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Jegatheesan P, Lee HC, Jelks A, Song D. Quality improvement efforts directed at optimal umbilical cord management in delivery room. Semin Perinatol 2024; 48:151905. [PMID: 38679508 DOI: 10.1016/j.semperi.2024.151905] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Delayed or deferred cord clamping (DCC) and umbilical cord milking (UCM) benefit all infants by optimizing fetal-neonatal transition and placental transfusion. Even though DCC is recommended by almost all maternal and neonatal organizations, it has not been universally implemented. There is considerable variation in umbilical cord management practices across institutions. In this article, we provide examples of successful quality improvement (QI) initiatives to implement optimal cord management in the delivery room. We discuss a number of key elements that should be considering among those undertaking QI efforts to implement DCC and UCM including, multidisciplinary team collaboration, development of theory for change, mapping of the current and ideal process and workflow for cord management, and creation of a unit-specific evidence-based protocol for cord management. We also examine important strategies for implementation and provide suggestions for developing a system for measurement and benchmarking.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Henry C Lee
- Department of Pediatrics, Division of Neonatology, University of California San Diego, San Diego, CA, USA
| | - Andrea Jelks
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Cahill C, Jegatheesan P, Song D, Cortes M, Adams M, Narasimhan SR, Huang A, Angell C, Stemmle M. Implementing Higher Phototherapy Thresholds for Jaundice in Healthy Infants 35 Plus Weeks. Hosp Pediatr 2023; 13:857-864. [PMID: 37635692 DOI: 10.1542/hpeds.2022-007098] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVES To determine the impact of higher bilirubin thresholds on testing and treatment of healthy infants during the neonatal period. METHODS This quality improvement study included infants born at ≥35 weeks gestation and admitted to the well-baby nursery between July 2018 and December 2020. We assessed the transition from infants treated according to the 2004 AAP guidelines (pregroup) with those following the Northern California Neonatal Consortium guidelines (postgroup). We examined the proportion of infants receiving phototherapy and total serum bilirubin (TSB) assessments as outcome measures. We examined critical hyperbilirubinemia (TSB above 25 mg/dL or TSB within 2 mg/dL of threshold for exchange transfusion), exchange transfusion, and readmission for jaundice as balancing measures. We compared the differences in outcomes over time using Statistical Process Control p charts. Balancing measures between the pre and postgroups were compared using χ square tests and t-tests. RESULTS In our population of 6173 babies, there was a significant shift in the proportion receiving phototherapy from 6.4% to 4%. There were no significant changes in incidences of bilirubin >25 mg/dL (0 of 1472 vs 7 of 4709, P = .37), bilirubin within 2 mg/dL of exchange transfusion thresholds (4 of 1472 vs 5 of 4709, P = .15), exchange transfusion (0 of 1472 vs 1 of 4709, P = .70) or readmission for phototherapy (2.9% versus 2.4%, P = .30), between the 2 groups. CONCLUSIONS Higher thresholds for phototherapy treatment of neonatal hyperbilirubinemia can decrease the need for phototherapy without increasing critical hyperbilirubinemia or readmission rate.
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Affiliation(s)
- Chris Cahill
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Dongli Song
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Maria Cortes
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Marian Adams
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Angela Huang
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Cathy Angell
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Monica Stemmle
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Barlow SM, Liao C, Lee J, Kim S, Maron JL, Song D, Jegatheesan P, Govindaswami B, Wilson BJ, Bhakta K, Cleary JP. Spectral features of non-nutritive suck dynamics in extremely preterm infants. Pediatr Med 2023; 6:23. [PMID: 37900782 PMCID: PMC10611428 DOI: 10.21037/pm-21-91] [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: 10/31/2023]
Abstract
Background Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). Methods A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. Results ML of Welch PSD method and Yule-Walker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Conclusions Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population.
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Affiliation(s)
- Steven M. Barlow
- Department of Communication Disorders and Department of Biological Systems Engineering, Center for Brain, Biology & Behavior, University of Nebraska, Lincoln, NE, USA
| | - Chunxiao Liao
- Department of Biochemistry, Baylor College of Medicine, Houston, TX, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Seungman Kim
- Department of Educational Psychology, Leadership & Counseling, Texas Tech University, Lubbock, TX, USA
| | - Jill L. Maron
- Division of Newborn Medicine, Tufts Medical Center, Boston, MA, USA
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
- Division of Newborn Medicine, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard J. Wilson
- Division of Neonatal-Perinatal Medicine, CHI Health St. Elizabeth, Lincoln, NE, USA
| | - Kushal Bhakta
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
| | - John P. Cleary
- Neonatology, Children’s Hospital of Orange County, Orange, CA, USA
- Department of Pediatrics, University of California-Irvine, Irvine, CA, USA
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Jegatheesan P, Narasimhan SR, Huang A, Nudelman M, Song D. Higher NICU admissions in infants born at ≥35 weeks gestational age during the COVID-19 pandemic. Front Pediatr 2023; 11:1206036. [PMID: 37484778 PMCID: PMC10360125 DOI: 10.3389/fped.2023.1206036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Background Increasing evidence has shown that the COVID-19 pandemic has had a profound negative impact on vulnerable populations and a significant effect on maternal and neonatal health. We observed an increase in the percentage of infants admitted to NICU from 8% to 10% in the first year of the pandemic. This study aimed to compare the delivery room outcomes, NICU admissions and interventions, and neonatal outcomes two years before and during the pandemic. Methods This was a retrospective study in a public hospital between pre-COVID-19 (April 2018-December 2019) and COVID-19 (April 2020-December 2021). Data were obtained from all live births at ≥35 weeks gestation (GA). Maternal and neonatal demographics, delivery room (DR), and NICU neonatal outcomes were compared between the study periods using simple bivariable generalized estimating equations (GEE) regression. Multivariable GEE logistic regression analysis was performed to adjust for the effects of baseline differences in demographics on the outcomes. Results A total of 9,632 infants were born ≥35 weeks gestation during the study period (pre-COVID-19 n = 4,967, COVID-19 n = 4,665). During the COVID-19 period, there was a small but significant decrease in birth weight (33 g); increases in maternal diabetes (3.3%), hypertension (4.1%), and Hispanic ethnicity (4.7%). There was a decrease in infants who received three minutes (78.1% vs. 70.3%, p < 0.001) of delayed cord clamping and increases in the exclusive breastfeeding rate (65.9% vs. 70.1%, p < 0.001), metabolic acidosis (0.7% vs. 1.2%, p = 0.02), NICU admission (5.1% vs. 6.4%, p = 0.009), antibiotic (0.7% vs. 1.7%, p < 0.001), and nasal CPAP (1.2% vs. 1.8%, p = 0.02) use. NICU admissions and nasal CPAP were not significantly increased after adjusting for GA, maternal diabetes, and hypertension; however, other differences remained significant. Maternal hypertension was an independent risk factor for all these outcomes. Conclusion During the COVID-19 pandemic period, we observed a significant increase in maternal morbidities, exclusive breastfeeding, and NICU admissions in infants born at ≥35 weeks gestation. The increase in NICU admission during the COVID-19 pandemic was explained by maternal hypertension, but other adverse neonatal outcomes were only partly explained by maternal hypertension. Socio-economic factors and other social determinants of health need to be further explored to understand the full impact on neonatal outcomes.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Matthew Nudelman
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Song D, Narasimhan SR, Huang A, Jegatheesan P. Increased newborn NICU admission for evaluation of hypoxic-ischemic encephalopathy during COVID-19 pandemic in a public hospital. Front Pediatr 2023; 11:1206137. [PMID: 37456571 PMCID: PMC10338929 DOI: 10.3389/fped.2023.1206137] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Background Prenatal and perinatal care of pregnant mothers has been adversely affected during the COVID-19 pandemic. Hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal death and long-term neurological disabilities. Therapeutic hypothermia is effective for neonatal HIE. This study evaluated the effect of the pandemic on neonatal HIE. Methods This retrospective single-center study compared neonatal HIE evaluation and hypothermia treatment between pre-COVID-19 pandemic (1 January 2018-31 December 2019) and COVID-19 pandemic (1 January 2020-31 December 2021) periods. Infants with abnormal neurological examination and or significant metabolic acidosis were admitted to NICU for evaluation of HIE and therapeutic hypothermia. Demographics, NICU admission and interventions, and neonatal outcomes were compared between infants born during the two periods using χ2, t-test, and Wilcoxon rank-sum test as appropriate. Statistical Process Control charts show the yearly proportion of infants evaluated for HIE and those treated with therapeutic hypothermia. Results From the pre-pandemic to the pandemic period, the proportion of infants that met HIE screening criteria increased from 13% to 16% (p < 0.0001), the proportion of infants admitted to NICU for HIE evaluation increased from 1% to 1.4% (p = 0.02), and the maternal hypertension rates of the admitted infants increased from 30% to 55% (p = 0.006). There was no difference in the proportions of the infants diagnosed with HIE (0.7% vs. 0.9%, p = 0.3) or treated with therapeutic hypothermia (0.2% vs. 0.3%, p = 0.3) between the two periods. There were no differences in the HIE severity and outcomes of the infants treated with therapeutic hypothermia between the two periods. Conclusion During the COVID-19 pandemic, we observed a significant increase in NICU admission for HIE evaluation. While we did not find significant increases in neonatal HIE and the need for therapeutic hypothermia, larger studies are needed for a comprehensive assessment of the impact of the COVID-19 pandemic on neonatal HIE.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
