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Pillai A, Albersheim S, Niknafs N, Maugo B, Rasmussen B, Lam M, Grewal G, Albert A, Elango R. Human Milk Calorie Guide: A Novel Color-Based Tool to Estimate the Calorie Content of Human Milk for Preterm Infants. Nutrients 2023; 15:nu15081866. [PMID: 37111084 PMCID: PMC10146985 DOI: 10.3390/nu15081866] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of preterm infants. Commercial human milk analyzers (HMA) to individually fortify HM are unavailable in most centers. We describe the development and validation of a bedside color-based tool called the 'human milk calorie guide'(HMCG) for differentiating low-calorie HM using commercial HMA as the gold standard. Mothers of preterm babies (birth weight ≤ 1500 g or gestation ≤ 34 weeks) were enrolled. The final color tool had nine color shades arranged as three rows of three shades each (rows A, B, and C). We hypothesized that calorie values for HM samples would increase with increasing 'yellowness' predictably from row A to C. One hundred thirty-one mother's own milk (MOM) and 136 donor human milk (DHM) samples (total n = 267) were color matched and analyzed for macronutrients. The HMCG tool performed best in DHM samples for predicting lower calories (<55 kcal/dL) (AUC 0.87 for category A DHM) with modest accuracy for >70 kcal/dL (AUC 0.77 for category C DHM). For MOM, its diagnostic performance was poor. The tool showed good inter-rater reliability (Krippendorff's alpha = 0.80). The HMCG was reliable in predicting lower calorie ranges for DHM and has the potential for improving donor HM fortification practices.
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Affiliation(s)
- Anish Pillai
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Neonatology, Surya Hospitals, Mumbai 400054, India
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Susan Albersheim
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Nikoo Niknafs
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Brian Maugo
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi 00100, Kenya
| | - Betina Rasmussen
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Mei Lam
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Gurpreet Grewal
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Arianne Albert
- Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Rajavel Elango
- Division of Neonatal-Perinatal Medicine, British Columbia Women's Hospital and Health Centre, University of British Columbia, Vancouver, BC V6H 3N1, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V5Z 3V4, Canada
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Roychaudhuri S, Grewal G, Vijayashankar SS, Lavoie P, Maheshwari A. Necrotizing Enterocolitis Associated with Congenital Heart Disease-A Review Article. Newborn (Clarksville) 2022; 1:170-176. [PMID: 36864827 PMCID: PMC9976612 DOI: 10.5005/jp-journals-11002-0016] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Necrotizing enterocolitis (NEC) is a relatively rare but devastating entity associated classically with the preterm cohort in the neonatal intensive care unit. Preterm and term babies with congenital heart disease are at risk of a number of comorbidities because of the hemodynamic derangements due to a structurally abnormal heart and the corrective procedures adopted. Necrotizing enterocolitis is one of the dreaded complications associated with this cohort and impacts the course of these babies in the hospital in a major way. A large majority of term babies with NEC are in the backdrop of a significant congenital cardiac lesion. This review article summarizes the literature and elaborates this entity including its specific features, risk factors associated with its causality, histopathology and related aspects of hemodynamics, and feeding in this vulnerable population. It also provides insight into modifiable risk factors and early markers of detection of gut necrosis to facilitate prevention and early detection. It highlights the subtle but definite difference in outcome variables to help physicians enable the parents of babies with heart disease to develop a better understanding of the entity and its expected course while counseling.
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Affiliation(s)
- Sriya Roychaudhuri
- Department of Pediatrics, Division of Neonatology, BC Women’s Hospital, Vancouver, Canada
| | - Gurpreet Grewal
- Department of Neonatal-Perinatal Medicine BC Women’s Hospital and Health Centre, British Columbia, Vancouver, Canada
| | | | - Pascal Lavoie
- Department of Neonatal-Perinatal Medicine BC Women’s Hospital and Health Centre, British Columbia, Vancouver, Canada
| | - Akhil Maheshwari
- Department of Neonatal-Perinatal Medicine, Global Newborn Society, Baltimore, Maryland, United States of America
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Grewal G, Ting J, Lam C, Yadav K, Kuan M. 38 Clinical features and echocardiographic parameters of relative adrenal insufficiency (RAI) among preterm infants: A five-year review. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.029] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Infants born at low gestational age (GA) often present with a septic shock-like picture in the neonatal intensive care unit (NICU). Some of these premature infants are noticed to exhibit inadequate cortisol levels at such a time of stress, an entity termed ‘relative adrenal insufficiency’ (RAI), which is postulated to compromise the compensatory mechanisms and further circulatory collapse.
