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  1. Article ; Online: Infant Body Composition in an Asian Pacific Islander Population.

    Wong Ramsey, Kara N / Davis, James D / Tanaka, John S / Kuo, Sheree

    Journal of racial and ethnic health disparities

    2022  Volume 10, Issue 6, Page(s) 2663–2669

    Abstract: Background: Normative infant body composition data using air displacement plethysmography (ADP) are from primarily Caucasian populations. Racial differences may exist.: Objectives: To describe body composition in Asian and Pacific Islander infants ... ...

    Abstract Background: Normative infant body composition data using air displacement plethysmography (ADP) are from primarily Caucasian populations. Racial differences may exist.
    Objectives: To describe body composition in Asian and Pacific Islander infants and compare them to previously published data on Caucasian infants.
    Design: Body composition was measured using ADP with the PEA POD® Infant Body Composition System in 249 healthy full-term newborns in a predominately Asian and Pacific Islander population in Hawaii within the first 3 days of life and compared to published data on Caucasian infants with multiple t-tests adjusted for false discovery rate.
    Results: There were no differences in percent body fat between Asian, Pacific Islander, or mixed race Asian Pacific Islander infants. Both Asian and Pacific Islander infants had significantly higher percent body fat than Caucasians from Italy in Europe (13.2% and 11.8% vs 8.9%, p < 0.01 among males, 15.3% and 15.6% vs 8.7%, p < 0.01 among females) but not when compared to Caucasians from New York.
    Conclusions: Racial and geographical differences in body composition exist at birth between Asian and Pacific Islanders and other Caucasian cohorts. Previously published ADP nomograms must be interpreted with caution. Future studies are needed to investigate the impact of environmental, perinatal, and genetic factors on infant body composition and its relationship to future cardiometabolic morbidity. Efforts to address racial disparities in cardiometabolic disease measures must also address pre-conceptual maternal health, which may have long-term implications on future body composition in offspring.
    MeSH term(s) Female ; Humans ; Infant ; Infant, Newborn ; Male ; Adipose Tissue ; Body Composition ; White ; Hawaii ; Europe ; Asian American Native Hawaiian and Pacific Islander
    Language English
    Publishing date 2022-11-10
    Publishing country Switzerland
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2760524-3
    ISSN 2196-8837 ; 2197-3792
    ISSN (online) 2196-8837
    ISSN 2197-3792
    DOI 10.1007/s40615-022-01444-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Influence of Eat, Sleep, and Console on Infants Pharmacologically Treated for Opioid Withdrawal: A Post Hoc Subgroup Analysis of the ESC-NOW Randomized Clinical Trial.

    Devlin, Lori A / Hu, Zhuopei / Merhar, Stephanie L / Ounpraseuth, Songthip T / Simon, Alan E / Lee, Jeannette Y / Das, Abhik / Crawford, Margaret M / Greenberg, Rachel G / Smith, P Brian / Higgins, Rosemary D / Walsh, Michele C / Rice, Ward / Paul, David A / Maxwell, Jessie R / Fung, Camille M / Wright, Tanner / Ross, Julie / McAllister, Jennifer M /
    Crowley, Moira / Shaikh, Sophie K / Christ, Lori / Brown, Jaime / Riccio, Julie / Wong Ramsey, Kara / Braswell, Erica F / Tucker, Lauren / McAlmon, Karen / Dummula, Krishna / Weiner, Julie / White, Jessica R / Newman, Sarah / Snowden, Jessica N / Young, Leslie W

    JAMA pediatrics

    2024  

    Abstract: Importance: The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased ... ...

