R. Nandyal - Academia.edu (original) (raw)

Papers by R. Nandyal

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2012

To determine whether patients receiving higher doses of caffeine have increased alkaline phosphat... more To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. A majority of the patients (n=122) were incl...

Emerging Trends in Disease and Health Research Vol. 7

New Horizons in Medicine and Medical Research Vol. 6

Issues and Developments in Medicine and Medical Research Vol. 9, 2021

Journal of Perinatology, 2014

OBJECTIVE To determine whether patients receiving higher doses of caffeine have increased alkalin... more OBJECTIVE To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. METHODS This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, ,1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for .2 weeks. Patients were divided into a low-dose (,7.5 mg/kg/day) and high-dose (� 7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. RESULTS A majority of the patients...

Cell and Tissue Banking

The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been ... more The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of a neonate's death. We report on the recovery of neonatal organs and tissues for research. A working group made up of bioethicists, neonatologists, lawyers, obstetric practioners as well as organ procurement and tissue banking professionals evaluated legal, ethical and medical issues. Neonatal donor family members were also consulted. Our primary goals were (a) to ensure that referrals were made in compliance with all applicable federal and state laws, regulations and institutional protocols, and (b) to follow

Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but t... more Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s life and among families with multiple well-known CM risk factors.

The Journal of Pediatrics, 1950

... AA Bagdasarov, MD. Moscow, USSR Michel A. Jamra, MD, Sao Paulo, Brazil Walter A. Cervoni, MD,... more ... AA Bagdasarov, MD. Moscow, USSR Michel A. Jamra, MD, Sao Paulo, Brazil Walter A. Cervoni, MD, San. ... Jean Dausset, MD, Paris, France Kazuo Miyoshi, MD, Tokyo, Japan GC de Gruchy, MD, Melbourne, Australia Arno G. Motulsky, MD, Seattle Pietro de Nicola, MD, Pavia. ...

Early Human Development, 1991

Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal in... more Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) 1 84, 3 had a GCI between 68 and 83 and 12 scored < 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI < 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay. asphyxia; multisystem involvement; neurodevelopmental sequelae.

The Journal of Perinatal & Neonatal Nursing, 2008

Group B Streptococcus (GBS), one of the β-Hemolytic streptococci, remains a leading cause of neon... more Group B Streptococcus (GBS), one of the β-Hemolytic streptococci, remains a leading cause of neonatal sepsis in the United States. The first consensus guidelines for the prevention of neonatal GBS disease were published in 1996, recommending intrapartum antibiotic prophylaxis on the basis of screening-based or risk-based strategies. Since then, there has been a 70% decrease in the rate of early-onset GBS disease. On the basis of evidence-validating superiority of this screening-based strategy, new national guidelines were released in 2002. Data from the Centers for Disease Control and Prevention in 2005 showed a continued decrease in the annual incidence of early-onset GBS infection. The screening-based strategy involves universal screening of all pregnant women at 35 to 37 weeks' gestation for vaginal and rectal GBS colonization and recommends intrapartum antibiotic prophylaxis for all GBS carriers (unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes) with penicillin-G (or ampicillin). For mothers with severe penicillin allergy, clindamycin or erythromycin is recommended, when GBS' sensitivity is known; otherwise, vancomycin is recommended. Cefazolin is recommended for individuals with mild penicillin allergy. Severe anaphylactic reactions to penicillin were extremely rare. Emergence of antibiotic resistance to penicillin is still a theoretical possibility. This article provides a detailed account of recommendations for screening, diagnosing, and treating GBS disease in newborns.

Journal of neonatal-perinatal medicine, 2014

Transfusion Associated Necrotizing Enterocolitis (TANEC) is defined as the onset of necrotizing e... more Transfusion Associated Necrotizing Enterocolitis (TANEC) is defined as the onset of necrotizing enterocolitis (NEC) within 48 hours of receiving a blood transfusion in preterm neonates. We wanted to determine if hematocrit changes following blood transfusions were associated with disease development. This is a case-control analysis of inborn neonates ≤32 weeks' gestational age, from January 1, 2007 and December 31, 2010, who were diagnosed with Bell stage II or greater NEC. Those meeting TANEC criteria were identified and an analysis completed to determine if beginning or ending hematocrit values were associated with an increased risk for disease development. Nineteen of forty-nine (39%) infants with NEC met the criteria for TANEC. We found no differences in gestational age at birth or birth weight in our experimental groups. The degree of illness including PDA, IVH, central line use, and respiratory support 48 hours prior to disease onset was also similar between groups. Those ...

