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Ball MK, Seabrook RB, Bonachea EM, Chen B, Fathi O, Nankervis CA, Osman A, Schlegel AB, Magers J, Kulpa T, Sharpin P, Snyder ML, Gajarski RJ, Nandi D, Backes CH. Evidence-Based Guidelines for Acute Stabilization and Management of Neonates with Persistent Pulmonary Hypertension of the Newborn. Am J Perinatol 2023; 40:1495-1508. [PMID: 34852367 DOI: 10.1055/a-1711-0778] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Persistent pulmonary hypertension of the newborn, or PPHN, represents a challenging condition associated with high morbidity and mortality. Management is complicated by complex pathophysiology and limited neonatal specific evidence-based literature, leading to a lack of universal contemporary clinical guidelines for the care of these patients. To address this need and to provide consistent high-quality clinical care for this challenging population in our neonatal intensive care unit, we sought to develop a comprehensive clinical guideline for the acute stabilization and management of neonates with PPHN. Utilizing cross-disciplinary expertise and incorporating an extensive literature search to guide best practice, we present an approachable, pragmatic, and clinically relevant guide for the bedside management of acute PPHN. KEY POINTS: · PPHN is associated with several unique diagnoses; the associated pathophysiology is different for each unique diagnosis.. · PPHN is a challenging, dynamic, and labile process for which optimal care requires frequent reassessment.. · Key management goals are adequate tissue oxygen delivery, avoiding harm..
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Affiliation(s)
- Molly K Ball
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Ruth B Seabrook
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Elizabeth M Bonachea
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Bernadette Chen
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics Pulmonary Hypertension Group, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Omid Fathi
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Craig A Nankervis
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Ahmed Osman
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy B Schlegel
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jacqueline Magers
- Department of Pharmacy, Nationwide Children's Hospital, Columbus, Ohio
| | - Taylor Kulpa
- Division of Neonatology Nationwide Children's Hospital Neonatal Intensive Care Unit, Neonatal Service Line, Columbus, Ohio
| | - Paula Sharpin
- Division of Neonatology Nationwide Children's Hospital Neonatal Intensive Care Unit, Neonatal Service Line, Columbus, Ohio
| | - Mary Lindsay Snyder
- Division of Neonatology Nationwide Children's Hospital Neonatal Intensive Care Unit, Neonatal Service Line, Columbus, Ohio
| | - Robert J Gajarski
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Deipanjan Nandi
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Carl H Backes
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Neonatology, Nationwide Children's Hospital, Columbus, Ohio
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Department of Pediatrics, Columbus, Ohio
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Rogers TP, Fathi O, Sánchez PJ. Neonatologists and vitamin K hesitancy. J Perinatol 2023; 43:1067-1071. [PMID: 36707666 DOI: 10.1038/s41372-023-01611-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 11/03/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
Hemorrhagic disease of the newborn, more aptly termed "Vitamin K Deficiency Bleeding (VKDB)," has long been recognized as a cause of significant morbidity and mortality in early infancy. A single intramuscular dose of vitamin K administered at birth has virtually eliminated VKDB, and this prophylactic regimen has been recommended by the American Academy of Pediatrics since 1961. Although most newborns in the United States receive vitamin K at birth, a growing number of parents are hesitant about this intervention, citing concerns about harm from the injection, preservatives contained in the medication, and clashes with personal belief systems. Ultimately, there is distrust in the medical establishment as many of these parents also opt out of newborn ophthalmic prophylaxis and importantly, childhood vaccinations, establishing a dangerous public health precedent that will lead to resurgence of vaccine-preventable diseases. Various shared decision making models and educational efforts can assist newborn health care professionals in addressing these parental concerns so that VKDB can be effectively prevented in all newborns.
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Affiliation(s)
- Timothy P Rogers
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA
| | - Omid Fathi
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA
| | - Pablo J Sánchez
- Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA.
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43205, USA.
