ADVANCE: a biomedical informatics approach to investigate acute kidney injury in infants.

Background: Acute kidney injury (AKI) occurs in up to half of infants admitted to the neonatal intensive care unit (NICU) and is associated with increased risks of death and more days of mechanical ventilation, hospitalization, and vasopressor drug support. Our objective was to build a granular relational database to study the impact that AKI has on infants admitted to Level-IV NICUs.

Methods: A relational database was created by linking data from the Children's Hospitals Neonatal Database with AKI-focused data from electronic health records from 9 centers.

Rethinking Pulse Oximetry Screening in the Level-IV Neonatal Intensive Care Unit.

Objective: This study aimed to evaluate the outcomes of newborn pulse oximetry screening in a level IV, tertiary care neonatal intensive care unit (NICU).

Study Design: This is a retrospective cohort study of neonates who received newborn pulse oximetry screening after being admitted to a single-center, level-IV NICU between 2014 and 2021. Neonates with known critical congenital heart disease were excluded from the study.

A New Approach to Recognize Neonatal Impaired Kidney Function.

Introduction: Previous studies in term newborns with hypoxic ischemic encephalopathy showed that the rate of serum creatinine (SCr) decline during the first week of life could be used to identify newborns with impaired kidney function (IKF) who are missed by standard definitions of neonatal acute kidney injury (nAKI).

Methods: Retrospective review of the medical records of 329 critically ill newborns ≥27 weeks of gestational age (GA) admitted to a level 4 neonatal intensive care unit (NICU). We tested the hypothesis that the rate of SCr decline combined with SCr thresholds provides a sensitive approach to identify term and preterm newborns with IKF during the first week of life.

Quality Improvement Interventions to Improve Critical Congenital Heart Disease Screening.

Unlabelled: Newborn screening for critical congenital heart disease (CCHD) using pulse oximetry improves detection and is associated with decreased related infant mortality. In 2015, the Healthy Hearts of Babies Act required hospitals to screen all newborns in the District of Columbia for CCHD using pulse oximetry and to provide documentation of individual screening results to the Department of Health. A regulatory report from the electronic health record revealed an opportunity to improve both documentation and protocol adherence within our hospital.

Incidence and Risk Factors of Early Onset Neonatal AKI.

Background And Objectives: Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week.

Design, Setting, Participants, & Measurements: The international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids.

Late onset neonatal acute kidney injury: results from the AWAKEN Study.

Background: Most studies of neonatal acute kidney injury (AKI) have focused on the first week following birth. Here, we determined the outcomes and risk factors for late AKI (>7d).

Methods: The international AWAKEN study examined AKI in neonates admitted to an intensive care unit.

Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.

Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery.

Risk and clinical course of retinopathy of prematurity in 78 infants of gestational age 22-25 weeks.

Purpose: To characterize the retinopathy of prematurity (ROP) and survival of infants born at gestational age (GA) of 22-25 weeks.

Methods: This study was a comparative case series for the total set of 78 infants ≤25 GA screened for ROP at a level IV NICU during a 21-month period. Data are presented on infants screened for ROP from 6 weeks after birth for 22 and 23 weeks' GA infants and from 5 weeks after birth for 24 and 25 weeks' GA.

Long-term outcomes for infants with intestinal atresia studied at Children's National Medical Center.

Objectives: Intestinal atresia is a common cause of intestinal obstruction in neonates. The predominant cause of late complications in these children is prolonged dependence on parenteral nutrition (PN). Our aims were to analyze the outcomes for patients with intestinal atresia at our institution, and to see how these changed with the implementation of an intestinal rehabilitation program (IRP).

Plasma fatty acids in premature infants with hyperbilirubinemia: before-and-after nutrition support with fish oil emulsion.

Infants who are dependent on parenteral nutrition (PN) sometimes develop PN-associated cholestasis (PNAC). A compassionate use protocol, approved by the U.S.

Parenteral nutrition-associated conjugated hyperbilirubinemia in hospitalized infants.

Parenteral nutrition-associated conjugated hyperbilirubinemia (PNAC), commonly defined as direct bilirubin ≥2 mg/dL (34.2 μmol/L), is primarily a pediatric disease with premature infants being the most susceptible. Severe morbidity and increased mortality are associated with bilirubin >10 mg/dL (171.

