Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

AIM: The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood. METHOD: Standardised cognitive, memory and motor skills tests were used to determine the brain volumes of 20-year-old adults who had formed part of a randomised controlled trial of KMC versus incubator care. Multivariate analysis of brain volumes was conducted according to KMC exposure. RESULTS: The study comprised 178 adults born preterm: 97 had received KMC and 81 were incubator care controls. Bivariate analysis showed larger volumes of total grey matter, basal nuclei and cerebellum in those who had received KMC, and the white matter was better organised. This means that the volumes of the main brain structures associated with intelligence, attention, memory and coordination were larger in the KMC group. Multivariate lineal regression analysis demonstrated the direct relationship between brain volumes and duration of KMC, after controlling for potential confounders. CONCLUSION: Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Comparing long-term educational effects of two early childhood health interventions.

We compare the educational effects of two medical protocols that mitigate long-term consequences of prematurity or low birth weight. The two protocols are Traditional Care (TC), which uses incubators, and Kangaroo Mother Care (KMC) which replaces incubators for 24-hour skin-to-skin contact between newborns and caregivers. We concentrate on educational outcomes addressing contradictory results in previous contributions. We use a randomized controlled trial implemented in 1993 that randomly assigned children to either TC or KMC. OLS results suggest that KMC children spent more time in preschool, had fewer temporary school absences, and showed lower math test scores. Both groups observed similar effects on high-school graduation and language test scores. We correct for attrition, small sample, and multiple outcomes. Effects on preschool attendance and school absenteeism are robust, particularly for more vulnerable infants (birth weight ≤ 1,800 g). The other effects lose statistical significance due to multiple outcome testing or attrition corrections.

The Effects of Body Mass Index on In-hospital mortality following first ischemic or hemorrhagic stroke events: Does the "obesity paradox" apply?

BACKGROUND: While it is widely held that obesity is a risk factor for stroke, its role in mortality after stroke is less understood. We aim to examine effects of Body Mass Index (BMI) on in-hospital mortality after non-subarachnoid, subarachnoid, and ischemic stroke. METHODS: Retrospective cohort study. Patients aged ≥18 years, who were hospitalized in Florida hospitals between 2008 and 2012 with a diagnosis of first-time stroke as reported by the Agency for Health Care Administration (AHCA). The main independent variable was BMI category, which was divided into non-overweight/non-obese, obese, and morbidly obese. The primary outcome was the adjusted odds ratio (aOR) for in-hospital mortality for subarachnoid and non-subarachnoid hemorrhagic stroke, and ischemic stroke. Logistic regression modeling was utilized to examine the association between each BMI category and in-hospital mortality, while controlling for several potential confounders. This study was reported in line with the STROCSS criteria. RESULTS: Of the 333,367 patients included in the database, 150,153 (45.0%) patients met inclusion criteria. After adjusting for age, gender, ethnicity and other possible confounders, obese patients were 21% less likely to die during their hospitalization following a first ischemic stroke (0.79 aOR, 0.69-0.92, 95% CI, p = 0.002), and 32% less likely following a first non-subarachnoid hemorrhage (0.68 aOR, 0.57-0.82, 95% CI, p = 0.0001) compared to non-overweight/non-obese counterparts. CONCLUSION: Obese patients are less likely to die during hospitalization following first-time non-subarachnoid hemorrhage and ischemic stroke than non-overweight/non-obese patients. These findings support the "obesity paradox" concept, though more research is needed for recurrent stroke patients.

Association between giant cell glioblastoma and glioblastoma multiforme in the United States: A retrospective cohort study.