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Song D, Jelks A, Narasimhan SR, Jegatheesan P. Cord management strategies in multifetal gestational births. Semin Perinatol 2023:151743. [PMID: 37005172 DOI: 10.1016/j.semperi.2023.151743] [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: 04/04/2023]
Abstract
Multifetal gestations are associated with high risks of neonatal mortality and morbidities primarily due to prematurity. Delayed cord clamping and cord milking facilitate the postnatal transition and improve outcomes. Limited evidence shows that delayed cord clamping for 30-60 s and cord milking are feasible without causing harm and potentially beneficial in uncomplicated multifetal deliveries. However, data on maternal bleeding from the limited studies are inconsistent. Based on current knowledge of the risk vs. benefits, it is reasonable to perform delayed cord clamping or cord milking (>28 weeks of gestation) in uncomplicated monochorionic and dichorionic multiples. Clearly defined criteria for suitable candidates, indications for clamping or milking the cord during delivery, and improved obstetric techniques in Cesarean deliveries are critical to minimize risks and optimize neonatal transition. Research is needed to identify safe and optimal cord-management strategies for improving survival and long-term outcomes in this high-risk population.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Andrea Jelks
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Anderson Enni JB, Narasimhan SR, Huang A, Jegatheesan P. Screening and diagnosis of neonatal hypoglycaemia in at-risk late preterm and term infants following AAP recommendations: a single centre retrospective study. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001766. [PMID: 36941020 PMCID: PMC10030920 DOI: 10.1136/bmjpo-2022-001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/09/2022] [Accepted: 02/22/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There is a lack of consensus regarding the definition and treatment threshold for neonatal hypoglycaemia. The American Academy of Pediatrics (AAP) has a published clinical report making recommendations on practice guidelines. There is limited literature discussing the impact of these guidelines. In this study, we evaluated the screening and diagnosis of neonatal hypoglycaemia following the AAP guidelines. METHODS Infants born ≥35 weeks gestational age and admitted to the well-baby nursery between January and December 2017 were included in this study. Our hypoglycaemia policy was based on the AAP clinical report for hypoglycaemia management in newborns. Chart review was done to obtain infant hypoglycaemia risk factors and blood glucose values in the first 24 hours. Data analysis was conducted using Stata V.14.2 (StataCorp). RESULTS Of 2873 infants born and admitted to the well-baby nursery, 32% had at least one hypoglycaemia risk factor and 96% of them were screened for hypoglycaemia. Screened infants were more likely to be born at a lower gestational age, via C-section, and to a multiparous older mother. Screened infants and hypoglycaemic infants had lower exclusive breastfeeding rates compared with those who were not screened or not hypoglycaemic, respectively. Sixteen per cent of screened infants were diagnosed with hypoglycaemia; 0.8% of at-risk screened infants and 5% of hypoglycaemic infants were admitted to the NICU for treatment of hypoglycaemia. Thirty-one per cent of preterm infants, 15% of large for gestational age infants, 13% of small for gestational age infants and 15% of infants of diabetic mothers were hypoglycaemic. Hypoglycaemic infants were more likely to be born preterm and via C-section. CONCLUSION Using the AAP time-based definitional blood glucose cut-off values, our incidence of hypoglycaemia found in those who were screened for risk factors was lower compared with other studies. Future long-term follow-up studies will be important.
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Affiliation(s)
| | - Sudha Rani Narasimhan
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Angela Huang
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Priya Jegatheesan
- Pediatrics/Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
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Peltz G, Jansson LM, Adeniyi-Jones S, Cohane C, Drover D, Shafer S, Wang M, Wu M, Govindaswami B, Jegatheesan P, Argani C, Khan S, Kraft WK. Ondansetron to reduce neonatal opioid withdrawal severity a randomized clinical trial. J Perinatol 2023; 43:271-276. [PMID: 36030327 PMCID: PMC9968817 DOI: 10.1038/s41372-022-01487-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if treatment with a 5-HT3 antagonist (ondansetron) reduces need for opioid therapy in infants at risk for neonatal opioid withdrawal syndrome (NOWS). STUDY DESIGN A multicenter, randomized, placebo controlled, double blind clinical trial of ninety (90) infants. The intervention arms were intravenous ondansetron or placebo during labor followed by a daily dose of ondansetron or placebo in infants for five days. RESULTS Twenty-two (49%) ondansetron-treated and 26 (63%) placebo-treated infants required pharmacologic treatment (p > 0.05). The Finnegan score was lower in the ondansetron-treated group (4.6 vs. 5.6, p = 0.02). A non-significant trend was noted for the duration of hospitalization. There was no difference in need for phenobarbital or clonidine therapy, or total dose of morphine in the first 15 days of NOWS treatment. CONCLUSIONS Ondansetron treatment reduced the severity of NOWS symptoms; and there was an indication that it could reduce the length of stay. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01965704.
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Affiliation(s)
- Gary Peltz
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Lauren M Jansson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Adeniyi-Jones
- Department of Pediatrics Nemours Neonatology at Jefferson, Thomas Jefferson University, Philadelphia, PA, USA
| | - Carol Cohane
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David Drover
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven Shafer
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Meiyue Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Manhong Wu
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Balaji Govindaswami
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Cynthia Argani
- Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Salwa Khan
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Walter K Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
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Raja P, Rajkumar P, Jegatheesan P, Amalraj AS, Lourdu Rajah AJ. Investigation of structural, optical and photoluminescence properties of non-essential amino acid capped zinc sulfide nanoparticles for optoelectronic applications. J INDIAN CHEM SOC 2022. [DOI: 10.1016/j.jics.2022.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Matsui Y, Li L, Prahl M, Cassidy AG, Ozarslan N, Golan Y, Gonzalez VJ, Lin CY, Jigmeddagva U, Chidboy MA, Montano M, Taha TY, Khalid MM, Sreekumar B, Hayashi JM, Chen PY, Kumar GR, Warrier L, Wu AH, Song D, Jegatheesan P, Rai DS, Govindaswami B, Needens J, Rincon M, Myatt L, Asiodu IV, Flaherman VJ, Afshar Y, Jacoby VL, Murtha AP, Robinson JF, Ott M, Greene WC, Gaw SL. Neutralizing antibody activity against SARS-CoV-2 variants in gestational age-matched mother-infant dyads after infection or vaccination. JCI Insight 2022; 7:e157354. [PMID: 35579965 PMCID: PMC9309042 DOI: 10.1172/jci.insight.157354] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Pregnancy confers unique immune responses to infection and vaccination across gestation. To date, there are limited data comparing vaccine- and infection-induced neutralizing Abs (nAbs) against COVID-19 variants in mothers during pregnancy. We analyzed paired maternal and cord plasma samples from 60 pregnant individuals. Thirty women vaccinated with mRNA vaccines (from December 2020 through August 2021) were matched with 30 naturally infected women (from March 2020 through January 2021) by gestational age of exposure. Neutralization activity against the 5 SARS-CoV-2 spike sequences was measured by a SARS-CoV-2-pseudotyped spike virion assay. Effective nAbs against SARS-CoV-2 were present in maternal and cord plasma after both infection and vaccination. Compared with WT spike protein, these nAbs were less effective against the Delta and Mu spike variants. Vaccination during the third trimester induced higher cord-nAb levels at delivery than did infection during the third trimester. In contrast, vaccine-induced nAb levels were lower at the time of delivery compared with infection during the first trimester. The transfer ratio (cord nAb level divided by maternal nAb level) was greatest in mothers vaccinated in the second trimester. SARS-CoV-2 vaccination or infection in pregnancy elicits effective nAbs with differing neutralization kinetics that are influenced by gestational time of exposure.
