Publications by authors named "Rebecca Hoban"

20 Publications

  • Page 1 of 1

Proactive Lactation Care is Associated With Improved Outcomes in a Referral NICU.

J Hum Lact 2021 Feb 13:890334421993467. Epub 2021 Feb 13.

10051 Princess Margaret Hospital, Toronto, Canada.

Background: Mother's milk improves outcomes. Referral neonatal intensive care units face unique lactation challenges with maternal-infant separation and maternal pump dependency. Little is known about lactation resource allocation in this high-risk population.

Research Aims: To determine differences in human milk outcomes, (1) the proportion of infants fed exclusive or any mother's milk and (2) recorded number and volume of pumped mothers' milk bottles, between two models of lactation care in a referral neonatal intensive care unit.

Methods: This retrospective, longitudinal, two-group comparison study utilized medical record individual feeding data for infants admitted at ≤ Day 7 of age and milk room storage records from reactive and proactive care model time periods (April, 2017-March, 2018; May, 2018-April, 2019). The reactive care model ( = 509 infants, 58% male, median birth weight and gestational age of 37 weeks,) involved International Board Certified Lactation Consultant referral for identified lactation problems; whereas, the proactive model ( = 472 infants, 56% male, median birth weight and gestational age 37 weeks) increased International Board Certified Lactation Consultant staffing, who then saw all admissions. Comparisons were performed using chi square, Mann Whitney, and tests.

Results: A proactive lactation approach was associated with an increase in the receipt of any mother's milk from 74.3% to 80.2% ( = .03) among participants in the proactive model group. Additionally, their milk room mean monthly bottle storage increased from 5153 ( 788) to 6620 ( 1314) bottles ( < .01).

Conclusions: In this retrospective study at a tertiary referral neonatal intensive care unit, significant improvement inhuman milk outcomes suggests that increased resources for proactive lactation care may improve mother's milk provision for a high-risk population.
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http://dx.doi.org/10.1177/0890334421993467DOI Listing
February 2021

Maternal production of milk for infants in the neonatal intensive care unit.

Semin Perinatol 2021 Mar 2;45(2):151381. Epub 2021 Jan 2.

Department of Pediatrics, Division of Neonatology, Rush University Medical Center, Chicago, USA.

Mother's own milk (MOM) feeding is a cost-effective strategy to reduce risks of comorbidities associated with prematurity and improve long-term health of infants hospitalized in the Neonatal Intensive Care Unit (NICU). Significant racial and socioeconomic disparities exist in MOM provision in the NICU, highlighting the importance of developing strategies to reduce these disparities. Mothers of infants in the NICU experience many health concerns which may negatively impact lactation physiology. Objective measures of lactation physiology are limited but may assist in identifying mothers at particular risk. Several strategies to assist mothers of hospitalized infants are essential, including maternal education, qualified lactation professionals, early and frequent milk expression with a hospital-grade double electric breast pump, and providing support for transitioning to direct breastfeeding prior to discharge from the NICU.
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http://dx.doi.org/10.1016/j.semperi.2020.151381DOI Listing
March 2021

Mother's Own Milk Biomarkers Predict Coming to Volume in Pump-Dependent Mothers of Preterm Infants.

J Pediatr 2021 01 9;228:44-52.e3. Epub 2020 Sep 9.

Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL; College of Nursing, Rush University Medical Center, Chicago, IL.

Objective: To assess serial secretory activation biomarker concentrations (sodium [Na], potassium [K], Na:K, protein, lactose, and citrate) in mother's own milk (MOM) from breast pump-dependent mothers of preterm infants to determine associations with coming to volume (CTV), defined as producing at least 500 mL/day MOM by day 14 postpartum.

Study Design: We collected serial MOM samples and pumped MOM volume data for 14 days postpartum in mothers who delivered at <33 weeks of gestation. Regression models and the Mann-Whitney U test were used to evaluate associations.

