Biomedical subjects

Morton B Brown

Publications and source records attributed to Morton B Brown.

36 records · Page 2Linked to original sources

PubMed2005

Elevated maternal glucose concentrations and placental infection in twin pregnancies.

OBJECTIVE: To evaluate the association between maternal screening glucose concentration and placental infection in nondiabetic twin pregnancies. STUDY DESIGN: One thousand sixty-one nondiabetic twin pregnancies at > or =28 weeks' gestation were divided into 3 groups based on the screening 50-g fasting glucose concentration at 24-28 weeks: lowest quartile (< 96 mg/dL), middle 2 quartiles (96-128 mg/dL) and upper quartile (> 128 mg/dL). Outcomes were modeled using general linear and multinomial logistic regression, controlling for confounding factors. RESULTS: The middle and highest glucose groups were associated with increased risks for clinical chorioamnionitis (adjusted OR [AOR] 3.18, 95% CI 1.34, 7.54; AOR 6.80, CI 1.89, 24.53, respectively). Birth at <32 weeks and histologic diagnosis of placental infection (chorioamnionitis, funisitis, necrosis, vasculitis or villitis) were significantly associated only with the highest glucose group (AOR 1.79, CI 1.02, 3.13; AOR 6.95, CI 1.10, 8.68, respectively). CONCLUSION: Elevated screening glucose in nondiabetic twin pregnancies may be a marker of placental inflammation and infection.

Adult↗

PubMed2004

Fetal phenotypes and neonatal and early childhood outcomes in twins.

OBJECTIVES: The purpose of this study was to evaluate factors associated with, and postnatal consequences of, altered patterns of fetal growth in twins. STUDY DESIGN: Fetal growth was measured at 28 weeks' gestation on 218 twins, including head circumference, abdominal circumference, and femur length, and characterized as > or < or =10th %ile; children were followed up until the age of three years. Logistic regression was used to generate odds ratios of perinatal factors associated with reduced fetal growth. RESULTS: Maternal height <62 inches was associated with reductions in femur length (adjusted odds ratio [AOR] 3.88, 95% CI 1.42-10.57) and abdominal circumference (AOR 8.63, 95% CI 2.41-30.94), while primiparity had a protective effect on both of these fetal measurements (AOR 0.28, 95% CI 0.13-0.64, and AOR 0.18, 95% CI 0.06-0.60, respectively), as well as head circumference (AOR 0.32, 95% CI 0.15-0.69). Smoking adversely affected femur and head growth (AOR 24.10, 95% CI 3.69-157.57, and AOR 10.82, 95% CI 1.73-67.79, respectively). Fetal reduction adversely affected femur and abdomen growth (AOR 5.85, 95% CI 1.52-22.51 and AOR 4.90, 95% CI 1.01-23.86, respectively), and monochorionicity and maternal weight gain <0.65 lb/wk before 20 weeks adversely affected femur growth (AOR 5.47, 95% CI 1.65-18.10, and AOR 3.39, 95% CI 1.34-8.59, respectively). At age 3 years, all categories of twins with reduced growth by 28 weeks' gestation were significantly shorter in height, and those with reduced abdominal circumference or head circumference at 28 weeks were also significantly lighter in weight compared with twins with adequate fetal growth by 28 weeks' gestation. CONCLUSION: These data identify short maternal height, smoking, monochorionicity, fetal reduction, and inadequate weight gain before 20 weeks as risk factors associated with reduced twin fetal growth by 28 weeks' gestation and significant residual reductions in height and weight through 3 years of age.

Body Height↗

PubMed2004

Basal circadian and pulsatile ACTH and cortisol secretion in patients with fibromyalgia and/or chronic fatigue syndrome.

The objective of this study was to evaluate and compare the basal circadian and pulsatile architecture of the HPA axis in groups of patients with FMS, CFS, or both syndromes with individually matched control groups. Forty patients with either FMS (n = 13), FMS and CFS (n = 12), or CFS (n = 15) were matched by age (18-65), sex, and menstrual status to healthy controls. Subjects were excluded if they met criteria for major Axis I psychiatric disorders by structured clinical interview (SCID). Subjects were admitted to the General Clinical Research Center where meals and activities were standardized. Blood was collected from an intravenous line every 10 min over 24 h for analysis of ACTH and cortisol. Samples were evaluable for ACTH in 36 subject pairs and for cortisol in 37 subject pairs. There was a significant delay in the rate of decline from acrophase to nadir for cortisol levels in patients with FMS (P <.01). Elevation of cortisol in the late evening quiescent period was evident in half of the FMS patients compared with their control group, while cortisol levels were numerically, but not significantly, lower in the overnight period in patients with CFS compared with their control group. Pulsatility analyses did not reveal statistically significant differences between patient and control groups. We conclude that the pattern of differences for basal circadian architecture of HPA axis hormones differs between patients with FMS and CFS compared to their matched control groups. The abnormalities in FMS patients are consistent with loss of HPA axis resiliency.

