Elevated risk for developmental disabilities in children with congenital heart defects.

BACKGROUND: This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level. METHODS: Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive). RESULTS: Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability. CONCLUSIONS: Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.

Evaluation of Administrative Data for Identifying Maternal Opioid Use at Delivery in Florida.

OBJECTIVES: Studies have shown significant increases in the prevalence of maternal opioid use. Most prevalence estimates are based on unverified ICD-10-CM diagnoses. This study determined the accuracy of ICD-10-CM opioid-related diagnosis codes documented during delivery and examined potential associations between maternal/hospital characteristics and diagnosis with an opioid-related code. METHODS: To identify people with prenatal opioid use, we identified a sample of infants born during 2017-2018 in Florida with a NAS related diagnosis code (P96.1) and confirmatory NAS characteristics (N = 460). Delivery records were scanned for opioid-related diagnoses and prenatal opioid use was confirmed through record review. The accuracy of each opioid-related code was measured using positive predictive value (PPV) and sensitivity. Modified Poisson regression was used to calculate adjusted relative risks (aRR) and 95% confidence intervals (CI). RESULTS: We found the PPV was nearly 100% for all ICD-10-CM opioid-related codes (98.5-100%) and the sensitivity was 65.9%. Non-Hispanic Black mothers were 1.8 times more likely than non-Hispanic white mothers to have a missed opioid-related diagnosis at delivery (aRR:1.80, CI 1.14-2.84). Mothers who delivered at a teaching status hospital were less likely to have a missed opioid-related diagnosis (p < 0.05). CONCLUSIONS FOR PRACTICE: We observed high accuracy of maternal opioid-related diagnosis codes at delivery. However, our findings suggest that over 30% of mothers with opioid use may not be diagnosed with an opioid-related code at delivery, although their infant had a confirmed NAS diagnosis. This study provides information on the utility and accuracy of ICD-10-CM opioid-related codes at delivery among mothers of infants with NAS.

From 2010 to 2017, maternal opioid-related diagnoses at delivery increased by 100% in the US. Most prevalence estimates are based on unverified ICD-10-CM diagnosis codes. Evaluations of maternal opioid-related diagnoses at delivery are extremely limited but essential for utilizing prevalence estimates generated from administrative data.

Outcome of PET-Negative Solid Pulmonary Nodules: A Retrospective Study.

OBJECTIVE: It was observed that malignancy had been found on follow-up in patients with PET-negative solid solitary pulmonary nodules (SPN). A retrospective analysis was performed to observe the natural history and malignant potential of these lesions, which, in routine practice, are presumed to be inactive. MATERIALS AND METHODS: Patients with an incidentally-discovered solid solitary pulmonary nodule who then had a negative follow-up PET/CT from 2005 to 2015 were identified using a text-based search methodology. These patients' charts were mined to determine the rate of development of subsequent malignancy from these index nodules. RESULTS: Of the patients with initially PET-negative solitary pulmonary nodule (n = 62, 43.5% women, mean age 65), 44 had clinical follow-up of the index lesion. 8 (7 pathology-proven) subsequent malignancies were identified with a mean time to diagnosis of 37.6 (±31.3) months. There were no statistically significant predictors of subsequent development of cancer (including age, gender, and smoking status). CONCLUSION: Upon follow up, 18.2% of the initially queried solid PET-negative nodules developed subsequent malignancy at an average time of 37.6 months, suggesting the continued need for follow-up of these initially PET-negative nodules beyond the 2 years currently suggested in popular guidelines. Importantly, these findings also remind radiologists that a negative PET/CT is not a surrogate for tissue diagnosis in the case of non-FDG avid SPN.

Diagnosis Codes and Case Definitions for Neonatal Abstinence Syndrome.

BACKGROUND AND OBJECTIVES: The increase in neonatal abstinence syndrome (NAS) has underscored the need for NAS surveillance programs, but many rely on passive surveillance using unverified diagnosis codes. Few studies have evaluated the validity of these codes, and no study has assessed the recently proposed Council of State and Territorial Epidemiologists (CSTE) case definition. The Florida Birth Defects Registry investigated the accuracy of International Classification of Diseases, 10th Revision, Clinical Modification codes related to NAS (P96.1 and P04.49) and assessed the sensitivity of the CSTE case definition. METHODS: We identified a sample of infants born during 2016 coded with P96.1 and/or P04.49. Record review was completed for 128 cases coded with P96.1, 68 with P04.49, and 7 with both codes. Lacking consensus regarding a gold standard definition of NAS, we used clinical data to classify each case using the Florida and CSTE definitions. The code-specific accuracy was measured by using the positive predictive value (PPV). The clinical characteristics indicative of NAS were compared for case classification based on both definitions. RESULTS: By using the Florida definition, the overall PPV was 68% but varied by code: 95.3% for P96.1 and 13.2% for P04.49. The overall (47.8%) and code-specific PPVs were lower by using the CSTE definition. Comparison of clinical characteristics demonstrated that 60.7% of cases classified as no NAS by using the CSTE definition had robust clinical signs of NAS. In our sample, the CSTE case definition underestimated NAS prevalence. CONCLUSIONS: Only the P96.1 International Classification of Diseases, 10th Revision, Clinical Modification code displayed high accuracy. Discordance in NAS case definitions and surveillance methodologies may result in erroneous comparisons and conclusions that negatively impact NAS-related surveillance and research.

