A Difference in Mortality Rate and Incidence of Kernicterus Among Premature Infants Allotted to Two Prophylactic Antibacterial Regimens, by William A. Silverman, et al, Pediatrics, 1956;18:614–624

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 225-227
Author(s):  
John C. Sinclair
Keyword(s):  
Birth Weight ◽  
Death Rate ◽  
Prophylactic Treatment ◽  
Absolute Risk ◽  
Risk Increase ◽  
Serious Infections ◽  
Significant Difference ◽  
Postmortem Blood ◽  
High Incidence ◽  
To Receive

Background. Low birth-weight (LBW) infants have a high incidence of serious infections. These are difficult to diagnose early. Thus, prophylactic treatment with antibiotics appears to be rational, but the best choice of antibiotics is uncertain. Objective. In newborn LBW infants, to compare the effects on death rate and principal findings at necropsy of two prophylactic antibacterial regimens, oxytetracycline (OT) versus penicillin/sulfisoxazole (P/S). Methods. Consecutively admitted LBW infants (N = 193) were randomly assigned, within three birth-weight strata, to receive either subcutaneous 0T or a combination of P/S. The primary outcomes were death before 120 hours, death before 28 days, and principal diagnoses at necropsy. Results. Infants allocated to P/S had a large and statistically significant increase in death rate, determined up to 120 hours (OT, 20.6%; P/S, 48.4%; absolute risk increase, 27.8%) and up to 28 days (0T, 27.8%; P/S, 63.2%; absolute risk increase, 35.3%). This increase in deaths was not attributable to death from infection; the incidence of positive postmortem blood culture results was lower in the P/S group, and there was no significant difference between groups in the incidence of pneumonia or other infections at necropsy. However, in the P/S group, there was a large, unexpected, and statistically significant increase in the finding of kernicterus at necropsy among necropsied deaths occurring up to 120 hours (0T, 6.3%; P/S 36.4%; absolute risk increase 30.1%) and up to 28 days (0T, 4.5%; P/S, 43.2%; absolute risk increase, 38.7%). Conclusions. Infants who received P/S died at a significantly higher rate and had a higher rate of kernicterus at necropsy than those who received OT. The mechanism of the differences observed in rates of mortality and death with kernicterus is unknown.

scholarly journals Bend it like Beckham or fix them like Florence—proportional representation of healthcare in New Year honours: an observational study

BMJ ◽  
2019 ◽  
pp. l6721
Author(s):  
John A Emelifeonwu ◽  
James E Hazelwood ◽  
Oscar Nolan ◽  
Emma Sharland ◽  
Anna O’Donald ◽  
...  
Keyword(s):  
Observational Study ◽  
Absolute Risk ◽  
Proportional Representation ◽  
Relative Risks ◽  
The Arts ◽  
Gender Biases ◽  
Significant Difference ◽  
And Gender ◽  
The Uk ◽  
To Receive

AbstractObjectivesTo compare the proportional representation of healthcare workers in receipt of New Year honours (NYHs) with workers in other industries and to determine whether the NYH system has gender or geographical biases.DesignObservational study of the UK honours system with a comparative analysis of proportional representation of the UK workforce and subgroup analyses of gender and geographical representations.ParticipantsRecipients of NYHs from 2009 to 2018.Main outcome measuresAbsolute risk of receiving an NYH based on industry, gender, or region of the UK. Relative risk of receiving an NYH for services to healthcare compared with other industries.Results10 989 NYHs were bestowed from 2009 to 2018, 47% of which were awarded to women. 832 awards (7.6%) were for services to healthcare. People working in sport and in the arts and media were more likely to receive NYHs than those working in healthcare (relative risks of 22.01 (95% confidence interval 19.91 to 24.34) and 5.84 (5.31 to 6.44), respectively). There was no significant difference between the rate of receiving honours for healthcare and for science and technology (P=0.22). 34% (3741) of awards were issued to people living in London and in the southeast of England, and only 496 of 1447 (34%) higher order awards (knighthoods, damehoods, companions of honour, and commanders of the order of the British empire) were received by women.ConclusionsIn relation to the size of its workforce, a career in healthcare is not as “honourable” as careers in certain other industries. Geographical and gender biases might exist in the honours system.

