Jorge Lua | Wayne State University (original) (raw)

Papers by Jorge Lua

Research paper thumbnail of Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry

Pediatrics

OBJECTIVES The American Academy of Pediatrics National Registry for the Surveillance and Epidemio... more OBJECTIVES The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed. RESULTS From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the ...

Research paper thumbnail of sj-pdf-1-gph-10.1177_2333794X211022710 – Supplemental material for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Supplemental material, sj-pdf-1-gph-10.1177_2333794X211022710 for COVID-19 among Minority Childre... more Supplemental material, sj-pdf-1-gph-10.1177_2333794X211022710 for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic by Jocelyn Y. Ang, Nirupama Kannikeswaran, Katherine Parker, Eric McGrath, Nahed Abdel-Haq, Harbir Arora, Jorge L. Lua, Ronald Thomas, Hossein Salimnia, Teena Chopra, Tommy Tran and Basim Asmar in Global Pediatric Health

Research paper thumbnail of sj-pdf-2-gph-10.1177_2333794X211022710 – Supplemental material for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Supplemental material, sj-pdf-2-gph-10.1177_2333794X211022710 for COVID-19 among Minority Childre... more Supplemental material, sj-pdf-2-gph-10.1177_2333794X211022710 for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic by Jocelyn Y. Ang, Nirupama Kannikeswaran, Katherine Parker, Eric McGrath, Nahed Abdel-Haq, Harbir Arora, Jorge L. Lua, Ronald Thomas, Hossein Salimnia, Teena Chopra, Tommy Tran and Basim Asmar in Global Pediatric Health

Research paper thumbnail of SARS-CoV-2 Virus Not Detected in Meconium Samples of Neonates Born to COVID-19 Positive Parturients

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of Spontaneous fracture and migration of distal segment of a peripherally inserted central venous catheter to heart in a neonate

The journal of vascular access

Research paper thumbnail of A Randomized Placebo-Controlled Trial of Massage Therapy on the Immune System of Preterm Infants

Pediatrics, 2012

OBJECTIVES:The aim of this study was to investigate the effects of massage therapy (MT) on the im... more OBJECTIVES:The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers.METHODS:A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated.RESULTS:The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 cons...

Research paper thumbnail of Role of Plasma B-Type Natriuretic Peptide in Screening for Hemodynamically Significant Patent Ductus Arteriosus in Preterm Neonates

Journal of Perinatology, 2005

BACKGROUND: B-type natriuretic peptide (BNP) is a hormone secreted by the ventricles under hemody... more BACKGROUND: B-type natriuretic peptide (BNP) is a hormone secreted by the ventricles under hemodynamic stress and congestive failure.

Research paper thumbnail of Nasopharyngeal Carriage of Streptococcus Pneumoniae in Very Low-Birth-Weight Infants After Administration of Heptavalent Pneumococcal Conjugate Vaccine

Archives of Pediatrics & Adolescent Medicine, 2010

T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (... more T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (NP) carriage in very low-birth-weight (VLBW) infants has not been studied. Our primary objective was to characterize NP carriage of Streptococcus pneumoniae in a group of VLBW infants (weight, 401-1500 g) before administration of the first PCV-7 vaccine (prevaccine) and at 4 to 6 weeks after a 3-dose PCV-7 primary series (postvaccine). We also investigated the correlation between vaccine-induced pneumococcal IgG antibody level and pneumococcal NP carriage after PCV-7 (postvaccine). Methods. Very low-birth-weight infants who participated in a PCV-7 immunogenicity study 1 were enrolled from

Research paper thumbnail of Postnatal Respiratory Compliance among Premature Ventilated Neonates Associated with Variable Timing and Dosing of Antenatal Steroids

