A Vasoactive Inotropic Score Predicts the Severity of Hypotensive Shock and Mortality in Preterm Infants

2021 ◽  
Author(s):  
Reem Amer ◽  
Mary M Seshia ◽  
Yasser N Elsayed
Keyword(s):  
Preterm Infants ◽  
Primary Outcome ◽  
Area Under The Curve ◽  
Cumulative Exposure ◽  
Receiver Operator Curve ◽  
Predictive Values ◽  
Inotropic Score ◽  
Cardiovascular Medications ◽  
Vasoactive Inotropic Score ◽  
Operator Curve

Abstract Objective: To validate the prediction of the severity of hypotensive shock and mortality using the vasoactive inotropic score in preterm infants.Methods: In this retrospective study we calculated the vasoactive inotropic score (VIS) and cumulative exposure to cardiovascular medications over time (VISct) in a cohort of preterm infants with hypotensive shock who received a cardiovascular support. Receiver operator curve was constructed to predict the primary outcome which was death due to hypotensive shock. Results: VIS had an area under the curve of 0.73 (95% CI 0.85-0.98, p < 0.001). A VIS cut off of 25 has sensitivity and specificity of 66% and 92%, and positive and negative predictive values of 78.5% and 83%, respectively.Conclusion: High VIS predicts high mortality rate due to irreversible shock in preterm infants

scholarly journals Prediction of Extubation Readiness Using Transthoracic Ultrasound in Preterm Infants

2020 ◽  
Author(s):  
Reem M. Soliman ◽  
Yasser Elsayed ◽  
Reem N. Said ◽  
Abdulaziz M. Abdulbaqi ◽  
Rania H. Hashem ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Preterm Infants ◽  
Pulmonary Artery Pressure ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Interventricular Septum ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Predictive Values ◽  
Artery Pressure

ABSTRACTObjectiveTo test the hypothesis that a lung ultrasound severity score (LUSsc) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated preterm infants with respiratory distress syndrome (RDS).DesignProspective observational study of premature infants <34 weeks’ of gestation age supported with mechanical ventilation due to RDS. LUSsc and LVEI were performed on postnatal days 3 and 7 by an investigator who was masked to infants’ ventilator parameters and clinical conditions. RDS was classified based on LUSsc into mild (score 0–9) and moderate-severe (score 10–18). A receiver operator curve was constructed to assess the ability to predict extubation success. Pearson’s correlation was performed between LVEI and pulmonary artery pressure (PAP).SettingLevel III neonatal intensive care unit, Cairo, Egypt.ResultsA total of 104 studies were performed to 66 infants; of them 39 had mild RDS (LUSsc 0–9) and 65 had moderate-severe RDS (score ≥10). LUSsc predicted extubation success with a sensitivity and a specificity of 91% and 69%; the positive and negative predictive values were 61% and 94%, respectively. Area under the curve (AUC) was 0.83 (CI: 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. However, it correlated with pulmonary artery pressure during both systole (r=0.62) and diastole (r=0.53) and with hemodynamically significant patent ductus arteriosus (r=0.27 and r=0.46, respectively).ConclusionLUSsc predicts extubation success in preterm infants with RDS whereas LVEI correlates with high PAP.

scholarly journals Effect of Co-Medication on the Pharmacokinetic Parameters of Phenobarbital in Asphyxiated Newborns

2015 ◽  
pp. S513-S519 ◽  
Author(s):  
M. ŠÍMA ◽  
P. POKORNÁ ◽  
K. HRONOVÁ ◽  
O. SLANAŘ
Keyword(s):  
Area Under The Curve ◽  
Compartmental Analysis ◽  
Volume Of Distribution ◽  
Hypoxic Ischemic Encephalopathy ◽  
Pharmacokinetic Parameters ◽  
Vasoactive Medication ◽  
Inotropic Score ◽  
Study Population ◽  
Vasoactive Inotropic Score ◽  
Ischemic Encephalopathy

