Research Alert
This year, pediatric researchers with the Icahn School of Medicine at Mount Sinai will be presenting their latest research findings at the Pediatric Academic Societies 2021 annual meeting. Below please find highlights from two presentations taking place in the coming days:
Poster Presentation/Embargo: May 2, 2021, 7:10 PM
“Psychosocial Outcomes of Marijuana Smoking in Adolescent Girls of Color,” in which researchers report worrisome findings after investigating the impact of heavy marijuana use among adolescent women of color in an urban health center.
Platform presentation/Embargo: May 3, 2021 at 6:15pm EST
“An Improvement Project to Limit Use of Invasive Mechanical Ventilation and Reduce Ventilator Days in a Level IV Neonatal Intensive Care Unit,” where Mount Sinai clinicians implemented both practice and culture change that resulted in several improvements in care.
“Psychosocial Outcomes of Marijuana Smoking in Adolescent Girls of Color”
Poster Presentation/Emabargo: May 2, 2021, 7:10 PM
In a poster session to be presented on May 2, lead author Nathalie Duroseau, M.D., Adolescent Medicine Fellow, Adolescent Health Center at Mount Sinai Hospital will discuss “Psychosocial Outcomes of Marijuana Smoking in Adolescent Girls of Color.”
With little known about the effect of marijuana smoke on the brain and with many states liberalizing and /or legalizing the use of marijuana, researchers at the Icahn School of Medicine at Mount Sinai designed a study to investigate the impact of heavy marijuana use among adolescent women of color in an urban health center. The study was derived from another ongoing study of human papillomavirus (HPV) vaccination taking place at the Mount Sinai Adolescent Health Center, where adolescents without health insurance are welcomed for a wide suite of services, all free of charge and anonymous. Conducting a regression analysis during the time period of 2013-2018, all pre pandemic, the researchers uncovered strikingly deleterious associations between marijuana use and school problems and delinquent behavior among this vulnerable a cohort of young women. Specifically, the researchers found that among girls who reported smoking 20 times or more a month, there was a 2.7 times higher likelihood of being suspended from school. The women in this group also scored 0.48 times higher than non-smokers on validated depression scales and 0.81 times higher on delinquency scales than girls who did not smoke marijuana.
The researchers also conducted two separate autoregressive crossâlagged models to look at the relationship between marijuana, depression, and delinquency in participants who reported smoking 20 or more times a month. The models revealed significant bidirectional relationships between pathways of marijuana and depression and marijuana and delinquency over 1 year or 3 study visits. They found more frequent marijuana use at baseline predicted higher depressive symptoms six months later. In addition, more frequent marijuana use was associated with higher levels of delinquency from baseline to six months and from six months to 12 months later. Higher delinquency was associated with more frequent marijuana use six to 12 months later.
“The results are very worrisome because they paint a picture of young women of color who may be using marijuana heavily and may be depressed. Their use can become problematic and lead to worsening depression, missing out on school, and increased interaction with the juvenile justice system. The data was collected before the Covid pandemic and before the legalization of recreational marijuana in New York State, which together will likely lead to further marijuana use by this vulnerable group of young women. We should really be considering how we counsel these young women around their motivations to use marijuana and address any mental health issues that promote use, as legalization and accessibility grow in New York and the rest of the United States, ” says lead author, Dr. Duroseau.
An Improvement Project to Limit Use of Invasive Mechanical Ventilation and Reduce Ventilator Days in a Level IV Neonatal Intensive Care Unit”
Platform presentation/Embargo: May 3, 2021 at 6:15pm EST
In an upcoming platform presentation to take place on May 3, Courtney Juliano, MD, Interim Chief, Division of Newborn Medicine, the Jack and Lucy Department of Pediatrics at the Icahn School of Medicine at Mount Sinai, and colleagues will present “An Improvement Project to Limit Use of Invasive Mechanical Ventilation and Reduce Ventilator Days in a Level IV Neonatal Intensive Care Unit.” In this project to improve neonatal outcomes in a Level IV NICU, the researchers implemented sequential practice changes and interventions to increase and improve the utilization and delivery of continuous positive airway pressure (CPAP).
The series of interventions included a change in CPAP delivery device, education surrounding the importance of CPAP use for lung protection and development, training for providers on how to effectively avoid intubation for preterm infants in the delivery room, and daily respiratory rounds to optimize CPAP use and delivery. The result was practice and culture change that lead to a significant reduction in the total number of ventilator days per 1000 patients days per month in the NICU. Much of this change was driven by a reduction in the number preterm infants who were mechanical ventilated. Targeted analysis of the number of very low birth weight infants intubated within the first 7 days of life revealed a 60 percent decrease between 2017 and 2019. Importantly, in the unit, decreased mechanical ventilation of preterm infants was associated with a reduction in the number of ELBW infants requiring tracheostomy or discharge on oxygen for severe chronic lung disease.
“Although it is widely accepted that one of the most effective ways to reduce chronic lung disease of prematurity is to limit the use of mechanical ventilation in vulnerable preterm infants, knowing something and being able to reliably implement it are very different. Through our work we demonstrate how, by way of targeted education, changes in respiratory practice, and careful process monitoring and assessment, we were able to significantly shift clinical care. As a result of our interventions, we intubate and mechanically ventilate far fewer vulnerable infants, a change that has real clinical impact and one that can likely be replicated in other units,” says Dr. Juliano.
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