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Biomedical subjects

Kenneth J Moise

Publications and source records attributed to Kenneth J Moise.

At least 19 recordsLinked to original sources
PubMed2026

Paediatric outcomes after maternal nipocalimab for haemolytic disease of the fetus and newborn: an open-label, single-arm study.

OBJECTIVES: To describe haemolytic disease outcomes, growth, neurodevelopment and health-related quality of life (HRQoL) through 24 months of life in infants exposed to nipocalimab in pregnancies at high risk of early-onset severe haemolytic disease of the fetus and newborn (EOS-HDFN). DESIGN: A multicentre, open-label, single-arm trial. SETTING: Centres with expertise in HDFN management. PATIENTS: Pregnant individuals with previous EOS-HDFN and maternal anti-D titres &#x2265;32&#x2009;or anti-K titres &#x2265;4. INTERVENTIONS: Weekly nipocalimab (30 and/or 45 mg/kg) from 14 to 35&#x2009;gestational weeks. MAIN OUTCOME MEASURES: Infants' cord-blood alloantibody titres at birth, HDFN management, growth through 6 months, neurodevelopment (caregiver-reported Ages and Stages Questionnaire, third edition (ASQ-3)) and HRQoL assessments through 24 months of life. RESULTS: Of 13 pregnancies, 12 resulted in live births; one fetal loss occurred due to intrauterine transfusion (IUT) complications. A single simple transfusion was administered in one of seven infants delivered after a maternal nipocalimab course without IUTs, where cord blood alloantibody titres were <8. Multiple transfusions (one to seven&#x2009;simple transfusions/infant; one exchange transfusion) were administered to five infants delivered after early nipocalimab discontinuation and IUTs, with cord-blood alloantibody titres ranging from 512 to 32 768. No unusual growth patterns were observed through 6 months. No neurodevelopmental delays were identified through 24 months of life, with mean ASQ-3 domain scores within normal ranges. HRQoL outcomes were positive across physical, emotional, social and cognitive functioning. CONCLUSIONS: Maternal nipocalimab in pregnancies at high risk of EOS-HDFN may reduce adverse neonatal outcomes correlating with low cord-blood alloantibody titres, without affecting growth through 6 months, neurodevelopment or HRQoL through 24 months of life. TRIAL REGISTRATION NUMBER: NCT03842189.

Child Health↗
PubMed2006

A randomized controlled trial of acupuncture for initiation of labor in nulliparous women.

OBJECTIVE: To evaluate the utility of outpatient acupuncture for labor stimulation. METHODS: Nulliparous women at 39 4/7 weeks or greater with a singleton gestation and Bishop score of less than 7 were randomized to usual medical care (control group) versus usual care and three outpatient acupuncture treatments (acupuncture group). Each treatment consisted of eight needles applied to bilateral points LI4, SP6, UB31, and UB32. The primary outcome was time elapsed from the time of randomization to delivery. Secondary outcomes included rates of cesarean section and induction of labor. Medical records were abstracted for maternal demographic, medical, and delivery outcome data. A priori sample size calculation revealed that 56 women were required to detect a 72-hour difference in delivery time with a power of 83% and an alpha of 0.05. Student's t-test, Chi-square, and Kaplan-Meier statistics were used to compare groups. RESULTS: Fifty-six women were randomized and completed the study procedures. Race, age, gestational age, and cervical Bishop score were similar in both groups. Mean time to delivery occurred 21 hours sooner in the acupuncture group, but this difference did not reach statistical significance (p = 0.36). Compared to controls, women in the acupuncture group tended to be more likely to labor spontaneously (70% vs. 50%, p = 0.12) and less likely to deliver by cesarean section (39% vs. 17%, p = 0.07). Of women who were not induced, those in the acupuncture group were more likely to be delivered than the controls at any point after enrollment (p = 0.05). CONCLUSION: Acupuncture is well tolerated among term nulliparous women and holds promise in reducing interventions that occur in post-term pregnancies.

Acupuncture Therapy↗
PubMed2005

Antenatal maternal administration of phenobarbital for the prevention of exchange transfusion in neonates with hemolytic disease of the fetus and newborn.

