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1. The Diaphragmatic Initiated Ventilatory Assist (DIVA) trial: study protocol for a randomized controlled trial comparing rates of extubation failure in extremely premature infants undergoing extubation to non-invasive neurally adjusted ventilatory assist versus non-synchronized nasal intermittent positive pressure ventilation

Author

Matlock, David N., Ratcliffe, Sarah J., Courtney, Sherry E., Kirpalani, Haresh, Firestone, Kimberly, Stein, Howard, Dysart, Kevin, Warren, Karen, Goldstein, Mitchell R., Lund, Kelli C., Natarajan, Aruna, Demissie, Ejigayehu, and Foglia, Elizabeth E.

Published
2024
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6. Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic–Ischemic Encephalopathy in the Late Hypothermia Trial

Author

Caplan, Michael S., Polin, Richard A., Keszler, Martin, Oh, William, Vohr, Betty R., McGowan, Elizabeth C., Alksninis, Barbara, Basso, Kristin, Bliss, Joseph, Bishop, Carmena, Burke, Robert T., Cashore, William, Caskey, Melinda, Gingras, Dan, Guerina, Nicholas, Johnson, Katharine, Keszler, Mary Lenore, Knoll, Andrea M., Leach, Theresa M., Leonard, Martha R., Little, Emilee, Stephens, Bonnie E., Vieira, Elisa, Watson, Victoria E., Hibbs, Anna Maria, Wilson-Costello, Deanne E., Newman, Nancy S., Batton, Beau, Bhola, Monika, Di Fiore, Juliann M., Friedman, Harriet G., Siner, Bonnie S., Stork, Eileen K., Yalcinkaya, Gulgun, Zadell, Arlene, Pallotto, Eugenia K., Kilbride, Howard W., Gauldin, Cheri, Holmes, Anne, Johnson, Kathy, Knutson, Allison, Schibler, Kurt, Yolton, Kimberly, Grisby, Cathy, Gratton, Teresa L., Merhar, Stephanie, Wuertz, Sandra, Cotten, C. Michael, Fisher, Kimberley A., Grimes, Sandra, Finkle, Joanne, Goldstein, Ricki F., Gustafson, Kathryn E., Malcolm, William F., Ashley, Patricia L., Auten, Kathy J., Lohmeyer, Melody B., Laughon, Matthew M., Bose, Carl L., Bernhardt, Janice, Clark, Cindy, Warner, Diane D., Wereszcsak, Janice, Aliaga, Sofia, Carlton, David P., Stoll, Barbara J., Hale, Ellen C., Loggins, Yvonne, Bottcher, Diane I., Mackie, Colleen, LaRossa, Maureen Mulligan, Adams-Chapman, Ira, Wineski, Lynn C., Carter, Sheena L., Higgins, Rosemary D., Archer, Stephanie Wilson, Harmon, Heidi M., Papile, Lu-Ann, Dusick, Anna M., Gunn, Susan, Herron, Dianne E., Hines, Abbey C., Kardatzke, Darlene, Lytle, Carolyn, Minnich, Heike M., Richard, Leslie, Smiley, Lucy C., Wilson, Leslie Dawn, Kennedy, Kathleen A., Allain, Elizabeth, Mason, Carrie M., Arldt-McAlister, Julie, Burson, Katrina, Dempsey, Allison G., Duncan, Andrea F., Evans, Patricia W., Garcia, Carmen, Green, Charles E., Jimenez, Margarita, John, Janice, Jones, Patrick M., Lillie, M. Layne, Martin, Karen, Martin, Sara C., McDavid, Georgia E., McKee, Shannon, Pierce Tate, Patti L., Rodgers, Shawna, Siddiki, Saba Khan, Sperry, Daniel K., Wright, Sharon L., Sánchez, Pablo J., Nelin, Leif D., Jadcherla, Sudarshan R., Luzader, Patricia, Fortney, Christine A., Grothause, Jennifer