Neal Goldstein, Ph.D., MBI

Epidemiologist, Department of Pediatrics, Christiana Care; Assistant Professor, Department of Epidemiology and Biostatistics, Drexel University

Publications

Characteristics of late-onset sepsis in the NICU: does occupancy impact risk of infection?
Characteristics of late-onset sepsis in the NICU: does occupancy impact risk of infection?
Goldstein ND, Eppes SC, Ingraham BC, Paul DA

J Perinatol 2016 Sep;36(9):753-7

PMID: 27149054

Abstract

OBJECTIVE: Infants in neonatal intensive care units (NICUs) are vulnerable to a variety of infections, and occupancy in the unit may correlate with risk of infection.
STUDY DESIGN: A retrospective cohort of infants admitted to the NICUs between 1997 and 2014. Survival analysis was used to model the relative hazard of sepsis infection in relation to two measures of occupancy: 1) the average census and 2) proportion of infants <32 weeks gestation in the unit.
RESULT: There were 446 (2.3%) lab-confirmed cases of bacterial or fungal sepsis, which steadily declined over time. For each additional percentage of infants <32 weeks gestation, there was an increased hazard of 2% (hazard ratio 1.02, 95% confidence interval: 1.00, 1.03) over their NICU hospitalization. Census was not associated with risk for infection.
CONCLUSION: During times of a greater proportion of infants <32 weeks gestation in the NICU, enhanced infection-control interventions may be beneficial to further reduce the incidence of infections.
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Cardiovascular risk factors one year after a hypertensive disorder of pregnancy
Cardiovascular risk factors one year after a hypertensive disorder of pregnancy
Ehrenthal DB, Rogers S, Goldstein ND, Edwards DG, Weintraub WS

J Womens Health (Larchmt) 2015 Jan;24(1):23-9

PMID: 25247261

Abstract

OBJECTIVE: To identify differences in women's cardiovascular risk, independent of obesity, one year after delivery of a pregnancy complicated by a hypertensive disorder of pregnancy (HDP).
METHODS: We compared traditional and novel cardiovascular risk factors of women recruited at delivery following the diagnosis of an HDP with those of women with uncomplicated pregnancies, at 3 months and 12-18 months postpartum. Measures included blood pressure, fasting lipids, inflammatory biomarkers, and measures of insulin resistance. Multiple linear regressions were used to adjust for body mass index (BMI) and other characteristics.
RESULTS: We studied 71 subjects: 31 women with HDP and 40 with an uncomplicated pregnancy. There were no significant differences between groups for total cholesterol, HDL-c, LDL-c, triglycerides, HgbA1c, or homeostasis model assessment-estimated insulin resistance. Values for tumor necrosis factor-α were significantly higher in the HDP group (p<0.01), while those for interleukin-6 and c-reactive protein were not. A diagnosis of HDP was associated with a 9 mm Hg difference in systolic blood pressure at both 3 months and 1 year, after adjustment for age, BMI, race, family history of cardiovascular disease, tobacco use, and insurance.
CONCLUSIONS: Women with HDP had significantly higher blood pressure 3 months and 1 year after delivery, independent of obesity. There were no significant differences in lipids or measures of insulin resistance after adjusting for BMI. Elevated blood pressure may account for the observed associations between HDP and future cardiovascular disease.
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Arterial stiffness and wave reflection 1 year after a pregnancy complicated by hypertension
Arterial stiffness and wave reflection 1 year after a pregnancy complicated by hypertension
Ehrenthal DB, Goldstein ND, Wu P, Rogers S, Townsend RR, Edwards DG

J Clin Hypertens (Greenwich) 2014 Oct;16(10):695-9

PMID: 25116457

Abstract

Hypertensive disorders of pregnancy (HDP) are associated with cardiovascular disease (CVD) later in life. The authors investigated the association of HDP with blood pressure (BP) and arterial stiffness 1-year postpartum. Seventy-four participants, 33 with an HDP and 41 with uncomplicated pregnancies, were examined using applanation tonometry to measure BP, carotid-femoral pulse wave velocity (cfPWV), and augmentation index (AIx). On average, women with HDP had a 9 mm higher systolic BP (P<.01), 0.8 m/s faster cfPWV (P=.09), and 5.4% greater AIx (P=.09) at the 1-year examination. After adjustment for covariates, there was no significant difference in cfPWV between groups, while a 7.3% greater AIx (P<.05) remained. These findings suggest that reduced endothelial function may be detected 1 year after HDP. Large prospective studies are needed to further understand the contribution of arterial stiffness and endothelial dysfunction in the evolution of CVD after these complicated pregnancies.
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