Pancreatic neuroendocrine tumours: a comparison of cytological classification systems.

AIMS: Cytological classification systems provide a standardised interpretation framework for reporting cytological specimens. Three well-known classification systems can be applied when reporting pancreatic cytology. This study aimed to compare the accuracy of these classification systems (C1-C5 system, the Papanicolaou system and the WHO classification) for the assessment of pancreatic neuroendocrine lesions. METHODS: We analysed 73 pancreatic neuroendocrine tumour resections, 49 of which had corroborative cytology available, reported over a 12-year period, at a single UK tertiary referral centre. Each cytology case was classified using the aforementioned systems. The final tumour grade allocated at resection was used to assess and compare the accuracy of each cytological classification system. RESULTS: Cytological assessment accurately reported 77.6% of neuroendocrine lesions as category IVB (neoplastic - other) on Papanicolaou grading, 77.6% as C5 (malignant) lesions and 85.7% as VII (malignant) on WHO grading. 74.3% of resected tumours were grade 1, 17.1% grade 2 and 8.6% grade 3. Complete resection was achieved in 80.8% of cases. CONCLUSIONS: The results demonstrated that the WHO classification appeared to provide reduced ambiguity when compared with both 'C' and Papanicolaou classification systems; with a lower proportion of cases being classified as suspicious of malignancy as opposed to malignant. The Papanicolaou system was able to supersede the other two systems through its ability to distinguish neuroendocrine tumours from more aggressive entities such as pancreatic adenocarcinoma, thus, offering flexibility in management while still retaining a similar level of accuracy to the WHO classification system in distinguishing benign from malignant lesions.

Single Ventricular Assist Device Care and Outcomes for Failed Stage I Palliation: A Single-Center Decade of Experience.

Single ventricular assist device (SVAD) use before and after stage I palliation (S1P) is increasing with limited data on outcomes. To address this knowledge gap, we conducted a single-center retrospective review to assess pre- and post-SVAD clinical status, complications, and outcomes. We leveraged a granular, longitudinal, local database that captures end-organ support, procedural interventions, hematologic events, laboratory data, and antithrombotic strategy. We identified 25 patients between 2013 and 2023 implanted at median age of 53 days (interquartile range [IQR] = 16-130); 80% had systemic right ventricles and underwent S1P. Median SVAD days were 54 (IQR = 29-86), and 40% were implanted directly from ECMO. Compared to preimplant, there was a significant reduction in inotrope use ( p = 0.013) and improved weight gain ( p = 0.008) post-SVAD. Complications were frequent including bleeding (80%), stroke (40%), acute kidney injury (AKI) (40%), infection (36%), and unanticipated catheterization (56%). Patients with in-hospital mortality had significantly more bleeding complications ( p = 0.02) and were more likely to have had Blalock-Thomas-Taussig shunts pre-SVAD ( p = 0.028). Survival to 1 year postexplant was 40% and included three recovered and explanted patients. At 1 year posttransplant, all survivors have technology dependence or neurologic injury. This study highlights the clinical outcomes and ongoing support required for successful SVAD use in failed single-ventricle physiology before or after S1P.

Factors influencing diagnostic accuracy among intensive care unit clinicians - an observational study.

OBJECTIVES: Diagnostic errors are a source of morbidity and mortality in intensive care unit (ICU) patients. However, contextual factors influencing clinicians' diagnostic performance have not been studied in authentic ICU settings. We sought to determine the accuracy of ICU clinicians' diagnostic impressions and to characterize how various contextual factors, including self-reported stress levels and perceptions about the patient's prognosis and complexity, impact diagnostic accuracy. We also explored diagnostic calibration, i.e. the balance of accuracy and confidence, among ICU clinicians. METHODS: We conducted an observational cohort study in an academic medical ICU. Between June and August 2019, we interviewed ICU clinicians during routine care about their patients' diagnoses, their confidence, and other contextual factors. Subsequently, using adjudicated final diagnoses as the reference standard, two investigators independently rated clinicians' diagnostic accuracy and on each patient on a given day ("patient-day") using 5-point Likert scales. We conducted analyses using both restrictive and conservative definitions of clinicians' accuracy based on the two reviewers' ratings of accuracy. RESULTS: We reviewed clinicians' responses for 464 unique patient-days, which included 255 total patients. Attending physicians had the greatest diagnostic accuracy (77-90 %, rated as three or higher on 5-point Likert scale) followed by the team's primary fellow (73-88 %). Attending physician and fellows were also least affected by contextual factors. Diagnostic calibration was greatest among ICU fellows. CONCLUSIONS: Additional studies are needed to better understand how contextual factors influence different clinicians' diagnostic reasoning in the ICU.

