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104. Dexmedetomidine Opioid Sparing Effect in Mechanically Ventilated Children (DOSE): Trial of Fentanyl versus Fentanyl + Dexmedetomidine for Maintenance of Sedation

Author

Becker, Mara L., additional, Fischer, Gwenyth, additional, Hornik, Chi D., additional, Alibrahim, Omar, additional, Iheagwara, Kelechi, additional, Abulebda, Kamal, additional, Bass, Andora L., additional, Irby, Katherine, additional, Subbaswamy, Anjali, additional, Zivick, Elizabeth E., additional, Sweney, Jill, additional, Stormorken, Anne G., additional, Barker, Erin E., additional, Mahadaveiah, Shruthi, additional, Lutfi, Riad, additional, McCrory, Michael C., additional, Costello, John M., additional, Ackerman, Kate G., additional, Munoz-Pareja, Jennifer C., additional, Feger, Bryan J., additional, Dean, J. Michael, additional, Hanley, Daniel F., additional, Greenberg, Rachel G., additional, Avadhani, Radhika, additional, Thompson, Richard E., additional, Benjamin, Daniel K., additional, Hornik, Christoph P., additional, and Zimmerman, Kanecia O., additional

Published
2023
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105. Generalizability of the Necrotizing Enterocolitis Surgery Trial (NEST) to the Target Population of Eligible Infants

Author

Rysavy, Matthew A., primary, Eggleston, Barry, additional, Dahabreh, Issa, additional, Tyson, Jon E., additional, Patel, Ravi M., additional, Watterberg, Kristi L., additional, Greenberg, Rachel G., additional, Pedroza, Claudia, additional, Trotta, Marissa, additional, Stevenson, David K., additional, Stoll, Barbara J., additional, Lally, Kevin P., additional, Das, Abhik, additional, and Blakely, Martin L., additional

Published
2023
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108. Updated Perspectives on the Diagnosis and Management of Neonatal Invasive Candidiasis

Author

Daniel,Katherine, Greenberg,Rachel G, Boutzoukas,Angelique, Katakam,Lakshmi, Daniel,Katherine, Greenberg,Rachel G, Boutzoukas,Angelique, and Katakam,Lakshmi

Abstract

Katherine Daniel,1 Rachel G Greenberg,2,3 Angelique Boutzoukas,2,3 Lakshmi Katakam4 1Duke University School of Medicine, Durham, NC, USA; 2Department of Pediatrics, Duke University, Durham, NC, USA; 3Duke Clinical Research Institute, Durham, NC, USA; 4Department of Pediatrics, Neonatal-Perinatal Medicine, Durham, NC, USACorrespondence: Lakshmi Katakam, Department of Pediatrics, Neonatal-Perinatal Medicine, 2400 Pratt Street, North Pavilion Building, 8th Floor, Durham, NC, 27705, USA, Tel +1 919 681 6035, Fax +1 919 681 6085, Email lakshmi.katakam@duke.eduAbstract: Invasive candidiasis can cause severe illness in immunocompromised hosts, such as premature infants. Clinical presentation in neonates is variable and often characterized by non-specific signs with potential to involve several organ systems. Awareness of risk factors for Candida infections in the neonatal intensive care unit (NICU) can aid in screening infants with signs and symptoms of generalized illness. Cultures of blood, urine, and cerebrospinal fluid are the main diagnostic tools available in this population of infants, but several biomarkers and alternate identification methodologies such as 1,3-β-D-glucan, serum mannan or anti-mannan, and T2 magnetic resonance testing are being studied in the neonatal population. Prompt diagnosis of Candida infection, in conjunction with a comprehensive assessment of disease progression and organ involvement, is critical for optimizing treatment and patient outcomes. Supportive care and systemic antifungal medications remain the mainstay of treatment, and the efficacy and safety of newer therapeutic agents continue to be evaluated in neonates. Disease prevention strategies must be thoughtfully implemented and customized to each individual NICU based on local incidence of Candida infection, practice patterns, and risk factors, and may include prophylactic antifungal therapy. This review summarizes the evidence for current approaches to diagnosis and management of n

Published
2023

110. Association between neonatal intensive care unit medication safety practices, adverse events, and death

Author

Miller, Laura E., DeRienzo, Chris, Smith, P. Brian, Bose, Carl, Clark, Reese H., Cotten, C. Michael, Benjamin, Daniel K., Hornik, Chi D., and Greenberg, Rachel G.

