Jeffrey M Perlman

New York Presbyterian Hospital, New York, New York, United States

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Publications (247)1159.93 Total impact

  • Circulation 11/2015; 132(18 suppl 2):S543-S560. DOI:10.1161/CIR.0000000000000267 · 14.43 Impact Factor

  • Circulation 10/2015; 132(16 suppl 1):S2-S39. DOI:10.1161/CIR.0000000000000270 · 14.43 Impact Factor
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    Resuscitation 10/2015; 132(16 suppl 1). DOI:10.1016/j.resuscitation.2015.07.045 · 4.17 Impact Factor
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    Resuscitation 10/2015; 95. DOI:10.1016/j.resuscitation.2015.07.039 · 4.17 Impact Factor

  • PEDIATRICS 10/2015; 132(18). DOI:10.1542/peds.2015-3373G · 5.47 Impact Factor
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    Pediatrics 10/2015; DOI:10.1542/peds.2015-3373D · 5.47 Impact Factor
  • Ericalyn Kasdorf · Amos Grunebaum · Jeffrey M. Perlman ·
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    ABSTRACT: Objective: This study aims to categorize infants treated with therapeutic hypothermia who presented with suspected subacute hypoxia-ischemia-that is, injury that likely occurred well before delivery and thus beyond the 6-hour window for therapeutic hypothermia-and to contrast the clinical characteristics with infants who suffered a known acute hypoxia-ischemia event. Design: A retrospective chart review was undertaken of infants treated with therapeutic hypothermia at our center during a 6-year period. Suspected subacute injury is defined as decreased fetal movement >6 hours before delivery or severe depression at birth without need for cardiopulmonary resuscitation. Acute injury is defined as an acute perinatal event including placental abruption, ruptured uterus, or umbilical cord abnormalities. Abnormal outcome is defined as death, cognitive delay, or spastic quadriplegia at follow-up. Results: Infants with subacute (n = 7) versus acute injury (n = 26) were less likely to require cardiopulmonary resuscitation, were less acidotic at birth on cord gases with no significant difference in initial postnatal pH or base deficit, were more severely encephalopathic with severe amplitude electroencephalogram suppression, and demonstrated universal adverse outcome. Conclusions: These data demonstrate greater benefit of therapeutic hypothermia for those infants with acute versus subacute injury. Early initiation of therapeutic hypothermia relative to the presumed onset of hypoxia-ischemia is critical. Early severe encephalopathy in the absence of a known acute perinatal event should raise concern in some cases for a subacute insult where the effect of therapeutic hypothermia is unlikely to be of benefit.
    Pediatric Neurology 08/2015; DOI:10.1016/j.pediatrneurol.2015.07.012 · 1.70 Impact Factor
  • Abigail Wellington · Jeffrey M Perlman ·
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    ABSTRACT: Many neonatal units are adopting developmentally appropriate feeding practices such as cue-based or infant-driven feeding (IDF). There have been limited studies examining the clinical benefit of this approach. A quality improvement initiative was undertaken to introduce an IDF protocol for premature infants <34 weeks gestational age (GA). Data were abstracted to determine whether time to full feeds and time to discharge would be shortened when compared with traditional practitioner-driven feeding (PDF) approach. Baseline data on postmenstrual age (PMA) at first feed, full nipple feeds and at discharge prior to implementation were compared with data obtained after implementation of the IDF protocol. Infants were divided into three subgroups: <28, 28-31(6/7) and 32-33(6/7) weeks gestation. A questionnaire assessed provider's acceptance of the plan. The PMA at full nipple feeds and at discharge was significantly lower in the IDF than PDF group. Infants <28 weeks GA in the IDF versus PDF group reached full nipple feeds 17 days sooner and were discharged 9 days earlier. Babies 28-31(6/7) weeks GA reached full nipple feeds 11 days sooner and were discharged 9 days earlier in the IDF versus PDF group. Babies 32-33(6/7) weeks GA reached full nipple feeds 3 days sooner and were discharged 3 days earlier in the IDF versus PDF group. Providers viewed the implementation of the plan favourably. The IDF approach was associated with significant reduction in time to full feeds and discharge, an effect that was most pronounced in infants >28 weeks GA. The downstream benefits included provider and parent satisfaction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Archives of Disease in Childhood - Fetal and Neonatal Edition 06/2015; DOI:10.1136/archdischild-2015-308296 · 3.12 Impact Factor
  • Jeffrey Perlman · Sithembiso Velaphi · Hege L Ersdal · Monica Gadhia ·

    The Lancet 05/2015; 385(9981). DOI:10.1016/S0140-6736(15)60954-0 · 45.22 Impact Factor
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    ABSTRACT: "Helping Babies Breathe" (HBB) is a simulation-based educational program developed to help reduce perinatal mortality worldwide. A one-day HBB training course did not improve clinical management of neonates. The objective was to assess the impact of frequent brief (3-5minutes weekly) on-site HBB simulation training on newborn resuscitation practices in the delivery room and the potential impact on 24-hour neonatal mortality. Before/after educational intervention study in a rural referral hospital in Northern Tanzania. Baseline data was collected from 01.02.2010 to 31.01.2011 and post-intervention data from 01.02.2011 to 31.01.2012. All deliveries were observed by research assistants who recorded information about labor, newborn delivery room management, perinatal characteristics, and neonatal outcomes. A newborn simulator was placed in the labor ward and frequent brief HBB simulation training was implemented on-site; 3-minutes of weekly paired practice, assisted by local-trainers. Local-trainers also facilitated 40-minutes monthly re-trainings. Outcome measures were; delivery room management of newborns and 24-hour neonatal outcomes (normal, admitted to a neonatal area, death, or stillbirths). There were 4894 deliveries pre and 4814 post-implementation of frequent brief simulation training. The number of stimulated neonates increased from 712(14.5%) to 785(16.3%) (p=0.016), those suctioned increased from 634(13.0%) to 762(15.8%) (p≤0.0005). Neonates receiving bag mask ventilation decreased from 357(7.3%) to 283(5.9%) (p=0.005). Mortality at 24-hour decreased from 11.1/1000 to 7.2/1000 (p=0.040). On-site, brief and frequent HBB simulation training appears to facilitate transfer of new knowledge and skills into clinical practice and to be accompanied by a decrease in neonatal mortality. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Resuscitation 05/2015; 93. DOI:10.1016/j.resuscitation.2015.04.019 · 4.17 Impact Factor
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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; 130(1). DOI:10.1016/j.ijgo.2015.01.012 · 1.54 Impact Factor
  • Jeffrey M Perlman ·

