The Effect of Birth Order on Neonatal Morbidity and Mortality in Very Preterm Twins

Objective This retrospective cohort study examined the effect of birth order on neonatal morbidity and mortality in very preterm twins. Study Design Using 2005 to 2012 data from the Canadian Neonatal Network, very preterm twins born between 24 0/7 and 32 6/7 weeks of gestation were included. Odds of morbidity and mortality of second-born cotwins compared with first-born cotwins were examined by matched-pair analysis. Outcomes were neonatal death, severe brain injury (intraventricular hemorrhage grade 3 or 4 or persistent periventricular echogenicity), bronchopulmonary dysplasia, severe retinopathy of prematurity (ROP) (> stage 2), necrotizing enterocolitis (≥ stage 2), and respiratory distress syndrome (RDS). Multivariable analysis was performed adjusting for confounders. Result There were 6,636 twins (3,318 pairs) included with a mean gestational age (GA) of 28.9 weeks. A higher rate of small for GA occurred in second-born twins (10 vs. 6%). Mortality was significantly lower for second-born twins (4.3 vs. 5.3%; adjusted odds ratio: 0.75; 95% confidence interval [CI]: 0.59–0.95). RDS (66 vs. 60%; adjusted odds ratio: 1.40; 95% CI: 1.29–1.52) and severe retinopathy (9 vs. 7%; adjusted odds ratio: 1.46; 95% CI: 1.07–2.01) were significantly higher in second-born twins. Conclusion Thus, while second-born twins had reduced odds of mortality, they also had increased odds of RDS and ROP.

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Racial and Economic Neighborhood Segregation, Site of Delivery, and Very Preterm Neonatal Morbidity and Mortality

The Journal of Pediatrics ◽

10.1016/j.jpeds.2021.03.049 ◽

2021 ◽

Author(s):

Teresa Janevic ◽

Jennifer Zeitlin ◽

Natalia N. Egorova ◽

Paul Hebert ◽

Amy Balbierz ◽

...

Keyword(s):

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Very Preterm ◽

Neighborhood Segregation

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Leptomeningeal Collateral Flow Modifies Endovascular Treatment Efficacy on Large-Vessel Occlusion Strokes

Stroke ◽

10.1161/strokeaha.120.031338 ◽

2021 ◽

Vol 52 (1) ◽

pp. 299-303

Author(s):

Álvaro García-Tornel ◽

Ludovico Ciolli ◽

Marta Rubiera ◽

Manuel Requena ◽

Marian Muchada ◽

...

Keyword(s):

Ct Angiography ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Large Vessel ◽

Collateral Flow ◽

Vessel Occlusion ◽

Shift Analysis ◽

Final Degree ◽

Large Vessel Stroke

Background and Purpose: We aim to evaluate if good collateral flow (CF) modifies endovascular therapy (EVT) efficacy on large-vessel stroke. To do that, we used final degree of reperfusion and number of device-passes performed, factors previously associated with better functional outcome, as main outcome measures. Methods: Single-center retrospective study including consecutive stroke patients receiving EVT for anterior circulation large-vessel stroke. CF degree was assessed on CT angiography before EVT using a previously validated 4-grade score. Final degree of reperfusion, using modified Thrombolysis in Cerebral Ischemia (mTICI), and number of device-passes performed were prospectively collected. Multivariable analysis was performed to evaluate the influence of collateral flow degree on final degree of reperfusion and number of device-passes performed. Results: Six hundred twenty-six patients were included in the study; 369 patients (59%) presented good collateral flow on CT angiography. Five hundred twenty-two patients (84%) achieved successful reperfusion (mTICI 2B-3) after EVT, 304 (48%) of them with a final mTICI 2C-3. Median number of device-passes was 2 (interquartile range, 1–3). Good CF was independently associated with better final degree of reperfusion (shift analysis for mTICI0-2A/2B/2C-3%, poor CF 19/38/43 versus good CF 15/32/53, adjusted odds ratio, 1.51 [95% CI, 1.08–2.11]). Poor CF was independently associated with higher number of device-passes performed to achieve successful reperfusion (mTICI2B-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.59, [95% CI, 1.09–2.31]) and complete reperfusion (mTICI2C-3; shift analysis for 1/2/3/4+ device-passes, adjusted odds ratio, 1.70 [95% CI, 1.04–2.90]). Conclusions: Patients with good CF treated with EVT experience higher rates of successful reperfusion with lower number of device-passes. CF may facilitate thrombus retrieval and prevent distal embolization of clot fragments, improving device-passes efficacy.

