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  1. Article: Optimizing Invasive Neonatal Respiratory Care: A Systematic Review of Invasive Neurally Adjusted Ventilatory Assist.

    Balasundaram, Palanikumar / Sakr, Mohamed

    Healthcare (Basel, Switzerland)

    2024  Volume 12, Issue 6

    Abstract: Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) is a unique mode relying on diaphragmatic electrical signals for synchronization. We ... ...

    Abstract Background: Mechanical ventilation in preterm neonates aims for synchrony, preventing complications such as lung injury. Neurally Adjusted Ventilatory Assist (NAVA) is a unique mode relying on diaphragmatic electrical signals for synchronization. We conducted a review focusing on the long-term consequences of using invasive NAVA in neonates with a focus on bronchopulmonary dysplasia (BPD).
    Methods: A systematic review following PRISMA explored invasive NAVA in preterm neonates. Primary objectives compared NAVA to conventional ventilation, assessing BPD incidence, ventilation duration, length of stay, and adverse events. Secondary objectives analyzed ventilator parameters.
    Results: After screening 282 records, the review incorporated two randomized controlled trials for primary outcomes and seven trials for secondary outcomes, including two randomized crossovers, four prospective crossovers, and one retrospective study. NAVA showed reduced oxygen requirement at 28 days but no significant differences in oxygen need at 36 weeks postmenstrual age, total length of stay, or ventilator days. Substantial variations were not observed in adverse events. Ventilator variables favored NAVA, indicating decreased peak inspiratory pressure, tidal volume, work of breathing, and respiratory severity score.
    Conclusion: Our study found no significant reduction in BPD with NAVA despite short-term benefits. Future large-scale trials are essential to assess NAVA's impact on long-term outcomes comprehensively.
    Language English
    Publishing date 2024-03-11
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2721009-1
    ISSN 2227-9032
    ISSN 2227-9032
    DOI 10.3390/healthcare12060632
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Monitoring Neonatal Bilirubin after Discharge.

    Balasundaram, Palanikumar / Campbell, Deborah

    Pediatrics in review

    2023  Volume 44, Issue 2, Page(s) 110–113

    MeSH term(s) Humans ; Infant, Newborn ; Patient Discharge ; Bilirubin/analysis
    Chemical Substances Bilirubin (RFM9X3LJ49)
    Language English
    Publishing date 2023-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 774515-1
    ISSN 1526-3347 ; 0191-9601
    ISSN (online) 1526-3347
    ISSN 0191-9601
    DOI 10.1542/pir.2022-005522
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.B 2595: Show issues Location:
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    Zs.MO 53: Show issues

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  3. Article ; Online: 50 Years Ago in TheJournalofPediatrics: Management of Neonatal Hyperbilirubinemia-Has Much Changed?

    Balasundaram, Palanikumar / Nafday, Suhas

    The Journal of pediatrics

    2021  Volume 239, Page(s) 88

    MeSH term(s) Humans ; Hyperbilirubinemia, Neonatal/therapy ; Infant, Newborn ; Phototherapy/adverse effects ; Phototherapy/methods
    Language English
    Publishing date 2021-11-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3102-1
    ISSN 1097-6833 ; 0022-3476
    ISSN (online) 1097-6833
    ISSN 0022-3476
    DOI 10.1016/j.jpeds.2021.09.041
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  4. Article ; Online: A Neonate with a Rare Presentation of Persistent Hypoglycemia and Prolonged Jaundice.

    Balasundaram, Palanikumar / Lucena, Michelle H / Nafday, Suhas

    NeoReviews

    2022  Volume 24, Issue 1, Page(s) 39–42

    MeSH term(s) Infant, Newborn ; Humans ; Jaundice/diagnosis ; Jaundice/etiology ; Hypoglycemia/diagnosis ; Hypoglycemia/etiology
    Language English
    Publishing date 2022-12-29
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 1526-9906
    ISSN (online) 1526-9906
    DOI 10.1542/neo.24-1-e39
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  5. Article: Unraveling Leukocyte Profile Shifts and Platelet Dynamics Following Leukoreduced Packed Red Cell Transfusions in Very Low Birth Weight Preterm Neonates.