Results: Among 40 mothers, 39 (mean gestational age, 28.8 weeks; 67% overweight/obese; 59% nonwhite) had paired MOM volume and biomarker data; 33% achieved CTV between postpartum days 6 and 14. In univariate models, MOM Na on postpartum day 5 and Na:K on days 3 and 5 were associated with CTV. Mothers achieving CTV were more likely to have postpartum Na:K ≤1 on day 3 (75% vs 25%; P = .06) and ≤0.8 on day 5 (69% vs 10%; P < .01). In a multivariable regression model, day 5 Na:K (1 unit decrease in Na:K: OR, 18.7; 95% CI, 1.13-311.41; P = .049) and maternal prepregnancy body mass index (BMI) (1 unit increase in BMI: OR, 0.88; 95% CI, 0.78-0.99; P = .04) were associated with CTV between postpartum days 6 and 14.

Conclusions: Secretory activation and CTV were compromised in breast pump-dependent mothers with preterm delivery. CTV was predicted by MOM Na level and Na:K. These biomarkers have potential as objective point-of-care measures to detect potentially modifiable lactation problems in a high-risk population.
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http://dx.doi.org/10.1016/j.jpeds.2020.09.010DOI Listing
January 2021

Measures of Secretory Activation for Research and Practice: An Integrative Review.

Breastfeed Med 2020 04 9;15(4):191-212. Epub 2020 Mar 9.

Department of Women and Children's Nursing, College of Nursing, Rush University, Chicago, Illinois.

Maternal concern about inadequate milk volume commonly emerges in the first 2 weeks postpartum, a critical lactation period that includes secretory activation. This review summarizes the biology of secretory activation and evaluates the accuracy and feasibility of published measures of secretory activation. A systematic search of measures of secretory activation for mothers of healthy term and preterm infants yielded 62 abstracts. Following additional screening, 15 publications qualified for quantitative synthesis review and were evaluated with respect to accuracy (validated with another measure of secretory activation in the same mother) and feasibility (accessibility, cost, and ease of use). (MP) is the most feasible measure, but its accuracy has not been established. have been validated with maternal milk-borne biomarkers in breastfeeding, and breast pump-dependent mothers and normal values have been published. Accuracy of concentrations has not been established for secretory activation and lacks feasibility. are the accurate standard to which other measures are compared but currently lack feasibility for routine use. Use of secretory activation measures can personalize lactation care by matching maternal risk with appropriate diagnostics. Priorities for research and practice include validation of MP as a population-based screening tool, implementation of techniques that measure patterns of increase in milk volume for moderate risk populations, and the development of milk biomarker science for point-of-care use in the most complicated lactation scenarios.
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http://dx.doi.org/10.1089/bfm.2019.0247DOI Listing
April 2020

Supplementation of Mother's Own Milk with Donor Milk in Infants with Gastroschisis or Intestinal Atresia: A Retrospective Study.

Nutrients 2020 Feb 24;12(2). Epub 2020 Feb 24.

Department of Paediatrics, Division of Neonatology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.

Background: Mother's own milk (MOM) improves in-hospital outcomes for preterm infants. If unavailable, donor milk (DM) is often substituted. It is unclear if DM vs. formula to supplement MOM is associated with improved in-hospital outcomes in term/late preterm surgical infants with gastroschisis or intestinal atresia.

Methods: This retrospective study included infants born ≥33 weeks gestational age (GA) with a birth weight of >1500 g who were admitted to a quaternary neonatal intensive care unit (NICU). Using Chi square and Mann-Whitney u testing, we compared hospital outcomes (length of stay, parenteral nutrition and central line days) before and after a clinical practice change to offer DM instead of formula in this surgical population.

Results: Baseline characteristics were similar between eras for the 140 infants (median GA 37 weeks). Fewer infants in DM era were receiving formula at discharge (50.0% vs. 31.4%, = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, < 0.01) and the central line days (28 vs. 20, < 0.01) were lower in the DM era.

Conclusion: In this retrospective study, offering DM instead of formula was associated with less formula feeding at discharge, and in infants with gastroschisis or small bowel atresia, shorter length of stay and central line days.
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http://dx.doi.org/10.3390/nu12020589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071452PMC
February 2020

Correction: Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants.

Pediatr Res 2019 Dec;86(6):786

Department of Pediatrics, Rush University Children's Hospital, Chicago, IL, USA.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41390-019-0576-4DOI Listing
December 2019

Priorities for Contraception and Lactation Among Breast Pump-Dependent Mothers of Premature Infants in the Neonatal Intensive Care Unit.

Breastfeed Med 2019 09 23;14(7):448-455. Epub 2019 May 23.

