Rush Children's Hospital

BackgroundThe aim of this study was to examine the impact of a sulfur-containing diet and a CTH polymorphism (G1208T; rs1021737) on bone density.MethodsA total of 200 Uyghur residents aged over 50 from Xinjiang, China, were recruited for this study. Fasting blood samples were collected from the participants to measure serum hydrogen sulfide (H2S) levels and perform CTH polymorphism sequencing. Dietary sulfur intake was assessed using a food frequency questionnaire and categorized into animal protein-derived and non-animal protein-derived sources. Skeletal health of the calcaneus was evaluated using quantitative ultrasound scanning.ResultsThe study included a total of 200 participants, comprising 81 males and 119 females. Participants were stratified based on osteopenia status, with a T-score ≥ −1.0 indicating normal bone density and a T-score < −1.0 indicating osteopenia. Individuals in the osteopenia group exhibited significantly lower bone density markers, including broadband ultrasound attenuation (BUA) and speed of sound (SOS), as well as lower total weekly dietary sulfur intake and weekly dietary sulfur intake from animal protein. Additionally, they had significantly higher serum H2S levels compared to participants with normal bone density. However, no differences in CTH genotype were observed between the normal bone density group and the osteopenia group. Participants were further categorized into tertiles (Q1 to Q3) based on weekly dietary sulfur intake from animal protein. Compared to the Q1 group, the Q3 group showed significantly higher T-scores and BUA values. Binary logistic regression analysis revealed that, compared to the group with high weekly dietary sulfur intake from animal protein, the low and middle intake groups had 3.252 times and 4.330 times higher risks of osteopenia, respectively.ConclusionDietary sulfur intake from animal protein may exert a protective effect on bone density.

Background/Objective: The accurate diagnosis of congenital central nervous system abnormalities is critical to pre- and postnatal prognostication and management. When an abnormality is found in the posterior fossa of the fetal brain, parental counseling is challenging because of the wide spectrum of clinical and neurodevelopmental outcomes in patients with Dandy-Walker (DW) spectrum posterior malformations. The objective of this study was to evaluate the utility of biometric measurements obtained from fetal magnetic resonance imaging (MRI) to facilitate the prenatal differentiation of Dandy-Walker (DW) spectrum malformations, including vermian hypoplasia (VH), Blake's pouch cyst (BPC), and classic Dandy-Walker malformation (DWM). Methods: This retrospective single-center study evaluated 34 maternal-infant dyads referred for fetal MRI evaluation of suspected DW spectrum malformations identified on antenatal ultrasound. Radiologists took posterior fossa measurements, including the vermis anteroposterior (AP) diameter, vermis height (VH), and tegmento-vermian angle (TVA). The posterior fossa, fourth ventricle, and cisterna magna were classified as normal, large, or dilated. The postnatal imaging findings were evaluated for concordance. The acquired values were compared between the groups and with normative data. The genetic testing results are reported when available. Results: A total of 27 DW spectrum fetal MRI cases were identified, including 7 classic DWMs, 14 VHs, and 6 BPCs. The TVA was significantly higher in the DWM group compared with the VH and BPC groups (p < 0.001). All three groups had reduced AP vermis measurements for gestational age compared with normal fetal brains, as well as differences in the means across the groups (p = 0.002). Conclusions: Biometric measurements derived from fetal MRI can effectively facilitate the prenatal differentiation of VH, BPC, and classic DWM when assessing DW spectrum posterior fossa lesions. Standardizing biometric measurements may increase the diagnostic utility of fetal MRI and facilitate improved antenatal counseling and clinical decision-making.

