Papers by Khorshid mOHAMMAD
Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times
American Journal of Perinatology, Jul 10, 2023
Objective In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handli... more Objective In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. Study Design This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The “dispatch time” (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas “mobilization time” (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the “Situation” component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the “washout” period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. Results The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). Conclusion Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. Key Points
Prevalence and Characteristics of Intracranial Hemorrhages in Neonates with Hypoxic Ischemic Encephalopathy
American Journal of Perinatology, Dec 8, 2017
The risk factors of intracranial hemorrhages (ICH) in the context of neonatal hypoxic ischemic e... more The risk factors of intracranial hemorrhages (ICH) in the context of neonatal hypoxic ischemic encephalopathy (HIE) and related interventions are unclear. This article examines the prevalence and risk factors associated with ICH in neonates with HIE. This is a retrospective cohort study of neonates with HIE in Southern Alberta. ICH (subdural [SDH], subarachnoid [SAH], intraventricular [IVH], intraparenchymal [IPH]) were diagnosed by magnetic resonance imaging (MRI). Perinatal and neonatal characteristics were examined. Relation of hemorrhages with hypoxic changes on MRI and HIE stages were assessed. Number of HIE patients, = 157; brain MRI was done in 138 infants; median gestation, 40 weeks; and cooled = 103 (66%). Prevalence of SDH, IPH, IVH, and SAH were 47, 22, 11, and 10 (34.1%, 15.9%, 7.8%, 7.2%), respectively. There was no significant increase in hemorrhage with mode of delivery, seizures, hypo/hypercarbia, severe thrombocytopenia, or deranged coagulation. All hemorrhages increased with higher HIE stage, regardless of the HIE severity in MRI. Adjusting for HIE staging, cooling, and gestation, IPH was observed more in infants who received inotropes (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.20, 9.20). SDH followed by IPH were the most common ICH. Thrombocytopenia and deranged coagulation did not increase risk of hemorrhages in HIE. Our study was not powered to determine the impact of inotrope use on the risk of IPH.
Placental pathology as a marker of brain injury in infants with hypoxic ischemic encephalopathy
Early Human Development, Nov 1, 2022
Childs Nervous System, Jun 8, 2022
Purpose To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associate... more Purpose To evaluate change in the severity of hypoxic-ischemic encephalopathy (HIE) and associated morbidities between pre-and during COVID-19 pandemic periods in Canada. Methods We conducted a retrospective cohort study extracting the data from level-3 NICUs participating in Canadian Neonatal Network (CNN). The primary outcome was a composite of death in the first week after birth and/or stage 3 HIE (Sarnat and Sarnat). Secondary outcomes included rate and severity of HIE among admitted neonates, overall mortality, brain injury on magnetic resonance imaging (MRI), neonates requiring resuscitation, organ dysfunction, and therapeutic hypothermia (TH) usage. We included 1591 neonates with gestational age ≥ 36 weeks with HIE during the specified periods: pandemic cohort from April 1st to December 31st of 2020; pre-pandemic cohort between April 1st and December 31st of 2017, 2018, and 2019. We calculated the odds ratio (OR) and confidence intervals (CI). Results We observed no significant difference in the primary outcome (15% vs. 16%; OR 1.08; 95%CI 0.78-1.48), mortality in the first week after birth (6% vs. 6%; OR 1.10, 95%CI 0.69-1.75), neonates requiring resuscitation, organ dysfunction, TH usage, or rate of brain injury. In the ad hoc analysis, per 1000 live births, there was an increase in the rate of infants with HIE and TH use. Conclusions Severity of HIE, associated morbidities, and mortality were not significantly different during the pandemic lockdown compared to a pre-pandemic period in Canada. Anticipated risks and difficulties in accessing healthcare have not increased the mortality and morbidities in neonates with HIE in Canada.