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2012

To determine whether patients receiving higher doses of caffeine have increased alkaline phosphat... more To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. A majority of the patients (n=122) were incl...

Journal of Perinatology, 2014

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2012

To determine whether patients receiving higher doses of caffeine have increased alkaline phosphat... more To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. A majority of the patients (n=122) were incl...

Emerging Trends in Disease and Health Research Vol. 7

New Horizons in Medicine and Medical Research Vol. 6

Issues and Developments in Medicine and Medical Research Vol. 9, 2021

Journal of Perinatology, 2014

OBJECTIVE To determine whether patients receiving higher doses of caffeine have increased alkalin... more OBJECTIVE To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. METHODS This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, ,1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for .2 weeks. Patients were divided into a low-dose (,7.5 mg/kg/day) and high-dose (� 7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. RESULTS A majority of the patients...

Cell and Tissue Banking

The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been ... more The donation of organs and tissues from neonates (birth to 28 days) for transplantation has been a relatively infrequent occurrence. Less common has been the use of neonatal organs and tissues for research. Specific ethical and legal questions beg for rational and transparent guidelines with which to evaluate referrals of potential donors. Donation of organs and tissues from a neonate can play a key role in the care and support provided to families by health care professionals around the time of a neonate's death. We report on the recovery of neonatal organs and tissues for research. A working group made up of bioethicists, neonatologists, lawyers, obstetric practioners as well as organ procurement and tissue banking professionals evaluated legal, ethical and medical issues. Neonatal donor family members were also consulted. Our primary goals were (a) to ensure that referrals were made in compliance with all applicable federal and state laws, regulations and institutional protocols, and (b) to follow

Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but t... more Studies suggest that neonatal illness may cause increased risk for child maltreatment (CM), but these findings may be biased by observed and unobserved confounding factors (social, family, and maternal characteristics) including increased surveillance by health care providers. This study expands on previous research by examining and controlling for these potential study biases and confounders using a sibling discordance retrospective cohort study design. Infants born in a Level IV neonatal intensive care unit (NICU) were matched with non-NICU born sibling controls. Cox proportional hazard models with shared frailty terms were used to account for clustering and heterogeneity in CM survival time (time to CM event). Potentially key covariates were selected using the directed acyclic graph approach, and surveillance reports were identified and systematically included or excluded from analyses. Managing these sources of bias reduced but did not eliminate the association between neonatal illness and CM report risk. Risk was especially high during the first year of the NICU infant&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s life and among families with multiple well-known CM risk factors.

The Journal of Pediatrics, 1950

... AA Bagdasarov, MD. Moscow, USSR Michel A. Jamra, MD, Sao Paulo, Brazil Walter A. Cervoni, MD,... more ... AA Bagdasarov, MD. Moscow, USSR Michel A. Jamra, MD, Sao Paulo, Brazil Walter A. Cervoni, MD, San. ... Jean Dausset, MD, Paris, France Kazuo Miyoshi, MD, Tokyo, Japan GC de Gruchy, MD, Melbourne, Australia Arno G. Motulsky, MD, Seattle Pietro de Nicola, MD, Pavia. ...

