Alan M. Fujii, MD

Clinical Professor, Pediatrics

Alan Fujii
617.414.3735

Biography

My research focused on the importance of maturation on the development of compensatory pressure overload left ventricular hypertrophy (LVH). Neonatal lambs and adult sheep had LVH induced by surgical placement of a supracoronary aortic band. Mathematical models of left ventricular geometry and function were utilized to assess myocardial systolic and diastolic function. LVH in lambs is similar to the physiologic hypertrophy of normal growth with “hyperdyanamic” function (partially an artifact of geometry), normal subendomyocardial perfusion and capillary density, and normal calcium handling proteins. LVH in sheep is associated with a gradual depression in myocardial systolic function, decreased subendomyocardial perfusion and capillary density and depressed myocyte calcium handling proteins. Subendomyocardial perfusion and density may be increased with heparin (an angiogenesis factor) during the development of hypertrophy. These data help explain the relative tolerance pediatric hearts to LVH, when compared to adults. We published reviews of our findings (Fujii AM. Left ventricular function in congenital heart disease. Semin Perinatol 1992; 16:147-154 and Donato RM, Fujii AM, Jonas RA, Castaneda AR. Age-dependent ventricular response to pressure overload. Considerations for the arterial switch operation. J Thorac Cardiovasc Surg 1992;104:713-722).

The opportunity to study cerebral perfusion and oxygen delivery in piglets using a new Near Infra-Red Spectroscopy unit resulted in publication of two papers. I continue to investigate strategies to reduce morbidity and improve management in extremely premature infants. We have explored different strategies for the management of PDA. These strategies include early vs. late administration of indomethacin (paper published). We monitored prevalence of RSV antigen in all the babies in the NICU for over a decade, in collaboration with the Pediatric Infectious Disease division. This study resulted in a published manuscript. The AVIOX study (Data Coordinating Center was New England Medical Center) which compared the actual vs. intended oxygen saturation maintained in different NICU’s in infants less than 28 weeks gestation at birth during the first month of life. The AVIOX study was designed to document baseline practices in oxygen management, in anticipation of an intervention study to prevent Retinopathy of Prematurity (POST-ROP) and resulted in a published manuscript. We completed an industry sponsored multi-centered study (2004-10) investigating the impact of the surfactants Curosurf (poractant) and Survanta (Beractant) on the mortality and morbidity in very premature infants <29 weeks gestation at birth in which I am the PI, resulting in two publications. A study of whether or not to continue feeding in patients with PDA’s being medically treated (multicenter collaborative study, Ronald Clyman, UCSF PI) was completed and resulted in two published manuscripts. I am currently working with the Biomedical Engineering Department at Boston University to create biomedical devices that will be useful in the care of infants delivered at Boston Medical Center. Clinical management of the NICU at Boston Medical Center (BMC) has been my primary occupation for the past 7-10 years. During this time, End tidal CO2 detectors to document adequacy of endotracheal intubation were introduced into the NICU and made the standard of care, as is currently the case with anesthesiologists in the OR. State of the art high frequency oscillatory (SensorMedics 3100A) and JET (Bunnell Life Pulse) ventilators were purchased to replace antiquated Infant Star high frequency ventilators. More recently I have brought in the Drager Evita Ventilator, Bubble CPAP, Nitric Oxide (INO-Vent, 2002), and the Cool Cap (Cerebral Cooling, 2008. I assisted in providing the initial and on-going in-service training for the utilization of these machines. Echocardiography skills were acquired and used not only to facilitate management of patent ductus arteriosus in micropremies and rule out congenital heart disease, but also as a tool to assess the cardiovascular physiology of the sick neonate. Percutaneous central venous catheter (PICC-CVL) placement was introduced into the NICU. A modified Seldinger technique was used to place over 100 CVL’s (98% success) in extremely infants and has been compared to surgically placed Broviac CVL’s. Percutaneous placement of PICC lines has been taught to a select group of NICU nurses who will place these catheters in infants in need of central venous catheters, under the supervision of a neonatologist.

Education

  • University of California, Los Angeles, MD
  • University of California, Davis, BS

Publications

  • Published on 12/29/2015

    Al-Rabadi L, Ayalon R, Bonegio RG, Ballard JE, Fujii AM, Henderson JM, Salant DJ, Beck LH. Pregnancy in a Patient With Primary Membranous Nephropathy and Circulating Anti-PLA2R Antibodies: A Case Report. Am J Kidney Dis. 2016 May; 67(5):775-8. PMID: 26744127.

    Read at: PubMed
  • Published on 4/23/2015

    Sinha B, Castro-Aragon I, Wachman EM, Fujii AM, Levesque BM. Hypo-pharyngeal distension in an extremely low birth weight preterm infant. Arch Dis Child Fetal Neonatal Ed. 2015 Nov; 100(6):F500. PMID: 25907255.

    Read at: PubMed
  • Published on 4/2/2015

    Peluso AM, Harnish BA, Miller NS, Cooper ER, Fujii AM. Effect of young sibling visitation on respiratory syncytial virus activity in a NICU. J Perinatol. 2015 Aug; 35(8):627-30. PMID: 25836315.

    Read at: PubMed
  • Published on 2/27/2014

    Scott MV, Fujii AM, Behrman RH, Dillon JE. Diagnostic ionizing radiation exposure in premature patients. J Perinatol. 2014 May; 34(5):392-5. PMID: 24577436.

    Read at: PubMed
  • Published on 12/8/2013

    Yanowitz TD, Reese J, Gillam-Krakauer M, Cochran CM, Jegatheesan P, Lau J, Tran VT, Walsh M, Carey WA, Fujii A, Fabio A, Clyman R. Superior mesenteric artery blood flow velocities following medical treatment of a patent ductus arteriosus. J Pediatr. 2014 Mar; 164(3):661-3. PMID: 24321538.

    Read at: PubMed
  • Published on 3/6/2013

    Clyman R, Wickremasinghe A, Jhaveri N, Hassinger DC, Attridge JT, Sanocka U, Polin R, Gillam-Krakauer M, Reese J, Mammel M, Couser R, Mulrooney N, Yanowitz TD, Derrick M, Jegatheesan P, Walsh M, Fujii A, Porta N, Carey WA, Swanson JR. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr. 2013 Aug; 163(2):406-11. PMID: 23472765.

    Read at: PubMed
  • Published on 1/31/2012

    Sinha B, Mirochnick MH, Kumar S, Fujii AM. Targeted echocardiography in the neonatal intensive care unit. J Am Soc Echocardiogr. 2012 Mar; 25(3):361; author reply 361-2. PMID: 22297083.

    Read at: PubMed
  • Published on 3/25/2010

    Fujii AM, Patel SM, Allen R, Doros G, Guo CY, Testa S. Poractant alfa and beractant treatment of very premature infants with respiratory distress syndrome. J Perinatol. 2010 Oct; 30(10):665-70. PMID: 20336076.

    Read at: PubMed
  • Published on 3/25/2010

    Fujii A, Allen R, Doros G, O'Brien S. Patent ductus arteriosus hemodynamics in very premature infants treated with poractant alfa or beractant for respiratory distress syndrome. J Perinatol. 2010 Oct; 30(10):671-6. PMID: 20336077.

    Read at: PubMed
  • Published on 9/1/2009

    Fujii AM, Carillo M. Animal-derived surfactant treatment of respiratory distress syndrome in premature neonates: a review. Drugs Today (Barc). 2009 Sep; 45(9):697-709. PMID: 19956811.

    Read at: PubMed

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