There is controversy on the most advantageous management for infants with patent ductus arteriosus (PDA) and whether to favor actively closing the PDA or to conservatively observe. We aimed to describe the outcome of infants with PDA... more
There is controversy on the most advantageous management for infants with patent ductus arteriosus (PDA) and whether to favor actively closing the PDA or to conservatively observe. We aimed to describe the outcome of infants with PDA based on three management strategies used for its closure (conservative, indomethacin, ligation). Methods: Retrospective medical record review of data from LBW infants (< 2000 with PDA admitted to NICU-SJCH. Results: The prevalence of PDA was 16%. Based on management strategies: 31% did not require treatment. 19% resolved with conservative measures, 38% resolved with omethacin treatment, and 12% required ligation. There was no difference in birth weight, gestational, clinical criteria, morbidities and mortality in patients managed with the strategies evaluated. Conclusion: Results are consistent with previous reports. Development of PDA management guidelines will help standardize the definition of PDA and management criteria instead of treating on a case-by-case basis.
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Healthcare associated influenza is a serious public health problem that contributes to patient morbidity and mortality. Objective: To determine the seasonal influenza vaccination rate and reasons for its acceptance among healthcare... more
Healthcare associated influenza is a serious public health problem that contributes to patient morbidity and mortality. Objective: To determine the seasonal influenza vaccination rate and reasons for its acceptance among healthcare workers in a hospital located at the metropolitan area of Puerto Rico. Methods: Self-administered, anonymous questionnaires were distributed to 120 volunteer healthcare workers and ancillary staff. Results: Immunization rates for the 2009 Influenza A (H1N1), seasonal vaccines 2009 and 2010 seasonal influenza vaccine were 50%, 53% and 65%, respectively. Determinant factors for acceptance of vaccination in 2010 included obtaining the 2009 vaccines, not knowing someone with adverse effect to the vaccine, and believing the vaccine should be mandatory for all healthcare workers. Conclusion: Influenza immunization rate is below the recommended rate to decrease healthcare associated influenza infection. Our results serve to confirm that education is needed to improve immunization rates among these healthcare workers and eliminate misconceptions about the vaccine.
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Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications Objective: To determine fac tors associated to parents willingness to accept the influenza vaccine for their... more
Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications Objective: To determine fac tors associated to parents willingness to accept the influenza vaccine for their children. Methods: An anonymous questionnaire was administered to 297 volunteer parents/caregivers during 2011. Results: Only 40% of the parents planne to have their children vaccinated agains influenza. Most subjects had medical insurance (52% government, 44% private, 4% no insurance). Factors associated to parents willingness to accept the vac cine were having the vaccine previously. thinking that the vaccine was safer this year. not knowing someone who had an influenza vaccine side effect and having a family member who had influenza. Conclusion: The 40% planned vaccinatio rate lies below the 80% Healthy Peopl 2020 goal and seems to be unassociated to access to healthcare services. Establishing campaigns that reassure parents of vaccine safety could attain a higher vaccination rate.
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In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and... more
In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and knowledge needed to become a member of the neonatal team. It establishes as main parameters the evaluation and intervention in communication, feeding and swallowing: parents and caregivers counseling and education: as well as the collaboration and education of the neonatal team. In the NICU, the SLP works in the preparation to initiate the nutritive sucking process and describes maturation levels for nutritive sucking with bottle and breastfeeding The SLP establishes an intervention plan for the development of safe feeding and swallowing skills as well as for the training of parents and caregivers during the process. Research should be promoted to support these interventions and establish the standards for the field.
Research Interests:
Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus vaccine administration to infants was incorporated in 2007. The objective of this study is to determine the frequency of acute rotavirus... more
Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus vaccine administration to infants was incorporated in 2007. The objective of this study is to determine the frequency of acute rotavirus gastroenteritis (ARGE) after the initiation of the rotavirus immunization schedule. Methodology: The study included children younger than 5 years of age admitted to San Jorge Children's Hospital from 2005-2008 with ARGE. Results: There were 7,686 cases of acute gastroenteritis during the study period with 15% caused by Rotavirus. The peak season occurred from January through June. Rotavirus accounted for 22% of the acute gastroenteritis cases in the years pre-vaccination (2005-2006) and only 8.5 % in the post-vaccination years (2007-2008) (p < 0.01) with a 68% reduction in ARGE hospitalizations after vaccination. Conclusions: Our study supports the significant decline in ARGE after routine administration rotavirus vaccine in Puerto Rico.