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The prevalence of nasal obstruction as a consideration in the treatment of opioid overdose

Journal of Opioid Management ◽

10.5055/jom.2017.0370 ◽

2017 ◽

Vol 13 (2) ◽

pp. 69 ◽

Cited By ~ 3

Author(s):

Scott G. Weiner, MD, MPH ◽

Andrew R. Joyce, PhD ◽

Heather N. Thomson, MS

Keyword(s):

Nasal Cavity ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Opioid Overdose ◽

Intranasal Route ◽

Deviated Nasal Septum ◽

International Classification Of Disease ◽

Nasal Pathology

Objectives: The intranasal route of administration for naloxone delivery is one treatment for opioid overdose, but treatment failures with this modality have been documented. This study determines the incidence of obstructive nasal pathology in patients who experienced serious opioid-induced respiratory depression (OIRD).Design: Retrospective analysis of the IMS LifeLink: Health Plan Claims Database to detect patients with at least one opioid pharmacy claim from 2009 to 2013 and who experienced serious OIRD. Four controls were randomly assigned to each case.Main Outcome Measures: A multivariable analysis determined the adjusted odds ratio of OIRD for patients with obstructive nasal pathology.Results: A total of 7,234 patients experienced a serious OIRD event; 840 (11.6 percent) had obstructive nasal pathology: 20 (2.4 percent) had deviated nasal septum (International Classification of Disease, 9th revision [ICD-9] 470), 246 (29.3 percent) had polyp of the nasal cavity (ICD-9 470.1), 130 (15.5 percent) had hypertrophy of nasal turbinates (ICD-9 478.0), and 659 (78.5 percent) had other disease of the nasal cavity (ICD-9 478.19). The adjusted odds ratio for patients who experienced serious OIRD having concurrent obstructive nasal pathology was 1.28 (95% confidence interval 1.13-1.46).Conclusions: Obstructive nasal pathology is relatively common in patients who experience serious OIRD, and in itself is associated with a higher risk of having OIRD.

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Adverse effects of small for gestational age differ by gestational week among very preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2017-314171 ◽

2018 ◽

Vol 104 (2) ◽

pp. F192-F198 ◽

Cited By ~ 6

Author(s):

Erik A Jensen ◽

Elizabeth E Foglia ◽

Kevin C Dysart ◽

Rebecca A Simmons ◽

Zubair H Aghai ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Intraventricular Haemorrhage ◽

Neonatal Morbidity ◽

Excess Risk ◽

Very Preterm Infants ◽

Adjusted Risk ◽

Very Preterm ◽

Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

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Outcome Following Hemorrhage From Cranial Dural Arteriovenous Fistulae

Stroke ◽

10.1161/strokeaha.121.034707 ◽

2021 ◽

Vol 52 (10) ◽

Author(s):

Matthew J. Koch ◽

Christopher J. Stapleton ◽

Ridhima Guniganti ◽

Giuseppe Lanzino ◽

Jason Sheehan ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Odds Ratio ◽

Dural Arteriovenous Fistula ◽

Multivariable Analysis ◽

Patient Characteristics ◽

Morbidity And Mortality ◽

Cerebrovascular Lesions ◽

Arteriovenous Fistulae ◽

Poor Outcome

Background and Purpose: Dural arteriovenous fistulae can present with hemorrhage, but there remains a paucity of data regarding subsequent outcomes. We sought to use the CONDOR (Consortium for Dural Arteriovenous Fistula Outcomes Research), a multi-institutional registry, to characterize the morbidity and mortality of dural arteriovenous fistula–related hemorrhage. Methods: A retrospective review of patients in CONDOR who presented with dural arteriovenous fistula–related hemorrhage was performed. Patient characteristics, clinical follow-up, and radiographic details were analyzed for associations with poor outcome (defined as modified Rankin Scale score ≥3). Results: The CONDOR dataset yielded 262 patients with incident hemorrhage, with median follow-up of 1.4 years. Poor outcome was observed in 17.0% (95% CI, 12.3%–21.7%) at follow-up, including a 3.6% (95% CI, 1.3%–6.0%) mortality. Age and anticoagulant use were associated with poor outcome on multivariable analysis (odds ratio, 1.04, odds ratio, 5.1 respectively). Subtype of hemorrhage and venous shunting pattern of the lesion did not affect outcome significantly. Conclusions: Within the CONDOR registry, dural arteriovenous fistula–related hemorrhage was associated with a relatively lower morbidity and mortality than published outcomes from other arterialized cerebrovascular lesions but still at clinically consequential rates.

