Factors that affect the rate of preterm birth: An examination of the inter-related impacts of social determinants, behavior and physical health status

The work seeks to examine the factors that have significant relationships to the rate of preterm birth (PTB) along with its cost to society. There are four papers within this work. This purpose of the first paper is to measure the impact that healthy behaviors have on the rate of PTB when modeled with other factors like household demographics, community deprivation, chronic disease and mental health. This work finds that positive health behaviors has a negative relationship with PTB. The interaction between body mass index (BMI) and social class and its relationship to PTB is examined in the second paper. This paper finds that there is a curvilinear between BMI and PTB for women who are of a lower socioeconomic status (LSES). This result is not present with women who are of a higher socioeconomic status. This work also finds an obesity paradox for LSES women where the rate of PTB decreases as BMI increases except for those who were morbidly obese. The third paper re-examines Black women\u27s risk of PTB. This study results indicate that although Black women have a higher rate of PTB than other races of women, race itself is not a risk factor. Race\u27s interaction with other health and social factors are more significant than race as an independent factor. The final paper is a cost effective analysis that examines the cost of free standing birth centers compared to standard hospital care with respect to the estimated reduction in PTB. The analysis shows that free standing birthing centers are the most cost effective alternative for low to no risk pregnant women. This option also has lower rates of PTB. The final conclusion of this paper is that promotion of birthing centers can not only potentially reduce the national rate of PTB, but also can save the healthcare system money in the cost of birth and preterm birth

Factors Impacting Length of Treatment and Length of Hospital Stay in Neonatal Abstinence

Background: Neonatal Opiate Withdrawal Syndrome (NOWS) has been a concern in the United States, with an incidence of 20 cases per 1000 live births. Most research on NOWS uses length of stay (LOS) in the hospital or length of pharmacological treatment (LOT) as outcome measures for treatment effectiveness. However, LOS does not account for other factors impacting neonatal care, such as other medical or social confounders. LOT may be a more precise measure to evaluate treatment effectiveness but does not account for possible need to continue close, in-hospital monitoring of withdrawal symptoms. Therefore, the aim of our research is to evaluate LOT and LOS, assessing what factors prolong hospital stay after completing pharmacological treatment for NOWS. Objective: To evaluate factors that contribute to the difference between LOT and LOS. Methods: A retrospective medical chart review of all neonates born to mothers with evidence of substance use/abuse from 2011 – 2017 at a tertiary care center was conducted by using EPIC EHR system. Neonates over 35 weeks gestational age with in-utero opioid exposure and no other major congenital anomalies, who received pharmacological treatment for NOWS were included. Demographic data as well as outcome data related to the difference between LOT and LOS was analyzed using multivariate analysis. Prolonged hospital stay is considered for LOS-LOT greater than 48 hours. Results: 229 neonates were included in the study with median LOT 22 days and median LOS 29 days. Of the 62% who had prolonged hospital stay after cessation of pharmacological treatment for NOWS, 43% were due to a hold placed by child protection service. There was a correlation in increased time between LOT and LOS and maternal age (p=0.001), as well as receiving treatment in the NICU (p=0.005). There is a trend towards a shorter stay in neonates with higher birth weight (p=0.05) and gestational age (p=0.08). Maternal polysubstance use did not statistically increase the stay (p=0.929). Prolonged stay had no effect on readmission within 30 days (p=0.882). Mean LOS and LOT per year of birth were statistically different (p Conclusions: Close to half of the babies treated for NOWS had a pronged LOS, most of which was due to a social hold or a hold by child protective services. The average cost of treatment for infants with NOWS is $79,937.75. By addressing underlying factors that prolong the stay in the hospital past medical care, we may be able to decrease medical spending and improve overall care for these neonates

Adverse Effects Associated with Diazoxide Use in Neonates

Objective: To evaluate the type and frequency of adverse effects associated with diazoxide used for treatment of hyperinsulinemic hypoglycemia (HIH) in neonates

Knowledge, Attitudes, and Beliefs About Safe Sleep Among Preconception Adolescents​

