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Sammour I, Karnati S, Othman H, Heis F, Peluso A, Aly H. Trends in Procedures in the Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e494-e500. [PMID: 35858651 DOI: 10.1055/a-1905-5245] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The aim of the study is to identify the rates and trends of various procedures performed on newborns. STUDY DESIGN The Healthcare Cost and Utilization Project (HCUP) database for the years 2002 to 2015 was queried for the number of livebirths, and various procedures using International Classification of Diseases, Ninth Revision (ICD-9) codes. These were adjusted to the rate of livebirths in each particular year. A hypothetical high-volume hospital based on data from the last 5 years was used to estimate the frequency of each procedure. RESULTS Over the study period, there was a decline in the rates of exchange transfusions and placement of arterial catheters. There was an increase in the rates of thoracentesis, abdominal paracentesis, placement of umbilical venous catheter (UVC) lines, and central lines with ultrasound or fluoroscopic guidance. No change was observed in the rates of unguided central lines, pericardiocentesis, bladder aspiration, intubations, and LP. Intubations were the most performed procedures. Placement of UVC, central venous lines (including PICCs), arterial catheters, and LP were relatively common, whereas others were rare such as pericardiocentesis and paracentesis. CONCLUSION Some potentially lifesaving procedures are extremely rare or decreasing in incidence. There has also been an increase in utilization of fluoroscopic/ultrasound guidance for the placement of central venous catheters. KEY POINTS · Advances in neonatal care have impacted the number of procedures performed in the NICU.. · It is unclear whether invasive procedures occur at rates sufficient for adequate training and maintenance of skills.. · Understanding the NICU procedural trends is important in designing simulation and competency-based medical education programs..
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Affiliation(s)
- Ibrahim Sammour
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hasan Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
| | - Farah Heis
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Allison Peluso
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
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Puthuraya S, Karnati S, Othman H, Sripathi R, Nandakumar V, Aly H. Neonatal outcomes of preterm infants with in-utero exposure to drugs of substance use: US national data. Pediatr Neonatol 2023; 64:53-60. [PMID: 36283910 DOI: 10.1016/j.pedneo.2022.03.021] [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] [Received: 09/26/2021] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Infants exposed prenatally to drugs of substance use are at increased risk for seizures, strabismus, feeding difficulty, and neurodevelopmental delays. Exposed preterm infants may have additional morbidities related to prematurity. There is limited literature on national outcomes of preterm infants exposed to drugs of substance use. We aimed to evaluate the trends and neonatal outcomes of preterm infants born in the USA who were exposed in-utero to drugs of substance use. METHODS Retrospective cohort study of preterm live born (<37 weeks gestation) exposed in-utero to opioids, hallucinogens, or cocaine in the Healthcare Cost and Utilization Project database from 2002 to 2017. Neonatal outcomes were identified using international classification of diseases 9&10 codes. RESULTS Of the 54,469,720 live-born infants, 7.7% (4,194,816) were preterm, and 58 679 (1.4%) were exposed in-utero to maternal opioids/hallucinogens (n = 39,335) or cocaine (n = 19,344). There was a trend for increased exposure to opioids/hallucinogens (Z score = 76.14, p < 0.001) during the study period. Exposed preterm infants had significantly more neurological anomalies, intra-ventricular hemorrhage and periventricular leukomalacia (p < 0.001). CONCLUSIONS There was a trend for increased in-utero exposure to opioids and hallucinogens in the preterm infants in the USA. Exposed preterm infants had more neurological morbidities.