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Cistone N, Erlenwein D, Bapat R, Ryshen G, Thomas L, Haghnazari MS, Thomas R, Foor N, Fathi O. Quality Improvement Initiative in the NICU for Improved Practice of Cuff Blood Pressure Measurements. Adv Neonatal Care 2022; 22:291-299. [PMID: 34966056 DOI: 10.1097/anc.0000000000000947] [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: 11/26/2022]
Abstract
BACKGROUND Extreme preterm infants face lengthy hospitalizations and are often subjected to painful stimuli. These stimuli may be related to routine caregiving that may negatively impact long-term developmental outcomes. Frequently obtained cuff blood pressure (BP) measurements are an example of a potentially noxious stimulus to preterm infants that may have a cumulating impact on development. PURPOSE The primary aim was to explore the frequency of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the neonatal intensive care unit (NICU). Our secondary aim was to reduce the number of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the NICU. METHODS Quality improvement methodologies per the Institute for Healthcare Improvement were used combined with a multidisciplinary approach. Participants were infants born less than 27 weeks of gestation and discharged home. The baseline period was 2015 through Q2-2018 and the intervention period was Q3-2018 through Q1-2020. The electronic medical record was used to collect data and Minitab Statistical Software was used for data analysis. FINDINGS/RESULTS A baseline of 5.0% of eligible patients received the desired number of cuff BP measurements and increased to 63.2% after the intervention period. IMPLICATIONS FOR PRACTICE Findings demonstrate that using quality improvement methodology can improve clinical care. Findings suggest the feasibility and safety of reducing the number of cuff BP measurements obtained on hemodynamically stable infants in the NICU. IMPLICATIONS FOR RESEARCH Future endeavors should aim to reduce the quantity of painful stimuli in the NICU. Long-term developmental outcomes should be correlated in these patients.
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Affiliation(s)
- Nicole Cistone
- The Ohio State University College of Nursing, Columbus (Ms Cistone); Nationwide Children's Hospital, Neonatal Network Columbus, Ohio (Messrs D Erlenwein, G. Ryshen, L. Thomas, R. Thomas, and N. Foor); and Department of Neonatology (Drs Bapat and Fathi), Nationwide Children's Hospital/The Ohio State University Wexner Medical Center, Columbus, OSU NICU Parent Advisor Nationwide Children's Hospital/The Ohio State University Wexner Medical Center, Columbus, Ohio. (Ms Haghnazari)
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Logan JW, Bapat R, Ryshen G, Bagwell G, Eisner M, Kielt M, Hanawalt M, Payne K, Alt-Coan A, Tatad M, Krendl D, Jebbia M, Reber KM, Halling C, Osman AAF, Bonachea EM, Nelin LD, Fathi O. Use of a Quality Scorecard to Enhance Quality and Safety in Community Hospital Newborn Nurseries. J Pediatr 2022; 247:67-73.e2. [PMID: 35358590 DOI: 10.1016/j.jpeds.2022.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/16/2021] [Revised: 02/22/2022] [Accepted: 03/10/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To implement a quality improvement (QI) scorecard as a tool for enhancing quality and safety efforts in level 1 and 2 community hospital nurseries affiliated with Nationwide Children's Hospital. STUDY DESIGN A QI scorecard was developed for data collection, analytics, and reporting of neonatal quality metrics and cross-sector collaboration. Newborn characteristics were included for risk stratification, as were clinical and process measures associated with neonatal morbidity and mortality. Quality and safety activities took place in community hospital newborn nurseries in Ohio, and education was provided in both online and in-person collaborations, followed by local team sessions at partner institutions. Baseline (first 12 months) and postbaseline comparisons of clinical and process measures were analyzed by logistic regression, adjusting for potential confounders. RESULTS In logistic regression models, at least 1 center documented improvements in each of the 4 process measures, and 3 of the 4 centers documented improvements in compliance with glucose checks obtained within 90 minutes of birth among at-risk infants. CONCLUSION Collaborative QI projects led to improvements in perinatal metrics associated with important outcomes. Formation of a center-driven QI scorecard is feasible and provides community hospitals with a framework for collecting, analyzing, and reporting neonatal QI metrics.