An overview of the therapeutic strategies for neoplastic meningitis due to breast cancer: when and why?

INTRODUCTION: Neoplastic meningitis (NM), also known as leptomeningeal carcinomatosis, is characterized by the infiltration of tumor cells into the meninges, and poses a significant therapeutic challenge owing to its aggressive nature and limited treatment options. Breast cancer is a common cause of NM among solid tumors, further highlighting the urgent need to explore effective therapeutic strategies. This review aims to provide insights into the evolving landscape of NM therapy in breast cancer by collating existing research, evaluating current treatments, and identifying potential emerging therapeutic options. AREAS COVERED: This review explores the clinical features, therapeutic strategies, recent advances, and challenges of managing NM in patients with breast cancer. Its management includes multimodal strategies, including systemic and intrathecal chemotherapy, radiation therapy, and supportive care. This review also emphasizes targeted drug options and optimal drug concentrations, and discusses emerging therapies. Additionally, it highlights the variability in treatment outcomes and the potential of combination regimens to effectively manage NM in breast cancer. EXPERT OPINION: Challenges in treating NM include debates over clinical trial end points and the management of adverse effects. Drug resistance and low response rates are significant hurdles, particularly inHER2-negative breast cancer. The development of more precise and cost-effective medications with improved selectivity is crucial. Additionally, global efforts are needed for infrastructure development and cancer control considering the diverse nature of the disease.

Myths and Misconceptions of Breast Cancer in the Pakistani Population.

Background Breast cancer is one of the most prevalent types of cancer in the female population. The cultural diversity, religious beliefs, myths, and misinformation regarding the disease contribute to diagnostic delays and enhanced burden on the healthcare system. This study aimed to ascertain the extent of knowledge and prevalence of erroneous beliefs and misconceptions regarding breast cancer among Pakistani women belonging to diverse socioeconomic and educational backgrounds. Methodology This cross-sectional study was performed in a tertiary care hospital in Karachi, Pakistan. A total of 350 women were enrolled in the study as a representative female population, and 300 participants were included who met the inclusion criteria. Participants were conveniently interviewed using a pre-piloted questionnaire designed to assess the prevalent myths and misconceptions about breast cancer. The data were analyzed by SPSS version 23 (IBM Corp., Armonk, NY, USA) using descriptive statistics. Results The study findings point to a significant prevalence of erroneous beliefs and a lack of accurate information on breast cancer. The mean age of the participants was 20.8 ± 10.4 years. The majority of the participants belonged to a middle socioeconomic status (70%) and were undergraduates (61.4%). The participants' friends and family members were the most frequent sources of information regarding breast cancer. The most common myth was "breast-feeding offers immunity to breast cancer completely" (76.6%), followed by "breast cancer spreads after biopsy" (63.8%). Participants also believed that breast tissue biopsy can lead to the spread of cancer (63.4%) and that faith healers and alternative medicine can cure breast cancer (47.5%). One-third (33.3%) of the participants considered all lumps to be breast cancer; however, approximately half (41.6%) of the participants thought that only painful lumps were associated with breast cancer. A significant number of participants believed breast cancer to be a result of God's curse (31.4%) or evil eye (38.7%). Conclusions The findings suggest a critical need for community-based breast health education initiatives that take into account Pakistani women's distinctive cultural and societal attitudes and work to dispel common misconceptions about the condition.

Rapid Correction of Hyponatremia With Isotonic Saline Leading to Central Pontine Myelinolysis.

Central pontine myelinolysis (CPM) is a part of the spectrum of osmotic demyelination syndrome (ODS), which is a rare demyelinating disorder due to the rapid correction of low serum sodium. It affects the neurons of the pons but may also involve other extra-pontine sites. The disease is characterized by a wide variety of clinical features ranging from dysarthria, dysphagia, bulbar palsy, quadriplegia, and behavioral and psychiatric disturbances. We present a case of a young female who developed CPM due to rapid sodium correction after vomiting. She presented with quadriplegia and locked-in syndrome. The diagnosis is on the basis of clinical and radiographic features. Magnetic resonance imaging (MRI) of the brain is superior to computed tomography (CT) in detecting changes. It shows hyperintensities on T2-weighted images that are classically known as the trident sign in the region of the pons. The patient was managed supportively, and the family was counseled regarding the poor prognosis of the disease. Unfortunately, she met a fatal fate due to a complication of CPM that is aspiration pneumonia. It is, therefore, imperative to create more awareness regarding the disease, and measures should be taken for its prevention that includes correction of low sodium levels not greater than 10 mmol/L/day.

