Objective: To evaluate the relationship between prenatal and postnatal inflammation-related risk factors and severe retinopathy of prematurity (ROP). Study Design: The study included infants born <30 weeks in California from 2007–2011. Multivariable log binomial regression was used to assess the association between prenatal and postnatal inflammation-related exposures and severe ROP, defined as stage 3–5 or surgery for ROP. Results: Of 14,816 infants, 10.8% developed severe ROP. Though prenatal inflammation-related risk factors were initially associated with severe ROP, after accounting for the effect of these risk factors on gestational age at birth through mediation analysis, the association was non-significant (P=0.6). Postnatal factors associated with severe ROP included prolonged oxygen exposure, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis. Conclusion: Postnatal inflammation-related factors were associated with severe ROP more strongly than prenatal factors. The association between prenatal inflammation-related factors and ROP was explained by earlier gestational age in infants exposed to prenatal inflammation.

Background In the United States, the mortality rate from traffic injury is higher in rural and in southern regions, for reasons that are not well understood. Methods For 1754 (56%) of the 3142 US counties, we obtained data allowing for separation of the deaths/population (D/P) rate into deaths/injury (D/I), injuries/crash (I/C), crashes/exposure (C/E), and exposure/population (E/P), with exposure measured as vehicle miles traveled. A “decomposition method” proposed by Li and Baker was extended to study how the contributions of these components were affected by three measures of rural location, as well as southern location. Results The method of Li and Baker extended without difficulty to include non-binary effects and multiple exposures. D/I was by far the most important determinant in the county-to-county variation in D/P, and accounted for the greatest portion of the rural/urban disparity. After controlling for the rural effect, I/C accounted for most of the southern/northern disparity. Conclusions The increased mortality rate from traffic injury in rural areas can be attributed to the increased probability of death given that a person has been injured, possibly due to challenges faced by emergency medical response systems. In southern areas, there is an increased probability of injury given that a person has crashed, possibly due to differences in vehicle, road, or driving conditions.

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Thrombolytic therapy with this tPA protocol may be safe and effective in treating neonates with coronary thrombosis.

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BACKGROUND Understanding factors that impact tissue oxygen extraction may guide red blood cell (RBC) transfusion decision making in preterm infants. Our objective was to assess the influence of enteral feeding and anemia on cerebral and mesenteric oxygen saturation (Csat and Msat) and fractional tissue oxygen extraction (cFTOE and mFTOE) over the entire time course of RBC transfusion. STUDY DESIGN AND METHODS Preterm, very low‐birth‐weight infants receiving RBC transfusions at a single center were enrolled. Near‐infrared spectroscopy sensors measured Csat and Msat levels from an hour before transfusion to 24 hours after. During this period, changes in Csat, Msat, cFTOE, and mFTOE were described, and their association with enteral feeding status and pretransfusion degree of anemia were assessed using generalized estimating equations. RESULTS RBC transfusion data from 31 preterm infants were included. Infants receiving enteral feeds exhibited lower pretransfusion Msat. Infants with pretransfusion hematocrit greater than 30% exhibited higher pretransfusion Csat and lower pretransfusion cFTOE. Such differences in baseline measurements persisted through 24 hours after transfusion. However, no statistically significant differences in oxygenation measures over time by enteral feeding or anemia status were identified. CONCLUSION Compared to NPO, enteral feeding was associated with lower Msat; anemia (hematocrit ≤30%) was associated with lower Csat and higher cFTOE. Over the time course of RBC transfusion, trajectories of Csat, Msat, cFTOE and mFTOE did not differ by enteral feeding or anemia status.

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