Adrenocorticotropic Hormone↗

PubMed2004

Risk factors for adverse outcomes in spontaneous versus assisted conception twin pregnancies.

OBJECTIVE: To evaluate risk factors for adverse outcomes in spontaneous vs. assisted conception twin pregnancies. DESIGN: Historical cohort study. SETTING: Four academic tertiary medical centers. PATIENT(S): Women with twin pregnancies, including 2,143 spontaneous and 424 assisted conception; 2,492 nonreduced and 75 reduced. INTERVENTION(S): None (observational). MAIN OUTCOME MEASURE(S): Preeclampsia, preterm premature rupture of membranes, birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth (<10th percentile between 20 and 28 weeks). RESULT(S): Among nonreduced pregnancies, assisted conception was not significantly associated with any adverse outcomes; among nulliparas, the risk for preeclampsia was increased regardless of method of conception; among spontaneous conceptions, the risks for preterm premature rupture of membranes, low birth weight, very low birth weight, and slowed midgestation fetal growth were increased. Among all pregnancies, fetal reduction increased risks for birth <32 weeks and <30 weeks, low birth weight, very low birth weight, and slowed midgestation fetal growth. Among nulliparas with assisted conceptions, fetal reduction increased the risks for birth <30 weeks, very low birth weight, and slowed midgestation fetal growth. CONCLUSION(S): These findings indicate that in twin pregnancies, assisted conception is not a risk factor for adverse outcomes, but rather specific factors that are more common among these pregnancies, such as nulliparity and fetal reduction, increase risks.

Adult↗

PubMed2004

Control groups appropriate for surgical interventions: ethical and practical issues.

Surgical trials differ in several critical aspects from pharmaceutic trials because they are invasive and the procedure itself may carry a significant risk. The surgical procedure cannot be fully specified in advance; although the general approach may be the same, the exact methods used during surgery may differ. Surgeons may have different levels of skill and experience with the techniques; experience is known to affect success rates. Sham surgeries are difficult to justify ethically, yet they have been successful in showing that accepted surgical procedures were not efficacious. Double masking participants in a surgical trial may be difficult; for example, we cannot mask the surgeon. There is also a need to minimize or avoid bias. Therefore, greater flexibility is needed in the design of surgical trials than in the design of pharmaceutic trials. Some of this flexibility is possible through the use of more sophisticated statistical designs. At times, it is necessary to separate the provider of the treatment (the surgeon) from the evaluator of the success of the treatment (a different physician, research nurse, or study coordinator).

Ethics, Medical↗

PubMed2004

A population pharmacokinetic model with time-dependent covariates measured with errors.

We propose a population pharmacokinetic (PK) model with time-dependent covariates measured with errors. This model is used to model S-oxybutynin's kinetics following an oral administration of Ditropan, and allows the distribution rate to depend on time-dependent covariates blood pressure and heart rate, which are measured with errors. We propose two two-step estimation methods: the second-order two-step method with numerical solutions of differential equations (2orderND), and the second-order two-step method with closed form approximate solutions of differential equations (2orderAD). The proposed methods are computationally easy and require fitting a linear mixed model at the first step and a nonlinear mixed model at the second step. We apply the proposed methods to the analysis of the Ditropan data, and evaluate their performance using a simulation study. Our results show that the 2orderND method performs well, while the 2orderAD method can yield PK parameter estimators that are subject to considerable biases.

Biometry↗

PubMed2004

The prevalence of the metabolic syndrome among arab americans.