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Affiliation(s)
- Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hasan Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA
| | - Rachana Sripathi
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Vanishree Nandakumar
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Abramsky R, Acun C, Alt J, Aly H, Arad N, Baak LM, Bakalar D, Balasingham T, Bammler T, Benders MJNL, Benitez D, Boni E, Boylan G, Campbell E, Castri P, Chandrashekar P, Chavez-Valdez R, Chen M, Chiodin E, Comstock B, Damien J, Damien J, de Vries LS, de Vries L, Dickman J, Doucette L, Duckworth E, Duckworth E, Echeverria-Palacio C, El Jalbout R, El-Dib M, Elshibiny H, Flock D, Gallagher A, Gasperoni E, Glass H, Harteman JC, Harvey-Jones K, Hazan I, Heagerty P, Inder T, Jantzie L, Juul S, Karnati S, Kute N, Lacaille H, Lange F, Lemmers PMA, Liu W, Llaguno N, Magalhães M, Mambule I, Marandyuk B, Marks K, Martin LJ, Massaro A, Mathieson S, Mathieson S, McCaul MC, Meehan C, Meledin I, Menna E, Menzato F, Mintoft A, Mitra S, Nakimuli A, Nanyunya C, Norris G, Northington FJ, Numis A, O'Reilly JJ, Ortiz S, Padiyar S, Paquette N, Parmeggiani L, Patrizi S, Pavlidis E, Pellegrin S, Penn AA, Petitpas L, Pinchefsky E, Ponta A, Puthuraya JPS, Rais R, Robertson NJ, Rodrigues D, Salandin M, Salzbank J, Sánchez L, Schalij N, Serrano-Tabares C, Shany E, Staffler A, Steggerda S, Tachtsidis I, Tann C, Tataranno ML, Trabatti C, Tremblay J, Tromp S, Tucker K, Turnbill V, Vacher CM, van Bel F, van der Aa NE, Van Meurs K, Van Steenis A, van Wyk L, Vannasing P, Variane G, Verma V, Voldal E, Wagenaar N, Wu Y, Wustoff C. Proceedings of the 14th International Newborn Brain Conference: Neonatal Neurocritical Care, seizures, and continuous aEEG and /or EEG monitoring. J Neonatal Perinatal Med 2023; 16:S33-S62. [PMID: 37599542 DOI: 10.3233/npm-239003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
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Acun C, Karnati S, Padiyar S, Puthuraya S, Aly H, Mohamed M. Trends of neonatal hypoxic-ischemic encephalopathy prevalence and associated risk factors in the United States, 2010 to 2018. Am J Obstet Gynecol 2022; 227:751.e1-751.e10. [PMID: 35690081 DOI: 10.1016/j.ajog.2022.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Despite recent advances in perinatal care, neonatal hypoxic-ischemic encephalopathy remains one of the most common causes of neonatal morbidity and mortality. The trends for prevalence and mortality of neonatal hypoxic-ischemic encephalopathy have not been examined in the era of therapeutic hypothermia in the United States. OBJECTIVE This study aimed to determine (1) the overall and gestational age-specific (35-36, ≥37, and >42 weeks) trends of hypoxic-ischemic encephalopathy prevalence and use of therapeutic hypothermia, (2) the trends of mortality in association with hypoxic-ischemic encephalopathy, (3) the confounding variables associated with hypoxic-ischemic encephalopathy, and (4) the clinical outcomes of neonates with hypoxic-ischemic encephalopathy. STUDY DESIGN This study used National Inpatient Sample datasets from 2010 to 2018. Moreover, the study included infants with a gestational age of ≥35 weeks with a documented hypoxic-ischemic encephalopathy diagnosis (mild, moderate, severe, or unspecified). We calculated trends in hypoxic-ischemic encephalopathy prevalence and the use of therapeutic hypothermia using chi-squared testing. Furthermore, this study used logistic regression models to control for confounders. RESULTS A total of 32,180,617 infants were included, of which 31,249,100 were term (gestational age of ≥37 weeks) and 931,517 were late preterm (gestational age of 35-36 weeks). Hypoxic-ischemic encephalopathy prevalence slightly increased from 0.093% in 2010-2012 to 0.097% in 2016-2018 (P=.01) in term infants and did not significantly change in late preterm infants (P=.20). There were 6235 term infants (20.8%) and 449 late preterm infants (21.1%) with hypoxic-ischemic encephalopathy who were managed with therapeutic hypothermia. The use of therapeutic hypothermia in both term and late preterm infants has increased over the years (P<.01). The mortality rate with hypoxic-ischemic encephalopathy decreased over time from 11.5% to 12.3% between 2010 to 2012, and from 8.3% to 10.6% betweenn 2016 to 2018 (P<.01). The factors with the strongest association with hypoxic-ischemic encephalopathy were placental infarction or insufficiency (odds ratio, 144; 95% confidence interval, 134-157), placental abruption (odds ratio, 101; 95% confidence interval, 91-112), cord prolapse (odds ratio, 74; 95% confidence interval, 65-84), and maternal anemia (odds ratio, 26; 95% confidence interval, 20-37). CONCLUSION Hypoxic-ischemic encephalopathy prevalence in neonates essentially remained the same at 1 per 1000 live births. The use of therapeutic hypothermia increased, and the mortality rate decreased in infants with hypoxic-ischemic encephalopathy. The identification of hypoxic-ischemic encephalopathy-associated factors should promote increased vigilance to optimize newborn outcomes.