Introduction–To protect against SUID/SIDS, the American Academy of Pediatrics (AAP) released recommendations on creating a safe sleep environment. Studies about teen parents indicate gaps in knowledge regarding infant safe sleep practices, however there are no published studies about adolescents who are preconception. The objective of this stud is to investigate adolescents’ knowledge, attitudes, and beliefs regarding infant safe sleep practices prior to conceiving. Methods–This was a cross-sectional study of adolescents aged 14-22 years recruited from two outpatient primary care pediatric sites in Southern NJ. Following consent, participants completed a 27-question survey about infant safe sleep practices. For analysis, a knowledge score was calculated on a scale of 1-100% and differences by ethnicity, race, age, gender, and caregiver experience were evaluated. Results–A total of 147 subjects were enrolled. Forty-three participants (27.9%) self-identified as Hispanic or Latino, 53 (39.0%) as Black or African American, and 65 (47.8%) as Caucasian. The mean knowledge scores were 47.25%, 55%, and 53.33% for Blacks, Caucasians, and other races, respectively (p=.009). There were no significant differences in knowledge scores between gender, age group, Hispanic ethnicity, or caregiver experience. Eighty-two subjects (55%) identified preconception as an ideal time period to learn about safe sleep practices. Discussion–A significant knowledge gap was observed among subjects, and Black subjects had the lowest knowledge scores. Most adolescents identified preconception as an ideal time period to learn about infant safe sleep practices. Safe sleep promotion may be enhanced through SUID/SIDS education in high schools, or conversations during adolescent well visits

Do psychosocial conditions contribute to hospital readmission in patients with sepsis?

•Sepsis is the most expensive condition in hospitalized patients, recently reported to cost more than $23.7 billion per year (1). •Despite a decrease in mortality, the number of severe sepsis/septic shock (sepsis) cases have increased (2). •Sepsis survivors are at risk for unplanned readmissions, which are associated with increased mortality and discharge to hospice (2). •Psychiatric and social disorders have been associated with increased readmission rates in patients with heart failure, myocardial infarction, and pneumonia (3). •Ascertaining variables associated with sepsis readmissions may aid in identification of risk factors and opportunities for improvement (4, 5). •The purpose of this study is to evaluate if psychosocial conditions may be correlated with increased risk for readmission after a sepsis hospitalization

Adverse Effects Associated with Diazoxide Use in Neonates

Abstract Introduction: Diazoxide is the first-line treatment used to manage infants and children with hypoglycemia secondary to hyperinsulinemic hypoglycemia (HH), after initial stabilization of blood glucose. Recent changes in Pediatric Endocrine Society guidelines regarding definition of, and screening for hypoglycemia in the neonate led to an increase in the number of infants treated with diazoxide. Previous studies have noted various side effects of diazoxide. With the increased use of this drug in neonates, our aim is to further evaluate these side effects. Methods: We performed a retrospective case control analysis of all neonates admitted to a tertiary care center in New Jersey who were treated with diazoxide for hypoglycemia after a confirmed diagnosis of HH between 1/1/2015 and 9/1/2019. All subjects were younger than 6 months of age at treatment initiation with diazoxide. We collected data regarding general patient characteristics, diuretic dosing, findings on echocardiogram, blood counts, episodes of emesis, and quantity of feeds at time points before and after diazoxide initiation. Results: A total of 25 infants (64% males) met inclusion criteria and were included in the analysis. Based on echocardiogram results, one baby (4%) had pulmonary hypertension (PHTN) prior to initiation of diazoxide, and 20% after, with 5 cases (20%) of reopening of the ductus arteriosus (DA). Nine patients (36%) required a diuretic dose increase after diazoxide initiation. There was increased feeding intolerance with increased number of emesis events after diazoxide initiation (p=0.006). A week after initiation of diazoxide, there was no improvement in the percent of total oral intake as would typically be expected. Conclusion: New onset PHTN and re-opening of the DA were associated with initiation of diazoxide treatment. Significant increase in emesis after diazoxide initiation suggests that infants may be experiencing feeding difficulties associated with this medication. Larger studies are needed to further evaluate the extent and frequencies of these side effects

The Effects of Natural Epigenetic Therapies in 3D Ovarian Cancer and Patient-Derived Tumor Explants: New Avenues in Regulating the Cancer Secretome.

