Lama Charafeddine

ABSTRACT The interest in parental aging and reproductive outcomes has increased significantly with the change in societal structure and age at family planning. Although the effect of advanced maternal age on obstetric and neonatal morbidities is well established, the effect of advanced paternal age needs additional exploration in association with adverse reproductive outcomes. Some studies suggest that the sperm of fathers with advanced age harbor germline mutations that influence reproductive, neonatal, and adult health outcomes of the progeny. Data on the contribution of advanced paternal age to spontaneous abortion, postconceptual age, birth weight, and neonatal mortality depends on the population and the design of the study. There is stronger evidence that advanced paternal age contributes significantly to congenital malformations and the health of the offspring in adolescence and adulthood with an increased risk of cancer, neurologic disorders, and cardiac diseases. In this review, we summarize the results of different studies that address the effect of advanced paternal age on reproductive outcomes and the origin of illnesses in adulthood. We also discuss possible mechanisms and theories behind these potential associations.

Maternal behavior before and after conception affects maternal and child health. Limited awareness of adolescents in preconception health may be addressed through school education. The aim of this intervention is to assess preconception health awareness among adolescents in Lebanese high schools and to test the effectiveness of a one-time educational session in improving preconception knowledge. The intervention consisted of a 30-minute educational session about good practices in preconception health, developed by the National Collaborative Perinatal Neonatal Network's (NCPNN) research team. A convenience sample of high school Lebanese students in grades 10 to 12, aged 14 to 26 years old, from 70 private and public schools in all six Lebanese provinces, participated in the intervention in 2011 and 2012. A multiple-choice questionnaire administered prior to and 2 months after the session was used to assess knowledge improvement among the students. A total of 7,290 students were e...

Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are reported to impact the preterm birth (PTB) rate and newborn size. Most studies have been conducted in developed countries, although PTB and adverse pregnancy outcomes are more frequent in the developing world. The aim of this study is to elucidate the association of pre-pregnancy BMI and GWG on the occurrence of PTB and sub-optimal fetal size in Lebanon. This is a retrospective cohort study using a hospital-based register covering 35% of births in Lebanon between 2001 and 2012. Data were collected on 170 428 pregnancies from 32 hospitals using medical records and interviews. After adjusting for confounders, underweight women had increased odds of having very preterm [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.16, 2.14], preterm (OR 1.42, 95% CI 1.28, 1.58), and small for gestational age (SGA) (OR 1.50, 95% CI 1.37, 1.63) neonates. When BMI was analysed with GWG, only SGA remained significant in underweight women with low GWG. For all BMI groups, low GWG was protective against large for gestational age (LGA) and high GWG increased the odds of LGA. GWG, both low (OR 1.25, 95% CI 1.15, 1.35) and high (OR 1.43, 95% CI 1.32, 1.55) increased the risk of PTB in normal weight women. The same result was obtained for overweight women. High GWG increased the risk of LGA for all groups and PTB in normal weight and overweight women, whereas low GWG increased the risk of SGA and PTB. Given that there are not many studies from middle income/developing countries on patterns of weight gain during pregnancy, findings from this study may help with pre-conception counselling with emphasis on the importance of an optimal pre-pregnancy BMI and appropriate weight gain during pregnancy.

Airway management and endotracheal intubation are essential skills for pediatric residents. Simulation-based technology is used for training residents but it remains unclear whether high fidelity simulation results in better retention of skills compared to low fidelity. The study assesses high fidelity simulation of endotracheal intubation and traditional low fidelity training in improving pediatric residents' knowledge retention and technical skills; and if the difference translates into higher "real time" intubation success rates. Second and third year pediatric residents were randomized into high fidelity (intervention) or low fidelity simulation (control) groups. Airway management and intubation skills were taught using a didactic lecture and demonstration on low fidelity mannequins. Knowledge was assessed before randomization (T0) and 6 months after training (T6). Other outcome measures were: 1) airway management and intubation skills at T6 and T12 (12 months late...

Our objective was to assess the perinatal management and neonatal outcomes of premature, severely intrauterine growth-restricted (IUGR) neonates. A cohort of neonates <1000 grams, < or = first percentile for weight, and <37 weeks' gestation was identified and matched 2:1 to two control sets of premature, appropriate-for-gestational age (AGA) infants-one with similar gestational age (AGA-GA group) and the other with similar birth weight (AGA-BW group) to determine the effect of IUGR on the outcome of the premature infant. The IUGR group was then examined in detail for descriptive statistics. Data were analyzed by t-tests and Chi-square analyses where appropriate. The IUGR infants had worse outcomes than AGA-GA controls but had somewhat better results than the AGA-BW controls. In the IUGR group, a birth weight less than 550 grams was significantly associated with neonatal death (p < 0.001). However, increasing gestational age was not associated with neonatal survival (p = 0.661) if birthweight remained below 550 grams. Classical cesarean delivery was associated with neonatal death (p = 0.003). Neonatal variables associated with poor outcome included patent ductus arteriosus (p = 0.034), feeding intolerance (p = 0.046), and failure to thrive (p = 0.05). Overall, neonatal survival was 73%. Of the surviving neonates, 69% had evidence of neurodevelopmental delay when tested at 6 and 12 months. Premature, growth-restricted neonates with birth weights of <550 grams versus those of >550 grams have dismal outcomes despite a gestational age that is compatible with survival.

There is need in the Arab world for validated instruments that can reliably assess infant feeding attitudes among women. The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has consistently shown good reliability and validity in different cultures and the ability to predict breastfeeding intention and exclusivity. This study assessed the psychometric properties of the Arabic version of the IIFAS (IIFAS-A). After translating to classical Arabic and back-translating to English, the IIFAS-A was pilot tested among 20 women for comprehension, clarity, length, and cultural appropriateness. The IIFAS-A was then validated among 170 women enrolled in a breastfeeding promotion and support clinical trial in Lebanon. The IIFAS-A showed acceptable internal consistency reliability (Cronbach's α = 0.640), with principal components analysis revealing that it is unidimensional. The 17 items had good interitem reliabilities ranging between 0.599 and 0.665. The number of breastfed children was the only predictor of the overall IIFAS-A score in a multivariate stepwise regression model (β = 1.531, P < .0001). The 17-item IIFAS-A is a reliable and valid instrument for measuring women's infant feeding attitudes in the Arab context.

Right ventricular dysfunction is uncommon following surgical repair of dextrotransposition of great arteries (d-TGA) by the arterial switch procedure. Inhaled nitric oxide (iNO) is a specific pulmonary vasolidator that has proven successful in treating pulmonary hypertension when delivered via endotracheal tube. We present a five-month-old infant with d-TGA and ventricular septal defect (VSD) who developed pulmonary hypertensive crisis, causing severe right ventricular dysfunction with hemodynamic deterioration at day 6 postsurgical repair by VSD closure and arterial switch. He was successfully treated with iNO via nonrebreather face mask avoiding endotracheal reintubation. This modality should be considered in the management of such infants.