Gender differences in ECG markers of increased risk for malignant arrhythmias, peripheral blood parameters, and adverse outcomes in patients with COVID-19 pneumonia

Background: The available data on gender differences in a) markers of cardiac involvement, b) peripheral blood parameters, and c) clinical adverse outcomes related to COVID-19 pneumonia severity are limited in the literature.: Objectives: To investigate gender differences in ECG markers of increased risk for malignant arrhythmias. This includes T from peak to end (Tp-e) interval, corrected QT (QTc), transmural dispersion of repolarization (TDR)(Tp-e/QTc), and index of cardiac electrophysiological balance (iCEB)(QTc/QRS), peripheral blood parameters, and in-hospital adverse outcomes in patients with COVID-19 pneumonia. Methods: A cross sectional study enrolled patients with COVID-19 pneumonia admitted to hospital from August 20th, to September 30th, 2020. Results: A total of 197 patients were included. Ninety-six (47%) were men and 101 women. There were no significant gender related differences concerning comorbidities. Men had higher QRS values, Tp-e interval and TDR, and lower values of iCEB. No significant gender differences were observed in the distribution of QTc interval. Men stayed longer in the hospital and had more extensive lung injury than women. In men, prolonged QTc interval, low lymphocytes %, high platelet distribution width (PDW), and low hemoglobin (Hb) were the main predictors of adverse in-hospital outcome, while prolonged QTc interval, high PDW, and low platelet count were the main predictors of adverse in-hospital outcome for women. Conclusions: Men had higher TDR values, lower iCEB, stayed longer in the hospital, and had more extensive lung injury than women, suggesting that, despite that there was no significant difference in mortality incidents between the two genders, the difference in surrogate markers may indicate that men are at a higher risk for adverse outcomes.

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Emotional and cardiovascular health: the impact of depression on cardiac autonomic activity

European Heart Journal ◽

10.1093/eurheartj/ehab724.2421 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

P Theofilis ◽

E Oikonomou ◽

G Lazaros ◽

G Vogiatzi ◽

S Tsalamandris ◽

...

Keyword(s):

Cardiovascular Health ◽

Depression Scale ◽

Adverse Outcomes ◽

Qtc Interval ◽

Autonomic Activity ◽

Elderly Individuals ◽

Increased Risk ◽

The Impact ◽

Cardiac Autonomic Activity ◽

Group 1

Abstract Background The coexistence of depression and cardiovascular diseases is frequently accompanied by an increased risk of adverse outcomes. QTc, an indicator of ventricular depolarization and cardiac autonomic activity, has been proposed as a biomarker of this interplay. Purpose We aimed to investigate the possible association of depression with QTc interval. Methods Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung self-rating depression scale in those younger than 65 years of age (Group 1) and with the geriatric depression scale in elderly individuals (>65 years, Group 2). Moreover, electrocardiogram was performed and measurement of the QT interval was derived after correction for heart rate (QTc) using the Bazett's formula. Abnormal QTc was present when QTc duration exceeded 440 ms. Results Group 1 individuals classified as having depression had longer QTc duration (No depression: 389.3±27.0 ms vs. Depression: 401.1±32.9 ms, p<0.001) and percentage of abnormal QTc (No depression: 2.0% vs. Depression: 10.8%, p=0.001) (Figure 1, Panels A and B). Elderly individuals had similar values of QTc (No depression: 409.9±29.6 ms vs. Depression: 405.2±46.4 ms, p=0.37) and percentage of abnormal QTc (No depression: 13.2% vs. Depression: 12.3%, p=0.78) irrespective of depression status (Figure 1, Panels C and D). The presence of depression in Group 1 subjects was associated with an increased QTc- by 10.8 ms and with an approximately 7-fold higher prevalence of abnormal QTc duration, even after adjustment for confounders (). Such finding was not detected in elderly individuals (Figure 1, Panel F). Conclusion Depression might adversely affect ventricular repolarization especially in middle-aged subjects. These findings highlight the interrelationship between emotional and cardiovascular health and the role of depression as a cardiovascular risk factor. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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Does Erythrocyte Blood Transfusion Prevent Acute Kidney Injury?

