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Clinical characteristics and factors associated with term and late preterm infants that do not respond to inhaled nitric oxide (iNO)

Morel, Alexandra Almanzar; Shreck, Evan; Mally, Pradeep V; Kim, Yang; Bailey, Sean M; Wachtel, Elena V
AIM: Inhaled nitric oxide (iNO) is used to treat neonates with hypoxic respiratory failure (HRF). The aim of this study was to determine clinical characteristics and factors associated with non-response to iNO therapy that may assist in clinical management and weaning strategies. METHODS: Retrospective chart review. The study cohort included gestational age >/=34 weeks' infants with acute HRF who received iNO within 7 days of birth. Subjects were stratified as responders or non-responders to iNO. Non-responders were defined as infants with failure to improve their PaO2 >20 mm Hg within 6 h of iNO initiation, need for extracorporeal membrane oxygenation (ECMO), or mortality. Clinical and laboratory characteristics were then compared between groups. RESULTS: Forty four subjects were included. There were 31 responders and 13 non-responders to iNO therapy. Regression analysis showed significant correlation between a non-response to iNO therapy and changes in PaO2 and pH levels. We found for every 10 mm Hg decrease in PaO2 immediate post-iNO therapy there is a 17.5% decrease in the likelihood of responding to iNO (odds ratio [OR] 0.98, P=0.012). Similarly, for every 0.15 point decrease in pH, there is a 16.3% increased chance of not responding to iNO therapy (OR 1.16, P=0.002). The need for pressor support prior to iNO initiation was also found to be associated with a non-response (OR 2. 94, P=0.034). CONCLUSIONS: Hypotension requiring treatment with pressors at the time of iNO therapy, as well as changes in pH and PaO2 after iNO initiation can be used as early clinical predictors to identify patients quickly who may be iNO non-responders.
PMID: 26352080
ISSN: 1619-3997
CID: 2239532

Skin-to-Skin Care and the Development of the Preterm Infant Oral Microbiome

Hendricks-Munoz, Karen D; Xu, Jie; Parikh, Hardik I; Xu, Ping; Fettweis, Jennifer M; Kim, Yang; Louie, Moi; Buck, Gregory A; Thacker, Leroy R; Sheth, Nihar U
Objective The oral cavity represents an initial entry way for oral and gut indigenous colonization. Skin-to-skin (STS) care, in which the mother holds the diaper clad naked preterm (PT) infant between her breasts, is associated with improved digestive function, decreased stress, and improved survival. This study evaluated the development of oral microbial colonization repertoires and health characteristics in PT infants with or without STS exposure. Methods Saliva from 42 PT infants (<32 weeks of gestation at birth) was collected prospectively at 1 month and/or at discharge. High-throughput 16S rRNA sequencing identified microbial diversity and prevalence of bacterial signatures correlated with clinical STS or non-STS care. Results Corrected for gestational age (CGA) at sampling, bacterial taxa demonstrated increased Streptococcus as a signature of oral repertoire maturation. STS was associated with increased Streptococcus (p < 0.024), while non-STS was associated with greater Corynebacterium (p < 0.023) and Pseudomonas (p < 0.019) in infants 32 weeks CGA, Neisseria and Acinetobacter were more prevalent, 50 vs. 16.7% and 40 vs. 0%, respectively. STS care was associated with shorter hospitalization (p < 0.039). Conclusion STS care during earlier gestation was associated with a distinct microbial pattern and an accelerated pace of oral microbial repertoire maturity.
PMCID:5550897
PMID: 26007311
ISSN: 1098-8785
CID: 1603322

Evacuation of a neonatal intensive care unit in a disaster: lessons from hurricane sandy

