18 research outputs found
The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: a systematic review
“Developmental hemostasis” refers to the dynamic process of gradual
hemostatic maturation. Conventional coagulation tests seem to fail to
accurately depict the in vivo hemostasis, while viscoelastic tests,
thromboelastography (TEG), and rotational thromboelastometry (ROTEM)
appear very promising as they provide insight more rapidly and
accurately into the hemostatic potential. We systematically reviewed the
literature in PubMed to examine the use of TEG and ROTEM in neonates.
Our search yielded 34 studies, of which 18 concerned healthy neonates
and 16 sick neonates. These viscoelastic tests have shown accelerated
initiation of coagulation, increased clot strength, and increased
fibrinolysis in healthy neonates compared to children and adults. Cord
blood leads to a hypercoagulable state as compared to whole blood when
testing is performed with TEG. Pre-term neonates have a more
hypocoagulable profile, but balanced hemostasis, related to term
neonates, that evolves to a more procoagulant phenotype over the first
month of life. Critically ill neonates exhibit a more hypocoagulable
profile as compared to healthy neonates. TEG and ROTEM have shown
predictive value for bleeding events in critically ill neonates and
neonates undergoing cardiopulmonary bypass or therapeutic hypothermia.
Conclusion: TEG and ROTEM need to become part of the standard
coagulation assessment in clinical settings in which hemostatic
abnormalities are involved, as they seem to provide more rapid and
accurate information regarding the hemostatic profile of the neonates.
Their predictive value for bleeding events in critically ill neonates
could lead to a more targeted therapy optimizing utilization of blood
products
Breastfeeding in Neonates Admitted to an NICU: 18-Month Follow-Up
Introduction: The admission of neonates to Neonatal Intensive Care Units (NICUs) has been identified as a primary inhibiting factor in the establishment of breastfeeding. The aims of this study were to (1) estimate the prevalence and duration of breastfeeding in infants/toddlers who had been admitted to an NICU in Greece and (2) to investigate factors, associated with the NICU stay, which affected the establishment and maintenance of breastfeeding in infants/toddlers previously admitted to the NICU. Materials and methods: Data for this cohort study were retrieved from interviews with mothers of infants/toddlers who had been admitted to our NICU as neonates during the period of 2017–2019. Interviews were conducted based on a questionnaire regarding the child’s nutrition from birth to the day of the interview, including previous maternal experience with breastfeeding. Information related to the prenatal period, gestation age, delivery mode, duration of NICU stay, and neonatal feeding strategies during their hospital stay were recorded. Results: The response rate to the telephone interviews was 57%, resulting in 279 mother–infant pairs being included in this study. The results showed that 78.1% of children received maternal milk during their first days of life. Of all infants, 58.1% were exclusively breastfed during their first month, with a gradual decrease to 36.9% and 19.4% by the end of the third and sixth months of life, respectively. The prevalence of breastfed children reached 14.7% and 7.5% at the ages of twelve and eighteen months, respectively. In the multivariate analysis, prematurity emerged as an independent prognostic factor for the duration of exclusive and any breastfeeding (aHR 1.64, 95% CI: 1.03–2.62; and 1.69, 95% CI: 1.05–2.72, respectively; p < 0.05). Additionally, the nationality of the mother, NICU breastfeeding experience, the administration of maternal milk during neonatal hospital stay, and previous breastfeeding experience of the mother were independent prognostic factors for the duration of breastfeeding. Conclusions: Although breastfeeding is a top priority in our NICU, the exclusive-breastfeeding rates at 6 months were quite low for the hospitalized neonates, not reaching World Health Organization (WHO) recommendations. Mothers/families of hospitalized neonates should receive integrated psychological and practical breastfeeding support and guidance
Amino-terminal pro-C-type natriuretic peptide is associated with arterial stiffness, endothelial function and early atherosclerosis
Objective: C-type natriuretic peptide (CNP) is a paracrine molecule with
effects on endothelial integrity, vascular tone and atherosclerotic
process. Arterial stiffness, wave reflections, endothelial dysfunction
and carotid intima-media thickness (IMT) are predictors of
cardiovascular events. We investigated whether CNP is related to
arterial structure and function in men.
Methods: We evaluated arterial structural and functional characteristics
in 117 consecutive men (mean age 57.3 +/- 9.2 years), with and without
cardiovascular risk factors, who had no established cardiovascular
disease. Arterial elastic properties were evaluated with carotid-femoral
pulse wave velocity (PWV), wave reflections with augmentation index
(AIx), endothelial function with flow-mediated dilatation of the
brachial artery (FMD) and early atherosclerosis with carotid IMT.
Amino-terminal proCNP (NT-proCNP) was assessed in venous blood.
