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News Article | February 15, 2017
Site: www.prweb.com

Lying on the operating room table with blood transfusing into her body, Tanedra DuBose looked at her fiancé, said “I love you” and took what she thought would be her last breath. The next thing the 31-year-old mother heard were the cries of her newborn daughter as doctors feverishly worked to bring her first child into the world during an urgent C-section. “She gasped for air and it felt like we both took in the same air,” DuBose recalled three days later in her hospital room at Baptist Medical Center Jacksonville, with tears streaming down her face. “It was the most beautiful sound. They brought her up to me and I gave her a kiss. After that, I couldn’t actually believe I was alive. It was so surreal.” Her fiancé, who she first met in the 7th grade on the track team at Twin Lakes Academy Middle school in Jacksonville, tried distracting her during the delivery by singing and playing her favorite country and R & B dance songs on his cell phone. Doctors at Baptist Jacksonville had been monitoring DuBose since December because of a heart valve problem. With her health deteriorating, they performed the C-section on Jan. 20, even though she was only 30 weeks pregnant. DuBose said she spent the day and night before praying and coming to terms with God that she may not live to meet or hold her daughter. She told her fiancé to let their daughter know she loved her very much. She knew the odds. She had recently lost four great aunts to heart issues and signed legal papers two days before to ensure her daughter was cared for if she didn’t make it. “My aunts were always on my mind,” DuBose said. “I thought about my baby, my family and my fiancé. In the end, if I was not able to meet her or hold her or kiss her, I knew her dad would be strong enough to raise her. I knew she would be born into a family that cared about her.” Coordinated care DuBose was diagnosed with congestive heart failure in May 2015, after feeling shortness of breath and passing out at her home in Arlington, where she lives with her fiancé. Doctors found DuBose has a leaky heart valve, known as mitral regurgitation, where blood flows backward and forces the heart to work harder to pump blood through her body while causing blood to back up into her lungs. Ultimately, this problem led to high blood pressure in her lungs known as pulmonary hypertension. She was monitored and placed on medication for her heart and blood pressure, she said. Deciding to start a family, she became pregnant in June 2016. But on Nov. 12—her birthday—DuBose was coughing again. She thought it might be an upper respiratory problem from the change in the weather. But as days and weeks went by, her cough became worse and she couldn’t keep food down or talk. She also had excessive swelling in her legs and feet but she thought it might be because she was pregnant. On Dec. 31, when she and her fiancé had planned to be in Georgia getting married, she couldn’t breathe and could barely walk. At the Baptist Jacksonville emergency room, more than four liters of fluid were removed from her body. Doctors said they’d have to monitor her at the hospital until the baby’s birth, expected in March. At times, depression set in. “I would wake up not knowing what the next day would hold and would wonder if the only way I will feel my daughter is through my stomach,” DuBose said. “It was a scary time.” Her hospital stay took a dramatic turn on Jan. 18 when the fluid once again built up in her body and lungs and she became short of breath. Doctors told her they would have to take the baby in the next 24 to 48 hours. “It was a very tenuous situation and she started to deteriorate,” said Kathryn S. Villano, MD, medical director for Regional Obstetric Consultants, who specializes in maternal-fetal medicine and was involved throughout her pregnancy. “She had a mortality risk of 30 to 40 percent during delivery or shortly after. She is definitely a success story.” Rahil Malik, MD, obstetrician at North Florida OB/GYN, who performed the C-section, said DuBose had several medical issues such as heart failure, anemia and large uterine fibroids that could have complicated the delivery process. “We had to operate rapidly to make sure blood loss was minimal,” Dr. Malik said. Coordinated care was the key. Multiple specialists of more than a dozen physicians and nurses were involved throughout her pregnancy, including maternal fetal medicine, intensive care, cardiology, neonatology, anesthesia and pulmonology. “One of the benefits of delivering at Baptist Jacksonville is physicians are routinely exposed to medically complex patients and can coordinate care with multiple specialists,” Dr. Malik said. “Had (DuBose) been at a small, suburban hospital without these specialists and services available, she may not have had such a positive outcome.” A beautiful rose DuBose said it’s been a tough journey, but she was never alone. Her fiancé, family and extended family were by her side. The team at Baptist Jacksonville in Labor and Delivery and Newborn floors and in the Intensive Care Unit gave her encouragement and hugs throughout her stay, from nursing to housekeeping. “It brought tears to my eyes. It’s refreshing to know your life means something to someone other than your family,” DuBose said. “I don’t have the words to express how this hospital, this team, this group of people have treated me and my family.” Cicely Brooks, perinatal services director for Baptist Health, said she was very proud of the level of care the teams were able to provide DuBose, including teams in the ICU and operating room as well as neonatal care providers, OB staff and specialists. “Everyone was on the same page when it came to having a safe delivery,” Brooks said. “Our team was able to pull everything together and go above and beyond to make sure she was comfortable. We treated her like family because she could be a family member.” Today, as she recovers, DuBose steals moments with her new baby girl and she’s grateful they both are alive. In the Wolfson Children’s Hospital Newborn Intensive Care Unit, she reached through a small hole in the specialized enclosed bed and touched her three-pound daughter’s delicate hand. She then whispered, “Savannah. It’s your momma. Hey, gorgeous.” Her daughter is doing well, Brooks said, and continues to develop with the help of a tiny feeding tube. “I always prayed and asked God what is my purpose in life. I never knew until now,” DuBose said. “I found out my purpose is to share my story to give someone else hope and to let them know it will be OK if you just trust in prayer.” She is also encouraging others to listen to their body. “I don’t care if you think it is something minor, don’t ignore the signs. If something doesn’t sit well with you, go get it checked,” she said. As she looks to the future, which will involve a repair of her heart valve, and taking her daughter home, DuBose and her mom have nicknamed her baby Rose because of her rosy color. “She came from this dark place (a body battling health issues) and she blossomed into this beautiful rose,” she said. To learn more about Baptist Heart services, go to baptistjax.com/heart. Women who are at risk should also consult with their primary care physician or OB/GYN about prenatal counseling with a specialist. Baptist Health has also joined with the American Heart Association for its “Little Hats, Big Hearts” campaign where volunteers have knitted red hats for babies during Heart Month. Moms at each of the five Baptist hospitals in the area will receive a red hat in February for their baby before going home. About Baptist Health Baptist Health is a faith-based, mission-driven system in Northeast Florida comprised of Baptist Medical Center Jacksonville; Baptist Medical Center Beaches; Baptist Medical Center Nassau; Baptist Medical Center South; Baptist Clay Medical Campus and Wolfson Children’s Hospital – the region’s only children’s hospital. All Baptist Health hospitals, along with Baptist Home Health Care, have achieved Magnet™ status for excellence in patient care. Baptist Health is part of Coastal Community Health, a regional affiliation between Baptist Health, Flagler Hospital and Southeast Georgia Health System forming a highly integrated hospital network focused on significant initiatives designed to enhance the quality and value of care provided to our contiguous communities. Baptist Health has the area’s only dedicated heart hospital; orthopedic institute; women’s services; neurological institute, including comprehensive neurosurgical services, a comprehensive stroke center and three primary stroke centers; a Bariatric Center of Excellence; a full range of psychology and psychiatry services; urgent care services; and primary and specialty care physicians’ offices throughout Northeast Florida. Baptist MD Anderson Cancer Center is a regional destination for multidisciplinary cancer care which is clinically integrated with MD Anderson Cancer Center, the internationally renowned cancer treatment and research institution in Houston. For more details, visit baptistjax.com.