L., Wallace, Dennis, Gantz, Marie G., Zaterka-Baxter, Kristin M., Crawford, Margaret M., McDonald, Scott A., Newman, Jamie E., O'Donnell Auman, Jeanette, Petrie Huitema, Carolyn M., Pickett, James W., II, Yost, Patricia, Van Meurs, Krisa P., Stevenson, David K., Ball, M. Bethany, Bentley, Barbara, Chock, Valerie Y., Bruno, Elizabeth F., Davis, Alexis S., DeAnda, Maria Elena, DeBattista, Anne M., Earhart, Beth, Huffman, Lynne C., Kohn, Jean G., Krueger, Casey E., Proud, Melinda S., Rhine, William D., St. John, Nicholas H., Taylor, Heather, Weiss, Hali E., Carlo, Waldemar A., Peralta-Carcelen, Myriam, Collins, Monica V., Cosby, Shirley S., Phillips, Vivien A., Rector, Richard V., Whitley, Sally, Colaizy, Tarah T., Brumbaugh, Jane E., Johnson, Karen J., Eastman, Diane L., Acarregui, Michael J., Walker, Jacky R., Goeke, Claire A., Klein, Jonathan M., Krutzfield, Nancy J., Segar, Jeffrey L., Dagle, John M., Lindower, Julie B., McElroy, Steven J., Rabe, Glenda K., Roghair, Robert D., Meyer, Lauritz R., Ellsbury, Dan L., Campbell, Donia B., Murphy, Cary R., Bhavsar, Vipinchandra, Ohls, Robin K., Lacy, Conra Backstrom, Beauman, Sandra Sundquist, Brown, Sandra, Fernandez, Erika, Duncan, Andrea Freeman, Fuller, Janell, Kuan, Elizabeth, Lowe, Jean R., Schmidt, Barbara, Kirpalani, Haresh, DeMauro, Sara B., Dysart, Kevin C., Abbasi, Soraya, Mancini, Toni, Cucinotta, Dara M., Bernbaum, Judy C., Gerdes, Marsha, Hurt, Hallam, D'Angio, Carl, Lakshminrusimha, Satyan, Laroia, Nirupama, Myers, Gary J., Yost, Kelley, Guilford, Stephanie, Jensen, Rosemary L., Wynn, Karen, Farooq, Osman, Reynolds, Anne Marie, Wadkins, Holly I.M., Williams, Ashley, Merzbach, Joan, Conway, Patrick, Bowman, Melissa, Hartley-McAndrew, Michele, Zorn, William, Fallone, Cait, Binion, Kyle, Orme, Constance, Scorsone, Ann Marie, Brion, Luc P., Chalak, Lina F., Heyne, Roy J., Chen, Lijun, Vasil, Diana M., Adams, Sally S., Boatman, Catherine Twell, Guzman, Alicia, Heyne, Elizabeth T., Lee, Lizette E., Leps, Melissa H., Madden, Linda A., Miller, Nancy A., Ramon, Emma, Yoder, Bradley A., Osborne, Karen A., Spencer, Cynthia, Steele, R. Edison, Steffen, Mike, Strong, Karena, Weaver-Lewis, Kimberlee, Baker, Shawna, Winter, Sarah, Bird, Karie, Burnett, Jill, Sood, Beena G., Bara, Rebecca, Childs, Kirsten, De Jesus, Lilia C., Panaitescu, Bogdan, Chawla, Sanjay M.D., Prentice, Jeannette E., Goldston, Laura A., Woldt, Eunice Hinz, Natarajan, Girija, Bajaj, Monika, Barks, John, Christensen, Mary, Wiggins, Stephanie A., Laptook, Abbot R., Shankaran, Seetha, Barnes, Patrick, Rollins, Nancy, Do, Barbara T., Parikh, Nehal A., Hamrick, Shannon, Hintz, Susan R., Tyson, Jon E., Bell, Edward F., Ambalavanan, Namasivayam, Goldberg, Ronald N., Pappas, Athina, Huitema, Carolyn, Pedroza, Claudia, Chaudhary, Aasma S., Hensman, Angelita M., Das, Abhik, Wyckoff, Myra, Khan, Amir, Walsh, Michelle C., Watterberg, Kristi L., Faix, Roger, Truog, William, Guillet, Ronnie, Sokol, Gregory M., and Poindexter, Brenda B.

