Ranjit I Kylathu
- Professor, Pediatrics - (Clinical Scholar Track)
1: Kylat RI, Bartholomew A, Cramer N, Bader MY. Neonatal listeriosis: Uncommonor misdiagnosed? J Neonatal Perinatal Med. 2016 Sep 16;9(3):313-6. doi:10.3233/NPM-16915121. PubMed PMID: 27589546.2: Kylat RI, Ohlsson A. Recombinant human activated protein C for severe sepsisin neonates. Cochrane Database Syst Rev. 2012 Apr 18;(4):CD005385. doi:10.1002/14651858.CD005385.pub3. Review. PubMed PMID: 22513930.3: Kylat RI, Kelly EN, Ford-Jones EL. Clinical findings and adverse outcome inneonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur JPediatr. 2006 Nov;165(11):773-8. PubMed PMID: 16835757.4: Kylat RI, Ohlsson A. Recombinant human activated protein C for severe sepsisin neonates. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005385. Review. Updatein: Cochrane Database Syst Rev. 2012;4:CD005385. PubMed PMID: 16625638.
5: Marquez J, Gedalia O, Candia L, Ranjit K, Hescock GC, Espinoza LR, Stopa AR,Gedalia A. Kawasaki disease: clinical spectrum of 88 patients in ahigh-prevalence African-American population. J Natl Med Assoc. 2008Jan;100(1):28-32. PubMed PMID: 18277805.
Licensure & Certification
- Fellow, American Academy of Pediatrics (2004)
- Board certification in neonatal_Perinatal medicine, American Board Of Pediatrics (2015)
- Board Certification and recertification in General Pediatrics, American Board Of Pediatrics (2014)
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- Kylat, R. I., & Samson, R. A. (2020). Junctional ectopic tachycardia in infants and children. Journal of arrhythmia, 36(1). doi:https://doi.org/10.1002/joa3.12282
- Kylat, R. I., Addams, J., & Sobonya, R. E. (2020). Fatal Disseminated Herpes Simplex in a very premature neonate. Autopsy & case reports, 8(4), e2018050.More infoHerpes Simplex Virus infections (HSV) are ubiquitous. The neonatal HSV infection (NHSV) is rare. The incidence is estimated globally at only 10.3 per 100,000 births, but it can cause devastating disease in premature infants. Both HSV-1 and HSV-2 can be the etiologic agents in this type of vertically transmittted NHSV infection. Here we describe the pathological findings from a complete autopsy of a very low birth weight infant who succumbed to the infection despite early institution of antiviral treatment. We urge more awareness of this disease with continued surveillance; every effort should be taken to make an early diagnosis and thus prevent this devastating disease.
- Bellini, C., Ramenghi, L. A., Magnano, G. M., Paladini, D., Boccardo, F., Bernas, M. J., Kylathu, R., Witte, M. H., Bellini, T., & DeAngelis, L. C. (2019). Congenital chylothorax: Current evidence-based prenatal and post-natal diagnosis and management. Lymphology, 52(3), 108-125.
- Ghishan, F. K., Dori, Y., Barber, B. J., Witte, M. H., & Kylat, R. (2019). Resolution of protein-losing enteropathy after congenital heart disease repair by selective lymphatic embolization. Pediatr Gastroenterol Hepatol Nutr, 22(6), 1-7.
- Klewer, S. E., Seckeler, M., Witte, M. H., Kylathu, R., & Myles, R. (2019). The "Failing Fontan" Challenge to the Cardiolymphologist: Case Analysis. 27th World Congress of Lymphology Abstract Booklet.
- Kylat, R. I. (2019). Complete and Incomplete Pentalogy of Cantrell. Children (Basel, Switzerland), 6(10).More infoPentalogy of Cantrell (PC) is a malformation characterized by defects in the ventral abdominal wall, lower sternum, diaphragmatic pericardium, anterior diaphragm associated with omphalocele, thoraco-abdominal ectopia cordis, diaphragmatic hernia, and intracardiac abnormalities. PC is stratified as complete or incomplete and we present both the complete and incomplete forms.
- Kylat, R. I. (2019). Pneumomediastinum Mimicking Congenital Pulmonary Airway Malformation. Children (Basel, Switzerland), 6(9).More infoPneumomediastinum is the collection of free air in the mediastinum. Its incidence is higher in preterm infants and those on positive airway pressure support or on mechanical ventilation. But it has decreased dramatically after the introduction of surfactant and synchronized, non-invasive mechanical ventilation. Underlying cystic lesions could also increase the risk of pneumomediastinum and other air leak syndromes. Most cases resolve spontaneously but rare hemodynamic compromise may require ultrasound-guided intervention.