Rush University College of Nursing, Chicago, Illinois.

Determine the knowledge and priorities for postpartum contraception and lactation in mothers of premature infants. Twenty-five mothers of premature infants (mean gestational age = 29.9 weeks) hospitalized in a tertiary neonatal intensive care unit (NICU) participated in a multi-methods study using a multiple-choice contraceptive survey and qualitative interview in the first 2 weeks postpartum. Data were analyzed using content analysis and descriptive statistics. Although 60% of mothers planned to use contraception, all questioned the timing of postpartum contraceptive counseling while recovering from a traumatic birth and coping with the critical health status of the infant. All mothers prioritized providing mothers' own milk (MOM) over the use of early hormonal contraception because they did not want to "take any risks" with their milk. They had limited knowledge of risks for repeat preterm birth (e.g., prior preterm birth:  = 13, 52%; multiple birth:  = 9, 36%; no knowledge:  = 3, 12%); only two mothers (0.08%) were counseled about the risks of a short interpregnancy interval. The context of the infants' NICU admission and the mother's desire to "do what is best for the baby" by prioritizing MOM should be integrated into postpartum contraceptive counseling for this population.
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http://dx.doi.org/10.1089/bfm.2019.0007DOI Listing
September 2019

Mediators of racial and ethnic disparity in mother's own milk feeding in very low birth weight infants.

Pediatr Res 2019 04 18;85(5):662-670. Epub 2019 Jan 18.

Department of Pediatrics, Rush University Children's Hospital, Chicago, IL, USA.

Background: Despite high initiation rates for mother's own milk (MOM) provision, MOM feeding at discharge from the neonatal intensive care unit (NICU) drops precipitously and reveals a racial/ethnic disparity. This study sought to identify factors that (1) predict MOM feeding at NICU discharge, and (2) mediate racial/ethnic disparity in MOM feeding at discharge.

Methods: Secondary analysis of prospective cohort study of 415 mothers and their very low birth weight infants. Variables were grouped into five categories (demographics, neighborhood structural, social, maternal health, and MOM pumping). Significant predictors from each category were entered into a multivariable logistic regression model.

Results: Although 97.6% of infants received MOM feedings, black infants were significantly less likely to receive MOM feeding at discharge. Positive predictors were daily pumping frequency, reaching pumped MOM volume ≥500 mL/day by 14 days, and maternal age. Negative predictors were low socioeconomic status (SES) and perceived breastfeeding support from the infant's maternal grandmother. Low SES, maternal age, and daily pumping frequency mediated the racial/ethnic differences.

Conclusions: Multiple potentially modifiable factors predict MOM feeding at NICU discharge. Importantly, low SES, pumping frequency, and maternal age were identified as the mediators of racial and ethnic disparity. Strategies to mitigate the effects of modifiable factors should be developed and evaluated in future research.
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http://dx.doi.org/10.1038/s41390-019-0290-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435382PMC
April 2019

Impact of Donor Milk on Short- and Long-Term Growth of Very Low Birth Weight Infants.

Nutrients 2019 Jan 22;11(2). Epub 2019 Jan 22.

Department of Pediatrics, Section of Neonatology, Rush University Medical Center, Chicago, IL 60612, USA.

Mother's own milk (MOM) reduces the risk of morbidities in very low birth weight (VLBW) infants. When MOM is unavailable, donor breastmilk (DM) is used, with unclear impact on short- and long-term growth. This retrospective analysis compared anthropometric data at six time points from birth to 20⁻24 months corrected age in VLBW infants who received MOM supplements of preterm formula ( = 160) versus fortified DM ( = 161) during neonatal intensive care unit (NICU) hospitalization. The cohort was 46% female; mean birth weight and gestational age (GA) were 998 g and 27.3 weeks. Multilevel linear growth models assessed changes in growth -scores short-term (to NICU discharge) and long-term (post-discharge), controlling for amount of DM or formula received in first 28 days of life, NICU length of stay (LOS), birth GA, and sex. -scores for weight and length decreased during hospitalization but increased for all parameters including head circumference post-discharge. Short-term growth was positively associated with LOS and birth GA. A higher preterm formula proportion, but not DM proportion, was associated with slower rates of decline in short-term growth trajectories, but feeding type was unrelated to long-term growth. In conclusion, controlling for total human milk fed, DM did not affect short- or long-term growth.
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http://dx.doi.org/10.3390/nu11020241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6412258PMC
January 2019

Human Milk Biomarkers of Secretory Activation in Breast Pump-Dependent Mothers of Premature Infants.

