Head injuries related to birth trauma among low birthweight neonates during vacuum extraction: a retrospective cohort study

Objective: Prematurity [gestational age (GA)<34w] is a relative contraindication to vacuum extraction (VE). Current data do not discriminate clearly between prematurity and low-birthweight (LBW). We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth-trauma (HI), among newborns with LBW (<2,500g). Design: A retrospective cohort. Population: 3,335 singleton pregnancies, delivered by VE from 2014 to 2019. All were >34w GA. Methods: We compared 207 (6.2%) neonates with LBW <2,500g to 3,128 (93.8%) neonates with higher BW, divided into 3 subgroups (2,500-2,999g, 3,000-3,499g, and >3,500g). Main outcome measures: HI and other neonatal complications. Results: The lowest rates of subgaleal hematoma occurred in neonates <2,500g (0.5%) and increased with every additional 500g of neonatal birthweight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively; p=0.001). Fewer cephalohematomas occurred among LBW neonates (0.5% in <2,500g) and increased with every additional 500g of birthweight (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively, p=0.026). Logistic regression found increasing birthweight as a significant risk-factor for head injuries during VE, with adjusted odds ratios of 8.874, 10.624, 13.980 for 2,500-2,999g, 3,000-3,499g, and >3,500g, respectively (p=0.015). NICU hospitalization rates were highest among neonates weighing <2,500g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, >3,500g respectively, p=0.000). Conclusions: VE of neonates weighing <2500g at 34w and beyond seems as a safe mode of delivery when indicated, with lower rates of HI, compared to neonates with higher BW. Funding: none.

Download Full-text

The impact of levothyroxine exposure on delivery outcome in hypothyroid pregnant women (PETAL study): A five-year retrospective cohort study

Obstetric Medicine ◽

10.1177/1753495x211064108 ◽

2021 ◽

pp. 1753495X2110641

Author(s):

Diana Oprea ◽

Nadine Sauvé ◽

Jean-Charles Pasquier

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Caesarean Delivery ◽

Significant Risk ◽

Significant Risk Factor ◽

Singleton Pregnancy ◽

Delivery Outcome ◽

The Impact

Background Hypothyroidism affects 3% of pregnant women, and to date, no studies have addressed the impact levothyroxine-treated hypothyroidism on delivery outcome. Methods This retrospective cohort study was conducted among 750 women with a singleton pregnancy who gave birth between 2015 and 2019. Delivery modes were compared between 250 hypothyroid women exposed to levothyroxine and 500 euthyroid control women. The aim of this study was to determine the impact of levothyroxine exposure on delivery outcome. Results Multiple logistic regression showed no significant association between exposure to levothyroxine and the overall rate of caesarean delivery (aOR 1.1; 95% CI 0.8 to 1.6). Mean TSH concentrations were significantly higher throughout the pregnancy in hypothyroid women despite levothyroxine treatment. Maternal and neonatal outcomes in both groups were not different. Conclusion Hypothyroidism treated with levothyroxine during pregnancy according to local guidelines is not a significant risk factor for caesarean delivery.

Download Full-text

Timing of resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.77 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S11-S11 ◽

Cited By ~ 2

Author(s):

D Guha ◽

S Coyne ◽

RL Macdonald

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Postoperative Complications ◽