Abstract 14810: Gender Differences in the Prevalence of Physical Frailty in Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mary C Davis ◽  
Christopher S Lee ◽  
Amy Corcoran ◽  
Nandita Gupta ◽  
Izabella Uchmanowicz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Physical Frailty ◽  
Risk Increase ◽  
Significant Difference ◽  
Future Work ◽  
Risk Ratios

Introduction: The intersection of frailty and heart failure (HF) continues to garner interest. Almost half of patients with HF are frail; however, gender differences in the prevalence of frailty in HF are poorly understood. The objective of this study was to quantify gender differences in the prevalence of frailty in HF. Methods: Data from a subset of studies from a previous meta-analysis were analyzed if they included prevalence of frailty by gender. We performed a random-effects meta-analysis to quantify the relative and absolute risk of frailty in women compared to men with HF overall, and divided into Physical and Multidimensional Frailty measures. Risk ratios (RR) along with their confidence intervals (CI) were estimated. Results: Thirteen studies involving 3,662 women and men with HF were included in this meta-analysis. The estimated prevalence of frailty in HF was 51.4% for women and 33.9% for men. The overall absolute risk increase for women compared to men with HF being frail was 14% (z = 3.92, p < 0.001). Overall, women with HF had a 42.1% higher risk of being frail (RR = 1.42 (CI = 1.19-1.69), p < 0.001) compared to men with HF, and there was significant heterogeneity in RRs across studies ( I 2 = 81.7%). Among studies that used Physical Frailty measures, women with HF had a 43.7% higher risk of being frail (RR = 1.44 (CI = 1.20-1.73), p < 0.001) compared with men. Among studies that used Multidimensional Frailty measures, there was no significant difference in risk of frailty between women and men (RR = 1.36 (CI = 0.94,1.96), p = 0.105). Conclusions: In HF, frailty affects women significantly more than men, although this was only noted among studies that measured physical frailty, and there was significant heterogeneity across studies. Future work should focus on elucidating potential causes of gender differences in frailty in HF.

51 Donor Milk in the NICU: A Community Pediatrics Perspective

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e36-e36
Author(s):  
Tasha Stoltz ◽  
Aaron Jones ◽  
Lynn Rogers ◽  
Hargun Sidhu ◽  
Rina Patel ◽  
...  
Keyword(s):  
Birth Weight ◽  
Hospital Stay ◽  
Growth Rates ◽  
Length Of Hospital Stay ◽  
Daily Weight Gain ◽  
Feeding Intolerance ◽  
Donor Milk ◽  
Increased Risk ◽  
Significant Difference ◽  
To Receive

Abstract Primary Subject area Community Paediatrics Background Use of pasteurized donor human milk (PDHM) has been recommended as an alternative to formula for preterm or low birth weight infants when mom’s own breast milk (MOM) is unavailable. Studies show that compared to PDHM, formula-fed neonates had better growth rates but were at increased risk of necrotizing enterocolitis (NEC) and feeding intolerance. Notably, most of these studies were conducted in tertiary-level NICUs. The Canadian Paediatric Society recommends PDHM as an alternative to formula for neonates admitted to NICUs. However, at time of study, PDHM was not offered in many community NICUs. Objectives The aim of this project is to determine whether the introduction of donor milk in the Level 2B NICU at Grand River Hospital has made a difference in rates of suspected NEC, feeding intolerance, growth, and length of hospital stay. Design/Methods We conducted a retrospective pre-post study comparing medical records of neonates in the NICU who met the criteria to receive PDHM 2 years after the introduction of PDHM at our centre (October 2017 to September 2019) to neonates who met the same criteria but were admitted prior to introduction of PDHM (October 2015 to September 2017) and thus received formula. Neonates who received privately purchased donor milk were excluded from our analysis. Results Gestational age and birth weight was similar for the PDHM (n=127) and control (n=120) groups. Compared to the PDHM group, formula-fed neonates were more likely to be transferred to a tertiary care NICU for concerns of suspected NEC (8.9% vs. 3.1%, p=0.017). When comparing any feeding intolerance, there was no significant difference between the two groups (p=0.23). Neonates receiving PDHM had higher average daily weight gain (33.9 vs. 28.9, p &lt; 0 .001), but were more likely to receive additional calorie supplementation. There were no differences in length of hospital stay. Conclusion The data from our community NICU support the current literature that infants who receive formula are at increased risk for transfer for suspected NEC compared to those who receive PDHM. However, in our centre, there appears to be no difference in rates of feeding intolerance, and neonates fed fortified PDHM appeared to have better growth rates. Results from this study can be used to guide the allocation of health care resources, and can be applied to other community centres. Future studies can look to replicating these results on a larger scale and analyze the cost-effectiveness of PDHM use in community centers.

