Perinatal correlates of Ureaplasma urealyticum in placenta parenchyma of singleton pregnancies that end before 28 weeks of gestation

I Nicholas Olomu, Jonathan L Hecht, Andrew O Onderdonk, Elizabeth N Allred, Alan Leviton, Extremely Low Gestational Age Newborn Study Investigators

Pediatrics 2009;123:1329-136.

PubMed Link

U urealyticum was recovered from 6% and bacteria from 47%; 47% of placentas had no bacteria detectable. The presence of U urealyticum in placental parenchyma before 28 weeks is associated with increased risk of preterm labor and delivery, higher risk of fetal and maternal inflammation, and increased risk of intraventricular hemorrhage and echolucent brain lesions but not of early neonatal death.

Positive screening on the Modified-Checklist for Autism in Toddlers (M-CHAT) in Extremely Low Gestational Age Newborns

Karl C K Kuban, T Michael O'Shea, Elizabeth N Allred, Helen Tager-Flusberg, Donald J Goldstein, Alan Leviton

J Pediatr 2009;154:535-540.e1

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Odds for screening + on M-CHAT ↑ 23-fold for those unable to sit or stand and 7-fold if unable to walk. Children with QP were 13 X more likely to screen +, and those with HP 4 X more likely to screen +. Children with major vision or hearing impairments were 8 X more likely to screen +. Odds for screening + were increased 13-fold with MDI <55 and > than 4-fold for MDI 55-69. Even after motor, cognitive, visual, & hearing impairments eliminated, 10% screened +: double expected rate.

Patterns of respiratory disease during the first two postnatal weeks in extremely premature infants

Matthew Laughon, Elizabeth N Allred, Carl Bose, T Michael O'Shea, Linda J Van Marter, Richard A Ehrenkranz, Alan Leviton, ELGAN Study Investigators

Pediatrics 2009;123:1124 -1131.

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20% of infants had consistently low fraction of inspired oxygen, ~ 38% had pulm deterioration, and remaining 43% had consistently high fraction of inspired O2 (early and persistent lung dysfunction). Infants w/pulm deterioration had lower GA and lower B Wts, had higher SNAP, and received more respiratory support. Gender, multifetal pregnancy, C/S, ACS, chorioamnionitis, & funisitis not associated w/pulm deterioration. Incidence of CLD, O2 tx at 36 wks’, was 17% in low fraction of inspired O2 group, 51% in pulm deterioration group, & 67% in early/persistent pulm dysfunction group.

Cranial ultrasound lesions in the NICU predict cerebral palsy at age 2 years in children who were born at extremely low gestational age

Karl C K Kuban, Elizabeth N Allred, T Michael O'Shea, Nigel Paneth, Marcello Pagano, Olaf Dammann, Alan Leviton, Adré Du Plessis, Sjirk J Westra, Cindy R Miller, Haim Bassan, Kalpathy Krishnamoorthy, Joseph Junewick, Nicholas Olomu, Elaine Romano, Joanna Seibert, Steve Engelke, Padmani Karna, Daniel Batton, Sunila E O'Connor, Cecelia E Keller, ELGAN study investigators

J Child Neurol 2009;24:63-72

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HUS in 1053 infants were read with respect to IVH, VMeg, and EL. Standardized neuro exams classified CP, and functional impairment. 44% w/ VMeg and 52% w/ EL developed cerebral palsy. Compared with no ultrasound abnormalities, children with were 24 X > likely to have QP and 29 X > likely to have HP. Children w/VMeg were 17 X > likely to have QP or HP. 43 % w/CP had nl HUS. EL, late VMeg had ↑probability of CP, esp QP. Nearly ½ w/CP had no HUS abnormality.

Pregnancy disorders that lead to delivery before the 28th week of gestation: and epidemiologic approach to classification

T F McElrath, J L Hecht, O Dammann, K Boggess, A Onderdonk, G Markenson, M Harper, E Delpapa, E N Allred, A Leviton, ELGAN Study Investigators

Am J Epidemiol 2008;168:980-9

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We enrolled 1,006 women who delivered a liveborn singleton ELGAN infants. Each delivery classified by presentation: preterm labor (40%), prelabor premature rupture of membranes (23%), preeclampsia (18%), placental abruption (11%), cervical incompetence (5%), and fetal indication/intrauterine growth restriction (3%). Using factor analysis, the authors found 2 broad patterns. One pattern, characterized by histo chorioamnionitis and placental microbe recovery, was associated with preterm labor, prelabor PROM, placental abruption, and cervical insufficiency. The other, had paucity of orgs and inflammation but presence of histo features of abnl placentation, & ass’ed w/PET and IUGR. Preterm delivery disorders may be separated into two groups: those with intrauterine inflammation and those associated with aberrations of placentation.

