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Kidney Stones, Low-risk Deliveries, SARS-CoV-2 Seroprevalence, MIS-C, Leigh Syndrome

Published on January 21, 2022 in Cornerstone Blog · Last updated 3 months 4 weeks ago
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In the News

mccannn [at] chop.edu (By Nancy McCann)

In today’s roundup of research news, learn how one Children’s Hospital of Philadelphia researcher and his team have connected climate change to kidney stones, congratulate another scientist on her funding award from People Against Leigh Syndrome, and get the latest on infants with low-risk deliveries, how heart function recovers quickly in children with MIS-C, and CHOP employees’ seroprevalence rates during the early part of the pandemic.

Gregory Tasian, MD, MSc, MSCE

Gregory Tasian, MD, MSc, MSCE

Can Climate Change Lead to an Increase in Kidney Stones?

The answer is “yes” according to a new study by CHOP researchers. Findings published in Scientific Reports, reveal that rising temperatures due to climate change will lead to an increase in cases of kidney stones over the next seven decades — even if measures are put in place to reduce greenhouse gas emissions.

The study quantified the effect of heat on kidney stone presentations in South Carolina. The researchers used a time series analysis of historical kidney stone presentations (1997-2014) and distributed lag non-linear models to estimate the temperature dependence of kidney stone presentations, and then quantified the projected impact of climate change on future heat-related kidney stone presentations using daily projections of wet-bulb temperatures through 2089, assuming no adaptation or demographic changes. Two climate change models were explored. The first one assumed moderately aggressive reduction in greenhouse gas emissions, and the other represented uninhibited greenhouse gas emissions.

The telling results showed that even with a reduction in greenhouse gas emissions, the estimated total statewide kidney stone presentations attributable to heat are projected to increase by 2.2 percent with estimated total excess cost of approximately $57 million. The uninhibited greenhouse gas emissions model revealed a projected increase of 3.9 percent and $99 million in total excess cost.

“With climate change, we don’t often talk about the impact on human health, particularly when it comes to children, but a warming planet will have significant effects on human health,” said senior study author Gregory Tasian, MD, MSc, MSCE, an attending pediatric urologist in the Division of Urology at CHOP. “As pediatric researchers, we have a duty to explore the burden of climate change on human health, as the children of today will be living this reality in the future.”

Check out CHOP News for more details.

Dustin Flannery, DO, MSCE

Dustin Flannery, DO, MSCE

Infants with Low-Risk Deliveries Should Not Need Antibiotics at Birth

CHOP researchers found that infants with low-risk deliveries should not need antibiotics at birth. By analyzing delivery characteristics, the researchers identified infants at lowest risk of early-onset sepsis (EOS), a life-threatening infection that can occur within 72 hours after birth, due to exposure to bacteria during the birthing process. The findings, published in Pediatrics, could help clinicians tailor the use of early antibiotics in newborns. Only those deemed at risk for infection should receive antibiotics, thereby reducing unnecessary use.

In a retrospective study, the researchers assessed 7,549 infants born between 2009 and 2014 at two Philadelphia birth hospitals who had a blood or cerebrospinal fluid culture obtained within 72 hours after birth. They examined medical record data for confirmed infection and for delivery characteristics, defining a “low-risk” delivery as a cesarean section, without rupture of amniotic membranes prior to delivery; an absence of labor or attempts to induce labor; and an absence of suspected or confirmed maternal intraamniotic infection or fetal distress.

Although none of the 1,121 infants born in a low-risk delivery setting developed EOS, 80 percent of them were empirically treated with antibiotics. Also, there was no difference between the low-risk and non-low-risk groups in the proportion of infants who received prolonged antibiotics, suggesting that clinicians did not appreciate or account for the lower risk of infection and stop antibiotics in the absence of confirmed infection.

“Given the risks associated with early-onset sepsis in infants, it isn’t surprising that newborns are often administered antibiotics immediately after birth,” said first author Dustin Flannery, DO, MSCE, attending neonatologist and clinical researcher at CHOP. “However, our study shows that it is safe to withhold antibiotics in infants, including those born preterm, with low-risk delivery characteristics. Such infants are unlikely to be infected at birth and can be spared the potential complications of systemic antibiotic exposure.”

See this CHOP press release for study details.

Brian Fisher, DO, MPH, MSCE

Brian Fisher, DO, MPH, MSCE

Evolution of SARS-CoV-2 Seroprevalence Among CHOP Employees During COVID-19 Pandemic

The immune response to SARS-CoV-2 among CHOP employees working in various settings across the Hospital during early months of the COVID-19 pandemic was assessed in a collaborative study by CHOP and University of Pennsylvania researchers, including lead author Brian Fisher, DO, MPH, MSCE, of CHOP’s Division of Infectious Diseases, and senior author Scott Hensley, PhD, of the University of Penn.