Phenobarbital is an anticonvulsive drug widely used in newborns with hypoxic-ischemic encephalopathy. The objective of our study was to describe possible effect of frequently co-administered medications (dopamine, dobutamine, norepinephrine, furosemide, phenytoin, and analgesics) on the phenobarbital pharmacokinetics in full term newborns with hypoxic-ischemic encephalopathy. Phenobarbital pharmacokinetic parameters (standardized intravenous loading dose was 10-20 mg/kg, maintenance dose 2-6 mg/kg/day) were computed using non-compartmental analysis. Co-medication was evaluated throughout the whole treatment period up to 5 days. Volume of distribution, clearance, and half-life median values (95 % CI) for phenobarbital in the whole study population (n=37) were 0.48 (0.41-0.56) l/kg, 0.0034 (0.0028-0.0040) l/h/kg, and 93.7 (88.1-99.2) h, respectively. Phenobarbital pharmacokinetic parameters were not significantly affected by vasoactive drugs (dopamine, dobutamine, and norepinephrine), furosemide, phenytoin, or analgesics. Furthermore, no dose-dependent alteration of phenobarbital pharmacokinetic parameters was noted for vasoactive medication at doses equivalent to cumulative vasoactive-inotropic score (area under the curve in a plot of vasoactive-inotropic score against time) 143.2-8473.6, furosemide at cumulative doses of 0.2-42.9 mg/kg, or phenytoin at cumulative doses of 10.3-46.2 mg/kg. Phenobarbital pharmacokinetics was not affected by investigated co-administered drugs used in newborns with hypoxic-ischemic encephalopathy in real clinical settings.

scholarly journals Prediction of Extubation Readiness Using Transthoracic Ultrasound in Preterm Infants

2021 ◽  
Author(s):  
Reem Soliman ◽  
Yasser Elsayed ◽  
Reem Said ◽  
Abdulaziz Abdulbaqi ◽  
Rania Hashem ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Interventricular Septum ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Mechanically Ventilated ◽  
A Prospective Study ◽  
Transthoracic Ultrasound ◽  
Severe Lung Disease ◽  
Operator Curve ◽  
Severe Lung

We aimed to test the hypothesis that a lung ultrasound severity score (LUS) and assessment of left ventricular eccentricity index of the interventricular septum (LVEI) by focused heart ultrasound can predict extubation success in mechanically ventilated infants. We conducted a prospective study on premature infants <34 weeks’ of gestation. LUS was performed on postnatal days 3 and 7 by an investigator who was masked to infants’ ventilator parameters. LVEI and pulmonary artery pressure (PAP) were measured at postnatal day 3. A receiver operator curve was constructed to assess the ability to predict extubation success. Spearman correlation was performed between LVEI and PAP. A total of 104 studies were performed to 66 infants; of them 39 had mild and 65 had moderate-severe lung disease. LUS predicted extubation success with a sensitivity and a specificity of 91% and 69%, respectively. Area under the curve was 0.83 (CI: 0.75-0.91). LVEI did not differ between infants that succeeded and failed extubation. It correlated with PAP during systole (r=0.66). We conclude that LUS predicts extubation success in mechanically ventilated preterm infants whereas LVEI correlates with high PAP.

scholarly journals Determination of Urinary Calcium/Creatinine Ratio in a Spot Sample of Urine For Early Prediction of Pre-Eclampsia

2014 ◽  
Vol 41 (2) ◽  
pp. 20-22 ◽  
Author(s):  
SY Moni ◽  
KM Ahmed ◽  
F Siddika ◽  
A Habib ◽  
N Ara ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Urine Sample ◽  
Urinary Calcium ◽  
Early Prediction ◽  
Creatinine Ratio ◽  
Receiver Operator Curve ◽  
Predictive Values ◽  
Spot Urine ◽  
Single Urine Sample ◽  
Operator Curve