Breastfeed Med 2018 06 30;13(5):352-360. Epub 2018 Apr 30.

1 Department of Pediatrics, Section of Neonatology, Rush University Medical Center , Chicago, Illinois.

Objective: Mothers of premature infants confront barriers to coming to volume (CTV; ≥500 mL/day mother's own milk [MOM] by postpartum day 14), a strong predictor of continued MOM provision at neonatal intensive care unit (NICU) discharge. We sought to determine concentrations of secretory activation biomarkers (MOM sodium, total protein, lactose, and citrate) during the first 14 postpartum days and to describe relationships among these biomarkers, pumped MOM volume, CTV, and pumping frequency.

Study Design: This descriptive observational study collected serial MOM samples, pumped MOM volume, and pumping frequency during the first 14 postpartum days in 16 breast pump-dependent mothers who delivered <33 weeks gestation. Daily biomarker concentrations were compared to published normal values for mothers of term infants. Relationships among biomarkers, pumped MOM volume, and pumping frequency were determined.

Results: On postpartum day 5, only 40% of MOM samples revealed normal concentrations of all four biomarkers, and normalcy was not maintained throughout the first 14 days. All eight mothers (50%) who achieved CTV had normal concentrations for four biomarkers at 5.4 ± 3.5 days postpartum and had more cumulative pumping sessions by day 5 (p = 0.03). A dose-response relationship between number of normal biomarkers and pumped MOM volume was demonstrated for postpartum days 3 (p = 0.01) and 5 (p = 0.04).

Conclusion: Secretory activation is delayed in mothers who deliver prematurely and is closely tied to CTV, MOM volume, and pumping frequency. MOM biomarkers hold promise as objective research outcome measures and for point-of-care testing to identify and proactively manage mothers at risk for compromised lactation.
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http://dx.doi.org/10.1089/bfm.2017.0183DOI Listing
June 2018

Milk Volume at 2 Weeks Predicts Mother's Own Milk Feeding at Neonatal Intensive Care Unit Discharge for Very Low Birthweight Infants.

Breastfeed Med 2018 03 29;13(2):135-141. Epub 2018 Jan 29.

1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.

Objective: This study sought to determine the maternal prepregnancy, pregnancy, and delivery risk factors that predicted coming to volume (CTV; achieving pumped mother's own milk [MOM] volume ≥500 mLs/day) and the continuation of MOM provision through to discharge from the neonatal intensive care unit (NICU) in mothers and their very low birthweight (VLBW; <1,500 g at birth) infants.

Study Design: Secondary analysis of prospectively collected data from 402 mothers of VLBW infants admitted to an urban NICU, including detailed MOM pumping records for a subset (51%) of the cohort. Analyses included inverse probability weighting, multivariate regression, and chi-square statistics.

Results: In this high-risk cohort (51.2% black, 27.1% Hispanic, 21.6% white/Asian; 72.6% low income; 61.4% overweight/obese prepregnancy), CTV by day 14 was the strongest predictor of MOM feeding at NICU discharge (odds ratio [OR] 9.70 confidence interval [95% CI] 3.86-24.38, p < 0.01.). Only 39.5% of mothers achieved CTV by postpartum day 14, an outcome that was predicted by gestational age at delivery (OR 1.41, 95% CI 1.15-1.73, p < 0.01), being married (OR 3.66, 95% CI 1.08-12.39, p = 0.04), black race (OR 7.70, 95% CI 2.05-28.97, p < 0.01), cesarean delivery (OR 0.22, 95% CI 0.08-0.63, p = 0.01), and chorioamionitis (OR 0.14, 95% CI 0.02-0.82, p = 0.03).

Conclusion: Continued provision of MOM at NICU discharge can be predicted in the first 14 postpartum days on the basis of achievement of CTV. We posit that CTV can serve as a quality indicator for improving MOM feedings in the NICU and that lactation support resources should target this early critical postbirth period.
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http://dx.doi.org/10.1089/bfm.2017.0159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863077PMC
March 2018

Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor.