OBJECTIVE: To estimate the prevalence of the metabolic syndrome in Arab Americans by age, sex, and BMI and to examine the association between insulin resistance and each of the components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: We studied a representative, cross-sectional, population-based sample of 542 Arab Americans aged 20-75 years. The metabolic syndrome was defined by Adult Treatment Panel III (ATP III) and World Health Organization (WHO) diagnostic criteria. Insulin resistance was estimated by homeostasis model assessment (HOMA-IR). RESULTS: The age-adjusted prevalence of the metabolic syndrome was 23% (95% CI 19-26%) by the ATP III definition and 28% (24-32%) by the WHO definition. Although the prevalence increased significantly with age and BMI in both sexes by both definitions, differences in estimates were noted. With ATP III, the age-specific rates were similar for men and women aged 20-49 years but were significantly higher for women aged >/=50 years. With WHO, rates were higher for men than women aged 20-49 years and similar for those aged >/=50 years. The most common component of the metabolic syndrome in men and women was low HDL cholesterol with the ATP III and the presence of glucose intolerance and HOMA-IR with the WHO. Strong associations between HOMA-IR and individual components of the metabolic syndrome were observed. After fitting a model with HOMA-IR as the outcome, waist circumference, triglyceride level, and fasting plasma glucose level were significantly associated with HOMA-IR. CONCLUSIONS: The metabolic syndrome is common among Arab Americans and is related to modifiable risk factors.

Adult↗

PubMed2003

Fetal programming: prenatal testosterone excess leads to fetal growth retardation and postnatal catch-up growth in sheep.

Alterations in the maternal endocrine, nutritional, and metabolic environment disrupt the developmental trajectory of the fetus, leading to adult diseases. Female offspring of rats, subhuman primates, and sheep treated prenatally with testosterone (T) develop reproductive/metabolic defects during adult life similar to those that occur after intrauterine growth retardation. In the present study we determined whether prenatal T treatment produces growth-retarded offspring. Cottonseed oil or T propionate (100 mg, im) was administered twice weekly to pregnant sheep between 30-90 d gestation (term = 147 d; cottonseed oil, n = 16; prenatal T, n = 32). Newborn weight and body dimensions were measured the day after birth, and postnatal weight gain was monitored for 4 months in all females and in a subset of males. Consistent with its action, prenatal T treatment produced females and males with greater anogenital distances relative to controls. Prenatal T treatment reduced body weights and heights of newborns from both sexes and chest circumference of females. Prenatally T-treated females, but not males, exhibited catch-up growth during 2-4 months of postnatal life. Plasma IGF-binding protein-1 and IGF-binding protein-2, but not IGF-I, levels of prenatally T-treated females were elevated in the first month of life, a period when the prenatally T-treated females were not exhibiting catch-up growth. This is suggestive of reduced IGF availability and potential contribution to growth retardation. These findings support the concept that fetal growth retardation and postnatal catch-up growth, early markers of future adult diseases, can also be programmed by prenatal exposure to excess sex steroids.

Animals↗

PubMed2003

A randomized trial of colpopexy and urinary reduction efforts (CARE): design and methods.

The primary aim of this randomized clinical trial is to evaluate whether a standardized modified Burch colposuspension, when added to planned abdominal sacrocolpopexy for the treatment of pelvic organ prolapse, improves the rate of urinary stress continence in subjects without preoperative symptoms of stress urinary incontinence. Secondary aims include comparison of immediate and short-term complications, overall urinary tract function, and other aspects of pelvic health between subjects with and without a concomitant Burch. The value of preoperative urodynamic testing with prolapse reduction will also be compared between subjects with and without a concomitant Burch. This trial is performed through the Pelvic Floor Disorders Network, which is funded by the National Institutes of Health-National Institute of Child Health and Human Development. Subjects will be enrolled at seven clinical centers across the United States and data will be analyzed by the central data coordinating center. Standardized questionnaires and physical observations and measurements will be obtained. The surgical team is masked to the preoperative urodynamic findings, and the patient and research coordinator are masked to treatment assignment. The primary outcome will be determined at 3 months after surgery. Stress continence is defined as absence of stress incontinence symptoms by questionnaire, a negative standardized stress test, and no treatment for stress incontinence other than the study intervention. Additional follow-up occurs at 6, 12, and 24 months. Accrual began in April 2002 and is projected to take 3 years. As of March 6, 2003, 91 patients have been randomized. This article highlights the scientific aspects of trial design for this pivotal clinical trial. The optimal approach to the urinary tract in women treated surgically for prolapse is not known. This trial is designed to provide pelvic surgeons and their patients with scientific data regarding the utility of urodynamics with and without prolapse reduction and the role of colposuspension with sacrocolpopexy.

Female↗

PubMed2003

Specialized prenatal care and maternal and infant outcomes in twin pregnancy.

