This study compared mortality rates in preterm infants with respiratory distress syndrome (RDS) treated with three surfactant preparations - poractant alfa, calfactant, or beractant. Using data from over 14,000 infants treated between 2005-2009, the study found:
1) Calfactant treatment was associated with a 49.6% greater likelihood of death compared to poractant alfa.
2) Beractant treatment showed a non-significant 37% higher mortality risk compared to poractant alfa.
3) There was no significant difference in mortality between calfactant and beractant.
4) Poractant alfa treatment was associated with significantly reduced mortality compared
Đặc điểm điện di huyết sắc tố và kiểu gene hội chứng thai tích dịch do Hb Bart'sVõ Tá Sơn
Electrophoresis features and genotypes of Hb Bart’s hydrops fetalis
Đặc điểm điện di huyết sắc tố và kiểu gene hội chứng thai tích dịch do Hb Bart's
bsvotason
bs võ tá sơn
bác sĩ võ tá sơn
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bện...Võ Tá Sơn
CORD BLOOD ANALYSIS FOR RAPID PRENATAL CONFIRMATION OF Hb BART’S DISEASE USING THE SEBIA CAPILLARY ELECTROPHORESIS SYSTEM
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bệnh Hb Bart's bằng cách sử dụng hệ thống điện di mao quản
bs võ tá sơn
bsvotason
bác sĩ võ tá sơn
Are environmental levels of bpa associated with reproductive function in fert...ricguer
Bisphenol A (BPA) is commonly found in many plastic and food packaging products. This study examined the relationship between environmental exposure to BPA, as measured in urine samples, and male reproductive health in 375 fertile men. The study found no significant associations between urinary BPA levels and semen quality measures. However, higher BPA exposure was associated with slightly lower levels of free testosterone and markers of free testosterone. While the effects seen were small, this study adds to evidence that environmental BPA exposure may impact the male endocrine system even at current exposure levels.
This document summarizes a study from the 1940s-1950s that investigated the use of diethylstilbestrol (DES) to prevent miscarriages and complications in pregnancy. The study was conducted at Harvard, Tulane, and the University of Chicago and was found to be unethical as it did not obtain informed consent from participants, exposed women to unnecessary harm, and violated principles of voluntary participation and self-determination. While the data should be used cautiously, the study overall should not have been conducted due to the ethical violations and long term health risks it posed.
1) The study tested the hypothesis that maternal ingestion of green tea in late pregnancy causes fetal ductal constriction by inhibiting prostaglandins. 2) Echocardiography of fetal lambs exposed to green tea in utero showed signs of ductal constriction compared to controls. 3) Autopsies found dilated and hypertrophic right ventricles in lambs exposed to green tea, and histological analysis found thicker ductal walls in these lambs.
This study examined the relationship between maternal consumption of polyphenol-rich foods late in pregnancy and fetal ductus arteriosus flow dynamics. Doppler ultrasound was used to compare ductal velocities and right-to-left ventricular dimensions in 102 fetuses exposed to high maternal polyphenol intake versus 41 unexposed fetuses. Exposed fetuses had higher ductal velocities and right-to-left ventricular ratios, suggesting maternal polyphenol-rich food intake may influence fetal ductal dynamics by inhibiting prostaglandin synthesis, similarly to non-steroidal anti-inflammatory drugs. As polyphenol-rich foods are commonly consumed during pregnancy, their effects on the fetal ductus warrant further consideration.
exome sequencing improves genetic diagnosis of fetal increased nuchal translu...Võ Tá Sơn
This study analyzed exome sequencing results from 73 fetuses with isolated increased nuchal translucency but normal chromosomal microarray analysis. Exome sequencing identified pathogenic variants in 4 cases (5.5% diagnostic rate), including 3 de novo dominant variants and 1 recessive variant. Three of the 4 cases developed structural anomalies on later ultrasound. This shows exome sequencing can detect genetic conditions in some cases with increased nuchal translucency not detected by other tests, aiding parental counseling.
Đặc điểm điện di huyết sắc tố và kiểu gene hội chứng thai tích dịch do Hb Bart'sVõ Tá Sơn
Electrophoresis features and genotypes of Hb Bart’s hydrops fetalis
Đặc điểm điện di huyết sắc tố và kiểu gene hội chứng thai tích dịch do Hb Bart's
bsvotason
bs võ tá sơn
bác sĩ võ tá sơn
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bện...Võ Tá Sơn
CORD BLOOD ANALYSIS FOR RAPID PRENATAL CONFIRMATION OF Hb BART’S DISEASE USING THE SEBIA CAPILLARY ELECTROPHORESIS SYSTEM
Liao2011 phân tích máu cuống rốn để khẳng định chẩn đoán nhanh trước sinh bệnh Hb Bart's bằng cách sử dụng hệ thống điện di mao quản
bs võ tá sơn
bsvotason
bác sĩ võ tá sơn
Are environmental levels of bpa associated with reproductive function in fert...ricguer
Bisphenol A (BPA) is commonly found in many plastic and food packaging products. This study examined the relationship between environmental exposure to BPA, as measured in urine samples, and male reproductive health in 375 fertile men. The study found no significant associations between urinary BPA levels and semen quality measures. However, higher BPA exposure was associated with slightly lower levels of free testosterone and markers of free testosterone. While the effects seen were small, this study adds to evidence that environmental BPA exposure may impact the male endocrine system even at current exposure levels.
This document summarizes a study from the 1940s-1950s that investigated the use of diethylstilbestrol (DES) to prevent miscarriages and complications in pregnancy. The study was conducted at Harvard, Tulane, and the University of Chicago and was found to be unethical as it did not obtain informed consent from participants, exposed women to unnecessary harm, and violated principles of voluntary participation and self-determination. While the data should be used cautiously, the study overall should not have been conducted due to the ethical violations and long term health risks it posed.
1) The study tested the hypothesis that maternal ingestion of green tea in late pregnancy causes fetal ductal constriction by inhibiting prostaglandins. 2) Echocardiography of fetal lambs exposed to green tea in utero showed signs of ductal constriction compared to controls. 3) Autopsies found dilated and hypertrophic right ventricles in lambs exposed to green tea, and histological analysis found thicker ductal walls in these lambs.
This study examined the relationship between maternal consumption of polyphenol-rich foods late in pregnancy and fetal ductus arteriosus flow dynamics. Doppler ultrasound was used to compare ductal velocities and right-to-left ventricular dimensions in 102 fetuses exposed to high maternal polyphenol intake versus 41 unexposed fetuses. Exposed fetuses had higher ductal velocities and right-to-left ventricular ratios, suggesting maternal polyphenol-rich food intake may influence fetal ductal dynamics by inhibiting prostaglandin synthesis, similarly to non-steroidal anti-inflammatory drugs. As polyphenol-rich foods are commonly consumed during pregnancy, their effects on the fetal ductus warrant further consideration.
exome sequencing improves genetic diagnosis of fetal increased nuchal translu...Võ Tá Sơn
This study analyzed exome sequencing results from 73 fetuses with isolated increased nuchal translucency but normal chromosomal microarray analysis. Exome sequencing identified pathogenic variants in 4 cases (5.5% diagnostic rate), including 3 de novo dominant variants and 1 recessive variant. Three of the 4 cases developed structural anomalies on later ultrasound. This shows exome sequencing can detect genetic conditions in some cases with increased nuchal translucency not detected by other tests, aiding parental counseling.
SOURCES
CDC Resources and Educational Tools - Educational Tools for Clinicians
DES Lecture Presentation and DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_clinicians.html
CDC Resources and Educational Tools - Educational Tools for Nurses
DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_nurses.html
CDC Resources and Educational Tools - Clinician Information
DES References > http://www.cdc.gov/des/hcp/bibliography/index.html
MORE DES DIETHYLSTILBESTROL RESOURCES
DES cases and lawsuits:
http://diethylstilbestrol.co.uk/studies/des-lawsuits/
DES studies on cancers and screening:
https://desdaughter.com/2013/09/08/diethylstilbestrol-resources-1/
DES studies on epigenetics and transgenerational effects:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-6/
DES studies on fertility:
http://diethylstilbestrol.co.uk/studies/des-and-fertility/
DES studies on gender identity and psychological health:
https://desdaughter.com/2015/12/04/diethylstilbestrol-resources-3/
DES studies on in-utero exposure to DES and side-effects:
https://desdaughter.com/2013/12/31/diethylstilbestrol-resources-4/
DES studies on pregnancy:
http://diethylstilbestrol.co.uk/studies/des-and-pregnancy/
DES studies on the genital tract:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-7/
DES videos:
https://www.youtube.com/playlist?list=PL3D4F4A11812DAE00
This document is a manuscript describing a study on the effects of maternal consumption of polyphenol-rich foods on fetal ductus arteriosus constriction in pregnant sheep. The study found that 2 weeks of polyphenol supplementation in pregnant sheep resulted in ductus arteriosus constriction in fetuses, accompanied by increased polyphenol excretion and decreased inflammatory markers in the mothers. It also observed changes in oxidative stress biomarkers in the mothers, despite some markers of oxidative damage being lower after supplementation. The results suggest that high maternal polyphenol intake can induce fetal ductal constriction through anti-inflammatory effects, and oxidative stress may be involved.
Low dose aspirin and low molecular weight heparin in recurrent miscarriageDr. Aisha M Elbareg
This study compared the effects of low dose aspirin alone versus low dose aspirin combined with low-molecular-weight heparin in treating 150 Libyan women with a history of recurrent miscarriages. Women received either low dose aspirin daily or low dose aspirin daily plus low-molecular-weight heparin injections. The combination therapy resulted in significantly fewer miscarriages and more live births compared to aspirin alone. There were no significant differences in preterm birth rates or birth weights between the groups. The combination of low dose aspirin and low-molecular-weight heparin was found to be more effective than low dose aspirin alone in maintaining pregnancy for women with a history of recurrent first trimester
Four Studies Find Association Between Zofran & Birth Defects - Press Releasewoodenwaif5291
Four epidemiological studies have found an association between the anti-nausea drug Zofran (ondansetron) and increased risks of major birth defects when taken during pregnancy. Women who took Zofran were 2-5 times more likely to have babies with heart defects or cleft palate. While Zofran is approved only for post-surgery use, doctors often prescribe it for morning sickness without studies of its effects on pregnancies. Multiple lawsuits have been filed against the drug's manufacturer, GlaxoSmithKline, for failing to disclose these risks. The document provides contact information for a law firm representing families in the ongoing Zofran litigation.
