About

Dr. Onajovwe O. Fofah is the Medical Director of the Neonatal Intensive Care Unit and Newborn Services at University Hospital in Newark and serves as an Assistant Professor in the Department of Pediatrics at Rutgers New Jersey Medical School. He is Board Certified by the American Board of Pediatrics in General Pediatrics and Neonatal-Perinatal Medicine. Dr. Fofah graduated from the University of Ilorin Medical School in Nigeria in June 1984 and moved to the USA in 1991, where he trained in Pediatrics at UMDNJ-NJMS and Children Hospital of NJ from 1992 through 1995. He completed a Fellowship in Neonatal Medicine at the Albert Einstein College of Medicine/Montefiore Medical Center from 1995 through 1998. His professional experience includes practicing as an Attending Neonatologist at the Illinois Northwest Regional Perinatal Center from 1998 through 2005, where he was involved with the Vermont Oxford Network quality collaborative initiative and was recognized as one of the best doctors in Northwest Illinois. He joined Rutgers New Jersey Medical School in October 2005. Dr. Fofah is a member of several professional organizations, including the American Academy of Pediatrics, the American Academy of Palliative and Hospice Medicine, the NJ consortium of Palliative Care, and the NICU consortium of NJ. His academic and clinical contributions include submitting abstracts, publishing papers, and writing chapters in his field.

Research topics

• Medicine
• Surgery
• Internal medicine
• Pediatrics
• Anesthesia
• Pharmacology
• Pathology
• Obstetrics

Selected publications

• Composite Scoring and the Natural Course of Post-Hemorrhagic Ventricular Dilation in Neonates with Severe Intraventricular Hemorrhage

  Research Square · 2026-01-29

  preprintOpen accessSenior author
  PublisherOA PDFDOI

• Isolated, severe cerebellar hypoplasia and microcephaly secondary to congenital cytomegalovirus infection in a late preterm neonate

  BMJ Case Reports · 2025-01-01

  articleSenior author

  This case report presents a late preterm infant diagnosed with severe cerebellar hypoplasia and microcephaly secondary to congenital cytomegalovirus (cCMV) infection. Initially suspected to have Dandy-Walker malformation, postnatal MRI revealed significant cerebellar hypoplasia, without other typical cCMV findings. The diagnosis was confirmed by the presence of CMV in serum and urine. The patient was started on valganciclovir for 6 months, and despite the significant cerebellar hypoplasia, the clinical course was benign, with normal respiratory and feeding functions. Physical examination showed microcephaly, hypotonia and partial bilateral hearing loss. Follow-up showed persistent hypotonia but normal developmental progression otherwise. This case is notable for isolated cerebellar hypoplasia without other common cCMV-related radiological abnormalities, highlighting the need for further exploration into the atypical presentations of cCMV.