Pyoderma Gangrenosum as a Presenting Feature of Takayasu Arteritis.

Takayasu arteritis (TA) is a large vessel vasculitis that involves the aorta and its major branches. The disease has a female preponderance, and it presents with a wide variety of symptoms including skin manifestations, mainly ulcerative nodules, pyoderma gangrenosum, and erythema nodosum-like lesions. We report a case of a 50-year-old female who presented to the outpatient department with multiple ulcerative lesions over both upper extremities and chest. On physical examination, the patient had pulseless upper limbs. Laboratory investigations revealed positive antinuclear antibodies (ANA) and raised inflammatory markers. CT angiography of the aorta showed thickened aortic arch with the obliterated lumen of the left common carotid and left subclavian arteries. A biopsy of the skin lesion revealed surface ulceration and densely inflamed granulation tissue with a fibroblastic proliferation of deeper tissues. The patient had three out of six features of the American College of Rheumatology 1990 (ACR-1990) criteria for the classification of TA and was diagnosed with TA associated with pyoderma gangrenosum. The patient was managed with steroids and immunosuppressants along with gentle wound debridement with grafting of skin wounds. Since TA has varying presentations, its diagnosis is often challenging and requires a combined approach including clinical signs and symptoms, as well as laboratory and radiological workup. The disease also requires long-term follow-up due to its remitting and relapsing course.

Primary Cutaneous Actinomycosis: A Diagnostic Enigma.

Actinomyces are Gram-positive, filamentous rods found endogenously as a part of the normal flora and can be acquired exogenously as they are present in the soil. The most common species known to infect humans is Actinomyces israelii. Five forms of the disease have been identified so far, of which the primary infection of the skin is the most uncommon. It is also commonly considered one of the most misdiagnosed diseases. We present a case of a young male diagnosed with primary cutaneous actinomycosis based on a histopathology specimen after multiple failed diagnoses of Madura foot/mycetoma, cutaneous tuberculosis, and malignancy. The patient was successfully treated with antibiotics with the restoration of his functional disability caused by the lesion.

Nutraceutical Effect of Resveratrol on the Mammary Gland: Focusing on the NF-κb /Nrf2 Signaling Pathways.

The aim of this study is to evaluate the defensive role of resveratrol, which is antagonistic to the oxidative stress and inflammation that is prompted by LPS in mammary tissue of female mice. Thirty adult mice were distributed into three groups (n = 10) control (CON), lipopolysaccharides at 2.5 mg/kg (LPS), and lipopolysaccharides at 2.5 mg/kg with 2 mg/kg of resveratrol (RES + LPS). The treatments were applied for 15 consecutive days. Spectrophotometry was used to quantify ROS in the blood, and proinflammatory cytokines concentrations were determined through radioimmunoassay. NF-κB, Jnk, IL-1ß, Erk, IL-6, Nrf2 and TNF-α were quantified by RT-qPCR, and Western blots were used to quantifyP65 and pP65 protein intensities. MDA production was considerably increased, and the activity of T-AOC declined in the LPS treatment in comparison with the CON group but was significantly reversed in the RES + LPS group. Proinflammatory cytokines production and the genes responsible for inflammation and oxidative stress also showed higher mRNA and pP65 protein intensity in the LPS group, while Nrf2 showed a remarkable decline in mRNA expression in the LPS versus the CON group. All these mRNA intensities were reversed in the RES + LPS group. There were no remarkable changes in P65 protein intensity observed between the CON, LPS, and RES + LPS groups. In conclusion, resveratrol acts as a protective agent to modulate cellular inflammation and oxidative stress caused by LPS in mammary tissue of female mice.

Quantitative Morphometry and Machine Learning Model to Explore Duodenal and Rectal Mucosal Tissue of Children with Environmental Enteric Dysfunction.

