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Sewell E, Cohen S, Zaniletti I, Couture D, Dereddy N, Coghill CH, Flanders TM, Foy A, Heuer GG, Jano E, Kemble N, Lee S, Ling CY, Malaeb S, Mietzsch U, Ocal E, Padula MA, Welch CD, White B, Wilson D, Flibotte J. Surgical interventions and short-term outcomes for preterm infants with post-haemorrhagic hydrocephalus: a multicentre cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-327084. [PMID: 38697810 DOI: 10.1136/archdischild-2024-327084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE To (1) describe differences in types and timing of interventions, (2) report short-term outcomes and (3) describe differences among centres from a large national cohort of preterm infants with post-haemorrhagic hydrocephalus (PHH). DESIGN Cohort study of the Children's Hospitals Neonatal Database from 2010 to 2022. SETTING 41 referral neonatal intensive care units (NICUs) in North America. PATIENTS Infants born before 32 weeks' gestation with PHH defined as acquired hydrocephalus with intraventricular haemorrhage. INTERVENTIONS (1) No intervention, (2) temporising device (TD) only, (3) initial permanent shunt (PS) and (4) TD followed by PS (TD-PS). MAIN OUTCOME MEASURES Mortality and meningitis. RESULTS Of 3883 infants with PHH from 41 centres, 36% had no surgical intervention, 16% had a TD only, 19% had a PS only and 30% had a TD-PS. Of the 46% of infants with TDs, 76% were reservoirs; 66% of infants with TDs required PS placement. The percent of infants with PHH receiving ventricular access device placement differed by centre, ranging from 4% to 79% (p<0.001). Median chronological and postmenstrual age at time of TD placement were similar between infants with only TD and those with TD-PS. Infants with TD-PS were older and larger than those with only PS at time of PS placement. Death before NICU discharge occurred in 12% of infants, usually due to redirection of care. Meningitis occurred in 11% of the cohort. CONCLUSIONS There was significant intercentre variation in rate of intervention, which may reflect variability in care or referral patterns. Rate of PS placement in infants with TDs was 66%.
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Affiliation(s)
- Elizabeth Sewell
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta at Egleston, Atlanta, Georgia, USA
| | - Susan Cohen
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Dan Couture
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Narendra Dereddy
- AdventHealth for Children, Orlando, Florida, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Carl H Coghill
- Children's of Alabama, Birmingham, Alabama, USA
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Tracy M Flanders
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Foy
- University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Gregory G Heuer
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Eni Jano
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nicole Kemble
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Lee
- University of Iowa Health Care, Iowa City, Iowa, USA
| | - Con Yee Ling
- The University of Utah School of Medicine, Salt Lake City, Utah, USA
- Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Shadi Malaeb
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ulrike Mietzsch
- Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eylem Ocal
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Michael A Padula
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cherrie D Welch
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Diane Wilson
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Flibotte
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Williams S, Bostain R, Couch N, Kamdar T, Oh W, Thompson L, Pepe J, Yi F, Dereddy N. Routine versus no assessment of gastric residual volumes in preterm infants receiving enteral feeding via intermittent feeding tubes: a randomized controlled trial. J Matern Fetal Neonatal Med 2023; 36:2211200. [PMID: 37156548 DOI: 10.1080/14767058.2023.2211200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To evaluate whether eliminating routine gastric residual volume (GRV) assessments would lead to quicker attainment of full feeding volumes in preterm infants. STUDY DESIGN This is a prospective randomized controlled trial of infants ≤32 weeks gestation and birthweight ≤1250 g admitted to a tertiary care NICU. Infants were randomized to assess or not assess GRV before enteral tube feedings. The primary outcome was time to attain full enteral feeding volume defined as 120 ml/kg/day. The Wilcoxon rank sum test was used to compare the days to reach full enteral feeds between the two groups. RESULTS 80 infants were randomized, 39 to the GRV assessing and 41 to the No-GRV assessing group. A predetermined interim analysis at 50% enrollment showed no difference in primary outcome and the study was stopped as recommended by the Data Safety Monitoring Committee. There was no significant difference in median days to reach full enteral feeds between the two groups [GRV assessment: 12d (5) vs. No-GRV assessment:13d (9)]. There was no mortality in either group, one infant in each group developed necrotizing enterocolitis stage 2 or greater. CONCLUSION Eliminating the practice of gastric residual volume assessment before feeding did not result in shorter time to attain full feeding.