OBJECTIVES: The current study aims to find the differences between glioblastoma multiforme (GBM) and giant cell glioblastoma (GCG) regarding mortality and prognosis among adults and elderly patients in the U.S. METHODS AND MATERIALS: This study is a historical cohort type of study and is conducted on adults and elderly individuals with GBM or GCG from the years 1985-2014 in the U.S. Data were collected from the Surveillance, Epidemiology, and End Results Program (SEER) database. The study exposure was GBM or GCG and the outcome was mortality. The potential confounders were age, sex, race, ethnicity, year of diagnosis, primary site, brain overlap, and surgery. A chi-square test was used for categorical data. A univariate analysis was used for variables having a p-value <.05. Potential confounders were selected and evaluated using multivariate logistic regression models to calculate the odds ratio with stepwise selection. RESULTS: The study sample was 25,117. The incidences of GBM and GCG were not similar in relation to age group. Also, Spanish-Hispanic ethnicity was independently protective of GBM and GCG as compared to Non-Spanish-Hispanic ethnicity patients with GBM have a higher mortality rate than do GCG patients. The mortality rate was higher among patients diagnosed before 2010. CONCLUSION: GCG was not statistically significant in association to reduced mortality. Non-Spanish-Hispanics with GBM or GCG had a higher mortality rate than did Spanish-Hispanics. Factors such as being female, being age 59-65, and having a year of diagnosis before 2010 were independently associated with increased mortality.

Latin American Clinical Epidemiology Network Series - Paper 9: The Kangaroo Mother Care Method: from scientific evidence generated in Colombia to worldwide practice.

Kangaroo Mother Care (KMC) is a human-based care intervention devised to complement neonatal care for low birth weight and premature infants. Kangaroo position (skin-to-skin contact on the mother's chest) offers thermal regulation, physiological stability, appropriate stimulation, and enhances bonding and breastfeeding. Kangaroo nutrition is based on breastfeeding, and kangaroo discharge policy relies on family empowerment and early discharge in kangaroo position with close ambulatory follow-up. We describe how the evidence has been developed and how it has been put into practice by means of direct preterm infants care and dissemination of the method, including training of KMC excellence centers in many countries not only in Latin America but worldwide.

Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida: A nonconcurrent prospective study.

Stroke remains one of the leading causes of death in the United States. Current evidence identified electrocardiographic abnormalities and cardiac arrhythmias in 50% of patients with an acute stroke. The purpose of this study was to assess whether the presence of ventricular arrhythmia (VA) in adult patients hospitalized in Florida with acute stroke increased the risk of in-hospital mortality.Secondary data analysis of 215,150 patients with ischemic and hemorrhagic stroke hospitalized in the state of Florida collected by the Florida Agency for Healthcare Administration from 2008 to 2012. The main outcome for this study was in-hospital mortality. The main exposure of this study was defined as the presence of VA. VA included the ICD-9 CM codes: paroxysmal ventricular tachycardia (427.1), ventricular fibrillation (427.41), ventricular flutter (427.42), ventricular fibrillation and flutter (427.4), and other - includes premature ventricular beats, contractions, or systoles (427.69). Differences in demographic and clinical characteristics and hospital outcomes were assessed between patients who developed versus did not develop VA during hospitalization (χ and t tests). Binary logistic regression was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals (CIs) between VA and in-hospital mortality.VA was associated with an increased risk of in-hospital mortality after adjusting for all covariates (odds ratio [OR]: 1.75; 95% CI: 1.6-1.2). There was an increased in-hospital mortality in women compared to men (OR: 1.1; 95% CI: 1.1-1.14), age greater than 85 years (OR: 3.9, 95% CI: 3.5-4.3), African Americans compared to Whites (OR: 1.1; 95% CI: 1.04-1.2), diagnosis of congestive heart failure (OR: 2.1; 95% CI: 2.0-2.3), and atrial arrhythmias (OR: 2.1, 95% CI: 2.0-2.2). Patients with hemorrhagic stroke had increased odds of in-hospital mortality (OR: 9.0; 95% CI: 8.6-9.4) compared to ischemic stroke.Identifying VAs in stroke patients may help in better target at risk populations for closer cardiac monitoring during hospitalization. The impact of implementing methods of quick assessment could potentially reduce VA associated sudden cardiac death.

Latin American Clinical Epidemiology Network Series - Paper 4: Economic evaluation of Kangaroo Mother Care: cost utility analysis of results from a randomized controlled trial conducted in Bogotá.

BACKGROUND AND OBJECTIVE: Although kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention. METHODS: A cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost-utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed. RESULTS: ICUR at 1 year of corrected age was $ -1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ -7,963 to $ 4,910). CONCLUSION: In Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings.