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Affiliation(s)
- Yusuke Matsui
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, California, USA
| | - Lin Li
- Division of Maternal-Fetal Medicine and
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Mary Prahl
- Department of Pediatrics
- Division of Pediatric Infectious Diseases and Global Health
| | | | - Nida Ozarslan
- Division of Maternal-Fetal Medicine and
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Yarden Golan
- Department of Bioengineering and Therapeutic Sciences
| | | | | | - Unurzul Jigmeddagva
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Megan A. Chidboy
- Division of Maternal-Fetal Medicine and
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Mauricio Montano
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, California, USA
| | - Taha Y. Taha
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | - Mir M. Khalid
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | - Bharath Sreekumar
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | - Jennifer M. Hayashi
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | - Pei-Yi Chen
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | - G. Renuka Kumar
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
| | | | - Alan H.B. Wu
- Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Daljeet S. Rai
- Stanford-O’Connor Family Medicine Residency Program, Division of Family Medicine, Stanford University, Palo Alto, California, USA
| | | | - Jordan Needens
- Department of Obstetrics and Gynecology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia, USA
| | - Monica Rincon
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Yalda Afshar
- Department of Obstetrics and Gynecology, UCLA, Los Angeles, California, USA
| | | | | | - Joshua F. Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
| | - Melanie Ott
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, California, USA
- Department of Medicine, and
| | - Warner C. Greene
- Gladstone Institute of Virology, Gladstone Institutes, San Francisco, California, USA
- Michael Hulton Center for HIV Cure Research at Gladstone, San Francisco, California, USA
- Department of Medicine, and
- Department of Microbiology and Immunology, UCSF, San Francisco, California, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine and
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, UCSF, San Francisco, California, USA
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11
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Rodriguez K, Nudelman MJ, Jegatheesan P, Huang A, Devarajan K, Haas JE, Cervantes R, Falbo K, Narasimhan SR, Cormier M, Stewart MB, Patel R, Govindaswami B. Are preterm birth and very low birth weight rates altered in the early COVID (2020) SARS-CoV-2 era? Front Pediatr 2022; 10:1093371. [PMID: 36699310 PMCID: PMC9869366 DOI: 10.3389/fped.2022.1093371] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE We evaluated the prevalence of preterm birth (PTB) and very low birth weight (VLBW) during Jan-Dec 2,020 (early COVID era) at 5 hospitals (2 in West Virginia, 3 in California) compared to Jan 2017-Dec 2019 (pre-COVID) inclusive of 2 regional perinatal centers (1 in Huntington, WV and 1 in San Jose, CA) and 3 community hospitals (1 each in Cabell, Los Angeles and Santa Clara counties). DESIGN/METHODS We examined PTB and VLBW rates of live births at 5 US hospitals from Jan 2017-Dec 2020. We compared PTB and VLBW rates in 2020 to 2017-2019 using Poisson regression and rate ratio with a 95% confidence interval. We stratified live births by gestational age (GA) (<37, 33-36, and <33 weeks) and birth weight (≤1,500 g, >1,001 g to ≤1,500 g, ≤1,000 g). We examined PTB rates at 4 of the hospitals during Jan-Dec 2020 and compared them to the prior period of Jan 2017-Dec 2019 using Statistical Process Control (SPC) for quarterly data. RESULTS We examined PTB and VLBW rates in 34,599 consecutive live births born Jan 2017-Dec 2019 to rates of 9,691 consecutive live births in 2020. There was no significant change in PTB (<37 weeks GA) rate, 10.6% in 2017-2019 vs. 11.0% in 2020 (p = 0.222). Additionally, there was no significant change when comparing VLBW rates in 2017-2019 to 2020, 1.4% in 2017-2019 vs. 1.5% in 2020 (p = 0.832). CONCLUSION We found no significant change in the rates of PTB or VLBW when combining the live birth data of 5 US hospitals in 3 different counties.
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Affiliation(s)
- Kayla Rodriguez
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, United States
| | - Matthew J Nudelman
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Priya Jegatheesan
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Angela Huang
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Kamakshi Devarajan
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States.,Utilization Managment and Population Health, Silversummit Health Plan, Nevada Subsidiary of Centene Corporation, Las Vegas, Nevada, MO, United States
| | - Jessica E Haas
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Rosemarie Cervantes
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States
| | - Kelle Falbo
- Neonatology/Pediatrics, St. Francis Medical Center, Lynwood, CA, United States
| | | | - Machelnil Cormier
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Mary Beth Stewart
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States
| | - Rupalee Patel
- Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States
| | - Balaji Govindaswami
- Neonatology/Pediatrics, Mountain Health Network, Marshall University, Huntington, WV, United States.,Neonatology/Pediatrics, Santa Clara Valley Healthcare, San Jose, CA, United States.,VMC Foundation, San Jose, CA, United States
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12
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Loeliger KB, González V, Prahl M, Robinson JF, Song D, Jegatheesan P, Gaw SL. Identifying Unique Inflammatory Cytokine Profiles in Maternal-Fetal Dyads with COVID-19. Am J Obstet Gynecol 2022. [PMCID: PMC8696708 DOI: 10.1016/j.ajog.2021.11.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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13
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Song D, Prahl M, Gaw SL, Narasimhan SR, Rai DS, Huang A, Flores CV, Lin CY, Jigmeddagva U, Wu A, Warrier L, Levan J, Nguyen CBT, Callaway P, Farrington L, Acevedo GR, Gonzalez VJ, Vaaben A, Nguyen P, Atmosfera E, Marleau C, Anderson C, Misra S, Stemmle M, Cortes M, McAuley J, Metz N, Patel R, Nudelman M, Abraham S, Byrne J, Jegatheesan P. Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: prospective cohort study. BMJ Open 2021; 11:e053036. [PMID: 34234001 PMCID: PMC8264915 DOI: 10.1136/bmjopen-2021-053036] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterise neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively and passively acquired antibodies in infants. DESIGN A prospective observational study. SETTING Public healthcare system in Santa Clara County (California, USA). PARTICIPANTS Women with symptomatic or asymptomatic SARS-CoV-2 infection during pregnancy and their infants were enrolled between 15 April 2020 and 31 March 2021. OUTCOMES SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and 8 with severe-critical symptoms. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56% to 0.73%) and the cord blood was 58% (95% CI 0.49% to 0.66%). IgG levels significantly correlated between the maternal and cord blood (Rs=0.93, p<0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared with <60 days (1.2 vs 0.6, p<0.0001). Infant IgG seroreversion rates over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4 of 48), 12% (3 of 25), and 38% (5 of 13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to 6 months of age. Two newborns showed seroconversion at 2 weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. CONCLUSIONS Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than 2 months before delivery. Maternally derived passive immunity may persist in infants up to 6 months of life. Neonates are capable of mounting a strong antibody response to perinatal SARS-CoV-2 infection.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Mary Prahl
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
| | - Stephanie L Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sudha Rani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Daljeet S Rai
- Department of Family Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Claudia V Flores
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Christine Y Lin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Unurzul Jigmeddagva
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California San Francisco, San Francisco, California, USA
| | - Alan Wu
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lakshmi Warrier
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Justine Levan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Catherine B T Nguyen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Perri Callaway
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Lila Farrington
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gonzalo R Acevedo
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Veronica J Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Anna Vaaben
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Phuong Nguyen
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Elda Atmosfera
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Constance Marleau
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Christina Anderson
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sonya Misra
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Monica Stemmle
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Maria Cortes
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jennifer McAuley
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Nicole Metz
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Rupalee Patel
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Matthew Nudelman
- Department of Pediatrics, Marshall University, Huntington, West Virginia, USA
| | - Susan Abraham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - James Byrne
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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14
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Narasimhan SR, Flaherman V, McLean M, Nudelman M, Vallejo M, Song D, Jegatheesan P. Practice Variations in Diagnosis and Treatment of Hypoglycemia in Asymptomatic Newborns. Hosp Pediatr 2021; 11:595-604. [PMID: 34011565 DOI: 10.1542/hpeds.2020-004101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To describe variations in the practice of hypoglycemia screening and treatment in asymptomatic infants in the United States. METHODS During the time period from February 2018 to June 2018, we surveyed representatives of hospitals participating in the Better Outcomes through Research for Newborns Network, a national research network of clinicians providing hospital care to term and late-preterm newborns. The survey included 22 questions evaluating practices related to hypoglycemia screening and management of asymptomatic infants. RESULTS Of 108 network sites, 84 (78%) responded to the survey; 100% had a hypoglycemia protocol for screening at-risk infants in the well-baby nursery. There were wide variations between sites regarding the definition of hypoglycemia (mg/dL) (<45 [24%]; <40 [23%]; <40 [0-4 hours] and <45 [4-24 hours] [27%]; <25 [0-4 hours] and <35 [4-24 hours] [8%]), timing of first glucose check (<1 hour [18%], 1-2 hours [30%], 30 minutes post feed [48%]), and threshold glucose level for treatment (<45 [19%]; <40 [18%]; <40 [0-4 hours] and <45 [4-24 hours] [20%]; <25 [0-4 hours] and <35 [4-24 hours] [15%]). All respondents used breast milk as a component of initial therapy. Criteria for admission to the NICU for hypoglycemia included the need for dextrose containing intravenous fluids (52%), persistent hypoglycemia despite treatment (49%), and hypoglycemia below a certain value (37%). CONCLUSIONS There is a significant practice variation in hypoglycemia screening and management across the United States.