Anesthesiology ◽

10.1097/aln.0b013e181f70f56 ◽

2010 ◽

Vol 113 (5) ◽

pp. 1126-1133 ◽

Cited By ~ 8

Author(s):

Milo Engoren

Keyword(s):

Acute Kidney Injury ◽

Acute Lung Injury ◽

Lung Injury ◽

Fluid Management ◽

Kidney Injury ◽

Adverse Outcomes ◽

Data Sets ◽

Erythrocyte Transfusion ◽

Risk Of Death ◽

Increased Risk

Background Acute kidney injury is a common occurrence in intensive care unit patients with a reported incidence of 11-67% and is associated with an increased risk of death. In other patient populations, erythrocyte transfusion has been associated with increased risk of adverse outcomes including sepsis, multisystem organ dysfunction, and death. The purpose of this study was to determine the effect of erythrocyte transfusion on the development of acute kidney injury. Methods This was a retrospective analysis of prospectively collected data that used propensity matched transfused and nontransfused patients. Propensity matching was done using semiparsimonious logistic regression. McNemar test for nonindependent data sets was used to compare groups. Results Four hundred two patients from a trial on fluid management in patients with acute lung injury were matched. 38% of transfused patients had a rise in creatinine the day after transfusion compared with 33% of their nontransfused matches (P = 0.315). By day 7, creatinine had increased in 51% of transfused patients compared with 52% in nontransfused patients (P = 0.832). The incidences of renal risk, injury, and failure were 39 (19%), 27 (13%), and 11 (5%) in the transfused group and 38 (19%), 24 (12%), and 11 (5%) in the nontransfused group, P = 1.00, 0.785, and 1.00, respectively. Conclusions Transfusion of erythrocytes to patients with acute lung injury had no effect on the development of acute kidney injury.

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Blood indices, in-hospital outcome and short-term prognosis in patients with COVID-19 pneumonia

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1782 ◽

2021 ◽

Author(s):

Karrar Al-Buthabhak ◽

Hussein Nafakhi ◽

Mohammed H. Shukur ◽

Ahmed Nafakhi ◽

Mohammed Alareedh ◽

...

Keyword(s):

Mechanical Ventilation ◽

Lung Injury ◽

Hospital Death ◽

Newly Diagnosed ◽

Short Term ◽

Blood Indices ◽

Hospital Outcome ◽

Icu Stay ◽

Increased Risk ◽

Recovery Status

The predictive role of blood indices in coronavirus disease 2019 (COVID-19) related in-hospital adverse outcomes and post-recovery status is not fully defined. The main aim was to assess the association of complete blood indices measured at baseline with COVID-19 related in-hospital clinical outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury and in-hospital death, and post-recovery status. This retrospective study included patients with newly diagnosed COVID-19 infection from August 20, to September 25, 2020. The initial study cohort included 127 patients with newly diagnosed COVID-19. Of whom 26 patients were excluded, leaving 101 patients for final analysis. low lymphocytes % [Odds ratio and confidence intervals = OR (CI)] [0.2(0.0-0.2, p=0.03] increased the odds of ICU stay length while high platelet mean volume (PMV) [0.9 (1.1-5, p<0.00], high platelet distribution width (PDW) [0.3(0.4-1.9), p<0.00], and low lymphocytes % [0.2 (0.0-0.2), p=0.02] increased the odds of length of hospital stay. Decreased lymphocytes % showed significant independent association with increased risk for mechanical ventilation use [0.9 (0.9-1), p=0.04], extensive degree of lung injury [0.2 (0.1-0.7), p<0.00], and in-hospital death [0.5 (0.3-0.8), p=0.01]. High lymphocytes %[0.9 (0.9-1), p<0.00] and high PMV [0.3 (0.3-0.8), p=0.02] were significantly associated with complete recovery while increased neutrophil % [1 (1-1.1), p=0.04] was associated with increased risk for post recovery fatigue. In conclusion, low lymphocytes % and high neutrophil % are useful markers for predicting adverse in-hospital outcome and post-recovery persistent fatigue, respectively. High PMV and lymphocyte % showed significant association with favorable short-term prognosis.