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Affiliation(s)
- Ceyda Acun
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH.
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Swetha Padiyar
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
| | - Mohamed Mohamed
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
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Abstract
Angiomyxoma of the umbilical cord is a rare benign vascular malformation with potential for fetal morbidity and mortality. Gross and histologic features of this lesion are identical to those described as "hemangioma," however "angiomyxoma" is a preferable term as current practice restricts the term "hemangioma" to infantile capillary proliferations that express glucose transporter 1. Here we describe the case of an umbilical cord angiomyxoma with associated pseudocysts diagnosed after delivery at 33 weeks. It presented as a heterogeneous-appearing mass near the fetal cord insertion and mimicked serious fetal anomalies throughout gestation. We found fetal MRI helpful for monitoring this lesion, narrowing the differential, and informing management. Proximity to the fetal end of the cord and uncertainty about diagnosis also required surgical resection of the mass after delivery with umbilicoplasty.
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Affiliation(s)
- Navkiranjot Kaur
- 161821Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Amy Heerema-McKenney
- Pathology and Laboratory Medicine Institute, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women's Health Institute, 2569Cleveland Clinic, Cleveland, OH, USA
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Peluso AM, Othman HF, Karnati S, Sammour I, Aly HZ. Epidemiologic evaluation of inhaled nitric oxide use among neonates with gestational age less than 35 weeks. Pediatr Pulmonol 2022; 57:427-434. [PMID: 34842352 DOI: 10.1002/ppul.25775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 06/28/2021] [Revised: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of inhaled nitric oxide (iNO) in +late preterm and term infants with pulmonary hypertension is Food and Drug Administration (FDA) approved and has improved outcomes and survival. iNO use is not FDA approved for preterm infants and previous studies show no mortality benefit. The objectives were 1) to determine the usage of iNO among preterm neonates <35 weeks before and after the 2010 National Institutes of Health consensus statement and 2) to evaluate characteristics and outcomes among preterm neonates who received iNO. METHODS This is a population-based cross-sectional study. Billing and procedure codes were used to determine iNO usage. Data were queried from the National Inpatient Sample from 2004 to 2016. Neonates were included if gestational age was <35 weeks. The epochs were spilt into 2004-2010 (Epoch 1) and 2011-2016 (Epoch 2). Prevalence of iNO use, mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, length of stay, mechanical ventilation, and cost of hospitalization. RESULTS There were 4865 preterm neonates <35 weeks who received iNO. There was a significant increase in iNO use during Epoch 2 (p < 0.001). There was significantly higher use in Epoch 2 among neonates small for gestational age (SGA) 2.3% versus 7.2%, congenital heart disease (CHD) 11.1% versus 18.6%, and BPD 35.2% versus 46.8%. Mortality was significantly lower in Epoch 2 19.8% versus 22.7%. CONCLUSION Usage of iNO was higher after the release of the consensus statement. The increased use of iNO among preterm neonates may be targeted at specific high-risk populations such as SGA and CHD neonates. There was lower mortality in Epoch 2; however, the cost was doubled.
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Affiliation(s)
- Allison M Peluso
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hasan F Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Ibrahim Sammour
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hany Z Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
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Jasthi D, Kollikonda S, Karnati S. Clinical course and long-term follow-up of a preterm infant with non-fatal respiratory distress syndrome due to heterozygous ABCA3 gene mutation: A case report and review of literature. J Neonatal Perinatal Med 2022; 15:653-658. [PMID: 35342051 DOI: 10.3233/npm-210879] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adenosine triphosphate-binding cassette transporter A3 (ABCA3) mutations are recognized as a congenital cause of surfactant deficiency. Clinical presentations of such mutations are largely variable. There are many mutations of the ABCA3 gene, of which, p.E292V is the most common. Despite being the most common ABCA3 gene mutation, there is limited literature on extra pulmonary and long-term outcomes of the affected infants. CASE We present the case of a Caucasian male infant born at 32 weeks gestation that developed severe respiratory distress shortly after birth, and review published case reports and case series of infants affected with this gene mutation. He was found to have a heterozygous missense mutation p.E292V of ABCA3 resulting in a chronic lung disease. He required multiple courses of systemic and inhalational steroids. He developed supraventricular tachycardia (SVT), feeding problems and hypotonia during his prolonged hospital stay. He demonstrated mild neurodevelopmental delays on follow up at 18 months of age. The chronic lung disease improved over the first 2 years of life. He continued to have feeding difficulties and supraventricular tachycardia at nearly 2 years of age. CONCLUSION The infant's SVT may be associated with this ABCA3 variant. Further long-term follow-up studies are needed to better characterize extrapulmonary manifestations of this ABCA3 mutation.
