- Neonatal-Perinatal Medicine
Clinical Associate Professor, Pediatrics - Neonatal and Developmental Medicine
Epic Physician Builder, El Camino Hospital (2018 - Present)
Chief, Pediatrics, El Camino Hospital (2018 - 2019)
Vice Chief, Pediatrics, El Camino Hospital (2016 - 2018)
Physician Lead for Quality Improvement in Neonatology, LPCH (2012 - 2015)
Fellowship: Stanford University Neonatology Fellowship (2010) CA
Residency: University of Washington Pediatric Residency (2005) WA
Internship: University of Washington Pediatric Residency (2003) WA
Medical Education: Perelman School of Medicine University of Pennsylvania (2002) PA
Board Certification: American Board of Pediatrics, Neonatal-Perinatal Medicine (2012)
Board Certification: American Board of Pediatrics, Pediatrics (2005)
Current Research and Scholarly Interests
Nutrition & growth in premature infants
Quality improvement in the NICU
Leveraging electronic health record (Epic) for improvement in NICU outcomes
Phase 3 Study to Compare Safety and Efficacy of Smoflipid 20% to Intralipid 20% in Hospitalized Neonates and Infants
To show the superiority in safety of Smoflipid over Intralipid® as measured by the number of study patients in each treatment group with conjugated bilirubin exceeding 2 mg/dL during the first 28 days of study treatment, confirmed by a second sample collected 7 days after the first sample.
Stanford is currently not accepting patients for this trial. For more information, please contact Kari McCallie, MD, 650-723-5711.
Using Technology to Improve NICU Discharge Education, El Camino Hospital NICU (4/1/2018 - Present)
Our quality improvement journey to deliver more comprehensive and consistent discharge information, by first creating a discharge education electronic book (eBook) using the iBooks® application program (Apple Inc., Cupertino, CA), and subsequently by using MyChart Bedside (Epic Systems Corporation, Verona, WI) to enhance NICU families’ preparedness for discharge.
Balasundaram M, Miller S, Sivakumar D, Fleming A, Porter M, Charles J, McCallie K. “Using the ‘MyChart Bedside’ App to Enhance NICU Discharge Preparedness,” Poster, Gravens Conference on the Environment of Care for High Risk Newborns, Clearwater Beach, FL, March 4-7, 2020
Babcock R, Fleming A, Miller S, Sivakumar D, McCallie K, Charles J, Balasundaram M. “New innovative approach for NICU discharge education,” Poster, Vermont-Oxford Network (VON) Annual Quality Congress, Chicago, IL, October 2-6, 2019
Corton L, Berghem-Kantor K, Babcock R, Matsumoto K, Celestino A, Miller S, Sivakumar D, McCallie K, Charles J, Balasundaram M. “Path to home starts at birth: benefits of consistent, early discharge teaching using technology as a supplemental resource,” Abstract and oral presentation, Gravens Conference on the Environment of Care for High Risk Newborns, Clearwater Beach, FL, March 6-9, 2019
Corton L, Berghem-Kantor K, Babcock R, Matsumoto K, Celestino A, Miller S, Sivakumar D, McCallie K, Fontenot A, Charles J, Balasundaram M. “Using Technology to Support Consistent, Early NICU Discharge Teaching,” Abstract & poster presentation, California Association of Neonatologists Cool Topics Conference, San Diego, CA, March 1-3, 2019
Mountain View, California
Management of Infants at Risk for Early Onset Sepsis Born to Mothers with Suspected Chorioamnionitis, El Camino Hospital (2016 - 2018)
Risk of Early Onset Sepsis (EOS) is low in a well-appearing late preterm and term neonate, even if maternal risk factors (i.e. fever/chorioamnionitis) are present. Use of a clinical monitoring approach for EOS in well-appearing neonates was successfully implemented in a community hospital and was associated with substantial reductions in antibiotic exposure and laboratory testing.
Bain L, Sivakumar D, McCallie K, Balasundaram M, Frymoyer A. “A Clinical Monitoring Approach for Early Onset Sepsis in Well-Appearing Neonates: A Community Hospital Experience,” Oral Platform Presentation, Pediatric Academic Societies Annual Meeting, Philadelphia, PA, May 2-5, 2020 [meeting cancelled due to COVID-19]
Mountain View, California
Neuro-Humoral Biomarkers for Neonatal Skin-to-Skin Contact: An Observational Study, Gates Foundation Grand Challenges Explorations Grant (6/1/2015 - 10/31/2016)
Collaboration with University of California, Davis School of Veterinary Medicine to measure neurosteroid levels in infants to determine whether they are affected by skin-to-skin contact, thereby influencing neurodevelopment. Skin-to-skin contact between mother and child shortly after birth has been linked with improved infant growth, breastfeeding and attachment, and, for preterm infants, enhanced neurodevelopment. The biological basis for this in humans is unclear, however in horses, high levels of neuroactive steroids in newborn foals can induce abnormal behavior including a failure to breastfeed. We will track neurosteroid levels in human infants, both full-term and premature, some of whom receive routine skin-to-skin contact, to identify any associations between the two that could identify potential neurodevelopmental defects amenable to treatment with skin-to-skin contact.
Lucile Packard Children's Hospital Stanford
- Vinod Bhutani, Division of Neonatal and Developmental Medicine
- David Stevenson, Stanford
- John Madigan, DVM, Professor and Researcher at UC Davis School of Veterinary Medicine, Medicine & Epidemiology
For More Information:
A Clinical Monitoring Approach for Early Onset Sepsis: A Community Hospital Experience.
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
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
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 edited by Stevenson, D., Cohen, R., Sunshine, P. McGraw-Hill Education. 2015; 1st ed.: 1017–1020
- Inhaled Nitric Oxide Neonatology: Clinical Practice and Procedures 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 2012; 36: 20S-24S
- Neonatology Pediatrics for Medical Students 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
2011; 31: S61-S67
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