Results: The number of cardiovascular risk factors was inversely related
to levels of NT-proCNP (P<0.01) and there was a progressive increase in
Framingham risk score according to decreasing tertiles of NT-proCNP
(P<0.001). In multivariable regression analysis NT-proCNP exhibited
significant negative associations with PWV and IMT and positive
association with FMD (all P<0.05) that were independent of age, blood
pressure, smoking habits, body mass index, blood glucose, total
triglycerides, low-density lipoprotein and endothelin-1 or
high-sensitivity C-reactive protein. There was no relation between
NT-proCNP and AIx.
Conclusion: The present study is the first to demonstrate in a global
arterial approach relationship between CNP and functional and early
structural arterial changes. These findings elucidate pathophysiological
links and may have important clinical implications for the estimation of
cardiovascular risk in men. (C) 2010 Elsevier Ireland Ltd. All rights
reserved
Prediction of cardiovascular events with levels of proprotein convertase subtilisin/kexin type 9: A systematic review and meta-analysis
Background and aims: Inhibition of proprotein convertase
subtilisin/kexin type 9 (PCSK9) reduces atherogenic lipoproteins and
could lead to reduction of cardiovascular (CV) events. However, it is
unclear whether blood PCSK9 levels predict future CV events. We
performed a meta-analysis of all longitudinal studies to determine the
ability of PCSK9 levels to predict risk of future CV events.
Methods: A comprehensive search of electronic databases was conducted up
to February 2016. Longitudinal studies that reported events or relative
risk (RR) estimates with 95% confidence intervals (CI) were included.
Results: All 9 studies included (12,081 participants, mean follow-up
6.62 years) reported results on total CV events. The pooled RR of total
CV events for an increase in baseline PCSK9 by 1 standard deviation (SD)
was 1.098 (95% CI, 1.02-1.18), corresponding to a risk increase of 10%
(Z = 2.43, p = 0.015). The pooled RR of total CV events for subjects
categorized in the highest tertile of baseline PCSK9 was 1.228 (95% CI,
1.035-1.457), corresponding to a risk increase of 23% (Z = 2.35, p =
0.019). When pooled estimates were derived independently for low-and
high-CV risk populations, baseline PCSK9 levels predicted total CV
events only in apparently healthy subjects (RR = 1.13, 95% CI:
1.050-1.222, Z = 3.21, p = 0.001) and not in populations with
established CV or renal disease (RR = 1.09, 95% CI: 0.961-1.23, Z =
1.33, p = 0.182).
Conclusions: PCSK9 levels are modestly but significantly associated with
increased risk of total CV events. These results suggest a predictive
role of PCSK9 levels on CV health and support the possible clinical role
of PCSK9 inhibitors. (C) 2016 Elsevier Ireland Ltd. All rights reserved
Routine histopathology of septal myectomy for hypertrophic obstructive cardiomyopathy in a greek cohort
Hypertrophic cardiomyopathy (HCM) is a
diverse inherited disease affecting 1 in 500 individuals
irrespective of gender and ethnicity. A fraction of HCM
patients will eventually develop drug refractory dynamic
obstruction of the left ventricular outflow tract. For such
patients, septal myectomy is the procedure of choice to
alleviate their symptoms and improve their quality of
life. The current histopathological study, the first from
the Greek region, aims to examine the hallmark
histopathological characteristics of Hypertrophic
Obstructive Cardiomyopathy in a population of patients
undergoing septal myectomy at a single center over a ten
year period. Medical records and histopathology
specimens of thirty nine (n=39) patients were evaluated.