Out of the Past: Old Exposures, Heritable Effects, and Emerging Concepts for ...Jill Escher
This document discusses emerging concepts in autism research, focusing on the potential roles of germline exposures and heritable epigenetic effects. It notes the dramatic surge in autism cases and outlines current thinking on genetic and environmental contributions. However, it argues that the field has overlooked the possibility of germline mutations or epigenetic alterations caused by parental exposures that could contribute to autism in offspring. The document examines evidence that prenatal exposures like medications, cigarette smoke, and other toxins during critical windows of germline development may cause heritable effects through mutagenesis or epigenetic mechanisms. It calls for further research on transgenerational transmission of environmentally-induced autism phenotypes from germline exposures.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
Increasing Trends in Male Reproductive Disorders, Environmental Exposures, an...DES Daughter
On this call, Dr. Skakkebaek presented his concerns about increasing trends in male reproductive disorders, including the significant global increase in incidence of germ cell tumors. He and colleagues from all over the world demonstrated that over half of all young men's semen quality does not meet the reference standard of the World Health Organization. Dr. Skakkebaek presented evidence linking testicular cancer, poor semen quality, childlessness, and rapidly decreasing fertility rates. He showed how there is little doubt that environmental factors, most likely associated with modern lifestyles, have - in a broad sense - had an adverse influence on male reproductive health. He and his group are examining a fundamental role that exposure to endocrine-disrupting chemicals may play in these trends, trends that in a few decades will result in decreasing populations in industrialized countries, and believes collaborative research is required to identify the causes of these adverse trends.
Sources: http://healthandenvironment.org/partnership_calls/18355
The study aimed to identify genetic factors associated with pre-eclampsia by genotyping over 650 women affected by pre-eclampsia and their families at 28 SNPs in 7 candidate genes. Using transmission disequilibrium testing to distinguish maternal and fetal effects, they found that none of the genetic variants tested conferred a statistically significant risk of pre-eclampsia based on their criteria. The results emphasize the need for large, well-designed studies to reliably identify genetic risks and avoid false positives.
This document describes a systematic approach used by the authors' laboratory to assess the clinical significance of genetic variants identified through molecular genetic testing. They first search existing literature and databases to find existing data on variants. They then perform full evidence-based assessments of each variant through statistical analyses of population and disease cohort data, experimental studies, and computational predictions. Finally, they weigh all evidence to classify each variant into one of five categories regarding its potential to cause disease. They aim to help standardize variant assessment approaches through sharing their experience and tools.
Collaborative on Health and the Environment Webinar, 20 March 2019.
Study : https://diethylstilbestrol.co.uk/multigenerational-neurodevelopmental-deficits/
Analysis : https://diethylstilbestrol.co.uk/transgenerational-neurodevelopmental-deficits/
DES transgenerational effects studies : https://diethylstilbestrol.co.uk/studies/transgenerational-effects/
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
Time Bomb : a Journey into Old Exposures, Gametic Glitches, and the Autism Ex...DES Daughter
This February 2017 presentation, by Jill Escher, MA, JD, via Germline Exposure, to a student-run chapter of SFN, explained the history and science behind the "Time Bomb" hypothesis of autism.
Sources : http://www.germlineexposures.org/sfn-wonder-feb-2017.html
PDF : http://www.germlineexposures.org/uploads/6/4/0/9/6409433/sfn_escher_slides.pdf
This study examined the association between obstetrician forceps volume and maternal and neonatal outcomes using data from 2,369 forceps deliveries over 4 years at a single hospital. The key findings were:
1) Physicians in the highest quartile of annual forceps volume performed a median of 11.5 forceps deliveries per year compared to 1.3 for the lowest quartile.
2) Bivariate analysis found higher rates of severe perineal lacerations among physicians in the highest volume quartile, but no differences in adverse neonatal outcomes.
3) After adjusting for patient characteristics, there was no significant association between physician volume quartile and severe perineal lacerations or adverse
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
This study characterized the risk factors, characteristics, and comorbidities of 173 Brazilian patients with cleft lip and/or cleft palate (CL/P). Most patients were male with cleft lip and palate. Common neonatal issues included jaundice and respiratory distress. Associated comorbidities included anemia, respiratory diseases, and cardiovascular diseases. Many patients had delayed neuropsychomotor development or speech delays. A high proportion of patients had not received recommended lip or palate surgery by the standard ages. The study found high frequencies of parental consanguinity, familial recurrence of CL/P, and maternal exposures like alcohol and smoking during pregnancy that could increase CL/P risk. Characterizing this patient population is important
Vita D Supple Breatfed Infants Pediatrics 2010alisonegypt
This document summarizes a study examining the use of supplemental vitamin D among infants who were breastfed for prolonged periods. The study found that among infants who were predominantly breastfed for at least 6 months, the rate of receiving supplemental vitamin D was only 15.9%. Parental decisions about vitamin D supplementation were significantly associated with whether the parent agreed their pediatrician recommended it and whether they believed breast milk contains all needed nutrition. Educational efforts are needed to increase compliance with guidelines recommending all breastfed infants receive vitamin D supplementation.
Genetic testing analyzes human DNA to detect genotypes, mutations, and karyotypes for clinical purposes. There are two main types - constitutional tests for inherited disorders impact patients and families by providing diagnostic and reproductive information, while acquired disease tests like cancer genetics help with diagnosis, prognosis and treatment selection. Genetic testing is increasingly relevant to many aspects of life.
Genetic counseling is a communication process that advises individuals and families about genetic disorders and associated risks. It helps them understand medical, psychological and familial implications. The process involves taking a family history, constructing a pedigree, estimating genetic risks, and providing information and management options. Genetic counselors work with prenatal, pediatric, and adult populations, as well as those with cancer risks. They discuss testing options like amniocentesis and address ethical issues around choices like abortion. Nurses play a role in guiding patients, assisting with decisions, coordinating care, and providing support.
This study compared mortality rates in preterm infants with respiratory distress syndrome (RDS) treated with three surfactant preparations - poractant alfa, calfactant, or beractant. Using data from over 14,000 infants treated between 2005-2009, the study found:
1) Calfactant treatment was associated with a 49.6% greater likelihood of death compared to poractant alfa.
2) Beractant treatment showed a non-significant 37% higher mortality risk compared to poractant alfa.
3) There was no significant difference in mortality between calfactant and beractant.
4) Poractant alfa treatment was associated with significantly reduced mortality compared
This randomized, multicenter trial compared the effectiveness of two natural surfactants - poractant alfa (Curosurf) and beractant (Survanta) - for the treatment of respiratory distress syndrome (RDS) in preterm infants. 293 infants weighing 750-1750g were randomized to receive an initial dose of either 100mg/kg or 200mg/kg of poractant alfa, or 100mg/kg of beractant. The primary outcome was the area under the curve for fractional inspired oxygen from 0-6 hours after the first dose. Secondary outcomes included mortality, oxygen requirements, and other measures. The study found that poractant alfa resulted in a faster reduction in oxygen needs
Bandwidth Marketing Group is an agency that provides creative marketing solutions across various industries. They customize their solutions for each client and ensure big thinking from experienced teams. Some of their clients include Gore, Allstate, Soap.com, Infasurf, and O-Cedar. They have helped launch new products and divisions, designed branding and collateral, and run promotional campaigns through various channels including print, TV, digital and events.
SOURCES
CDC Resources and Educational Tools - Educational Tools for Clinicians
DES Lecture Presentation and DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_clinicians.html
CDC Resources and Educational Tools - Educational Tools for Nurses
DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_nurses.html
CDC Resources and Educational Tools - Clinician Information
DES References > http://www.cdc.gov/des/hcp/bibliography/index.html
MORE DES DIETHYLSTILBESTROL RESOURCES
DES cases and lawsuits:
http://diethylstilbestrol.co.uk/studies/des-lawsuits/
DES studies on cancers and screening:
https://desdaughter.com/2013/09/08/diethylstilbestrol-resources-1/
DES studies on epigenetics and transgenerational effects:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-6/
DES studies on fertility:
http://diethylstilbestrol.co.uk/studies/des-and-fertility/
DES studies on gender identity and psychological health:
https://desdaughter.com/2015/12/04/diethylstilbestrol-resources-3/
DES studies on in-utero exposure to DES and side-effects:
https://desdaughter.com/2013/12/31/diethylstilbestrol-resources-4/
DES studies on pregnancy:
http://diethylstilbestrol.co.uk/studies/des-and-pregnancy/
DES studies on the genital tract:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-7/
DES videos:
https://www.youtube.com/playlist?list=PL3D4F4A11812DAE00
This document is a manuscript describing a study on the effects of maternal consumption of polyphenol-rich foods on fetal ductus arteriosus constriction in pregnant sheep. The study found that 2 weeks of polyphenol supplementation in pregnant sheep resulted in ductus arteriosus constriction in fetuses, accompanied by increased polyphenol excretion and decreased inflammatory markers in the mothers. It also observed changes in oxidative stress biomarkers in the mothers, despite some markers of oxidative damage being lower after supplementation. The results suggest that high maternal polyphenol intake can induce fetal ductal constriction through anti-inflammatory effects, and oxidative stress may be involved.
