All Publications

  • Inflammatory bowel disease and the impact on rates of chorioamnionitis, sepsis, and severe maternal morbidity Igbinosa, I., Trepman, P., Sie, L., Leonard, S. A., Herrero, T. MOSBY-ELSEVIER. 2021: S441–S442
  • Individualized growth assessment in pregnancies complicated by fetal gastroschisis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Sherwin, E., Deter, R., Joudi, N., Trepman, P., Lee, W., El-Sayed, Y. Y., Girsen, A. I., Datoc, I., Hintz, S. R., Blumenfeld, Y. J. 2021: 1-11


    Prenatal ultrasound (US) has been shown to overestimate the incidence of suspected fetal growth restriction (FGR) in gastroschisis cases. This is largely because of altered sonographic abdominal circumference (AC) measurements when comparing gastroschisis cases with population nomograms. Individualized Growth Assessment (IGA) evaluates fetal growth using serial US measurements that allow consideration of the growth potential for a given case. Our goal was to assess the utility of IGA for distinguishing normal and pathological fetal growth in gastroschisis cases.Pregnancies with prenatally diagnosed fetal gastroschisis were managed and delivered at a single academic medical center. US fetal biometry including head circumference (HC), abdominal circumference (AC), and femur diaphysis length (FDL), and neonatal measurements including birthweight and HC were collected and analyzed for 32 consecutive fetal gastroschisis cases with at least two 2nd and two 3rd trimester measurements. Second trimester growth velocities were compared to a group of 118 non-anomalous fetuses with normal neonatal growth outcomes. Gastroschisis cases were classified into groups based on fetal growth pathology score (FGPS9) patterns. Agreement between IGA (FGPS9) and serial conventional estimated fetal weight (EFW) measurements for determining growth pathology was evaluated. Neonatal size outcomes were compared between conventional birthweight classifications for determining small for gestational age (SGA) and IGA Growth Potential Realization Index (GPRI) for weight and head circumference measurements.Fetal growth pathology score (FGPS9) measurements identified three in-utero growth patterns: no growth pathology, growth restriction and recovery, and progressive growth restriction. In the no growth pathology group (n = 19), there was 84% agreement between IGA and conventional methods in determining pathological growth in both the 3rd trimester and at birth. In the growth restriction and recovery group (n = 7), there was 71% agreement both in the 3rd trimester and at birth between IGA and conventional methods. In the progressive growth restriction group (n = 5), there was 100% agreement in the 3rd trimester and 60% agreement at birth between IGA and conventional methods.We present the first study using IGA to evaluate normal and pathological fetal growth in prenatally diagnosed gastroschisis cases. IGA was able to delineate two 3rd trimester growth pathology patterns - one with persistent growth restriction and another with in-utero growth recovery. Further validation of these initial findings with larger cohorts is warranted.

    View details for DOI 10.1080/14767058.2021.1926976

    View details for PubMedID 34098833

  • Effects of gestational age at delivery and type of labor on neonatal outcomes among infants with gastroschisis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians Girsen, A. I., Davis, A. S., Hintz, S. R., Fluharty, E., Sherwin, K., Trepman, P., Desai, A., Mansour, T., Sylvester, K. G., Oshiro, B., Blumenfeld, Y. J. 2019: 1–191


    Objective: To investigate the effect of preterm gestational age on neonatal outcomes of gastroschisis and to compare the neonatal outcomes after spontaneous labor versus iatrogenic delivery both in the preterm and early term gestational periods. Study design: A retrospective study of prenatally-diagnosed gastroschisis cases born at Loma Linda University Medical Center and Lucile Packard Children's Hospital (CA, USA) between January 2009 and October 2016. A total of 194 prenatally diagnosed gastroschisis cases were identified and included in the analysis. We compared infants delivered < 37 0/7 to those ≥ 37 0/7 weeks' gestation. Adverse neonatal outcome was defined as any of: sepsis, short bowel syndrome, prolonged ventilation or death. Prolonged length of stay (LOS) was defined as ≥ 75th percentile value. Outcomes following spontaneous versus iatrogenic delivery were compared. Analyses were performed using chi-squared test or Fisher's exact test for categorical variables, and Student's t-test or Wilcoxon rank-sum test for continuous variables. Results: One hundred six neonates were born < 37weeks and 88 at ≥ 37weeks. Adverse outcome was statistically similar among those born < 37weeks compared to ≥ 37weeks (48 versus 34%, p = 0.07). Prolonged LOS was more frequent among neonates delivered < 37weeks (p = 0.03). Among neonates born < 37weeks, bowel atresia was more frequent in those with spontaneous versus iatrogenic delivery (p = 0.04). There was no significant difference in the adverse neonatal composite outcome between those with spontaneous preterm labor versus planned iatrogenic delivery at < 37weeks (n = 30 (58%) versus n = 21 (39%), p = 0.08). Conclusion: Neonates with gastroschisis delivered < 37weeks had prolonged LOS whereas the rate of adverse neonatal outcomes was similar between those delivered preterm versus term. Neonates born after spontaneous preterm labor had a higher rate of bowel atresia compared to those born after planned iatrogenic preterm delivery.

