Early Cessation Research Articles

Psychosocial predictors of post-natal anxiety and depression: Using Structural Equation Modelling to investigate the relationship between pressure to breastfeed, health care professional support, post-natal guilt and shame, and post-natal anxiety and depression within an infant feeding context.

High perceived pressure to breastfeed and poor perceived quality of health care professional support have been associated with early breastfeeding cessation, guilt, and shame. This is problematic because guilt and shame significantly predict post-natal anxiety and depression. No previous attempts have been made to provide quantitative evidence for relationships mapped between the post-natal social context, infant feeding method and post-natal emotional well-being. The current study aimed to empirically investigate aforementioned pathways. Structural equation modelling was applied to survey data provided online by 876 mothers. Guilt and shame both significantly predicted anxiety and depression. Poor health care professional support and high pressure to breastfeed increased anxiety and depression, and these effects were explained by indirect pathways through increases in guilt and shame. Formula feeding exclusivity was negatively correlated with post-natal anxiety symptoms. This finding may be explained by feelings of relief associated with observed infant weight gain and being able to share infant feeding responsibilities others e.g., with one's partner. This relationship was counterbalanced by an indirect pathway where greater formula feeding exclusivity positively predicted guilt, which increased post-natal anxiety score. While guilt acted as mediator of infant feeding method to increase post-natal depression and anxiety, shame acted independently of infant feeding method. These identified differences provide empirical support for the transferability of general definitions of guilt (i.e., as remorse for having committed a moral transgression) and shame (i.e., internalisation of transgressive remorse to the self), to an infant feeding context. Recommendations for health care practitioners and the maternal social support network are discussed.

Breastfeeding in primiparous women – expectations and reality: a prospective questionnaire survey

BackgroundBreastfeeding provides the optimal nutrition for infants and offers numerous benefits for both mother and child. The World Health Organisation recommends exclusive breastfeeding during the first 6 months of life and the introduction of complementary feeding between the fifth and seventh months of life. There is a discrepancy between breastfeeding recommendations and the actual duration of breastfeeding. The aim of this study was to analyse breastfeeding behaviour in primiparous women in order to be able to provide support for mothers.MethodsIn this prospective, questionnaire-based study conducted between 2020 and 2022, primiparous women were asked to complete three questionnaires at three defined survey time points (routine prepartum presentation, postpartum hospitalization, completed sixth month of life).ResultsA total of 140 women were included and returned all three questionnaires. Fifty-eight percent performed breastfeeding exclusively at least until their baby had reached the age of 6 months, whereas 20% already stopped within the first 6 months. The main reasons given for early cessation were insufficient milk supply and inadequate infant weight gain. A comprehensive level of prepartum knowledge had a significant positive effect on participants’ sense of confidence with breastfeeding. Sociodemographic factors such as age and educational level were also associated with breastfeeding behaviour, but significant corresponding differences in the duration of breastfeeding were not observed. Women with postpartum midwifery care breastfed significantly longer (p < 0.05).ConclusionsBreastfeeding behaviour and duration are influenced by multiple factors. Although certain sociodemographic factors are unalterable, comprehensive prepartum knowledge transfer and postpartum midwifery care have a positive impact on breastfeeding behaviour.Trial registrationThe study was retrospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) on 6 December 2022 (DRKS00030763).

Using telemedicine to improve early medical abortion at home (UTAH): a randomised controlled trial to compare telemedicine with in-person consultation for early medical abortion

ObjectivesTo compare telephone consultations with in-person consultations for the provision of medical abortion (using mifepristone 200 mg and misoprostol 800 µg). We hypothesised that telemedicine consultations would be non-inferior to...

Use of Galactagogues to Increase Milk Production A mong Breastfeeding Mothers in the United States: A Descriptive Study.