Low dose aspirin and low molecular weight heparin in recurrent miscarriageDr. Aisha M Elbareg
This study compared the effects of low dose aspirin alone versus low dose aspirin combined with low-molecular-weight heparin in treating 150 Libyan women with a history of recurrent miscarriages. Women received either low dose aspirin daily or low dose aspirin daily plus low-molecular-weight heparin injections. The combination therapy resulted in significantly fewer miscarriages and more live births compared to aspirin alone. There were no significant differences in preterm birth rates or birth weights between the groups. The combination of low dose aspirin and low-molecular-weight heparin was found to be more effective than low dose aspirin alone in maintaining pregnancy for women with a history of recurrent first trimester
Four Studies Find Association Between Zofran & Birth Defects - Press Releasewoodenwaif5291
Four epidemiological studies have found an association between the anti-nausea drug Zofran (ondansetron) and increased risks of major birth defects when taken during pregnancy. Women who took Zofran were 2-5 times more likely to have babies with heart defects or cleft palate. While Zofran is approved only for post-surgery use, doctors often prescribe it for morning sickness without studies of its effects on pregnancies. Multiple lawsuits have been filed against the drug's manufacturer, GlaxoSmithKline, for failing to disclose these risks. The document provides contact information for a law firm representing families in the ongoing Zofran litigation.
Out of the Past: Old Exposures, Heritable Effects, and Emerging Concepts for ...Jill Escher
This document discusses emerging concepts in autism research, focusing on the potential roles of germline exposures and heritable epigenetic effects. It notes the dramatic surge in autism cases and outlines current thinking on genetic and environmental contributions. However, it argues that the field has overlooked the possibility of germline mutations or epigenetic alterations caused by parental exposures that could contribute to autism in offspring. The document examines evidence that prenatal exposures like medications, cigarette smoke, and other toxins during critical windows of germline development may cause heritable effects through mutagenesis or epigenetic mechanisms. It calls for further research on transgenerational transmission of environmentally-induced autism phenotypes from germline exposures.
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
Increasing Trends in Male Reproductive Disorders, Environmental Exposures, an...DES Daughter
On this call, Dr. Skakkebaek presented his concerns about increasing trends in male reproductive disorders, including the significant global increase in incidence of germ cell tumors. He and colleagues from all over the world demonstrated that over half of all young men's semen quality does not meet the reference standard of the World Health Organization. Dr. Skakkebaek presented evidence linking testicular cancer, poor semen quality, childlessness, and rapidly decreasing fertility rates. He showed how there is little doubt that environmental factors, most likely associated with modern lifestyles, have - in a broad sense - had an adverse influence on male reproductive health. He and his group are examining a fundamental role that exposure to endocrine-disrupting chemicals may play in these trends, trends that in a few decades will result in decreasing populations in industrialized countries, and believes collaborative research is required to identify the causes of these adverse trends.
Sources: http://healthandenvironment.org/partnership_calls/18355
The study aimed to identify genetic factors associated with pre-eclampsia by genotyping over 650 women affected by pre-eclampsia and their families at 28 SNPs in 7 candidate genes. Using transmission disequilibrium testing to distinguish maternal and fetal effects, they found that none of the genetic variants tested conferred a statistically significant risk of pre-eclampsia based on their criteria. The results emphasize the need for large, well-designed studies to reliably identify genetic risks and avoid false positives.
This document describes a systematic approach used by the authors' laboratory to assess the clinical significance of genetic variants identified through molecular genetic testing. They first search existing literature and databases to find existing data on variants. They then perform full evidence-based assessments of each variant through statistical analyses of population and disease cohort data, experimental studies, and computational predictions. Finally, they weigh all evidence to classify each variant into one of five categories regarding its potential to cause disease. They aim to help standardize variant assessment approaches through sharing their experience and tools.
Collaborative on Health and the Environment Webinar, 20 March 2019.
Study : https://diethylstilbestrol.co.uk/multigenerational-neurodevelopmental-deficits/
Analysis : https://diethylstilbestrol.co.uk/transgenerational-neurodevelopmental-deficits/
DES transgenerational effects studies : https://diethylstilbestrol.co.uk/studies/transgenerational-effects/
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
Time Bomb : a Journey into Old Exposures, Gametic Glitches, and the Autism Ex...DES Daughter
This February 2017 presentation, by Jill Escher, MA, JD, via Germline Exposure, to a student-run chapter of SFN, explained the history and science behind the "Time Bomb" hypothesis of autism.
Sources : http://www.germlineexposures.org/sfn-wonder-feb-2017.html
PDF : http://www.germlineexposures.org/uploads/6/4/0/9/6409433/sfn_escher_slides.pdf
This study examined the association between obstetrician forceps volume and maternal and neonatal outcomes using data from 2,369 forceps deliveries over 4 years at a single hospital. The key findings were:
1) Physicians in the highest quartile of annual forceps volume performed a median of 11.5 forceps deliveries per year compared to 1.3 for the lowest quartile.
2) Bivariate analysis found higher rates of severe perineal lacerations among physicians in the highest volume quartile, but no differences in adverse neonatal outcomes.
3) After adjusting for patient characteristics, there was no significant association between physician volume quartile and severe perineal lacerations or adverse
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
This study characterized the risk factors, characteristics, and comorbidities of 173 Brazilian patients with cleft lip and/or cleft palate (CL/P). Most patients were male with cleft lip and palate. Common neonatal issues included jaundice and respiratory distress. Associated comorbidities included anemia, respiratory diseases, and cardiovascular diseases. Many patients had delayed neuropsychomotor development or speech delays. A high proportion of patients had not received recommended lip or palate surgery by the standard ages. The study found high frequencies of parental consanguinity, familial recurrence of CL/P, and maternal exposures like alcohol and smoking during pregnancy that could increase CL/P risk. Characterizing this patient population is important
Vita D Supple Breatfed Infants Pediatrics 2010alisonegypt
This document summarizes a study examining the use of supplemental vitamin D among infants who were breastfed for prolonged periods. The study found that among infants who were predominantly breastfed for at least 6 months, the rate of receiving supplemental vitamin D was only 15.9%. Parental decisions about vitamin D supplementation were significantly associated with whether the parent agreed their pediatrician recommended it and whether they believed breast milk contains all needed nutrition. Educational efforts are needed to increase compliance with guidelines recommending all breastfed infants receive vitamin D supplementation.
Genetic testing analyzes human DNA to detect genotypes, mutations, and karyotypes for clinical purposes. There are two main types - constitutional tests for inherited disorders impact patients and families by providing diagnostic and reproductive information, while acquired disease tests like cancer genetics help with diagnosis, prognosis and treatment selection. Genetic testing is increasingly relevant to many aspects of life.
Genetic counseling is a communication process that advises individuals and families about genetic disorders and associated risks. It helps them understand medical, psychological and familial implications. The process involves taking a family history, constructing a pedigree, estimating genetic risks, and providing information and management options. Genetic counselors work with prenatal, pediatric, and adult populations, as well as those with cancer risks. They discuss testing options like amniocentesis and address ethical issues around choices like abortion. Nurses play a role in guiding patients, assisting with decisions, coordinating care, and providing support.
This study compared mortality rates in preterm infants with respiratory distress syndrome (RDS) treated with three surfactant preparations - poractant alfa, calfactant, or beractant. Using data from over 14,000 infants treated between 2005-2009, the study found:
1) Calfactant treatment was associated with a 49.6% greater likelihood of death compared to poractant alfa.
2) Beractant treatment showed a non-significant 37% higher mortality risk compared to poractant alfa.
3) There was no significant difference in mortality between calfactant and beractant.
4) Poractant alfa treatment was associated with significantly reduced mortality compared
This randomized, multicenter trial compared the effectiveness of two natural surfactants - poractant alfa (Curosurf) and beractant (Survanta) - for the treatment of respiratory distress syndrome (RDS) in preterm infants. 293 infants weighing 750-1750g were randomized to receive an initial dose of either 100mg/kg or 200mg/kg of poractant alfa, or 100mg/kg of beractant. The primary outcome was the area under the curve for fractional inspired oxygen from 0-6 hours after the first dose. Secondary outcomes included mortality, oxygen requirements, and other measures. The study found that poractant alfa resulted in a faster reduction in oxygen needs
Bandwidth Marketing Group is an agency that provides creative marketing solutions across various industries. They customize their solutions for each client and ensure big thinking from experienced teams. Some of their clients include Gore, Allstate, Soap.com, Infasurf, and O-Cedar. They have helped launch new products and divisions, designed branding and collateral, and run promotional campaigns through various channels including print, TV, digital and events.
This study compared the effectiveness of three surfactant preparations (beractant, calfactant, and poractant alfa) in premature infants. The study used data from over 51,000 infants treated at 322 neonatal intensive care units from 2005-2010. After adjusting for factors like gestational age and use of antenatal steroids, the study found no significant differences between the three surfactants for preventing air leak syndromes, death, or bronchopulmonary dysplasia (BPD) or death. Previously reported differences in mortality between surfactants were likely due to site variation rather than true differences in effectiveness.
This document reviews the evidence from clinical trials comparing different surfactant preparations used to treat respiratory distress syndrome (RDS) in preterm infants. It discusses the benefits of natural surfactants over synthetic surfactants, noting that natural surfactants contain surfactant proteins SP-B and SP-C which enhance their function. It also summarizes four key clinical trials that directly compared the efficacy of different natural surfactant preparations (Curosurf, Survanta, Infasurf, Alveofact), noting they used different doses and treatment protocols. The document concludes that while natural surfactants are generally preferred to older synthetic preparations, results of trials comparing newer synthetic surfactants to natural surfactants are
This document summarizes evidence from randomized controlled trials comparing animal-derived surfactants and synthetic surfactants for treating respiratory distress syndrome in preterm infants. It finds that animal-derived surfactants are generally superior to synthetic surfactants in improving clinical outcomes like reducing oxygen needs and ventilation pressures. Specifically, one trial found poractant alfa was associated with lower mortality compared to the synthetic surfactant pumactant. The document also reviews trials comparing the three major animal-derived surfactants - beractant, calfactant, and poractant alfa - and finds poractant alfa is associated with more rapid improvement and fewer additional doses needed compared to the other surfactants. Differences in
Este documento trata sobre la ictericia neonatal. Explica que la ictericia fisiológica es común y transitoria, mientras que la ictericia patológica requiere evaluación y posible tratamiento. Detalla los enfoques de diagnóstico clínico y de laboratorio, así como las opciones de tratamiento como la fototerapia, medicamentos y exanguinotransfusión en ciertos casos.