Early Human Development, 1991

Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal in... more Twenty-eight term neonates with severe perinatal asphyxia were referred to a tertiary neonatal intensive care unit (NICU). The morbidity of asphyxia included involvement of the pulmonary (n = 24 infants), central nervous system (n = 22), renal (n = 15), cardiac (n = 14), metabolic (n = 13) and hematologic (n = 10) systems. The majority of neonates had more than three organ systems involved. Twenty-four neonates survived the neonatal course and at NICU discharge all system effects other than the central nervous system had resolved. At 5 years (60 months), 14 children had a normal neurologic examination, 9 had spastic quadriplegia and one had hemiplegia. Nine children had a McCarthy General Cognitive Index (GCI) 1 84, 3 had a GCI between 68 and 83 and 12 scored < 67. Neonatal seizures, renal problems, microcephaly at 3 months, and post-neonatal seizures were associated with an abnormal neurologic outcome or a GCI < 67. A neurologic examination during the first year of life may reveal whether children with birth asphyxia will be relatively normal at age 5 years or whether they will show considerable delay. asphyxia; multisystem involvement; neurodevelopmental sequelae.

The Journal of Perinatal & Neonatal Nursing, 2008

Group B Streptococcus (GBS), one of the β-Hemolytic streptococci, remains a leading cause of neon... more Group B Streptococcus (GBS), one of the β-Hemolytic streptococci, remains a leading cause of neonatal sepsis in the United States. The first consensus guidelines for the prevention of neonatal GBS disease were published in 1996, recommending intrapartum antibiotic prophylaxis on the basis of screening-based or risk-based strategies. Since then, there has been a 70% decrease in the rate of early-onset GBS disease. On the basis of evidence-validating superiority of this screening-based strategy, new national guidelines were released in 2002. Data from the Centers for Disease Control and Prevention in 2005 showed a continued decrease in the annual incidence of early-onset GBS infection. The screening-based strategy involves universal screening of all pregnant women at 35 to 37 weeks' gestation for vaginal and rectal GBS colonization and recommends intrapartum antibiotic prophylaxis for all GBS carriers (unless delivered by planned cesarean section before the onset of labor in a woman with intact membranes) with penicillin-G (or ampicillin). For mothers with severe penicillin allergy, clindamycin or erythromycin is recommended, when GBS' sensitivity is known; otherwise, vancomycin is recommended. Cefazolin is recommended for individuals with mild penicillin allergy. Severe anaphylactic reactions to penicillin were extremely rare. Emergence of antibiotic resistance to penicillin is still a theoretical possibility. This article provides a detailed account of recommendations for screening, diagnosing, and treating GBS disease in newborns.

Journal of neonatal-perinatal medicine, 2014

Transfusion Associated Necrotizing Enterocolitis (TANEC) is defined as the onset of necrotizing e... more Transfusion Associated Necrotizing Enterocolitis (TANEC) is defined as the onset of necrotizing enterocolitis (NEC) within 48 hours of receiving a blood transfusion in preterm neonates. We wanted to determine if hematocrit changes following blood transfusions were associated with disease development. This is a case-control analysis of inborn neonates ≤32 weeks' gestational age, from January 1, 2007 and December 31, 2010, who were diagnosed with Bell stage II or greater NEC. Those meeting TANEC criteria were identified and an analysis completed to determine if beginning or ending hematocrit values were associated with an increased risk for disease development. Nineteen of forty-nine (39%) infants with NEC met the criteria for TANEC. We found no differences in gestational age at birth or birth weight in our experimental groups. The degree of illness including PDA, IVH, central line use, and respiratory support 48 hours prior to disease onset was also similar between groups. Those ...

The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 2012

To determine whether patients receiving higher doses of caffeine have increased alkaline phosphat... more To determine whether patients receiving higher doses of caffeine have increased alkaline phosphatase (ALP) levels, as a biomarker for osteopenia. This descriptive, retrospective study included 152 extremely low-birth-weight infants (ie, <1 kg) admitted from January 1, 2007, to September 30, 2009, who received caffeine for >2 weeks. Patients were divided into a low-dose (<7.5 mg/kg/day) and high-dose (≥7.5 mg/kg/day) group based on maximum caffeine dose received. The primary objective was to compare peak ALP levels between groups. Secondary objectives included a comparison of caffeine regimens and risk factors for osteopenia between groups and identification of factors significantly related to increase in ALP. Between-group analysis was performed using the chi-squared or Fisher exact test and Wilcoxon Mann-Whitney median test or t-tests where appropriate. A linear regression model was used, with peak ALP as the dependent variable. A majority of the patients (n=122) were incl...

Journal of Perinatology, 2014