Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry
Hudak, Mark L; Falnnery, Dustin D; Barnette, Kimberly; Getzlaff, Trace; Gautam, Shiva; Dhudasia, Miren B; Mukhopadhyay, Sagori; Pfeifer, Madeline R; Ellington, Sascha R; Galang, Romeo R; Snead, Margaret C; Woodworth, Kate R; Zapata, Lauren B; Puopolo, Karen M; [Verma, Sourabh; Auyeung, NS Freda; Vaz, Michelle]
Developing a new pediatric extracorporeal membrane oxygenation (ECMO) program
Cicalese, Erin; Meisler, Sarah; Kitchin, Michael; Zhang, Margaret; Verma, Sourabh; Dapul, Heda; McKinstry, Jaclyn; Toy, Bridget; Chopra, Arun; Fisher, Jason C
OBJECTIVES/OBJECTIVE:We aimed to critically evaluate the effectiveness of a designated ECMO team in our ECMO selection process and patient outcomes in the first 3 years of our low-volume pediatric ECMO program. METHODS:We conducted a retrospective chart review of patients who received an ECMO consultation between the start of our program in March 2015 and May 2018. We gathered clinical and demographic information on patients who did and did not receive ECMO, and described our selection process. We reflected on the processes used to initiate our program and our outcomes in the first 3 years. RESULTS:, lactate, and pH between the patients who went on ECMO and who did not. We improved our outcomes from 0% survival to discharge in 2015, to 60% in 2018, with an average of 63% survival to discharge over the first 3 years of our program. CONCLUSIONS:In a low-volume pediatric ECMO center, having a designated team to assist in the patient selection process and management can help provide safe and efficient care to these patients, and improve patient outcomes. Having a strict management protocol and simulation sessions involving all members of the medical team yields comfort for the providers and optimal care for patients. This study describes our novel structure, processes, and outcomes, which we hope will be helpful to others seeking to develop a new pediatric ECMO program.
Mother to Newborn Transmission of SARS-CoV-2 Infection: Evolution of Evidence in 1.5 Years of COVID-19 Pandemic
Gupta, Arpit; Kamity, Ranjith; Sharma, Rishika; Caprio, Martha; Mally, Pradeep; Verma, Sourabh
Coronavirus disease 2019 (COVID-19) pandemic caused significant mortality and morbidity in people of all age groups worldwide. Given the uncertainty regarding the mode of transmission and potential effects of COVID-19 on pregnant mothers and their newborns, guidelines for taking care of maternal-newborn dyads have evolved tremendously since the pandemic began. There has been an enormous influx of published materials regarding the outcomes of mothers and newborns. Still, multiple knowledge gaps regarding comprehensive information about risk to the mothers and newborns exist, which need to be addressed. Current evidence suggests that mothers with symptomatic COVID-19 infection are at increased risk of severe illness during pregnancy, with a higher need for respiratory support and premature deliveries. Neonates born to mothers with COVID-19 are at increased risk of needing intensive care; however, most newborns do well after birth. As new mutant variants arise, we need to be cautious while proactively understanding any new evolving patterns. All leading health authorities strongly recommend COVID-19 vaccination before or during pregnancy to reduce the risk of maternal morbidities and benefit from passing antibodies to newborns prenatally and via breastmilk. Additionally, there are racial, ethnic, and socioeconomic disparities in outcomes and vaccination coverage for pregnant women. This article summarizes the rapidly evolving evidence for the last 1.5 years and aims to help health care professionals care for mothers with COVID-19 and their newborns. KEY POINTS: Â· COVID-19 in pregnancy can cause perinatal morbidities.. Â· Breastfeeding and breast milk are safe for newborns.. Â· COVID-19 vaccination reduces the risk for morbidities..
Near-infrared spectroscopy in the medical management of infants
Bailey, Sean M; Prakash, Shrawani Soorneela; Verma, Sourabh; Desai, Purnahamsi; Kazmi, Sadaf; Mally, Pradeep V
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.
Impact on neonatal morbidities after a change in policy to administer antenatal corticosteroids to mothers at risk for late preterm delivery
Mally, Pradeep; Katz, Julia; Verma, Sourabh; Purrier, Sheryl; Wachtel, Elena V; Trillo, Rebecca; Bhutada, Kiran; Bailey, Sean M
OBJECTIVES/OBJECTIVE:Antenatal corticosteroids (ACS) administered to mothers at risk for preterm delivery before 34Â weeks has been standard care to improve neonatal outcomes. After introducing a new obstetric policy based on updated recommendations advising the administration of ACS to pregnant women at risk for late preterm (LPT) delivery (34-36 6/7Â weeks), we set out to determine the short-term clinical impact on those LPT neonates. METHODS:Retrospective chart review of LPT neonates delivered at NYU Langone Medical Center both oneÂ year before and after the policy went into place. We excluded subjects born to mothers with pre-gestational diabetes, multiple gestations, and those with congenital/genetic abnormalities. We also excluded subjects whose mothers already received ACS previously in pregnancy. Subjects were divided into pre-policy and post-policy groups. Neonatal and maternal data were compared for both groups. RESULTS:388 subjects; 180 in the pre-policy and 208 in the post-policy group. This policy change resulted in a significant increase in ACS administration to mothers who delivered LPT neonates (67.3 vs. 20.6%, p<0.001). In turn, there was a significant reduction in LPT neonatal intensive care unit (NICU) admissions (44.2 vs. 54.4%, p=0.04) and need for respiratory support (27.9 vs. 42.8%, p<0.01). However, we also found an increased incidence of hypoglycemia (49.5 vs. 28.3%, p<0.001). CONCLUSIONS:This LPT ACS policy appears effective in reducing the need for LPT NICU level care overall. However, clinicians must be attentive to monitor for adverse effects like hypoglycemia, and there remains a need for better understanding of potential long-term impacts.