The document discusses inhalants and respiratory stimulants. It defines inhalants as quick-evaporating substances whose vapors can cause mind-altering effects. Common inhalants include volatile solvents, aerosols, gases, and nitrites. Respiratory stimulants work to increase breathing rate and tidal volume by stimulating the central nervous system. Examples given include doxapram, theophylline, and almitrine. The document provides information on the respiratory system and lists various inhalants and respiratory stimulants.
Minimally invasive surfactant therapy in pretermdrsadhana86
This study evaluated a technique called minimal invasive surfactant therapy (MIST) which involves administering surfactant through a narrow bore catheter inserted into the trachea of preterm infants on continuous positive airway pressure (CPAP). The study found MIST was successfully applied in two hospitals with no significant complications. Infants receiving MIST at 25-28 weeks gestation had sustained reductions in oxygen requirements and decreased need for intubation compared to historical controls. The study concluded MIST is a promising technique for improving outcomes for preterm infants on CPAP but that a large randomized controlled trial is still needed.
Surfactant administration - Take care technique -Journal clubgopan2596
This randomized controlled trial compared the Take Care technique of administering surfactant via thin catheter during spontaneous breathing to the InSurE technique of intubation and brief ventilation. The study found the Take Care technique significantly reduced the need for mechanical ventilation in the first 72 hours and had a lower rate of bronchopulmonary dysplasia compared to InSurE. However, the study had limitations including being conducted at a single center and having insufficient power to detect differences in chronic lung disease. Further research is still needed to establish the generalizability and applicability of the Take Care technique in clinical practice.
This document discusses exogenous surfactant therapy for preterm infants. It provides guidelines on its use, including:
- Natural surfactants are preferred over synthetic versions.
- Prophylactic use within 15 minutes of life or rescue therapy improves outcomes like mortality and pneumothoraces.
- Multiple doses may be more beneficial than a single dose due to transient response and functional inactivation.
- Combining antenatal steroids and postnatal surfactant therapy has synergistic benefits and reduces mortality and morbidity.
This document discusses pulmonary surfactant, which lines the alveoli and reduces surface tension. Surfactant deficiency causes respiratory distress syndrome (RDS) in preterm infants by increasing surface tension. Surfactant contains lipids like phosphatidylcholine and proteins important for function. Natural animal-derived surfactants are superior to older synthetic surfactants without proteins. A synthetic surfactant containing a protein analogue was as effective as natural surfactants in clinical trials. Prophylactic or early surfactant treatment within 2 hours of birth reduces mortality and morbidity compared to rescue treatment after RDS onset in infants under 30 weeks.
This study investigated potential risk factors for postpartum depression using patient records from 209 women. The researchers found that formula feeding instead of breastfeeding, a history of depression, and cigarette smoking were significant risk factors for higher scores on the Edinburgh Postnatal Depression Scale, indicating probable postpartum depression. The findings support results from previous studies on risk factors for postpartum depression. A larger study is recommended to further determine risk factors.
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
This study examined the effects of maternal consumption of polyphenol-rich foods during late pregnancy on fetal ductus arteriosus blood flow dynamics. Doppler ultrasound was used to compare ductal blood flow velocities and right-to-left ventricular dimensions in 102 fetuses exposed to high maternal polyphenol intake versus 41 unexposed fetuses. Exposed fetuses had higher ductal velocities and right-to-left ventricular ratios, indicating potential inhibition of prostaglandin synthesis from polyphenols and effects on ductal constriction. The findings suggest maternal polyphenol-rich food intake during late pregnancy may impact fetal ductal dynamics and warrant changes to perinatal dietary guidance.
This study aimed to identify risk factors for death in children under 15 years old admitted for treatment of visceral leishmaniasis (VL) in northeast Brazil. The researchers reviewed records of 546 patients and found that 57 died, giving a case fatality rate of 10%. Multivariate analysis identified several independent risk factors for death: presence of mucosal bleeding increased the risk 4 times, jaundice 4 times, dyspnea (fast breathing) 3 times, suspected bacterial infections 3 times, and very low neutrophil and platelet counts 3 times and 12 times, respectively. Based on these factors, the researchers created a prognostic score that classified patients as high or low risk, with 88% sensitivity and 79% specificity.
Autism Spectrum Disorder and Particulate Matter Air Pollution before, during ...joaquin_project
Pregnant women may nearly double their risk of giving birth to a child with autism by inhaling smog spewed by vehicles or smoke stacks, according to a new Harvard study that could help unlock the deepest autism mysteries.
The research fortifies previous scientific findings that linked air pollution to autism. And it offers fresh insights by showing women in their third trimesters seem most vulnerable if they breathe in elevated levels of tiny airborne particles emitted by power plants, fires and automobiles.
This document summarizes an open clinical trial that tested the hypothesis that restricting polyphenol-rich foods (PRF) in maternal diets during the third trimester can reverse fetal ductal constriction (DC). The study found that 96% of fetuses with DC showed complete reversal after their mothers discontinued PRF for at least 3 weeks. Maternal PRF intake decreased significantly, while ductal blood flow parameters like velocity and pulsatility index normalized. In a control group where no dietary changes were made, ductal measurements did not significantly change. The results support that maternal PRF intake during pregnancy can cause DC through anti-inflammatory effects, and that restricting these foods can reverse the condition.
This study aims to identify whether a woman's diet during pregnancy is linked to her risk of developing preeclampsia. Preeclampsia affects 3-10% of pregnancies and can cause health problems for both mother and baby. This study will use food frequency questionnaires completed by 1,000 women both before and during pregnancy to analyze any connections between dietary factors and preeclampsia risk. The researchers hope to identify specific foods or nutrients that may increase preeclampsia risk so dietary advice can be given to help reduce rates of maternal and neonatal complications.
Perinatal magnesium administration and the prevention of periventricular leuk...Ross Finesmith M.D.
This study examined the effect of magnesium sulfate (MgSO4) on the development of cystic periventricular leukomalacia (cPVL) in preterm infants. The researchers conducted a retrospective case-control study of 492 preterm infants born between 1992-1994 weighing less than 1750g who survived at least 7 days. They found infants exposed to MgSO4 in utero were less likely to develop cPVL. Specifically, 2 of 18 infants with cPVL were exposed to MgSO4 compared to 14 of 36 controls, indicating MgSO4 exposure is associated with a reduced risk of cPVL. Further analysis confirmed the groups were similar in other variables and preeclampsia alone did
Magnesium Prevents the Cerebral Palsy Precursor in Premature InfantsRoss Finesmith M.D.
To determine if magnesium sulfate has an effect on the development of cystic
periventricular leukomalacia in preterm infants, this retrospective case control study
was conducted. There were 23,382 infants born at three teaching hospitals in the metropolitan New York area from January 1992 to December 1994. Four hundred ninety-two infants met our entrance criteria. Criteria included a birth weight less than 750 g, survival to at least 7 days of life and at least one cranial ultrasound after 7 days of life.
Infants exposed to magnesium sulfate in utero were less likely to develop periventricular
leukomalacia. Two of 18 (11%) infants with periventricular leukomalacia were
exposed to magnesium sulfate in-utero compared to 14 of 36 controls (39%) (p =
0.035) (OR = 0.196, 95% Cl = 0.039-0.988). Pre-eclampsia as an independent factor
was not associated with a reduced risk (p = 0.251) (OR = 0.294, 95% Cl =
0.033-2.65). Preterm infants exposed to antenatal magnesium sulfate were found to
have a reduced risk of developing cystic periventricular leukomalacia.
This document describes a study that examined practice variation in the diagnosis and treatment of chorioamnionitis among US obstetricians. The study involved distributing a survey to 500 obstetricians querying their demographics, practice setting, and chorioamnionitis management strategies. 212 surveys were analyzed. The results found wide variation in diagnostic criteria, antibiotic regimens, and postpartum treatment duration. Specifically, over 25 different antibiotic regimens were reported, with 30% using a single agent. Postpartum treatment duration ranged from no treatment to 48 hours. No practitioner characteristics were independently associated with diagnostic or treatment strategies. This variation may reflect a lack of high-quality evidence on best practices for chorio
This study examined maternal and fetal outcomes in term premature rupture of membranes (PROM) using medical records from a hospital in Ethiopia between 2011-2013. The study found that 22.2% of women experienced unfavorable maternal outcomes like puerperal sepsis. 33.5% of neonates experienced unfavorable outcomes like stillbirth. Factors associated with unfavorable outcomes included residing in a rural area, duration of PROM over 12 hours, latency over 24 hours, and birth weight under 2500g. The study aims to identify factors that can help reduce complications from term PROM and improve outcomes.
This study compared the efficacy of two animal-derived surfactants, poractant alfa and beractant, in treating respiratory distress syndrome (RDS) in preterm infants. The study found that infants treated with poractant alfa required significantly less oxygen in the first 5 days after treatment compared to those treated with beractant. Infants in the poractant alfa group also had higher rates of extubation within 3 days. Additionally, poractant alfa treatment resulted in fewer infants requiring multiple doses of surfactant compared to beractant treatment. While mortality and other outcomes were similar between groups, survival without bronchopulmonary dysplasia at the end of the study period was significantly higher
1) The document proposes a new model of prenatal care based on a comprehensive assessment at 11-13 weeks of gestation. This assessment uses maternal characteristics, ultrasound findings, and biochemical testing to determine patient-specific risks for various pregnancy complications.
2) Most major fetal aneuploidies, structural abnormalities, and a variety of pregnancy complications can potentially be identified or assessed at high risk during the 11-13 week assessment.
3) Based on the risk assessment, most women would be classified as low risk and require fewer prenatal visits, while high risk women would receive specialized monitoring and treatment. This shifts prenatal care from routine visits to a personalized, disease-specific approach.
Lipid Screening in Childhood for Detection of Multifactorial DyslipidemiaGlobal Medical Cures™
Lipid Screening in Childhood for Detection of Multifactorial Dyslipidemia
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
1. The study examined the association between prenatal air pollution exposure and childhood IQ in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood cohort.
2. Prenatal exposure to particulate matter (PM10) was associated with slightly lower full-scale IQ scores in children, while nitrogen dioxide and road proximity were not associated.
