Interview – Rangasamy Ramanathan, MD, FAAP, Professor of Pediatrics

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I have been blessed to work with excellent group of neonatal nurses, respiratory care practitioners and faculty colleagues. My main motto is that any baby in our NICU should not know if it is a day or night, and weekday or weekend. I always try to provide consistent care to our sick neonates, based on evidence. The smallest baby in the world weighing 270g at birth is now a beautiful young girl, is a testament to our team work.

Who or what has impacted you most in your decision to dedicate to the field of neonatal – perinatal medicine?   

I trained in India with over 30,000 deliveries each year, and many deaths of newborn babies without good facilities for proper care of these newborns. I moved to USA to learn more about neonatal care and have been privileged to learn from experts in this filed.

According to statistics, there is a great increase to premature births. What is the main cause of prematurity and how can it be prevented?

Major causes of prematurity include lack of prenatal care, lack of access to prenatal care for women with high-risk pregnancies, poor nutrition during pregnancy, and spontaneous onset of preterm labor of unknown causes. Genetic factors contribute to nearly 40% of all preterm births. Maternal infections are another important factor in causing preterm births.

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Do you believe that the U.S. Health Care System has contributed in a positive or negative way to the effect of prematurity?

Organizations in USA, such as March of Dimes, have contributed positively to address issue of preterm birth. One of the 3 missions of March of Dimes is prevention of preterm births, through research and public awareness campaign.

What is the most common health problem of newborns nowadays?

Most common causes of neonatal mortality worldwide are neonatal infections, including sepsis and pneumonia, preterm births, and birth asphyxia.

You manage one of the largest fellowship programs in neonatal – perinatal medicine in the USA. In the past, you have been awarded for your ability to educate new students. Can young scientists have access to appropriate training to motivate them into developing new ideas?

Every trainee in neonatal-perinatal medicine fellowship training program has the opportunity to do scholarly work, participate in quality improvement activities, and understanding health disparities.

You have been several times awarded for your unselfish offer in the health sector. How do you believe that distinction and recognition can be an incentive for scientists?

Getting recognized for one’s work is definitely a significant motivation factor and wants one to keep working more.

Life Time Achiement Award Dec 9, 2017

As a specialist in neonatology, would you like to talk to us about the latest facts and new practices in this field?

Preterm birth related complications, such as, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity are major morbidities among survivors of preterm neonates. Interventions, such as, antenatal steroids, delayed cord clamping, application continuous positive airway pressure during resuscitation, avoiding hypo – and hyperthermia in the delivery room, early, rescue surfactant therapy in preterm infants with respiratory distress syndrome, early caffeine therapy in infants weighing <1250 g at birth, exclusive use of breast milk, minimizing use of antibiotics, appropriate targeting of oxygen saturation and avoidance of mechanical ventilation are some of the therapies that have been shown to improve outcomes of neonates.

Your research field includes, among other things, your theory for the treatment of neonates with surfactants for RDS and ARDS, non-invasive ventilation in neonates, and caffeine therapy in preterm infants. Talk to us about new techniques and how do they work more effectively in treating problems faced by early infants?

Noninvasive ventilation mode, mainly, nasal continuous positive airway pressure (NCPAP) has been used since the early 1970s. However, pulmonary and non-pulmonary outcomes have not improved over the past 4 decades. Major reason for lack of benefit is due to high failure rates with NCPAP, needing intubation and invasive ventilation, and prolonged oxygen therapy. Use of nasal intermittent positive ventilation (NIPPV) is superior to NCPAP in decreasing the need for invasive ventilation, decreased duration of oxygen therapy, and less BPD. Early, rescue surfactant therapy using porcine derived surfactant, poractant alfa has been shown to decrease death or BPD, decrease the need for patent ductus arteriosus (PDA) treatment, and decrease in the number of infants receiving more than one dose of surfactant, when compared to bovine derived surfactant, beractant. Caffeine therapy has been shown to decrease intermittent hypoxic episodes, BPD, and PDA.

We know that the smallest infant weighted 270 gr. How difficult is it to keep alive such a tiny baby? Describe us the situation and the problems which you were confronted with?

It was a total “Team Effort”. I have been blessed to work with excellent group of neonatal nurses, respiratory care practitioners and faculty colleagues. My main motto is that any baby in our NICU should not know if it is a day or night, and weekday or weekend. I always try to provide consistent care to our sick neonates, based on evidence. The smallest baby in the world weighing 270 g at birth is now a beautiful young girl, is a testament to our team work.

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Tell us about the importance and the difficulties you encounter in conducting multicenter studies?

Multicenter studies are difficult to conduct due to different populations, and different approaches to care. However, multicenter studies are the best way to enroll many patients and after adjusting for study center as a variable, results may be a generalizable.

You visit a lot of centers for the protection and living of premature infants all over the world. Which one stands out and why?

Most centers in developed countries are able to provide excellent care to neonates. With advances in technology and support from Governments and other Organizations, care in low- and middle-income countries is also improving.

 

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