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Affiliation(s)
- D Jasthi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - S Kollikonda
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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8
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Kollikonda S, Chavan M, Cao C, Yao M, Hackett L, Karnati S. Transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through infant feeding and early care practices: A systematic review. J Neonatal Perinatal Med 2022; 15:209-217. [PMID: 34219674 DOI: 10.3233/npm-210775] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Perinatal practices such as breast-feeding, kangaroo mother care, rooming-in, and delayed cord clamping have varied by institution during the COVID-19 pandemic. The goal of this systematic review was to examine the success of different practices in preventing viral transmission between SARS-CoV-2 positive mothers and their infants. METHODS Electronic searches were performed in the Ovid MEDLINE, Ovid Embase, Cochrane Library, EBSCOhost CINAHL Plus, Web of Science, and Scopus databases. Studies involving pregnant or breastfeeding patients who tested positive for SARS-CoV-2 by RT-PCR were included. Infants tested within 48 hours of birth who had two tests before hospital discharge were included. Infants older than one week with a single test were also included. RESULTS Twenty eight studies were included. In the aggregated data, among 190 breastfeeding infants, 22 tested positive for SARS-CoV-2 (11.5%), while 4 of 152 (2.63%) among bottle-fed (Fisher's exact test p = 0.0006). The positivity rates for roomed in infants (20/103, 19.4%) were significantly higher than those isolated (5/300, 1.67%) (P < 0.0001). There was no significant difference in positivity rate among infants who received kangaroo care (25%vs 9%, p = 0.2170), or delayed cord clamping (3.62%vs 0.9%, p = 0.1116). CONCLUSIONS Lack of robust studies involving large patient population does not allow meaningful conclusions from this systematic review. Aggregated data showed increased positivity rates of SARS-CoV-2 among infants who were breast fed and roomed-in. There were no differences in SARS-CoV-2 positivity rates in infants received skin to skin care or delayed cord clamping.
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Affiliation(s)
- S Kollikonda
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - M Chavan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - C Cao
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - M Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - L Hackett
- Floyd D Loop Alumni library, Cleveland Clinic, Cleveland, OH, USA
| | - S Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Elgendy MM, Puthuraya S, LoPiccolo C, Liu W, Aly H, Karnati S. Neonatal stroke: Clinical characteristics and neurodevelopmental outcomes. Pediatr Neonatol 2022; 63:41-47. [PMID: 34509386 DOI: 10.1016/j.pedneo.2021.06.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 04/10/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Neonatal stroke can potentially result in significant neurological sequelae in affected infants. Studies on neurodevelopmental outcomes and the need for rehabilitation therapies in the first two years are limited. We aimed to describe the clinical characteristics, diagnostic evaluation, and neurodevelopmental outcomes of a cohort of infants with neonatal stroke. METHODS A retrospective cohort study of infants with neonatal stroke, from 2011 to 2020. Maternal and infant characteristics were described. Placental pathology, echocardiogram results, and prothrombotic evaluations were reported. The neurodevelopmental outcomes using Bayley scale of infant development (BSID III), rates of epilepsy and cerebral palsy, and the need for rehabilitation therapies at two years were described. RESULTS During the study period, 55 infants had neonatal stroke. Majority (93%) were term or late preterm infants. Maternal chorioamnionitis and perinatal HIE were diagnosed in about a third of the infants. Most (66%) of the infants presented with seizures. On brain MRI, the lesions were unilateral in 76% and arterial in origin in 86% of the infants. Meconium exposure (42%), intrauterine inflammation/infection (37%) and fetal vascular malperfusion (16%) were seen on placental histopathology. At two-year BSID III assessment, median (min, max) composite cognitive, language, and motor scores were 100 (55-145), 97 (47-124), and 100 (46-141), respectively. Among this cohort, epilepsy (27%), cerebral palsy (16%) and the need for rehabilitation therapies (physical -24%, occupational -18%, speech -21%) were reported at two years. CONCLUSION Neonatal stroke presented commonly in term or late preterm infants with seizures. It was unilateral and arterial in origin in most infants. Maternal chorioamnionitis and perinatal HIE were the most commonly associated conditions at birth. About one-fifth of the infants had mild or severe developmental delays at two years. Epilepsy, cerebral palsy, and need for rehabilitation therapies were noted in a significant proportion of infants at two years.