3. The association between PM10 and IQ appeared to be modified by maternal plasma folate levels during pregnancy, with a stronger negative association observed among children of mothers in the lowest folate quartile.
Breastfeeding And The Risk Of Postneonatal Death In The United StatesBiblioteca Virtual
This study examined the association between breastfeeding and postneonatal mortality in the United States using data from the 1988 National Maternal and Infant Health Survey. The study found that children who were ever breastfed had a 21% lower risk of postneonatal death compared to children who were never breastfed. Longer durations of breastfeeding were associated with even lower risk. The protective effect of breastfeeding was seen across different causes of postneonatal death, including infections, injuries, and sudden infant death syndrome.
This document discusses guidelines for screening and testing adolescents for pregnancy before undergoing radiologic procedures. It notes that adolescents aged 12 and older should be screened due to the risks of radiation exposure to a potential pregnancy. A case study of a 13-year-old girl presenting for an abdominal CT scan illustrates how to determine if screening is needed based on her menstrual history and risk factors, obtain consent for pregnancy testing, and determine how to share results while maintaining confidentiality. The document reviews adolescent development, sexuality, and guidelines for determining pregnancy risk to guide radiology staff in properly screening and testing adolescent patients.
1- Differentiate between primary and secondary sources and provide an.pdfcontact28
1. Differentiate between primary and secondary sources and provide an example for each one. 2.
Describe the similarities and differences between a research paper and a review paper. 4. Is the
following Abstract from a research article? Abstract People of African ancestry (Blacks) have an
increased risk of kidney failure due to numerous socioeconomic, environmental, and clinical
factors. Two variants in the APOL1 gene are now thought to account for much of the racial
disparity associated with hypertensive kidney failure in Blacks. However. this knowledge has not
been translated into clinical care to help improve patient outcomes and address disparities.
GUARDD is a randomized trial to evaluate the effects and challenges of incorporating genetic
risk information into primary care. Hypertensive, non-diabetic, adults with self-reported African
ancestry. without kidney dysfunction, are recruited from diverse clinical settings and randomized
to undergo APOL1 genetic testing at baseline (intervention) or at one year (waitlist control).
Providers are educated about genomics and APOL1. Guided by a genetic counselor, trained staff
return APOL1 results to patients and provide low-literacy educational materials. Real-time
clinical decision support ols alert clinicians of their patients' APOL1 results and associated risk
status at the point of care. Our academiccommunity-clinical partnership designed a study to
generate information about the impact of genetic risk information on patient care (blood pressure
and renal surveillance) and on patient and provider knowledge, attitudes, beliefs, and behaviors.
GUARDD will help establish the effective implementation of APOLL risk-informed
management of hypertensive patients at high risk of CKD, and will provide a robust framework
for future endeavors to implement genomic medicine in diverse clinical practices. It will also add
to the important dialog about factors contributing to and may help eliminate racial disparities in.
kidney disease. True: False 5. Of the 3 titles listed below, which title(s) is suitable for a review
paper: a. Chronic Kidney Disease Diagnosis and Management b. Determining the Effects and
Challenges of Incorporating Genetic Testing into Primary Care Management of Hypertensive
Patients with African Ancestry c. Pharmacist Intervention for Blood Pressure Control in Patients
with Diabetes and/or Chronic Kidney Disease d. all of the above 6. Which reference style is used
for citing electronic journal articles. a. DOI b. APA c. NLM d. MLA e. all of the above f. none of
the above.
LESSON 12 Paying for Care and Health Information LEA.docxSHIVA101531
LESSON 12
Paying for Care and Health Information
LEARNING OUTCOMES
______________________________________________________________________________
In this lesson, you will do the following:
Describe how coding, reimbursement, and billing are impacted by health information systems.
READINGS
The following reading assignments are for Lessons 9 through 12:
Gartee Text:
Chapter 4, pp. 74 - 95
Chapter 5, pp. 98 - 126
Chapter 6, pp. 127 - 151
Chapter 9, pp. 208 - 236
Chapter 10, pp. 237 - 259
ACTIVITIES / ASSESSMENTS
The following activities/assessments are for Lessons 9 through 12:
1. Read the assigned pages from the Gartee text.
2. Review the Lecture Notes, Unit 3 PowerPoint, and Voice Pod.
3. Participate in the weekly discussion question.
4. Complete the written assignment.
WRITTEN ASSIGNMENTS
Hospital Medicare Payment System - DRGs:
Research how large hospitals are paid by a Medicare fee for service reimbursements (DRG’s).
Include a brief history and relate how health information supports the request for a payment.
PLEASE NOTE: All graded assignments for the lessons in this unit should be grouped together
and submitted as ONE document using the Assignment Submission form accessed from your
course homepage or http://www.sjcme.edu/gps/assignments.
All activities/assignments for this unit should be as follows:
1. Should include a cover sheet for each assignment stating the following:
Course (HA 214)
Your Name
Unit and Lesson Number
Date Submitted
2. Each individual assignment number and copy of the assignment directions should be
included in the submission as the starting header of each lesson.
3. Carefully check grammar and spelling.
4. Use APA format for any research or sources that are being used or quoted.
5. Email the instructor if you have questions regarding the assignments.
http://www.sjcme.edu/gps/assignments
g
Research www.AJOG.org
O B S T E T R I C S
Preterm premature rupture of membranes >32 weeks’
estation: impact of revised practice guidelines
Arij Faksh, DO; Joseph R. Wax, MD; F. Lee Lucas, PhD; Angelina Cartin; Michael G. Pinette, MD
OBJECTIVE: The purpose of this study was to determine the perinatal
impact of the 2007 American College of Obstetricians and Gynecolo-
gists Practice Bulletin on preterm premature membrane rupture.
STUDY DESIGN: Perinatal outcomes were compared in women who
had experienced preterm membrane rupture in the 3 years before the
2007 Practice Bulletin to similar women who experienced preterm pre-
mature rupture of membranes in the 3 years after the issue and imple-
mentation of the guideline.
RESULTS: After adjustment for gestational age at membrane rupture
and steroids, composite severe morbidity (death, respiratory distress
Obstet Gynecol 2011;205:340.e1-5.
p
remained uncertain, p
doi: 10.1016/j.ajog.2011.05.036
340.e1 American Journal of Obstetrics & Gynecology OCTOB ...
Similar to Articulo revision surfactantes 2011 (20)
Este documento presenta una guía para realizar farmacovigilancia. Explica los objetivos de la farmacovigilancia como promover el uso seguro y racional de medicamentos y evaluar riesgos y beneficios. También define conceptos clave como eventos adversos e inesperados y describe métodos para notificar reacciones adversas a medicamentos.
Este documento proporciona información sobre varios productos farmacéuticos de Novamed S.A., incluyendo sus indicaciones, componentes activos y beneficios. Resalta que estos productos están diseñados para el cuidado de la salud de la mujer y cubren áreas como deficiencias nutricionales, salud reproductiva, infecciones vaginales, trastornos venosos y dolor menstrual. También incluye referencias bibliográficas.
This study evaluated the efficacy and safety of bronchoalveolar lavage (BAL) with diluted porcine surfactant in 8 mechanically ventilated term infants with acute respiratory distress syndrome (ARDS) due to meconium aspiration syndrome (MAS). Infants received BAL with 15 mL/kg of diluted porcine surfactant. BAL improved oxygenation and chest x-ray findings at 3 and 6 hours post-treatment without adverse effects. Radiological improvement was seen in all infants by 6 hours. Oxygenation parameters including a/ApO2 ratio and oxygenation index significantly improved. BAL was well tolerated and no adverse events occurred.
Surfactante tratamiento prevencion y tratamientoMauricio Piñeros
The document summarizes clinical trials comparing animal-derived surfactants for treating neonatal respiratory distress syndrome. It finds:
1) Calfactant provides short-term benefits like faster weaning from ventilation compared to beractant, likely due to its higher surfactant protein B content, though it does not reduce mortality or oxygen need at 36 weeks.
2) Studies found no clear advantage of alveofact over beractant, as alveofact's higher surfactant protein B is balanced by beractant's higher phospholipid dose.
3) Poractant may have advantages over beractant for some secondary outcomes when a higher initial dose is used, strengthening the case for poract
This document summarizes the history of research into surfactants and their use in treating respiratory distress syndrome (RDS) in preterm infants. It discusses early experiments in the 1920s and 1950s that helped identify the role of surfactants. Major milestones included the 1959 study demonstrating RDS is caused by a surfactant deficiency, the first animal and human trials of surfactant treatments in the 1970s and 1980s, and randomized controlled trials in the 1980s that established natural surfactants as superior to early synthetic versions. The use of surfactant therapy has since reduced mortality from RDS significantly.
This randomized clinical trial compared two treatment regimens of natural surfactant preparations, Curosurf and Survanta, in 75 neonates with respiratory distress syndrome (RDS). Infants receiving Curosurf had a more rapid improvement in oxygenation and required lower ventilatory support up to 24 hours after treatment compared to those receiving Survanta. Complication rates including pneumothorax and severe intracranial hemorrhage were lower in the Curosurf group, though differences were not statistically significant. The Curosurf treatment regimen resulted in faster clinical improvement for RDS.
Five randomized controlled trials involving 529 preterm infants compared the efficacy of porcine surfactant (poractant alfa) to bovine surfactant (beractant) for the treatment of respiratory distress syndrome. The studies found that high-dose poractant alfa significantly reduced deaths and the need for re-dosing compared to beractant, but low-dose poractant alfa did not show a significant difference. No trials compared poractant alfa to calfactant.
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- The study compared the effects of beractant and poractant surfactants in treating 58 premature infants with respiratory distress syndrome (RDS).
- Infants who received poractant had a lower oxygen requirement in the first 48 hours compared to beractant. They also had fewer cases of patent ductus arteriosus.
- There were no significant differences between the groups in outcomes like time to extubation, total ventilation time, or rates of bronchopulmonary dysplasia.
