Clinical Focus


  • Developmental Care
  • Care of the Preterm Newborn
  • Neonatal-Perinatal Medicine

Academic Appointments


Professional Education


  • Fellowship: Georgetown University Hospital (2012) DC
  • Residency: University of Alabama at Birmingham (2001) AL
  • Medical Education: Georgetown University School of Medicine Registrar (1997) DC
  • Board Certification: American Board of Pediatrics, Neonatal-Perinatal Medicine (2014)
  • Board Certification: American Board of Pediatrics, Pediatrics (2001)

Graduate and Fellowship Programs


All Publications


  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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