Diabetic Medicine, Oct 11, 2019
Aims To determine if in-target intrapartum glucose control is associated with neonatal hypoglycae... more Aims To determine if in-target intrapartum glucose control is associated with neonatal hypoglycaemia in women with type 1, type 2 or gestational diabetes. Methods This was a retrospective cohort study of pregnant women with diabetes and their neonates. The primary exposure was in-target glucose control, defined as all capillary glucose values within the range 3.5-6.5 mmol/l during the intrapartum period. The primary outcome, neonatal hypoglycaemia, was defined as treatment with intravenous dextrose therapy. Multiple logistic regression was used to examine the association between maternal intrapartum glycaemic control and neonatal hypoglycaemia, adjusting for covariates. Results Intrapartum glucose testing was available for 157 (86.3%), 267 (76.3%) and 3256 (52.4%) women with type 1, type 2 and gestational diabetes, respectively. In the univariate analysis, in-target glycaemic control was significantly associated with neonatal hypoglycaemia in women with gestational diabetes, but not in women with type 1 or 2 diabetes. However, after adjustment for important neonatal factors (large for gestational age, preterm delivery and infant sex), intrapartum in-target glycaemic control was not significantly associated with neonatal hypoglycaemia in women regardless of diabetes type [adjusted odds ratios 0.4 (95% CI 0.1, 1.4), 0.7 (95% CI 0.3, 1.3) and 0.7 (95% CI 0.5, 1.0) for women with type 1, type 2 and gestational diabetes, respectively]. Conclusions There was no significant association between in-target glycaemic control and neonatal hypoglycaemia after adjustment for neonatal factors. Given the high risk of maternal hypoglycaemia and the resources required, future trials should consider whether more relaxed intrapartum glycaemic targets may be safer and yield similar neonatal outcomes.
Journal of neonatal-perinatal medicine, Dec 26, 2017
OBJECTIVE: To determine the association between hemodynamic instability requiring inotropes and b... more OBJECTIVE: To determine the association between hemodynamic instability requiring inotropes and brain injury or death in neonates with hypoxic ischemic encephalopathy (HIE). METHODS: Retrospective cohort study of 221 neonates with HIE. Brain injury was defined using four HIE patterns based on MRI diffusion or T1 changes. The primary outcome was death or brain injury. Secondary outcomes were abnormal MRI, death, and abnormal EEG. Logistic regression was used to examine the risk of death or brain injury with the use of inotropes while adjusting for confounding factors. RESULTS: Brain injury or death occurred more often in neonates who received inotropes (71.1%, 69/97) compared to those who did not (44.3%, 55/124). The use of inotropes was associated with increased risk of death or brain injury (OR 3.11; 95% CI 1.39-7.004) and abnormal MRI (OR 2.78; 95% CI 1.22-6.34) after adjusting for confounding factors. Mortality was significantly higher in neonates exposed to inotropes (21.6%, 21/97) compared with those who did not receive inotropes (4%, 5/124), P < 0.001. CONCLUSION: In infants with HIE, hemodynamic instability requiring inotropes in the first 72 hours of life was associated with increased risk of death or brain injury detected by MRI.
Continuous EEG monitoring still recommended for neonatal seizure management: commentary on NEST trial
Pediatric Research, Jun 9, 2022
Diabetic Medicine, Jan 14, 2018
This is the first rigorous systematic review assessing the impact of intrapartum glycaemic cont... more This is the first rigorous systematic review assessing the impact of intrapartum glycaemic control on neonatal hypoglycaemia in pregnancies complicated by diabetes. We found that studies were discordant in finding an association between intrapartum maternal glucose and neonatal hypoglycaemia, with 12 of the 23 studies identified finding no significant association. We highlight the paucity of high-quality evidence supporting an association between intrapartum glycaemic control and neonatal hypoglycaemia. Additional high-quality studies are needed to determine whether tight intrapartum glycaemic control is superior to more relaxed glycaemic targets intrapartum for women with diabetes in pregnancy.
Comparing Three Methods of Therapeutic Hypothermia Among Transported Neonates with Hypoxic–Ischemic Encephalopathy
Therapeutic hypothermia and temperature management, Mar 24, 2023
Journal of neonatal-perinatal medicine, Apr 12, 2022
BACKGROUND: Hypoxic-ischemic (HI) brain injury is one of the most common neurological problems ob... more BACKGROUND: Hypoxic-ischemic (HI) brain injury is one of the most common neurological problems observed in infants. Hypothermia is the only approved therapy for neonatal HI encephalopathy. This therapy is only partially protective, cannot be used in preterm infants, and has a narrow therapeutic window after birth. Therefore,
Canadian Journal of Neurological Sciences, Jun 1, 2018
Suppl. 2-S31 included in those studies. The most common antibiotics used were cefazolin and cefta... more Suppl. 2-S31 included in those studies. The most common antibiotics used were cefazolin and ceftazidime. The rate of infection ranged from 0.5% to 3.1 % for meningitis as the most common infection. Conclusions: The need to use antibiotic(s) perioperatively is not clear in patients with pituitary lesions undergoing EETS. Randomized control trials are needed to evaluate the efficacy of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS.
Journal of Neonatal-Perinatal Medicine, 2020
Examining pupil reaction to light is an important component of the neurological examination in in... more Examining pupil reaction to light is an important component of the neurological examination in infants with hypoxic ischemic encephalopathy (HIE) to determine eligibility for therapeutic hypothermia (TH) and as part of serial neurological assessment for prognostication. Pupil examination can be challenging in critically ill infants with generalized edema. In this paper I report a simple technique using bedside point of care ultrasound to examine the pupil reaction to light in an infant with moderate HIE undergoing therapeutic hypothermia.