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Affiliation(s)
- J Wells Logan
- Department of Pediatrics, University of Florida College of Medicine and Wolfson Children's Hospital, Jacksonville, FL
| | - Roopali Bapat
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Greg Ryshen
- Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH
| | - Gail Bagwell
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Matthew Kielt
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Martin Hanawalt
- Pediatric Hospitalist Program, Nationwide Children's Hospital, Ohio Health Mansfield, Mansfield, OH
| | - Kelly Payne
- Pediatric Hospitalist Program, Nationwide Children's Hospital, Ohio Health Mansfield, Mansfield, OH
| | - Amy Alt-Coan
- Pediatric Hospitalist Program, Blanchard Valley Health System, Findlay, OH
| | - Magdalino Tatad
- Pediatric Hospitalist Program, St. Rita's Health System, Lima, OH
| | - Debbie Krendl
- Pediatric Hospitalist Program, St. Rita's Health System, Lima, OH
| | - Maria Jebbia
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Kristina M Reber
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Cecilie Halling
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Ahmed A F Osman
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | | | - Leif D Nelin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Omid Fathi
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
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Abstract
The Small Baby Program at Nationwide Children's Hospital was launched in 2004 in response to a need for better care for infants born extremely preterm. Standardization of care, decreased variability, multidisciplinary support, and robust research and quality improvement have allowed us to greatly improve our outcomes. In addition to the numerous medical and technological advances during this time, a strong commitment to kangaroo care and family-centered care have been integral to the growth and success of our program. The following review of the program aims to highlight the above areas while detailing the specific processes that have contributed to its ongoing success. Key areas of focus have been on respiratory management, neurodevelopmental care, and nutritional optimization. The implementation and continued refinement of the Small Baby Program has allowed us to improve the survival of extremely preterm infants, decrease certain morbidities, and improve long-term neurodevelopmental outcomes.
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Affiliation(s)
- Leeann R Pavlek
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205, United States.
| | - Clifford Mueller
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Maria R Jebbia
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Matthew J Kielt
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Leif D Nelin
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 575 Children's Crossroad, Columbus, OH 43205, United States
| | - Edward G Shepherd
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Kristina M Reber
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Omid Fathi
- Small Baby ICU, Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
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Abstract
With advances in neonatal care, survival of premature infants at the limits of viability has improved significantly. Despite these improvement in mortality, infants born at 22-24 weeks gestation are at a very high risk for short- and long-term morbidities associated with prematurity. Many of these diseases have been attributed to abnormalities of tissue oxygenation and perfusion. Near-infrared spectroscopy utilizes the unique absorption properties of oxyhemoglobin and deoxyhemoglobin to provide an assessment of regional tissue oxygen saturation, which can be used to calculate the fractional tissue oxygen extraction. This allows for a non-invasive way to monitor tissue oxygen consumption and enables targeted hemodynamic management. This mini-review provides a brief and complete overview of the background and physiology of near-infrared spectroscopy, practical use in extremely preterm infants, and potential applications in the neonatal intensive care unit. In this mini-review, we aim to summarize the three primary application sites for near-infrared spectroscopy, disease-specific indications, and available literature regarding use in extremely preterm infants.