Perceived insufficient milk is a primary reason for early breastfeeding cessation. Some breastfeeding mothers may use galactagogues (ie, foods, beverages, herbal supplements, and pharmaceuticals) to try to increase milk supply. However, milk production requires frequent and effective milk removal, and there is limited evidence on the safety and efficacy of galactagogues. Additional research on the use of galactagogues is needed to inform breastfeeding support. Describe the prevalence of use and perceived effects of galactagogues and compare galactagogue use by maternal characteristics. Cross-sectional online survey. A convenience sample of 1,294 adult women breastfeeding a singleton child and living in the United States were recruited using paid Facebook advertisements between December 2020 and February2021. Self-reported current or previous use of galactagogues and their perceived effects on milk production. Frequencies and percentages described the use and perceived effects of galactagogues. The χ2 test of independence and independent t tests compared galactagogue use by select maternal characteristics. More than half of participants (57.5%) reported using any galactagogues, 55.4% reported consuming foods or beverages, and 27.7% reported using herbal supplements. Few participants (1.4%) reported using pharmaceuticals. Participants reported varying effects of specific galactagogues on milk production. Reported galactagogue use was higher among participants who reported first-time breastfeeding (yes: 66.7% vs no: 49.3%; P < 0.001), breastfeeding pumped milk (yes: 63.1% vs no: 50.4%; P < 0.001), formula supplementation (yes: 66.8% vs no: 50.4%; P < 0.001), and perceived insufficient milk (yes: 78.8% vs no: 53.8%; P < 0.001). Breastfeeding mothers in the United States commonly reported using galactagogues to increase milk production, highlighting the need for research on the safety and efficacy of galactagogues and enhanced breastfeeding support.

Epidemiological and clinical characteristics of pulmonary arterial hypertension in Indian patients: A hospital-based observational study

Context: Pulmonary hypertension (PH) is a condition characterized by an increase in pulmonary artery pressure, leading to morbidity and poor survival. In India, the high prevalence of certain diseases contributes to the burden of PH. To address this, this study provides epidemiological data and clinical characteristics of pulmonary artery hypertension. Materials and Methods: A cross-sectional study was conducted at a tertiary cardiac care hospital, recruiting 964 patients with severe pulmonary arterial hypertension (PAH). Patient data were obtained through a detailed history and physical examination, including 12-lead electrocardiogram, two-dimensional echocardiography, coronary angiography, right heart catheterization, and hematological and serological investigations. Results: The majority of patients (28.94%) were in the age group of 31–40 years, with a female preponderance in PAH disease. Idiopathic PAH (IPAH) was the most common type, accounting for 69.78% of all cases. The most common comorbid conditions were hypertension (48.55%) and Type-2 diabetes mellitus (44.81%). Dyspnea on exertion (98.34%) and edema of extremities (91.18%) were the most common symptoms. The mean survival rate was 50.98 months, with Type 1 PAH having the worst survival rate of 47.56 months. The statistical analysis showed a significant association between smoking and PAH. Conclusion: This study provides epidemiological data and clinical characteristics of PAH patients in India, emphasizing the need for early diagnosis, prompt management, and smoking cessation programs. The high prevalence of IPAH and female preponderance was also observed in this study. These findings can help in the development of targeted interventions and management strategies for PH patients in India.

Factors associated with exclusive breastfeeding of children under six months of age in Cote d’Ivoire

BackgroundDespite benefits of exclusive breastfeeding (EBF) and its strategic place in the national guidelines for infant and young child feeding, its practice remains insufficient in Cote d’Ivoire. It is therefore important to identify its early stopping associated factors. We aimed to (i) assess the extent of children’s exposure to exclusive breastfeeding and the associated explanatory factors for discontinuation before six months, and (ii) to profile non-exclusively breastfed children and interrelationships between these factors.MethodsA secondary analysis of data from the 2016 Cote d’Ivoire Fifth Multi Indicator Cluster Survey (MICS5) of 980 children under six months of age was conducted in this study. Data were analyzed using the actuarial method of survival hazard estimation combined with the Wilcoxon (Gehan) test, discrete time proportional hazards regression models, and Multiple Correspondence Analysis (MCA) to profile the children.ResultsMaternal exposure to counseling session, age at delivery, and child sex were significantly associated with the likelihood of discontinuing exclusive breastfeeding before the first six months of life. Children deprived of EBF resided in urban areas, in high and very high economic welfare households. Their mothers had a secondary education or higher and had three or fewer children.Logistic analysis showed that health status and sex of the child were significantly associated (P < 0.001) with exclusive breastfeeding. An extremely important and rarely studied factor is that children who were sick in weeks prior to the survey were more likely to remain exclusive breastfeeding (adjusted OR 1.80; 95% Confidence Interval (CI) 1.452, 2.234). Girls are less likely to be exclusively breastfed than boys (adjusted OR 1.48; 95% CI 1.22, 1.798). Low standard of living was associated with early cessation of EBF (adjusted OR 2.15; CI 1.325, 3.499). The duration of the exclusive breastfeeding was significantly longer among mothers with high exposure to medical discourse (adjusted OR 0.74; CI 0.595, 0.91).ConclusionsImproving the practice of exclusive breastfeeding in Cote d’Ivoire requires strengthening the capacities of health professionals in terms of advice and assistance to mothers for the practice of exclusive breastfeeding and its maintenance until six months of age, regardless of the health status and sex of the child.

