David L Schutzman

Albert Einstein Medical Center, Philadelphia, Pennsylvania, United States

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Publications (7)20.62 Total impact

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    ABSTRACT: OBJECTIVE: The American Academy of Pediatrics recommends all infants born at <37 weeks gestation spend a period of observation in a car seat prior to hospital discharge to assess for apnoea, bradycardia or oxygen desaturation. The most recent Cochrane review suggested further studies to determine if the infant car seat challenge (ICSC) accurately predicts the risk of clinically adverse events. We reviewed our experience with the ICSC and the polysomnogram (PSG) to determine if the ICSC accurately predicts the risk of adverse events when compared with the PSG. STUDY DESIGN: Retrospective chart review of all infants in our institution who had an ICSC and a PSG between January 2005 and December 2008. RESULT: 785 infants had ICSCs. In addition, 313 infants (56.6%) had an abnormal PSG, even though the vast majority, 158 (88.3%), passed their ICSC. There were no significant differences in gestational age at birth, birth weight, chronological age at study or postmenstrual age at study between infants who either passed or failed the ICSC with those who passed or failed the PSG. The sensitivity of the ICSC was 0.11 and specificity was 0.96. The positive predictive value of the ICSC was 0.77 and the negative predictive value was 0.45. CONCLUSIONS: The ICSC has a low negative predictive value (0.45) when compared with the PSG as a reference standard for identifying adverse cardiorespiratory events. Although less time consuming and cumbersome than extended polysomnography, the ICSC is not a reliable substitute.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 02/2013; · 3.45 Impact Factor
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    ABSTRACT: There are currently no standard recommendations regarding the optimal method to obtain a blood culture in neonates. We performed an online survey of the membership of the Section on Perinatal Pediatrics of the American Academy of Pediatrics regarding their practices when drawing blood cultures. The survey included questions regarding the type of antisepsis used in preparing the site for sampling, the amount of blood drawn and preferred site for obtaining the culture. Overall 715 of 2955 (24%) members responded to the survey. There was wide variability in responses to all of the questions. However, virtually all providers washed their hands and wore gloves while performing the procedure, and virtually all providers obtained ≥0.5 mL of blood for the sample. Given the wide variability of practices among the members of the Section, evidence-based standards are needed to guide clinical practice for this procedure.
    World Journal of Pediatrics 08/2012; 8(3):260-2. · 1.08 Impact Factor
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    ABSTRACT: To compare the incidence of cholestasis in very low birth weight infants receiving cycled versus continuous parenteral nutrition, and to determine factors that predispose to parenteral nutrition-associated cholestasis (PNAC). Preterm infants weighing ≤ 1250 g (n = 70) at birth were randomly assigned within the first 5 postnatal days to either cycle (n = 34) or continuous (n = 36) parenteral nutrition. Liver function tests were obtained at baseline, and sequentially thereafter. Cholestasis was defined as direct bilirubin >2 mg/dL. Infants with major congenital anomalies, congenital hepatic disease, clinically apparent congenital viral infection, and those who required major abdominal surgery were excluded. The incidence of PNAC was similar in the 2 groups (cycle 32% vs continuous 31%; P = 1.0). Bilirubin and transaminases were similar in both groups by repeated measures of ANOVA. Gestational age, birth weight, and Apgar scores were significantly lower, and Clinical Risk Index for Babies II scores were significantly higher in infants who developed PNAC. Using backward selection logistic regression, bronchopulmonary dysplasia, duration of parenteral nutrition, and days to full enteral nutrition emerged as factors independently associated with PNAC. Early prophylactic parenteral nutrition cycling in very low birth weight infants in this study did not reduce cholestasis. Time to full feedings is a significant predictor for PNAC in very low birth weight infants. Preterm infants with bronchopulmonary dysplasia are more likely to have PNAC as a comorbidity. The Clinical Risk Index for Babies II score may help identify those preterm infants who might benefit from future prospective prevention trials.
    The Journal of pediatrics 03/2012; 161(2):229-33.e1. · 4.02 Impact Factor
  • David L Schutzman, Romal Sekhon, Shilpa Hundalani
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    ABSTRACT: To determine the usefulness of the hour-specific Bhutani et al bilirubin nomogram when applied to infants with Coombs-positive test results. Retrospective chart review. Term nursery and neonatal intensive care unit of a university-affiliated hospital. All infants with A+ or B+ blood type born in our center from September 1, 2006, through August 31, 2008, to mothers with O+ blood. Proportion of infants with Coombs-positive results from the nomogram zones who required phototherapy and comparison of the percentage of infants with Coombs-positive results in each zone with the percentage of those with Coombs-negative results in each zone. A total of 240 infants with Coombs-positive and 460 with Coombs-negative results having a gestational age of 35 weeks or older were evaluated. Sensitivity and specificity of data for infants with direct Coombs-positive results in zone 4 (high risk; 74.2% and 97.1%) and those for infants in zones 3 (high-intermediate risk) and 4 combined (96.7% and 83.7%) compared favorably with the data from the Bhutani et al cohort, which had direct Coombs-negative results (54.0% and 96.2% for zone 4; 90.5% and 84.7% for zones 3 and 4 combined). The likelihood ratio for infants with direct Coombs-positive results in zone 4, 25.8 (95% confidence interval, 11.4-58.4), was twice that of the Bhutani et al cohort, 14.1 (11.0-18.1). The nomogram performed well in directing the timing of bilirubin level follow-up. All infants in zones 3 and 4 with Coombs-positive results were followed up after hospital discharge. None required an exchange transfusion or developed bilirubin encephalopathy. The Bhutani et al bilirubin nomogram reliably identified infants at gestational age of older than 35 weeks with direct Coombs-positive results who were at risk for significant hyperbilirubinemia and directed the timing of follow-up for these infants. This finding has direct clinical applicability to the health care professional practicing in the newborn nursery.
    JAMA Pediatrics 12/2010; 164(12):1158-64. · 4.28 Impact Factor
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    ABSTRACT: With increasing survival of extremely premature infants, emphasis is now focused on the quality of these survivors' lives. Possibly the most important factor in the premature's ability to survive in the NICU and thrive is the ability to replicate in utero growth through enteral and parenteral nutrition. Current literature and review articles were retrieved from PubMed and personal files of the authors. The use and complications of the various components of total parenteral nutrition (TPN) were reviewed. The composition of appropriate enteral feeds for the premature was reviewed as was the difficulties associated with the establishment of adequate enteral feeds in the premature infants. Early initiation of amino acids in TPN and timely increases in the components of TPN can improve the caloric intake of prematures. Enteral feeds, particularly of breast milk, may be started within the first few days of life in all but hemodynamically unstable prematures. Newer lipid preparations show promise in reversing the hepatic damage of TPN associated cholestatic jaundice.
    World Journal of Pediatrics 12/2008; 4(4):248-53. · 1.08 Impact Factor
  • Prenatal Diagnosis 05/2008; 28(4):366-8. · 2.68 Impact Factor
  • David L Schutzman, Rachel Porat
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    ABSTRACT: We recently observed several babies in our neonatal intensive care unit (NICU) with necrotizing enterocolitis (NEC) who were subsequently found to have glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of this study was to explore the association of NEC and G6PD deficiency. G6PD deficiency was significantly higher (27.8%) in infants with NEC compared with the 5.3% prevalence among NICU admissions (odds ratio = 6.9; 95% confidence interval = 2 to 23.5). G6PD deficiency also was found to be a marker for more severe NEC. G6PD deficiency should be considered a risk factor for NEC.
    The Journal of pediatrics 11/2007; 151(4):435-7. · 4.02 Impact Factor