American Journal of Perinatology, 2014

Antenatal steroids (ANSs) improve the respiratory compliance of premature infants. Many premature... more Antenatal steroids (ANSs) improve the respiratory compliance of premature infants. Many premature neonates are born before the administration of a complete course of ANS. The objective of this study was to evaluate the respiratory system compliance (Crs) of premature (≤ 32 weeks gestation), intubated neonates in relation to the dose, and timing of ANS administration. Neonates (n = 61) were divided into four groups based on the dose and timing of ANS exposure: Group 1: no ANS; Group 2: partial course (one dose of betamethasone); Group 3: complete course (two doses of betamethasone administered within 2 weeks of delivery); and Group 4: remote course (two doses of betamethasone administered > 2 weeks before delivery). Crs was measured by single-breath occlusion technique. Indexed respiratory compliance ± standard error of the mean (mL/cmH2O/kg) adjusted for gestational ages were 0.359 ± 0.074, 0.366 ± 0.080, 0.625 ± 0.038, and 0.505 ± 0.060 for Groups 1 to 4, respectively. The mean indexed Crs in complete ANS was significantly higher than that of no ANS (0.266 ± 0.085; p = 0.016) as well as partial ANS group (0.259 ± 0.086; p = 0.025). Crs after birth was significantly higher among premature intubated neonates born to mothers who received a complete course of ANS within 2 weeks, compared with no ANS or a partial course of ANS.

Research paper thumbnail of 95: Respiratory system compliance in premature infants in relation to antenatal steroids and as a guide to extubation

American Journal of Obstetrics and Gynecology, 2008

To estimate the effectiveness of cerclage for short cervix by degrees of cervical length shorteni... more To estimate the effectiveness of cerclage for short cervix by degrees of cervical length shortening STUDY DESIGN: Meta-analysis of trials of women with second trimester tranvaginal cervical length Ͻ25mm randomized to ultrasound-indicated cerclage or no cerclage. Only the group with singleton gestation and prior preterm birth Ͻ37 weeks was analyzed. Primary outcome of preterm birth Ͻ35 weeks was analyzed by cervical length strata. RESULTS: In the 4 randomized studies identified, 189 women with singleton gestation, prior preterm birth Ͻ37 weeks, and cervical length (CL) Ͻ25mm were randomized to ultrasound-indicated cerclage or no cerclage. Outcomes stratified by degree of cervical shortening are presented in the table. CONCLUSION: Ultrasound-indicated cerclage, when performed in women with singleton gestation, prior preterm birth, and CLϽ25mm, seems to have similar effect regardless of the degree of cervical shortening. It is most remarkable that it seems to remain efficacious at both end of the spectum, both in women with CL 16-24mm, as well as those with CLϽ5mm.

Research paper thumbnail of Postdischarge Adverse Events Among Neonates Admitted to the Neonatal Intensive Care Unit

Journal of Patient Safety, 2022

OBJECTIVES We aimed to determine the rate of postdischarge adverse events (AEs), classify the typ... more OBJECTIVES We aimed to determine the rate of postdischarge adverse events (AEs), classify the types of postdischarge AEs, and identify risk factors for postdischarge AEs among neonates admitted to the neonatal intensive care unit (NICU). STUDY DESIGN This was a prospective cohort study of neonates admitted to the NICU from February 2017 through June 2019. We enrolled 170 neonates from a level 4 NICU who were being discharged home and whose parents can speak English and could be contacted after discharge. The main outcome of the study was postdischarge AEs based on structured telephone interviews, health record review, and adjudication by 2 blinded, trained physicians using a previously established methodology. RESULTS Fourteen percent of 170 neonates admitted to the NICU experienced postdischarge AEs, with 48% being either preventable or ameliorable. Adverse drug events and procedural complications comprised most of the AEs (48%), but most of the preventable and ameliorable AEs were due to management, therapeutic, or diagnostic errors. Seventy-nine percent of neonates who suffered an AE experienced either a readmission to the hospital or an emergency department visit. Neonates admitted to a level 4 NICU from another NICU (level 1, 2, or 3) (adjusted odds ratio, 3.62; 95% confidence interval, 1.27-12.60; P = 0.01) and those 28 to 36 weeks (adjusted odds ratio, 11.38; 95% confidence interval, 1.67-127.98; P = 0.01) had a significantly higher risk of AEs at discharge. CONCLUSIONS Neonates discharged from a level 4 NICU were at high risk for experiencing postdischarge AEs. The identification of AE types and risk factors can be used to guide efforts to develop interventions to improve neonatal patient safety during the postdischarge period.