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Affiliation(s)
- Sudha Rani Narasimhan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California;
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Matthew Nudelman
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Maricela Vallejo
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Dongli Song
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Priya Jegatheesan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California
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15
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Song D, Prahl M, Gaw SL, Narasimhan S, Rai D, Huang A, Flores C, Lin CY, Jigmeddagva U, Wu AH, Warrier L, Levan J, Nguyen CB, Callaway P, Farrington L, Acevedo GR, Gonzalez VJ, Vaaben A, Nguyen P, Atmosfera E, Marleau C, Anderson C, Misra S, Stemmle M, Cortes M, McAuley J, Metz N, Patel R, Nudelman M, Abraham S, Byrne J, Jegatheesan P. Passive and active immunity in infants born to mothers with SARS-CoV-2 infection during pregnancy: Prospective cohort study. medRxiv 2021:2021.05.01.21255871. [PMID: 33972953 PMCID: PMC8109203 DOI: 10.1101/2021.05.01.21255871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate maternal immunoglobulins' (IgM, IgG) response to SARS-CoV-2 infection during pregnancy and IgG transplacental transfer, to characterize neonatal antibody response to SARS-CoV-2 infection, and to longitudinally follow actively- and passively-acquired SARS-CoV-2 antibodies in infants. DESIGN A prospective observational study. SETTING A public healthcare system in Santa Clara County (CA, USA). PARTICIPANTS Women with SARS-CoV-2 infection during pregnancy and their infants were enrolled between April 15, 2020 and March 31, 2021. OUTCOMES SARS-CoV-2 serology analyses in the cord and maternal blood at delivery and longitudinally in infant blood between birth and 28 weeks of life. RESULTS Of 145 mothers who tested positive for SARS-CoV-2 during pregnancy, 86 had symptomatic infections: 78 with mild-moderate symptoms, and eight with severe-critical symptoms. Of the 147 newborns, two infants showed seroconversion at two weeks of age with high levels of IgM and IgG, including one premature infant with confirmed intrapartum infection. The seropositivity rates of the mothers at delivery was 65% (95% CI 0.56-0.73) and the cord blood was 58% (95% CI 0.49-0.66). IgG levels significantly correlated between the maternal and cord blood (Rs= 0.93, p< 0.0001). IgG transplacental transfer ratio was significantly higher when the first maternal positive PCR was 60-180 days before delivery compared to <60 days (1.2 vs. 0.6, p=<0.0001). Infant IgG negative conversion rate over follow-up periods of 1-4, 5-12, and 13-28 weeks were 8% (4/48), 12% (3/25), and 38% (5/13), respectively. The IgG seropositivity in the infants was positively related to IgG levels in the cord blood and persisted up to six months of age. CONCLUSIONS Maternal SARS-CoV-2 IgG is efficiently transferred across the placenta when infections occur more than two months before delivery. Maternally-derived passive immunity may protect infants up to six months of life. Neonates mount a strong antibody response to perinatal SARS-CoV-2 infection.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Mary Prahl
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Global Health, University of California, San Francisco, CA, USA
| | - Stephanie L. Gaw
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - SudhaRani Narasimhan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Daljeet Rai
- Department of Family Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Angela Huang
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Claudia Flores
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Christine Y. Lin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Unurzul Jigmeddagva
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Alan H.B. Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Lakshmi Warrier
- Department of Medicine, University of California San Francisco, CA, USA
| | - Justine Levan
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Perri Callaway
- Department of Medicine, University of California San Francisco, CA, USA
| | - Lila Farrington
- Department of Medicine, University of California San Francisco, CA, USA
| | | | - Veronica J. Gonzalez
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Anna Vaaben
- Department of Medicine, University of California San Francisco, CA, USA
| | - Phuong Nguyen
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Elda Atmosfera
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Constance Marleau
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Christina Anderson
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonya Misra
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Monica Stemmle
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Maria Cortes
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jennifer McAuley
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Nicole Metz
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Rupalee Patel
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Matthew Nudelman
- Department of Pediatrics, Marshall University, Huntington, WV, USA
| | - Susan Abraham
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - James Byrne
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Santa Clara Valley, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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16
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Magassa S, Haddad M, El-Hafaia N, Colas C, Lafkihi S, Ramassamy R, Aboubacar M, De Bandt JP, Jegatheesan P. Citrulline, crosstalk hépatocytes-macrophages et stéatose hépatique non alcoolique. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.02.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Tran CL, Parucha JM, Jegatheesan P, Lee HC. Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units. Am J Perinatol 2020; 37:151-157. [PMID: 30900218 DOI: 10.1055/s-0039-1683876] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/27/2022]
Abstract
OBJECTIVE To assess the current practice of delayed cord clamping (DCC) and to determine patient and hospital factors that predict DCC. STUDY DESIGN The California Perinatal Quality Care Collaborative (CPQCC) collects data on preterm and acutely ill infants. In 2016, 52 CPQCC neonatal intensive care units (NICUs) collected data on DCC. Hospital and patient characteristics were analyzed using multivariable logistic regression. RESULTS Of 5,332 deliveries, 1,555 (29%) newborns received DCC. Hospital rates ranged from 0 to 74.5% and increased from 21 to 37% throughout 2016. Infants delivered at <32 weeks or with birth weight <1,500 g were more likely to receive DCC (odds ratio: 2.80; 95% confidence interval: 2.33, 3.36). Cesarean delivery was associated with less likelihood of DCC (odds ratio: 0.68; 95% confidence interval: 0.59, 0.79). After risk adjustment, 17 (33%) hospitals had higher than expected DCC rate. Hospitals with less than 50 NICU beds are more likely to practice DCC, whereas Level 3 American Academy of Pediatrics NICUs, nonprofit owned hospitals, and teaching institutions were less likely to practice DCC (p < 0.001). CONCLUSION There are opportunities to implement quality improvement activities to increase DCC rates.
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Affiliation(s)
- Chinh L Tran
- School of Medicine, University of California, Irvine, California.,California Perinatal Quality Care Collaborative, Stanford, California
| | - Janella M Parucha
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
| | - Henry C Lee
- California Perinatal Quality Care Collaborative, Stanford, California.,Division of Neonatal and Developmental Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
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18
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Jegatheesan P, Belogolovsky E, Nudelman M, Song D, Govindaswami B. Neonatal outcomes in preterm multiples receiving delayed cord clamping. Arch Dis Child Fetal Neonatal Ed 2019; 104:F575-F581. [PMID: 30894397 PMCID: PMC6855790 DOI: 10.1136/archdischild-2018-316479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Received: 10/29/2018] [Revised: 01/28/2019] [Accepted: 02/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare neonatal outcomes in singletons versus multiples, first-born versus second-born multiples and monochorionic versus dichorionic/trichorionic multiples <33 weeks' gestational age (GA) who received delayed cord clamping (DCC). DESIGN Retrospective, observational study of 529 preterm infants receiving ≥30 s DCC. Generalised estimating equations and mixed effects models were used to compare outcomes in singletons versus multiples and monochorionic versus dichorionic/trichorionic multiples. Wilcoxon signed-rank and McNemar tests were used to compare first-born versus second-born multiples. SETTING Level III neonatal intensive care unit, California, USA. PATIENTS 433 singletons and 96 multiples <33 weeks' GA, born January 2008-December 2017, who received DCC. RESULTS 86% of multiples and 83% of singletons received DCC. Multiples had higher GA (31.0 weeks vs 30.6 weeks), more caesarean sections (91% vs 54%), fewer males (48% vs 62%) and higher 12-24 hour haematocrits (54.3 vs 50.5) than singletons. Haematocrit difference remained significant after adjusting for birth weight, delivery type and sex. Compared with first-born multiples, second-born multiples were smaller (1550 g vs 1438 g) and had lower survival without major morbidity (91% vs 77%). Survival without major morbidity was not significant after adjusting for birth weight. Compared with dichorionic/trichorionic multiples, monochorionic multiples had slightly lower admission temperatures (37.0°C vs 36.8°C), although this difference was not clinically significant. There were no other differences in delivery room, respiratory, haematological or neonatal outcomes between singletons and multiples or between multiples' subgroups. CONCLUSIONS Neonatal outcomes in preterm infants receiving DCC were comparable between singletons and multiples, first and second order multiples and monochorionic and dichorionic/trichorionic multiples.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Esther Belogolovsky
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Matthew Nudelman
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Dongli Song
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Balaji Govindaswami
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA,Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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Jegatheesan P, Lhuillier M, Akir N, El-Hafaia N, Ramassamy R, Aboubacar M, Nakib S, Neveux N, Loï C, Cynober L, De Bandt JP. OR21: Effects of N-Carbamoyl-Putrescine on Muscle Protein Metabolism in Malnourished Old Rats. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32493-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Seyssel K, Jegatheesan P, Stefanoni N, Rey V, Schneiter P, Giusti V, Tappy L. OR39: Gastric Bypass Decreases Postprandial Exogenous and Endogenous Triglyceride Responses. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32511-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Song D, Jegatheesan P, Nafday S, Ahmad KA, Nedrelow J, Wearden M, Nemerofsky S, Pooley S, Thompson D, Vail D, Cornejo T, Cohen Z, Govindaswami B. Patterned frequency-modulated oral stimulation in preterm infants: A multicenter randomized controlled trial. PLoS One 2019; 14:e0212675. [PMID: 30817764 PMCID: PMC6394921 DOI: 10.1371/journal.pone.0212675] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/30/2019] [Indexed: 12/15/2022] Open
Abstract
