A5090690448- Neonatal Respiratory Health Research
- Neonatal and fetal brain pathology
- Mechanical Circulatory Support Devices
- Congenital Heart Disease Studies
- Neonatal Health and Biochemistry
- Retinopathy of Prematurity Studies
- Infant Development and Preterm Care
- Metabolism and Genetic Disorders
- Neonatal and Maternal Infections
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Cardiac Arrest and Resuscitation
- Cystic Fibrosis Research Advances
- Pulmonary Hypertension Research and Treatments
- Central Venous Catheters and Hemodialysis
- Fetal and Pediatric Neurological Disorders
- Mitochondrial Function and Pathology
- Cardiac Structural Anomalies and Repair
- Cardiac pacing and defibrillation studies
- Anesthesia and Neurotoxicity Research
- Sepsis Diagnosis and Treatment
- Neurogenetic and Muscular Disorders Research
- Simulation-Based Education in Healthcare
- Patient Safety and Medication Errors
- Lymphatic Disorders and Treatments
- Lymphatic System and Diseases
St. Christopher's Hospital for Children
2017-2025
Drexel University
2017-2025
OBJECTIVE Antibiotics are the most frequently prescribed pharmacologic agents in neonatal intensive care unit (NICU). Antibiotic treatment for suspected or culture-negative sepsis surpasses that culture-proven infection. Therefore, we sought to reduce our overall antibiotic utilization rate (AUR), defined by total days per 1000 patient (DOT/1000-PD), 20% within a 4-year period (by December 2023). METHODS A multidisciplinary team was convened develop an stewardship quality improvement...
Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is associated with fewer neurological complications and decreased mortality compared to veno-arterial (VA) ECMO in neonatal respiratory failure. The Crescent right atrial (RA) cannula the only dual-lumen for VV designed have tip atrium. purpose of this study describe experience early use RA cannula. We performed a retrospective cohort 58 neonates infants cannulated from September 2021 through August 2023 at 15 institutions...
This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers.
Background: Osteopenia of prematurity (OOP) is often a silent disease in the neonatal intensive care unit (NICU). Despite its association with increased morbidity, such as fractures, wide variation exists screening, diagnostic, and management practices. We sought to decrease rate OOP-related fractures our level IV NICU by 20% within 1 year. Methods: A multidisciplinary quality improvement team identified inconsistent diagnosis, OOP, well handling at-risk patients, primary drivers for...
Treatment of neonates with persistent pulmonary hypertension newborn includes optimization ventilatory support, use vasodilators, and/or inotropic support. If refractory to this management, some may require extracorporeal membrane oxygenation. We describe a case series 10 treated vasopressin in single tertiary center. Mean initiation time was at 30 h life dose ranging from 85 milliunits/kg/h. Oxygenation index decreased after 12 exposure (25 11) and mean arterial pressure improved 1 (45 58...
Background Neonatal intensive care unit (NICU) patients are at increased risk for handoff communication failures due to complexity and prolonged length of stay. We report a quality initiative aimed reducing avoidable interruptions during neonatal handoffs while monitoring duration provider satisfaction. Methods Observational time series between August 2015 March 2018 in an academic level IV NICU. NICU I-PASS process changes were implemented using plan–do–study–act cycle, statistical control...
Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.To determine if higher during first 4 days age, quantified by hospital costs, associated with survival without impairment (NDI) among infants HIE.Retrospective cohort analysis neonates HIE who underwent therapeutic hypothermia (TH) at US children's hospitals participating Children's Hospitals...
Despite the advantages of umbilical cord blood culture (UCBC) use for diagnosis early onset sepsis (EOS), contamination rates have deterred neonatologists from its widespread use. We aimed to implement UCBC collection in a level III neonatal intensive care unit (NICU) and apply quality improvement (QI) methods reduce sepsis.
Abstract Objective: Antibiotics are widely prescribed in the neonatal intensive care unit (NICU) and duration of prescription is varied. We sought to decrease unnecessary antibiotic days for most common indications our outborn level IV NICU by 20% within 1 year. Design interventions: A retrospective chart review was completed determine treatment therapy 39-bed NICU. multidisciplinary team convened develop an stewardship quality improvement initiative with new consensus guidelines these...