  PublisherDOI

• A Newborn Infant with Hand Nodule Following Intravenous Extravasation

  NeoReviews · 2022 · 1 citations

  • Medicine
  • Anesthesia
  • Pathology

  A male infant is born at 39 weeks and 5 days of gestation to a 22-year-old primigravida via spontaneous vaginal delivery. The labor course is complicated by premature rupture of membranes (ROM) for 22 hours, preeclampsia, and non-reassuring fetal heart rate. The mother receives azithromycin, cefazolin, and penicillin G for prolonged ROM. The infant’s birthweight is 3,240 g (41st percentile), length 48.3 cm (20th percentile), and head circumference 34 cm (36th percentile). His Apgar scores are 9 and 9 at 1 and 5 minutes, respectively. The infant is initially admitted to the well newborn nursery. Within the first hour after birth, he begins to show signs of respiratory distress with grunting, nasal flaring, and retractions. He is transferred to the NICU for further management. NICU and admission vital signs are as follows: temperature 99.1°F (37.2°C), heart rate 178 beats/min, respiratory rate 48 breaths/min, and oxygen saturation 89% in room air.In the NICU, the infant is given continuous positive airway pressure of +5, requiring 25% fraction of inspired oxygen to maintain normal oxygen saturations. A partial sepsis evaluation is initiated and the infant is started on ampicillin and gentamicin. Blood culture, complete blood cell count, and C-reactive protein measurements are obtained. The infant is initially made nil per os and intravenous fluids are started with D10W at 60 mL/kg per day. Respiratory distress resolves on day 1 after birth and the infant makes a successful transition to room air. Intravenous fluids are weaned as the infant is successfully advanced to full enteral feeds. Chemistry findings on day 1 after birth are significant for a serum calcium level of 7.1 mg/dL (1.77 mmol/L). Repeat chemistry on day 2 shows further decrease of serum calcium to 6.3 mg/dL (1.57 mmol/L) for which he receives calcium gluconate 200 mg/kg via peripheral intravenous catheter in the left hand. On completion of the infusion, the insertion site is noted to have a 1 × 1 cm area of white discoloration and swelling. Hyaluronidase is administered subcutaneously to the site. Plastic surgery and wound care services are consulted and recommendations are made for hand elevation, and bacitracin and xeroform gauze are applied to the site.Repeat calcium levels improve to 7.3 mg/dL (1.82 mmol/L) on day 3 and 7.5 mg/dL (1.88 mmol/L) on day 4, with a phosphorus level of 8.1 mg/dL (2.62 mmol/L; high), magnesium of 1.6 mg/dL (0.66 mmol/L; normal), and 25-hydroxyvitamin D of 8.4 ng/mL (21 nmol/L; low). Pediatric endocrinology is consulted at this point. The etiology of the hypocalcemia and low vitamin D level is determined to be secondary to low maternal stores and the infant is subsequently started on 1,600 IU of ergocalciferol by mouth once daily.The extravasation lesion on the dorsum of the left hand progresses to blanching erythema with swelling extending from the dorsum of the hand to the forearm by day 6 after birth. An initial radiograph of the left upper extremity shows normal soft tissue with no bony abnormalities (Fig 1). On day 9, the soft tissue swelling becomes indurated and tender to touch concerning for cellulitis. Due to the rapid progression of the cellulitis, a sepsis evaluation including a lumbar puncture is performed. The infant is started on vancomycin and cefepime for cellulitis with methicillin-resistant Staphylococcus aureus coverage for 10 days. The cerebrospinal fluid culture is negative, and parameters are within normal limits and not concerning for infection. The blood culture is also negative. On completion of the 10-day antibiotic course, nontender induration of the forearm remains, and a new firm, nontender nodule is noted on the dorsum of the left hand. Mobility of all joints of the left upper extremity remains unrestricted. Repeat radiography shows diffuse extraosseous calcification of the soft tissue of the forearm and hand, with sheetlike distributions along fascial planes of extensor and flexor muscle groups (Fig 2). Orthopedic surgery evaluates the infant and recommends no further acute orthopedic intervention. The infant is discharged from the hospital on day 18 after birth. Anticipatory guidance is provided to the parents before discharge to reinforce that intradermal calcifications most often reabsorb spontaneously over time over the course of weeks to months. Close follow-up with pediatric endocrinology, orthopedics, pediatrics, and neonatal high-risk clinic is set up for the infant.Calcinosis cutis is a common but overlooked condition that is seen in both the pediatric and neonatal populations. It is characterized by the presence of precipitated calcium crystals in soft tissue. The condition is divided into 5 subtypes based on etiology and severity: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. (1) Dystrophic calcinosis cutis is caused by local trauma to the tissue, such as by repeated intravenous access, heel sticks, or other procedures, and is present in patients with normal calcium and phosphorus levels. (1) Metastatic calcinosis cutis occurs in patients with underlying disorders of calcium or phosphorus metabolism (and therefore abnormal calcium and phosphorus levels) and can also be associated with calcium deposition in blood vessels, lungs, kidneys, and intestines. (1) Iatrogenic calcinosis cutis is caused by the extravasation of intravenous calcium gluconate, calcium chloride, or fluids containing phosphorus. (1) Idiopathic calcinosis cutis occurs in the absence of underlying causes like metabolic disorders or tissue damage. Calciphylaxis is the most serious subtype, defined as a vasculopathy of small and medium vessels that lead to ischemic necrosis. It is also known as uremic gangrene syndrome or calcific uremic arteriolopathy and most often seen in patients with chronic renal failure. (1)Iatrogenic calcinosis cutis generally presents days to weeks after the administration of intravenous calcium with initial erythema, swelling, and local tenderness at the intravenous site. The appearance of the lesion develops over time as the extravasated calcium spreads along fascia, often resulting in large areas of swelling and erythema. (1) Eventually the lesion progresses to hard, tender nodules that persist for weeks to months.Existing cases in the literature involve patients who present when their lesions have already progressed to the nodular stage, or report patients whose lesions are not described starting from the day of intravenous calcium administration. The early presentation of calcinosis cutis, as observed in our patient, is similar to cellulitis and often initially diagnosed as cellulitis. (2) However, unlike cellulitis, calcinosis cutis is not associated with systemic signs of infection such as fever, elevated leukocytes, or elevated C-reactive protein, though altered vital signs like tachycardia related to pain can be present.The first-line imaging modality is radiography, which confirms the presence of calcifications in soft tissue. Radiographs should be taken 7 days to 3 weeks after the initial administration of calcium. (1)Iatrogenic calcinosis cutis is generally self-limiting. Nodules and swelling regress slowly over time and eventually disappear over a period of weeks to months, fully clearing by 6 months after the initial insult. (3) Symptomatic treatment with hot and cold compresses can be helpful, as is the administration of hyaluronidase immediately after extravasation. (3) Conservative approaches are preferable, especially in younger children, though surgical intervention with excision of calcified nodules can be considered. Although this condition is usually benign, it is also important to note that idiopathic calcinosis cutis has been documented as the cause of compartment syndrome in the neonatal population. (4)Idiopathic calcinosis cutis is a complication that can occur in neonates after the administration of intravenous calcium.Radiographic findings may not be present until 7 days after extravasation of calcium.The condition is self-resolving, typically in weeks to months.Conservative treatment may be advisable with resolution of findings in weeks to months.

