Katherine Rachel McCallie

All Publications

• Safety and Efficacy of a Composite Lipid Emulsion with Fish Oil in Hospitalized Neonates and Infants Requiring Prolonged Parenteral Nutrition - A Randomized, Double-Blind, Multicenter, Controlled Trial. The Journal of nutrition Abrams, S. A., Ernst, K. D., Weitkamp, J. H., Mascarenhas, M., Anderson-Berry, A., Rudolph, J., Ling, C. Y., Robinson, D. T., Shores, D., Hair, A. B., Lai, J., Lane, B., McCallie, K. R., Levit, O., Kim, J. H. 2024

  Abstract

  Intravenous lipids are critical to the care of extremely premature and other high-risk infants.The study evaluated safety and efficacy of parenteral nutrition (PN) with composite intravenous lipid emulsion (CO-ILE) with fish oil compared to pure soybean oil lipid emulsion (SOLE).Randomized, controlled, double-blind, multicenter study (NCT02579265) in neonates/ infants anticipated to require ≥28 days of PN due to gastrointestinal malformations or injury. Duration of the initial and extended treatment phase was 28 days and 84 days (for patients with PN indication after day 28).83/ 78 patients (mean postnatal age: 11.4/ 8.3 days, 54/ 59 preterm) received CO-ILE and SOLE, respectively. 33 patients per group completed 28 days on treatment. Risk of having conjugated bilirubin values > 2 mg/dL confirmed by a second sample 7 days after the first during the initial treatment phase (primary outcome) was 2.4% (2 of 83) with CO-ILE and 3.8% (3 of 78) with SOLE (risk ratio 0.59 [95% CI: 0.09, 3.76]). Between days 29 and 84, the number of patients with confirmed conjugated bilirubin values > 2 mg/dL did not increase in the CO-ILE group (n=2) and increased in the SOLE group (n=9). At the end of the initial treatment phase, conjugated bilirubin concentrations were 45.6% lower under CO-ILE than under SOLE (p=0.006). There was no clinical or laboratory evidence of essential fatty acid deficiency in patients in the CO-ILE group. Median time to discharge alive was 56.7 and 66.4 days with CO-ILE and SOLE, respectively (hazard ratio: 1.16; 95% CI: 0.81, 1.68).CO-ILE was associated with a possible lower risk of cholestasis and significantly lower conjugated bilirubin at the end of the initial treatment phase in high-risk neonates and infants as compared to patients treated with SOLE. In summary, these data indicate that CO-ILE can be considered safe and may be preferable over SOLE in high-risk neonates.Clinicaltrials.gov, study ID NCT02579265.

  View details for DOI 10.1016/j.tjnut.2024.10.005

  View details for PubMedID 39374788

• Family Perception of OpenNotes in the Neonatal Intensive Care Unit. Applied clinical informatics McCallie, K., Balasundaram, M., Sarabu, C. 2024

  Abstract

  OpenNotes, or sharing of medical notes via a patient portal, has been studied extensively in the adult population, but less in pediatric populations, and even more rarely in inpatient pediatric or intensive care settings.To understand families' interaction with and perception of inpatient hospital notes shared via patient portal in a community Neonatal Intensive Care Unit (NICU).At the end of the NICU discharge education, completed in the patient portal before discharge, families were offered an anonymous survey on OpenNotes.Out of 446 NICU patients from 3/16/22-3/16/23, there were 59 respondents (13%). Race was primarily Asian (48%), and English was the predominant language (93%). Most families indicated the notes were "very or somewhat easy to understand" (93%). Seventy-three percent of respondents felt much better about the doctor(s) after reading the notes, and 53% contacted the physicians about something in the notes. Six (16%) felt that OpenNotes were more confusing than helpful.To the authors' knowledge, this is the first study on NICU families' perceptions of OpenNotes, which indicated positive interactions with the doctors' daily progress notes and gave important suggestions for improvement.