Determinants of early cessation of exclusive breastfeeding practices among rural mothers from Jaffna District of Sri Lanka

BackgroundSri Lanka is an upper-middle-income country with excellent health statistics. However, 2016 Demographic and Health Survey data have shown 82% and 64% of mothers exclusively breastfed infants aged 0–6 months and 4–5 months, respectively. The short duration of exclusive breastfeeding (EBF) has an impact on the growth and development of babies. Since no studies have been reported on EBF practices of the rural mothers in Jaffna District, an administrative district among 25 districts of Sri Lanka, this study aimed to assess the factors influencing the early cessation of EBF.MethodsFor this community-based cross-sectional study, 338 mother–child pairs were selected from 2013–14. EBF was defined as children not receiving any food or drink, including complementary foods, formula milk or milk products except for medicines and vitamins or mineral drops, other than breast milk since birth. Socio-economic and demographic factors, the influence of the mode of delivery, and knowledge on EBF were obtained using an interviewer-administered questionnaire. The details of EBF and reasons for the cessation of breastfeeding before six months were obtained from a subgroup of mothers (n = 208). Multivariate analysis was performed to explore the correlates of breastfeeding.ResultsIn this study, 71.2% (95% CI 64.5, 77.2) had practiced EBF for six months. Early discontinuation of EBF was practiced by employed mothers (AOR 4.3; 95% CI 1.3, 13.9), mothers of low birth weight babies (AOR 3.6; 95% CI 1.6, 8.2) and those who experienced Cesarean section birth (AOR 2.9; 95% CI 1.2, 6.9). The EBF practiced by mothers of rural Jaffna was not associated with the gender of the babies, type of family, number of children in a family, religion of the household, knowledge on EBF, or family income.ConclusionThe prevalence of EBF up to six months was low in rural Jaffna, and it was influenced by employment, birthweight of the babies, and the mode of delivery. To enhance EBF, the Regional Directorate of Health Service, Jaffna, should take necessary action with policymakers to increase maternity leave for at least six months, reduce the Cesarean section rate, and provide nutritional support to pregnant mothers.

Association of chemotherapy dose intensity and age with outcomes in patients with Ewing's family sarcoma.

Ewing's family sarcoma (EFS) is an aggressive malignancy with a peak incidence in adolescents. Multimodal treatment involves surgery and/or radiotherapy, and chemotherapy typically with VDC/IE (vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide and etoposide). There is a paucity of data for the treatment of adults, with protocols extrapolated from the pediatric setting. This study aimed to assess patterns of care, chemotherapy tolerability across age groups, and outcomes from four Australian sarcoma centers. ANZSA ACCORD sarcoma database and medical records were used to identify and collect data of patients aged≥10 years with EFS who received VDC/IE between 2010 and 2020. Survival outcomes were analyzed based on chemotherapy received dose intensity (RDI). Clinical predictors of RDI were explored using logistic regression. Of 146 patients with EFS, 76 received VDC/IE. The majority had localized disease (65%). Seventy-one percent completed scheduled chemotherapy, with some requiring dose reduction (29%), delay>7 days (65%), or cycle omission (4%). Hematological toxicity was the main reason for dose reduction/delay. Fifty-seven percent patients achieved an acceptable RDI ≥85%. Compared to those aged 10-19, the odds ratio for acceptable RDI aged 40-59 was 0.20 (95% CI 0.04-0.86, p=0.04). RDI was an independent prognostic factor for overall survival, after accounting for age, gender, Ewing's type, primary site, and stage (adjusted HR 0.25 [95% CI 0.10-0.63], p=0.004). Survival outcomes in EFS were associated with chemotherapy RDI. Older adults more commonly required dose reduction or early cessation of treatment due to toxicity. VDC/IE chemotherapy should be carefully tailored in adults>40 years.

Balancing crop water requirements through supplemental irrigation under rainfed agriculture in a semi-arid environment