Published
2021
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12. Association between Use of Prophylactic Indomethacin and the Risk for Bronchopulmonary Dysplasia in Extremely Preterm Infants

Author

Caplan, Michael S., Polin, Richard A., Laptook, Abbot R., Keszler, Martin, Hensman, Angelita M., Basso, Kristin M., Vieira, Elisa, Little, Emily, Fanaroff, Avroy A., Hibbs, Anna Marie, Newman, Nancy S., Truog, William E., Kilbride, Howard W., Pallotto, Eugenia K., Gauldin, Cheri, Holmes, Anne, Johnson, Kathy, Knutson, Allison, Schibler, Kurt, Donovan, Edward F., Alexander, Barbara, Grisby, Cathy, Hessling, Jody, Fischer, Estelle E., Jackson, Lenora D., Kirker, Kristin, Muthig, Greg, Goldberg, Ronald N., Cotten, C. Michael, Fisher, Kimberley A., Auten, Kathy J., Foy, Katherine A., Grimes, Sandra, Finkle, Joanne, Laughon, Matthew M., Bose, Carl L., Bernhardt, Janice, Bose, Gennie, Carlton, David P., Hale, Ellen C., Archer, Stephanie Wilson, Poindexter, Brenda B., Sokol, Gregory M., Wilson, Leslie Dawn, Herron, Dianne E., Sánchez, Pablo J., Nelin, Leif D., Jadcherla, Sudarshan R., Luzader, Patricia, Fortney, Christine A., Besner, Gail E., Parikh, Nehal A., Das, Abhik, Wallace, Dennis, Auman, Jeanette O'Donnell, Crawford, Margaret M., Petrie Huitema, Carolyn M., Zaterka-Baxter, Kristin M., Van Meurs, Krisa P., Adams, Marian M., Stevenson, David K., Ball, M. Bethany, Palmquist, Andrew W., Proud, Melinda S., Frantz, Ivan D., III, Fiascone, John M., MacKinnon, Brenda L., Nylen, Ellen, Carlo, Waldemar A., Ambalavanan, Namasivayam, Collins, Monica V., Cosby, Shirley S., Devaskar, Uday, Garg, Meena, Chanlaw, Teresa, Geller, Rachel, Bell, Edward F., Ellsbury, Dan L., Widness, John A., Johnson, Karen J., Campbell, Donia B., Watterberg, Kristi L., Ohls, Robin K., Lacy, Conra Backstrom, Montman, Rebecca A., Brown, Sandra, Wussow, Theresa, Hartenberger, Carol, Schmidt, Barbara, Kirpalani, Haresh, DeMauro, Sara B., Chaudhary, Aasma S., Abbasi, Soraya, Mancini, Toni, Cucinotta, Dara M., D'Angio, Carl T., Guillet, Ronnie, Lakshminrusimha, Satyan, Reynolds, Ann Marie, Reubens, Linda J., Jensen, Rosemary, Maffett, Deana, Wadkins, Holly I.M., Sacilowski, Michael G., Williams, Ashley, Guilford, Stephanie, Horihan, Cassandra A., Kennedy, Kathleen A., Tyson, Jon E., Burson, Katrina, Harris, Beverly Foley, McDavid, Georgia E., Pierce Tate, Patti L., Wright, Sharon L., Brion, Luc P., Chen, Lijun, Guzman, Alicia, Leps, Melissa H., Miller, Nancy A., Morgan, Janet S., Vasil, Diana M., Torres, Lizette E., Faix, Roger G., Yoder, Bradley A., Osborne, Karen A., Bird, Karie, Burnett, Jill, Jensen, Jennifer J., Spencer, Cynthia, Weaver-Lewis, Kimberlee, Zanetti, Karen, Shankaran, Seetha, Barks, John, Bara, Rebecca, Johnson, Mary, Christensen, Mary, Wiggins, Stephanie, Ehrenkranz, Richard A., Jacobs, Harris, Cervone, Patricia, Konstantino, Monica, Poulsen, JoAnn, Taft, Janet, Jensen, Erik A., Dysart, Kevin C., Gantz, Marie G., Carper, Benjamin, Higgins, Rosemary D., Stoll, Barbara J., and Walsh, Michele C.