  View details for DOI 10.1055/a-2244-4478

  View details for PubMedID 38216145

• A Clinical Monitoring Approach for Early Onset Sepsis: A Community Hospital Experience. Hospital pediatrics Bain, L., Sivakumar, D., McCallie, K., Balasundaram, M., Frymoyer, A. 1800

  Abstract

  BACKGROUND: A serial clinical examination approach to screen late preterm and term neonates at risk for early onset sepsis has been shown to be effective in large academic centers, resulting in reductions in laboratory testing and antibiotic use. The implementation of this approach in a community hospital setting has not been reported. Our objective was to adapt a clinical examination approach to our community hospital, aiming to reduce antibiotic exposure and laboratory testing.METHODS: At a community hospital with a level III NICU and >4500 deliveries annually, the pathway to evaluate neonates ≥35 weeks at risk for early onset sepsis was revised to focus on clinical examination. Well-appearing neonates regardless of perinatal risk factor were admitted to the mother baby unit with serial vital signs and clinical examinations performed by a nurse. Neonates symptomatic at birth or who became symptomatic received laboratory evaluation and/or antibiotic treatment. Antibiotic use, laboratory testing, and culture results were evaluated for the 14 months before and 19 months after implementation.RESULTS: After implementation of the revised pathway, antibiotic use decreased from 6.7% (n = 314/4694) to 2.6% (n = 153/5937; P < .001). Measurement of C-reactive protein decreased from 13.3% (n = 626/4694) to 5.3% (n = 312/5937; P < .001). No cases of culture-positive sepsis occurred, and no neonate was readmitted within 30 days from birth with a positive blood culture.CONCLUSIONS: A screening approach for early onset sepsis focused on clinical examination was successfully implemented at a community hospital setting resulting in reduction of antibiotic use and laboratory testing without adverse outcomes.

  View details for DOI 10.1542/hpeds.2021-006058

  View details for PubMedID 34935049

• Increasing Parent Satisfaction With Discharge Planning: An Improvement Project Using Technology in a Level 3 NICU. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Balasundaram, M. n., Porter, M. n., Miller, S. n., Sivakumar, D. n., Fleming, A. n., McCallie, K. n. 2021

  Abstract

  Neonatal intensive care unit (NICU) families are often overwhelmed by the discharge process. Their anxiety can inhibit learning and contribute to poor infant outcomes and increased healthcare utilization after discharge. Quality of the discharge teaching is the strongest predictor of discharge readiness, so NICUs must develop excellent discharge preparation programs.This improvement project enhances NICU discharge preparedness by providing consistent, early discharge teaching using technology as a supplemental resource and raises parental satisfaction with the process.Neonatal intensive care unit staff and former NICU parents developed a task force to create technology-based discharge education content. The content was originally uploaded to an e-book and later transferred to the electronic health record inpatient portal. Families were able to view discharge teaching content at their own convenience and pace and review topics as needed with the NICU staff. Postdischarge follow-up phone calls provided insight into parental reaction to the new education format.Parent satisfaction top-box scores, reflecting the highest rating in the "Prepared for Discharge" category of the patient satisfaction survey, improved from a baseline of 47% in 2017 to 70% in 2019. Overwhelmingly, 92% of families highly rated the tablet-based discharge teaching during postdischarge phone calls.A comprehensive, consistent, and early discharge program using technology can lead to more effective and efficient NICU discharge education and improved parent satisfaction.Further studies are needed to generalize hospital-based inpatient portal teaching as an additional resource for parental education in the NICU.