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Abstract WMP92: Quality of Care and Outcomes for Acute Ischemic Stroke Patients Admitted During the International Stroke Conference

Stroke ◽

10.1161/str.48.suppl_1.wmp92 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Steven R Messe ◽

Michael T Mullen ◽

Marguerrite Cox ◽

Gregg Fonarow ◽

Eric E Smith ◽

...

Keyword(s):

Ischemic Stroke ◽

Quality Of Care ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Stroke Patients ◽

Time Periods ◽

Iv Tpa

Introduction: Patients who present to the hospital during off-hours receive sub-optimal care and experience worse outcomes, often attributed to reduced staffing. It is unknown whether stroke patients receive less guideline-adherent care and experience worse outcomes when medical providers attend scientific meetings. The AHA International Stroke Conference (ISC) is the premier US conference for cerebrovascular disease and is well attended by stroke clinicians. Methods: The national Get With The Guidelines - Stroke (GWTG-Stroke) dataset was analyzed from 2009-2015 to identify acute ischemic stroke (AIS) patients admitted during: 1) the week of ISC, and 2) the 2 weeks before and 2 weeks after ISC. We compared adherence to GWTG-Stroke quality measures and outcomes for AIS patients admitted during these two time periods using univariable and multivariable analysis, including both patient and hospital level variables. Results: Overall, 69,738 AIS patients were included, mean age 72, 52% female, and 29% non-white. There was no difference between the average weekly number of AIS cases admitted during ISC weeks versus non-ISC weeks (1,984 vs 1,997, p= 0.95). Patient and hospital characteristics were also similar between ISC vs. non-ISC time periods. No significant differences were noted in 14 quality of care metrics and 5 clinical outcomes between AIS patients treated during ISC vs. non-ISC weeks (Table). After adjusting for potential confounders, among patients who presented within 2 hours of onset there was no difference in the likelihood of receiving IV tPA within 3 hours (adjusted odds ratio 0.89, 95% confidence interval [CI] 0.77 - 1.03, p=0.13), nor in the likelihood of receiving IV tPA within 60 minutes of arrival (adjusted odds ratio 0.92, 95% CI 0.83 - 1.02, p=0.13). Conclusions: The treatment and outcome of patients who present with AIS to a GWTG-Stroke participating hospital are not degraded during the week of the International Stroke Conference.

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Individual Probability of Allogeneic Erythrocyte Transfusion in Elective Spine Surgery

Anesthesiology ◽

10.1097/aln.0b013e31819df9e0 ◽

2009 ◽

Vol 110 (5) ◽

pp. 1050-1060 ◽

Cited By ~ 44

Author(s):

Brigitte Lenoir ◽

Paul Merckx ◽

Catherine Paugam-Burtz ◽

Cyril Dauzac ◽

Marie-Madeleine Agostini ◽

...

Keyword(s):

Spine Surgery ◽

Odds Ratio ◽

Goodness Of Fit ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Erythrocyte Transfusion ◽

Operating Characteristics ◽

Individual Probability ◽

Validation Set ◽

The Individual

Background The aim of this study was to generate a score based on preoperative characteristics and predictive of the individual probability of allogeneic erythrocyte transfusion in patients undergoing elective thoracolumbar spine surgery. Methods Two hundred thirty consecutive patients were retrospectively included over a 15-month period (derivation set). Preoperative independent predictors of erythrocyte transfusion from the day of surgery until postoperative day 5 were determined by multivariable analysis, from which a model of individual probability of transfusion was derived and prospectively validated in 125 additional patients (validation set). Results Four preoperative independent predictors were associated with transfusion: age older than 50 yr (adjusted odds ratio = 4.9 [2-13.5]), preoperative hemoglobin level less than 12 g/dl (adjusted odds ratio = 6.9 [3.1-17.2]), fusion of more than two levels (adjusted odds ratio = 6.7 [3.1-15.2]), and transpedicular osteotomy (adjusted odds ratio = 19.9 [5.6-98.2]). A 0-4 score (0 = no risk, 4 = maximum risk) predictive of allogeneic transfusion was derived by weighting estimate parameters for each variable in a multivariable logistic regression model. Discriminating capacity of the score was 0.86 [0.81-0.92] in the receiver operating characteristics in the derivation sample and 0.83 [0.75-0.91] in the validation sample. The observed transfusion rates in the validation set and the individual probabilities of erythrocyte transfusion from the score were well correlated (y = 0.98x + 0.04; P < 0.0001), and the observed differences were not statistically different (goodness-of-fit chi-square, P = 0.125). The score was also correlated with the number of erythrocyte units transfused (Spearman rho = 0.61; P < 0.0001). Conclusion The Predictive Model of Transfusion in Spine Surgery may be useful in clinical practice to identify patients undergoing spine surgery at risk of massive bleeding and encourage erythrocyte-saving strategies in these patients.