- Kylat, R. I. (2019). Pulmonary hypertension occurring with diazoxide use in a preterm infant with hypoglycemia. Drug, healthcare and patient safety, 11, 7-10.More infoPharmacologic modulation to open the K channels with diazoxide is useful in treating hyperinsulinemia. Diazoxide is being used more often in neonates with hyperinsulinemic hypoglycemia. This report highlights a case of severe pulmonary hypertension (PH) with re-opening of ductus arteriosus in an extremely premature infant after the use of diazoxide. The rapid onset of PH with respiratory failure was completely reversible. This case emphasizes the need for extreme caution with use of diazoxide in the premature infant population, especially those with chronic lung disease of prematurity. In addition, the use of diazoxide should be limited to the persistent form of congenital hyperinsulinism, after adequate work up has been completed to evaluate for other causes of hypoglycemia. It is postulated that development of PH could be related to K agonsim.
- Kylat, R. I. (2019). Tracheal Stenosis and Congenital Heart Disease in Trisomy 21. Children (Basel, Switzerland), 6(9).More infoTracheal rings (TR) are rare, congenital cartilaginous defect of the upper airway and are usually due to complete or near complete circumferential cartilaginous tracheal rings, with variable degrees of tracheal stenosis (TS) and shortening. Chromosomal anomalies like trisomy 21 are characteristically associated with a wide range of upper airway anomalies including TS and congenital heart disease (CHD). However, the overall prevalence of severe forms of TS is rare and reported in 1.2% of all CHD patients. Herein, we present a rare association of severe TS due to complete tracheal rings in a trisomy 21 patient with CHD and the challenges in the management.
- Kylat, R. I., & Samson, R. A. (2019). Permanent junctional reciprocating tachycardia in infants and Children. Journal of arrhythmia, 35(3), 494-498.More infoPermanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate treatment is started early in the course, the failure can be ameliorated, and the cardiomyopathy can be resolved.
- Kylat, R. I., Witte, M. H., Barber, B. J., Dori, Y., & Ghishan, F. K. (2019). Resolution of Protein-Losing Enteropathy after Congenital Heart Disease Repair by Selective Lymphatic Embolization. Pediatric gastroenterology, hepatology & nutrition, 22(6), 594-600.More infoWith improving survival of children with complex congenital heart disease (CCHD), postoperative complications, like protein-losing enteropathy (PLE) are increasingly encountered. A 3-year-old girl with surgically corrected CCHD (ventricular inversion/L-transposition of the great arteries, ventricular septal defect, pulmonary atresia, post-double switch procedure [Rastelli and Glenn]) developed chylothoraces. She was treated with pleurodesis, thoracic duct ligation and subsequently developed chylous ascites and PLE (serum albumin ≤0.9 g/dL) and was malnourished, despite nutritional rehabilitation. Lymphangioscintigraphy/single-photon emission computed tomography showed lymphatic obstruction at the cisterna chyli level. A segmental chyle leak and chylous lymphangiectasia were confirmed by gastrointestinal endoscopy, magnetic resonance (MR) enterography, and MR lymphangiography. Selective glue embolization of leaking intestinal lymphatic trunks led to prompt reversal of PLE. Serum albumin level and weight gain markedly improved and have been maintained for over 3 years. Selective interventional embolization reversed this devastating lymphatic complication of surgically corrected CCHD.
- Witte, M. H., Erickson, R. P., Georgieva, T., Simon, A. M., Kanady, J. D., Myles, R., Bernas, M. J., Mustacich, D., & Kylathu, R. (2019). Lymphatic Anomalies in Mice Expressing a Connexin47 Point Mutation. 27th World Congress of Lymphology Abstract Booklet.
- Witte, M. H., Mustacich, D., Moedano, L., Behan, S., Bernas, M. J., Klewer, S. E., Barber, B. J., Kuo, P. H., & Kylathu, R. (2019). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Lymphatic Congestion after Surgical Repair of Complex Congenital Heart Disease. 27th World Congress of Lymphology Abstract Booklet.
- Kylat, R. I. (2018). 22q11.2 Microduplication: An Enigmatic Genetic Disorder. Journal of pediatric genetics, 7(3), 138-142.More infoMicroduplication of 22q11.2 involves having an extra copy at position q11.2 on chromosome 22. Very few cases have been reported but the real incidence may be higher as the absence of obvious clinical signs makes diagnosis difficult. In the cases that are diagnosed, the phenotype is extremely variable. We describe a case of severe micrognathia, cleft palate, and Pierre-Robin sequence. A prenatal ultrasound showed severe micrognathia and subsequent microarray done on amniocentesis revealed the microduplication of 22q11.2, which was confirmed postnatally. Although micrognathia has often been detected in this microduplication, the constellation of these findings has not been previously described.
