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Hearing Disorders: HELP
Articles by Elizabeth V. Asztalos
Based on 5 articles published since 2010
(Why 5 articles?)
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Between 2010 and 2020, Elizabeth Asztalos wrote the following 5 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Article Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. 2018

Askie, Lisa M / Darlow, Brian A / Finer, Neil / Schmidt, Barbara / Stenson, Ben / Tarnow-Mordi, William / Davis, Peter G / Carlo, Waldemar A / Brocklehurst, Peter / Davies, Lucy C / Das, Abhik / Rich, Wade / Gantz, Marie G / Roberts, Robin S / Whyte, Robin K / Costantini, Lorrie / Poets, Christian / Asztalos, Elizabeth / Battin, Malcolm / Halliday, Henry L / Marlow, Neil / Tin, Win / King, Andrew / Juszczak, Edmund / Morley, Colin J / Doyle, Lex W / Gebski, Val / Hunter, Kylie E / Simes, Robert J / Anonymous4020950. ·National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia. · Department of Paediatrics, University of Otago, Christchurch, New Zealand. · Department of Pediatrics, University of California, San Diego. · Division of Neonatology, University of Pennsylvania, Philadelphia. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · Department of Neonatology, Royal Infirmary of Edinburgh, Edinburgh, Scotland. · Newborn Research, Royal Women's Hospital, Departments of Obstetrics and Gynaecology, and Paediatrics, University of Melbourne, Melbourne, Australia. · Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia. · Department of Pediatrics, University of Alabama, Birmingham. · Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, England. · National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England. · Statistics and Epidemiology Unit, RTI International, Rockville, Maryland. · Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina. · Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany. · Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada. · Newborn Services, Auckland City Hospital, Auckland, New Zealand. · Royal Maternity Hospital, Belfast, Ireland. · Department of Child Health, Queen's University, Belfast, Ireland. · EGA Institute for Women's Health, University College London, London, England. · Department of Neonatal Medicine, James Cook University, Middlesbrough, England. · University of Cambridge, Department of Obstetrics and Gynaecology, Cambridge, England. ·JAMA · Pubmed #29872859.

ABSTRACT: Importance: There are potential benefits and harms of hyperoxemia and hypoxemia for extremely preterm infants receiving more vs less supplemental oxygen. Objective: To compare the effects of different target ranges for oxygen saturation as measured by pulse oximetry (Spo2) on death or major morbidity. Design, Setting, and Participants: Prospectively planned meta-analysis of individual participant data from 5 randomized clinical trials (conducted from 2005-2014) enrolling infants born before 28 weeks' gestation. Exposures: Spo2 target range that was lower (85%-89%) vs higher (91%-95%). Main Outcomes and Measures: The primary outcome was a composite of death or major disability (bilateral blindness, deafness, cerebral palsy diagnosed as ≥2 level on the Gross Motor Function Classification System, or Bayley-III cognitive or language score <85) at a corrected age of 18 to 24 months. There were 16 secondary outcomes including the components of the primary outcome and other major morbidities. Results: A total of 4965 infants were randomized (2480 to the lower Spo2 target range and 2485 to the higher Spo2 range) and had a median gestational age of 26 weeks (interquartile range, 25-27 weeks) and a mean birth weight of 832 g (SD, 190 g). The primary outcome occurred in 1191 of 2228 infants (53.5%) in the lower Spo2 target group and 1150 of 2229 infants (51.6%) in the higher Spo2 target group (risk difference, 1.7% [95% CI, -1.3% to 4.6%]; relative risk [RR], 1.04 [95% CI, 0.98 to 1.09], P = .21). Of the 16 secondary outcomes, 11 were null, 2 significantly favored the lower Spo2 target group, and 3 significantly favored the higher Spo2 target group. Death occurred in 484 of 2433 infants (19.9%) in the lower Spo2 target group and 418 of 2440 infants (17.1%) in the higher Spo2 target group (risk difference, 2.8% [95% CI, 0.6% to 5.0%]; RR, 1.17 [95% CI, 1.04 to 1.31], P = .01). Treatment for retinopathy of prematurity was administered to 220 of 2020 infants (10.9%) in the lower Spo2 target group and 308 of 2065 infants (14.9%) in the higher Spo2 target group (risk difference, -4.0% [95% CI, -6.1% to -2.0%]; RR, 0.74 [95% CI, 0.63 to 0.86], P < .001). Severe necrotizing enterocolitis occurred in 227 of 2464 infants (9.2%) in the lower Spo2 target group and 170 of 2465 infants (6.9%) in the higher Spo2 target group (risk difference, 2.3% [95% CI, 0.8% to 3.8%]; RR, 1.33 [95% CI, 1.10 to 1.61], P = .003). Conclusions and Relevance: In this prospectively planned meta-analysis of individual participant data from extremely preterm infants, there was no significant difference between a lower Spo2 target range compared with a higher Spo2 target range on the primary composite outcome of death or major disability at a corrected age of 18 to 24 months. The lower Spo2 target range was associated with a higher risk of death and necrotizing enterocolitis, but a lower risk of retinopathy of prematurity treatment.

