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Preemie Baby

Optimizing pediatric quality & safety in the NICU

Preemie Baby

Children’s National doctors are optimizing pediatric quality and safety by working to decrease the rate of hypothermia in the Neonatal Intensive Care Unit.

Jessica Cronin, M.D., an anesthesiologist at Children’s National Health System, is working closely with staff and researchers to optimize pediatric quality and safety at the hospital. One of the projects Dr. Cronin is assisting with helps some of the smallest and most vulnerable patients that need surgery. Specifically, she is working to decrease the rate of hypothermia in the Neonatal Intensive Care Unit (NICU).

“It’s a significant problem that children may become cold during the surgery and immediately afterwards,” said Dr. Cronin. “There are a number of complications associated with that occurrence and our doctors and researchers are looking for solutions to combat that issue,” she added.

The hospital staff has instituted several interventions by making data available to the anesthesiologists responsible for temperature management and receiving feedback every month on the types of incidences that are happening. From when a baby is in the NICU, moved to the operating room and when they get transferred back, the doctors at Children’s National have created a checklist of tools to keep babies warm and monitor their temperatures during the perioperative period.

The NICU team has also worked closely with Dr. Rana Hamdy, M.P.H., M.S.C.E., who leads the antimicrobial stewardship team, Sudeepta Basu, M.D., a board certified neonatologist at Children’s National, and the pharmacy team to decrease out antibiotic utilization rates. To achieve its goals, the hospital has implemented the use of real-time check-ins during rounds, new algorithms, de-escalation of antibiotics and the frequent auditing has significantly reduced the unnecessary use of vancomycin.

This project is currently being tested in other parts of the hospital. Furthermore, the Children’s National team recently won an award from the District of Columbia Hospital Association (DCHA) to develop and implement interventions including clinical practice guidelines, educational initiatives, pharmacy-initiated prompts on rounds to de-escalate or discontinue vancomycin review from the antimicrobial stewardship team and provide documentation of culture volumes.

The DCHA serves as the unifying voice working to advance hospitals and health systems in D.C to strengthen systems of care, preserve access and promote better health outcomes for patients and communities. The Children’s National NICU team has been recognized for their outstanding work.

“The work that Dr. Cronin and the rest of the anesthesia team are performing is outstanding,” said Lamia Soghier, M.D., F.A.A.P., C.H.S.E., neonatologist and medical director of the neonatal intensive care unit (NICU) at Children’s National. “Our doctors have cut our rates of hypothermia for postoperative NICU infants by 60% and this project marks one of our major successes!”

Sudeepta Basu

GABA concentration in pre-term brain increases with gestational age

Sudeepta Basu

“A more complete understanding of the diagnostic and prognostic importance of GABA and glutamate in the preterm brain will help us to direct treatment strategies for the most vulnerable preterm infants at risk of brain injury,” says Sudeepta K. Basu, M.D.

The major neurotransmitters gamma-aminobutyric acid (GABA) and glutamate are pivotal to fetal and newborn brain development and influence evolution of brain injury and repair following preterm birth. Magnetic resonance spectroscopy (MRS) enables in vivo measurement of brain metabolites. However, GABA and glutamate are found in the developing brain in low concentrations, and their weak signal can be swamped by the stronger signal of more dominant metabolites.

A Children’s research team reports findings from a pilot study utilizing an innovative technique of MRS to reliably measure in vivo GABA in the developing preterm brain. The groundbreaking research done by the team that includes Principal Investigator Sudeepta K. Basu, M.D., neonatology attending at Children’s National Health System, is very unique and original since there are no existing data of in vivo GABA concentrations in the developing cerebellum. Under the mentorship of Catherine Limperopoulos, Ph.D., director of Children’s Developing Brain Research Laboratory, the team of multi-disciplinary specialists is pursuing cutting-edge technologies in advanced MRI neuroimaging to explore brain development and injury in preterm infants.

The research, presented at the Eastern Society for Pediatric Research (ESPR) annual meeting by Dr. Basu, was honored with the “2018 Meritorious Poster Award.” The research titled “Distinct temporal trends of GABA and glutamate in the cerebellum and frontal cortex of preterm infants” reports, for the first time, positive temporal trends in the specific regions of the developing brain intricately involved in cognitive and motor functions. This work lays the foundation for developing novel ways to diagnose, monitor and investigative brain protective therapies for vulnerable prematurely born infants.

The Children’s team performed non-sedated MRS in 44 preterm infants whose mean gestational age at birth was 26.5 weeks, placing voxels at the middle of the cerebellum and the right frontal cortex. GABA and GIx (glutamate combined with glutamine) were positively correlated with post-menstrual age in the frontal cortex, but not the cerebellum.  At the ESPR meeting, the team also presented for the first time that caffeine, a neuroprotective agent in preemies, leads to increased in vivo GABA concentration in the developing frontal cortex.

“Open questions include whether these findings reflect varying paces of maturation and vulnerability to injury among specific regions of the brain. Also, the relationship between clinical factors and medication exposure and changes in the concentration of these neurotransmitters may guide brain protective therapies in future,” Dr. Basu says. “A more complete understanding of the diagnostic and prognostic importance of GABA and glutamate in the preterm brain will help us to direct treatment strategies for the most vulnerable preterm infants at risk of brain injury.”

Children’s senior fellows from Division of Neonatology made four platform presentations during the ESPR conference:

  • “Caffeine increases GABA/Cr ratio in frontal cortex of preterm infants on spectroscopy.” Aditi Gupta; Sudeepta K. Basu, M.D.; Mariam Said, M.D.; Subechhya Pradhan, Linda White; Kushal Kapse; Jonathan Murnick, M.D., Ph.D.; Taeun Chang, M.D.; and Catherine Limperopoulos, Ph.D.
  • “Impact of early nutrition on microstructural brain development in VLBW Infants.” Katherine M. Ottolini, Nickie Andescavage, M.D.; Kushal Kapse; and Catherine Limperopoulos, Ph.D.
  • “Direct measurement of neonatal cardiac output utilizing the CO status monitor.” Simranjeet S. Sran, Mariam Said, M.D.; and Khodayar Rais-Bahrami, M.D.
  • “Cerebro-cerebellar diaschisis in preterm infants following unilateral cerebral parenchymal injury.” Huma Mirza, Yao Wu, Kushal Kapse, Jonathan Murnick, M.D., Ph.D.; Taeun Chang, M.D.; and Catherine Limperopoulos, Ph.D.