Necrotizing enterocolitis : imaging and risk assessment

Despite decades of research on necrotizing enterocolitis (NEC), no major finding has improved the mortality and morbidity of the disease or changed the clinical management. The exact pathogenesis remains unclear, but several factors such as immature intestinal immunity, impaired bowel microcirculation, enteral nutrition and abnormal microbiota may play important roles. In the post-surfactant era, the NEC patient population has changed, with an increasing proportion of extremely preterm infants. Plain abdominal radiography is still considered the gold standard imaging technique for NEC. Unfortunately, abdominal radiography has low sensitivity and specificity, making the decision to intervene surgically very challenging. Recent studies have shown the increasing role of abdominal ultrasound and near-infrared spectroscopy in the diagnosis and monitoring of NEC. The overall aim of this project was to describe the preterm infants at risk of NEC and how those who develop severe NEC and need surgical treatment could be identified early, using new imaging techniques and monitoring. The aim of Paper I was to describe the difference in the clinical and radiological presentation of NEC in extremely preterm infants compared with more mature ones. Extremely preterm infants show less typical signs of NEC, such as bloody stool or pneumatosis intestinalis, compared with more mature neonates. The aim of Paper II was to assess if splanchnic oxygenation, as measured by near infrared spectroscopy (NIRS), in the first week of life is associated with the risk of developing necrotizing enterocolitis. Extremely preterm infants underwent NIRS monitoring during enteral nutrition. Low mean splanchnic oxygenation, below 30%, was associated with an increased risk of developing necrotizing enterocolitis during enteral nutrition in the first days of life. The aim of Paper III was to determine whether a correlation exists between the sonographic findings and the clinical outcomes, defined as surgery or death in infants with NEC. Infants with a confirmed diagnosis of NEC, who underwent an abdominal ultrasound, were included in the study. The sonographic sign of complex fluid collections appeared to be strongly correlated with the need for surgery in infants with severe NEC. The aim of Paper IV was to assess if hyponatremia, or worsening of already present hyponatremia, at the onset of necrotizing enterocolitis is associated with intestinal inflammation and ischaemia requiring surgery or death. In this cohort study, neonates with a confirmed diagnosis of NEC were included. Hyponatremia and a sudden decrease in plasma sodium concentration at the onset of NEC can be useful markers for severe intestinal inflammation/ischemia where an imminent need for surgery can be expected

Combination of fecal calprotectin and initial coronary dimensions to predict coronary artery lesions persistence in Kawasaki disease

Kawasaki Disease (KD) is systemic vasculitis involving medium-sized vessels in children. The aim of our study is to determine if fecal calprotectin (FC) could be useful in predicting the development or persistence of coronary artery lesions (CALs) in KD. We conducted a prospective monocentric study including all consecutive diagnoses of. Clinical, laboratory, echocardiographic data were recorded during the acute and subacute phase, including FC. Correlations among laboratory values, FC, clinical manifestations, IVIG-responsiveness and CALs development were investigated. We enrolled 26 children (76.9% boys; median age 34.5 months). The combination of FC > 250 microg/g and z-score > 2 during the acute phase was associated with the persistence of CALs (p = 0.022). A z-score > 2 alone during the acute phase was not related to CALs during the subacute stage (p > 0.05). A neutrophil percentage > 70% and WBC > 15,000/mmc during the acute phase significantly correlated with the presence of CALs during the subacute phase (p = 0.008). C-reactive protein (CRP) > 13 mg/dL at KD onset was significantly associated with the presence of CALs during the acute (p = 0.017) and subacute phase (p = 0.001). The combination of FC > 250 microg/g and a z-score > 2 during the acute phase of KD may be used as a predictor of CALs persistence. It can be useful especially in children with an initial CRP < 13 mg/dl

Clinical usefulness of splanchnic oxygenation in predicting necrotizing enterocolitis in extremely preterm infants:a cohort study