  PublisherDOI

• Delayed Presentation of Neonatal Drug Withdrawal in Neonate With Congenital Hypothyroidism

  Clinical Pediatrics · 2022 · 2 citations

  • Medicine
  • Pediatrics
  • Internal medicine
  PublisherDOI

• Resident Perspectives on Palliative Care at an Urban Teaching Hospital

  Journal of Palliative Care · 2021-11-29 · 4 citations

  article

  Background: There has been an increasing need to address end of life (EOL) care and palliative care in an era when measures to extend life for terminal illnesses are often initiated without consideration of quality of life. Addressing the barriers for resident physicians to initiate EOL conversations with patients is an important step towards eliminating the disconnect between patient wishes and provider goals. Objective: To assess resident physician perspectives on initiating palliative care conversations with terminally ill patients at an urban teaching hospital. Methods: This paper solicited the experiences of pediatric, general surgery, and internal medicine residents through an anonymous survey to assess exposure to palliative care during training, comfort with providing palliative care, and barriers to implementing effective palliative care. Results: 45% of residents reported exposure to palliative care prior to medical training. Ninety-three percent of these residents reported being formally introduced to palliative care during medical training through formal lecture, although the majority reported also being exposed through either small group discussions or informal teaching sessions. Time constraints and lack of knowledge on how to initiate and continue conversations surrounding EOL care were the greatest barriers to effectively caring for patients with terminal illnesses. Residents concurred that either attending physicians or hospital-designated palliative care providers should initiate palliative care discussions, with care managed by an interdisciplinary palliative care team; this consensus demonstrates a potential assumption that another provider will initiate EOL discussions. Conclusions: This study evaluated the current state of physician training in EOL care and provided support for the use of experience-based training as an important adjunct to traditional didactic lectures in physician education.

  PublisherDOI

• Maternal antepartum antibiotic administration and patterns of bacterial resistance in early preterm neonates