High mortality rates in ovarian cancer have been linked to recurrence, metastasis, and chemoresistant disease, which are known to involve not only genetic changes but also epigenetic aberrations. In ovarian cancer, adipose-derived stem cells from the omentum (O-ASCs) play a crucial role in supporting the tumor and its tumorigenic microenvironment, further propagating epigenetic abnormalities and dissemination of the disease. Epigallocatechin gallate (EGCG), a DNA methyltransferase inhibitor derived from green tea, and Indole-3-carbinol (I3C), a histone deacetylase inhibitor from cruciferous vegetables, carry promising effects in reprograming aberrant epigenetic modifications in cancer. Therefore, we demonstrate the action of these diet-derived compounds in suppressing the growth of 3D ovarian cancer spheroids or organoids as well as post-treatment cancer recovery through proliferation, migration, invasion, and colony formation assays when compared to the synthetic epigenetic compound Panobinostat with or without standard chemotherapy. Finally, given the regulatory role of the secretome in growth, metastasis, chemoresistance, and relapse of disease, we demonstrate that natural epigenetic compounds can regulate the secretion of protumorigenic growth factors, cytokines, extracellular matrix components, and immunoregulatory markers in human ovarian cancer specimens. While further studies are needed, our results suggest that these treatments could be considered in the future as adjuncts to standard chemotherapy, improving efficiency and patient outcomes

The Effects of Natural Epigenetic Therapies in 3D Ovarian Cancer and Patient-Derived Tumor Explants: New Avenues in Regulating the Cancer Secretome

High mortality rates in ovarian cancer have been linked to recurrence, metastasis, and chemoresistant disease, which are known to involve not only genetic changes but also epigenetic aberrations. In ovarian cancer, adipose-derived stem cells from the omentum (O-ASCs) play a crucial role in supporting the tumor and its tumorigenic microenvironment, further propagating epigenetic abnormalities and dissemination of the disease. Epigallocatechin gallate (EGCG), a DNA methyltransferase inhibitor derived from green tea, and Indole-3-carbinol (I3C), a histone deacetylase inhibitor from cruciferous vegetables, carry promising effects in reprograming aberrant epigenetic modifications in cancer. Therefore, we demonstrate the action of these diet-derived compounds in suppressing the growth of 3D ovarian cancer spheroids or organoids as well as post-treatment cancer recovery through proliferation, migration, invasion, and colony formation assays when compared to the synthetic epigenetic compound Panobinostat with or without standard chemotherapy. Finally, given the regulatory role of the secretome in growth, metastasis, chemoresistance, and relapse of disease, we demonstrate that natural epigenetic compounds can regulate the secretion of protumorigenic growth factors, cytokines, extracellular matrix components, and immunoregulatory markers in human ovarian cancer specimens. While further studies are needed, our results suggest that these treatments could be considered in the future as adjuncts to standard chemotherapy, improving efficiency and patient outcomes

Stereotactic Body Radiation Therapy (SBRT) for Liver Metastasis: Early Experience with the Cyberknife Robotic Radio-Surgery System

Background: The liver is a common site for malignant metastases. Surgical metastatic resection, ablative therapies, and external beam radiation therapy (EBRT) all have advantages and limitations. Preliminary reports reveal SBRT treats hepatic metastases with limited toxicities. We reviewed our institution’s SBRT experience for the treatment of liver metastases to assess toxicity and outcomes.Methods: Hepatic metastases treated with SBRT were retrospectively reviewed from 2008-2010. Computed tomography (CT) identified tumor volume prior to SBRT, local recurrence and out-of-field progression after SBRT. Study endpoints were local recurrence, toxicity, and overall survival.Results: Thirty-three patients had 37 liver metastases treated with a median SBRT dose of 30Gy. Median follow-up was 8.1 months. Five lesions (13.5%) locally recurred after a median of 10.6 months. Seventeen patients had out-of-field progression (15 liver, 6 systemic) after a median of 5.1 months. Overall 23.5-month survival was 45.5%. Five patients reported nausea and seven reported pain after SBRT. There were no grade 4-5 toxicities or cases of liver failure.Conclusion: SBRT is safe and well tolerated in patients with hepatic metastases. SBRT offers a local therapy with limited toxicities to patients with lesions not amenable to traditional ablative, surgical, or regional therapies