Background: Impaired intestinal microcirculation seems to play an important role in the pathogenesis of necrotizing enterocolitis (NEC). A previous study showed that a SrSO2 &lt; 30% is associated with an increased risk of developing of NEC. We aimed to determine the clinical usefulness of the cut off &lt; 30% for SrSO2 in predicting NEC in extremely preterm neonates.Methods: This is a combined cohort observational study. We added a second cohort from another university hospital to the previous cohort of extremely preterm infants. SrSO2 was measured for 1–2 h at days 2–6 after birth. To determine clinical usefulness we assessed sensitivity, specificity, positive and negative predictive values for mean SrSO2 &lt; 30. Odds ratio to develop NEC was assessed with generalized linear model analysis, adjusting for center.Results: We included 86 extremely preterm infants, median gestational age 26.3 weeks (range 23.0-27.9). Seventeen infants developed NEC. A mean SrSO2 &lt; 30% was found in 70.5% of infants who developed NEC compared to 33.3% of those who did not (p = 0.01). Positive and negative predictive values were 0.33 CI (0.24–0.44) and 0.90 CI (0.83–0.96), respectively. The odds of developing NEC were 4.5 (95% CI 1.4–14.3) times higher in infants with SrSO2 &lt; 30% compared to those with SrSO2 ≥ 30%.Conclusions: A mean SrSO2 cut off ≥ 30% in extremely preterm infants between days 2–6 after birth may be useful in identifying infants who will not develop NEC.</p

Transition of Extremely Preterm Infants from Birth to Stable Breathing : A Secondary Analysis of the CORSAD Trial

© 2023 The Author(s). Published by S. Karger AG, Basel.OBJECTIVE: Exploratory secondary analysis of the CORSAD trial compared a new resuscitation system (rPAP) to the standard T-piece system. This analysis focused on the subgroup of infants who were not intubated in the delivery room. The aim was to compare the use of noninvasive positive pressure ventilation (PPV), oxygen saturation, and Apgar scores for the two resuscitation systems during the 30-min intervention period. METHODS: This is secondary analysis of CORSAD trial using data from the intervention period in the delivery room. Infants in the original randomized system groups were divided into intubated and nonintubated groups. For nonintubated breathing infants, we compared demographics, the use of PPV, Apgar scores, and oxygen saturation at 5 and 10 min after birth. Generalized linear models were applied to calculate the risk difference and odds ratio with 95% CI between the two groups. RESULTS: Among nonintubated infants, the use of PPV repeatedly (defined as PPV with at least 1 min of spontaneous breathing between PPV cycles) was less frequent in the rPAP group (26.8% vs. 43.3%, %RD -16.5, 95% CI [-31.7 to -1.1], p 0.04). The use of PPV after 5 min of age was also less common in the rPAP group (23.2% vs. 38.8%, %RD -15.6, 95% CI [-30.7 to -0.8], p 0.04). There were no statistically significant differences in Apgar scores or oxygen saturation levels between the groups. CONCLUSION: In the CORSAD trial, less PPV was needed to establish stable breathing in extremely preterm infants using the rPAP compared to using the standard T-piece without significant difference in Apgar scores or oxygenation.Peer reviewe

Respiratory outcomes after delivery room stabilisation with a new respiratory support system using nasal prongs

Funding Information: The study was funded by H.K.H. Kronprinsessan Lovisas Förening för Barnasjukvård, Sällskapet Barnavård Research Fund, Region Stockholm and the Swedish Heart‐Lung Fund. Publisher Copyright: © 2023 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.Aim: To study if stabilisation using a new respiratory support system with nasal prongs compared to T-piece with a face mask is associated with less need for mechanical ventilation and bronchopulmonary dysplasia. Methods: A single-centre follow-up study of neonates born <28 weeks gestation at Karolinska University Hospital, Stockholm included in the multicentre Comparison of Respiratory Support after Delivery (CORSAD) trial and randomised to initial respiratory support with the new system versus T-piece. Data on respiratory support, neonatal morbidities and mortality were collected up to 36 weeks post-menstrual age. Results: Ninety-four infants, 51 female, with a median (range) gestational age of 25 + 2 (23 + 0, 27 + 6) weeks and days, were included. Significantly fewer infants in the new system group received mechanical ventilation during the first 72 h, 24 (52.2%) compared with 35 (72.9%) (p = 0.034) and during the first 7 days, 29 (63.0%) compared with 39 (81.3%) (p = 0.045) in the T-piece group. At 36 weeks post-menstrual age, 13 (28.3%) in the new system and 13 (27.1%) in the T-piece group were diagnosed with bronchopulmonary dysplasia. Conclusion: Stabilisation with the new system was associated with less need for mechanical ventilation during the first week of life. No significant difference was seen in the outcome of bronchopulmonary dysplasia.Peer reviewe

