Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates.

Objective: To identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates.

Design: Observational study of prospectively collected registry data from 19 National Institute of Child Health and Human Development Neonatal Research Network centres on neonates born at 22-28 weeks gestation who died >12 hours through 120 days of age during 2011-2016. Sociodemographic and clinical factors were compared between infants who died following WWLST and without WWLST.

Association of prenatal opiate exposure with youth outcomes assessed from infancy through adolescence.

Objective: This study examined acute findings and long-term outcome trajectories between birth and adolescence in children with prenatal opiate exposure.

Study Design: Ninety children (45 opiate-exposed, 45 non-exposed) completed assessments between 1 month and 15 years of age. Outcome variables (medical, anthropomorphic, developmental, and behavioral) were analyzed at individual time points and using longitudinal statistical modeling.

Genetic and behavioral modification of hemoglobin and iron status among first-time and high-intensity blood donors.

Background: Some people rapidly develop iron deficiency anemia following blood donation, while others can repeatedly donate without becoming anemic.

Methods: Two cohorts of blood donors were studied. Participants (775) selected from a 2-year longitudinal study were classified into six analysis groups based on sex, donation intensity, and low hemoglobin deferral.

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

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.

Outcome trajectories in extremely preterm infants.

Objective: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course.

PGE2 EP1 receptor exacerbated neurotoxicity in a mouse model of cerebral ischemia and Alzheimer's disease.

Stroke and Alzheimer's disease (AD) are major age-related neurodegenerative diseases that may worsen the prognosis of each other. Our study was designed to delineate the prostaglandin E(2) EP1 receptor role in AD and in the setting of cerebral ischemia. Genetic deletion of the prostaglandin EP1 receptor significantly attenuated the more severe neuronal damage (38.

Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants.

Rationale: Benefits of identifying risk factors for bronchopulmonary dysplasia in extremely premature infants include providing prognostic information, identifying infants likely to benefit from preventive strategies, and stratifying infants for clinical trial enrollment.

Objectives: To identify risk factors for bronchopulmonary dysplasia, and the competing outcome of death, by postnatal day; to identify which risk factors improve prediction; and to develop a Web-based estimator using readily available clinical information to predict risk of bronchopulmonary dysplasia or death.

Methods: We assessed infants of 23-30 weeks' gestation born in 17 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and enrolled in the Neonatal Research Network Benchmarking Trial from 2000-2004.

Compact wave functions for the beryllium isoelectronic series, Li- to Ne6+: a standard Hylleraas approach.

Variational calculations have been carried out for the ground states of several members of the beryllium isoelectronic series using a standard Hylleraas approach involving Slater-type basis functions. The species examined are Li(-), Be, B(+), C(2+), N(3+), O(4+), F(5+), and Ne(6+). For each species, the nonrelativistic energy, the electronic density at the nucleus, the expectation value <∇(i)·∇(j)>, the moments for n = -1, 1, 2, and 3, and for n = -1, 1, and 2, are reported.

Hypocarbia and adverse outcome in neonatal hypoxic-ischemic encephalopathy.

Objective: To evaluate the association between early hypocarbia and 18- to 22-month outcome among neonates with hypoxic-ischemic encephalopathy.

Study Design: Data from the National Institute of Child Health and Human Development Neonatal Research Network randomized, controlled trial of whole-body hypothermia for neonatal hypoxic-ischemic encephalopathy were used for this secondary observational study. Infants (n = 204) had multiple blood gases recorded from birth to 12 hours of study intervention (hypothermia versus intensive care alone).

Prediction of death for extremely premature infants in a population-based cohort.

Objective: Although gestational age (GA) is often used as the primary basis for counseling and decision-making for extremely premature infants, a study of tertiary care centers showed that additional factors could improve prediction of outcomes. Our objective was to determine how such a model could improve predictions for a population-based cohort.

Methods: From 2005 to 2008, data were collected prospectively for the California Perinatal Quality Care Collaborative, which encompasses 90% of NICUs in California.

Impact of postnatal corticosteroid use on neurodevelopment at 18 to 22 months' adjusted age: effects of dose, timing, and risk of bronchopulmonary dysplasia in extremely low birth weight infants.

Objective: Postnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid.

Methods: Steroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age.

Intensive care for extreme prematurity--moving beyond gestational age.

Background: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.

Methods: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months.

Importance of stability of early living arrangements on behavior outcomes of children with and without prenatal drug exposure.

Objective: We evaluated whether living arrangements of children with or without prenatal drug exposure would be associated with their behavior outcomes and adaptive functioning.

Methods: A total of 1388 children with or without prenatal cocaine or opiate exposure were enrolled in a longitudinal cohort study at 1 month of age, were seen at intervals, tracked over time for their living situation, and evaluated for behavior problems and adaptive functioning at 3 years of age. The Child Behavior Checklist and Vineland Adaptive Behavior Scales were administered.

Persistent beneficial effects of breast milk ingested in the neonatal intensive care unit on outcomes of extremely low birth weight infants at 30 months of age.