    Balasundaram, Palanikumar / Al-Mulaabed, Sharef Waadallah / Roger, Kim

    Cureus

    2023  Volume 15, Issue 9, Page(s) e44900

    Abstract: Background Packed red blood cell (PRBC) transfusions are routine in neonatal care and the most common blood product administered to sick neonates. However, their impact on leukocyte and platelet profiles in very low birth weight (VLBW) preterm infants ... ...

    Abstract Background Packed red blood cell (PRBC) transfusions are routine in neonatal care and the most common blood product administered to sick neonates. However, their impact on leukocyte and platelet profiles in very low birth weight (VLBW) preterm infants remains largely unexplored. This study examines leukocyte profile shifts and platelet dynamics following leukoreduced PRBC transfusions in VLBW preterm infants, offering insights to improve neonatal care and reduce unnecessary interventions. Methods The study utilized a retrospective cohort design within a single center, focusing on VLBW preterm infants who received PRBC transfusions at a level 3 NICU between January 2014 and June 2019. Data collection encompassed white blood cell (WBC) and platelet count measurements taken 24 hours before and up to 72 hours after PRBC transfusion. Neonates lacking complete blood count (CBC) data within the 72-hour post-transfusion window were excluded. A subgroup analysis distinguished the outcome between the initial PRBC transfusion and subsequent ones. The statistical significance of pre- and post-transfusion laboratory data was determined using the Wilcoxon signed ranks test and paired T-test. Results A cohort of 108 VLBW preterm infants who underwent a total of 402 PRBC transfusions was included in the analysis. The subjects exhibited a mean gestational age of 27.2 ± 2.5 weeks and a mean birth weight of 913 ± 264 grams. Analysis of pre- and post-transfusion data revealed no significant differences in total white blood cell count (WBC), absolute neutrophil count (ANC), absolute monocyte count (AMC), absolute eosinophil count, and absolute lymphocyte count. Notably, the platelet count was significantly decreased in the post-transfusion group (p < 0.001). In a subset analysis limited to the first-time transfusions among the 108 infants, a statistically significant increase was observed in total WBC, AMC, and ANC following transfusion. Conclusions The findings of this study highlight that PRBC transfusions can prompt an increase in neutrophils, monocytes, and eosinophils, coupled with a decline in platelet counts, all within a 72-hour window post-transfusion. Notably, these changes were predominantly discernible after the initial transfusion, with subsequent transfusions demonstrating consistency, except for the observed platelet count reduction. Recognizing these patterns could prove instrumental in averting undue investigations for suspected sepsis, particularly following the initial transfusion event. However, further in-depth investigations are necessary to uncover the underlying factors responsible for the shifts in leukocyte and platelet profiles triggered by PRBC transfusions.
    Language English
    Publishing date 2023-09-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.44900
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  6. Article ; Online: A Quality Improvement Initiative to Increase Skin-to-Skin Care Duration in Preterm Neonates.

    Balasundaram, Palanikumar / Frascone, Melissa / Wnukowski, Samantha / Murphy, Alana G / Connors, Jillian

    Hospital pediatrics

    2024  Volume 14, Issue 4, Page(s) 291–299

    Abstract: Background: Skin-to-skin (STS) care effectively improves neonatal outcomes, particularly for preterm neonates. However, utilization of STS remains suboptimal for the most vulnerable preterm neonates in the first 4 weeks of life. This quality improvement ...