Espiritu, Michael; Patil, Uday; Cruz, Hannaise; Gupta, Arpit; Matterson, Heideh; Kim, Yang; Caprio, Martha; Mally, Pradeep
NICU patients are among those potentially most vulnerable to the effects of natural or man-made disaster on a medical center. The published data on evacuations of NICU patients in the setting of disaster are sparse. In October of 2012, New York University Langone Medical Center was evacuated during Hurricane Sandy in the setting of a power outage secondary to a coastal surge. In this setting, 21 neonates were safely evacuated from the medical center's NICU to receiving hospitals within New York City in a span of 4.5 hours. Using data recorded during the evacuation and from staff debriefings, we describe the challenges faced and lessons learned during both the power outage and vertical evacuation. From our experience, we identify several elements that are important to the functioning of an NICU in a disaster or to an evacuation that may be incorporated into future NICU-focused disaster planning. These include a clear command structure, backups (personnel, communication, medical information, and equipment), establishing situational awareness, regional coordination, and flexibility as well as special attention to families and to the availability of neonatal transport resources.
PMID: 25384488
ISSN: 0031-4005
CID: 1368982

Maternal and Neonatal Nurse Perceived Value of Kangaroo Mother Care and Maternal Care Partnership in the Neonatal Intensive Care Unit

Hendricks-Munoz, Karen D; Li, Yihong; Kim, Yang S; Prendergast, Carol C; Mayers, Roslyn; Louie, Moi
Background Kangaroo Mother Care (KMC) enhances infant and maternal well-being and requires maternal-care partnerships (MCP) for implementation.Objective To examine maternal and neonatal nurse provider perspectives on the value of KMC and MCP.Study Design Prospective cohort design of neonatal nurses and mothers of preterm infants self-report anonymous questionnaire. Analyses of categorical independent variables and continuous variables were calculated.Results In all, 82.3% of nurses (42) and 100% (143) of mothers participated in the survey. compared with 18% of nurses, 63% of mothers believed "KMC should be provided daily" and 90% of mothers compared with 40% of nurses strongly believed "mothers should be partners in care." In addition, 61% of nonwhite mothers identified that "KMC was not something they were told they could do for their infant" compared with 39% of white mothers. Nonwhite and foreign-born nurses were 2.8 and 3.1 times more likely to encourage MCP and KMC.Conclusion Mothers held strong positive perceptions of KMC and MCP value compared with nurses. Nonwhite mothers perceived they received less education and access to KMC. Barriers to KMC and MCP exist among nurses, though less in nonwhite, foreign-born, and/or nurses with their own children, identifying important provider educational opportunities to improve maternal KMC access in the NICU.
PMCID:4417481
PMID: 23359231
ISSN: 0735-1631
CID: 438992

Maternal antenatal treatments influence initial oral microbial acquisition in preterm infants

Hendricks-Munoz, Karen D; Perez-Perez, Guillermo; Xu, Jie; Kim, Yang; Louie, Moi
Objective The purpose of this study was to analyze the association of maternal antenatal therapy on initial preterm infant oral microbial acquisition of gut metabolically important bacteria: Firmicutes, Bacteroidetes, Lactobacillus, Bifidobacterium, and Bacteroides species.Study Design Infant oral samples were collected prefeeding at 24 hours and analyzed using group-specific primers by real-time 16S rRNA quantitative polymerase chain reaction with analysis of variance and logistic regression to evaluate effect of antenatal exposure.Results Sixty-five infants <34 weeks' gestational age (GA) were evaluated; mean GA was 28.6 +/- 2.6 (standard deviation) weeks. Infants unexposed to antenatal treatment (n = 5) acquired <1% Firmicutes, which was composed of 100% Lactobacillus species with no detectable Bifidobacterium, Bacteroidetes, or Bacteroides species. Infants exposed to antibiotics (n = 7), acquired fivefold less total bacterial density (TBD) with 45% Firmicutes 1.3% Lactobacillus species, 23.5% Bacteroidetes and rare Bacteroides. Compared with unexposed infants, steroids (n = 26) or steroid and antibiotics (n = 27) exposure led to an eightfold increase in TBD with <1% Lactobacillus species and Bacteroides species 100% and 30%, respectively (p < 0.04). Bifidobacterium was undetectable in all groups.Conclusion Preterm infant exposure to routine maternal antenatal treatments influence early oral microbial acquisition during the primary hours related to establishment of gut commensal bacteria.
PMID: 22814801
ISSN: 0735-1631
CID: 240862

Multifaceted Interventions to Prevent Central Line Associated Blood Stream Infections in a New York City, Neonatal Intensive Care Unit

