Try a new search

Format these results:

Searched for:

person:dumpav01

in-biosketch:true

Total Results:

20


A QUALITY IMPROVEMENT PROJECT TO DECREASE NASAL PRESSURE INJURIES IN A NEONATAL ICU [Meeting Abstract]

Dumpa, V; Rios, L; Tiozzo, C; Pitter, L; Quintos, Alagheband M; Kim, M
Purpose of Study Early use of non-invasive ventilation (NIV) in neonates decreases the risk of lung injury and is the preferred mode of ventilation even in extremely premature neonates. Preterm infants are at an increased risk of nasal injuries due to the continuous pressure from the interface on their fragile skin. With the increasing use of NIV, the incidence of nasal pressure injuries (PI) in the neonatal intensive care unit (NICU) is estimated to be as high as 60%. These injuries can cause pain, infection, and rarely damage to underlying nasal cartilage leading to severe nasal deformities. After observing an increased incidence of NIV-related PI in our NICU, we launched a quality improvement project to tackle this problem. The objective of this study is to decrease the rate of nasal PI by 30% from a baseline of 0.36 injuries/100 NIV days to a goal of 0.25 injuries/100 NIV days by December 2020. The secondary aim is to eliminate any serious harm nasal PI (stage 3 and beyond as per the national pressure injury advisory panel staging). Methods Used An interdisciplinary team was formulated in late 2017 and the collection of data on NIV-related PI and NIV days was started. We conducted a series of plan-dostudy- act (PDSA) cycles focused around early detection of injury, change of NIV interface and alternating mask and prongs at the first sign of injury, use of nasal cannulaide as a protective barrier, engagement of both frontline nursing and respiratory therapy staff to do daily skin checks, and increased involvement of wound care nursing. NIV-related PI rates/100 NIV days were analyzed monthly using run charts (figure 1). Summary of Results Through this series of PDSA cycles, we were able to significantly decrease our rate of nasal PI from a baseline of 0.34 from January 2018 to Q2 2019 to 0.24 injuries/ 100 NIV days by December 2020, with a continued improvement noted in 2021 with a rate of 0.11 injuries/100 NIV days. There was no serious harm nasal PI after 2019. A spike of events was noted in the second quarter of 2020 during the COVID-19 surge in New York. This increase is likely secondary to the strain on healthcare resources during that time. Conclusions Using quality improvement methodology, we identified opportunities for improvement and instituted measures to decrease nasal PI in neonates. Multidisciplinary collaboration, accessibility to alternative interface(s) if needed, and the use of a barrier between interface and skin are effective strategies to decrease nasal PI in the NICU. (Figure Presented)
EMBASE:638065948
ISSN: 1708-8267
CID: 5251562

DECREASING PERIPHERAL INTRAVENOUS INFILTRATION AND EXTRAVASATION RATES IN CHILDREN- A QUALITY IMPROVEMENT INITIATIVE [Meeting Abstract]

Dumpa, V.; Mody, D.; Dziomba, M.; Thomas, D.; Alagheband, M. Quintos
ISI:000783822200076
ISSN: 1081-5589
CID: 5243652

EVALUATION OF DEXTROSE GEL USE IN NEONATAL HYPOGLYCEMIA- A SINGLE CENTER STUDY [Meeting Abstract]

Abuso, S.; Choi, J. J.; Akerman, M.; El-Khawam, R.; Kamity, R.; Clauss, C.; Hanna, N.; Dumpa, V.
ISI:000783822200130
ISSN: 1081-5589
CID: 5243662

THREE LIMB BLOOD PRESSURES VS. FOUR LIMB BLOOD PRESSURES MEASUREMENT IN NEONATES TO DETECT AORTIC ARCH ANOMALIES [Meeting Abstract]

Choi, J. J.; Pitter, L.; Hanna, N.; Dumpa, V.
ISI:000783822200213
ISSN: 1081-5589
CID: 5243692

Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia-Where Are We in 2021?