OBJECTIVE: This study was undertaken to evaluate the effect of a prenatal nutrition and education program on twin pregnancy, neonatal, and early childhood outcomes. STUDY DESIGN: This prospective intervention study of women who participated in a specialized program (Program Pregnancies) versus nonparticipants included twice-monthly visits, dietary prescription of 3000 to 4000 kcal per day, multimineral supplementation, and patient education. RESULTS: Program Pregnancies were associated with improved pregnancy outcomes (preeclampsia, adjusted odds ratio [AOR] 0.41, 95% CI, 0.23-0.75; preterm premature rupture of membranes, AOR 0.35, 95% CI, 0.20-0.60; delivery <36 weeks, AOR 0.62, 95% CI, 0.43-0.89; low birth weight, AOR 0.42, 95% CI, 0.29-0.61), significantly longer gestations (+7.6 days), higher birth weights (+220 g), lower neonatal morbidity (retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, or ventilator support, AOR 0.44, 95% CI, 0.31-0.62), length of stay (-5.3 days), and cost per twin (-14,023 dollars). Through 3 years of age, program children were significantly less likely to be rehospitalized (AOR 0.31, 95% CI, 0.11-0.91) or to be developmentally delayed (AOR 0.65, 95% CI, 0.44-0.96). CONCLUSION: Program participation was associated with improved outcomes at birth and through age 3 years.

Adult↗

PubMed2003

Shape-invariant modeling of circadian rhythms with random effects and smoothing spline ANOVA decompositions.

Medical studies often collect physiological and/or psychological measurements over time from multiple subjects, to study dynamics such as circadian rhythms. Under the assumption that the expected response functions of all subjects are the same after shift and scale transformations, shape-invariant models have been applied to analyze this kind of data. The shift and scale parameters provide efficient and interpretable data summaries, while the common shape function is usually modeled nonparametrically, to provide flexibility. However, due to the deterministic nature of the shift and scale parameters, potential correlations within a subject are ignored. Furthermore, the shape of the common function may depend on other factors, such as disease. In this article, we propose shape-invariant mixed effects models. A second-stage model with fixed and random effects is used to model individual shift and scale parameters. A second-stage smoothing spline ANOVA model is used to study potential covariate effects on the common shape function. We apply our methods to a real data set to investigate disease effects on circadian rhythms of cortisol, a hormone that is affected by stress. We find that patients with Cushing's syndrome lost circadian rhythms and their 24-hour means were elevated to very high levels. Patients with major depression had the same circadian shape and phases as normal subjects. However, their 24-hour mean levels were elevated and amplitudes were dampened for some patients.

Analysis of Variance↗

PubMed2003

Neuroendocrine control of follicle-stimulating hormone (FSH) secretion: III. Is there a gonadotropin-releasing hormone-independent component of episodic FSH secretion in ovariectomized and luteal phase ewes?

Our previous studies in ovariectomized ewes have provided direct evidence that FSH secretion is comprised of basal and episodic modes. In those studies, each GnRH pulse coincided with an FSH pulse, but additional FSH pulses were noted. To determine whether non-GnRH-associated pulses of FSH represent a GnRH-independent component of FSH secretion, we determined whether episodic FSH secretion persists after blockade of GnRH action with a GnRH antagonist. Hypophyseal portal and jugular blood was collected from five ovariectomized and six luteal phase ewes at 5-min intervals for 6 h before and 6 h after a single iv injection of Nal-Glu (10 micro g/kg body weight). Hypophyseal portal LH and FSH and jugular patterns of FSH were compared with patterns of GnRH. Before Nal-Glu, in both models, there was a one-to-one concordance between GnRH and portal LH pulses, and each GnRH pulse was associated with a FSH pulse. However, additional non-GnRH-associated pulses of FSH were present. Nal-Glu administration eliminated LH but not FSH pulsatility. Nal-Glu inhibited interaction of GnRH I with GnRH type I receptor but not interaction of GnRH II with type II receptor. These studies provide the first direct evidence of the existence of an acute GnRH I-independent component of episodic FSH secretion.

Animals↗

PubMed2003

Epidemiology of diabetes among Arab Americans.