Rainfed farming is a dominant agricultural system in Tigray, Ethiopia. However, rainfall is characterized by short duration, intense and erratic subjected to late-onset and early cessation, suggesting a pressing need for Supplemental Irrigation (SI) to fill the crop water demand. Understanding the effects of SI during rainfall late-onset, early cessation, or both, along with their underlying causes, is a critical knowledge gap globally. Although wheat is one of the principal food crops in Tigray, it is subjected to moisture stress during critical growth stages, limiting its potential productivity. Studies specifically related to impacts due to the late-onset of rainfall on wheat are non-existent. Here, we investigated the agrometeorological characteristics of rainfall variability, onset, cessation, and length of the growing season to evaluate the use of SI for balancing the moisture stress in rainfed farming. Meanwhile, using an on-farm experiment, we also evaluated double-season (2017 and 2018) SI application during late-onset (Pre), early cessation (Post), and its combined effects (Pre + Post) on yield and water productivity (WP) of wheat. Yield and WP were significantly (P < 0.05) affected by SI application with higher grain yield (3298 kg/ha) and WP (0.538 kg/m3) obtained from applying Pre + Post. Applying Pre + Post has increased grain yield, biomass, and WP of wheat by 45.6, 27.7, and 21.5% over Rain-fed farming, respectively. Thus, balancing crop water requirements using SI during inadequate rainfall distribution is key for improving WP and wheat production in semi-arid environments. Particularly, the application of SI both during the late-onset and early cessation of rainfall is suggested for greater wheat productivity in semi-arid regions.

Early cessation of calcineurin inhibitors is feasible post–haploidentical blood stem cell transplant: the ANZHIT 1 study

AbstractHaploidentical hematopoietic stem cell transplant (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) is appropriate for those who lack matched donors. Most studies using PTCy have been retrospective making conclusions difficult. ANZHIT-1 was a phase 2 study conducted at 6 Australian allogeneic HSCT centers. The primary end points were disease-free and overall survival at 2 years after HSCT. The reduced-intensity conditioning (RIC) included fludarabine, cyclophosphamide, and 200 cGy total body irradiation, and the myeloablative conditioning (MAC) was IV fludarabine and busulfan. PTCy, MMF and a calcineurin inhibitor (CNI) were used for graft-versus-host disease (GVHD) prophylaxis. CNIs were weaned and ceased by day +120 in eligible patients on day 60. Patients (n = 78) with hematological malignancies were included in the study, with a median follow-up of 732 days (range, 28-1728). HSCT was RIC in 46 patients and MAC in 32 patients. Disease-free survival probability at 2 years was 67.5% (95% [CI], 53.2-85.6) for MAC recipients and 68.3% (95% CI, 56.3-83.01) for RIC recipients. Transplant-related mortality (TRM) on day 100 and year 1 was 4.9% (95% CI, 1.6-15.3) and 17.9% (95% CI, 8.8-36.5), respectively, in the MAC group compared with 3.1% (95% CI, 0.8.1-12) and 11.6% (95% CI, 6-22.4), respectively, in the RIC group. The median time for elective cessation of CNI was day 142.5 days, with no excess chronic GVHD (cGVHD) or mortality. Of the evaluable patients, 71.6% discontinued immunosuppression 12 months after transplant. This prospective haplo-HSCT trial using PTCY demonstrated encouraging survival rates, indicating that early CNI withdrawal is feasible and safe.

Phage Therapy for Diabetic Foot Infection: A Case Series

PurposeInfected diabetic foot ulcers can be difficult to treat and, despite appropriate antibiotic therapy, some diabetic foot infections (DFIs) require amputation. Bacteriophages (phages) are viruses that infect and kill bacteria. Phage therapy has been repeatedly used to successfully treat DFIs and other chronic wounds. MethodsThis article reports the provision of topical adjunctive anti-staphylococcal phage therapy to 10 patients with DFI at high risk of amputation at two UK hospitals as part of clinical care; tolerability and efficacy were clinically assessed. FindingsThe opinion of the experienced clinical teams caring for these patients was that 9 of the 10 patients appeared to benefit from adjunctive phage therapy. No adverse effects were reported by clinicians or patients. In 6 of 10 patients the clinical impression was that phage therapy facilitated clinical resolution of infection and limb salvage. Resolution of soft tissue infection was observed in a 7th patient but unresolved osteomyelitis required amputation. An 8th patient demonstrated eradication of Staphylococcus aureus from a polymicrobial infection and a 9th showed signs of clinical improvement before early cessation of phage therapy due to an unrelated event. One patient, with a weakly susceptible S aureus isolate, had no significant response. ImplicationsThis report describes the largest application of phage therapy in the United Kingdom to date and the first application of phage therapy for DFI in the United Kingdom and offers subjective hints toward impressive tolerability and efficacy. Phage therapy has the potential to transform the prevention and treatment of DFIs.

