Papers by PRABHAKAR KOCHERLAKOTA
Research Square (Research Square), Oct 18, 2023
Background: Identifying substance use disorder (SUD) during pregnancy is challenging as there is ... more Background: Identifying substance use disorder (SUD) during pregnancy is challenging as there is no general consensus on which pregnant women should be tested for SUD during pregnancy. Recent studies have shown that a criteria-based approach may be essential for toxicological testing. Objective: To identify maternal and neonatal risk factors associated with positive neonatal drug toxicology results. Design/Methods: A retrospective chart review of mothers and their delivered infants from 2016 to 2022 at Monte ore St. Luke's Cornwall Hospital, Newburgh, NY. Urine, umbilical cord, and meconium were analyzed for toxicological testing. Results: Of the 5488 deliveries, 10.2% of mothers had risk factors, and 5.4% of dyads had positive toxicology results. Mothers with recent substance use disorder (SUD), including SUD on medication-associated treatment (MAT), infants with withdrawal signs, small for gestational age (SGA), and exposure to sexually transmitted infections (STD) had positive toxicology results. Conclusion: Insu cient prenatal care, the most common indication for toxicology testing, was not associated with positive toxicology results.
Abstract Neonatal abstinence syndrome (NAS) is a constellation of signs and symptoms and is a con... more Abstract Neonatal abstinence syndrome (NAS) is a constellation of signs and symptoms and is a consequence of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. The incidence of NAS is increasing; so are the length of stay and the need for pharmacologic therapy. Nonpharmacologic measures should be tried in all neonates before the initiation of pharmacologic therapy. Protocolized management is shown to decrease the length of stay and the length of treatment. Methadone and morphine are common medications used in the treatment of NAS. Either a weight-based or score-based approach to opioid dose can be used. Adjunct medications like phenobarbital and clonidine are helpful when monotherapy is not successful or when the maximum dose of opioid is reached. Breastfeeding decreases the need and the duration of pharmacotherapy. All NAS babies need to be followed up regularly. Further studies are needed to standardize the management of NAS.
American Journal of Perinatology, Oct 19, 2021
Background The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries a... more Background The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries and premature births; however, the impact of this pandemic on the well-baby nursery (WBN) is unknown. Objective The aim of the study is to evaluate the impact of the COVID-19 pandemic on infants admitted to the WBN by comparing pandemic and pre-pandemic cohorts. Study Design We performed a retrospective study of infants admitted to a WBN during the pandemic period (March 18, 2020 to March 17, 2021) and compared them to those during the pre-pandemic period (March 18, 2019 to March 17, 2020). Maternal (age, parity, gestation, method of delivery, and COVID-19 status) and neonatal (sex, weight, Apgar score, feeding pattern, urine toxicology, and neonatal intensive care unit [NICU] admission) data were collected and compared between the two periods. The results were statistically analyzed, and significance was set at p <0.05. Results There were 824 and 859 WBN admissions during the pandemic and pre-pandemic periods, respectively, a 4% decrease in WBN admissions during the pandemic period. During the pandemic period, the number of deliveries among nulliparous women increased (From 40.3% to 45.1% p = 0.01), and deliveries among multiparous women decreased (From 59.2% to 53.1% p = 0.01). The number of infants exposed to marijuana in utero increased (From 8.2% to 16.1% p = 0.035), and transfers from WBN to NICU decreased (From 9% to 6.3% p = 0.044) during the pandemic period. Conclusion Compared with the pre-pandemic period, the number of WBN admissions, multiparous deliveries, and NICU admissions decreased, while the number of nulliparous deliveries and infants exposed to marijuana in-utero increased during the pandemic period. Key Points
Pediatric Research, Apr 1, 1998
Pediatric Research, Apr 1, 1997
Pediatric Research, Apr 1, 1997
Pediatric Research, Apr 1, 1996
The Journal of Pediatrics, Mar 1, 1995
ABSTRACT Absolute neutropenia lasting longer than 72 hours after birth occurred in four very low ... more ABSTRACT Absolute neutropenia lasting longer than 72 hours after birth occurred in four very low birth weight neonates with a maternal history of severe pregnancy-induced hypertension, and was treated with recombinant granulocyte colony-stimulating factor for 3 days. Absolute neutrophil counts increased nearly four-fold within 48 hours; maximal values were recorded on the ninth day after the infusion was started. Total leukocyte counts subsequently decreased but remained in the normal range. It appears that recombinant human granulocyte colony-stimulating factor promotes a rapid increase in circulating neutrophils in these patients despite the possible presence of a circulating preeclampsia-associated inhibitor of neutrophil production.