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Studies have identified fathers' attitude as the strongest indicator of whether her partner will breastfeed. Objective: To determine the attitudes and knowledge of fathers toward breastfeeding. Methods: The study included 84 volunteer... more
Studies have identified fathers' attitude as the strongest indicator of whether her partner will breastfeed. Objective: To determine the attitudes and knowledge of fathers toward breastfeeding. Methods: The study included 84 volunteer fathers who answered a survey. Results: Mean age of participants was 27 years. Most fathers (88%) would like their partners to breastfeed. Most men (56%) reported that it is acceptable for a woman to breastfeed in public. Negative attitudes included feeling jealous about breastfeeding (10%), thinking that breastfeeding is bad for breasts (17%), breastfeeding makes breasts look ugly (26%), and breastfeeding separates the baby from the father (7%). A few misconceptions about breastfeeding were identified. Conclusions: Most fathers have positive attitudes towards breastfeeding. We should emphasize the importance of exclusive breastfeeding and clarify misconceptions that may cause early discontinuation of breastfeeding. Programs directed toward educating fathers will help them serve as sources of support for their partners.
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Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. Methods: Retrospective... more
Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. Methods: Retrospective medical record review of infants born to mothers with confirmed ZIKV infection during pregnancy was performed from January 2016-June 2017. We included patients admitted to UPH Neonatal Intensive Care Unit or referred for follow-up at UPH High Risk Clinics. The database was approved by the University of Puerto Rico, Medical Sciences Campus, IRB. Results: 191 infants born to ZIKV positive mothers during pregnancy were identified. Normal head sonogram was found in 93% of the normo cephalic infants. Ocular findings were reported in 50% of the patients with microcephaly and 31% of the normo-cephalics. Fifteen newborns (7.8%) presented with microcephaly, of which 73% showed calcifications in head sonogram, and had severe anomalies on brain MRI. Auditory brainstem response test was performed on all newborns, 80% were within normal limits. Conclusion: Among the group of infants born to mothers with Zika positive test 4% had microcephaly. Of concern to us is the fact that 31% of normo cephalic infants had ocular manifestations and 7% of them had findings on head sonogram. While microcephaly is the severest form of Congenital Zika Syndrome, ocular manifestations might characterize the spectrum of disease. These findings reiterate the importance of detailed neonatal evaluations of exposed infants.
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Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. Objective: To determine factors associated to breastfeeding after returning to... more
Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. Objective: To determine factors associated to breastfeeding after returning to work. Methods: Anonymous questionnaires distributed among breastfeeding working mothers. Results: The study subjects were 100 mothers. Most of them (77%) worked for the government. Fifty-six percent continued breastfeeding after returning to work. In 33% of the workplaces there was an area designated for milk extraction.Thirty-six percent of employers allowed the 30 minute periods mandated by law for extraction. Factors associated to continuing breastfeeding were: working in the private setting, having a place designated for extraction, knowing that employers were mandated to have such a place, being allowed time for extraction, and knowing the laws protecting breastfeeding. Conclusions: There is need for more education to working mothers about their rights to continue breastfeeding after returning to work.
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Research Interests:
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the... more
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the development of structural congenital heart malformations. The objective of this study was to identify common polymorphisms in the MTHFR gene in children with isolated CHD and their mothers. The DNA analysis for the C677T and A1298C mutations was performed. The study group included 27 mothers, 27 children with CHD, and 220 controls. The prevalence of the TT polymorphism was higher in mothers (22%) than in controls (10%). Compound heterozygosity for both polymorphisms was 3.7 times more common in children with CHD than in the newborn controls. Mothers of children with CHD were more likely to be compound heterozygotes. The higher prevalence of C677T polymorphisms in mothers of children with CHD and of compound heterozygosity for both polymorphisms suggests the possible role of folic acid in the prevention of CHD. Due to the relation of this enzyme to folate metabolism, current folate recommendations for women in childbearing age in Puerto Rico to reduce neural tube defects may need to be extended to the prevention of CHD.