- Kylat, R. I. (2018). Pleuro-pericardial communication due to pigtail catheters in extreme preterm infants: Diagnosis and intervention. Journal of neonatal-perinatal medicine, 11(1), 93-96.More infoPneumothorax in preterm infants is associated with an increased risk of chronic lung disease, intraventricular hemorrhage and mortality. In mechanically ventilated preterm infants, for the management of tension pneumothorax if needle aspiration is not successful a thoracostomy is needed. In the last two decades management of tension pneumothorax has changed from the use of traditional chest tubes to percutaneous pigtail catheter thoracostomy (PPCT) as the most commonly used technique. When compared to placement of traditional chest tubes, PPCT is touted as being faster requiring, less analgesia and less training for proficiency and having fewer complications. There are only infrequent reports of complications with this procedure. Here, a rare complication, which previously has only been reported at autopsy, is described in an extreme preterm with prompt diagnosis and early management.
- Kylathu, R., Addams, J., & Sobonya, R. E. (2018). Fatal disseminated herpes simplex in a very premature neonate. Autopsy Case Reports, 8(4). doi:10.4322/acr.2018.050
- Bader, M., Kurland, Y., Barber, B. J., Bedrick, A. D., Johnson, D., & Kylat, R. I. (2017). Intravenous Immunoglobulin for congenital Parvovirus myocarditis. Journal of Pediatric Infectious diseases. doi:10.1055/s-0037-1620249
- Bader, M., Kylathu, R., Johnson, D., Kurland, Y., Barber, B. J., Bedrick, A. D., Bedrick, A. D., Barber, B. J., Kurland, Y., Johnson, D., Kylathu, R., & Bader, M. (2017). Intravenous Immunoglobulin for congenital Parvovirus myocarditis. Journal of Pediatric Infectious diseases.
- Desoky, S. M., Gilbertson-Dahdal, D., Kylat, R. I., Udayasankar, U., Udayasankar, U., Kylat, R. I., Gilbertson-Dahdal, D., & Desoky, S. M. (2017). Managing Neonatal Bowel Obstruction: Clinical Perspectives. Research and Reports in Neonatology, 8, 19-32. doi:10.2147/RRN.S125760
- Kurland, Y., Kylathu, R. I., Desoky, S. M., & Bader, M. (2017). Spontaneous Resolution of Choledochal Cyst. Journal of Clinical Neonatology, 2(112-5), 6. doi:10.4103/jcn.JCN_108_16More infoCase report for patient with spontaneous resolution of a choledochal cyst
- Kylat, R. (2017). Neonatal testicular torsion: Is it time for consensus?. Journal of Clinical Neonatology, 6(2), 53-56. doi:10.4103/jcn.JCN_124_16
- Kylat, R. I. (2017). Achondroplasia and Biliary Atresia: A Rare Association and Review of Literature. Journal of pediatric genetics, 6(2), 122-125. doi:10.1055/s-0036-1597930More infoAchondroplasia (ACH) occurs in most cases as de novo mutations of the gene-encoding fibroblast growth factor receptor 3 (FGFR3). Biliary atresia (BA) is a progressive neonatal inflammatory and fibro-obliterative cholangiopathy affecting the extra- and intrahepatic biliary tree to varying degrees, and it results in obstruction to bile flow and cholestatic jaundice in neonates. BA is thought to be a multifactorial disease, genome association studies have shown abnormalities in susceptibility genes, and levels of fibroblast growth factor 21 (FGF21) and fibroblast growth factor 23 (FGF23) have been noted to be increased. These two conditions occurring in the same patient has never been reported before.
- Kylat, R. I. (2017). Internal Hernia Masquerading As Necrotizing Enterocolitis. Frontiers in pediatrics, 5, 225. doi:10.3389/fped.2017.00225More infoIn extremely preterm infants, acute abdominal emergencies are fortunately less common with improving care. Spontaneous intestinal perforation and necrotizing enterocolitis are conditions where emergency surgery is most often needed. Conservative medical management and placement of temporary drain are often used in the initial management. Internal hernia (IH) is an uncommon cause of bowel obstruction in neonates, is difficult to diagnose and unfortunately are found only at autopsy. The presentation in preterm infants, distinction between these conditions, and the need for early diagnosis of IH are discussed.
