The population prevalence of undetected abdominal aortic aneurysm in New Zealand Maori.

BACKGROUND: The prevalence of abdominal aortic aneurysm (AAA) in Polynesian populations such as the New Zealand Maori has not been characterized. We measured this in a large population-based sample. METHODS: A cross-sectional population-based prevalence study was conducted as part of an AAA screening pilot; 2467 Maori men aged 54 to 74 years and 1526 women aged 65 to 74 years registered with a primary care practice in Auckland (New Zealand) were invited to be screened by abdominal ultrasound between June 2016 and March 2018. Patients with pre-existing AAA disease and those with terminal conditions or circumstances that would make them unlikely to benefit from screening were excluded. The prevalence rate of AAA in Maori women was calculated with a cutoff definition of 27 mm as well as with the normal 30-mm definition (used in men). A log-binomial regression model estimated the prevalence rate at exactly 65 years for the purpose of comparison with screened populations in the United Kingdom. RESULTS: The crude prevalence rate of undiagnosed AAA in Maori men aged 60 to 74 years was 3.6%. In women, it was 1.7% at the 30-mm threshold and 2.3% at 27 mm. The prevalence rate at exactly 65 years of age was calculated from the log-binomial regression model to be 2.7% (confidence interval [CI], 2.0%-3.8%) in men, 0.9% (CI, 0.4%-2.2%) in women at the 30-mm threshold, and 1.5% (CI, 0.7%-3.0%) in women at the 27-mm threshold. Among smokers, the crude prevalence rates were 7.5% (CI, 4.9%-11.5%) in men and 6.9% (CI, 4.1%-11.5%) in women (30 mm+). CONCLUSIONS: The prevalence of undiagnosed AAA in New Zealand Maori men is considerably higher than in screened populations of equivalent age in the United Kingdom and Sweden. Prevalence rates in New Zealand Maori women are close to those of screened British men. New Zealand should consider implementing a population-based screening program for Maori men and conduct further research into the health impact of screening Maori women.

High incidence of nephrocalcinosis in extremely preterm infants treated with dexamethasone.

BACKGROUND: The use of postnatal corticosteroids to treat or prevent chronic lung disease is common in very preterm infants. Medullary nephrocalcinosis has been noted as a possible side effect. OBJECTIVE: This prospective study was designed to assess the incidence of nephrocalcinosis in extremely preterm infants exposed to dexamethasone. PATIENTS AND METHODS: A prospective study of extremely preterm infants, recruited to a randomized trial of dexamethasone treatment for chronic lung disease, was initiated. Infants had US of the renal tract scheduled on entry into the study, at day 28 and at discharge or at the corrected gestational age of 36 weeks. RESULTS: Thirty-three infants were enrolled in the study. Birth weight ranged between 440 and 990 g and gestation between 24 and 28 weeks. Nine infants died and six had incomplete data. Because there was no difference in incidence of calcification between those on the short course and those on the long course of dexamethasone, analysis was made on the entire cohort. One infant had nephrocalcinosis at the time of the initial US examination on day 26 of life. By day 28, nephrocalcinosis was present in 31% of those with complete data. By discharge, or corrected gestational age of 36 weeks, US evidence of nephrocalcinosis was present in 15 (83%) of 18 infants. All infants had at least one course of an aminoglycoside antibiotic during the study. All infants had parenteral nutrition. Only four infants received furosemide more regularly than single doses. The longest course was 10 days, received by an infant who did not develop nephrocalcinosis. CONCLUSION: The incidence of nephrocalcinosis is high in this group of sick, extremely preterm infants. Dexamethasone may be a factor in the development of nephrocalcinosis. Future research should focus on the natural history of nephrocalcinosis in extremely preterm infants.