Research paper thumbnail of A Case of Congenital Infection: Missed Opportunities for Prevention and the Importance of Maternal Testing and Screening

Global Pediatric Health

A 2-month-old female was seen in our emergency department for evaluation of a congenital infectio... more A 2-month-old female was seen in our emergency department for evaluation of a congenital infection. During pregnancy, mother was routinely screened for human immunodeficiency virus (HIV) and syphilis in the first trimester and tests results were negative. Throughout the entire pregnancy, mother had regular prenatal care at scheduled visits. She presented to her obstetrician at 28 weeks gestation with generalized skin lesions on palms and soles, as well as a painless lesion in her genital area. At both the 28-week and 36-week prenatal visits, she was referred to dermatology, and mother was subsequently treated with topical hydrocortisone cream. No further workup was done. Two months after delivery, mother followed up with her primary care provider due to lack of resolution of skin lesions. At that time, a sexually transmitted infection was suspected and mother was tested for syphilis, and rapid plasma reagin (RPR) came back positive at 1:128. Infant was referred for further workup. On presentation, physical exam of the infant was significant for desquamation of the skin on the bilateral soles of her feet, pinpoint pink dots on the soles of her feet bilaterally, and a erythematous skin lesion 1 × 1 cm on her right medial knee. Mother did report that infant was not moving her left leg. Infant did not exhibit any neurological deficits on physical exam. Significant laboratory findings included slight anemia, hemoglobin of 8.9 g/dL, and hematocrit of 26.5%. Further workup for congenital infection was done including lumbar puncture. All findings in the cerebrospinal fluid in this patient were within normal limits, including normal cell count, glucose, and protein. Venereal disease research laboratory (VDRL) tests was negative as well. Long-bone radiographs were also done, which were significant for osteochondritis and periostitis. This was seen in the medial metaphysis of the proximal left tibia and distal left femur (Figure 1A), the metaphysis of the medial right proximal tibia, and in the distal left ulnar metaphysis (Figure 2A).

Research paper thumbnail of Epidemiology of Invasive Fungal Infections at Two Tertiary Care Neonatal Intensive Care Units Over a 12-Year Period (2000-2011)

Global Pediatric Health

We conducted a retrospective review of 168 patients with invasive fungal infections from January ... more We conducted a retrospective review of 168 patients with invasive fungal infections from January 2000 to December 2011 in 2 neonatal intensive care units. Patients with Candida bloodstream infection (BSI, n = 152) were further analyzed. C albicans was the most common species overall (47%); however, there was an increase in non– albicans sp from 2006 to 2011. Candida BSI clearance rates were lower in extremely low birth weight infants (77% vs 93%, P = .01) and in patients with C albicans infections (77% vs 91%, P = .01). Clearance rates improved from 2000 to 2005 (70% - 90%) to 2006 to 2011 (86% -100%). Combination antifungal use increased during the later years (73% vs 49%, P < .05) and in patients with end-organ dissemination (83% vs 54%, P < .05). We concluded that extremely low birth weight infants and C albicans infection are factors associated with nonclearance of Candida BSI. Successful clearance of Candida BSI improved in 2006 to 2011, perhaps due to increase in non– al...

Research paper thumbnail of Epidemiology of Invasive Fungal Infections in Two Tertiary Care Neonatal Intensive Care Units Over an 11-year Period (2000-2011)

Research paper thumbnail of Hasopharyngeal Carriage of Streptococcus Pneumoniae in Very Low-Birth-Weight Infants After Administration of Heptavalent Pneumococcal Conjugate Vaccine

Archives of Pediatrics Adolescent Medicine, 2010

Research paper thumbnail of Nasopharyngeal carriage of Streptococcus Pneumoniae in very low-birth-weight infants after administration of heptavalent pneumococcal conjugate vaccine

JAMA Pediatrics

T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (... more T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (NP) carriage in very low-birth-weight (VLBW) infants has not been studied. Our primary objective was to characterize NP carriage of Streptococcus pneumoniae in a group of VLBW infants (weight, 401-1500 g) before administration of the first PCV-7 vaccine (prevaccine) and at 4 to 6 weeks after a 3-dose PCV-7 primary series (postvaccine). We also investigated the correlation between vaccine-induced pneumococcal IgG antibody level and pneumococcal NP carriage after PCV-7 (postvaccine). Methods. Very low-birth-weight infants who participated in a PCV-7 immunogenicity study 1 were enrolled from

