Jeffrey M Perlman

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

Are you Jeffrey M Perlman?

Claim your profile

Publications (246)1185.54 Total impact

  • Source
    Gail S. Ross · L.M. Foran · Baptiste Barbot · K. Mark Sossin · Jeffrey M. Perlman
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Very low birthweight (VLBW) premature infant follow-up studies report on single developmental outcome variables but do not assess profiles of development. Aims: To identify developmental profiles of VLBW premature infants based on cognitive and language development and their association with demographic, perinatal, and behavior variables. Study design: Retrospective chart review. Subjects: 117 children<1250g BW seen at 18months post-term on the Bayley Scales-III and Child Behavior Checklist 1 ½-5 (CBCL 1 ½-5), a behavior problem questionnaire. Demographic and perinatal variables were obtained from medical records. Outcome measures: Bayley Cognitive, Expressive Language, and Receptive Language scores were used to cluster the subjects into developmental profiles. Demographic, perinatal, and CBCL variables were analyzed as they related to clusters. Results: Children were clustered into 4 groups based on their Bayley Cognitive, Expressive Language, and Receptive Language scores: Consistently High, Consistently Average, Average with Delayed Expressive Language, and Consistently Low. Socioeconomic status, bronchopulmonary dysplasia, Grades III-IV intraventricular hemorrhage, and summary Behavior Problems and Attention Deficit/Hyperactivity (ADHD) Problems scores were significantly related to clusters. Conclusion: Cluster analysis defined distinct outcome groups in VLBW premature children and provides an informative means of identifying factors related to developmental outcome. This approach may be useful in predicting later outcome and determining which groups of children will require early intervention.
    Full-text · Article · Jan 2016 · Early human development
  • [Show abstract] [Hide abstract]
    ABSTRACT: Neonatal immune response is characterized by an uncompensated pro-inflammatory response that can lead to inflammation-related morbidity and increased susceptibility to infection. We investigated the effects of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs) docosahexaenoic acid (DHA) or eicosapentaenoic acid (EPA) pre-treatment on cytokine secretion to low-concentration endotoxin (lipopolysaccharide, LPS) in THP-1 monocytes and neonatal cord blood (CB) from healthy full-term infants. Pre-treatment of THP-1 cells, with either n-3 PUFA at 25 or 100 μM significantly reduced IL-6, IL-10, and IL-12 secretion while DHA, but not EPA, reduced TNF-α response to LPS. DHA inhibition was stronger compared to EPA and effective at the low concentration. The same concentrations of n-3 PUFAs inhibited IL-12 but not IL-10 cytokine response in whole CB from 9 infants pre-treated for 24 h. To assess clinical relevance for acute response to LPS, the effects of low-concentration DHA at 25 μM or 12.5 μM were assessed before and after LPS exposure of isolated CB mononuclear cells from 20 infants for 1 h. When added before or after LPS, physiologic DHA treatment produced significant concentration-dependent inhibition of TNF-α, IL-6, IL-1β, and IL-8 secretion. The results demonstrate prophylactic and therapeutic modulation of neonatal cytokine response to LPS and provide proof-of-concept that low-concentration administration of n-3 PUFA could attenuate or resolve neonatal inflammatory response.
    No preview · Article · Jan 2016 · Journal of Perinatal Medicine
  • H L Ersdal · J Linde · B Auestad · E Mduma · S Lyanga · E Svensen · J Perlman
    [Show abstract] [Hide abstract]
    ABSTRACT: The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of breathing or positive pressure ventilation (PPV) after stimulation/suction and 24-hour neonatal mortality/morbidity. Observational study. A rural Tanzanian referral hospital. Depressed nonbreathing newborns. Trained research assistants have observed every delivery (November 2009 through January 2014) using stop-watches and recorded data including fetal heart rate; time intervals from birth to CC and start of breathing or PPV and perinatal characteristics. Twenty-four-hour neonatal outcome (dead, admitted, normal). There were 19 863 liveborn infants; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate breathing. However, 1269 (41.0%) neonates failed to breath and received PPV at 98 ± 66 seconds and CC at 39 ± 35 seconds after birth. Adverse outcomes in neonates receiving PPV included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before PPV and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of PPV with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of PPV before versus after CC was not associated with death/admission when adjusted for time to PPV. The risk for death/admission increased by 12% for every 30-second delay in PPV (P = 0.001). This observational study failed to demonstrate any relationship between time to CC and onset of breathing or initiation of PPV following stimulation/suction, and 24-hour outcome. Delay in initiation of PPV was significantly associated with death/admission. No relationship between time to cord clamp, breathing or ventilation and 24-hour deaths in depressed neonates.
    No preview · Article · Dec 2015 · BJOG An International Journal of Obstetrics & Gynaecology

