Jeffrey M Perlman

Weill Cornell Medical College, New York, New York, United States

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Publications (214)999.2 Total impact

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    ABSTRACT: To determine whether specific medical conditions and/or fetal compromise during labor are associated with fresh stillbirth (FSB), and whether absent fetal heart rate (FHR) before delivery can increase risk of FSB. An observational cohort study was conducted at three university referral hospitals in Tanzania between January and September 2013. Maternal, labor, and neonatal characteristics were recorded for all deliveries. FSB was defined as an Apgar score of 0 at 1 and 5minutes, with intact skin and suspected death during labor or delivery. Among 15 305 deliveries, there were 499 stillbirths (243 FSBs and 256 macerated stillbirths). Stillbirth was significantly more likely than a live birth after maternal transfer (odds ratio [OR] 3.27; 95% confidence interval [CI] 2.73-3.92; P<0.001) and when FHR was absent (OR 996.29; 95% CI 632.19-1570.09; P<0.001). Risk of stillbirth increased with uterine rupture (OR 138.62; 95% CI 60.73-316.44), placental abruption (OR 40.96; 95% CI 28.97-57.91), cord prolapse (OR 13.49; 95% CI 6.97-26.11), and prematurity (OR 6.87; 95% CI 4.71-10.03; P<0.001 for all). In low-resource settings, FSB may be prevented by using a combined strategy of clinical risk identification, early detection of abnormal FHR, and expedited delivery. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 03/2015; DOI:10.1016/j.ijgo.2015.01.012 · 1.56 Impact Factor
  • Jeffrey M Perlman
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    ABSTRACT: Asystole at birth and extending through 10 min is rare, with current international recommendations stating it may be appropriate to consider discontinuation of resuscitation in this clinical scenario. These recommendations are based on small case series of both term and preterm infants, where death or abnormal outcome was nearly universal. Study objective was to determine recent outcome of infants with an Apgar score of 0 at 10 min despite cardiopulmonary resuscitation, treated with therapeutic hypothermia or standard treatment, in randomised cooling studies.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 10/2014; DOI:10.1136/archdischild-2014-306687 · 3.86 Impact Factor
  • Trang Huynh, Rae Jean Hemway, Jeffrey M Perlman
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    ABSTRACT: Delivery room cardiopulmonary resuscitation is rare. Recent evidence suggests that effective ventilation may be compromised during chest compressions (CC).
    Archives of Disease in Childhood - Fetal and Neonatal Edition 09/2014; DOI:10.1136/archdischild-2014-306309 · 3.86 Impact Factor
  • Jeffrey Perlman
    Obstetrics and Gynecology 09/2014; 124(3):635. DOI:10.1097/AOG.0000000000000439 · 4.37 Impact Factor
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    ABSTRACT: Evolving data indicate that cord clamping (CC) beyond 30 to 60 seconds after birth is of benefit for all infants. Recent experimental data demonstrated that ventilation before CC improved cardiovascular stability by increasing pulmonary blood flow. The objective was to describe the relationship between time to CC, onset of spontaneous respirations (SR), and 24-hour neonatal outcome.METHODS: In a rural Tanzanian hospital, trained research assistants, working in shifts, have observed every delivery (November 2009-February 2013) and recorded data including time interval from birth to SR and CC, fetal heart rate, perinatal characteristics and outcome (normal, death, admission).RESULTS: Of 15 563 infants born, 12 780 (84.3%) initiated SR at 10.8 ± 16.7 seconds, and CC occurred at 63 ± 45 seconds after birth. Outcomes included 12 730 (99.7%) normal, 31 deaths, and 19 admitted; 11 967 were of birth weight (BW) ≥2500 g and 813 <2500 g. By logistic modeling, the risk of death/admission was consistently higher if CC occurred before SR. Infants of BW <2500 g were more likely to die or be admitted. The risk of death/admission decreased by 20% for every 10-second delay in CC after SR; this risk declined at the same rate in both BW groups.CONCLUSIONS: Healthy self-breathing neonates are more likely to die or be admitted if CC occurs before or immediately after onset of SR. These clinical observations support the experimental findings of a smoother cardiovascular transition when CC is performed after initiation of ventilation.