OBJECTIVE: To examine the prevalence of diabetes and glucose intolerance by age and sex in the Arab-American community of Dearborn, Michigan. RESEARCH DESIGN AND METHODS: Participants were randomly selected adult Arab Americans, 20-75 years of age, from randomly selected households in Dearborn, Michigan. Demographic and anthropometric data were recorded. Glucose tolerance was assessed with 2-h 75-g oral glucose tolerance tests and classified according to 1997 American Diabetes Association and 1998 World Health Organization criteria. RESULTS: A total of 626 eligible adults were selected, and 542 participated (87% response rate). Because prevalence increases with age and the overall response rate for women (328/352; 93%) was higher than that for men (214/274; 78%), prevalence rates were adjusted for age and sex. The overall prevalence of diabetes was 15.5% (95% CI 12.2-18.7%) in women and 20.1% (15.0-25.2%) in men (P = 0.13). The prevalence of previously diagnosed diabetes was similar to that of undiagnosed diabetes. Impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG) were present in 16.8% (12.8-20.8%) of women and 29.7% (23.4-35.9%) of men (P = 0.0007). The combined rates of glucose intolerance (diabetes, IGT, and IFG) were 32.3% (27.8-36.7%) for women and 49.8% (43.1-56.4%) for men (P < 0.0001). Among younger adults, the prevalence in men was higher than that in women. As expected, subjects with diabetes or IGT/IFG were older and had greater BMI and waist-to-hip ratios than subjects with normal glucose tolerance. CONCLUSIONS: The prevalence of diabetes and glucose intolerance is extremely high among adult Arab Americans in Michigan and represents a major clinical and public health problem. Community-based intervention programs to prevent and treat diabetes are urgently needed.

Adult↗

PubMed2003

Lack of acculturation is a risk factor for diabetes in arab immigrants in the US.

OBJECTIVE: To examine the relationship between dysglycemia (impaired fasting glucose, impaired glucose tolerance, and diabetes) and acculturation, physical activity, and perceived stress in Arab immigrants in the U.S. RESEARCH DESIGN AND METHODS: In a cross-sectional population-based study, we examined 520 Arab Americans, aged 20-75 years, who were born in the Middle East and immigrated to southeastern Michigan. Dysglycemia was assessed by history and with a 2-h 75-g oral glucose tolerance test. Acculturation, physical activity, and perceived stress were measured with standardized questionnaires. RESULTS: Associations were found between dysglycemia in men and older age at immigration, unemployment, speaking Arabic with friends, being less active in Arabic organizations, more frequent consumption of Arabic food, and less integration into American society. Dysglycemia in women was associated with being raised in rural areas of the Middle East, older age at immigration, longer length of stay in the U.S., not being employed outside the home, less than high school education, not attending Arabic or American schools, and not being able to read Arabic. Among men, older age at immigration, shorter length of stay in the U.S., less activity in Arab organizations, and eating Arabic food were associated with dysglycemia independent of age and BMI. Among women, acculturation was very low and was confounded with age and BMI as powerful risk factors for dysglycemia. No association was found between physical activity, perceived stress, and the risk of dysglycemia in either sex. CONCLUSIONS: Lack of acculturation is an important risk factor for dysglycemia in immigrant Arab Americans. Intervention programs aimed at diabetes prevention should consider the acculturation process.

Acculturation↗

PubMed2003

The direct medical cost of type 2 diabetes.

OBJECTIVE: To describe the direct medical costs associated with type 2 diabetes, as well as its treatments, complications, and comorbidities. RESEARCH DESIGN AND METHODS: We studied a random sample of 1,364 subjects with type 2 diabetes who were members of a Michigan health maintenance organization. Demographic characteristics, duration of diabetes, diabetes treatments, glycemic control, complications, and comorbidities were assessed by surveys and medical chart reviews. Annual resource utilization and costs were assessed using health insurance claims. The log-transformed annual direct medical costs were fitted by multiple linear regression to indicator variables for demographics, treatments, glycemic control, complications, and comorbidities. RESULTS: The median annual direct medical costs for subjects with diet-controlled type 2 diabetes, BMI 30 kg/m(2), and no microvascular, neuropathic, or cardiovascular complications were 1,700 dollars for white men and 2,100 dollars for white women. A 10-kg/m(2) increase in BMI, treatment with oral antidiabetic or antihypertensive agents, diabetic kidney disease, cerebrovascular disease, and peripheral vascular disease were each associated with 10-30% increases in cost. Insulin treatment, angina, and MI were each associated with 60-90% increases in cost. Dialysis was associated with an 11-fold increase in cost. CONCLUSIONS: Insulin treatment and diabetes complications have a substantial impact on the direct medical costs of type 2 diabetes. The estimates presented in this model may be used to analyze the cost-effectiveness of interventions for type 2 diabetes.