Introduction: Pain impacts brain development for neonates, causing deleterious neurodevelopmental outcomes. Prescription opioids analgesia or sedation are common; however, prolonged opioid exposure in neonates is associated with impairment. Balancing the impact of inadequate pain control against a clinical paradox. Therefore, we sought to decrease average days used critically ill at level IV Neonatal Intensive Care Unit by 10% within 1 year. Methods: A multidisciplinary quality improvement...
Recent data describe an increasing use of extracorporeal membrane oxygenation (ECMO) in neonates with various clinical conditions besides primary respiratory or cardiac diagnoses. Infants underlying genetic disorders characterized by cardiopulmonary failure pose unique management challenges. When pathognomonic dysmorphic features for common diagnoses are not present, the prognosis is uncertain at best when determining ECMO candidacy. Lengthy turnaround times testing often delay definitive...
Over the wire removal of an ECMO cannula and exchange for another or catheter vascular closure device is desirable in certain circumstances.We describe a novel technique this.
The study aims to describe our experience with the implementation of phenobarbital as a primary sedation strategy during neonatal extracorporeal membrane oxygenation (ECMO).
Objective This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic–ischemic encephalopathy (HIE) without exposure sedation–analgesia (SA) during therapeutic hypothermia (TH). Study Design A single-center, retrospective cohort of HIE undergoing TH between January 2010 December 2020. Demographics, clinical characteristics, MRI scores, were compared patients SA those use. Results Of the 131 neonates, 55 (42%) did...
Introduction: Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation retinopathy of prematurity (ROP) is the standard practice at our institution, 100% patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce percentage infants intubated by 30% June 2022. Methods: We assembled a multidisciplinary team and implemented deep sedation guideline utilizing dexmedetomidine, fentanyl, midazolam noninvasive ventilation...
Advances in neonatal care for hypoxic respiratory failure, with high-frequency ventilation and inhaled nitric oxide, have led to a decreased need extracorporeal membrane oxygenation (ECMO). However, neonates resistant such therapies are more complex at higher risk of mortality. One population includes those ischemic encephalopathy (HIE) undergoing controlled hypothermia (CH). We present challenging case full-term neonate inotrope-resistant Escherichia coli septic shock, profound...
Since the initial deployment of neonatal extracorporeal membrane oxygenation (ECMO) for respiratory failure, use ECMO in this population has diversified. We present a term female infant with carbamoyl phosphate synthetase 1 and partial N-acetylglutamate synthase deficiencies who developed severe hyperammonemia refractory to medical management requiring venoarterial ECMO-driven continuous veno-venous hemodiafiltration ammonia detoxification. This case report illustrates subpopulation where...
Pulmonary hemorrhage (PH) is an infrequent and potentially fatal event in term neonates. Reports of successful management PH on extracorporeal membrane oxygenation (ECMO) are limited, given the accentuated risk mortality imposed by use heparin to prevent thrombosis ECMO. We present a case neonate with hypoxic ischemic encephalopathy undergoing controlled hypothermia who developed respiratory failure, hemodynamic instability, Enterobacter cloacae pneumonia sepsis complicated severe required...
The objective of this paper was to describe peri-procedural events and complications infants requiring laser photocoagulation for retinopathy prematurity (ROP) in a level IV neonatal intensive care unit.
Congenital chylothorax is a rare presentation of nonimmune hydrops fetalis (NIHF). We report case congenital presenting as NIHF managed successfully with chemical pleurodesis. A term male infant presented at birth anasarca and respiratory failure secondary to bilateral pleural effusions. The was initially ventilation tube thoracocentesis however re-accumulation fluid occurred when feeds were started. Pleural analysis consistent chylothorax. re-accumulated despite conservative management...
Background: Hyperglycemia is a common complication in preterm, very low birth weight (VLBW) infants. This may be due to glucose infusion, relative insulin resistance, deficiency, or defect processing of pro-insulin the pancreas. There evidence indicating that hyperglycemia has an effect on short-term outcomes, namely increased risk for retinopathy prematurity (ROP), respiratory distress syndrome (RDS), and intraventricular hemorrhage (IVH). However, long-term outcomes …