Objective To evaluate the effect of patterned, frequency-modulated oro-somatosensory stimulation on time to full oral feeds in preterm infants born 26–30 weeks gestation. Study design This is a multicenter randomized controlled trial. The experimental group (n = 109) received patterned, frequency-modulated oral stimulation via the NTrainer system through a pulsatile pacifier and the control group (n = 101) received a non-pulsatile pacifier. Intent-to-treat analysis (n = 210) was performed to compare the experimental and control groups and the outcomes were analyzed using generalized estimating equations. Time-to-event analyses for time to reach full oral feeds and length of hospital stay were conducted using Cox proportional hazards models. Results The experimental group had reduction in time to full oral feeds compared to the control group (-4.1 days, HR 1.37 (1.03, 1.82) p = 0.03). In the 29–30 weeks subgroup, infants in the experimental group had a significant reduction in time to discharge (-10 days, HR 1.87 (1.23, 2.84) p < 0.01). This difference was not observed in the 26–28 weeks subgroup. There was no difference in growth, mortality or morbidities between the two groups. Conclusions Patterned, frequency-modulated oro-somatosensory stimulation improves feeding development in premature infants and reduces their length of hospitalization. Trial registration ClinicalTrials.gov NCT01158391
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Affiliation(s)
- Dongli Song
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
- * E-mail:
| | - Priya Jegatheesan
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Suhas Nafday
- Pediatrics—Neonatology, Children's Hospital at Montefiore-Weiler Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Kaashif A. Ahmad
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
- Pediatrics–Neonatology, Baylor College of Medicine, San Antonio, TX, United States of America
| | - Jonathan Nedrelow
- Pediatrics–Neonatology, Cook Children's Medical Center, Fort Worth, TX, United States of America
| | - Mary Wearden
- Pediatrix Medical Group, North Central Baptist Hospital, San Antonio, TX, United States of America
| | - Sheri Nemerofsky
- Pediatrics–Neonatology, Children's Hospital at Montefiore-Wakefield Division, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Sunshine Pooley
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Diane Thompson
- aVenture Consulting, LLC, Leawood, KS, United States of America
| | - Daniel Vail
- Stanford University School of Medicine, Palo Alto, CA, United States of America
| | - Tania Cornejo
- Neonatology, Montefiore Medical Center-Weiler, Bronx, New York, United States of America
| | - Zahava Cohen
- Neonatology, Montefiore Medical Center-Wakefield, Bronx, New York, United States of America
| | - Balaji Govindaswami
- Pediatrics—Neonatology, Santa Clara Valley Medical Center, San Jose, CA, United States of America
- Stanford University School of Medicine, Palo Alto, CA, United States of America
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22
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Nudelman MJ, Goel K, Jegatheesan P, Song D, Huang A, Govindaswami B. Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study. BMJ Paediatr Open 2019; 3:e000531. [PMID: 31646196 PMCID: PMC6782040 DOI: 10.1136/bmjpo-2019-000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 06/12/2019] [Revised: 08/29/2019] [Accepted: 09/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To describe haematocrit at birth in preterm infants who received ≥60 s of delayed cord clamping (DCC). DESIGN Retrospective observational study. SETTING A California public hospital with an American Academy of Pediatrics level 4 neonatal intensive care unit, with 3500-4000 deliveries annually. PARTICIPANTS 467 preterm infants born at <35 weeks' gestational age (GA) between January 2013 and December 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Haematocrit reference ranges for 0-4 hours after birth and paired haematocrit differences between 0-4 and 4-24 hours. METHODS Haematocrits were obtained when clinically indicated and collected from arterial, venous and capillary sources. Haematocrits obtained after packed red blood cell transfusions were excluded. We summarised the first available haematocrit between 0 and 4 hours by GA strata. We used mixed-effects linear regression to describe the associations between haematocrit and predictor variables including GA, male sex and hours after an infant's birth. We also compared paired haematocrits at 0-4 and 4-24 hours after birth. RESULTS The median GA of the 467 included infants was 33.3 weeks, birth weight was 1910 g and DCC duration was 60 s. The mean (95% CI) first haematocrit at 0-4 hours was 46.6 (45.0% to 48.1%), 51.2 (49.6% to 52.8%), 50.6 (49.1% to 52.1%), 54.3 (52.8% to 55.8%) and 55.6 (54.6% to 56.6%) for infants 23-29, 30-31, 32, 33 and 34 weeks' GA strata, respectively. The subanalysis of 174 infants with paired haematocrits at 0-4 and 4-24 hours showed that for each additional hour after birth, the mean (95% CI) haematocrit increased by 0.2 (0.1% to 0.3%), 0.2 (0.1% to 0.4%) and 0.1 (0.0% to 0.2%) for infants in 23-29, 30-31 and 32 weeks' GA strata, respectively. The subanalysis showed no change between the paired haematocrits in the 33 and 34 weeks' GA strata. CONCLUSIONS Our study describes haematocrit in preterm infants who received ≥60 s DCC as standard of care. Haematocrit during the first 0-4 hours in our study is higher than the previously described reference ranges prior to DCC becoming routine clinical practice. The paired second haematocrit at 4-24 hours is higher than haematocrit at 0-4 hours.
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Affiliation(s)
- Matthew Jr Nudelman
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States.,Stanford, School of Medicine, Palo Alto, California, United States.,University of California, San Francisco, San Francisco, California, United States
| | - Keshav Goel
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States
| | - Priya Jegatheesan
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States.,Stanford, School of Medicine, Palo Alto, California, United States
| | - Dongli Song
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States.,Stanford, School of Medicine, Palo Alto, California, United States
| | - Angela Huang
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States
| | - Balaji Govindaswami
- Pediatrics / Newborn Medicine, Santa Clara Valley Medical Center: Hospital and Clinics, San Jose, California, United States.,Stanford, School of Medicine, Palo Alto, California, United States
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23
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Abstract
Preterm birth (PTB) rate varies widely and has significant racial and ethnic disparities. Although causal mechanisms are ill understood, socioenvironment, phenotype, and genotype provide insight into pathways for preventing PTB. Data suggest varied response to current medical interventions is explicable Approved by underlying pharmacogenomics. Currently, prevention focuses on minimizing iatrogenic PTB and risk reduction especially in those with prior PTB using proven medical and public health strategies. In the future, preventive approaches will be based on better understanding of sociodemography, nutrition, lifestyles, and underlying individual genetic and epigenetic variation. Statistical approaches and "big-data" models are critical in future study.
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Affiliation(s)
- Balaji Govindaswami
- Division of Neonatology, Pediatrics, Santa Clara Valley Medical Center: Hospital and Clinics, 751 South Bascom Avenue, San Jose, CA 95128, USA.
| | - Priya Jegatheesan
- Division of Neonatology, Pediatrics, Santa Clara Valley Medical Center: Hospital and Clinics, 751 South Bascom Avenue, San Jose, CA 95128, USA
| | - Matthew Nudelman
- Division of Neonatology, Pediatrics, Santa Clara Valley Medical Center: Hospital and Clinics, 751 South Bascom Avenue, San Jose, CA 95128, USA
| | - Sudha Rani Narasimhan
- Division of Neonatology, Pediatrics, Santa Clara Valley Medical Center: Hospital and Clinics, 751 South Bascom Avenue, San Jose, CA 95128, USA
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24
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Jegatheesan P, Nudelman M, Goel K, Song D, Govindaswami B. Perfusion index in healthy newborns during critical congenital heart disease screening at 24 hours: retrospective observational study from the USA. BMJ Open 2017; 7:e017580. [PMID: 29273653 PMCID: PMC5778276 DOI: 10.1136/bmjopen-2017-017580] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To describe the distribution of perfusion index (PI) in asymptomatic newborns at 24 hours of life when screening for critical congenital heart disease (CCHD) using an automated data selection method. DESIGN This is a retrospective observational study. SETTING Newborn nursery in a California public hospital with ~3500 deliveries annually. METHODS We developed an automated programme to select the PI values from CCHD screens. Included were term and late preterm infants who were screened for CCHD from November 2013 to January 2014 and from May 2015 to July 2015. PI measurements were downloaded every 2 s from the pulse oximeter and median PI were calculated for each oxygen saturation screen in our cohort. RESULTS We included data from 2768 oxygen saturation screens. Each screen had a median of 29 data points (IQR 17 to 49). The median PI in our study cohort was 1.8 (95% CI 1.8 to 1.9) with IQR 1.2 to 2.7. The median preductal PI was significantly higher than the median postductal (1.9 vs 1.8, p=0.03) although this difference may not be clinically significant. CONCLUSION Using an automated data selection method, the median PI in asymptomatic newborns at 24 hours of life is 1.8 with a narrow IQR of 1.2 to 2.7. This automated data selection method may improve accuracy and precision compared with manual data collection method. Further studies are needed to establish external validity of this automated data selection method and its clinical application for CCHD screening.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Matthew Nudelman
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Keshav Goel
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Dongli Song
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Balaji Govindaswami
- Department of Pediatrics, Newborn Medicine, Santa Clara Valley Health and Hospital System, San Jose, California, USA
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25
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Van Naarden Braun K, Grazel R, Koppel R, Lakshminrusimha S, Lohr J, Kumar P, Govindaswami B, Giuliano M, Cohen M, Spillane N, Jegatheesan P, McClure D, Hassinger D, Fofah O, Chandra S, Allen D, Axelrod R, Blau J, Hudome S, Assing E, Garg LF. Evaluation of critical congenital heart defects screening using pulse oximetry in the neonatal intensive care unit. J Perinatol 2017; 37:1117-1123. [PMID: 28749481 PMCID: PMC5633653 DOI: 10.1038/jp.2017.105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/24/2017] [Accepted: 05/22/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the implementation of early screening for critical congenital heart defects (CCHDs) in the neonatal intensive care unit (NICU) and potential exclusion of sub-populations from universal screening. STUDY DESIGN Prospective evaluation of CCHD screening at multiple time intervals was conducted in 21 NICUs across five states (n=4556 infants). RESULTS Of the 4120 infants with complete screens, 92% did not have prenatal CHD diagnosis or echocardiography before screening, 72% were not receiving oxygen at 24 to 48 h and 56% were born ⩾2500 g. Thirty-seven infants failed screening (0.9%); none with an unsuspected CCHD. False positive rates were low for infants not receiving oxygen (0.5%) and those screened after weaning (0.6%), yet higher among infants born at <28 weeks (3.8%). Unnecessary echocardiograms were minimal (0.2%). CONCLUSION Given the majority of NICU infants were ⩾2500 g, not on oxygen and not preidentified for CCHD, systematic screening at 24 to 48 h may be of benefit for early detection of CCHD with minimal burden.