    Pediatrics 07/2014; 134(2). DOI:10.1542/peds.2014-0467 · 5.30 Impact Factor
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    ABSTRACT: The Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania.
    PLoS ONE 07/2014; 9(7):e102080. DOI:10.1371/journal.pone.0102080 · 3.53 Impact Factor
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    ABSTRACT: Moderate hypothermia (temperature <36°C) at birth is common in premature infants and is associated with increased mortality and morbidity. A multidisciplinary practice plan was implemented to determine in premature infants <35 weeks old whether a multifaceted approach would reduce the number of inborn infants with an admitting axillary temperature <36°C by 20% without increasing exposure to a temperature >37.5°C. The plan included use of occlusive wrap a transwarmer mattress and cap for all infants and maintaining an operating room temperature between 21°C and 23°C. Data were obtained at baseline (n = 66), during phasing in (n = 102), and at full implementation (n = 193). Infant axillary temperature in the delivery room (DR) increased from 36.1°C ± 0.6°C to 36.2°C ± 0.6°C to 36.6°C ± 0.6°C (P < .001), and admitting temperature increased from 36.0°C ± 0.8°C to 36.3°C ± 0.6°C to 36.7°C ± 0.5°C at baseline, phasing in, and full implementation, respectively (P < .001). The number of infants with temperature <36°C decreased from 55% to 6.2% at baseline versus full implementation (P < .001), and intubation at 24 hours decreased from 39% to 17.6% (P = .005). There was no increase in the number of infants with a temperature >37.5°C over time. The use of occlusive wrap, mattress, and cap increased from 33% to 88% at baseline versus full implementation. Control charts showed significant improvement in DR ambient temperature at baseline versus full implementation. The practice plan was associated with a significant increase in DR and admitting axillary infant temperatures and a corresponding decrease in the number of infants with moderate hypothermia. There was an associated reduction in intubation at 24 hours. These positive findings reflect increased compliance with the practice plan.
    PEDIATRICS 03/2014; 133(4). DOI:10.1542/peds.2013-2544 · 5.30 Impact Factor
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    ABSTRACT: Hippocampal injury is most often observed in conjunction with basal ganglia injury after hypoxia-ischemia in term newborns. Objective was to determine perinatal characteristics leading to selective hippocampal injury vs basal ganglia injury on diffusion-weighted imaging in term encephalopathic infants following intrapartum hypoxia-ischemia treated with selective head cooling and to correlate specific injury to subsequent neurodevelopmental outcome. Retrospective chart review of obstetric and/or perinatal risk factors and patient characteristics in term infants treated with selective head cooling. All infants met standard enrollment criteria for cooling. MRI was obtained at a median of 7 days of life. Abnormal outcome was defined as spastic quadriplegia, cognitive delay, both, or death. Fifty-seven infants were included for analysis. Diffusion-weighted imaging findings included normal (n = 31), basal ganglia injury (n = 16), and selective hippocampal injury (n = 10). No differences in gestational age, birth weight, sex, or labor complications between groups. More infants in the basal ganglia vs hippocampal group required delivery room cardiopulmonary resuscitation (P = 0.05), exhibited persistent severe acidosis, severe amplitude electroencephalography suppression, and encephalopathy at birth (P < 0.05). Abnormal neurodevelopmental outcome or death was observed in 88% vs 10% of infants in the basal ganglia vs the hippocampal group, respectively (P = 0.0001). Infants with hippocampal injury on diffusion-weighted imaging recovered from an intrapartum asphyxial insult more rapidly as reflected by an earlier correction of acid-base status, were less likely to need cardiopulmonary resuscitation, and were less severely encephalopathic. These findings highlight the exquisite vulnerability of the hippocampus to acute hypoxia unaffected by selective head cooling, whereas the normal appearance of the basal ganglia in these infants suggests a neuroprotective effect of cooling.
