Neonatology News
A bimonthly publication of the Department of Neonatology
Volume 14, Issue 3
Beth Israel Deaconess
Medical Center
330 Brookline Avenue
Boston, MA 02215
(617) 667-3276
(617) 667-7040 fax
Fall, 2008
2008 Clinical Fellows in Neonatology
Six new fellows recently began their first of three years in the neonatal-perinatal fellowship program. They will each do
one of two one-month rotations this year in the Beth Israel-Deaconess NICU.
Alpna Aggarwal received her Bachelor
of Science degree in neuroscience from
New York University, undertook her
medical studies at the New York College of Osteopathic Medicine and completed her pediatrics residency at
Schneider Children’s Hospital in New
York. During her medical training, Alpna received a
Neuroscience Research Fellowship and was a finalist in
the Associated Medical Schools of New York Annual
Awards Program for Student Research for her role in
work on an animal model of SSRI treatment. She is interested in continuing laboratory research in neural physiology or a related field.
Jonathan Litt completed a Bachelor of
Arts degree in Classical Civilization
from Yale, taught language and literature in Greece, then returned to the
United States to receive his MD from
Case Western. A project with Dr. Maureen Hack to describe learning disabilities in children with low birth weight earned Jonathan a
Dean’s First Prize at the school’s Research Day Poster
Session, as well as a first-author publication in the Journal
of Learning Disabilities. Jonathan has just completed his
pediatrics residency at UCSF and plans to continue his
work in neurodevelopmental outcomes research during
his fellowship.
Chaitanya Chavda received his Medical degree and pediatrics training from
M.P Shah Medical College in India before moving to Brookdale University
Hospital and Medical Center in New
York for a US pediatrics residency. He
has experience in both basic science
research, with a project on cardiac embryological molecular biology, and in clinically oriented
research examining the effects of prophylactic fluconazole on candida colonized infants.
Marlin Touma received her medical
training at the Damascus University,
completed a pediatric residency at the
Children’s Hospital of Damascus and
practiced pediatrics at Al-Obaid General
Hospital in Saudi Arabia, where she was
Senior Pediatrician and Chief of the
Continuing Medical Education Department. Marlin moved to the United States in 2002 and
worked as a research assistant at Loma Linda University
Hospital for 3 years before completing a pediatrics residency at Children’s Hospital of Austin and the University
of Texas. She has published in the field of pediatric endocrinology, and is interested in pulmonary vascular biology.
Molly Lacy graduated cum laude with a
Bachelor of Arts degree in Anthropology and Molecular Biology from Dartmouth College, where she was a member of the Golden Key National Honor
Society and a Presidential Scholar. During her undergraduate studies, she conducted research in archaeoastronomy as
well as spending several months in biochemistry work at
the Max Planck Institute. She completed her medical
training at Washington University and her pediatrics residency at St. Louis Children’s Hospital, where she was
Chief Resident. Molly plans to continue her basic science
work at Harvard, possibly in the field of neuroscience.
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Jenny Yu graduated Summa Cum
Laude from Saint Louis University
with a Bachelor of Science in Biology.
She received her medical training at
Saint Louis University School of
Medicine, where she was named a
Medical Scholar for academic
achievement. Jenny completed her pediatrics residency at
Phoenix Children’s Hospital. She worked as a summer
research assistant in the Departments of Biology and Biochemistry at Saint Louis University, and is interested in
neurodevelopmental outcomes of premature infants.
BIDMC Celebrates World
Breastfeeding Week
2008 Richardson Awards
Mary Vadnais, MD, was honored
with the 2008 Douglas K. Richardson
Perinatal Collaboration Award at the
obstetrics resident graduation dinner.
This award is given annually by the
staff of the Neonatal Intensive Care
Unit to an outstanding obstetric resident, in recognition of her/his impact Mary Vadnais, MD
on high quality perinatal care through a
clear commitment to collaboration across all disciplines,
on behalf of obstetric and newborn patients.