Published
2017
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13. Interdisciplinary Care of Children with Severe Bronchopulmonary Dysplasia

Author

Abman, Steven H., Collaco, Joseph M., Shepherd, Edward G., Keszler, Martin, Cuevas-Guaman, Milenka, Welty, Stephen E., Truog, William E., McGrath-Morrow, Sharon A., Moore, Paul E., Rhein, Lawrence M., Kirpalani, Haresh, Zhang, Huayan, Gratny, Linda L., Lynch, Susan K., Curtiss, Jennifer, Stonestreet, Barbara S., McKinney, Robin L., Dysart, Kevin C., Gien, Jason, Baker, Christopher D., Donohue, Pamela K., Austin, Eric, Fike, Candice, and Nelin, Leif D.

Published
2017
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18. Echocardiographic Assessment of Pulmonary Arterial Hypertension Following Inhaled Nitric Oxide in Infants with Severe Bronchopulmonary Dysplasia.

Author

Fraga, María V., Dysart, Kevin C., Stoller, Jason Z., Huber, Matthew, Fedec, Anysia, Mercer-Rosa, Laura, and Kirpalani, Haresh

Subjects
*PULMONARY arterial hypertension, *BRONCHOPULMONARY dysplasia, *NITRIC oxide, *LOW birth weight, *VERY low birth weight, *PULMONARY hypertension
Abstract

Objectives: Inhaled nitric oxide (iNO) is an effective pulmonary vasodilator. However, the efficacy of iNO in former premature infants with established bronchopulmonary dysplasia (BPD) has not been studied. This study aimed to determine the efficacy of iNO in reducing pulmonary artery pressure in infants with severe BPD as measured by echocardiography. Study Design: Prospective, observational study enrolling infants born at less than 32 weeks gestation and in whom (1) iNO therapy was initiated after admission to our institution, or (2) at the outside institution less than 48 h before transfer and received an echocardiogram prior to iNO initiation, and (3) had severe BPD. Data were collected at three time-points: (1) before iNO; (2) 12–48 h after initiation of iNO; and (3) 48–168 h after initiation of iNO. The primary outcome was the effect of iNO on pulmonary artery pressure measured by echocardiography in patients with severe BPD between 48 and 168 h after initiating iNO therapy. Results: Of 37 enrolled, 81% had echocardiographic evidence of pulmonary arterial hypertension (PAH) before iNO and 56% after 48 h of iNO (p = 0.04). FiO2 requirements were significantly different between time-points (1) and (3) (p = 0.05). There were no significant differences between Tricuspid Annular Plane Systolic Excursion (TAPSE) Z-Scores, time to peak velocity: right ventricular ejection time (TPV:RVET), and ventilator changes. Conclusions: Although we found a statistically significant reduction of PAH between time-point (1) and (3), future trials are needed to further guide clinical care. [ABSTRACT FROM AUTHOR]

Published
2023
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21. The Uptake of Telemedicine in Obstetric Care During the Early Acute Phase of the Coronavirus 2019 Pandemic.

Author

McKenney, Kathryn M., Lundsberg, Lisbet S., Burris, Heather H., Ledyard, Rachel F., Son, Moeun, Greenspan, Jay, Handley, Sara C., Dysart, Kevin, and Culhane, Jennifer

Subjects
COVID-19 pandemic, MEDICAL care, GESTATIONAL diabetes, PRENATAL care, ELECTRONIC health records, MEDICAL care use
Abstract

