Publications

Scholarly Journals--Published

  • Chetan C, Suryawanshi P, Patnaik S, Soni NB, Rath C, Pareek P, Gupta B, Garegrat R, Verma A, Singh Y. Oral versus intravenous sildenafil for pulmonary hypertension in neonates: a randomized trial. BMC Pediatr. 2022 May 27;22(1):311. doi: 10.1186/s12887-022-03366-3. PMID: 35624452; PMCID: PMC9137149. (05/2022) (link)
  • Verma A, Suryawanshi P, Chetan C, Oka G, Singh Y, Kallimath A, Singh P, Garegrat R. A detailed echocardiographic evaluation of ventricular functions in stable full term small for gestational age babies. J Ultrasound. 2022 May 26. doi: 10.1007/s40477-022-00691-2. Epub ahead of print. PMID: 35616853. (05/2022) (link)
  • Györgyi Z, de Luca D, Singh Y. The European Society of Paediatric Radiology's position statement on point-of-care ultrasound. Pediatr Radiol. 2022 Mar;52(3):608-609. doi: 10.1007/s00247-021-05184-8. Epub 2022 Jan 21. PMID: 35059783; PMCID: PMC8776388. (03/2022) (link)
  • Erdeve Ö, Okulu E, Singh Y, Sindelar R, Oncel MY, Terrin G, Boscarino G, Bülbül A, Sallmon H, Atasay B, Ovali F, Clyman RI. An Update on Patent Ductus Arteriosus and What is Coming Next. Turk Arch Pediatr. 2022 Mar;57(2):118-131. doi: 10.5152/TurkArchPediatr.2022.21361. PMID: 35383006. (03/2022) (link)
  • Singh Y, McGeoch L, Job S. Fifteen-minute consultation: Neonatal hypertension. Arch Dis Child Educ Pract Ed. 2022 Feb;107(1):2-8. doi: 10.1136/archdischild-2020-318871. Epub 2020 Nov 19. PMID: 33214239. (02/2022) (link)
  • Singh Y. Response to the letter regarding the original article: the evolution of cardiac point of care ultrasound for the neonatologist. Eur J Pediatr. 2021 Dec;180(12):3579. doi: 10.1007/s00431-021-04192-y. Epub 2021 Oct 7. PMID: 34618228. (12/2021) (link)
  • Conlon TW, Yousef N, Mayordomo-Colunga J, Tissot C, Fraga MV, Bhombal S, Suryawanshi P, Villanueva AM, Siassi B, Singh Y. Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr. 2022 Apr;181(4):1449-1457. doi: 10.1007/s00431-021-04324-4. Epub 2021 Nov 30. PMID: 34846557; PMCID: PMC8964607. (11/2021) (link)
  • Singh Y, Lakshminrusimha S. Pathophysiology and Management of Persistent Pulmonary Hypertension of the Newborn. Clin Perinatol. 2021 Aug;48(3):595-618. doi: 10.1016/j.clp.2021.05.009. PMID: 34353582; PMCID: PMC8351908. Persistent pulmonary hypertension of the newborn (PPHN) is a disorder of circulatory transition resulting in high pulmonary vascular resistance with extrapulmonary right-to-left shunts causing hypoxemia. There has been substantial gain in understanding of pathophysiology of PPHN over the past 2 decades, and biochemical pathways responsible for abnormal vasoconstriction of pulmonary vasculature are now better understood. Easy availability of bedside echocardiography helps in establishing early definitive diagnosis, understanding the pathophysiology and hemodynamic abnormalities, monitoring the disease process, and response to therapeutic intervention. There also has been significant advancement in specific management of PPHN targeted at deranged biochemical pathways and hemodynamic instability. (08/2021) (link)
  • Singh Y, Lakshminrusimha S. Perinatal Cardiovascular Physiology and Recognition of Critical Congenital Heart Defects. Clin Perinatol. 2021 Aug;48(3):573-594. doi: 10.1016/j.clp.2021.05.008. PMID: 34353581. Understanding the perinatal cardiovascular physiology is essential for timely diagnosis and management of congenital heart defects (CHDs) in neonatal period. The incidence of CHDs is reported in 7 to 9 out of 1000 live births, with around 25% of them being critical congenital heart disease, defined as a congenital heart condition needing surgery/intervention or leading to death within 1 month after birth. Around 50% to 60% of the critical CHDs are detected on fetal anomaly screening. The signs and symptoms of critical congenital heart defects are often nonspecific during early neonatal period. The routine newborn physical examination often fails to detect many of these critical CHDs during the transitional circulation because of lack of signs soon after birth. While routine pulse oximetry screening typically performed at 24 to 48 hours after birth may help in detecting cyanotic heart conditions, noncyanotic CHDs such as coarctation of aorta may go undetected on pulse oximetry screening in asymptomatic infants. Some infants may deteriorate early