Environmental enteric dysfunction (EED) is a subclinical enteropathy prevalent in resource-limited settings, hypothesized to be a consequence of chronic exposure to environmental enteropathogens, resulting in malnutrition, growth failure, neurocognitive delays, and oral vaccine failure. This study explored the duodenal and colonic tissues of children with EED, celiac disease, and other enteropathies using quantitative mucosal morphometry, histopathologic scoring indices, and machine learning-based image analysis from archival and prospective cohorts of children from Pakistan and the United States. We observed villus blunting as being more prominent in celiac disease than in EED, as shorter lengths of villi were observed in patients with celiac disease from Pakistan than in those from the United States, with median (interquartile range) lengths of 81 (73, 127) µm and 209 (188, 266) µm, respectively. Additionally, per the Marsh scoring method, celiac disease histologic severity was increased in the cohorts from Pakistan. Goblet cell depletion and increased intraepithelial lymphocytes were features of EED and celiac disease. Interestingly, the rectal tissue from cases with EED showed increased mononuclear inflammatory cells and intraepithelial lymphocytes in the crypts compared with controls. Increased neutrophils in the rectal crypt epithelium were also significantly associated with increased EED histologic severity scores in duodenal tissue. We observed an overlap between diseased and healthy duodenal tissue upon leveraging machine learning image analysis. We conclude that EED comprises a spectrum of inflammation in the duodenum, as previously described, and the rectal mucosa, warranting the examination of both anatomic regions in our efforts to understand and manage EED.

Pausing TPN to Decrease Abnormal Newborn Screens: A NICU Quality Initiative.

Detection of metabolic and genetic disorders via the newborn screen (NBS) remains a great diagnostic achievement in medicine. Unfortunately, many false positives for neonates due to acute illness lead to repeat testing. For example, the rate of abnormal NBS in very low birth weight (VLBW) neonates at the University of Virginia was 66%, with 23% due to total parenteral nutrition (TPN) on the amino acid profile. Methods: This study describes a quality improvement (QI) initiative completed in the NICU at a quaternary care center. The primary and secondary outcomes were the percentage of abnormal NBSs in VLBWs and all admissions. The intervention required a pause in TPN, and a dextrose-containing fluid ran for 4 hours before collecting the NBS. During PDSA cycle 1, the TPN pause occurred at 1400, and the collection of the NBS occurred at 1800. During PDSA cycle 2, we aimed to decrease the number of blood draws per neonate and, thus, paused the TPN at 0000 to enable NBS collection at 0400 with routine morning laboratory work. Results: The rate of abnormal screens in VLBWs decreased from 66% to 49%; P < 0.006; 95% CI, 0.04-0.27, and the rate of abnormal screens in all admissions dropped from 45.2% to 28.8%; P < 0.0001; 95% CI, 0.06-0.51. Hospital costs decreased from $244.79 to $170.86 per patient in the cost of the NBS cards alone. Conclusion: By pausing TPN for 4 hours before drawing the NBS, we decreased the number of abnormal NBS in all admissions while also decreasing hospital costs.

Unusual Initial Presentation Of Primary Antiphospholipid Syndrome As Postpartum Symmetrical Peripheral Gangrene.

BACKGROUND: Antiphospholipid syndrome (APS) is an acquired prothrombic state with recurring thromboembolic and obstetric complications in the presence of antiphospholipid antibodies. Isolated skin manifestation especially symmetrical peripheral gangrene (SPG) in postpartum phase is reported rarely. To highlight this unusual presentation of APS with SPG we present a case of young female who developed SPG on her third postpartum day. Postpartum period runs a high risk of sepsis but development of such extensive and rapid ischemic changes in APS is seen uncommonly.

Effect of health education on awareness and practices of breast self examination among females attending a charitable hospital at North Karachi.

OBJECTIVE: To assess the effectiveness of health education as an intervention to promote breast self-examination in a low-resource setting. METHODS: The quasi-experimental study was conducted from January to August 2018 in Karachi after approval by the Jinnah Sindh Medical University, and comprised women from a low resource locality and dividing them into intervention group A and control group B. Demographic data was collected using a pretested questionnaire filled through interviews. Subsequently, group A received health education regarding carcinoma of breast, importance of breast self-examination and monthly motivation through cell phone to perform self-examination. The questionnaire was again filled after 6 months of intervention. Data was analysed using SPSS 20. Group B was given the same health education sessions after the completion of the study. RESULTS: Of the 172 subjects, there were 86(50%) in each of the two groups. In terms of demographic data, the groups were similar (p>0.05). After the intervention, group A showed significant (p<0.001) improvement in knowledge and practice of breast self-examination. There was no change in group B (p>0.05). Being in the intervention group (p=0.001) and level of education (p=0.018) showed positive and negative associations with selfexamination practice. Upon adjusting for age, marital status, family history and education, group A (p=0.001) remained significant, while the level of education (p=0.116) became non-significant. CONCLUSIONS: Designed health promotion programmes with monthly reminders through cell phone improved knowledge and practice of breast self-examination.

