Reedhi Dasani
Academic Prog Prof 1, Pediatrics - Neonatology
Current Role at Stanford
Point-of-Care Ultrasound (POCUS) Program Manager
All Publications
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Point-of-care lung ultrasound for continuous positive airway pressure discontinuation in preterm infants.
Journal of perinatology : official journal of the California Perinatal Association
2024
Abstract
To determine if the lung ultrasound score (LUS) is predictive of successful continuous positive airway pressure (CPAP) discontinuation in preterm neonates born <32 weeks' gestation with history of respiratory distress syndrome.Retrospective study of preterm infants requiring CPAP. Univariate and multivariate logistic regression performed to formulate a predictive score using clinical variables with and without LUS. Area under the curve (AUC) was compared to determine the added predictive ability of LUS.Forty-one patients with discontinuation attempts associated with a LUS were included. Lower LUS obtained within 0-7 days prior to CPAP discontinuation was associated with successful CPAP discontinuation (OR 0.46 [0.23, 0.91]; p = 0.025). Cross-validated AUC for clinical variables alone (Model 1) was 0.85 (95% CI: 0.74-0.93) versus 0.90 (95% CI: 0.81-0.97) when LUS was incorporated (Model 2, p < 0.001). AUC of LUS alone was 0.83 (95% CI: 0.68-0.93, p < 0.0001).In preterm infants requiring CPAP, LUS aids in the prediction of successful CPAP discontinuation and may significantly improve a predictive tool.
View details for DOI 10.1038/s41372-024-02157-1
View details for PubMedID 39496765
View details for PubMedCentralID 8391473
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The Role of Neonatal Nurse Practitioners in the Implementation of a Bedside Point-of-Care Ultrasound Program.
Advances in neonatal care : official journal of the National Association of Neonatal Nurses
2024
Abstract
Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described.To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs.In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols.The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators.NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers.
View details for DOI 10.1097/ANC.0000000000001217
View details for PubMedID 39445723
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Quantitative Lung Ultrasonography to Guide Surfactant Therapy in Neonates Born Late Preterm and Later.
JAMA network open
2024; 7 (5): e2413446
Abstract
Surfactant administration may be needed in late preterm through full-term neonates, but the pathophysiology of their respiratory failure can be different from that of early preterm neonates. The lung ultrasonography score (LUS) is accurate to guide surfactant replacement in early preterm neonates, but to our knowledge, it has not yet been studied in the late preterm through full-term neonatal population.To assess whether LUS is equally accurate to predict surfactant need in late preterm through full-term neonates as in early preterm neonates.This prospective, international, multicenter diagnostic study was performed between December 2022 and November 2023 in tertiary academic neonatal intensive care units in France, Italy, Spain, and the US. Late preterm through full-term neonates (≥34 weeks' gestation) with respiratory failure early after birth were enrolled.Point-of-care lung ultrasonography to calculate the neonatal LUS (range, 0-18, with higher scores indicating worse aeration), which was registered in dedicated research databases and unavailable for clinical decision-making.The main outcomes were the area under the curve (AUC) in receiver operating characteristic analysis and derived accuracy variables, considering LUS as a replacement for other tests (ie, highest global accuracy) and as a triage test (ie, highest sensitivity). Sample size was calculated to assess noninferiority of LUS to predict surfactant need in the study population compared with neonates born more prematurely. Correlations of LUS with the ratio of hemoglobin oxygen saturation as measured by pulse oximetry (SpO2) to fraction of inspired oxygen (FiO2) and with the oxygen saturation index (OSI) were assessed.A total of 157 neonates (96 [61.1%] male) were enrolled and underwent lung ultrasonography at a median of 3 hours (IQR, 2-7 hours) of life; 32 (20.4%) needed surfactant administration (pretest probability, 20%). The AUC was 0.87 (95% CI, 0.81-0.92). The highest global accuracy and sensitivity were reached for LUS values higher than 8 or 4 or lower, respectively. Subgroup analysis gave similar diagnostic accuracy in neonates born late preterm (AUC, 0.89; 95% CI, 0.81-0.97; n = 111) and early term and later (AUC, 0.84; 95% CI, 0.73-0.96; n = 46). After adjusting for gestational age, LUS was significantly correlated with SpO2:FiO2 (adjusted β, -10.4; 95% CI, -14.0 to -6.7; P < .001) and OSI (adjusted β, 0.2; 95% CI, 0.1-0.3; P < .001).In this diagnostic study of late preterm through full-term neonates with respiratory failure early after birth, LUS accuracy to predict surfactant need was not inferior to that observed in earlier preterm neonates. An LUS higher than 8 was associated with highest global accuracy (replacement test), suggesting that it can be used to guide surfactant administration. An LUS value of 4 or lower was associated with the highest sensitivity (triage test), suggesting it is unlikely for this population to need surfactant.
