Faculty Bibliography

OBJECTIVES/OBJECTIVE:To compare the rates of Chronic Lung Disease (CLD) between premature infants weaned with either Continuous Positive Airway Pressure (CPAP) or High Velocity Nasal Cannula (HVNC). METHODS:This was a retrospective, observational cohort study at a level IV NICU including infants <34 weeks gestational age (GA) on NIV (noninvasive ventilation) for at least 5 days. Maternal and infant demographics and clinical data from the infant's hospital course were collected. Infants were assigned to CPAP (n=175) and HVNC (n=48) cohorts based on which modality they were treated with for most of their time on NIV. RESULTS:Demographics and clinical characteristics were similar between the CPAP group and the HVNC group. The rates of CLD were significantly higher in the HVNC group as compared to the CPAP group (58.3 vs. 24.6 %, p<0.001). After logistic regression analysis was performed accounting for GA, invasive respiratory support requirement, sepsis and administration of antenatal corticosteroids, the HVNC group was found to be almost 4 times more likely to develop CLD. Further analysis using propensity score matching yielded similar results. CONCLUSIONS:When used as the primary modality of noninvasive support, preterm infants on HVNC were more likely to develop CLD than those on CPAP.

OBJECTIVE:A standardized multifaceted approach to follow-up is crucial for monitoring neurodevelopment in neonates who undergo extracorporeal membrane oxygenation (ECMO). The Pittsburgh Index for Pre-ECMO Risk (PIPER+) score, which predicts the probability of hospital mortality, may help predict adverse neurodevelopmental outcomes. This study sought to assess the neurodevelopment of neonates who were treated with ECMO in our newly developed ECMO program, by analyzing Bayley Scales of Infant Development (BSID) scores obtained at the Neonatal Comprehensive Care Program (NCCP), our neurodevelopmental follow-up clinic, through two years of age. It also aimed to determine whether neurodevelopmental outcomes in our study population were correlated to PIPER+ score, magnetic resonance imaging (MRI), or video electroencephalography (vEEG) findings. STUDY DESIGN/METHODS:We conducted a retrospective chart review of neonatal patients placed on ECMO at our institution between March 2015 and June 2023 who had at least one follow-up visit at the NCCP clinic. The relationships between neurodevelopmental outcomes, quantified by the BSID score, PIPER + score, MRI results, and vEEG abnormalities were analyzed. RESULTS:A total of 18 patients met the inclusion criteria. There was a significant negative correlation (p<0.05) between PIPER+ and BSID scores at 12 months across all developmental domains analyzed. However, this correlation was no longer significant at 24 months. The odds of the combined outcome of mortality or neurodevelopmental impairment at two years of age increased by 17% for each 1% increase in the PIPER+ score. CONCLUSIONS:Higher PIPER+ scores were associated with higher mortality in our population; they also correlated with worse neurodevelopmental outcomes at 12 months, but not at 24 months. It is important and feasible to follow neonates who underwent ECMO using a neurodevelopmental follow-up clinic.

OBJECTIVE:To evaluate the incidence of cardiorespiratory events in preterm infants when administering the 2-month vaccine series all at once compared to spreading vaccines over multiple days. STUDY DESIGN/METHODS:This single-center, retrospective cohort study from 2019-2022 included preterm neonates receiving 2-month vaccinations. The primary outcome was incidence of cardiorespiratory events from time of initial vaccine administration up to 48 h after final administration. Univariate analysis was performed to identify predictors of primary outcome. RESULTS:There were 127 patients (pre-practice change n1 = 52, post-practice change n2 = 75) included with no difference in the number of cardiorespiratory events between groups. Predictors of severe event included younger gestational age, smaller birth weight, shorter birth length, and greater cardiorespiratory events at baseline. Vaccine schedule interruptions occur more often when administration is spread over multiple days. CONCLUSION/CONCLUSIONS:Administration of 2-month vaccinations all at once was not associated with increased cardiorespiratory events and prevents interruptions to vaccine schedule.