    The Journal of pediatrics 03/2015; 166(3):650. DOI:10.1016/j.jpeds.2014.10.006 · 3.79 Impact Factor
  • Ericalyn Kasdorf · Abbot Laptook · Dennis Azzopardi · Susan Jacobs · Jeffrey M Perlman ·
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    ABSTRACT: Objective 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. Design Outcome studies of infants with an Apgar of 0 at 10 min subsequently resuscitated and treated with hypothermia or standard treatment were reviewed and combined with local outcome data of infants treated with hypothermia. Results Four recent studies (n=81) and local data (n=9) yielded a total of 90 infants with an Apgar of 0 at 10 min, with 56 treated with hypothermia and 34 controls. Primary outcome of death or abnormal neurodevelopmental outcome (18–24 months) occurred in 73% cooled and 79.5% normothermic infants (p=0.61). Implications Although poor, the outcome for infants with an Apgar of 0 at 10 min of life has improved substantially in recent years. This may be related to treatment with hypothermia, enhanced resuscitation techniques and/or other supportive management. Current recommendations to consider discontinuation of resuscitation without a detectable heart rate at 10 min should consider these findings.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 10/2014; 100(2). DOI:10.1136/archdischild-2014-306687 · 3.12 Impact Factor
  • Trang Huynh · Rae Jean Hemway · Jeffrey M Perlman ·
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    ABSTRACT: Background Delivery room cardiopulmonary resuscitation is rare. Recent evidence suggests that effective ventilation may be compromised during chest compressions (CC). Objectives To determine whether trained neonatal personnel can assess effective ventilation during CC in the setting of changing lung compliance. Methods Neonatal providers (n=30) provided CC using a 3:1 CC to ventilation ratio performed for 2 min, with lung compliance adjusted every 30 s from 0.5 (low) to 1.0 mL/cmH2O (normal), followed by face mask ventilation (FMV) alone for 1 min. A neonatal lung simulator connected to a neonatal manikin was used to simulate the volume/pressure relation at low and normal compliance. Results Group analysis showed no difference in peak inflating pressure (PIP) at low versus normal compliance, but a threefold increase in tidal volume (TV) (p=0.00005) during synchronised CC. Paired analysis demonstrated minimal change in PIP, but a significant decrease in TV at low versus normal compliance. During FMV only, a significant decrease in PIP and increase in TV was noted with improved compliance. The face mask was incorrectly applied in 12 (40%) cases and in 20/30 (67%) providers did not perceive a change in compliance. During FMV only, 7/30 (23%) took corrective steps to achieve chest rise. Discussion Most providers cannot assess the effectiveness of delivered TV in the face of changing compliance during synchronised CC, limiting the ability to make appropriate and necessary adjustments. This may prolong cardiopulmonary resuscitation and result in escalating therapies unrelated to the delivery of effective ventilation.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 09/2014; 100(1). DOI:10.1136/archdischild-2014-306309 · 3.12 Impact Factor
  • Jeffrey Perlman ·

    Obstetrics and Gynecology 09/2014; 124(3):635. DOI:10.1097/AOG.0000000000000439 · 5.18 Impact Factor
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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 07/2014; 5(2):368-87. DOI:10.4338/ACI-2013-09-RA-0069 · 0.39 Impact Factor
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    ABSTRACT: Background and objective: 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 · 5.47 Impact Factor
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    ABSTRACT: Objective 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. Methods Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health. Findings Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated. Conclusion The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.
    PLoS ONE 07/2014; 9(7):e102080. DOI:10.1371/journal.pone.0102080 · 3.23 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 · 5.47 Impact Factor

Publication Stats

9k Citations
1,159.93 Total Impact Points


  • 2005-2015
    • New York Presbyterian Hospital
      • • Department of Pediatrics
      • • Department of Nursing
      New York, New York, United States
    • The Children's Hospital of Philadelphia
      Filadelfia, Pennsylvania, United States
  • 2004-2015
    • Weill Cornell Medical College
      • Department of Pediatrics
      New York, New York, United States
  • 2012
    • American Academy of Pediatrics
      Elk Grove Village, Illinois, United States
  • 2010
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
  • 2006-2009
    • Cornell University
      • Department of Pediatrics
      Итак, New York, United States
    • Eunice Kennedy Shriver National Institute of Child Health and Human Development
      Роквилл, Maryland, United States
  • 2008
    • Rosalind Franklin University of Medicine and Science
      North Chicago, Illinois, United States
    • 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
  • 1997-2002
    • 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
  • 1981-1993
    • Washington University in St. Louis
      • Department of Pediatrics
      San Luis, Missouri, United States
  • 1984
    • Radiological Society of North America
      Chicago, Illinois, United States