This study compared the efficacy of two surfactant treatments, poractant alfa and beractant, in very premature infants with respiratory distress syndrome. Fifty-two infants between 24 and 29 weeks gestation were randomly assigned to receive either poractant alfa or beractant. The study found that infants receiving poractant alfa required lower respiratory support as measured by mean airway pressure and respiratory index over the first 72 hours of life. Additionally, more infants in the poractant alfa group were extubated by 48 and 72 hours compared to the beractant group. While the study was not powered to detect differences in morbidities, rates of bronchopulmonary dysplasia and death were
This study evaluated the effects of two surfactant treatments, poractant alfa and beractant, on patent ductus arteriosus (PDA) hemodynamics in very premature infants with respiratory distress syndrome (RDS). 50 infants were randomized to receive either poractant alfa or beractant. Infants treated with poractant alfa had a lower rate of clinically significant PDAs, lower right ventricle pressure to systemic arterial pressure ratio in the first week, and earlier extubation than those treated with beractant. Neither surfactant had a direct effect on PDA hemodynamics following a second dose.
This document provides consensus guidelines from a panel of European experts on the management of neonatal respiratory distress syndrome (RDS). Key points include:
1. Prenatal corticosteroids are recommended for women at risk of preterm birth to reduce the risk of RDS and improve neonatal outcomes. A single course is recommended, though repeated courses remain controversial.
2. Resuscitation of preterm infants should use the lowest possible oxygen concentration while maintaining adequate heart rate. Continuous positive airway pressure (CPAP) is recommended to stabilize the airway.
3. Surfactant therapy is crucial for treating RDS and reduces mortality and air leaks. Prophylactic surfactant is recommended for infants <27
Eficacia de poractan vs beractan en sra metanalisisMauricio Piñeros
This systematic review and meta-analysis examined 5 randomized controlled trials comparing the efficacy of porcine surfactant (poractant alfa) to bovine surfactants (beractant and calfactant) in preterm newborns with respiratory distress syndrome. The studies involved a total of 529 infants. No significant differences were found between poractant alfa and beractant in rates of oxygen dependence at 36 weeks. High-dose poractant alfa was associated with significant reductions in mortality, need for re-dosing, oxygen requirements and duration of oxygen therapy and ventilation compared to beractant. Low-dose poractant alfa did not significantly reduce these outcomes compared to beractant.
The document summarizes a study that compared outcomes for 150 premature infants treated with two different natural surfactants: poractant alfa (Curosurf) and beractant (Survanta). The study found that infants treated with poractant alfa had a significantly shorter duration of intubation but no significant differences in other outcomes like mortality, morbidity, duration of oxygen therapy or hospitalization between the two groups. While poractant alfa appeared superior in reducing intubation time, the study concluded there was no clear overall superiority of one surfactant over the other.
This study compared the effects of beractant and poractant surfactant treatments in 58 premature infants with respiratory distress syndrome (RDS). The main findings were:
1) Infants who received poractant had a lower oxygen requirement (FiO2) during the first 48 hours compared to infants who received beractant.
2) Infants who received poractant also had fewer cases of patent ductus arteriosus (PDA) than infants who received beractant.
3) There was no significant difference between the groups in factors like time to first extubation, total intubation time, or rates of bronchopulmonary dysplasia.
Este estudio comparó dos surfactantes naturales, porcino (poractant alfa) y bovino (beractant), en el tratamiento profiláctico del síndrome de dificultad respiratoria en recién nacidos prematuros. Se encontró que el poractant alfa requirió menor fracción de oxígeno inspirado y tiempo de ventilación mecánica, y tuvo menor incidencia de SDR, enfermedad pulmonar crónica, retinopatía del prematuro y necesidad de múltiples dosis que el ber
This document provides updated European consensus guidelines for the management of neonatal respiratory distress syndrome (RDS) in preterm infants. Key recommendations include:
- Administering a single course of antenatal corticosteroids to women at risk of preterm birth between 23 and 34 weeks gestation.
- Delaying umbilical cord clamping for at least 60 seconds after birth to promote placental transfusion in preterm infants.
- Using targeted oxygen levels between 21-30% during delivery room stabilization and guiding adjustments with pulse oximetry.
- Stabilizing spontaneously breathing preterm infants with CPAP of at least 5-6 cm H2O via mask or nasal prongs.
- Reser
This study examined the pharmacokinetics of porcine surfactant in 61 preterm infants with respiratory distress syndrome (RDS) who received doses of either 100 mg/kg or 200 mg/kg. Tracheal aspirates were collected from infants over time and analyzed for the presence of a stable isotope label added to the surfactant. Higher and longer-lasting levels of the surfactant marker were found in infants receiving 200 mg/kg compared to 100 mg/kg, along with fewer needing repeat doses and better oxygenation. The results suggest that a 200 mg/kg dose of porcine surfactant may be more effective for treating RDS in preterm infants.
This study compared outcomes for premature infants with respiratory distress syndrome (RDS) treated with three natural surfactant preparations: Alveofact, Poractant, or Beractant. The study found that infants treated with Alveofact or Poractant spent fewer days on ventilators and needing oxygen supplementation compared to Beractant, but there were no significant differences in mortality or other morbidities between the groups. This suggests that Alveofact and Poractant may provide quicker improvement in respiratory status for RDS infants compared to Beractant.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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One health condition that is becoming more common day by day is diabetes.
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1. Journal of Perinatology (2011), 1–7
r 2011 Nature America, Inc. All rights reserved. 0743-8346/11
www.nature.com/jp
ORIGINAL ARTICLE
Mortality in preterm infants with respiratory distress
syndrome treated with poractant alfa, calfactant or beractant:
a retrospective study
R Ramanathan1, JJ Bhatia2, K Sekar3 and FR Ernst4
1
LAC þ USC Medical Center and Children’s Hospital Los Angeles, Los Angeles, CA, USA; 2Division of Neonatology, Medical College of
Georgia, Georgia Health Sciences University, Augusta, GA, USA; 3Department of Pediatrics, University of Oklahoma Health Sciences
Center, Oklahoma City, OK, USA and 4Premier Research Services, Premier healthcare alliance, Charlotte, NC, USA
Objective: The objective of this study is to compare all-cause in-hospital
mortality in preterm infants with respiratory distress syndrome (RDS)
treated with poractant alfa, calfactant or beractant.
Study Design: A retrospective cohort study of 14 173 preterm infants
with RDS, treated with one of three surfactants between 2005 and 2009,
using the Premier Database was done. Multilevel, multivariable logistic
regression modeling, adjusting for patient- and hospital-level factors was
performed.
Result: Calfactant treatment was associated with a 49.6% greater
likelihood of death than poractant alfa (odds ratio (OR): 1.496, 95%
confidence interval (CI): 1.014–2.209, P ¼ 0.043). Beractant treatment
was associated with a non-significant 37% increase in mortality,
compared with poractant alfa (OR: 1.370, 95% CI: 0.996–1.885,
P ¼ 0.053). No differences in mortality were observed between calfactant
and beractant treatment (OR: 1.092, 95% CI: 0.765–1.559, P ¼ 0.626).
Conclusion: Poractant alfa treatment for RDS was associated with a
significantly reduced likelihood of death when compared with calfactant
and a trend toward reduced mortality when compared with beractant.
Journal of Perinatology advance online publication, 1 September 2011;
doi:10.1038/jp.2011.125
Keywords: surfactant; mortality; respiratory distress syndrome;
poractant alfa; calfactant; beractant
Introduction
Preterm births continue to increase in spite of major advances in
perinatal care, especially in developed countries.1 Prematurity and
low birth weight (LBW, < 2500 g) accounted for 16.5% of all
Correspondence: Dr FR Ernst, Premier Research Services, Premier healthcare alliance, 13034
Ballantyne Corporate Place, Charlotte, NC 28277, USA.
E-mail: frank_ernst@premierinc.com
Received 16 March 2011; revised 22 July 2011; accepted 25 July 2011
infant deaths in 2005 and was the second leading cause of infant
mortality.2 Respiratory distress syndrome (RDS) is the most
common cause of respiratory distress in preterm infants and occurs
in nearly 50% of preterm infants born at less than 30 weeks of
gestation.3
Treatment with surfactant for RDS has been shown to
significantly decrease pneumothorax, and neonatal and infant
mortality.3–8 The animal-derived surfactants, poractant alfa
(Curosurf, Chiesi Farmaceutici SpA, Parma, Italy), calfactant
(Infasurf, Ony, St Louis, MO, USA) and beractant (Survanta, Abbott
Nutrition, Columbus, OH, USA) have been shown to be associated
with greater early improvement in the requirement for ventilatory
support, fewer pneumothoraces and reduced mortality when
compared with treatment with first-generation synthetic
surfactants.9,10
Nine randomized, controlled clinical trials (RCTs)11–17 and one
retrospective study18 comparing these surfactant preparations in
the setting of RDS treatment have now been published. No
significant differences in mortality were found in the four trials
that compared beractant with calfactant.11,12 Among the five trials
that compared beractant with poractant alfa,13–16 one reported
significantly lower mortality with poractant alfa in infants p32
weeks gestational age.15 Furthermore, in a meta-analysis of
comparative trials, mortality was significantly lower (relative risk:
0.57, 95% CI: 0.34–0.96, P<0.05) with poractant alfa compared
with beractant.3 In the only retrospective study published to date
comparing surfactants, Clark et al.18 found no significant
differences in all-cause mortality between beractant- and
calfactant-treated patients overall or in any birth weight (BW)
subgroups.
There are no published studies comparing mortality in preterm
infants treated with the three animal-derived surfactants available
in the US. RCTs using mortality as a primary outcome require
large sample size, are expensive, and may take several years to
complete. The difficulties with conducting comparative RCTs in
premature infants with RDS are evidenced by the premature
2. Neonatal mortality with animal-derived surfactant use
R Ramanathan et al
2
interruption of studies aimed at comparing different surfactant
preparations in terms of mortality or bronchopulmonary
dysplasia due to insufficient enrollment.12 To overcome these
hurdles, we used data from a large national hospital
database to assess whether there were differences in all-cause
mortality among preterm infants treated with poractant alfa,
calfactant or beractant.