Follow-up study of adolescents exposed to di(2-ethylhexyl) phthalate (DEHP) as neonates on extracorporeal membrane oxygenation (ECMO) support.

Di(2-ethylhexyl) phthalate (DEHP) is used to make polyvinyl chloride (PVC) plastic tubing soft and flexible. Animal data show that adverse effects of DEHP exposure may include reduced fertility, reduced sperm production in males, and ovarian dysfunction in females. Known treatments that involve high DEHP exposures are blood exchange transfusions, extracorporeal membrane oxygenation (ECMO), and cardiovascular surgery.

Breastfeeding practices in a cohort of inner-city women: the role of contraindications.

Background: Little is known about the role of breastfeeding contraindications in breastfeeding practices. Our objectives were to 1) identify predictors of breastfeeding initiation and duration among a cohort of predominantly low-income, inner-city women, and 2) evaluate the contribution of breastfeeding contraindications to breastfeeding practices.

Methods: Mother-infant dyads were systematically selected from 3 District of Columbia hospitals between 1995 and 1996.

Infant-parent bed sharing in an inner-city population.

Background: In the United States, infant-parent bed sharing is a controversial and poorly understood practice. Proponents site potential advantages such as increases in bonding and facilitation of breastfeeding, whereas opponents site potential increases in risks of suffocation and sudden infant death syndrome, particularly among mothers who smoke. Few studies have examined normative practices in low-income populations.

Prevalence and predictors of the prone sleep position among inner-city infants.

Context: The prone sleep position is associated with an increased risk of sudden infant death syndrome (SIDS), but few studies have assessed factors associated with the choice of infant sleep position.

Objectives: To describe infant sleep position in a cohort of infants born to predominantly low-income, inner-city mothers and to identify predictors of the prone sleep position in this population.

Design: Prospective birth cohort study.

Adrenal hemorrhage in infants undergoing ECMO: prevalence and clinical significance.

Objective: To determine the prevalence and clinical significance of adrenal hemorrhage in infants undergoing ECMO therapy.

Methods: Prospective US evaluation of the adrenal glands was performed in 50 consecutive infants undergoing ECMO. The infants were examined at least every other day while on bypass.

Mortality and morbidity rates among lower birth weight infants (2000 to 2500 grams) treated with extracorporeal membrane oxygenation.

To assess the validity of the currently accepted lower weight limit of 2 kg for treatment of neonates with extracorporeal membrane oxygenation (ECMO), we reviewed the outcome of lower birth weight (2.0 to 2.5 kg, n = 29) and higher birth weight (n = 235) for infants treated with venoarterial ECMO at our institution from 1984 through 1990.

Lactoferrin and lysozyme deficiency in airway secretions: association with the development of bronchopulmonary dysplasia.

To test whether the presence of airway inflammatory markers differentiated babies with hyaline membrane disease (HMD) who recovered (n = 18) from those in whom bronchopulmonary dysplasia (BPD) developed (n = 18), tracheal aspirate samples from 36 newborn infants with HMD who underwent intubation were collected during days 1 to 28 of life and analyzed for the mucosal antimicrobial proteins lactoferrin and lysozyme. For babies with HMD in whom BPD developed, lactoferrin concentrations were decreased during the first 4 days of life (7 +/- 3, 14 +/- 3, 18 +/- 3, and 18 +/- 3 micrograms/ml, respectively) in comparison with those in babies with HMD who recovered (23 +/- 8, 29 +/- 6, 41 +/- 9, and 81 +/- 19 micrograms/ml); group differences reached statistical significance on days 3 and 4 (p less than 0.05).

Posterior fossa intracranial hemorrhage in infants treated with extracorporeal membrane oxygenation: sonographic findings.

Posterior fossa hemorrhage was documented by autopsy in five infants who had been treated with extracorporeal membrane oxygenation over a 5-year-period. In all five cases, the diagnosis was made prospectively by cranial sonography. Sonographic findings were compared with those in a control group of 15 infants with normal posterior fossae at autopsy.