while waiting for pulse oximetry screening, and this risk is much higher if the pulse oximetry screening is not performed to detect congenital heart conditions. There should be high degree of suspicion of critical CHDs in infants presenting with shock or hypoxia. Delay in diagnosis of CHDs has been reported to be associated with poor outcomes, and hence, it is extremely important to detect them in asymptomatic well-infants. Timely recognition and therapy with prostaglandin E1 infusion can be lifesaving in neonatal cardiac emergencies, and they should be urgently discussed with a pediatric cardiologist. This article reviews diagnosis and management of CHD in the delivery room and before surgery in the NICU. (08/2021) (link)
  • Singh Y, Bhombal S, Katheria A, Tissot C, Fraga MV. The evolution of cardiac point of care ultrasound for the neonatologist. Eur J Pediatr. 2021 Jun 14. doi: 10.1007/s00431-021-04153-5. Epub ahead of print. PMID: 34125292. Cardiac point of care ultrasound (POCUS) is increasingly being utilized in neonatal intensive care units to provide information in real time to aid clinical decision making. While training programs and scope of practice have been well defined for other specialties, such as adult critical care and emergency medicine, there is a lack of structure for neonatal cardiac POCUS. A more comprehensive and advanced hemodynamic evaluation by a neonatologist has previously published its own clinical guidelines and specific rigorous training programs have been established to achieve competency in neonatal hemodynamics. However, it is becoming increasingly evident that access and training for basic cardiac assessment by ultrasound enhances bedside clinical care for specific indications. Recently, expert consensus POCUS guidelines for use in neonatal and pediatric intensive care endorsed by the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) have been published to guide the clinicians in using POCUS for specific indications, though the line between cardiac POCUS and advanced hemodynamic evaluation remains somewhat fluid.Conclusion: This article is focused on neonatal cardiac POCUS and its evolution, value, and limitations in the modern neonatal clinical practice. Cardiac POCUS can provide physiological and hemodynamic information in making clinical decisions while dealing with neonatal emergencies. However, it should be applied only for the specific indications and should be performed by a clinician trained in cardiac POCUS. There is an urgent need of developing cardiac POCUS curriculum and certification to support a widespread and safe use in neonates. What is Known: • International training guidelines and curriculum have been published for neonatologist-performed echocardiography (NPE) or targeted neonatal echocardiography (TNE). • International evidence-based guidelines for use of point of care ultrasound (POCUS) in neonates and children have been recently published. What is New: • Cardiac POCUS is increasingly being incorporated in neonatal practice for emergency situations. However, one must be aware of its specific indications and limitations, especially for the neonatal clinical practice. • Cardiac POCUS and NPE/TNE are continuum of cardiac imaging with different indications and training requirements. (08/2021) (link)
  • Martini S, Galletti S, Kelsall W, Angeli E, Agulli M, Gargiulo GD, Chen SE, Corvaglia L, Singh Y. Ductal ligation timing and neonatal outcomes: a 12-year bicentric comparison. Eur J Pediatr. 2021 Jul;180(7):2261-2270. doi: 10.1007/s00431-021-04004-3. Epub 2021 Mar 13. PMID: 33713339; PMCID: PMC7955694. Singh Y as senior author. Patent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known: • Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation. • Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new: • The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery. • Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications. (07/2021) (link)
