The Incubator
The Incubator
🟠CHNC 2023 COVERAGE - Open Mic w CHNC Mentored fellows - Pavika Varma and Yo Nishihara
CHNC 2021 mentored fellows, Pavika Varma and Yo Nishihara, share their breakthrough findings from recent research. Pavika tackles the challenging issue of racial disparities in enteral tube feeding for preterm infants, unearthing the hidden elements of language barriers and complex family dynamics. At the same time, Yo walks us through his study of neonatal infections over a 10-year period, shedding light on significant shifts in isolated organisms and potential regional differences and whether altitude plays a role.
As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.
Enjoy!
Hello everybody, welcome back to the podcast. We are joined by Yone Shihara and Pavika Varma Guys, thank you so much for being on the show.
Speaker 2:Thanks for having us.
Speaker 1:So tell us a little bit about who you are, where you're from and what stage of your career you're at. And how does that coincide with when you were selected as a mentored fellow?
Speaker 3:And we should say they are the 2021 mentored fellows.
Speaker 2:Yeah, I'm Pavika. I am originally born and raised Southern California and I came out to Denver for my fellowship and was introduced to the CH&C through a number of faculty members who are at Children's Hospital of Colorado and was encouraged to apply for the Mentored Fellow Award. I've had a wonderful experience with it and I've stayed on at Children's Colorado as now an assistant professor.
Speaker 1:Congratulations, thank you. When did you begin your attending career?
Speaker 2:Just in August, so we're very fresh into it.
Speaker 1:So you didn't really take a big break after fellowship I took one month off and then went straight in.
Speaker 2:Good for you, you tell us.
Speaker 4:Yeah, so my name is Yone Shihara, so I've taken a slightly scenic route in my medical training. I'm originally from Japan and then I grew up in the UK, went to med school in the UK, did my pediatric training in the UK. I met a Colorado native who is responsible for me relocating to sunny Colorado. You know that goes, so I had the joy of redoing residency training, so I'm currently still a fellow, even though Pavika and I are in the same class. I was on the accelerated program, so I have four years of fellowship.
Speaker 1:Are you doing like a combined pediatrics and no, it's mostly all.
Speaker 4:So do you mean neonatology?
Speaker 1:Yeah, I mean, I'm just wondering what people may say like why, why are they making him do four years? I only did three.
Speaker 4:Oh no, the deal was I did two years of residency. And the third year of residency got added onto the fellowship.
Speaker 1:Okay, so that people don't feel like you're being a.
Speaker 3:Punished, punished.
Speaker 1:You're doing five years of neonatology.
Speaker 3:Okay, well, tell us what you guys have been studying all this time.
Speaker 2:So my project was focused on the use of enteral tube feeding, post discharge and preterm infants, with a specific focus on racial and ethnic disparities. It's kind of where the project was born, but being able to do this at the level of the CHNC and use such a large data set, we were able to analyze far more clinical demographic factors as well, and so the study really wound up looking at prevalence and predictors of durable enteral tube feeds and preterm infants after NICU discharged, and we did find that there was a racial ethnic disparity. The findings of our studies show that Hispanic infants non-white Hispanic infants are more likely to be discharged home with G tube feeds compared to NG feeds. And then we saw differences looking again at private insurance versus public insurance, with a ASCUE towards NG feeds being more common in infants who had private insurance or whose parents had private insurance, and then in SGA infants, more G tubes as well.
Speaker 3:And why do you think that is? Have you been able to parse out any of the data to think about those?
Speaker 2:factors, the racial and ethnic disparity piece, specifically, given that the signal is far higher in non-white Hispanic infants. As we're kind of thinking about next steps of this study, wondering how much language barriers? Come into play.
Speaker 1:That's an interesting point.
Speaker 2:And whether that is contributing to lack of kind of informed consent around the time of procedures or modalities of tube feeds being offered at the time of discharge. That's really hard to capture in a data set. It's a complicated topic you picked Very nuanced, and so how to study that further is something that we've been giving a lot of thoughts towards.