Objectives
To review the clinical features and echocardiographic parameters of RAI in preterm infants, and their correlation with adrenocorticotropic hormone (ACTH) stimulation tests in a quaternary NICU over 5 years.
Design/Methods
This is a single centre retrospective study. Infants born at < 32 weeks GA between January 2015 to June 2019, admitted to the British Columbia Women’s Hospital NICU (Vancouver, British Columbia), were reviewed. Infants who presented with a shock-like picture with a cortisol level at this time of stress of < 250 nmol/L were included. Infants who have received corticosteroid prior to cortisol collection were excluded.
Results
There were 798 infants < 32 weeks admitted to the BCWH NICU over a 5 year period, of which 284 had a spot cortisol drawn. We identified 45 eligible infants in our study (5.6% of NICU admissions). Their median (IQR) for GA, birth weight, cortisol level, and age of onset of RAI were 25 weeks (24, 26), 690 g (590, 815), 83 (58, 127), and 13 days of life (8, 24), respectively. Among these infants, 73% developed significant hypotension or respiratory failure (Table 1). 13 infants (28.9%) had echocardiogram performed at the time of cardiopulmonary deterioration, and all had normal left ventricular (LV) fractioning shortening (median [IQR]: 42% [38-49%]) and LV output (median [IQR]: 242 mL/kg/min [155-330 mL/kg/min]). Only 19 infants (42.2%) received hydrocortisone, with a median [range] treatment duration of 2 days [1–8]. Lower cortisol level was associated with lower GA at the presentation of RAI (p=0.049), but not predictive of adverse clinical and laboratory outcomes (Table 2). ACTH stimulation tests were performed in 20 (44.5%) infants and 3 (15%) were found to be abnormal, and results were not correlated with clinical features.
Conclusion
In our cohort, we identified 5% of NICU admission with RAI, based on the cut-off of cortisol < 250 nmol/L at the time of shock-like presentation. Lower cortisol level was associated with lower GA at the presentation of RAI. Further prospective study with a well-defined protocol is needed to understand the use of cortisol and its clinical implications.
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Affiliation(s)
| | | | | | | | - Mimi Kuan
- B.C. Children’s Hospital Research Institute
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Yadav K, Ting J, Castaldo M, Grewal G, Kuan M. 46 Impact of early versus late medical treatment of a hemodynamically significant patent ductus arteriosus on time to reach full feeds in preterm neonates. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxab061.036] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Primary Subject area
Neonatal-Perinatal Medicine
Background
Prolonged exposure to a hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants has been associated with an increase in neonatal morbidities.
Objectives
To examine the effect of timing of medical treatment (within first 7 days of life versus after 7 days of life) for a hsPDA on the duration to achieve full feeds in infants born at <30 weeks of gestation.
Design/Methods
This was a retrospective cohort study in a quaternary neonatal intensive care unit (NICU) with a targeted neonatal echocardiography service. Infants admitted between July 2015 – June 2019 who received medical treatment for an hsPDA were included and grouped based on those who received first medical therapy within 7 days of life (early treatment) and after 7 days of life (late treatment). An hsPDA was defined using both clinical (worsening ventilation, pulmonary hemorrhage/edema, or hypotension requiring inotrope or hydrocortisone) and echocardiographic findings (LA/Ao ratio >1.4; LVO >350 mL/kg/min, PDA >1.4 mm, IVRT < 35 ms). Duration to reach full feeds was calculated based on number of days to reach a total enteral feed ≥ 120 mL/kg/day with no parenteral source of nutrition.
Results
Forty-six infants met the inclusion criteria. Of the 46 infants, 24 were identified as receiving early treatment and 22 received late treatment. Infants in the early treatment group had lower median birth weight than the late treatment group (802 g vs. 1016 g, p=0.022). All other clinical characteristics were not significantly different. No significant difference was found in the use of indomethacin, ibuprofen, or acetaminophen as the initial medical treatment (Table 1). The late treatment group had elevated left ventricular output (median: 286 vs. 369 mL/kg/min, p=0.013) and tricuspid annular plane systolic excursion (median: 6 vs. 8 mm, p=0.002) (Table 2). Infants in the early treatment group reached full feeds earlier than those in the late treatment group (19 vs. 30 days, p=0.042) (Table 1).
