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Article ; Online: Does enteral nutrition during therapeutic hypothermia increase the risk for necrotizing enterocolitis?

Gillen, Matthew C / Patel, Ravi M

Journal of perinatology : official journal of the California Perinatal Association

2023 Volume 44, Issue 1, Page(s) 151–154

MeSH term(s)	Infant, Newborn ; Humans ; Enterocolitis, Necrotizing/etiology ; Enterocolitis, Necrotizing/therapy ; Enteral Nutrition/adverse effects ; Infant, Premature ; Parenteral Nutrition ; Infant, Newborn, Diseases/therapy ; Hypothermia, Induced/adverse effects
Language	English
Publishing date	2023-09-06
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/s41372-023-01771-9
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Article ; Online: Use of darbepoetin alfa in haemolytic disease of the fetus and newborn.

Patel, Ravi M / Ohls, Robin

The Lancet. Haematology

2023 Volume 10, Issue 12, Page(s) e943–e945

MeSH term(s)	Humans ; Infant, Newborn ; Anemia ; Darbepoetin alfa/therapeutic use ; Erythropoietin/therapeutic use ; Fetus ; Hematologic Diseases/drug therapy ; Hemolysis
Chemical Substances	Darbepoetin alfa (15UQ94PT4P) ; Erythropoietin (11096-26-7)
Language	English
Publishing date	2023-11-29
Publishing country	England
Document type	Journal Article
ISSN	2352-3026
ISSN (online)	2352-3026
DOI	10.1016/S2352-3026(23)00316-2
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Article ; Online: Using Quality Improvement to Improve Value and Reduce Waste.

King, Brian / Patel, Ravi M

Clinics in perinatology

2023 Volume 50, Issue 2, Page(s) 489–506

Abstract: Value is defined as health outcomes achieved per dollar spent. Addressing value in quality improvement (QI) efforts can help optimize patient outcomes while reducing unnecessary spending. In this article, we discuss how QI focused on reducing morbidities ...

Abstract	Value is defined as health outcomes achieved per dollar spent. Addressing value in quality improvement (QI) efforts can help optimize patient outcomes while reducing unnecessary spending. In this article, we discuss how QI focused on reducing morbidities frequently reduces costs, and how proper cost accounting can help demonstrate improvements in value. We provide examples of high-yield opportunities for value improvement in neonatology and review the literature associated with these topics. Opportunities include reducing neonatal intensive care admissions for low-acuity infants, sepsis evaluations in low-risk infants, unnecessary total parental nutrition use, and utilization of laboratory and imaging.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Intensive Care Units, Neonatal ; Quality Improvement ; Intensive Care, Neonatal ; Neonatology ; Hospitalization
Language	English
Publishing date	2023-03-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193116-7
ISSN	1557-9840 ; 0095-5108
ISSN (online)	1557-9840
ISSN	0095-5108
DOI	10.1016/j.clp.2023.01.009
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Article ; Online: Red Blood Cell Transfusion, Anemia, Feeding, and the Risk of Necrotizing Enterocolitis.

Salem, Anand / Patel, Ravi M

Clinics in perinatology

2023 Volume 50, Issue 3, Page(s) 669–681

Abstract: Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Severe anemia and red blood cell (RBC) transfusion are associated with gut inflammation and injury in preclinical models and observational studies. However, ...

Abstract	Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Severe anemia and red blood cell (RBC) transfusion are associated with gut inflammation and injury in preclinical models and observational studies. However, there is uncertainty about the causal role of these factors in the pathogenesis of NEC. Observational studies have shown that withholding feeding during RBC transfusion may reduce the risk of NEC, although confirmatory data from randomized trials are lacking. In this review, we summarize data on feeding during RBC transfusion and its role in NEC and highlight ongoing randomized trials.
MeSH term(s)	Infant ; Female ; Infant, Newborn ; Humans ; Infant, Premature ; Enterocolitis, Necrotizing/epidemiology ; Enterocolitis, Necrotizing/etiology ; Erythrocyte Transfusion/adverse effects ; Anemia/therapy ; Infant, Newborn, Diseases ; Risk Factors ; Fetal Diseases
Language	English
Publishing date	2023-06-20
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	193116-7
ISSN	1557-9840 ; 0095-5108
ISSN (online)	1557-9840
ISSN	0095-5108
DOI	10.1016/j.clp.2023.04.014
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Article ; Online: Nutritional Supplements to Improve Outcomes in Preterm Neonates.

