Tasha Lalos

All Publications

• Development and implementation of restrictive platelet transfusion thresholds in a neonatal intensive care unit. Journal of perinatology : official journal of the California Perinatal Association Lalos, N., Brumfiel, A., Viehl, L. T., Pet, G. C., Lahart, A. 2025

  Abstract

  Thrombocytopenia is a common problem affecting preterm neonates. Recent studies show increased morbidity and mortality with liberal platelet transfusion thresholds. We sought to standardize thrombocytopenia management through a transfusion guideline to reduce excessive transfusions.We developed and implemented a guideline using PDSA cycles for infants with birth weights <1000 grams. Platelet transfusions were classified as indicated or non-indicated per the guideline. Severe (grade 3 or 4) intraventricular hemorrhage and pulmonary hemorrhage rates were balancing measures.We analyzed 101 infants pre-guideline and 96 infants post-guideline. The mean monthly non-indicated transfusions significantly decreased from 13.0 to 2.0, respectively (p-value < 0.01). Incidence of severe grade IVH and pulmonary hemorrhage remained stable.Rapid implementation of an evidence-based, restrictive platelet transfusion guideline significantly reduced non-indicated platelet transfusions without a concomitant increase in major bleeding events.

  View details for DOI 10.1038/s41372-025-02302-4

  View details for PubMedID 40259097

  View details for PubMedCentralID 11014734

• A Preterm Infant with an Unlucky Airway. NeoReviews Lalos, N., Thamrongsak, C., Friedman, H., Brennan, S. K. 2024; 25 (12): e812-e815

  View details for DOI 10.1542/neo.25-12-e812

  View details for PubMedID 39616142

• Estimation of gestational age-specific reference intervals for coagulation assays in a neonatal intensive care unit using real-world data. Journal of thrombosis and haemostasis : JTH Lalos, N., Vesoulis, Z., Maucione, C., Eby, C., Dietzen, D. J., Roper, S. M., Spies, N. C. 2024; 22 (12): 3473-3478

  Abstract

  Interpretation of coagulation testing in neonates currently relies on reference intervals (RIs) defined from older patient cohorts. Direct RI studies are difficult, but indirect estimation may allow us to infer normative neonatal distributions from routinely collected clinical data.Assess the utility of indirect reference interval methods in estimating coagulation reference intervals in critically ill neonates.We analyzed first-in-life coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between January 1, 2018, and January 1, 2024. Results obtained after transfusion of any blood product were excluded. Indirect RIs were estimated across gestational age groups using refineR and compared with currently reported intervals for patients less than 1 year of age.Prothrombin times (PTs) and international normalized ratios (INRs) were available for 1128 neonates, while activated partial thromboplastin times (APTTs) were available for 790 neonates. The indirect RI was 10 to 25 seconds in preterm, 10 to 22 seconds in term, and 10 to 24 seconds in all neonates for PT; 0.7 to 2.1 in preterm, 0.8 to 1.8 in term, and 0.8 to 1.9 in all neonates for INR; and 25 to 68 seconds in preterm, 25 to 58 seconds in term, and 25 to 62 seconds in all neonates for APTT. Compared with our current intervals, the indirect RIs would flag 58% fewer PT, 43% fewer INR, and 17% fewer APTT results as abnormal.Indirectly estimated RIs in neonates admitted to intensive care show substantial divergence from current, first-year-of-life RIs, leading to an abundance of abnormal flags. The associations between these flags and provider behavior, transfusion practice, or clinical outcomes are areas of future exploration.

  View details for DOI 10.1016/j.jtha.2024.08.017

  View details for PubMedID 39271017

• Cerebral Near-Infrared Spectroscopy Use in Neonates: Current Perspectives RESEARCH AND REPORTS IN NEONATOLOGY Vesoulis, Z. A., Sharp, D. P., Lalos, N., Swofford, D. P., Chock, V. Y. 2024; 14: 85-95

  View details for DOI 10.2147/RRN.S408536

  View details for Web of Science ID 001223165500001

• Racial discrepancy in pulse oximeter accuracy in preterm infants. Journal of perinatology : official journal of the California Perinatal Association Vesoulis, Z., Tims, A., Lodhi, H., Lalos, N., Whitehead, H. 2022; 42 (1): 79-85

  Abstract

  Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients.Black and White infants <32 weeks gestation underwent simultaneous arterial blood gas and pulse oximetry measurement. Error by race was examined using mean bias, Arms, Bland-Altman, and linear/non-linear analysis.A total of 294 infants (124 Black, 170 White) were identified with mean GA of 25.8 ± 2.1 weeks and mean BW of 845 ± 265 grams, yielding 4387 SaO2-SpO2 datapoints. SpO2 overestimation, measured by mean bias, was 2.4-fold greater for Black infants and resulted in greater occult hypoxemia (SpO2 > 90% when SaO2 < 85%; 9.2% vs. 7.7% of samples). Sensitivity and specificity for detection of true hypoxemia were similar between groups (39 vs. 38%; 81 vs. 78%).There is a modest but consistent difference in SpO2 error between Black and White infants, with increased incidence of occult hypoxemia in Black infants.

  View details for DOI 10.1038/s41372-021-01230-3

  View details for PubMedID 34642469

  View details for PubMedCentralID PMC8508473

• Ventilator-Associated Tracheobronchitis: To Treat or Not to Treat? Antibiotics (Basel, Switzerland) Koulenti, D., Arvaniti, K., Judd, M., Lalos, N., Tjoeng, I., Xu, E., Armaganidis, A., Lipman, J. 2020; 9 (2)

  Abstract

  Ventilator-associated tracheobronchitis (VAT) is an infection commonly affecting mechanically ventilated intubated patients. Several studies suggest that VAT is associated with increased duration of mechanical ventilation (MV) and length of intensive care unit (ICU) stay, and a presumptive increase in healthcare costs. Uncertainties remain, however, regarding the cost/benefit balance of VAT treatment. The aim of this narrative review is to discuss the two fundamental and inter-related dilemmas regarding VAT, i.e., (i) how to diagnose VAT? and (ii) should we treat VAT? If yes, should we treat all cases or only selected ones? How should we treat in terms of antibiotic choice, route, treatment duration?

  View details for DOI 10.3390/antibiotics9020051

  View details for PubMedID 32023886

  View details for PubMedCentralID PMC7168312