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To investigate the ongoing controversy on the effect of BMI (body mass index) on EOP (early onset preeclampsia) vs LOP (late onset), especially focusing on diabetes and maternal booking/pre-pregnancy BMI as possible independent variables. 18 year-observational cohort study (2001-2018). The study population consisted of all consecutive births delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion's maternity (ap. 4,300 birth per year, only level 3 maternity in the south of Reunion Island, sole allowed to follow and deliver all preeclampsia cases of the area). History of pregnancies, deliveries and neonatal outcomes have been collected in standardized fashion into an epidemiological perinatal data base. Chronic hypertension and, history of preeclampsia in multigravidas, were the strongest risk factors for EOP. Primiparity, age over 35 years and BMI ≥ 35 kg/m² were rather associated with LOP. In a multivariate analysis with EOP or LOP as outcome variables compared with controls (normotensive), maternal age and pre-pregnancy BMI were independent risk factors for both EOP and LOP (p < 0.001). However, analyzing by increment of 5 (years of age, kg/m² for BMI) rising maternal ages and incidence of preeclampsia were strictly parallel for EOP and LOP, while increment of BMI was only associated with LOP. Controlling for maternal ages and booking/pre-pregnancy BMI, diabetes was not an independent risk factor neither for EOP or LOP. Metabolic factors, other than diabetes, associated with pre-pregnancy maternal corpulence are specifically associated with LOP. This may be a direction for future researches on the maternal preeclamptic syndrome. This may explain the discrepancy we are facing nowadays where high-income countries report 90% of their preeclampsia being LOP, while it is only 60-70% in medium-low income countries.

The aim of this study was to pilot test a screening approach to detect potential look-alike, sound-alike (LASA) errors in pediatric outpatient prescriptions. Medicaid pharmacy claims from one state were reviewed. From a list of LASA drug pairs, we identified candidate pairs meeting the following criteria: 1) one drug was commonly prescribed in children; 2) the paired drug was uncommonly prescribed for children; and 3) both drugs were available as oral preparations only, resulting in 11 LASA pairs. We identified patients who usually received one drug in a pair, then presented with a first dispensing of the paired drug, representing a “screening alert” for potential LASA error. We determined a “true error” as any patient who triggered a screening alert, received only one dispensing of the paired drug in the subsequent 6 months, and had no diagnoses supporting the dispensing of the paired drug. Among the 22 test drugs, there were 1 420 091 prescriptions to 173 005 subjects. There were 395 screening alerts generated, representing a screening alert frequency of 0.28 screening alerts per 1000 prescriptions. We identified 43 true LASA errors. In the dataset, the overall LASA error rate is estimated to be approximately 0.00003%, or 0.03 LASA errors per 1000 prescriptions. Prescription dispensing patterns can be used to screen for LASA errors in pediatric prescriptions. The rates of pediatric LASA errors appear to be much lower than other types of pediatric medication errors and may be best addressed by automated processes.

Either placebo or a preparation of chemically defined extracts from Echinacea angustifolia root was administered to 399 volunteers before or after inoculation with rhinovirus. These rigorously controlled studies found no evidence that echinacea is effective in treating or preventing the common cold. These rigorously controlled studies found no evidence that echinacea is effective in treating or preventing the common cold. The common cold is a benign and self-limited illness most commonly caused by the rhinoviruses. Although the importance of the common cold derives primarily from its frequency and from the enormous socioeconomic impact it has, it is clear that the common cold in general and rhinovirus infection in particular are associated with significant medical consequences. 1 – 8 There are no specific antiviral treatments for rhinovirus infection. Perhaps because of the lack of specific therapies, concern about the risks relative to the benefits of treatments for symptoms, and the relatively benign nature of the common cold, there is wide interest in the . . .