[The clinical course and one year forcast for a cohort of premature infants who were discharged with home oxygen in Bogota, Colombia]. / Curso clínico y pronóstico a un año de una cohorte de prematuros dados de alta con oxígeno domiciliario en Bogotá, Colombia.

OBJECTIVE: Documenting the clinical course and forecast for a concurrent cohort of discharged preterm infants who received home oxygen in Bogota, Colombia. METHODS: This was a prospective study of a concurrent cohort of 194 newborn infants having 34 weeks gestational age (GA) or less at birth who were born in 12 institutions and followed up for one year of corrected age to assess mortality, morbidity, growth and development. RESULTS: Oxygen dependency was mild in 49 infants (25.3 %) and moderate-severe in 145 of them (74.7 %). There were 3 deaths; vital status was known in 169 infants at 40 weeks GA (87.1 %) and 103 (53%) at 1 year. Breast feeding at term was successful in 147 (75.8 %) infants. Growth indices at one year were appropriate (8,991 g weight, 73 cm height and 46.2 cm head circumference) 74.1 % of the cohort were still receiving home oxygen at 40 weeks and and 22.7 % at 3 months and oxygen was discontinued on average on postnatal day 109. 56.8 % of the cohort were readmitted to hospital at least once, 47% of them because of respiratory conditions. Only 71 % had ophthalmological screening and retinopathy of prematurity (ROP) was detected in 38 % of cases (4 severe cases: 3 laser surgery and 1 blind infant). Neuro-psychomotor and sensorial screening tests were only performed on 19 % of the infanys. CONCLUSION: More than 60 % of newborn infants discharged with home oxygen lacked structured follow-up. Oxygen-dependancy in infants is complex; our data suggested that there is plenty of room for improvement in Bogotá in that respect.

Absorção de nitrogênio pelo algodoeiro herbáceo em dois sistemas de cultivo / Nitrogen uptake by cotton plant in two tillage system

O estudo da marcha de absorção de nutrientes é de fundamental importância para a nutrição de plantas, visto que além de informar a época (estádio fenológico) que está sendo mais absorvido pela cultura, também sinaliza para os níveis de adubação a serem utilizados. Com o objetivo de estabelecer a marcha de absorção de nitrogênio para a cultura do algodão (Gossypium hirsutum L. r. latifolium Hutch.) conduziu-se um experimento num Argissolo Vermelho Amarelo sob delineamento experimental em blocos casualizados sendo dois tratamentos, semeadura convencional, após preparo do solo e semeadura direta sobre a palha da cultura antecessora (milheto), com cinco repetições. As amostragens foram realizadas em função da fenologia e do desenvolvimento das plantas. O acúmulo de massa seca no algodoeiro herbáceo (variedade NuOpal) é linear e crescente até o período de "maçãs", sendo mais intenso com o aparecimento das flores e maçãs, entre 50 e 100 DAE. O teor de nitrogênio é maior em plantas recém emergidas, possuindo picos no inicio do aparecimento dos botões florais e flores, sendo que a partir do aparecimento das "maçãs, o teor de nitrogênio na planta decresce linearmente. A extração de nitrogênio é acentuada a partir do aparecimento das flores (55 a 60 DAE).

The study of nutrient uptake is of fundamental importance to plant nutrition, as well as tell the time (growth stage) being absorbed by the culture, also signals to the levels of fertilizer to be used. Aiming to establish the uptake of nitrogen for cultivation of cotton (Gossypium hirsutum L. r. latifolium Hutch.) led to an experiment in a Alfissol under randomized block design with two treatments, sowing conventional tillage and after tillage on the straw of previous crop (millet), with five replicates. Samples were taken according to the phenology and plants development. The dry matter accumulation in cotton is linear and increasing until the period of large boll, being more intense with the appearance of flowers and boll, or 50 to 100 days after emergence. The nitrogen content is higher in newly emerged plants, having peaks at the beginning of the appearance of squares and flowers, and from the appearance of small boll, the nitrogen content in the plant decreases linearly. The extraction of nitrogen is bigger from the appearance of flowers (55-60 days after emergence).