Speaker 3:Yeah, I wonder, even in the feeding trial, parent feeding practice, how much language barrier is an obstacle and it's not clear what is the easiest solution for parents.
Speaker 1:I mean, sometimes you may be thinking, oh, g tube, it's there. There's no concerns about NGs falling out, coming back to the ER and so on and so forth, but it's labor intensive to maintain a G tube at home. So there's yeah, it's very, I think yeah all the intricacies of family dynamics where they're living. How accessible are these areas and how much support do they get after discharge? I mean all these are very important factors in how we make that decision on the front end, before discharge home.
Speaker 3:So Kudos to you for taking that on Very interesting work. Yeah, hey, yeah.
Speaker 4:So my project and my research interest has been in neonatal infections and so for this project it really stemmed from one question or actually one comment from an attending during rounds who said you don't see a X, y and Z infections because we're a high altitude and you know. And it made me think, you know, is that true? And then when you actually look in the literature there really isn't a lot on level four units. And as a newcomer to this country, you know, not really knowing the geography, you know, it kind of spurred me to come up with a new idea. It kind of spurred me to kind of look at you know, is this true? And along came this opportunity to use this huge data set across multiple sites. And so what really started off as a simple question kind of snowballed into a rather large question.
Speaker 4:And what we did was to look at characterizing 10 year trends of infections across different institutions, other regional differences and one of the demographic and outcome data associated with those infections. It's still, as you can imagine, a big work in progress, but I think that you know a couple of the interesting findings. I think we've seen some changes in isolated organisms, namely decrease in coagulating and increased difficulty, increase in coagulating and increased staff, but increase in some more E coli, staph aureus and even MRSA. There weren't huge variation in geography but there were some subtle changes which we're still working on trying to determine, and then the whole associated diseases and outcomes and mortality. Again, that is something we're still working on characterizing and there are some interesting findings which you know I'm sure will be coming out soon.
Speaker 3:I mean, that just seems like a I mean a career building question right. It's really been unstudied.
Speaker 4:Yeah, so it's exciting. It's definitely I put more on my plate than I can finish in one go and then, yes, it may end up becoming my career.
Speaker 1:Any international data on this, I mean well, if you.
Speaker 4:Well, I guess Toronto is part of the CHNC network, but they, you know all the all the member sites are North America.
Speaker 1:Right, right, but you in your literature review. There's no other countries that have looked at this question as well, just you know.
Speaker 4:I did take a look briefly into Europe. I didn't really kind of go into it in too much detail, but really I do think there is a huge amount, especially in referral NICUs that take mostly outborn a lot of term codes. There's really not a lot of data.
Speaker 1:Interesting, that's so interesting.
Speaker 3:Very exciting. We are very much looking forward to what you guys bring to the table. We're asking everybody what's one thing they're taking home that they learned at the meeting this week. So I don't know if you guys have any pearls that you're taking with you.
Speaker 1:Anything you listen to that you're like man, that's cool.
Speaker 3:Super cool, we're going to think about that.
Speaker 1:a little bit more on my institution and for and for Pavika. I mean, it's like your home right.
Speaker 2:So you're not taking it far back. So I have to say One theme that was at this conference, that was present at last year's conference as well was is VV, ecmo and, coming on in a faculty role, I'm on our core ECMO team.
Speaker 1:You got roped in, huh.
Speaker 2:I got roped in. I'm so happy to be a part of that team, but we exclusively use VA ECMO. And so I feel like leaving this session. I'm invigorated and feel empowered to go back and revisit that and try just a few cases.
Speaker 3:Just a few patients. Try some VV. How about you Jo.
Speaker 4:Yeah, no, I think, as a fellow coming to these conferences, I think that one of the real advantages is that it really is a very open and friendly environment with a lot of people from across the country. And I think that, specifically for this year I think that will stand out for me has been the talks on the neurosurgical management, and that's been fascinating. But again, every year there's always something new, some new poles to take away in a very kind of communal and friendly environment. So this is definitely a conference that will continue to be on my list of.
Speaker 3:Certainly a friendly bunch. Yeah, we've really liked that Pavaka Jo. Thank you so much. Best of luck, thank you so much.