Low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score (VIS) have been used as surrogate markers for early postoperative outcomes in pediatric cardiac surgery. The objective of this study was to determine the associations between LCOS and maximum VIS with clinical outcomes in neonatal cardiac surgery. This was a secondary retrospective analysis of a prospective randomized trial, and the setting was a pediatric cardiac intensive care unit in a tertiary care children’s hospital. Neonates (n = 76) undergoing corrective or palliative cardiac operations requiring cardiopulmonary bypass were prospectively enrolled. LCOS was defined by a standardized clinical criteria. VIS values were calculated by a standard formula during the first 36 postoperative hours, and the maximum score was recorded. Postoperative outcomes included hospital mortality, duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay (LOS), as well as total hospital charges. At surgery, the median age was 7 days and weight was 3.2 kg. LCOS occurred in 32 of 76 (42%) subjects. Median maximum VIS was 15 (range 5–33). LCOS was not associated with duration of mechanical ventilation, ICU LOS, hospital LOS, and hospital charges. Greater VIS was moderately associated with a longer duration of mechanical ventilation (p = 0.001, r = 0.36), longer ICU LOS (p = 0.02, r = 0.27), and greater total hospital costs (p = 0.05, r = 0.22) but not hospital LOS (p = 0.52). LCOS was not associated with early postoperative outcomes. Maximum VIS has only modest correlation with duration of mechanical ventilation, ICU LOS, and total hospital charges.

Background A recent review supports a strategy of deferring treatment of patent ductus arteriosus (PDA) in the preterm neonate until at least the second week after birth. In light of previous suggestion that later initiation of treatment may be less efficacious for closing PDAs it is reasonable to question if delayed treatment may be less effective. Design We conducted a single center retrospective review of a neonatal intensive care unit database of infants ≤37 weeks gestation with the diagnosis of PDA and treated with indomethacin from 1999 to 2007. We determined gestational age (GA), timing of indomethacin initiation, and status of the PDA at hospital discharge. Treatment failure was defined as neonates requiring further intervention to close their PDA or those who died without echo-proven PDA closure. Results Of the 341 infants meeting the study criteria, 77 (23%) had defined treatment failure. The failure group had a younger median GA of 25 weeks (interquartile range [IQR], 24-26) vs. 28 weeks (IQR, 26-30) for the successful group (P < .0001). The failure group had a median treatment initiation on day of life (DOL) 4 (IQR, 1-8) compared with DOL 3 (IQR, 1-6) for those in the successful group (P = .15). Taken as a whole, infants treated after DOL 5 were significantly more likely to have treatment failure (30.1% vs. 19.3% for those treated DOL 1-5, P = .03). Conclusions Our study confirms that younger GA at birth is correlated with increased likelihood of failed PDA closure. We also show a trend indicating that later initiation of treatment may decrease the chances of successfully closing a PDA. Future examination of PDA management should consider the potential unintended consequences that may accompany a delayed treatment strategy.

Blubber tissue samples from bottlenose dolphins collected during the summers of 2003 and 2004 were screened for 13 (17, 28, 47, 66, 71, 85, 99, 100, 138, 154, 153, 183, 190) polybrominated diphenyl ethers (PBDEs) from dolphin populations in the Indian River Lagoon, FL (n = 58) and the Charleston Harbor estuary, SC (n = 53). Within each population, we investigated contaminant levels of PBDEs and the effects of factors including age, sex, the interaction of age and sex, and location. Six PBDE congeners (28, 47, 99, 100, 153, and 154) were routinely detected in all samples using gas chromatography/mass spectometry methods. Significantly higher (p <= 0.0001) mean ΣPBDE blubber concentrations were observed for Charleston dolphins ( [graphic removed] = 5,860 ng/g lipid; range = 429-22,780 ng/g lipid) when compared to Indian River Lagoon dolphins ( [graphic removed] = 1,260 ng/g lipid; range = 195-3,790 ng/g lipid). PBDE 47 was the major congener representing ~61% of the ΣPBDE in both dolphin populations, followed by BDE100, BDE154, BDE99, BDE153, and BDE28, respectively. Significantly higher (p < 0.0001) mean ΣPBDE were observed in adult male dolphins compared to pregnant and adult female dolphins at both sites, with gender differences two-fold in the Indian River Lagoon and twelve-fold for Charleston. For Charleston dolphins, the juveniles in addition to the adult males also had significantly higher levels compared to pregnant and adult females. This study establishes baseline levels of PBDEs in bottlenose dolphins for these two areas and is the first assessment of PBDEs in free-ranging dolphins. The levels of PBDEs in Charleston dolphins represent some of the highest measured in marine mammals and warrants further investigation of these emerging, bioaccumulative chemicals and their potential deleterious effects.

