Akshaya Vachharajani

Washington University in St. Louis, San Luis, Missouri, United States

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Publications (24)42.38 Total impact

  • D. E. Coplen · A. Vachharajani

    No preview · Article · Aug 2015 · NeoReviews
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    A Vachharajani · G J Vricella · T Najaf · D E Coplen
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    ABSTRACT: Objective: The 2011 American Academy of Pediatrics (AAP) guidelines address imaging after initial febrile urinary tract infection (UTI) in infants >2 months of age. We sought to determine the frequency of upper urinary tract anomalies (hydronephrosis and vesicoureteral reflux (VUR)) in hospitalized premature infants with UTI. Study design: We retrospectively reviewed the electronic medical records of neonatal intensive care unit (NICU) admissions at a tertiary care children's hospital between 1 January 2006 and 31 December 2010. We queried the records for UTI, renal ultrasound (US) and voiding cystourethrogram (VCUG). Result: We identified 3518 unique admissions. UTI occurred in 118 infants (3%). Sixty-nine (60%) had a normal US. Renal dilation was predominantly renal pelvic dilation (12%) and isolated caliectasis (22%). VUR was identified in 15 (14%) infants evaluated with a VCUG. VUR was identified in nine (12%) infants without and in seven (16%) with an abnormality on US. Reflux was identified in 7% of male and 38% of female infants with a UTI. Conclusion: Anatomic abnormalities of the upper urinary tract are uncommon in premature infants with a UTI that occurs during neonatal hospitalization. In concordance with the AAP guidelines, a VCUG may not be required in all NICU infants under age 2 months after a single UTI.
    Full-text · Article · Dec 2014 · Journal of perinatology: official journal of the California Perinatal Association
  • T E Herman · M J Siegel · A Mathur · A Vachharajani
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    No preview · Article · Aug 2013 · Journal of perinatology: official journal of the California Perinatal Association
  • A. Vachharajani · N. A. Vachharajani · T. Najaf
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    ABSTRACT: Diagnostic radiology is essential in the care of neonates. Survival of extremely preterm neonates and neonates with multiple birth defects inevitably results in a number of diagnostic radiologic procedures being performed in modern neonatal intensive care units (NICUs). Harmful effects of radiation are well known. The number of radiographs performed on preterm neonates is described in several studies over the years. There is no estimate of the number of radiographs performed on neonates of all gestational ages admitted to a NICU. There are multiple dosimetry studies describing the radiation doses from plain chest and abdominal radiographs in preterm neonates. Some of the studies measure the doses imparted by contrast studies in neonates, not preterm neonates. Background natural radiation is estimated to be higher than the radiation from plain radiographs. The radiation from the contrast studies is not known. The article describes the units used to describe doses of radiation, the effects of radiation, and our experience with diagnostic radiographic procedures in neonates of all gestational ages. © 2013 by the American Academy of Pediatrics. All rights reserved.
    No preview · Article · Apr 2013 · NeoReviews
  • T E Herman · M J Siegel · A Vachharajani

    No preview · Article · Mar 2013 · Journal of perinatology: official journal of the California Perinatal Association
  • Douglas Coplen · Akshaya Vachharajani · Tasnim Najaf · Erica Traxel · Paul Austin