Mature results of a randomized trial of two doses of cisplatin for the treatment of ovarian cancer. Scottish Gynecology Cancer Trials Group.

1996 ◽  
Vol 14 (7) ◽  
pp. 2113-2119 ◽  
Author(s):  
S B Kaye ◽  
J Paul ◽  
J Cassidy ◽  
C R Lewis ◽  
I D Duncan ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Death Rate ◽  
Randomized Study ◽  
Advanced Ovarian Cancer ◽  
High Dose ◽  
Optimal Balance ◽  
Significant Difference ◽  
First Results ◽  
To Receive

PURPOSE In 1992, we reported the first results of a randomized study in ovarian cancer, comprising two doses of cisplatin and indicated a significant difference (P = .0008) in median survival. Four years later, we now describe the results of this trial. PATIENTS AND METHODS After a median follow-up of 4 years and 9 months, 115 of 159 cases of advanced ovarian cancer, originally randomized to receive six cycles of cyclophosphamide 750 mg/m2 and either a high dose (HD) of 100 mg/m2 cisplatin or a low dose (LD) of 50 mg/m2 (LD) cisplatin, have now died. RESULTS The overall survival for HD and LD patients is 32.4% and 26.6%, respectively, and the overall relative death rate is 0.68 (P = .043). This represents a reduction in overall benefit with longer follow-up compared with the first 2 years (relative death rate of 0.52). Toxicity, particularly neurotoxicity, is still evident in the fourth year (10/31 on HD compared with 1/24 on LD). CONCLUSION Our recommended dose of cisplatin in combination schedule is therefore 75 mg/m2, representing the optimal balance between efficacy and toxicity.

scholarly journals Association of Calcium Supplementation During Pregnancy with the Birth Weight of Single-Born Neonates in Rural Northwest China

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1106-1106
Author(s):  
Gao Xiangyu ◽  
Mi Baibing ◽  
Dang Shaonong ◽  
Yan Hong
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Regression Models ◽  
Calcium Supplementation ◽  
Northwest China ◽  
Incidence Rates ◽  
Shaanxi Province ◽  
Significant Difference ◽  
Birth Weight Percentile ◽  
Weight Percentile

Abstract Objectives To investigate the association of calcium supplementation during the pregnancy with the birth weight of single-born neonates. Methods The survey employed a multistage, stratified and random sampling to investigate 15–49 aged pregnant women in 2010 to 2013 in Shaanxi province. A self - designed questionnaire was utilized. Birth weight between the 10(th) and 90(th) percentile was classified as appropriate for gestational age(AGA) infants. Chi-square test and logistic regression models were conducted to evaluate the association of calcium supplementation with single-born neonatal birth weight. Results A total of 28,490 women was enrolled in this study, 17 349 (60.9%) of participants had calcium supplementation during pregnancy. The incidence rates of small and large gestational age infants were 13.5% and 8.3%, respectively. The study conducted that calcium supplementation had a statistically significant difference in SGA (birth weight percentile &lt;10) (P &lt; 0.01). After adjusting the regression models by confounding factors, we found that calcium supplementation was still protective towards SGA birth, the difference was statistically significant (OR = 0.89, 95% CI: 0.82–0.96, P &lt; 0.05), but there was no significant difference in the birth to LGA (birth weight percentile &lt;10). Conclusions Calcium supplementation during pregnancy reduced the risk of SGA, but was not associated with the birth of LGA. Funding Sources

scholarly journals A birth population-based survey of preterm morbidity and mortality by gestational age

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaojing Guo ◽  
Xiaoqiong Li ◽  
Tingting Qi ◽  
Zhaojun Pan ◽  
Xiaoqin Zhu ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Birth Defects ◽  
Gestational Age ◽  
Death Rate ◽  
Preterm Births ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Hospital Death

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight <  1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight <  1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

scholarly journals PSIII-5 Effects of ingredient composition of oral drenches in small piglets post-farrowing on average daily gain and pre-wean mortality