Dumpa, Vikramaditya; Bhandari, Vineet
Recent advances in neonatology have led to the increased survival of extremely low-birth weight infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not improved proportionally, partly due to increased survival of extremely premature infants born at the late-canalicular stage of lung development. Due to minimal surfactant production at this stage, these infants are at risk for severe respiratory distress syndrome, needing prolonged ventilation. While the etiology of BPD is multifactorial with antenatal, postnatal, and genetic factors playing a role, ventilator-induced lung injury is a major, potentially modifiable, risk factor implicated in its causation. Infants with BPD are at a higher risk of developing complications including sepsis, pulmonary arterial hypertension, respiratory failure, and death. Long-term problems include increased risk of hospital readmissions, respiratory infections, and asthma-like symptoms during infancy and childhood. Survivors who have BPD are also at increased risk of poor neurodevelopmental outcomes. While the ultimate solution for avoiding BPD lies in the prevention of preterm births, strategies to decrease its incidence are the need of the hour. It is time to focus on gentler modes of ventilation and the use of less invasive surfactant administration techniques to mitigate lung injury, thereby potentially decreasing the burden of BPD. In this article, we discuss the use of non-invasive ventilation in premature infants, with an emphasis on studies showing an effect on BPD with different modes of non-invasive ventilation. Practical considerations in the use of nasal intermittent positive pressure ventilation are also discussed, considering the significant heterogeneity in clinical practices and management strategies in its use.
PMCID:7918044
PMID: 33670260
ISSN: 2227-9067
CID: 4808162

Pneumothorax in Neonates Born to COVID-19-Positive Mothers: Fact or Fortuity? [Case Report]

Kamity, Ranjith; Nayak, Amrita; Dumpa, Vikramaditya
Neonates born to mothers with coronavirus disease 2019 (COVID-19) have been largely asymptomatic based on initial reports. All neonates born to mothers with COVID-19 have tested negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in our institution (published data as of April 12, 2020). As novel presentations of COVID-19, such as multisystem inflammatory syndrome in children are being increasingly reported, we raise the possibility of increased incidence of pneumothorax in neonates born to SARS-CoV-2-positive mothers. Two recently described neonates with COVID-19 infection were noted to have pneumothoraces. We describe two SARS-CoV-2-negative neonates born to COVID-19-positive mothers at 38 and 33 weeks, respectively, admitted to our neonatal intensive care unit for respiratory distress and subsequently developed pneumothoraces. As diverse clinical presentations in various age groups are being described, it becomes difficult to differentiate the increased incidence of complications related to an underlying illness, from COVID-19-related illness. It remains to be seen if neonates with in utero exposure to SARS-CoV-2 have an elevated inflammatory response with pneumonitis and exaggerated lung disease, similar to adult COVID-19 patients, due to in utero exposure.
PMCID:7987496
PMID: 33767908
ISSN: 2157-6998
CID: 4822962

The effects of oral feeding while on nasal continuous positive airway pressure (NCPAP) in preterm infants

Dumpa, Vikramaditya; Kamity, Ranjith; Ferrara, Louisa; Akerman, Meredith; Hanna, Nazeeh
OBJECTIVE:To determine whether delaying oral feeding until coming off NCPAP will alter feeding and respiratory-related morbidities in preterm infants. DESIGN/METHODS:In this retrospective pre-post analysis, outcomes were compared in two preterm infant groups (≤32 weeks gestation). Infants in Group 1 were orally fed while on NCPAP, while infants in Group 2 were only allowed oral feedings after ceasing NCPAP. RESULTS:Although infants in Group 2 started feeds at a later postmenstrual age (PMA), they reached full oral feeding at a similar PMA compared with Group 1. Interestingly, there was a positive correlation between the duration of oral feeding while on NCPAP and the time spent on respiratory support in Group 1. CONCLUSIONS:Delayed oral feeding until ceasing NCPAP did not contribute to feeding-related morbidities. We recommend caution when initiating oral feedings in preterm infants on NCPAP without evaluating the safety of the infants and their readiness for oral feedings.
PMID: 32086439
ISSN: 1476-5543
CID: 4322902