World Breastfeeding Week was the
first week in August, and BIDMC
celebrated! This is a week set aside
world wide to remind us of the importance of “breastfeeding for
health.” The theme this year was
“Mother Support: Going for the
Gold” to coincide with the Summer
Olympics. Just like athletes, mothers need to be supported in order to learn how to breastfeed their babies.
We want to encourage mothers to exclusively breastfeed
for the first six months of their baby’s life and continue to
breastfeed for one year and beyond while adding complimentary foods. It is also a time to recognize that all
mothers and infants need access to a “circle of care” to
reach these breastfeeding goals. Beth Israel Deaconess
Medical Center is committed to promoting, supporting
and protecting breastfeeding. The week was illuminated
in numerous ways.
A former chief resident in obstetrics, Dr. Vadnais is currently a fellow in Maternal-Fetal Medicine at BIDMC.
Steven Donn, MD was the Richardson Memorial Lecture awardee at the annual New England Association of
Neonatologists Griffin Symposium. Dr. Donn is a neonatologist in Ann Arbor, Michigan.
A display of posters that highlighted the benefits of
breastfeeding could be found in both the East and West
Campuses of the hospital. Breast milk has been shown to
be one of the cornerstones of health, for public health begins with breastfeeding.
FDA Issues Health Information
Advisory on Infant Formula from
China
The OB and Neonatology departments sponsored “teas”
on the antepartum and postpartum floors for the families
as well as for the nurses and staff to thank them for their
efforts to support breastfeeding.
The Food and Drug Administration (FDA) has issued a
Health Information Advisory urging U.S. consumers to
avoid all infant formula from China, after several brands
sold in that country may have been contaminated with a
substance known as melamine, a chemical used in plastics. Although sales of infant formula from China are
illegal in the U.S., FDA officials are concerned that some
formula from China may be on sale at ethnic grocery
stores here. The FDA stresses there is no risk of contamination to the U.S. domestic supply of infant formula.
Gifts and gift certificates were donated by The Baby Carriage, Ameda Hollister, Souper Salad, Cambridge Medical, and the Friendshop, the medical center’s gift shop.
Gifts were given to patients via a raffle throughout the
week. Many thanks go out to those who donated their
time and gifts to help celebrate World Breastfeeding
Week!
The Lactation Service extends an appreciative “thank
you” to all the nurses, staff, and providers who help and
promote the best nutrition for our families. You are all
doing a great job.
Melamine in known to cause kidney stones and other serious kidney conditions. The FDA is encouraging physicians to report diagnoses of kidney stones in infants of
Chinese ethnicity to FDA MedWatch (1-800-FDA-1088),
Centers for Disease Control and Prevention (1-770-4887100), or local/state health departments.
Birth Announcement
Congratulations to Neonatology fellow,
Heather Herson Burris, MD, and her
husband, Darren, on the birth of their
daughter, Clara Gail, on September 14th.
For more information, please go to the FDA website at
www.fda.gov.
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NICU Grads in the News
Flu Shots Protect Pregnant Women
and Their Babies
From Beth Israel-Deaconess CEO Paul Levy’s internet blog,
“Running a Hospital,” September 9, 2008.
Receiving the influenza (flu) vaccine during pregnancy can help protect both a pregnant woman and her newborn against the
infection. In “Effectiveness of Maternal Influenza Immunization in Mothers and Infants,” which appears in the
September 17th online edition of the New England Journal of Medicine, researchers studied mothers and infants
in Bangladesh. They found that babies born to vaccinated
mothers had a 63 percent lower risk of flu compared to
babies whose mothers had not received the flu shot. The
study authors conclude that, “Maternal influenza immunization is a strategy with substantial benefits for both
mothers and infants.”
The really cute kid below is Kevin Pierro, a 5-year-old
Red Sox fan who was born at BIDMC on May 15, 2003.
