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  1. Article ; Online: Unveiling triglyceride levels in preterm neonates: a study to guide targeted monitoring.

    Balasundaram, Palanikumar / Lucena, Michelle H / Morgan-Joseph, Toshiba / Kim, Mimi / Havranek, Tomas / Forman, Katie R

    Minerva pediatrics

    2023  

    Abstract: Background: Mixed lipid emulsion (MLE), most commonly soybean, medium chain triglycerides, olive, and fish oils (SMOF), has replaced soybean-based lipid emulsions in many neonatal intensive care units. Only a few studies report the triglyceride (TG) ... ...

    Abstract Background: Mixed lipid emulsion (MLE), most commonly soybean, medium chain triglycerides, olive, and fish oils (SMOF), has replaced soybean-based lipid emulsions in many neonatal intensive care units. Only a few studies report the triglyceride (TG) trajectory in neonates receiving MLE. We designed a study to compare TG levels in neonates receiving MLE stratified by gestational age (GA), birth weight (BW), and growth restriction status.
    Methods: We included neonates born at <32 weeks GA or with BW <1500 gm. SMOF is started on admission, and plasma TG levels are measured 24 hours after 2 gm/kg/day and 24 hours after 3 gm/kg/day. TG levels were compared across groups defined by GA (<28 weeks vs.
    Results: From 2018 to 2021, 427 infants met the inclusion criteria. TG levels were significantly higher in neonates with GA <28 weeks, BW <1000 grams, and SGA with a notable broad distribution of TG levels. Logistic regression analysis confirmed SGA and BW as significant independent predictors of hypertriglyceridemia after SMOF at 2 gm/kg/day and 3 gm/kg/day, respectively.
    Conclusions: The study emphasizes the importance of TG monitoring for neonates with GA <28 weeks, BW <1000 grams, and SGA. Conversely, it is advisable to individualize TG monitoring for infants with GA>28 weeks, BW>1000 grams, and non-SGA status. Prospective studies with larger sample sizes are warranted to validate our findings.
    Language English
    Publishing date 2023-12-21
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 3062664-X
    ISSN 2724-5780
    ISSN (online) 2724-5780
    DOI 10.23736/S2724-5276.23.07405-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Novel TTN Mutation Causing Severe Congenital Myopathy and Uncertain Association with Infantile Hydrocephalus.

    Balasundaram, Palanikumar / Avulakunta, Indirapriya Darshini / Delfiner, Leslie / Levy, Paul / Forman, Katie R

    Case reports in genetics

    2023  Volume 2023, Page(s) 5535083

    Abstract: Arthrogryposis multiplex congenita (AMC) is characterized by nonprogressive symmetric contractures of multiple joints with normal intellect and normal systemic examination. AMC is often due to fetal akinesia, which has neurologic, muscular, and ... ...

    Abstract Arthrogryposis multiplex congenita (AMC) is characterized by nonprogressive symmetric contractures of multiple joints with normal intellect and normal systemic examination. AMC is often due to fetal akinesia, which has neurologic, muscular, and connective tissue etiologies. We present a case of AMC due to a variant in the titin (TTN) gene in a term neonate. The infant is homozygous for this variant,
    Language English
    Publishing date 2023-07-18
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2664417-4
    ISSN 2090-6552 ; 2090-6544
    ISSN (online) 2090-6552
    ISSN 2090-6544
    DOI 10.1155/2023/5535083
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Pediatrician and Marijuana: An Era of Change.

    Forman, Katie R / Havranek, Tomas

    Advances in pediatrics

    2018  Volume 65, Issue 1, Page(s) 159–171

    MeSH term(s) Brain/growth & development ; Breast Feeding ; Cannabinoids/chemistry ; Cannabis/adverse effects ; Cannabis/chemistry ; Female ; Humans ; Internationality ; Marijuana Use/adverse effects ; Marijuana Use/legislation & jurisprudence ; Maternal-Fetal Exchange ; Medical Marijuana ; Pediatricians ; Pregnancy ; Societies, Medical
    Chemical Substances Cannabinoids ; Medical Marijuana
    Language English
    Publishing date 2018-05-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 210524-x
    ISSN 1878-1926 ; 0065-3101
    ISSN (online) 1878-1926
    ISSN 0065-3101
    DOI 10.1016/j.yapd.2018.04.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Educational Perspectives: Palliative Care Education in Neonatal-Perinatal Medicine Fellowship.

    Forman, Katie R / Thompson-Branch, Alecia

    NeoReviews

    2020  Volume 21, Issue 2, Page(s) e72–e79

    Abstract: The neonatal period from birth to less than or equal to 28 days is one of increased risk of death. Congenital anomalies and prematurity are 2 of the most common risk factors for death at this early age. Many of these neonates will die in an intensive ... ...