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Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in... more
Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV. Methods: A retrospective review of the medical records of infants born to mothers found to be ZIKV-positive during their pregnancies (January 2016-July 2017) was performed. We included all newborns and infants admitted to the NICU and/or receiving ambulatory care at the high-risk clinics at the University Pediatric Hospital, San Juan, Puerto Rico. The creation of this database was approved by the IRB of the University of Puerto Rico, Medical Sciences Campus. Results: Records from 234 newborns born to Zika-positive mothers were identified. The ophthalmic evaluations of 95 patients were available. Sixty-three of them had normal findings (66%). Twelve of the 95 patients had microcephaly (12.6% of the cohort). Of the microcephalic group, half had normal ophthalmological findings. Of the normocephalic group (83/95), almost 31% had ocular findings: a small optic nerve in 3%, a double-ring sign in 10%, macular stippling in 8%, mottling in 4%, an oval optic nerve in 2%, a tilted nerve in 1%, and blunted foveal reflex in 1%. Conclusion: We report herein ZIKV associated ophthalmologic findings, similar to those published, in 34% of the infants with suspected/confirmed ZIKV fetal exposure. These data underline the importance of ocular examination in patients with suspected congenital Zika but without other findings on physical exam.
Research Interests:
Research Interests:
Cleft Lip and Palate, Medicine, Anatomy, Congenital Heart Defects, Case Report, and 15 moreHumans, Female, Pediatric, Newborn Infant, Autopsy, Cleft Lip, Congenital malformation, Abdominal Wall Hernias, Ductus Arteriosus, Atrial Septal Defect, Patent Ductus Arteriosus, Hypoplasia, Paediatrics and reproductive medicine, diaphragm, and Abdominal wall
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Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone exposure. Although is reported to present in the first two weeks, few studies address its duration and timing of resolution. This study evaluated... more
Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone exposure. Although is reported to present in the first two weeks, few studies address its duration and timing of resolution. This study evaluated the presence, duration, and complications of thrombocytosis in newborns exposed to illicit drugs. A retrospective review of medical records of newborns with intrauterine drug exposure admitted to the San Juan City Hospital from 1999 to 2001 was performed. Thirty-one newborns were included. Eighty-seven percent (87%) presented abstinence syndrome. Of these, 96% presented thrombocytosis. All infants exposed to methadone presented thrombocytosis and 75% of those exposed to heroin and cocaine. Thrombocytosis presented at ten days of life with a median resolution at 26 days. In this group of newborns, thrombocytosis was associated to intrauterine exposure to methadone, heroin, and cocaine. Thrombocytosis presented at ten days of life and resolution was ...
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Research Interests:
Cytomegalovirus is a common cause of congenital infection in developed countries, affecting approximately 1% of live births. We report the case of a baby boy born with Cytomegalovirus pneumonitis dying from complications of persistent... more
Cytomegalovirus is a common cause of congenital infection in developed countries, affecting approximately 1% of live births. We report the case of a baby boy born with Cytomegalovirus pneumonitis dying from complications of persistent pulmonary hypertension of the newborn.
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The paper investigates the effects of temporary consumption tax cuts for selected durables in Turkey in 2009 using firm-level data. Our empirical strategy exploits variation in firm exposure to the tax cuts and at the same time controls... more
The paper investigates the effects of temporary consumption tax cuts for selected durables in Turkey in 2009 using firm-level data. Our empirical strategy exploits variation in firm exposure to the tax cuts and at the same time controls for unobserved industry- and region-specific shocks to address potential endogeneity. Using data on the change of sales of firms that benefited from this measure and of those that did not over different periods, we find positive and robust effects of consumption tax cuts on the change of firm sales. In line with theoretical predictions, we also find a reversal of these effects following the expiration of the tax cuts.
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Research Interests:
Background: Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight / obesity in a group of... more
Background: Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight / obesity in a group of children in Puerto Rico. Methods: Participants included 158 children receiving pediatric care at the San Juan City Hospital and a primary care clinic. Body mass index (BMI) was calculated in children and parents. Results: Fifty-six percent of children were overweight / obese as well as 61% of mothers and 75% of fathers.