    Abstract Importance: The function-based eat, sleep, console (ESC) care approach substantially reduces the proportion of infants who receive pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). This reduction has led to concerns for increased postnatal opioid exposure in infants who receive pharmacologic treatment. However, the effect of the ESC care approach on hospital outcomes for infants pharmacologically treated for NOWS is currently unknown.
    Objective: To evaluate differences in opioid exposure and total length of hospital stay (LOS) for pharmacologically treated infants managed with the ESC care approach vs usual care with the Finnegan tool.
    Design, setting, and participants: This post hoc subgroup analysis involved infants pharmacologically treated in ESC-NOW, a stepped-wedge cluster randomized clinical trial conducted at 26 US hospitals. Hospitals maintained pretrial practices for pharmacologic treatment, including opioid type, scheduled opioid dosing, and use of adjuvant medications. Infants were born at 36 weeks' gestation or later, had evidence of antenatal opioid exposure, and received opioid treatment for NOWS between September 2020 and March 2022. Data were analyzed from November 2022 to January 2024.
    Exposure: Opioid treatment for NOWS and the ESC care approach.
    Main outcomes and measures: For each outcome (total opioid exposure, peak opioid dose, time from birth to initiation of first opioid dose, length of opioid treatment, and LOS), we used generalized linear mixed models to adjust for the stepped-wedge design and maternal and infant characteristics.
    Results: In the ESC-NOW trial, 463 of 1305 infants were pharmacologically treated (143/603 [23.7%] in the ESC care approach group and 320/702 [45.6%] in the usual care group). Mean total opioid exposure was lower in the ESC care approach group with an absolute difference of 4.1 morphine milligram equivalents per kilogram (MME/kg) (95% CI, 1.3-7.0) when compared with usual care (4.8 MME/kg vs 8.9 MME/kg, respectively; P = .001). Mean time from birth to initiation of pharmacologic treatment was 22.4 hours (95% CI, 7.1-37.7) longer with the ESC care approach vs usual care (75.4 vs 53.0 hours, respectively; P = .002). No significant difference in mean peak opioid dose was observed between groups (ESC care approach, 0.147 MME/kg, vs usual care, 0.126 MME/kg). The mean length of treatment was 6.3 days shorter (95% CI, 3.0-9.6) in the ESC care approach group vs usual care group (11.8 vs 18.1 days, respectively; P < .001), and mean LOS was 6.2 days shorter (95% CI, 3.0-9.4) with the ESC care approach than with usual care (16.7 vs 22.9 days, respectively; P < .001).
    Conclusion and relevance: When compared with usual care, the ESC care approach was associated with less opioid exposure and shorter LOS for infants pharmacologically treated for NOWS. The ESC care approach was not associated with a higher peak opioid dose, although pharmacologic treatment was typically initiated later.
    Trial registration: ClinicalTrials.gov Identifier: NCT04057820.
    Language English
    Publishing date 2024-04-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701223-2
    ISSN 2168-6211 ; 2168-6203
    ISSN (online) 2168-6211
    ISSN 2168-6203
    DOI 10.1001/jamapediatrics.2024.0544
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  3. Article ; Online: The perinatal presentation of cardiofaciocutaneous syndrome.

    Wong Ramsey, Kara N / Loichinger, Matthew H / Slavin, Thomas P / Kuo, Sheree / Seaver, Laurie H

    American journal of medical genetics. Part A

    2014  Volume 164A, Issue 8, Page(s) 2036–2042

    Abstract: There is limited information available related to the perinatal course of cardiofaciocutaneous syndrome (CFC) compared to other syndromes within the Ras-MAP kinase pathway (rasopathies) such as Noonan and Costello syndrome. Retrospective chart review ... ...

