ABSTRACT
OBJECTIVES: The objectives of this study were to establish days between birth and death for neonates over a 14-year period, determine if days between birth and death have changed over time across gestational age cohorts, and identify diagnoses which may put infants at high risk of prolonged hospitalization leading to death. STUDY DESIGN: This was a single-site, retrospective chart review of inborn infants who died prior to hospital discharge. RESULTS: Two hundred and thirty-nine patients born between 1/1/2006 and 12/31/2020 met inclusion criteria. Days until death ranged from 0 to 300 with a median of 6 days (interquartile range = 23). Median days until death increased over time, with a statistically significant increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants with complex congenital heart disease or a gastrointestinal (GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues. CONCLUSIONS: Our findings demonstrate an increase in time to death for newborns who did not survive to hospital discharge over a 14-year period. This trend suggests that the dynamics informing Meadows' assertion that "doomed infants die early" may be shifting, with some seriously ill infants who die before hospital discharge surviving longer than previously described. More research is needed to understand how best to care for babies who will not survive to discharge and to explore when supports such as palliative care consultation may be beneficial. KEY POINTS: As per W. Meadow, "Doomed infants die early" · Pre-death length of stay varies with diagnosis.. · Some seriously ill infants who die before hospital discharge are no longer dying early.. · These infants and families may need supports..
ABSTRACT
Arsenic exposure through contaminated food, water, and air causes irreversible neural damage and affects millions of people worldwide. Several studies have demonstrated that the secreted factors (secretome) from mesenchymal stromal/stem cells (MSCs) can promote neural recovery after several forms of injury including stroke and neurodegenerative diseases. The present study was conducted to determine if the secretome from adipose-derived MSCs (ADSCs) prevents arsenic damage to SH-SY5Y cells. To this end, human neuroblastoma cells (SH-SY5Y) were pre-treated with the secretome from ADSCs and then challenged with different concentrations of arsenic. After various doses and exposure times, the extent of neuronal injury was assessed using MTT reduction and LDH release assays as well as LIVE/DEAD staining. These data demonstrate that the ADSC secretome protects SH-SY5Y cells from arsenic-induced toxicity. Previous reports have shown that the secretome of MSCs can induce neuroblast differentiation and mature neurons are less susceptible to chemical-induced toxicity. In the current study, proliferation assays, neurite length assessment, and quantitative RT-PCR of differentiation markers indicated that the ADSC secretome does not induce SH-SY5Y differentiation into a mature neuron-like phenotype. In contrast, our results demonstrated that soluble factor(s) in the ADSC secretome enhance SH-SY5Y cell substrate-dependent adhesion. The present study is the first to illustrate that the secretome from ADSCs protects SH-SY5Y cells from arsenic-induced toxicity. Additionally, we showed that protection against arsenic toxicity is not dependent on SH-SY5Y cell differentiation into a mature neuron-like phenotype, but involves soluble factor(s) in the secretome that appear to enhance cell survival by an adhesion-dependent mechanism.