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2018
Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high r... more Background: Despite advances in neonatal care, neonates with moderate to severe HIE are at high risk of mortality and morbidity. we report the impact of a dedicated NNCC team on short term mortality and morbidities. Methods: A retrospective cohort study on neonates with moderate to serve HIE between July 1st 2008 and December 31st 2017. primary outcome : a composite of death and/or brain injury on MRI. Secondary outcomes: rate of cooling, length of hospital stay, anti-seizure medication burden, and use of inotropes. A regression analysis was done adjusting for gestational age, birth weight, gender, out-born status, Apgar score at 10 minutes, cord blood pH, and HIE clinical staging Results: 216 neonates were included, 109 before NNCC implementation, and 107 thereafter. NNCC program resulted in reduction in the primary outcome (AOR: 0.28, CI: 0.14-0.54,…
Paediatrics & Child Health, 2012
HYPOtENsION AND WHItE mAttEr INJurY (WmI) IN PrEtErm NEONAtEs *K mohammad, K Poskitt, V chau, A s... more HYPOtENsION AND WHItE mAttEr INJurY (WmI) IN PrEtErm NEONAtEs *K mohammad, K Poskitt, V chau, A synnes, r Grunau, J rigney, s miller university of british columia, Vancouver, british columbia BACkgROuND: WMI is identified on MRI in >1/4 of preterm neonates. While WMI risk is not adequately predicted by gestational age (GA), preliminary data suggests that hypotension may increase the risk of WMI. OBjECTIVES: To determine 1) the association of symptomatic hypotension with WMI in the very low gestational age (VLGA) newborn, and 2) the timing and context of hypotension modifies this relationship. DESIgN/METhODS: 118 preterm neonates (24-32 weeks GA) underwent MRI at a median of 32 weeks (IQ range: 30.3-33.6). The severity of WMI was scored using a validated system by a neuroradiologist blinded to clinical history.The severities of intraventricular hemorrhage (IVH) and cerebellar hemorrhage (CH) were also documented. Clinical information extracted from detailed chart review included: symptomatic hypotension defined as blood pressure <GA (by cuff, umbilical or peripheral arterial line) treated with fluid bolus or pressors, context of hypotension (occurring either (a) during sedation or (b) without sedation), timing of hypotension (either (a) early (72 hours of age) or (b) late (>72 hours). We used logistic regression analyses to determine the association of hypotension with the risk of WMI, IVH,& CH, adjusting for GA , age at MRI, SNAP score, days of ventilation, and infection. RESulTS: WMI was seen in 34 (29%) neonates, IVH in 56 (48%) and CH in 15 (13%).Symptomatic hypotension (1 episodes n=45 [38%]) was associated with a significantly increased risk of WMI (OR 4.7; CI 1.4-16, P=0.013) in the multivariable model. Hypotension episodes during sedation occurred in 56% (25/45). The risk of WMI was greater in the context of hypotension without sedation (OR 5.2; 95% CI 1.4-19.4, P=0.014) compared to with sedation (OR 4; 95% CI 0.9-18.1). Days and doses of sedation did not differ significantly in neonates with or without hypotension, or by WMI status. WMI risk was greater with late (OR 5.9; 95% CI 1.4-24.2, P 0.014) than early hypotension (OR 3.9; 95% CI 0.96-15.7). Hypotension was not an independent predictor of IVH (OR 1; CI 0.4-2.9), or CH (OR 1.5; CI 0.3-7.7). CONCluSIONS: Hypotension, even when treated, is an important risk factor for WMI in premature newborns. This risk is modulated by the timing and context of hypotensive episodes. Further study on the effect of management of hypotension on WMI is needed.
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2018
Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and man... more Background: Continuous video-EEG (cvEEG) monitoring is the standard of care for diagnosis and management of neonatal seizures. However, it is labour-intensive. We aimed to establish consistency in monitoring of newborns utilising NICU nurses. Methods: Neonatal nurses were trained to apply scalp electrodes, troubleshoot technical issues. Guidelines, checklists and visual training modules were developed. A central network system allowed remote access to the cvEEGs by the epileptologist for timely interpretation and feedback. We compared 100 infants with moderate to severe HIE before and after the training program. Results: 192 cvEEGs were performed. Of the 100 infants compared; time to initiate brain monitoring decreased by average of 31.5 hours, in electrographic seizure detection increased(20% compared to 34% a), seizure clinical misdiagnosis decreased (65% compared to 36% ), and Anti-Seizure burden decreased. Conclusions: Training experienced NICU nurses to set-up, start and monito...