Harris D.L.,Newborn Intensive Care Unit | Harris D.L.,University of Auckland | Battin M.R.,University of Auckland | Battin M.R.,Auckland City Hospital | And 2 more authors.
Journal of Pediatrics | Year: 2010

Objective: To determine the usefulness of continuous glucose monitoring in babies at risk of neonatal hypoglycemia. Study design: Babies ≥32 weeks old who were at risk of hypoglycemia and admitted to newborn intensive care received routine treatment, including intermittent blood glucose measurement using the glucose oxidase method, and blinded continuous interstitial glucose monitoring. Results: Continuous glucose monitoring was well tolerated in 102 infants. There was good agreement between blood and interstitial glucose concentrations (mean difference, 0.0 mmol/L; 95% CI, -1.1-1.1). Low glucose concentrations (<2.6 mmol/L) were detected in 32 babies (32%) with blood sampling and in 45 babies (44%) with continuous monitoring. There were 265 episodes of low interstitial glucose concentrations, 215 (81%) of which were not detected with blood glucose measurement. One hundred seven episodes in 34 babies lasted >30 minutes, 78 (73%) of which were not detected with blood glucose measurement. Conclusion: Continuous interstitial glucose monitoring detects many more episodes of low glucose concentrations than blood glucose measurement. The physiological significance of these previously undetected episodes is unknown. Copyright © 2010 Mosby Inc.

