Melissa Scala

All Publications

• Introducing the i-Rainbow©: An Evidence-Based, Parent-Friendly Care Pathway Designed for Critically Ill Infants in the NICU Setting. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association Byrne, E. M., Hunt, K., Scala, M. 2024; 36 (2): 266-273

  Abstract

  PURPOSE: This study investigated the feasibility and effectiveness of a novel, evidence-based developmental care pathway to be used by health care providers and parents in the neonatal intensive care unit (NICU) setting. The i-Rainbow is based on current evidence and responds to individual infant health status. It is not based on infant age.METHODS: After development and implementation of the i-Rainbow, pre- and postimplementation nurse and parent survey data were collected and pre- and post-developmental care rates were compared.RESULTS: After i-Rainbow implementation, disagreement among providers on appropriate developmental care interventions significantly decreased, total minutes of daily developmental care and swaddled holding increased significantly, and parents reported that they would recommend the tool.CONCLUSION: The i-Rainbow is a unique, parent-friendly, infant-based tool that guides sensory interventions in the NICU by staging infants based on cardiorespiratory status and physiologic maturity, not age. The i-Rainbow improved the delivery of developmental care activities in our unit and was well received by parents and nurses.VIDEO ABSTRACT: Supplemental Digital Content available at: http://links.lww.com/PPT/A516.

  View details for DOI 10.1097/PEP.0000000000001094

  View details for PubMedID 38568275

• Increasing in-person medical interpreter utilization in the NICU through a bundle of interventions. Journal of perinatology : official journal of the California Perinatal Association Feister, J., Razdan, S., Sharp, D., Punjabi, S., Blecharczyk, E., Escobar, V., Gay, P. M., Scala, M., Bonifacio, S. 2024

  Abstract

  In-person medical interpretation improves communication with patients who have preferred language other than English (PLOE). Multi-dimensional barriers to use of medical interpreters limit their use in the NICU.Medical teams in our NICU were not consistently using in-person medical interpreters, leading to ineffective communication with families with PLOE.Interventions included staff educational sessions and grand rounds regarding equitable language access, distribution of interpreter request cards to families, and allocation of dedicated in-person interpreters for NICU rounds. Interpreter utilization was calculated by total requests per Spanish-speaking person day in the NICU.Interpreter utilization increased five-fold during the intervention period (from 0.2 to 1.0 requests per Spanish-speaking person day).We substantially increased our unit in-person interpreter utilization through a bundle of multifaceted interventions, many of which were low-cost. NICUs should regard dedicated medical interpreters as a critical part of the care team.

  View details for DOI 10.1038/s41372-024-01915-5

  View details for PubMedID 38424233

  View details for PubMedCentralID 1955368

• Sample entropy correlates with intraventricular hemorrhage and mortality in premature infants early in life. Pediatric research Scahill, M. D., Chock, V., Travis, K., Lazarus, M., Helfenbein, E., Scala, M. 2024

  Abstract

  Mortality and intraventricular hemorrhage (IVH) are common adverse outcomes in preterm infants and are challenging to predict clinically. Sample entropy (SE), a measure of heart rate variability (HRV), has shown predictive power for sepsis and other morbidities in neonates. We evaluated associations between SE and mortality and IVH in the first week of life.Participants were 389 infants born before 32 weeks of gestation for whom bedside monitor data were available. A total of 29 infants had IVH grade 3 or 4 and 31 infants died within 2 weeks of life. SE was calculated with the PhysioNet open-source benchmark. Logistic regressions assessed associations between SE and IVH and/or mortality with and without common clinical covariates over various hour of life (HOL) censor points.Lower SE was associated with mortality by 4 HOL, but higher SE was very strongly associated with IVH and mortality at 24-96 HOL. Bootstrap testing confirmed SE significantly improved prediction using clinical variables at 96 HOL.SE is a significant predictor of IVH and mortality in premature infants. Given IVH typically occurs in the first 24-72 HOL, affected infants may initially have low SE followed by a sustained period of high SE.SE correlates with IVH and mortality in preterm infants early in life. SE combined with clinical factors yielded ROC AUCs well above 0.8 and significantly outperformed the clinical model at 96 h of life. Previous studies had not shown predictive power over clinical models. First study using the PhysioNet Cardiovascular Toolbox benchmark in young infants. Relative to the generally accepted timing of IVH in premature infants, we saw lower SE before or around the time of hemorrhage and a sustained period of higher SE after. Higher SE after acute events has not been reported previously.