Research paper thumbnail of COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Global Pediatric Health, 2021

Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups ... more Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups in the US where long-standing health issues and structural inequities are now known to have resulted in increased risk for infection, severe illness, and death from the virus. The objective of our study was to describe demographic characteristics, clinical presentations, medical interventions and outcomes of pediatric patients with COVID-19 treated at Children’s Hospital of Michigan (CHM), a tertiary care center in urban Detroit, an early hotspot during the initial surge of the SARS-CoV-2 pandemic. Methods. A retrospective chart review was performed of children ≤18 years of age who had polymerase chain reaction (RT-PCR) testing via NP swab or serum IgG antibody testing for SARS-CoV-2 during March 1, 2020–June 30, 2020. Results. Seventy-eight COVID-19 infected children were identified of whom 85.8% (67/78) were from minority populations (African American, Hispanic). Hospitalization rate w...

Research paper thumbnail of Vancomycin-resistant Enterococcus faecium endocarditis in a premature infant successfully treated with linezolid

The Pediatric Infectious Disease Journal, 2003

A 4 1/2-month-old, 26-week premature infant with multiple complications of prematurity required a... more A 4 1/2-month-old, 26-week premature infant with multiple complications of prematurity required a central venous catheter for venous access and antibiotic treatment of bacterial nosocomial infections. He developed tricuspid valve endocarditis with vegetation caused by Enterococcus faecium resistant to ampicillin, vancomycin and quinupristin-dalfopristin but susceptible to linezolid. He was successfully treated with linezolid intravenously (7 weeks) and then orally (2 weeks).

Research paper thumbnail of Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry

Pediatrics

OBJECTIVES The American Academy of Pediatrics National Registry for the Surveillance and Epidemio... more OBJECTIVES The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed. RESULTS From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the ...

Research paper thumbnail of sj-pdf-1-gph-10.1177_2333794X211022710 – Supplemental material for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Supplemental material, sj-pdf-1-gph-10.1177_2333794X211022710 for COVID-19 among Minority Childre... more Supplemental material, sj-pdf-1-gph-10.1177_2333794X211022710 for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic by Jocelyn Y. Ang, Nirupama Kannikeswaran, Katherine Parker, Eric McGrath, Nahed Abdel-Haq, Harbir Arora, Jorge L. Lua, Ronald Thomas, Hossein Salimnia, Teena Chopra, Tommy Tran and Basim Asmar in Global Pediatric Health

Research paper thumbnail of sj-pdf-2-gph-10.1177_2333794X211022710 – Supplemental material for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Supplemental material, sj-pdf-2-gph-10.1177_2333794X211022710 for COVID-19 among Minority Childre... more Supplemental material, sj-pdf-2-gph-10.1177_2333794X211022710 for COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic by Jocelyn Y. Ang, Nirupama Kannikeswaran, Katherine Parker, Eric McGrath, Nahed Abdel-Haq, Harbir Arora, Jorge L. Lua, Ronald Thomas, Hossein Salimnia, Teena Chopra, Tommy Tran and Basim Asmar in Global Pediatric Health

Research paper thumbnail of SARS-CoV-2 Virus Not Detected in Meconium Samples of Neonates Born to COVID-19 Positive Parturients

American Journal of Obstetrics and Gynecology, 2022

Research paper thumbnail of Spontaneous fracture and migration of distal segment of a peripherally inserted central venous catheter to heart in a neonate

The journal of vascular access

Research paper thumbnail of A Randomized Placebo-Controlled Trial of Massage Therapy on the Immune System of Preterm Infants

Pediatrics, 2012

OBJECTIVES:The aim of this study was to investigate the effects of massage therapy (MT) on the im... more OBJECTIVES:The aim of this study was to investigate the effects of massage therapy (MT) on the immune system of preterm infants. The primary hypothesis was that MT compared with sham therapy (control) will enhance the immune system of stable premature infants by increasing the proportion of their natural killer (NK) cell numbers.METHODS:A randomized placebo-controlled trial of MT versus sham therapy (control) was conducted among stable premature infants in the NICU. Study intervention was provided 5 days per week until hospital discharge for a maximum of 4 weeks. Immunologic evaluations (absolute NK cells, T and B cells, T cell subsets, and NK cytotoxicity), weight, number of infections, and length of hospital stay were also evaluated.RESULTS:The study enrolled 120 infants (58 massage; 62 control). At the end of the study, absolute NK cells were not different between the 2 groups; however, NK cytotoxicity was higher in the massage group, particularly among those who received ≥5 cons...

