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Medscape
an hour ago
- Health
- Medscape
Severe Neonatal Illness Predicts Mortality Into Adolescence
Severe neonatal morbidity (SNM) significantly increased the risk for death from infancy through late adolescence, particularly for neurologic conditions. Female infants and those born term with SNM faced higher relative mortality risks. METHODOLOGY: Researchers conducted a population-based cohort study using data from the Swedish Medical Birth Register to assess the association between SNM and all-cause and cause-specific mortality from infancy to adolescence. This study included 2,098,752 live-born singleton infants born between 2002 and 2021, of whom 49,225 (2.4%) were diagnosed with SNM (defined as respiratory infections or neurologic or procedural complications within 27 days of birth). Mortality was classified on the basis of age as infancy (28 days to 11 months), early childhood (1-4 years), later childhood (5-9 years), and adolescence (≥ 10 years). Primary outcomes were all-cause and cause-specific mortality from 28 days to a follow-up duration of 21.2 years. TAKEAWAY: The mortality rate was 1.81 vs 0.13 per 1000 person-years among children with SNM vs those without SNM (adjusted hazard ratio [aHR], 5.92; 95% CI, 5.27-6.64). Neurologic morbidity had the strongest association (aHR, 17.67; 95% CI, 15.08-20.71). Female children with SNM had a higher risk for mortality than male children (aHR, 7.28 vs 4.97; P for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. for interaction < .001), with the association between SNM and neurologic morbidity notably stronger among female children. Among children aged 1 year or older, SNM was strongly associated with deaths from neurologic diseases (aHR, 18.64; 95% CI, 12.51-27.79), circulatory diseases (aHR, 5.41; 95% CI, 2.67-10.94), and metabolic disorders (aHR, 3.56; 95% CI, 1.70-7.44). Among children with SNM, those born preterm had higher absolute mortality rates than those born term (2.76 vs 1.30 per 1000 person-years); however, infants born term showed a stronger relative risk than those born preterm (aHR, 7.16 vs 3.51). IN PRACTICE: "Efforts to further prevent severe neonatal morbidity, ensure early identification, and provide long-term follow-up care may help reduce mortality and inform discussions with families regarding prognosis and follow-up needs," the authors wrote. SOURCE: This study was led by Hillary Graham, MS, Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden. It was published online on June 10, 2025, in JAMA Pediatrics . LIMITATIONS: This study included over 20 years of follow-up; mortality data became limited beyond 15 years. Lower early-life survival in the earliest birth cohort may have led to survivor bias, potentially underestimating the long-term risk for mortality. Although the sibling-controlled analysis helps address familial confounding, it may still be affected by unmeasured differences between siblings. DISCLOSURES: This study was supported by grants from the Swedish Research Council and Stockholm City Council, ALF Medicine. The authors reported having no conflicts of interest.
Yahoo
8 hours ago
- Health
- Yahoo
Something in Your Poop May Predict an Imminent Death
The contents of a patient's entrails could be key to assessing how close they are to death. No, it's not some form of living haruspicy. A team of doctors led by Alexander de Porto of the University of Chicago and the University of Amsterdam has created an index of markers in a patient's feces that can help gauge the risk of mortality within 30 days. They have named it the metabolic dysbiosis score (MDS), and it could help save the lives of critically ill patients in medical intensive care. Their results, they caution, require further investigation and validation, but offer exciting promise as a future tool for diagnostic medicine. "The findings suggest that fecal metabolic dysbiosis, quantified through the MDS, holds potential as a biomarker to identify critically ill patients at increased risk of mortality," de Porto and his colleagues, Eric Pamer and Bhakti Patel of the University of Chicago, told ScienceAlert. "This underscores the importance of gut-derived metabolites as independent contributors to host resilience, offering an avenue for precision medicine." Critically ill patients admitted to intensive care units often develop severe syndromes such as sepsis and acute respiratory distress – but these syndromes don't always develop and evolve in the same way. This heterogeneity poses a huge challenge for trying to treat these patients; two patients with the same syndrome may respond to the same treatment very differently. One way to circumvent this challenge, the researchers said, is to identify specific traits to treat rather than attacking the whole syndrome at once. Scientists know that critically ill patients often have reduced diversity in their gut microbiota, as well as altered concentrations of the metabolites produced by their microbiomes. De Porto and his colleagues embarked on an investigation into dysbiosis, an imbalance in the gut microbiome, in critically ill patients, as a trait that could be treated. They studied fecal samples collected from 196 patients exhibiting respiratory failure or shock, dividing them into a training cohort of 147 patients and a validation cohort of 49 patients. They used these samples to develop the MDS, based on concentrations of 13 distinct fecal metabolites. The results indicate an auspicious avenue for further investigation. "The MDS performed well in predicting mortality in the training cohort of medical ICU patients, with 84 percent accuracy, 89 percent sensitivity, and 71 percent specificity," the researchers said. "However, the validation cohort, despite showing similar trends, failed to reach statistical significance, probably due to its smaller sample size. These findings highlight the promise of the MDS but also underscore the necessity to validate its predictive capacity and generalizability in