About

Iona Monteiro, MD, MBBS, is a Professor of Pediatrics and the Division Director of Pediatric Gastroenterology, Hepatology and Nutrition at Rutgers New Jersey Medical School. She is board certified in Pediatrics and Pediatric Gastroenterology and runs a busy clinical pediatric gastroenterology practice caring for children with gastrointestinal and liver problems. Her practice encompasses management of a wide variety of gastrointestinal and liver diseases in children, including gastroesophageal reflux, chronic abdominal pain, constipation, inflammatory bowel disease, autoimmune and viral hepatitis, obesity, and its comorbidities especially non-alcoholic fatty liver disease and dyslipidemias. Her research interests are obesity and the microbiome, and she is currently studying the changes in the microbiome in obese and overweight children in collaboration with researchers at the Public Health Research Institute, Rutgers University. She has been the principal investigator on various grants for basic science and clinical trials, and has published on a wide range of topics from basic research to clinical case reports. She has also published a review article on the diagnosis and management of inflammatory bowel disease in the British Medical Journal and her most recent publication addresses the effects of immigration on infant feeding practices in an inner city, low socioeconomic community. She is actively involved in professional societies, serving as a liaison to the American Gastroenterological Association’s section on Pediatric Gastroenterology and Developmental Biology, and has been an invited speaker at local, regional, national, and international meetings.

Research topics

• Medicine
• Psychiatry
• Anesthesia
• Pediatrics
• Surgery
• Internal medicine

Selected publications

• The anesthetic management of a child with ohtahara syndrome and severe stridor: a case report

  BMC Pediatrics · 2024 · 3 citations

  • Medicine
  • Anesthesia
  • Surgery

  BACKGROUND: Ohtahara syndrome is a progressive developmental and epileptic encephalopathy that manifests in the early infantile period. This rare condition is characterized by intractable seizures, psychomotor retardation, and poor prognosis. To date, there are a handful of case reports regarding the anesthetic management of children with Ohtahara syndrome. However, limited reports exist of patients with Ohtahara syndrome who present with difficult airways. This report describes our airway findings and general anesthetic management of a pediatric patient with Ohtahara syndrome undergoing diagnostic bronchoscopy for severe inspiratory stridor. CASE PRESENTATION: A 14-month-old, 9 kg, male patient with Ohtahara syndrome presented with a year-long history of severe inspiratory stridor and was scheduled for bronchoscopy with lavage. On exam, the patient had noisy breathing, was non-verbal with developmental delay, and had poor head control with significant central hypotonia. The patient was induced with ketamine and general anesthesia was maintained with propofol. Bronchoscopic evaluation was completed uneventfully and revealed a diagnosis of laryngotracheomalacia. The patient's breathing was maintained spontaneously throughout the procedure and no seizures were noted. In the post anesthesia care unit, the patient's respiratory and cardiovascular function were stable. CONCLUSIONS: This report documents the unusual finding of severe inspiratory stridor in a 14-month-old child diagnosed with Ohtahara syndrome and our anesthetic management during their diagnostic bronchoscopy. Currently, documentation of complex airway pathology present in patients with Ohtahara syndrome is limited and should be further evaluated. This will assist pediatric anesthesiologists as these patients may require careful preoperative assessment, thoughtful airway management, and surgical alternatives on standby.

  PublisherOA PDFDOI

• Hospital Utilization, Treatment Modalities, and Mortality Using Different Biopsy Methods in Infants With Biliary Atresia