  • Yousef N, Singh Y, De Luca D. "Playing it SAFE in the NICU" SAFE-R: a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU. Eur J Pediatr. 2021 Jul 5:1–6. doi: 10.1007/s00431-021-04186-w. Epub ahead of print. PMID: 34223967; PMCID: PMC8256195. Rapid diagnosis of sudden, unexpected, and potentially fatal complications in the neonatal intensive care unit (NICU) is essential for the initiation of prompt and life-saving management. Point-of-care ultrasound (POCUS) protocols are widely used in adult emergency situations to diagnose and guide treatment, but none has been specifically developed for the neonate. We propose a targeted diagnostic ultrasound protocol for the suddenly decompensating infant in the NICU for rapid screening for the most common life-threatening complications needing immediate attention. We integrated current knowledge on the use of POCUS for diagnosis of the most critical neonatal complications into the "SAFE-R protocol" (Sonographic Assessment of liFe-threatening Emergencies - Revised). The ultrasound algorithm was evaluated at the bedside for suitability and ease of use. Main features of SAFE-R are the use of standardized ultrasound points and a simple one-probe rule-in/rule-out approach. The flowchart is designed by order of urgency and priority is given to treatable causes. Hence, ruling out cardiac tamponade is the first step in the decision tree, followed by pneumothorax, pleural effusion, then acute critical aortic occlusion, acute abdominal complications, and severe intraventricular hemorrhage.Conclusion: SAFE-R is the first ultrasound algorithm specifically conceived for use in the NICU to screen for the most common urgent neonatal complications leading to sudden deterioration, thereby providing critical information within minutes. The simplified and rapid approach is designed for the neonatologist and is easy to learn and quick to perform. What is Known: • The fields of neonatal and pediatric critical care are undergoing a transformation with the adoption of POCUS and the recent publication of the first international guidelines on POCUS for critically ill children and neonates. • Targeted emergency ultrasound protocols are widely used in adult emergency and critical care medicine, but specific and adapted ultrasound algorithms are lacking for the pediatric and neonatal population. What is New: • We propose the first targeted ultrasound protocol specifically designed for the suddenly decompensating infant in the NICU for rapid screening of the most common life-threatening complications needing immediate attention. • The SAFE-R ultrasound algorithm integrates current knowledge on ultrasound diagnosis of the most critical neonatal complications into a simple and easy-to-perform emergency scanning protocol aimed to guide initial management and resuscitation efforts. (07/2021) (link)
  • Pedraza-Melchor RL, Hernández-Benítez R, Iglesias-Leboreiro J, Vidaña-Pérez D, Bernardez-Zapata I, Singh Y. Right ventricular anatomical and functional parameters in healthy Mexican term newborns. Arch Cardiol Mex. 2021;91(3):315-320. English. doi: 10.24875/ACM.20000063. PMID: 34310586. Singh Y as senior author. Abstract  Objective: Right ventricle (RV) function plays an important role during fetal and neonatal transitional circulation. Despite the published echocardiography guidelines in children including neonates, there is scare evidence on RV assessment using echocardiography in Mexican neonates. This study was aimed at assessing RV function and anatomical measures in healthy term newborns and defines normal values in this cohort of patients. Methods: A prospective study involving healthy term newborns in a single center were enrolled in the study to assess RV, all patients were recruited within 24-72 h after birth. The right ventricular assessment was performed as per American Society of Echocardiography's guidelines. Results: Seventy healthy term newborns with a median gestational age of 38 (38.5 ± 2.7) weeks had RV function assessment and anatomical structures measures with a predefined ten echocardiographic parameters protocol. The mean values for: tricuspid valve diameter was 13 mm ± 1.8, basal diameter of the RV 16.7 mm ± 2, RV length 27.8 mm ± 2.2, mid cavity diameter 14.3 mm ± 1.7, RV-anteroinferior basal diameter 21.5 mm ± 2.5, tricuspid regurgitation gradient 13.3 mmHg ± 5.9, tricuspid annular plane systolic excursion 8.7 mm, right ventricular fractional area change (RVFAC) 4 chamber (%) 40.6 ± 7.5, tricuspid E/A 0.7 ± 0.5, myocardial velocities (cm/s) E´ 8 ± 2.7, A´ 9.6 ± 2.4, S´ 6.9 ± 1.2, myocardial performance index 0.5 ± 0.1, RVFAC 3 chamber (%) 37.8 ± 15.8, and pulmonary acceleration time mean value 58.8 ± 14.9. Flattening of interventricular septum was seen in 13% infants. Conclusions: This study describes echocardiographic parameters for anatomical structures and assessment of RV function in healthy term newborns during transitional circulation. We reported novel anatomical measures of the RV; this information can provide normal reference range values and be referenced while assessing RV function in normal and sick newborns during transitional circulation. (07/2021) (link)