Breastfeed Med 2017 Jan/Feb;12:20-27. Epub 2016 Dec 1.

2 Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois.

Background: While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.

Materials And Methods: A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.

Results: For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.

Conclusions: Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.
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http://dx.doi.org/10.1089/bfm.2016.0105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220570PMC
January 2018

Goals for Human Milk Feeding in Mothers of Very Low Birth Weight Infants: How Do Goals Change and Are They Achieved During the NICU Hospitalization?

Breastfeed Med 2015 Jul-Aug;10(6):305-11. Epub 2015 Jun 25.

1 Section of Neonatology, Department of Pediatrics, Rush University Medical Center , Chicago, Illinois.

Background: Little is known about human milk (HM) feeding goals for mothers of very low birth weight (VLBW) (<1,500 g birth weight) infants, especially for black mothers, for whom rates of VLBW birth are higher and lactation rates lower. This study examined the establishment, modification, and achievement of HM feeding goals during neonatal intensive care unit (NICU) hospitalization for mothers of VLBW infants and the influence of maternal race and income.

Materials And Methods: A prospective cohort study measured maternal HM feeding goals (exclusive [EHM], partial, none) predelivery and during three time intervals: day of life (DOL) 1-14, 15-28, and 29-72. Goal achievement compared the goal for the time interval with the proportion of HM feedings received by the infant. Goal establishment, modification, and achievement were examined using chi-squared and contingency tables.

Results: Three hundred fifty-two mother-infant dyads (53% black; 70% low-income; mean birth weight, 1,048 g) were studied. Predelivery, 55% of mothers planned to provide EHM; fewer black and low-income mothers chose EHM. During DOL 1-14, 63% of mothers chose EHM, and predelivery racial differences disappeared. Only 10% of mothers chose exclusive at-breast EHM feedings. EHM feeding goals decreased during NICU hospitalization, especially for black mothers. Whereas most mothers met their HM feeding goals initially, achievement rates declined during hospitalization. Mothers' EHM goal achievement was not influenced by race or income.

Conclusions: Mothers changed their predelivery HM feeding goals after birth of a VLBW infant. Longitudinally, HM feeding goals and achievement reflected less HM use, highlighting the need to target lactation maintenance in this population.
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http://dx.doi.org/10.1089/bfm.2015.0047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4523097PMC
April 2016

Assessment of Response to Lithium Maintenance Treatment in Bipolar Disorder: A Consortium on Lithium Genetics (ConLiGen) Report.

PLoS One 2013 19;8(6):e65636. Epub 2013 Jun 19.

Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.

Objective: The assessment of response to lithium maintenance treatment in bipolar disorder (BD) is complicated by variable length of treatment, unpredictable clinical course, and often inconsistent compliance. Prospective and retrospective methods of assessment of lithium response have been proposed in the literature. In this study we report the key phenotypic measures of the "Retrospective Criteria of Long-Term Treatment Response in Research Subjects with Bipolar Disorder" scale currently used in the Consortium on Lithium Genetics (ConLiGen) study.

Materials And Methods: Twenty-nine ConLiGen sites took part in a two-stage case-vignette rating procedure to examine inter-rater agreement [Kappa (κ)] and reliability [intra-class correlation coefficient (ICC)] of lithium response. Annotated first-round vignettes and rating guidelines were circulated to expert research clinicians for training purposes between the two stages. Further, we analyzed the distributional properties of the treatment response scores available for 1,308 patients using mixture modeling.

Results: Substantial and moderate agreement was shown across sites in the first and second sets of vignettes (κ = 0.66 and κ = 0.54, respectively), without significant improvement from training. However, definition of response using the A score as a quantitative trait and selecting cases with B criteria of 4 or less showed an improvement between the two stages (ICC1 = 0.71 and ICC2 = 0.75, respectively). Mixture modeling of score distribution indicated three subpopulations (full responders, partial responders, non responders).

Conclusions: We identified two definitions of lithium response, one dichotomous and the other continuous, with moderate to substantial inter-rater agreement and reliability. Accurate phenotypic measurement of lithium response is crucial for the ongoing ConLiGen pharmacogenomic study.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065636PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3686769PMC
October 2017

The risk of congenital malformations associated with exposure to β-blockers early in pregnancy: a meta-analysis.