    Abstract There is limited information available related to the perinatal course of cardiofaciocutaneous syndrome (CFC) compared to other syndromes within the Ras-MAP kinase pathway (rasopathies) such as Noonan and Costello syndrome. Retrospective chart review revealed four cases of CFC with molecular confirmation between 2005 and 2012 at Hawaii's largest obstetric and pediatric referral center. We report on details of the prenatal, neonatal, and infancy course and long-term follow-up beyond infancy in two patients. This report includes novel features including systemic hypertension, hyponatremia, and chronic respiratory insufficiency, not previously reported in CFC. We provide pathologic diagnosis of loose anagen hair in one patient. Some of these findings have been reported in the other rasopathies, documenting further clinical overlap among these conditions. Molecular testing can be useful to differentiate CFC from other rasopathies and in counseling families about potential complications and prognosis. We recommend a full phenotypic evaluation including echocardiogram, renal ultrasound, brain imaging, and ophthalmology examination. We additionally recommend close follow-up of blood pressure, pulmonary function, and monitoring for electrolyte disturbance and extra-vascular fluid shifts.
    MeSH term(s) Ectodermal Dysplasia/diagnosis ; Ectodermal Dysplasia/genetics ; Ectodermal Dysplasia/therapy ; Facies ; Failure to Thrive/diagnosis ; Failure to Thrive/genetics ; Failure to Thrive/therapy ; Female ; Gestational Age ; Hair/pathology ; Heart Defects, Congenital/diagnosis ; Heart Defects, Congenital/genetics ; Heart Defects, Congenital/therapy ; Humans ; Infant ; Infant, Newborn ; MAP Kinase Kinase 2/genetics ; Male ; Mutation ; Phenotype ; Skin/pathology
    Chemical Substances MAP Kinase Kinase 2 (EC 2.7.12.2)
    Language English
    Publishing date 2014-04-09
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 1493479-6
    ISSN 1552-4833 ; 1552-4825
    ISSN (online) 1552-4833
    ISSN 1552-4825
    DOI 10.1002/ajmg.a.36558
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  4. Article ; Online: Eat, Sleep, Console Approach or Usual Care for Neonatal Opioid Withdrawal.

    Young, Leslie W / Ounpraseuth, Songthip T / Merhar, Stephanie L / Hu, Zhuopei / Simon, Alan E / Bremer, Andrew A / Lee, Jeannette Y / Das, Abhik / Crawford, Margaret M / Greenberg, Rachel G / Smith, P Brian / Poindexter, Brenda B / Higgins, Rosemary D / Walsh, Michele C / Rice, Ward / Paul, David A / Maxwell, Jessie R / Telang, Sucheta / Fung, Camille M /
    Wright, Tanner / Reynolds, Anne Marie / Hahn, Devon W / Ross, Julie / McAllister, Jennifer M / Crowley, Moira / Shaikh, Sophie K / Puopolo, Karen M / Christ, Lori / Brown, Jaime / Riccio, Julie / Wong Ramsey, Kara / Akshatha / Braswell, Erica F / Tucker, Lauren / McAlmon, Karen R / Dummula, Krishna / Weiner, Julie / White, Jessica R / Howell, Meghan P / Newman, Sarah / Snowden, Jessica N / Devlin, Lori A

    The New England journal of medicine

    2023  Volume 388, Issue 25, Page(s) 2326–2337

    Abstract: Background: Although clinicians have traditionally used the Finnegan Neonatal Abstinence Scoring Tool to assess the severity of neonatal opioid withdrawal, a newer function-based approach - the Eat, Sleep, Console care approach - is increasing in use. ... ...