Introduction: The early acute phase of the coronavirus disease 2019 pandemic created rapid adaptation in health care delivery. Methods: Using electronic medical record data from two different institutions located in two different states, we examined how telemedicine was integrated into obstetric care. Results: With no telemedicine use prior, both institutions rapidly incorporated telemedicine into prenatal care (PNC). There were significant patient-level and institutional-level differences in telemedicine use. Telemedicine users initiated PNC earlier and had more total visits, earlier timing of ultrasounds, and earlier diabetes screening during pregnancy compared with nonusers. There were no significant differences in delivery mode or stillbirth associated with telemedicine use at either institution. Conclusions: Rapid adoption of obstetric telemedicine maintained adequate prenatal care provision during the early pandemic, but implementation varied across institutions. [ABSTRACT FROM AUTHOR]

Published
2023
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25. Effect of Depth and Duration of Cooling on Deaths in the NICU Among Neonates With Hypoxic Ischemic Encephalopathy: A Randomized Clinical Trial

Author

Shankaran, Seetha, Laptook, Abbot R., Pappas, Athina, McDonald, Scott. A., Das, Abhik, Tyson, Jon E., Poindexter, Brenda B., Schibler, Kurt, Bell, Edward F., Heyne, Roy J., Pedroza, Claudia, Bara, Rebecca, Van Meurs, Krisa P., Grisby, Cathy, Petrie Huitema, Carolyn M., Garg, Meena, Ehrenkranz, Richard A., Shepherd, Edward G., Chalak, Lina F., Hamrick, Shannon E. G., Khan, Amir M., Reynolds, Anne Marie, Laughon, Matthew M., Truog, William E., Dysart, Kevin C., Carlo, Waldemar A., Walsh, Michele C., Watterberg, Kristi L., and Higgins, Rosemary D.

Published
2014
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28. A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit.

Author

Kristoff, Kimberly, Wang, Rui, Munson, David, Dysart, Kevin, Stracuzzi, Lauren, Wade, Kelcey, and Birnbaum, Shira

Subjects
INTRAVENOUS catheterization, CATHETER-related infections, NEONATAL intensive care, CENTRAL venous catheterization, RETROSPECTIVE studies, NEONATAL intensive care units, QUALITY assurance
Abstract

Background: Timely central venous access is essential in the care of critically ill neonates. Peripherally inserted central catheters (PICCs) are the preferred form of central venous access when umbilical venous catheters cannot be placed or are discontinued. However, time delays increase risk for injury from peripheral intravenous lines and may contribute to inconsistent delivery of necessary fluids and medications.Purpose: The aim of this quality improvement project was to decrease wait times for PICC placement in the neonatal intensive care unit (NICU).Methods: A unit-based PICC team was developed consisting of NICU nurses and attending neonatologists and implemented in 2 phases. Data were collected from chart reviews before, during, and after implementation of the team. We tracked time between PICC order and placement and number of attempts. Hospital metrics on peripheral intravenous line infiltrations and central line-associated blood stream infection were also monitored. At the end of the project, we continued tracking outcomes to determine whether gains would be sustained past the project period.Results: Implementation of a unit-based interdisciplinary specialty team led to a 50% reduction in mean PICC wait times from 1.2 days to 0.58 days. Benefits of the initiative were sustained past the initial project period.Implications For Practice: The development of a dedicated, local team played a key role in improving vascular access in the NICU.Implications For Research: Proximity of specialized teams provides a solution to address gaps in care in the NICU. [ABSTRACT FROM AUTHOR]

Published
2022
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37. Performance Evaluation of Nasal Prong Interface for CPAP Delivery on a Critical Care Ventilator: A Bench Experiment.

Author

Napolitano, Natalie, Roberts, Tracey, Nickel, Amanda J., McDonough, Joseph, Haorui Sun, Rui Feng, Jensen, Erik A., Dysart, Kevin, and Lin, Richard

Subjects
EXPERIMENTAL design, POSITIVE end-expiratory pressure, CONTINUOUS positive airway pressure, MECHANICAL ventilators, CRITICAL care medicine, CATHETERIZATION
Abstract

