1
|
Fottrell AK, Curtis MA, Weeks FH. Ambient Air Pollution, Housing Context, and Birth Outcomes Among Wisconsin Mothers. Matern Child Health J 2024; 28:1386-1394. [PMID: 38847990 PMCID: PMC11269423 DOI: 10.1007/s10995-024-03941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES To assess the association between air pollution exposure and housing context during pregnancy and adverse birth outcomes. METHODS We linked air pollution data from the Environmental Protection Agency and housing data from the American Community Survey with birth records from Wisconsin counties over a 9-year period. We calculated average daily pregnancy exposure to fine particulate matter and ozone and modeled its relationship to preterm birth, low birthweight and NICU admission, adjusting for individual characteristics and housing context. RESULTS Ozone exposure and housing cost-burden had substantive and statistically significant negative associations with birthweight and gestational age, and positive associations with NICU admission, while a poor-quality housing environment had a significant negative effect on weeks of gestation. Fine particulate matter exposure had a negligible correlation with these outcomes. CONCLUSIONS FOR PRACTICE An additional tenth of one part-per-million daily average exposure to ozone is associated with a 33 g decrease in birthweight. This decrease in birthweight is about the same size as the association of gestational diabetes (32 g), larger than the association of chronic hypertension (22 g), and about 40% the size of the effect of smoking during pregnancy on birthweight (84 g). Given the magnitudes of the associations with atmospheric ozone and adverse birth outcomes, reducing atmospheric ozone should be a public health priority. Inclusion of controls for housing cost-burden and poor-quality housing reduces the magnitude of the association with mothers who identify as Black, suggesting the importance of these structural factors in understanding adverse birth outcomes by race.
Collapse
Affiliation(s)
- Amy K Fottrell
- L. Douglas Wilder School of Public of Government and Public Affairs, Virginia Commonwealth University, 1808 Gordon Ave., Richmond, VA, 23224, USA.
| | - Marah A Curtis
- Sandra Rosenbaum School of Social Work, Institute for Research on Poverty, University of Wisconsin-Madison, 1350 University Ave, Madison, WI, 53706, USA
| | - Fiona H Weeks
- Department of Population Health Sciences, Center for Demography and Ecology, University of Wisconsin-Madison, 610 Walnut St., Madison, WI, 53704, USA
- Division of Public Health, Wisconsin Department of Health Services, Madison, USA
| |
Collapse
|
2
|
Gyamfi-Bannerman C. Antenatal Late Preterm Steroids: The Evolution of the ALPS Trial. Clin Obstet Gynecol 2024; 67:399-410. [PMID: 38688083 PMCID: PMC11068095 DOI: 10.1097/grf.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
The Antenatal Late Preterm Steroids (ALPS) trial was designed to address respiratory morbidity common in infants born late preterm. The study was published in April, 2016 and, shortly thereafter, changed clinical practice in obstetrics in the United States. The following chapter describes the ALPS trial study design in detail, including the background leading to the trial, the study outcomes, and the initial findings of the long-term follow-up study. The ALPS story would not be complete without Elizabeth Thom, PhD, who died before her time. Her brilliance largely contributed to the design of the ALPS trial.
Collapse
Affiliation(s)
- Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, La Jolla, California
| |
Collapse
|
3
|
Miller ME, Donohue P, Seltzer R, Kwak C, Boss RD. Costs of Neonatal Medical Complexity: Impact on New Parent Stress and Decision-Making. Am J Perinatol 2024; 41:e833-e842. [PMID: 36130670 DOI: 10.1055/a-1948-2580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Parents of children with medical complexity experience substantial financial burdens. It is unclear how neonatal intensive care unit (NICU) clinicians prepare new parents of medically complex infants for this reality. This study explored new parent awareness of health care costs, desire to discuss costs with clinicians, and impact of costs on parents' medical decision-making. STUDY DESIGN The study design comprised semistructured interviews and surveys of parents of infants with medical complexity currently or previously in a NICU. Conventional content analysis was performed on interview transcripts, and descriptive analyses were applied to surveys. RESULTS Thematic saturation was reached with 27 families (15 NICU families and 12 post-NICU families) of diverse race/ethnicity/education/household income. Most were worried about their infants' current/future medical expenses and approximately half wanted to discuss finances with clinicians, only one parent had. While finances were not part of most parent's NICU decision-making, some later regretted this and wished cost had been incorporated into treatment choices. The family desire to discuss costs did not vary by family financial status. Parents described their infant's health care costs as: "We are drowning"; and "We'll never pay it off." CONCLUSION Most parents were worried about current and future medical expenses related to their infant's evolving medical complexity. Many wanted to discuss costs with clinicians; almost none had. NICU clinicians should prepare families for the future financial realities of pediatric medical complexity. KEY POINTS · Many families want to discuss costs with NICU clinicians.. · Some families want costs to be a part of medical decisions.. · Few families currently discuss costs with NICU providers..