Based on the fact that urinary hypocalciuria in pre-eclampsia this study was designed to determine the predictive value of calcium to creatinine ratio in a spot urine sample in second trimester of pregnancy. The calcium to creatinine ratio Calcium/creatinine ratio has been considered for early detection of pre-eclamptic toxaemia (PET). So for the diagnosis of PET we try to investigate the relation of urinary calcium, urinary creatinine, urinary calcium/creatinine ratio. For this purpose total number of 60 healthy gravid and clinically suspected PET women of 20-28 weeks of pregnancy having age ranged from, 17-39 years were selected. On these 30 healthy pregnant women urinary calcium/creatinine ratio was within normal range and On the other hand urinary calcium/creatinine ratio in PET women was significantly decreased on the clinically diagnosed 30 PET women. These observations suggest that low calcium/creatinine ratio help in early prediction of PET .The result expressed by receiver operator curve analytic tecnique. Using the receiver operator curve a cut off level of 0.225 the calcium to creatinine ratio was chosen for prediction of PET. Twenty Two out of 30 woman had a calcium/creatinine ratio equal or less than 0.225. Thirty who had remained normotensive 13 had calcium/creatinine ratio equal or less than 0.225. This level thus yielded a 75% sensitivity and 65% specificity. Positive and negative predictive values 68.2% and 72.2% were calculated respectively, at this cut-off point. In conclusion a spot single urine sample calcium/creatinine ratio may be an effective method for screening pregnant women for detection of pre-eclampsia. DOI: http://dx.doi.org/10.3329/bmj.v41i2.18796 Bangladesh Medical Journal 2012 Vol. 41 No. 2: 20-22

The Impact of Hypoxemia on the Development of Retinopathy of Prematurity in Infants Less Than 29 Weeks of Gestation

2018 ◽  
Vol 35 (12) ◽  
pp. 1148-1153 ◽  
Author(s):  
Narges Afshar ◽  
Ronald Baier ◽  
Mohamed Tagin ◽  
Cecilia Cabo ◽  
John Minski ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Retrospective Analysis ◽  
Preterm Infants ◽  
Study Design ◽  
Retinopathy Of Prematurity ◽  
Primary Outcome ◽  
Cumulative Exposure ◽  
The Impact ◽  
Cumulative Time

Objective To study the impact of cumulative exposure to hypoxemia on the development of retinopathy of prematurity (ROP) in preterm infants less than 29 weeks' gestation. Study Design This is a retrospective analysis of the effect of cumulative exposure to hypoxemia during the first 10 weeks of life in preterm infants <29 weeks' gestation. Cumulative time spent at various levels of oxygen saturation was calculated by converting the daily percentage of time to minutes per day. Cumulative exposure to hypoxemia (cT<80 or oxygen saturation <80%) was calculated weekly and compared between outcomes. The primary outcome was the development of ROP requiring treatment. Results Cumulative hypoxemia exposure was significantly associated with ROP requiring treatment. When adjusted for other neonatal morbidities, only gestation was consistently associated with ROP requiring treatment. Conclusion Cumulative exposure to hypoxemia in the first few weeks was not associated with ROP or treatment of ROP after adjustment for confounders.

Quantitative morphometrics reveals glomerular changes in patients with infrequent segmentally sclerosed glomeruli

2021 ◽  
pp. jclinpath-2020-207149
Author(s):  
Jennifer A Schaub ◽  
Christopher L O'Connor ◽  
Jian Shi ◽  
Roger C Wiggins ◽  
Kerby Shedden ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Kidney Biopsy ◽  
Geometric Distribution ◽  
Kidney Tissue ◽  
Area Under The Curve ◽  
Clinical Markers ◽  
Receiver Operator Curve ◽  
Multivariate Modelling ◽  
Operator Curve ◽  
Total Nephrectomy