Retrospective Cohort ◽

Significant Risk ◽

Significant Risk Factor ◽

Antithrombotic Agents ◽

Major Hemorrhage ◽

Subdural Hematomas ◽

Surgical Evacuation

Background: Antithrombosis (AT), with antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDH). Resumption of AT following hematoma evacuation is variable, with scant evidence for guidance. Methods: We retrospectively analyzed 479 patients with surgically-evacuated cSDH at St. Michael’s Hospital from 2007-2012. Collected variables included type of AT, indication for AT, timing and type of postoperative complications, and restart intervals for AT agents. Postoperative complications were classified as major or minor hemorrhages, or thromboembolism. Results: Among all patients, 14.8% experienced major hemorrhage, 23.0% minor hemorrhage, and 1.67% thromboembolism. Patients on any preoperative AT were at higher risk of major hemorrhage (OR=1.93, p=0.014), experienced earlier major hemorrhage (mean 16.2 versus 26.5d, p=0.052) and earlier thromboembolism (mean 2.7 versus 51.5d, p=0.036). The type of agent did not affect complication frequency or timing. Patients restarted on any AT postoperatively were at decreased risk of major rebleed following resumption, than those not restarted (OR=0.06, p<0.01). Conclusions: Patients on preoperative AT experienced thromboembolism significantly earlier, at 3d postoperatively, with no increase in rebleed risk following AT resumption. We provide cursory evidence that resuming AT early, at 3d postoperatively, may be safe. Larger prospective studies are required for definitive recommendations.

Download Full-text

1487. Pneumonia due to Co-Infection in the ICU: Detection and Clinical Significance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1668 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S745-S746

Author(s):

Casey S Zelus ◽

Michael Blaha ◽

Kaeli Samsom ◽

Jasmine R Marcelin ◽

Trevor C Van Schooneveld ◽

...

Keyword(s):

Clinical Significance ◽

Diagnostic Testing ◽

Significant Risk ◽

Significant Risk Factor ◽

Categorical Variables ◽

Chi Square ◽

Mechanically Ventilated ◽

Critical Care Units ◽

Outcomes Measures ◽

The Impact

Abstract Background Pneumonia is a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of co-infection. However, the impact of methodology to obtain lower respiratory samples along with the utility of various microbiological diagnostic testing remains unclear. Methods A single-center retrospective analysis was performed on bronchoalveolar lavage (BAL) samples obtained from mechanically ventilated adults treated in critical care units from August 2012 to December 2017. BAL methodology (bronchoscopic vs blinded), microbiological diagnostic testing, and outcomes measures were obtained. Associations between categorical variables were assessed using Chi-Square or Fisher’s exact tests. Kruskal Wallace tests analyzed differences in distributions of measures between categories based on number of organism types detected. SAS software version 9.4 (SAS Institute Inc., Cary, NC). Results Analysis of the 803 samples that met inclusion criteria found a significant linear association between mortality and number of organism types detected by BAL, with 30 day mortality rates of 43.0%, 47.8%, and 58.3% among those with zero, one, and two or more organisms respectively (p = 0.003). Comparing BALs with at least one organism isolated, the detection of viruses specifically was associated with increased mortality, with the presence and absence of viral organisms corresponding to 56.3% and 46.5% mortality at thirty days (p = 0.03). No association was found between mortality and isolation of acid-fast bacilli, bacteria, or fungi. Co-infection was detected more frequently among bronchoscopic BALs than blinded BALs (26.3% vs 8.6%, p < 0.0001), with more viruses detected bronchoscopic BALs (41.9% vs 13.1%, p < 0.0001), and more bacteria in blinded BALs (41.8% vs 33.0%, p = 0.01). 30 Day Mortality vs Isolation of Specific Organism Types from BAL Number of Organism Types Isolated from BAL Compared to BAL Methodology BAL Methodology vs Isolation of Specific Organism Types Conclusion Co-infection in mechanically ventilated adult patients with pneumonia appears to be a significant risk factor for mortality, with the detection of viral organisms potentially playing an independent role. Within this population, bronchoscopic BALs may have a valuable diagnostic and prognostic methodology. Disclosures All Authors: No reported disclosures

Download Full-text

Implementation of Global Strategies to Prevent Hospital-Onset Clostridium difficile Infection: Targeting Proton Pump Inhibitors and Probiotics

Annals of Pharmacotherapy ◽

10.1177/1060028017694050 ◽

2017 ◽

Vol 51 (10) ◽

pp. 848-854 ◽

Cited By ~ 7

Author(s):

Paul O. Lewis ◽

Timothy S. Lundberg ◽

Jennifer L. Tharp ◽

Clay W. Runnels

Keyword(s):

Cohort Study ◽

Clostridium Difficile ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Clostridium Difficile Infection ◽