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Affiliation(s)
- K Van Naarden Braun
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA,New Jersey Department of Health, Trenton, NJ, USA,National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE MS E-86, Atlanta, GA 30341-3717, USA. E-mail:
| | - R Grazel
- New Jersey Department of Health, Trenton, NJ, USA,New Jersey Chapter, American Academy of Pediatrics, East Windsor, NJ, USA
| | - R Koppel
- Long Island Jewish Cohen Children’s Medical Center, New Hyde Park, NY, USA
| | | | - J Lohr
- University of Minnesota Medical System, Minneapolis, MN, USA
| | - P Kumar
- University of Illinois Medical Center, Peoria, IL, USA
| | | | - M Giuliano
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - M Cohen
- Children’s Hospital of New Jersey at Newark Beth Israel Medical Center, Newark, NJ, USA
| | - N Spillane
- Hackensack University Medical Center, Hackensack, NJ, USA
| | - P Jegatheesan
- Santa Clara Valley Medical Center, San Jose, CA, USA
| | - D McClure
- Saint Joseph’s Regional Medical Center, Paterson, NJ, USA
| | - D Hassinger
- Morristown Medical Center, Morristown, NJ, USA
| | - O Fofah
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - S Chandra
- Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - D Allen
- Saint Peter’s University Hospital, New Brunswick, NJ, USA
| | - R Axelrod
- Capital Health Medical Center Hopewell, Pennington, NJ, USA
| | - J Blau
- Northwell Staten Island University Hospital, Staten Island, NY, USA
| | - S Hudome
- Monmouth Medical Center, Long Branch, NJ, USA
| | - E Assing
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | - L F Garg
- New Jersey Department of Health, Trenton, NJ, USA
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26
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Ouelaa W, Jegatheesan P, M’bouyou-Boungou J, Vicente C, Nakib S, Nubret E, De Bandt JP. OR17: Citrulline and LPS-Induced Oxidative Stress During Nonalcoholic Fatty Liver Disease. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30770-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Jegatheesan P, Surowska A, Campos V, Cros J, Stefanoni N, Rey V, Schneiter P, De Bandt JP, Tappy L. MON-P291: Dietary Protein Content Modulates the Amino-Acid and IGF1 Responses to Sucrose Overfeeding in Humans. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30798-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Barlow SM, Maron JL, Alterovitz G, Song D, Wilson BJ, Jegatheesan P, Govindaswami B, Lee J, Rosner AO. Somatosensory Modulation of Salivary Gene Expression and Oral Feeding in Preterm Infants: Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e113. [PMID: 28615158 PMCID: PMC5489710 DOI: 10.2196/resprot.7712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background Despite numerous medical advances in the care of at-risk preterm neonates, oral feeding still represents one of the first and most advanced neurological challenges facing this delicate population. Objective, quantitative, and noninvasive assessment tools, as well as neurotherapeutic strategies, are greatly needed in order to improve feeding and developmental outcomes. Pulsed pneumatic orocutaneous stimulation has been shown to improve nonnutritive sucking (NNS) skills in preterm infants who exhibit delayed or disordered nipple feeding behaviors. Separately, the study of the salivary transcriptome in neonates has helped identify biomarkers directly linked to successful neonatal oral feeding behavior. The combination of noninvasive treatment strategies and transcriptomic analysis represents an integrative approach to oral feeding in which rapid technological advances and personalized transcriptomics can safely and noninvasively be brought to the bedside to inform medical care decisions and improve care and outcomes. Objective The study aimed to conduct a multicenter randomized control trial (RCT) to combine molecular and behavioral methods in an experimental conceptualization approach to map the effects of PULSED somatosensory stimulation on salivary gene expression in the context of the acquisition of oral feeding habits in high-risk human neonates. The aims of this study represent the first attempt to combine noninvasive treatment strategies and transcriptomic assessments of high-risk extremely preterm infants (EPI) to (1) improve oral feeding behavior and skills, (2) further our understanding of the gene ontology of biologically diverse pathways related to oral feeding, (3) use gene expression data to personalize neonatal care and individualize treatment strategies and timing interventions, and (4) improve long-term developmental outcomes. Methods A total of 180 extremely preterm infants from three neonatal intensive care units (NICUs) will be randomized to receive either PULSED or SHAM (non-pulsing) orocutaneous intervention simultaneous with tube feedings 3 times per day for 4 weeks, beginning at 30 weeks postconceptional age. Infants will also be assessed 3 times per week for NNS performance, and multiple saliva samples will be obtained each week for transcriptomic analysis, until infants have achieved full oral feeding status. At 18 months corrected age (CA), infants will undergo neurodevelopmental follow-up testing, the results of which will be correlated with feeding outcomes in the neo-and post-natal period and with gene expression data and intervention status. Results The ongoing National Institutes of Health funded randomized controlled trial R01HD086088 is actively recruiting participants. The expected completion date of the study is 2021. Conclusions Differential salivary gene expression profiles in response to orosensory entrainment intervention are expected to lead to the development of individualized interventions for the diagnosis and management of oral feeding in preterm infants. Trial Registration ClinicalTrials.gov NCT02696343; https://clinicaltrials.gov/ct2/show/NCT02696343 (Archived by WebCite at http://www.webcitation.org/6r5NbJ9Ym)
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Affiliation(s)
- Steven Michael Barlow
- Center for Brain, Biology, and Behavior, Department of Special Education and Communication Disorders, Biological Systems Engineering, University of Nebraska, Lincoln, NE, United States
| | - Jill Lamanna Maron
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
| | - Gil Alterovitz
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA, United States
| | - Dongli Song
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Bernard Joseph Wilson
- CHI Health St. Elizabeth, Division of Neonatal-Perinatal Medicine, Lincoln, NE, United States
| | - Priya Jegatheesan
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Balaji Govindaswami
- Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Jaehoon Lee
- IMMAP, Department of Educational Psychology and Leadership, Texas Tech University, Lubbock, TX, United States
| | - Austin Oder Rosner
- Tufts Medical Center, Division of Neonatology, Department of Pediatrics, Boston, MA, United States
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29
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Bortolotti M, Ventura G, Jegatheesan P, Choisy C, Cynober L, De-Bandt JP. Intérêt des protéines partiellement hydrolysées pour la croissance de rattrapage dans un modèle de privation de nourriture/renutrition chez le jeune rat. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2016.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Tennoune N, Bouslah S, Le Plénier S, Archambault E, Ramassamy R, De Bandt J, Jegatheesan P. PT06.2: Mechanistic Study of the Effects of Citrulline in an In Vitro Model of Nonalcoholic Liver Disease. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30315-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Song D, Jegatheesan P, DeSandre G, Govindaswami B. Duration of Cord Clamping and Neonatal Outcomes in Very Preterm Infants. PLoS One 2015; 10:e0138829. [PMID: 26390401 PMCID: PMC4577121 DOI: 10.1371/journal.pone.0138829] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Delayed cord clamping (DCC, ≥30 s) increases blood volume in newborns and is associated with fewer blood transfusions and short-term neonatal complications. The optimal timing of cord clamping for very preterm infants should maximize placental transfusion without interfering with stabilization and resuscitation. AIM We compared the effect of different durations of DCC, 30-45 s vs. 60-75 s, on delivery room (DR) and neonatal outcomes in preterm infants <32 weeks gestational age (GA). METHODS This is a single-center prospective observational study. Data were collected prospectively from eligible infants from two groups: 30-45 s DCC group (January 2008 to February 2011, n = 187) and 60-75 s DCC group (March 2011 to April 2014, n = 166). RESULTS The 60-75 s DCC group compared to the 30-45 s DCC group had higher hematocrits at <2 hours (49.2% vs. 47.4%, p = 0.02). In infants <28 weeks GA, the 12-36 hours hematocrit was higher in the 60-75 s DCC group compared to the 30-45 s DCC group (47.9% vs. 42.1%, p = 0.002). The 60-75 s DCC group had reductions in DR intubation (11% vs. 22%, p = 0.004), hypothermia on admission (1% vs. 5%, p = 0.01), surfactant therapy (13% vs. 28%, p = 0.001), intubation in the first 24 hours (20% vs. 34%, p = 0.004), any intubation (27% vs. 40%, p = 0.007), and any red blood cell transfusion (20% vs. 33%, p = 0.008) during the hospitalization compared to the 30-45 s DCC group. These reductions remained significant after adjusting for GA, gender and >48 hours of antenatal steroid exposure. There was no difference between the two groups in neonatal death, intraventricular hemorrhage, chronic lung disease, late onset sepsis, necrotizing enterocolitis and severe retinopathy of prematurity. CONCLUSION In this study cohort increasing DCC duration from 30-45 s to 60-75 s is associated with decreased hypothermia on admission, neonatal respiratory interventions and red blood cell transfusions without increase in neonatal mortality and morbidities.
