- Neonatal-Perinatal Medicine
Clinical Assistant Professor, Pediatrics - Neonatal and Developmental Medicine
Honors & Awards
Ernest and Amelia Gallo Endowed Fellow., Child Heath Research Institute (CHRI) (7/2017-7/2019)
Board Certification: American Board of Pediatrics, Pediatrics (2013)
Fellowship: Stanford University Neonatology Fellowship (2019) CA
Medical Education: Grant Medical College - University of Mumbai (2003) India
Residency: Brookdale University Hospital and Medical Center (2010) NY
Board Certification, American Board of Pediatrics., Pediatrics. (2013)
Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22-26 months' corrected age after extremely preterm birth.
Archives of disease in childhood. Fetal and neonatal edition
OBJECTIVE: To compare death or severe neurodevelopmental impairment (NDI) at 22-26 months' corrected age (CA) among extremely preterm infants following exposure to different forms of umbilical cord management.DESIGN: Retrospective study.SETTING: Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry.PATIENTS: Infants born <27 weeks' gestation in 2016-2018 without severe congenital anomalies who received active treatment after birth and underwent neurodevelopmental assessments between 22 and 26 months' CA.EXPOSURES: Immediate cord clamping (ICC), delayed cord clamping (DCC) or umbilical cord milking (UCM).MAIN OUTCOMES AND MEASURE: Primary composite outcome of death or severe NDI at 22-26 months' CA, defined as severe cerebral palsy, Bayley-III cognitive/motor composite score <70, bilateral deafness or blindness; individual components were examined as secondary outcomes. Multivariable regression examined associations, adjusting for risk factors identified a priori and potential confounders. Mediation analysis explored the effect of severe intraventricular haemorrhage (IVH) on the exposure-outcome relationship.RESULTS: Among 1900 infants, 64.1% were exposed to ICC, 27.8% to DCC and 8.1% to UCM. Compared with ICC-exposed infants, DCC-exposed infants had lower odds of death or severe NDI (adjusted OR 0.64, 95%CI 0.50 to 0.83). No statistically significant differences were observed when comparing UCM with either ICC or DCC, or between secondary outcomes across groups. Association between cord management and the primary outcome was not mediated by severe IVH.CONCLUSION: Compared with ICC, DCC exposure was associated with lower death or severe NDI at 22-26 months' CA among extremely preterm infants, which was not mediated by severe IVH.
View details for DOI 10.1136/archdischild-2022-324565
View details for PubMedID 36253076
Umbilical Cord Milking versus Delayed Cord Clamping and Associations with In-Hospital Outcomes among Extremely Premature Infants.
The Journal of pediatrics
To compare in-hospital outcomes after umbilical cord milking versus delayed cord clamping among infants <29 weeks' gestation.Multicenter retrospective study of infants born <29 weeks' gestation from 2016 to 2018 without congenital anomalies who received active treatment at delivery and were exposed to UCM or DCC. The primary outcome was mortality or severe (grade III or IV) intraventricular hemorrhage (IVH) by 36 weeks postmenstrual age (PMA). Secondary outcomes assessed at 36 weeks PMA were mortality, severe IVH, any IVH or mortality, and a composite of mortality or major morbidity. Outcomes were assessed using multivariable regression, incorporating mortality risk factors identified a priori, confounders, and center. A prespecified, exploratory analysis evaluated severe IVH in two GA strata, 22-246/7 and 25-286/7 weeks.Among 1,834 infants, 23.6% were exposed to UCM and 76.4% to DCC. The primary outcome, mortality or severe IVH, occurred in 21.1% of infants: 28.3% exposed to UCM and 19.1% exposed to DCC, with an adjusted odds ratio that was similar between groups (aOR 1.45, 95% CI 0.93, 2.26). UCM exposed infants had higher odds of severe IVH (19.8% UCM vs. 11.8% DCC, aOR 1.70 95% CI 1.20, 2.43), as did the 25-286/7 week stratum (14.8% UCM vs. 7.4% DCC, aOR 1.89 95% CI 1.22, 2.95). Other secondary outcomes were similar between groups.This analysis of extremely preterm infants suggests that DCC is the preferred practice for placental transfusion, as UCM exposure was associated with an increase in the adverse outcome of severe IVH.
View details for DOI 10.1016/j.jpeds.2020.12.072
View details for PubMedID 33417919
- Is prophylaxis with early low-dose hydrocortisone in very preterm infants effective in preventing bronchopulmonary dysplasia? Journal of perinatology : official journal of the California Perinatal Association 2019