Elizabeth E. Foglia

University of Pennsylvania · Rehabilitation Medicine

Active 1992–2026

h-index38

Citations5.3k

Papers201104 last 5y

Funding$1.3M

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About

Elizabeth E. Foglia, MD, MSCE, is an Associate Professor of Pediatrics specializing in Neonatology and Newborn Services at the Children's Hospital of Philadelphia. She also serves as an Attending Physician in the Division of Neonatology at both the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania. Dr. Foglia is the Director of Neonatal Resuscitation and Simulation at the Hospital of the University of Pennsylvania and is an Associate Scholar at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania. Her educational background includes a B.S. in Biological Sciences from the University of Notre Dame, an M.A. and M.D. from Washington University School of Medicine in St. Louis, and an M.S.C.E. in Clinical Epidemiology from the University of Pennsylvania. Her research and clinical interests focus on neonatal care, with contributions to understanding ventilator-associated pneumonia in neonatal and pediatric intensive care patients, as well as the impact of nosocomial infections caused by antibiotic-resistant organisms on patient outcomes.

Research topics

Emergency medicine
Medicine
Medical emergency
Intensive care medicine
Anesthesia
Internal medicine
Pediatrics
Psychology

Selected publications

Noninvasive optical monitoring of cerebral hemodynamics immediately after birth in neonates with congenital heart disease
Resuscitation Plus · 2026-02-13
articleOpen access
Objective: Critical congenital heart disease is associated with altered cerebral hemodynamics in the neonatal period, but the effect on cerebral physiology earlier in life during the fetal to neonatal transition period is yet to be elucidated. This period of neonatal resuscitation could represent an opportunity for intervention, so we aimed to characterize cerebral hemodynamics immediately after birth in four neonates with critical congenital heart disease using noninvasive optical monitoring. Methods: This case series analysis included term neonates with hypoplastic left heart syndrome or with transposition of the great arteries who were born at Children’s Hospital of Philadelphia. Continuous measurements of cerebral blood flow, cerebral tissue oxygen saturation, and cerebral metabolic rate of oxygen were acquired non-invasively during the first hour after birth with near-infrared spectroscopy, frequency-domain diffuse optical spectroscopy, and diffuse correlation spectroscopy techniques. Results: In all four newborns, cerebral tissue oxygen saturation was lower than reference values in the literature. Additionally, we observed decreases in cerebral blood flow and oxygen metabolism during postnatal transition that were not reflected by standard of care metrics such as peripheral oxygen saturation. The decreases were spontaneous in infants with hypoplastic left heart syndrome and temporally associated with invasive respiratory support in infants with transposition of the great arteries. Conclusion: This case series demonstrates periods of possible neurological vulnerability during postnatal transition in critical congenital heart disease and motivates further study of cerebral physiology during the transition period using advanced optical techniques.
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Exception from Informed Consent in Neonatal Research
The Journal of Pediatrics · 2026-01-16
article
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Procedural Outcomes of Minimally Invasive Surfactant Therapy: An International Matched Cohort Study
The Journal of Pediatrics · 2026-02-18
articleSenior author
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Impact of attending neonatologist presence on neonatal intubation success and adverse events: a cohort study
Journal of Perinatology · 2026-01-27
articleOpen access
OBJECTIVE: To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events. STUDY DESIGN: Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014-December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes. RESULTS: Among 12,652 intubation encounters, attendings were present for 8391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with higher first attempt intubation success (OR 1.11, 95% CI 1.04-1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70-0.86) and intubation requiring ≥3 intubation attempts (aOR 1.39, 95% CI 1.21-1.60). CONCLUSION: After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.
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Tactile Stimulation and Newborn Heart Rate Responses in the Delivery Room: An Observational Video Study
Resuscitation · 2026-05-01
articleOpen access
AIMS: Newborn resuscitation guidelines recommend stimulation as a first step in non-breathing newborns to facilitate spontaneous breathing. We aimed to evaluate the extent of stimulation in the delivery room, heart rate (HR) responses to stimulation, and association between bradycardia (HR <100 beats per minute (bpm) ≥10 seconds) in the first minute after birth and the need for positive pressure ventilation (PPV) versus stimulation alone. METHOD: A prospective observational study conducted at tertiary level Stavanger University Hospital, Norway, September 2022 - July 2024 including newborns with gestational age ≥34 weeks. Stimulation was registered from thermal videos in the delivery room and visible light cameras over resuscitaires. HR was obtained using dry-electrode ECG. RESULTS: 449 included newborns had thermal videos ± visible light video and HR data. 70/449 (16%) newborns did not receive any resuscitative interventions, 345/449 (77%) received stimulation alone, 14/449 (3.1%) received continuous positive airway pressure, and 20/449 (4.4%) received PPV. We observed a HR increase of median 7 bpm among newborns with HR <140 bpm at start stimulation (p<0.001). Newborns with bradycardia in the first minute after birth had four-fold likelihood of requiring PPV versus tactile stimulation alone. (OR 4.81 95% CI 1.39-15.3, p=0.009). CONCLUSION: Tactile stimulation is widely applied during neonatal transition. We observed an increase in HR in relation to tactile stimulation, especially among newborns with HR <140 bpm at start stimulation. Newborns with bradycardia (HR <100 bpm ≥10 seconds) in the first minute after birth had a four-fold likelihood of requiring PPV versus tactile stimulation alone.