Conclusion
Early medical treatment of hsPDA was associated with shorter duration to reach full feeds in our cohort of preterm infants. Further larger scale study is needed to understand the association between the timing of medical therapy and prolonged exposure of splanchnic circulation to hemodynamically significant ductus.
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Affiliation(s)
| | | | | | | | - Mimi Kuan
- B.C. Children’s Hospital Research Institute (BCCHR)
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Desai T, Carvalho M, Fung R, Ahuja D, Gollee S, Almeida B, Grewal G, Enright K. Standardization of oral chemotherapy delivery to improve patient safety: A pilot study. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.7_suppl.90] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: Oral chemotherapy (OC) presents unique challenges to patient safety. In contrast with parenteral chemotherapy, patient education and comprehension are crucial to the safe administration of OC, appropriate toxicity interventions and patient adherence. At Trillium Health Partners we identified a lack of standardization to OC education and monitoring, that resulted in gaps in patient care. Using the American Society of Clinical Oncology/Oncology Nursing Society 2013 chemotherapy safety standards as guidance, we developed and piloted a multi-disciplinary oral chemotherapy care pathway (OCCP) to improve the approach to education and monitoring of patients newly started on OC. Methods: Patients newly started on OC between 03/15–06/15 were enrolled by 2 participating physicians representing a predominantly lung/GI practice. Baseline data was abstracted retrospectively in the 3 months prior to the pilot to reflect all study participants. The OCCP included in-person and telephone assessments by an oncology pharmacist and nurse over 2 cycles of OC. Pilot outcomes included pharmacy interventions, dose modification for toxicity, medication errors, the percent of prescriptions on computerized physician order entry (CPOE), adherence documentation and comprehension of treatment plan. Results: The pilot enrolled 20 patients and compared them against 21 baseline patients. During the pilot there were improvements in the percentage of patients who had pharmacy interventions, documentation of adherence and assessment of comprehension of the treatment plan as well as a reduction in dose modifications due to toxicity (Table 1). Conclusions: Use of a newly developed oral chemotherapy care pathway demonstrated both feasibility as well as improvements in a variety of key patient safety indicators. These results suggest that implementation of a standardized oral chemotherapy care pathway can feasibly improve patient safety outcomes. [Table: see text]
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Affiliation(s)
- Tejas Desai
- University of Toronto, Mississauga, ON, Canada
| | | | - Ron Fung
- Trillium Health Partners, Mississauga, ON, Canada
| | - Devi Ahuja
- Trillium Health Partners, Mississauga, ON, Canada
| | | | | | | | - Katherine Enright
- Peel Regional Cancer Centre, Credit Valley Hospital, Mississauga, ON, Canada
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Lofters A, Virani T, Grewal G, Lobb R. Using Knowledge Exchange to Build and Sustain Community Support to Reduce Cancer Screening Inequities. Prog Community Health Partnersh 2016; 9:379-87. [PMID: 26548789 DOI: 10.1353/cpr.2015.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND "Knowledge exchange" (KE) refers to the interaction between knowledge users and researchers toward a goal of mutual learning and collaborative problem solving. METHODS Using a case study approach, this article describes how researchers leading a multiphase community engagement project, the Peel Cancer Screening Study (PCSS), used KE to engage a community advisory group (CAG) of knowledge users to build community support for interventions to reduce cancer screening inequities for South Asians in Peel Region, Ontario, Canada. RESULTS As a result of KE activities (concept mapping, a CAG launch meeting, regular CAG meetings, workgroup meetings, a community report), there is currently a resident-targeted, community-level program being implemented and a provider-targeted intervention that is funded, with both ethnospecific and health service organizations involved. The process of KE received positive evaluations from advisory group members. CONCLUSIONS The experiences of the PCSS illustrate the benefits of KE for researchers and community members.