Pammi, Mohan / Patel, Ravi M

Clinics in perinatology

2022 Volume 49, Issue 2, Page(s) 485–502

Abstract: Preterm infants are at higher risk of mortality and morbidity compared with those born at term. Nutrition-related morbidities include poor growth, immune deficiency, nutritional deficiencies, and adverse long-term neurodevelopment. In addition to ... ...

Abstract	Preterm infants are at higher risk of mortality and morbidity compared with those born at term. Nutrition-related morbidities include poor growth, immune deficiency, nutritional deficiencies, and adverse long-term neurodevelopment. In addition to macronutrients, many nutritional supplements have been used to enhance growth and development, and decrease infections. Nutrients can enhance preterm infants' immune status, optimize the microbiome, improve growth and development, and influence the risk of necrotizing enterocolitis, sepsis, and other outcomes.
MeSH term(s)	Dietary Supplements ; Enterocolitis, Necrotizing/prevention & control ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Sepsis/prevention & control
Language	English
Publishing date	2022-04-21
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	193116-7
ISSN	1557-9840 ; 0095-5108
ISSN (online)	1557-9840
ISSN	0095-5108
DOI	10.1016/j.clp.2022.02.012
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Article ; Online: Platelet Transfusion and Death or Neurodevelopmental Impairment in Children Born Extremely Preterm.

Davenport, Patricia E / Wood, Thomas R / Heagerty, Patrick J / Sola-Visner, Martha C / Juul, Sandra E / Patel, Ravi M

JAMA network open

2024 Volume 7, Issue 1, Page(s) e2352394

Abstract: Importance: Infants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed ... ...

Abstract	Importance: Infants born extremely preterm receive transfusions at higher platelet count thresholds than older children and adults due to concerns for intracranial hemorrhage. A recent randomized trial comparing 2 platelet transfusion thresholds showed the higher threshold was associated with increased risk of long-term adverse neurodevelopmental outcomes. Objective: To evaluate the association of platelet transfusion exposure with death and severe neurodevelopmental impairment (NDI) at 2 years' corrected age in a cohort of infants born extremely preterm. Design, setting, and participants: An observational cohort study and secondary analysis of the Preterm Erythropoietin Neuroprotection Trial, a randomized, placebo-controlled clinical trial of erythropoietin neuroprotection in neonates born extremely preterm, was conducted in 30 neonatal intensive care units in the US from December 1, 2013, to September 31, 2016. This analysis included 819 infants born extremely preterm at 24 to 27 completed weeks of gestation who had a documented outcome (death or neurodevelopmental assessment). Analysis was performed in April 2023. Exposures: Any platelet transfusion during neonatal intensive care unit hospitalization. Main outcomes and measures: The primary composite outcome was death or severe NDI evaluated at 2 years' corrected age using the Bayley Scales of Infant Development-Third Edition (BSID-III) and the Gross Motor Function Classification System and was defined as the presence of severe cerebral palsy or a BSID-III composite motor or cognitive score 2 SDs below the mean. Confounding by indication for platelet transfusion was addressed with covariate adjustment and propensity score methods. Results: Of the 819 infants included in the analysis (429 [52.4%] male; mean [SD] gestational age, 25.5 [1.1] weeks), 245 (30.0%) received at least 1 platelet transfusion during their initial hospitalization. The primary outcome occurred in 46.5% (114 of 245) of infants exposed to a platelet transfusion and 13.9% (80 of 574) of nonexposed infants with a corresponding odds ratio of 2.43 (95% CI, 1.24-4.76), adjusted for propensity score, gestational age at birth, and trial treatment group. The individual components of death and severe NDI were directionally consistent with the overall composite outcome. Conclusions and relevance: The findings of this study suggest that platelet transfusion in infants born extremely preterm may be associated with an increased risk of death or severe NDI at 2 years' corrected age, although the possibility of residual confounding by indication cannot be excluded.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Male ; Cerebral Palsy ; Erythropoietin ; Gestational Age ; Infant, Extremely Premature ; Platelet Transfusion ; Randomized Controlled Trials as Topic
Chemical Substances	Erythropoietin (11096-26-7)
Language	English
Publishing date	2024-01-02
Publishing country	United States
Document type	Journal Article ; Observational Study
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.52394
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Article ; Online: Neonatal Intensive Care Unit Resource Use for Infants at 22 Weeks' Gestation in the US, 2008-2021.