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Affiliation(s)
- Marwa M Elgendy
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Subhash Puthuraya
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Carmela LoPiccolo
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OHio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA.
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Ruikka JL, Acun C, Karnati S. Entrapped peripherally inserted central catheter due to fibrin sheath in a neonate with noninvasive extraction and review of literature. J Neonatal Perinatal Med 2021; 15:383-386. [PMID: 34719444 DOI: 10.3233/npm-210830] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripherally inserted central catheter line entrapment is a rare complication in the neonatal intensive care unit and only a small number of cases have been reported. While studies have suggested recommendations for removal, there is still a need for surgical intervention in some cases. This is a case of a premature infant with long term peripherally inserted central catheter line placement with fibrin sheath formation that required multiple attempts before successful noninvasive removal and a review of the cases with difficult peripherally inserted central catheter removal in newborns.
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Affiliation(s)
- J L Ruikka
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - C Acun
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - S Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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11
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Chavan M, Qureshi H, Karnati S, Kollikonda S. COVID-19 Vaccination in Pregnancy: The Benefits Outweigh the Risks. J Obstet Gynaecol Can 2021; 43:814-816. [PMID: 34253304 PMCID: PMC8267012 DOI: 10.1016/j.jogc.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Chavan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hira Qureshi
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Swapna Kollikonda
- Department of Obstetrics & Gynecology, Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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12
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Elgendy MM, Durgham R, Othman HF, Heis F, Abu-Shaweesh G, Saker F, Karnati S, Aly H. Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study. Neonatology 2021; 118:425-433. [PMID: 33975321 DOI: 10.1159/000515900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/08/2020] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. OBJECTIVES The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. METHODS A cross-sectional study that utilized National Inpatient Sample for the years 2000-2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000-1,499 g. Logistic regression analysis was performed to adjust for confounding variables. RESULTS The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76-2.18, p < 0.001) and 1,000-1,499-g infants (aOR = 2.02, CI: 1.62-2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (p = 0.001) and in infants with BW 1,000-1,499 g (p < 0.001). CONCLUSIONS Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.
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Affiliation(s)
- Marwa M Elgendy
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Ryan Durgham
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hasan F Othman
- Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan, USA
| | - Farah Heis
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Ghada Abu-Shaweesh
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Firas Saker
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Sreenivas Karnati
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
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13
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Abstract
Premature births continue to rise globally with a corresponding increase in various morbidities among this population. Rates of respiratory distress syndrome and the consequent development of Bronchopulmonary Dysplasia (BPD) are highest among the extremely preterm infants. The majority of extremely low birth weight premature neonates need some form of respiratory support during their early days of life. Invasive modes of respiratory assistance have been popular amongst care providers for many years. However, the practice of prolonged invasive mechanical ventilation is associated with an increased likelihood of developing BPD along with other comorbidities. Due to the improved understanding of the pathophysiology of BPD, and technological advances, non-invasive respiratory support is gaining popularity; whether as an initial mode of support, or for post-extubation of extremely preterm infants with respiratory insufficiency. Due to availability of a wide range of modalities, wide variations in practice exist among care providers. This review article aims to address the physical and biological basis for providing non-invasive respiratory support, the current clinical evidence, and the most recent developments in this field of Neonatology.
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Affiliation(s)
- Ibrahim Sammour
- Department of Neonatology, Lerner College of Medicine, Pediatric Institute, Cleveland Clinic, Cleveland Clinic Foundation, Cleveland, OH, United States
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14
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Abstract
Late preterm infants, defined as newborns born between 340/7-366/7 weeks of gestational age, constitute a unique group among all premature neonates. Often overlooked because of their size when compared to very premature infants, this population is still vulnerable because of physiological and structural immaturity. Comprising nearly 75% of babies born less than 37 weeks of gestation, late preterm infants are at increased risk for morbidities involving nearly every organ system as well as higher risk of mortality when compared to term neonates. Neurodevelopmental impairment has especially been a concern for these infants. Due to various reasons, the rate of late preterm births continue to rise worldwide. Caring for this high risk population contributes a significant financial burden to health systems. This article reviews recent trends in regarding rate of late preterm births, common morbidities and long term outcomes with special attention to neurodevelopmental outcomes.