    Pediatric Neurology 03/2014; 51(1). DOI:10.1016/j.pediatrneurol.2014.03.002 · 1.50 Impact Factor
  • Ericalyn Kasdorf, Murray Engel, Linda Heier, Jeffrey M. Perlman
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    ABSTRACT: Background Hippocampal injury is most often seen in conjunction with basal ganglia (BG) injury following hypoxia-ischemia in term newborns. Objective was to determine perinatal characteristics leading to selective hippocampal injury versus BG injury on diffusion-weighted imaging (DWI) in term encephalopathic infants following intrapartum hypoxia-ischemia treated with selective head cooling (SHC), and to correlate specific injury to subsequent neurodevelopmental outcome. Methods Retrospective chart review of obstetric/perinatal risk factors and patient characteristics in term infants treated with SHC. All infants met standard enrollment criteria for cooling. MRI was obtained at a median of 7 days of life. Abnormal outcome was defined as spastic quadriplegia, cognitive delay, both, or death. Results 57 infants were included for analysis. DWI findings included normal (n=31), BG injury (n=16), and selective hippocampal injury (n=10). No differences in gestational age, birthweight, sex or labor complications between groups. More infants in the BG vs. hippocampal group required delivery room CPR (p=0.05), exhibited persistent severe acidosis, severe amplitude EEG suppression, and encephalopathy at birth (p <0.05). Abnormal neurodevelopmental outcome or death was seen in 88% vs. 10% of infants in the BG vs. the hippocampal group respectively (p=0.0001). Conclusions Infants with hippocampal injury on DWI recovered from an intrapartum asphyxial insult more rapidly as reflected by an earlier correction of acid-base status, without the need for CPR, and were less severely encephalopathic. These findings highlight the exquisite vulnerability of the hippocampus to acute hypoxia unaffected by SHC, whereas the normal appearance of the basal ganglia in these infants suggests a neuroprotective effect of cooling.
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    ABSTRACT: Objective: To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool. Methods: Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool. Results: The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%). Discussion: During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved. Conclusion: To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges.
    Applied Clinical Informatics 01/2014; 5(2):368-87. DOI:10.4338/ACI-2013-09-RA-0069 · 0.39 Impact Factor
  • Ericalyn Kasdorf, Jeffrey M Perlman
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    ABSTRACT: Hypoxia-ischemia is an infrequent event which may occur prior to or during delivery, following a period of decreased placental and/or fetal blood flow. Following recovery, a reperfusion phase and secondary energy failure may occur 6-48 h subsequent to the initial insult. Therapeutic hypothermia may be offered to infants at risk for evolving encephalopathy if identified within the 6 h therapeutic window, and should be instituted as early as possible for eligible infants. Additionally, the clinician must pay close attention to supportive measures such as avoidance of hyperthermia, as well as comprehensive management of clinical or electrographic seizures, blood pressure, blood glucoses, and carbon dioxide levels.
    Seminars in Fetal and Neonatal Medicine 09/2013; DOI:10.1016/j.siny.2013.08.004 · 3.13 Impact Factor
  • Ericalyn Kasdorf, Murray Engel, Jeffrey M Perlman
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    ABSTRACT: Recent studies suggest an increased risk of neurodevelopmental impairment following patent ductus arteriosus surgical ligation. The mechanisms are unclear, but intraoperative stress or pain may contribute. The objectives of this study were to determine if pain, evidenced by an increase in heart rate and blood pressure, during patent ductus arteriosus ligation would be accompanied by an increase in amplitude-integrated electroencephalogram (aEEG) voltage. This was an observational, pilot study of infants born at 22.6-35.1 weeks with patent ductus arteriosus requiring surgical ligation. The aEEG was recorded prior to, during surgery, and for 2 hours following surgery. Mean heart rate, blood pressure, and aEEG voltage were analyzed for each recording period. Seventeen preterm infants were studied at a mean postmenstrual age of 26.6 weeks. Following anesthetic induction, aEEG became suppressed and remained suppressed during the postoperative period. Heart rate and blood pressure increased significantly intraoperatively. The aEEG voltage did not increase with an increase in heart rate. Infants received between 3.7-47 μg/kg of fentanyl. There was no correlation between aEEG voltage and vital sign changes. aEEG is not a useful tool as a marker of pain during patent ductus arteriosus ligation, rather a more standardized approach to pain management should be considered.
