NEONATOLOGY Peer Reviewed Research, News and Information TODAY in Neonatal and Perinatal Medicine Volume 16 / Issue 3 | March 2021 Romiplostim Administration to a Preterm Neonate with Severe Prolonged I CAN Digitally Involved (iCANDI) Acquired Thrombocytopenia Amy Ohmer Michael D. Kamitsuka, MD, Shrena Patel, MD, .............................................................................................................Page 81 Richy T. Lee, MD, Robert D. Christensen, MD The Next Generation of NICU Staff .............................................................................................................Page 3 Kelly Welton, RRT-NPS 27th Cool Topics in Neonatology Conference .............................................................................................................Page 84 A Virtual Educational Conference The Nature of Neonatal Experience during Pandemic COVID-19 Clara H. Song, MD Daved van Stralen, MD, FAAP, Thomas A. Mercer, RAdm, USN .............................................................................................................Page 11 .............................................................................................................Page 87 Developing a Shiny WebApp User Interface Neonatal Clinical Nurse Specialist (CNS): The Importance of Fu-Sheng Chou, MD, PhD Specialized Nursing Care for NICU Patients and Families .............................................................................................................Page 22 Robin Koeppel, DNP, CPNP, CNS, RNC-NIC, C-ELBW, C-NNIC Fellow Column: Comparing Transcutaneous Bilirubin Levels with .............................................................................................................Page 99 Serum Bilirubin Levels to Screen for Neonatal Jaundice Medical News, Products & Information Kaivan Dadachanji, DO Compiled and Reviewed by Mitchell Goldstein, MD Editor in Chief .............................................................................................................Page 28 .............................................................................................................Page 110 On Adapting to Remote Learning for Healthcare Professionals The Genetics Corner: The Positive Predictive Value of NIPT for 22q11 Barb Himes, IBCLC Deletion Syndrome Varies with the Indication .............................................................................................................Page 31 Nivedita Rajakumar, Subhadra Ramanathan, Robin D. Clark, MD Section on Neonatal-Perinatal Medicine Update – Raising our Voices .............................................................................................................Page 124 Lily J. Lou, MD, FAAP Human Milk: The Best Medicine for Vulnerable Babies ...................................................................................................................Page 35 Heidi E. Karpen, MD Interpreting Umbilical Cord Blood Gases Cord Occlusion with Terminal Fetal .............................................................................................................Page 129 Bradycardia: Part IV Clinical Pearl: Jeffrey Pomerance, MD, MPH A Thoughtful Approach to Neonatal End-of-life Discussions .............................................................................................................Page 37 Patricia Stevens, MS, NNP-BC Neonatology Solutions Redesigned Interfaces .............................................................................................................Page 137 Scott Snyder, MD Letters to the Editor: Truth in Monitoring ...................................................................................................................Page 42 Mitchell Goldstein, MD responds to Hernando Baquero Latorre, MD Conversations About COVID Vaccines with Latino Immigrant Communities .................................................................................................................Page 143 Julia Koehler MD Erratum ...................................................................................................................Page 44 .............................................................................................................Page 145 Medical Legal Forum: Case Debrief: J.S. v. 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Subscriptions and Contact Information ...................................................................................................................Page 51 .............................................................................................................Page 148 Abstracts from National Perinatal Association 2020 Conference, December Editorial Board 2-4, 2020: New Framework for Multidisciplinary Care in the 4th Trimester .............................................................................................................Page 151 Jerasimos (Jerry) Ballas, MD, MPH, FACOG Neonatology Today: Policy on Animal and Human Research ...................................................................................................................Page 55 .............................................................................................................Page 153 Featured Conference: Agenda for the Virtual 37th Annual Advances in Thera- Neonatology Today: Instructions for Manuscript Submission peutics and Technology: Critical Care of Neonates, Children, and Adults .............................................................................................................Page 153 Donald Null, MD, Mitchell Goldstein, MD, Arun Pramanick, MD Neonatology and the Arts - Herbert Vasquez, MD ...................................................................................................................Page 73 .............................................................................................................Page 153 New Congress Takes Aim at Maternal Health Inequities Stargazer Lily - Paula Whiteman, MD Michelle Winokur, DrPH, and the AfPA Governmental Affairs Team, .............................................................................................................Page 154 Alliance for Patient Access (AfPA) Mallard Duck in Hiding - Larry Tinsley, MD .............................................................................................................Page 79 .............................................................................................................Page 155 NEONATOLOGY TODAY Loma Linda Publishing Company © 2006-2021 by Neonatology Today A Delaware “not for profit” 501(c) 3 Corporation. Published monthly. All rights reserved. c/o Mitchell Goldstein, MD ISSN: 1932-7137 (Online), 1932-7129 (Print) 11175 Campus Street, Suite #11121 All editions of the Journal and associated Loma Linda, CA 92354 manuscripts are available on-line: Tel: +1 (302) 313-9984 www.NeonatologyToday.net [email protected] www.Twitter.com/NeoToday NT Peer Reviewed Romiplostim Administration to a Preterm Neonate with Severe Prolonged Acquired Thrombocytopenia Michael D. Kamitsuka, MD, Shrena Patel, MD, Introduction Richy T. Lee, MD, Robert D. Christensen, MD The purpose of this report is to describe a case in which an ex- tremely premature, low birth weight neonate, developed a pro- Abstract longed course of thrombocytopenia requiring multiple platelet Platelet transfusions can be lifesaving for neonates with throm- transfusions but subsequently stopped requiring platelet transfu- bocytopenic hemorrhage. However, multiple transfusions them- sions following a short course of the Tpo-mimetic, romiplostim. selves convey risks and hazards. We cared for a preterm neonate In 1994 the principal physiological regulator of thrombopoiesis, with severe/prolonged acquired thrombocytopenia who received thrombopoietin (Tpo), was cloned (1). Two recombinant forms 61 platelet transfusions. Her platelet counts stabilized, and further were created: a full-length Tpo and a pegylated form containing transfusions were not needed, following three escalating doses of only the receptor-binding domain. In early clinical trials, a few sub- romiplostim. jects receiving these molecules developed cross-reactive neutral- izing antibodies against their endogenous Tpo, resulting in severe hypo-regenerative thrombocytopenia and aplastic anemia (2). Abbreviations Second-generation Tpo-mimetics were developed, which do not Tpo: thrombopoietin share any sequence homology with endogenous Tpo, but stimu- DOL: day of life late thrombopoiesis by binding and activating the Tpo receptor (3). In 2018, the FDA approved romiplostim for use in children >1 NEC: necrotizing enterocolitis year of age with immune thrombocytopenic purpura of > 6 months SQ: subcutaneously (3). Although romiplostim has been used in cases of refractory thrombocytopenia in children, published use in neonates is limited IPF: immature platelet fraction (4). We would like to describe our experience of using romiplos- tim in a neonate with protracted thrombocytopenia. Keywords: thrombopoietin; immature platelet