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Cytopenias in the Early Post-Autologous Hematopoietic Cell Transplantation (aHCT) Period Predict for Subsequent Development of Therapy-Related Myelodysplasia/ Acute Myeloid Leukemia (t-MDS/AML) Among Patients with Lymphoma

Blood ◽

10.1182/blood.v124.21.2507.2507 ◽

2014 ◽

Vol 124 (21) ◽

pp. 2507-2507

Author(s):

Liton Francisco ◽

Can-Lan Sun ◽

Patrick Halliday ◽

Alysia Bosworth ◽

Lindsey Hageman ◽

...

Keyword(s):

Blood Cell ◽

Hodgkin Lymphoma ◽

Cell Transplantation ◽

Peripheral Blood ◽

Hematopoietic Cell Transplantation ◽

Blood Parameters ◽

P Value ◽

Time Points ◽

Increased Risk ◽

Autologous Hematopoietic Cell Transplantation

Abstract t-MDS/AML is the most common cause of non-relapse mortality in patients undergoing autologous hematopoietic cell transplantation (aHCT) for Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL). Cytopenias are a common occurrence in the early post-aHCT period. To better understand the significance of cytopenias with respect to the risk of t-MDS/AML, we conducted a prospective, longitudinal study in patients undergoing aHCT for HL or NHL between 1999 and 2009 at City of Hope, with serial collection of peripheral blood samples from pre-aHCT to 10y. Patients with post-aHCT persistent disease (n=55) or solid second malignancies (n=9) or refusal to participate (n=18) were excluded from the analysis, leaving 292 study participants (HL: n=81; NHL: n=211). The median length of follow-up was 4.5y from aHCT. The cumulative incidence of t-MDS/AML approached 9% at 7y (Figure). Older age at aHCT (50+y: RR=3.6, 95%CI, 1.3-9.8, p=0.01) and exposure to total body irradiation (TBI: RR=2.5, 95%CI, 1.0-5.9, p=0.04) were associated with an increased risk of t-MDS/AML. Serial evaluation of peripheral blood parameters (hematocrit [Hct], mean corpuscular volume [MCV], red blood cell [RBC] count, hemoglobin [Hgb], red cell distribution width [RDW], white blood cell [WBC] count, and platelet [Plt] count) were abstracted from medical records at pre-aHCT, and after aHCT at d100, 6m, 1y, and annually thereafter for up to 10y (a total of 1,919 time points). This report focuses on alterations in peripheral blood parameters from pre-aHCT to several years post-aHCT among patients who developed t-MDS/AML (n=21; cases) and those who did not (n=271; controls). Values of peripheral blood parameters associated with post-aHCT relapse or development of t-MDS/AML were censored at 3m prior to the development of these events. As shown in the Figure, comparison of the peripheral blood parameters between cases and controls revealed that Hct, Hgb, Plt, and RBC values were significantly lower for cases compared to controls at d100, 6m, 1y, and 2y (p<0.001); WBC values for cases were lower than for controls at the pre-aHCT, d100, and 6m time points (p<0.01); RDW and MCV values did not differ between cases and controls. A Cox regression model was fitted to the data to examine the association between t-MDS/AML and specific low peripheral blood parameter values at d100, 6m, and 1y post-aHCT (adjusting for year of aHCT, age at aHCT, primary diagnosis, race/ethnicity, sex and TBI). The following parameters (with their cutpoints) emerged as significantly associated with increased risk of t-MDS/AML: Hgb<12, Plt<100k, and RBC<3. Compared with patients with Hgb, Plt and RBC values above these cutpoints at d100, 6m, or 1y, those with low values for all three blood parameters had a significantly increased risk of developing t-MDS/AML (d100: HR=10.5, 95%CI, 2.1-53.1, p=0.004; 6m: HR=9.9, 95%CI, 1.9-53.1, p=0.007; 1y: HR=10.7, 95%CI, 1.5-74.0, p=0.02). In summary, we consistently observed lower values for specific blood parameters during the post-aHCT period among patients who subsequently developed t-MDS/AML as compared to controls across multiple timepoints post-aHCT. These differences appeared soon after aHCT, persisted, and preceded the development of t-MDS/AML, providing evidence that bone marrow injury long predates the development of t-MDS/AML. Importantly, the combination of low Hgb, Plt, and RBC values at d100, 6m, or 1y predicted future development of t-MDS/AML, and could be used as early indicators of t-MDS/AML risk and the need for close monitoring. Abstract 2507. Table Peripheral blood parameters Day 100 (HR, 95%CI) p-value 6 month (HR, 95%CI) p-value 1 year (HR, 95%CI) p-value All normal Hgb≥12 and Plt ≥100 and RBC ≥3 1.00 0.004 1.00 0.007 1.00 0.02 All low Hgb <12 and Plt<100 and RBC <3 10.5 (2.1-53.1) 9.9 (1.9-53.1) 10.7 (1.5-74.0) Figure Figure. Disclosures No relevant conflicts of interest to declare.