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Singh P, Singh J, Antle J, Topper E, Grewal G. Load Securement and Packaging Methods to Reduce Risk of Damage and Personal Injury for Cargo Freight in Truck, Container and Intermodal Shipments. japr 2014. [DOI: 10.14448/japr.01.0005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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McGovern E, Moss H, Grewal G, Taylor A, Bjornsson S, Pell J. Factors affecting the use of folic acid supplements in pregnant women in Glasgow. Br J Gen Pract 1997; 47:635-7. [PMID: 9474827 PMCID: PMC1410125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Use of folic acid supplements preconception, and during the first trimester, is associated with a reduced incidence of first and subsequent neural tube defects. The Department of Health guidelines recommend the use of folic acid supplements by all women planning a pregnancy. AIM To ascertain the proportion using folic acid supplements and the factors affecting their use. METHOD Questionnaires were distributed postpartum to the 515 women who delivered normal babies in three maternity units in Glasgow over a four-week period. RESULTS Forms were completed by 487 (95%) women. Only 57% took supplements at some point during their pregnancy, and only 21% took them before conception. Failure to take supplements was significantly associated with unplanned pregnancy, younger age, and previous pregnancies. Lack of awareness of the potential benefits associated with folic acid use was the commonest reason cited by women for not taking supplements. CONCLUSIONS Increased health education through health care professionals and mass media campaigns can improve awareness and thereby increase the use of supplements in planned pregnancies. However, 42% of women in our study had unplanned pregnancies. Intake of folic acid supplements in this group can only be increased by improvements in dietary intake within the population as a whole, and by fortification of commonly ingested foods.
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Hodgkinson R, Bhatt M, Kim SS, Grewal G, Marx GF. Neonatal neurobehavioral tests following cesarean section under general and spinal anesthesia. Am J Obstet Gynecol 1978; 132:670-4. [PMID: 717473 DOI: 10.1016/0002-9378(78)90862-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Scanlon Group of Early Neonatal Neurobehavioral Tests (E.N.N.S.) was administered to 150 babies delivered by elective cesarean section. Fifty of the mothers were induced into general anesthesia with thiopental, 4 mg. per kilogram, and 50 with ketamine, 1 mg. per kilogram. Fifty mothers received spinal anesthesia with 6 to 8 mg. of tetracaine. All mothers receiving spinal anesthesia were given 100 per cent oxygen by a transparent face mask and all undergoing general anesthesia received N2O-O2 (6L:6L) until delivery of the baby. All mothers were healthy and all babies weighed 2,500 grams or more, were apparently normal, and had Apgar scores of 7 or more at one minute to 10 at five minutes. Spinal anesthesia was associated with the greatest percentage of high scores on both the first and second day for overall assessment, pinprick response, tone, rooting, sucking. Moro response, placing, alertness, and total decrement (habituation) scores. There was a statistically significant difference between all the scores for spinal compared to the other two groups. The scores were lowest following a thiopental induction and intermediate with ketamine although the difference did not reach statistical significance.
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Hodgkinson R, Bhatt M, Grewal G, Marx GF. Neonatal neurobehavior in the first 48 hours of life: effect of the administration of meperidine with and without naloxone in the mother. Pediatrics 1978; 62:294-8. [PMID: 704198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The early neonatal neurobehavioral scale was administered to three groups of newborns at 2, 4, and 24 hours of age. Group 1 consisted of 28 babies whose mothers had received no narcotics during labor, group 2 of 33 babies whose mothers had received meperidine hydrochloride alone during labor, and group 3 of 40 babies whose mothers had received meperidine followed by 0.4 mg of naloxone hydrochloride intravenously approximately 15 minutes before delivery. Babies who were not exposed to meperidine showed a statistically significantly greater percentage of high scores than those exposed to meperidine alone for all items on the neurobehavioral scale at 2 and 4 hours and for all items except tone and Moro response at 24 hours. Similarly, babies whose mothers had received meperidine and naloxone showed a significantly greater percentage of high scores than those whose mothers had received meperidine alone at 2 hours of age. At 4 hours a difference was found for tone and rooting and at 24 hours for overall score, placing, and total decrement score. It is concluded that naloxone given intravenously to the mother reverses the effect of meperidine on neonatal neurobehavior for approximately two hours after birth. At 4 and 24 hours, however, the neurobehavior of neonates exposed to meperidine and naloxone is depressed almost as much as that of babies exposed to meperidine alone.
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