    Abstract The neonatal period from birth to less than or equal to 28 days is one of increased risk of death. Congenital anomalies and prematurity are 2 of the most common risk factors for death at this early age. Many of these neonates will die in an intensive care unit, some with full resuscitative efforts being undertaken despite the understanding that these actions are highly unlikely to yield an outcome different from death. Palliative care allows curative therapies to be provided alongside supportive techniques such as enhanced family communication, attention to spirituality and the psychosocial health of the family, management of symptoms other than those specific to the underlying disease process, and enhancing comfort. The American Academy of Pediatrics has set forth recommendations related to pediatric palliative care for the various pediatric subspecialties; however, much of the focus is on disease processes and curing or mitigating various illnesses. Given the high preponderance of death in the neonatal period, neonatal-perinatal medicine training programs should be tasked with generating formal palliative care training. Such training should be geared to providing better care for neonatal patients with a life-limiting or life-altering illness, and better equipping future neonatologists with the tools needed to provide truly comprehensive care for their sickest patients at risk for death and disability. This article serves to review the concept of palliative care in neonates, discuss the paucity of formal education in palliative care, explore the general trend in palliative care education, review various ways in which palliative care education can be formalized, and define metrics of a successful educational program.
    MeSH term(s) Humans ; Infant, Newborn ; Infant, Newborn, Diseases/therapy ; Internship and Residency ; Neonatology/education ; Palliative Care/methods ; Palliative Care/standards ; Palliative Medicine/education ; Perinatology/education
    Language English
    Publishing date 2020-01-29
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1526-9906
    ISSN (online) 1526-9906
    DOI 10.1542/neo.21-2-e72
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Thromboelastography in term neonates: an alternative approach to evaluating coagulopathy.

    Sewell, Elizabeth K / Forman, Katie R / Wong, Edward C C / Gallagher, Meanavy / Luban, Naomi L C / Massaro, An N

    Archives of disease in childhood. Fetal and neonatal edition

    2017  Volume 102, Issue 1, Page(s) F79–F84

    Abstract: Objective: To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates.: Design: Prospective observational study.: Setting: An outborn neonatal and cardiac intensive care unit in a free- ... ...

    Abstract Objective: To develop normative ranges for citrate-modified and heparinase-modified thromboelastography (TEG) in term neonates.
    Design: Prospective observational study.
    Setting: An outborn neonatal and cardiac intensive care unit in a free-standing academic children's hospital.
    Patients: Thirty term neonates were enrolled as control subjects. Seventeen infants with clinically documented bleeding requiring blood transfusion were enrolled in the comparison group.
    Main outcome measures: Citrate-modified and heparinase-modified TEG parameters were calculated from blood specimens drawn via peripheral arterial stick or arterial line.
    Results: TEG in neonates differs from older children and adults; clotting time (R) and clot kinetics (K) values are generally lower while fibrinolysis or rate of clot breakdown (LY30) and coagulation index (CI) are often higher in neonates. TEG values in term neonates calculated as median (Q1-Q3) are as follows: R 4.150 (3.200-6.200), K 1.550 (1.200-1.800), α angle (α) 70.100 (66.000-72.900), maximum amplitude (MA) 61.850 (59.400-66.000), LY30 1.050 (0.100-1.600) and CI 1.950 (0.100 to 2.900). Cut points selected for optimal predictive value for bleeding using receiver operating curve analyses were R>6.3 (sensitivity 82.4%, specificity 80%); K>2.5 (sensitivity 82.4%, specificity 96.7%); α<59 (sensitivity 82.4%, specificity 96.7%); MA<57 (sensitivity 82.4%, specificity 86.7%); CI<-0.15 (sensitivity 88.2%, specificity 83.3%).
    Conclusions: The reference ranges and cut points for citrate-modified and heparinase-modified TEG can be used to diagnose and evaluate coagulopathy in term neonates.
    MeSH term(s) Blood Coagulation ; Blood Coagulation Disorders/blood ; Blood Coagulation Disorders/diagnosis ; Blood Coagulation Tests ; Female ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Prospective Studies ; Term Birth/blood ; Thrombelastography/methods
    Language English
    Publishing date 2017-01
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 2007331-8
    ISSN 1468-2052 ; 1359-2998
    ISSN (online) 1468-2052
    ISSN 1359-2998
    DOI 10.1136/archdischild-2016-310545
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Coagulopathy in newborns with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia: a retrospective case-control study.

    Forman, Katie R / Diab, Yaser / Wong, Edward C C / Baumgart, Stephen / Luban, Naomi L C / Massaro, An N

    BMC pediatrics

    2014  Volume 14, Page(s) 277

    Abstract: Background: Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemic oxygen deprivation. Additionally, therapeutic hypothermia (TH) slows enzymatic activity of the coagulation cascade, leading to constitutive ... ...

