Tetralogy of Fallot Strategies, Pediatric Stroke and SARS-CoV-2, Oxygen Therapy Timing

 

By Emily Shafer

In this week's news roundup, we highlight several Children's Hospital of Philadelphia studies, including one comparing treatment strategies for tetralogy of Fallot, one on the effects of oxygen therapy timing on susceptibility to influenza, and one on the incidence of stroke after SARS-CoV-2. Also, Food Allergy Research & Education (FARE), designated CHOP as a Data Coordination Center. Finally, find out how CHOP is a trailblazer in cardiopulmonary resuscitation (CPR) research. Read on for more details.

Two Treatment Strategies for Tetralogy of Fallot Offer Potential Benefits

The Cardiac Center at CHOP usually takes two main approaches for treating infants with symptomatic tetralogy of Fallot, a congenital heart defect: primary repair, in which surgery is performed immediately; and staged repair, in which a surgical or transcatheter procedure is performed to increase pulmonary blood flow, and a complete repair is performed later.

Both strategies used to treat infants with symptomatic tetralogy of Fallot have benefits for patients, depending on several different factors, according to a study co-led by the Cardiac Center that appeared in the Journal of the American College of Cardiology. The retrospective cohort study included all newborns with tetralogy of Fallot at nine centers who underwent initial intervention between January 2005 and November 2017, at age 30 days or younger.

The researchers found that among those who underwent primary repair, early mortality, neonatal morbidity, and procedural complications were lower. In the group that underwent staged repair, cumulative morbidity and the need for additional interventions were lower.

"These findings support the use of a tailored initial interventional strategy in neonates with symptomatic tetralogy of Fallot, considering patient, procedural, and institutional factors," said Andrew C. Glatz, MD, MSCE, an interventional cardiologist at the Cardiac Center at CHOP.

Read more in the CHOP press release.

CPR Researchers Ranked High for Number of Published Articles

Two CHOP doctors in the field of CPR research ranked as the top "most productive" authors, according to the findings that appeared in Medical Science Monitor. Overall, CHOP ranks sixth in institutional contributions to CPR research, with 286 article counts. The University of Pennsylvania ranks first, with 606 article counts.

Researchers from Shanghai Jiaotong University in China evaluated the number of research studies and reviews published on CPR from 2010 through 2019. The top-ranking "most productive" author was Robert A. Berg, MD, division chief of Critical Care Medicine and the Russell Raphaley endowed chair of Critical Care Medicine at CHOP. Dr. Berg published 160 articles on the topic. The second-ranking author was Vinay M. Nadkarni, MD, medical director of the Center for Simulation, Advanced Education and Innovation at CHOP. Dr. Nadkarni published 144 articles.

Oxygen Therapy Timing in Neonatal Period Linked to Influenza Susceptibility

A preclinical study conducted by researchers at CHOP found that the side effects of oxygen therapy in the neonatal period increase susceptibility to influenza by eliminating protection via the lung circadian clock. The findings appeared in eLife.

Previous research conducted at CHOP and the University of Pennsylvania showed that circadian rhythms protect against influenza; animal models of infection showed that mortality was three time lower in the morning rather than the evening. Working with a new mouse model, researchers analyzed the connection between neonatal hyperoxia, circadian clock disruption, and influenza infection. They found that adult mice exposed to hyperoxia as neonates lose the time-of-day protection from the circadian regulation of influenza. However, adult mice exposed to hyperoxia in adulthood did not lose the time-of-day protection.

"Our work here suggests that a unique window exists in the lung in the early neonatal period that affects circadian regulation throughout life," said Shaon Sengupta, MBBS, MPH, attending neonatologist in the Division of Neonatology at CHOP.

This line of research paves the way for novel therapeutics and chronobiolological strategies for children born prematurely who receive live-saving oxygen therapy that may inadvertently lead to bronchopulmonary dysplasia (BPD). Hyperoxia is the key risk factor for developing BPD, which results from the lungs not developing appropriately.

Learn more about the study in the CHOP press release.

FARE Designates CHOP as Data Coordination Center

Food Allergy Research & Education (FARE), the world's leading non-governmental organization devoted to food allergy advocacy and research, selected CHOP as the FARE Clinical Network Data Coordination Center. The grant will fund research infrastructure to support the multicenter studies in the FARE Clinical Network.

The Data Coordination Center will support the design, development, execution, monitoring, and analysis of clinical research studies. The Center's services will also include assisting research teams at the FARE Clinical Network sites with protocol development, FDA submissions, and safety oversight for network studies.

"We are honored to once again work with FARE on our shared mission of bringing the latest in care to children with food allergies," said Jonathan Spergel, MD, chief of the Allergy Program at CHOP. "The research developed here will hopefully lead to cutting-edge therapeutics that could change the lives of children with food allergies. We are excited to be chosen as the Data Coordination Center for FARE Clinical Network."

Stroke is an Infrequent Complication in Children With SARS-CoV-2

Pediatric stroke is an infrequent complication of SARS-CoV-2 infection, according to study results that appeared in Annals of Neurology. The first author of the paper was Lauren A. Beslow, MD, MSCE, attending physician in the Division of Neurology at CHOP. The study was a collaboration within the International Pediatric Stroke Study Group.

The researchers surveyed 61 international sites on the incidence of SARS-CoV-2 and incidence of neonatal and childhood ischemic strokes from March 1 to May 31, 2020. Among the 42 centers with SARS-CoV-2 hospitalization numbers, eight patients of the 971 with SARS-CoV2 had ischemic strokes. However, the researchers noted that fewer than 50 percent of the patients with stroke were tested for SARS-CoV-2.

"Lack of uniform testing practices around the world demonstrates the urgent need for increased SARS-CoV-2 testing among pediatrics patients with stroke given what is known both about stroke in adult patients with SARS-CoV-2 and about viruses that trigger stroke in children," the researchers wrote.

ICYMI

Catch up on our headlines from our Feb. 19 In the News:

• Stephen Hunger, MD, Chief of Division Oncology, Featured in 'TODAY Show' Story
• Benefits of Fetal Surgery for Spina Bifida Extend Beyond Early Childhood
• What are Effects of Population Level Exposures and the Pandemic on Preterm Births?
• Postdoctoral Diversity Fellow, Mallory Perry, PhD, RN, Awarded Impact Grant
• Socioeconomic Factors Linked to Neurodevelopment Deficits in Patients with TOF

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