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Affiliation(s)
- Leeann R Pavlek
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Clifford Mueller
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Maria R Jebbia
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Matthew J Kielt
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
| | - Omid Fathi
- Division of Neonatology, Nationwide Children's Hospital, Columbus, OH, United States
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Fathi O, Bapat R, G. Shepherd E, Wells Logan J. Golden Hours: An Approach to Postnatal Stabilization and Improving Outcomes. Neonatal Medicine 2019. [DOI: 10.5772/intechopen.82810] [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: 11/08/2022] Open
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Fathi O, Shepherd EG. We Can Do Better for Our Tiniest Babies. Pediatr Crit Care Med 2019; 20:676-677. [PMID: 31274793 DOI: 10.1097/pcc.0000000000001929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Omid Fathi
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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Pavlek L, Kraft M, Simmons C, Ryan M, Prusakov P, Campbell A, Brandehoff N, Ng PC, Russell J, Ciciora SL, Fathi O. Acetaminophen and Acetylsalicylic Acid Exposure in a Preterm Infant after Maternal Overdose. Am J Perinatol 2019; 36:136-140. [PMID: 29945281 DOI: 10.1055/s-0038-1661405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/28/2022]
Abstract
Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances.
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Affiliation(s)
- Leeann Pavlek
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Monica Kraft
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Caitlyn Simmons
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Mary Ryan
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Pavel Prusakov
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Amanda Campbell
- Medical Scientist Training Program, The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nicklaus Brandehoff
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Patrick C Ng
- Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, Colorado
| | - Jason Russell
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Steven L Ciciora
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Omid Fathi
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
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McAdams RM, Backes CH, Fathi O, Hutchon DJR. Revert to the original: time to re-establish delayed umbilical cord clamping as the standard approach for preterm neonates. Matern Health Neonatol Perinatol 2018; 4:13. [PMID: 29997896 PMCID: PMC6030773 DOI: 10.1186/s40748-018-0081-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/24/2018] [Accepted: 03/28/2018] [Indexed: 01/18/2023] Open
Abstract
Delayed cord clamping, the common term used to denote placental-to-newborn transfusion at birth, is a practice now endorsed by the major governing bodies affiliated with maternal-newborn care. Despite considerable evidence, delayed cord clamping, not early cord clamping, continues to be viewed as the “experimental” intervention category when discussed in research studies. We provide a brief overview of placental-to-newborn transfusion in relation to birth transitional physiology and discuss areas where we may need to modify our interpretation of “normal” vital signs and laboratory values as delayed cord clamping becomes standardized. We also assert that delayed cord clamping should now be viewed as the standard of care approach, especially given that multiple randomized controlled trials have revealed that early cord clamping, which lacks evidence-based support, is associated with a greater risk for morbidity and mortality than delayed cord clamping.
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Affiliation(s)
- Ryan M McAdams
- 1Department of Pediatrics, Division of Neonatology, University of Wisconsin School of Medicine and Public Health, 1010 Mound St., Rm 414, Madison, WI 53715 USA
| | - Carl H Backes
- 2Department of Pediatrics, The Center for Perinatal Research and The Heart Center, Nationwide Children's Hospital, Columbus, OH USA
| | - Omid Fathi
- 2Department of Pediatrics, The Center for Perinatal Research and The Heart Center, Nationwide Children's Hospital, Columbus, OH USA
| | - David J R Hutchon
- 3Obstetrics and Gynaecology, Darlington Memorial Hospital, Darlington, UK
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Abstract
Laser speckle imaging (LSI) enables measurement of relative changes in blood flow in biological tissues. We postulate that a point-of-care form factor will lower barriers to routine clinical use of LSI. Here, we describe a first-generation handheld LSI device based on a tablet computer. The coefficient of variation of speckle contrast was < 2% after averaging imaging data collected over an acquisition period of 5.3 s. With a single, experienced user, handheld motion artifacts had a negligible effect on data collection. With operation by multiple users, we did not identify any significant difference (p > 0.05) between the measured speckle contrast values using either a handheld or mounted configuration. In vivo data collected during occlusion experiments demonstrate that a handheld LSI is capable of both quantitative and qualitative assessment of changes in blood flow. Finally, as a practical application of handheld LSI, we collected data from a 53-day-old neonate with confirmed compromised blood flow in the hand. We readily identified with LSI a region of diminished blood flow in the thumb of the affected hand. Our data collectively suggest that handheld LSI is a promising technique to enable clinicians to obtain point-of-care measurements of blood flow.