  • No preview · Article · Nov 2015 · Circulation

  • No preview · Article · Oct 2015 · Circulation
  • Source

    Full-text · Article · Oct 2015
  • Source

    Full-text · Article · Oct 2015 · Resuscitation
  • Source

    Full-text · Article · Oct 2015 · Resuscitation
  • Source

    Full-text · Article · Oct 2015 · PEDIATRICS
  • Source

    Full-text · Article · Oct 2015 · Pediatrics
  • Scarlett McKinsey · Jeffrey M Perlman
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Determine how consistently providers follow neonatal resuscitation programme (NRP) guidelines in the management of asystolic infants requiring intensive resuscitation in a simulated environment and determine time to first administration of intravenous adrenaline. Design: Neonatal fellows (n=10) underwent delivery room simulation involving an asystolic infant as part of their educational curriculum. Each intervention performed by the resuscitation team during the scenario was timed and compared against recommended timeline (RT) as suggested by NRP. Results: Ten simulations were conducted. Heart rate auscultation and initiation of positive pressure ventilation occurred on average within 10 s of the RT. Asystole was correctly identified by auscultation in 6 (60%) cases. Initiation of cardiopulmonary resuscitation on average was 60 s later than RT. Time to place an umbilical catheter was almost twice the RT (354±100 s) and time to first dose of intravenous adrenaline was almost 120 s later than the RT. Average time to discontinuation of resuscitation was 17 min, 43 s, which was 10 min, 42 s after initial intravenous adrenaline. Conclusions: Critical resuscitation steps during intensive resuscitation often occur later than the RT. Identifying asystole by auscultation is difficult, takes time and can delay responses. Even a trained team during a simulation code took over 7 min to administer the initial dose of intravenous adrenaline. Recommendations related to discontinuation of resuscitation should clearly delineate what constitutes effective resuscitation (minimum of early intubation, intravenous adrenaline). We recommend the 'timer' to discontinuation of resuscitation only starts following the first dose of intravenous adrenaline.
    No preview · Article · Sep 2015 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • Ericalyn Kasdorf · Amos Grunebaum · Jeffrey M. Perlman
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Aug 2015 · Pediatric Neurology
  • Abigail Wellington · Jeffrey M Perlman
    [Show abstract] [Hide abstract]
    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 http://group.bmj.com/group/rights-licensing/permissions.
    No preview · Article · Jun 2015 · Archives of Disease in Childhood - Fetal and Neonatal Edition

  • No preview · Article · May 2015 · The Lancet
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · May 2015 · Resuscitation
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Mar 2015 · International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
  • Jeffrey M Perlman

    No preview · Article · Mar 2015 · The Journal of pediatrics
  • [Show abstract] [Hide abstract]
    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.
    No preview · Article · Oct 2014 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • Trang Huynh · Rae Jean Hemway · Jeffrey M Perlman
    [Show abstract] [Hide abstract]
    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.
    No preview · Article · Sep 2014 · Archives of Disease in Childhood - Fetal and Neonatal Edition
  • Source
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jul 2014 · Pediatrics

Publication Stats

10k Citations
1,185.54 Total Impact Points

Institutions

  • 2004-2016
    • Weill Cornell Medical College
      • Department of Pediatrics
      New York, New York, United States
  • 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
  • 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
  • 1992-2005
    • University of Texas Southwestern Medical Center
      • • Department of Pediatrics
      • • Division of Neonatal-Perinatal Medicine
      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