Collapse
Affiliation(s)
- Mattea E Miller
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Pamela Donohue
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rebecca Seltzer
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Berman Institute of Bioethics, Baltimore, Maryland
| | - Cecilia Kwak
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Renee D Boss
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
- Berman Institute of Bioethics, Baltimore, Maryland
| |
Collapse
|
4
|
Monson MA, Chmait RH, Einerson B. Fetoscopic Laser Ablation of Type II Vasa Previa: A Cost Benefit Analysis. Am J Perinatol 2024; 41:e2454-e2462. [PMID: 37494587 DOI: 10.1055/s-0043-1771262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE We aimed to compare costs of two strategies for third-trimester type II vasa previa management: (1) fetoscopic laser ablation surgery (FLS) referral and (2) standard management (SM). STUDY DESIGN A decision analytic model and cost-benefit analysis from a health care perspective were performed. The population included patients with type II vasa previa at approximately 32 weeks. SM entailed 32-week antepartum admission and cesarean at approximately 35 weeks. FLS referral included consultation and possible laser surgery at 32 weeks for willing/eligible candidates. Successful laser surgery allowed the possibility of term vaginal delivery. Outcomes included antepartum admission, preterm birth, cesarean, neonatal transfusion, and death. Sensitivity analyses were performed. RESULTS In base case analysis, FLS referral was cost saving compared with SM (total cost per patient $65,717.10 vs. 71,628.16). FLS referrals yielded fewer antepartum admissions, cesareans, premature births, neonatal transfusions, and deaths. Eligible referred patients choosing FLS incurred a total cost of $41,702.46, a >40% decrease compared with SM. FLS referral was cost saving in all one-way sensitivity analyses except when antepartum admission costs were low. In threshold analyses, FLS referral was cost saving unless laser surgery cost was >$39,892 (2.75x expected cost), antepartum admission cost for monitoring of vasa previa or ruptured membranes was <$7,455, <11% patients were eligible for laser surgery, and when <12% of eligible patients chose laser surgery. In two-way sensitivity analysis, FLS referral was cost saving except at very high laser surgery costs and extremely low antepartum admission costs. CONCLUSION Referral for FLS for type II vasa previa was cost saving and improved outcomes compared with SM, despite upfront costs, fetoscopy-related risks, and many patients being ineligible or not opting for surgery after referral. KEY POINTS · Vasa previa rupture may lead to fetal exsanguination and death.. · Late preterm cesarean is common practice for prenatally diagnosed vasa previa.. · Successful fetoscopic laser ablation for type II vasa previa has been described.. · Laser ablation of vasa previa allows for a safe-term vaginal delivery.. · Referral for laser surgery is cost saving and is associated with improved outcomes..
Collapse
Affiliation(s)
- Martha A Monson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Ramen H Chmait
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brett Einerson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City, Utah
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| |
Collapse
|
5
|
Mara KC, Clark RH, Carey WA. Necrotizing Enterocolitis in Very Low Birth Weight Neonates: A Natural History Study. Am J Perinatol 2024; 41:e435-e445. [PMID: 35554890 DOI: 10.1055/a-1851-1692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE We characterize the most recent natural history of necrotizing enterocolitis (NEC), as this is an essential first step in guiding the prevention and treatment of this disease in the present day. STUDY DESIGN We performed a retrospective cohort study of neonates who were born at 23 to 29 weeks' gestation and birth weight <1,500 g who received care from the Pediatrix Medical Group between 2004 and 2019. We assessed the incidence of medical and surgical NEC and the patterns of initial antibiotic treatment to develop a contemporary cohort for further analysis. Among patients discharged between 2015 and 2019, we characterized the stage-specific risk factors for patients diagnosed with medical or surgical NEC, as well as patterns of disease onset, progression, biomarkers, and outcomes. We used the same approach to characterize patients diagnosed with suspected NEC. RESULTS Among 34,032 patients in the contemporary cohort, 1,150 (3.4%) were diagnosed with medical NEC and 543 (1.6%) were diagnosed with surgical NEC. The temporal pattern of disease onset was different for medical and surgical NEC, with gestational age- and birth weight-specific risk disparities emerging earlier in surgical NEC. Thirty-day mortality was much greater among surgical NEC patients (medical NEC 16.4% vs. surgical NEC 43.0%), as were rates of various in-hospital and long-term outcomes. Suspected NEC was diagnosed in 1,256 (3.7%) patients, among whom risk factors and disease onset, progression, and outcomes closely resembled those of medical NEC. CONCLUSION Analyzing data from a contemporary cohort enabled us to characterize the current, stage-specific natural history of NEC, including novel insights into suspected NEC. Future studies could leverage this cohort to characterize how specific patient characteristics, care processes, or biomarkers may influence or predict disease outcomes. KEY POINTS · The incidence of NEC has reached a stable baseline in recent years.. · Risk factors for NEC vary in a stage-specific manner.. · The stage-specific onset and progression of NEC differ by gestational age and birth weight..