    Pediatric Neurology 08/2013; 49(2):102-6. DOI:10.1016/j.pediatrneurol.2013.03.005 · 1.50 Impact Factor
  • Sithembiso Velaphi, Jeffrey Perlman
    The Lancet 07/2013; 382(9889). DOI:10.1016/S0140-6736(13)61052-1 · 39.21 Impact Factor
  • Ericalyn Kasdorf, Jeffrey M Perlman
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    ABSTRACT: Hyperthermia at the time of or following a hypoxic-ischemic insult has been associated with adverse neurodevelopmental outcome. Moreover, an elevation in temperature during labor has been associated with a variety of other adverse neurologic sequelae such as neonatal seizures, encephalopathy, stroke, and cerebral palsy. These outcomes may be secondary to a number of deleterious effects of hyperthermia including an increase in cellular metabolic rate and cerebral blood flow alteration, release of excitotoxic products such as free radicals and glutamate, and hemostatic changes. There is also an association between chorioamnionitis at the time of delivery and cerebral palsy, which is thought to be secondary to cytokine-mediated injury. We review experimental and human studies demonstrating a link between hyperthermia and perinatal brain injury.
    Pediatric Neurology 05/2013; 49(1). DOI:10.1016/j.pediatrneurol.2012.12.026 · 1.50 Impact Factor
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    ABSTRACT: OBJECTIVE: "Helping Babies Breathe" (HBB) is a simulation-based one-day course developed to help reduce neonatal mortality globally. The study objectives were to 1) determine the effect on practical skills and management strategies among providers using simulations seven months after HBB training, and 2) describe neonatal management in the delivery room during the corresponding time period before/after a one-day HBB training in a rural Tanzanian hospital. METHODS: The one-day HBB training was conducted by Tanzanian master instructors in April 2010. Two simulation scenarios; "routine care" and "neonatal resuscitation" were performed by 39 providers before (September 2009) and 27 providers after (November 2010) the HBB training. Two independent raters scored the videotaped scenarios. Overall "pass/fail" performance and different skills were assessed. During the study time period (September 2009-November 2010) no HBB re-trainings were conducted, no local ownership was established, and no HBB action plans were implemented in the labour ward to facilitate transfer and sustainability of performance in the delivery room at birth. Observational data on neonatal management before (n=2745) and after (n=3116) the HBB training was collected in the delivery room by observing all births at the hospital during the same time period. RESULTS: The proportion of providers who "passed" the simulated "routine care" and "neonatal resuscitation" scenarios increased after HBB training; from 41 to 74% (p=0.016) and from 18 to 74% (p≤0.0001) respectively. However, the number of babies being suctioned and/or ventilated at birth did not change, and the use of stimulation in the delivery room decreased after HBB training. CONCLUSION: Birth attendants in a rural hospital in Tanzania performed significantly better in simulated neonatal care and resuscitation seven months after one day of HBB training. This improvement did not transfer into clinical practice.
    Resuscitation 04/2013; 84(10). DOI:10.1016/j.resuscitation.2013.04.005 · 3.96 Impact Factor
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    ABSTRACT: resource-limited countries, including Tanzania. Without change, these countries will fail to meet Millennium Development Goal 4 targets by 2015. WHAT THIS STUDY ADDS: The Helping Babies Breathe program was implemented in 8 hospitals in Tanzania in 2009. It has been associated with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years. abstract BACKGROUND: Early neonatal mortality has remained high and un-changed for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic inter-ventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.