Colbert, Larry; Pavia, Marianne; Marchione, Susan; Horowitz, Harold; Kim, Yang; Mayers, Roslyn
ORIGINAL:0007534
ISSN: 0196-6553
CID: 170490

Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections

Schulman, J; Stricof, R L; Stevens, T P; Holzman, I R; Shields, E P; Angert, R M; Wasserman-Hoff, R S; Nafday, S M; Saiman, L; Adeyeye, Adebisi; Angert, Robert; Barbara, Barbara; Barone, Anthony; Bateman, David; Bhutada, Alok; Biniwale, Manoj; Bock, Steven; Bode, Michelle; Brumberg, Heather; Campbell, Deborah; Caprio, Martha C; Carp, Diane; Clones, Barbara; Combs, Adriann; Cutrone, Joan; DeSomma, Michelle; Duchon, Jennifer; Furdon, Susan A; Gibbs, Kathleen; Graham, Philip; Grippi, Christine; Gross, Steven J; Hendricks-Munoz, Karen D; Hills, Kenyatta; Hoey, Hyacinth; Holzman, Ian R; Horgan, Michael; Isaacson, Teofilita; Jones, Zina; Kim, Yang; Koppel, Robert; Kumar, Vasanth H; Lahage, Nadine E; Lewis, Rudy; Marin, Grace; Moylan, Margaret; Nafday, Suhas M; Nugent, Clare; O'Donnell, Rebecca; Park, Jennifer; Parker, Pam; Parvez, Boriana; Perlman, Jeffrey M; Pupke, Nancy; Rastogi, Shantanu; Reyes, Mitch; Ross, Barbara G; Ryan, Rita M; Saiman, Lisa; Schanler, Richard J; Schulman, Joseph; Shields, Eileen; Spilman, Lynn; Stevens, Timothy P; Stricoff, Rachel; Susser, Joann; Valencia, Gloria B; Wachtel, Elena V; Wasserman, Randi
OBJECTIVE:To characterize hospital-acquired bloodstream infection rates among New York State's 19 regional referral NICUs (at regional perinatal centers; RPCs) and develop strategies to promote best practices to reduce central line-associated bloodstream infections (CLABSIs). STUDY DESIGN/METHODS:During 2006 and 2007, RPC NICUs reported bloodstream infections, patient-days and central line-days to the Department of Health, and shared their results. Aiming to improve, participants created a central line-care bundle based on visiting a potentially best performing NICU and reviewing the literature. RESULT/RESULTS:All 19 RPCs participated in this quality initiative, contributing 218,096 patient-days and 56,911 central line-days of observation. Individual RPC nosocomial sepsis infection (NI) rates ranged from 1.0 to 5.8 NIs per 1000 patient-days (2006), and CLABSI rates ranged from 2.6 to 15.1 CLABSIs per 1000 central line-days (2007). A six-fold rate variation among RPC NICUs was observed. Participants unanimously approved a level-1 evidence-based central line-care bundle. CONCLUSION/CONCLUSIONS:Individual RPC rates and consequent morbidity and resource use attributable to these infections were substantial and varied greatly. No center was without infections. It is hoped that the cooperation and accountability exhibited by the RPCs will result in a major network for characterizing performance and improving outcomes.
PMID: 19262569
ISSN: 1476-5543
CID: 5012772

Developmental delay in normal gastric wave pattern formation in neonates measured by electrogastrography [Meeting Abstract]

Kim, YS; Zayed, SZ; Shah, P; Hendricks-Munoz, KD
ISI:000079476700656
ISSN: 0031-3998
CID: 54066

Very low birth weight infants - a new hypertensive population? [Meeting Abstract]

Kim, YS; Wang, J; Hendricks-Munoz, KD; Schacht, RG
ISI:000079476701452
ISSN: 0031-3998
CID: 54069

Effects of intrauterine exposure to cocaine, opium and methadone on gut myoelectrical activity of neonates [Meeting Abstract]

Javed, SZ; Kim, YS; Shah, P; Hendricks-Munoz, KD
ISI:000079476701675
ISSN: 0031-3998
CID: 54071