First name
Daniel
Middle name
K
Last name
Benjamin

Title

Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools.

Year of Publication

2022

Date Published

08/2022

ISSN Number

1098-4275

Abstract

OBJECTIVES: We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission.

METHODS: Close contacts of those with confirmed SARS-CoV-2 infection were eligible for enrollment in the TTS program if exposure to a non-household contact occurred between 11/29/2021 and 01/28/2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at pre-specified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion.

RESULTS: A total of 1675 participants tested positive or received at least one negative test between days 5 and 7, and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% CI 6-19%) and 7,272 (89%) of potentially missed days were saved through TTS implementation. We estimated one additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period.

CONCLUSIONS: Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.

DOI

10.1542/peds.2022-058200

Alternate Title

Pediatrics

PMID

35971240

Title

Outcomes associated with surfactant in more mature and larger premature infants with respiratory distress syndrome.

Year of Publication

2020

Date Published

2020 Feb 20

ISSN Number

1476-5543

Abstract

<p><strong>OBJECTIVE: </strong>Examine the effect of off-label surfactant on mortality and morbidity in more mature and larger premature infants diagnosed with respiratory distress syndrome (RDS).</p>

<p><strong>STUDY DESIGN: </strong>Cohort study of premature infants born at 30-36 weeks, birth weight &gt; 2 kg, and a diagnosis of RDS. We compared the odds of mortality and morbidity between infants who were exposed vs unexposed to surfactant. We used a treatment effects model to balance covariates between groups.</p>

<p><strong>RESULTS: </strong>Of 54,964 included infants, 25,278 (46%) were exposed to surfactant. The frequency of mortality and morbidities were higher in the exposed group in unadjusted analyses. Following adjustment with a doubly robust treatment effects model, we found no significant treatment effect of surfactant on mortality or morbidity.</p>

<p><strong>CONCLUSION: </strong>Surfactant exposure is not associated with reduced or increased mortality or morbidity in more mature premature infants with RDS.</p>

DOI

10.1038/s41372-020-0625-1

Alternate Title

J Perinatol

PMID

32080333

Title

Harmonisation in study design and outcomes in paediatric antibiotic clinical trials: a systematic review.

Year of Publication

2016

Number of Pages

e178-89

Date Published

2016 Sep

ISSN Number

1474-4457

Abstract

<p>There is no global consensus on the conduct of clinical trials in children and neonates with complicated clinical infection syndromes. No comprehensive regulatory guidance exists for the design of antibiotic clinical trials in neonates and children. We did a systematic review of antibiotic clinical trials in complicated clinical infection syndromes (including bloodstream infections and community-acquired pneumonia) in children and neonates (0-18 years) to assess whether standardised European Medicines Agency (EMA) and US Food and Drug Administration (FDA) guidance for adults was used in paediatrics, and whether paediatric clinical trials applied consistent definitions for eligibility and outcomes. We searched MEDLINE, Cochrane CENTRAL databases, and ClinicalTrials.gov between Jan 1, 2000, and Nov 18, 2015. 82 individual studies met our inclusion criteria. The published studies reported on an average of 66% of CONSORT items. Study design, inclusion and exclusion criteria, and endpoints varied substantially across included studies. The comparison between paediatric clinical trials and adult EMA and FDA guidance highlighted that regulatory definitions are only variably applicable and used at present. Absence of consensus for paediatric antibiotic clinical trials is a major barrier to harmonisation in research and translation into clinical practice. To improve comparison of therapies and strategies, international collaboration among all relevant stakeholders leading to harmonised case definitions and outcome measures is needed.</p>

DOI

10.1016/S1473-3099(16)00069-4

Alternate Title

Lancet Infect Dis

PMID

27375212

Title

Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.

