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Article ; Online: The influence of late prematurity on the encephalopathy exam of infants with neonatal encephalopathy.

Kodidhi, A / Riley, M / Vesoulis, Z

2023 Volume 16, Issue 4, Page(s) 693–700

Abstract: Background: Late preterm (LPT) infants are increasingly treated for hypoxic-ischemic encephalopathy (HIE). However, neurodevelopmental differences of LPT infants may independently influence the neurologic exam and confound care.: Methods: Perinatal ... ...

Abstract	Background: Late preterm (LPT) infants are increasingly treated for hypoxic-ischemic encephalopathy (HIE). However, neurodevelopmental differences of LPT infants may independently influence the neurologic exam and confound care. Methods: Perinatal and outcome characteristics were extracted along with the worst autonomic and state/neuromuscular/reflex Sarnat components in a cross-section of infants with moderate/severe HIE. Infants were classified as late preterm (LPT, 34-36 weeks) or term (>36 weeks). Results: 250 infants were identified, 55 were late preterm. LPT infants had lower mean gestational age and birthweight and greater length of stay (LOS). LPT infants had higher median scores for the Moro and respiratory autonomic components, but no difference in total score. Conclusions: LPT infants had increased LOS, worse Moro reflex, and respiratory status, but no clinically or statistically significant differences in total Sarnat scores. Although it is important to note the impact of immaturity on the exam, it is unlikely to independently alter management.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Infant, Premature ; Infant, Newborn, Diseases/therapy ; Gestational Age ; Birth Weight ; Hypoxia-Ischemia, Brain/diagnosis ; Hypoxia-Ischemia, Brain/therapy ; Hypothermia, Induced
Language	English
Publishing date	2023-11-23
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2435387-5
ISSN	1878-4429 ; 1934-5798
ISSN (online)	1878-4429
ISSN	1934-5798
DOI	10.3233/NPM-230041
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Article ; Online: aEEG in the first 3 days after extremely preterm delivery relates to neurodevelopmental outcomes.

Pineda, Roberta / Vesoulis, Zachary / El Ters, Nathalie / Mathur, Amit

Journal of perinatology : official journal of the California Perinatal Association

2024

Abstract: Objectives: Investigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age.: Methods: Sixty-four ... ...

Abstract	Objectives: Investigate relationships between aEEG in the first 72 h in extremely preterm infants with 1) infant, medical, and environmental factors, and 2) infant feeding and neurobehavioral outcomes at term and school-age. Methods: Sixty-four preterm infants (≤28 weeks gestation) were enrolled within the first 24-hours of life and had two-channel aEEG until 72 h of life. Standardized neurobehavioral and feeding assessments were conducted at term, and parent-reported outcomes were documented at 5-7 years. Results: Lower aEEG Burdjalov scores (adjusted for gestational age) were related to vaginal delivery (p = 0.04), cerebral injury (p = 0.01), Black race (p < 0.01) and having unmarried parents (p = 0.02). Lower Burdjalov scores related to less NICU Network Neurobehavioral Scale arousal (p = 0.002) at term and poorer BRIEF global executive function (p = 0.004), inhibition (p = 0.007), working memory (p = 0.02), material organization (p = 0.0008), metacognition (p = 0.01), and behavioral regulation (p = 0.02) at 5-7 years. We did not observe relationships of early aEEG to feeding outcomes or sensory processing measures. Conclusion: Early aEEG within the first 72 h of life was related to medical and sociodemographic factors as well as cognitive outcome at 5-7 years.
Language	English
Publishing date	2024-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	645021-0
ISSN	1476-5543 ; 0743-8346
ISSN (online)	1476-5543
ISSN	0743-8346
DOI	10.1038/s41372-024-01945-z
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Article ; Online: Dexmedetomidine During Therapeutic Hypothermia: A Multicenter Quality Initiative.

Elliott, Megan / Fairchild, Karen / Zanelli, Santina / McPherson, Christopher / Vesoulis, Zachary

Hospital pediatrics

2023 Volume 14, Issue 1, Page(s) 30–36

Abstract: Objectives: Sedation is typically used during neonatal therapeutic hypothermia (TH). This report describes a quality improvement (QI) initiative with the aim of decreasing opioid exposure during TH by implementing dexmedetomidine as the primary sedative ...