P-683 Live birth rate following medicated frozen-thawed embryo transfer with or without GnRH-antagonist (Cetrotide) pituitary suppression. A randomised, controlled pilot trial

Abstract Study question Does the administration of GnRH-antagonist (Cetrotide) in medicated frozen-thawed embryo transfer (FET) cycles improve live birth (LBR) or cycle cancellation rate? Summary answer Live birth and cycle cancellation were similar with or without Cetrotide. However, cancellation for threatened ovulation was statistically significantly lower when Cetrotide was administered. What is known already During medicated FET, embryo and endometrial development must be synchronized, with endometrial window of implantation dependent on duration of progesterone. Suppression of spontaneous ovulation is key to maintaining synchrony. There are insufficient data regarding the use of supplementary pituitary suppression in medicated FET. A recent Cochrane review identified one small RCT comparing live birth rate between medicated FET with or without GnRH-agonist pretreatment. The study suggested benefit to GnRH-agonist, but cycles were not monitored for ovulation. One RCT compared GnRH-antagonist with agonist showing better clinical pregnancy rate with GnRH-antagonist. No published RCT has compared medicated FET with versus without GnRH-antagonist. Study design, size, duration We conducted an open, two-arm, single-centre, randomised, controlled trial comparing medicated FET with or without Cetrotide. Target recruitment was 300. However, the study was stopped due to the Covid-19 pandemic. Recruitment occurred between 23rd January 2019 and 11th March 2020 and ended at 161 participants. Analysis was undertaken on an intention-to-treat basis, with live birth rate (LBR) as the primary outcome. Participants/materials, setting, methods Patients were given oestradiol 2mg orally TDS. Once the endometrium was ≥7mm, vaginal progesterone was commenced, with FET on the sixth day of progesterone. The Cetrotide group were given Cetrotide 0.25mg SC OD from days 1-7. Urine pregnancy test was done 11 days following FET, with oestradiol and progestogen continued to 10 weeks gestation. Cycles were cancelled for “threatened ovulation” if daily urinary LH-surge testing was positive or an ovarian follicle (≥12mm) was growing. Main results and the role of chance 161 patients were randomised (Cetrotide: 76, no Cetrotide: 85). Six were withdrawn after randomisation (three withdrew consent, two did not start, one natural pregnancy). 155 participants started treatment (Cetrotide: 73, no Cetrotide: 82) and 140 had embryo transfer (Cetrotide: 68, no Cetrotide: 72). The LBR was similar between groups (Cetrotide: 39% (30/76), no Cetrotide (29/85): 34%; OR 0.79, 95% CI 0.42 - 1.51), as were pregnancy rate (42% versus 38%; OR 0.87; 95% CI 0.47-1.63), clinical pregnancy rate (52% versus 49%; OR 0.83; 95% CI 0.44 – 1.56), biochemical pregnancy rate (20% versus 24%; OR 1.25; 95% CI 0.44 - 3.58) and miscarriage rate (7% versus 10%; OR 1.55; 95% CI 0.24 – 9.97). In the Cetrotide group, 7% of cycles were cancelled, compared to 12% in the no Cetrotide group (NS). However, cancellation due to threatened ovulation was statistically significantly lower in the Cetrotide group, with 0% of cycles cancelled compared to 5% in the no Cetrotide group (OR 1.05; 95% CI 1.001 – 1.105). Baseline characteristics (age at oocyte retrieval, age at FET, parity, subfertility diagnosis, number of oocytes retrieved, number of viable blastocysts, proportion of IVF/ICSI, endometrial thickness, number of embryos transferred, embryo quality) were similar between groups. Limitations, reasons for caution The study is limited by the fact it was unblinded, undertaken at a single site and was underpowered for live birth due to early trial cessation. Wider implications of the findings Results suggest no effect of Cetrotide on LBR in medicated FET. There was a significantly higher risk of cycle cancellation due to risk of ovulation in patients not taking Cetrotide. This is clinically significant and requires further study, as cancelled cycles increase costs and duration to birth. Trial registration number EudraCT Number: 2018-001915-63

MACULAR HOLE IN A PATIENT WITH PENTOSAN POLYSULFATE MACULOPATHY.

Pentosan polysulfate (PPS), a drug used for interstitial cystitis, has recently been detected to cause maculopathy in a dose-dependent manner. Outer retinal atrophy is the hallmark of this condition. History, examination, and multimodal imaging were used to guide diagnosis and management. We report a case of PPS-related maculopathy in a 77-year-old lady, who presented with florid retinal atrophy at the posterior pole in both eyes, and a concurrent macular hole in the left eye. She had been diagnosed with interstitial cystitis several years before for which she was prescribed PPS (Elmiron). She had noticed a drop in vision 5 years after initiation of PPS and self-discontinued the drug after 24 years of use. A diagnosis of PPS-related maculopathy with a macular hole was made. She was counselled regarding the prognosis and was advised to avoid PPS. Surgery for macular hole was deferred in view of the severe retinal atrophy. Pentosan polysulfate-related maculopathy can lead to severe retinal atrophy and a subsequent degenerative macular hole. A high index of suspicion is required for early detection and cessation of drug to prevent this irreversible vision loss.