  View details for DOI 10.1097/ANC.0000000000000841

  View details for PubMedID 33534225

• Skin-to-skin contact after birth and the natural course of neurosteroid levels in healthy term newborns. Journal of perinatology McCallie, K. R., Gaikwad, N. W., Castillo Cuadrado, M. E., Aleman, M., Madigan, J. E., Stevenson, D. K., Bhutani, V. K. 2017

  Abstract

  To determine the postnatal course of neurosteroid levels in relation to gender, mode of delivery and the extent of skin-to-skin (STS) contact during the first days of life in healthy term newborns.Prospective observational study of 39 neonates in which parents recorded total duration of STS in the first 2 days and nine neurosteroids (dehydroepiandrosterone-sulfate, progesterone, pregnenolone, pregnenolone-sulfate, allopregnanolone, isopregnanolone, epipregnanolone, pregnanolone and pregnanolone-sulfate) were assayed from blood samples at birth and at 1-2 days of age.All nine neurosteroid levels declined significantly during the first 2 days of life. Gender did not significantly affect the change in neurosteroid levels. The decline in neurosteroid levels was generally more pronounced in vaginal deliveries, and there was a trend toward a larger decline with more exposure to STS.Ongoing studies may better characterize the role of neurosteroids and the influence of STS in more critically ill and premature neonates.

  View details for DOI 10.1038/jp.2016.268

  View details for PubMedID 28102853

• Feeding Protocols for VLBW Infants Neonatology: Clinical Practice and Procedures McCallie, K. edited by Stevenson, D., Cohen, R., Sunshine, P. McGraw-Hill Education. 2015; 1st ed.: 1017–1020
• Inhaled Nitric Oxide Neonatology: Clinical Practice and Procedures McCallie, K., Van Meurs, K. edited by Stevenson, D., Cohen, R., Sunshine, P. McGraw-Hill Education. 2015; 1st ed.: 1125–1127
• Feeding Premature Infants: Why, When, and What to Add to Human Milk JOURNAL OF PARENTERAL AND ENTERAL NUTRITION Cohen, R. S., McCallie, K. R. 2012; 36: 20S-24S

  View details for DOI 10.1177/0148607111421342

  View details for Web of Science ID 000328729700005

• Neonatology Pediatrics for Medical Students Cohen, R., McCallie, K., Rhine, W. edited by Bernstein, D., Shelov, S. Lippincott Williams & Wilkins. 2012; 3rd ed.: 223–250
• Improved outcomes with a standardized feeding protocol for very low birth weight infants JOURNAL OF PERINATOLOGY McCallie, K. R., Lee, H. C., Mayer, O., Cohen, R. S., Hintz, S. R., Rhine, W. D. 2011; 31: S61-S67

  Abstract

  The objective of this study was to evaluate the impact of a standardized enteral feeding protocol for very low birth weight (VLBW) infants on nutritional, clinical and growth outcomes.Retrospective analysis of VLBW cohorts 9 months before and after initiation of a standardized feeding protocol consisting of 6-8 days of trophic feedings, followed by an increase of 20 ml/kg/day. The primary outcome was days to reach full enteral feeds defined as 160 ml/kg/day. Secondary outcomes included rates of necrotizing enterocolitis and culture-proven sepsis, days of parenteral nutrition and growth end points.Data were analyzed on 147 VLBW infants who received enteral feedings, 83 before ('Before') and 64 subsequent to ('After') feeding protocol initiation. Extremely low birth weight (ELBW) infants in the After group attained enteral volumes of 120 ml/kg/day (43.9 days Before vs 32.8 days After, P=0.02) and 160 ml/kg/day (48.5 days Before vs 35.8 days After, P=0.02) significantly faster and received significantly fewer days of parenteral nutrition (46.2 days Before vs 31.3 days After, P=0.01). Necrotizing enterocolitis decreased in the After group among VLBW (15/83, 18% Before vs 2/64, 3% After, P=0.005) and ELBW infants (11/31, 35% Before vs 2/26, 8% After, P=0.01). Late-onset sepsis decreased significantly in the After group (26/83, 31% Before vs 6/64, 9% After, P=0.001). Excluding those with weight <3rd percentile at birth, the proportion with weight <3rd percentile at discharge decreased significantly after protocol initiation (35% Before vs 17% After, P=0.03).These data suggest that implementation of a standardized feeding protocol for VLBW infants results in earlier successful enteral feeding without increased rates of major morbidities.

  View details for DOI 10.1038/jp.2010.185

  View details for Web of Science ID 000289236900010

  View details for PubMedID 21448207