BACKGROUND: The RAM cannula (Neotech, Valencia, CA) has become a commonly used interface for CPAP in neonatal intensive care. Performance characteristics of this interface used with a critical care ventilator are not well described. METHODS: This was a bench study utilizing a lung simulator configured as an actively breathing infant (weights of 800 g, 1.5 kg, and 3 kg) with moderate lung disease and a critical care ventilator in CPAP mode with leak compensation on. Three sizes of the RAM cannulae (preemie, newborn, and infant) were compared to 3 BabyFlow nasal prongs (Dräger Medical, Lübeck, Germany) (medium, large, and extra-large). Fabricated nasal models produced a 70% occlusive fit for the RAM cannula and an occlusive fit with the Dräger prongs. Delivered flow and pressure levels were recorded at 9 CPAP levels between 5 and 20 cm H2O. RESULTS: The Dräger prongs produced a mean airway pressure (Paw) within 0.20 cm H2O (range -0.10 to 0.35) of the set CPAP across all evaluated prong sizes and CPAP levels. In contrast, the RAM cannula produced Paw values that averaged 8.5 cm H2O (range -15 to -3.5) below the set CPAP levels. The deficit in delivered versus target CPAP level for the RAM cannula increased with greater set CPAP. Set CPAP of 5 cm H2O delivered Paw values that ranged from 0.6 to 1.5 cm H2O (difference of 3.5-4.4 cm H2O). Set CPAP of 20 cm H2O delivered Paw values that ranged from 5.0 to 8.4 cm H2O (difference of 11.7-15 cm H2O). Inspiratory flow required to achieve set CPAP levels did not differ between interfaces, suggesting high resistance in the RAM cannula device masks the delivered CPAP levels. CONCLUSIONS: Use of the RAM cannula with a 30% leak on a critical care ventilator delivered Paw values lower than set CPAP. This may be clinically meaningful and should be considered when choosing a nasal interface. [ABSTRACT FROM AUTHOR]

Published
2021
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42. Influence of Patient Characteristics on Antibiotic Use Rates Among Preterm Infants.

Author

Flannery, Dustin D, Mukhopadhyay, Sagori, Jensen, Erik A, Gerber, Jeffrey S, Passarella, Molly R, Dysart, Kevin, Aghai, Zubair H, Greenspan, Jay, and Puopolo, Karen M

Subjects
LENGTH of stay in hospitals, NEONATAL necrotizing enterocolitis, SURVIVAL, STATISTICS, ANTIMICROBIAL stewardship, SCIENTIFIC observation, RETROSPECTIVE studies, GESTATIONAL age, ANTI-infective agents, BENCHMARKING (Management), DRUG prescribing, DESCRIPTIVE statistics, DRUG utilization, PHYSICIAN practice patterns, ANTIBIOTICS
Abstract

Background The antibiotic use rate (AUR) has emerged as a potential metric for neonatal antibiotic use, but reported center-level AURs are limited by differences in case mix. The objective of this study was to identify patient characteristics associated with AUR among a large cohort of preterm infants. Methods Retrospective observational study using the Optum Neonatal Database, including infants born from January 1, 2010 through November 30, 2016 with gestational age 23–34 weeks admitted to neonatal units across the United States. Exposures were patient-level characteristics including length of stay, gestational age, sex, race/ethnicity, bacterial sepsis, necrotizing enterocolitis, and survival status. The primary outcome was AUR, defined as days with ≥ 1 systemic antibiotic administered divided by length of stay. Descriptive statistics, univariable comparative analyses, and generalized linear models were utilized. Results Of 17 910 eligible infants, 17 836 infants (99.6%) from 1090 centers were included. Median gestation was 32.9 (interquartile range [IQR], 30.3–34) weeks. Median length of stay was 25 (IQR, 15–46) days and varied by gestation. Overall median AUR was 0.13 (IQR, 0–0.26) and decreased over time. Gestational age, sex, and race/ethnicity were independently associated with AUR (P   <  .01). AUR and gestational age had an unexpected inverse parabolic relationship, which persisted when only surviving infants without bacterial sepsis or necrotizing enterocolitis were analyzed. Conclusions Neonatal AURs are influenced by patient-level characteristics besides infection and survival status, including gestational age, sex, and race/ethnicity. Neonatal antibiotic use metrics that account for patient-level characteristics as well as morbidity case mix may allow for more accurate comparisons and better inform neonatal antibiotic stewardship efforts. [ABSTRACT FROM AUTHOR]

Published
2021
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44. Individualising care in severe bronchopulmonary dysplasia: a series of N-of-1 trials comparing transpyloric and gastric feeding.