Rysavy, Matthew A / Bennett, Monica M / Ahmad, Kaashif A / Patel, Ravi M / Shah, Zubin S / Ellsbury, Dan L / Clark, Reese H / Tolia, Veeral N

JAMA network open

2024 Volume 7, Issue 2, Page(s) e240124

Abstract: Importance: During the past decade, clinical guidance about the provision of intensive care for infants born at 22 weeks' gestation has changed. The impact of these changes on neonatal intensive care unit (NICU) resource utilization is unknown.: ... ...

Abstract	Importance: During the past decade, clinical guidance about the provision of intensive care for infants born at 22 weeks' gestation has changed. The impact of these changes on neonatal intensive care unit (NICU) resource utilization is unknown. Objective: To characterize recent trends in NICU resource utilization for infants born at 22 weeks' gestation compared with other extremely preterm infants (≤28 weeks' gestation) and other NICU-admitted infants. Design, setting, and participants: This is a serial cross-sectional study of 137 continuously participating NICUs in 29 US states from January 1, 2008, through December 31, 2021. Participants included infants admitted to the NICU. Data analysis was performed from October 2022 to August 2023. Exposures: Year and gestational age at birth. Main outcomes and measures: Measures of resource utilization included NICU admissions, NICU bed-days, and ventilator-days. Results: Of 825 112 infants admitted from 2008 to 2021, 60 944 were extremely preterm and 872 (466 [53.4%] male; 18 [2.1%] Asian; 318 [36.5%] Black non-Hispanic; 218 [25.0%] Hispanic; 232 [26.6%] White non-Hispanic; 86 [9.8%] other or unknown) were born at 22 weeks' gestation. NICU admissions at 22 weeks' gestation increased by 388%, from 5.7 per 1000 extremely preterm admissions in 2008 to 2009 to 27.8 per 1000 extremely preterm admissions in 2020 to 2021. The number of NICU admissions remained stable before the publication of updated clinical guidance in 2014 to 2016 and substantially increased thereafter. During the study period, bed-days for infants born at 22 weeks increased by 732%, from 2.5 per 1000 to 20.8 per 1000 extremely preterm NICU bed-days; ventilator-days increased by 946%, from 5.0 per 1000 to 52.3 per 1000 extremely preterm ventilator-days. The proportion of NICUs admitting infants born at 22 weeks increased from 22.6% to 45.3%. Increases in NICU resource utilization during the period were also observed for infants born at less than 22 and at 23 weeks but not for other gestational ages. In 2020 to 2021, infants born at less than or equal to 23 weeks' gestation comprised 1 in 117 NICU admissions, 1 in 34 of all NICU bed-days, and 1 in 6 of all ventilator-days. Conclusions and relevance: In this serial cross-sectional study of 137 US NICUs from 2008 to 2021, an increasing share of resources in US NICUs was allocated to infants born at 22 weeks' gestation, corresponding with changes in national clinical guidance.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Male ; Pregnancy ; Cross-Sectional Studies ; Gestational Age ; Infant, Extremely Premature ; Infant, Premature, Diseases ; Intensive Care Units, Neonatal
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.0124
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Article ; Online: A high fiber diet or supplementation with