  View details for DOI 10.1038/s41390-024-03075-w

  View details for PubMedID 38365874

  View details for PubMedCentralID 4760862

• The Safety of Body Wraps on Skin-to-Skin Care in the Neonatal Population: A Pilot Study. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Freccero, A., Scala, M., McLeod, K. A., Donahue, B., Webb, M., Briggs, M., Najm, I., Sinha, M., Santagata, L., Dahlen, A., Nasr, A. 2023

  Abstract

  Despite well-established benefits of skin-to-skin care (SSC) for preterm infants and parents, standardized guidelines for implementation do not exist. Furthermore, the literature offers little evidence-based information to guide best practice.To discover whether SSC using a body wrap to hold preterm infants would increase the duration of SSC, decrease parental stress during SSC, and minimize adverse events to ensure that body wraps are safe and feasible.Twenty-nine dyads of parents and preterm infants younger than 34 weeks postmenstrual age were enrolled. The first 15 dyads to meet inclusion criteria were assigned to a standard of care group for SSC with no body wrap. The remaining 14 dyads were assigned to an experimental group for SSC with a body wrap. Each dyad performed 2 SSC holds. Parents completed the Parental Stressor Scale and Parent Feedback Form. Adverse events were also documented.No statistically significant differences were found between the 2 groups in total SSC time (P = .33), the number of adverse events (P = .31 for major events; P = .38 for minor events), average parental stress (P = .22), and parental confidence performing SSC (P = .18).This study found that SSC with a body wrap is safe for preterm infants in a neonatal intensive care unit (NICU). This is the first study to explore the use, safety, and effectiveness of body wraps during SSC with preterm infants in an NICU. Future research should be conducted with larger sample sizes to further evaluate the safety and efficacy.

  View details for DOI 10.1097/ANC.0000000000001133

  View details for PubMedID 38127581

• Early, low-dose hydrocortisone and near-term brain connectivity in extremely preterm infants. Pediatric research Dubner, S. E., Rickerich, L., Bruckert, L., Poblaciones, R. V., Sproul, D., Scala, M., Feldman, H. M., Travis, K. E. 2023

  Abstract

  Postnatal steroids are used to prevent bronchopulmonary dysplasia in extremely preterm infants but may have adverse effects on brain development. We assessed connectivity metrics of major cerebral and cerebellar white matter pathways at near-term gestational age among infants who did or did not receive a standardized regimen of hydrocortisone during the first 10 days of life.Retrospective cohort study.Infants born <28 weeks: Protocol group (n = 33) received at least 50% and not more than 150% of an intended standard dose of 0.5 mg/kg hydrocortisone twice daily for 7 days, then 0.5 mg/kg per day for 3 days; Non-Protocol group (n = 22), did not receive protocol hydrocortisone or completed <50% of the protocol dose. We assessed group differences in near-term diffusion MRI mean fractional anisotropy (FA) and mean diffusivity (MD) across the corticospinal tract, inferior longitudinal fasciculus, corpus callosum and superior cerebellar peduncle.Groups were comparable in gestational age, post-menstrual age at scan, medical complications, bronchopulmonary dysplasia, and necrotizing enterocolitis. No significant large effect group differences were identified in mean FA or MD in any cerebral or cerebellar tract.Low dose, early, postnatal hydrocortisone was not associated with significant differences in white matter tract microstructure at near-term gestational age.This study compared brain microstructural connectivity as a primary outcome among extremely preterm infants who did or did not receive early postnatal hydrocortisone. Low dose hydrocortisone in the first 10 days of life was not associated with significant differences in white matter microstructure in major cerebral and cerebellar pathways. Hydrocortisone did not have a significant effect on early brain white matter circuits.

  View details for DOI 10.1038/s41390-023-02903-9

  View details for PubMedID 38030826

  View details for PubMedCentralID 3265791

• Neurodevelopmental, Mental Health, and Parenting Issues in Preterm Infants. Children (Basel, Switzerland) Shaw, R. J., Givrad, S., Poe, C., Loi, E. C., Hoge, M. K., Scala, M. 2023; 10 (9)

  Abstract

  The World Health Organization in its recommendations for the care of preterm infants has drawn attention to the need to address issues related to family involvement and support, including education, counseling, discharge preparation, and peer support. A failure to address these issues may translate into poor outcomes that extend across the lifespan. In this paper, we review the often far-reaching impact of preterm birth on the health and wellbeing of the parents and highlight the ways in which psychological stress may have a negative long-term impact on the parent-child interaction, attachment, and the styles of parenting. This paper addresses the following topics: (1) neurodevelopmental outcomes in preterm infants, including cognitive, sensory, and motor difficulties, (2) long-term mental health issues in premature infants that include elevated rates of anxiety and depressive disorders, autism, and somatization, which may affect social relationships and quality of life, (3) adverse mental health outcomes for parents that include elevated rates of depression, anxiety, and symptoms of post-traumatic stress, as well as increased rates of substance abuse, and relationship strain, (4) negative impacts on the parent-infant relationship, potentially mediated by maternal sensitivity, parent child-interactions, and attachment, and (5) impact on the parenting behaviors, including patterns of overprotective parenting, and development of Vulnerable Child Syndrome. Greater awareness of these issues has led to the development of programs in neonatal mental health and developmental care with some data suggesting benefits in terms of shorter lengths of stay and decreased health care costs.