    No preview · Article · Apr 2012 · The Journal of Urology
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    Hanny T Al-Samkari · Alex A Kane · David W Molter · Akshaya Vachharajani
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    ABSTRACT: The aim of this study was to characterize the outcomes of one institute's experience regarding upper airway and feeding management in Pierre Robin sequence (PRS) neonates. A retrospective review of 33 neonates was performed. Average daily weight gain for all patients and average length of stay for each group was calculated and the results were compared using Student's t test. Average daily weight gain was 16.5 g in the mandibular distraction osteogenesis (MDO) group (MDO; N = 12) and 5.6 g in the nonsurgical intervention (NSI) group (N = 18; P = .043). Average length of stay was longer in the MDO group (P = .01). In all, 67% of MDO patients were discharged with total PO (per os) feeds compared with 22% of NSI patients. Neonates with PRS who do not require surgical airway intervention are more likely to require assisted feeding, have slower weight gain, and a shorter average hospital stay compared to neonates undergoing mandibular MDO.
    Full-text · Article · Dec 2010 · Clinical Pediatrics
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    ABSTRACT: To determine the prenatal factors associated with the need for extracorporeal membrane oxygenation (ECMO) and neonatal survival in congenital diaphragmatic hernia (CDH). A retrospective cohort study of all cases of CDH seen in our center between 1998 and 2008. Prenatal ultrasound and neonatal records were reviewed. Both univariable and logistic regression analyses were performed to determine the significant factors associated with the use of ECMO and survival. Among 107 cases of CDH seen during the study period, 62 were evaluated prenatally in our center and 49 had information on all variables evaluated. The overall rate of ECMO use was 27/107 (25%) and survival rate was 53/107 (49.5%). The lung area to head circumference ratio (LHR) and gestational age (GA) at delivery were the only significant factors associated with ECMO use, and the LHR and absence of liver herniation were significantly associated with survival. LHR values under 1.0 were associated with 57% need for ECMO and 100% neonatal death. Although, overall, the observed:expected LHR (O:E LHR) was not significantly associated with ECMO use or survival, levels below 65% were associated with 58% need for ECMO (p = 0.004) and 100% neonatal death (p = 0.002). The study confirms the LHR, GA at delivery and liver herniation as significant prenatal predictors of the need for ECMO or survival in cases with CDH. This information is helpful for counseling women with fetuses complicated by CDH.
    No preview · Article · Jun 2010 · Prenatal Diagnosis
  • Tasnim A Najaf · Neeta A Vachharajani · Brad W Warner · Akshaya J Vachharajani
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    ABSTRACT: To define the interval between clinical presentation of necrotizing enterocolitis (NEC) and bowel perforation in neonates. Charts of neonates with discharge diagnosis of NEC (n = 124) from our NICU during 2004-2008 were retrospectively reviewed. Demographic data were collected. Acute episode of NEC was defined as the interval between clinical presentations to resumption of enteral feeds. Neonates are followed, as a standard of care, clinically and radiologically until resumption of enteral feeds at the discretion of the attending clinician. Abdominal radiograph results were reviewed serially to determine the interval between clinical presentation and bowel perforation using pneumoperitoneum as the surrogate radiological marker. Histological report of resected bowel specimens was reviewed for coagulative necrosis as evidence of NEC and to exclude spontaneous intestinal perforation (SIP). Neonates with stage 1 NEC and SIP were excluded from the results. 105 neonates with stage 2 NEC were included in the study. Forty-six needed surgical treatment (group 2) and 59 did not need surgery (group 1). Twenty-six (26/46, 56%) group 2 neonates had bowel perforation and hence required surgery. Pneumoperitoneum was noted at a median interval of 1 day after presentation of symptoms. Twenty neonates in group 2 needed surgery for clinical indications including worsening clinical examination, thrombocytopenia or persistent metabolic acidosis. Fifty-nine neonates (group 1) were treated with bowel rest, antibiotics and parenteral nutrition. Group 2 neonates were significantly more premature, weighed less and had less radiographs than group 1 neonates. Mortality was significantly higher in group 2 compared to group 1. Bowel perforation occurs at a median interval of 1 day after clinical presentation of NEC. Neonates not needing surgery for their disease are exposed to significantly more radiographs than those needing surgery. Radiological evaluation can be safely minimized or eliminated after 2 days of presentation.
    No preview · Article · Apr 2010 · Pediatric Surgery International
  • A. J. Vachharajani