2 Article Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants. 2015

Schmidt, Barbara / Roberts, Robin S / Davis, Peter G / Doyle, Lex W / Asztalos, Elizabeth V / Opie, Gillian / Bairam, Aida / Solimano, Alfonso / Arnon, Shmuel / Sauve, Reginald S / Anonymous7420840 / Anonymous7430840. ·Division of Neonatology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Electronic address: barbara.schmidt@uphs.upenn.edu. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · Department of Obstetrics and Gynecology, University of Melbourne and The Royal Women's Hospital, Melbourne, Victoria, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia. · Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. · Mercy Hospital, Melbourne, Victoria, Australia. · Department of Pediatrics, Laval University, Quebec City, Quebec, Canada. · Department of Pediatrics, University of British Columbia, Vancouver, Canada. · Department of Neonatology, Meir Medical Center, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. ·J Pediatr · Pubmed #26318030.

ABSTRACT: OBJECTIVE: To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants. STUDY DESIGN: We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness. RESULTS: BPD, serious brain injury, and severe ROP occurred in 43%, 13%, and 6% of the infants, respectively. Each of the 3 morbidities was similarly and independently correlated with poor 5-year outcome. Rates of death or disability (95% CI) in children with none, any 1, any 2, and all 3 morbidities were 11.2% (9.0%-13.7%), 22.9% (19.6%-26.5%), 43.9% (35.5%-52.6%), and 61.5% (40.6%-79.8%), respectively. CONCLUSIONS: In very low birth weight infants who survive to 36 weeks PMA, a count of BPD, serious brain injury, and severe ROP predicts the risk of a late death or survival with disability at 5 years.

3 Article Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants. 2015

Poets, Christian F / Roberts, Robin S / Schmidt, Barbara / Whyte, Robin K / Asztalos, Elizabeth V / Bader, David / Bairam, Aida / Moddemann, Diane / Peliowski, Abraham / Rabi, Yacov / Solimano, Alfonso / Nelson, Harvey / Anonymous1090839. ·Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. · Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada3Division of Neonatology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia. · Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. · Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada. · Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel. · Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec, Canada. · Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada. · Royal Alexandra Hospital, Edmonton, Alberta, Canada. · Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. · Department of Pediatrics, University of British Columbia, Vancouver, Canada. ·JAMA · Pubmed #26262797.

ABSTRACT: IMPORTANCE: Extremely preterm infants may experience intermittent hypoxemia or bradycardia for many weeks after birth. The prognosis of these events is uncertain. OBJECTIVE: To determine the association between intermittent hypoxemia or bradycardia and late death or disability. DESIGN, SETTING, AND PARTICIPANTS: Post hoc analysis of data from the inception cohort assembled for the Canadian Oxygen Trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, including 1019 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days who were born between December 2006 and August 2010 and survived to a postmenstrual age of 36 weeks. Follow-up assessments occurred between October 2008 and August 2012. EXPOSURES: Episodes of hypoxemia (pulse oximeter oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds or longer. Values were sampled every 10 seconds within 24 hours after birth until at least 36 weeks' postmenstrual age. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death after 36 weeks' postmenstrual age, motor impairment, cognitive or language delay, severe hearing loss, or bilateral blindness at 18 months' corrected age. Secondary outcomes were motor impairment, cognitive or language delay, and severe retinopathy of prematurity. RESULTS: Downloaded saturation and pulse rate data were available for a median of 68.3 days (interquartile range, 56.8-86.0 days). Mean percentages of recorded time with hypoxemia for the least and most affected 10% of infants were 0.4% and 13.5%, respectively. Corresponding values for bradycardia were 0.1% and 0.3%. The primary outcome was ascertained for 972 infants and present in 414 (42.6%). Hypoxemic episodes were associated with an estimated increased risk of late death or disability at 18 months of 56.5% in the highest decile of hypoxemic exposure vs 36.9% in the lowest decile (modeled relative risk, 1.53; 95% CI, 1.21-1.94). This association was significant only for prolonged hypoxemic episodes lasting at least 1 minute (relative risk, 1.66; 95% CI, 1.35-2.05 vs for shorter episodes, relative risk, 1.01; 95% CI, 0.77-1.32). Relative risks for all secondary outcomes were similarly increased after prolonged hypoxemia. Bradycardia did not alter the prognostic value of hypoxemia. CONCLUSIONS AND RELEVANCE: Among extremely preterm infants who survived to 36 weeks' postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3 months after birth were associated with adverse 18-month outcomes. If confirmed in future studies, further research on the prevention of such episodes is needed.

