Early cranial ultrasound lesions predict microcephaly at age 2 years in preterm infants
Kalpathy S Krishnamoorthy, Karl C K Kuban, T Michael O'Shea, Sjirk J Westra, Elizabeth N Allred, Alan Leviton, ELGAN Study Co-investigators
J Child Neurol. 2011;26:188-94
OR (95% CI) for MC associated with different HUS images were IVH, 1.5 (0.8-3.0); VM, 3.3 (1.8-6.0); an ED, 1.6 (0.7-3.5); and EL, 3.1 (1.5-6.2). VM and EL had similar low PPV (24% and 27%, respectively) and high NPV (91% and 90%, respectively) for MC. VM had higher sensitivity for MC than did EL (24% vs 16%, respectively). Focal WM lesion (EL) and diffuse WMD (VM) predict increased risk of MC.
Blood gases and retinopathy of prematurity: the ELGAN Study
Alisse K Hauspurg, Elizabeth N Allred, Deborah K Vanderveen, Minghua Chen, Francis J Bednarek, Cynthia Cole, Richard A Ehrenkranz, Alan Leviton, Olaf Dammann
Neonatology. 2011;99:104-11
MVA indicate exposure to PCO(2) in highest quartile predicts ROP (stage 3- 5: OR = 1.6, – 1.1-2.3); zone 1: 2.0, 1.1-3.6; prethreshold/threshold: 1.9, 1.2-3.0; plus disease: 1.8, 1.1-2.9). Estimates similar for a low pH for zone 1 (2.1, 1.2-3.8), and prethreshold-threshold (1.8, 1.1-2.8). A PaO(2) in highest quartile for GA on at least 2 postnatal days associated with doubled risk of ROP, and 70% risk ↑ for plus disease.
Maternal microbe-specific modulation of inflammatory response in extremely low-gestational-age newborns
Raina N Fichorova, Andrew B Onderdonk, Hidemi Yamamoto, Mary L Delaney, Andrea M DuBois, Elizabeth Allred, Alan Leviton, Extremely Low Gestation Age Newborns (ELGAN) Study Investigators
MBio. 2011 18;2:e00280-10
Mixed bacterial vaginosis (BV) organisms were associated with a proinflammatory pattern similar to facultative anaerobes. Prevotella and Gardnerella species, anaerobic streptococci, peptostreptococci, and genital mycoplasmas associated with different patterns of elevated inflammation-related proteins. Lactobacillus associated with low inflammatory response. Microorganisms colonizing placenta provoke distinctive newborn inflammatory responses & Lactobacillus may suppress these responses.
Inflammation-related proteins in the blood of extremely low gestational age newborns. The contribution of inflammation to the appearance of developmental regulation
Alan Leviton, Raina Fichorova, Yoshika Yamamoto, Elizabeth N Allred, Olaf Dammann, Jonathan Hecht, Karl Kuban, Thomas McElrath, T Michael O'Shea, Nigel Paneth
Cytokine. 2011;53:66-73
Some blood protein concentrations increase with ↑ GA. More commonly, the inflammation-related proteins decrease with ↑ GA. We observed this pattern regardless of whether or not the placenta is inflamed.
Relationship Between Neonatal Blood Protein Concentrations and Placenta Histologic Characteristics in ELGANs
Jonathan L Hecht, Raina N Fichorova, Vanessa F Tang, Elizabeth N Allred, Thomas F McElrath, Alan Leviton, Elgan Study Investigators
Pediatr Res. 2011;69:68-73
Placental inflammation had (p< 0.01) ↑ blood cytokines (IL-1β, IL-6, and TNF-α), chemokines (IL-8, MIP-1β, RANTES, and I-TAC), adhesion molecules (ICAM-1, ICAM-3, and E-selectin), matrix metalloproteinases (MMP-1 and MMP-9), VEGF and its receptor VEGF-R2, and SAA and CRP in first 3 d.
Does BPD contribute to the occurrence of CP among infants born before 28 weeks of gestation?
Linda J Van Marter, Karl C K Kuban, Elizabeth Allred, Carl Bose, Olaf Dammann, Michael O'Shea, Matthew Laughon, Richard A Ehrenkranz, Michael D Schreiber, Padmani Karna, Alan Leviton, ELGAN Study Investigators
Arch Dis Child Fetal Neonatal Ed. 2011;96:F20-9
The 536 infants with BPD were at increased risk of all CP phenotypes. Receipt of oxygen without MV at 36 weeks PMA (BPD) was not associated with increased risk of CP. In contrast, BPD accompanied by MV at 36 weeks PMA was associated with a nearly six-fold increased risk of QP and a fourfold increased risk of DP.
Presumed and definite bacteremia in extremely low gestational age newborns
Sonal Patel, Olaf Dammann, Camilia R Martin, Elizabeth N Allred, Alan Leviton, ELGAN Study Investigators
Acta Paediatr. 2011;100:36-41
Risk patterns did not differ much for presumed and definite bacteremia in first month. While maternal and pregnancy characteristics were associated with early bacteremia, neonatal comorbidities, especially NEC, were the main antecedents/correlates of late bacteremia. Definite and presumed late bacteremias have rather similar risk patterns, while those of early and late bacteremia differ appreciably.
The clustering of disorders in infants born before the 28th week of gestation
Alan Leviton, Olaf Dammann, Stephen Engelke, Elizabeth Allred, Karl C K Kuban, T Michael O'Shea, Nigel Paneth, ELGAN study investigators
Acta Paediatr. 2010;99:1795-800
Adjusted for GA, children with severe NEC (Bell stage IIIb) were at ↑ risk of cerebral WMD, severe ROP (stage 3+), and severe BPD. Children who had early bacteremia were at increased risk of late bacteremia and severe ROP. Those who had severe ROP were at increased risk of severe BPD and both early and late bacteremia.
Neurodevelopment of extremely preterm infants who had necrotizing enterocolitis with or without late bacteremia
Camilia R Martin, Olaf Dammann, Elizabeth N Allred, Sonal Patel, T Michael O'Shea, Karl C K Kuban, Alan Leviton
J Pediatr. 2010;157:751-6
Children with surgical NEC w/o late bacteremia were at increased risk of PDI <70 (OR = 2.7 [1.2, 6.4]), and children with both surgical NEC and late bacteremia were at increased risk of DP CP (OR = 8.4 [1.9, 39]) and MC (OR = 9.3 [2.2, 40]). In contrast, all children with medical NEC were not at increased risk of developmental dysfunction.
Early blood gas abnormalities and the preterm brain
Alan Leviton, Elizabeth Allred, Karl C K Kuban, Olaf Dammann, T Michael O'Shea, Deborah Hirtz, Michael D Schreiber, Nigel Paneth, ELGAN Study Investigators
Am J Epidemiol. 2010;172:907-16
Hypoxemia, hyperoxemia, hypocapnia, hypercapnia, and acidosis were associated with multiple indicators of brain damage. The associations were seen with 1 or with 2 or more days’ exposure. Findings suggest individual blood gas derangements do not increase brain damage risk. Rather, the multiple derangements associated with indicators of brain damage might represent immaturity/vulnerability and illness severity.