Neonatal hyperglycemia is a metabolic disorder found in the neonatal intensive care units. Neonatal diabetes mellitus (NDM) is a very uncommon cause of hyperglycemia in the newborn, occurring in 1 in every 400,000 births. There are two... more
Neonatal hyperglycemia is a metabolic disorder found in the neonatal intensive care units. Neonatal diabetes mellitus (NDM) is a very uncommon cause of hyperglycemia in the newborn, occurring in 1 in every 400,000 births. There are two subtypes of neonatal diabetes mellitus: permanent neonatal diabetes mellitus (PNDM) and transient neonatal diabetes mellitus (TNDM). We describe a term, small for gestational age, female neonate with transient neonatal diabetes mellitus who presented with poor feeding tolerance and vomiting associated with hyperglycemia (385 mg/dL), glycosuria, and metabolic acidosis within the first 12 hours of life. The neonate was treated with intravenous insulin, obtaining a slight control of hyperglycemia. An adequate glycemia was achieved at 5 weeks of life. The molecular studies showed complete loss of maternal methylation at the TND differentially methylated region on chromosome 6q24. The etiology of this neonate’s hyperglycemia was a hypomethylation of the ma...
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Some small for gestational age (SGA) neonates have a higher weight gain rate than adequate for gestational age (AGA) neonates. The objectives of this study were to evaluate the postdischarge growth of a cohort of very low birthweight... more
Some small for gestational age (SGA) neonates have a higher weight gain rate than adequate for gestational age (AGA) neonates. The objectives of this study were to evaluate the postdischarge growth of a cohort of very low birthweight infants to determine the percentage of those born SGA that achieve catch-up growth and whether AGA infants maintain adequate growth. We performed a record review at the high-risk follow-up clinics of a previously paired group of infants. The infant's weight, height, and head circumference percentile at their last clinic visit were determined by using sex-adjusted curves. We also documented if the patient had presented any type of delay. Of 216 infants that were included in the original cohort, only 116 had evidence of enrollment in the clinic. The percentage of SGA that achieved catch-up growth was 18.6% (n = 59). The percentage of adequate for gestational age that maintained adequate growth was 42.1% (n = 57). The rate of developmental delay was no...
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Medicine, Birth Weight, Humans, Female, Male, and 15 moreKey words, Infant, Small for Gestational Age, Risk factors, Newborn Infant, Public health systems and services research, Retrospective Studies, Prognosis, Chi Square Distribution, Risk Factors, Gestational Age, Developmental delay, Weight Gain, Catching up, and High risk
Having a baby in the Neonatal Intensive Care Unit (NICU) is a major source of stress for parents. The barriers to parenting and reactions to the environment may negatively influence the parent-infant relationship. To identify NICU-related... more
Having a baby in the Neonatal Intensive Care Unit (NICU) is a major source of stress for parents. The barriers to parenting and reactions to the environment may negatively influence the parent-infant relationship. To identify NICU-related parental stress and associated factors. Parents (N = 156) of newborns admitted to NICU completed the Parental Stressor Scale. Most of the parents (46%) rated the experience to be extremely stressful. The principal cause of stress was the alteration in parental role and being separated from their baby. Stress was not associated to education, marital status, infants' birth weight, gestational age, congenital anomalies or if the parents expected the baby to be in the NICU. Identification of areas associated to higher levels of stress in parents may help the NICU staff to establish strategies to help parents cope with the stress caused by being unable to start their parenting role immediately after their babies' birth.
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Hemangiolymphangioma is a mixed vascular malformation that is detected in the prenatal period by sonography. Five cases of prenatal diagnosis have been reported that have resulted in termination of pregnancy (two) or aggressive versus... more
Hemangiolymphangioma is a mixed vascular malformation that is detected in the prenatal period by sonography. Five cases of prenatal diagnosis have been reported that have resulted in termination of pregnancy (two) or aggressive versus purely surgical post-natal management. We present the case of an infant with pre-natal diagnosis of a multicystic intra-abdominal mass that received surgical management followed by conservative treatment.