Harris D.L.,Newborn Intensive Care Unit | Harris D.L.,University of Auckland | Weston P.J.,Newborn Intensive Care Unit | Harding J.E.,University of Auckland
Archives of Disease in Childhood: Fetal and Neonatal Edition | Year: 2015

Objective: Alternative cerebral fuels are reputed to provide neuroprotection during hypoglycaemia, particularly in breastfed babies. We measured concentrations of alternative cerebral fuels in hypoglycaemic babies in the first 48 h. Patient and methods: Babies were ≥35 weeks, ≤48 h old and at risk of hypoglycaemia (infant of diabetic, preterm, small or large). Plasma glucose, ß-hydroxybutyrate, lactate and insulin concentrations were measured in babies who had been hypoglycaemic (<2.6 mM) for >1 h. Results: Samples were taken from 35 hypoglycaemic babies at 3.7; 1.8-39.6 (median; range) hours after birth. Concentrations of glucose and β-hydroxybutyrate were low (2.03; 0.19-3.39 mM and 0.06; 0.00-1.20 mM), but lactate concentrations varied widely (3.06; 0.02-7.96 mM). Infants of diabetics had lower β-hydroxybutyrate and higher insulin concentrations, but mode of feeding did not influence plasma concentrations of alternative cerebral fuels. Conclusions: Hypoglycaemic babies within the first 48 h after birth are unlikely to receive neuroprotection from ketones. However, lactate may provide an alternative cerebral fuel for many. Lactate, rather than ketones, may provide alternative cerebral fuel in hypoglycaemic newborns.

Thoene M.,Newborn Intensive Care Unit | Hanson C.,University of Nebraska Medical Center | Lyden E.,University of Nebraska Medical Center | Dugick L.,Newborn Intensive Care Unit | And 2 more authors.
Nutrients | Year: 2014

The use of human milk fortifiers (HMF) helps to meet the high nutritional requirements of the human milk-fed premature infant. Previously available powdered products have not met the protein requirements of the preterm infant population and many neonatologists add powder protein modulars to help meet protein needs. The use of powdered products is discouraged in neonatal intensive care units (NICU) due to concern for invasive infection. The use of a commercially available acidified liquid product with higher protein content was implemented to address these two concerns. During the course of this implementation, poor growth and clinically significant acidosis of infants on Acidified Liquid HMF (ALHMF) was observed. The purpose of this study was to quantify those observations by comparing infant outcomes between groups receiving the ALHMF vs. infants receiving powdered HMF (PHMF). A retrospective chart review compared outcomes of human milk-fed premature infants <2000 g receiving the ALHMF (n = 23) and the PHMF (n = 46). Infant growth, enteral feeding tolerance and provision, and incidence of necrotizing enterocolitis (NEC), metabolic acidosis, and diaper dermatitis were compared between the two groups. No infants were excluded from this study based on acuity. Use of ALHMF resulted in a higher incidence of metabolic acidosis (p = 0.002). Growth while on HMF as measured in both g/kg/day (10.59 vs. 15.37, p < 0.0001) and in g/day (23.66 vs. 31.27, p = 0.0001) was slower in the ALHMF group, on increased mean cal/kg/day (128.7 vs. 117.3, p = 0.13) with nearly twice as many infants on the ALHMF requiring increased fortification of enteral feedings beyond 24 cal/ounce to promote adequate growth (48% vs. 26%, p = 0.10). Although we were not powered to study NEC as a primary outcome, NEC was significantly increased in the ALHMF group. (13% vs. 0%, p = 0.03). Use of a LHMF in an unrestricted NICU population resulted in an increase in clinical complications within a high-acuity NICU, including metabolic acidosis and poor growth. Although further research is needed to assess outcomes among infants with a variety of clinical acuities, gestational ages, and weights to confirm these findings, based on this experience, caution is urged to avoid potential risks. © 2014 by the authors; licensee MDPI, Basel, Switzerland.

Harris D.L.,Newborn Intensive Care Unit | Harris D.L.,University of Auckland | Weston P.J.,Newborn Intensive Care Unit | Harding J.E.,University of Auckland
Journal of Pediatrics | Year: 2012

