on behalf of the PENUT Trial Consortium* Objective To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26 months of corrected gestational age (cGA) compared with those randomized to placebo. Study designWe performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. ResultsThe prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26 months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m 2 , 35.8% had urine albumin/creatinine ratio >30 mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P < .04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit.Conclusions ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26 months of cGA.Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26 months of cGA.
Objective. There are few reports of young adult outcomes of infants born at 23-26 weeks gestation. The objective of this study is to report educational, health, social, and employment outcomes of a large cohort of these infants born during an era when significant advances in neonatal care led to a marked increase in survival.Methods. Medical records of 316 infants who were born between January 1, 1986 and December 31, 1990, were analyzed retrospectively. Two hundred three (64%) infants survived to discharge home, and 5 died following discharge, leaving 198 young adults available for follow-up. One hundred sixty-two (82%) young adults responded to a 27 item telephone questionnaire designed to assess educational, health, social, and employment status at a mean age of 19.3 years. Parents of subjects were interviewed in cases where subjects could not be contacted or had cognitive issues which precluded their responding (19 subjects). Parent social and educational status was previously obtained by response to a phone survey at eight year follow-up and also by phone interview of parents of young adults previously not available for follow-up, but who were located for this report.Results. The only statistically significant differences between the 162 young adult responders and the 36 non-responders were a younger maternal age at delivery (28 ± 6 years vs 25 ± 6 years, respectively, p = 0.015) and race (91% of responders were white compared to 67% of the non-responders, p = 0.001). One hundred forty-three (88%) young adults had graduated from high school. Eighty-four (52%) required educational assistance in the form of special education, a tutor, or an Individual Education Plan (IEP). Ninety-one (56%) were currently enrolled in post-secondary education. These levels of educational achievement closely correspond to the 91% of their mothers who graduated from high school and the 57% who had completed some college level courses, including 30% with either four-year or advanced degrees. Twenty-nine (18%) of the young adults interviewed reported some problems with depression. Thirty subjects admitted to using alcohol socially, 11 reported tobacco use, and 3 admitted to using marijuana. One hundred forty-two have been or are currently employed.Conclusions. The majority of infants born at the lower limits of viability not only have the potential to survive, but with appropriate assistance and resources have the ability to successfully navigate the educational system and eventually be employed as productive members of society.
Philadelphia is celebrating 150 years of Alice in Wonderland with public programming and multiple exhibitions beginning in 2015 through 2016. There are lectures, tea parties, hands-on tours at the Rosenbach of the Free Library of Philadelphia, talks of medical oddities of Alice, costume parties, and more. Carroll’s original manuscript is traveling around the East coast in pop-up displays in Philadelphia and New York. This focus on Lewis Carroll’s work provides an intriguing opportunity to examine Woolf’s review, which was written on the occasion of the Nonesuch Press issue of the complete works in 1939. Woolf ‘s response to Carroll’s legacy, in the midst of what she calls “non-war” and “written in barren horror,” hones in on the construction of childhood, the relationship of the child to the adult, and the illusory nature of the author. Woolf’s diary entries, documenting what she calls the many distractions surrounding her, point to the irony of composition and the world Carroll creates. In this paper I will approach these topics and consider the ways in which Woolf reflects on, engages with, and represents the connections and disconnections with the literary heritage of Alice and her enduring appeal.
Woolf’s well-documented fashion angst is read through the lens of fashion contemporaries like Marianne Moore, whose fashion (and literary) identity was supported by family and friends in a kind of female patronage, resulting in her development as a fashion icon celebrated in magazines like Harper’s Bazaar and Vogue, which printed interviews, spreads, and poetry. Keying on the ideas of individuality and identity and working with the extensive Moore collection at the Rosenbach Museum and Library (Philadelphia), this essay examines how the support of Moore’s circle enabled her to navigate and rise above the doubts that beset Woolf ‘s relationship with fashion.
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