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Affiliation(s)
- Sadie Williams
- AdventHealth for Children, Orlando, FL, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, FL, USA
| | | | | | | | - William Oh
- AdventHealth for Children, Orlando, FL, USA
| | | | - Julie Pepe
- AdventHealth Research Institute, Orlando, FL, USA
| | - Fanchao Yi
- AdventHealth Research Institute, Orlando, FL, USA
| | - Narendra Dereddy
- AdventHealth for Children, Orlando, FL, USA
- Department of Pediatrics, University of Central Florida College of Medicine, Orlando, FL, USA
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Saoud R, Locke D, Fry JT, Matoba N, Datta A, DiGeronimo R, Leuthner SR, Coghill CH, Natarajan G, Niehaus JZ, Schlegel AB, Weiner J, Dereddy N, Shah A, Sullivan KM. Withdrawal of artificial nutrition and hydration: a survey of level IV neonatal intensive care units. J Perinatol 2021; 41:2372-2374. [PMID: 33758396 DOI: 10.1038/s41372-021-01011-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/04/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Robin Saoud
- Department of Pediatrics and Division of Neonatology, Harbor-UCLA Medical Center, Torrance, CA, USA.,Division of Neonatology, Children's Hospital of Orange County, Orange, CA, USA
| | - Devika Locke
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.,Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Jessica T Fry
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Nana Matoba
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Ankur Datta
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Robert DiGeronimo
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Division of Neonatology, Seattle Children's Hospital, Seattle, WA, USA
| | - Steven R Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Neonatology, Children's Wisconsin, Milwaukee, WI, USA
| | - Carl H Coghill
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.,Division of Neonatology, Children's of Alabama, Birmingham, AL, UK
| | - Girija Natarajan
- Department of Pediatrics, Central Michigan University, Detroit, MI, USA.,Division of Neonatology, Children's Hospital of Michigan, Detroit, MI, USA
| | - Jason Z Niehaus
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA.,Division of Neonatology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Amy Brown Schlegel
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH, USA.,Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Julie Weiner
- Department of Pediatrics at University of Missouri - Kansas City, Kansas City, MO, USA.,Division of Neonatology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Narendra Dereddy
- Department of Pediatrics, University of Central Florida, Orlando, FL, USA.,Division of Neonatology, AdventHealth for Children, Orlando, FL, USA
| | - Anita Shah
- Division of Neonatology, Children's Hospital of Orange County, Orange, CA, USA
| | - Kevin M Sullivan
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA. .,Division of Neonatology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
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Cohen S, Mietzsch U, Coghill C, Dereddy N, Ducis K, El Ters N, Heuer GG, Sewell E, Flibotte J. Survey of Quaternary Neonatal Management of Posthemorrhagic Hydrocephalus. Am J Perinatol 2021; 40:883-892. [PMID: 34293803 DOI: 10.1055/s-0041-1732417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to determine clinical care practices for infants at risk for posthemorrhagic hydrocephalus (PHH) across level IV neonatal intensive care units (NICUs). STUDY DESIGN Cross-sectional survey that addressed center-specific surveillance, neurosurgical intervention, and follow-up practices within the Children's Hospitals Neonatal Consortium. RESULTS We had a 59% (20/34 sites) response rate, with 10 sites having at least two participants. Respondents included neonatologists (53%) and neurosurgeons (35%). Most participants stated having a standard guideline for PHH (79%). Despite this, 42% of respondents perceive inconsistencies in management. Eight same-center pairs of neonatologists and neurosurgeons were used to determine response agreement. Half of these pairs disagreed on nearly all aspects of care. The greatest agreement pertained to a willingness to adopt a consensus-based protocol. CONCLUSION Practice variation in the management of infants at risk of PHH in level IV NICUs exists despite the perception that a common practice is available and used. KEY POINTS · Practice variation exists despite the perception that common practices are available/used for PHH.. · Our survey had same-center pairs of neonatologist and neurosurgeons to determine response agreement.. · The greatest agreement pertained to a willingness to adopt a consensus-based protocol..
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Affiliation(s)
- Susan Cohen
- Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, Wisconsin
| | - Ulrike Mietzsch
- Division of Neonatology, Department of Pediatrics, University of Washington Medical School, Seattle Children's Hospital, Seattle, Washington
| | - Carl Coghill
- Division of Neonatology, Department of Pediatrics, University of Alabama, Children's of Alabama, Birmingham, Alabama
| | - Narendra Dereddy
- Division of Neonatology, Department of Pediatrics, University of Central Florida College of Medicine, AdventHealth for Children, Orlando, Florida
| | - Katerina Ducis
- Division of Neurosurgery, Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
| | - Nathalie El Ters
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri
| | - Gregory G Heuer
- Division of Neurosurgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Sewell
- Division of Neonatology, Department of Pediatrics, Children's Healthcare of Atlanta & Emory University School of Medicine, Atlanta, Georgia
| | - John Flibotte
- Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Patel S, Dereddy N, Talati AJ, Gaston K, Dhanireddy R. Glycerin Suppositories Use in Very Low Birth Weight Infants. Am J Perinatol 2017; 34:169-173. [PMID: 27367284 DOI: 10.1055/s-0036-1584927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective To study the characteristics of very low birth weight (VLBW) infants receiving glycerin suppositories (GS) and evaluate the association of GS use with outcomes. Study Design This is a retrospective study of VLBW infants admitted to a level III neonatal intensive care unit. Infants with birth weight between 500 and 1,499 g were evaluated. We evaluated the frequency of GS use and compared the characteristics and outcomes of the GS group with the no-GS group. Multivariate analyses controlling for gestational age and small for gestational age status were performed to study the effect of GS on outcomes. Results A total of 1,073 infants were included in the study. Out of those, 527 (49.1%) infants received GS. Incidence of necrotizing enterocolitis was not significantly different between the two groups, while days to reach full enteral feeds and length of hospital stay were significantly longer in the GS group. Conclusion Frequent use of GS warrants further prospective studies to evaluate its safety and efficacy in view of our study showing association with longer time to reach full enteral feeds. We speculate that GS use could be a marker for gastrointestinal dysmotility and hence the association with unfavorable clinical outcomes.