  View details for DOI 10.3390/children10091565

  View details for PubMedID 37761526

  View details for PubMedCentralID PMC10528009

• Recommendations for creating a collaborative NICU environment to support teamwork and trainee education. Journal of perinatology : official journal of the California Perinatal Association Marc-Aurele, K., Branche, T., Adams, A., Feister, J., Boyle, K., Scala, M. 2023

  Abstract

  In a 2022 survey, a majority of neonatology program directors reported regular conflict between neonatal-perinatal fellows and frontline providers (FLPs) (i.e., neonatal nurse practitioners (NNPs), neonatal physician assistants (PAs), and neonatal hospitalists). This paper reviews recommendations of a multidisciplinary workgroup for creating a more collaborative unit environment that supports teamwork and education. The self-study framework is a helpful tool to identify specific pressure points at individual institutions. Implementing clear guidelines for procedural distribution and role clarification are often critical interventions. FLPs and Pediatric Physician Trainees may benefit from conflict management coaching and communication training. At the same time, we recommend that respective leaders support a psychologically safe environment for team members to feel safe to solve problems on their own. Going forward, more work is important to optimize teamwork in the setting of anticipated staffing shortages, limitations to resident neonatology exposure, changes in training requirements, and ongoing development of the FLP role.

  View details for DOI 10.1038/s41372-023-01756-8

  View details for PubMedID 37620402

  View details for PubMedCentralID 4535243

• Optimizing clinical care and training in the neonatal intensive care unit: the relationship between front line providers and physician trainees. Journal of perinatology : official journal of the California Perinatal Association Dyess, N. F., Keels, E., Myers, P., French, H., Reber, K., LaTuga, M. S., Johnston, L. C., Frontline Provider Interprofessional Writing Group (FLIP), Scala, M., Marc-Aurele, K., Branche, T., Adams, A., Feister, J., Boyle, K., Odumade, O. A. 2023

  Abstract

  Changes in neonatal intensive care unit (NICU) coverage models, restrictions in trainee work hours, and alterations to the training requirements of pediatric house staff have led to a rapid increase in utilization of front-line providers (FLPs) in the NICU. FLP describes a provider who cares for neonates and infants in the delivery room, nursery, and NICU, and includes nurse practitioners, physician assistants, and/or hospitalists. The increasing presence and responsibility of FLPs in the NICU have fundamentally changed the way patient care is provided as well as the learning environment for trainees. With these changes has come confusion over role clarity with resulting periodic conflict. While staffing changes have addressed a critical clinical gap, they have also highlighted areas for improvement amongst the teams of NICU providers. This paper describes the current landscape and summarizes improvement opportunities with a dynamic neonatal interprofessional provider team.

  View details for DOI 10.1038/s41372-023-01749-7

  View details for PubMedID 37580512

• Maternal mental health and engagement in developmental care activities with preterm infants in the NICU. Journal of perinatology : official journal of the California Perinatal Association Dubner, S. E., Morales, M. C., Marchman, V. A., Shaw, R. J., Travis, K. E., Scala, M. 2023

  Abstract

  To examine associations between maternal mental health and involvement in developmental care in the NICU.Mothers of infants born <32 weeks gestation (n = 135) were approached to complete mental health screening questionnaires at two weeks after admission. Mothers who completed screening (n = 55) were further classified as with (n = 19) and without (n = 36) elevated scores. Mothers' frequency, rate, and duration of developmental care activities were documented in the electronic health record.35% of screened mothers scored above the cutoff for clinical concern on ≥1 measure. No significant differences between the 3 groups were identified for rates, frequency, or amount of all developmental care, kangaroo care, and swaddled holding.Elevated scores on maternal mental health questionnaires did not relate to developmental care. Maternal developmental care engagement may not indicate mental health status. Universal screening for psychological distress is required to accurately detect symptoms in mothers of hospitalized preterm infants.

