Publications (32) View all
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Article: Parental Perception of Functional Status Following Tracheostomy in Infancy: A Single Center Study.
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ABSTRACT: OBJECTIVE: To examine the functional outcomes of children who underwent a tracheostomy in the initial hospitalization after birth and to determine their correlates. STUDY DESIGN: We administered the validated 43-item Functional Status-II (FS-II) questionnaire by Stein and Jessop over the telephone to caregivers of surviving children. The FS-II items generated a total score, age-specific: (1) total; (2) general health (GH); and (3) responsiveness, activity, or interpersonal functioning (IPF) scores in specific age group categories. RESULTS: FS-II was administered to 51/62 (82.2%) survivors at a median (range) age of 5 (1-10) years; 27% children were on the ventilator and 43% required devices. About 40% of children had a median of 1 (1-4) hospitalization in the previous 6 months. Scores were >2 SD below means in 55%, 24%, and 55% cases for age-specific T, GH, and R/A/IPF scores respectively. The T and R/A/IPF scales were significantly higher in those with private, rather than public, maternal insurance, as were T and R/A/IPF scores for children ≥4 years, compared with younger children. On regression analysis, FS-II T, GH, and R/A/IPF scores were independently associated with maternal private insurance (P = .02). R/A/IPF scores were also significantly associated with corrected age at FS-II administration. CONCLUSIONS: One-third of surviving children who underwent tracheostomy during their initial hospitalization remained technology-dependent. The parental FS-II questionnaires revealed low R/A/IPF scores, especially at younger ages and in those with maternal public insurance. Further research on family-level interventions to improve functional outcomes in this population is warranted.The Journal of pediatrics 05/2013; · 4.02 Impact Factor -
Article: Neurodevelopmental Outcome of Extremely Premature Infants Exposed to Incomplete, No or Complete Antenatal Steroids.
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ABSTRACT: Abstract Objective: To compare the neurodevelopmental outcomes at 18-22 months' corrected age of extremely premature infants exposed to a complete course, an incomplete course or no dose of antenatal steroids (ANS). Methods: Retrospective chart review of extremely premature (< 28 weeks gestational age) neonates over a 3 year period. Neurodevelopmental assessment at 18-22 months' corrected age included a standardized neurologic examination and the Bayley Scales of Infant and Toddler development II or III. Intact survival was defined as survival without cerebral palsy, blindness or deafness and mental developmental index (MDI) /cognitive score > 85. Neurodevelopmental impairment (NDI) was defined as any of: moderate or severe cerebral palsy (CP), MDI/cognitive score < 70, deafness or blindness. Patients were categorized into 3 groups: A) No ANS; B) Incomplete course; and C) Complete course of ANS. Results: Outcome data were available for 134 (88%) patients of our cohort (n=153). Severe intraventricular hemorrhage (IVH) was significantly lower and intact survival higher in the complete ANS group (p<0.01). On logistic regression, with gestational age, gender, maternal insurance and ANS exposure as covariates, an incomplete (vs. complete) course of ANS (p=0.006) and gestational age were significantly associated with lower intact survival at 18-22 months. Conclusions: A complete course of ANS was associated with an increased likelihood of intact survival at a corrected age of 18-22 months among extremely premature infants, compared with an incomplete course. Follow-up studies should account for the differential benefit of complete versus incomplete course of ANS administration.The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 04/2013; · 1.36 Impact Factor -
Article: Single-center Experience of Outcomes of Tracheostomy in Children with Congenital Heart Disease.
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ABSTRACT: OBJECTIVE.: A subset of children with repaired congenital heart disease (CHD) may require tracheostomy for ongoing ventilatory support. Data on outcomes of children with CHD and tracheostomy are scarce. Our objectives were to describe indications for tracheostomy and outcomes, including readmission data in this population. METHODS.: This is a retrospective chart review of children (<18 years old) with CHD who underwent tracheostomy at a single center over a 12-year period. Exclusion criteria were prematurity with isolated patent ductus arteriosus ligation. Outcomes until discharge and data on all readmissions after the initial discharge were reviewed. RESULTS.: A total of 21 subjects with CHD underwent tracheostomy at a median (range) age of 4 (1-84) months and mean (standard deviation) weight of 7.2 (5.9) kg. The most common indication for tracheostomy was tracheomalacia with ventilator-dependent respiratory failure (14/21 subjects), followed by subglottic stenosis (5) and vocal cord palsy (2). Genetic syndromes were present in 13 (62%) subjects. The mean (standard deviation) post-tracheostomy length of stay was 55 (35) days. All subjects survived to discharge; 17 (81%) required home ventilation. A total of 11 (52%) subjects died during follow-up, all of whom were mechanically ventilated while three (14%) children underwent successful decannulation. The mean number of nonelective readmissions decreased from 2.4/patient-year in the first year to 1.4/patient-year in the second year, respectively. The commonest reasons for readmission were respiratory deterioration, infections, and mechanical tracheostomy-related problems. CONCLUSIONS.: The majority of children with CHD who underwent tracheostomy did so for ventilator dependence and tracheomalacia and had coexisting genetic syndromes. About half the cohort died; among survivors, readmissions were common but decreased after the first year. These results underscore the ongoing mortality and morbidity risks faced by this vulnerable population.Congenital Heart Disease 03/2013; · 0.90 Impact Factor -
Article: Congenital absence of bilateral common carotid arteries.
The Annals of thoracic surgery 02/2013; 95(2):719. · 3.74 Impact Factor -
Article: Improving admission temperature in extremely low birth weight infants: a hospital-based multi-intervention quality improvement project.
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ABSTRACT: Abstract Objective: To reduce the incidence of hypothermia (admission temperatures <36°C) in extremely low birth weight (ELBW) neonates using a multi-intervention quality improvement (QI) initiative. Study design: We conducted a multi-intervention QI initiative to reduce hypothermia (admission temperatures <36°C) among preterm ELBW (≤1000 g birth weight) neonates born at Hutzel Women's Hospital. The QI project was conducted in three periods: period 1, traditional thermal care of drying and wrapping in towel; period 2, wrapping in plastic wrap without first drying; and period 3, periodic staff education, additional use of chemical warming mattress, and increase in operating room temperature from 20°C to 21°C. Statistical analysis included ANOVA, χ2, and logistic regression as appropriate. Results: In our cohort of 209 patients, baseline characteristics were comparable in the three periods except for a reduction in the need for surfactant doses in the 3rd period. Temperature on admission to the neonatal intensive care unit was significantly higher, with a reduction in hypothermia in the 3rd period. There was no patient with a temperature of ≥37.5°C. On logistic regression, with gestational age, 5-min Apgar score, and mode of delivery as covariates, time period 3 was significantly associated with a reduction in the incidence of hypothermia (P=0.02). Conclusion: A concerted QI approach improved admission temperature in ELBW neonates, with more neonates in the euthermic range, without increasing the risk for hyperthermia. Such an approach could be associated with improved outcomes in this population.Journal of Perinatal Medicine 01/2013; · 1.70 Impact Factor