Visitor restriction during the COVID-19 pandemic did not impact rates of Staphylococcus aureus colonization in the NICU patients
Evans, Hailey Zie; Bailey, Sean; Verma, Sourabh; Cicalese, Erin
OBJECTIVES/OBJECTIVE:colonization rates before and after the visitor policy change, which coincided with the exponential riseÂ of COVID-19 cases in New York City (NYC). METHODS:colonization. RESULTS:=0.02). CONCLUSIONS:colonization rate. Hospital unit leaders may need to focusÂ on other strategies in order to reduce colonization.
Effects of Inhaled Iloprost for the Management of Persistent Pulmonary Hypertension of the Newborn
Verma, Sourabh; Lumba, Rishi; Kazmi, Sadaf H; Vaz, Michelle J; Prakash, Shrawani Soorneela; Bailey, Sean M; Mally, Pradeep V; Randis, Tara M
OBJECTIVE:â€ƒThe study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN/METHODS:) were recorded. RESULTS:â€‰<â€‰0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost. CONCLUSION/CONCLUSIONS:â€ƒInhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone. KEY POINTS/CONCLUSIONS:Â· Inhaled iloprost seems to have beneficial effects in improving oxygenation indices in PPHN.. Â· Inhaled iloprost is generally well tolerated in newborns with PPHN.. Â· There is a need for prospective RCTs to further ascertain the benefits of using inhaled iloprost..
Implementation and outcomes of a standard dose dextrose gel protocol for management of transient neonatal hypoglycemia
Desai, Purnahamsi; Verma, Sourabh; Bhargava, Sweta; Rice, Marissa; Tracy, Joanna; Bradshaw, Chanda
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)â€‰â‰¥â€‰35 weeks admitted to the nursery over 3 years. RESULTS:There was reduction in IV dextrose use 10.9% vs 6.5% (pâ€‰=â€‰0.004) and NICU admissions 27.9% vs 16.1% (pâ€‰<â€‰0.001) associated with DG use, and increased rate of breastfed infants 33.8% vs 43.5% (pâ€‰=â€‰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.
Identification and Treatment of Neonatal Seizures During Therapeutic Hypothermia and Rewarming
Verma, Sourabh; Bailey, Sean M; Mally, Pradeep V
Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry
Bhalala, Utpal S; Gist, Katja M; Tripathi, Sandeep; Boman, Karen; Kumar, Vishakha K; Retford, Lynn; Chiotos, Kathleen; Blatz, Allison M; Dapul, Heda; Verma, Sourabh; Sayed, Imran A; Gharpure, Varsha P; Bjornstad, Erica; Tofil, Nancy; Irby, Katherine; Sanders, Ronald C; Heneghan, Julia A; Thomas, Melissa; Gupta, Manoj K; Oulds, Franscene E; Arteaga, Grace M; Levy, Emily R; Gupta, Neha; Kaufman, Margit; Abdelaty, Amr; Shlomovich, Mark; Medar, Shivanand S; Iqbal O'Meara, A M; Kuehne, Joshua; Menon, Shina; Khandhar, Paras B; Miller, Aaron S; Barry, Suzanne M; Danesh, Valerie C; Khanna, Ashish K; Zammit, Kimberly; Stulce, Casey; McGonagill, Patrick W; Bercow, Asher; Amzuta, Ioana G; Gupta, Sandeep; Almazyad, Mohammed A; Pierre, Louisdon; Sendi, Prithvi; Ishaque, Sidra; Anderson, Harry L; Nawathe, Pooja; Akhter, Murtaza; Lyons, Patrick G; Chen, Catherine; Walkey, Allan J; Bihorac, Azra; Wada Bello, Imam; Ben Ari, Judith; Kovacevic, Tanja; Bansal, Vikas; Brinton, John T; Zimmerman, Jerry J; Kashyap, Rahul
OBJECTIVES:Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN:Retrospective study. SETTING:Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS:Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4â€‰kg/m2 (16-25.8â€‰kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS:In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.