  Cureus · 2022-05-04

  articleOpen accessSenior author

  Objectives To present a nationwide retrospective analysis of the sequelae and aftereffects of different liver biopsy methods in the care of pediatric patients with biliary atresia. Methods The National Inpatient Sample 2001-2013 database was queried for a primary diagnosis of biliary atresia and stratified based on biopsy type including percutaneous, surgical, laparoscopic, and transjugular. Patient demographics, length of stay, hospital costs, type of treatment, and mortality were compared by biopsy type. One-way analysis of variance test and multivariable logistic regression were used for analysis with α < 0.05. Results A total of 4,306 patients with biliary atresia were identified, of whom 2,293 underwent no biopsy, and 723 and 1,080 underwent a percutaneous or surgical biopsy, respectively. Significant differences in socio-demographics were demonstrated between the biopsy types. The length of stay and hospital charges were statistically significantly different between the biopsy types where patients without biopsies had the smallest length compared to percutaneous, surgical, and combination of biopsies. Overall, the Kasai procedure was done more frequently compared to direct liver transplantation, and compared to other biopsy types, undergoing a combination of biopsies had the highest odds of undergoing either procedure. Conclusions When comparing different biopsy methods, surgical biopsies of the liver outperformed percutaneous biopsies in hospital utilization and progression to definitive treatments with the Kasai procedure. Our research indicated that vulnerable populations such as minorities or the indigent may undergo inferior treatments or infrequently undergo definitive treatment. The need for definitive diagnostic guidelines is understated in patients with biliary atresia.

  PublisherOA PDFDOI

• S0749 Increasing Prevalence and Resource Utilization for Pediatric Inflammatory Bowel Disease Patients With Comorbid Psychiatric Disorders

  The American Journal of Gastroenterology · 2020

  Senior authorCorresponding
  • Medicine
  • Psychiatry
  • Internal medicine

  INTRODUCTION: Psychiatric disorders are increasingly diagnosed in pediatric patients with inflammatory bowel disease (IBD) however the impact on hospital outcomes and resource utilization is relatively unknown. This study aimed to characterize trends of three most prevalent psychiatric conditions in pediatric patients hospitalized with IBD, as well as the impact of these conditions on hospital resource utilization. METHODS: Patients with IBD were identified in the Kids Inpatient Database using International Classification for Disease 9th and 10th revision codes from 2003, 2006, 2012, and 2016. Patient and hospital characteristics, disease severity, receipt of endoscopy, intestinal surgery, and parenteral nutrition were assessed. Psychiatric conditions were defined as major depressive, anxiety, and adjustment disorder. Multivariate regression was used to determine factors impacting hospital charges and length of stay. RESULTS: A weighted total of 92,290 patients with pediatric IBD were included. Median age was 17 and 50.2% were female; 63.2% had Crohn’s disease and 37.8% had ulcerative colitis. Overall, 7.9% of patients had any psychiatric condition; 2.8% had depression, 4.9% had anxiety, and 1.5% had adjustment disorder. Patients with psychiatric conditions had significantly higher proportion of females, white race, stoma presence, and malnutrition on univariate tests (P < .001) (Table 1). Incidence of each psychiatric condition increased significantly during the study period (Figure 1). In multivariate models, presence of any and each psychiatric disorder was associated with elevated length of stay and hospital charges overall as well as for Crohn’s disease and ulcerative colitis individually (Table 2). Each additional psychiatric condition similarly increased cost and length of stay. CONCLUSION: This study demonstrates a rising incidence of comorbid psychiatric disorders in hospitalized pediatric IBD patients. We additionally found that presence of psychiatric disorders was independently associated with increased length of stay and hospital charges despite having variable odds of receiving surgery and endoscopy. Given the potentially traumatic effects of surgery and hospitalization on pediatric IBD patients, development of strategies to improve mental health support are needed to reduce the psychosocial and finacial burden of these conditions.Table 1.: Baseline patient and hospital characteristics of hospitalized pediatric inflammatory bowel disease patients. EGD = esophagogastroduodenoscopyTable 2.: Negative binomial regression assessing impact of psychiatric conditions on length of stay and cost. *Adjusted for patient age, race, sex, insurance status, hospital bed size, disease severity, stoma, perianal disease, malnutrition, anemia, receipt of surgery, and endoscopyFigure 1.: Estimated national frequency of major depressive disorder, anxiety disorder, and adjustment disorder in pediatric inflammatory bowel disease patients from 2003 to 2016.

