Clinical Focus

  • Pediatrics
  • well newborns

Academic Appointments

Professional Education

  • Medical Education: University of New Mexico School of Medicine (2000) NM
  • Board Certification: American Board of Pediatrics, Pediatrics (2003)
  • Residency: University of New Mexico Office of GME (2003) NM

Contact

  • Academic
    cwalrave@stanford.edu
    Department: Pediatrics - General Pediatrics Position: Clinical Assistant Professor
  • Clinical (Primary)  LPCH Hospital Medicine 725 Welch Rd Palo Alto, CA 94304 (650) 498-5783 (fax)

Additional Clinical Info

Additional Info

  • Mail Code: 5459

Links

All Publications

  • Implementing a Hearing-Targeted Congenital CMV Screening Program in a Low-Prevalence Region. Hospital pediatrics Wang, N., Frymoyer, A., Walravens, C., Capasso, C., Gupta, A., Hudson, J., Pinsky, B. A., Srinivas, N. S. 2025

    Abstract

    OBJECTIVE: Congenital cytomegalovirus (cCMV) is the most common nongenetic cause of congenital sensorineural hearing loss. Hearing-targeted screening (HTS) programs have variable adherence and performance in terms of cCMV detection. Our institution implemented a cCMV HTS program in the newborn nursery with the aim of screening all eligible newborns during the birth hospitalization.METHODS: A bundle of interventions, including a nurse-driven HTS algorithm and process for cCMV screening test follow-up, was implemented in December 2018. cCMV screening was performed by saliva polymerase chain reaction (PCR) with confirmatory urine PCR within 21days of birth. Our primary outcome was the median percentage of eligible newborns each quarter who completed cCMV screening. Secondary outcomes included the number of patients with confirmed cCMV (saliva +, urine +) and a false-positive saliva screen (saliva +, urine -). An annotated run chart was used to measure the impact of the bundle over time.RESULTS: Between December 2018 and September 2024, 650 newborns referred on hearing screening. cCMV screening increased from 0% to 94% during the first 14 quarters after implementation and increased further to 100% in the remaining 9 quarters. Thirteen newborns tested positive by saliva; all underwent confirmatory urine testing. Only 1 newborn had confirmed cCMV infection and remained asymptomatic with normal hearing. The remaining 12 were false positives.CONCLUSION: We achieved high adherence to HTS but identified only 1 newborn with cCMV infection in 6years. Alternative approaches to cCMV screening should be considered in regions with low cCMV prevalence that balance feasibility and yield.

    View details for DOI 10.1542/hpeds.2025-008434

    View details for PubMedID 40907984

  • Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia. Journal of perinatology : official journal of the California Perinatal Association Walravens, C., Gupta, A., Cohen, R. S., Kim, J. L., Frymoyer, A. 2023

    Abstract

    OBJECTIVE: Evaluate the impact of a neonatal hypoglycemia (NH) clinical pathway implementing buccal dextrose gel in late preterm and term infants.STUDY DESIGN: Quality improvement study at a children's hospital associated birth center. Number of blood glucose checks, use of supplemental milk, and need for IV glucose were followed for 26-months after implementation of dextrose gel and compared to previous 16-month period.RESULTS: After QI implementation, 2703 infants were screened for hypoglycemia. Of these, 874 (32%) received at least one dose of dextrose gel. Special cause shifts with reductions in mean number of blood glucose checks per infant (pre 6.6 vs. post 5.6), use of supplemental milk (pre 42% vs. post 30%), and need for IV glucose (pre 4.8% vs. post 3.5%) were found.CONCLUSION: Incorporating dextrose gel into a clinical pathway for NH was associated with a sustained reduction in number of interventions, use of supplemental milk and need for IV glucose.

    View details for DOI 10.1038/s41372-023-01638-z

    View details for PubMedID 36871107