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Small for gestational age neonates have a higher risk of growth delay. The purpose of the study is to determine if there are differences in their early weight gain patterns that persist after adjusting for confounding variables.... more
Small for gestational age neonates have a higher risk of growth delay. The purpose of the study is to determine if there are differences in their early weight gain patterns that persist after adjusting for confounding variables. Two-hundred sixteen neonates born between 1999 and 2003 were included. The group for analysis was derived by matching all the SGA infants with AGA infants by sex, year of birth, and birth weight. The period of observation was from birth to date of discharge. Weight gain rate was defined as grams gained per kilogram of birth weight per day. Two sample T-test was used to determine the difference in growth rate between the groups. Simple regression was used to establish the effect of morbidities on weight gain rate. The total mean birth weight was 1105 g (+/- 223 g), the mean gestational age was 30 weeks (+/- 2.7 weeks), and the mean weight gain rate was 13.4 g/kg/d (+/- 6.8 g/kg/d). The mean weight gain rate for the adequate for gestational age group was lower...
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After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all... more
After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV.
Research Interests:
Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants.
In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and... more
In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and knowledge needed to become a member of the neonatal team. It establishes as main parameters the evaluation and intervention in communication, feeding and swallowing: parents and caregivers counseling and education: as well as the collaboration and education of the neonatal team. In the NICU, the SLP works in the preparation to initiate the nutritive sucking process and describes maturation levels for nutritive sucking with bottle and breastfeeding The SLP establishes an intervention plan for the development of safe feeding and swallowing skills as well as for the training of parents and caregivers during the process. Research should be promoted to support these interventions and establish the standards for the field.
Research Interests:
Fungal infections are a common cause of late-onset sepsis in very low birth weight infants and can impact mortality and morbidity. The purpose of this study is to determine the impact of systemic fluconazole prophylaxis in the prevalence... more
Fungal infections are a common cause of late-onset sepsis in very low birth weight infants and can impact mortality and morbidity. The purpose of this study is to determine the impact of systemic fluconazole prophylaxis in the prevalence of fungemia.
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In children less than two years old, minor head trauma can result in intracranial injury. No known studies exist that determine the number of children younger than two years old who visit the emergency room (ER) due to minor head injury... more
In children less than two years old, minor head trauma can result in intracranial injury. No known studies exist that determine the number of children younger than two years old who visit the emergency room (ER) due to minor head injury in Puerto Rico. To determine the prevalence of children with minor head trauma and describe related issues. Information was gathered from the medical records of children 0 to 2 years old who visited the University Pediatric Hospital ER from 2004-2006. Several factors were analyzed. From our 136 subjects, there was a male prevalence of 59%. The predominant reason for head injury was a fall (86%). There was abuse in 7% of the subjects. Eighty-five percent (85%) of injuries occurred at home. The most common etiology of head trauma was a fall at home. The prevalence of abuse in 7% of these children should alert physicians.
Research Interests:
Medicine, Humans, Female, Male, Infant, and 3 morePrevalence, University Hospitals, and Injury Severity Score
Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places.
Research Interests:
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the... more
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the development of structural congenital heart malformations. The objective of this study was to identify common polymorphisms in the MTHFR gene in children with isolated CHD and their mothers. The DNA analysis for the C677T and A1298C mutations was performed. The study group included 27 mothers, 27 children with CHD, and 220 controls. The prevalence of the TT polymorphism was higher in mothers (22%) than in controls (10%). Compound heterozygosity for both polymorphisms was 3.7 times more common in children with CHD than in the newborn controls. Mothers of children with CHD were more likely to be compound heterozygotes. The higher prevalence of C677T polymorphisms in mothers of children with CHD and of compound heterozygosity for both polymorphisms suggests the...