    Abstract Background: Skin-to-skin (STS) care effectively improves neonatal outcomes, particularly for preterm neonates. However, utilization of STS remains suboptimal for the most vulnerable preterm neonates in the first 4 weeks of life. This quality improvement (QI) project aimed to increase STS duration for neonates under 35 weeks gestation.
    Methods: The QI initiative was conducted in a 35-bed level IV NICU within a teaching hospital in New York City from July 2021 to January 2023. Six months of baseline data and a staff survey determined interventions across "Plan, Do, Study, Act" cycles. Interim analyses guided interventions using run charts. Interventions included parental counseling and information leaflets, discussion during rounds on STS eligibility, STS education for residents, nurses' feedback, and visual reminders. The primary outcome measure was the mean duration of STS per eligible patient day. The process measures were the age at first STS and documentation of eligibility for STS care in the electronic medical records. Balancing measures included adverse events such as apnea, bradycardia, desaturation, hypothermia, and inadvertent dislodgement of central lines and endotracheal tube.
    Results: The study included 185 infants with a mean gestational age of 29.1 weeks. The mean STS duration per eligible patient day increased from a baseline of 13.3 minutes to 32.4 minutes without significantly increasing adverse events.
    Conclusions: The QI interventions implemented have successfully increased the duration of STS in preterm infants. Our interventions combined into an STS bundle can be a potential model for other NICUs to improve STS practice.
    MeSH term(s) Infant ; Infant, Newborn ; Humans ; Infant, Premature ; Quality Improvement ; Gestational Age ; Intensive Care Units, Neonatal ; Parents
    Language English
    Publishing date 2024-03-21
    Publishing country United States
    Document type Journal Article
    ISSN 2154-1671
    ISSN (online) 2154-1671
    DOI 10.1542/hpeds.2023-007421
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  7. Article: Unveiling Peripherally Inserted Central Catheter Fractures and Related Complications in the Neonatal Intensive Care Unit: A Concise Review.

    Balasundaram, Palanikumar / Lucena, Michelle H / Jiang, Lan / Nafday, Suhas

    Cureus

    2023  Volume 15, Issue 10, Page(s) e47572

    Abstract: Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal ... ...

    Abstract Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal complication. This narrative review aims to identify factors predisposing neonates to PICC fracture and related complications, such as catheter jamming, and explore strategies for preventing and detecting this complication. A thorough search of PubMed and Google Scholar was conducted using relevant keywords to identify articles discussing PICC fracture in neonates. The review encompassed English-language literature on PICC fracture in neonates, with additional pertinent publications identified through citation searching. The incidence of PICC fracture in neonates varies from less than 1% to 10%, with a higher risk associated with prolonged catheterization, lower gestational age and lower birth weight, and the use of multi-lumen catheters. PICC fractures can occur during insertion, maintenance, or removal. Factors such as catheter duration, gestational age, birth weight, and catheter type increase the risk of PICC fracture. Excessive syringe pressure, securement failure, and excessive force during removal are contributing factors. Catheter fatigue and thin-walled catheter design are common causes of breakage. Preventive measures include proper training of healthcare providers, regular monitoring, early recognition, and prompt catheter removal upon fracture. Preventing and detecting PICC fractures is crucial for neonatal safety. Vigilance during insertion, maintenance, and removal, along with care to avoid excessive force during removal and high pressure during flushing, can help prevent catheter breakage. More research is required to improve prevention strategies for PICC fractures in neonates.
    Language English
    Publishing date 2023-10-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.47572
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  8. Article ; Online: Leukocytosis and Splenomegaly in a Neonate With NRAS Mutation.

