Duration of Simultaneous Exposure to High-Risk and Lower-Risk Nephrotoxic Antimicrobials in the Neonatal Intensive Care Unit (NICU) and Future Adolescent Kidney Health.

OBJECTIVE: To determine whether greater duration of simultaneous exposure to antimicrobials with high nephrotoxicity risk combined with lower-risk antimicrobials (simultaneous exposure) in the neonatal intensive care unit (NICU) is associated with worse later kidney health in adolescents born preterm with very low birth weight (VLBW). STUDY DESIGN: Prospective cohort study of participants born preterm with VLBW (<1500 g) as singletons between January 1, 1992, and June 30, 1996. We defined simultaneous exposure as a high-risk antimicrobial, such as vancomycin, administered with a lower-risk antimicrobial on the same date in the NICU. Outcomes were serum creatinine, estimated glomerular filtration rate (eGFR), and first-morning urine albumin-creatinine ratio (ACR) at age 14 years. We fit multivariable linear regression models with days of simultaneous exposure and days of nonsimultaneous exposure as main effects, adjusting for gestational age, birth weight, and birth weight z-score. RESULTS: Of the 147 out of 177 participants who had exposure data, 97% received simultaneous antimicrobials for mean duration 7.2 days (SD 5.6). No participant had eGFR <90 ml/min/1.73 m2. The mean ACR was 15.2 mg/g (SD 38.7) and 7% had albuminuria (ACR >30 mg/g). Each day of simultaneous exposure was associated only with a 1.04-mg/g higher ACR (95% CI 1.01 to 1.06). CONCLUSIONS: Despite frequent simultaneous exposure to high-risk combined with lower-risk nephrotoxic antimicrobials in the NICU, there were no clinically relevant associations with worse kidney health identified in adolescence. Although future studies are needed, these findings may provide reassurance in a population thought to be at increased risk of chronic kidney disease.

Reanastomosis and rehabilitation of interrupted left pulmonary artery derived from atretic ductus.

True absence of a branch pulmonary artery is rare. We identified a patient initially diagnosed with an absent left pulmonary artery at a previous hospital. Due to disagreement in the initial diagnosis, she had a diagnostic catheterisation, which revealed an isolated left pulmonary artery off the left innominate artery via a ductus. The ductus was recanalised with serial stenting and balloon dilatation followed by reanastomosis to the main pulmonary artery. In a patient who initially is diagnosed with an absent pulmonary artery, an alternative diagnosis, such as this case report, should be considered.

Impact of Participation in the Commodity Supplemental Food Program on Food Insecurity Among Low-Income Elderly Rhode Islanders.

BACKGROUND: Food insecurity continues to impact low-income elderly Americans. The Commodity Supplemental Food Program (CSFP) is a federal food-box program targeted specifically to this population. However, the effectiveness of this program has not been well studied. DESIGN: We conducted a cross-sectional survey evaluating the effects of CSFP participation on food insecurity status of elderly low-income Rhode Islanders. This study was conducted during June and July 2016. PARTICIPANTS: A total of 93 responses was received. About 50% was from individuals receiving boxes at food pantries and 50% was from those receiving boxes at senior housing. RESULTS: About 85% of the survey population was found to be food insecure prior to CSFP participation. Overall, CSFP participation was associated with a 20.7% decrease in food insecurity. Reduction of food insecurity was stronger among senior housing participants. CONCLUSIONS: CSFP participation can help reduce food insecurity among elderly low-income Rhode Islanders. [Full article available at http://rimed.org/rimedicaljournal-2019-03.asp].

Bone-Specific Alkaline Phosphatase in Patients Who Have Undergone the Fontan Operation.

Bone-specific alkaline phosphatase (BALP) is produced by osteoblasts. A recent series noted a positive association between cardiac index (CI) and BALP in patients with Fontan circulation. CI is low at baseline in these patients, and small decreases in CI may result in diverting of blood away from bone. We prospectively enrolled 15 patients (males ≤ 14 yo, females ≤ 12 yo) who had previously undergone Fontan operation and were undergoing cardiac catheterization. Serum BALP was measured at catheterization, and analysis performed to evaluate association between age-/gender-specific BALP z-score and CI as well as other patient variables. The median age at catheterization was 5.6 years (3.1-13.1), and time from Fontan was 1.5 years (0.1-12.1). The median superior vena cava saturation (SVC) was 65 % (52-74), median average between SVC and inferior vena cava (IVC) saturations was 62.5 % (51-70), and median CI was 3.8 L/min/m(2) (2.0-8.4). The median BALP was 65 IU/L and BALP z-score was -2.1 (-3.2 to 0.9). BALP z-score was not associated with CI (ρ = -0.1, p = 0.7), but a positive correlation was noted with the average of SVC and IVC saturation (ρ = 0.5, p = 0.052) and with SVC saturation (ρ = 0.4, p = 0.07), both nearly reaching statistical significance. In our cohort of children with Fontan circulation undergoing catheterization, BALP z-score was not associated with CI, but an association with estimates of mixed venous saturation was noted that nearly reached statistical significance. We hypothesize that BALP is a marker of oxygen delivery in those with Fontan circulation and may represent a valuable biomarker in this population.