Retrospective Cohort ◽

Significant Risk ◽

Significant Risk Factor ◽

Order Sets ◽

Global Strategies

Background: Proton pump inhibitors (PPIs) have been identified as a significant risk factor for the development of Clostridium difficile infection (CDI). Probiotics given concurrently with antibiotics have been shown to have a moderate impact on preventing CDI. Objective: To evaluate the effectiveness of hospital-wide interventions designed to reduce PPI use and increase probiotics and whether these interventions were associated with a change in the incidence of hospital onset (HO)-CDI. Methods: This retrospective cohort study compared 2 fiscal years: July 2013 to June 2014 (FY14) and July 2014 to June 2015 (FY15). In July of FY15, global educational initiatives were launched targeting PPIs. Additionally, a HO-CDI prevention bundle was added to antibiotic-containing order sets targeting probiotics. Overall PPI use, probiotic use, and incidence of HO-CDI were recorded and compared for each cohort. Charts were also reviewed for patients who developed HO-CDI for the presence and appropriateness of a PPI and presence of probiotics. Results: The interventions resulted in a decrease in PPI use by 14% or 96 doses/1000 patient days (TPD; P = 0.0002) and a reduction in IV PPI use by 31% or 71 doses/TPD ( P = 0.0008). Probiotic use increased by 130% or 126 doses/TPD ( P = 0.0006). The incidence of HO-CDI decreased by 20% or 0.1 cases/TPD ( P = 0.04). Conclusions: A collaborative, multifaceted educational initiative directed at highlighting the risks associated with PPI use was effective in reducing PPI prescribing. The implementation of a probiotic bundle added to antibiotic order sets was effective in increasing probiotic use. These interventions were associated with a decrease in incidence of HO-CDI.

Download Full-text

Routine deworming during antenatal care decreases risk of neonatal mortality and low birthweight: A retrospective cohort of survey data

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009282 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009282

Author(s):

Bhavneet Walia ◽

Brittany L. Kmush ◽

Sandra D. Lane ◽

Timothy Endy ◽

Antonio Montresor ◽

...

Keyword(s):

Confidence Interval ◽

Antenatal Care ◽

Neonatal Mortality ◽

Retrospective Cohort ◽

Low Birthweight ◽

Health Benefit ◽

Low Transmission ◽

Random Intercept ◽

Poor Access ◽

The Impact

Background Soil transmitted helminths (STH) are a common infection among pregnant women in areas with poor access to sanitation. Deworming medications are cheap and safe; however, the health benefit of deworming during pregnancy is not clear. Methods / Principal findings We created a retrospective cohort of more than 800,000 births from 95 Demographic and Health Survey datasets to estimate the impact of deworming medicine during routine antenatal care (ANC) on neonatal mortality and low birthweight. We first matched births on the probability of receiving deworming during ANC. We then modeled the birth outcomes with the matched group as a random intercept to estimate the effect of deworming during antenatal care after accounting for various risk factors. We also tested for effect modification of soil transmitted helminth prevalence on the impact of deworming during ANC. Receipt of deworming medication during ANC was associated with a 14% reduction in the risk of neonatal mortality (95% confidence interval = 10–17%, n = 797,772 births), with no difference between high and low transmission countries. In low transmission countries, we found an 11% reduction in the odds of low birth weight (95% confidence interval = 8–13%) for women receiving deworming medicine, and in high transmission countries, we found a 2% reduction in the odds of low birthweight (95% confidence interval = 0–5%). Conclusions / Significance These results suggest a substantial health benefit for deworming during ANC that may be even greater in countries with low STH transmission.