Moderate and Severe Congenital Heart Diseases Adversely Affect the Growth of Children in Italy: A Retrospective Monocentric Study

: Children with congenital heart disease (CHD) are at increased risk for undernutrition. The aim of our study was to describe the growth parameters of Italian children with CHD compared to healthy children. We performed a cross-sectional study collecting the anthropometric data of pediatric patients with CHD and healthy controls. WHO and Italian z-scores for weight for age (WZ), length/height for age (HZ), weight for height (WHZ) and body mass index (BMIZ) were collected. A total of 657 patients (566 with CHD and 91 healthy controls) were enrolled: 255 had mild CHD, 223 had moderate CHD and 88 had severe CHD. Compared to CHD patients, healthy children were younger (age: 7.5 ± 5.4 vs. 5.6 ± 4.3 years, p = 0.0009), taller/longer (HZ: 0.14 ± 1.41 vs. 0.62 ± 1.20, p &lt; 0.002) and heavier (WZ: -0,07 ± 1.32 vs. 0.31 ± 1.13, p = 0.009) with no significant differences in BMIZ (-0,14 ± 1.24 vs. -0.07 ± 1.13, p = 0.64) and WHZ (0.05 ± 1.47 vs. 0.43 ± 1.07, p = 0.1187). Moderate and severe CHD patients presented lower z-scores at any age, with a more remarkable difference in children younger than 2 years (WZ) and older than 5 years (HZ, WZ and BMIZ). Stunting and underweight were significantly more present in children affected by CHD (p &lt; 0.01). In conclusion, CHD negatively affects the growth of children based on the severity of the disease, even in a high-income country, resulting in a significant percentage of undernutrition in this population

Shell Game: Randomized representative based election to defend against 51% attacks in Crowd sensing frameworks

Thesis (Master's)--University of Washington, 2019Smart devices and wearable have become an epicenter of human lives and have increasingly become more complex and powerful to make people’s life easier. Smart devices like smart phones and wearable like a smart watch today are equipped to provide pervasive connectivity, quality communication and a glut of other services made possible by an array of high-grade sensors like ambient light sensor, proximity sensor, barometer and gyroscope to name a few. This unique coupling between sensor technology and human interaction has a potential to offer a multitude of opportunities and applications in mobile crowd sensing paradigm, such as real-time road traffic monitoring, noise pollution, health monitoring etc. In this paradigm, people become the centerpiece of the sensing process where users can gather data whenever and wherever, using the mobile sensor devices and they own the process of data retrieval and maintaining of the cleanliness of the data. But humans may be unreliable and malevolent and can affect the cleanliness of the data being collected for their own benefit, which is why mechanisms for detecting and deterring malevolent activities in mobile crowd sensing become imperative than ever. This paper presents a unique and efficient fabric for impeding activities like 51% attack, maintaining the integrity of the data and reduce monetary loss for the data aggregator during such attacks. This has been achieved by implementing a moving target defense in a Randomized representative based election with a proof of stake payment mechanism. To test this method, we simulate an attack by an adversary who gives malicious data and assess their total gain and the percentage of adversary presence needed to obtain a profit

RESOURCE ALLOCATION AND SECURITY FOR CLOUD-NATIVE 5G NETWORK SLICING

Ph.DDOCTOR OF PHILOSOPHY (CDE-ENG