  View details for DOI 10.1038/s41372-023-01661-0

  View details for PubMedID 37046070

  View details for PubMedCentralID 8552262

• Inpatient Kangaroo Care Predicts Early Cognitive Development at 6 and 12 Months in Infants Born Very Preterm. medRxiv : the preprint server for health sciences Lazarus, M. F., Marchman, V. A., Brignoni-Perez, E., Dubner, S., Feldman, H. M., Scala, M., Travis, K. E. 2023

  Abstract

  Background: Limited research links hospital-based experiences of Kangaroo Care (KC), or skin-to-skin holding to longer-term neurodevelopmental outcomes in preterm children. The present study examined relations between inpatient KC and cognitive abilities measured at 6- and 12-months of age in a sample of very preterm (VPT) infants.Methods: Retrospective study reviewing medical records of 132 (54% male) VPT infants (<32 weeks gestational age (GA)). We calculated KC frequency (instances/day), KC rate (minutes/day), and KC duration (minutes/instance). Scores on the Cognitive-Adaptive Test were available as part of routine follow-up care at 6 ( n =77) and 12 ( n = 37) months.Results: Families engaged in KC about 2 days/week, 20 minutes/day, and 70 minutes/session, on average, although there was substantial variability. Variation in KC was positively associated with cognitive outcomes at both 6 (frequency: r=0.32; rate: r=0.29) and 12 (frequency: r=0.53; rate: r=0.59; duration: r=0.38) months. KC significantly predicted 7 to 27% unique variance in 6- and 12-month cognitive outcomes, after controlling for GA, socioeconomic status, health acuity, visitation frequency, and prior cognitive scores. Small increases in KC frequency (e.g., 1 day/week), rate (e.g., 20 minutes/day) or duration (e.g., 20 minutes/instance) were associated with 0.5 to 1.0 SD increases in cognitive outcomes at 12 months. SES, GA, and infant health acuity did not moderate these relations.Conclusion: VPT infants with more KC during hospitalization demonstrated higher scores on 6- and 12- month assessments of cognitive development. Results provide strong evidence that KC may confer neuroprotection on VPT infants through the first year of life.Article Summary: Variation in family-delivered Kangaroo Care in the NICU predicted infants' higher cognitive performance at 6 and 12 months, beyond visitation, clinical, and demographic factors.What is Known on This Subject: Kangaroo Care is a developmental care practice associated with positive short-term outcomes for preterm infants. Kangaroo Care is thought to mitigate adverse neurodevelopmental outcomes associated with preterm birth, but direct evidence of effects beyond hospital discharge is limited.What This Study adds: In this retrospective cohort study, frequency, amount, and duration of family-delivered Kangaroo Care in the NICU predicted cognitive abilities at 6 and 12 months. Kangaroo care may be a long-term neuroprotective clinical strategy for infants born preterm.

  View details for DOI 10.1101/2023.04.06.23288260

  View details for PubMedID 37066271

• Investigating relations between the NICU speech environment and weight gain in infants born very preterm. American journal of perinatology Kumar, K., Marchman, V. A., Morales, M. C., Scala, M., Travis, K. E. 2023

  Abstract

  Children born preterm, especially those born very preterm (< 32 weeks gestational age, GA), are at risk for poor growth and adverse neurodevelopmental outcomes. Adverse growth and neurodevelopmental outcomes in preterm children have been attributed, in part, to the aversive sounds and relative speech paucity of the neonatal intensive care unit (NICU). Experimental studies that directly expose preterm infants to speech sounds in the NICU find significant improvements in health factors relevant for neurodevelopment. Few studies have examined whether natural variations in the speech environment of the NICU are related to short-term health outcomes in preterm infants. Such data are important for optimizing the sound environment of the NICU.Examine relations between the NICU speech environment and rate of weight gain during hospitalization.Participants were infants born very preterm (n = 20). The speech environment of each infant was assessed at 32-36 weeks postmenstrual age using an automatic speech-counting device. Average rates of weight gain (g/kg/day) were ascertained over the same period. Calories were derived from charted intake (kcals/kg/day). Linear regressions examined caloric intake and speech counts as predictors of infant weight gain.Infant weight gain was significantly predicted by caloric intake and speech exposure, each uniquely accounting for ~27% variance (Total R2 = 60.2%; p < .001). Speech counts were uncorrelated with rates of family visitation, time in incubator, or health acuity.While future research should establish causality and direction of effects, enhancing speech exposure in the NICU may be beneficial for physical growth. NICU care plans should consider opportunities to increase speech exposure.

  View details for DOI 10.1055/a-2023-8813

  View details for PubMedID 36720260

• Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families. PEC innovation Scala, M., Marchman, V. A., Dowtin, L. L., Givrad, S., Nguyen, T., Thomson, A., Gao, C., Sorrells, K., Hall, S. 2022; 1: 100053

  Abstract

  Objectives: Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families.Methods: Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments.Results: Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37).Conclusions: Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula.Innovation: An online course enriched by patient perspectives is an effective method of disseminating education around mental health.