They found that employee SARS-CoV-2 seroprevalence rates remained below the surrounding community’s point prevalence rates, but they varied by employment type and demographic factors. Providing direct patient care, Black race, and exposure to a confirmed case in a non-healthcare setting were associated with a significantly increased risk for seropositivity. This information can be used to inform occupational protection measures — at CHOP and elsewhere — to maximize protection of employees within the workplace during current and future COVID-19 waves or other epidemics. Infection Control & Hospital Epidemiology published the initial findings.

Of the 1,740 subjects enrolled and followed between April and December 2020, a total of 4,985 blood samples were collected at intervals of baseline, one-month, two-month, and six-month intervals. At six months, cumulative seroprevalence of the employee cohort was 5.3 percent — below estimated community point seroprevalence. Seroprevalence was 5.8 percent and 3.4 percent among employees with and without direct patient care, respectively.

“This suggests mitigation strategies implemented early during the pandemic by the Hospital, including universal masking, targeted N95 use and remote work for non-essential employees were protective, likely resulting in reduced transmission from employees to employees, patients to employees, and employees to patients,” said Dr. Fisher who is also the associate chair of Research for the Department of Pediatrics. “Additionally, some employees may have benefited from enhanced awareness of risk factors associated with infection and use of mitigation measures in community settings.”

To learn more see the Infection Control & Hospital Epidemiology publication.

Anirban Banerjee, MD

Anirban Banerjee, MD

Within Three Months, Heart Function in Children with MIS-C Returns to Normal

A new study by CHOP researchers shows children with multisystem inflammatory syndrome (MIS-C), a post-infectious complication of SARS-CoV-2, regained normal cardiac function within approximately three months of initial treatment. Cardiac improvement began quickly in the first week of treatment and gradually improved and normalized within three to four months. The Journal of the American Heart Association published the findings.

As a recently described disease, long-term studies to determine when normal heart function would return for MIS-C patients have been scarce, leading to a lack of follow-up guidelines and confusion in the minds of primary physicians and parents alike.

To provide follow-up data, the researchers analyzed data on 60 children hospitalized with MIS-C due to COVID-19 exposure at one of two Philadelphia hospitals between April 2020 and January 2021 as compared to 60 healthy children of the same ages who had structurally normal hearts.

By using conventional echocardiograms and strain parameters, the researchers analyzed the data at four time points: initial hospitalization, within one week of the first echocardiogram, one-month follow-up, and three- to four-month follow-up. They found that systolic function in the left ventricle and right ventricle recovered quickly within the first week, followed by continued improvement and complete normalization by three months. Approximately 81 percent of MIS-C patients lost some contraction function in the left ventricle during the acute phase of illness, but contraction function returned to normal by the three- to four-month follow-up. Four patients with MIS-C presented with coronary aneurysms, which resolved relatively quickly.

“Our detailed characterization of short-term cardiac outcomes from MIS-C provides evidence that functional recovery and coronary outcomes are good,” said senior author Anirban Banerjee, MD, an attending cardiologist with the Cardiac Center at CHOP. “These findings may inform early guidelines for outpatient management strategies and recommendations for returning to competitive sports.”

For study details see these press releases: CHOP News, AHA Newsroom.

Deborah Murdock, PhD

Deborah Murdock, PhD

CHOP Scientist Receives Funding From People Against Leigh Syndrome

Congratulations to Deborah Murdock, PhD, a scientist with the Division of Pathology and Laboratory Medicine at CHOP, who received a grant from the People Against Leigh Syndrome (PALS), a Houston-based organization dedicated to funding Leigh syndrome research.

Leigh syndrome is a devastating disorder that can cause deterioration of the central nervous system, including the brain, spinal cord, and optic nerve. There is no cure for Leigh syndrome, and individuals with the disease typically live anywhere from a few years to their mid-teens.

Dr. Murdock’s project “Harnessing immunotherapy to battle neurodegeneration in Leigh syndrome,” will test the therapeutic benefit of a PD-L1 inhibitor in an established mouse model of Leigh syndrome and access the PD-L1 inhibitor’s ability to improve the most common symptoms seen in Leigh syndrome patients.

“The use of immunotherapy has been revolutionary in harnessing the power of the individual’s immune system to fight cancer,” Dr. Murdock said. “Immune checkpoint inhibitors more recently have shown promising results resolving neuroinflammation in neurodegenerative disorders such as Alzheimer’s disease. The funding from PALS allows us to test the ability of immunotherapy to battle neurodegeneration in Leigh syndrome in a mouse model of the disease.”

For more information see this PALS press release.

ICYMI

Catch up on our headlines from our Jan. 7 In the News:

  • Pediatric Providers Often Do Not Discuss Transportation With Autistic Patients
  • CHOP Researchers Publish Comprehensive Clinical Description of WAGR Syndrome
  • Poverty Affects Risk of Cleft Lip and Cleft Palate
  • Study Supports Echinocandin Therapy for Pediatric Invasive Candidiasis
  • ATOP Highlights Science Communication, Competition Winners

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