Does Duration Off Respiratory Support Prior to Discharge from NICU Predict Hospital Readmission among Extremely Low Gestational Age Neonates?

OBJECTIVE: Our objective was to determine if the duration off respiratory support prior to discharge home from the neonatal intensive care unit (NICU) would impact hospital readmission rates among extremely low gestational age neonates (ELGAN). STUDY DESIGN: In this retrospective chart review, we examined readmission rates for ELGAN admitted to the Montefiore-Weiler NICU between 2013 and 2015. RESULTS: Of 140 infants born at <29 weeks' gestational age, 30 (21%) of these infants were subsequently readmitted within 90 days, primarily for respiratory complaints. Readmitted infants were born at an earlier gestational age (median = 26 weeks; interquartile range [IQR]: 24-27 weeks) compared to infants who did not require readmission (median = 27 weeks; IQR: 25-28 weeks), p = 0.03. Birth weights were smaller among infants who required readmission, 800 ± 248 g compared to 910 ± 214 g (p = 0.02). Infants with Hispanic ethnicity and those discharged during the spring season were likely to be readmitted. Duration off respiratory support prior to discharge did not predict 90-day readmission rates. Lower gestational age and birth weight were associated with higher rates of readmissions after NICU discharge. CONCLUSION: Duration off and invasiveness of respiratory support prior to discharge did not predict risk of 90-day readmission nor did discharge during months with traditionally higher prevalence of respiratory viruses.

In situ examination of osteoblast biomineralization on sulfonated polystyrene-modified substrates using Fourier transform infrared microspectroscopy.

Osteoporosis is a skeletal disorder that is characterized by the loss of bone mineral density (BMD) resulting in increased risk of fracture. However, it has been shown that BMD is not the only indicator of fracture risk, as the strength of bone depends on a number of factors, including bone mass, architecture and material properties. Physiological mineral deposition requires the formation of a properly developed extracellular matrix (ECM), which recruits calcium and phosphate ions into the synthesis of apatite crystals. Temporal and spatial compositional and structural changes of biological apatite greatly depend on the properties of the crystals initially formed. As such, Fourier-transform infrared microspectroscopy (FTIRM) is capable of examining adaptive remodeling by providing compositional information such as the level of mineralization and carbonate substitution, as well as quality and perfection of the mineral phase. The objective of this study was to evaluate the in vitro mineralization development of MC3T3-E1 murine calvarial preosteoblasts cultured on different substrata by comparing FTIRM measurements from two subclones (mineralizing subclone 4 and nonmineralizing subclone 24) maintained in culture for up to 21 days. The results showed that modulation of the substrate surface using a thin coating of sulfonated polystyrene (SPS) provided favorable conditions for the development of a mineralizable ECM and that the mineral formed by the osteoblasts was similar to that of fully mineralized bone tissue. Specifically, the mineralizing subclone produced significantly more mineral phosphate when cultured on SPS-coated substrates for 21 days, compared to the same culture on bare substrates. In contrast, the level of mineralization in nonmineralizing subclone was low on both SPS-coated and uncoated substrates. The mineralizing subclone also produced comparable amounts of collagen on both substrates; however, mineralization was significantly higher in the SPS culture. The nonmineralizing subclone produced comparable amounts of collagen on day 1 but much less on day 21. Collagen maturity ratio increased in the mineralizing subclone from day 1 to day 21, but remained unchanged in the nonmineralizing subclone. These results suggest that SPS-treatment of the substrate surface may alter collagen remodeling; however, other factors may also influence osteoblast mineralization in the long term.