Abstract	Objectives: Sedation is typically used during neonatal therapeutic hypothermia (TH). This report describes a quality improvement (QI) initiative with the aim of decreasing opioid exposure during TH by implementing dexmedetomidine as the primary sedative agent. Methods: This dual-center QI initiative used a multidisciplinary team to create a sedation algorithm for safe implementation of dexmedetomidine as first-line therapy during TH. The primary measure in this initiative was cumulative opioid exposure during TH; balancing measures included safety parameters, primarily the rate of dexmedetomidine discontinuation because of bradycardia. Baseline demographic and clinical data were collected retrospectively for the period before implementation and prospectively during the QI period. Data were analyzed using statistical process control charts to identify change over time. Results: One-hundred and fifty-four neonates in the 2-year pre-QI period were compared with 135 neonates in the 2 years after guideline implementation. Guideline compliance with dexmedetomidine initiation was 99% and compliance with initial dosing increased from 70% to 91% during the QI period. The cumulative dose of opioid during TH decreased by >90% by the end of the QI period. Dexmedetomidine was discontinued for transient bradycardia in 9.6% of the study population. No other adverse effects were observed. Conclusions: Dexmedetomidine may be used as the primary sedative during neonatal TH with a low incidence of adverse effects. Clinical trials evaluating the impact of sedation during TH on neurologic outcomes are needed.
MeSH term(s)	Infant, Newborn ; Humans ; Dexmedetomidine/therapeutic use ; Bradycardia/chemically induced ; Bradycardia/therapy ; Analgesics, Opioid ; Retrospective Studies ; Hypnotics and Sedatives/therapeutic use ; Hypothermia, Induced
Chemical Substances	Dexmedetomidine (67VB76HONO) ; Analgesics, Opioid ; Hypnotics and Sedatives
Language	English
Publishing date	2023-12-04
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ISSN	2154-1671
ISSN (online)	2154-1671
DOI	10.1542/hpeds.2023-007403
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Article ; Online: Potential risk modifiers for severe intraventricular hemorrhage in very low birthweight infants requiring transport.

Morris, Hallie / Magers, Nicole / Saunders, Scott / Vesoulis, Zachary

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

2020 Volume 35, Issue 15, Page(s) 2988–2991

Abstract: Background: Very low birthweight (VLBW) infants must undergo transport when born at a facility unequipped for their care. Previous research suggests an increased risk for intraventricular hemorrhage (IVH) associated with transport. It is unknown whether ...

Abstract	Background: Very low birthweight (VLBW) infants must undergo transport when born at a facility unequipped for their care. Previous research suggests an increased risk for intraventricular hemorrhage (IVH) associated with transport. It is unknown whether logistical aspects of transport, particularly mode and distance, or skill level of the resuscitation team are drivers of risk. Objective: To determine if the transport vehicle, distance traveled, or absence of advanced resuscitation team increased risk for severe IVH in outborn VLBW infants. Design/methods: Outborn VLBW infants, transported by specialized team via helicopter or ambulance to a Level IV NICU, were included; inborn VLBW infants served as controls. Infants transported >24 h after birth, by referring center's team, or without head ultrasound were excluded. Baseline clinical data were collected along with IVH grade, transport vehicle, distance traveled, and skill of resuscitation team. Results: Two hundred and ninety-three outborn were matched to 293 inborn infants. Outborn infants had increased incidence of severe IVH even when controlling for antenatal steroids, race, delivery method, and surfactant use (17% vs. 11%, OR = 1.6, 95% CI = 1.1-2.7). Despite this increased incidence, severe IVH was not associated with transport vehicle ( Conclusion: Compared to inborn, outborn infants had increased risk of severe IVH. Transport vehicle, distance traveled, and the skill of resuscitation team did not significantly impact risk.
MeSH term(s)	Cerebral Hemorrhage/epidemiology ; Cerebral Hemorrhage/etiology ; Female ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature, Diseases/epidemiology ; Infant, Very Low Birth Weight ; Pregnancy
Language	English
Publishing date	2020-09-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2077261-0
ISSN	1476-4954 ; 1057-0802 ; 1476-7058
ISSN (online)	1476-4954
ISSN	1057-0802 ; 1476-7058
DOI	10.1080/14767058.2020.1813708
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Zs.A 3510: Show issues

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Article ; Online: Practical approaches to sedation and analgesia in the newborn.

