Cindy K Barney

Intermountain Medical Center, Salt Lake City, Utah, United States

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Publications (6)5.77 Total impact

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    ABSTRACT: Safely reducing the proportion of very low birth weight neonates (<1500 g) that receive a red blood cell (RBC) transfusion would be an advance in transfusion practice. We performed a prospective, single-centered, case-control, feasibility analysis, preparatory to designing a definitive trial. Specifically, we sought to determine whether we could obtain all baseline neonatal intensive care unit blood tests from the placenta, after placental delivery, thereby initially drawing no blood from the neonate. Ten cases where all baseline blood tests were drawn from the placenta, and 10 controls where all tests were drawn from the neonate, were closely matched for birth weight, gestational age, sex, and race. Early cord clamping was used for all 20. Over the first 18 hours the hemoglobin increased in nine cases versus two controls (p = 0.005). During the first 72 hours one case versus five controls qualified for and received an RBC transfusion. In the first week the cases received four transfusions and the controls received 16 (p = 0.02). None of the cases had an intraventricular hemorrhage (IVH) but four of the controls had a Grade 1 and two had a Grade 3 (p = 0.01). We speculate that this method is feasible and generally postpones the first RBC transfusion until beyond the period of peak vulnerability to IVH.
    Transfusion 02/2011; 51(2):253-8. · 3.53 Impact Factor
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    ABSTRACT: Evidence is needed to guide NICU use of lansoprazole (Prevacid), ranitidine (Zantac), and metoclopramide (Reglan). As a step toward that goal, we conducted a historic cohort analysis of all patients who received any of these medications in 4 Intermountain Healthcare NICUs during the year 2006. Data were obtained from all patients admitted between January 1 and December 31, 2006, to any of 4 Intermountain Healthcare NICUs. This was a retrospective descriptive design. Data were obtained from electronic pharmacy records and electronic medical records. The NICUs involved were blinded and included McKay-Dee Hospital Center, Ogden, Utah; LDS Hospital, Salt Lake City, Utah; Utah Valley Regional Medical Center, Provo, Utah; and Dixie Regional Medical Center, St George, Utah. Although the demographics of the patients at the 4 centers were similar, significant differences were seen among the centers in drug use patterns. Lansoprazole use ranged from a high of 17% of patients in one center to a low of 7% of patients in another. Ranitidine use ranged from 9% in one center to 1% in another. Metoclopramide use ranged from 9% of patients in one center to <1% in another. The extreme variability among the centers in use patterns of these 3 medications suggests lack of an adequate evidence base to guide practice and indicates that case controlled studies or random controlled trials are needed to devise a consistent evidence-based approach.
    Advances in Neonatal Care 06/2009; 9(3):129-31.
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    ABSTRACT: Neonatal alloimmune thrombocytopenia (NAIT) occurs when maternal antibodies are directed against antigens on fetal and paternal but not maternal platelets. Most cases of NAIT arise when platelets of the father (and the fetus) express the human platelet antigen (HPA)1a and the mother's platelets expresses HPA-1b. A female patient presented with congenital severe thrombocytopenia and received 4 platelet transfusions, on days 2, 7, 16, and 28. This appeared to be a case of NAIT; however, extensive serologic evaluation by 2 reference laboratories failed to reveal the offending platelet antigen. Consistent with NAIT, the condition resolved by 6 weeks of age. By patient day of life 42, the platelet count had increased without additional need for transfusions, and by 16 weeks, the patient had a completely normal platelet count of 437,000/microL. The patient's platelet count remains normal at a 2-year follow-up. This case is reported as an instructive atypical case of NAIT, in which the relevant platelet antigen could not be identified.
    Advances in Neonatal Care 05/2007; 7(2):66-8.
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    ABSTRACT: Feeding intolerance is a common problem in the neonatal intensive care unit (NICU) and some cases might be causally related to atrophic changes in the small bowel mucosa. We speculated that for such patients, feeding tolerance might improve after oral administration of enterocyte growth factors in a sterile, isotonic solution patterned after amniotic fluid. Twenty neonates meeting criteria for feeding intolerance were eligible for this trial. They were randomized to either Group 1 (test solution) or Group 2 (control). Group 1 received 2.5 ml of test solution/kg every 3 h by oral-gastric or nasal-gastric (OG/NG) tube. This was begun when the patient was NPO because of feeding intolerance and continued until 80 ml/k/day of milk feedings were tolerated, or for a maximum of 7 days. Group 2 received a sham OG/NG administration every 3 h, until 80 ml/k/day of milk feedings were tolerated, or for a maximum of 7 days. Only the bedside nurse and the NICU pharmacist were aware which patients received the test solution and which received the sham administrations. The volumes of milk feedings were increased by order of the attending neonatologist and nurse practitioner. The study outcome was enteral calories/kg/day during and for 7 days after the cessation of the treatments. Eleven patients were randomized to receive the test solution and nine to receive