Objective
To determine genetic and clinical risk factors associated with elevated systolic blood pressure (ESBP) in preterm infants following discharge.
Study design
A convenience cohort of infants <32 weeks gestational age was followed after discharge; we retrospectively identified a subgroup of subjects with ESBP (SBP > 90th percentile for term infants). Genetic testing identified alleles associated with ESBP. Multivariable logistic regression analysis was performed for the outcome ESBP with clinical characteristics and genotype as independent variables.
Results
Predictors of ESBP were: CYP2D6 (rs28360521) CC genotype (OR 2.92; 95% CI 1.48, 5.79), adjusted for outpatient oxygen therapy (OR 4.53, 95%CI 2.23, 8.81) and history of urinary tract infection (OR 4.68, 95% CI 1.47, 14.86). Maximum SBP was modeled by multivariable linear regression analysis: Maximum SBP = 84.8 mmHg + 6.8 mmHg (if CYP2D6 CC genotype) + 6.8 mmHg (if discharged on supplemental oxygen) + 4.4 mmHg (if received inpatient glucocorticoids) (p=0.0002).
Conclusion
ESBP is common among preterm infants with residual lung disease following NICU discharge. This study reveals clinical factors associated with ESBP, identifies a candidate gene for further testing, and supports the recommendation that BP be monitored sooner than at age 3 years as suggested for term infants.
Financial aid programs enable students from families with fewer financial resources to pay less to attend college than other students from families with greater financial resources. When income is uncertain, a means-tested financial aid formula that requires more of an Expected Family Contribution (EFC) when income and assets are high and less of an EFC when income and assets are low provides insurance against that uncertainty. Using a stochastic, life-cycle model of consumption and labor supply, we show that the insurance value of financial aid is substantial. Across a range of parameterizations, we calculate that financial aid would have to increase by enough to reduce the net cost of attendance by 30 to 80 percent to compensate families for the loss of the income-and asset-contingent elements of the current formula. This compensating variation is net of the negative welfare consequences of the disincentives to work and save inherent in the means-testing of financial aid. Replacing just the "financial aid tax" on assets with a lump sum would also reduce welfare.
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