Research paper thumbnail of Role of Plasma B-Type Natriuretic Peptide in Screening for Hemodynamically Significant Patent Ductus Arteriosus in Preterm Neonates

Journal of Perinatology, 2005

BACKGROUND: B-type natriuretic peptide (BNP) is a hormone secreted by the ventricles under hemody... more BACKGROUND: B-type natriuretic peptide (BNP) is a hormone secreted by the ventricles under hemodynamic stress and congestive failure.

Research paper thumbnail of Nasopharyngeal Carriage of Streptococcus Pneumoniae in Very Low-Birth-Weight Infants After Administration of Heptavalent Pneumococcal Conjugate Vaccine

Archives of Pediatrics & Adolescent Medicine, 2010

T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (... more T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (NP) carriage in very low-birth-weight (VLBW) infants has not been studied. Our primary objective was to characterize NP carriage of Streptococcus pneumoniae in a group of VLBW infants (weight, 401-1500 g) before administration of the first PCV-7 vaccine (prevaccine) and at 4 to 6 weeks after a 3-dose PCV-7 primary series (postvaccine). We also investigated the correlation between vaccine-induced pneumococcal IgG antibody level and pneumococcal NP carriage after PCV-7 (postvaccine). Methods. Very low-birth-weight infants who participated in a PCV-7 immunogenicity study 1 were enrolled from

Research paper thumbnail of Postnatal Respiratory Compliance among Premature Ventilated Neonates Associated with Variable Timing and Dosing of Antenatal Steroids

American Journal of Perinatology, 2014

Antenatal steroids (ANSs) improve the respiratory compliance of premature infants. Many premature... more Antenatal steroids (ANSs) improve the respiratory compliance of premature infants. Many premature neonates are born before the administration of a complete course of ANS. The objective of this study was to evaluate the respiratory system compliance (Crs) of premature (≤ 32 weeks gestation), intubated neonates in relation to the dose, and timing of ANS administration. Neonates (n = 61) were divided into four groups based on the dose and timing of ANS exposure: Group 1: no ANS; Group 2: partial course (one dose of betamethasone); Group 3: complete course (two doses of betamethasone administered within 2 weeks of delivery); and Group 4: remote course (two doses of betamethasone administered &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 2 weeks before delivery). Crs was measured by single-breath occlusion technique. Indexed respiratory compliance ± standard error of the mean (mL/cmH2O/kg) adjusted for gestational ages were 0.359 ± 0.074, 0.366 ± 0.080, 0.625 ± 0.038, and 0.505 ± 0.060 for Groups 1 to 4, respectively. The mean indexed Crs in complete ANS was significantly higher than that of no ANS (0.266 ± 0.085; p = 0.016) as well as partial ANS group (0.259 ± 0.086; p = 0.025). Crs after birth was significantly higher among premature intubated neonates born to mothers who received a complete course of ANS within 2 weeks, compared with no ANS or a partial course of ANS.

Research paper thumbnail of 95: Respiratory system compliance in premature infants in relation to antenatal steroids and as a guide to extubation

American Journal of Obstetrics and Gynecology, 2008

To estimate the effectiveness of cerclage for short cervix by degrees of cervical length shorteni... more To estimate the effectiveness of cerclage for short cervix by degrees of cervical length shortening STUDY DESIGN: Meta-analysis of trials of women with second trimester tranvaginal cervical length Ͻ25mm randomized to ultrasound-indicated cerclage or no cerclage. Only the group with singleton gestation and prior preterm birth Ͻ37 weeks was analyzed. Primary outcome of preterm birth Ͻ35 weeks was analyzed by cervical length strata. RESULTS: In the 4 randomized studies identified, 189 women with singleton gestation, prior preterm birth Ͻ37 weeks, and cervical length (CL) Ͻ25mm were randomized to ultrasound-indicated cerclage or no cerclage. Outcomes stratified by degree of cervical shortening are presented in the table. CONCLUSION: Ultrasound-indicated cerclage, when performed in women with singleton gestation, prior preterm birth, and CLϽ25mm, seems to have similar effect regardless of the degree of cervical shortening. It is most remarkable that it seems to remain efficacious at both end of the spectum, both in women with CL 16-24mm, as well as those with CLϽ5mm.