sham administrations. At study entry, the two groups were not different in gestational age, postnatal age, signs of feeding intolerance or cal/k/day taken enterally during the previous 3 days. The study doses were given for an average of just under 6 days (range, 2 to 7 days). During the week following the administrations, the test solution recipients trended toward more enteral calories. Specifically, they had an increase averaging 78+/-20.8 cal/k/day more than before the study, whereas the sham recipients had an increase averaging 55.9+/-33 cal/k/day more than before the study (P=0.05 for a one-sided test and P=0.10 for a two-sided test). The test solution recipients also had a trend toward fewer formula changes than did the sham recipients (P=0.10). In this small, randomized, controlled, masked trial, the administration of a sterile, non-caloric, growth factor containing solution patterned after human amniotic fluid was associated with trends that we interpret as reflecting better tolerance of milk feedings. On this basis, we suggest that a phase III efficacy trial should be accomplished, using the present data for sample size calculations.
    Journal of Perinatology 02/2007; 27(1):28-31. · 2.25 Impact Factor
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    ABSTRACT: Feeding intolerance is a common problem in neonates; in some cases it may be related to atrophic changes in the small bowel mucosa. In these infants, feeding tolerance might improve after oral administration of enterocyte growth factors in a sterile, isotonic, noncaloric solution patterned after human amniotic fluid. Ten infants who met the study criteria for feeding intolerance were enrolled in this pilot trial. The test solution was administered, 2.5 mL/kg every 3 hours, until 80 mL/kg/day of milk feedings were tolerated, or for a maximum of 7 days. When milk feedings were prescribed, they were mixed with the test solution. Volumes of milk feedings were increased in amounts determined by the attending neonatologist and neonatal nurse practitioner. The outcome was the net average enteral kilocalories per kilogram of body weight per day (kcal/kg/day) for 3 periods: (1) the 3 days before the test treatment was begun, (2) the days the test treatment was administered, and (3) the 7 days following cessation of the test treatment. At study entry the infants' chronological ages ranged from 3 to 65 days. All infants tolerated the test solution, which was given for a mean of 5 days (range 3 to 7 days). During that period, the infants received more enteral calories (mean 18 kcal/kg/day, range 1 to 32) than during the preceding 3 day period (mean 3 kcal/kg/day, range 0 to 7, P < 0.05). During the 7 days following the test treatment the infants received 87 enteral kcal/kg/day (range 11 to 109, P < 0.02 compared to the treatment period). In this Phase 1 pilot trial, 10 heterogeneous infants in the neonatal intensive care unit with feeding intolerance had a significant increase in milk feedings after treatment with a sterile, isotonic, noncaloric solution patterned after human amniotic fluid.
    Advances in Neonatal Care 05/2006; 6(2):89-95.
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    ABSTRACT: Certain growth factors exist in relatively high concentrations in fluids swallowed by the fetus and neonate; namely amniotic fluid, colostrum, and human milk. We postulated that; 1) after these factors are swallowed they are not enterally digested into non-functional units, but remain biologically active, 2) the ingested factors bind to specific receptors on the luminal surface of villous enterocytes where they exert a topical antiapoptotic effect, 3) the ingested factors are not absorbed into the blood and have no systemic effect, 4) when a fetus is delivered prematurely and amniotic fluid swallowing abruptly ceases, if the patient is NPO (thus receiving no growth factors from colostrum or milk) disuse atro- phy of the small bowel mucosa can begin, leading to feeing intolerance once milk feed- ings are started. We developed a sterile, isotonic, growth factor-containing solution, sim- ulating second trimester amniotic fluid. We called the fluid SAFEstart® (an acronym for Simulated, Amniotic Fluid for Enteral administration); a patent was obtained by the Uni- versity of Florida. The growth factors contained in SAFEstart were concentrated 10 fold above natural amniotic fluid, so that 20 mL/k/d of SAFEstart would provide the amount of growth factors ingested by a fetus swallowing 200 mL/k/d of amniotic fluid. Preclini- cal studies on stability and digestion were followed by six clinical trials. Whether mixed with human milk, preterm infant formulas, or kept by itself, SAFEstart was stable for at least three weeks frozen, with only minimal and gradual degradation of activity in the weeks thereafter. No evidence of absorption of factors into the blood and no systemic effects were observed after usage. Four clinical trials have examined its use to prevent feeding intolerance and two additional trials have examined its treatment use among neonates with established feeding intolerance. CONCLUSIONS: One hundred-twenty neonates have now participated in six SAFEstart trials. It is feasible to administer 20 mL/k/d of SAFEstart (2.5 mL/k every 3 h) to ill preterm neonates, and it is well tolerated, with no safety issues uncovered to date. Early controlled studies suggest efficacy in pre- venting feeding intolerance and also in treating established feeding intolerance, presum- ably by topical actions of relevant growth factors on the small bowel mucosa. Multicen- tered randomized, placebo controlled trials are now needed to estimate the risks and benefits of administering SAFEstart to neonates who are otherwise NPO.