An algorithm for identifying and classifying cerebral palsy in young children

Karl C K Kuban, Elizabeth N Allred, Michael O'Shea, Nigel Paneth, Marcello Pagano, Alan Leviton, ELGAN Study Cerebral Palsy-Algorithm Group

J Pediatr 2008;153:466-472

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Of 1056 children examined, 11.4% had an algorithm-based CP. Of these, 31% had DP, 17% had HP, and 52% had QP. Children with QP were 9 X more likely than DP (76% versus 8%) to be more highly impaired and 5 X more likely to be microcephalic (43% versus 8%). They were > than 2 X as likely as children with DP to have MDI <70 and were MCHAT+ 76% compared with DP (30%) and w/oCP (18%).

Neonatal Cranial Ultrasound Lesions and Developmental Delays at 2 Years of Age Among Extremely Low Gestational Age Children

T Michael O'Shea, Karl C K Kuban, Elizabeth N Allred, Nigel Paneth, Marcello Pagano, Olaf Dammann, Lisa Bostic, Kara Brooklier, Samantha Butler, Donald J Goldstein, Gail Hounshell, Cecelia Keller, Susan McQuiston, Alice Miller, Steve Pasternak, Susan Plesha-Troyke, Joan Price, Elaine Romano, Katherine M Solomon, Amanda Jacobson, Sjirk Westra, Alan Leviton, Extremely Low Gestational Age Newborns Study Investigators

Pediatrics 2008;122:e662-e669

PubMed Link

26% of all children had MDI < 70, and 31% had PDI < 70. HUS more associated with low PDI than with low MDI. Children w/o HUS abnormality had lowest probability (23% and 26%) of delayed development. Mod/severe Vmeg associated with 4-fold risk of low PDI and 3-fold risk of low MDI. EL was next best predictor of delay At particularly high risk were infants with bilat cerebellar hemorrhage, Vmeg and bilat/post EL

Colonization of second trimester placenta parenchyma

Andrew B Onderdonk, Jonathan L Hecht, Thomas F McElrath, Mary L Delaney, Elizabeth N Allred, Alan Leviton, ELGAN Study Investigators

Am J Obstet Gynecol 2008;199:52.e1-52.e10

PubMed Link

Bx specimens of chorion from 1083 placentas cultured, and placentas examined. Placentas delivered by c/s w/ PET had lowest bacteria (25%). Preterm labor had highest rates, which ↓with ↑GA from 79% at 23 weeks to 43% at 27 wks. Microorgs in placenta associated w/wbc in fetal stem vessels of chorion or in vessels of umb cord.

Histologic characteristics of singleton placentas delivered before the 28th week of gestation

Jonathan L Hecht, Elizabeth N Allred, Harvey J Kliman, Eduardo Zambrano, Barbara J Doss, Aliya Husain, Solveig M V Pflueger, Chung-Ho Chang, Chad A Livasy, Drucilla Roberts, Ina Bhan, Dennis W Ross, Patricia Kaman Senagore, Alan Leviton, Elgan Study Investigators

Pathology 2008;40:372-6

PubMed Link

Lesions of uteroplacental circulation (abruption, extensive infarction/thrombosis, basal or perivillous fibrin deposition, ↑syncytial knots) inversely related to membrane & cord inflammation. Earlier GA favored inflamm; older age favored charact of ↓blood flow. Inflammation of chorionic plate in 43%, cord in 19%, & chorionic plate vessels in 30%. Of placentas w/umb cord inflammation, 8% had no inflammation of chorionic plate.

Detection of Bacteria in Placental Tissues Obtained from Extremely Low Gestational Age Neonates (ELGAN)

Andrew B Onderdonk, Mary L Delaney, Andrea M DuBois, Elizabeth N Allred, Alan Leviton, Extremely Low Gestational Age Newborns (ELGAN) Study Investigators

Am J Obstet Gynecol 2008;198:110.e1-7

PubMed Link

The culture + rate was higher for vaginal deliveries (333/489; 68%) than for cesarean sections (363/876; 41%). 30% of culture-positive samples had only aerobic bacteria, 21% had only anaerobic bacteria, and 9% had only Mycoplasma/Ureaplasma. Staph and Corynebacterium & organisms associated w/bacterial vaginosis most frequently recovered. Approximately 1/2 of 2nd trimester placentas had orgs w/i chorionic plate.