Although mother's own milk (MOM) is associated with reduced risk of neonatal complications of prematurity and improved neurodevelopmental outcomes, to our knowledge, there have been no large US studies reporting rates of MOM feeding initiation and sustained MOM feedings by gestational age (GA). To compare rates of MOM feeding initiation and continuation at 12 weeks for infants by GA. This retrospective cross-sectional study used state-level surveillance data for maternal characteristics and behaviors before and after pregnancy. Participants were women who gave birth from January 1 through December 31, 2021, in 36 US jurisdictions (33 states, the District of Columbia, New York City, and Puerto Rico) and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. Data were analyzed from July 2023 to April 2024. Infant GA, including early preterm (EPT; ≤27 weeks' gestation), moderately preterm (MPT; 28-33 weeks' gestation), late preterm (LPT; 34-36 weeks' gestation), and early term to postterm (≥37 weeks' gestation). MOM feeding initiation and continuation at 12 weeks after delivery. Weighted multivariable binary logistic regression models were used to test the association between MOM feeding initiation and continued provision at 12 weeks after delivery by infant GA. Among 29 098 births, there were 0.4% EPT, 1.8% MPT, 6.7% LPT, and 91.1% early-term to postterm infants. Unadjusted MOM feeding initiation was highest for EPT infants (89.7% [95% CI, 85.0%-94.7%]) and lowest for LPT infants (81.8% [95% CI, 79.5%-84.1%]). For infants that initially received MOM, 71.6% (95% CI, 70.7%-72.6%) of early-term to postterm infants still received MOM at 12 weeks followed by 63.1% (95% CI, 52.9%-73.2%) of EPT infants, 61.2% (95% CI, 58.0%-64.3%) of LPT infants, and 58.6% (95% CI, 53.4%-63.8%) of MPT infants. After adjusting for maternal characteristics, LPT infants were 4.4 (95% CI, -6.7 to -2.1) percentage points less likely to initiate MOM feedings and those who received any MOM were 6.7 (95% CI, -9.9 to -3.5) percentage points less likely to receive MOM at 12 weeks compared with early-term to postterm infants. There were no differences in adjusted initiation or continuation rates among EPT (3.1 [95% CI, -1.4 to 7.5] percentage points for initiation and -0.0 [95% CI, -8.6 to 8.6] percentage points for continuation) or MPT (2.4 [95% CI, -0.5 to 5.3] percentage points for initiation and -3.3 [95% CI, -8.0 to 1.5] percentage points for continuation) infants compared with early-term to postterm infants. This cross-sectional study found that MOM feeding initiation and continuation rates at 12 weeks after birth for LPT infants were substantially lower than rates for infants with other GAs. Research is needed to pinpoint barriers to MOM feeding initiation and continuation in this vulnerable population of infants.

This cross-sectional survey aimed to examine employment characteristics and their associations with employment precarity in two high socioeconomic hardship Chicago neighborhoods. We used a community-based participatory approach to develop and administer a survey to residents who perceived their work situations to be precarious. A total of 489 residents were surveyed. Responses were skewed toward the most precarious work situations, with the majority of respondents employed outside of a traditional arrangement. Those in the highest precarity category were most likely to identify as Latinx and born outside of the United States. Unstable, low-quality employment conditions were nearly all significantly associated with highest precarity work situations. Precarious employment is an important predictor of other employment conditions, and characterizing these at a hyperlocal level allows for a nuanced understanding of work as a determinant of health.

Most severe child scalds in the United States involve food and beverages. The wide variety of burn mechanisms, however, makes prevention challenging. Over the past 15 years, we have worked toward protecting young children from 1 specific mechanism: children opening microwave oven doors themselves and spilling the heated contents, resulting in often severe scalds. In our published research, we documented the frequency and severity of these cases and the vulnerability of young toddlers to be burned in this way. We have presented our findings and ideas for prevention at multiple national meetings and enlisted college engineering students to design microwave doors that would thwart a young child from opening them. In 2017, we became active members of a national task group convened by Underwriters Laboratories to address this issue, and two authors became voting members on the Underwriters Laboratories Standards Technical Panel for microwave ovens. We worked with microwave manufacturers and others for >1 year to address concerns of the industry, including those related to potential impacts on older adults. This effort resulted in the task group proposing a change in the standard, requiring "two distinct actions" to open the door of a microwave oven. On September 17, 2018, the panel voted to pass the measure, which will require child-resistant doors for all new microwave ovens in 2023. This report highlights how research can inform and support child injury prevention advocacy. Children will now be protected from this type of scald as microwaves with child-resistant doors replace current models.