The REDUCED trial: a cluster randomized trial for REDucing the utilization of CEsarean delivery for dystocia
American Journal of Obstetrics and Gynecology
Newborn, Dec 23, 2022
Objective: To determine the association between the degree of intrauterine growth restriction (IU... more Objective: To determine the association between the degree of intrauterine growth restriction (IUGR) [defined by birth weight (BW) Z-score] and the efficacy of pharmacologic patent ductus arteriosus (PDA) closure and the rate of surgical PDA ligation in preterm neonates. Materials and methods: In this retrospective cohort study, we included neonates born below 30 weeks' gestational age (GA), who received medical treatment for PDA between January 2010 and December 2018. Birth weight Z-scores were calculated using Olsen nomograms and classified into three categories: above −0.5; from −0.5 to −2.0; below−2. We compared responses to PDA treatment with non-steroidal anti-inflammatory drugs (NSAIDs) and PDA ligations between these groups utilizing multivariable logistic regression analysis. Results: Of 769 neonates with PDA, 517 (67.2%) neonates received medical treatment for PDA. Of which, 323 (62.5%) had BW Z-score above −0.5, 154 (29.8%) had from −0.5 to −2.0., and 40 (7.7%) had below −2. The efficacy of the first course of NSAIDs for the PDA closure was not different among the three groups (51% vs 49% vs 50%). Multivariable logistic regression analysis showed there was no significant difference in PDA closure rate following the first course of NSAIDs between neonates with BW Z-score below −2 and those with BW Z-score above −0.5 [adjusted odds ratio (aOR): 0.68; 95% CI: 0.33-1.39] as well as those with BW Z-score from −0.5 to −2.0 (aOR: 0.89; 95% CI: 0.59-1.35). However, the odds of PDA ligation were significantly higher among neonates with BW Z-scores below −2 (aOR: 2.67, 95% CI: 1.12-6.34) but not among neonates with Z-scores from −0.5 to −2.0 (aOR: 1.41; 95% CI: 0.84-2.39), as compared to those with BW Z-scores above-0.5. Conclusion: We observed a similar rate of PDA closure following the first course of NSAIDs between appropriately grown and growth-restricted neonates. However, severe growth restriction (BW Z-score below −2) is associated with higher rates of PDA ligation as compared to normally grown infants.
24 Persistent pulmonary hypertension and short-term neurological outcomes in infants with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia
Paediatrics & Child Health
Background Neonatal hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia is a serious c... more Background Neonatal hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia is a serious clinical condition that may result in permanent neurologic deficits or death. There is an increased incidence of persistent pulmonary hypertension of the newborn (PPHN) in asphyxiated infants. Due to the high disease burden of HIE, studying its altered cardiopulmonary hemodynamics might identify those patients at highest risk for adverse outcome early on. Objectives To investigate the relationship between severity of PPHN and the extent of short-term brain injury in infants with moderate to severe HIE who received therapeutic hypothermia (TH). Design/Methods Retrospective cohort study of 230 TH-treated HIE infants. PPHN was defined and graded clinically and based on echocardiography findings. The primary outcome was the presence of HIE changes on brain MRI and/or death within the first month of life according to the diagnosis and severity of PPHN. Secondary outcomes were the pattern of HI...
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
Objective: To evaluate the impact of dexmedetomidine on opioid use in neonates. Methods: A retros... more Objective: To evaluate the impact of dexmedetomidine on opioid use in neonates. Methods: A retrospective chart review of neonates that received dexmedetomidine compared to matched historical controls in a surgical tertiary NICU. The primary endpoint was overall opioid exposure. Secondary endpoints included the duration of regular opioid use, duration of opioid wean, duration of mechanical ventilation, and time to achieve full enteral feeds. Results: There were no statistically significant differences in opioid exposure (60.3 vs 42.6 mcg ME/kg, p ¼ .25), duration (583 vs 340 h, p ¼ .07), or wean duration (261 vs 147 h, p ¼ .12) between the two cohorts. In fact, these parameters showed clinically, if not statistically, significant increases in the dexmedetomidine cohort. Opioid exposure per day, length of NICU stay, duration of mechanical ventilation, and days to full enteral feeds did not differ between cohorts. Conclusion: This retrospective cohort study did not show reduced opioid exposure in surgical neonates receiving dexmedetomidine, which is in contrast to other literature. It highlights the limitations of using a medication without appropriate guidance and assessment tools to support its use.
Paediatrics & Child Health, 2019
Société canadienne de pédiatrie, comité d'étude du foetus et du nouveau-né, Ottawa (Ontario)
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Papers by Khorshid mOHAMMAD