    No preview · Article · Jan 2010 · NeoReviews
  • Anthony Odibo · Tasnim Najaf · Akshaya Vachharajani · Barbara Warner · Amit Mathur · Brad Warner

    No preview · Article · Dec 2009 · American Journal of Obstetrics and Gynecology
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    T E Herman · A Vachharajani · M J Siegel
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    Preview · Article · Jun 2009 · Journal of perinatology: official journal of the California Perinatal Association
  • Akshaya J Vachharajani · Neeta A Vachharajani · Jeffrey G Dawson
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    ABSTRACT: We compare 4 short-term outcomes--namely admission to special care nursery (SCN), length of stay (LOS), age at full feeds (AFF) and respiratory morbidity/need for ventilation--in 1015 late preterm singletons and 366 twins and triplets born at our institution over a 4-year period. Birth weight (BW) and gestational age (GA) rather than plurality of birth determined need for admission to SCN, LOS, AFF, and need for respiratory support. When matched for GA, compared to singletons, twins and triplets needed less admission to SCN and respiratory support at 36 weeks, whereas at 34 weeks, they had longer LOS and took longer to get to full feeds. We conclude that the outcomes of interest are affected by GA and BW rather than plurality.
    No preview · Article · Jun 2009 · Clinical Pediatrics
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    Akshaya J Vachharajani · Rakesh Rao · Sundeep Keswani · Amit M Mathur
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    ABSTRACT: Abdominal wall defects, particularly exomphalos, in newborn infants are associated with significant morbidity and mortality. The objective of the present study was to review the outcomes of neonates with exomphalos in our neonatal intensive care unit during the last 12 years. In this retrospective study 52 neonates with exomphalos were identified from 1996 to 2007. Exomphalos were stratified by the type of defect [exomphalos minor versus major (major defined as defect size more than 5 cm and/or liver in the sac)]. Clinical data, demographic data, and outcome measures of mortality, length of stay (LOS), duration of mechanical ventilation and age at full enteral feeds were studied. Associated anomalies were compared between the two groups. Of the 52 neonates, 1 was transferred back to referring hospital after surgical repair of the defect and was not analyzed. Exomphalos minor accounted for 24 cases and exomphalos major in 27 cases. Mortality was higher in infants with exomphalos major (n = 9, 33%) compared to infants with exomphalos minor (n = 2, 8%). The median LOS (10 vs. 47 days, P = 0.023), median age at full enteral feeds (5 vs. 23 days, P = 0.004) and median duration of mechanical ventilation (7 vs. 23 days, P = 0.001) were shorter for exomphalos minor compared to exomphalos major. Bacteremia was present in 4 (15%) of neonates with exomphalos major. Syndromic associations were present in 8 neonates (33%) with exomphalos minor compared to 2 neonates (7%) with exomphalos major. Beckwith Wiedemann syndrome was most frequently noted in neonates with syndromic exomphalos minor. Trisomy 13 was the only chromosomal abnormality in the entire cohort (1/51 = 2%) and was seen in a single neonate (1/27 = 3.7%) with exomphalos major. Non-syndromic anomalies were seen in 12 (50%) and 14 neonates (52%) with the minor and major defects, respectively. Only four neonates with exomphalos minor (16%) and ten neonates with exomphalos major (37%) had no associated anomalies. Pulmonary hypoplasia and pulmonary hypertension were identified on either lung biopsy or autopsy (n = 5) as causes of mortality. Neonates with exomphalos minor have better survival, decreased LOS, time to full enteral feeds and shorter duration of mechanical ventilation. Syndromic associations were more common in exomphalos minor. Respiratory failure was the major cause of mortality in infants with exomphalos major.
    Full-text · Article · Feb 2009 · Pediatric Surgery International
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    T E Herman · A Vachharajani · M J Siegel
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    Preview · Article · Jan 2009 · Journal of perinatology: official journal of the California Perinatal Association
  • A.J. Vachharajani · A.M. Mathur · R. Rao