Collapse
Affiliation(s)
- Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Reese H Clark
- Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, Florida
| | - William A Carey
- Division of Neonatal Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
6
|
Schrager NL, Parker SE, Werler MM. The timing, duration, and severity of nausea and vomiting of pregnancy and adverse birth outcomes among controls without birth defects in the National Birth Defects Prevention Study. Birth Defects Res 2024; 116:e2334. [PMID: 38578229 DOI: 10.1002/bdr2.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in approximately 70% of pregnant people, with varying severity and duration. Treatments include pharmacologic and herbal/natural medications. The associations between NVP and birth outcomes, including preterm birth, small for gestational age (SGA), and low birth weight are inconclusive. OBJECTIVE To determine whether NVP and reported medications are associated with adverse birth outcomes. METHODS We used data from the population-based, multisite National Birth Defects Prevention Study (1997-2011) to evaluate whether self-reported NVP according to timing, duration, and severity or its specific treatments were associated with preterm birth, SGA, and low birth weight among controls without birth defects. Odds ratios (aOR) and 95% confidence intervals (CI) were adjusted for sociodemographic, reproductive, and medical factors. For any NVP, duration, treatment use, and severity score analyses, the comparison group was participants with no reported NVP. For timing analyses, the comparison group was women with no reported NVP in the same trimester of pregnancy. RESULTS Among 6018 participants, 4339 (72.1%) reported any NVP. Among those with NVP, moderate or severe symptoms were more common than mild symptoms. Any versus no NVP was not associated with any of the outcomes of interest. NVP in months 4-6 (aOR 1.21, 95% CI: 1.00, 1.47) and 7-9 (aOR 1.57, 95% CI: 1.22, 2.01) of pregnancy were associated with an increase in the risk of preterm birth. NVP lasting one trimester in duration was associated with decrease in risk of SGA (aOR: 0.74, 95% CI: 0.58, 0.95), and NVP present in every trimester of pregnancy had a 50% increase in risk of preterm birth (aOR: 1.50, 95% CI: 1.11, 2.05). For NVP in months 7-9 and preterm birth, ORs were elevated for moderate (aOR: 1.82, 95% CI: 1.26, 2.63), and severe (aOR: 1.53, 95% CI: 1.06, 2.19) symptoms. NVP was not significantly associated with low birth weight. Our analyses of medications were limited by small numbers, but none suggested increased risk of adverse outcomes associated with use of the medication. CONCLUSION Mild NVP and NVP limited to early pregnancy appear to have no effect or a small protective effect on birth outcomes. Long-lasting NVP, severe NVP, and NVP later in pregnancy may increase risk of preterm birth and SGA.
Collapse
Affiliation(s)
- Nina L Schrager
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Poulios E, Pavlidou E, Papadopoulou SK, Rempetsioti K, Migdanis A, Mentzelou M, Chatzidimitriou M, Migdanis I, Androutsos O, Giaginis C. Probiotics Supplementation during Pregnancy: Can They Exert Potential Beneficial Effects against Adverse Pregnancy Outcomes beyond Gestational Diabetes Mellitus? BIOLOGY 2024; 13:158. [PMID: 38534428 DOI: 10.3390/biology13030158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Probiotics, as supplements or food ingredients, are considered to exert promising healthy effects when administered in adequate quantity. Probiotics' healthy effects are related with the prevention of many diseases, as well as decreasing symptom severity. Currently, the most available data concerning their potential health effects are associated with metabolic disorders, including gestational diabetes mellitus. There is also clinical evidence supporting that they may exert beneficial effects against diverse adverse pregnancy outcomes. The purpose of the current narrative study is to extensively review and analyze the current existing clinical studies concerning the probable positive impacts of probiotics supplementation during pregnancy as a protective agent against adverse pregnancy outcomes beyond gestational diabetes mellitus. METHODS a comprehensive and thorough literature search was conducted in the most precise scientific databases, such as PubMed, Scopus, and Web of Sciences, utilizing efficient, representative, and appropriate keywords. RESULTS in the last few years, recent research has been conducted concerning the potential beneficial effects against several adverse pregnancy outcomes such as lipid metabolism dysregulation, gestational hypertensive disorders, preterm birth, excessive gestational weight gain, caesarean risk section, vaginal microbiota impairment, mental health disturbances, and others. CONCLUSION up to the present day, there is only preliminary clinical data and not conclusive results for probiotics' healthy effects during pregnancy, and it remains questionable whether they could be used as supplementary treatment against adverse pregnancy outcomes beyond gestational diabetes mellitus.
Collapse
Affiliation(s)
- Efthymios Poulios
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Kalliopi Rempetsioti
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Athanasios Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| | - Maria Chatzidimitriou
- Department of Biomedical Science, International Hellenic University, 57400 Thessaloniki, Greece
| | - Ioannis Migdanis
- Faculty of Medicine, University of Thessaly, 41500 Larissa, Greece
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece
| |
Collapse
|
8
|
Patil AS, Grotegut CA, Smith PB, Clark RH, Greenberg RG. The Hassan Neonatal Morbidity Composite Scale and Neonatal Length of Stay-A Validation Study. Am J Perinatol 2024; 41:98-105. [PMID: 34856613 DOI: 10.1055/s-0041-1740154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Obstetric studies often report neonatal morbidity as a composite score. Composite scores can simplify data analysis when multiple outcomes of interest are present and allows researchers to conduct smaller, more manageable trials. The Hassan scale is a neonatal morbidity composite scale that assigns high scores to infants with multiple morbidities and low scores to infants without or with single morbidities. The objective of this study was to validate the association between scores on the Hassan scale and neonatal intensive care unit (NICU) length of stay STUDY DESIGN: We conducted a cohort study of all infants born between 22 and 366/7 weeks' gestation and cared for within 419 neonatal units in the Pediatrix Medical Group between 1997 and 2018. Each infant was assigned a Hassan's score based on the number of neonatal morbidity events that occurred during the delivery hospitalization. The association between Hassan's scores and neonatal length of stay was evaluated using linear regression. Multivariable models were constructed to determine if the Hassan score was independently associated with neonatal length of stay. RESULTS There were 760,037 infants included. The median (interquartile range [IQR]) gestational age of delivery was 34 (31, 35) weeks and the median (IQR) birth weight at delivery was 2,000 (1,503, 2,430) g. The median length of stay for infants discharged home was 17 (10-33) days. A Hassan's score was able to be assigned to 699,206 (92%) patients. Neonatal morbidities included in the Hassan scale were more common among infants born earlier in gestation. On adjusted analysis, the Hassan scale was found to be independently associated with neonatal length of stay (p < 0.001, coefficient = 10.4 days [95% confidence interval (CI): 10.3, 10.4 days]) with higher scores associated with longer lengths of stay. CONCLUSION The Hassan scale, more than a binary composite score, is able to differentiate preterm infants with prolonged hospitalizations from those with short hospitalizations. KEY POINTS · The Hassan scale is an independent predictor of neonatal length of stay.. · Classification of infants based on number of morbidities correlates with neonatal length of stay.. · The Hassan scale provided better discrimination than binary composite morbidity scores.. · The Hassan scale may be an economic predictor of health-related costs..