Pediatrics, Jul 1, 1997
Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-sti... more Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) could reverse sepsis-associated neonatal neutropenia and improve neonatal survival compared with conventional therapy in a phase I/II-type trial. Study Design. An intravenous infusion of rhG-CSF (10 g/kg/d ؋ 3 d) was administered to 14 septic neutropenic neonates. Neutrophilic responses and outcome of these neonates were compared with 11 concurrently treated, retrospectively selected, case-matched control septic patients identified by using a search of medical records coded for sepsis with neutropenia ( 24 hours). Results. Seven neonates with early-onset sepsis with neutropenia at birth and seven neonates with late-onset sepsis plus neutropenia (all with necrotizing enterocolitis) were entered in the rhG-CSF treatment group. Results were compared with a conventional therapy control group (five early onset, six late onset). No significant differences existed in the birth weight, gestational age, use of antibiotic therapy, magnitude of respiratory support, severity of metabolic acidosis, use of vasopressors, or other supportive therapy between the two groups. In the rhG-CSF-treated group and in the conventionally treated control group, the absolute neutrophil count (ANC) (mean ؎ SEM) was 585 ؎ 138 and 438 ؎ 152, respectively. The ANC increased to more than baseline in the rhG-CSF-treated group by 10-fold versus 2-fold at 24 hours, 18-fold versus 4-fold at 48 hours, 24-fold versus 5-fold at 72 hours (significant by one-way analysis of variance in the rhG-CSF group only), and 29-fold versus 16-fold at 7 to 10 days when compared with the conventional therapy group. There were no nonresponders in the rhG-CSF group by 24 hours after the first dose of study drug. Monocyte cell counts also increased significantly in both groups by 7 days after entry into this protocol but remained within normal range for age. No clinically significant effect on lymphocytes, erythrocytes, or platelet counts was noted. Thirteen patients in the rhG-CSF-treated group (92%; 13 out of 14) and five in the conventionally treated group (55%; 5 out of 11) survived to 28 days after the onset of the signs of sepsis. No adverse effects were noted in the rhG-CSF-treated group. Conclusions. rhG-CSF can increase the neutrophil count in critically ill septic neutropenic neonates. This finding suggests that rhG-CSF may be effective in a therapeutically useful time frame to treat septic neonates with neonatal neutropenia attributable to bone marrow suppression or neutrophil consumption. Future randomized trials are needed to validate the beneficial effects of rhG-CSF and to determine whether any significant side effects of therapy exist. Pediatrics 1997;100(1). URL: ; neonatal sepsis, recombinant human granulocyte colony stimulating factor, bacteremia, cytokines, very low birth weight, neutropenia.