2020 ◽  
Vol 98 (Supplement_3) ◽  
pp. 238-238
Author(s):  
Olivia Harrison ◽  
Samantha Tauer ◽  
Brent Frederick
Keyword(s):  
Birth Weight ◽  
Average Daily Gain ◽  
High Energy ◽  
Experimental Unit ◽  
Swine Industry ◽  
Bioactive Proteins ◽  
Randomized Design ◽  
Significant Difference ◽  
Key Factor ◽  
Daily Gain

Abstract Number of pigs born alive has been a key factor of the increasing efficiency of the U.S. swine industry. However, with increased pigs in the uterus, birth weight has been negatively impacted, with more small or at-risk pigs being born per litter. In order to overcome these changes, a study testing three commercial oral drenches against a control to determine which would increase average daily gain and decrease preweaning mortality. In a completely randomized design, 877 one-day-old suckling pigs from a high-health farm were selected for the experiment if they appeared to be in the bottom 20% of bodyweight compared to their contemporaries. Selected pigs were given one of four drenching treatments: 1) none (control), 2) bioactive proteins (BP), 3) high energy sugars (HES), and 4) immunoglobulins (IgY). Pigs were weighed on d 1 and d 19 of age (weaning), with mortality tracked during the suckling period. Data were analyzed using SAS v 9.4 (Cary, NC), with pig as the experimental unit and an accepted alpha of 0.05. Treatment had no detected effect on birth weight, weaning weight, ADG, or mortality (P = 0.79, 0.96, 0.86, 0.38 respectively). Likewise, statistical contrasts were used to determine there was no detected impact (P &gt; 0.10) of drench, regardless of type, compared to the control in any measured response criteria. Interesting, pigs drenched with BP or IgY had numerically lower preweaning mortality (11.2 and 11.5% respectively), than those administered the control or HES (15.4 and 15.2%, respectively). In conclusion, this experiment showed no significant difference in the performance between piglets given no product vs. those drenched with bioactive proteins, high energy sugars, or immunoglobulins. However, additional research is warranted with greater replication or disease stressors to better understand if oral drenches may improve preweaning performance or mortality in different situations.

scholarly journals Comparison of irinotecan and oxaliplatin as the first-line therapies for metastatic colorectal cancer: a meta-analysis

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sadayuki Kawai ◽  
Nozomi Takeshima ◽  
Yu Hayasaka ◽  
Akifumi Notsu ◽  
Mutsumi Yamazaki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Cochrane Central Register ◽  
First Line ◽  
Anti Vegf ◽  
Significant Difference ◽  
High Incidence

Abstract Background Irinotecan (IRI) and oxaliplatin (Ox) are standard therapeutic agents of the first-line treatments for metastatic colorectal cancer (mCRC). Previous meta-analyses of randomized controlled trials (RCTs) showed that treatment with Ox-based compared with IRI-based regimens was associated with better overall survival (OS). However, these reports did not include trials of molecular targeting agents and did not take methods for the administration of concomitant drugs, such as bolus or continuous infusion of 5-fluorouracil, into account. A systematic literature review was performed to compare the efficacy and toxicity profiles between IRI- and Ox-based regimens as the first-line treatments for mCRC. Methods This meta-analysis used data from the Cochrane Central Register of Controlled Trials, PubMed, and SCOPUS. The primary endpoint was OS, and the secondary endpoints were progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). Results Nineteen trials involving 4571 patients were included in the analysis. No statistically significant difference was observed between the two groups in terms of OS, PFS, and ORR. There was no significant heterogeneity. Regarding ≥ grade 3 AEs, IRI-based regimens were associated with a high incidence of leukopenia, febrile neutropenia, and diarrhea. Moreover, there was a high incidence of thrombocytopenia and peripheral sensory neuropathy in patients who received Ox-based regimens. In a subgroup analysis, IRI combined with bevacizumab was correlated with a better PFS (HR = 0.90, 95% CI = 0.82–0.98, P = 0.02), but not with OS (pooled HR = 0.91, 95% CI = 0.80–1.03, P = 0.15). Conclusion Although the safety profiles of IRI- and Ox-based regimens varied, their efficacy did not significantly differ. The combination of anti-VEGF antibody and IRI was associated with better PFS compared with anti-VEGF antibody and Ox. Both regimens could be used as the first-line treatments for mCRC with consideration of the patients’ condition or toxicity profiles.