Challenges of Continuation of Exclusive Breast Feeding up to 6 Months in a Setting with High Exclusive Breast Feeding Rates Reported. Experience from Eastern Province of Sri Lanka.

According to the World Breastfeeding Trends Initiative, Sri Lanka ranked as number one and only country to achieve green status. Exclusive breastfeeding (EBF) for six months is current practice with a rate of 75.5% among 0-5months. Identify factors contributing early cessation of breastfeeding in a single centre of Eastern province Sri Lanka. A descriptive cross-sectional study conducted in Sammanthurai Medical officer of Health area. Consecutive mother-infant days with the infant ageing < 6months were included from 25 public health midwife areas using an interviewer administered questionnaire. Missing values imputed using 'missForest' algorithm. The mean age of the sample was 28.4(SD ± 5.6). Of the 257 mothers recruited, 15(5.8%) were teenagers and 42(16.3%) > 35years. 251(97.6%) had children 1-5 and 86(33.5%) were first born. 140 (54.5%) had tertiary education, 28 (10.9%).31(12.1%) were employed. EBF rates 0-6months was 79.8% (n = 205). 239(93.0%) started breastfeeding within an hour. EBF was not associated with maternal age, birth order or income. 18 employed mothers and 186 unemployed mothers continued EBF. Regarding the factors associated with EBF, having a tertiary education (p < .001), being employed (p = .004) and having less than 3 children (p = .03) were associated with non-exclusive breastfeeding. Tertiary education was the significant predictor of non-exclusive breastfeeding in this population with an odds ratio of 4.50 (95% CI 1.331-15.215). Employment identified as a risk factor for early cessation of EBF needs well planned further research to overcome this practical issue. Also might need revision of workplace policies, establishment of lactation areas in office premises to overcome some of these issues.

Maternal intrapartum fluids and neonatal weight loss in the breastfed infant

Background/Aims Significant weight loss during early life can be of serious concern and assessing weight is key in decisions regarding supplementation. However, supplementation is a significant risk factor for early breastfeeding cessation. Recognising differential causes of weight loss supports identification of genuinely unwell infants and targets practices that support exclusive breastfeeding appropriately. This study's aim was to identify whether maternal fluid balance/load is associated with neonatal weight loss. Methods The databases CINAHL, MEDLINE, EMBASE, EMCARE were searched for relevant literature. Data were extracted using a structured form based on the Cochrane handbook. Meta-analysis was not possible because of the heterogeneity of all aspects of study design and outcome definitions. Results Eight studies presented original data. Four reported an association between maternal intravenous fluid intake and neonatal weight loss, and four did not. No two studies collected the same outcome data at the same time, using the same comparator or intervention. Conclusions Further research is required to clarify the relationship between maternal fluid intake and neonatal weight loss in a clinically useful way.

Racial disparity in dose intensity of early-stage breast cancer chemotherapy.

6556 Background: There are persistent, entrenched racial disparities noted in breast cancer outcomes. A basis for these disparities can be racial inequality for stage matched Black vs. White women in receiving early-stage breast cancer (ESBC) chemotherapy dose intensity of, at minimum, 85% or more of chemotherapy (historic gold standard) within prescribed timeframe. Our study measured dose reductions, early terminations, and overall dose intensity of ESBC chemotherapy in urban breast cancer centers and compared by race. Methods: Using a longitudinal, comparative descriptive design, treatment characteristics were measured in women receiving ESBC cancer chemotherapy in seven cancer centers in Western PA and Eastern Ohio. Dosing scheduled was calculated per patient chemotherapy prescription. Actual dose was measured as percentage of chemotherapy received / prescribed in “prescribed time,” meaning exact, ideal time to complete chemotherapy calculated from dose initiated without delay, dose reduction or early stoppage. The second measurement, “in any time,” measured chemotherapy completed over any course of time, incorporating delays and reductions. Results were dichotomized according to 85% of prescribed dose for both outcomes and compared by patient self-reported race (Black or White). Results: This study was conducted from August 2017 through June 2022. N=260 patients, race self-reported as 100 Black (38.5%) and 160 White (61.5%). Overall, n=36 (13.8%) had early termination of therapy. Early termination was more common for Black patients, 21%, vs 10% for White patients (p=.04). N=100 (38.3%) of all patients had some dose reduction, racially divided by 46.4% of Black patients vs. 34.3% of White patients, NS. By projected endpoint, Black patients received 77% (SD 24.1) of prescribed chemotherapy; White patients 86.7% (SD 16.6), p=.001. By “in any time” endpoint, Black patients received 86.5%, (SD 22.8) of prescribed therapy, White patients received 93.5% (SD 13.2), p=.002. By “in any time” measurement, 15% of White patients and 25% of Black patients did not receive the gold standard of 85% of prescribed chemotherapy. N= 7 of delays or terminations were due to disease progression, or poor response, and rarely, (n=4) to patient nonadherence. Largely, delays and early cessation were due to chemotherapy toxicity. Conclusions: Racial disparities in dose intensity and alterations of prescribed ESBC chemotherapy must be eliminated. Further examining the racial differences around dose delays and early chemotherapy termination, including racial barriers to patient- clinician communication around chemotherapy related toxicity, is essential to ensure equitable ESBC care and outcomes.