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Affiliation(s)
- Ryan Farraro
- University of California-Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612, United States
- University of California-Irvine, Department of Biomedical Engineering, 3120 Natural Sciences II, Irvine, California 92697, United States
| | - Omid Fathi
- University of California-Irvine, Department of Pediatrics, 505 South Main Street, Irvine, Orange, California 92868, United States
| | - Bernard Choi
- University of California-Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612, United States
- University of California-Irvine, Department of Biomedical Engineering, 3120 Natural Sciences II, Irvine, California 92697, United States
- University of California-Irvine, Department of Surgery, 333 City Boulevard West, Suite 1600, Orange, California 92868, United States
- University of California-Irvine, Edwards Lifesciences Center for Advanced Cardiovascular Technology, 2400 Engineering Hall, Irvine, California 92697, United States
- CHOC Children’s Hospital, 1201 West La Veta Avenue, Orange, California 92868, United States
- Address all correspondence to: Bernard Choi, E-mail:
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Vares B, Mohseni M, Heshmatkhah A, Farjzadeh S, Safizadeh H, Shamsi-Meymandi S, Rahnama Z, Reghabatpour L, Fathi O. Quality of life in patients with cutaneous leishmaniasis. Arch Iran Med 2013; 16:474-7. [PMID: 23906253 DOI: 013168/aim.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Leishmaniasis is a zoonotic infection caused by a protozoa belonging to the genus Leishmania. Its clinical manifestations range from a self-healing cutaneous leishmaniasis (CL) to lethal visceral leishmaniasis. We aim to examine the quality of life of patients with CL in Kerman, Iran. METHODS In this cross-sectional study we evaluated 124 patients with CL. The Dermatology Life Quality Index (DLQI) questionnaire was used for measuring quality of life. Data on demographics and characteristics of the lesions also were collected. Mann-Whitney U-test and Kruskal-Wallis were used for data analyses. RESULTS The mean DLQI score was 5.87 ± 5.96. We observed the highest effect in the symptoms and feelings domains; the lowest effect was seen in the treatment domain of the DLQI. There was no significant difference in DLQI scores between men and women. Patients with ulcerated lesions had lower quality of life (P < 0.05). CONCLUSION CL significantly affects the quality of life of patients. Further studies are suggested to examine the effect of its treatment on the quality of life in these patients.
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Affiliation(s)
- Behrooze Vares
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Iran
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Soltan M, El-Gendi E, Imam HH, Fathi O. Different Doses of Sublingual Misoprostol versus Methylergometrine for the Prevention of Atonic Postpartum Haemorrhage. Int J Health Sci (Qassim) 2007; 1:229-236. [PMID: 21475433 PMCID: PMC3068636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVE In the poor underdeveloped countries, anaemia is very common in pregnant women. Maternal mortality is four times higher in severely anaemic women than non-anaemic ones and postpartum haemorrhage (PPH) is the most common cause of death. Its main cause is uterine atony, which accounts for more than 70%. The objective of this study is to evaluate the use of sublingual misoprostol in different doses of 600, 800 and1000μg in management of the third stage of labor, with regards to blood loss and incidence of atonic postpartum haemorrhag (APPH). STUDY DESIGN Double blind randomized controlled study METHODS One thousand and two hundred parturient were studied in a control and three study groups, each composed of 300 women. Methylergometrine 0.2 mg IM injection and sublingual misoprostol 600, 800 and 1000 μg tablets were given to women in control and the three study groups respectively, immediately after delivery. OUTCOME MEASURES Duration of the third stage of labour, Blood loss in the third stage of labour, Outcomes in anaemic compared to non-anaemic women, Incidance of atonic postpartum haemorrhage in different groups, Haemoglobin deficit after 24 hrs of delivery, Changes in the women's blood pressure during the study, Side effects of the drug, and, Women's acceptability of sublingual misoprostol administration. RESULTS Only significant reduction in blood loss and haemoglobin deficits were seen in the third stage of labour and after delivery in women used misoprostol doses of 800 μg and 1000 μg. The incidences of PPH in studied women and controls were almost similar, ranging between 2 and 3%. Similar results were seen in anaemic and non-anaemic women with a higher incidence of APPH in the non-misoprostol user anaemic women. Side effects of the drug were dose related. CONCLUSION Misoprostol in high dose may be used for managing third stage of labour to reduce maternal morbidity and mortality due to APPH particularly, in the poor underdeveloped countries where, facilities to deliver in health centers, purchase and store the oxytocic ampoules or medically trained persons are not readily available in all places. Benefits of large dose misoprostol outweigh its side effects.