McPherson, Christopher / Ortinau, Cynthia M / Vesoulis, Zachary

Journal of perinatology : official journal of the California Perinatal Association

2020 Volume 41, Issue 3, Page(s) 383–395

Abstract: The prevention, assessment, and treatment of neonatal pain and agitation continues to challenge clinicians and researchers. Substantial progress has been made in the past three decades, but numerous outstanding questions remain. In this setting, ... ...

Abstract	The prevention, assessment, and treatment of neonatal pain and agitation continues to challenge clinicians and researchers. Substantial progress has been made in the past three decades, but numerous outstanding questions remain. In this setting, clinicians must establish safe and compassionate standardized practices that consider available efficacy data, long-term outcomes, and research gaps. Novel approaches with limited data must be carefully considered against historic standards of care with robust data suggesting limited benefit and clear adverse effects. This review summarizes available evidence while suggesting practical clinical approaches to pain assessment and avoidance, procedural analgesia, postoperative analgesia, sedation during mechanical ventilation and therapeutic hypothermia, and the issues of tolerance and withdrawal. Further research in all areas represents an urgent priority for optimal neonatal care. In the meantime, synthesis of available data offers clinicians challenging choices as they balance benefit and risk in vulnerable critically ill neonates.
MeSH term(s)	Analgesia ; Conscious Sedation ; Critical Illness ; Humans ; Infant, Newborn ; Pain ; Pain Management ; Respiration, Artificial
Language	English
Publishing date	2020-11-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	645021-0
ISSN	1476-5543 ; 0743-8346
ISSN (online)	1476-5543
ISSN	0743-8346
DOI	10.1038/s41372-020-00878-7
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Article ; Online: Racial discrepancy in pulse oximeter accuracy in preterm infants.

Vesoulis, Zachary / Tims, Anna / Lodhi, Hafsa / Lalos, Natasha / Whitehead, Halana

Journal of perinatology : official journal of the California Perinatal Association

2021 Volume 42, Issue 1, Page(s) 79–85

Abstract: Objective: Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients.: Study design: Black and White infants <32 weeks gestation ... ...

Abstract	Objective: Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients. Study design: Black and White infants <32 weeks gestation underwent simultaneous arterial blood gas and pulse oximetry measurement. Error by race was examined using mean bias, A Results: A total of 294 infants (124 Black, 170 White) were identified with mean GA of 25.8 ± 2.1 weeks and mean BW of 845 ± 265 grams, yielding 4387 SaO Conclusion: There is a modest but consistent difference in SpO
MeSH term(s)	Adult ; Blood Gas Analysis/adverse effects ; Humans ; Hypoxia ; Infant, Newborn ; Infant, Premature ; Oximetry/methods ; Oxygen
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-10-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	645021-0
ISSN	1476-5543 ; 0743-8346
ISSN (online)	1476-5543
ISSN	0743-8346
DOI	10.1038/s41372-021-01230-3
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Article ; Online: Active normothermia treatment for perioperative temperature management during bedside surgery in the NICU, a case report.

Delgado, A / Najaf, T / Viehl, L / Fishman, E / Baiel, J / Hepler, I / Vesoulis, Z A

Journal of neonatal-perinatal medicine

2022

Abstract: Infants in the NICU setting often require emergent bedside surgical procedures, during which, they are at high risk for developing hypothermia. Reasons for hypothermia in infants include poor temperature regulation, decreased fat stores to maintain ... ...