Research Interests:
The occurrence of neural tube defects (NTDs) varies by race/ethnicity, and the highest rates are among women of Hispanic ethnicity. Women of reproductive age are advised to use folic acid to prevent NTDs and other birth defects. Since... more
The occurrence of neural tube defects (NTDs) varies by race/ethnicity, and the highest rates are among women of Hispanic ethnicity. Women of reproductive age are advised to use folic acid to prevent NTDs and other birth defects. Since 1994, Puerto Rico has had a campaign to promote the use of folic acid, and since 1998, enriched grain products have been fortified with folic acid. After fortification, the incidence of NTDs in the island decreased. The objective of this study was to assess the use of folic acid by women of reproductive age in Puerto Rico and determine factors associated with its use. A self-administered questionnaire was answered by 964 women around the island. Folic acid consumption was reported by 30% of the participants, 21% reported consuming it at least 4 times per week, and only 14% consumed it the day before the survey. Knowledge about the recommendation for women to consume folic acid was reported by 97% of the participants. The use of folic acid was lower amo...
Research Interests:
Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight /obesity in a group of children in... more
Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight /obesity in a group of children in Puerto Rico. Participants included 158 children receiving pediatric care at the San Juan City Hospital and a primary care clinic. Body mass index (BMI) was calculated in children and parents. Fifty-six percent of children were overweight/obese as well as 61% of mothers and 75% of fathers. Using weight-height percentiles graphs, 49% of children were overweight. This study shows the high prevalence of overweight and obesity in children and their parents. Using the BMI for evaluating weight identified more children at risk than the traditionally used graphs. Identifying risk factors will help health care professionals and parents intervene to improve the health of these families.
Research Interests:
Obesity, Puerto Rico, Medicine, Overweight, Humans, and 5 moreChild, Female, Male, Prevalence, and Child preschool
Background Over three thousand children in Puerto Rico were potentially exposed to Zika virus infection during pregnancy during the 2016 Zika virus epidemic. This congenital exposure is an established risk factor for birth defects and... more
Background Over three thousand children in Puerto Rico were potentially exposed to Zika virus infection during pregnancy during the 2016 Zika virus epidemic. This congenital exposure is an established risk factor for birth defects and neurodevelopmental abnormalities, which may appear after birth. Puerto Rico guidelines require consistent pediatric monitoring for early identification and intervention of children up to age five. Methods Our objective was to assess factors that influence caregiver adherence to Zika-related follow-up pediatric services in Puerto Rico. We conducted qualitative semi-structured focus groups and individual interviews with 57 individuals, including 35 caregivers (aged ≥18 years and a primary caregiver for a child with laboratory evidence of confirmed or possible Zika virus infection during pregnancy) and 22 healthcare providers or service coordinators. We explored participants’ views on barriers to Zika-related pediatric services and suggestions for improvi...
Research Interests:
Hyperekplexia or Stiff Baby Syndrome is an uncommon disorder of non-epileptic movements with an autosomal dominant inheritance pattern. Neonates present exaggerated startle response to sensory stimuli and temporary muscular rigidity. We... more
Hyperekplexia or Stiff Baby Syndrome is an uncommon disorder of non-epileptic movements with an autosomal dominant inheritance pattern. Neonates present exaggerated startle response to sensory stimuli and temporary muscular rigidity. We report two neonates from the northern center of Puerto Rico who presented involuntary movements, hypertonia and apnea during first days of life, being treated with anticonvulsants without improvement. Both were diagnosed with hyperekplexia due to the clinical evolution associated to normal EEG and head radiologic studies. Electromyography showed persistent muscular activity with periods of rest. Both were managed with clonazepam satisfactorily. We emphasized prompt recognition to prevent seizures misdiagnosis and administering appropriate treatment due to complications of sudden death secondary to stiffness and apnea.
Research Interests:
Background: Tobacco, alcohol and/or illicit drug use during pregnancy are risk factors for neonatal complications. In Puerto Rico, the Department of Health reports that 32% of pregnant women use alcohol and 3% use illicit drugs. Nineteen... more
Background: Tobacco, alcohol and/or illicit drug use during pregnancy are risk factors for neonatal complications. In Puerto Rico, the Department of Health reports that 32% of pregnant women use alcohol and 3% use illicit drugs. Nineteen percent (19.1%) of ...
