Lei Li

Publications (7)28.63 Total impact

• Article: Outcomes of Small for Gestational Age Infants Born at <27 Weeks' Gestation.

  Lilia C De Jesus, Athina Pappas, Seetha Shankaran, Lei Li, Abhik Das, Edward F Bell, Barbara J Stoll, Abbot R Laptook, Michele C Walsh, Ellen C Hale, Nancy S Newman, Rebecca Bara, Rosemary D Higgins
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  ABSTRACT: OBJECTIVE: To determine whether small for gestational age (SGA) infants born at <27 weeks gestational age (GA) are at increased risk for mortality, morbidity, and growth and neurodevelopmental impairment at 18-22 months corrected age. STUDY DESIGN: This was a retrospective cohort study from National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-Up Studies. Infants born at <27 weeks GA between January 2006 and July 2008 were included. SGA was defined as birth weight <10th percentile for GA based on Olsen growth curves. Infants with birth weight ≥10th percentile for GA were classified as non-SGA. Maternal and infant characteristics, neonatal outcomes, and neurodevelopmental data were compared in SGA and non-SGA infants. Neurodevelopmental impairment was defined as any of the following: cognitive score <70 on the Bayley Scales of Infant Development III, moderate or severe cerebral palsy, bilateral hearing loss (with and without amplification), or blindness (bilateral vision <20/200). Logistic regression analysis was applied to evaluate the associations between SGA status and death or neurodevelopmental impairment. RESULTS: The SGA group comprised 385 infants; the non-SGA group, 2586 infants. Compared with mothers of non-SGA infants, mothers of SGA infants were more likely to have a high school education, prenatal care, cesarean delivery, pregnancy-induced hypertension, and antenatal corticosteroid exposure. Compared with non-SGA infants, SGA infants had higher mortality and were more likely to have postnatal growth failure, prolonged mechanical ventilation, and postnatal steroid use. SGA status was associated with increased risk of death or neurodevelopmental impairment (OR, 3.91; 95% CI, 2.91-5.25; P < .001). CONCLUSION: SGA status in infants born at <27 weeks GA is associated with an increased likelihood of postnatal steroid use, mortality, growth failure, and neurodevelopmental impairment at 18-22 months corrected age.
  The Journal of pediatrics 02/2013; · 4.02 Impact Factor
• Article: Approach to infants born at 22 to 24 weeks' gestation: relationship to outcomes of more-mature infants.

  P Brian Smith, Namasivayam Ambalavanan, Lei Li, C Michael Cotten, Matthew Laughon, Michele C Walsh, Abhik Das, Edward F Bell, Waldemar A Carlo, Barbara J Stoll, Seetha Shankaran, Abbot R Laptook, Rosemary D Higgins, Ronald N Goldberg
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  ABSTRACT: We sought to determine if a center's approach to care of premature infants at the youngest gestational ages (22-24 weeks' gestation) is associated with clinical outcomes among infants of older gestational ages (25-27 weeks' gestation). Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks' gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks' gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity. Our study included 3631 infants 22 to 24 weeks' gestation and 5227 infants 25 to 27 weeks' gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants. This study suggests that physicians' willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants.
  PEDIATRICS 05/2012; 129(6):e1508-16. · 4.47 Impact Factor
• Article: Multifunctional mercapto-tacrine derivatives for treatment of age-related neurodegenerative diseases.

  Yue Wang, Xin-Lei Guan, Peng-Fei Wu, Can-Ming Wang, Hui Cao, Lei Li, Xiao-Juan Guo, Fang Wang, Na Xie, Feng-Chao Jiang, Jian-Guo Chen
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  ABSTRACT: Cooperating mercapto groups with tacrine in a single molecular, novel multifunctional compounds have been designed and synthesized. These mercapto-tacrine derivatives displayed a synergistic pharmacological profile of long-term potentiation enhancement, cholinesterase inhibition, neuroprotection, and less hepatotoxicity, emerging as promising molecules for the therapy of age-related neurodegenerative diseases.
  Journal of Medicinal Chemistry 03/2012; 55(7):3588-92. · 4.80 Impact Factor
• Article: Feasibility study of early blood pressure management in extremely preterm infants.

  Beau J Batton, Lei Li, Nancy S Newman, Abhik Das, Kristi L Watterberg, Bradley A Yoder, Roger G Faix, Matthew M Laughon, Krisa P Van Meurs, Waldemar A Carlo, Rosemary D Higgins, Michele C Walsh
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  ABSTRACT: To assess the feasibility of a randomized placebo controlled trial (RCT) of blood pressure (BP) management for extremely preterm infants. This was a prospective pilot RCT of infants 23-0/7 to 26-6/7 weeks gestation who had protocol-defined low BP in the first 24 postnatal hours. Enrolled infants were administered a study infusion (dopamine or placebo) and a study syringe medication (hydrocortisone or placebo). Of the 366 infants screened, 119 (33%) had low BP, 58 (16%) met all entry criteria, and 10 (3%) were enrolled. A total of 161 infants (44%) were ineligible because they received early indomethacin. Only 17% of eligible infants were enrolled. Problems with consent included insufficient time, parent unavailability, and physician unwillingness to enroll critically ill infants. Two infants were withdrawn from the study because of the potential risk of intestinal perforation with simultaneous administration of hydrocortisone and indomethacin. This pilot RCT was not feasible because of low eligibility and consent rates. An RCT of BP management for extremely preterm infants may require a waiver of consent for research in emergency care. The frequent use of early indomethacin and the associated risk of intestinal perforation when used with hydrocortisone may limit future investigations to only inotropic medications.
  The Journal of pediatrics 02/2012; 161(1):65-9.e1. · 4.02 Impact Factor
• Article: Nasopharyngeal carriage of Streptococcus pneumoniae in very low-birth-weight infants after administration of heptavalent pneumococcal conjugate vaccine.