This study was aimed to evaluate the impact of donor milk (DM) received in the first 28 days of life (DOL) on neurodevelopmental (ND) outcome at 20-months corrected age (CA) in very low birth weight (VLBW) infants. A total of 84 infants born in 2011 to 2012 who received only mother's own milk (MOM) and/or preterm formula (PF) was compared with 69 infants born in 2013 to 2014 who received MOM and/or DM. Daily enteral intake of MOM, DM, and PF was collected through 28 DOL. ND outcomes were assessed with the Bayley-III. Multiple regression analyses adjusted for the effect of social and neonatal risk factors alongside era of birth on ND outcome. Infants exposed to DM were born to older mothers (p < 0.01) and had higher incidence of severe brain injury (p = 0.013). Although DM group infants received first feed at earlier DOL (p < 0.001), there were no differences in MOM intake at DOL 14 or 28 between the two groups. In regression analyses, DM group did not predict 20-month ND outcome. There were no differences in ND outcome between infants born before and after the introduction of DM. This may have been due to the similar percent of MOM at DOL 14 and 28 in the two eras. · Donor milk use is increasing in VLBW infant. The impact of donor milk on neurodevelopment is unclear.. · Provision of mother's own milk was high at days of life 14 and 28 for both groups of infants.. · Donor milk was not associated with improved neurodevelopmental outcome..

Abstract Background: To explore the kinetic changes in virology, specific antibody response and imaging during the clinical course of COVID-19.Methods: This observational study enrolled 20 patients with COVID-19, who were hospitalized between January 20-April 6, 2020, in the two COVID-19 designated hospitals of Zhoushan, Zhejiang and Rushan, Shandong, China, The laboratory findings, imaging, serum response to viral infection, and viral RNA level in the throat and stool samples were assessed from onset to recovery phase in patients with COVID-19. Results: SARS-COV-2 RNA was positive as early as day four. It remained positive until day 55 post-onset in the sputum-throat swabs and became negative in most cases (55%) within 14 days after onset. Lymphocytopenia occurred in 40% (8/20) of patients during the peak infection period and returned to normal at week five. The most severe inflammation in the lungs appeared in week 2 or 3 after onset, and this was completely absorbed between week 6 and 8 in 85.7% of patients. All patients had detectable antibodies to the receptor binding domain (RBD), and 95% of these patients had IgG to viral N proteins. The antibody titer peaked at week four. Anti-S IgM was positive in 7 of 20 patients after week three. Conclusions: All COVID-19 patients in this cohort were self-limiting and recovered well though it may take as long as 6-8 weeks. Our findings on the kinetic changes in imaging, serum response to viral infection and viral RNA level may help understand pathogenesis and define clinical course of COVID-19.

Mucopolysaccharidoses (MPS) are rare genetic lysosomal storage disorders caused by a deficiency of enzymes that catalyze the breakdown of glycosaminoglycans. MPS-III, also known as Sanfilippo syndrome, is caused by a deficiency of one of four enzymes that catalyze heparan sulfate proteoglycan degradation. MPS-IIIA results from a deficiency of heparan sulfatase. The natural history of MPS-IIIA is marked by progressive neurodegeneration. A nine-year-old boy with developmental delay presented with progressive three-month functional decline culminating in emergency department presentation for lethargy and immobility. Laboratory workup revealed hepatic and renal failure, coagulopathy, pancytopenia, hypernatremia, and uremia requiring emergent dialysis. He developed hyperkalemia during the second month of hospitalization, the workup of which led to a diagnosis of hyperreninemic hypoaldosteronism with normal cortisol. Blood chemistry consistent with renal hypoperfusion prompted exploration of adrenal ischemia, specifically affecting the zona glomerulosa and sparing the zona fasciculata, to explain low aldosterone with normal cortisol. Heparan sulfate (HS) normally acts as a storage site for basic fibroblast growth factor (bFGF), a paracrine stimulator of aldosterone, but accumulates in MPS-IIIA due to deficiency of heparan sulfatase. If bFGF is sequestered in HS deposits in MPS-III, then paracrine signaling is reduced, accounting for the state of hypoaldosteronism. To our knowledge, this is the first reported case of hyperreninemic hypoaldosteronism caused by an MPS disorder.

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%, p = 0.03). In sub-analyses including only small bowel atresia and gastroschisis infants, the median length of stay (35 vs. 25, p < 0.01) and the central line days (28 vs. 20, p < 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.