OBJECTIVE: Hemolytic disease of the fetus and newborn infant (HDFN) can be associated with bilirubin encephalopathy, which is usually averted through neonatal exchange transfusions (EXT). However, EXT can be associated with significant procedure-related morbidity. We hypothesized that maternal oral administration of phenobarbital (PB) to women with HDFN would reduce the rate of EXT. STUDY DESIGN: Cases of HDFN from January 1985 to June 2003 were reviewed. All patients who underwent serial intrauterine transfusions (IUTs) for red cell alloimmunization were included. Patients were offered oral phenobarbital (30 mg 3 times a day) after their last IUT in an effort to enhance fetal hepatic maturity. Variables studied included gestational age and hemoglobin multiples of the median at first transfusion and delivery, peak neonatal bilirubin, need for exchange transfusion, and maternal PB administration. Multivariate regression analysis was applied to determine relative risks and 95% CIs. RESULTS: Seventy-one patients met study criteria; 29% of the neonates underwent EXT. The use of antenatal PB was associated with a decreased incidence of EXT, 9% versus 52% ( P < .01). After controlling for confounding variables, the relative risk for EXT after antenatal PB administration was 0.23 (95% CI: 0.06-0.76). CONCLUSION: Maternal administration of PB reduces the need for neonatal EXTs in HDFN.

Adult↗
PubMed2005

Chronic maternal and fetal Porphyromonas gingivalis exposure during pregnancy in rabbits.

OBJECTIVE: This study was undertaken to develop a rabbit model of maternal exposure to Porphyromonas gingivalis and determine whether fetal or placental exposure occurs. STUDY DESIGN: Subcutaneous steel chambers were implanted in 8 New Zealand White female rabbits. On day 7 of pregnancy, 4 rabbits were inoculated through the chamber with 5 x 10 8 CFU/mL live P gingivalis , and 4 rabbits with broth (controls) and sacrificed at term. Polymerase chain reaction was used to detect P gingivalis in maternal and fetal liver and placenta. Fisher exact test was used to compare P gingivalis detection between groups. RESULTS: Among exposed does, P gingivalis was detected in 33% of the maternal livers, 49% of placentas, and 34% fetal livers compared with none from controls ( P < .001). CONCLUSION: Chronic maternal exposure to P gingivalis results in systemic dissemination, transplacental passage, and fetal exposure. This model may be useful to study placental and fetal effects of this oral pathogen and to study microbial dissemination across the placenta.

Animals↗
PubMed2005

A randomized trial of amnioreduction versus septostomy in the treatment of twin-twin transfusion syndrome.

OBJECTIVE: Left untreated, severe twin-to-twin transfusion syndrome (TTTS) presenting in the early second trimester of pregnancy is often associated with significant maternal morbidity and almost universal perinatal loss. Removal of excessive amounts of amniotic fluid through serial amniocenteses (amnioreduction) has been the mainstay of therapy. We sought to compare amnioreduction to intentional perforation of the intervening twin membrane (septostomy). STUDY DESIGN: Pregnant women with TTTS before 24 weeks' gestation were randomly assigned to serial amnioreduction or septostomy. A single puncture technique under ultrasound guidance was used for the septostomy. The primary outcome measure was survival to neonatal discharge, and was assessed based on the number of pregnancies or the number of fetuses as appropriate. RESULTS: The study was terminated at the planned interim analysis stage after 73 women were enrolled. This was because the rate of survival of at least 1 infant was similar in the amnioreduction group compared to the septostomy group (78% vs 80% of pregnancies, respectively; RR=0.94, 95%CI 0.55-1.61; P=.82). Patient undergoing septostomy were more likely to require a single procedure for treatment (64% vs 46%; P=.04). CONCLUSION: Although overall perinatal survival is not enhanced, septostomy offers the advantage of often requiring a single procedure compared to serial amnioreduction in the treatment of severe twin-to-twin transfusion syndrome.

Amniotic Fluid↗
PubMed2005

Impact of maternal-fetal surgery for myelomeningocele on the progression of ventriculomegaly in utero.

OBJECTIVE: Intrauterine myelomeningocele (MMC) repair decreases hindbrain herniation and the need for postnatal ventriculoperitoneal shunting. We examined the impact of intrauterine repair on the progression of ventriculomegaly in utero. STUDY DESIGN: Fetuses with MMC were identified through computerized databases from June 1988 to April 2003. A retrospective cohort design was used to evaluate the impact of intrauterine repair on ventricular progression with a multivariate linear regression model that included baseline ventricle measurement, gestational age, level of lesion, and gender. RESULTS: Fourteen fetuses with intrauterine repair and 39 fetuses with postnatal repair were identified. The natural history of progression of ventricular diameter increased in a linear fashion throughout gestation (0.57 mm/week). After adjusting for confounding variables, no transient or sustained difference was observed in the rate progression of ventriculomegaly between intrauterine and postnatal repair (0.27 +/- 0.35 mm/week; P=.45). CONCLUSION: Intrauterine MMC repair does not impact the progression of ventriculomegaly.

Cerebral Ventricles↗
PubMed2005

Insulin-like growth factor and interleukin-1beta levels and subsequent fetal size in response to chronic Porphyromonas gingivalis exposure in the pregnant rabbit.