  View details for DOI 10.1016/j.pecinn.2022.100053

  View details for PubMedID 37213727

• Disparities in Kangaroo Care for Premature Infants in the Neonatal Intensive Care Unit. Journal of developmental and behavioral pediatrics : JDBP Brignoni-Perez, E., Scala, M., Feldman, H. M., Marchman, V. A., Travis, K. E. 2021

  Abstract

  OBJECTIVE: The aim of this study was to investigate whether preterm infants whose families have lower socioeconomic status (SES) or communicate with clinical staff in a language other than English experience differences in the rate, frequency, and duration of kangaroo care (KC) in the neonatal intensive care unit (NICU) compared with preterm infants of higher SES or primarily English-speaking families.METHODS: Participants were infants born <32 weeks' gestational age (GA), N = 116. We defined SES by the infants' health insurance (private/higher vs public/lower) and language by the language mothers used to communicate with clinical staff (English vs Other language). SES or language groups were compared on (1) rate of KC infants experienced during hospitalization per visitation days, (2) frequency of KC per visitation days, and (3) duration of KC events per day.RESULTS: Infants in the lower SES and Other language groups experienced KC in reduced amounts, lower frequencies, and shorter durations than infants in either the higher SES or English language groups. SES and language group differences remained significant after controlling for family visitation and GA at birth. After controlling for SES, language group differences in KC duration remained significant.CONCLUSION: Our findings revealed disparities in the rate, frequency, and duration of KC experienced in the NICU as a function of both SES and language. Such disparities reduced infants' access to this developmental care practice shown to stabilize clinical status and promote neurodevelopment. We recommend that hospital nurseries implement policies that minimize these disparities.

  View details for DOI 10.1097/DBP.0000000000001029

  View details for PubMedID 34723932

• Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. Early human development Scala, M., Marchman, V. A., Brignoni-Perez, E., Morales, M. C., Dubner, S. E., Travis, K. E. 2021; 163: 105483

  Abstract

  OBJECTIVES: To assess the impact of the COVID-19 pandemic on rates of hospital visitation and rates and durations of developmental care practices for infants born preterm.METHODS: We analyzed electronic medical record data from 129 infants born at less than 32weeks gestational age (GA) cared for in the Lucile Packard Children's Hospital neonatal intensive care unit (NICU) in a COVID-19-affected period (March 8, 2020 to Nov 30, 2020, n=67) and the analogous period in 2019 (n=62). Rates of family visitation and of family- and clinical staff-delivered developmental care were compared across cohorts, adjusting for covariates.RESULTS: Families of infants visited the hospital at nearly half of the rate during 2020 as during 2019 (p=0.001). Infants experienced developmental care less frequently in 2020 vs. 2019 (3.0 vs. 4.3 activities per day; p=0.001), resulting in fewer minutes per day (77.5 vs. 130.0; p=0.001). In 2020, developmental care activities were 5min shorter, on average, than in 2019, p=0.001. Similar reductions occurred in both family- and staff-delivered developmental care. Follow-up analyses indicated that effects persisted and even worsened as the pandemic continued through fall 2020, despite relaxation of hospital visitation policies.CONCLUSIONS: The COVID-19 pandemic has negatively impacted family visitation and preterm infant developmental care practices in the NICU, both experiences associated with positive health benefits. Hospitals should create programs to improve family visitation and engagement, while also increasing staff-delivered developmental care. Careful attention should be paid to long-term follow up of preterm infants and families.

  View details for DOI 10.1016/j.earlhumdev.2021.105483

  View details for PubMedID 34649193

• Listening to Mom in the NICU: effects of increased maternal speech exposure on language outcomes and white matter development in infants born very preterm. Trials Brignoni-Perez, E., Morales, M. C., Marchman, V. A., Scala, M., Feldman, H. M., Yeom, K., Travis, K. E. 2021; 22 (1): 444