Collapse
Affiliation(s)
- Avinash S Patil
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
- Valley Perinatal Services, Phoenix, Arizona
| | - Chad A Grotegut
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina
| | - P Brian Smith
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, Florida
| | - Rachel G Greenberg
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
9
|
Andrade Júnior VLD, França MS, Santos RAF, Hatanaka AR, Cruz JDJ, Hamamoto TEK, Traina E, Sarmento SGP, Elito Júnior J, Pares DBDS, Mattar R, Araujo Júnior E, Moron AF. A new model based on artificial intelligence to screening preterm birth. J Matern Fetal Neonatal Med 2023; 36:2241100. [PMID: 37518185 DOI: 10.1080/14767058.2023.2241100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE The objective of this study is to create a new screening for spontaneous preterm birth (sPTB) based on artificial intelligence (AI). METHODS This study included 524 singleton pregnancies from 18th to 24th-week gestation after transvaginal ultrasound cervical length (CL) analyzes for screening sPTB < 35 weeks. AI model was created based on the stacking-based ensemble learning method (SBELM) by the neural network, gathering CL < 25 mm, multivariate unadjusted logistic regression (LR), and the best AI algorithm. Receiver Operating Characteristics (ROC) curve to predict sPTB < 35 weeks and area under the curve (AUC), sensitivity, specificity, accuracy, predictive positive and negative values were performed to evaluate CL < 25 mm, LR, the best algorithms of AI and SBELM. RESULTS The most relevant variables presented by LR were cervical funneling, index straight CL/internal angle inside the cervix (≤ 0.200), previous PTB < 37 weeks, previous curettage, no antibiotic treatment during pregnancy, and weight (≤ 58 kg), no smoking, and CL < 30.9 mm. Fixing 10% of false positive rate, CL < 25 mm and SBELM present, respectively: AUC of 0.318 and 0.808; sensitivity of 33.3% and 47,3%; specificity of 91.8 and 92.8%; positive predictive value of 23.1 and 32.7%; negative predictive value of 94.9 and 96.0%. This machine learning presented high statistical significance when compared to CL < 25 mm after T-test (p < .00001). CONCLUSION AI applied to clinical and ultrasonographic variables could be a viable option for screening of sPTB < 35 weeks, improving the performance of short cervix, with a low false-positive rate.
Collapse
Affiliation(s)
| | - Marcelo Santucci França
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Alan Roberto Hatanaka
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Jader de Jesus Cruz
- Fetal Medicine Unit, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Tatiana Emy Kawanami Hamamoto
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Evelyn Traina
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | | | - Júlio Elito Júnior
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - David Baptista da Silva Pares
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Rosiane Mattar
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Antonio Fernandes Moron
- Screening and Prevention of Preterm Birth Sector, Discipline of Fetal Medicine, Department of Obstetrics, Paulista School of Medicine - Federal University of Sao Paulo (EPM-UNIFESP), São Paulo, Brazil
| |
Collapse
|
10
|
Kwok TC, Poulter C, Algarni S, Szatkowski L, Sharkey D. Respiratory management and outcomes in high-risk preterm infants with development of a population outcome dashboard. Thorax 2023; 78:1215-1222. [PMID: 37640548 PMCID: PMC10715505 DOI: 10.1136/thorax-2023-220174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/15/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Bronchopulmonary dysplasia (BPD) is associated with adverse long-term respiratory and neurodevelopmental outcomes. No recent studies examined the changing respiratory management and outcomes, particularly severe BPD, across a whole population. PURPOSE Evaluate the temporal trends in the respiratory management and outcomes of preterm infants born below 32 weeks gestational age and develop an individualised dashboard of the incidence of neonatal outcome. METHODS Using the National Neonatal Research Database, we determined changes in respiratory management, BPD rates, postdischarge respiratory support and mortality in 83 463 preterm infants in England and Wales from 2010 to 2020. RESULTS Between 2010 and 2020, antenatal corticosteroids use increased (88%-93%, p<0.0001) and neonatal surfactant use decreased (65%-60%, p<0.0001). Postnatal corticosteroid use increased, especially dexamethasone (4%-6%, p<0.0001). More recently, hydrocortisone and budesonide use increased from 2% in 2017 to 4% and 3%, respectively, in 2020 (p<0.0001). Over the study period, mortality decreased (10.1%-8.5%), with increases in BPD (28%-33%), severe BPD (12%-17%), composite BPD/death (35%-39%) and composite severe BPD/death (21%-24%) (all p<0.0001). Overall, 11 684 infants required postdischarge respiratory support, increasing from 13% to 17% (p<0.0001), with 1843 infants requiring respiratory pressure support at discharge. A population dashboard (https://premoutcome.github.io/) depicting the incidence of mortality and respiratory outcomes, based on gestation, sex and birthweight centile, was developed. CONCLUSION More preterm infants are surviving with worse respiratory outcomes, particularly severe BPD requiring postdischarge respiratory support. Ultimately, these survivors will develop chronic respiratory diseases requiring greater healthcare resources.