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    ABSTRACT: The incidence of metabolic bone disease (MBD) in preterm infants has been declining due to advances in nutritional care. Although the terms osteopenia and rickets have been used in the literature, MBD of prematurity is the preferred terminology for this condition. Despite the use of human milk fortifiers and commercial infant formulas specified for this population, MBD remains an important cause of morbidity in preterm infants. This review focuses on the physiology of intrauterine bone growth, the development of MBD in preterm infants, the various risk factors for MBD, pitfalls in diagnosis, prevention, and treatment of MBD. The use of speed of sound (SOS) ultrasonography and dual-energy X-ray absorptiometry (DXA) in the diagnosis, management, and prognosis also is discussed.
    No preview · Article · Jan 2009 · NeoReviews
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    Akshaya J Vachharajani · Jeffrey G Dawson
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    ABSTRACT: This article describes the short-term outcomes of late preterm neonates born between 34 and 36 (6/7) weeks gestational age (GA) in a 4-year period. A total of 1381/ 20554 (6.7%) births were between 34 and 36 weeks of GA and were predominantly Caucasian (87%). In all, 697/1381 (51%) were admitted to nursery whereas 684/1381 (49%) remained with their mothers. Of the babies born at 34, 35, and 36 weeks GA, 97%, 53%, and 32%, respectively, required admission and of these 30%, 33%, and 23%, respectively, required respiratory support. Air leaks developed in <4% infants. Median length of stay and age at full enteral feeds were 11, 6, and 4 days and 10, 6, and 3 days for 34, 35, and 36 weeks GA, respectively. It is concluded that late preterms have significant morbidity in the neonatal period.
    Preview · Article · Oct 2008 · Clinical Pediatrics
  • Akshaya J Vachharajani · Patrick A Dillon · Amit M Mathur
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    ABSTRACT: We describe outcomes of 70 infants with gastroschisis admitted to our neonatal intensive care unit between 2001 and 2005. Demographic data and outcome measures including discharge or death, simple versus complex (intestinal atresia, perforation, bowel necrosis, or volvulus), length of stay, mechanical ventilation and total parenteral nutrition, commencement of enteral feeds and age at reaching full feeds, and number of episodes of bacteremia were evaluated. In our study, 72% of the patients (n = 58) were simple cases, 28% were complex, and 44% had a positive blood culture. Median length of stay was 43 and 116 days for simple and complex cases, respectively. Median age at commencement of enteral feeds was 19 and 44 days for simple and complex cases, respectively. Six (14%) infants with simple and 8 (50%) with complex gastroschisis required an assisted feeding device (gastrostomy) tube before discharge. We concluded that the type of gastroschisis (simple versus complex) is an important determinant of outcome, including time to start and get to full feeds, duration of parenteral nutrition, length of stay, and survival. Although it is not always possible to determine whether the defect is simple or complex by antenatal scans, this information will be valuable to families with infants with gastroschisis and should be made available as soon as possible.
    No preview · Article · Oct 2007 · American Journal of Perinatology
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    T E Herman · M J Siegel · A Vachharajani · P Masand · D Cross
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    ABSTRACT: JPER is a multi-disciplinary journal that promotes the health of the preterm infant.
    Full-text · Article · May 2007 · Journal of Perinatology
  • Caroline P Halverstam · Akshaya Vachharajani · Susan Bayliss Mallory
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    ABSTRACT: Netherton syndrome is a congenital skin disease associated with decreased skin barrier function and increased percutaneous absorption. We report an 11-year-old boy with Netherton syndrome who developed Cushing syndrome after application of 1% hydrocortisone ointment to his entire body for more than 1 year. This presentation illustrates that even low-potency steroid ointments should be used with caution in Netherton syndrome and warns about the use of long-term topical medications with potential systemic side effects when used in large quantities in any chronic skin disease.
    No preview · Article · Feb 2007 · Pediatric Dermatology