    View details for DOI 10.1080/14767058.2019.1656191

    View details for PubMedID 31409162

  • Impact of mode of delivery on neonatal microbial millieu Trepman, P. C., Aziz, A., Duffy, C., Turitz, A., Gyamfi-Bannerman, C. MOSBY-ELSEVIER. 2019: S432–S433
  • Interdisciplinary Food-Related Academic Programs: A 2015 Snapshot of the United States Landscape Journal of Agriculture, Food Systems, and Community Development Hartle, J. C., Cole, S., Trepman, P., Chrisinger, B. W., Gardner, C. D. 2017; 7 (4)
  • Interdisciplinary food-related academic programs: A 2015 snapshot of the United States landscape. Journal of agriculture, food systems, and community development Hartle, J. C., Cole, S. n., Trepman, P. n., Chrisinger, B. W., Gardner, C. D. 2017; 7 (4): 35–50


    Interdisciplinary food-related research and study is a growing field in academia. Each year, more universities add departments, courses, majors, and minors focused on studying food and society and the complexities of growing, processing, distributing, accessing, and consuming food. In this commentary, we present our exploratory findings about interdisciplinary food-related academic programs, including food studies and food systems programs in the United States. This cross-sectional research developed a snapshot of the 2015 land-scape of interdisciplinary food-related academic programs, provided a preliminary examination of their educational offerings, and will inform future research opportunities. In this formative study, we found 82 interdisciplinary food-related under-graduate programs focused on food. Nineteen program majors, minors, or concentrations had a core disciplinary focus on sustainable agriculture. "Food studies" and "food systems" were the primary focus of 15 undergraduate programs. We found 58 interdisciplinary food-related graduate programs and extracted information on their course offerings. Organizing courses into nine course categories, 78 percent of the programs offered courses in two to five categories, and 22 percent offered courses in six to eight categories. Few courses integrated material from multiple disciplines into a single course, suggesting that these interdisciplinary programs stemmed from traditional academic silos. Based on this preliminary work, we propose to further investigate the interdisciplinary nature of food-related academic programs, map their growth trajectory, and solicit feedback from faculty and administrators about their challenges in establishing and maintaining these programs. In future research, we are also interested in exploring job options for graduates of food-related academic programs to inform recruitment strategies and courses of study.

    View details for PubMedID 30740260

  • How do integrative practices influence patient-centered care?: An exploratory study comparing diabetes and mental health care. Health care management review Novikov, Z., Glover, W. J., Trepman, P. C., Naveh, E., Goldfracht, M. 2016; 41 (2): 113-126


    Integration between organizational units to achieve common goals has been of interest to health systems because of the potential to improve patient-centered care. However, the means by which integrative practices actually influence patient-centered care remain unclear. Whereas many studies claim a positive association between implementation of integrative practices and patient-centered care, others raise concerns that integrative practices may not necessarily improve patient-centered care.The aim of this study was to explore the mechanism by which integrative practices influence patient-centered care and to suggest a systematic approach for effective integration.We conducted a qualitative study comparing diabetes and mental health services through focus groups with 60 staff members from one health maintenance organization. We developed quantitative indicators to support the suggested model.We identified a five-category framework of integrative practices that each directly and distinctively influences patient-centered care. Moreover, our findings suggest that integrative practices influence patient-centered care indirectly through creation of interdependent treatment competence, which enables providers to repeatedly deliver interdependent treatment in a flexible and adaptive way.Providers should carefully implement integrative practices considering patient and disease characteristics, as our findings suggest that more implementation of integrative practices is not necessarily better for patient-centered care. Specifically, optimal implementation refers to the collective implementation of different integrative practices and thus encompasses both the extent (i.e., the amount of currently implemented practices out of those considered important to implement) and the extensiveness (i.e., the amount relative to the implementation of other practices) that may lead to interdependent treatment competence and higher patient-centered care. We suggest a creative measurement method of comparing the relative implementation of integrative practices that may assist managers and policy makers in developing interdependent treatment competence.

    View details for DOI 10.1097/HMR.0000000000000062

    View details for PubMedID 26002414