Outcomes of hypoxic respiratory failure at birth associated with previable rupture of membranes.

OBJECTIVE: To characterize clinical outcomes of infants born after previable rupture of membranes (pROM, < 23 weeks gestation and latency period ≥ 2 weeks) in relation to refractory hypoxic respiratory failure (rHRF). STUDY DESIGN: pROM neonates categorized as rHRF (FiO2 > 0.6 for ≥ 2 h) and treated (high frequency ventilation + inhaled nitric oxide) were compared with no rHRF group. Primary outcome was survival until discharge. Factors associated with rHRF and mortality were identified. RESULT: Overall, mortality and disability rates were 28% and 22%, respectively. Treated rHRF group (n = 32) had longer period of ROM, mortality was (31% vs. 14%; p = 0.20), with similar survival-without-disability (54% vs. 47%; p = 0.67). Higher gestational age at birth [1.57 (1.03,2.39)] and cesarean delivery [12.6 (1.22,125)] were associated with increased survival. CONCLUSION: Birth after pROM is associated with high rates of adverse outcomes, independent of latency period. Following treatment, rHRF infants may have similar long-term outcomes as those without rHRF.

Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide.

OBJECTIVE: To describe short-term and long-term outcomes of preterm neonates with severe acute pulmonary hypertension (aPHT) in relation to response to rescue inhaled nitric oxide (iNO) therapy. DESIGN: Retrospective cohort studyover a 6 year period. SETTING: Tertiary neonatal intensive care unit. PATIENTS: 89 neonates <35 weeks gestational age (GA) who received rescue iNO for aPHT, including 62 treated at ≤3 days of age (early aPHT). INTERVENTIONS: iNO ≥ 1 hour. MAIN OUTCOME MEASURES: Positive responders (reduction in fraction of inspired oxygen (FiO2) ≥0.20 within 1 hour of iNO) were compared with non-responders. Primary outcome was survival without moderate-to-severe disability at 18 months of age. RESULTS: Mean (SD) GA and birth weight was 27.7 (3.0) weeks and 1077 (473) gm, respectively. Median (IQR) pre-iNO FiO2 was 1.0 (1.0, 1.0). Positive response rate to iNO was 46%. Responders showed improved survival without disability (51% vs 15%; p<0.01), lower mortality (34% vs 71%; p<0.01) and disability among survivors (17% vs 50%; p=0.06). Higher GA (adjusted OR: 1.44 (95% CI 1.10 to 1.89)), aPHT in context of preterm prolonged rupture of membranes (6.26 (95% CI 1.44 to 27.20)) and positive response to rescue iNO (5.81 (95% CI 1.29 to, 26.18)) were independently associated with the primary outcome. Compared with late cases (>3 days of age), early aPHT had a higher response rate to iNO (61% vs 11%; p<0.01) and lower mortality (43% vs 78%; p<0.01). CONCLUSION: A positive response to rescue iNO in preterm infants with aPHT is associated with survival benefit, which is not offset by long-term disability.

DNA fingerprint analysis of three short tandem repeat (STR) loci for biochemistry and forensic science laboratory courses.

We have devised and implemented a DNA fingerprinting module for an upper division undergraduate laboratory based on the amplification and analysis of three of the 13 short tandem repeat loci that are required by the Federal Bureau of Investigation Combined DNA Index System (FBI CODIS) data base. Students first collect human epithelial (cheek) cells using sterile buccal swabs and then utilize commercially available kits and materials to extract genomic DNA. This is followed by the PCR amplification of three specific short tandem repeat loci (i.e. CSF1PO, TPOX, THO1). Polyacrylamide gel electrophoresis is used to resolve the allelic bands associated with the three short tandem repeat loci, and the results are statistically analyzed in the context of human population genetics. In addition, DNA was collected from a family, and the children's allele sets were compared with those of the parents to help illustrate paternal and maternal relatedness. This module enables students to use the materials and methods employed by actual law enforcement agencies and therefore can be used for laboratory exercises in traditional biochemistry curricula as well as for the growing field of forensic science and education.