OBJECTIVE: The purpose of this study was to describe maternal insulin-like growth factor, interleukin-1beta, and fetal size in a rabbit model of Porphyromonas gingivalis exposure. STUDY DESIGN: With the use of a previously described model, 8 New Zealand White rabbits were exposed to either P gingivalis or media during pregnancy and killed at term. Kit and placenta weight were compared between groups. Doe serum insulin-like growth factor system protein and interleukin-1beta levels were compared by analysis of variance for repeated measures; a probability value of <.05 was considered to be significant. RESULTS: No significant differences in kit and placental weights between exposed and unexposed groups were observed. Insulin-like growth factor system proteins increased significantly as pregnancy progressed, but there were no significant differences in insulin-like growth factor system proteins or interleukin-1beta between exposed and unexposed does. CONCLUSION: Chronic P gingivalis exposure does not disrupt insulin-like growth factor system proteins or systemic inflammation and does not impair fetal growth in the pregnant rabbit. Gestational age changes in doe insulin-like growth factor system proteins occur, and the timing of exposure to oral pathogens may influence fetal growth.

Animals↗
PubMed2005

The impact of gestational age on the sonographic detection of aneuploidy.

OBJECTIVE: The purpose of this study was to identify the influence of gestational age on the detection of sonographic markers of aneuploidy. STUDY DESIGN: Using a retrospective chart review, cases of trisomy 13, 18, and 21 with fetal ultrasounds between 14 1/7 and 36 4/7 weeks' gestation were identified. Sonographic markers were subdivided into major abnormalities and "soft" sonographic markers: nuchal thickening > or = 5 mm, humerus or femur length <10th percentile, intracardiac echogenic focus, echogenic bowel, pyelectasis > or = 4 mm, and choroid plexus cysts. Markers were stratified by karyotype and gestational age. RESULTS: Fifteen fetuses with trisomy 13, 32 with trisomy 18, and 49 with trisomy 21 were identified. There was no difference in the prevalence of ultrasound markers by gestational age (P = .40). Soft markers were more common in the second trimester of pregnancy (P = .006) with a trend toward increased prevalence of major anomalies with advancing gestation (P = .22). CONCLUSION: Although sonographic markers change with gestational age, these markers are present throughout gestation and can provide clinically useful information to guide patient counseling.

Adult↗
PubMed2005

Correlation between middle cerebral artery peak systolic velocity and fetal hemoglobin after 2 previous intrauterine transfusions.

OBJECTIVE: The middle cerebral artery peak systolic velocity (MCA-PSV) has been successfully used for timing the first 2 transfusions in fetuses at risk for anemia because of maternal red cell alloimmunization. The objective of this study was to assess whether the correlation between the MCA-PSV and fetal hemoglobin is maintained in fetuses that had undergone 2 previous intrauterine transfusions. STUDY DESIGN: Doppler measurement of MCA-PSV was performed before cordocentesis in 39 fetuses. The timing of the third transfusion was based on traditional criteria. The values of MCA-PSV and hemoglobin were expressed as multiples of the median (MoM). Anemia was defined as mild (hemoglobin <0.84 MoM for a given gestational age, moderate (hemoglobin <0.65 MoM), and severe (hemoglobin <0.55 MoM). Regression analysis was used to assess the correlation between the MCA-PSV MoM and fetal hemoglobin MoM. RESULTS: Gestational age at Doppler study ranged from 22 to 35 weeks. Six fetuses (15%) had normal hemoglobin concentration; 21 (53%) had mild anemia; 7 (20%) had moderate anemia; and 5 (12%) had severe anemia. There was a linear correlation between fetal hemoglobin (y) and the MCA-PSV (x): y = 1.185 - 0.341x. CONCLUSION: Previously, concerns have been expressed about the accuracy of Doppler prediction of anemia after previous transfusions. Our data suggest that there is a good correlation between the MCA-PSV and fetal hemoglobin in fetuses that have undergone 2 previous transfusions. Our findings expand the clinical situation in which Doppler can be used to monitor red cell alloimmunized pregnancies.

Anemia↗
PubMed2005

Red blood cell alloimmunization in pregnancy.

Red blood cell (RBC) alloimmunization in pregnancy continues to occur despite the widespread use of both antenatal and postpartum Rhesus immune globulin (RhIG), due mainly to inadvertent omissions in administration as well as antenatal sensitization prior to RhIG given at 28 weeks' gestation. Additional instances are attributable to the lack of immune globulins to other RBC antigens. Evaluation of the alloimmunized pregnancy begins with the maternal titer. Once a critical value [32 for anti-Rh(D) and other irregular antibodies; 8 for anti-K and -k] is reached, fetal surveillance using serial Doppler ultrasound measurements of the peak velocity in the fetal middle cerebral artery (MCA) is standard. In the case of a heterozygous paternal phenotype, amniocentesis can be performed to detect the antigen-negative fetus that requires no further evaluation. MCA velocities greater than 1.5 multiples of the median necessitate cordocentesis, and if fetal anemia is detected, intrauterine transfusion therapy is initiated. A perinatal survival of greater than 85% with normal neurologic outcome is now expected. Future therapies will target specific immune manipulations in the pregnant patient.