Hypertension 2013 Aug 10;62(2):375-81. Epub 2013 Jun 10.

Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.

β-blockers are commonly used during the first trimester of pregnancy. Data about risks of congenital anomalies in offspring have not been summarized. We performed a meta-analysis to determine teratogenicity of β-blockers in early pregnancy. A systematic literature search was performed using PubMed, EMBASE, Cochrane Clinical Trials, and hand search. Meta-analyses were performed using random-effects models based on odds ratios (ORs). Prespecified subgroup analyses were performed to explore heterogeneity. Randomized controlled trials or observational studies examining risks of congenital malformations associated with first trimester β-blocker exposure compared with no exposure were included. Thirteen population-based case-control or cohort studies were identified. Based on meta-analyses, first-trimester oral β-blocker use showed no increased odds of all or major congenital anomalies (OR=1.00; 95% confidence interval, 0.91-1.10; 5 studies). However, in analyses examining organ-specific malformations, increased odds of cardiovascular defects (OR=2.01; 95% confidence interval, 1.18-3.42; 4 studies), cleft lip/palate (OR=3.11; 95% confidence interval, 1.79-5.43; 2 studies), and neural tube defects (OR=3.56; 95% confidence interval, 1.19-10.67; 2 studies) were observed. The effects on severe hypospadias were nonsignificant (1 study). Causality is difficult to interpret given the small number of heterogeneous studies and possibility of biases. Given the frequency of this exposure in pregnancy, further research is needed.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.111.00833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086784PMC
August 2013

'Helping babies breathe' training in sub-saharan Africa: educational impact and learner impressions.

J Trop Pediatr 2013 Jun 17;59(3):180-6. Epub 2013 Jan 17.

Division of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA.

Background: Poor resuscitation contributes significantly to neonatal deaths globally. Helping Babies Breathe (HBB) is a new evidence-based neonatal resuscitation curriculum for low-resource settings.

Objective: We sought to characterize knowledge changes after national-level HBB training in Ethiopia, factors correlated with successful training, resuscitation skills and trainees' perceptions.

Methods: Trainees completed multiple-choice questionnaires (MCQ) before and after a 2-day course. After training, bag-mask ventilation (BMV) skills were assessed and feedback questionnaires completed.

Results: Resuscitation knowledge improved from 8.7/10 (SD 1.4) to 9.4/10 (SD 1.1; p = 0.003). Correct MCQ responses relating to essential aspects of resuscitation increased 68-79%. Pre-training knowledge differences between physicians and non-physicians disappeared. MCQ scores increased as trainer:trainee ratio decreased (p = 0.004). Mean post-HBB BMV scores [5.7/7 (SD 1.6)] were not impacted by trainer:trainee ratio.

Conclusions: Ethiopian HBB training improved neonatal resuscitation knowledge and was well received. Lower trainer:trainee ratio was associated with increased MCQ scores. HBB eliminated baseline knowledge differences between Ethiopian healthworker cadres.
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http://dx.doi.org/10.1093/tropej/fms077DOI Listing
June 2013

The association of maternal race and ethnicity and the risk of postpartum hemorrhage.

Anesth Analg 2012 Nov 10;115(5):1127-36. Epub 2012 Aug 10.

Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Background: There are profound racial and ethnic disparities in obstetric outcomes in the United States, but little is known about disparities in risk of postpartum hemorrhage (PPH). We explored the association of race and ethnicity on the risk of PPH due to uterine atony with sequential adjustment for possible mediating factors.

Methods: This analysis was based on the Nationwide Inpatient Sample, from between 2005 and 2008. The frequencies of atonic PPH and atonic PPH resulting in transfusion or hysterectomy were estimated. We developed multivariable logistic regression models to estimate the odds of these outcomes in maternal racial/ethnic groups by sequentially adding potential mediators.

Results: Hispanic ethnicity and Asian/Pacific Islander race were associated with a statistically significant increased odds of atonic PPH in comparison with Caucasians, despite adjustment for potential mediators (adjusted odds ratio [OR] for Hispanics: 1.21, 99% confidence interval [1.18, 1.25]; for Asians/Pacific Islanders: 1.31 [1.25, 1.38], with Caucasians as reference). Similar results were observed for these racial/ethnic groups for atonic PPH resulting in transfusion or hysterectomy.