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Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

Current Vascular Pharmacology ◽

10.2174/1570161116666180305160116 ◽

2019 ◽

Vol 17 (3) ◽

pp. 298-306 ◽

Cited By ~ 1

Author(s):

Charalambos Vlachopoulos ◽

Dimitrios Terentes-Printzios ◽

Konstantinos Aznaouridis ◽

Nikolaos Ioakeimidis ◽

Panagiotis Xaplanteris ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Beneficial Effect ◽

Harmful Effect ◽

Adverse Outcomes ◽

Intensive Treatment ◽

Serious Adverse Events ◽

Stroke Incidence ◽

Increased Risk ◽

All Cause Mortality

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP). Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome. Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042). Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

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Diabetes and Heart Failure: Is it Hyperglycemia or Hyperinsulinemia?

Current Vascular Pharmacology ◽

10.2174/1570161117666190408164326 ◽

2020 ◽

Vol 18 (2) ◽

pp. 148-157 ◽

Cited By ~ 3

Author(s):

Triantafyllos Didangelos ◽

Konstantinos Kantartzis

Keyword(s):

Heart Failure ◽

Insulin Treatment ◽

Close Association ◽

Adverse Outcomes ◽

Negative Effects ◽

Beneficial Effects ◽

Appropriate Treatment ◽

Increased Risk ◽

Treatment Of Diabetes

The cardiac effects of exogenously administered insulin for the treatment of diabetes (DM) have recently attracted much attention. In particular, it has been questioned whether insulin is the appropriate treatment for patients with type 2 diabetes mellitus and heart failure. While several old and some new studies suggested that insulin treatment has beneficial effects on the heart, recent observational studies indicate associations of insulin treatment with an increased risk of developing or worsening of pre-existing heart failure and higher mortality rates. However, there is actually little evidence that the associations of insulin administration with any adverse outcomes are causal. On the other hand, insulin clearly causes weight gain and may also cause serious episodes of hypoglycemia. Moreover, excess of insulin (hyperinsulinemia), as often seen with the use of injected insulin, seems to predispose to inflammation, hypertension, dyslipidemia, atherosclerosis, heart failure, and arrhythmias. Nevertheless, it should be stressed that most of the data concerning the effects of insulin on cardiac function derive from in vitro studies with isolated animal hearts. Therefore, the relevance of the findings of such studies for humans should be considered with caution. In the present review, we summarize the existing data about the potential positive and negative effects of insulin on the heart and attempt to answer the question whether any adverse effects of insulin or the consequences of hyperglycemia are more important and may provide a better explanation of the close association of DM with heart failure.