  Abstract

  BACKGROUND: Infants born very preterm (<32weeks gestational age (GA)) are at risk for developmental language delays. Poor language outcomes in children born preterm have been linked to neurobiological factors, including impaired development of the brain's structural connectivity (white matter), and environmental factors, including decreased exposure to maternal speech in the neonatal intensive care unit (NICU). Interventions that enhance preterm infants' exposure to maternal speech show promise as potential strategies for improving short-term health outcomes. Intervention studies have yet to establish whether increased exposure to maternal speech in the NICU offers benefits beyond the newborn period for brain and language outcomes.METHODS: This randomized controlled trial assesses the long-term effects of increased maternal speech exposure on structural connectivity at 12months of age (age adjusted for prematurity (AA)) and language outcomes between 12 and 18months of age AA. Study participants (N=42) will include infants born very preterm (24-31weeks 6/7days GA). Newborns are randomly assigned to the treatment (n=21) or standard medical care (n=21) group. Treatment consists of increased maternal speech exposure, accomplished by playing audio recordings of each baby's own mother reading a children's book via an iPod placed in their crib/incubator. Infants in the control group have the identical iPod setup but are not played recordings. The primary outcome will be measures of expressive and receptive language skills, obtained from a parent questionnaire collected at 12-18months AA. The secondary outcome will be measures of white matter development, including the mean diffusivity and fractional anisotropy derived from diffusion magnetic resonance imaging scans performed at around 36weeks postmenstrual age during the infants' routine brain imaging session before hospital discharge and 12months AA.DISCUSSION: The proposed study is expected to establish the potential impact of increased maternal speech exposure on long-term language outcomes and white matter development in infants born very preterm. If successful, the findings of this study may help to guide NICU clinical practice for promoting language and brain development. This clinical trial has the potential to advance theoretical understanding of how early language exposure directly changes brain structure for later language learning.TRIAL REGISTRATION: NIH Clinical Trials (ClinicalTrials.gov) NCT04193579 . Retrospectively registered on 10 December 2019.

  View details for DOI 10.1186/s13063-021-05385-4

  View details for PubMedID 34256820

• Barriers to Kangaroo Care in the NICU: A Qualitative Study Analyzing Parent Survey Responses. Advances in neonatal care : official journal of the National Association of Neonatal Nurses Saltzmann, A. M., Sigurdson, K., Scala, M. 2021

  Abstract

  BACKGROUND: Despite its benefits, parents in the neonatal intensive care unit (NICU) face significant barriers to kangaroo care (KC). Clinician-reported barriers to KC include staff education, environment, and equipment among others; however, parent-perceived barriers are underexplored.PURPOSE: To examine parental understanding of KC, parental perception of experiences with KC, and parental views on the key factors that help or hinder KC.METHODS: This is an observational, mixed-methods study that used an author-developed survey to assess parental feelings, perceived importance, and barriers to KC. Likert scale responses were analyzed using descriptive statistics. Free-text responses were analyzed using thematic analysis. A comparison of results was made between parents receiving and not receiving infant mental health services.RESULTS: Fifty (N = 50) parents completed surveys. Eighty percent of parents stated they wanted more information on KC. Common barriers to KC were reported by parents, such as issues with space/environment. The most frequently reported barrier when asked openly was fear of hurting their infant. Ninety-six percent of parents believed that KC helped their emotional well-being. Parents receiving mental health services reported more fear but results did not reach significance.IMPLICATIONS FOR PRACTICE AND RESEARCH: The frequency with which factors are reported as important to parents may allow a prioritization of barriers to KC, which may help focus quality improvement initiatives. The results of this study underscore the vital role nurses play in supporting KC. Additional attention needs to be given to the mental health of NICU parents and its impact on care practices.

  View details for DOI 10.1097/ANC.0000000000000907

  View details for PubMedID 34054009

• PretermConnect: Leveraging mobile technology to mitigate social disadvantage in the NICU and beyond. Seminars in perinatology Jani, S. G., Nguyen, A. D., Abraham, Z., Scala, M., Blumenfeld, Y. J., Morton, J., Nguyen, M., Ma, J., Hsing, J. C., Moiwa-Grant, M., Profit, J., Wang, C. J. 2021: 151413

  Abstract

  Preterm birth (PTB) - delivery prior to 37-weeks gestation - disproportionately affects low-income and minority populations and leads to substantial infant morbidity and mortality. The time following a PTB represents an optimal window for targeted interventions that encourage mothers to prioritize their own health and that of their babies. Healthcare teams can leverage digital strategies to address maternal and infant needs in this postpartum period, both in the neonatal intensive care unit and beyond. We therefore developed PretermConnect, a mobile app designed to educate, engage, and empower women at risk for PTB. This article describes the participant-centered design approach of PretermConnect, with preliminary findings from focus groups and co-design sessions in different community settings and suggested future directions for mobile technologies in population health. Apps such as PretermConnect can mitigate social disadvantage by serving as remote monitoring tools, providing social support, preventing recurrent PTB and lowering infant mortality rates.