Research Interests:
Medicine and Drug abuse
Determine the incidence of neutropenia and thrombocytopenia during the first week of life in very low birth weight (VLBW) infants born to mothers with preeclampsia. Medical records of infants born to mothers with preeclampsia admitted to... more
Determine the incidence of neutropenia and thrombocytopenia during the first week of life in very low birth weight (VLBW) infants born to mothers with preeclampsia. Medical records of infants born to mothers with preeclampsia admitted to NICU from 2005-2007 were reviewed. A total of 93 infants were included with a mean birth weight of 988 g and gestational age of 29 weeks. Neutropenia was present in 49% of the infants and thrombocytopenia in 56%. Infants with neutropenia had lower birth weights (p<0.01) and were born at lower gestational ages (p<0.01). Neutropenia was associated to a higher prevalence of positive blood cultures during the first week of life especially coagulase negative organisms. In this group of VLBW infants born to mothers with preeclampsia, neutropenia was common and it was associated to increase risk of bacterial infections during the first week of life.
Research Interests:
OBJECTIVE After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in... more
OBJECTIVE After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV. METHODS A retrospective review of the medical records of infants born to mothers found to be ZIKV-positive during their pregnancies (January 2016-July 2017) was performed. We included all newborns and infants admitted to the NICU and/or receiving ambulatory care at the high-risk clinics at the University Pediatric Hospital, San Juan, Puerto Rico. The creation of this database was approved by the IRB of the University of Puerto Rico, Medical Sciences Campus. RESULTS Records from 234 newborns born to Zika-positive mothers were identified. The ophthalmic evaluations of 95 patients were available. Si...
Research Interests:
BACKGROUND Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight /obesity in a group of... more
BACKGROUND Obesity in children has been related with co-morbid conditions being an important risk factor in adult morbidity and mortality. The objective of this study was to identify the prevalence of overweight /obesity in a group of children in Puerto Rico. METHODS Participants included 158 children receiving pediatric care at the San Juan City Hospital and a primary care clinic. Body mass index (BMI) was calculated in children and parents. RESULTS Fifty-six percent of children were overweight/obese as well as 61% of mothers and 75% of fathers. Using weight-height percentiles graphs, 49% of children were overweight. CONCLUSIONS This study shows the high prevalence of overweight and obesity in children and their parents. Using the BMI for evaluating weight identified more children at risk than the traditionally used graphs. Identifying risk factors will help health care professionals and parents intervene to improve the health of these families.
Research Interests:
Obesity, Puerto Rico, Medicine, Overweight, Humans, and 5 moreChild, Female, Male, Prevalence, and Child preschool
INTRODUCTION The occurrence of neural tube defects (NTDs) varies by race/ethnicity, and the highest rates are among women of Hispanic ethnicity. Women of reproductive age are advised to use folic acid to prevent NTDs and other birth... more
INTRODUCTION The occurrence of neural tube defects (NTDs) varies by race/ethnicity, and the highest rates are among women of Hispanic ethnicity. Women of reproductive age are advised to use folic acid to prevent NTDs and other birth defects. Since 1994, Puerto Rico has had a campaign to promote the use of folic acid, and since 1998, enriched grain products have been fortified with folic acid. After fortification, the incidence of NTDs in the island decreased. The objective of this study was to assess the use of folic acid by women of reproductive age in Puerto Rico and determine factors associated with its use. METHODS A self-administered questionnaire was answered by 964 women around the island. RESULTS Folic acid consumption was reported by 30% of the participants, 21% reported consuming it at least 4 times per week, and only 14% consumed it the day before the survey. Knowledge about the recommendation for women to consume folic acid was reported by 97% of the participants. The us...
Research Interests:
BACKGROUND In children less than two years old, minor head trauma can result in intracranial injury. No known studies exist that determine the number of children younger than two years old who visit the emergency room (ER) due to minor... more
BACKGROUND In children less than two years old, minor head trauma can result in intracranial injury. No known studies exist that determine the number of children younger than two years old who visit the emergency room (ER) due to minor head injury in Puerto Rico. OBJECTIVE To determine the prevalence of children with minor head trauma and describe related issues. METHODS Information was gathered from the medical records of children 0 to 2 years old who visited the University Pediatric Hospital ER from 2004-2006. Several factors were analyzed. RESULTS From our 136 subjects, there was a male prevalence of 59%. The predominant reason for head injury was a fall (86%). There was abuse in 7% of the subjects. Eighty-five percent (85%) of injuries occurred at home. CONCLUSIONS The most common etiology of head trauma was a fall at home. The prevalence of abuse in 7% of these children should alert physicians.