Year of Publication

2015

Number of Pages

e153785

Date Published

2015 Dec

ISSN Number

2168-6211

Abstract

<p><strong>IMPORTANCE: </strong>Postnatally acquired cytomegalovirus (CMV) is typically benign in term infants but in very low-birth-weight (VLBW) infants can cause pneumonitis and sepsislike illness. Whether postnatal CMV infection results in long-term pulmonary sequelae in these infants is unknown.</p>

<p><strong>OBJECTIVE: </strong>To investigate the association between postnatal CMV infection and bronchopulmonary dysplasia (BPD) and mortality in a large multicenter cohort of VLBW infants.</p>

<p><strong>DESIGN, SETTING, AND PARTICIPANTS: </strong>Conducted between October 2014 and June 2015, this propensity-matched retrospective cohort study involved 101,111 hospitalized VLBW (&lt;1500 g) infants at 348 neonatal intensive care units in the United States from 1997 to 2012. We matched infants with postnatal CMV infection 1:1 to comparison infants using propensity scores, and we used Poisson regression to examine the effect of postnatal CMV on the combined risk for death or BPD at 36 weeks' postmenstrual age. To describe features of postnatal CMV infection, we extracted clinical and laboratory data from 7 days before until 7 days after infants met criteria for postnatal CMV.</p>

<p><strong>EXPOSURES: </strong>Postnatal CMV infection was defined as a diagnosis of CMV or detection of CMV from blood, urine, cerebrospinal fluid, or respiratory secretions on or after day of life 21. Infants with a CMV diagnosis or virologic detection of CMV prior to day of life 21 were not considered to have postnatal infection.</p>

<p><strong>MAIN OUTCOMES AND MEASURES: </strong>The primary outcome was death or BPD at 36 weeks' postmenstrual age.</p>

<p><strong>RESULTS: </strong>Of 101,111 infants, 328 (0.3%) had postnatal CMV infection. We matched a comparison infant to 303 CMV-infected infants (92%) for a final cohort of 606 infants. The median gestational age and birth weight of this cohort were 25 weeks and 730 g, respectively. Postnatal CMV infection was associated with an increased risk for death or BPD at 36 weeks' postmenstrual age (risk ratio, 1.21; 95% CI, 1.10-1.32) and BPD (risk ratio, 1.33; 95% CI, 1.19-1.50). Changes in cardiorespiratory status associated with postnatal CMV infection included a new requirement for vasopressor medications (9%; n = 29), intubation for mechanical ventilation (15%; n = 49), a new oxygen requirement (28%; n = 91), and death (1.2%; n = 4).</p>

<p><strong>CONCLUSIONS AND RELEVANCE: </strong>In VLBW infants, postnatal CMV infection was associated with increased risk for BPD. Further studies are needed to determine the role of preventive measures against CMV in this population.</p>

DOI

10.1001/jamapediatrics.2015.3785

Alternate Title

JAMA Pediatr

PMID

26642118

Title

Postnatal Cytomegalovirus Infection and the Risk for Bronchopulmonary Dysplasia.

Year of Publication

2015

Number of Pages

e153785

Date Published

2015 Dec

ISSN Number

2168-6211

Abstract

<p><strong>IMPORTANCE: </strong>Postnatally acquired cytomegalovirus (CMV) is typically benign in term infants but in very low-birth-weight (VLBW) infants can cause pneumonitis and sepsislike illness. Whether postnatal CMV infection results in long-term pulmonary sequelae in these infants is unknown.</p>

<p><strong>OBJECTIVE: </strong>To investigate the association between postnatal CMV infection and bronchopulmonary dysplasia (BPD) and mortality in a large multicenter cohort of VLBW infants.</p>

<p><strong>DESIGN, SETTING, AND PARTICIPANTS: </strong>Conducted between October 2014 and June 2015, this propensity-matched retrospective cohort study involved 101,111 hospitalized VLBW (&lt;1500 g) infants at 348 neonatal intensive care units in the United States from 1997 to 2012. We matched infants with postnatal CMV infection 1:1 to comparison infants using propensity scores, and we used Poisson regression to examine the effect of postnatal CMV on the combined risk for death or BPD at 36 weeks' postmenstrual age. To describe features of postnatal CMV infection, we extracted clinical and laboratory data from 7 days before until 7 days after infants met criteria for postnatal CMV.</p>