View details for DOI 10.1001/jamanetworkopen.2024.13446
View details for PubMedID 38805223
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POCUS increases successful placement of peripheral arterial lines in neonates by less experienced providers.
European journal of pediatrics
2023
Abstract
To assess success of peripheral arterial line (PAL) placement after implementing a point-of-care ultrasound (POCUS) program in a neonatal intensive care unit. This was a retrospective chart review of infants who underwent successful PAL placement from January 2019 to March 2021. Outcomes included first-attempt success and the number of attempts with and without the use of POCUS. Among 80 PALs, 36% were POCUS-guided. All POCUS-guided lines were placed by providers with < 5 years neonatology experience. Among infants ≥ 2.5 kg, the use of POCUS was associated with fewer attempts compared to non-POCUS PAL placement (1 vs. 2, p = 0.035). Conclusions: Use of POCUS for PAL placement was associated with fewer attempts for successful placement in infants ≥ 2.5 kg by providers with less neonatology experience compared with traditional method. What is Known: • Arterial line placement in neonates has been traditionally done by palpation and can be technically challenging. • POCUS is an emerging tool in the NICU with increasing number of less clinically experienced providers in the NICU having access to ultrasound. What is New: • Use of POCUS by less experienced clinicians for arterial line placement resulted in fewer attempts compared to the traditional landmark-based approach in a cohort of neonates.
View details for DOI 10.1007/s00431-023-05160-4
View details for PubMedID 37615892
View details for PubMedCentralID 6353047
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MODIFIED ASSESSMENT OF COMPETENCY IN THORACIC SONOGRAPHY (ACTS) SCALE IN THE NICU AND PICU
LIPPINCOTT WILLIAMS & WILKINS. 2023: 302
View details for Web of Science ID 000921450900590
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Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit.
American journal of perinatology
2022
Abstract
In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program. A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound. A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful. Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management.· Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.. · Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.. · Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound..
View details for DOI 10.1055/s-0042-1750118
View details for PubMedID 35691294
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Negative affect is associated with increased stress-eating for women with high perceived life stress.
Physiology & behavior
2019; 210: 112639
Abstract
Perceived life stress (PLS) and cognitive restraint are associated with increased comfort food intake under stress and lead to weight gain and obesity, but the mechanisms by which they do so remain unclear. Stress and negative affect (NA) are associated with increased reward-driven comfort food intake as a means to 'feel better', particularly for individuals with higher PLS and cognitive restraint. Thus, we propose that PLS and cognitive restraint increase stress-eating by strengthening the relationship between stress-induced NA and comfort food intake. Upon comfort eating, individuals with higher PLS show greater reductions in the negative consequences of stress (e.g. NA). The rewarding effects of this 'emotional relief' may promote future stress-induced comfort eating, but this has yet to be examined. Thus, we investigate the pathways by which PLS or cognitive restraint increase snack intake under stress by proposing that 1) stress-induced NA is a stronger predictor of increased snack intake for women with greater PLS and cognitive restraint, and 2) greater PLS will be associated with greater reductions in NA upon snacking under stress (i.e. emotional relief). Forty-three healthy women were given snacks (chips, golden oreos, and M&Ms) to eat after a Trier Social Stress Test or rest period on separate days in counterbalanced order. Following linear regression analyses, we determined that stress-induced NA predicted more snack intake for women with higher PLS, and that higher PLS was associated with heightened emotional relief upon snacking under stress. Future studies are needed to directly assess whether greater emotional relief following stress-eating reinforces the learned association between stress-induced NA and intake, and ultimately explains greater stress-eating and obesity in women with higher PLS. This work may lead clinicians to focus on NA in the treatment of obesity-and stress-related illnesses for women with higher PLS.
View details for DOI 10.1016/j.physbeh.2019.112639
View details for PubMedID 31377311
View details for PubMedCentralID PMC7001866
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NEONATAL HYPERBILIRUBINEMIA AFTER MECHANICAL CIRCULATORY SUPPORT
BMJ PUBLISHING GROUP. 2018: 164–65
View details for DOI 10.1136/jim-2017-000663.236
View details for Web of Science ID 000432007400247