Barbian, Maria E / Owens, Joshua A / Naudin, Crystal R / Denning, Patricia / Patel, Ravi M / Jones, Rheinallt M

Gut microbes

2024 Volume 16, Issue 1, Page(s) 2337317

Abstract: The diet during pregnancy, or antenatal diet, influences the offspring's intestinal health. We previously showed that antenatal butyrate supplementation reduces injury in adult murine offspring with dextran sulfate sodium (DSS)-induced colitis. Potential ...

Abstract	The diet during pregnancy, or antenatal diet, influences the offspring's intestinal health. We previously showed that antenatal butyrate supplementation reduces injury in adult murine offspring with dextran sulfate sodium (DSS)-induced colitis. Potential modulators of butyrate levels in the intestine include a high fiber diet or dietary supplementation with probiotics. To test this, we supplemented the diet of pregnant mice with high fiber, or with the probiotic bacteria
MeSH term(s)	Female ; Pregnancy ; Animals ; Mice ; Lactococcus lactis/genetics ; Gastrointestinal Microbiome ; Colitis ; Dietary Supplements ; Butyrates ; Lactococcus
Chemical Substances	Butyrates
Language	English
Publishing date	2024-04-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2575755-6
ISSN	1949-0984 ; 1949-0984
ISSN (online)	1949-0984
ISSN	1949-0984
DOI	10.1080/19490976.2024.2337317
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Article ; Online: Trends and Racial and Geographic Differences in Infant Mortality in the United States Due to Necrotizing Enterocolitis, 1999 to 2020.

Wolf, Mattie F / Rose, Allison T / Goel, Ruchika / Canvasser, Jennifer / Stoll, Barbara J / Patel, Ravi M

JAMA network open

2023 Volume 6, Issue 3, Page(s) e231511

MeSH term(s)	Infant ; Humans ; Infant, Newborn ; United States ; Enterocolitis, Necrotizing ; Infant Mortality ; Infant, Newborn, Diseases
Language	English
Publishing date	2023-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2023.1511
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Article ; Online: Safety and efficacy of probiotic administration to preterm infants: ten common questions.

Underwood, Mark A / Umberger, Erin / Patel, Ravi M

Pediatric research

2020 Volume 88, Issue Suppl 1, Page(s) 48–55

Abstract: In spite of a large number of randomized placebo-controlled clinical trials and observational cohort studies including >50,000 preterm infants from 29 countries that have demonstrated a decrease in the risk of necrotizing enterocolitis, death, and sepsis, ...

Abstract	In spite of a large number of randomized placebo-controlled clinical trials and observational cohort studies including >50,000 preterm infants from 29 countries that have demonstrated a decrease in the risk of necrotizing enterocolitis, death, and sepsis, routine prophylactic probiotic administration to preterm infants remains uncommon in much of the world. This manuscript reflects talks given at NEC Society Symposium in 2019 and is not intended to be a state-of-the-art review or systematic review, but a summary of the probiotic-specific aspects of the symposium with limited additions including a recent strain-specific network analysis and position statement from the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). We address ten common questions related to the intestinal microbiome and probiotic administration to the preterm infant.
MeSH term(s)	Clinical Trials as Topic ; Dysbiosis/physiopathology ; Enterocolitis, Necrotizing/prevention & control ; Enterocolitis, Necrotizing/therapy ; Europe ; Gastrointestinal Microbiome ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Infant, Premature ; Milk, Human ; Observational Studies as Topic ; Patient Safety ; Probiotics/therapeutic use ; Sepsis/prevention & control ; Societies, Medical ; Treatment Outcome
Language	English
Publishing date	2020-08-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	4411-8
ISSN	1530-0447 ; 0031-3998
ISSN (online)	1530-0447
ISSN	0031-3998
DOI	10.1038/s41390-020-1080-6
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