Clinical Focus

  • Neonatal-Perinatal Medicine

Academic Appointments

Professional Education

  • Board Certification: American Board of Pediatrics, Pediatrics (2022)
  • Residency: UCSF Pediatric Residency (2022) CA
  • Medical Education: University of California at San Francisco School of Medicine (2019) CA

All Publications

  • Improving the Rate of Delayed Cord Clamping in Preterm Infants: A Quality Improvement Project. Hospital pediatrics Chan, S., Duck, M., Frometa, K., Liebowitz, M., Rosenstein, M. G., Tesfalul, M., Cornet, M. C., Kramer, K. P. 2023


    Delayed cord clamping (DCC) provides many benefits for preterm infants. The aim of this quality improvement project was to increase the rate of DCC by 25% within 12 months for neonates <34 weeks' gestation born at a tertiary care hospital.A multidisciplinary team investigated key drivers and developed targeted interventions to improve DCC rates. The primary outcome measure was the rate of DCC for infants <34 weeks' gestation. Process measures were adherence to the DCC protocol and the rate of births with an experienced neonatology provider present at the bedside. Balancing measures included the degree of neonatal resuscitation, initial infant temperature, and maternal blood loss. Data were collected from chart review and a perinatal research database and then analyzed on control charts. The preintervention period was from July 2019 to June 2020 and the postintervention period was from July 2020 to December 2021.322 inborn neonates born at <34 weeks' met inclusion criteria (137 preintervention and 185 postintervention). The rate of DCC increased by 63%, from a baseline of 40% to 65% (P <.001), with sustained improvement over 18 months. Significant improvement occurred for all process measures without a significant change in balancing measures.Using core quality improvement methodology, a multidisciplinary team implemented a series of targeted interventions which was associated with an increased rate of DCC in early preterm infants.

    View details for DOI 10.1542/hpeds.2022-006633

    View details for PubMedID 36946125

  • Barriers to exclusive breast-feeding in Indonesian hospitals: a qualitative study of early infant feeding practices. Public health nutrition Flaherman, V. J., Chan, S., Desai, R., Agung, F. H., Hartati, H., Yelda, F. 2018; 21 (14): 2689-2697


    Although initiating breast-feeding is common in Indonesia, rates of exclusive breast-feeding are low. Our objective was to identify early barriers to exclusive breast-feeding in Indonesian hospitals.Qualitative. Semi-structured interviews were conducted in April-June 2015. The data were analysed using thematic analysis.Indonesian provinces of Jakarta, Banten and West Java.Fifty-four participants including public health officials, hospital administrators, health-care professionals and parents.Five themes were identified as contributing to low rates of early exclusive breast-feeding in Indonesian hospitals: (i) quality and quantity of breast-feeding education; (ii) marketing and influence of infant formula manufacturers; (iii) hospital infrastructure; (iv) policy, legislation and protocols; and (v) perceived need for infant formula supplementation. Participants noted that providers and mothers receive inadequate or incorrect education regarding breast-feeding; manufacturers promote infant formula use both inside and outside hospitals; constraints in physical space and hospital design interfere with early breast-feeding; legislation and protocols designed to promote breast-feeding are inconsistently enforced and implemented; and providers and mothers often believe infant formula is necessary to promote infant health. All participants identified numerous barriers to early exclusive breast-feeding that related to more than one identified theme.Our study identified important barriers to early exclusive breast-feeding in Indonesian hospitals, finding that participants consistently reported multifaceted barriers to early exclusive breast-feeding. Future research should examine whether system-level interventions such the Baby-Friendly Hospital Initiative might improve rates of exclusive breast-feeding by improving breast-feeding education, reducing manufacturer influence, modifying existing infrastructure and providing tools needed for protocols and counselling.

    View details for DOI 10.1017/S1368980018001453

    View details for PubMedID 29973298