Download Full-text

Obesity Does Not Increase Mortality after Emergency Surgery

Journal of Obesity ◽

10.1155/2014/492127 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 5

Author(s):

Paula Ferrada ◽

Rahul J. Anand ◽

Ajai Malhotra ◽

Michel Aboutanos

Keyword(s):

Wound Infection ◽

Emergency Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Patient Characteristics ◽

Obese Patients ◽

Exact Test ◽

Icu Admission ◽

Nonobese Patients ◽

The Impact

Objective.The aim of this study is to evaluate the impact of obesity on patient outcomes after emergency surgery.Methods.A list of all patients undergoing emergent general surgical procedures during the 12 months ending in July 2012 was obtained from the operating room log. A chart review was performed to obtain the following data: patient characteristics (age, gender, BMI, and preexisting comorbidities), indication for surgery, and outcomes (pulmonary embolus (PE), deep venous thrombosis (DVT), respiratory failure, ICU admission, wound infection, pneumonia, and mortality). Obesity was defined as a BMI over 25. Comparisons of outcomes between obese and nonobese patients were evaluated using Fischer’s exact test. Predictors of mortality were evaluated using logistic regression.Results.341 patients were identified during the study period. 202 (59%) were obese. Both groups were similar in age (48 for obese versus 47 for nonobese,P=0.42). Obese patients had an increased incidence of diabetes, (27% versus 7%,P<0.05), hypertension (52% versus 34%,P<0.05), and sleep apnea (0% versus 5%,P<0.05). There was a statistically significant increased incidence of postoperative wound infection (obese 9.9% versus nonobese 4.3%,P<0.05) and ICU admission (obese 58% versus nonobese 42%,P=0.01) among the obese patients. Obesity alone was not shown to be a significant risk factor for mortality.Conclusions.A higher BMI is not an independent predictor of mortality after emergency surgery. Obese patients are at a higher risk of developing wound infections and requiring ICU admission after emergent general surgical procedure.

Download Full-text

Maternal Obesity and Rectovaginal Group B Streptococcus Colonization at Term

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2015/586767 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 12

Author(s):

Shelby M. Kleweis ◽

Alison G. Cahill ◽

Anthony O. Odibo ◽

Methodius G. Tuuli

Keyword(s):

Risk Factor ◽

Maternal Obesity ◽

Management Strategies ◽

Group B Streptococcus ◽

Significant Risk ◽

Positive Culture ◽

Significant Risk Factor ◽

Entire Cohort ◽

Group B ◽

The Impact

Objective. To test the hypothesis that maternal obesity is an independent risk factor for rectovaginal group B streptococcus (GBS) colonization at term.Study Design. Retrospective cohort study of consecutive women with singleton term pregnancies admitted in labor at Barnes-Jewish Hospital (2004–2008). Maternal BMI ≥ 30 Kg/m2(obese) or <30 Kg/m2(nonobese) defined the two comparison groups. The outcome of interest was GBS colonization from a positive culture. Baseline characteristics were compared using Student’st-test and Chi-squared or Fisher’s exact test. The association between obesity and GBS colonization was assessed using univariable and multivariable analyses.Results. Of the 10,564 women eligible, 7,711 met inclusion criteria. The prevalence of GBS colonization in the entire cohort was relatively high (25.8%). Obese gravidas were significantly more likely to be colonized by GBS when compared with nonobese gravidas (28.4% versus 22.2%,P<0.001). Obese gravidas were still 35% more likely than nonobese women to test positive for GBS after adjusting for race, parity, smoking, and diabetes (adjusted OR 1.35 [95% CI 1.21–1.50]).Conclusion. Maternal obesity is a significant risk factor for GBS colonization at term. Further research is needed to evaluate the impact of this finding on risk-based management strategies.

Download Full-text

Television Viewing and Cognitive Dysfunction of Korean Older Adults

Healthcare ◽

10.3390/healthcare8040547 ◽

2020 ◽

Vol 8 (4) ◽

pp. 547

Author(s):

Mi Sook Jung ◽

Eunyoung Chung

Keyword(s):

Older Adults ◽

Cognitive Dysfunction ◽

Cognitive Aging ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Later Life ◽