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Flow disruptions during delivery room intubation of neonates with congenital diaphragmatic hernia
Resuscitation · 2025-09-05
articleSenior author
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Ten steps to improve outcomes of in-facility neonatal resuscitation
Resuscitation · 2025-07-31 · 3 citations
articleOpen access1st authorCorresponding
BACKGROUND: Up to 10 % of all newborns require assistance to breathe at birth. Although neonatal resuscitation guidelines and educational platforms exist, best practices to implement high-quality neonatal resuscitation care have not been defined. AIM: To establish a Neonatal Global Resuscitation Alliance and develop ten steps to improve outcomes of in-facility neonatal resuscitation across global settings. METHODS: Three-stage iterative consensus-based process: (1) invited input from the neonatal resuscitation community to identify pertinent measures, (2) convened a face-to-face meeting of 28 global neonatal resuscitation content experts to refine consensus steps, (3) presented draft steps and related content to stakeholders; solicited public comment and revised ten steps based on feedback. RESULTS: The consensus-based ten steps include: Implement effective education systems; Ensure team and equipment readiness; Identify high-risk pregnancies and prevent perinatal risks; Respond to every birth; Perform guideline based resuscitation; Deliver guideline based post-resuscitation care; Collect data throughout resuscitation care; Improve quality of resuscitation; Support parent and family well-being; Cultivate a culture of excellence. For each of these steps, key concepts and suggested approaches to put the steps into practice are identified. CONCLUSION: These ten steps to improve outcomes of in-facility neonatal resuscitation represent a clear framework for healthcare professionals, institutions, and policymakers to evaluate and strengthen their readiness, training, and response to newborns who need resuscitation at birth. This consensus-based guidance can be used to optimize in-facility neonatal resuscitation and improve outcomes for newborns worldwide.
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Impact of attending neonatologist presence on neonatal intubation success and adverse events: a cohort study
Research Square · 2025-10-15
preprintOpen accessSenior author
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Respiratory Targets Associated With Lung Aeration During Delivery Room Resuscitation of Preterm Neonates
JAMA Pediatrics · 2025-08-11 · 2 citations
articleOpen accessSenior author
Importance: Effective lung aeration is crucial for successful postnatal transition. Goal targets to achieve lung aeration during positive pressure ventilation have not been established for preterm neonates. Objective: To identify respiratory parameters associated with successful lung aeration during delivery room resuscitation. Design, Setting, and Participants: This multicenter prospective cohort study was conducted from March 2016 to April 2021. The primary population included preterm neonates from 3 centers of 22 weeks to 31 weeks 6 days' gestation with bradycardia who received positive pressure ventilation during resuscitation after birth. An independent population of preterm neonates (24 weeks to 27 weeks 6 days' gestation) in the multicenter Monitoring Neonatal Resuscitation randomized clinical trial served as a confirmatory dataset. Data were analyzed January 2022 to May 2025. Exposures: Rolling means of pressure, inspiratory and expiratory tidal volumes (VTE), and mask leak, as measured with a respiratory function monitor (RFM). Counts of spontaneous breaths between inflations and mask removal instances. Main Outcomes and Measures: The primary outcome was a sustained increase in heart rate to at least 100 beats per minute, indicating effective lung aeration, within the first 10 minutes of resuscitation. Associations between clinical covariates, respiratory parameters, and heart rate increase were examined using cause-specific Cox proportional hazards regression models. Results: There were 132 neonates in the primary dataset (median [IQR] gestation, 26.6 [25.1-29.2] weeks; 67 [50.8%] male) and 115 in the confirmatory dataset (median [IQR] gestation, 26.7 [25.6-27.4] weeks; 65 [56.5%] male). Of 132 primary dataset participants, 125 (94.7%) achieved the primary outcome. Among the measured respiratory parameters, only VTE was associated with an increase in heart rate (adjusted hazard ratio [AHR], 1.10 [95% CI, 1.01-1.20]). The AHR was higher for increases in VTE up to 4 mL/kg (AHR, 1.55 [95% CI, 1.20-2.00]) than for VTEs higher than 4 mL/kg (AHR, 1.04 [95% CI, 0.98-1.10]). These results were consistent with those in the confirmatory dataset: an association for an increase in heart rate with VTE values up to 4 mL/kg (AHR, 1.31 [95% CI, 1.01-1.70]) but not higher than 4 mL/kg (AHR, 1.02 [95% CI, 0.96-1.08]). Other covariates associated with an increase in heart rate included birth weight (per 100 g) (AHR, 1.12 [95% CI, 1.05-1.20]) and mask removal count (AHR, 0.83 [95% CI, 0.70-0.98]). Conclusions and Relevance: This cohort study observed in one neonatal population and confirmed in another that a minimum VTE of 4 mL/kg was associated with successful lung aeration as assessed by an increase in heart rate to at least 100 beats per minute during preterm neonate resuscitation. These results may inform future studies to determine the clinical impact of incorporating data-based targets for delivery room resuscitation of preterm neonates.
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Success and safety of neonatal endotracheal tube exchanges: a NEAR4NEOS multicentre retrospective cohort study
Archives of Disease in Childhood Fetal & Neonatal · 2025-02-08 · 5 citations
article
OBJECTIVES: To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes. DESIGN: Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes. RESULTS: A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%-31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication. CONCLUSION: Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.
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