Neonatal Coronavirus 2019 (COVID-19) Infection: A Case Report and Review of Literature [Case Report]

Dumpa, Vikramaditya; Kamity, Ranjith; Vinci, Alexandra N; Noyola, Estela; Noor, Asif
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global pandemic affecting 213 countries as of April 26, 2020. Although this disease is affecting all age groups, infants and children seem to be at a lower risk of severe infection, for reasons unknown at this time. We report a case of neonatal infection in New York, United States, and provide a review of the published cases. A 22-day-old, previously healthy, full-term neonate was hospitalized after presenting with a one-day history of fever and poor feeding. Routine neonatal sepsis evaluation was negative. SARS-CoV-2 polymerase chain reaction (PCR) testing was obtained, given rampant community transmission, which returned positive. There were no other laboratory or radiographic abnormalities. The infant recovered completely and was discharged home in two days once his feeding improved. The family was advised to self-quarantine to prevent the transmission of COVID-19. We believe that the mode of transmission was horizontal spread from his caregivers. This case highlights the milder presentation of COVID-19 in otherwise healthy, full-term neonates. COVID-19 must be considered in the evaluation of a febrile infant. Infants and children may play an important role in the transmission of COVID-19 in the community. Hence, with an understanding of the transmission patterns, parents and caregivers would be better equipped to limit the spread of the virus and protect the more vulnerable population.
PMCID:7234017
PMID: 32432015
ISSN: 2168-8184
CID: 4444292

Congenital Diaphragmatic Hernia

Chapter by: Dumpa, Vikramaditya; Chandrasekharan, Praveen
in: StatPearls by
Treasure Island FL : StatPears, 2020
pp. -
ISBN:
CID: 4439852

Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants-A Pilot Study

Kamity, Ranjith; Ferrara, Louisa; Dumpa, Vikramaditya; Reynolds, Jenny; Islam, Shahidul; Hanna, Nazeeh
Introduction: The assessment of dysphagia in preterm infants has been limited to clinical bedside evaluation followed by videofluoroscopic swallow study (VFSS) in selected patients. Recently, fiberoptic endoscopic evaluation of swallowing (FEES) is being described more in literature for preterm infants. However, it is unclear if one test has a better diagnostic utility than the other in this population. Furthermore, it is also unclear if performing FEES and VFSS simultaneously will increase the sensitivity and specificity of detecting dysphagia compared to either test performed independently. Objectives: The primary objective of this study is to evaluate the feasibility of performing VFSS and FEES simultaneously in preterm infants. Our secondary objective is to determine whether simultaneously performed VFSS-FEES improves the diagnostic ability in detecting dysphagia in preterm infants compared to either test done separately. Methods: In this pilot study, we describe the process involved in performing simultaneous VFSS-FEES in five preterm infants (postmenstrual age ≥36 weeks) with dysphagia. A total of 26 linked VFSS-FEES swallows were analyzed, where the same bolus during the same swallow was compared using simultaneous fluoroscopy and endoscopy. The sensitivity and specificity of detecting penetration and aspiration were evaluated in simultaneous VFSS-FEES compared with each test done independently. Results: Our results demonstrated that performing simultaneous VFSS-FEES is feasible in preterm infants with dysphagia. All patients tolerated the procedures well without any complications. Our pilot study in these five symptomatic preterm infants demonstrated a low incidence of aspiration but a high incidence of penetration. Simultaneous VFSS-FEES (26 linked swallows) improved the ability to detect penetration compared to each test done separately. Conclusion: To our knowledge, this study is the first to demonstrate the feasibility of performing VFSS and FEES simultaneously in symptomatic preterm infants with dysphagia resulting in potentially higher diagnostic yield than either procedure done separately.
PMCID:7522365
PMID: 33042904
ISSN: 2296-2360
CID: 4632422