independent cohorts before widespread application." What the researchers found particularly interesting is that, even though a lack of diversity in the microbiome has previously been associated with adverse outcomes in critically ill patients, they could find no such link. Instead, their results showed a strong link between dysbiosis and increased mortality risk, suggesting that an imbalance in the microbiome plays a crucial role in patient health. A lot more work needs to be done before the team's approach is suitable for clinical application. The null result in the validation cohort of just 47 patients shows that quite a bit of refinement is required. However, there are several encouraging points. The lab has shown, for instance, that fecal metabolites can identify liver transplant patients who have a higher risk of developing a post-operative infection. In addition, while specific treatments have not yet been investigated or identified, the MDS indicates some pathways for further exploration. "The metabolites comprising the score, such as short-chain fatty acids, bile acids, and tryptophan metabolites, point to biological pathways that might be targeted therapeutically," the researchers said. "Potential interventions might include dietary changes, administration of probiotics, or direct supplementation with these metabolites." The next step is to work on validating MDS in new sets of patients, and to examine whether the link between the observed dysbioses and the increased mortality risk is causal or symptomatic of another cause. "Subsequently," the researchers said, "intervention trials targeting specific metabolites or metabolic pathways are necessary to assess therapeutic benefits." The research has been published in Science Advances. Long-Term Contraceptive Pill Use Linked With Brain Tumor Risk Just One Night of Poor Sleep Can Change How Your Brain Sees Food Insulin Isn't Just Made by The Pancreas. Here's Another Location Few Know About.
Medscape
20-05-2025
- Health
- Medscape
Does Weight Gain After Breast Cancer Affect Outcome?
Women who gain a more substantial amount of weight after being diagnosed with breast cancer face an increased risk of dying from the disease, according to findings from a new study. However, that higher mortality risk only appears to apply to women who are overweight or at a healthy weight before diagnosis, not to those who are obese prediagnosis, explained lead study author Sixten Harborg, MD, PhD, with Aarhus University, Aarhus, Denmark, who presented the findings at European Society for Medical Oncology (ESMO) Breast Cancer 2025. Obesity at breast cancer diagnosis is associated with dismal prognosis, but the effect of postdiagnosis weight change remains underinvestigated and 'the evidence is inconclusive,' Harborg told attendees. The researchers set out to identify weight gain thresholds associated with breast cancer mortality using the prospective Nurses' Health Study. Harborg and colleagues focused on a subpopulation of 6803 women with nonmetastatic breast cancer and calculated the relative weight change from prediagnosis and postdiagnosis weight records as percentage of weight change from the last reported prediagnosis weight to the first postdiagnosis weight. Weight change was classified as stable weight (−2% to +2%), moderate weight loss (−2% to −5%), major weight loss (< −5%), moderate weight gain (+2% to +5%), and major weight gain (> +5%). Overall, 1179 women died of breast cancer during a median follow-up of 8.5 years. Compared with women with stable weight after diagnosis, women with major weight gain had an increased risk for breast-cancer mortality (adjusted hazard ratio [aHR], 1.26). The increased risk associated with major weight gain after diagnosis was observed in women with healthy weight or overweight before diagnosis (aHR, 1.32 and 1.37, respectively) but not in those with obesity before diagnosis (aHR, 1.01). There was also a trend towards increased breast cancer mortality in women with major weight loss, although this was not statistically significant (aHR, 1.14; 95% CI, 0.96-1.34), and moderate weight gain or loss was not associated with increased mortality risk. Those who are overweight or a healthy weight at diagnosis seem to be most affected by weight gain post-diagnosis, Harborg concluded. Invited discussant for the study, Hope Rugo, MD, with University of California San Francisco Comprehensive Cancer Center, said the effect of weight gain on breast cancer mortality is 'fascinating.' That the risk was seen only in women at a healthy weight or overweight at diagnosis is 'presumably because those who are obese at the start already have a higher risk of mortality from breast cancer,' said Rugo. Rugo noted that in a recent meta-analysis of 64 studies looking at weight change in relation to breast cancer prognosis, higher postdiagnosis body mass index (BMI) was associated with an increased all-cause mortality, breast cancer–specific mortality, and second primary breast cancer. So, what can be done? 'The BWEL trial stands out as a trial that may help us understand what the benefit of weight loss [is],' Rugo told attendees. That trial enrolled more than 3100 overweight or obese women (BMI ≥ 27) with stages II-III breast cancer diagnosed within the past 14 months who had completed treatment. The study team showed that a telephone-based weight loss intervention led to clinically meaningful weight loss and sustained weight loss over 12 months, which was associated with improved metabolic markers and insulin resistance. Rugo also noted that in the Prospective Studies of Diet and Cancer study, compared with stable weight, sustained weight loss, even modest amounts, was associated with a lower risk of developing breast cancer for women aged 50 years or older. 'We still don't know what weight loss does,' she concluded. But 'we know that prevention of weight gain is better, and we will look to the BWEL study over time, as well as exercise intervention studies that are ongoing for more insights.'
