scholarly journals 737. The Prevalence of Diagnosed Chronic Lung Disease in US Infants by Gestational Age: Implications for RSV Policy

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S264-S265 ◽  
Author(s):  
Christopher S Ambrose ◽  
Xiaohui Jiang ◽  
Kunjana Mavunda
Keyword(s):  
United States ◽  
Lung Disease ◽  
Gestational Age ◽  
Chronic Lung Disease ◽  
The United States ◽  
Supplemental Oxygen ◽  
High Risk Group ◽  
Term Infants ◽  
Postmenstrual Age ◽  
Nationally Representative

Abstract Background Perinatal chronic lung disease (CLD), previously referred to as bronchopulmonary dysplasia (BPD), is associated with preterm birth and occurs rarely among term infants. Children with CLD are at elevated risk for severe RSV disease in the first 2 years of life. Definitions of CLD/BPD identify infants who require supplemental oxygen at 28 days of life or 36 weeks postmenstrual age, with no restriction by gestational age (GA) at birth. However, the AAP Committee on Infectious Disease guidance does not recommend RSV immunoprophylaxis for infants with CLD born at ≥32 weeks gestational age (wGA), even though infants with CLD/BPD up to 41 wGA were included in pivotal efficacy studies. This study determined the prevalence of diagnosed CLD in US infants as a function of wGA at birth and the number of infants with CLD born at ≥32 wGA. Methods The Kids’ Inpatient Database (KID) is a nationally representative survey conducted every 3 years in the United States. Birth hospitalization data from KID were utilized to estimate the prevalence of CLD (ICD-9 = 770.7) among US infants in 2003–2012 overall and as a function of coincident codes for GA (ICD-9 = 765.21–765.29, reported in 2-week intervals). The prevalence of CLD among 32 wGA infants was imputed based on the distribution of CLD cases as a function of wGA. KID data from 2015 were not available due to the transition to ICD-10 coding. Results A total of 31,984 infants had a CLD diagnosis across the 4 years, representing 0.2% of US births. The prevalence of CLD declined from 20.8 to 19.5 per 10,000 between 2003 and 2012. Of those, 25,554 infants with CLD (80%) had GA coded in the database. The percentage of CLD infants born at <27 wGA increased from 44% in 2003 to 52% in 2012, whereas the percentage at ≥29 wGA decreased from 27% to 21% (figure). Overall, the percentages born at 31–32, 33–34, and >34 wGA were 5.7%, 2.2%, and 1.2%, respectively. An estimated 5.7% of infants with CLD were born at ≥32 wGA, representing 0.9 of every 10,000 US births or ~350 infants annually. Conclusion Fewer than 400 infants are born at ≥32 wGA and diagnosed with CLD annually in the United States. The rationale for excluding this small but high-risk group of infants from the population recommended for RSV immunoprophylaxis is not clear. Funded by AstraZeneca :Disclosures. C. S. Ambrose, AstraZeneca: Employee, Salary and Stocks. X. Jiang, EpiStat Institute: Employee, Consulting fee and Salary. AstraZeneca: Consultant, Consulting fee. K. Mavunda, AstraZeneca: Speaker’s Bureau, Speaker honorarium.

Breath-to-breath variability of exhaled CO2 as a marker of lung dysmaturity in infancy

2017 ◽  
Vol 123 (6) ◽  
pp. 1563-1570 ◽  
Author(s):  
Sotirios Fouzas ◽  
Ilias Theodorakopoulos ◽  
Edgar Delgado-Eckert ◽  
Philipp Latzin ◽  
Urs Frey
Keyword(s):  
Lung Disease ◽  
Preterm Infants ◽  
Chronic Lung Disease ◽  
Tidal Breathing ◽  
Term Infants ◽  
Young Infants ◽  
Postmenstrual Age ◽  
Preterm Group ◽  
Preterm Born ◽  
The Relationship