Pediatric Research, Apr 1, 1996
Pediatrics, Nov 1, 1998
Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-sti... more Objectives. To determine whether adjunctive therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) could reverse the neutropenia and reduce the incidence of sepsis (≤28 days postnatal age) in neonates with prolonged preeclampsia-associated neutropenia compared with conventional therapy. Study Design. An intravenous infusion of rhG-CSF (10 μg/kg/day × 3 days for 10 neonates or 5 μg/kg/day × 3 days for 5 neonates) was administered to ventilated patients with prolonged (≥3 consecutive days in the first postnatal week) preeclampsia-associated neutropenia (absolute neutrophil count [ANC] <1500/mm3). Neutrophilic responses and the incidence of neonatal sepsis in the next 28 postnatal days were compared with 13 case-matched control neonates who also had prolonged preeclampsia-associated neutropenia. Sepsis was defined as at least one positive blood culture in a newly symptomatic neonate treated with antibiotics for ≥7 days. Results. No significant differences existed among the three groups in the birth weight, gestational age, sex, growth retardation, method of delivery, magnitude of respiratory support, use of surfactant, usage of intravascular catheters, or in the initial (pretreatment) ANC. The average baseline ANC (pretreatment) in the 10-μg rhG-CSF group was 815 ± 169/mm3 (mean ± SEM), in the 5 μg group it was 786 ± 165/mm3, and in the conventional group it was 965 ± 283. Eighteen of 28 (64%) neonates with preeclampsia-associated neutropenia were neutropenic at birth, the other 10 (36%) had normal neutrophil counts at birth but subsequently developed ≥3 days of neutropenia between 24 and 120 hours after birth. The ANC increased by 2-fold at 24 hours, by 4-fold at 72 hours, and 14-fold by the 7th day in the 10-μg group. In the 5-μg group, a 2-fold and 5-fold increase occurred at 72 hours and 7 days, respectively. In the conventionally-treated group, only a 4-fold increase was seen as late as 7 days after achieving entry criteria. Sepsis was observed in 13% (2/15) of the rhG-CSF-treated neonates compared with an incidence of 54% (7/13) in the conventionally-treated neonates. Conclusions. rhG-CSF increases the ANC significantly (at 10 μg/kg/day × 3 days) and reduces the incidence of neonatal sepsis in critically ill ventilated neonates with prolonged preeclampsia-associated neutropenia when compared with conventional therapy. A future prospective, randomized, and blinded trial is needed to validate the beneficial effects of prophylactic rhG-CSF therapy in neonates with prolonged preeclampsia-associated neutropenia.
Journal of Pediatric infectious diseases, May 30, 2017
Objective We sought to determine whether recombinant human granulocyte colony stimulating factor ... more Objective We sought to determine whether recombinant human granulocyte colony stimulating factor (rhG-CSF) and intravenous immunoglobulin (IVIG) combination can increase white blood cell (WBC) count and improve the survival of extremely low-birth-weight (ELBW) neonates having necrotizing enterocolitis (NEC) with Bell stage II or above. Methods This retrospective chart review consisted of ELBW neonates with NEC provided with standard of care (standard group) or standard of care and a combination of rhG-CSF along with IVIG (treated group) at the discretion of the treating physician. Serial blood counts (days 0,1,2,3, and 7 to 10), survival, need for surgical intervention, time to reach full feeds, and time to discharge were compared between the two groups. Results The treated (27 neonates) and the standard (35 neonates) groups had birth weights of 857 ± 52 g and 1,009 ± 50 g; gestational ages of 26 ± 0.5 and 28 ± 0.5 weeks; WBC counts of 7,950 ± 6,452 and 14,105 ± 9,578/mm3; absolute neutrophil count (ANC) of 3,930 ± 5,152 and 7,117 ± 7,545/mm3, respectively (p < 0.05). During the study, WBC count and ANC increased in the treated group till days 7 to 10, but decreased till day 3 in the standard group (p < 0.05). ANC (11-fold) and monocytes (4-fold) increased in the treated patients with neutropenia by days 7 to 10 (p < 0.05). There was no change in the survival, need for surgery, time to reach full feed, or time to discharge between the two groups. Conclusion The combination of rhG-CSF and IVIG increased WBC, ANC, and monocytes in the treated group but did not affect the survival, need for surgery, time to reach full feed, or time to discharge.
Pediatrics
Background: The incidence of Neonatal abstinence syndrome (NAS) is increasing across the world. F... more Background: The incidence of Neonatal abstinence syndrome (NAS) is increasing across the world. Finnegan scoring system is the most popular scoring system used in the management of NAS. However Finnegan scoring is lengthy, time consuming, and complex, with many measures being subjective, and operator dependent, and with different weightages for different measures. Hence we proposed a new scoring system NASCORE with 3 central nervous system signs, 3 behavioral signs, …
Infectious Disease and Pharmacology
Abstract Neonatal abstinence syndrome (NAS) is a constellation of signs and symptoms and is a con... more Abstract Neonatal abstinence syndrome (NAS) is a constellation of signs and symptoms and is a consequence of the sudden discontinuation of fetal exposure to substances that were used or abused by the mother during pregnancy. The incidence of NAS is increasing; so are the length of stay and the need for pharmacologic therapy. Nonpharmacologic measures should be tried in all neonates before the initiation of pharmacologic therapy. Protocolized management is shown to decrease the length of stay and the length of treatment. Methadone and morphine are common medications used in the treatment of NAS. Either a weight-based or score-based approach to opioid dose can be used. Adjunct medications like phenobarbital and clonidine are helpful when monotherapy is not successful or when the maximum dose of opioid is reached. Breastfeeding decreases the need and the duration of pharmacotherapy. All NAS babies need to be followed up regularly. Further studies are needed to standardize the management of NAS.
