susan albersheim - Academia.edu (original) (raw)

Papers by susan albersheim

The journal of pediatrics/The Journal of pediatrics, Feb 1, 2024

Neonatology is a branch of paediatrics dealing with extremely ill or premature babies, and the ne... more Neonatology is a branch of paediatrics dealing with extremely ill or premature babies, and the neonatal intensive care unit (NICU) is frequently the setting for life-and-death decisions. Society considers parents to be the proper persons to make those decisions for their babies, but in practice they seem to be allowed to do this only as long as they agree with medical recommendations; otherwise, the "best interest standard" is proposed. My objective is to evaluate decision-making in the NICU. Part I of this research, a descriptive study, compares decision-making by parents, doctors, and nurses when presented with hypothetical scenarios. Part II, through in-depth interviews, evaluates factors important to parents in making life-anddeath decisions. Part III, using structured interviews, explores the neonatologists' perceptions of the limits of parental decision-making authority. The results reveal that parents make different decisions from those of doctors and nurses. Parents have an equal commitment to intensive care (35-40%) with either mental or physical handicap. Doctors and nurses, on the other hand, have less commitment to intensive care with severe mental handicap (10%), but more commitment with physical handicap (90%). Religious commitment and experience with handicap influence decisions by parents, but not by doctors and nurses. The right of parents to decide for their baby and the interests of the family are also more important for parents than for doctors and nurses. For parents, furthermore, the important factors are an honest, caring, transparent relationship with good communication with their neonatologist; being fully informed; their values and beliefs; their roles and their sense of loss of control; and emotional turmoil. Of these interrelated factors, the most important is the relationship between CHAPTER II Body of Thesis: Methodology and Results 2.

PubMed, Aug 1, 1991

It is important to identify high-risk women abusing drugs in order to provide good care for them ... more It is important to identify high-risk women abusing drugs in order to provide good care for them and their babies. These infants require close observation after birth for perinatal complications withdrawal, long-term neurobehavioral abnormalities (even with drug use only early in pregnancy), and sudden infant death syndrome. The degree of withdrawal is not an indicator of outcome. Early involvement of Child Protective Services is important for this group, at risk for abuse and neglect.

PubMed, 2014

Counselling couples facing the birth of an extremely preterm infant is a complex and delicate tas... more Counselling couples facing the birth of an extremely preterm infant is a complex and delicate task, entailing both challenges and opportunities. This revised position statement proposes using a prognosis-based approach that takes the best estimate of gestational age into account, along with additional factors, including estimated fetal weight, receipt of antenatal corticosteroids, singleton versus multiple pregnancy, fetal status and anomalies on ultrasound and place of birth. This statement updates data on survival in Canada, long-term neurodevelopmental disability at school age and quality of life, with focus on strategies to communicate effectively with parents. It also proposes a framework for determining the prognosis-based management option(s) to present to parents when initiating the decision-making process. This statement replaces the 2012 position statement.

Paediatrics and Child Health, Mar 1, 2010

Nutrients

Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of ... more Fixed-dose fortification of human milk (HM) is insufficient to meet the nutrient requirements of preterm infants. Commercial human milk analyzers (HMA) to individually fortify HM are unavailable in most centers. We describe the development and validation of a bedside color-based tool called the ‘human milk calorie guide’(HMCG) for differentiating low-calorie HM using commercial HMA as the gold standard. Mothers of preterm babies (birth weight ≤ 1500 g or gestation ≤ 34 weeks) were enrolled. The final color tool had nine color shades arranged as three rows of three shades each (rows A, B, and C). We hypothesized that calorie values for HM samples would increase with increasing ‘yellowness’ predictably from row A to C. One hundred thirty-one mother’s own milk (MOM) and 136 donor human milk (DHM) samples (total n = 267) were color matched and analyzed for macronutrients. The HMCG tool performed best in DHM samples for predicting lower calories (<55 kcal/dL) (AUC 0.87 for category A ...

Pediatric Research 23(4 Part, May 23, 1988

Archives of Disease in Childhood, 2020

Objective To evaluate whether a pragmatic corrected fortification (CF) model achieves recommended... more Objective To evaluate whether a pragmatic corrected fortification (CF) model achieves recommended target protein and calorie content of human milk (HM) for preterm infants when compared with standard fixed-dose fortification (SF). Design In this prospective non-interventional study, we enrolled mothers of infants with birth weight ≤1500 g fed exclusive HM. Infants with chromosomal or intestinal disorders were excluded. A total of 405 HM samples from 29 mothers and 45 donor milk samples were analysed for macronutrient content using a real-time HM analyser. A stepwise CF model was derived based on published data on HM calorie and protein content corrected for lactation stage and milk type. We applied both models to the measured protein and calorie content for all HM samples and compared the proportion of samples achieving target nutrient requirement in each group. Results Target protein and calorie content of feed was achieved in 68% of HM samples with CF, compared with 5% samples wit...