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Affiliation(s)
- M.H. Soltan
- Corrospondance :Prof. Mohamed H. Soltan, Director General, Suzan Mubarak Maternity University Hospital, El-menia, Egypt,
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Abdel-Wahab M, El-Shennawy F, Agha S, Ragab E, Fathi O, Sultan A, Elghawalby N, Ezzat F. Evaluation of cell mediated immunity in advanced pancreatic carcinoma before and after treatment with interleukin-2 (IL-2). Hepatogastroenterology 1999; 46 Suppl 1:1293-6. [PMID: 10429977] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS The administration of high doses of Interleukin-2 (IL-2) either alone or in combination with other cytokines demonstrated that immunologic manipulation is capable of mediating the regression of established cancer in humans. Thus, there is an urgent need to develop and evaluate the effect of treatment with IL-2 on immunological parameters and outcome of patients with inoperable pancreatic carcinoma. METHODOLOGY Twenty-one patients with advanced pancreatic cancer were the subjects of this study and all patients were diagnosed as unresectable pancreatic carcinoma on a clinical, surgical, radiological and laboratory basis. The patients were classified as group I: 10 patients treated by IL-2, and group II: 11 non-treated patients. We used a novel method of intra-arterial therapy. Patients in group I were subjected to surgical exploration for assessing the inoperability and catheterization of the splenic artery, gastroduodenal artery and hepatic artery in patients with liver metastasis. The course of therapy that started 15 days after catheterization included the following for 10 days, lipiodol 2.5ml, 0.5ml urographin 58%, and IL-2 1ml. After 15 days of immunostimulation bolus injection of chemotherapy was given including, lipiodol 10ml, urographin 2ml, mitomycin C 0.2mg/kg, carboplatin 1.5mg/kg, farmorubicin 1mg/kg, 5-fluorouracil 10mg/kg, and leukovorin 1.5mg/kg. Forty-five days following locoregional chemotherapy, the same procedure was followed in the same sequence with 10 daily courses of locoregional immunotherapy. RESULTS The results showed that there is a 70% relief of pain in group I compared to 0% in group II. Also, there is an improvement in body weight in 50% of group I in comparison to group II. Tumor size was decreased in 70% of the cases in group I. The mean survival was 11.9+/-4.9 months in group I compared to 5.6+/-1.5 in group II (p<0.0008). A highly significant increase of CD3 (p<0.0001), CD4 (p<0.001), CD8 (p<0.0001), CD16 (p<0.001), CD14 (p<0.0001), NK cytotoxicity (p<0.0001), T cell cytotoxicity (p<0.001), ICAM-1 (p<0.001), TNFalpha (p=0.001) IL-2 (p<0.001), and IL-2R (p=0.001) was seen in group I patients compared to group II patients. CONCLUSIONS Immunotherapy is a new modality for treatment of pancreatic carcinoma. Local administration of therapy seems to be an attractive way for delivering the optimum concentration of IL-2 target tissues avoiding the toxic side effects associated with high dose systemic treatment.
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Khalifa A, Fathi O, Mousa MA, el Magraby H. Immunoglobulin A and alpha 2-macroglobulin as tumor markers in bladder cancer. Chemioterapia 1987; 6:736-7. [PMID: 2475266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A Khalifa
- Department of Biochemistry, Ain Shams University, Cairo, Egypt
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