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Work 1-4 of 4

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Article

Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants

by Girija Natarajan; Seetha Shankaran; Shampa Saha; Abbot Laptook; Abhik Das; Rosemary Higgins; Barbara Stoll; Edward F Bell; Waldemar A Carlo; Carl D'Angio; Sara B. DeMauro; Pablo Sanchez; Krisa Van Meurs; Betty Vohr; Nancy Newman; Ellen Hale; Michele Walsh; David Carlton

2018

Subjects
  • Health Sciences, Radiology
  • Health Sciences, General
  • Health Sciences, Human Development
  • File Download
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Abstract:Close

Objectives: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. Study design: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center. Results: Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P <.0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging. Conclusion: Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.

Article

Older age at the completion of linear growth is associated with an increased risk of adult glioma

by Rebecca B. Little; L. Burt Nabors; Jeffrey James Olson; Zachary J. Thompson; Carrie M. Rozmeski; Renato V. LaRocca; Peter A. Forsyth; Reid C. Thompson; Robert A. Oster; Sajeel A. Chowdhary; Kathleen M. Egan

2017

Subjects
  • Health Sciences, Oncology
  • Health Sciences, General
  • File Download
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Abstract:Close

Purpose: To examine the association of age when adult height was attained with glioma risk. Methods: We analyzed data from a US-based case–control study of glioma risk factors. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) associated between age at attainment of adult height and glioma risk. Multivariate models were adjusted for age, race, sex, education, and state of residence. We examined associations overall, and according to glioma grade, sex, and final adult height. Results: The study set included n = 951 controls and n = 776 cases, with a median age of 56 (18–92); the majority was male (53.8%) and identified as Caucasian. Older age at height completion was associated with an increased risk of glioma. A significant positive trend was observed both for glioblastoma (OR 1.10; 95% CI 1.04–1.17 per 1-year increase in age) and lower grade non-glioblastoma subtypes combined (OR 1.18; 95% CI 1.10–1.28 per year increase in age). The association was observed in men and women, and in all categories of final adult height. Conclusions: We observed for the first time a positive association between glioma risk and a prolonged adolescent growth phase. Our results suggest a role for factors governing the timing and intensity of growth in adolescence as risk-determining exposures in adult glioma.

Article

An epigenetic clock for gestational age at birth based on blood methylation data

by Anna K. Knight; Jeffrey M. Craig; Christiane Theda; Marie Bækvad-Hansen; Jonas Bybjerg-Grauholm; Christine S. Hansen; Mads V. Hollegaard; David M. Hougaard; Preben B. Mortensen; Shantel M. Weinsheimer; Thomas M. Werge; Patricia Brennan; Joseph Cubells; D. Jeffrey Newport; Zachary N. Stowe; Jeanie L.Y. Cheong; Philippa Dalach; Lex W. Doyle; Yuk J. Loke; Andrea A. Baccarelli; Allan C. Just; Robert O. Wright; Mara M. Tellez-Rojo; Katherine Svensson; Letizia Trevisi; Elizabeth M. Kennedy; Elisabeth B. Binder; Stella Iurato; Darina Czamara; Katri Räikkönen; Jari M.T. Lahti; Anu-Katriina Pesonen; Eero Kajantie; Pia M. Villa; Hannele Laivuori; Esa Hämäläinen; Hea Jin Park; Lynn B. Bailey; Sasha E. Parets; Varun Kilaru; Ramkumar Menon; Steve Horvath; Nicole R. Bush; Kaja Z. LeWinn; Frances A. Tylavsky; Karen Conneely; Alicia K Smith

2016

Subjects
  • Biology, Genetics
  • Health Sciences, General
  • Health Sciences, Obstetrics and Gynecology
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Background: Gestational age is often used as a proxy for developmental maturity by clinicians and researchers alike. DNA methylation has previously been shown to be associated with age and has been used to accurately estimate chronological age in children and adults. In the current study, we examine whether DNA methylation in cord blood can be used to estimate gestational age at birth. Results: We find that gestational age can be accurately estimated from DNA methylation of neonatal cord blood and blood spot samples. We calculate a DNA methylation gestational age using 148 CpG sites selected through elastic net regression in six training datasets. We evaluate predictive accuracy in nine testing datasets and find that the accuracy of the DNA methylation gestational age is consistent with that of gestational age estimates based on established methods, such as ultrasound. We also find that an increased DNA methylation gestational age relative to clinical gestational age is associated with birthweight independent of gestational age, sex, and ancestry. Conclusions: DNA methylation can be used to accurately estimate gestational age at or near birth and may provide additional information relevant to developmental stage. Further studies of this predictor are warranted to determine its utility in clinical settings and for research purposes. When clinical estimates are available this measure may increase accuracy in the testing of hypotheses related to developmental age and other early life circumstances.

Article

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

by Jennifer James; David Munson; Sara B. DeMauro; John C. Langer; April Dworetz; Girija Natarajan; Margarita Bidegain; Christine A. Fortney; Ruth Seabrook; Betty R. Vohr; Jon E. Tyson; Edward F. Bell; Brenda B. Poindexter; Seetha Shankaran; Rosemary D. Higgins; Abhik Das; Barbara Stoll; Haresh Kirpalani

2017

Subjects
  • Health Sciences, General
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Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%-29.9%) as did WWLST (5.2%-20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.
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