The significance of that day is that it was when the record
Red Sox 456 sold-out game streak began. Kevin was one
of three fans who were invited to throw out the ceremonial first pitch at the Sox’s game on September 8th. Participating with Kevin were Dora Giglio, who holds the
oldest season ticket account which began in 1935, along
with Maurice Polite, a fan (not in photo) who was chosen
at random to represent all Red Sox fans.
The four kids shown in the photo below Kevin were also
born that day at BIDMC and are shown ready to yell
“Play ball!” at the start of the game. They are Christian
Trodden, Teddy English, Michael Gunning, and Abigail
Weiss.
To access the study online, go to http://content.nejm.org/
cgi/content/full/NEJMoa0708630.
BIDMC became the official hospital of the Red Sox in April, 2003.
Testing perinatal care strategies
Safe and Healthy Beginnings project highlights how improved processes can provide
effective and family-centered care
Lori O’Keefe, Correspondent
From AAP News Vol. 29 No. 10 October 2008, p. 46
Preliminary results from the midway point of the inaugural project of the Academy’s new quality improvement
initiative are encouraging, showing significant increases
in the use of methods in the newborn nursery and primary
care settings to provide care consistent with AAP recommendations.
From left: John Henry, Kevin Pierro, Tom Werner, Larry Lucchino,
and Dora Giglio.
The Safe and Healthy Beginnings (SHB) project tested
improving assessment of a newborn’s risk for severe hyperbilirubinemia, support for breastfeeding and coordination of care from the newborn nursery to the primary care
practice setting.
Newborn nursery teams were recruited from the Academy’s Quality Improvement Innovation Network (QuIIN),
which uses quality improvement (QI) methods to test
tools, interventions and strategies in the field (see sidebar). They were asked to review patient medical charts to
see how often newborns were evaluated for risk of severe
jaundice. They also looked at whether mothers received
breastfeeding education and structured assessment, and if
hospital personnel used specific procedures to transition
newborns from the hospital to primary care follow-up.
From left: Christian Trodden, Teddy English, Michael Gunning, and
Abigail Weiss.
(Photos were taken by Will Nunnally from the Red Sox.)
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continued on Page 4
In addition, primary care teams reviewed patient charts to
see how often newborns visited the pediatrician within
two days after hospital discharge, whether breastfeeding
was evaluated and documented, and if breastfeeding support was offered.
also was one of the SHB team leaders. “Safe and Healthy
Beginnings tells pediatricians exactly how to do the quality improvements. The toolkit materials make that easy.”
Focus on key aspects of AAP guideline
Like Dr. Driscoll, Laura E. Ferguson, MD, FAAP, was an
SHB team leader for both newborn nursery and primary
care setting teams.
“This project was an attempt to integrate the recommendations from the 2004 AAP guideline on the prevention of
severe hyperbilirubinemia in newborns and the strategies
for successful breastfeeding developed by the AAP Section on Breastfeeding,” said Carole M. Lannon, MD,
MPH, FAAP, co-chair of the SHB Expert Group.
After reviewing charts, Dr. Ferguson said her teams were
pleasantly surprised to discover that they already were
performing well in some areas. However, they needed
improvements in others, including breastfeeding support,
which she said improved by as much as 40% over the
course of the project.
AAP guidelines emphasize the importance of assessing
the risk of severe hyperbilirubinemia in newborns prior to
hospital discharge. “This is especially important because
moms and infants are often discharged within 48 hours
following a vaginal delivery,” she said. Because the peak
serum bilirubin occurs at three to five days of age, the
newborn is typically at home during this time rather than
in a newborn nursery under clinical observation.
Results improve
“In addition, breastfeeding may not be well-established at
the time of newborn hospital discharge,” she added. “Also,
late preterm infants are commonly cared for in the newborn nursery. These babies are at increased risk for hyperbilirubinemia and breastfeeding challenges. Studies from
the Academy’s Pediatric Research in Office Settings
(PROS) have documented that newborns may not be seen
for the initial follow-up visit for seven days, which makes
addressing these issues particularly important and compelling,” said Dr. Lannon.