Abstract	Infants in the NICU setting often require emergent bedside surgical procedures, during which, they are at high risk for developing hypothermia. Reasons for hypothermia in infants include poor temperature regulation, decreased fat stores to maintain temperature, increased insensible losses. Neonatal hypothermia is associated with an increased risk of sepsis, cardiorespiratory failure (pulmonary hypertension), hypoglycemia and death. In this case series, we describe the novel use of servo-controlled water blanket system as a method to actively maintain normothermia during three surgical cases. Although water blanket systems are frequently used in the neonatal ICU to provide active hypothermia treatment, to our knowledge there have been no prior reports of this system being deployed in normal and low-birthweight infants in the perioperative period.
Language	English
Publishing date	2022-09-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2435387-5
ISSN	1878-4429 ; 1934-5798
ISSN (online)	1878-4429
ISSN	1934-5798
DOI	10.3233/NPM-221022
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Article ; Online: Respiratory effects of prolonged prednisolone use in infants with evolving and established Bronchopulmonary dysplasia.

Liviskie, Caren / Vesoulis, Zachary / Zeller, Brandy / Rao, Rakesh / McPherson, Christopher

Early human development

2021 Volume 156, Page(s) 105344

Abstract: Background: Current literature focuses on systemic corticosteroids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants with limited data on use for pulmonary disease after the first month of life. Prednisolone may be a reasonable ... ...

Abstract	Background: Current literature focuses on systemic corticosteroids for prevention of bronchopulmonary dysplasia (BPD) in preterm infants with limited data on use for pulmonary disease after the first month of life. Prednisolone may be a reasonable option for late treatment given its desirable pharmacologic properties and use in other pediatric disease states. Aims: To characterize a premature population that received an extended prednisolone course and determine the effect on respiratory and anthropometric outcomes over time. Study design: Single-center, retrospective study. Subjects: Preterm infants who received ≥30 days of prednisolone or methylprednisolone for treatment of respiratory complications following preterm birth. Outcomes measures: Assessment of pulmonary severity score (PSS), weight, length, and occipital frontal circumference weekly during the first 4 weeks of prednisolone and after discontinuation. Results: Thirty-four infants with a mean gestational age of 26.5 ± 2.5 weeks and birth weight of 846 ± 353 g were identified. Nine patients were on invasive mechanical ventilation and 25 patients were on non-invasive respiratory support at prednisolone initiation. Prednisolone was initiated at a mean post-menstrual age of 41.7 ± 5 weeks and a mean dose of 1.7 ± 0.6 mg/kg/day. A significant decrease in PSS was seen over time (p < 0.001) without rebound following discontinuation. Eleven patients decreased the mode of respiratory support during prednisolone treatment. No significant impact in anthropometric outcomes were identified. Conclusion: Prolonged prednisolone use was associated with a sustained decrease in PSS without adverse effects on growth measurements. These results suggest potential benefit of prednisolone on respiratory outcomes in a subset of preterm infants.
MeSH term(s)	Bronchopulmonary Dysplasia/drug therapy ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Prednisolone/adverse effects ; Premature Birth ; Respiration, Artificial ; Retrospective Studies
Chemical Substances	Prednisolone (9PHQ9Y1OLM)
Language	English
Publishing date	2021-03-03
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	752532-1
ISSN	1872-6232 ; 0378-3782
ISSN (online)	1872-6232
ISSN	0378-3782
DOI	10.1016/j.earlhumdev.2021.105344
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Zs.A 1373: Show issues

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Article ; Online: A phase-II clinical trial of targeted cerebral near infrared spectroscopy using standardized treatment guidelines to improve brain oxygenation in preterm infants (BOx-II): A study protocol.

Vesoulis, Zachary / Hopper, Andrew / Fairchild, Karen / Zanelli, Santina / Chalak, Lina / Noroozi, Mona / Liu, Jessica / Chock, Valerie

Contemporary clinical trials

2022 Volume 120, Page(s) 106886

Abstract: Background: Mortality and brain injury are common adverse outcomes in infants born <28 weeks. Conventional pulse oximetry may not detect subclinical changes prior to deterioration and fails to detect changes within the brain. Increasing evidence ... ...