Author

Jensen, Erik A., Huayan Zhang, Rui Feng, Dysart, Kevin, Nilan, Kathleen, Munson, David A., Kirpalani, Haresh, Zhang, Huayan, and Feng, Rui

Subjects
TREATMENT of premature infant diseases, RESEARCH, CLINICAL trials, RESEARCH methodology, DISEASE incidence, EVALUATION research, MEDICAL cooperation, COMPARATIVE studies, RESEARCH funding, ENTERAL feeding, BRONCHOPULMONARY dysplasia, CROSSOVER trials
Abstract

Objective: Compare rates of hypoxaemia during transpyloric and gastric feedings in very preterm infants with severe bronchopulmonary dysplasia.Design: N-of-1 multiple crossover trials with individual patient and pooled data analyses.Setting: Level IV intensive care nursery.Patients: Infants receiving positive airway pressure between 36 and 55 weeks postmenstrual age were enrolled between December 2014-July 2016.Intervention: N-of-1 trial consisting of two blocks, each with a 4-day gastric and 4-day transpyloric feeding period assigned in random order.Main Outcome Measures: The primary outcome was the frequency of daily intermittent hypoxaemic events (SpO2 ≤80% lasting 10-180 s). Secondary outcomes included the daily proportion of time with an SpO2 ≤80% and mean daily fraction of inspired oxygen.Results: Of 15 infants, 13 completed the trial and 2 stopped early for transient worsening in respiratory status during gastric feedings. In the intention-to-treat analyses, transpyloric feedings resulted in increased rates of intermittent hypoxaemia in five infants, greater time per day in hypoxaemia in three infants and more supplemental oxygen use in three infants. One infant received more supplemental oxygen during gastric feedings. The remaining study outcomes were similar between the feeding routes in all other infants. Pooling all data, transpyloric feedings resulted in a higher frequency of intermittent hypoxaemic events (median 7.5/day (IQR 1-23.5) vs 3/day (1-11); adjusted incidence rate ratio 1.8, 95% CI 1.3 to 2.5) and a greater proportion of daily hypoxaemia time (median 0.8% (IQR 0.1-2.3) vs 0.4% (0.07-1.8); adjusted mean difference 1.6, 95% CI 1.1 to 2.5).Conclusions: Transpyloric compared with gastric feedings modestly increased rates of hypoxaemia among study participants.Trial Registration Number: NCT02142621. [ABSTRACT FROM AUTHOR]

Published
2020
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46. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach.

Author

Jensen, Erik A., Dysart, Kevin, Gantz, Marie G., McDonald, Scott, Bamat, Nicolas A., Keszler, Martin, Kirpalani, Haresh, Laughon, Matthew M., Poindexter, Brenda B., Duncan, Andrea F., Yoder, Bradley A., Eichenwald, Eric C., and DeMauro, Sara B.

Subjects
BRONCHOPULMONARY dysplasia, DYSPLASIA, PREMATURE infants, NEONATOLOGY, OXYGEN therapy, LOW birth weight, PREMATURE infant diseases, PEDIATRICS, EVIDENCE-based medicine
Abstract

