Manish Malkar

The Ohio State University, Columbus, Ohio, United States

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Publications (4)9.91 Total impact

  • Manish B Malkar, Sudarshan Jadcherla
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    ABSTRACT: Background:Aero-digestive morbidities are common in congenital heart disease infants and mechanisms are unclear. We hypothesized that adaptive pharyngo-esophageal motility reflexes are different in surgical congenital heart disease infants (S-CHD) vs. nonsurgical congenital heart disease infants (CHD) and healthy controls.Methods:Abrupt pharyngeal provocation was performed with graded water infusions using purpose-built micro-manometry. Data from 12 S-CHD were compared with 10 CHD and 12 controls. 197 water stimulations were examined for the frequency, latency, duration and magnitude of Pharyngo-Upper Esophageal Sphincter contractile response (PUCR), Pharyngeal reflexive swallow (PRS), esophageal body peristalsis and lower esophageal sphincter (LES) relaxation characteristics. Mixed statistical models were applied.Results:Frequency distribution (%) of PUCR: PRS: None in S-CHD vs. CHD vs. controls respectively were 36:46:17 vs. 9:80:11 vs. 15:61:24 (p < 0.05). Response latency to the final esophageal body waveform (p = 0.01) and the response duration of esophageal body peristalsis (p = 0.04) were prolonged in S-CHD vs. controls but were similar to CHD (p = 0.22). Pharyngeal infusion induced LES relaxation characteristics were similar in all 3 groups.Conclusions:Abnormality in the recruitment of PUCR or PRS reflexes and esophageal body peristalsis in S-CHD implicate dysregulation in vagal cholinergic excitatory neuromotor responses.Pediatric Research (2014); doi:10.1038/pr.2014.68.
    Pediatric Research 05/2014; · 2.67 Impact Factor
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    ABSTRACT: Objective We tested the hypothesis that Respiratory Severity Score (RSS) on day of life 30 is predictive of mortality and length of mechanical ventilation in premature infants on prolonged mechanical ventilation. MethodsA retrospective chart review was performed using the Nationwide Children's Hospital medical record and Vermont-Oxford Network databases. The primary outcome variable was survival to hospital discharge and the secondary outcome was length of mechanical ventilation after day of life 30. ResultsWe identified 199 neonates admitted to Nationwide Children's Hospital between 2004 and 2007 with birth weight less than 1,500 g that received prolonged mechanical ventilation in the first 30 days of their life. A total of 184 infants were included in the analysis, excluding 14 patients with congenital anomalies and one infant with incomplete data. RSS on day of life 30 was significantly greater in the group of infants that died compared to those that survived (P = 0.003, 95% CI = [0.08, 0.40]). Further analysis demonstrated that the maximum difference in mortality was obtained with a threshold RSS of 6. Of the 109 patients who had RSS less than 6 on day of life 30, mortality rate was 4.6% (5/109) while those greater than or equal to 6 had a mortality rate of 21.3% (16/75). Both Kaplan–Meier survival curves comparing mortality and length of mechanical ventilation in infants with RSS < 6 versus those with RSS ≥ 6 demonstrated strong associations between RSS on day of life 30 and survival (P = 0.002) and length of ventilation after day of life 30 (P < 0.001). ConclusionRSS ≥ 6 on day of life 30 is associated with higher mortality and longer period of mechanical ventilation in premature infants requiring mechanical ventilation through 30 days of life. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.
    Pediatric Pulmonology 03/2014; · 2.38 Impact Factor
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    ABSTRACT: Optimizing the timing and safety for the placement of a tracheostomy in infants with bronchopulmonary dysplasia (BPD) has not been determined. The purpose of the present study was to describe the data from a single institution about the efficacy and safety of tracheostomy placement in infants with BPD needing long-term respiratory support. We established a service line for the comprehensive care of infants with BPD and we collected retrospective clinical data from this service line. We identified patients that had a trachostomy placed using the local Vermont-Oxford database, and obtained clinical data from chart reviews. We identified infants who had a tracheostomy placed for the indication of severe BPD only. Safety and respiratory efficacy was assessed by overall survival to discharge and the change in respiratory supportive care from just before placement to 1-month post-placement. Twenty-two patients (750 ± 236 g, 25.4 ± 2.1 weeks gestation) had a tracheostomy placed on day of life 177 ± 74 which coincided with a post-conceptual age of 51 ± 10 weeks. At placement these infants were on high settings to support their lung disease. The mean airway pressure (MAP) was 14.3 ± 3.3 cmH(2) O, the peak inspiratory pressure was 43.7 ± 8.0 cmH(2) O, and the FiO(2) was 0.51 ± 0.13. The mean respiratory severity score (MAP × FiO(2) ) 1 month after tracheostomy was significantly (P = 0.03) lower than prior to tracheostomy. Survival to hospital discharge was 77%. All patients with tracheostomies that survived were discharged home on mist collar supplemental oxygen. In conclusion, the high survival rate in these patients with severe BPD and the decreased respiratory support after placement of a tracheostomy suggests that high ventilatory pressures should not be a deterrent for placement of a tracheostomy. Future research should be aimed at determining optimal patient selection and timing for tracheostomy placement in infants with severe BPD. Pediatr Pulmonol. © 2012 Wiley Periodicals, Inc.
    Pediatric Pulmonology 05/2012; · 2.38 Impact Factor
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    ABSTRACT: Feeding difficulties and gastroesophageal reflux (GER) are common problems in neonates. The authors hypothesize that GER could be influenced by feeding mechanics by evaluating the effects of feeding volumes, feeding durations, feeding flow rates, and caloric density on the chemical composition and clearance of GER in dysphagic neonates. Symptomatic dysphagic neonates (n = 35) underwent evaluation for suspected GER using pH-impedance methods. The proportions of acid and nonacid GER were different during the first, second, and third postprandial hours (P < .0001). Prolonged feeding duration was significantly associated with decreased total, nonacid GER and BCT (P < .03). Significant positive correlations (P < .05) were detected between feeding flow rate vs frequency of total, nonacid GER and BCT. Significant positive correlation (P = .002) was noted between feeding volume and BCT. BCT decreased with each hourly interval (analysis of variance [ANOVA] P < .05); however, ACT increased with each hourly interval (ANOVA P = .05). Comparison between BCT and ACT at each postprandial hour is remarkable for longer ACT during the second and third hours after the initiation of feed (P ≤ .001). No significant correlation was noted between the milk types (breast milk or formula) or caloric density with regard to the GER characteristics. Oral-fed infants had more GER events than gavage-fed infants. Prolonged feeding durations and slower flow rates are associated with decreased frequency of GER. Modification of feeding duration and flow rate can be a useful adjunct to ameliorate GER in dysphagic neonates.
    Journal of Parenteral and Enteral Nutrition 10/2011; 36(4):449-55. · 2.49 Impact Factor