Research paper thumbnail of Postdischarge Adverse Events Among Neonates Admitted to the Neonatal Intensive Care Unit

Journal of Patient Safety, 2022

OBJECTIVES We aimed to determine the rate of postdischarge adverse events (AEs), classify the typ... more OBJECTIVES We aimed to determine the rate of postdischarge adverse events (AEs), classify the types of postdischarge AEs, and identify risk factors for postdischarge AEs among neonates admitted to the neonatal intensive care unit (NICU). STUDY DESIGN This was a prospective cohort study of neonates admitted to the NICU from February 2017 through June 2019. We enrolled 170 neonates from a level 4 NICU who were being discharged home and whose parents can speak English and could be contacted after discharge. The main outcome of the study was postdischarge AEs based on structured telephone interviews, health record review, and adjudication by 2 blinded, trained physicians using a previously established methodology. RESULTS Fourteen percent of 170 neonates admitted to the NICU experienced postdischarge AEs, with 48% being either preventable or ameliorable. Adverse drug events and procedural complications comprised most of the AEs (48%), but most of the preventable and ameliorable AEs were due to management, therapeutic, or diagnostic errors. Seventy-nine percent of neonates who suffered an AE experienced either a readmission to the hospital or an emergency department visit. Neonates admitted to a level 4 NICU from another NICU (level 1, 2, or 3) (adjusted odds ratio, 3.62; 95% confidence interval, 1.27-12.60; P = 0.01) and those 28 to 36 weeks (adjusted odds ratio, 11.38; 95% confidence interval, 1.67-127.98; P = 0.01) had a significantly higher risk of AEs at discharge. CONCLUSIONS Neonates discharged from a level 4 NICU were at high risk for experiencing postdischarge AEs. The identification of AE types and risk factors can be used to guide efforts to develop interventions to improve neonatal patient safety during the postdischarge period.

Research paper thumbnail of A Case of Congenital Infection: Missed Opportunities for Prevention and the Importance of Maternal Testing and Screening

Global Pediatric Health

A 2-month-old female was seen in our emergency department for evaluation of a congenital infectio... more A 2-month-old female was seen in our emergency department for evaluation of a congenital infection. During pregnancy, mother was routinely screened for human immunodeficiency virus (HIV) and syphilis in the first trimester and tests results were negative. Throughout the entire pregnancy, mother had regular prenatal care at scheduled visits. She presented to her obstetrician at 28 weeks gestation with generalized skin lesions on palms and soles, as well as a painless lesion in her genital area. At both the 28-week and 36-week prenatal visits, she was referred to dermatology, and mother was subsequently treated with topical hydrocortisone cream. No further workup was done. Two months after delivery, mother followed up with her primary care provider due to lack of resolution of skin lesions. At that time, a sexually transmitted infection was suspected and mother was tested for syphilis, and rapid plasma reagin (RPR) came back positive at 1:128. Infant was referred for further workup. On presentation, physical exam of the infant was significant for desquamation of the skin on the bilateral soles of her feet, pinpoint pink dots on the soles of her feet bilaterally, and a erythematous skin lesion 1 × 1 cm on her right medial knee. Mother did report that infant was not moving her left leg. Infant did not exhibit any neurological deficits on physical exam. Significant laboratory findings included slight anemia, hemoglobin of 8.9 g/dL, and hematocrit of 26.5%. Further workup for congenital infection was done including lumbar puncture. All findings in the cerebrospinal fluid in this patient were within normal limits, including normal cell count, glucose, and protein. Venereal disease research laboratory (VDRL) tests was negative as well. Long-bone radiographs were also done, which were significant for osteochondritis and periostitis. This was seen in the medial metaphysis of the proximal left tibia and distal left femur (Figure 1A), the metaphysis of the medial right proximal tibia, and in the distal left ulnar metaphysis (Figure 2A).