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Affiliation(s)
- Shalinkumar Patel
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Narendra Dereddy
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ajay J Talati
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kan Gaston
- Department of Pharmacy, Regional One Health, Memphis, Tennessee
| | - Ramasubbareddy Dhanireddy
- Division of Neonatology, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
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Shah SD, Dereddy N, Jones TL, Dhanireddy R, Talati AJ. Early versus Delayed Human Milk Fortification in Very Low Birth Weight Infants-A Randomized Controlled Trial. J Pediatr 2016; 174:126-131.e1. [PMID: 27112041 DOI: 10.1016/j.jpeds.2016.03.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effect of initiating human milk fortification at 2 different feeding volumes on feeding intolerance and the time to reach full feeding volume. STUDY DESIGN Very low birth weight infants (n = 100) were prospectively randomized to early fortification (EF) (beginning at a feeding volume of 20 mL/kg/d) or delayed fortification (at a feeding volume of 100 mL/kg/d). We employed a standardized feeding protocol and parenteral nutrition guidelines for the nutritional management of all study infants. RESULTS The median days to reach full feeding volumes were equivalent in the 2 groups (20 vs 20, P = .45). No significant difference was observed in the total number of episodes of feeding intolerance (58 vs 57). Two cases of necrotizing enterocolitis (Bell stage ≥2) and deaths occurred in each group. Median daily protein intake (g/kg/d) was higher in EF group in week 1 (3.3 [3.2, 3.5] vs 3.1 [2.9, 3.3], P < .001), week 2 (3.6 [3.5, 3.8] vs 3.2 [2.9, 3.4], P < .001), and week 3 (3.7 [3.4, 3.9] vs 3.5 [2.8, 3.8], P = .006). Cumulative protein intake (g/kg) in the first 4 weeks of life was higher in EF group (98.6 [93.8, 104] vs 89.6 [84.2, 96.4], P < .001). CONCLUSIONS Very early human milk fortification may improve early protein intake in very low birth weight infants without increasing frequencies of adverse events. TRIAL REGISTRATION ClinicalTrials.gov: NCT01988792.
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Affiliation(s)
- Sanket D Shah
- Department of Pediatrics, University of Florida, Jacksonville, FL.
| | - Narendra Dereddy
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Tamekia L Jones
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Children's Foundation Research Institute at Le Bonheur Children's Hospital, Memphis, TN
| | - Ramasubbareddy Dhanireddy
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN
| | - Ajay J Talati
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN
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Dereddy N, Huang J, Erb M, Guzel S, Wolk JH, Sett SS, Gewitz MH, Mathew R. Associated inflammation or increased flow-mediated shear stress, but not pressure alone, disrupts endothelial caveolin-1 in infants with pulmonary hypertension. Pulm Circ 2013; 2:492-500. [PMID: 23372934 PMCID: PMC3555420 DOI: 10.4103/2045-8932.105038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Endothelial caveolin-1 loss is an important feature of pulmonary hypertension (PH); the rescue of caveolin-1 abrogates experimental PH. Recent studies in human PH suggest that the endothelial caveolin-1 loss is followed by an enhanced expression of caveolin-1 in smooth muscle cells (SMC) with subsequent neointima formation. In order to evaluate caveolin-1 expression in infants with PH, we examined the available clinical histories, hemodynamic data, and the expression of caveolin-1, PECAM-1, vWF, and smooth muscle α-actin in the lung biopsy/autopsy specimens obtained from infants with congenital heart disease (CHD, n = 8) and lung disease (n = 9). In CHD group, PH associated with increased pulmonary blood flow exhibited loss of endothelial caveolin-1 and PECAM-1 in pulmonary arteries; additional vWF loss was associated with enhanced expression of caveolin-1 in SMC. In the absence of PH, increased or decreased pulmonary blood flow did not disrupt endothelial caveolin-1, PECAM-1, or vWF; nor was there any enhanced expression of caveolin-1 in SMC. In Lung Disease + PH group, caveolin-1, PECAM-1, and vWF were well preserved in seven infants, and importantly, SMC in these arteries did not exhibit enhanced caveolin-1 expression. Two infants with associated inflammatory disease exhibited loss of endothelial caveolin-1 and PECAM-1; additional loss of vWF was accompanied by enhanced expression of caveolin-1 in SMC. Thus, associated flow-induced shear stress or inflammation, but not elevated pulmonary artery pressure alone, disrupts endothelial caveolin-1. Subsequent vWF loss, indicative of extensive endothelial damage is associated with enhanced expression of caveolin-1 in SMC, which may worsen the disease.
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Affiliation(s)
- Narendra Dereddy
- Section of Pediatric Cardiology, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York, USA
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