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Affiliation(s)
- Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
| | - Swapna Kollikonda
- Department of Obstetrics and Gynecology, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jalal Abu-Shaweesh
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
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15
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Bachhuka A, Madathiparambil Visalakshan R, Law CS, Santos A, Ebendorff-Heidepriem H, Karnati S, Vasilev K. Modulation of Macrophages Differentiation by Nanoscale-Engineered Geometric and Chemical Features. ACS Appl Bio Mater 2020; 3:1496-1505. [DOI: 10.1021/acsabm.9b01125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Bachhuka
- ARC Center of Excellence for Nanoscale BioPhotonics (CNBP), The University of Adelaide, Adelaide, South Australia 5005, Australia
- Institute for Photonics and Advanced Sensing (IPAS), The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - R. Madathiparambil Visalakshan
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Adelaide, South Australia 5095, Australia
| | - C. S. Law
- ARC Center of Excellence for Nanoscale BioPhotonics (CNBP), The University of Adelaide, Adelaide, South Australia 5005, Australia
- Institute for Photonics and Advanced Sensing (IPAS), The University of Adelaide, Adelaide, South Australia 5005, Australia
- School of Chemical Engineering, University of Adelaide, Engineering North Building, Adelaide, South Australia 5005, Australia
| | - A. Santos
- ARC Center of Excellence for Nanoscale BioPhotonics (CNBP), The University of Adelaide, Adelaide, South Australia 5005, Australia
- Institute for Photonics and Advanced Sensing (IPAS), The University of Adelaide, Adelaide, South Australia 5005, Australia
- School of Chemical Engineering, University of Adelaide, Engineering North Building, Adelaide, South Australia 5005, Australia
| | - H. Ebendorff-Heidepriem
- ARC Center of Excellence for Nanoscale BioPhotonics (CNBP), The University of Adelaide, Adelaide, South Australia 5005, Australia
- Institute for Photonics and Advanced Sensing (IPAS), The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - S. Karnati
- Institute for Anatomy and Cell Biology, Julius Maximilians University, Koellikerstrasse 6, Wuerzburg 97070, Germany
| | - K. Vasilev
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Adelaide, South Australia 5095, Australia
- School of Engineering, University of South Australia, Mawson Lakes Campus, Adelaide, South Australia 5095, Australia
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16
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Druce HM, Ramsey DL, Karnati S, Carr AN. Topical nasal decongestant oxymetazoline (0.05%) provides relief of nasal symptoms for 12 hours. Rhinology 2019; 56:343-350. [PMID: 29785414 DOI: 10.4193/rhin17.150] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nasal congestion, often referred to as stuffy nose or blocked nose is one of the most prevalent and bothersome symptoms of an upper respiratory tract infection. Oxymetazoline, a widely used intranasal decongestant, offers fast symptom relief, but little is known about the duration of effect. METHODOLOGY The results of 2 randomized, double-blind, vehicle-controlled, single-dose, parallel, clinical studies (Study 1, n=67; Study 2, n=61) in which the efficacy of an oxymetazoline (0.05% Oxy) nasal spray in patients with acute coryzal rhinitis was assessed over a 12-hour time-period. Data were collected on both subjective relief of nasal congestion (6-point nasal congestion scale) and objective measures of nasal patency (anterior rhinomanometry) in both studies. RESULTS A pooled study analysis showed statistically significant changes from baseline in subjective nasal congestion for 0.05% oxymetazoline and vehicle at each hourly time-point from Hour 1 through Hour 12 (marginally significant at Hour 11). An objective measure of nasal flow was statistically significant at each time-point up to 12 hours. Adverse events on either treatment were infrequent. The number of subjects who achieved an improvement in subjective nasal congestion scores of at least 1.0 was significantly higher in the Oxy group vs. vehicle at all hourly time-points on a 6-point nasal congestion scale. CONCLUSIONS This study shows for the first time, that oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose.