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    ABSTRACT: resource-limited countries, including Tanzania. Without change, these countries will fail to meet Millennium Development Goal 4 targets by 2015. WHAT THIS STUDY ADDS: The Helping Babies Breathe program was implemented in 8 hospitals in Tanzania in 2009. It has been associated with a sustained 47% reduction in early neonatal mortality within 24 hours and a 24% reduction in fresh stillbirths after 2 years. abstract BACKGROUND: Early neonatal mortality has remained high and un-changed for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic inter-ventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.
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    ABSTRACT: BACKGROUND:Early neonatal mortality has remained high and unchanged for many years in Tanzania, a resource-limited country. Helping Babies Breathe (HBB), a novel educational program using basic interventions to enhance delivery room stabilization/resuscitation, has been developed to reduce the number of these deaths.METHODS:Master trainers from the 3 major referral hospitals, 4 associated regional hospitals, and 1 district hospital were trained in the HBB program to serve as trainers for national dissemination. A before (n = 8124) and after (n = 78 500) design was used for implementation. The primary outcomes were a reduction in early neonatal deaths within 24 hours and rates of fresh stillbirths (FSB).RESULTS:Implementation was associated with a significant reduction in neonatal deaths (relative risk [RR] with training 0.53; 95% confidence interval [CI] 0.43-0.65; P ≤ .0001) and rates of FSB (RR with training 0.76; 95% CI 0.64-0.90; P = .001). The use of stimulation increased from 47% to 88% (RR 1.87; 95% CI 1.82-1.90; P ≤ .0001) and suctioning from 15% to 22% (RR 1.40; 95% CI 1.33-1.46; P ≤ .0001) whereas face mask ventilation decreased from 8.2% to 5.2% (RR 0.65; 95% CI 0.60-0.72; P ≤ .0001).CONCLUSIONS:HBB implementation was associated with a significant reduction in both early neonatal deaths within 24 hours and rates of FSB. HBB uses a basic intervention approach readily applicable at all deliveries. These findings should serve as a call to action for other resource-limited countries striving to meet Millennium Development Goal 4.
    PEDIATRICS 01/2013; 131(2). DOI:10.1542/peds.2012-1795 · 5.30 Impact Factor

Publication Stats

7k Citations
999.20 Total Impact Points

Institutions

  • 2004–2015
    • Weill Cornell Medical College
      • Department of Pediatrics
      New York, New York, United States
  • 2005–2014
    • New York Presbyterian Hospital
      • • Department of Pediatrics
      • • Department of Nursing
      New York, New York, United States
    • The Children's Hospital of Philadelphia
      Philadelphia, Pennsylvania, United States
  • 2010–2012
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
  • 2001–2010
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
    • University of Virginia
      Charlottesville, Virginia, United States
  • 2006–2009
    • Cornell University
      • Department of Pediatrics
      Итак, New York, United States
  • 2008
    • North Shore-LIJ Health System
      • Department of Pediatrics
      Manhasset, New York, United States
  • 1991–2005
    • University of Texas Southwestern Medical Center
      • • Department of Pediatrics
      • • Division of Neonatal-Perinatal Medicine
      • • Department of Radiology
      Dallas, TX, United States
  • 2001–2002
    • University of Texas at Dallas
      Richardson, Texas, United States
  • 1999
    • University of North Texas at Dallas
      Dallas, Texas, United States
    • Baylor University
      Waco, Texas, United States
  • 1995
    • Parkland Memorial Hospital
      Dallas, Texas, United States
  • 1981–1992
    • Washington University in St. Louis
      • Department of Pediatrics
      San Luis, Missouri, United States
  • 1984
    • Radiological Society of North America
      Chicago, Illinois, United States