Curso clínico y pronóstico a un año de una cohorte de prematuros dados de alta con oxígeno domiciliario en Bogotá, Colombia / The clinical course and one year forcast for a cohort of premature infants who were discharged with home oxygen in Bogota, Colombia

Objetivo Documentar el curso clínico y pronóstico de una cohorte de niños prematuros dados de alta con oxígeno domiciliario en Bogotá, Colombia. Método Cohorte prospectiva de 194 prematuros de 34 o menos semanas de edad gestacional (EG) al nacer, egresados de 12 unidades neonatales con oxígeno suplementario, seguidos hasta la edad corregida de 12 meses para determinar supervivencia, crecimiento, desarrollo y morbilidad. Resultados 49 niños (25,3 %) tenían una oxigenodependencia leve y 145 (74,7 %) moderada-severa. Se presentaron 3 muertes (1,5 %), el estado vital a 40 semanas de EG fue conocido en 169 pacientes (87,1 %) y en 103 (53 %) a 12 meses. La lactancia materna fue exitosa en 147 (75,8 %) niños a 40 semanas. La antropometría al año fue: peso 8 991 g, talla 73 cm y perimetro craneano 46,2 cm. A las 40 semanas y a 3 meses 74,1 % y 22,7 % de la cohorte aún utilizaba oxígeno el cual fue descontinuado en promedio a los109 días postnatales. El 56,8 % de los niños tuvo al menos un reingreso y 47 % por patologías respiratorias. Sólo se tamizó para retinopatía al 71 % y en ellos la incidencia de retinopatía de la prematurez (ROP) fue 38 % con 3 cirugías y 1 niño ciego. Un tamizado neuropsicomotor y sensorial se realizó solamente en 19 % encontrando algún tipo de alteración neuropsicomotriz en 30 %, refractiva en 40 % y auditiva en 5 %. Conclusión Más del 60 % de los niños oxígeno-dependientes fueron dados de alta sin plan de seguimiento estructurado. El problema de los niños oxigenodependientes es complejo y nuestros datos sugieren un gran espacio para mejorar el seguimiento.

Objective Documenting the clinical course and forecast for a concurrent cohort of discharged preterm infants who received home oxygen in Bogota,Colombia. Methods This was a prospective study of a concurrent cohort of 194 newborn infants having 34 weeks gestational age (GA) or less at birth who were born in 12 institutions and followed up for one year of corrected age to assess mortality, morbidity, growth and development. Results Oxygen dependency was mild in 49 infants (25.3 %) and moderate-severe in 145 of them (74.7 %). There were 3 deaths; vital status was known in 169 infants at 40 weeks GA (87.1 %) and 103 (53%) at 1 year. Breast feeding at term was successful in 147 (75.8 %) infants. Growth indices at one year were appropriate (8,991 g weight, 73 cm height and 46.2 cm head circumference) 74.1 % of the cohort were still receiving home oxygen at 40 weeks and and 22.7 % at 3 months and oxygen was discontinued on average on postnatal day 109. 56.8 % of the cohort were readmitted to hospital at least once, 47% of them because of respiratory conditions. Only 71 % had ophthalmological screening and retinopathy of prematurity (ROP) was detected in 38 % of cases (4 severe cases: 3 laser surgery and 1 blind infant). Neuro-psychomotor and sensorial screening tests were only performed on 19 % of the infanys. Conclusion More than 60 % of newborn infants discharged with home oxygen lacked structured follow-up. Oxygen-dependancy in infants is complex; our data suggested that there is plenty of room for improvement in Bogotá in that respect.

Kangaroo Mother Care: 25 years after.