Pneumonia panel results and antibiotic prescribing in COVID-19 patients in 2020 versus 2022

Background: Antibiotics are frequently prescribed in patients with COVID-19 infections to treat secondary bacterial pneumonia. The pneumonia panel (PNP) is a molecular diagnostic tool that rapidly detects 33 bacterial and viral targets. The utility of this panel in COVID-19 patients and how it may direct antibiotic use is unknown. We sought to understand the utilization of PNP in patients with COVID-19 pneumonia over time by comparing clinical parameters, microbiologic results, and antibiotic use between May–December 2020 and January–July 2022. Methods: We implemented the PNP in May 2020 with antimicrobial stewardship guidance, provider education, and order restriction to critical care and infectious disease clinicians. From February–July 2021 prescribers received regular structured antimicrobial stewardship feedback regarding PNP results; from August 2021 to January 2022, no antimicrobial stewardship feedback was provided; from February to July 2022, intermittent feedback was provided. We compared PNP and culture results from sputum or bronchoalveolar lavage samples and antibiotic use and modification within 24 hours of PNP result from patients with confirmed COVID-19 pneumonia between May–December 2020 and January–July 2022. Clinical data and antibiotic use were abstracted through chart review. We excluded patients who died within 72 hours of PNP, those who had concurrent nonpulmonary infections, and those whose COVID-19 test was &gt;30 days prior. Results: We included 114 patients in 2020 and 71 patients in 2022. The overall median age was 61 years, 71% were male, and 66% were mechanically ventilated without statistical differences between the cohorts, including their comorbidities. Acute or worsening hypoxia remained the predominant indication for PNP (77% in 2020 vs 75% in 2022, NS). The median number of days between admission and PNP was 4 (IQR, 1–8) in 2020 versus 3 (IQR, 1–7), and the difference was not significant. PNP and culture results in Table 1 show that Staphylococcus aureus and Hemophilus influenzae were the pathogens most commonly identified. Table 2 describes empiric prescribing and modifications for commonly prescribed antibiotics. Prescribers used empiric cefepime and ceftriaxone more in 2020 and vancomycin more in the 2022 group; however, these were not statistically significant. Cefepime de-escalation was more common in 2022 (53% vs 28%; P = .03). Antibiotic modifications within 24 hours of PNP remained similar in 2020 vs 2022. Although vancomycin cessation was more common in 2020 (78%) versus 2022 (57%), the difference was not statistically significant. Conclusions: With ASP guidance, PNP may be a useful tool to stop or target antibiotics for secondary bacterial pneumonia in COVID-19 pneumonia. Early vancomycin cessation (prior to culture results) may be an enduring consequence of PNP implementation.Disclosures: None

Survival outcomes in patients with muscle-invasive bladder cancer receiving neoadjuvant chemotherapy stratified by number of cycles.