  View details for DOI 10.1016/j.semperi.2021.151413

  View details for PubMedID 33888330

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000670615500076

• Disparities in Kangaroo Care in the Neonatal Intensive Care Unit as a function of Mother's Language Brignoni-Perez, E., Scala, M., Marchman, V. A., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S24-S25

  View details for Web of Science ID 000656627200082

• Retrospective Cohort Study of Early Postnatal Hydrocortisone in Infants Born Extremely Preterm and 12 Month Outcomes Dubner, S. E., Scala, M., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S22

  View details for Web of Science ID 000656627200076

• Disparities in Kangaroo Care in the Neonatal Intensive Care Unit as a function of Mother's Language Brignoni-Perez, E., Scala, M., Marchman, V. A., Feldman, H. M., Travis, K. E. LIPPINCOTT WILLIAMS & WILKINS. 2021: S24-S25

  View details for Web of Science ID 000670615500082

• Promoting infant mental health in the neonatal intensive care unit (NICU): A review of nurturing factors and interventions for NICU infant-parent relationships. Early human development Givrad, S., Hartzell, G., Scala, M. 2020: 105281

  Abstract

  Premature and medically vulnerable infants experience early and sometimes prolonged separation from their parents, intrusive and unnatural environments, painful and distressing procedures, difficulties with physiological regulation, increased biological and neurological vulnerabilities, and grow up to have higher rates of neurocognitive and psychosocial difficulties. Parents of infants born prematurely or with medical vulnerabilities, in turn, experience significant distress and are a psychiatrically vulnerable population, with very high rates of depression, anxiety, and posttraumatic stress disorder. The combination of these factors cause significant challenges for some of these infants and parents in developing an early optimal relationship and connection. Given the critical importance of early relationships with main caregivers for infant mental health and long-term developmental outcomes, we review various targets of intervention to promote healthy infant and parent mental health and bonding thereby facilitating an optimal infant-parent relationship in the NICU population.

  View details for DOI 10.1016/j.earlhumdev.2020.105281

  View details for PubMedID 33229068

• Former NICU Families Describe Gaps in Family-Centered Care. Qualitative health research Sigurdson, K., Profit, J., Dhurjati, R., Morton, C., Scala, M., Vernon, L., Randolph, A., Phan, J. T., Franck, L. S. 2020: 1049732320932897

  Abstract

  Care and outcomes of infants admitted to neonatal intensive care vary and differences in family-centered care may contribute. The objective of this study was to understand families' experiences of neonatal care within a framework of family-centered care. We conducted focus groups and interviews with 18 family members whose infants were cared for in California neonatal intensive care units (NICUs) using a grounded theory approach and centering the accounts of families of color and/or of low socioeconomic status. Families identified the following challenges that indicated a gap in mutual trust and power sharing: conflict with or lack of knowledge about social work; staff judgment of, or unwillingness to address barriers to family presence at bedside; need for nurse continuity and meaningful relationship with nurses and inconsistent access to translation services. These unmet needs for partnership in care or support were particularly experienced by parents of color or of low socioeconomic status.

  View details for DOI 10.1177/1049732320932897

  View details for PubMedID 32713256

• Assessing speech exposure in the NICU: Implications for speech enrichment for preterm infants. Journal of perinatology : official journal of the California Perinatal Association Scala, M. L., Marchman, V. A., Godenzi, C. n., Gao, C. n., Travis, K. E. 2020

  Abstract

  Quantify NICU speech exposure over multiple days in relation to NICU care practices.Continuous measures of speech exposure were obtained for preterm infants (n = 21; 12 M) born <34 weeks gestational age in incubators (n = 12) or open cribs (n = 9) for 5-14 days. Periods of care (routine, developmental) and delivery source (family, medical staff, cuddler) were determined through chart review.Infants spent 13% of their time in Care, with >75% of care time reflecting developmental care. Speech counts were higher during care than no care, for mature vs. immature infants, and for infants in open cribs vs. incubators. Family participation in care ranged widely, with the highest speech counts occurring during periods of intentional voice exposure.Care activities represent a small portion of NICU experiences. Speech exposure during Developmental Care, especially with intentional voice exposure, may be an important source of stimulation. Implications for care practices are discussed.