New toolkit resources tested
Tools and strategies were tested by the 10 newborn nursery and 12 primary care practice teams that participated in
the QuIIN SHB project to see if these would help clinical
teams implement the AAP recommendations for assessment of severe hyperbilirubinemia and breastfeeding support.
“The toolkit provided initially to the project teams was a
draft, and the group played a major role in helping to revise it to make it better for pediatricians to use,” said Ann
R. Stark, MD, FAAP, co-chair of the SHB Expert Group.
“It’s always important to get input from people who are
on the front line about anything that is going to be implemented in the care setting because they are the ones who
know and understand the barriers and what is needed to
help facilitate whatever is being implemented.”
Preliminary analyses indicate that, overall, quality improvements were made by the project. SHB newborn
nursery teams reviewed charts at the beginning of the project and found that, on average, less than two-thirds of
newborns were appropriately assessed for their risk of
developing severe jaundice. At the midway point, preliminary analyses suggested that about three-quarters of newborns were evaluated.
In addition, the frequency of breastfeeding counseling
improved from about half of mothers to three-quarters.
Primary care practices saw significant improvements in
the documentation of breastfeeding evaluation and provision of breastfeeding support resources to mothers. Several teams helped to develop a brief assessment of breastfeeding for use in busy primary care practices, adapting a
tool used in newborn inpatient settings.
In addition to reviewing baseline performance at the onset
of the project, teams were asked to perform monthly chart
reviews and collect data over an eight-month period, provide monthly reports about QI changes that were made
and tested, attend two training sessions and participate in
monthly conference calls with other team members.
QuIIN partnered with the Center for Health Care Quality
at Cincinnati Children’s Hospital Medical Center and received support from the Center for Education and Research in Therapeutics Program at the federal Agency for
Healthcare Research and Quality, McNeil Consumer
Healthcare and the AAP Section on Perinatal Pediatrics.
Although the trial of SHB QI materials, tools and strategies is complete, work already has begun on another
QuIIN project that is testing the effectiveness of a brochure to educate parents about the misuse of ADHD
medications.
“There are always recommendations about how to improve the quality of care, but pediatricians don’t know
Resource
how to go about doing that,” said Amy B. Driscoll, MD,
To pre-order a copy of the Safe & Healthy Beginnings
FAAP, a member of the QuIIN steering committee who
4 toolkit available in January, visit www.aap.org/bookstore.
MONTHLY LINE-UP: Fall 2008
OCTOBER
“A” Attending Neonatologist:
“B” Attending Neonatologist:
Neonatology Fellow:
Jane Stewart
Stephaine Hale
Padmaja Itikala
Stewart
Hale
Itikala
Tran
Martin
Hartman
Gupta
Brodsky
Chavda
NOVEMBER
“A” Attending Neonatologist:
“B” Attending Neonatologist:
Neonatology Fellow:
Tai Tran
Camilia Martin
Tyler Hartman
DECEMBER
“A” Attending Neonatologist:
“B” Attending Neonatologist:
Neonatology Fellow:
Munish Gupta
Dara Brodsky
Chaitanya Chavda
NURSING LINE-UP:
NICU Nurse Manager:
NICU Clinical Nurse Specialist:
NNP Coordinator:
L&D Nurse Manager:
L&D Clinical Nurse Specialist:
Postpartum/Nursery Nurse Manager:
Nursery Clinical Nurse Specialist:
Jane Smallcomb
Susan Young
Mary Quinn
Barbara Stabile
Susan Crafts
Deirdre Burke
MaryAnn Ouellette
x7-3250
x7-4042
x7-4042
x7-2669
x7-4042
x7-4325
x7-3297
ATTENTION
Please submit any suggestions, ideas,
or comments you wish us to include in our
newsletter to Deb Brice in the Department of
Neonatology. Your responses can be
telephoned (617-667-3276), faxed (617-6677040), or e-mailed to dbrice@bidmc.harvard.edu.
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