun 2017
TL;DR: Maternal factor V Leiden may be associated with fetal growth independent of placental characteristics, and plasminogen activator inhibitor type 1 in both maternal blood and placenta/cord blood.
Abstract: Pregnancy results in alterations in coagulation processes, which may increase the risk of thrombosis. Inherited thrombophilia mutations may further increase this risk, possibly through alterations in the placenta, which may result in pregnancy complications such as poor fetal growth. The purpose of our study is to evaluate the association of fetal growth, approximated by birth weight for gestational age percentile, with genetic markers of thrombophilia and placental characteristics related to vascular malperfusion. We analyzed data from the Stillbirth Collaborative Research Network's population-based case–control study conducted in 2006–2008. Study recruitment occurred in five states: Rhode Island and counties in Massachusetts, Georgia, Texas, and Utah. The analysis was restricted to singleton, nonanomalous live births ≤42 weeks' gestation with a complete placental examination and successful testing for ≥1 thrombophilia marker (858 mothers, 902 infants). Data were weighted to account for oversampling, differential consent, and availability of placental examination. We evaluated five thrombophilia markers: factor V Leiden, factor II prothrombin, methylenetetrahydrofolate reductase A1298C and C677T, and plasminogen activator inhibitor type 1 in both maternal blood and placenta/cord blood. We modeled maternal and fetal thrombophilia markers separately using linear regression. Maternal factor V Leiden mutation was associated with a 13.16-point decrease in adjusted birth weight percentile (95% confidence interval: −25.50, −0.82). Adjustment for placental abnormalities related to vascular malperfusion did not affect the observed association. No other maternal or fetal thrombophilia markers were significantly associated with birth weight percentile. Maternal factor V Leiden may be associated with fetal growth independent of placental characteristics.
TL;DR: This research presents a novel and scalable approach to caring for young patients with complex medical histories that combines traditional and innovative approaches to care.