  The Journal of Maternal-Fetal & Neonatal Medicine · 2020-05-04 · 4 citations

  article

  Objective The objective of this study was to determine the relationship between maternal antepartum antibiotic administration and antibiotic resistance patterns in preterm neonates admitted to the neonatal intensive care unit (NICU).Methods This was a retrospective cohort study of women and their preterm neonates delivered at a single tertiary care center over a 5-year period. Women and neonates were included if they delivered between 23 weeks 0 days and 28 weeks 6 days of gestation and neonates were admitted to the NICU. Subjects were excluded if there was incomplete antibiotic administration data or incomplete laboratory or bacterial culture data for either mothers or neonates. Data collected from maternal and neonatal charts included the type, duration, and total number of antibiotics administered to subjects, neonatal culture results within the first 7 days of life, and bacterial antibiotic resistance information. Women with neonates that cultured positive for bacteria demonstrating antibiotic resistance were compared to those whose neonates did not have antibiotic-resistant bacteria.Results 79 women with 90 neonates met inclusion criteria. Of the 79 women, 71 (89.9%) received at least 1 antibiotic antepartum. 14 neonatal bacterial isolates were resistant to at least 1 antibiotic. Antibiotic-resistant bacteria were present in 11 neonates; 3 neonates had more than 1 resistant bacteria cultured. The most common resistant bacteria cultured were Coagulase-negative Staphylococcus (6/14, 42.9%), S. aureus (3/14, 21.4%), and E. coli (2/14, 14.3%). Enterobacter spp (2) and Klebsiella pneumoniae (1) made up the remainder. Of the 11 neonates with resistant bacteria isolated, 10 of their mothers received antibiotics antepartum. Neonates with antibiotic-resistant bacterial isolates were more likely to be born at lower gestational ages (24.6 vs 25.9 weeks, p = .013) and have lower mean birth weights (679.5 vs 849.3 g, p = .009) than those without resistant bacteria. In 8 of 11 (73%) neonates with resistant bacteria, the mother received an antibiotic to which the bacteria cultured were resistant: 6 coagulase-negative Staphylococcus, 1 MRSA, and 1 S. aureus.Conclusions Although preterm neonates are often treated for presumed sepsis, they infrequently have positive bacterial cultures. In this study, those that had positive bacterial cultures for resistant bacteria were born at earlier gestational ages and had lower birth weights. These bacteria cultured in neonates are likely to be resistant to antibiotics received by mothers in the antepartum period. Careful selection of maternal and neonatal antibiotics in the preterm setting with consideration for local antibiotic resistance patterns is suggested.

  PublisherDOI

• Maternal morbidity after early preterm delivery (23–28 weeks)

  American Journal of Obstetrics & Gynecology MFM · 2020 · 26 citations

  • Medicine
  • Obstetrics
  • Pediatrics
  PublisherDOI

• Percutaneous Route of Life: Chylothorax or Total Parenteral Nutrition-Related Bilateral Pleural Effusion in a Neonate?

  Fetal and Pediatric Pathology · 2020 · 8 citations

  • Medicine
  • Surgery
  • Internal medicine

  Objective Peripherally Inserted Central Catheter (PICC) lines are an essential tool in the management of premature neonates. Pleural effusion (PLE) secondary to the leakage of alimentation into the pleural cavity is an encountered complication of central-line total parenteral nutrition (TPN) administration. Methods: We review a case of a premature neonate who suffered large, bilateral PLE after insertion of an upper extremity PICC line for TPN. Results: Pleural fluid biochemical analysis confirmed PICC line infiltration, predominantly with monocytes, low protein, high triglycerides and high glucose. These results favored TPN leakage over chylothorax. Conclusions: To our knowledge, this is the first case of bilateral PLE due to PICC complication in a neonate, which highlights the importance of chylothorax differential diagnosis, the role of autopsy, and the need for clinical precautions when providing premature neonates with high osmolarity TPN.

  PublisherDOI

• Maternal antepartum antibiotic administration and patterns of bacterial resistance in early preterm neonates

  American Journal of Obstetrics and Gynecology · 2019-11-28

  article
  PublisherDOI

• Furthering the integration of palliative care in the community

  Memorial University Research Repository (Memorial University) · 2018-03-27

  articleOpen accessSenior author
  Publisher

Frequent coauthors

• Lisa Gittens‐Williams

  Rutgers New Jersey Medical School

  12 shared

• Matthew P. Romagano

  Lehigh Valley Hospital-Pocono

  12 shared

• Shauna F. Williams

  11 shared

• Joseph J. Apuzzio

  Rutgers New Jersey Medical School

  11 shared

• Danitza M. Velazquez

  Rutgers New Jersey Medical School

  8 shared

• James M. Oleske

  6 shared

• Janet Piscitelli

  5 shared

• Dhaval Swaminarayan

  Rutgers New Jersey Medical School

  5 shared

Education

• MBBS, Faculty of Health Sciences

  University of Ilorin Teaching Hospital

• Fellow in Neonatal-Perinatal Medicine, Pediatrics

  Montefiore Medical Center

Awards & honors

• Voted by peers and patients as one of the best Doctors in No…