AimsDetection of one segmentally sclerosed glomerulus (SSG) identifies patients with focal segmental glomerulosclerosis (FSGS) but rare SSGs may be missed in kidney biopsies. It is unknown whether alterations of unaffected glomeruli in patients with infrequent SSG can be detected by quantitative morphometrics.MethodsWe determined SSG frequency and obtained quantitative morphometrics in glomeruli without a pathologic phenotype in large kidney sections of non-involved kidney tissue from 137 patients undergoing total nephrectomy. We used multivariate modelling to identify morphometrics independently associated with increasing frequency of SSG and Receiver Operator Curve (ROC) analysis to determine the ability of quantitative morphometrics to identify patients with FSGS. We used the geometric distribution to estimate the sensitivity and specificity of a needle biopsy to identify patients with FSGS.ResultsIn seventy-one patients (51.8%), at least one SSG was observed, and of those, 39 (54.9%) had an SSG lesion in less than 2% of all glomeruli (mean of 249 glomeruli per specimen). Increasing percent of SSG was independently associated with decreasing podocyte density and increasing mesangial index in multivariate modelling. For infrequent SSG lesions (<1% of glomeruli), kidney biopsy could miss FSGS diagnosis more than 74% of the time, and podocyte density had an area under the curve (AUC) of 0.77, and mesangial index, an AUC of 0.79 to identify patients with FSGS.ConclusionsMore than half of patients had FSGS, although 30% had infrequent SSG. Quantitative morphometrics in glomeruli without pathology, such as podocyte density and mesangial index, identified patients with infrequent SSG and may serve as clinical markers to identify patients with FSGS.

scholarly journals Vasoactive-inotropic Score for Early Detection and Mortality Prediction of Sepsis in Children

2021 ◽  
Vol 13 (1) ◽  
pp. 34-9
Author(s):  
Aileen Clarissa Dauhan ◽  
Aridamuriany Dwiputri Lubis ◽  
Munar Lubis
Keyword(s):  
Early Detection ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Area Under The Curve ◽  
Mortality Prediction ◽  
Reduce Mortality Rate ◽  
Logistic Organ Dysfunction ◽  
Inotropic Score ◽  
Vasoactive Inotropic Score

BACKGROUND: Early detection and treatment of sepsis can prevent septic shock and reduce mortality rate. Troponin can become a prognostic factor in sepsis. However, not all health facilities are equipped to assess troponin levels. Vasoactive-inotropic score (VIS) is a simpler and more accessible method to describe hemodynamic status. The aim of this study was to assess the suitability of VIS score as early prognosis and mortality predictor of sepsisMETHODS: A retrospective study was conducted to determine the correlation between VIS and troponin levels for sepsis cases in Pediatric Intensive Care Unity (PICU) Haji Adam Malik Hospital, Medan from January 2018 to December 2019. VIS score at 48 hours, maximum VIS score, pediatric logistic organ dysfunction-2 (PELOD-2) score, cardiac troponin levels at 48 hours were taken from medical records.RESULTS: There were 54 samples analyzed. VIS scores were positively correlated (p<0.001) to troponin T and troponin I levels at 48 hours (r=0.670 and r=0.606, respectively). VIS at 48 hours and maximum VIS were related to mortality (p=0.001 and p<0.001, respectively). VIS score at 48 hours could be used as a predictive factor for mortality (area under the curve (AUC): 79.7%, p<0.001) with a cut-off point at 11 (74.4% sensitivity and 80% specificity). High VIS at 48 hours indicated poor outcomes of sepsis in children with odd ratio (OR) value: 1.99 (95% confidence interval (CI): 1.25-3.19).CONCLUSION: Vasoactive-inotropic score was suitable as an alternative to cardiac troponin T and troponin I levels at 48 hours to early detect myocardial dysfunctions and mortality in children.KEYWORDS: troponin, vasoactive-inotropic score, sepsis, children, mortality

Discriminating Malignancy in Thyroid Nodules: The Nomogram Versus the Kwak and ACR TI-RADS

2020 ◽  
Vol 163 (6) ◽  
pp. 1156-1165
Author(s):  
Juan Xiao ◽  
Qiang Xiao ◽  
Wei Cong ◽  
Ting Li ◽  
Shouluan Ding ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Diagnostic Study ◽  
Diagnostic Efficiency ◽  
Training Set ◽  
Multivariable Logistic Regression Model ◽  
Predictive Values ◽  
Validation Set ◽  
Sensitivity Specificity