Accuracy of STOP-Bang Questionnaire in Predicting Difficult Mask Ventilation: An Observational Study.

Introduction Difficulty with bag-mask ventilation after the induction of general anesthesia and muscle relaxation places the patient at risk for a prolonged period of apnea and hypoxia and thus, at an increased risk of morbidity and mortality. This study was designed to assess the accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation (DMV) in patients receiving general anesthesia for elective surgical procedures. Methods It was a prospective cross-sectional, observational study conducted at a university teaching hospital. A total of 530 patients undergoing surgery under general anesthesia with endotracheal intubation were enrolled. STOP-Bang questionnaire was filled at pre-operative anesthesia assessment. Ease or difficulty of mask ventilation was assessed and documented by a senior resident responsible for intraoperative anesthetic management. Results Out of 530 patients, 139 (26.22%) had a STOP-Bang score of ≥ 3, of whom 55 (39.5%) were found to have DMV. Out of 391 patients with a STOP-Bang score of < 3, only 29 patients (7.5%) had DMV (P ≤0.001). Snoring, high blood pressure, BMI more than 35 kg/m2, age more than 50 years, neck circumference more than 40 cm, and male gender were significantly associated with DMV. The accuracy of the STOP-Bang questionnaire in predicting difficult mask ventilation was 78.68% (95% CI 74.99-81.95) with a negative predictive value of 92.58%. The sensitivity and specificity were found to be 65.48% and 81.17% respectively. Conclusion STOP-Bang score has a high negative predictive value and can be very useful in ruling out the possibility of difficult mask ventilation.

Urine My Heart: A Case of Aerococcal Endocarditis.

An elderly woman with previously known valvular disease presented to the emergency department due to altered mental status. In addition to obtaining an infectious work-up, a bedside echocardiogram was performed and revealed right heart strain prompting a formal echocardiogram evaluation and treatment for a possible pulmonary embolism. Initial laboratory work returned with blood and urine cultures positive for Aerococcus urinae. A transthoracic echocardiogram further revealed new aortic regurgitation. Given this, a transesophageal echocardiogram was completed, confirming new aortic insufficiency as well as findings of infective endocarditis. She did not undergo surgical intervention; however, she was discharged with a plan to continue intravenous antibiotics for six weeks. Although typically seen in genitourinary infections, A. urinae is a rare cause of infective endocarditis and is increasingly identified due to improved speciation techniques. We describe a unique presentation of invasive A. urinae infection to increase awareness and further research on a less commonly encountered bacteria that may present as a urinary tract infection and has the potential to cause invasive disease.

Artificial Intelligence-based Analytics for Diagnosis of Small Bowel Enteropathies and Black Box Feature Detection.

OBJECTIVES: Striking histopathological overlap between distinct but related conditions poses a disease diagnostic challenge. There is a major clinical need to develop computational methods enabling clinicians to translate heterogeneous biomedical images into accurate and quantitative diagnostics. This need is particularly salient with small bowel enteropathies; environmental enteropathy (EE) and celiac disease (CD). We built upon our preliminary analysis by developing an artificial intelligence (AI)-based image analysis platform utilizing deep learning convolutional neural networks (CNNs) for these enteropathies. METHODS: Data for the secondary analysis was obtained from three primary studies at different sites. The image analysis platform for EE and CD was developed using CNNs including one with multizoom architecture. Gradient-weighted class activation mappings (Grad-CAMs) were used to visualize the models' decision-making process for classifying each disease. A team of medical experts simultaneously reviewed the stain color normalized images done for bias reduction and Grad-CAMs to confirm structural preservation and biomedical relevance, respectively. RESULTS: Four hundred and sixty-one high-resolution biopsy images from 150 children were acquired. Median age (interquartile range) was 37.5 (19.0-121.5) months with a roughly equal sex distribution; 77 males (51.3%). ResNet50 and shallow CNN demonstrated 98% and 96% case-detection accuracy, respectively, which increased to 98.3% with an ensemble. Grad-CAMs demonstrated models' ability to learn different microscopic morphological features for EE, CD, and controls. CONCLUSIONS: Our AI-based image analysis platform demonstrated high classification accuracy for small bowel enteropathies which was capable of identifying biologically relevant microscopic features and emulating human pathologist decision-making process. Grad-CAMs illuminated the otherwise "black box" of deep learning in medicine, allowing for increased physician confidence in adopting these new technologies in clinical practice.

