- Pediatrics, General
- Neonatal quality improvement work
- Neonatal resuscitation
- Neonatal-Perinatal Medicine
Clinical Associate Professor, Pediatrics - Neonatal and Developmental Medicine
Boards, Advisory Committees, Professional Organizations
Coordinator, Transport Follow Up, El Camino Hospital NICU (2016 - Present)
Leader, Family Centered Care Committee, El Camino Hospital (2016 - Present)
Member, NICU Partnership, El Camino Hospital (2016 - Present)
Member, PQIP Panel CPQCC (2016 - Present)
NICU Liasion, Department of Pediatrics, El Camino Hospital (2016 - Present)
Member, American Academy of Pediatrics (2004 - 2015)
Board Certification: American Board of Pediatrics, Neonatal-Perinatal Medicine (2016)
Board Certification, Neonatal-Perinatal Medicine, American Board of Pediatrics (2016)
Fellowship: University of California San Diego (2015) CA
Board Certification: American Board of Pediatrics, Pediatrics (2007)
Residency: St Joseph's Regional Medical Center (2007) NJ
Medical Education: Government Chengalpattu College (2002) India
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
Predictors of poor neonatal outcomes in prenatally diagnosed multicystic dysplastic kidney disease.
Journal of perinatology : official journal of the California Perinatal Association
OBJECTIVE: Multicystic dysplastic kidney (MCDK) is one of the most common anomalies detected by prenatal ultrasound. Our objective was to identify factors associated with severe adverse neonatal outcomes of prenatally diagnosed MCDK STUDY DESIGN: A retrospective review of prenatally diagnosed MCDK (1 January 2009 to 30 December 2014) from a single academic center was conducted. The primary outcome was death or need for dialysis among live-born infants. Associations between prenatal characteristics and outcome were analyzed by Fisher's exact test and Mann-Whitney test.RESULTS: A total of 53 cases of prenatally suspected MCDK were included, of which 46 cases were live-born and confirmed postnatally (38 survivors, 8 non-survivors). Prenatally diagnosed extrarenal anomalies, bilateral MCDK, contralateral renal anomalies, and anhydramnios were significantly associated with death or need for dialysis (all p<0.0001).CONCLUSIONS: Prenatally identified findings are associated with adverse neonatal outcome, and can guide counseling and management planning. In the absence of significant associated findings, prenatally diagnosed unilateral MCDK has a benign neonatal course.
View details for PubMedID 29572458