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COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

British Journal of Cancer ◽

10.1038/s41416-021-01324-x ◽

2021 ◽

Author(s):

Alvin J. X. Lee ◽

Karin Purshouse

Keyword(s):

Risk Factors ◽

Performance Status ◽

Poor Performance ◽

Cancer Registries ◽

Adverse Outcomes ◽

Smoking History ◽

Poor Performance Status ◽

International Studies ◽

Patients With Cancer ◽

Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

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Lower perception of pharmacological treatment increases risk of non-adherence to medication

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.258 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

CB Graversen ◽

JB Valentin ◽

ML Larsen ◽

S Riahi ◽

T Holmberg ◽

...

Keyword(s):

Pharmacological Treatment ◽

Poisson Regression ◽

Drug Class ◽

Angiotensin Receptor Blockers ◽

Adverse Outcomes ◽

Adherence To Medication ◽

Increased Risk ◽

Patient Reported ◽

High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

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Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

Nature Reviews Nephrology ◽

10.1038/s41581-021-00418-2 ◽

2021 ◽

Author(s):

John R. Prowle ◽

Lui G. Forni ◽

Max Bell ◽

Michelle S. Chew ◽

Mark Edwards ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Disease ◽

Kidney Injury ◽

Adverse Outcomes ◽

Baseline Risk ◽

Major Surgery ◽

Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

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Comparison of coenzyme Q10 or fish oil for prevention of intermittent hypoxia-induced oxidative injury in neonatal rat lungs

Respiratory Research ◽

10.1186/s12931-021-01786-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Christina D’Agrosa ◽

Charles L. Cai ◽

Faisal Siddiqui ◽

Karen Deslouches ◽

Stephen Wadowski ◽

...

Keyword(s):

Oxidative Stress ◽

Lipid Peroxidation ◽

Lung Injury ◽

Fish Oil ◽

Coenzyme Q10 ◽

Intermittent Hypoxia ◽

Oxidative Injury ◽

Adverse Outcomes ◽

Neonatal Rat ◽

Antioxidant Systems

Abstract Background Neonatal intermittent hypoxia (IH) results in oxidative distress in preterm infants with immature antioxidant systems, contributing to lung injury. Coenzyme Q10 (CoQ10) and fish oil protect against oxidative injury. We tested the hypothesis that CoQ10 is more effective than fish oil for prevention of IH-induced lung injury in neonatal rats. Methods Newborn rats were exposed to two clinically relevant IH paradigms at birth (P0): (1) 50% O2 with brief hypoxia (12% O2); or (2) room air (RA) with brief hypoxia (12% O2), until P14 during which they were supplemented with daily oral CoQ10, fish oil, or olive oil from P0 to P14. Pups were studied at P14 or placed in RA until P21 with no further treatment. Lungs were assessed for histopathology and morphometry; biomarkers of oxidative stress and lipid peroxidation; and antioxidants. Results Of the two neonatal IH paradigms 21%/12% O2 IH resulted in the most severe outcomes, evidenced by histopathology and morphometry. CoQ10 was effective for preserving lung architecture and reduction of IH-induced oxidative stress biomarkers. In contrast, fish oil resulted in significant adverse outcomes including oversimplified alveoli, hemorrhage, reduced secondary crest formation and thickened septae. This was associated with elevated oxidants and antioxidants activities. Conclusions Data suggest that higher FiO2 may be needed between IH episodes to curtail the damaging effects of IH, and to provide the lungs with necessary respite. The negative outcomes with fish oil supplementation suggest oxidative stress-induced lipid peroxidation.

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