Impact of Fellows-as-Teachers Workshops on Teaching Rounds: An Observational Study in an ICU.

During training, fellows serve as teachers and role models for junior colleagues. Fellows-as-teachers curricula may support these roles, but little is known about their effectiveness and durability. We sought to measure the long-term effects on ICU rounds after administering fellows-as-teachers workshops. DESIGN: Prospective pre-/postintervention observational study of ICU rounds. SETTING: Tertiary-care medical ICU with both pulmonary critical care and critical care medicine fellowships. SUBJECTS: ICU teaching teams. INTERVENTIONS: Fellows attended immersive workshops on promoting clinical reasoning, managing the learning environment, teaching bedside skills, and developing situational awareness on ICU rounds. After the workshops, faculty physicians were encouraged to have fellows routinely lead afternoon rounds. MEASUREMENTS AND MAIN RESULTS: We gathered data from direct observations of ICU rounding activities, residents' evaluations of rounds from surveys, and faculty physicians' written comments on fellows' performance in the ICU from end-of-rotation evaluations. Data were analyzed using descriptive statistics, nonparametric comparative tests, and chi-square tests for categorical data. A total of 61 ICU rounding sessions were observed with 501 discrete provider-patient interactions. Survey responses were collected from a total of 53 residents preintervention and 34 residents postintervention. We reviewed 72 open-ended faculty comments on fellows' end-of-rotation evaluations, with 22 occurring postintervention. During the postintervention period, fellows were significantly more likely to make clinical decisions, explain their reasoning, provide teaching points, and ask questions on rounds. Additionally, we observed significantly higher quality written feedback on end-of-rotation evaluations by faculty physicians. However, residents generally harbored neutral or negative perceptions about the educational value of fellow-led rounds postintervention. CONCLUSIONS: Fellows' contributions to patient care and teaching on ICU rounds increased for several months after our fellows-as-teachers workshops. Despite limitations and contamination in our design, our data suggest that similarly designed curricula may promote fellow engagement, possibly at the expense of residents' education.

Time to regain birth weight predicts neonatal growth velocity: A single-center experience.

BACKGROUND: Failure to Thrive (FTT) describes the development of an inappropriate pattern of growth, generally secondary to inadequate nutritional intake, and is associated with several negative outcomes. We describe key features among neonates with FTT as well as the variables that predicted their growth after birth at a Neonatal Intensive Care Unit. METHODS: A retrospective single center study of 340 patients grouped into FTT (n = 100) and non-FTT (n = 240) was conducted. FTT was defined as having a weight <10th percentile on the Fenton 2013 curve at the time of discharge. For analyzing growth velocity, 204 patients were grouped into 4 quartiles based on their calculated growth velocity (grams/kilograms/day [g/kg/day]; 4th quartile had the highest velocity). Multivariate regression models were used to identify predictors of growth velocity. RESULTS: When comparing FTT vs. non-FTT patients, lower birth weights (1897.9 ± 561.4 vs. 2445.9 ± 783.0 g, t(255.1) = -7.2, p < 0.001) and higher growth velocities (9.2 ± 3.9 vs. 8.0 ± 4.1 g/kg/day, t(153.6) = 2.2, p = 0.03) were noted. Among patients with higher growth velocities, birth weights were lower (1st to 4th quartiles: 2474.0 ± 677.0, 2000.0 ± 297.0, 1715.0 ± 285.0, 1533.0 ± 332.0 g, F(3, 200) = 46.5, p < 0.001, adjusted R2 = 0.4). Days to regain birth weight was the most consistent predictor of growth velocity in our overall patient sample (ß [SE] = -0.3 [0.03], p < 0.001) and in the lowest growth velocity quartile subgroup (ß [SE] = -0.3 [0.04], p < 0.001). CONCLUSIONS: Days to regain birth weight was consistently the strongest predictor of neonatal growth velocity along with difference in gender positive predicting growth velocity in the total sample. This highlights the importance of the first week of life in growth pattern establishment.