Abstract	Background: Mortality and brain injury are common adverse outcomes in infants born <28 weeks. Conventional pulse oximetry may not detect subclinical changes prior to deterioration and fails to detect changes within the brain. Increasing evidence supports the use of cerebral near-infrared spectroscopy (NIRS) in the early care of preterm infants, yet the impact of specific interventions on cerebral oxygenation and the relationship between cerebral hypoxia and brain injury on MRI remain to be determined. Methods/design: 100 infants <28 completed weeks of gestation will be recruited for a prospective, multicenter intervention trial. After informed consent, infants will undergo cerebral NIRS monitoring starting within 6 h of birth and continuing through 72 h. Infants with persistent cerebral desaturation will receive interventions following a standard treatment algorithm selected by the provider based on the patient's clinical condition. Providers will record the timing and choice of intervention(s) and term equivalent brain MRI will be performed for survivors. There are three objectives of this study: 1) to identify the relationship between cerebral hypoxia burden and brain injury on term-equivalent MRI. 2) to identify most common interventions after cerebral hypoxia, and 3) to quantify frequency of occult cerebral hypoxia events. Discussion: There is increasing evidence for the role of early cerebral NIRS monitoring in the neuroprotective care of preterm infants. This phase-II trial will provide essential data to improve the intervention approach, model the effect size of interventions on a wider extent of brain injury, and quantify the discrepancy between measurements of systemic and cerebral hypoxia.
MeSH term(s)	Brain/diagnostic imaging ; Brain Injuries/diagnostic imaging ; Brain Injuries/therapy ; Clinical Trials, Phase II as Topic ; Humans ; Hypoxia, Brain/diagnostic imaging ; Infant ; Infant, Newborn ; Infant, Premature ; Multicenter Studies as Topic ; Oxygen ; Prospective Studies ; Spectroscopy, Near-Infrared/methods
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2022-08-19
Publishing country	United States
Document type	Clinical Trial Protocol ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2182176-8
ISSN	1559-2030 ; 1551-7144
ISSN (online)	1559-2030
ISSN	1551-7144
DOI	10.1016/j.cct.2022.106886
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Zs.A 1581: Show issues

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Article ; Online: An Amplitude-Integrated EEG Evaluation of Neonatal Opioid Withdrawal Syndrome.

Lust, Christopher / Vesoulis, Zachary / Zempel, John / Gu, Hongjie / Lee, Stephanie / Rao, Rakesh / Mathur, Amit M

American journal of perinatology

2022

Abstract: Objective: Infants with neonatal opioid withdrawal syndrome (NOWS) have disrupted neurobehavior that requires hospitalization and treatment. This article aimed to evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) ...

Abstract	Objective: Infants with neonatal opioid withdrawal syndrome (NOWS) have disrupted neurobehavior that requires hospitalization and treatment. This article aimed to evaluate electroencephalography (EEG) abnormalities using amplitude-integrated EEG (aEEG) in NOWS. Study design: Eighteen term born infants with NOWS were recruited prospectively for an observational pilot study. aEEG monitoring was started within 24 hours of recruitment and twice weekly through discharge. aEEG data were analyzed for background and seizures. Severity of withdrawal was monitored using the modified Finnegan scoring (MFS) system. Results: Fifteen neonates had complete datasets. Thirteen (87%) had continuous aEEG background in all recordings. None had sleep-wake cyclicity (SWC) at initial recording. Brief seizures were noted in 9 of 15 (60%) infants. Lack of SWC was associated with higher MFS scores. At discharge, 8 of 15 (53%) had absent or emerging SWC. Conclusion: aEEG abnormalities (absent SWC) are frequent and persist despite treatment at the time of discharge in the majority of patients with NOWS. Brief electrographic seizures are common. Neonates with persistent aEEG abnormalities at discharge warrant close follow-up. Key points: · EEG abnormalities are common and persist after clinical signs resolve in patients with NOWS.. · Short subclinical seizures may be seen.. · aEEG may identify neonates who need follow-up..
Language	English
Publishing date	2022-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	605671-4
ISSN	1098-8785 ; 0735-1631
ISSN (online)	1098-8785
ISSN	0735-1631
DOI	10.1055/a-1877-9291
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