Significant Risk Factor ◽

Tv Viewing ◽

Increased Risk ◽

The Impact

This study examined the association between television (TV) viewing and cognitive dysfunction in elderly Koreans. Among participants of the 2014 National Survey of Older Koreans, 9644 were considered in this study. To better identify the association between two factors, propensity score (PS) matching with exact method was used. Finally, 168 viewers and non-viewers each were selected based on estimated PS on key variables and eliminating double matches. Multivariate logistic regression analysis was performed when controlling for possible covariates. Viewers were more likely to have cognitive dysfunction than non-viewers, with significant differences in most covariates. After correcting confounding effects of these covariates with PS matching, TV viewing was found to be a significant risk factor of cognitive dysfunction, along with absence of diagnosed hypertension and non-participation in physical leisure activities. TV viewing might be associated with increased risk of cognitive dysfunction in later life. Appropriate education and strategies to minimize TV viewing among older adults should be established to contribute to attenuating cognitive aging. More interventional studies can help older adults, caregivers, and healthcare professionals explore the cognitively beneficial alternatives to TV use considering the impact of socioeconomic factors of selecting TV viewing as a preferred leisure activity.

Download Full-text

Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0360 ◽

2017 ◽

Vol 45 (2) ◽

Author(s):

Cenk Gezer ◽

Atalay Ekin ◽

Gokhan Goynumer ◽

Kaan Pakay ◽

Hicran Acar ◽

...

Keyword(s):

Significant Risk ◽

Perinatal Outcomes ◽

Invasive Procedure ◽

Significant Risk Factor ◽

Adverse Outcomes ◽

Control Group ◽

Needle Technique ◽

Adverse Perinatal Outcomes ◽

Chorion Villus ◽

The Impact

AbstractObjective:To determine the impact of the chorion villus sampling (CVS) technique on adverse perinatal outcomes.Methods:In this case-control study, 412 women who underwent CVS at 11–14 weeks of gestation and 231 women who did not undergo any invasive procedure were retrospectively evaluated. The women in the CVS group were further divided into two groups according to the use of single-needle technique (n=148) vs. double-needle technique (n=264). The adverse outcomes were compared between controls and the two CVS groups, and regression analysis was used to determine the significance of independent contribution.Results:The rate of preeclampsia for the control group was 2.2%, for the double-needle group was 3% and for the single-needle group was 8.1%. CVS with single-needle technique was found to be an independent and statistically significant risk factor for preeclampsia [odds ratio (OR)=2.1, 95% confidence interval (CI); 1.4–2.7, P=0.008].Conclusion:The risk of preeclampsia after CVS appears to be increased with single-needle technique compared with double-needle technique.

Download Full-text

Parvovirus Enteritis and Other Risk Factors Associated With Persistent Gastrointestinal Signs in Dogs Later in Life: a Retrospective Cohort Study

10.21203/rs.3.rs-711893/v1 ◽

2021 ◽

Author(s):

Kanae Takada ◽

Anne M. Flemming ◽

Maarten J. Voordouw ◽

Anthony P. Carr

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Significant Risk ◽

Significant Risk Factor ◽

Health Problems ◽

Organ Systems ◽

Increased Risk

Abstract Background: Parvoviral enteritis is a viral gastrointestinal (GI) infection of dogs. Recovery from PE has been associated with persistent GI signs. The objectives of this study were: (i) To determine whether dogs that have recovered from PE (post-parvo dogs) had an increased risk of persistent GI signs compared to uninfected controls. (ii) To investigate the lifestyle and clinicopathologic factors that are associated with persistent GI signs in post-parvo dogs. Methods: Eighty-six post-parvo dogs and 52 age-matched control dogs were enrolled in this retrospective cohort study. The owners were interviewed about the health and habits of their dogs using a questionnaire. We used logistic regression to test whether parvovirus enteritis and other risk factors are associated with general health problems in all dogs and with persistent GI signs in post-parvo dogs.Results: The prevalence of persistent GI signs was significantly higher in post-parvo dogs compared to control dogs (57% vs 25%, P < 0.001). Markers of disease severity such as neutropenia, low body temperature, and treatment with an antiemetic medication (metoclopramide) were significant risk factors for persistent GI signs in post-parvo dogs. Persistent GI signs in post-parvo dogs was a risk factor for health problems in other organ systems.Conclusions: Parvovirus enteritis is a significant risk factor for persistent GI signs in dogs highlighting the importance of prevention. The risk factors identified in the present study may guide future investigations on the mechanisms that link parvovirus enteritis to chronic health problems in dogs.

Download Full-text