Collapse
Affiliation(s)
- Tng Chang Kwok
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Caroline Poulter
- Nottingham Neonatal Service, Queen's Medical Centre, Nottingham, UK
| | - Saleh Algarni
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lisa Szatkowski
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| | - Don Sharkey
- Centre for Perinatal Research, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
11
|
Khan W, Zaki N, Ahmad A, Masud MM, Govender R, Rojas-Perilla N, Ali L, Ghenimi N, Ahmed LA. Node embedding-based graph autoencoder outlier detection for adverse pregnancy outcomes. Sci Rep 2023; 13:19817. [PMID: 37963898 PMCID: PMC10645849 DOI: 10.1038/s41598-023-46726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/04/2023] [Indexed: 11/16/2023] Open
Abstract
Adverse pregnancy outcomes, such as low birth weight (LBW) and preterm birth (PTB), can have serious consequences for both the mother and infant. Early prediction of such outcomes is important for their prevention. Previous studies using traditional machine learning (ML) models for predicting PTB and LBW have encountered two important limitations: extreme class imbalance in medical datasets and the inability to account for complex relational structures between entities. To address these limitations, we propose a node embedding-based graph outlier detection algorithm to predict adverse pregnancy outcomes. We developed a knowledge graph using a well-curated representative dataset of the Emirati population and two node embedding algorithms. The graph autoencoder (GAE) was trained by applying a combination of original risk factors and node embedding features. Samples that were difficult to reconstruct at the output of GAE were identified as outliers considered representing PTB and LBW samples. Our experiments using LBW, PTB, and very PTB datasets demonstrated that incorporating node embedding considerably improved performance, achieving a 12% higher AUC-ROC compared to traditional GAE. Our study demonstrates the effectiveness of node embedding and graph outlier detection in improving the prediction performance of adverse pregnancy outcomes in well-curated population datasets.
Collapse
Affiliation(s)
- Wasif Khan
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Nazar Zaki
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates.
- ASPIRE Precision Medicine Research Institute Abu Dhabi (ASPIREPMRIAD), Al Ain, United Arab Emirates.
| | - Amir Ahmad
- Department of Information Systems and Security, College of Information Technology, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Mohammad M Masud
- Department of Information Systems and Security, College of Information Technology, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Romana Govender
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Natalia Rojas-Perilla
- Department of Analytics in the Digital Era, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Luqman Ali
- Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Nadirah Ghenimi
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| | - Luai A Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
- Zayed Centre for Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, United Arab Emirates
| |
Collapse
|
12
|
Mdege ND, Masuku SD, Musakwa N, Chisala M, Tingum EN, Boachie MK, Shokraneh F. Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002551. [PMID: 37939029 PMCID: PMC10631642 DOI: 10.1371/journal.pgph.0002551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.
Collapse
Affiliation(s)
- Noreen Dadirai Mdege
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, York, United Kingdom
| | - Sithabiso D. Masuku
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nozipho Musakwa
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mphatso Chisala
- Department of Population, Policy and Practice, Great Ormond Street Hospital, Institute of Child Health, University College London, London, United Kingdom
| | | | - Micheal Kofi Boachie
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Farhad Shokraneh
- Department of Evidence Synthesis, Systematic Review Consultants LTD, Nottingham, United Kingdom
| |
Collapse
|
13
|
Alsamae AA, Elzilal HA, Alzahrani E, Abo-Dief HM, Sultan MA. A Comparative Cross-sectional Study on Prevalence of Low Birth Weight and its Anticipated Risk Factors. Glob Pediatr Health 2023; 10:2333794X231203857. [PMID: 37846399 PMCID: PMC10576915 DOI: 10.1177/2333794x231203857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023] Open
Abstract
Objective. This study aims to highlight the low birth weight (LBW) in Taiz City (Yemen), as LBW is one of the public health challenges experiencing a profound effect on newborns. Methods. This was a cross-sectional study since the interview and medical records were the sources of data to be analyzed by SPSS. Results. The findings of this study include; a high prevalence of LBW (39.11%), the maternal age was not associated with LBW (P = .68), and education level, economic status, residence place, and health status were not associated with LBW (P < .05). Although the pre-pregnancy BMI, during-pregnancy BMI, MUAC, and gestational age were significantly associated with LBW (P < .05), the only risk factor was gestational age (OR = 9.606, CI = 3.988-23.135, P = .00). Conclusion. LBW is highly prevalent in Taiz (Yemen), so providing good healthcare services is essential to manage LBW incidence.