Patients and methods
A retrospective observational cohort analysis was conducted
using the US hospital administrative data from the Premier
Database.19–20 The Premier Database is a large US
hospital-based database, containing information on approximately
5.5 million annual hospital discharges (approximately onefifth of all acute care hospitalizations in the US) with day-by-day
service level detail. The Premier Data included hospitalizations
from more than 600 hospitals, approximately 30 of which
were children’s hospitals or had children’s hospital facilities.
These hospitals utilize the database for quality and
utilization benchmarking. Hospitals submit data to the database,
which undergo quality checks and validation. As well, the data are
also used by the US government agencies such as the Food
and Drug Administration and Centers for Medicare and
Medicaid Services.19,20
The analyses were conducted using de-identified data in
compliance with the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). No institutional review board
approval for the study was sought, as, in addition to being HIPAA
compliant, the de-identified nature of the database would preclude
the researchers from identifying any hospital sites or patients. The
study was designed to compare all-cause in-hospital mortality,
defined by the discharge status of ‘expired’, in preterm infants
treated with poractant alfa, calfactant or beractant.
Study population
Infants were included in the study if they were discharged as an
inpatient from a Premier Database hospital from 1 January 2005,
through 31 December 2009. Inclusion criteria for the study
included having gestational age of 25–32 weeks, BW 500–1999 g,
diagnosis of RDS, age p 2 calendar days, when they received the
first dose of surfactant, and having received only one of the three
study surfactants.
Patients were excluded from the study in case of missing values
for any of the variables planned a priori to be included in the
logistic regression model, if they received more than one surfactant
during their hospitalization, or if there was evidence of congenital
abnormalities such as trisomy 13 or 18, anencephaly or dwarfism.
Information on diagnosis of RDS, gestational age at birth, BW and
congenital anomalies was obtained from International
Classification of Diseases, 9th Revision, Clinical Modification
(ICD-9) codes.
Journal of Perinatology
Statistical analysis
Patient demographics and hospital characteristics were compared
between treatment groups using the w2-test for categorical
variables. The comparison between surfactants in terms of
mortality was based on a mixed multilevel, multivariable logistic
regression model. The multilevel structure accounted for clustering
of infants within hospitals, including a random center effect in the
model.21 Other than the type of surfactant, the following patientlevel factors were included in the model to control for potentially
confounding variables: gestational age (categorized into 2-week
groups, from 25–26 weeks to 31–32 weeks), BW (categorized into
250-g groups, from 500–749 g to 1750–1999 g), gender, race, 3M
All Patient Refined Diagnosis Related Group severity of illness
category and risk of mortality category.22,23 Furthermore, the
following hospital-level factors were included as covariates: US
Census region, population served (urban/rural), teaching status
(teaching/non-teaching) and hospital size (categorization based
on the number of beds).
To assess the sensitivity of the results, three alternative models
were estimated. In the first of these, gestational age at birth was
excluded from the factors due to the potential inaccuracy in
gestational dating.24 In the second model, the covariates were
submitted to a backward selection procedure (removal from the
model if P>0.1) to reduce the number of parameters and to obtain
more stable estimates of the effects of the surfactants. In the third
sensitivity model, the year during which the hospital discharge
occurred was added as a covariate to account for potential trends in
mortality over time. All statistical analyses were performed using
SAS 9.1.3 (SAS Institute Cary, NC, USA).
Results
A total of 14 173 infants discharged from 236 hospitals were
included in the study population. Patient demographics and
hospital characteristics of the study population are shown in
Table 1.
Overall, the unadjusted all-cause in-hospital mortality rates
were 3.61% (n ¼ 184) in the poractant alfa group, 5.95%
(n ¼ 201) in the calfactant group, and 4.58% (n ¼ 261) in the
beractant group. When stratified by BW, as shown in Figure 1, the
lowest mortality rate was always observed in the poractant alfa
group, except for the category 1250–1499 g, where beractanttreated infants had the lowest mortality. Mortality was significantly
lower for infants 500–749 g, who received poractant alfa (11.72%)
than for those who received calfactant (20.67%, P<0.001) or
beractant (17.39%, P ¼ 0.011). In the 1000–1249 g BW category,
mortality was significantly higher in the calfactant group (5.46%)
than in the poractant alfa (2.67%, P ¼ 0.002) and beractant
(3.54%, P ¼ 0.035) groups.
The results of the multilevel, multivariable logistic regression
model for all-cause in-hospital mortality are shown in Figure 2.
3. Neonatal mortality with animal-derived surfactant use
R Ramanathan et al
3
Table 1 Patient demographics and hospital characteristics by surfactant treatment
Poractant alfa
Calfactant
Beractant
All
P vs C
3378
(100.0)
5698
(100.0)
14 173
653
(12.8)
832
(24.3)
1196
(21.0)
2681
918
1022
(18.0)
(20.1)
802
578
(23.7)
(17.1)
1363
1135
(23.9)
(19.9)
3083
2735
1252
(24.6)
558
(16.5)
991
(17.4)
2801
1252
(24.6)
608
(18.0)
1013
(17.8)
2873
1016
(19.9)
754
(22.3)
1272
(22.3)
3042
1309
(25.7)
936
(27.7)
1544
(27.1)
3789
1427
1345
(28.0)
(26.4)
909
779
(26.9)
(23.1)
1602
1280
(28.1)
(22.5)
3938
3404
(9.7)
329
(9.7)
506
(8.9)
1330
<0.001
(27.8)
(24.0)
495
<0.001
(26.7)
29–30 weeks
31–32 weeks
<0.001
(21.5)
27–28 weeks
0.008
(20.3)
25–26 weeks
<0.001
(19.8)
2009
<0.001
(21.8)
(19.3)
2008
<0.001
(18.9)
2006
2007
<0.001
(100.0)
2005
0.179
<0.001
(100.0)
0.489
(%)
5097
0.437
<0.001
n
0.002
<0.001
(%)
0.629
<0.001
n
<0.001
0.475
(%)
<0.001
0.451
n
<0.001
<0.001
(%)
C vs B
<0.001
n
P vs B
(9.4)
Discharges
Calendar year of discharge
Gestational age
Birth weight
500–749 g
750–999 g
1164
(22.8)
806
(23.9)
1419
(24.9)
3389
(23.9)
1000–1249 g
1160
(22.8)
770
(22.8)
1358
(23.8)
3288
(23.2)
1250–1499 g
959
(18.8)
664
(19.7)
1105
(19.4)
2728
(19.2)
1500–1749 g
1750–1999 g
806
513
(15.8)
(10.1)
498
311
(14.7)
(9.2)
822
488
(14.4)
(8.6)
2126
1312
(15.0)
(9.3)
Female
2308
(45.3)
1503
(44.5)
2618
(45.9)
6429
(45.4)
Male
2789
(54.7)
1875
(55.5)
3080
(54.1)
7744
(54.6)
2920
1343
(57.3)
(26.3)
2185
866
(64.7)
(25.6)
2763
2100
(48.5)
(36.9)
7868
4309
(55.5)
(30.4)
Hispanic
564
(11.1)
251
(7.4)
698
(12.2)
1513
(10.7)
Other
270
(5.3)
76
(2.2)
137
(2.4)
483
(3.4)
47
(0.9)
33
(1.0)
46
(0.8)
126
(0.9)
2 ¼ moderate
561
(11.0)
268
(7.9)
418
(7.3)
1247
(8.8)
3 ¼ major
4 ¼ extreme
2436
2053
(47.8)
(40.3)
1395
1682
(41.3)
(49.8)
2670
2564
(46.9)
(45.0)
6501
6299
(45.9)
(44.4)
1 ¼ minor
1401
(27.5)
725
(21.5)
1422
(25.0)
3548
(25.0)
2 ¼ moderate
1907
(37.4)
1184
(35.1)
2128
(37.3)
5219
(36.8)
3 ¼ major
1472
(28.9)
1218
(36.1)
1783
(31.3)
4473
(31.6)
317
(6.2)
251
(7.4)
365
(6.4)
933
(6.6)
371
(7.3)
648
(19.2)
450
(7.9)
1469
(10.4)
(13.3)
Gender
Race
White
Black
3M APR-DRG severity of illness
1 ¼ minor
3M APR-DRG risk of mortality
4 ¼ extreme
US census region of treating hospital
Northeast
Midwest
808
(15.9)
173
(5.1)
899
(15.8)
1880
South
2715
(53.3)
2466
(73.0)
3988
(70.0)
9169
(64.7)
West
1203
(23.6)
91
(2.7)
361
(6.3)
1655
(11.7)
Journal of Perinatology
4. Neonatal mortality with animal-derived surfactant use
R Ramanathan et al
4
Table 1 Continued
Poractant alfa
Calfactant
Beractant
All
P vs C
(%)
n
(%)
n
4758
(93.3)
3313
(98.1)
5219
(91.6)
13290
339
(6.7)
65
(1.9)
479
(8.4)
883
3199
(62.8)
2281
(67.5)
3325
(58.4)
8805
1898
(37.2)
1097
(32.5)
2373
(41.6)
5368
(37.9)
1
(0.02)
87
(2.6)
55
(1.0)
143
<0.001
(62.1)
Non-teaching
<0.001
(6.2)
Teaching
<0.001
(93.8)
Rural
<0.001
(%)
Urban
<0.001
<0.001
n
<0.001
<0.001
(%)
C vs B
<0.001
n
P vs B
(1.0)
Population served by treating hospital
Teaching status of treating hospital
Size (no. of beds) of treating hospital
<100
100–299
698
(13.7)
441
(13.1)
824
(14.5)
1963
(13.9)
300–499
2325
(45.6)
736
(21.8)
1760
(30.9)
4821
(34.0)
500+
2073
(40.7)
2114
(62.6)
3059
(53.7)
7246
(51.1)
Abbreviations: 3M APR-DRG, 3M All Patient Refined Diagnosis Related Group; B, beractant; C, calfactant; P, poractant alfa.
P-values are based on the w2-test.
Bold values are statistically significant.
These results were supported by the sensitivity analyses
performed. The increase in the likelihood of death with
calfactant compared with poractant alfa was significant in
the first two alternative models (51.9% increase, P ¼ 0.036 in the
model excluding gestational age and 56.3%, P ¼ 0.016 in the
backward selection model) and non-significant in the third
model adding discharge year (35.0% increase, P ¼ 0.134).