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Affiliation(s)
- Dongli Song
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, United States of America
- * E-mail:
| | - Priya Jegatheesan
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, United States of America
| | - Glenn DeSandre
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, United States of America
| | - Balaji Govindaswami
- Department of Pediatrics, Division of Neonatology, Santa Clara Valley Medical Center, San Jose, California, United States of America
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Bortolotti M, Ventura G, Jegatheesan P, Choisy C, Cynober L, De Bandt JP. SUN-PP021: Partially Hydrolyzed Proteins for Catch-Up Growth in Food-Deprived-Refed Young Rats. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jegatheesan P, Beutheu S, Freese K, Waligora-Dupriet AJ, Nubret E, Butel MJ, Bergheim I, De Bandt JP. OR027: Citrulline as a Therapeutic Strategy to Prevent the Western Diet-Induced Progression of Hepatic Steatosis to Steatohepatitis. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jegatheesan P, Beutheu S, Freese K, Waligora-Dupriet AJ, Ouelaa W, Ventura G, De Bandt JP. P173: La Citrulline en prévention de la stéatose hépatique non-alcoolique associée à l’obésité ? NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yanowitz TD, Reese J, Gillam-Krakauer M, Cochran CM, Jegatheesan P, Lau J, Tran VT, Walsh M, Carey WA, Fuji A, Fabio A, Clyman R. Superior mesenteric artery blood flow velocities following medical treatment of a patent ductus arteriosus. J Pediatr 2014; 164:661-3. [PMID: 24321538 PMCID: PMC4077598 DOI: 10.1016/j.jpeds.2013.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 06/11/2013] [Revised: 09/24/2013] [Accepted: 11/04/2013] [Indexed: 12/01/2022]
Abstract
We examined superior mesenteric artery blood flow velocity in response to feeding in infants randomized to trophic feeds (n = 16) or nil per os (n = 18) during previous treatment for patent ductus arteriosus. Blood flow velocity increased earlier in the fed infants, but was similar in the 2 groups at 30 minutes after feeding.
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Affiliation(s)
| | - Jeff Reese
- Department of Pediatrics, Vanderbilt University, Nashville, TN
| | | | | | - Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA
| | - John Lau
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA
| | - Vy Thao Tran
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA
| | - Michele Walsh
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH
| | | | - Alan Fuji
- Department of Pediatrics, Boston University Medical Center, Boston, MA
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Pittsburgh PA
| | - Ronald Clyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA,Cardiovascular Research Institute, University of California San Francisco, San Francisco, CA
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Clyman R, Wickremasinghe A, Jhaveri N, Hassinger DC, Attridge JT, Sanocka U, Polin R, Gillam-Krakauer M, Reese J, Mammel M, Couser R, Mulrooney N, Yanowitz TD, Derrick M, Jegatheesan P, Walsh M, Fujii A, Porta N, Carey WA, Swanson JR. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr 2013; 163:406-11. [PMID: 23472765 PMCID: PMC3683087 DOI: 10.1016/j.jpeds.2013.01.057] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/10/2013] [Accepted: 01/25/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that infants who are just being introduced to enteral feedings will advance to full enteral nutrition at a faster rate if they receive "trophic" (15 mL/kg/d) enteral feedings while receiving indomethacin or ibuprofen treatment for patent ductus arteriosus. STUDY DESIGN Infants were eligible for the study if they were 23(1/7)-30(6/7) weeks' gestation, weighed 401-1250 g at birth, received maximum enteral volumes ≤60 mL/kg/d, and were about to be treated with indomethacin or ibuprofen. A standardized "feeding advance regimen" and guidelines for managing feeding intolerance were followed at each site (N = 13). RESULTS Infants (N = 177, 26.3 ± 1.9 weeks' mean ± SD gestation) were randomized at 6.5 ± 3.9 days to receive "trophic" feeds ("feeding" group, n = 81: indomethacin 80%, ibuprofen 20%) or no feeds ("fasting [nil per os]" group, n = 96: indomethacin 75%, ibuprofen 25%) during the drug administration period. Maximum daily enteral volumes before study entry were 14 ± 15 mL/kg/d. After drug treatment, infants randomized to the "feeding" arm required fewer days to reach the study's feeding volume end point (120 mL/kg/d). Although the enteral feeding end point was reached at an earlier postnatal age, the age at which central venous lines were removed did not differ between the 2 groups. There were no differences between the 2 groups in the incidence of infection, necrotizing enterocolitis, spontaneous intestinal perforation, or other neonatal morbidities. CONCLUSION Infants required less time to reach the feeding volume end point if they were given "trophic" enteral feedings when they received indomethacin or ibuprofen treatments.
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Affiliation(s)
- Ronald Clyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA 94143-0544, USA.
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Abstract
OBJECTIVE To establish simultaneous pre- and postductal oxygen saturation nomograms in asymptomatic newborns when screening for critical congenital heart disease (CCHD) at ∼24 hours after birth. METHODS Asymptomatic term and late preterm newborns admitted to the newborn nursery were screened with simultaneous pre- and postductal oxygen saturation measurements at ∼24 hours after birth. The screening program was implemented in a stepwise fashion in 3 different affiliated institutions. Data were collected prospectively from July 2009 to March 2012 in all 3 centers. RESULTS We screened 13 714 healthy newborns at a median age of 25 hours. The mean preductal saturation was 98.29% (95% confidence interval [CI]: 98.27-98.31), median 98%, and mean postductal saturation was 98.57% (95% CI: 98.55-98.60), median 99%. The mean difference between the pre- and postductal saturation was -0.29% (95% CI: -0.31 to -0.27) with P < .00005. Its clinical relevance to CCHD screening remains to be determined. The postductal saturation was equal to preductal saturation in 38% and greater than preductal saturation in 40% of the screens. CONCLUSIONS We have established simultaneous pre- and postductal oxygen saturation nomograms at ∼24 hours after birth based on >13 000 asymptomatic newborns. Such nomograms are important to optimize screening thresholds and methodology for detecting CCHD.
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Affiliation(s)
- Priya Jegatheesan
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
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Lee HC, Jegatheesan P, Gould JB, A Dudley R. Hospital-wide breastfeeding rates vs. breastmilk provision for very-low-birth-weight infants. Acta Paediatr 2013; 102:268-72. [PMID: 23174012 DOI: 10.1111/apa.12096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Received: 07/30/2012] [Revised: 10/30/2012] [Accepted: 11/19/2012] [Indexed: 11/28/2022]
Abstract
AIM To investigate the relationship between breastmilk feeding in very-low-birth-weight infants in the neonatal intensive care unit and breastmilk feeding rates for all newborns by hospital. METHODS This was a cross-sectional study of 111 California hospitals in 2007 and 2008. Correlation coefficients were calculated between overall hospital breastfeeding rates and breastmilk feeding rates of very-low-birth-weight infants. Hospitals were categorized in quartiles by crude and adjusted very-low-birth-weight infant rates to compare rankings between measures. RESULTS Correlation between breastmilk feeding rates of very-low-birth-weight infants and overall breastfeeding rates varied by neonatal intensive care unit level of care from 0.13 for intermediate hospitals to 0.48 for regional hospitals. For hospitals categorized in the top quartile according to overall breastfeeding rate, only 46% were in the top quartile for both crude and adjusted very-low-birth-weight infant rates. On the other hand, when considering the lowest quartile for overall breastfeeding hospitals, three of 27 (11%) actually were performing in the top quartile of performance for very-low-birth-weight infant rates. CONCLUSIONS Reporting hospital overall breastfeeding rates and neonatal intensive care unit breastmilk provision rates separately may give an incomplete picture of quality of care.
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Affiliation(s)
| | - Priya Jegatheesan
- Department of Pediatrics; Santa Clara Valley Medical Center; San Jose; CA; USA
| | | | - Raymond A Dudley
- Departments of Medicine and Health Policy; University of California; San Francisco; CA; USA
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Manani M, Jegatheesan P, DeSandre G, Song D, Showalter L, Govindaswami B. Elimination of admission hypothermia in preterm very low-birth-weight infants by standardization of delivery room management. Perm J 2013; 17:8-13. [PMID: 24355884 PMCID: PMC3783084 DOI: 10.7812/tpp/12-130] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Temperature instability is a serious but potentially preventable morbidity in preterm infants. Admission temperatures below 36°C are associated with increased mortality and late onset sepsis. OBJECTIVE The goal of our quality-improvement effort was to increase preterm infants' admission temperatures to above 36°C by preventing heat loss in the immediate postnatal period. DESIGN This quality-improvement initiative used the rapid-cycle Plan-Do-Study-Act approach. Preterm infants born at less than 33 weeks' gestation with very low birth weight less than 1500 g who were born at a Regional Level III Neonatal Intensive Care Unit (NICU) in San Jose, CA, were enrolled. Our intervention involved standardizing the management of thermoregulation from predelivery through admission to the NICU. Data on admission temperature were collected prospectively. MAIN OUTCOME MEASURES The primary outcome measure was hypothermia, defined as temperature below 36°C on admission to the NICU. RESULTS The hypothermia rate was reduced from 44% in early 2006 to 0% by 2009. There was a slight increase to 6% in 2010. Subsequently, with further real-time feedback, we were able to sustain 0% hypothermia through 2011. Our hypothermia rate remained substantially lower than state and national hypothermia benchmarks that have shown moderate improvement over the same period. CONCLUSION We reduced hypothermia in very low-birth-weight infants using a standardized protocol, multidisciplinary team approach, and continuous feedback. Sustaining improvement is a challenge that requires real-time progress evaluation of outcomes and ongoing staff education.