Research Interests:
Medicine, Humans, Female, Male, Infant, and 3 morePrevalence, University Hospitals, and Injury Severity Score
OBJECTIVE Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. METHODS Retrospective... more
OBJECTIVE Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. METHODS Retrospective medical record review of infants born to mothers with confirmed ZIKV infection during pregnancy was performed from January 2016-June 2017. We included patients admitted to UPH Neonatal Intensive Care Unit or referred for follow-up at UPH High Risk Clinics. The database was approved by the University of Puerto Rico, Medical Sciences Campus, IRB. RESULTS 191 infants born to ZIKV positive mothers during pregnancy were identified. Normal head sonogram was found in 93% of the normo cephalic infants. Ocular findings were reported in 50% of the patients with microcephaly and 31% of the normo-cephalics. Fifteen newborns (7.8%) presented with microcephaly, of which 73% showed calcifications in head sonogram, and had severe anomalies on brain MRI. Auditory brai...
In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and... more
In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and knowledge needed to become a member of the neonatal team. It establishes as main parameters the evaluation and intervention in communication, feeding and swallowing: parents and caregivers counseling and education: as well as the collaboration and education of the neonatal team. In the NICU, the SLP works in the preparation to initiate the nutritive sucking process and describes maturation levels for nutritive sucking with bottle and breastfeeding The SLP establishes an intervention plan for the development of safe feeding and swallowing skills as well as for the training of parents and caregivers during the process. Research should be promoted to support these interventions and establish the standards for the field.
Research Interests:
UNLABELLED Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications OBJECTIVE To determine fac tors associated to parents willingness to accept the influenza vaccine... more
UNLABELLED Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications OBJECTIVE To determine fac tors associated to parents willingness to accept the influenza vaccine for their children. METHODS An anonymous questionnaire was administered to 297 volunteer parents/caregivers during 2011. RESULTS Only 40% of the parents planne to have their children vaccinated agains influenza. Most subjects had medical insurance (52% government, 44% private, 4% no insurance). Factors associated to parents willingness to accept the vac cine were having the vaccine previously. thinking that the vaccine was safer this year. not knowing someone who had an influenza vaccine side effect and having a family member who had influenza. CONCLUSION The 40% planned vaccinatio rate lies below the 80% Healthy Peopl 2020 goal and seems to be unassociated to access to healthcare services. Establishing campaigns that reassure parents of vaccine sa...
Research Interests:
Adolescent, Humans, Child, Female, Male, and 8 moreYoung Adult, Vaccination, Aged, Middle Aged, Parents, Questionnaires, Adult, and Influenza vaccines
UNLABELLED Fungal infections are a common cause of late-onset sepsis in very low birth weight infants and can impact mortality and morbidity. The purpose of this study is to determine the impact of systemic fluconazole prophylaxis in the... more
UNLABELLED Fungal infections are a common cause of late-onset sepsis in very low birth weight infants and can impact mortality and morbidity. The purpose of this study is to determine the impact of systemic fluconazole prophylaxis in the prevalence of fungemia. METHODS Subjects included 402 very low birth weight premature infants with birth weights between 500 and 1,250 grams admitted to the University Pediatric Hospital NICU over a six year period. The period before and after prophylaxis was retrospectively compared RESULTS There was a marginal decrease in fungemia in the prophylaxis group (2.6% vs. 6.7%, p = 0.0525). Factors associated to fungemia were chorioamnionitis (p = 0.0240), H2-receptor inhibitors use (p = 0.0109), mechanical ventilati (p = 0.0049), prolonged antibiotic t py (p = 0.0015), and parenteral nutriti (p = 0.0048). Infants with fungemia had longer lengths of stay (p = 0.0143) and lower survival (p = 0.002). CONCLUSION Prophylaxis with fluconazole decreases mortal...