Objectives: Routine blood glucose screening is recommended for babies at risk of neonatal hypoglycemia. However, the incidence of hypoglycemia in those screened is not well described. We sought to determine the incidence of hypoglycemia in babies identified as being at risk, and also to determine differences in incidence between at risk groups. Study design: Infants (n = 514) were recruited who were born in a tertiary hospital, ≥35 weeks gestation and identified as at risk of hypoglycemia (small, large, infant of a diabetic, late-preterm, and other). Blood glucose screening used a standard protocol and a glucose oxidase method of glucose measurement in the first 48 hours after birth. Results: One-half of the babies (260/514, 51%) became hypoglycemic (<2.6 mM), 97 (19%) had severe hypoglycemia (≤2.0 mM), and 98 (19%) had more than 1 episode. The mean duration of an episode was 1.4 hours. Most episodes (315/390, 81%) occurred in the first 24 hours. The median number of blood glucose measurements for each baby was 9 (range 1-22). The incidence and timing of hypoglycemia was similar in all at risk groups, but babies with a total of 3 risk factors were more likely to have severe hypoglycemia. Conclusions: Hypoglycemia is common amongst babies recommended for routine blood glucose screening. We found no evidence that screening protocols should differ in different at risk groups, but multiple risk factors may increase severity. The significance of these hypoglycemic episodes for long-term outcome remains undetermined. Copyright © 2012 Mosby Inc.

Harris D.L.,Newborn Intensive Care Unit | Harris D.L.,University of Auckland | Alsweiler J.M.,University of Auckland | Ansell J.M.,University of Auckland | And 5 more authors.
Journal of Pediatrics | Year: 2016

Objective To determine neurodevelopmental outcome at 2 years' corrected age in children randomized to treatment with dextrose gel or placebo for hypoglycemia soon after birth (The Sugar Babies Study). Study design This was a follow-up study of 184 children with hypoglycemia (<2.6 mM [47 mg/dL]) in the first 48 hours and randomized to either dextrose (90/118, 76%) or placebo gel (94/119, 79%). Assessments were performed at Kahikatea House, Hamilton, New Zealand, and included neurologic function and general health (pediatrician assessed), cognitive, language, behavior, and motor skills (Bayley Scales of Infant and Toddler Development, Third Edition), executive function (clinical assessment and Behaviour Rating Inventory of Executive Function-Preschool Edition), and vision (clinical examination and global motion perception). Coprimary outcomes were neurosensory impairment (cognitive, language or motor score below -1 SD or cerebral palsy or blind or deaf) and processing difficulty (executive function or global motion perception worse than 1.5 SD from the mean). Statistical tests were two sided with 5% significance level. Results Mean (±SD) birth weight was 3093 ± 803 g and mean gestation was 37.7 ± 1.6 weeks. Sixty-six children (36%) had neurosensory impairment (1 severe, 6 moderate, 59 mild) with similar rates in both groups (dextrose 38% vs placebo 34%, relative risk 1.11, 95% CI 0.75-1.63). Processing difficulty also was similar between groups (dextrose 10% vs placebo 18%, relative risk 0.52, 95% CI 0.23-1.15). Conclusions Dextrose gel is safe for the treatment of neonatal hypoglycemia, but neurosensory impairment is common among these children. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN 12608000623392. © 2016 Elsevier Inc.

Signal M.,University of Canterbury | Le Compte A.,University of Canterbury | Harris D.L.,University of Auckland | Harris D.L.,Newborn Intensive Care Unit | And 3 more authors.
Diabetes Technology and Therapeutics | Year: 2012

Background: Neonatal hypoglycemia is common and may cause serious brain injury. Diagnosis is by blood glucose (BG) measurements, often taken several hours apart. Continuous glucose monitoring (CGM) could improve hypoglycemia detection, while reducing the number of BG measurements. Calibration algorithms convert sensor signals into CGM output. Thus, these algorithms directly affect measures used to quantify hypoglycemia. This study was designed to quantify the effects of recalibration and filtering of CGM data on measures of hypoglycemia (BG <2.6 mmol/L) in neonates. Subjects and Methods: CGM data from 50 infants were recalibrated using an algorithm that explicitly recognized the high-accuracy BG measurements available in this study. CGM data were analyzed as (1) original CGM output, (2) recalibrated CGM output, (3) recalibrated CGM output with postcalibration median filtering, and (4) recalibrated CGM output with precalibration median filtering. Hypoglycemia was classified by number of episodes, duration, severity, and hypoglycemic index. Results: Recalibration increased the number of hypoglycemic events (from 161 to 193), hypoglycemia duration (from 2.2% to 2.6%), and hypoglycemic index (from 4.9 to 7.1 μmol/L). Median filtering postrecalibration reduced hypoglycemic events from 193 to 131, with little change in duration (from 2.6% to 2.5%) and hypoglycemic index (from 7.1 to 6.9 μmol/L). Median filtering prerecalibration resulted in 146 hypoglycemic events, a total duration of hypoglycemia of 2.6%, and a hypoglycemic index of 6.8 μmol/L. Conclusions: Hypoglycemia metrics, especially counting events, are heavily dependent on CGM calibration BG error, and the calibration algorithm. CGM devices tended to read high at lower levels, so when high accuracy calibration measurements are available it may be more appropriate to recalibrate the data. © Copyright 2012, Mary Ann Liebert, Inc. 2012.

