Current Research and Scholarly Interests
My recent clinical research project involved being a recipient of UCSF sub-award grant for a Multicenter clinical research study-PDA Tolerate Trial- ( PDA: TO LEave it alone or Respond And Treat Early - Trial)Trial of Early Treatment of the patent ductus arteriosus versus Conservative Treatment.
I have been interested in clinical research on studying factors determining patent ductus arteriosus closure in preterm infants. Despite a large body of basic science and clinical research and clinical experience with thousands of infants over nearly 6 decades, there is still uncertainty and controversy about the significance, evaluation, and management of patent ductus arteriosus in preterm infants, resulting in substantial heterogeneity in clinical practice. My initial research project looked at the factors determining closure of a PDA in preterm infants and examined the role of prophylactic indomethacin treatment in achieving ductal closure. The study found that prophylactic indomethacin improved the rate of permanent ductus closure by increasing the degree of initial constriction. Prophylactic indomethacin did not affect the remodeling process, nor did it alter the inverse relationship between infant maturity and subsequent reopening. Even when managed with prophylactic indomethacin, the rate of ductus reopening remained unacceptably high in the most immature infants. By providing evidence and clinical solutions, this body of work has been widely cited and informed practical applications for clinicians who care for preterm infants.
My interest in PDA in preterm infants extended to research in assessing the safety and efficacy of medications used in the management of PDA. We looked at Mednax National group’s extensive database and identified infants <28weeks gestational age discharged from neonatal intensive care units who were treated with indomethacin or ibuprofen between postnatal days 2 and 14. We used multivariable logistic regression to determine the association of indomethacin versus ibuprofen on clinical outcomes. We observed similar effectiveness and safety profiles for indomethacin and ibuprofen in the medical management of PDA in premature infants.
In an effort to study parental knowledge and education in caring for very low birth weight infants, we collaborated with investigators at Center for Policy, Outcomes and Prevention research. We specifically focused on Retinopathy of prematurity (ROP) which is a disorder of the developing retina that occurs in two-thirds of infants born preterm or very low birth weight (VLBW). Given rapid progression of this condition, timely screening exams and treatment by skilled ophthalmologists are necessary to reduce risks of visual impairment and blindness. Parents are also essential partners for ensuring timely ROP care in preterm/VLBW infants. Gaps in parents’ understanding of ROP—particularly the importance of and time-sensitivity of ROP exams may compromise timely follow-up and attendance of outpatient ophthalmologic appointments. However, no prior studies have explored parents’ knowledge of ROP and parents’ experiences obtaining outpatient ROP care for their infants. We found that parents of VLBW infants, particularly those with LEP and/or low health literacy, lack knowledge about ROP. Use of visual modalities, rather than standard verbal or written instructions, may improve parents’ understanding and adherence with recommended outpatient ROP care.