OBJECTIVES/OBJECTIVE:and fractional tissue oxygen extraction (FTOE) in stable preterm infants in the first week of life. METHODS:, splanchnic cerebral oxygen ratio (SCOR), FTOE, and regional intra-subject variability was calculated at each location at five different time intervals: 0-12 h, 12-24 h, 24-48 h, 48-72 h, and one week of life. RESULTS:=0.81). The FTOE increased in all three locations over time. Intra-subject variability was lowest in the cerebral region (1.3 % (±1.9)). CONCLUSIONS:in preterm infants.

OBJECTIVE:Objective structured clinical exams (OSCE) are used to train and assess resident foundational family-centered communication skills incorporating key stakeholders. In 2020 encounters were conducted virtually. We sought to compare standardized patient (SP) and family faculty (FF) assessment across OSCE and virtual OSCE (VOSCE) formats. METHODS:The intern classes of 2019 and 2020 completed a live OSCE and VOSCE respectively where they disclosed an error to an SP. The 10 minute encounter was observed by an FF and facilitator followed by a 20 minute debrief. The SP and FF completed a behavioral checklist to evaluate skill mastery. RESULTS:Eighteen (90%) of the 20 interns completed the encounter each year. Total mastery scores were significantly higher for SP assessment than for FF assessment in both OSCE [68% vs 46% (z=-3.005, p<.05)] and VOSCE formats [68% vs 53% (z=-2.105, p<0.05)]. Total mastery scores of SPs across OSCE and VOSCE formats did not significantly differ, nor did FF scores based on evaluation format. CONCLUSIONS:Our current experience suggests VOSCEs are a viable alternative to in person sessions given the comparable assessment across the two modalities. The ease of participating in virtual sessions may provide a way to more easily partner with key stakeholders.

Near-infrared spectroscopy (NIRS) is a technology that is easy to use and can provide helpful information about organ oxygenation and perfusion by measuring regional tissue oxygen saturation (rSO2) with near-infrared light. The sensors can be placed in different anatomical locations to monitor rSO2 levels in several organs. While NIRS is not without limitations, this equipment is now becoming increasingly integrated into modern healthcare practice with the goal of achieving better outcomes for patients. It can be particularly applicable in the monitoring of pediatric patients because of their size, and especially so in infant patients. Infants are ideal for NIRS monitoring as nearly all of their vital organs lie near the skin surface which near-infrared light penetrates through. In addition, infants are a difficult population to evaluate with traditional invasive monitoring techniques that normally rely on the use of larger catheters and maintaining vascular access. Pediatric clinicians can observe rSO2 values in order to gain insight about tissue perfusion, oxygenation, and the metabolic status of their patients. In this way, NIRS can be used in a non-invasive manner to either continuously or periodically check rSO2. Because of these attributes and capabilities, NIRS can be used in various pediatric inpatient settings and on a variety of patients who require monitoring. The primary objective of this review is to provide pediatric clinicians with a general understanding of how NIRS works, to discuss how it currently is being studied and employed, and how NIRS could be increasingly used in the near future, all with a focus on infant management.

OBJECTIVE:The use of oral dextrose gel (DG) reduces IV dextrose use. Prior studies used weight-based dosing (WD), though barriers exist, and are mitigated using standard dosing (SD). Our outcomes include IV dextrose use, NICU admissions, breastfeeding, adverse events, and assessment of WD vs SD. STUDY DESIGN/METHODS:Retrospective chart review comparing pre-DG, WD, and SD in 16490 newborns (1329 hypoglycemic) ≥ 35 weeks admitted to the nursery over 3 years. RESULTS:There was reduction in IV dextrose use 10.9% vs 6.5% (p = 0.004) and NICU admissions 27.9% vs 16.1% (p < 0.001) associated with DG use, and increased rate of breastfed infants 33.8% vs 43.5% (p = 0.001), with no difference between WD and SD. No difference noted in adverse events across the study period. CONCLUSIONS:DG utilization is associated with reduced IV dextrose use, NICU admissions, and improved breastfeeding rates without changes in adverse events. We offer SD as a safe alternative to WD.