Collapse
|
14
|
Manuck TA, Gyamfi-Bannerman C, Saade G. What now? A critical evaluation of over 20 years of clinical and research experience with 17-alpha hydroxyprogesterone caproate for recurrent preterm birth prevention. Am J Obstet Gynecol MFM 2023; 5:101108. [PMID: 37527737 PMCID: PMC10591827 DOI: 10.1016/j.ajogmf.2023.101108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Abstract
Spontaneous preterm birth is multifactorial, and underlying etiologies remain incompletely understood. Supplementation with progestogens, including 17-alpha hydroxyprogesterone caproate has been a mainstay of prematurity prevention strategies in the United States in the last 2 decades. Following a recent negative confirmatory trial, 17-alpha hydroxyprogesterone caproate was withdrawn from the US market and is currently available only through clinical research studies. This expert review summarized clinical and research data regarding the use of 17-alpha hydroxyprogesterone caproate in the United States from 2003 to 2023 for recurrent prematurity prevention. In 17-alpha hydroxyprogesterone caproate. The history of the use, mechanisms of action, clinical trial results, and efficacy by clinical and biologic criteria of 17-alpha hydroxyprogesterone caproate are presented. We report that disparate findings and conclusions between similarly designed rigorous studies may reflect differences in a priori risk and population incidence and extreme care should be taken in interpreting the studies and making decisions regarding efficacy of 17-alpha hydroxyprogesterone caproate for the prevention of preterm birth. The likelihood of improved obstetrical outcomes after receiving 17-alpha hydroxyprogesterone caproate may vary by clinical factors (eg, body mass index), plasma drug concentrations, and genetic factors, although the identification of individuals most likely to benefit remains imperfect. It is crucial for the medical community to recognize the importance of preserving the decades-long efforts invested in preventing recurrent preterm birth in the United States. Moreover, it is important that we thoroughly and thoughtfully evaluate 17-alpha hydroxyprogesterone caproate as a promising contender for future well-executed prematurity studies.
Collapse
Affiliation(s)
- Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Manuck); Institute for Environmental Health Solutions, Gillings School of Global Public Health, Chapel Hill, NC (Dr Manuck).
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, CA (Dr Gyamfi-Bannerman)
| | - George Saade
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Dr Saade)
| |
Collapse
|
15
|
Noroña-Zhou AN, Ashby BD, Richardson G, Ehmer A, Scott SM, Dardar S, Marshall L, Talmi A. Rates of Preterm Birth and Low Birth Weight in an Adolescent Obstetric Clinic: Achieving Health Equity Through Trauma-Informed Care. Health Equity 2023; 7:562-569. [PMID: 37731783 PMCID: PMC10507928 DOI: 10.1089/heq.2023.0075] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 09/22/2023] Open
Abstract
Objectives Adolescents who are pregnant and identify as Black are exposed to more societal harms that increase their and their offspring's risk for poor health outcomes. The Colorado Adolescent Maternity Program (CAMP) offers comprehensive, multidisciplinary (medical, behavioral health, nutrition, case management), trauma-informed obstetric care to pregnant adolescents to ensure the healthiest pregnancy and birth possible and pursue health equity. The present study aimed to examine ethnic and racial disparities in preterm birth and low birth weight before and after implementation of a trauma-informed model of care. Methods Participants were 847 pregnant adolescents (ages 12-22 years; 41% self-identified as Hispanic, 32% as non-Hispanic Black, 21% as non-Hispanic white) who received prenatal treatment-as-usual (TAU) or trauma-informed treatment. Demographic information, mental health symptoms, and birth outcomes were abstracted from medical records. Results Overall, findings provided support that implementation of a trauma-informed model of prenatal care led to equitable birth outcomes across racial and ethnic groups. Specifically, Black adolescents in the TAU group were more than twice as likely to deliver preterm or low birth weight infants compared with white and Hispanic adolescents. In the trauma-informed group, however, there were no statistical differences in birth outcomes across racial/ethnic groups, indicating an elimination of disparities in both preterm birth and low birth weight in this population. These more equitable birth outcomes occurred even in the context of adolescents of color having reported more severe depression symptoms postimplementation. Conclusions These findings provide evidence that a health system-level intervention, herein trauma-informed obstetric care for adolescents, can play a meaningful role in the reduction of racial disparities in birth outcomes.
