Publications by authors named "Orna Rosen"

8 Publications

  • Page 1 of 1

Neonatal Hydrops Simulation Model: A Technical Report.

Cureus 2021 Feb 24;13(2):e13535. Epub 2021 Feb 24.

Division of Neonatology, The Children's Hospital at Montefiore, Bronx, USA.

This technical report describes the creation of a model of a newborn with hydrops fetalis (HF). This model is easy to assemble, quite authentic and reusable allowing for many neonatal intensive care providers to practice rare, life-saving procedures. Learning objectives and a critical action checklist have been included to guide the simulation and add additional complexity to the scenario, if desired.
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http://dx.doi.org/10.7759/cureus.13535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996473PMC
February 2021

Incidence of Complications Associated with Parenteral Nutrition in Preterm Infants < 32 Weeks with a Mixed Oil Lipid Emulsion vs a Soybean Oil Lipid Emulsion in a Level IV Neonatal Intensive Care Unit.

JPEN J Parenter Enteral Nutr 2020 Aug 30. Epub 2020 Aug 30.

Department of Pharmacy, Montefiore Medical Center, Bronx, New York, USA.

Background: Parenteral nutrition (PN) is crucial for the improvement of long-term outcomes in very low birth weight (VLBW) neonates. Lipid injectable emulsions are a key component of PN, as they contain essential fatty acids and provide energy critical for brain growth. Prolonged administration increases risk of intestinal failure-associated liver disease, including cholestasis, and other complications.

Methods: This is a retrospective, quasi-experimental cohort study of 215 VLBW neonates. The primary outcome was a change in direct bilirubin concentration. Secondary outcomes included change in total bilirubin concentration and incidences of cholestasis and other disease states associated with PN and prematurity. Cholestasis was defined as direct bilirubin ≥ 1.0 mg/dL with total bilirubin < 5.0 mg/dL or direct bilirubin > 20% of total bilirubin with total bilirubin > 5.0 mg/dL.

Results: Change in direct bilirubin concentration was not different between groups. Incidence of cholestasis was not different between groups per charted diagnosis or per study definition. Non-stage-0 retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, and necrotizing enterocolitis were all lower in the mixed oil lipid emulsion group, which remained significant after adjustment for differences in gestational age, birth weight, and PN duration.

Conclusions: Although mixed oil lipid emulsion was not found to be associated with a lower risk of cholestasis, it may decrease risks of other disease states associated with PN therapy.
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http://dx.doi.org/10.1002/jpen.2011DOI Listing
August 2020

Exchange Transfusion Simulation Models: A Technical Report.

Cureus 2019 Aug 4;11(8):e5317. Epub 2019 Aug 4.

Neonatology, New York University Langone Health, New York, USA.

This technical report describes the creation of two exchange transfusion models in the newborn. These are low cost, easy to assemble, authentic, and realistic task trainers that provide the opportunity for neonatal providers to practice this rare, life-saving procedure. A critical action checklist is included to guide the simulated procedure. Also included is a suggested clinical scenario with optional complications and variations.
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http://dx.doi.org/10.7759/cureus.5317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6776104PMC
August 2019

Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial.

J Matern Fetal Neonatal Med 2019 Oct 7:1-7. Epub 2019 Oct 7.

Department of Pediatrics, Albert Einstein College of Medicine, Montefiore , Bronx , NY , USA.

Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth. To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS). In a single center, randomized parallel clinical trial, vigorous term neonates delivered scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life. Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%,  = .93), mean RS duration (4.08 versus 4.39 min;  = .71), frequency of admission to the NICU (5% in both groups;  = .95) and mean length of stay (0.14 versus 0.28 days;  = .42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation ( = .02) as well as heart rate ( = .004). Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life.
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http://dx.doi.org/10.1080/14767058.2019.1674805DOI Listing
October 2019

Meningomyelocele Simulation Model: Pre-surgical Management-Technical Report.

Cureus 2018 Feb 26;10(2):e2231. Epub 2018 Feb 26.

Neonatology, Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center.

This technical report describes the creation of a myelomeningocele model of a newborn baby. This is a simple, low-cost, and easy-to-assemble model that allows the medical team to practice the delivery room management of a newborn with myelomeningocele. The report includes scenarios and a suggested checklist with which the model can be employed.
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http://dx.doi.org/10.7759/cureus.2231DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919767PMC
February 2018

Noise Reduction in the Neonatal Intensive Care Unit: A Quality Improvement Initiative.

Am J Med Qual 2018 Mar/Apr;33(2):177-184. Epub 2017 Jun 6.

2 The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY.

Exogenous noise has deleterious effects on the developing fetus and infant. The aim of this quality improvement project was to lower the mean ambient noise level within a level IV neonatal intensive care unit (NICU) by 10% from the baseline in one year. Multiple noise reduction strategies were tested through Plan-Do-Study-Act cycles based on the Institute for Healthcare Improvement model for improvement. Strategies targeted environmental and behavioral modifications. Noise levels were recorded continuously; means and peaks were calculated. The mean noise level decreased from 62.4 dB to 56.1 dB, and peak noise level decreased from 115 dB to 76 dB within 12 months. Day shift noise level decreased by 7.7 dB; night shift noise level decreased by 4.9 dB from baseline. Targeted education, behavioral, and environmental modifications decreased the noise level in the NICU as per the study aim. To create a change in culture, constant dialogue between the project champions and the NICU staff is necessary.
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http://dx.doi.org/10.1177/1062860617711563DOI Listing
May 2019

Gastroschisis Simulation Model: Pre-surgical Management Technical Report.

Cureus 2017 Mar 22;9(3):e1109. Epub 2017 Mar 22.

Neonatology, Pediatrics, Children's Hospital at Montefiore, Montefiore Medical Center.

This technical report describes the creation of a gastroschisis model for a newborn. This is a simple, low-cost task trainer that provides the opportunity for Neonatology providers, including fellows, residents, nurse practitioners, physician assistants, and nurses, to practice the management of a baby with gastroschisis after birth and prior to surgery. Included is a suggested checklist with which the model can be employed. The details can be modified to suit different learning objectives.
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http://dx.doi.org/10.7759/cureus.1109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400515PMC
March 2017

Leuconostoc septicemia in a preterm neonate on vancomycin therapy: case report and literature review.

Am J Perinatol 2009 Jan 21;26(1):89-91. Epub 2008 Nov 21.

Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York, USA.

We report the case of a 26-day-old premature infant born at 24 weeks' gestation who developed septicemia while receiving vancomycin therapy. The blood isolate initially identified as a vancomycin-resistant Streptococcous viridans was found to be Leuconostoc spp. Her condition improved with parenteral ampicillin and gentamicin therapy and removal of the intravenous central catheter. Prematurity is a recognized risk factor for Leuconostoc disease. Clinicians need to consider Leuconostoc spp. when vancomycin-resistant pathogens are identified and provide appropriate therapy.
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http://dx.doi.org/10.1055/s-0028-1103025DOI Listing
January 2009