The sample comprised 22 males (56.4%) and 17 females
(43.6%). Mean patient age at myectomy was 53.9±16.7
years, ranging from 12 to 79 years. Maximal IVS
thickness on echocardiography was available for 35
patients with a median value of 2.08cm. Peak resting
LVOT Pressure Gradient was available for 33 patients
with a mean value of 104.88±44.20 mmHg. Central
tendency of each histopathological attribute expressed as
the median value was: moderate for myocyte
hypertrophy, mild for cytoplasmic vacuolization,
moderate for subendocardial fibrosis, moderate for
interstitial fibrosis, mild for replacement fibrosis,
moderate for myofibrillar disarray and mild for capillary
stenosis. Myocyte hypertrophy, present in all specimens,
was positively correlated with maximal IVS thickness
(tau-b=0.43, p=0.002). Replacement fibrosis was
positively correlated with the grade of microvascular
stenosis (tau-b=0.45, p=0.004). LVEF was negatively
correlated with the grade of interstitial fibrosis (taub=−0.43, p=0.035) and with the extent of myocardial
fiber disarray (tau-b=−0.42, p=0.034). Histopathological
attributes were not correlated with patient gender or age
thus proving that HCM has a histological phenotype
unique to each patient, mainly depending on each
specific sarcomeric mutatio
Periostin is overexpressed, correlated with fibrosis and differs among grades of cardiomyocyte hypertrophy in myectomy tissue of patients with hypertrophic cardiomyopathy
Large main pulmonary artery aneurysm: Case report and brief review of the literature
Pulmonary artery aneurysms are a rare but often fatal clinical entity with an estimated incidence of 1 in 14,000 individuals in postmortem studies. They can be congenital or acquired. No specific guidelines regarding their optimal management, medical or surgical, currently exist and treatment is planned on a case-by-case basis since data regarding their clinical course and prognosis are limited. We present the case of a 77-year-old male patient who presented at the Emergency Department of our hospital with a complaint of exertional dyspnea and dull substernal pain over 1 week. Upon investigation, a main pulmonary artery true aneurysm measuring 61 mm on Computed Tomography was detected. The patient's history was remarkable for heavy smoking, arterial hypertension, dyslipidemia, known ascending aortic aneurysm, moderate COPD, and past tuberculosis. He was admitted to the Cardiology unit and treated as a case of decompensated heart failure with preserved ejection fraction. His symptoms improved with intravenous diuretics. A past chest MRI report, 7 years before his current event, described the main PA aneurysm measuring 51-52 mm. Regarding the main PA aneurysm, the heart team decided to follow a conservative approach with regular follow-up visits based on the patient's comorbidities, functional status, and slow growth rate of the PA aneurysm. Management of pulmonary artery aneurysms requires a heart-team approach in the context of the patient's underlying conditions and symptoms. More data are required in order to guide a treatment plan with an acceptable risk – benefit profile for each patient
Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
Background: To compare the prognostic accuracy of the most commonly used indexes of mortality over time and evaluate the potential of adding thromboelastometry (ROTEM) results to these well-established clinical scores. Methods: The study population consisted of 473 consecutive term and preterm critically-ill neonates. On the first day of critical illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring system, Score for Neonatal Acute Physiology (SNAP II), Perinatal extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM standard extrinsically activated (EXTEM) assay was performed simultaneously. Time-to-event methodology for competing-risks was used to assess the performance of the aforementioned indexes in predicting in-hospital mortality over time. Time-dependent receiver operator characteristics curves for censored observation were compared across indexes. The addition of EXTEM parameters to each index was tested in terms of discrimination capacity. Results: The modified NEOMOD score performed similarly to SNAPPE. Both scores performed significantly better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10) was the EXTEM parameter most strongly associated with mortality (A10 < 37 mm vs. ≥37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index apparently increased the prognostic accuracy in the case of SNAP II and SNAPPE II. However, these increases did not reach statistical significance. Conclusion: Although the four existing indexes considered showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE scores performed significantly better. Though larger studies are needed, adding A10 to well-established neonatal severity scores not including biomarkers of coagulopathy might improve their prediction of in-hospital mortality
Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry
Background: To compare the prognostic accuracy of the most commonly used
indexes of mortality over time and evaluate the potential of adding
thromboelastometry (ROTEM) results to these well-established clinical
scores. Methods: The study population consisted of 473 consecutive term
and preterm critically-ill neonates. On the first day of critical
illness, modified Neonatal Multiple Organ Dysfunction (NEOMOD) scoring
system, Score for Neonatal Acute Physiology (SNAP II), Perinatal
extension of SNAP (SNAPPE), and SNAPPE II, were calculated and ROTEM
standard extrinsically activated (EXTEM) assay was performed
simultaneously. Time-to-event methodology for competing-risks was used
to assess the performance of the aforementioned indexes in predicting
in-hospital mortality over time. Time-dependent receiver operator
characteristics curves for censored observation were compared across
indexes. The addition of EXTEM parameters to each index was tested in
terms of discrimination capacity. Results: The modified NEOMOD score
performed similarly to SNAPPE. Both scores performed significantly
better than SNAP II and SNAPPE II. Amplitude recorded at 10 min (A10)
was the EXTEM parameter most strongly associated with mortality (A10 <
37 mm vs. & GE;37 mm; sHR = 5.52; p < 0.001). Adding A10 to each index
apparently increased the prognostic accuracy in the case of SNAP II and
SNAPPE II. However, these increases did not reach statistical
significance. Conclusion: Although the four existing indexes considered
showed good to excellent prognostic capacity, modified NEOMOD and SNAPPE
scores performed significantly better. Though larger studies are needed,
adding A10 to well-established neonatal severity scores not including
biomarkers of coagulopathy might improve their prediction of in-hospital
mortality