Collapse
Affiliation(s)
- Amanda N. Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Bethany D. Ashby
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Georgette Richardson
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Psychological Health and Learning Sciences, College of Education, University of Houston, Houston, Texas, USA
| | - Amelia Ehmer
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stephen M. Scott
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shaleah Dardar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ladean Marshall
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Ob/Gyn, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ayelet Talmi
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
16
|
Tsou PY, Hayden LP. Obstructive sleep apnea is associated with use of assisted ventilation among children with bronchopulmonary dysplasia hospitalized with respiratory illness: A nationwide inpatient cohort. Sleep Med 2023; 109:181-189. [PMID: 37467551 DOI: 10.1016/j.sleep.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE (S) Children with bronchopulmonary dysplasia (BPD) are at higher risk of respiratory insufficiency during respiratory illness. We aimed to investigate whether obstructive sleep apnea (OSA) is associated with increased morbidity among children with BPD hospitalized with acute respiratory illnesses. STUDY DESIGN Hospital discharge records were obtained from the Kid's Inpatient Database for children <21 years of age with BPD hospitalized for acute respiratory illness between 1997 and 2012. Acute respiratory illnesses included bacterial and/or viral pneumonia, bronchiolitis, acute upper respiratory tract infections, aspiration pneumonia, or asthma exacerbation. The primary exposure was OSA. The primary outcome was invasive mechanical ventilation (IMV), and secondary outcomes were noninvasive mechanical ventilation (NIMV), length of hospital stay (LOS), and inflation-adjusted cost of hospitalization (IACH). Multivariable regression was conducted to ascertain the associations between OSA and primary and secondary outcomes accounting for BPD-associated comorbidities. RESULTS Among 33,640 hospitalizations of children with BPD for acute respiratory illness, there were 607 (1.8%) cases with comorbid OSA vs. 33,033 (98.2%) controls without OSA. Patients with OSA were more likely to have aspiration pneumonia, central sleep apnea, obesity, laryngeal stenosis, congenital airway, and skull/face/jaw anomalies. Multivariable regression showed that OSA was associated with IMV (OR 1.45, 95% CI 1.09-1.94, p = 0.012) and NIMV (OR 2.61, 95% CI 1.71-3.98, p < 0.001), but not LOS or IACH. CONCLUSIONS In BPD patients hospitalized with acute respiratory illness, having OSA is associated with increased risks for respiratory insufficiency requiring noninvasive or invasive mechanical ventilation. Clinicians should consider OSA, along with other BPD-associated comorbidities, in the management of this population.
Collapse
Affiliation(s)
- Po-Yang Tsou
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lystra P Hayden
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
17
|
Miller ER, Hudak ML. Medicaid and newborn care: challenges and opportunities. J Perinatol 2023; 43:1072-1078. [PMID: 37438483 DOI: 10.1038/s41372-023-01714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/30/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023]
Abstract
Since its creation in 1965, Medicaid has operated as a federal-state partnership that provides a robust set of medical benefits to low-income families, including pregnant people and infants. In many ways, Medicaid has met its initial promise. However, medical benefits, provider payments, and key administrative procedures regarding eligibility, enrollment, and access to care vary substantially among state Medicaid programs. These variations have created profound inequities across states in the care of parents and children, particularly during pregnancy and in the postpartum and neonatal periods. Here we review select aspects of the Medicaid program pertinent to newborns and infants that contribute to eligibility and enrollment gaps, variations in benefits coverage and payment rates, and racial disparities in both access to healthcare and infant health outcomes. We outline a number of structural reforms of the Medicaid program that can improve newborn and infant access to care and outcomes and redress existing inequities.
Collapse
Affiliation(s)
- Emily R Miller
- Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Mark L Hudak
- Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| |
Collapse
|
18
|
Kovács G, Abonyi-Tóth Z, Fadgyas-Freyler P, Kaló Z. Incremental cost of premature birth - a public health care payer perspective from Hungary. BMC Health Serv Res 2023; 23:686. [PMID: 37353814 DOI: 10.1186/s12913-023-09697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending. METHODS Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied. RESULTS A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life. CONCLUSION This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Gábor Kovács
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Zsolt Abonyi-Tóth
- University of Veterinary Medicine, Budapest, Hungary
- RxTarget Ltd, Budapest, Hungary
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
19
|
Lake ET, Staiger D, Smith JG, Rogowski JA. The Association of Missed Nursing Care With Very Low Birthweight Infant Outcomes. Med Care Res Rev 2023; 80:293-302. [PMID: 36692294 PMCID: PMC10121798 DOI: 10.1177/10775587221150950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study is the first to look at the association between missed nursing care and mortality, morbidity, and length of stay (LOS) for VLBW infants in a U.S. NICU sample. We used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. The 190 sample hospitals were from 19 states in all regions. Missed clinical nursing care was significantly associated with higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage. With further research, these results may motivate the development of interventions to reduce missed clinical nursing care in the NICU.