American Journal of Perinatology, 2019
Objective This study aimed to evaluate the concordance of a new scoring system for neonatal absti... more Objective This study aimed to evaluate the concordance of a new scoring system for neonatal abstinence syndrome (NAS) and NAS scores to the traditional Modified Finnegan Neonatal Abstinence Scoring Tool (M-FNAST) score. The NAS score is based on the physiology of withdrawal, with equal emphasis on behavior, and neurological signs. Study Design The NAS scores for a control group of 202 healthy, term neonates were compared with those for 45 term neonates with NAS. The NAS and M-FNAST scores obtained simultaneously in 45 term neonates with NAS were compared using correlation, linear regression, and receiver operating characteristic curve analysis to determine the validity, reliability, and specificity of the NAS scores. Results The association between the NAS and M-FNAST scores was high (Spearman's correlation, 83%; linear regression, 83%), with an area under the curve of the NAS score of 1.00 (p < 0.01). A cut-off NAS score ≥4 identified NAS neonates with a sensitivity of 100% ...
Annals of Saudi Medicine, 1991
Journal of Pediatric Infectious Diseases, 2017
Background Elevated levels of cytokines like interleukin-6 (IL-6) and tumor necrosis factor-alpha... more Background Elevated levels of cytokines like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are common in critically ill neonates, and may contribute to organ-based injury during acute illness contributing to neurodevelopmental delay. In both animals and human adults, recombinant human granulocyte-colony stimulating factor (rhG-CSF) is associated with a reduction in TNF-α blood levels. Objective We aim to determine whether rhG-CSF treatment affects the blood levels of proinflammatory cytokines, TNF-α and IL-6 or the anti-inflammatory cytokine, IL-10 in extremely-low-gestational age neonates (ELGANs) compared with conventional medical management. Methods The study included three groups of ELGANs between 2 and 4 days of age as subjects. Control group (n = 5); treated, nonseptic group (n = 10); and treated, septic group (n = 5) neonates were treated with conventional measures. In addition, the test subjects were treated with 10 μg/kg/d of rhG-CSF intravenously for 3 conse...
Journal of Pediatric Infectious Diseases, 2017
Objective We sought to determine whether recombinant human granulocyte colony stimulating factor ... more Objective We sought to determine whether recombinant human granulocyte colony stimulating factor (rhG-CSF) and intravenous immunoglobulin (IVIG) combination can increase white blood cell (WBC) count and improve the survival of extremely low-birth-weight (ELBW) neonates having necrotizing enterocolitis (NEC) with Bell stage II or above. Methods This retrospective chart review consisted of ELBW neonates with NEC provided with standard of care (standard group) or standard of care and a combination of rhG-CSF along with IVIG (treated group) at the discretion of the treating physician. Serial blood counts (days 0,1,2,3, and 7 to 10), survival, need for surgical intervention, time to reach full feeds, and time to discharge were compared between the two groups. Results The treated (27 neonates) and the standard (35 neonates) groups had birth weights of 857 ± 52 g and 1,009 ± 50 g; gestational ages of 26 ± 0.5 and 28 ± 0.5 weeks; WBC counts of 7,950 ± 6,452 and 14,105 ± 9,578/mm3; absolute ...
Sestrinski glasnik/Nursing Journal, 2014
U Republici Hrvatskoj [RH] postoje institucionalni okviri za suzbijanje zlouporabe opojnih droga.... more U Republici Hrvatskoj [RH] postoje institucionalni okviri za suzbijanje zlouporabe opojnih droga. Nacionalna strategija suzbijanja zloporabe opojnih droga provodi se djelovanjem povjerenstava, ureda i ministarstava. Mjere i aktivnosti Nacionalne strategije i akcijskog plana jesu: Ad 1] prevencija i edukacija; Ad 2] liječenje, resocijalizacija i rehabilitacija;
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Papers by PRABHAKAR KOCHERLAKOTA