Inside Pediatrics Spring/Summer 2024

DIVISION ROUNDS

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CARDIOLOGY

Heart team discovers new lung injury biomarker

Nearly all children who undergo cardiac surgery suffer lung injury afterward, and its treatment can determine whether the injury is short-lived or will follow a child for a lifetime. That’s why the discovery at Children’s of Alabama of a new biomarker to predict which patients are at higher risk of this complication—steering the use of respiratory support—is being heralded as a groundbreaking development that may reap benefits for children far and wide. Using samples from a Children’s biorepository, heart specialists revealed that blood levels of a protein called proteoglycan 4, commonly known as lubricin, significantly differ between children undergoing long- and short-term mechanical ventilation after cardiac surgery. Until now, physicians haven’t been able to predict which patients stood at higher risk of lung injury in this care setting. It’s the first time the finding has been reported in the United States, said Ahmed Asfari, M.D. , a cardiac intensivist in the Pediatric & Congenital Heart Center of Alabama at Children’s. Study suggests link between infant mortality and insurance type A new study published in JAMA Network Open suggests that the type of health insurance pregnant people have may impact infant mortality rates. The research, led by Children’s of Alabama neonatologist Colm P. Travers, M.D. , found that pregnant people with private health insurance had lower rates of infant deaths compared to those insured by Medicaid. The study analyzed data on more than 13 million births that occurred in the U.S. from 2017 to 2020. Overall, 46% of the pregnant people in the study had Medicaid insurance, while 54% had private insurance. The infant mortality rate—defined as the number of deaths in the first year of life per 1,000 live births—was 2.75 deaths per 1,000 live births for those with private insurance compared to 5.30 deaths per 1,000 live births for those covered by Medicaid. NEONATOLOGY

“There’s been nothing like this in regard to acute lung injury, especially for our patient population with congenital heart surgery,” said Asfari, who’s also an assistant professor in the Department of Pediatrics and Division of Cardiology at the University of Alabama at Birmingham (UAB). “When we tested the blood of patients with very long mechanical ventilation duration and compared them to patients with short duration, we found the level of this marker goes down, especially within two days of surgery.” Asfari said the breakthrough likely will change the landscape for children’s care in the future. “Having the ability to have a serum biomarker that we can use to grade the level of acute lung injury will be extremely helpful,” he said.

Those with private insurance also had a 43% lower risk of postneonatal mortality (from 28 days to one year after birth), a 10% lower risk of a low-birthweight infant, a 20% lower risk of vaginal breech delivery, and an 8% lower risk of preterm birth. They were 24% more likely to have received first-trimester prenatal care than those with Medicaid.

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