Algorithms↗
PubMed2005

Twin pregnancy complicated by severe hemolytic disease of the fetus and newborn due to anti-g and anti-C.

BACKGROUND: Hemolytic disease of the fetus and newborn caused by anti-G antibodies is rare, and in most previously reported cases, leads to a mild anemia. The RhG antigen is usually found in association with both RhD and RhC. We report a case of a twin pregnancy affected by both anti-G and anti-C alloantibodies leading to severe hemolytic disease of the fetus and newborn requiring multiple intrauterine transfusions and prolonged postnatal therapy. CASE: A patient with a prolonged history of previously affected pregnancies due to anti-D and anti-C was subsequently found to be affected with anti-G instead. She required aggressive therapy during her pregnancy, initially with intravenous immune globulin and plasmapheresis until umbilical blood sampling and intrauterine transfusions were feasible. CONCLUSION: Although hemolytic disease of the fetus and newborn due to anti-G antibodies is rare and usually mild, these pregnancies should be followed up closely and in utero therapy should be offered if necessary.

Adult↗
PubMed2005

Preventability of pregnancy-related deaths: results of a state-wide review.

OBJECTIVE: Although the risk of death from complications of pregnancy in the 20th century has decreased dramatically, several lines of evidence suggest that it has not reached an irreducible minimum. To further reduce pregnancy-related mortality, we must understand which deaths are potentially preventable and the changes needed to prevent them. We sought to identify all pregnancy-related deaths in North Carolina and conduct a comprehensive review examining ways in which the number of these deaths could potentially be reduced. METHODS: The North Carolina Pregnancy-Related Mortality Review Committee reviewed all of the 108 pregnancy-related deaths (women who died during or within 1 year of the end of pregnancy from a complication of pregnancy or its treatment) that occurred in the state in 1995-1999. For each death, the committee determined the cause of death, whether it could have been prevented, and if so, the means by which it might have been prevented. RESULTS: Although overall, 40% of pregnancy-related deaths were potentially preventable, this varied by the cause of death. Almost all deaths due to hemorrhage and complications of chronic diseases were believed to be potentially preventable, whereas none of the deaths due to amniotic fluid embolus, microangiopathic hemolytic syndrome, and cerebrovascular accident were considered preventable. Improved quality of medical care was considered to be the most important factor in preventing these deaths. Among African-American women, 46% of deaths were potentially preventable, compared with 33% of the deaths among white women. CONCLUSION: Despite the decline in pregnancy-related mortality rates, almost one half of these deaths could potentially be prevented, mainly through improved quality of medical care. In-depth review of pregnancy-related deaths can help determine strategies needed to continue making pregnancy safer.

Adolescent↗
PubMed2005

Umbilical cord stem cells.

Until recently, blood that remained in the umbilical cord and placenta after delivery was routinely discarded. Now that this blood is known to contain both hematopoietic stem cells and pluripotent mesenchymal cells, there has been a substantial increase in the clinical use and research investigation of umbilical cord blood in hematopoietic transplantation and regenerative medicine. Until now, standards for collection and processing were not well established. The debate continues regarding the private banking of autologous blood for "biologic insurance" versus public banking for access by the general population. Obstetricians should support the acquisition of cord units for public banking in their geographic location where cord blood banks have established collection procedures. Issues related to cost, quality control, and the need for ethnic diversity in public banks preclude the universal collection of units from all obstetric deliveries. Directed donation of cord blood should be considered when there is a specific diagnosis of a disease within a family known to be amenable to stem cell transplantation.

Blood Banks↗
PubMed2004

Use of maternal plasma for noninvasive determination of fetal RhD status.

Determination of the fetal RhD typing using free fetal DNA in maternal plasma is beginning to enjoy widespread acceptance in Europe. Case 1, the partner of an RhD-sensitized patient, was identified with a heterozygous paternal phenotype by serologic testing. Maternal plasma was drawn at 18 weeks' gestation to determine the fetal RhD status. The result was unable to be reported as RhD negative; the patient subsequently underwent amniocentesis to confirm an RhD-negative fetus. Case 2, a partner of another RhD-sensitized patient, was similarly identified with a heterozygous paternal phenotype by serologic testing. Maternal plasma was also drawn at 18 weeks' gestation to determine the fetal RhD status. It returned RhD negative and allowed for the avoidance of invasive testing for the remainder of the pregnancy. Therefore, maternal plasma testing for fetal RhD status represents a new tool in the management of the cases of RhD alloimmunization in pregnancy.

Adult↗