Abstract

Objective: Determine the associations between neonatal intensive care unit (NICU) medication safety practices, laboratory-based adverse events (lab-AEs), and death. Study design: We combined data from a 2016 survey of Pediatrix NICUs on use of medication safety practices with 2014–2016 infant data. We grouped NICUs based on the number of safety practices used (≤5, 6–7, and 8–10) and evaluated the association between the number of safety practices used and lab-AEs and deaths using logistic regressions. Results: Of the 94 NICUs included, 17% used ≤5 medication safety practices, 51% used 6–7, and 32% used 8–10. NICUs with more safety practices did not have a difference in lab-AEs or death. Conclusion: In this cohort, the use of more medication safety practices was not associated with fewer lab-AEs or decreased death.

Published
2024
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111. Prospective Survey of Discrimination in Pregnant Persons and Correlation with Unplanned Healthcare Utilization

Author

Greenberg, Rachel, Anguzu, Ronald, Jaeke, Elisha, and Palatnik, Anna

Abstract

Objective: To determine the association between lifetime exposure to discrimination and unplanned healthcare utilization in pregnant persons. Methods: This was a prospective cohort study of pregnant persons receiving care from 2021 to 2022. Primary data was collected from participants on sociodemographic factors and on Perceived Ethnic Discrimination Questionnaire (PED-Q), a validated 17-item scale measuring perceived lifetime interpersonal racial and ethnic discrimination in four domains: work/school, social exclusion, stigmatization, and threat. The primary outcome was unplanned healthcare utilization, defined as unplanned labor and delivery admissions, triage, Emergency Department, or urgent care visits. Bivariate and multivariate analyses were done to examine the association between lifetime exposure to discrimination and unplanned healthcare utilization. Results: A total of 289 completed the PED-Q and were included in the analysis. Of these, 123 (42.6%) had unplanned healthcare utilization. Mean (SD) of lifetime racial and ethnic discrimination was significantly higher in people with unplanned healthcare utilization compared to those with planned healthcare utilization [1.67 (0.63) vs 1.48 (0.45), p= 0.003]. Univariate analysis showed that lifetime racial and ethnic discrimination was significantly associated with unplanned healthcare utilization (OR 1.96, 95% CI 0.23–3.11). Significant associations were found between unplanned healthcare utilization and maternal age (p= 0.04), insurance type (p= 0.01), married status (p< 0.001), education (p= 0.013), household income (p= 0.001), and chronic hypertension (p= 0.004). After controlling for potential confounding factors, self-reported lifetime racial and ethnic discrimination remained significantly associated with higher odds of unplanned healthcare utilization (aOR 1.78, CI 95% 1.01–3.11). Conclusion: We found that a higher level of self-reported lifetime racial and ethnic discrimination was associated with increased unplanned healthcare utilization during pregnancy.

Published
2024
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112. Vasoactive medications in extremely low gestational age neonates during the first postnatal week

Author

Miller, Laura E., Laughon, Matthew M., Clark, Reese H., Zimmerman, Kanecia O., Hornik, Christoph P., Aleem, Samia, Brian Smith, P., and Greenberg, Rachel G.

Abstract

Objective: The management of early hypotension in extremely low gestational age neonates (ELGANs) varies greatly between centers. The objective of this study was to provide updated data on the use of vasoactive medications in ELGANs during the first postnatal week. Study design: We identified ELGANs (22–27 weeks gestational age) cared for at Pediatrix neonatal intensive care units from 2009 to 2018. We evaluated the frequency of exposure to vasoactive medications by gestational age, and compared use of vasoactive medications between two epochs (2009–2013 and 2014–2018). Results: A total of 10,070/34,234 (29%) ELGANs received ≥1 vasoactive medication. Dopamine was the most frequently used vasoactive medication. The majority (83%) of treated ELGANs initiated therapy on postnatal days 0–1. Overall use of vasoactive medications was slightly lower in 2014–2018 than 2009–2013 (28 vs 31%, p< 0.001). Conclusion: A substantial proportion of ELGANs were exposed to vasoactive medications during the first postnatal week.