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Affiliation(s)
- Madhu Manani
- Nurse Data Coordinator of the Neonatal Intensive Care Unit of the Santa Clara Valley Medical Center in San Jose, CA. E-mail:
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Byrne J, Govindaswami B, Jegatheesan P, Jelks A, Kunz L, Colon I. 480: Perinatal core measure: antenatal steroid performance improvement following a preterm birth risk assessment decision model and perinatal QI toolkit. Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jegatheesan P, Ianus V, Buchh B, Yoon G, Chorne N, Ewig A, Lin E, Fields S, Moon-Grady A, Tacy T, Milstein J, Schreiber M, Padbury J, Clyman R. Increased indomethacin dosing for persistent patent ductus arteriosus in preterm infants: a multicenter, randomized, controlled trial. J Pediatr 2008; 153:183-9. [PMID: 18534218 DOI: 10.1016/j.jpeds.2008.01.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 12/19/2007] [Accepted: 01/24/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We conducted a multicenter, randomized, controlled trial to determine whether higher doses of indomethacin would improve the rate of patent ductus arteriosus (PDA) closure. STUDY DESIGN Infants (<28 weeks gestation) who received a conventional, prophylactic 3-dose course of indomethacin were eligible if they had continued evidence of persistent ductus patency on an echocardiogram obtained before the third prophylactic indomethacin dose. Infants (n = 105) were randomized to receive an extended 3-day course of either low-dose (0.1 mg/kg/d) or higher-dose (0.2 or 0.5 mg/kg/d) indomethacin. An echocardiogram was obtained 24 hours after the last dose of study drug. RESULTS Despite increasing serum indomethacin concentrations by 2.9-fold in the higher-dose group, we failed to detect a significant decrease in the rate of persistent PDA (low = 52%; higher = 45%, P = .50). The higher-dose group had a significantly higher occurrence of serum creatinine >2 mg/100 mL (low = 6%, higher = 19%, P < .05) and moderate/severe retinopathy of prematurity (ROP) (low = 15%, higher = 36%, P < .025). The incidence of moderate/severe ROP was directly related to the poststudy indomethacin concentrations (odds ratio = 1.75, confidence interval: 1.15-2.68, P < .01). CONCLUSION Increasing indomethacin concentrations above the levels achieved with a conventional dosing regimen had little effect on the rate of PDA closure but was associated with higher rates of moderate/severe ROP and renal compromise.
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Affiliation(s)
- Priya Jegatheesan
- Cardiovascular Research Institute and Department of Pediatrics, University of California, San Francisco, California 94143-0544, USA
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Chorne N, Jegatheesan P, Lin E, Shi R, Clyman RI. Risk factors for persistent ductus arteriosus patency during indomethacin treatment. J Pediatr 2007; 151:629-34. [PMID: 18035143 DOI: 10.1016/j.jpeds.2007.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [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] [Received: 02/06/2007] [Revised: 03/23/2007] [Accepted: 05/01/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test the hypothesis that patent ductus arteriosus that fail to close with prostaglandin inhibition may be regulated by mechanisms that act independently of prostaglandin production. STUDY DESIGN We examined a cohort of 446 infants who were treated with indomethacin (within 15 hours of birth) to inhibit prostaglandin production. We used multiple logistic regression modeling to determine which perinatal/neonatal variables were most closely associated with the persistence of ductus patency in the presence of diminished prostaglandin production. RESULTS We identified 4 variables (immature gestational age, lack of exposure to antenatal betamethasone, severity of respiratory distress, and Caucasian race) that were significantly and independently associated with the degree of ductus patency. CONCLUSION Gestational age, antenatal glucocorticoid exposure, respiratory distress, and race are independent risk factors that appear to affect ductus closure even when indomethacin has been used to inhibit prostaglandin production. Future studies of these risk factors may identify new potential targets for patent ductus arteriosus treatment.
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Affiliation(s)
- Nancy Chorne
- Cardiovascular Research Institute and Department of Pediatrics, University of California, San Francisco, California, USA
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Abstract
OBJECTIVE To compare the incidence of chronic lung disease (CLD) in extremely low birth weight (ELBW, < or =1000 g) infants before and after the introduction of early, preferential application of nasal continuous airway pressure (NCPAP) utilizing a variable flow delivery system. STUDY DESIGN A retrospective cohort study of ELBW infants 2 years prior to (Pre-early NCPAP, n=96) and 2 years following (Early NCPAP, n=75) the initiation of an early NCPAP policy. RESULTS There were no significant changes (Pre-early NCPAP vs Early NCPAP) in the incidences of CLD (35 vs 33%, P=0.81) or CLD or death (50 vs 43%, P=0.34). Infants in the Early NCPAP group weaned off mechanical ventilation and supplemental oxygen more rapidly than infants in the Pre-early NCPAP group (hazard ratio (HR) 1.80, P=0.002 and HR 1.69, P=0.01). CONCLUSION A policy of early NCPAP has not decreased the incidence of CLD despite a decrease in time to successful tracheal extubation.
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Affiliation(s)
- P Jegatheesan
- Department of Pediatrics, University of California San Francisco, CA 94143-0748, USA
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Abstract
Knowledge of the formation of the normal male urethra may elucidate the etiology of hypospadias. We describe urethral formation in the mouse, show the similarities and relevance to human urethral development, and introduce the concept of the epithelial seam formation and remodeling during urethral formation. Three mechanisms may account for epithelial seam formation: (1) epithelial-mesenchymal transformation similar to that described in the fusion of the palatal shelves, (2) apoptosis, and/or (3) tissue remodeling via cellular migration. Urethral development in the embryonic mouse (14-21 days of gestation) was compared with urethral formation in embryonic human specimens (8-16 weeks of gestation) by using histology, immunohistochemistry, and three-dimensional reconstruction. The urethra forms by fusion of the epithelial edges of the urethral folds, giving a midline epithelial seam. The epithelial seam is remodeled via cellular migration into a centrally located urethra and ventrally displaced remnant of epithelial cells. The epithelial seam is remodeled by narrowing approximately at its midpoint, with subsequent epithelial migration into the urethra or penile skin. The epithelial cells are replaced by mesenchymal cells. This remodeling seam displays a narrow band (approximately 30 microns wide) of apoptotic activity corresponding to the mesenchymal cells and not to epithelial cells. No evidence was seen of the co-expression of cytokeratin and mesenchymal markers (actin or vimentin). Urethral seam formation occurs in both the mouse and the human. Our data in the mouse support the hypothesis that seam transformation occurs via cellular migration and not by epithelial mesenchymal transformation or epithelial apoptosis. We postulate that disruption of epithelial fusion remodeling, and cellular migration leads to hypospadias.
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Affiliation(s)
- L S Baskin
- Department of Urology, University of California School of Medicine, San Francisco, CA 94143-0738, USA.
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Kurzrock EA, Jegatheesan P, Cunha GR, Baskin LS. Urethral development in the fetal rabbit and induction of hypospadias: a model for human development. J Urol 2000; 164:1786-92. [PMID: 11025770] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
PURPOSE To determine whether the development of the rabbit phallus would be an appropriate model of human phallic development, we evaluated the formation of the fetal rabbit phallus and attempted to induce hypospadias pharmacologically. MATERIALS AND METHODS New Zealand rabbit fetuses were obtained on gestational days 20 to 24, 26, 28 and 31. Sex was determined by gonadal morphology, and 6 fetuses were obtained at each age. The perineum was dissected, fixed, sectioned and stained with hematoxylin and eosin, and monoclonal antibodies against neuronal specific enolase. Two pregnant rabbits were treated with 10 mg./kg. finasteride orally daily between gestational days 19 and 28. The development of the external genitalia was compared in treated and untreated control rabbits. RESULTS The rabbit phallus contains 2 corpora cavernosa and dorsolateral nerves similar to the human. In male and female fetuses fusion of the urethral folds progressed in a proximal to distal sequence forming a seam at the point of ventromedial fusion. In male fetuses urethral fold and ventral preputial fusion continued more distally toward the glans compared to females. Thus, in mature males the urethral meatus and ventral prepuce extended to the tip of the phallus, whereas in females the urethral meatus opened on the proximal phallus and the prepuce was deficient ventrally forming a dorsal hood. Male offspring had a significantly larger anogenital distance postnatally than female offspring. In male fetuses exposed to finasteride urethral fusion did not extend distally and the prepuce was deficient ventrally. Also, male offspring exposed to finasteride in utero had a significantly shorter anogenital distance than females and untreated control males at all ages (p <0.05). CONCLUSIONS Fetal development of the rabbit phallus and urethra is homologous to the human. Although the gestational period is significantly shorter, the temporospatial pattern of external genitalia development is analogous in these species. Feminization of the rabbit urethra, hypospadias, can be induced by inhibiting 5alpha-reductase. Use of this animal model will allow further study of molecular mechanisms involved in urethral fusion and the evaluation of the pathophysiological processes of hypospadias.
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Affiliation(s)
- E A Kurzrock
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, California, USA
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