The concept of diffusional screening implies that breath-to-breath variations in CO2 clearance, when related to the variability of breathing, may contain information on the quality and utilization of the available alveolar surface. We explored the validity of the above hypothesis in a cohort of young infants of comparable postmenstrual age but born at different stages of lung maturity, namely, in term-born infants ( n = 128), preterm-born infants without chronic lung disease of infancy (CLDI; n = 53), and preterm infants with moderate/severe CLDI ( n = 87). Exhaled CO2 volume (VE,CO2) and concentration (FE,CO2) were determined by volumetric capnography, whereas their variance was assessed by linear and nonlinear variability metrics. The relationship between relative breath-to-breath change of VE,CO2 (ΔVE,CO2) and the corresponding change of tidal volume (ΔVT) was also analyzed. Nonlinear FE,CO2 variability was lower in CLDI compared with term and non-CLDI preterm group ( P < 0.001 for both comparisons). In CLDI infants, most of the VE,CO2 variability was attributed to the variability of VT ( r2 = 0.749), whereas in term and healthy preterm infants this relationship was weaker ( r2 = 0.507 and 0.630, respectively). The ΔVE,CO2 − ΔVT slope was less steep in the CLDI group (1.06 ± 0.07) compared with non-CLDI preterm (1.16 ± 0.07; P < 0.001) and term infants (1.20 ± 0.10; P < 0.001), suggesting that the more dysmature the infant lung, the less efficiently it eliminates CO2 under tidal breathing conditions. We conclude that the temporal variation of CO2 clearance may be related to the degree of lung dysmaturity in early infancy. NEW & NOTEWORTHY Young infants exhibit appreciable breath-to-breath CO2 variability that can be quantified by nonlinear variability metrics and may reflect the degree of lung dysmaturity. In infants with moderate/severe chronic lung disease of infancy (CLDI), the variability of the exhaled CO2 is mainly driven by the variability of breathing, whereas in term-born and healthy preterm infants this relationship is less strong. The slope of the relative CO2-to-volume change is less steep in CLDI infants, suggesting that dysmature lungs are less efficient in eliminating CO2 under tidal breathing conditions.

scholarly journals New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life

2019 ◽  
Vol 109 (5) ◽  
pp. 1353-1360 ◽  
Author(s):  
Tom Norris ◽  
Sara E Ramel ◽  
Patrick Catalano ◽  
Carol ni Caoimh ◽  
Paola Roggero ◽  
...  
Keyword(s):  
United States ◽  
Body Composition ◽  
Preterm Infants ◽  
Fat Mass ◽  
Gestational Age ◽  
The United States ◽  
Fat Free Mass ◽  
Term Infants ◽  
Air Displacement Plethysmography ◽  
Young Infants

ABSTRACT Background Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. Objective Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1–27 wk). Methods The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. Results For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. Conclusions The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.

scholarly journals Receipt of Breast Milk by Gestational Age – United States, 2017 (P11-060-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Katelyn Chiang ◽  
Andrea Sharma ◽  
Jennifer Nelson ◽  
Christine Olson ◽  
Cria Perrine
Keyword(s):  
United States ◽  
Breast Milk ◽  
Gestational Age ◽  
Infant Nutrition ◽  
Birth Certificate ◽  
The United States ◽  
Late Preterm ◽  
Term Infants ◽  
Oak Ridge ◽  
Extremely Preterm

Abstract Objectives Breast milk is the optimal source of infant nutrition. For the nearly 1 in 10 infants born prematurely in the United States annually, breast milk is especially beneficial, helping prevent sepsis and necrotizing enterocolitis (NEC) and promoting neurological development. Though the importance of breast milk for preterm infants has been established, national estimates of feeding practices by gestational age are unavailable. Our objective was to describe receipt of breast milk among preterm and term infants delivered in the United States in 2017. Methods Birth certificate data from 48 states and the District of Columbia (n = 3,194,873; 82.7% of all births) were analyzed to describe receipt of breast milk before birth certificate completion among extremely preterm (20-27 weeks), early preterm (28-33 weeks), late preterm (34-36 weeks) and term infants (≥ 37 weeks) with further stratification by maternal and infant characteristics. Results The prevalence of infants receiving breast milk was 83.9% overall and varied by gestational age: 71.3% (extremely preterm), 76.0% (early preterm), 77.3% (late preterm), and 84.6% (term). Disparities in receipt of breast milk by maternal race/ethnicity were noted across gestational ages. Infants delivered to black or American Indian/Alaska Native mothers were the least likely to have received breast milk while those delivered to white, Hispanic, and Asian mothers were more likely to have received breast milk. Differences in receipt of breast milk by other maternal sociodemographic factors also persisted similarly across gestational ages. Among late preterm and term infants, receipt of breast milk was lower for those admitted to the neonatal intensive care unit (NICU) than those not admitted to the NICU. Conclusions Fewer preterm than term infants received breast milk in the first few days of life. Optimal hospital policies and practices that support breast milk feeding and ensure availability of donor milk for high-risk infants may help improve infant nutrition and reduce infant morbidity and mortality. Mothers of infants admitted to the NICU may need additional support given the challenges associated with having a medically fragile infant such as mother-infant separation and extended infant hospitalization. Funding Sources Centers for Disease Control and Prevention, Oak Ridge Institute for Science and Education.

scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

Gender, Parenting, and The Rise of Remote Work During the Pandemic: Implications for Domestic Inequality in the United States

2021 ◽  
Vol 35 (2) ◽  
pp. 194-205
Author(s):  
Allison Dunatchik ◽  
Kathleen Gerson ◽  
Jennifer Glass ◽  
Jerry A. Jacobs ◽  
Haley Stritzel
Keyword(s):  
United States ◽  
Child Care ◽  
Division Of Labor ◽  
Single Parents ◽  
The United States ◽  
Child Care Centers ◽  
Remote Work ◽  
Representative Survey ◽  
Working Parents ◽  
Nationally Representative

We examine how the shift to remote work altered responsibilities for domestic labor among partnered couples and single parents. The study draws on data from a nationally representative survey of 2,200 US adults, including 478 partnered parents and 151 single parents, in April 2020. The closing of schools and child care centers significantly increased demands on working parents in the United States, and in many circumstances reinforced an unequal domestic division of labor.

Is Music Teacher Professional Development Becoming More Effective? Evaluating Practice and Policy in the United States, 1993–2012

2020 ◽  
pp. 002242942098252
Author(s):  
Justin J. West
Keyword(s):  
Professional Development ◽  
United States ◽  
Social Interaction ◽  
Teacher Professional Development ◽  
The United States ◽  
Music Teacher ◽  
Policy Practice ◽  
Teacher Professional ◽  
Nationally Representative ◽  
Using Data

The purpose of this study was to evaluate music teacher professional development (PD) practice and policy in the United States between 1993 and 2012. Using data from the nationally representative Schools and Staffing Survey (SASS) spanning these 20 years, I examined music teacher PD participation by topic, intensity, relevance, and format; music teachers’ top PD priorities; and the reach of certain PD-supportive policies. I assessed these descriptive results against a set of broadly agreed-on criteria for “effective” PD: content specificity, relevance, voluntariness/autonomy, social interaction, and sustained duration. Findings revealed a mixed record. Commendable improvements in content-specific PD access were undercut by deficiencies in social interaction, voluntariness/autonomy, sustained duration, and relevance. School policy, as reported by teachers, was grossly inadequate, with only one of the nine PD-supportive measures appearing on SASS reaching a majority of teachers in any given survey year. Implications for policy, practice, and scholarship are presented.

The ideological divide in public perceptions of self-driving cars

2020 ◽  
Vol 29 (4) ◽  
pp. 436-451
Author(s):  
Yilang Peng
Keyword(s):  
Artificial Intelligence ◽  
United States ◽  
Scientific Literacy ◽  
Autonomous Vehicles ◽  
The United States ◽  
Public Perceptions ◽  
New Information ◽  
Nationally Representative ◽  
Self Driving Cars ◽  
Social Conservatism

Applications in artificial intelligence such as self-driving cars may profoundly transform our society, yet emerging technologies are frequently faced with suspicion or even hostility. Meanwhile, public opinions about scientific issues are increasingly polarized along the ideological line. By analyzing a nationally representative panel in the United States, we reveal an emerging ideological divide in public reactions to self-driving cars. Compared with liberals and Democrats, conservatives and Republicans express more concern about autonomous vehicles and more support for restrictively regulating autonomous vehicles. This ideological gap is largely driven by social conservatism. Moreover, both familiarity with driverless vehicles and scientific literacy reduce respondents’ concerns over driverless vehicles and support for regulation policies. Still, the effects of familiarity and scientific literacy are weaker among social conservatives, indicating that people may assimilate new information in a biased manner that promotes their worldviews.

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