- Kylat, R. I. (2017). What Is the Teratogenic Risk of Mycophenolate?. Journal of pediatric genetics, 6(2), 111-114. doi:10.1055/s-0036-1597933More infoMycophenolate is often used in the management of systemic lupus erythematosus. It has often been associated with significant fetal embryopathy, including fetal loss and multiple anomalies. The Food and Drug Administration has directed that women should be counseled regarding this prior to initiating treatment with this drug. Isolated total anomalous pulmonary venous return (TAPVR) is a rare association seen with its use in pregnancy.
- Kylat, R. I., Kuo, P. H., Bedrick, A. D., & Witte, M. H. (2017). Neonatal Lymphedema from Thoracic Duct Obstruction Complicating Percutaneous Intravenous Central Catheterization. Lymphology, 50(2), 67-72.More infoPercutaneous intravenous central catheter (PICC) complications are not common and generalized edema and anasarca in neonates as a complication of PICC malposition is even rarer. Documentation of the pathomechanisms of lymphedema in cases of severe anasarca in neonates is not often done. Here we document thoracic duct obstruction as the cause of lymphedema in a neonate with severe nonpitting generalized edema. Most PICC procedures should ideally be guided by point-of-care bedside ultrasound (US), and this precaution may prevent malposition of PICC lines although it will not detect subsequent migration or extravasation.
- Kylat, R. I., Senguttuvan, R., & Bader, M. Y. (2017). Personalized precision medicine in extreme preterm infants with transient neonatal diabetes mellitus. Journal of Pediatric Endocrinology & Metabolism : JPEM, 30(5), 593-6. doi:doi: 10.1515/jpem-2016-0261More infoAlthough hyperglycemia is common in neonates, especially preterm infants, a diagnosis of neonatal diabetes mellitus (NDM) is rarely made. NDM can be permanent (45%), transient (45%) or syndromic (10%). Of the 95% of identifiable mutations for NDM, methylation defects in 6q24, KCNJ11, ABCC8, and INS account for the majority. Two cases of transient NDM in extremely preterm, 24 weeks' gestational age (GA) triplets, due to a missense mutation c.685G>A in the KCNJ11 gene are presented. Both patients were successfully transitioned from insulin to Glyburide (Glibenclamide) at 2 months of age. Comprehensive genetic testing with targeted next-generation sequencing and 6q24 methylation analysis helps identify monogenic diabetes early, thereby improving metabolic and glycemic control when patients with potassium channel mutations are started on sulfonylurea (SU) treatment.
- Kylathu, R. (2017). Aminophylline Associated Hyponatremia in a Premature Infant. Journal of Clinical neonatology, 6(4), 259-61. doi:10.4103/jcn.JCN_1_17
- Kylat, R. I., Bartholomew, A., Cramer, N., & Bader, M. Y. (2016). Neonatal listeriosis: Uncommon or misdiagnosed?. Journal of neonatal-perinatal medicine, 9(3), 313-6. doi:10.3233/NPM-16915121More infoListeriosis is an uncommon foodborne infection. Perinatal listeriosis is underestimated due the number of undiagnosed still births. It can cause prematurity and neonatal listeriosis (NL) has the potential to be misdiagnosed. NL has a significant mortality and neurological sequelae. The recent outbreaks reinforce the need for better surveillance and targeted health education in certain population groups especially during pregnancy.
- Bader, M., Bader, M., Kylathu, R., Kurland, Y., Johnson, D., Kurland, Y., Barber, B. J., Barber, B. J., Bedrick, A. D., Bedrick, A. D., Bedrick, A. D., Barber, B. J., Johnson, D., Kurland, Y., Johnson, D., Kylathu, R., Kylat, R. I., & Bader, M. (2017). Intravenous Immunoglobulin for congenital Parvovirus myocarditis. Journal of Pediatric Infectious diseases. doi:10.1055/s-0037-1620249
- Kylat, R. I., & Ohlsson, A. (2012). Recombinant human activated protein C for severe sepsis in neonates. The Cochrane database of systematic reviews, 18(4), CD005385. doi:10.1002/14651858.CD005385.pub3More infoSepsis is a common problem in preterm and term infants. The incidence of neonatal sepsis has declined, but mortality remains high. Recombinant human activated protein C (rhAPC) possess a broad spectrum of activity modulating coagulation and inflammation. In septic adults it may reduce mortality, but no significant benefit has been reported in children with severe sepsis.