    Abstract Background: Although clinicians have traditionally used the Finnegan Neonatal Abstinence Scoring Tool to assess the severity of neonatal opioid withdrawal, a newer function-based approach - the Eat, Sleep, Console care approach - is increasing in use. Whether the new approach can safely reduce the time until infants are medically ready for discharge when it is applied broadly across diverse sites is unknown.
    Methods: In this cluster-randomized, controlled trial at 26 U.S. hospitals, we enrolled infants with neonatal opioid withdrawal syndrome who had been born at 36 weeks' gestation or more. At a randomly assigned time, hospitals transitioned from usual care that used the Finnegan tool to the Eat, Sleep, Console approach. During a 3-month transition period, staff members at each hospital were trained to use the new approach. The primary outcome was the time from birth until medical readiness for discharge as defined by the trial. Composite safety outcomes that were assessed during the first 3 months of postnatal age included in-hospital safety, unscheduled health care visits, and nonaccidental trauma or death.
    Results: A total of 1305 infants were enrolled. In an intention-to-treat analysis that included 837 infants who met the trial definition for medical readiness for discharge, the number of days from birth until readiness for hospital discharge was 8.2 in the Eat, Sleep, Console group and 14.9 in the usual-care group (adjusted mean difference, 6.7 days; 95% confidence interval [CI], 4.7 to 8.8), for a rate ratio of 0.55 (95% CI, 0.46 to 0.65; P<0.001). The incidence of adverse outcomes was similar in the two groups.
    Conclusions: As compared with usual care, use of the Eat, Sleep, Console care approach significantly decreased the number of days until infants with neonatal opioid withdrawal syndrome were medically ready for discharge, without increasing specified adverse outcomes. (Funded by the Helping End Addiction Long-term (HEAL) Initiative of the National Institutes of Health; ESC-NOW ClinicalTrials.gov number, NCT04057820.).
    MeSH term(s) Humans ; Infant, Newborn ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Narcotics/therapeutic use ; Neonatal Abstinence Syndrome/therapy ; Sleep ; Substance Withdrawal Syndrome/diagnosis ; Substance Withdrawal Syndrome/drug therapy ; Substance Withdrawal Syndrome/therapy ; Eating ; United States ; Severity of Illness Index ; Time Factors ; Patient Comfort
    Chemical Substances Analgesics, Opioid ; Narcotics
    Language English
    Publishing date 2023-04-30
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMoa2214470
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  5. Article ; Online: Advocating For a Culture of Support for Lactating Medical Residents in Hawai'i.

    Ramsey, Kara Wong / Beckwith, Nina / Heathcock, Lindsey / Myers, Theresa / Balaraman, Venkataraman

    Hawai'i journal of health & social welfare

    2021  Volume 80, Issue 12, Page(s) 304–306

    Abstract: Lactating medical residents face unique barriers due to intense clinical work schedules, limited support in the clinic and hospital workspaces, and competing pressures between career development and childcare. The objective of this project was to explore ...

    Abstract Lactating medical residents face unique barriers due to intense clinical work schedules, limited support in the clinic and hospital workspaces, and competing pressures between career development and childcare. The objective of this project was to explore the perceived culture of breastfeeding support among medical trainees and design an action plan to improve support for lactating residents in Hawai'i. Resident and faculty representatives from the Hawai'i Residency Programs and the University of Hawai'i John A Burns School of Medicine participated in an 8 month national learning collaborative to review the existing resident lactation policy and resident perception of lactation support. In a pre-survey, the majority of residents (88%) agreed that 20-30 minutes every 2-3 hours should be allowed to express milk but only 18% felt comfortable asking for a change in schedule to accommodate time to pump. An action plan was created with the following objectives: (1) revamping the existing policy to address protected pumping times, lactation spaces, and responsibilities of administration, faculty, and residents; (2) improving lactation space through uniform provision of educational material on available facilities and efficiency tips for new parents, and (3) improving awareness of the unique challenges lactating residents face and empowering faculty and trainees to advocate for lactating residents through department and educational presentations. Medical residents in Hawai'i recognize the importance of breastfeeding but perceive a lack of support in the workplace. A comprehensive action plan to revamp the resident lactation policy and improve faculty and resident education may foster an increased culture of lactation support and healthy development of the physician workforce.
    MeSH term(s) Breast Feeding ; Female ; Hawaii ; Humans ; Internship and Residency ; Lactation ; Physicians
    Language English
    Publishing date 2021-10-18
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2983566-5
    ISSN 2641-5224 ; 2641-5216
    ISSN (online) 2641-5224
    ISSN 2641-5216
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