<p><strong>EXPOSURES: </strong>Postnatal CMV infection was defined as a diagnosis of CMV or detection of CMV from blood, urine, cerebrospinal fluid, or respiratory secretions on or after day of life 21. Infants with a CMV diagnosis or virologic detection of CMV prior to day of life 21 were not considered to have postnatal infection.</p>

<p><strong>MAIN OUTCOMES AND MEASURES: </strong>The primary outcome was death or BPD at 36 weeks' postmenstrual age.</p>

<p><strong>RESULTS: </strong>Of 101,111 infants, 328 (0.3%) had postnatal CMV infection. We matched a comparison infant to 303 CMV-infected infants (92%) for a final cohort of 606 infants. The median gestational age and birth weight of this cohort were 25 weeks and 730 g, respectively. Postnatal CMV infection was associated with an increased risk for death or BPD at 36 weeks' postmenstrual age (risk ratio, 1.21; 95% CI, 1.10-1.32) and BPD (risk ratio, 1.33; 95% CI, 1.19-1.50). Changes in cardiorespiratory status associated with postnatal CMV infection included a new requirement for vasopressor medications (9%; n = 29), intubation for mechanical ventilation (15%; n = 49), a new oxygen requirement (28%; n = 91), and death (1.2%; n = 4).</p>

<p><strong>CONCLUSIONS AND RELEVANCE: </strong>In VLBW infants, postnatal CMV infection was associated with increased risk for BPD. Further studies are needed to determine the role of preventive measures against CMV in this population.</p>

DOI

10.1001/jamapediatrics.2015.3785

Alternate Title

JAMA Pediatr

PMID

26642118

Title

Results from a prospective, international, epidemiologic study of invasive candidiasis in children and neonates.

Year of Publication

2012

Number of Pages

1252-7

Date Published

2012 Dec

ISSN Number

1532-0987

Abstract

<p><strong>BACKGROUND: </strong>Candida species are the third most common cause of pediatric health care-associated bloodstream infection in the United States and Europe. To our knowledge, this report from the International Pediatric Fungal Network is the largest prospective, multicenter observational study dedicated to pediatric and neonatal invasive candidiasis.</p>

<p><strong>METHODS: </strong>From 2007 to 2011, we enrolled 196 pediatric and 25 neonatal patients with invasive candidiasis.</p>

<p><strong>RESULTS: </strong>Non-albicans Candida species predominated in pediatric (56%) and neonatal (52%) age groups, yet Candida albicans was the most common species in both groups. Successful treatment responses were observed in pediatric (76%) and neonatal patients (92%). Infection with Candida parapsilosis led to successful responses in pediatric (92%) and neonatal (100%) patients, whereas infection with Candida glabrata was associated with a lower successful outcome in pediatric patients (55%). The most commonly used primary antifungal therapies for pediatric invasive candidiasis were fluconazole (21%), liposomal amphotericin B (20%) and micafungin (18%). Outcome of pediatric invasive candidiasis was similar in response to polyenes (73%), triazoles (67%) and echinocandins (73%). The most commonly used primary antifungal therapies for neonatal invasive candidiasis were fluconazole (32%), caspofungin (24%) and liposomal amphotericin B (16%) and micafungin (8%). Outcomes of neonatal candidiasis by antifungal class again revealed similar response rates among the classes.</p>

<p><strong>CONCLUSIONS: </strong>We found a predominance of non-albicans Candida infection in children and similar outcomes based on antifungal class used. This international collaborative study sets the foundation for large epidemiologic studies focusing on the unique features of neonatal and pediatric candidiasis and comparative studies of therapeutic interventions in these populations.</p>

DOI

10.1097/INF.0b013e3182737427

Alternate Title

Pediatr. Infect. Dis. J.

PMID

22982980

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