Food Stamp Program participation but not food insecurity is associated with higher adult BMI in Massachusetts residents living in low-income neighbourhoods.

OBJECTIVE: Food-insecure populations employ multiple strategies to ensure adequate household food supplies. These strategies may increase the risk of overweight and obesity. However, existing literature reports conflicting associations between these strategies and BMI. The objective of the present study was to examine whether food insecurity and strategies for managing food insecurity are associated with BMI in adults. DESIGN, SETTING AND SUBJECTS: In 2005, RTI International and Project Bread conducted a representative survey of 435 adult residents of low-income census tracts in Massachusetts. Food insecurity was assessed using the US Department of Agriculture's eighteen-item Household Food Security Module. RESULTS: The prevalence of overweight and obesity was 51 % and 25 %, respectively. After adjusting for age, sex, sociodemographic characteristics and food insecurity, both participation in the Food Stamp Program (FSP) and participation in any federal nutrition programme 12 months prior to the survey were each associated with an approximate 3.0 kg/m2 higher adult BMI. In the subset of current FSP participants (n 77), participation for >or=6 months was associated with an 11.3 kg/m2 lower BMI compared with participation for <6 months. Respondents who consumed fast foods in the previous month had a mean BMI that was 2.4 kg/m2 higher than those who did not. Food insecurity was not associated with BMI after adjustment for sociodemographic characteristics and FSP participation. CONCLUSIONS: Participation in federal nutrition programmes and consumption of fast food were each associated with higher adult BMI independent of food insecurity and other sociodemographic factors. However, prolonged participation in the FSP was associated with lower BMI.

Child and parental poor health among families at risk for hunger attending a community health center.

BACKGROUND: Hunger is prevalent in low-income families. Community clinics offer an opportunity to identify families who experience hunger and to address hunger-related health problems. METHODS: Parents of pediatric patients seen in an urban clinic completed a single question hunger screen. A subsample of parents participated in an interview. Patient and parental medical and mental health diagnoses were collected from medical records. RESULTS: Children from families reporting hunger were more likely than those from families not reporting hunger to be obese and to have more documented medical diagnoses. Parents reporting hunger were also more likely to have mental health problems noted and to describe poor health status. CONCLUSION: Hunger is associated with specific health problems among children and parents in a low-income community clinic. A simple screen to identify hungry families in clinics may assist in recognition of hunger's contribution to child and parental poor health and development of targeted interventions.

Use of a single-question screening tool to detect hunger in families attending a neighborhood health center.

OBJECTIVE: To examine the use and accuracy of a brief screening tool to identify family hunger, administered in an inner-city primary health care setting and the use of food assistance programs by families in this setting. METHODS: Parents were asked to complete a screening tool for hunger during a routine visit with their children to their neighborhood health center. To evaluate the accuracy of the single-question screening, a subsample of parents who completed the screening participated in an extended interview. Patients were from a neighborhood health center in Chelsea, Massachusetts. A total of 1750 families were screened, and 122 parents completed extended interviews. The US Department of Agriculture (USDA) Household Food Security Scale (HFSS) was used as the standard to assess the accuracy of the brief hunger screening tool. The USDA Food Assistance Program Participation Survey was used to gather information about food program use. RESULTS: The brief hunger screening tool showed 83% sensitivity and 80% specificity (kappa = .62) compared with the HFSS. The screening also had significant time-to-time reliability (77%). Among families screened as hungry, no food assistance programs were fully used. CONCLUSIONS: The single-question screening tool had acceptable sensitivity, specificity, and reliability. Hungry families underused all types of food assistance programs. Taken together, these findings suggest that screening for hunger could become an important addition to routine pediatric health care in low-income neighborhoods.