The Pocket Pediatrician, 1996

Pediatric Research, 1985

Recurrent aspiration following GER may contribute to the severity of chronic lung disease. If so,... more Recurrent aspiration following GER may contribute to the severity of chronic lung disease. If so, it should be possible to document acid reflux to the proximal esophagus. Using an esophageal pH probe placed at the level of the 1st or 2nd thoracic vertebra, we evaluated GER in 11 infants with BPD and 9 infants with no BPD. Results (mean?SD): BPD Controls P Value

Canadian family physician Médecin de famille canadien, 1991

Clinical Biochemistry, 1997

Clinical Biochemistry, 1995

Pediatrics, 1986

We studied 12 infants with a clinical and radiologic diagnosis of bronchopulmonary dysplasia who ... more We studied 12 infants with a clinical and radiologic diagnosis of bronchopulmonary dysplasia who were oxygen dependent and older than 30 days. Simultaneous readings of hemoglobin oxygen saturation (Sao2) determined by two pulse oximeters (Nellcor 100, BTI Biox III) and transcutaneous (tc) Po2 (Sensor Medics, Transend) were correlated with Sao2 (Radiometer, OSM 2 Hemoximeter) and Pao2 (Corning 178) measured on blood from an indwelling arterial catheter. For each infant, the fractional inspiratory oxygen (Fio2) was adjusted to obtain three to five sets of data in the range of 70% to 95% Sao2. Fifty-three data points were generated and pooled for analysis. The slope of the regression line generated for the Nellcor 100 was .86; for the BTI Biox III, it was .91; and for the Sensor Medics Transend, it was .55, resulting in average errors of +2.5%, +1.0%, and –29%, respectively, when comparing corresponding transcutaneous and arterial values. When Sao2 was equal to or less than 95%, no inf...

Pediatrics & Neonatology, 2022

Although the Covid-19 pandemic has not had a direct impact on neonates so far, it has raised conc... more Although the Covid-19 pandemic has not had a direct impact on neonates so far, it has raised concerns about resource distribution and showed that planning is required before the next crisis or pandemic. Resource allocation must consider unique Neonatal Intensive Care Unit (NICU) attributes, including physical space and equipment that may not be transferable to older populations, unique skills of NICU staff, inherent uncertainty in prognosis both antenatally and postnatally, possible biases against neonates, and the future pandemic disease's possible impact on neonates. We identified the need for a validated Neonatal Severity of Illness Prognostic Score to guide triage decisions. Based on this score, triage decisions are the responsibility of an informed triage team not involved in direct patient care. Support for the distress experienced by parents and staff is needed. This paper presents essential considerations in developing a practical framework for resources and triage in the NICU before, during and after a pandemic.

Pediatrics, 1995

Reflecting on the 1994 meeting of the Society for Pediatrics Research (SPR), one thought that dis... more Reflecting on the 1994 meeting of the Society for Pediatrics Research (SPR), one thought that disturbs me is the difficulty that we as physicians have with the use/misuse of language. I do not mean the obvious errors in the use of words. Rather it is both how we use language to influence opinion and our use of euphemisms. First, I want to elaborate on how, in practice, language influences opinion; how the words chosen to express our thoughts may have an unintentional potential to influence practice.

Canadian Journal of Surgery, 2021

The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infa... more The effect of daily probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight Background: Necrotizing enterocolitis remains a leading cause of morbidity and mortality in premature infants. The role of prophylactic probiotics in its prevention is unclear. This study evaluates the effect of routine probiotics on the incidence and severity of necrotizing enterocolitis in infants with very low birth weight in the neo natal intensive care unit. Methods: This retrospective cohort study compared infants cared for at a single institution before and after implementation of routine probiotic administration (2014-2018). Babies born after July 2016 received probiotics containing Bifidobac terium and Lactobacillus daily until 35 weeks corrected gestational age. Baseline charac teristics, necrotizing enterocolitis incidence and severity, infections, mortality, and length of stay were compared between groups. Results: Of the 665 infants included in the study, 310 received probiotics and 355 did not. The 2 groups did not differ with regard to gestational age, birth anthropo metrics, mode of delivery, comorbidities, and type of enteral feed. The incidence of necrotizing enterocolitis (Bell's stage 2 of 3) was similar between groups (4% v. 5%, p = 0.35), as was its severity (p = 0.10). In addition, there were no significant differ ences in mortality and length of stay between the groups. Significantly fewer infants receiving probiotics developed infections (27% v. 34%, p = 0.046), with the rate of urinary tract infections having the largest reduction. Conclusion: The routine use of Bifidobacterium and Lactobacillus probiotics in infants with very low birth weight did not significantly affect the incidence and severity of necrotizing enterocolitis. However, the use of probiotics was associated with fewer overall infections. Contexte : L'entérocolite nécrosante demeure une importante cause de morbidité et de mortalité chez les nourrissons prématurés. Le rôle des probiotiques prophylac tiques pour la prévention de l'entérocolite nécrosante reste à déterminer. Cette étude évalue l'effet de l'administration systématique de probiotiques sur l'incidence et la gravité de l'entérocolite nécrosante chez les nourrissons de très faible poids à la nais sance dans les unités de soins intensifs néonataux.