Cardiopulmonary exercise testing (CPET) is a common method of evaluating patients with a Fontan circulation. Equations to calculate predicted CPET values are based on children with normal circulation. This study aims to create predictive equations for CPET variables solely based on patients with Fontan circulation. Patients who performed CPET in the multicenter Pediatric Heart Network Fontan Cross-Sectional Study were screened. Peak variable equations were calculated using patients who performed a maximal test (RER > 1.1) and anaerobic threshold (AT) variable equations on patients where AT was adequately calculated. Eighty percent of each cohort was randomly selected to derive the predictive equation and the remaining served as a validation cohort. Linear regression analysis was performed for each CPET variable within the derivation cohort. The resulting equations were applied to calculate predicted values in the validation cohort. Observed versus predicted variables were compared in the validation cohort using linear regression. 411 patients underwent CPET, 166 performed maximal exercise tests and 317 had adequately calculated AT. Predictive equations for peak CPET variables had good performance; peak VO2, R2 = 0.61; maximum work, R2 = 0.61; maximum O2 pulse, R2 = 0.59. The equations for CPET variables at AT explained less of the variability; VO2 at AT, R2 = 0.15; work at AT, R2 = 0.39; O2 pulse at AT, R2 = 0.34; VE/VCO2 at AT, R2 = 0.18; VE/VO2 at AT, R2 = 0.14. Only the models for VE/VCO2 and VE/VO2 at AT had significantly worse performance in validation cohort. Of the 8 equations for commonly measured CPET variables, six were able to be validated. The equations for peak variables were more robust in explaining variation in values than AT equations.

OBJECTIVE: Numerous risk factors for development of retinopathy of prematurity (ROP) in very low birth weight infants have been identified in the literature. However, the role of anemia in the development of ROP has not been adequately addressed. STUDY DESIGN: We retrospectively examined the medical records of all infants weighing ≤800 g who were admitted to a university hospital between July 1, 1992 and December 30, 1997. Highest and lowest hemoglobin and hematocrit values and the number of blood transfusions were recorded at each week of life during hospitalization. Gestational age at birth, birth weight, race, sex, oxygen status, history of bronchopulmonary dysplasia, length of hospital stay, and sepsis were also identified as potential risk factors. Data were analyzed using logistic regression to adjust for these confounding variables. RESULTS: Infants were grouped according to ROP status in the following manner: stage 0 to 1 ROP, stage 2 ROP, and stage 3 to threshold ROP. Sex, gestational age at birth, bronchopulmonary dysplasia, ventilator days, length of hospital stay, and number of blood transfusions were significantly associated with severity of ROP by univariate analysis. Using a logistic regression model, only gestational age ( p =0.007) and number of blood transfusions ( p =0.04) remained statistically significant. CONCLUSIONS: Anemia did not affect severity of ROP as an independent risk factor. However, the number of blood transfusions did affect the highest stage of ROP in this group of premature infants. Infants who remained severely anemic (Hgb≤8 g/dl or Hct≤25%) for longer periods of time developed milder ROP than less anemic infants.

Objectives: Targeted screening for childhood lead poisoning depends on assessment of risk factors including housing age. Using a geographic information system (GIS), we aim to determine high-risk regions in Charleston County, South Carolina, to assist public health officials in developing targeted lead-screening. Methods: Properties built before 1978 were geocoded (assigned latitude and longitude coordinates) from tax assessor data. Addresses of Charleston County children who have been screened for lead poisoning were also geocoded. Locations of all housing, lead poisoning cases, and negative screens were created as separate map layers. Prevalence ratios of lead poisoning cases were calculated, as were relative risks for each category of housing. Results: Maps of Charleston County were produced showing the location of old housing, where screening took place, and where cases were found. One thousand forty-four cases were identified. Twenty percent of children living in pre-1950 homes had elevated blood lead levels (EBLL). Children living in pre-1950 housing were 3.9 times more likely to have an EBLL than children living in post-1977 housing. There was no difference in risk of living in a 1950-1977 home vs. a post-1977 home. A large number of cases were also found in an area of newer houses, but near a potential point source. Eighty-two percent of all screens were from children in post-1977 homes. Conclusions: Children living in pre-1950 housing were at higher risk for lead poisoning. GIS is useful in identifying areas of risk and unexpected clustering from potential point sources and may be useful for public health officials in developing targeted screening programs.