Harris D.L.,Newborn Intensive Care Unit | Harris D.L.,University of Auckland | Weston P.J.,Newborn Intensive Care Unit | Signal M.,University of Canterbury | And 2 more authors.
The Lancet | Year: 2013

Background Neonatal hypoglycaemia is common, and a preventable cause of brain damage. Dextrose gel is used to reverse hypoglycaemia in individuals with diabetes; however, little evidence exists for its use in babies. We aimed to assess whether treatment with dextrose gel was more effective than feeding alone for reversal of neonatal hypoglycaemia in at-risk babies. Methods We undertook a randomised, double-blind, placebo-controlled trial at a tertiary centre in New Zealand between Dec 1, 2008, and Nov 31, 2010. Babies aged 35-42 weeks' gestation, younger than 48-h-old, and at risk of hypoglycaemia were randomly assigned (1:1), via computer-generated blocked randomisation, to 40% dextrose gel 200 mg/kg or placebo gel. Randomisation was stratified by maternal diabetes and birthweight. Group allocation was concealed from clinicians, families, and all study investigators. The primary outcome was treatment failure, defined as a blood glucose concentration of less than 2·6 mmol/L after two treatment attempts. Analysis was by intention to treat. The trial is registered with Australian New Zealand Clinical Trials Registry, number ACTRN12608000623392. Findings Of 514 enrolled babies, 242 (47%) became hypoglycaemic and were randomised. Five babies were randomised in error, leaving 237 for analysis: 118 (50%) in the dextrose group and 119 (50%) in the placebo group. Dextrose gel reduced the frequency of treatment failure compared with placebo (16 [14%] vs 29 [24%]; relative risk 0·57, 95% CI 0·33-0·98; p=0·04). We noted no serious adverse events. Three (3%) babies in the placebo group each had one blood glucose concentration of 0·9 mmol/L. No other adverse events took place. Interpretation Treatment with dextrose gel is inexpensive and simple to administer. Dextrose gel should be considered for first-line treatment to manage hypoglycaemia in late preterm and term babies in the first 48 h after birth.

PubMed | Newborn Intensive Care Unit and University of Nebraska Medical Center
Type: Journal Article | Journal: Nutrients | Year: 2016

This reply is a supplementary addition to our previous article entitled Comparison of a Powdered, Acidified Liquid, and Non-Acidified Liquid Human Milk Fortifier on Clinical Outcomes in Premature Infants as published in

PubMed | Newborn Intensive Care Unit and University of Nebraska Medical Center
Type: Journal Article | Journal: Nutrients | Year: 2016

We previously compared infant outcomes between a powdered human milk fortifier (P-HMF) vs. acidified liquid HMF (AL-HMF). A non-acidified liquid HMF (NAL-HMF) is now commercially available. The purpose of this study is to compare growth and outcomes of premature infants receiving P-HMF, AL-HMF or NAL-HMF. An Institutional Review Board (IRB) approved retrospective chart review compared infant outcomes (born < 2000 g) who received one of three HMF. Growth, enteral nutrition, laboratory and demographic data were compared. 120 infants were included (P-HMF = 46, AL-HMF = 23, NAL-HMF = 51). AL-HMF infants grew slower in g/day (median 23.66 vs. P-HMF 31.27, NAL-HMF 31.74 (p < 0.05)) and in g/kg/day, median 10.59 vs. 15.37, 14.03 (p < 0.0001). AL-HMF vs. NAL-HMF infants were smaller at 36 weeks gestational age (median 2046 vs. 2404 g, p < 0.05). However AL-HMF infants received more daily calories (p = 0.21) and protein (p < 0.0001), mean 129 cal/kg, 4.2 g protein/kg vs. P-HMF 117 cal/kg, 3.7 g protein/kg , NAL-HMF 120 cal/kg, 4.0 g protein/kg. AL-HMF infants exhibited lower carbon dioxide levels after day of life 14 and 30 (p < 0.0001, p = 0.0038). Three AL-HMF infants (13%) developed necrotizing enterocolitis (NEC) vs. no infants in the remaining groups (p = 0.0056). A NAL-HMF is the most optimal choice for premature human milk-fed infants in a high acuity neonatal intensive care unit (NICU).

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