Pediatrics, 1991

To the Editor.— We have discovered recently a major problem with the pulse oximeters which we hav... more To the Editor.— We have discovered recently a major problem with the pulse oximeters which we have been using in our Neonatal Intensive Care Unit. We felt that there was some urgency in alerting other neonatologists and pediatricians to this problem. The incident which led us to discover this problem involved a low birth weight infant who on admission was stabilized according to our Nursery protocol. In these very small neonates, who are at greatest risk of skin breakdown and yet require close monitoring, we recently have used the Fastrac monitor (SensorMedics Corporation, Anaheim, CA) which combines transcutaneous Pco2 and pulse oximetry.

Journal of Pediatric Surgery, 2021

PURPOSE Infants with short bowel syndrome (SBS) wean from parenteral nutrition (PN) support at va... more PURPOSE Infants with short bowel syndrome (SBS) wean from parenteral nutrition (PN) support at variable rates. Small bowel length is a predictor, but the importance of the ileocecal valve (ICV) and colon are unclear. We aim to determine if the ICV and/or colon predict enteral autonomy. METHODS Infants from a single intestinal rehabilitation program were retrospectively reviewed. Etiology of SBS, intestinal anatomy, and duration of nutritional support were collected for three years. The primary outcome was time to full enteral nutrition. ANCOVA and Cox proportional hazards model were used, with p < 0.05 significant. RESULTS 55 infants with SBS were included. After accounting for the effect of small bowel, PN duration was shorter for infants with the ICV compared to those without (mean 218 vs. 538 days, p = 0.003), and had a more significant effect on infants with ≤50% of small bowel. Increased small bowel length was a positive predictor of weaning. Patients with ≤50% of colon spent less time on PN with the ICV, compared to without (mean 220 vs 715 days, p = 0.009). CONCLUSIONS Preservation of the ICV was associated with shorter duration of PN support, while colon was not. Small bowel length is a positive predictor of enteral autonomy. LEVEL OF EVIDENCE Level III retrospective comparative study TYPE OF STUDY: Retrospective review.

Nutrition in Clinical Practice, 2021

Multidisciplinary intestinal rehabilitation (IR) teams have transformed care in pediatric intesti... more Multidisciplinary intestinal rehabilitation (IR) teams have transformed care in pediatric intestinal failure (IF).1 Although most children with IF are identified in the neonatal intensive care unit (NICU), IR teams may not be involved at this stage. We describe our collaborative model, blending NICU and IR expertise to optimize care. Over 6 years, the NeoCHIRP (Neonatal Children's IR Program) team followed 164 babies for weekly visits (median, 8; range, 1-27). Bedside rounds included CHIRP team physician and surgeons, neonatologist champion, attending neonatologist and fellow, NICU dietitian, bedside nurse, and family. Medical and nutrition status, nutrition history, and laboratory data were discussed, and a nutrition plan to support IR, considering the child's other medical needs, was created to guide the next week's management. Typical issues addressed included parenteral nutrition (PN) composition, enteral nutrition plan, oral feeding, management of small-intestinal bacterial overgrowth and sodium status, and cholestasis. A total of 164 babies were followed by the NeoCHIRP team. Of 153 survivors, IF resolved by discharge in 89% (136 of 153). Seventeen of 153 babies (11%) went on to require home PN and were transferred from NICU directly to the CHIRP team. By discharge, 99% of babies were orally fed (69/136, 50% fully, 67/136, 49% partially), and cholestasis improved or resolved in 80/105 (76%). Eleven babies (7%) died; four deaths were unrelated to IF, but in seven babies, IF was at least a contributing factor. In this high-risk cohort, most babies achieved good outcomes, and those who required longer-term IR transitioned smoothly to the CHIRP team.