  Jocelyn Y Ang, Jorge L Lua, Basim I Asmar, Seetha Shankaran, Roy J Heyne, Robert L Schelonka, Abhik Das, Lei Li, Delois M Jackson, Rosemary D Higgins, Carl T D'Angio
  Archives of pediatrics & adolescent medicine 12/2010; 164(12):1173-5. · 3.73 Impact Factor
• Article: Seizures in extremely low birth weight infants are associated with adverse outcome.

  Alexis S Davis, Susan R Hintz, Krisa P Van Meurs, Lei Li, Abhik Das, Barbara J Stoll, Michele C Walsh, Athina Pappas, Edward F Bell, Abbot R Laptook, Rosemary D Higgins
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  ABSTRACT: To examine risk factors for neonatal clinical seizures and to determine the independent association with death or neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants. A total of 6499 ELBW infants (401-1000 g) surviving to 36 weeks postmenstrual age (PMA) were included in this retrospective study. Unadjusted comparisons were performed between infants with (n = 414) and without (n = 6085) clinical seizures during the initial hospitalization. Using multivariate logistic regression modeling, we examined the independent association of seizures with late death (after 36 weeks PMA) or NDI after controlling for multiple demographic, perinatal, and neonatal variables. Infants with clinical seizures had a greater proportion of neonatal morbidities associated with poor outcome, including severe intraventricular hemorrhage, sepsis, meningitis, and cystic periventricular leukomalacia (all P < .01). Survivors were more likely to have NDI or moderate-severe cerebral palsy at 18 to 22 months corrected age (both P < .01). After adjusting for multiple confounders, clinical seizures remained significantly associated with late death or NDI (odds ratio, 3.15; 95% CI, 2.37-4.19). ELBW infants with clinical seizures are at increased risk for adverse neurodevelopmental outcome, independent of multiple confounding factors.
  The Journal of pediatrics 11/2010; 157(5):720-5.e1-2. · 4.02 Impact Factor
• Article: Heptavalent pneumococcal conjugate vaccine immunogenicity in very-low-birth-weight, premature infants.

  Carl T D'Angio, Roy J Heyne, T Michael O'Shea, Robert L Schelonka, Seetha Shankaran, Shahnaz Duara, Ronald N Goldberg, Barbara J Stoll, Krisa P Van Meurs, Betty R Vohr, Abhik Das, Lei Li, Robert L Burton, Betty Hastings, Dale L Phelps, Pablo J Sanchez, Waldemar A Carlo, David K Stevenson, Rosemary D Higgins
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  ABSTRACT: The heptavalent pneumococcal CRM197 conjugate vaccine (PCV-7) has been incompletely studied in very-low-birth-weight (< or =1500 g) infants. To assess PCV-7 immunogenicity in very-low-birth-weight, premature infants. We hypothesized that the frequency of postvaccine antibody concentrations > or =0.15 microg/mL would vary directly with birth weight. This was a multicenter observational study. Infants 401 to 1500 g birth weight and <32 0/7 weeks gestation, stratified by birth weight, were enrolled from 9 National Institute of Child Health and Human Development Neonatal Research Network centers. Infants received PCV-7 at 2, 4, and 6 months after birth and had blood drawn 4 to 6 weeks following the third dose. Antibodies against the 7 vaccine serotypes were measured by enzyme-linked immunosorbent assay. Of 369 enrolled infants, 244 completed their primary vaccine series by 8 months and had serum obtained. Subjects were 27.8 +/- 2.2 (mean +/- standard deviation) weeks gestation and 1008 +/- 282 g birth weight. Twenty-six percent had bronchopulmonary dysplasia and 16% had received postnatal glucocorticoids. Infants 1001 to 1500 g birth weight were more likely than those 401 to 1000 g to achieve antibody concentrations > or =0.15 microg/mL against the least 2 immunogenic serotypes (6B: 96% vs. 85%, P = 0.003 and 23F: 97% vs. 88%, P = 0.009). In multiple logistic regression analysis, lower birth weight, postnatal glucocorticoid use, lower weight at blood draw, and Caucasian race were each independently associated with antibody concentrations <0.35 microg/mL against serotypes 6B and/or 23F. When compared with larger premature infants, infants weighing < or =1000 g at birth have similar antibody responses to most, but not all, PCV-7 vaccine serotypes.
  The Pediatric Infectious Disease Journal 03/2010; 29(7):600-6. · 3.58 Impact Factor