  View details for DOI 10.1038/s41372-020-0672-7

  View details for PubMedID 32362660

• Premature Infants Conceived with Assisted Reproductive Technology: An Analysis of Infant Morbidity, Compared with Infants Conceived Naturally AMERICAN JOURNAL OF PERINATOLOGY Scala, M., Berg, J., Keszler, M., Abubakar, K. 2019; 36 (3): 258-261

  View details for DOI 10.1055/s-0038-1667288

  View details for Web of Science ID 000459125800005

• Effect of reading to preterm infants on measures of cardiorespiratory stability in the neonatal intensive care unit JOURNAL OF PERINATOLOGY Scala, M., Seo, S., Lee-Park, J., McClure, C., Scala, M., Palafoutas, J., Abubakar, K. 2018; 38 (11): 1536-1541

  View details for DOI 10.1038/s41372-018-0198-4

  View details for Web of Science ID 000449174800016

• Effect of reading to preterm infants on measures of cardiorespiratory stability in the neonatal intensive care unit. Journal of perinatology : official journal of the California Perinatal Association Scala, M., Seo, S., Lee-Park, J., McClure, C., Scala, M., Palafoutas, J. J., Abubakar, K. 2018

  Abstract

  OBJECTIVE: To evaluate the impact of parental bedside reading (PR) on cardio-respiratory (CR) stability of preterm infants.METHODS/STUDY DESIGN: Prospective examination of the impact of PR on CR stability in preterm NICU infants. CR data from 3 time points: pre-reading (3 and 1h before reading), during PR, and post-reading (1h after reading) were compared.RESULTS: Eighteen infants born at 23-31wks gestation, and 8 to 56 days old, were enrolled. Episodes of oxygen desaturation to <85% were fewer during PR as compared to the pre-reading periods and were fewer with live and maternal PR.CONCLUSION: Preterm infants showed fewer desaturation events less than 85% during PR than prior to reading exposure. This effect persisted up to 1h after reading exposure. Desaturation events were fewer with live and maternal PR. Voice exposure can be an important way for parents to participate in the care of their preterm infants.

  View details for PubMedID 30120423

• Premature Infants Conceived with Assisted Reproductive Technology: An Analysis of Infant Morbidity, Compared with Infants Conceived Naturally. American journal of perinatology Scala, M., Berg, J., Keszler, M., Abubakar, K. 2018

  Abstract

  OBJECTIVE: This article evaluates the morbidity of infants born via assisted reproductive technology (ART) compared with matched naturally conceived infants.STUDY DESIGN: This is a retrospective review of maternal and infant data among inborn infants conceived via ART and matched control infants born at 30 to 34 weeks' gestational age (GA) between 2006 and 2012. Data were analyzed using paired t-test or Wilcoxo-Mann-Whitney test for continuous and Fisher's exact test for categorical variables. p-Value of<0.05 was considered significant.RESULT: Of 120 study infants, 60 were conceived via ART and 60 naturally. Control infants were matched for GA, gender, race, and multiple gestations. ART infants required more respiratory support and took longer to reach full feeds compared with control infants.CONCLUSION: Infants born via ART are physiologically more immature with more intensive care needs than naturally conceived infants of similar gestation, potentially increasing health care costs. This immaturity should be considered when planning early delivery in these pregnancies.

  View details for PubMedID 30064149

• Pilot study of dornase alfa (Pulmozyme) therapy for acquired ventilator-associated infection in preterm infants. Pediatric pulmonology Scala, M., Hoy, D., Bautista, M., Palafoutas, J. J., Abubakar, K. 2017

  Abstract

  Evaluate the feasibility, safety, and efficacy of adjunctive treatment with dornase alfa in preterm patients with ventilator-associated pulmonary infection (VAPI) compared to standard care.We hypothesize that therapy with dornase alfa will be safe and well tolerated in the preterm population with no worsening of symptoms, oxygen requirement, or need for respiratory support.Prospective, randomized, blinded, pilot study comparing adjunctive treatment with dornase alfa to sham therapy. In addition to standard care, infants were randomized to receive dornase alfa 2.5 mg nebulized via endotracheal tube (ETT) every 12 hr for 7 days or sham therapy. ETT secretion gram stain and culture and chest X-ray (CXR) findings were evaluated. Respiratory support data were downloaded from the ventilator.Fourteen infants developed VAPI between 2012 and 2014; 11 enrolled in the study. Six received dornase alfa and five received sham therapy. Average gestational age at birth was 25 weeks and age at study entry was 31 days. There were no differences in demographics, ETT white blood cell count (WBC), CXR, or mean airway pressure (MAP) between the two groups. There was a trend towards decreased oxygen requirement (FiO2) in the treatment group that did not reach statistical significance. No side effects were observed in the treatment group.Treatment with dornase alfa is safe and treated infants had some improvement in FiO2 requirement but no improvement in MAP. A larger randomized trial is needed to evaluate the efficacy of this therapy. Pediatr Pulmonol. 2016; 9999:XX-XX. © 2016 Wiley Periodicals, Inc.

  View details for DOI 10.1002/ppul.23656

  View details for PubMedID 28052587