scholarly journals The Effect of Supplemental Oxygen on the Incidence of Hypoxaemia after Premedication in Patients Undergoing Cardiac Surgery

1997 ◽  
Vol 25 (4) ◽  
pp. 347-349 ◽  
Author(s):  
C. F. Royse ◽  
R. J. B. Tiernan ◽  
S. M. Portelli ◽  
S. Davies ◽  
R. Arblaster ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Arterial Oxygen Saturation ◽  
Supplemental Oxygen ◽  
Arterial Oxygen ◽  
Patient Demographics ◽  
Routine Administration ◽  
High Incidence ◽  
Patient Groups ◽  
To Receive ◽  
Elective Patients

Opiate premedication may cause significant respiratory depression, particularly when other sedative agents such as scopolamine or benzodiazepines are added. This can cause hypoxaemia with potential for worsening myocardial ischaemia in cardiac surgery patients. The aim of this study was to investigate the incidence of hypoxaemia (SpO2 <90%) in elective patients undergoing cardiac surgery and to assess the efficacy of supplemental oxygen in preventing it. One hundred elective patients without significant respiratory disease or cardiac failure, who received both an opiate and a sedative premedication, were prospectively randomized to receive either oxygen via a facemask at 4 l/min or no oxygen. Continuous arterial oxygen saturation was recorded using a pulse oximeter from the time of premedication until the patient arrived in theatre. An SpO2 <90% was recorded as a significant event and oxygen was administered to the patients. Six patients were excluded because of equipment failure or protocol violations. The patient groups were comparable with respect to patient demographics, premedication type and dose or the duration of monitoring. In patients receiving oxygen (n=48) there were no episodes of hypoxaemia (0%). In patients not receiving oxygen (n=46) there were 14 episodes of hypoxaemia (30%, P<0.0001). We conclude that there is a significantly high incidence of hypoxaemia in cardiac surgery patients following combined opiate and sedative premedication and that it can be reduced by the routine administration of supplemental oxygen.

RELATIONSHIP OF ELEVATED BLOOD TYROSINE TO THE ULTIMATE INTELLECTUAL PERFORMANCE OF PREMATURE INFANTS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 218-224 ◽  
Author(s):  
John H. Menkes ◽  
Doris W. Welcher ◽  
Helene S. Levi ◽  
Joseph Dallas ◽  
Neil E. Gretsky
Keyword(s):  
Birth Weight ◽  
Premature Infants ◽  
Maximum Level ◽  
Intellectual Performance ◽  
Wide Range Achievement Test ◽  
Follow Up Study ◽  
Wide Range ◽  
Significant Difference ◽  
Picture Completion

Blood tyrosine concentrations were followed from birth to nursery discharge in 71 premature infants fed a high protein formula supplemented by 60 mg/day of ascorbic acid. In 89% of infants blood tyrosine concentrations were abnormal, and in 38% of infants the maximum level observed was 15.0 mg/100 ml or higher. Maximum blood tyrosine levels correlated significantly with gestational age (p = &lt; 0.05) but not with birth weight. In a follow-up study performed at 15 months of age, infants with high tyrosine levels had no increase in the incidence of neurological abnormalities. Between 7 and 8 years of age a second follow-up study was performed on 62 children. This included a WISC, a Wide-Range Achievement Test (WRAT), and tests for psychomotor and language maturity. Two children had died in the interval, and five of the 62 were retarded for full testing. The full scale WISC I.Q. of all children correlated with birth weight at the 10% confidence level (p = &lt; 0.1). The mean WISC I.Q. of high and low tyrosine subjects was 82.9 and 81.6 respectively. When infants were grouped by birth weight, a significant difference was detected in subjects weighing 2,000 gm or more. High tyrosine infants had a significantly lower performance I.Q. than low tyrosine infants (82.4 and 97.8 respectively; p = &lt; 0.02). Significant differences were recorded in the scores on Object Assembly, Picture Assembly, and Picture Completion of the WISC. Significant differences were also seen on the Spelling subtest of the WRAT (p = &lt; 0.02). We observed no adverse effect of high tyrosine levels on the intellectual performance of smaller premature infants, who on the whole have a greater risk for other complications of prematurity.

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