    Abstract Background: Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemic oxygen deprivation. Additionally, therapeutic hypothermia (TH) slows enzymatic activity of the coagulation cascade, leading to constitutive prolongation of routinely assessed coagulation studies. The level of laboratory abnormality that predicts bleeding is unclear, leading to varying transfusion therapy practices.
    Methods: HIE infants treated with TH between 2008-2012 were included in this retrospective study. Initial, minimum (min) and maximum (max) values of International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen (Fib) and platelet (PLT) count (measured twice daily during TH) were collected. Bleeding was defined as clinically significant if associated with 1) decreased hemoglobin (Hb) by 2 g/dL in 24 hours, 2) transfusion of blood products for hemostasis, or 3) involvement of a critical organ system. Laboratory data between the bleeding group (BG) and non-bleeding group (NBG) were compared. Variables that differed significantly between groups were evaluated with Receiver Operating Characteristic Curve (ROC) analyses to determine cut-points to predict bleeding.
    Results: Laboratory and bleeding data were collected from a total of 76 HIE infants with a mean (±SD) birthweight of 3.34 ± 0.67 kg and gestational age of 38.6 ± 1.9 wks. BG included 41 infants. Bleeding sites were intracranial (n = 13), gastrointestinal (n = 19), pulmonary (n = 18), hematuria (n = 11) or other (n = 1). There were no differences between BG and NBG in baseline characteristics (p > 0.05). Both groups demonstrated INR and aPTT values beyond the acceptable reference ranges utilized for full tem newborns. BG had higher initial and max INR, initial aPTT, and lower min PLT and min Fib compared to NBG. ROC analyses revealed that platelet count <130 × 109/L, fib level <1.5 g/L, and INR >2 discriminated BG from NBG.
    Conclusions: Laboratory evidence of coagulopathy is universal in HIE babies undergoing TH. Transfusion strategies to maintain PLT counts >130 × 109/L, fib level >1.5 g/L, and INR <2 may prevent clinical bleeding in this high risk population.
    MeSH term(s) Blood Transfusion ; Case-Control Studies ; Female ; Fibrinogen/analysis ; Hemorrhage/etiology ; Hemorrhage/therapy ; Humans ; Hypothermia, Induced/adverse effects ; Hypoxia-Ischemia, Brain/complications ; Hypoxia-Ischemia, Brain/therapy ; Infant, Newborn ; International Normalized Ratio ; Male ; Partial Thromboplastin Time ; Platelet Count ; Retrospective Studies ; Risk Factors
    Chemical Substances Fibrinogen (9001-32-5)
    Language English
    Publishing date 2014-11-03
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2041342-7
    ISSN 1471-2431 ; 1471-2431
    ISSN (online) 1471-2431
    ISSN 1471-2431
    DOI 10.1186/1471-2431-14-277
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  7. Article ; Online: Effect of temperature on thromboelastography and implications for clinical use in newborns undergoing therapeutic hypothermia.

    Forman, Katie R / Wong, Edward / Gallagher, Meanavy / McCarter, Robert / Luban, Naomi L C / Massaro, An N

    Pediatric research

    2014  Volume 75, Issue 5, Page(s) 663–669

    Abstract: Background: Encephalopathic neonates undergoing therapeutic hypothermia have increased risk for coagulopathy secondary to perinatal asphyxia and effects of cooling on the coagulation enzyme cascade. Thromboelastography (TEG) allows for a comprehensive ... ...

    Abstract Background: Encephalopathic neonates undergoing therapeutic hypothermia have increased risk for coagulopathy secondary to perinatal asphyxia and effects of cooling on the coagulation enzyme cascade. Thromboelastography (TEG) allows for a comprehensive assessment of coagulation that can be regulated for temperature. TEG has not been previously evaluated in newborns undergoing hypothermia treatment.
    Methods: Encephalopathic neonates treated with systemic hypothermia were enrolled in this prospective observational study. Daily blood specimens were collected for standard coagulation tests and platelet counts during hypothermia and after rewarming. Concurrent TEG assays were performed at 33.5 and 37.0 °C for comparison.
    Results: A total of 48 paired TEGs from 24 subjects were performed. Forty percent of the subjects were males, the mean (± SD) birth weight was 3.2 ± 0.7 kg, and the mean gestational age was 38.4 ± 1.4 wk. TEG results differed significantly between assays performed at 37.0 vs. 33.5 °C, indicating more impaired coagulation at 33.5 °C. TEG parameters clot kinetics, angle, maximum amplitude (MA), and coagulation index were significantly associated with clinical bleeding (P < 0.05). These remained significant (except for MA) after controlling for transfusion therapy.
    Conclusion: TEG results are affected by temperature, consistent with the known association of hypothermia with coagulopathy. Several TEG parameters are predictive of clinical bleeding in newborns undergoing hypothermia. Selected cutpoints to predict bleeding risk are temperature dependent.
    MeSH term(s) Blood Coagulation ; Brain Ischemia/therapy ; Female ; Humans ; Hyperammonemia/therapy ; Hypothermia, Induced/methods ; Infant, Newborn ; Male ; Prospective Studies ; Risk ; Temperature ; Thrombelastography/methods
    Language English
    Publishing date 2014-02-12
    Publishing country United States
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 4411-8
    ISSN 1530-0447 ; 0031-3998
    ISSN (online) 1530-0447
    ISSN 0031-3998
    DOI 10.1038/pr.2014.19
    Database MEDical Literature Analysis and Retrieval System OnLINE

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