  PublisherDOI

• Sa2053 TO SIMULATE OR NOT TO SIMULATE? EXPLORING USE OF ENDOSCOPIC SIMULATION IN NORTH AMERICAN PEDIATRIC GASTROENTEROLOGY FELLOWSHIP TRAINING PROGRAMS

  Gastrointestinal Endoscopy · 2019-06-01

  article
  PublisherDOI

• Case 3: Persistent Elevated Transaminase Levels in a 9-year-old Boy

  Pediatrics in Review · 2019-12-01 · 1 citations

  articleSenior author

  1. Diane Hsu, MD* 2. Rohit Josyabhatla, MD* 3. Iona M. Monteiro, MD* 1. *Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ A 9-year-old overweight boy with seasonal allergies is referred to our gastroenterology service for persistently elevated transaminase levels for 6 months. His aspartate aminotransferase (AST) level is 90 U/L (1.5 μkat/L) and alanine aminotransferase (ALT) level is 103 U/L (1.7 μkat/L). In addition, he has an elevated cholesterol level (243 mg/dL [6.3 mmol/L]), a low high-density lipoprotein (HDL) cholesterol level (36 mg/dL [0.9 mmol/L]), and a borderline high triglyceride level (151 mg/dL [1.7 mmol/L]). On presentation he notes pain in the right upper quadrant that is dull, 5 of 10 in severity, and without aggravating or relieving factors. He recently had 3 loose, nonbloody, nonmucoid stools. He denies nausea, vomiting, chest pain, lower back pain, urinary frequency, or dysuria. His diet is rich in processed foods. His physical activity is minimal. He has no home medications or family history of liver disease. However, his 38-year-old father has an elevated cholesterol level and hypertension. His BMI is between the 90th and 95th percentiles for age. His physical examination is significant for right and left upper quadrant tenderness on deep palpation without guarding or rigidity. He has no hepatosplenomegaly. Diet and exercise counseling is provided. The repeated transaminase levels are still elevated. Iron studies and ceruloplasmin levels are normal, and hepatitis panel, anti–smooth muscle/mitochondrial antibodies, liver-kidney microsomal antibody, α1-antitrypsin phenotype, and antinuclear antibodies are all negative. Abdominal ultrasonography shows mild splenomegaly. During his follow-up visit, the patient notes epigastric pain and intermittent loose stools. His celiac panel is negative, and his transaminase and …

  PublisherDOI

• A Rare Cause of Septic Shock in the Emergency Department in an Intellectually-Disabled Child

  Journal of Emergency Medicine · 2019-11-07 · 1 citations

  article
  PublisherDOI

• Exploring Use of Endoscopy Simulation in North American Pediatric Gastroenterology Fellowship Training Programs

  Journal of Pediatric Gastroenterology and Nutrition · 2019-10-25 · 6 citations

  article

  OBJECTIVES: Increasing evidence supports simulation-based training; however, limited data exist regarding its use in pediatric gastroenterology (GI). We explored the use of simulation-based endoscopy training in pediatric GI fellowship programs across North America. METHODS: GI fellowship program directors (PDs) from the United States and Canada were surveyed between August to November 2018. The pretested, electronic survey comprised 3 sections: program demographics; details of current simulation-based training; and PDs' perceptions of endoscopy simulation. Responses were analyzed using descriptive statistics. RESULTS: Forty-three of 71 (61%) PDs responded (6 Canadian, 37 US). Programs were predominantly academic (95%) and enrolled 1.87 ± 1.01 fellows/yr. Twenty-four programs (56%) reported using simulation for endoscopy training, whereas 8 (19%) used simulation for nonprocedural education. Only 2 programs (5%) used endoscopy simulation for assessment. Of those using simulation (n = 24), upper endoscopy and colonoscopy were trained most frequently, and mechanical simulators were used most commonly. Eight programs (33%) required simulation training prior to clinical performance. Although 10 programs (42%) provided protected training time, only 2 (8%) tracked hours. Three programs (13%) reported having an organized curriculum and 6 (25%) train their endoscopic trainers. Cost, time constraints, and lack of a standardized curriculum were perceived as key barriers to integration. Most PDs reported a need for endoscopy simulation to train both technical and nontechnical skills; however, they felt simulation cannot replace clinical experience. CONCLUSION: PDs recognize the potential importance of endoscopy simulation, particularly for novices; however, only 56% report using it. Perceived barriers indicate the need for inexpensive portable simulators and a validated pediatric simulation curriculum to promote uptake.

