The Association between Admission Hypothermia and Neonatal Outcomes in Very Low Birth Weight Infants

PURPOSE: We aimed to evaluate the effect of admission hypothermia on neonatal outcomes in very low birth weight infants (VLBWIs). METHODS: Medical records of 153 preterm infants, with birth weights <1,500 g and gestational ages <32 weeks, were retrospectively reviewed. The clinical characteristics and neonatal outcomes in infants who experienced moderate hypothermia during the first hour of life (Group I) were compared to those in infants with mild hypothermia or normothermia (Group II). RESULTS: Fifty of 153 infants experienced moderate hypothermia after birth. Group I had lower birth weight than Group II (867.8±304.4 g vs. 1,140.3±247.5 g, P<0.001), and were younger than Group II (27.6±2.6 weeks vs. 29.1±1.9 weeks, P<0.001). Adjusted proportion of moderate to severe bronchopulmonary dysplasia (BPD) and persistent pulmonary hypertension of newborn (PPHN) were higher in Group I than in Group II (56% vs. 21.8%, P=0.005), (9.1% vs. 1.5%, P=0.019). Multiple logistic regression analysis that did not control for PPHN (model II) showed that gestational age (Odds ratio [OR] 0.93, P=0.001), moderate hypothermia (OR 4.07, P=0.013), and surgical patent ductus arteriosus (OR 4.96, P=0.023) were associated with moderate to severe BPD. Association of moderate hypothermia with moderate to severe BPD was invalid when further multiple logistic regression analysis adjusting for PPHN (model I), which had a strong association with moderate to severe BPD (OR=15.46, P=0.039), was performed. CONCLUSION: Moderate hypothermia after birth in VLBWIs was associated with PPHN and moderate to severe BPD. The association between moderate hypothermia and moderate to severe BPD might be mediated by PPHN.

Charlson Comorbidity Index as a Predictor of Long-Term Survival after Surgery for Breast Cancer: A Nationwide Retrospective Cohort Study in South Korea / 한국유방암학회지

PURPOSE: The aim of this article was to evaluate the impact of the Charlson Comorbidity Index (CCI) on long-term survival after surgery for breast cancer in South Korea. METHODS: The study subjects were 29,562 women patients aged 20 years and older that underwent surgery for breast cancer between 2002 and 2005. The data were obtained from claims submitted to the National Health Insurance. All patients were censored at the follow-up cutoff date of June 30, 2006. Survival curves were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to explore the impact of CCI on all-cause mortality. RESULTS: After a follow-up time of 47 months, higher all-cause mortality was associated with an increasing CCI. In terms of the 4-year survival rate, among patients with CCI=1, it was 91.1%, among patients with CCI=2 it was 87.8%, and those patients with CCI> or =3 it was 80.2%. Multivariate Cox proportional hazard analysis showed that CCI=1 (hazard ratios [HR], 1.10; 95% confidence interval [CI], 0.97-1.25), CCI=2 (HR, 1.61; 95% CI, 1.31-1.97) and CCI> or =3 (HR, 2.27; 95% CI, 1.59-3.24), were associated with long-term survival. CONCLUSION: CCI is a strong predictor of long-term survival after surgery for breast cancer. We recommend the use of a validated comorbidity index in the selection of patients for breast surgery.