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Affiliation(s)
- H M Druce
- Ear Nose and Throat Care P.C., Somerville, NJ 08876, USA
| | - D L Ramsey
- Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA
| | - S Karnati
- Procter and Gamble, Personal Health Care Division, Mason, OH 45040, USA
| | - A N Carr
- Procter and Gamble, Cincinnati, OH 45221, USA
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17
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Abstract
BACKGROUND Very low birth weight infants (VLBWI) have unexplained variation in respiratory morbidity, including respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD). We examined a potential association to serum 25-hydroxyvitamin D (s-25OHD) on day one. STUDY DESIGN Prospective, observational study on 89 VLBWI (≤1250 g). S-25OHD (day one and 21) and respiratory severity score (RSS) (day one) were examined. Other respiratory morbidities including BPD were compared between infants with s-25OHD ≤ 10 ng/ml (deficient) versus >10 ng/ml (adequate). RESULTS Eighty one neonates (91%) were African Americans. The mean (SD) birthweight was 868 (229) g, gestational age 27 (2) weeks. On day one, mean (SD) s-25OHD was 15.48 (8.31) ng/ml, with 32 (37%) being vitamin D deficient. The deficiency and adequate VLBWI groups had similar birthweight; 860 (262) vs 873 (210) g, and gestational age; 27 (2) vs 27 (2) weeks. In 78 survivors, s-25OHD rose from 15.48 (8.31) ng/ml day one to 52.36 (22.49) ng/ml day 21 after supplementation, p < 0.001. On day one, increasing RSS was inversely related to s-25OHD, trend p = 0.054. Compared to the adequate group, the deficiency group had higher RSS (5.0 ± 2.7 vs 3.6 ± 1.9), required surfactant therapy more frequently (91% vs 72%), and needed home oxygen therapy more often (48% vs 26%), p ≤ 0.05 for all. Among infants with BPD, the severity of disease was inversely related to s-25OHD, trend p < 0.09. CONCLUSION Lower levels of s-25OHD were associated with increased severity of RDS and BPD among a cohort of mostly African American VLBWI.
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Affiliation(s)
- S Nadya J Kazzi
- Department of Pediatrics, Wayne State University, Detroit, MI, United States.
| | - Sreenivas Karnati
- Department of Pediatrics, Wayne State University, Detroit, MI, United States
| | - Subhash Puthuraya
- Department of Pediatrics, Wayne State University, Detroit, MI, United States
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University, Detroit, MI, United States.
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18
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Puthuraya S, Karnati S, Kazzi SNJ, Qureshi F, Jacques SM, Thomas R. Does vitamin D deficiency affect placental inflammation or infections among very low birth weight infants? J Matern Fetal Neonatal Med 2017; 31:1906-1912. [DOI: 10.1080/14767058.2017.1332034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Subhash Puthuraya
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Sreenivas Karnati
- Department of Pediatrics, Cleveland Clinic Children’s, Cleveland, OH, USA
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | | | - Faisal Qureshi
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Suzanne M. Jacques
- Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
| | - Ronald Thomas
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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19
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Gupta S, Natarajan G, Gupta D, Karnati S, Dwaihy M, Wang B, Chawla S. Variability in Apgar Score Assignment among Clinicians: Role of a Simple Clarification. Am J Perinatol 2017; 34:8-13. [PMID: 27182997 DOI: 10.1055/s-0036-1584149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective We aimed to evaluate variability in Apgar score (AS) assignment among health care providers (HCPs) and to evaluate whether a simple clarification improves accuracy and consistency of AS assignment. Study Design An electronic questionnaire survey was provided to pediatric residents, nurse practitioners, neonatal fellows, and faculty in level III neonatal intensive care unit and major academic centers in the United State to assign AS for three clinical scenarios. Next, we provided a simple clarification on various components of AS. After review of clarification, responders were asked to provide AS for the same scenarios. We also sought the opinion of responders on the subjectivity of five components of AS. Results A total of 107 responses were collected. Correct assignment before and after clarification improved significantly: heart rate (78 vs. 90%, p = 0.02), reflex (63 vs.75%, p = 0.06), and breathing (82 vs. 96%, p = 0.003). Correct scoring for color and tone were 86 and 67%, respectively. Interobserver agreement improved significantly after clarification. Conclusion There was variability among HCPs for AS assignment, with improvement in correct response as well as consistency after a simple clarification. Availability of this clarification, along with the AS table in delivery room, will improve the correct assignment and consistency of AS for high-risk infants.
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Affiliation(s)
- Sabhya Gupta
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Girija Natarajan
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Dhruv Gupta
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Sreenivas Karnati
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Meghan Dwaihy
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Bo Wang
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
| | - Sanjay Chawla
- Division of Neonatology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan
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