Neural Tube Defects in Pregnancies Among Women With Diagnosed HIV Infection - 15 Jurisdictions, 2013-2017.

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.

Suicide history and mortality: a follow-up of a national cohort in the United States.

Little is known about the cause-specific deaths among young suicide attempters from the general population, and the time window for intervention to reduce the elevated rate of death was unclear. We analyzed a nationally representative sample of young adults (17-39 years old) who participated in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and were followed up with vital status through December 31, 2006. The history of attempted suicide was associated with an increased rate for all-cause death (HR = 1.52 [95% CI = 0.92-2.52]) with borderline statistical significance. Previous suicide attempters experienced a 3-fold (HR = 2.68[=1.01-7.09]) increased rate for cardiovascular diseases (CVD), and a 7-fold (HR = 7.10 [95% CI = 1.37-36.9]) increased rate of death due to completed suicide compared with non-attempters. The survival curves of the attempters declined rapidly for the first 3 years of follow-up, and the distance between curves remained consistent starting from the third year to the end of the follow-up. Prevention services should be tailored not only for suicide, but also for cardiovascular diseases among populations with suicidal tendency, and the service should be intensified within first 3 years after suicidal behaviors occur.

Impaired verbal memory is a significant predictor of early cerebral-cardiovascular death, an 18-year follow-up of a national cohort.

BACKGROUND: The mortality pattern of individuals with impaired verbal memory (IVM) has not yet been well described. We sought to describe the risk of all-causes, as well as specific causes of death associated with IVM. METHOD: We used the data of 4151 nationally representative adults ≥60 years old who participated in the third National Health and Nutrition Examination Survey, 1988-1994, and completed one non-contextual (i.e., word list memory) and one contextual delayed-recall tests (i.e., short story recall). The participants were passively followed up through 31 December 2006. We determined the hazard ratio of death from all-causes and specific cause through Cox proportional hazard regression. RESULTS: Severe and moderate IVM were present in 268 (6.5%) and 495 (11.9%) participants at baseline survey, and 2550 deaths occurred by the end of 18-year follow-up (median = 12 years). The medians of survival time adjusted for all-causes death were 6.17 (95% CI: 5.50, 6.92), 9.50 (8.92, 10.25), and 13.17 (12.75, 13.58) years, respectively for the individuals with severe, moderate, and no IVM. Severe IVM was significantly associated with death from cardio-cerebral vascular diseases [hazard ratio = 1.70, 95% CI = (1.36-2.12)], stroke [2.60 (1.69-3.99)], and Alzheimer's disease [3.50 (1.40-8.76)]. The shortened survival time of the participants with IVM was mainly driven by the deaths of cerebral-cardiovascular diseases, which accounted for almost half of all deaths. CONCLUSION: The predictability of memory scores to early cerebral-cardiovascular deaths demonstrated that central challenge among individuals with cognitive impairment was cardiovascular diseases management.

Port-a-cath embolisation to pulmonary artery.

Intravascular embolisation of catheter, a relatively uncommon event associated with the use of totally implanted port devices, can have serious cardiovascular, pulmonary and septic complications with an overall mortality of 1.8%. Here, the authors report an asymptomatic patient with pulmonary artery catheter embolisation diagnosed incidentally in a positron emission tomography scan who underwent successful percutaneous extraction of the catheter in an attempt to avoid the possible dreadful complications.

A phase I/II trial of fixed-dose docetaxel plus irinotecan and escalating doses of estramustine phosphate for second-line or greater treatment of selected advanced solid tumors.

This phase I/II study evaluated the safety of the combination of irinotecan, docetaxel, and estramustine for selected advanced solid tumors and also obtained initial efficacy data. Twenty-two patients were enrolled in the study. The regimen consisted of docetaxel 30 mg/m(2) and irinotecan 60 mg/m(2) both given intravenously on days 1 and 8 every 21 days in combination with escalating doses of estramustine (500 mg/m(2)/day escalated to 750 mg/m(2)/day on days 0, 1, 2, 7, 8, and 9 given every 21 days) during phase I. Dose escalation was continued until the maximum planned dose level of estramustine (750 mg/m(2)/day) was reached. After the appropriate phase II dose of estramustine was found additional patients were enrolled. Twenty-one of the 22 patients were evaluable for toxicity and 17 for tumor response. The recommended phase II dose of estramustine was found to be 750 mg/m(2)/day orally on days 0, 1, 2, 7, 8, and 9 given every 21 days. Hematologic toxicity was fairly mild, with only one episode of grade 3 neutropenia. Diarrhea was the most common nonhematologic toxicity with grade 3 toxicity occurring in five of 21 patients. Only one episode of venous thrombosis was observed. Objective response rate was 15.8%, overall clinical benefit rate was 63%, and median time to progression was 15 weeks. Estramustine in combination with the doublet of docetaxel and irinotecan is a well-tolerated regimen with minimal hematologic toxicity, mild to moderate nonhematologic toxicity, and promising initial antitumor activity in previously treated patients with advanced solid tumors.