Aged↗

PubMed2002

Neuroendocrine control of follicle-stimulating hormone (FSH) secretion: II. Is follistatin-induced suppression of FSH secretion mediated via changes in activin availability and does it involve changes in gonadotropin-releasing hormone secretion?

The objective of the present study was to determine to what extent activin participates in setting the level of FSH secretion and if this regulation includes mediation via changes in GnRH secretion. We administered follistatin, the high-affinity binding protein for activin, to five ovariectomized sheep; we reasoned that the resultant binding of follistatin to activin should lower activin bioavailability and FSH secretion. Hypophyseal portal and peripheral blood samples were collected simultaneously at 10-min intervals for 18 h to measure GnRH, LH, FSH, and both activin-free and total follistatin. Six hours into collection, each ewe received 150 microg/kg i.v. of recombinant human follistatin-288. A week later, the same ewes were subjected to a second series of blood collections of similar length (time control). The FSH levels in pituitary portal blood were approximately 8-fold higher than those in the peripheral circulation. The FSH secretory patterns changed minimally during the time-control period. In contrast, follistatin had profound suppressive effects on FSH secretion. Maximal FSH suppression after FS-288 administration occurred at 5-6 h in the pituitary portal (65% suppression) and 9-10 h in the peripheral (48% suppression) circulation. Follistatin had no effect on GnRH or LH secretory patterns. Disappearance of total follistatin (i.e., free follistatin plus activin-bound follistatin) from the circulation was slower (P < 0.05) than that of free follistatin alone, suggesting that some of the follistatin was complexed with circulating activin, thus reducing the bioavailability of activin. The slower clearance of total follistatin and the lack of follistatin effects on GnRH secretion suggest that changes in activin bioavailability dictate the level of pituitary FSH secretion and that this is a pituitary-specific effect.

Activins↗

PubMed2002

Estimation and inference for a spline-enhanced population pharmacokinetic model.

This article is motivated by an application where subjects were dosed three times with the same drug and the drug concentration profiles appeared to be the lowest after the third dose. One possible explanation is that the pharmacokinetic (PK) parameters vary over time. Therefore, we consider population PK models with time-varying PK parameters. These time-varying PK parameters are modeled by natural cubic spline functions in the ordinary differential equations. Mean parameters, variance components, and smoothing parameters are jointly estimated by maximizing the double penalized log likelihood. Mean functions and their derivatives are obtained by the numerical solution of ordinary differential equations. The interpretation of PK parameters in the model and its flexibility are discussed. The proposed methods are illustrated by application to the data that motivated this article. The model's performance is evaluated through simulation.

Biometry↗

PubMedDate not supplied

Parenteral nutrition-associated cholestasis in neonates: multivariate analysis of the potential protective effect of taurine.

BACKGROUND: Neonates receiving parenteral nutrition (PN) are at risk for PN-associated cholestasis (PNAC); however, no preventive factors for PNAC have been clearly identified. Despite reports suggesting that taurine may prevent PNAC in neonates, such an effect of taurine has not yet been definitively demonstrated. We determined whether taurine supplementation reduces the incidence of PNAC in premature or critically ill neonates. METHODS: This study was part of a prospective, randomized, multi-institutional trial designed to assess cholecystokinin vs placebo as a potential preventive therapy of PNAC. Taurine supplementation of PN varied between institutions. The presence or absence of taurine in PN was analyzed by multivariate analysis, with a primary outcome measure of serum conjugated bilirubin (CB) as a measure of PNAC. RESULTS: Taurine reduced PNAC in premature infants (estimated maximum CB [95% confidence interval] 0.50 mg/dL [-0.17 to 1.18] for those receiving taurine, vs 3.45 mg/dL [1.79-5.11] for neonates not receiving taurine, approaching significance, p = .07). Taurine significantly reduced PNAC in infants with necrotizing enterocolitis (NEC; estimated maximum CB 4.04 mg/dL [2.85-5.23], NEC infants receiving taurine, vs 8.29 mg/dL [5.61-10.96], NEC infants not receiving taurine, p < .01). There were too few neonates with surgical anomalies to evaluate the effect of taurine in this group. CONCLUSIONS: Within specific subgroups of neonatal patients, taurine supplementation does offer a very significant degree of protection against PNAC. Patients with NEC or severe prematurity are most likely to benefit substantially from taurine supplementation.

Bilirubin↗