Rationale: Current diagnostic criteria for bronchopulmonary dysplasia rely heavily on the level and duration of oxygen therapy, do not reflect contemporary neonatal care, and do not adequately predict childhood morbidity.Objectives: To determine which of 18 prespecified, revised definitions of bronchopulmonary dysplasia that variably define disease severity according to the level of respiratory support and supplemental oxygen administered at 36 weeks' postmenstrual age best predicts death or serious respiratory morbidity through 18-26 months' corrected age.Methods: We assessed infants born at less than 32 weeks of gestation between 2011 and 2015 at 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.Measurements and Main Results: Of 2,677 infants, 683 (26%) died or developed serious respiratory morbidity. The diagnostic criteria that best predicted this outcome defined bronchopulmonary dysplasia according to treatment with the following support at 36 weeks' postmenstrual age, regardless of prior or current oxygen therapy: no bronchopulmonary dysplasia, no support (n = 773); grade 1, nasal cannula ≤2 L/min (n = 1,038); grade 2, nasal cannula >2 L/min or noninvasive positive airway pressure (n = 617); and grade 3, invasive mechanical ventilation (n = 249). These criteria correctly predicted death or serious respiratory morbidity in 81% of study infants. Rates of this outcome increased stepwise from 10% among infants without bronchopulmonary dysplasia to 77% among those with grade 3 disease. A similar gradient (33-79%) was observed for death or neurodevelopmental impairment.Conclusions: The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks' postmenstrual age, regardless of supplemental oxygen use. [ABSTRACT FROM AUTHOR]

Published
2019
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47. Cardiac Output Measurement Using the Ultrasonic Cardiac Output Monitor: A Validation Study in Newborn Infants.

Author

Fraga, María V., Dysart, Kevin C., Rintoul, Natalie, Chaudhary, Aasma S., Ratcliffe, Sarah J., Fedec, Anysia, Kren, Stephanie, Cohen, Meryl S., and Kirpalani, Haresh

Subjects
*NEWBORN infants, *CARDIAC output, *DUCTUS arteriosus, *ULTRASONIC measurement, *PULMONARY valve, *STROKE volume (Cardiac output)
Abstract

Objectives: We aimed to determine the accuracy and validity of the Ultrasonic Cardiac Output Monitor (USCOM) measurements of cardiac output (CO) compared to echocardiography in newborn infants, and the inter-rater agreement of USCOM measurements. Methods: In a single-center study we prospectively evaluated neonates undergoing an echocardiographic evaluation. USCOM measurements of CO were obtained at the pulmonary and aortic valve by 2 physicians blinded to the echocardiographic results. All echocardiographic measurements were performed blinded to USCOM measurements. We first enrolled an ascertainment cohort which was subsequently validated in an independent new cohort. Agreement between echocardiography and USCOM methods was assessed by Bland-Altman analysis. Intra-class correlation coefficients (ICC) assessed the agreement between the 2 operators. The ascertainment cohort correction factors were applied in a second validation cohort and agreement of the calibrated measures evaluated with repeat Bland-Altman comparisons. Results: A total of 50 infants were enrolled in the initial cohort and 15 in the validation cohort. There was a high degree of correlation between the USCOM operators (ICC = 0.975). USCOM measurements of CO were significantly higher compared to echocardiography (left ventricular output bias 95 ± 52 mL/kg/min and right ventricular output bias 64 ± 30 mL/kg/min). There was no difference in the subgroup of infants with and without a ductus arteriosus. After the correction was applied to the validation cohort, there was no longer a significant difference between the measures. Conclusions: CO measured by USCOM consistently overestimated the results obtained from echocardiography. USCOM is not adequate to provide absolute estimates of CO. However, it may allow longitudinal hemodynamic assessment of sick neonates. [ABSTRACT FROM AUTHOR]

Published
2019
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49. Adverse effects of small for gestational age differ by gestational week among very preterm infants.

Author

Jensen, Erik A., Foglia, Elizabeth E., Dysart, Kevin C., Simmons, Rebecca A., Aghai, Zubair H., Cook, Alison, Greenspan, Jay S., and DeMauro, Sara B.

Subjects
PREMATURE infants, GESTATIONAL age, BIRTH weight, BRONCHOPULMONARY dysplasia, RETROLENTAL fibroplasia, BIRTH size, COMPARATIVE studies, PREMATURE infant diseases, INFANT mortality, RESEARCH methodology, MEDICAL cooperation, RESEARCH, RESEARCH funding, RISK assessment, EVALUATION research, RETROSPECTIVE studies
Abstract

Objective: To characterise the excess risk for death, grade 3-4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3-5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.Methods: Retrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).Results: Of 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3-4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2-3 weeks less mature.Conclusion: The excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age. [ABSTRACT FROM AUTHOR]

Published
2019
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