  PublisherDOI

• Cultural perceptions of breastfeeding are major determinants of breastfeeding habits

  PEDIATRICS · 2018-05-01 · 1 citations

  articleSenior author
  PublisherDOI

• Cultural perceptions of breastfeeding are major determinants of breastfeeding habits

  PEDIATRICS · 2018-05-01

  articleSenior author

  Purpose The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months of age. Studies have shown that immigrant mothers have higher breastfeeding rates compared to American-born mothers. This difference diminishes the longer immigrant mothers reside in the US. It has been suggested that the availability of formula through The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a strong contributing factor in this lowering of breastfeeding rate. We set out to test this hypothesis by examining breastfeeding habits …

  PublisherDOI

• Overall severities of gastrointestinal symptoms in pediatric outpatients with and without autism spectrum disorder

  Autism · 2018-03-02 · 36 citations

  article

  In order to determine the effectiveness of a Gastrointestinal Severity Index to screen for gastrointestinal disorders, the Gastrointestinal Severity Index was administered to 135 children with autism spectrum disorders and 146 comparisons with and without gastrointestinal disorders. The mean Gastrointestinal Severity Index scores of the groups were 3.53 ± 1.78, 3.15 ± 1.99, 0.81 ± 1.25, and 0.29 ± 0.76 (comparative pediatric patients with gastrointestinal disorder = autism spectrum disorder + gastrointestinal disorder > autism spectrum disorder-gastrointestinal disorder > comparative pediatric patients without gastrointestinal disorder, respectively), Ps < 0.05. Receiver operating characteristic curves and areas under the receiver operating characteristic curves were calculated to ascertain which Gastrointestinal Severity Index cutoff scores yielded the highest sensitivity and specificity rates for the diagnosis of gastrointestinal disorders. The area under the receiver operating characteristic curve (0.97) for the comparison group was higher (P < 0.001) than the area under the receiver operating characteristic curve (0.85) for autism spectrum disorder children indicating that the Gastrointestinal Severity Index was more effective in screening for gastrointestinal disorders in comparisons. However, the same Gastrointestinal Severity Index cutoff score of 2 and above yielded, respectively, sensitivity and specificity rates of 92% and 93% for comparisons and 80% and 79% for autism spectrum disorder children. The negative and positive predictive values based on these sensitivity and specificity rates were calculated for a range of prevalences of gastrointestinal disorders and indicated that the Gastrointestinal Severity Index may be useful for screening children with and without autism spectrum disorder for gastrointestinal symptoms.

  PublisherDOI

Frequent coauthors

• Ronaldo P. Ferraris

  Rutgers, The State University of New Jersey

  20 shared

• Stephanie B. Oliveira

  University of Cincinnati Medical Center

  16 shared

• Catharine M. Walsh

  The Wilson Centre

  10 shared

• Ayelet Rosenthal

  Northwestern University

  10 shared

• Hanan Tanuos

  Rutgers, The State University of New Jersey

  9 shared

• Uche Madubuko

  Rutgers, The State University of New Jersey

  9 shared

• Joseph Schwab

  Rutgers, The State University of New Jersey

  9 shared

• Harumi Jyonouchi

  Johnson University

  8 shared

Education

• M.D.

  Goa Medical College

  1988

• Other

  Goa Medical College

  1983