UNLABELLED: The components of the Kangaroo Mother Care (KMC) intervention, their rational bases, and their current uses in low-, middle-, and high-income countries are described. KMC was started in 1978 in Bogotá (Colombia) in response to overcrowding and insufficient resources in neonatal intensive care units associated with high morbidity and mortality among low-birthweight infants. The intervention consists of continuous skin-to-skin contact between the mother and the infant, exclusive breastfeeding, and early home discharge in the kangaroo position. In studies of the physiological effects of KMC, the results for most variables were within clinically acceptable ranges or the same as those for premature infants under other forms of care. Body temperature and weight gain are significantly increased, and a meta-analysis showed that the kangaroo position increases the uptake and duration of breastfeeding. Investigations of the behavioral effects of KMC show rapid quiescence. The psychosocial effects of KMC include reduced stress, enhancement of mother-infant bonding, and positive effects on the family environment and the infant's cognitive development. CONCLUSION: Past and current research has clarified some of the rational bases of KMC and has provided evidence for its effectiveness and safety, although more research is needed to clearly define the effectiveness of the various components of the intervention in different settings and for different therapeutic goals.

Apgar bajo al nacer y convulsiones neonatales: desarrollo motor grueso en el primer año de vida / Low Apgar score and neonatal seizures: neuromotor development at 1 year age

Diseño: Cohorte histórica. Escenario: Programa de seguimiento de recién nacidos de riesgo en un hospital de nivel 1 de complejidad, con una población de estrato socioeconómico bajo de Cali entre 1989 y 1997. Población: Se incluyeron 287 lactantes que completaron un año de seguimiento en el programa. Intervenciones: No aplica. Desenlaces principales: Frecuencia de compromiso neuromotor estimado mediante la prueba de Infanib. Resultados: Al año se evaluaron 80% de los niños que eran parte del programa. En 39 (13.6%) hubo un Apgar anormal a los 5 minutos. En 36 (12.5%) presentaron convulsiones neonatales, asociadas principalmente con asfixia perinatal severa e hipoglicemia. La prueba de Infanib fue anormal en 47 niños para una incidencia acumulada de 16.4% y una densidad de incidencia de 1.3 casos nuevos por 100 lactantes-año. La presencia de convulsiones se asoció con un Infanib anormal (RR crudo = 2.39 IC 95% 1.37-4.16). No hay modificación de efecto entre Apgar bajo y convulsiones. De los potenciales modificadores de efecto sólo el antecedente de meningitis bacteriana confundió el estimativo de la asociación entre convulsiones y un Infanib anormal. Conclusiones: Tanto las convulsiones neonatales como la meningitis bacteriana se asociaron independientemente con un Infanib anormal al año. Las convulsiones son un factor de riesgo importante (RR ajustado = 2.51 IC 95% 1.10-5.72) y fácil de reconocer que permite al clínico identificar pacientes con alto riesgo de compromiso neuromotor durante el primer año de vida.

Objective: To assess the putative association between 5 minutes Apgar score, neonatal seizures and neurodevelopmental delay (Infanib test) performed at 1 year of corrected age. Design: Historic cohort. Setting: A first level hospital in Cali, Colombia (1989 to 1997); Subjects came from a low socioeconomic stratum population. Study subjects: A total of 287 infants who completed the 1 year follow up program were included. Interventions: not applicable Main outcome measures: Incidence (cumulative and density) of neuromotor abnormalities (abnormal Infanib test) at 1 year of age. Results: Compliance with program visits was 80%. Thirty nine (13.6%) infants presented low 5 minutes Apgar score. Thirty six (12.5%) infants presented neonatal seizures, associated mainly with neonatal asphyxia and hypoglicemia. Forty seven infants had an abnormal Infanib test (cumulative incidence 16.4% and incidence density 1.3 new cases per 100 infants-year). A significant association between neonatal seizures and an abnormal Infanib was found (RR crude 2.39 IC 95% 1.37-4.16). Low 5 minutes Apgar score is not an effect modifier neither a confounder of the association between neonatal seizures and an abnormal Infanib. Exploring the presence or absence of effect modification only bacterial meningitis, demonstrated a role as confounder for the association between seizures and Infanib results. Conclusions: Both neonatal seizures and bacterial meningitis were independently associated with abnormal Infanib results. Neonatal seizures are not only an important risk factor (adjusted RR = 2.51 IC 95% 1.10-5.72), but an easily identifiable one that can help the physician taking the medical history to identify patients at high risk for neuromotor abnormalities during the first year of life.