Background: We previously reported beneficial effects of breast milk ingestion by infants with extremely low birth weight in the NICU on developmental outcomes at 18 months' corrected age. The objective of this study was to determine whether these effects of breast milk in infants with extremely low birth weight persisted at 30 months' corrected age.

Methods: Nutrition data, including enteral and parenteral feeds, were prospectively collected, and 30 months' corrected age follow-up assessments were completed on 773 infants with extremely low birth weight who participated in the National Institute of Child Health and Human Development Neonatal Research Network Glutamine Trial.

Human milk intake and retinopathy of prematurity in extremely low birth weight infants.

Objectives: Our goal was to analyze the association between human milk intake and severe retinopathy of prematurity in extremely low birth weight infants.

Patients And Methods: This study is a secondary analysis of data collected for a trial of glutamine supplementation in extremely low birth weight infants (birth weight <1000 g). Among the 1433 participants in that trial, data are available regarding human milk intake and the occurrence of severe retinopathy of prematurity (defined in this study as retinopathy of prematurity treated surgically) for 1057 infants.

Role of Nrf2 in protection against intracerebral hemorrhage injury in mice.

Nrf2 is a key transcriptional factor for antioxidant response element (ARE)-regulated genes. While its beneficial role has been described for stroke, its contribution to intracerebral hemorrhage (ICH)-induced early brain injury remains to be determined. Using wild-type (WT) and Nrf2 knockout (Nrf2(-/-)) mice, the role of Nrf2 in ICH induced by intracerebral injection of collagenase was investigated.

Cumulative index of exposure to hypocarbia and hyperoxia as risk factors for periventricular leukomalacia in low birth weight infants.

Background: Hypocarbia and hyperoxia are risk factors for periventricular leukomalacia in low birth weight infants. The association of a cumulative index of exposure to hypocarbia and hyperoxia and periventricular leukomalacia has not been evaluated.

Objective: Our goal was to examine the relationship between cumulative index of exposure to hypocarbia and hyperoxia and periventricular leukomalacia during the first 7 days of life in low birth weight infants.

Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age.

Objective: Beneficial effects of breast milk on cognitive skills and behavior ratings have been demonstrated previously in term and very low birth weight infants. Extremely low birth weight infants are known to be at increased risk for developmental and behavior morbidities. The benefits of breast milk that is ingested in the NICU by extremely low birth weight infants on development and behavior have not been evaluated previously.

Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome.

Objective: To determine if postnatal growth failure exerts an adverse effect on subsequent growth and neurodevelopment.

Study Design: A secondary analysis of 1018 infants who were enrolled in a randomized, clinical trial of glutamine supplementation was performed to determine whether early provision of parenteral amino acids (AA) is associated with better growth and neurodevelopmental outcomes. Infants were stratified by whether they were provided > or =3 g/kg per day of AA at < or =5 days of life (early; n = 182) or not (late; n = 836).

Upregulation of hypoxia-induced mitogenic factor in bacterial lipopolysaccharide-induced acute lung injury.

Hypoxia-induced mitogenic factor (HIMF), also known as FIZZ1 (found in inflammatory zone), plays important roles in lung inflammation. We found that intraperitoneal injection of lipopolysaccharide (LPS) induced intensive HIMF production exclusively in mouse lung, but not in the heart, liver, spleen or kidney. This HIMF production, at least partly, contributes to LPS-induced vascular cell adhesion molecule-1 (VCAM-1) upregulation and mononuclear cell sequestration to lung parenchyma, while protecting alveolar type II cells from LPS-resulted decrease in surfactant protein-C production and cell death.

Hypoxia-induced mitogenic factor modulates surfactant protein B and C expression in mouse lung.

Previous studies have demonstrated a robust pulmonary expression of hypoxia-induced mitogenic factor (HIMF) during the perinatal period, when surfactant protein (SP) synthesis begins. We hypothesized that HIMF modulates SP expression and participates in lung development and maturation. The temporal-spatial expression of HIMF, SP-B, and SP-C in developing mouse lungs was examined by immunohistochemical staining, Western blot, and RT-PCR.

Acute neonatal effects of cocaine exposure during pregnancy.

Objective: To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge.

Design: Multisite, prospective, randomized study.

Setting: Brown University, University of Miami, University of Tennessee (Memphis), and Wayne State University.

Upregulation of hypoxia-induced mitogenic factor in compensatory lung growth after pneumonectomy.

After pneumonectomy, the remaining lung increases in size. This process is referred to as compensatory lung growth. Various pathways likely play important roles in this growth response.

Outcome of extremely-low-birth-weight infants at highest risk: gestational age < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar < or =3.

Objective: The purpose of this study was to evaluate neurodevelopmental outcome in extremely-low-birth-weight (ELBW) infants, all of whom had 3 characteristics: gestational age (GA) < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar score < or =3.

Study Design: Surviving infants were evaluated at 18 to 22 months' corrected age with a neurologic examination and the Bayley II Mental and Psychomotor Developmental Index (MDI and PDI).

Results: Between 1993 and 1999, 1016 infants had GA < or =24 weeks, birth weight < or =750 g, and 1-minute Apgar score < or =3.