  • Ramanan AV, Modi N, de Wildt SN; Singh Y as collaborator and co-author; c4c Learning from COVID-19 Group. Improving clinical paediatric research and learning from COVID-19: recommendations by the Conect4Children expert advice group. Pediatr Res. 2021 Jun 7:1–9. doi: 10.1038/s41390-021-01587-3. Epub ahead of print. PMID: 34099854; PMCID: PMC8184051. Abstract Background: The COVID-19 pandemic has had a devastating impact on multiple aspects of healthcare, but has also triggered new ways of working, stimulated novel approaches in clinical research and reinforced the value of previous innovations. Conect4children (c4c, www.conect4children.org ) is a large collaborative European network to facilitate the development of new medicines for paediatric populations, and is made up of 35 academic and 10 industry partners from 20 European countries, more than 50 third parties, and around 500 affiliated partners. Methods: We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equity. Findings: We summarise aspects of clinical research in paediatrics stimulated and reinforced by COVID-19 that the Conect4children group recommends regulators, sponsors, and investigators retain for the future, to enhance the efficiency, reduce the cost and burden of medicines and non-interventional studies, and deliver research-equityWe provide examples of research innovation, and follow this with recommendations to improve the efficiency of future trials, drawing on industry perspectives, regulatory considerations, infrastructure requirements and parent-patient-public involvement. We end with a comment on progress made towards greater international harmonisation of paediatric research and how lessons learned from COVID-19 studies might assist in further improvements in this important area. (06/2021) (link)
  • Deshpande S, Suryawanshi P, Holkar S, Singh Y, Yengkhom R, Klimek J, Gupta S. Pulmonary hypertension in late onset neonatal sepsis using functional echocardiography: a prospective study. J Ultrasound. 2021 May 15. doi: 10.1007/s40477-021-00590-y. Epub ahead of print. PMID: 33991307. Abstract Purpose: Pulmonary hypertension (PH) in the newborn period is associated with significant morbidity and mortality. Sepsis has been identified as an independent risk factor for PH in newborns. Data on the proportion and severity of PH in association with neonatal sepsis are scarce. This study was aimed to measure the pulmonary artery systolic pressure (PASP) in neonates with late onset sepsis (LOS) and to estimate the proportion of PH in neonatal sepsis using functional echocardiography (FnECHO). Methods: This prospective observational study was conducted at a tertiary neonatal intensive care unit (NICU). All neonates admitted in the NICU with suspected LOS underwent FnECHO within 6 hours of onset of clinical signs and PASP was recorded. Pulmonary hypertension was defined as PASP of > 35 mmHg. PASP of neonates with positive culture results (proven LOS) was compared with that of gestational age-matched stable controls without sepsis. Results: Thirty three neonates with proven LOS were analysed (study group). Sixteen neonates (49%) in the study group had PH. Mean PASP of the study group was significantly higher than that of the control group (35.3 ± 10.13 mmHg and 12.58 ± 3.92 mmHg, respectively; P < 0.0001). None of the neonates in the control group had PH. Conclusion: Pulmonary artery pressure was higher in neonates with late onset neonatal sepsis as compared to that of stable babies without sepsis. Pulmonary hypertension was seen in nearly half of term as well as preterm neonates with late onset sepsis. (05/2021) (link)
  • Atasay B, Erdeve Ö, Sallmon H, Singh Y. Editorial: Management of Patent Ductus Arteriosus in Preterm Infants. Front Pediatr. 2021 Apr 14;9:681393. doi: 10.3389/fped.2021.681393. PMID: 33937158; PMCID: PMC8079752. Editorial: Management of Patent Ductus Arteriosus in Preterm Infants - PubMed (nih.gov) (04/2021) (link)