Effects of Prenatal PM10 Exposure on Fetal Cardiovascular Malformations in Fuzhou, China: A Retrospective Case-Control Study.

BACKGROUND: Maternal exposure to ambient air pollution has been associated with an increased risk of congenital heart defects in offspring; however, the results are inconsistent. OBJECTIVES: We investigated whether there is an association between prenatal exposure to particulate matter with diameter ≤10µm (PM10) during early pregnancy and fetal cardiovascular malformations. METHODS: The gravidae from a hospital-based case­control study in Fuzhou, China, during 2007­2013 were assigned 10-d or 1-mo averages of daily PM10 using an air monitor­based inverse distance weighting method during early pregnancy. A total of 662 live-birth or selectively terminated cases and 3,972 live-birth controls were enrolled. The exposure was considered as a categorical variable. A multivariable logistic regression model was constructed to quantify the adjusted odds ratios (aORs) of the exposure to PM10 and the risks of fetal cardiovascular malformations. RESULTS: PM10 levels were positively associated with the risks of atrial septal defect (aORs ranging from 1.29 to 2.17), patent ductus arteriosus [aORs = 1.54, 1.63; 95% confidence intervals (CIs): 1.17, 2.23; 1.06, 3.24], overall fetal cardiovascular malformations (aOR = 1.28; 95% CI: 1.03, 1.61), ventricular septal defect (aOR = 1.19; 95% CI: 1.00, 1.43), and tetralogy of Fallot (aOR = 1.44; 95% CI: 1.01, 2.19) in the various observed periods scaled by 10 d or 1 mo in the first and second gestation months. The strongest associations were observed for exposure to PM10 in the second quartile, whereas the associations were attenuated when higher concentrations of PM10 in the third and fourth quartiles of the exposure were evaluated. No correlations of PM10 levels with these cardiovascular malformations in the other time periods of gestation were observed. CONCLUSIONS: Our findings suggest some positive associations between maternal exposure to ambient PM10 during the first two months of pregnancy and fetal cardiovascular malformations. https://doi.org/10.1289/EHP289.

[Clinical effect of combination therapy with high-frequency oscillation ventilation, pulmonary surfactant and inhaled nitric oxide in the treatment of neonatal hypoxemic respiratory failure].

OBJECTIVE: To investigate the clinical effect of combination therapy with high-frequency oscillation ventilation (HFOV), pulmonary surfactant (PS) and inhaled nitric oxide (iNO) in the treatment of neonatal hypoxemic respiratory failure (HRF). METHODS: A total of 116 neonates with HRF were studied, and they were randomly divided into two groups: triple therapy (n=58) and dual therapy (n=58). The triple therapy group received HFOV, PS, and iNO, while the dual therapy group received HFOV and iNO. Blood gas values, PaO2/FiO2 (P/F), oxygenation index (OI), and pulmonary arterial pressure (PA) were determined before treatment and after 24 and 48 hours of treatment. Among the neonates with different P/F ratios and OI values and with or without persistent pulmonary hypertension of the newborn (PPHN), the treatment outcomes of two groups were compared. RESULTS: The durations of mechanical ventilation and iNO therapy in the triple therapy group were significantly shorter than in the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the triple therapy group had significantly improve PaO2 and PaCO2 compared with the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the neonates with PPHN in the triple therapy group had significantly decreased PA compared with the dual therapy group (P<0.01). In the cases with a P/F ratio of ≤50, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the P/F ratios of the neonates who died were significantly lower than those of survivors (P<0.01). In the cases with an OI of ≥40, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the OI values of the neonates who died were significantly higher than those of survivors (P<0.01). In neonates with PPHN, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). The triple therapy group had a significantly shorter length of hospital stay (P<0.01) and a significantly higher cure rate (P<0.05) compared with the dual therapy group. There were no significant differences in complications between the two groups (P>0.05). No severe side effect was found during the treatment in either group. CONCLUSIONS: Triple therapy with HFOV, PS and iNO is a more effective treatment for neonatal HRF compared with the dual therapy with HFOV and iNO. The triple therapy can significantly improve oxygenation and survival rate, providing a new treatment for the neonates with HRF, especially the critical cases who suffer severe lung disease with PPHN and have a P/F ratio of ≤50 or an OI of ≥40.

[Therapeutic effect of early administration of oral ibuprofen in very low birth weight infants with patent ductus arteriosus].

OBJECTIVE: To study therapeutic effect and safety of early administration of oral ibuprofen in very low birth weight infants (VLBWIs) with patent ductus arteriosus (PDA). METHODS: A total of 64 symptomatic VLBWIs (within 24 hours after birth) with PDA confirmed by bedside Color Doppler ultrasound were randomly divided into two groups: treatment and control (n=32 each). The treatment group was orally administered ibuprofen within 24 hours after birth at 10 mg/kg, followed 24 hours later by a second dose of 5 mg/kg and 48 hours later by a third dose of 5 mg/kg. The control group was treated with placebo (normal saline) at 1 mL/kg, followed 24 hours later by a second dose of 0.5 mL/kg and 48 hours later by a third dose of 0.5 mL/kg. The therapeutic efficacies and adverse effects in both groups were observed. RESULTS: The treatment group showed a significantly higher closure rate of ductus arterious than the control group after one course of treatment (84% vs 41%; P<0.01). The incidence rates of periventricular leukomalacia and bronchopulmonary dysplasia were significantly lower in the treatment group than in the control group (P<0.05). The duration of mechanical ventilation and mean hospitalization time were significantly shorter in the treatment group than in the control group (P<0.05). There were no significant differences in the incidence rates of intraventricular hemorrhage, early pulmonary hemorrhage and necrotizing enterocolitis between the two groups (P>0.05). No obvious adverse effects were observed in both groups. CONCLUSIONS: Early administration of oral ibuprofen for treatment of PDA in VLBWIs can decrease the incidence rates of some early complications and shorten hospitalization time, but causes no significant adverse effects.