Conclusion: Hispanic ethnicity and Asian/Pacific Islander race are significant risk factors for atonic PPH independent of measured potential mediators; biological differences may play a role.
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http://dx.doi.org/10.1213/ANE.0b013e3182691e62DOI Listing
November 2012

Noonan syndrome due to a SHOC2 mutation presenting with fetal distress and fatal hypertrophic cardiomyopathy in a premature infant.

Am J Med Genet A 2012 Jun 23;158A(6):1411-3. Epub 2012 Apr 23.

Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts 02111, USA.

We report on a patient with Noonan syndrome due to SHOC2 missense mutation predicting p.Ser2Gly, recently described in association with Noonan syndrome. The male infant presented with fetal distress requiring premature delivery at 32 weeks and was noted to have dysmorphic features, edema, hepatosplenomegaly, leukocytosis, thrombocytopenia, and respiratory distress following birth. An echocardiogram revealed hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. The infant's cardiac lesion rapidly progressed, and he was discharged home for palliative care. Clinical testing of genes causative of Noonan syndrome and related disorders detected the previously reported, pathogenic, de novo SHOC2 missense mutation predicting p.Ser2Gly. The patient's cardiac findings and features were not typical for those individuals previously reported with this SHOC2 mutation and thus expand the clinical phenotype.
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http://dx.doi.org/10.1002/ajmg.a.35318DOI Listing
June 2012

Noonan syndrome due to a SHOC2 mutation presenting with fetal distress and fatal hypertrophic cardiomyopathy in a premature infant.

Am J Med Genet A 2012 Jun 23;158A(6):1411-3. Epub 2012 Apr 23.

Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts 02111, USA.

We report on a patient with Noonan syndrome due to SHOC2 missense mutation predicting p.Ser2Gly, recently described in association with Noonan syndrome. The male infant presented with fetal distress requiring premature delivery at 32 weeks and was noted to have dysmorphic features, edema, hepatosplenomegaly, leukocytosis, thrombocytopenia, and respiratory distress following birth. An echocardiogram revealed hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. The infant's cardiac lesion rapidly progressed, and he was discharged home for palliative care. Clinical testing of genes causative of Noonan syndrome and related disorders detected the previously reported, pathogenic, de novo SHOC2 missense mutation predicting p.Ser2Gly. The patient's cardiac findings and features were not typical for those individuals previously reported with this SHOC2 mutation and thus expand the clinical phenotype.
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http://dx.doi.org/10.1002/ajmg.a.35318DOI Listing
June 2012

Utility of HbA1c in the detection of subclinical post renal transplant diabetes.

Transplantation 2006 Feb;81(3):379-83

Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

Background: We hypothesized that the use of HbA1c testing would help identify postrenal transplant diabetes (PTDM).

Methods: In all, 199 adult kidney transplant recipients at least 3 months posttransplant without previous history of diabetes or elevated fasting blood sugar were studied. Medical history, a fasting blood glucose, calcineurin inhibitor blood level, and HbA1c were obtained. Primary outcome was the incidence of subjects with HbA1c > or =6.1%. The covariates were use of cyclosporine or tacrolimus, time posttransplant, body mass index (BMI) at transplant and change since transplant, current steroid dose, history of graft rejection, current fasting glucose, age, and race. Proportions were compared between HbA1c <6 and > or =6.1% using Fisher's exact test. Means were compared using Student's t test. Logistic regression was used to identify risk factors associated with elevated HbA1c.

Results: Twenty subjects (10.1%) had an elevated HbA1c. High normal fasting glucose (P=0.003) and African American race (P=0.08, marginally significant) were found to be associated with an elevated HbA1c. Subjects with normal and abnormal HbA1c levels were otherwise similar. There was no difference in HbA1c in tacrolimus versus cyclosporine treated subjects or in the percent of subjects with elevated HbA1c between these groups.

Conclusions: HbA1c levels were found to be more a more sensitive test than fasting blood glucose levels in PTDM, with 10.1% of all patients and 19.4% of blacks found to have an elevated HbA1c. HbA1c testing should be considered as a screening test for PTDM, especially in African Americans.
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http://dx.doi.org/10.1097/01.tp.0000188622.00840.13DOI Listing
February 2006