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Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.01.048 ◽

2019 ◽

Vol 209 ◽

pp. 17-22.e2 ◽

Cited By ~ 1

Author(s):

Elizabeth E. Foglia ◽

Benjamin Carper ◽

Marie Gantz ◽

Sara B. DeMauro ◽

Satyan Lakshminrusimha ◽

...

Keyword(s):

Oxygen Saturation ◽

Neonatal Morbidity ◽

Morbidity And Mortality ◽

Policy Changes ◽

Very Preterm

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Patients carrying DPYD variant alleles have increased risk of severe toxicity and related treatment modifications during fluoropyrimidine chemotherapy

Pharmacogenomics ◽

10.2217/pgs-2020-0154 ◽

2021 ◽

Author(s):

Faisal Shakeel ◽

Fang Fang ◽

Jung Won Kwon ◽

Kyoin Koo ◽

Amy L Pasternak ◽

...

Keyword(s):

Odds Ratio ◽

Adjusted Odds Ratio ◽

Subsequent Treatment ◽

Severe Toxicity ◽

End Point ◽

Increased Risk ◽

Toxicity Risk ◽

Informed Treatment ◽

Variant Alleles ◽

Grade 3

Aim: To evaluate toxicity risk in carriers of four DPYD variants using an institutional genetic repository. Materials & methods: Of over 65,000 patients in the repository, 582 were evaluated for the primary composite end point of grade 3 or higher toxicity or treatment modification due to toxicity. Results: The primary end point was more common in DPYD variant carriers (36.5 vs 18.1%, adjusted odds ratio 2.42, 95% CI: 1.05–5.55, p = 0.04), and in patients with decreased DPD activity (≤1 vs 2) (75.6 vs 17.0%, adjusted odds ratio 16.31, 95% CI: 2.64–100.68, p = 0.003). Conclusion: Patients carrying any of the four DPYD variants are at increased risk of severe toxicity or subsequent treatment modifications, suggesting such patients may benefit from genotype-informed treatment.

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Clinical Outcome of Takotsubo Cardiomyopathy Diagnosed With or Without Coronary Angiography

Angiology ◽

10.1177/0003319718782049 ◽

2018 ◽

Vol 70 (1) ◽

pp. 56-61 ◽

Cited By ~ 3

Author(s):

Naoki Misumida ◽

Gbolahan O. Ogunbayo ◽

Sun Moon Kim ◽

Ahmed Abdel-Latif ◽

Khaled M. Ziada ◽

...

Keyword(s):

Coronary Angiography ◽

Hospital Mortality ◽

Takotsubo Cardiomyopathy ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Multivariable Analysis ◽

Primary Diagnosis ◽

Coronary Angiogram ◽

National Inpatient Sample ◽

Coronary Syndrome

Takotsubo cardiomyopathy (TC) is definitively diagnosed following the exclusion of acute coronary syndrome. We aimed to examine the rate of coronary angiography in patients diagnosed with TC and also the outcome of patients with TC diagnosed with or without coronary angiography. We analyzed the National Inpatient Sample database from 2010 to 2014 and identified patients hospitalized with a primary diagnosis of TC. We compared in-hospital mortality between patients who underwent coronary angiography and those who did not. We also evaluated the association between coronary angiography and in-hospital mortality using a propensity score–adjusted multivariable analysis. Among 22 818 patients diagnosed with TC, 87.4% underwent coronary angiography and 12.6% did not. Patients who did not undergo coronary angiography had a higher in-hospital mortality than those who did (3.0% vs 0.9%; P < .001). Increased mortality in patients who did not undergo coronary angiogram was observed in both male (8.0% vs 2.8%; P = .03) and female patients (2.6% vs 0.7%; P < .001) and in patients 61 to 80 years old and ≥81 years old, but not in patients ≤60 years old. Multivariable analysis demonstrated that the lack of coronary angiography was independently associated with higher in-hospital mortality (adjusted odds ratio: 2.92; 95% confidence interval: 1.52-5.65; P = .001).

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