    Lucena, Michelle H / Balasundaram, Palanikumar / Carney, Megan / Green, Erica / Breilyn, Margo S / Fuloria, Mamta

    Clinical pediatrics

    2023  Volume 63, Issue 4, Page(s) 451–455

    MeSH term(s) Infant, Newborn ; Humans ; Leukocytosis/genetics ; Splenomegaly/diagnostic imaging ; Splenomegaly/etiology ; Mutation ; Membrane Proteins/genetics ; GTP Phosphohydrolases/genetics
    Chemical Substances NRAS protein, human (EC 3.6.1.-) ; Membrane Proteins ; GTP Phosphohydrolases (EC 3.6.1.-)
    Language English
    Publishing date 2023-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207678-0
    ISSN 1938-2707 ; 0009-9228
    ISSN (online) 1938-2707
    ISSN 0009-9228
    DOI 10.1177/00099228231176341
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 454: Show issues Location:
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  9. Article: Novel TTN Mutation Causing Severe Congenital Myopathy and Uncertain Association with Infantile Hydrocephalus.

    Balasundaram, Palanikumar / Avulakunta, Indirapriya Darshini / Delfiner, Leslie / Levy, Paul / Forman, Katie R

    Case reports in genetics

    2023  Volume 2023, Page(s) 5535083

    Abstract: Arthrogryposis multiplex congenita (AMC) is characterized by nonprogressive symmetric contractures of multiple joints with normal intellect and normal systemic examination. AMC is often due to fetal akinesia, which has neurologic, muscular, and ... ...

    Abstract Arthrogryposis multiplex congenita (AMC) is characterized by nonprogressive symmetric contractures of multiple joints with normal intellect and normal systemic examination. AMC is often due to fetal akinesia, which has neurologic, muscular, and connective tissue etiologies. We present a case of AMC due to a variant in the titin (TTN) gene in a term neonate. The infant is homozygous for this variant,
    Language English
    Publishing date 2023-07-18
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2664417-4
    ISSN 2090-6552 ; 2090-6544
    ISSN (online) 2090-6552
    ISSN 2090-6544
    DOI 10.1155/2023/5535083
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  10. Article ; Online: A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations.

    Sakr, Mohamed / Al Kanjo, Mohamed / Balasundaram, Palanikumar / Kupferman, Fernanda / Al-Mulaabed, Sharef / Scott, Sandra / Viswanathan, Kusum / Basak, Ratna B

    Pediatric quality & safety

    2024  Volume 9, Issue 2, Page(s) e721

    Abstract: Background: Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR ... ...

    Abstract Background: Current national guidelines recommend against chest X-rays (CXRs) for patients with acute asthma exacerbation (AAE). The overuse of CXRs in AAE has become a concern, prompting the need for a quality improvement (QI) project to decrease CXR usage through guideline-based interventions. We aimed to reduce the percentage of CXRs not adhering to national guidelines obtained for pediatric patients presenting to the Emergency Department (ED) with AAE by 50% within 12 months of project initiation.
    Methods: We conducted this study at a New York City urban level-2 trauma center. The team was composed of members from the ED and pediatric departments. Electronic medical records of children aged 2 to 18 years presenting with AAE were evaluated. Monthly data on CXR utilization encompassing instances where the ordered CXR did not adhere to guidelines was collected before and after implementing interventions. The interventions included provider education, visual reminders, printed cards, grand-round presentations, and electronic medical records modifications.
    Results: The study encompassed 887 eligible patients with isolated AAE. Baseline data revealed a mean preintervention CXR noncompliance rate of 37.5% among children presenting to the ED with AAE. The interventions resulted in a notable decrease in unnecessary CXR utilization, reaching 16.7%, a reduction sustained throughout subsequent months.
    Conclusions: This QI project successfully reduced unnecessary CXR utilization in pediatric AAE. A multi-faceted approach involving education, visual aids, and electronic reminders aligned clinical practice with evidence-based guidelines. This QI initiative is a potential template for other healthcare institutions seeking to curtail unnecessary CXR usage in pediatric AAE.
    Language English
    Publishing date 2024-04-03
    Publishing country United States
    Document type Journal Article
    ISSN 2472-0054
    ISSN (online) 2472-0054
    DOI 10.1097/pq9.0000000000000721
    Database MEDical Literature Analysis and Retrieval System OnLINE

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