Objective To develop an easy-to-use nomogram for discrimination of malignant thyroid nodules and to compare diagnostic efficiency with the Kwak and American College of Radiology (ACR) Thyroid Imaging, Reporting and Data System (TI-RADS). Study Design Retrospective diagnostic study. Setting The Second Hospital of Shandong University. Subjects and Methods From March 2017 to April 2019, 792 patients with 1940 thyroid nodules were included into the training set; from May 2019 to December 2019, 174 patients with 389 nodules were included into the validation set. Multivariable logistic regression model was used to develop a nomogram for discriminating malignant nodules. To compare the diagnostic performance of the nomogram with the Kwak and ACR TI-RADS, the area under the receiver operating characteristic curve, sensitivity, specificity, and positive and negative predictive values were calculated. Results The nomogram consisted of 7 factors: composition, orientation, echogenicity, border, margin, extrathyroidal extension, and calcification. In the training set, for all nodules, the area under the curve (AUC) for the nomogram was 0.844, which was higher than the Kwak TI-RADS (0.826, P = .008) and the ACR TI-RADS (0.810, P < .001). For the 822 nodules >1 cm, the AUC of the nomogram was 0.891, which was higher than the Kwak TI-RADS (0.852, P < .001) and the ACR TI-RADS (0.853, P < .001). In the validation set, the AUC of the nomogram was also higher than the Kwak and ACR TI-RADS ( P < .05), each in the whole series and separately for nodules >1 or ≤1 cm. Conclusions When compared with the Kwak and ACR TI-RADS, the nomogram had a better performance in discriminating malignant thyroid nodules.

Nasal High-Frequency Oscillatory Ventilation in Preterm Infants with Moderate Respiratory Distress Syndrome: A Multicenter Randomized Clinical Trial

Neonatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Xingwang Zhu ◽  
Zhichun Feng ◽  
Chengjun Liu ◽  
Liping Shi ◽  
Yuan Shi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress Syndrome ◽  
Preterm Infants ◽  
High Frequency ◽  
Primary Outcome ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Risk Difference ◽  
High Frequency Oscillatory Ventilation ◽  
High Frequency Oscillatory

<b><i>Objective:</i></b> To determine whether nasal high-frequency oscillatory ventilation (NHFOV) as a primary mode of respiratory support as compared with nasal continuous airway pressure (NCPAP) will reduce the need for invasive mechanical ventilation in preterm infants (26<sup>0/7</sup>–33<sup>6/7</sup> weeks of gestational age [GA]) with respiratory distress syndrome (RDS). <b><i>Methods:</i></b> This multicenter randomized controlled trial was conducted in 18 tertiary neonatal intensive care units in China. A total of 302 preterm infants born at a GA of 26<sup>0/7</sup>–33<sup>6/7</sup> weeks with a diagnosis of RDS were randomly assigned to either the NCPAP (<i>n</i> = 150) or the NHFOV (<i>n</i> = 152) group. The primary outcome was the need for invasive mechanical ventilation during the first 7 days after birth. <b><i>Results:</i></b> Treatment failure occurred in 15 of 152 infants (9.9%) in the ­NHFOV group and in 26 of 150 infants (17.3%) in the NCPAP group (95% CI of risk difference: −15.2 to 0.4, <i>p =</i> 0.06). In the subgroup analysis, NHFOV resulted in a significantly lower rate of treatment failure than did NCPAP in the strata of 26<sup>+0/7</sup>–29<sup>+6/7</sup>weeks of GA (11.9 vs. 32.4%, 95% CI of risk difference: −39.3 to −1.7, <i>p =</i> 0.03) and birth weight &#x3c;1,500 g (10.4 vs. 29.6%, 95% CI of risk difference: −33.8 to −4.6, <i>p =</i> 0.01). The rate of thick secretions causing an airway obstruction was higher in the NHFOV group than in the NCPAP group (13.8 vs. 5.3%, 95% CI of risk difference: 1.9–15.1, <i>p =</i> 0.01). No significant differences in other secondary outcomes were found between the NHFOV and NCPAP groups. <b><i>Conclusions:</i></b> NHFOV was not superior to NCPAP with regard to the primary outcome when applied as the primary respiratory support for RDS in infants between 26<sup>+0/7</sup> and 33<sup>+6/7</sup> weeks of GA. In the subgroup analysis, NHFOV seemed to improve effectiveness than NCPAP in preterm infants &#x3c;30 weeks of GA.

Sign in / Sign up

Export Citation Format

Share Document