Published
2024
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124. It's better to forget: exploring the role of stigmergy decay in navigation behavior

Author

Moreno, Matthew, Ragusa, Vincent, and Greenberg, Rachel

Subjects
evolutionary computation, evolution, evolution of intelligence, stigmergy, markov brains
Abstract

Stigmergy is an indirect mechanism of coordination where an action alters the environment and the changed environment, in turn, alters the likelihood of future actions. Pheromone-marker-based stigmergy is the most common form of stigmergy used in social insect groups. The ant species Monomorium pharaonis produces pheromones that decay after several minutes, whereas Atta columbica ants produce pheromones that persist for several years. The respective transience and permanence of these ants’ foraging paths is thought to be related to their pheromones’ volatility. Several mathematical and computational models have demonstrated that relatively moderate pheromone decay rates are correlated with increased foraging success in stigmergic agents. However, the implications of pheromone volatility on the evolution of navigation behavior are not well-studied. Here we use digital agent-based evolution to show that moderate pheromone decay rates correspond to an increase in the extent to which agent foraging behavior relies on stigmergic cues. This result suggests that the properties of an organism’s pheromones play a vital role in the organism’s evolutionary trajectory, driving some towards, and others away from, stigmergic foraging strategies. These results help shed light on how elements of an organism’s environment, such as the stability of its food source, relate to the properties of that organism’s pheromones. Understanding the evolution of stigmergic group coordination strategies, an instance of collective cognition, provides a foundation for addressing the larger questions surrounding the evolution of intelligence.

Published
2022
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126. Online clinical tool to estimate risk of bronchopulmonary dysplasia in extremely preterm infants

Author

Greenberg, Rachel G, primary, McDonald, Scott A, additional, Laughon, Matthew M, additional, Tanaka, David, additional, Jensen, Erik, additional, Van Meurs, Krisa, additional, Eichenwald, Eric, additional, Brumbaugh, Jane E, additional, Duncan, Andrea, additional, Walsh, Michele, additional, Das, Abhik, additional, and Cotten, C Michael, additional

Published
2022
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134. Pharmacodynamics of Meropenem and Tobramycin for Neonatal Meningoencephalitis: Novel Approaches to Facilitate the Development of New Agents to Address the Challenge of Antimicrobial Resistance

Author

Farrington, Nicola, primary, McEntee, Laura, additional, Johnson, Adam, additional, Unsworth, Jennifer, additional, Darlow, Christopher, additional, Jimenez-Valverde, Ana, additional, Hornik, Christoph, additional, Greenberg, Rachel, additional, Schwartz, Julie, additional, Das, Shampa, additional, and Hope, William, additional

Published
2022
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139. Authors' Reply

Author

Tian, Di, primary, Lin, Zhen, additional, Kriner, Ellie M., additional, Esneault, Dalton J., additional, Tran, Jonathan, additional, DeVoto, Julia C., additional, Okami, Naima, additional, Greenberg, Rachel, additional, Yanofsky, Sarah, additional, Ratnayaka, Swarnamala, additional, Tran, Nicholas, additional, Livaccari, Maeghan, additional, Lampp, Marla, additional, Wang, Noel, additional, Tim, Scott, additional, Norton, Patrick, additional, Scott, John, additional, Hu, Tony Y., additional, Garry, Robert, additional, Hamm, Lee, additional, Delafontaine, Patrice, additional, and Yin, Xiao-Ming, additional

Published
2022
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145. Contributors

Author

Autmizguine, Julie, Barrero-Castillero, Alejandra, Bonifacio, Sonia Lomeli, Cotten, C. Michael, Ericson, Jessica E., Fillistorf, Laura, Franco, Susannah, Giannoni, Eric, Greenberg, Rachel G., Hammerschlag, Margaret R., Hanna, Mina, Hopper, Rachel K., Kabani, Nazia, Kaufman, David Alan, Kim-Chang, Julie J., Kimberlin, David W., Kocherlakota, Prabhakar, La Gamma, Edmund F., Lawrence, Shelley M., Liken, Hillary, Moussa, Ahmed, Mukhopadhyay, Sagori, Odackal, Namrita J., Permar, Sallie R., Puopolo, Karen Marie, Salvatore, Christine M., Sandoval Karamian, Amanda G., Sleasman, John William, Stark, Ashley, Stocker, Martin, Sullivan, Brynne Archer, Sullivan, Rachel T., Ting, Joseph Y., Van Meurs, Krisa P., Vesoulis, Zachary Andrew, and Wusthoff, Courtney J.

