Bio

Bio


As a neonatal hospitalist, I attend high risk deliveries where neonatal resuscitation is potentially anticipated, and care for infants in the newborn (level I) and intermediate intensive care (level II) nurseries. I am interested in high value care for late preterm and term infants, including evaluation and management for infants at risk for early onset sepsis.

Academic Appointments


Honors & Awards


  • Jennifer Daru Memorial Award (Best Manuscript), Hospital Pediatrics (2019)
  • AAMC Medical Education Scholarship Research and Evaluation Award of Excellence, AAMC (2014)
  • Dean?s Prize for Research and Scholarship: Health Professions Education, UCSF (2014)
  • Advocacy Training Scholarship, American Academy of Pediatrics (2011)
  • Dean?s Research Fellowship, UCSF (2011)
  • Chancellor's Service Award, UCLA (2010)
  • College of Letters and Science Honors Program, UCLA (2010)
  • Distinguished Senior Award, UCLA (2010)
  • Phi Beta Kappa, Phi Beta Kappa Society (2010)
  • Mortar Board National Honor Society, Mortar Board (2009)
  • Rose Gilbert Honors Scholarship, UCLA (2009)
  • Dean's Honors List, UCLA (2006-2010)
  • Crown Award, Columbia Scholastic Press Association (2006)
  • Golden Pen Award, Monta Vista (2006)
  • Pacemaker Award, National Scholastic Press Association (2006)

Boards, Advisory Committees, Professional Organizations


  • Fellow, American Academy of Pediatrics (2017 - Present)
  • Diplomate, American Board of Pediatrics (2017 - Present)

Professional Education


  • Internship, Lucile Packard Children's Hospital Stanford (2015)
  • Diplomate, American Board of Pediatrics (2017)
  • Residency, Lucile Packard Children's Hospital Stanford (2017)
  • MD with Distinction, UCSF School of Medicine, Doctorate of Medicine (2014)
  • BS with Honors, University of California, Los Angeles, Physiological Science (2010)

Publications

All Publications


  • Management of Chorioamnionitis-Exposed Infants in the Newborn Nursery Using a Clinical Examination-Based Approach. Hospital pediatrics Joshi, N. S., Gupta, A., Allan, J. M., Cohen, R. S., Aby, J. L., Kim, J. L., Benitz, W. E., Frymoyer, A. 2019

    Abstract

    BACKGROUND: Antibiotic use in well-appearing late preterm and term chorioamnionitis-exposed (CE) infants was reduced by 88% after the adoption of a care approach that was focused on clinical monitoring in the intensive care nursery to determine the need for antibiotics. However, this approach continued to separate mothers and infants. We aimed to reduce maternal-infant separation while continuing to use a clinical examination-based approach to identify early-onset sepsis (EOS) in CE infants.METHODS: Within a quality improvement framework, well-appearing CE infants ?35 weeks' gestation were monitored clinically while in couplet care in the postpartum unit without laboratory testing or empirical antibiotics. Clinical monitoring included physician examination at birth and nurse examinations every 30 minutes for 2 hours and then every 4 hours until 24 hours of life. Infants who developed clinical signs of illness were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, and clinical outcomes were collected.RESULTS: Among 319 initially well-appearing CE infants, 15 (4.7%) received antibiotics, 23 (7.2%) underwent laboratory testing, and 295 (92.5%) remained with their mothers in couplet care throughout the birth hospitalization. One infant had group B Streptococcus EOS identified and treated at 24 hours of age based on new-onset tachypnea and had an uncomplicated course.CONCLUSIONS: Management of well-appearing CE infants by using a clinical examination-based approach during couplet care in the postpartum unit maintained low rates of laboratory testing and antibiotic use and markedly reduced mother-infant separation without adverse events. A framework for repeated clinical assessments is an essential component of identifying infants with EOS.

    View details for PubMedID 30833294

  • Clinical Monitoring of Well-Appearing Infants Born to Mothers With Chorioamnionitis. Pediatrics Joshi, N. S., Gupta, A., Allan, J. M., Cohen, R. S., Aby, J. L., Weldon, B., Kim, J. L., Benitz, W. E., Frymoyer, A. 2018; 141 (4)

    Abstract

    The risk of early-onset sepsis is low in well-appearing late-preterm and term infants even in the setting of chorioamnionitis. The empirical antibiotic strategies for chorioamnionitis-exposed infants that are recommended by national guidelines result in antibiotic exposure for numerous well-appearing, uninfected infants. We aimed to reduce unnecessary antibiotic use in chorioamnionitis-exposed infants through the implementation of a treatment approach that focused on clinical presentation to determine the need for antibiotics.Within a quality-improvement framework, a new treatment approach was implemented in March 2015. Well-appearing late-preterm and term infants who were exposed to chorioamnionitis were clinically monitored for at least 24 hours in a level II nursery; those who remained well appearing received no laboratory testing or antibiotics and were transferred to the level I nursery or discharged from the hospital. Newborns who became symptomatic were further evaluated and/or treated with antibiotics. Antibiotic use, laboratory testing, culture results, and clinical outcomes were collected.Among 277 well-appearing, chorioamnionitis-exposed infants, 32 (11.6%) received antibiotics during the first 15 months of the quality-improvement initiative. No cases of culture result-positive early-onset sepsis occurred. No infant required intubation or inotropic support. Only 48 of 277 (17%) patients had sepsis laboratory testing. The implementation of the new approach was associated with a 55% reduction (95% confidence interval 40%-65%) in antibiotic exposure across all infants ?34 weeks' gestation born at our hospital.A management approach using clinical presentation to determine the need for antibiotics in chorioamnionitis-exposed infants was successful in reducing antibiotic exposure and was not associated with any clinically relevant delays in care or adverse outcomes.

    View details for PubMedID 29599112

  • Physician Preferences Surrounding Urinary Tract Infection Management in Neonates. Hospital pediatrics Joshi, N. S., Lucas, B. P., Schroeder, A. R. 2017

    Abstract

    Variability exists in the treatment of neonates with urinary tract infection (UTI), potentially reflecting an overuse of resources. A cross-sectional vignette survey was designed to examine variability in physician preferences for intravenous (IV) antibiotic duration, genitourinary imaging, and prophylactic antibiotics and to evaluate drivers of resource use.The survey was administered to a random sample of pediatricians through the American Medical Association's Physician Masterfile. Respondents were provided with a case vignette of a 2-week-old neonate with a febrile UTI and asked to indicate preferences for IV antibiotic duration and rank drivers of this decision. Respondents were also asked whether they would obtain a voiding cystourethrogram (VCUG) and, regardless of preference, randomly presented with a normal result or bilateral grade II vesicoureteral reflux. The survey was delivered electronically to facilitate skip logic and randomization.A total of 279 surveys were completed. Preference for total IV antibiotic duration differed significantly (P < .001) across specialty, with a median duration of 2 days for general pediatricians/hospitalists, 7 days for neonatologists, and 5 days for infectious disease pediatricians. For the 47% (n = 131) who did not want a VCUG, 24/61 (39%) wanted prophylactic antibiotics when presented with grade II vesicoureteral reflux (P < .001).Subspecialty status appeared to be the most influential driver of IV antibiotic duration in the treatment of UTI. A substantial proportion of pediatricians who initially expressed a preference against ordering a VCUG wished to prescribe prophylactic antibiotics when results were abnormal, which suggests that even unwanted diagnostic test results drive treatment decisions.

    View details for PubMedID 29196453

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