OBJECTIVE:Curricula designed to teach and assess the communication skills of pediatric residents variably integrates the parent perspective. We compared pediatric residents' communication skills in an objective structured clinical exam (OSCE) case as assessed by Family Faculty (FF), parents of pediatric patients, versus standardized patients (SP). METHODS:Residents participated in an OSCE case with a SP acting as a patient's parent. We compared resident performance as assessed by FF and SP with a behaviorally-anchored checklist. Items were rated as not done, partly done or well done, with well-done indicating mastery. The residents evaluated the experience. RESULTS:42 residents consented to study participation. FF assessed a lower percentage of residents as demonstrating skill mastery as compared to SP in 19 of the 23 behaviors. There was a significant difference between FF and SP for Total Mastery Score and Mastery of the Competency Scores in three domains (Respect and Value, Information Sharing and Participation in Care and Decision Making). The majority of residents evaluated the experience favorably. CONCLUSION/CONCLUSIONS:Involving parents of pediatric patients in the instructive and assessment components of a communication curriculum for pediatric residents adds a unique perspective and integrates the true stakeholders in parent-physician communication.

OBJECTIVE:To compare the efficacy of video-assisted self-directed neonatal resuscitation skills course with video-assisted facilitator-led course. METHODS:This multicenter, randomized, blinded, non-inferiority-controlled trial compared two methods of teaching basic neonatal resuscitation skills using mask ventilation. Groups of novice providers watched an instructional video. One group received instructor facilitation (Ins-Video). The other group did not (Self-Video). An Objective Structured Clinical Exam (OSCE) measured skills performance, and a written test gauged knowledge. RESULTS:One hundred and thirty-four students completed the study. Sixty-three of 68 in the Self-Video Group (92.6%) and 59 of 66 in the Ins-Video Group (89.4%) achieved post-training competency in positive pressure ventilation (primary outcome). OSCE passing rates were low in both groups. Knowledge survey scores were comparable between groups and non-inferior. CONCLUSIONS:Video self-instruction taught novice providers positive pressure ventilation skills and theoretical knowledge, but it was insufficient for mastery of basic neonatal resuscitation in simulation environment.

Background: Clear family-centered communication is a foundation of practicing effective pediatric medicine. Formal communications training during residency is often limited and experience is mostly observational. Publications have shown that communication skills of trainees improve after a standardized curriculum, but family representatives were not included. In July 2019 we launched a communications curriculum for pediatric residents anchored in tenants of family-centered care that incorporates Family Faculty (FF), trained parents of patients cared for at our children's hospital.
Objective(s): To investigate how FF assessment of learners in an objective structured clinical exam (OSCE) differs from the gold standard of Standardized Patient (SP) assessment.
Method(s): We designed an OSCE in which the resident disclosed a medical error to a SP (playing a patients parent). The SP was trained in character portrayal and checklist completion. The 10-minute encounter was observed by an experienced clinician (EC) and FF through one-way glass, followed by a 20 minute debrief with the learner, SP, EC and FF. The SP, EC and FF all completed a 23-item behavioral anchored checklist that reflected 5 core competencies of family centered communication. Items were rated as not done, partly done or well-done, with well-done indicating mastery.
Result(s): 52 residents participated in the OSCE and 42 consented to study participation. The overall average % of learners considered to achieve mastery in each competency was lower as assessed by the FF vs SP: respect and value (50%vs.70%), information sharing (48%vs.67%), participation in care and decision making (40%vs.70%), follow-up (47%vs.60%), and team work (33%vs.52%).
Conclusion(s): Across all 5 competencies a lower % of learners reached skill mastery when assessed by FF as compared to SP. Involving FF in the evaluative and instructive components of the curriculum offers a more holistic approach and integrates true stakeholders in parent-physician communication. This initial data suggests that the resources needed to include FF in communications training is likely worthwhile.
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