The trend towards an increased mortality with beractant
compared with poractant alfa that was observed in the main model
reached statistical significance in the first two alternative
models (38.2% increase, P ¼ 0.048 and 37.7%, P ¼ 0.040,
respectively), but did not reach significance in the third
model (24.7% increase, P ¼ 0.179). In all alternative models,
no differences in mortality were observed between calfactant
and beractant.
Figure 1 Unadjusted mortality rates by BW among the three surfactant-treated
groups.
Calfactant was found to be associated with a 49.6% greater
likelihood of death than poractant alfa (odds ratio (OR): 1.496,
95% confidence intervals (CI): 1.014–2.209, P ¼ 0.043). Beractant
treatment was associated with a 37.0% increased mortality
compared with poractant alfa, but the difference did not reach
statistical significance (OR: 1.370, 95% CI: 0.996–1.885,
P ¼ 0.053). No differences in mortality were observed between
calfactant- and beractant-treated infants (OR: 1.092, 95% CI:
0.765–1.559, P ¼ 0.626).
Journal of Perinatology
Discussion
The present study retrospectively investigated, for the first time, allcause mortality among preterm infants with RDS, treated with the
three animal-derived surfactants available in the US, namely,
poractant alfa, calfactant or beractant.
To overcome the difference in the demographic characteristics
of the population investigated, which can be an intrinsic limitation
of retrospective studies, a logistic regression model adjusting for
patient and hospital factors was applied. Furthermore, the
clustering of infants within hospitals was accounted for by the
inclusion of the center effect in the model.
5. Neonatal mortality with animal-derived surfactant use
R Ramanathan et al
5
Odds Ratio (95% CI), p-value
Calfactant vs. Poractant alfa
1.496 (1.014 – 2.209), 0.043
Beractant vs. Poractant alfa
1.370 (0.996 – 1.885), 0.053
1.092 (0.765 – 1.559), 0.626
Calfactant vs. Beractant
= Odds Ratio
|— —| = 95% CI
•
0.0
0.5
1.0
1.5
2.0
Mortality Odds Ratio
2.5
3.0
Figure 2 Comparison of mortality among the three surfactant-treated groups.
This model found calfactant to be associated with a significantly
greater likelihood of death than poractant alfa. Beractant was
associated with a non-significant increase in mortality,
compared with poractant alfa, and no differences were observed
between calfactant and beractant. The results obtained in
the full model were also supported by the sensitivity analyses.
The alternative models showed a statistically significant
reduction of the likelihood death with poractant alfa compared
with both calfactant and beractant, except the analysis including
discharge year, where the mortality reduction with poractant alfa
did not reach statistical significance. In particular, the model
which excluded gestational age was performed similar to the
approach followed by Clark et al.18 in the only retrospective
comparison of calfactant and beractant published in the
literature, which used BW, but not gestational age, as a key
covariate. Some evidence suggests that, despite the fact that
gestational age is a key factor in determining the outcome in
preterm infants, the methods to calculate it are not precise
unless an early first trimester fetal ultrasound was used for
estimating the gestational age.24
The unadjusted results were consistent with the adjusted model.
Overall, the unadjusted mortality rates found in this study were
3.61% for poractant alfa, 4.58% for beractant and 5.95% for
calfactant.
The results of this large retrospective study should be interpreted
and validated in the context of other evidence from the medical
literature, which report comparisons between animal-derived
surfactants. Focusing on poractant alfa and beractant, in a pilot
study of 75 preterm infants with RDS by Speer et al.,13 mortality at
28 days was 3% in the poractant alfa 200 mg kgÀ1 group and
12.5% in the beractant 100 mg kgÀ1 group; however, this difference
did not reach significance (adjusted OR: 0.23, 95% CI: 0.02–2.54,
P ¼ 0.23). In a prospective study of 58 RDS infants, Malloy et al.16
found no significant difference in mortality at 40 weeks between
infants receiving poractant alfa and beractant (0 vs 10%,
respectively P ¼ 0.08). A larger study by Ramanathan et al.15 in
293 RDS infants, found in those who were no more than 32 weeks
gestational age (n ¼ 270), a 3% mortality at 36 weeks postmenstrual age in the poractant alfa (200 mg kgÀ1)-treated infants
versus 11% for beractant (100 mg kgÀ1)- or poractant alfa
(100 mg kgÀ1)-treated patients (P ¼ 0.034 and P ¼ 0.046,
respectively). In another RCT in 52 RDS patients, Fujii et al.17
reported that mortality was 8% in the poractant alfa 200 mg kgÀ1
group versus 19% in the beractant 100 mg kgÀ1 group
(P ¼ 0.27). All together, these randomized, controlled studies
consistently showed a survival advantage with poractant alfa over
beractant, although this reduction in mortality did not reach
significance in most trials due to small sample size. Therefore, the
trend towards increased mortality with beractant compared
with poractant alfa found in the present retrospective study
confirmed the findings of the smaller RCTs performed between
these two surfactants.
As far as beractant and calfactant comparisons, both RCTs and
retrospective evaluations have shown no mortality difference. The
first RCT comparing beractant and calfactant in 1997 showed no
difference in mortality between these two surfactants in the overall
population.11 Additionally, Bloom et al.12 found 10% and 11%
mortality rates at 36 weeks post menstrual age for beractant- and
calfactant-treated patients, respectively (pX0.05). Finally, in the
retrospective study by Clark et al.18 on 5169 infants, no differences
were found in mortality rates before 28 days of age between
calfactant and beractant (OR: 1, 95% CI: 0.8–1.3). Our study
confirmed the absence of differences in mortality between beractant
and calfactant in prospective as well as retrospective studies
published to date.
Lastly, no study has been published comparing mortality
between poractant alfa and calfactant. This is therefore the first
direct comparison available between these two surfactants, showing
a significant greater likelihood of death with calfactant than
poractant alfa.
Our study has certain limitations due to the retrospective nature
of the database used. Among the restrictions of the database,
information on the precise cause of death is unavailable and the
number of surfactant doses is not reliably calculable. The database
Journal of Perinatology
6. Neonatal mortality with animal-derived surfactant use
R Ramanathan et al
6
also lacked reliable antenatal steroid use data, partly because
antenatal steroids may have been given to the mother before entry
into the hospital for delivery, and the Premier Database focused on
hospital data by design. It was not possible, therefore, to adjust the
model for this factor as a covariate, despite the importance that
antenatal steroid use has for improving lung function and
reducing RDS severity and its related mortality risk. However, in the
Clark et al.18 study where data on antenatal steroids were available
and the comparison between surfactants was adjusted for this
covariate, the finding of no difference in the outcome between
calfactant and beractant was coherent with our study results.
We acknowledge that the value of retrospective studies, despite
their limitations, lies in the possibility to study large patient sample
size, contributing to increased study power. This is particularly
important in the field of clinical investigation on surfactants,
where the known efficacy of treatment on mortality outcomes
implies the need for large sample size to detect even small, but
significant difference, making RCTs often unaffordable in terms of
costs and recruitment. As an example, the treatment trial published
by Bloom et al.12 required a sample size of 2080 infants to detect a
6% difference in infants alive without bronchopulmonary dysplasia
between calfactant and beractant. However, the study was
terminated prematurely after enrollment of 1361 infants (65.4% of
the target). Finally, emerging evidence shows that findings from
retrospective studies may provide the medical community with
information on drug effectiveness in real-world settings.25
The lower mortality observed in poractant alfa-treated infants
compared with calfactant or beractant prompts one to look for a
possible explanation for such different outcomes for poractant alfa
over the other two surfactants. The most likely explanation may be
due to different surfactant doses administered to the infants
included in the database, according to their US-prescribing
information: 200 mg kgÀ1 for poractant alfa, 100 mg kgÀ1 for
beractant and 105 mg kgÀ1 for calfactant. Poractant alfa is the
only surfactant that has been studied using 200 mg kgÀ1 for the
initial dose, and has been associated with faster weaning of oxygen
and peak inspiratory pressure, fewer doses and lower mortality.
Evidence from a RCT has shown that poractant alfa 200 mg kgÀ1
is better than poractant alfa 100 mg kgÀ1 in reducing mortality,
whereas when poractant alfa and beractant are used at the same
dose of 100 mg kgÀ1 for the initial dose, no difference in mortality
was observed, despite the faster onset of action with poractant
alfa.15 Compared with poractant alfa 100 mg kgÀ1, poractant alfa
200 mg kgÀ1 has also been shown to result in longer surfactant
half-life, fewer retreatments and improved oxygenation.26 Poractant
alfa is the surfactant preparation that closely resembles
phosphatidylcholine molecular species composition of human
surfactant and contains27,28 the highest amount of polyunsaturated
fatty acid-phospholipids and plasmalogens amongst other
surfactant preparations, when normalized for phospholipid
amounts.29 These components are important for reducing viscosity
Journal of Perinatology
and interacting with surfactant protein B to regulate the adsorption
and spreading properties of the phospholipids.30
In conclusion, this large retrospective study of preterm infants
with RDS found lower mortality among infants who received
poractant alfa, compared with infants who received either
calfactant or beractant, even after adjusting for patient
characteristics such as gestational age and BW, and after
accounting for hospital characteristics and center effects. These
results in real-world settings are consistent with prior RCTs, but
provide additional significant findings that most RCTs have not
been able to provide due to their relatively small sample size.
Conflict of interest
This study was sponsored by Chiesi Farmaceutici SpA, the
manufacturer of poractant alfa. Frank R Ernst is an employee of
Premier, which contracted with Chiesi Farmaceutici SpA to conduct
the study. Rangasamy Ramanathan, Kris Sekar and Jatinder Bhatia
have served as consultants to Chiesi Farmaceutici SpA.
Acknowledgments
We would like to thank Stefano Vezzoli for his extensive statistical support. The
authors also thank Raffaella Monno and Carmen Dell’Anna for their scientific
contribution and assistance with the manuscript, as well as Teresa Davis for her
database programming support.
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