Published
2024
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146. An Update on the Prevention and Management of Bronchopulmonary Dysplasia

Author

Hennelly,Marissa, Greenberg,Rachel G, and Aleem,Samia

Subjects
Pediatric Health, Medicine and Therapeutics
Abstract

Marissa Hennelly,1 Rachel G Greenberg,1,2 Samia Aleem1,2 1Department of Pediatrics, Duke University, Durham, NC, USA; 2Duke Clinical Research Institute, Durham, NC, USACorrespondence: Rachel G GreenbergDepartment of Pediatrics, Duke University, 300 W. Morgan St, Suite 800, Durham, NC, 27701, USATel +1 919-668-4725Email rachel.greenberg@duke.eduAbstract: Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants and is associated with substantial long-term disabilities. There has been no change in the incidence of BPD over the past 20 years, despite improvements in survival and other outcomes. The preterm lung is vulnerable to injuries occurring as a result of invasive ventilation, hyperoxia, and infections that contribute to the development of BPD. Clinicians caring for infants in the neonatal intensive care unit use multiple therapies for the prevention and management of BPD. Non-invasive ventilation strategies and surfactant administration via thin catheters are treatment approaches that aim to avoid volutrauma and barotrauma to the preterm developing lung. Identifying high-risk infants to receive postnatal corticosteroids and undergo patent ductus arteriosus closure may help to individualize care and promote improved lung outcomes. In infants with established BPD, outpatient management is complex and requires coordination from several specialists and therapists. However, most current therapies used to prevent and manage BPD lack solid evidence to support their effectiveness. Further research is needed with appropriately defined outcomes to develop effective therapies and impact the incidence of BPD.Keywords: bronchopulmonary dysplasia, neonate, preterm infant, chronic lung disease

Published
2021

147. Ct Values do not Predict SARS-CoV-2 Transmissibility in College Students

Author

Tian, Di, Lin, Zhen, Kriner, Ellie M., Esneault, Dalton J., Tran, Jonathan, DeVoto, Julia C., Okami, Naima, Greenberg, Rachel, Yanofsky, Sarah, Ratnayaka, Swarnamala, Tran, Nicholas, Livaccari, Maeghan, Lampp, Marla, Wang, Noel, Tim, Scott, Norton, Patrick, Scott, John, Hu, Tony Y., Garry, Robert, Hamm, Lee, Delafontaine, Patrice, and Yin, Xiao-Ming

Subjects
viruses, Article
Abstract

SARS-CoV-2 is highly contagious, and the global spread has caused significant medical/socioeconomic impacts. Other than vaccination, effective public health measures, including contact tracing, isolation and quarantine, is critical for deterring viral transmission, preventing infection progression and resuming normal activities. Viral transmission is affected by many factors but the viral load and vitality could be among the most important ones. Although in vitro studies have indicated that the amount of virus isolated from infected people affects the successful rate of virus isolation, whether the viral load carried at the individual level would determine the transmissibility was unknown. From the diagnostic point of view, we aimed to examine whether the Ct value, a measurement of viral load by RT-PCR assay, could differentiate the spreaders from the non-spreaders in a population of college students. Our results indicate that while at the population level the Ct value is lower, suggesting a higher viral load, in the symptomatic spreaders than that in the asymptomatic non-spreaders, there is significant overlap in the Ct values between the two groups. Thus Ct value, or the viral load, at the individual level could not predict the transmissibility. Our studies also suggest that a sensitive method to detect the presence of virus is needed to identify asymptomatic persons who may carry a low viral load but can still be infectious.

Published
2021

150. Ct Values Do Not Predict Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmissibility in College Students

Author

Tian, Di, primary, Lin, Zhen, additional, Kriner, Ellie M., additional, Esneault, Dalton J., additional, Tran, Jonathan, additional, DeVoto, Julia C., additional, Okami, Naima, additional, Greenberg, Rachel M., additional, Yanofsky, Sarah, additional, Ratnayaka, Swarnamala, additional, Tran, Nicholas, additional, Livaccari, Maeghan, additional, Lampp, Marla L., additional, Wang, Noel, additional, Tim, Scott, additional, Norton, Patrick, additional, Scott, John, additional, Hu, Tony Y., additional, Garry, Robert, additional, Hamm, Lee, additional, Delafontaine, Patrice, additional, and Yin, Xiao-Ming, additional

Published
2021
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