- Marquez, J., Gedalia, O., Candia, L., Ranjit, K., Hescock, G. C., Espinoza, L. R., Stopa, A. R., & Gedalia, A. (2008). Kawasaki disease: clinical spectrum of 88 patients in a high-prevalence African-American population. Journal of the National Medical Association, 100(1), 28-32.More infoKawasaki disease (KD) is a systemic vasculitis that predominantly affects infants and young children. Asian race has been described as an important factor for the development of this disease. We reported our experience in a cohort of patients with KD. Clinical and laboratory data from initial presentation and follow-up visits were reviewed in 88 patients with KD treated at Children's Hospital of New Orleans between March 1993 and November 2004. Forty-nine (56%) patients were African American, 35 (40%) Caucasian, two (3%) Asian and two (3%) Hispanic. Coronary artery aneurysms (CAAs) were detected in 15 (17%) patients. CAAs were less frequent in African-American patients compared to Caucasians [relative risk (RR)=0.2, 95% CI: 0.04400-0.8405, p=0.0164]. Eighty-three patients responded to one dose of intravenous human immunoglobulin (IVIG), five patients responded to a second infusion of IVIG, and two who were IVIG resistant responded only following methylprednisolone pulse. Hemoglobin (Hb) levels of
- Kylat, R. I., & Ohlsson, A. (2006). Recombinant human activated protein C for severe sepsis in neonates. The Cochrane database of systematic reviews, CD005385.More infoSepsis is a common problem in both preterm and term infants. Although the overall incidence of neonatal sepsis has declined over the past decade, mortality remains high. Recombinant human activated protein C (rhAPC) has been shown to possess a broad spectrum of activity modulating coagulation and has been shown in septic adults to reduce mortality. In septic children, an open label study has shown similar pharmacokinetics, adverse reaction profile and frequency as in adults with severe sepsis.
- Kylat, R. I., Kelly, E. N., & Ford-Jones, E. L. (2006). Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. European journal of pediatrics, 165(11), 773-8. doi:10.1007/s00431-006-0172-6More infoCongenital cytomegalovirus (CCMV) infection is a common neonatal infection affecting 1% of all live births, 10% of which are symptomatic. Many of these infants have long-term sequelae. The objective is to document the clinical presentation of SCCMV infection in neonates, the frequency of sequelae and severity of adverse neurologic outcomes and risk factors.
- Kylat, R., & Ohlson, A. (2006). Recombinant human activated protein C for severe sepsis in neonates. Cochrane Database Syst Rev, 19(2). doi:10.1002/14651858.CD005385.pub2
- Klewer, S. E., Seckeler, M., Witte, M. H., Kylathu, R., & Myles, R. (2019, September). The "Failing Fontan" Challenge to the Cardiolymphologist: Case Analysis. 27th World Congress of Lymphology. Buenos Aires and Iguazu, Argentina: International Society of Lymphology.
- Witte, M. H., Erickson, R. P., Georgieva, T., Simon, A. M., Kanady, J. D., Myles, R., Bernas, M. J., Mustacich, D., & Kylathu, R. (2019, September). Lymphatic Anomalies in Mice Expressing a Connexin47 Point Mutation. 27th World Congress of Lymphology. Buenos Aires and Iguazu, Argentina: International Society of Lymphology.
- Witte, M. H., Mustacich, D., Moedano, L., Behan, S., Bernas, M. J., Klewer, S. E., Barber, B. J., Kuo, P. H., & Kylathu, R. (2019, September). Whole Body Lymphangioscintigraphy and SPECT-CT in Infants and Children with Lymphatic Congestion after Surgical Repair of Complex Congenital Heart Disease. 27th World Congress of Lymphology. Buenos Aires and Iguazu, Argentina: International Society of Lymphology.
- Kylathu, R. I. (2018, October). The phenotype of a CRISPR mouse model of a human Gap Junction C2 (connexin 47) mutant causing lymphedema.. American Society For Human genetics. san Diego.
- Kylathu, R. (2017, May). Congenital Lobar emphysema Intervention Decision in infant with complex congenital heart disease. ATS 2017. Washington.
- Kylathu, R. (2017, May). Congenital heart disease associated Trisomy 21 with complete tracheal rings. American Thoracic society. Washington: ATS Pulmonary critical care.
- Kylat, R., & Haughey, B. (2017, 03/2017). Parenchymal disorder of the lung in the setting of complex congenital heart disease.. NeoHeart 2017. San Diego.
- Kylat, R., & Haughey, B. (2017, 03/2017). Structural Airway Malformation in Congenital Heart Disease Associated with Trisomy 21. NeoHeart International Conference. San Diego.