4586 Background: Neoadjuvant cisplatin-based chemotherapy (NAC) prior to radical cystectomy is the standard of care for patients with muscle invasive bladder cancer (MIBC). Three or more cycles of NAC are commonly administered based on outcomes in prior prospective trials, however many patients are intolerant of 3 cycles of NAC due to toxicity. The prognosis of patients receiving fewer than 3 cycles of NAC has yet to be elucidated. Methods: This is a retrospective single-center study to quantify pathologic response, recurrence-free survival (RFS), and overall survival (OS) from time of first NAC in patients treated with &lt; 3 cycles of NAC compared to patients treated with ≥3 cycles of NAC. Inclusion criteria include: diagnosis of MIBC between 2004-2017, ≥5 years of follow up, deceased or had recurrence prior to 5 years follow up but with adequate follow-up data. Patients were excluded from the study if they were found to have metastatic disease prior to initiation of NAC, lost to follow up prior to 5 years with no evidence of recurrence or death, or had progression of disease during NAC. The primary objective of this study was to determine RFS and OS in patients stratified by cycles of NAC. Patient characteristics were compared using chi-square tests, Fisher’s exact tests, and Wilcoxon rank sum tests. Kaplan Meier curves and log-rank tests were used to compare RFS between subgroups, and Cox proportional hazards models were used to compare RFS adjusting for ECOG performance status, baseline GFR, stage, type of NAC regimen, and patient age at first dose of NAC. 5-year OS was calculated as a percentage of patients surviving at 5 years. Results: A total sample of 195 patients were treated with NAC for MIBC, of which 30 (15.3%) patients received &lt; 3 cycles and 165 (84.6%) patients received ≥3 cycles of NAC. 53 patients received gemcitabine and cisplatin (GC) and 142 patients received methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC). Complete pathologic response (ypT0N0) was observed in 7.4% of patients receiving &lt; 3 cycles and in 26.8% of patient receiving ≥3 cycles of NAC (p = 0.024). Significant pathologic response ( &lt; ypT2) was obtained in 22.2% of patients receiving &lt; 3 cycles of NAC and in 41.8% of patients receiving ≥3 cycles (p &gt; 0.05). Median RFS in patients with &lt; 3 cycles of NAC was 8.8 months (95% CI 6.51, 13.4) and 54.5 months with ≥3 cycles of NAC (95% CI 29.8, 111.9). Based on a log-rank test there is a statistically significant difference in unadjusted RFS between the two groups (p &lt; 0.001). The 5-year OS in patients receiving &lt; 3 cycles of NAC was 13.3%, and the 5-year OS in those receiving ≥3 cycles was 53.3%. Conclusions: Early cessation of chemotherapy due to intolerance had significant implications on pathologic response, RFS and OS. Clinicians should prioritize administering at least 3 cycles of cisplatin-based chemotherapy when feasible to optimize outcomes.

Impacts of climate change on crop growing season characteristics in Northern Ethiopia

Abstract Understanding the likely impact of climate change on crop growth is very important to identify possible areas of intervention and consider climate-related impacts. This study aimed to investigate the future impact of climate change on the crop growing season in the Tigray region. Five global climate models under two representative concentration paths were projected for future periods using a delta downscaling approach. Results indicate that projections of rainfall showed an increase in annual and summer (Kiremt) rainfall at most stations. However, the Belg rainfall season had a declining trend except under RCP4.5 in a mid-term period that showed positive changes at most stations. On the contrary, projections of maximum and minimum temperatures indicated a continuous increase. In line with the increase in temperatures, the reference evapotranspiration consistently increased at all stations. Cumulatively, late onset and early cessation of rainfall are observed, accompanied by a 5.5–19% reduction in the length of the growing period (LGP), exacerbating the current short LGP in the study area and affecting the proper growth and maturity of major crops. The findings of this study have global implications in that similar areas may be alarmed to get prepared ahead and develop adaptive and sustainable crop production strategies.

Rainfall changes perceived by farmers and captured by meteorological data: two sides to every story

Subsistence farmers with high dependency on natural resources are exceptionally vulnerable to rainfall changes. Besides, they are in the front row when it comes to observing these changes. Studies that systematically investigate similarities and differences between measured and perceived rainfall changes are typically limited to trends in rainfall amounts, thereby disregarding changes in extreme events, rainy season durations, and timing. We address this gap by contrasting rainfall changes perceived by subsistence farmers in the Ethiopian highlands with meteorological daily rainfall data derived from the Climate Hazards Group Infrared Precipitation with Stations (CHIRPS). We applied nine distinct metrics for rainfall dynamics, accounting for rainfall variability, including extreme events and changes in the onset and cessation of the two rainy seasons. Farmers perceived increasingly unreliable rainfall for both the short and the long rainy seasons, with later onset and earlier cessation, increasing rainfall intensity, and increasing occurrence of untimely rainfall and droughts. This partially disagrees with the CHIRPS data that indicate most significant rainfall changes for the short rainy season only. Since the early 1980s, this season has been experiencing decreasing rainfall amounts, with high variability between years and an increasingly uncertain – yet delayed – onset. In contrast, the long rainy season experienced little changes in rainfall. Our results point towards changing farmers' water availability and water demand as an explanation for the perceived deteriorating rainfall conditions. As farmers’ perceptions partly diverge from meteorological observations, both data sources should be used complementarily to improve our understanding of climatic change.