4 Article Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. 2013

Schmidt, Barbara / Whyte, Robin K / Asztalos, Elizabeth V / Moddemann, Diane / Poets, Christian / Rabi, Yacov / Solimano, Alfonso / Roberts, Robin S / Anonymous3650757. ·Division of Neonatology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Philadelphia, PA, USA. barbara.schmidt@uphs.upenn.edu ·JAMA · Pubmed #23644995.

ABSTRACT: IMPORTANCE: The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimizing oxygen toxicity and oxidative stress. It remains uncertain what values of arterial oxygen saturations achieve this balance in preterm infants. OBJECTIVE: To compare the effects of targeting lower or higher arterial oxygen saturations on the rate of death or disability in extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel in which 1201 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days were enrolled within 24 hours after birth between December 2006 and August 2010. Follow-up assessments began in October 2008 and ended in August 2012. INTERVENTIONS: Study participants were monitored until postmenstrual ages of 36 to 40 weeks with pulse oximeters that displayed saturations of either 3% above or below the true values. Caregivers adjusted the concentration of oxygen to achieve saturations between 88% and 92%, which produced 2 treatment groups with true target saturations of 85% to 89% (n = 602) or 91% to 95% (n = 599). Alarms were triggered when displayed saturations decreased to 86% or increased to 94%. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of death, gross motor disability, cognitive or language delay, severe hearing loss, or bilateral blindness at a corrected age of 18 months. Secondary outcomes included retinopathy of prematurity and brain injury. RESULTS: Of the 578 infants with adequate data for the primary outcome who were assigned to the lower target range, 298 (51.6%) died or survived with disability compared with 283 of the 569 infants (49.7%) assigned to the higher target range (odds ratio adjusted for center, 1.08; 95% CI, 0.85 to 1.37; P = .52). The rates of death were 16.6% for those in the 85% to 89% group and 15.3% for those in the 91% to 95% group (adjusted odds ratio, 1.11; 95% CI, 0.80 to 1.54; P = .54). Targeting lower saturations reduced the postmenstrual age at last use of oxygen therapy (adjusted mean difference, -0.8 weeks; 95% CI, -1.5 to -0.1; P = .03) but did not alter any other outcomes. CONCLUSION AND RELEVANCE: In extremely preterm infants, targeting oxygen saturations of 85% to 89% compared with 91% to 95% had no significant effect on the rate of death or disability at 18 months. These results may help determine the optimal target oxygen saturation. TRIAL REGISTRATIONS: ISRCTN Identifier: 62491227; ClinicalTrials.gov Identifier: NCT00637169.

5 Article Survival without disability to age 5 years after neonatal caffeine therapy for apnea of prematurity. 2012

Schmidt, Barbara / Anderson, Peter J / Doyle, Lex W / Dewey, Deborah / Grunau, Ruth E / Asztalos, Elizabeth V / Davis, Peter G / Tin, Win / Moddemann, Diane / Solimano, Alfonso / Ohlsson, Arne / Barrington, Keith J / Roberts, Robin S / Anonymous4620715. ·Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. schmidt@mcmaster.ca ·JAMA · Pubmed #22253394.

ABSTRACT: CONTEXT: Very preterm infants are prone to apnea and have an increased risk of death or disability. Caffeine therapy for apnea of prematurity reduces the rates of cerebral palsy and cognitive delay at 18 months of age. OBJECTIVE: To determine whether neonatal caffeine therapy has lasting benefits or newly apparent risks at early school age. DESIGN, SETTING, AND PARTICIPANTS: Five-year follow-up from 2005 to 2011 in 31 of 35 academic hospitals in Canada, Australia, Europe, and Israel, where 1932 of 2006 participants (96.3%) had been enrolled in the randomized, placebo-controlled Caffeine for Apnea of Prematurity trial between 1999 and 2004. A total of 1640 children (84.9%) with birth weights of 500 to 1250 g had adequate data for the main outcome at 5 years. MAIN OUTCOME MEASURES: Combined outcome of death or survival to 5 years with 1 or more of motor impairment (defined as a Gross Motor Function Classification System level of 3 to 5), cognitive impairment (defined as a Full Scale IQ<70), behavior problems, poor general health, deafness, and blindness. RESULTS: The combined outcome of death or disability was not significantly different for the 833 children assigned to caffeine from that for the 807 children assigned to placebo (21.1% vs 24.8%; odds ratio adjusted for center, 0.82; 95% CI, 0.65-1.03; P = .09). The rates of death, motor impairment, behavior problems, poor general health, deafness, and blindness did not differ significantly between the 2 groups. The incidence of cognitive impairment was lower at 5 years than at 18 months and similar in the 2 groups (4.9% vs 5.1%; odds ratio adjusted for center, 0.97; 95% CI, 0.61-1.55; P = .89). CONCLUSION: Neonatal caffeine therapy was no longer associated with a significantly improved rate of survival without disability in children with very low birth weights who were assessed at 5 years.