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OBJECTIVE: Because the survival rate has increased for extremely low birth weight neonates, many have raised the concern that the rate of developmental disability among survivors will also increase. To address this concern, we analyzed changes over time in survival and major neurosensory impairment in a sample of extremely low birth weight infants born between July 1, 1979, and June 30, 1994. METHODS: The study sample included 513 infants with birth weights of 501 to 800 g who were cared for in either of the two neonatal intensive care units that serve a 17-county region in northwest North Carolina and who were born to mothers residing in that region. At 1 year of age (corrected for gestation), survivors were examined by a pediatrician and were tested using the Bayley Scales of Infant Development. Major neurosensory impairment was defined as cerebral palsy, a Bayley Mental Developmental Index <68, or blindness. A total of 209/216 (97%) of survivors were examined at 1 year of age. Epoch of birth was defined as follows: epoch 1, July 1, 1979 to June 30, 1984; epoch 2, July 1, 1984 to June 30, 1989; and epoch 3, July 1, 1989 to June 30, 1994. RESULTS: Survival rates for epochs 1, 2, and 3 were, respectively, 24/120 (20%), 63/175 (36%), and 129/218 (59%). In contrast, the proportions with a major neurosensory impairment did not increase over time; rates for successive epochs were 6/24 (25%), 17/61 (28%), and 26/124 (21%). Rates of cerebral palsy were 3/24 (13%), 12/61 (20%), and 9/124 (7%); rates of delayed mental development were 4/24 (17%), 12/61 (20%), and 17/124 (14%); and rates of blindness were 2/24 (8%), 0/62, and 5/124 (4%), respectively. CONCLUSIONS: This analysis suggests that the increasing survival of extremely low birth weight neonates since the late 1970s has not resulted in an increased rate of major developmental problems identifiable at 1 year of age. 相似文献
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Aberrant crypt focus promotion and glucose intolerance: correlation in the rat across diets differing in fat, n-3 fatty acids and energy 总被引:1,自引:0,他引:1
Koohestani N; Chia MC; Pham NA; Tran TT; Minkin S; Wolever TM; Bruce WR 《Carcinogenesis》1998,19(9):1679-1684
McKeown-Eyssen (Cancer Epidemiol. Biomarkers Prevent., 3, 687-695, 1994)
and Giovannucci (Cancer Causes Control, 6, 164-179, 1995), noting the
striking similarity in lifestyle risk factors for colorectal cancer and
insulin resistance, proposed that the hyperinsulinemia, glycemia and
hypertriglyceridemia associated with insulin resistance promotes colon
cancer. To compare the effect of diet on colon cancer promotion and insulin
resistance in the F344 rat, we assessed the effect of fat, n-3 fatty acids
and energy in pairwise comparisons on average size of aberrant crypt foci
(ACF) and on glucose intolerance in the same animals in a single
experiment. Diets high in fat and energy increased and diets with increased
n-3 fatty acids and calorie restriction decreased both ACF growth and
glucose intolerance compared with control diets. The measures of promotion
of colon cancer and insulin resistance were strongly correlated (n = 98, r
= 0.67, P < 0.001). In addition, both were highly correlated with daily
energy intake (r = 0.62 and 0.66) and were also correlated with basal
(post-prandial) insulin, glucose and triglycerides (r = 0.31-0.53, P <
0.01). We concluded that ACF growth and glucose intolerance are correlated
for a wide range of diets and that increased circulating energy (glucose
and triglycerides) may lead to both colon cancer promotion and insulin
resistance.
相似文献
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Michael P. Fitzgerald Adam Reynolds Cliona Mc Garvey Gary Norman Mary D. King Breda C. Hayes 《European journal of paediatric neurology》2019,23(1):81-86
Objective
To establish the local incidence of hearing loss in newborns with Hypoxic Ischaemic Encephalopathy (HIE) and to identify associated risk factors.Study design
Retrospective Cohort Study. Neonatal Intensive Care Unit (NICU) dual stage hearing screening protocol, including automated otoacoustic emissions (AOAE) and automated auditory brainstem response (AABR) testing.Results
57 newborns received therapeutic hypothermia for HIE. Twelve babies (21%) died. Audiology data was incomplete in 3 babies. Complete data was available for 42 babies (male n = 24), 4 (9.5%) of whom had hearing impairment. The development of hearing loss was associated with abnormal blood glucose levels (p = 0.006), low Apgar score at 1 min (p = 0.0219) and evidence of multi organ dysfunction [high creatinine (p = 0.0172 and 0.0198) and raised liver transaminases (aspartate aminotransferase (AST) p = 0.0012, alanine aminotransferase (ALT) p = 0.0037)]. An association with gentamicin was not found.Conclusion
This study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE. Blood glucose should be monitored carefully in these infants and developmental surveillance should include formal audiology. Further larger studies are needed to clarify the role, if any, of hypothermia per se in causation of hearing loss and to fully identify risk factors for hearing impairment in this population.What is new
The current study confirms that hearing impairment is common in term infants who have undergone therapeutic hypothermia for moderate/severe HIE.No association between gentamicin use and the development of hearing impairment was found however initial blood glucose outside the normal range was of significance.Other factors associated with hearing impairment were low Apgar scores, greater need for resuscitation and evidence of multi organ dysfunction (renal and liver failure). 相似文献17.
Robbins J Aragaki AK Kooperberg C Watts N Wactawski-Wende J Jackson RD LeBoff MS Lewis CE Chen Z Stefanick ML Cauley J 《JAMA》2007,298(20):2389-2398
Context The 329 000 hip fractures that annually occur in the United States are associated with high morbidity, mortality, and cost. Identification of those at high risk is a step toward prevention. Objective To develop an algorithm to predict the 5-year risk of hip fracture in postmenopausal women. Design, Setting, and Participants A total of 93 676 women who participated in the observational component of the Women's Health Initiative (WHI), a multiethnic longitudinal study, were used to develop a predictive algorithm based on commonly available clinical features. Selected factors that predicted hip fracture were then validated by 68 132 women who participated in the clinical trial. The model was tested in a subset of 10 750 women who had undergone dual-energy x-ray absorptiometry (DXA) scans for bone mass density assessment. Main Outcome Measure The prediction of centrally adjudicated hip fracture, measured by the area under the receiver operator characteristic (ROC) curves. Results During a mean (SD) follow-up of 7.6 (1.7) years, 1132 hip fractures were identified among women participating in the observational study (annualized rate, 0.16%), whereas during a mean follow-up of 8.0 (1.7) years, 791 hip fractures occurred among women participating in the clinical trial (annualized rate, 0.14%). Eleven factors predicted hip fracture within 5 years: age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes. Receiver operating characteristic curves showed that the algorithm had an area under the curve of 80% (95% confidence interval [CI], 0.77%-0.82%) when tested in the cohort of different women who were in the clinical trial. A simplified point score was developed for the probability of hip fracture. Receiver operating characteristic curves comparing DXA-scan prediction based on a 10% subset of the cohort and the algorithm among those who participated the clinical trial were similar, with an area under the curve of 79% (95% CI, 73%-85%) vs 71% (95% CI, 66%-76%). Conclusion This algorithm, based on 11 clinical factors, may be useful to predict the 5-year risk of hip fracture among postmenopausal women of various ethnic backgrounds. Further studies are needed to assess the clinical implication of the algorithm in general and specifically to identify treatment benefits. 相似文献
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