Research paper thumbnail of Epidemiology of Invasive Fungal Infections at Two Tertiary Care Neonatal Intensive Care Units Over a 12-Year Period (2000-2011)

Global Pediatric Health

We conducted a retrospective review of 168 patients with invasive fungal infections from January ... more We conducted a retrospective review of 168 patients with invasive fungal infections from January 2000 to December 2011 in 2 neonatal intensive care units. Patients with Candida bloodstream infection (BSI, n = 152) were further analyzed. C albicans was the most common species overall (47%); however, there was an increase in non– albicans sp from 2006 to 2011. Candida BSI clearance rates were lower in extremely low birth weight infants (77% vs 93%, P = .01) and in patients with C albicans infections (77% vs 91%, P = .01). Clearance rates improved from 2000 to 2005 (70% - 90%) to 2006 to 2011 (86% -100%). Combination antifungal use increased during the later years (73% vs 49%, P < .05) and in patients with end-organ dissemination (83% vs 54%, P < .05). We concluded that extremely low birth weight infants and C albicans infection are factors associated with nonclearance of Candida BSI. Successful clearance of Candida BSI improved in 2006 to 2011, perhaps due to increase in non– al...

Research paper thumbnail of Epidemiology of Invasive Fungal Infections in Two Tertiary Care Neonatal Intensive Care Units Over an 11-year Period (2000-2011)

Research paper thumbnail of Hasopharyngeal Carriage of Streptococcus Pneumoniae in Very Low-Birth-Weight Infants After Administration of Heptavalent Pneumococcal Conjugate Vaccine

Archives of Pediatrics Adolescent Medicine, 2010

Research paper thumbnail of Nasopharyngeal carriage of Streptococcus Pneumoniae in very low-birth-weight infants after administration of heptavalent pneumococcal conjugate vaccine

JAMA Pediatrics

T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (... more T he effect of pneumococcal conjugate vaccine-7 (PCV-7) in reducing pneumococcal nasopharyngeal (NP) carriage in very low-birth-weight (VLBW) infants has not been studied. Our primary objective was to characterize NP carriage of Streptococcus pneumoniae in a group of VLBW infants (weight, 401-1500 g) before administration of the first PCV-7 vaccine (prevaccine) and at 4 to 6 weeks after a 3-dose PCV-7 primary series (postvaccine). We also investigated the correlation between vaccine-induced pneumococcal IgG antibody level and pneumococcal NP carriage after PCV-7 (postvaccine). Methods. Very low-birth-weight infants who participated in a PCV-7 immunogenicity study 1 were enrolled from

Research paper thumbnail of COVID-19 among Minority Children in Detroit, Michigan during the Early National Surge of the Pandemic

Global Pediatric Health, 2021

Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups ... more Background. The COVID-19 pandemic has shed light on communities of racial/ethnic minority groups in the US where long-standing health issues and structural inequities are now known to have resulted in increased risk for infection, severe illness, and death from the virus. The objective of our study was to describe demographic characteristics, clinical presentations, medical interventions and outcomes of pediatric patients with COVID-19 treated at Children’s Hospital of Michigan (CHM), a tertiary care center in urban Detroit, an early hotspot during the initial surge of the SARS-CoV-2 pandemic. Methods. A retrospective chart review was performed of children ≤18 years of age who had polymerase chain reaction (RT-PCR) testing via NP swab or serum IgG antibody testing for SARS-CoV-2 during March 1, 2020–June 30, 2020. Results. Seventy-eight COVID-19 infected children were identified of whom 85.8% (67/78) were from minority populations (African American, Hispanic). Hospitalization rate w...

Research paper thumbnail of Vancomycin-resistant Enterococcus faecium endocarditis in a premature infant successfully treated with linezolid

The Pediatric Infectious Disease Journal, 2003

A 4 1/2-month-old, 26-week premature infant with multiple complications of prematurity required a... more A 4 1/2-month-old, 26-week premature infant with multiple complications of prematurity required a central venous catheter for venous access and antibiotic treatment of bacterial nosocomial infections. He developed tricuspid valve endocarditis with vegetation caused by Enterococcus faecium resistant to ampicillin, vancomycin and quinupristin-dalfopristin but susceptible to linezolid. He was successfully treated with linezolid intravenously (7 weeks) and then orally (2 weeks).