Collapse
Affiliation(s)
- Eileen T. Lake
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | | | | | | |
Collapse
|
20
|
Ren Y, Wu D, Tong Y, López-DeFede A, Gareau S. Issue of Data Imbalance on Low Birthweight Baby Outcomes Prediction and Associated Risk Factors Identification: Establishment of Benchmarking Key Machine Learning Models With Data Rebalancing Strategies. J Med Internet Res 2023; 25:e44081. [PMID: 37256674 DOI: 10.2196/44081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/02/2023] [Accepted: 04/04/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Low birthweight (LBW) is a leading cause of neonatal mortality in the United States and a major causative factor of adverse health effects in newborns. Identifying high-risk patients early in prenatal care is crucial to preventing adverse outcomes. Previous studies have proposed various machine learning (ML) models for LBW prediction task, but they were limited by small and imbalanced data sets. Some authors attempted to address this through different data rebalancing methods. However, most of their reported performances did not reflect the models' actual performance in real-life scenarios. To date, few studies have successfully benchmarked the performance of ML models in maternal health; thus, it is critical to establish benchmarks to advance ML use to subsequently improve birth outcomes. OBJECTIVE This study aimed to establish several key benchmarking ML models to predict LBW and systematically apply different rebalancing optimization methods to a large-scale and extremely imbalanced all-payer hospital record data set that connects mother and baby data at a state level in the United States. We also performed feature importance analysis to identify the most contributing features in the LBW classification task, which can aid in targeted intervention. METHODS Our large data set consisted of 266,687 birth records across 6 years, and 8.63% (n=23,019) of records were labeled as LBW. To set up benchmarking ML models to predict LBW, we applied 7 classic ML models (ie, logistic regression, naive Bayes, random forest, extreme gradient boosting, adaptive boosting, multilayer perceptron, and sequential artificial neural network) while using 4 different data rebalancing methods: random undersampling, random oversampling, synthetic minority oversampling technique, and weight rebalancing. Owing to ethical considerations, in addition to ML evaluation metrics, we primarily used recall to evaluate model performance, indicating the number of correctly predicted LBW cases out of all actual LBW cases, as false negative health care outcomes could be fatal. We further analyzed feature importance to explore the degree to which each feature contributed to ML model prediction among our best-performing models. RESULTS We found that extreme gradient boosting achieved the highest recall score-0.70-using the weight rebalancing method. Our results showed that various data rebalancing methods improved the prediction performance of the LBW group substantially. From the feature importance analysis, maternal race, age, payment source, sum of predelivery emergency department and inpatient hospitalizations, predelivery disease profile, and different social vulnerability index components were important risk factors associated with LBW. CONCLUSIONS Our findings establish useful ML benchmarks to improve birth outcomes in the maternal health domain. They are informative to identify the minority class (ie, LBW) based on an extremely imbalanced data set, which may guide the development of personalized LBW early prevention, clinical interventions, and statewide maternal and infant health policy changes.
Collapse
Affiliation(s)
- Yang Ren
- Department of Computer Science, University of South Carolina, Columbia, SC, United States
| | - Dezhi Wu
- Department of Integrated Information Technology, University of South Carolina, Columbia, SC, United States
| | - Yan Tong
- Department of Computer Science, University of South Carolina, Columbia, SC, United States
| | - Ana López-DeFede
- The Institute of Families in Society, University of South Carolina, Columbia, SC, United States
| | - Sarah Gareau
- The Institute of Families in Society, University of South Carolina, Columbia, SC, United States
| |
Collapse
|
21
|
Huda MM, Callaway LK, Jackson G, Fatima Y, Cumming J, Biswas T, Paz GR, Boyle F, Sly PD, Mamun AA. Time trends, projections, and spatial distribution of low birthweight in Australia, 2009-2030: Evidence from the National Perinatal Data Collection. Birth 2023; 50:76-89. [PMID: 36696404 PMCID: PMC10947513 DOI: 10.1111/birt.12708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/15/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Infants with low birthweight (LBW, birthweight <2500 g) have increased in many high-resource countries over the past two decades. This study aimed to investigate the time trends, projections, and spatial distribution of LBW in Australia, 2009-2030. METHODS We used standard aggregate data on 3 346 808 births from 2009 to 2019 from Australia's National Perinatal Data Collection. Bayesian linear regression model was used to estimate the trends in the prevalence of LBW in Australia. RESULTS Wefound that the prevalence of LBW was 6.18% in 2009, which has increased to 6.64% in 2019 (average annual rate of change, AARC = +0.76%). If the national trend remains the same, the projected prevalence of LBW in Australia will increase to 7.34% (95% uncertainty interval, UI = 6.99, 7.68) in 2030. Observing AARC across different subpopulations, the trend of LBW was stable among Indigenous mothers, whereas it increased among non-Indigenous mothers (AARC = +0.81%). There is also an increase among the most disadvantaged mothers (AARC = +1.08%), birthing people in either of two extreme age groups (AARC = +1.99% and +1.53% for <20 years and ≥40 years, respectively), and mothers who smoked during pregnancy (AARC = +1.52%). Spatiotemporal maps showed that some of the Statistical Area level 3 (SA3) in Northern Territory and Queensland had consistently higher prevalence for LBW than the national average from 2014 to 2019. CONCLUSION Overall, the prevalence of LBW has increased in Australia during 2009-2019; however, the trends vary across different subpopulations. If trends persist, Australia will not achieve the Sustainable Development Goals (SDGs) target of a 30% reduction in LBW by 2030. Centering and supporting the most vulnerable subpopulations is vital to progress the SDGs and improves perinatal and infant health in Australia.
Collapse
Affiliation(s)
- M. Mamun Huda
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
- ARC Life Course CentreThe University of QueenslandQueenslandBrisbaneAustralia
| | - Leonie K. Callaway
- Women's and Newborn ServicesRoyal Brisbane and Women's HospitalQueenslandBrisbaneAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneAustralia
| | - Greg Jackson
- Health Protection Branch, Queensland Department of HealthQueenslandBrisbaneAustralia
- Queensland Alliance for Environmental Health Sciences (QAEHS)The University of QueenslandQueenslandWoolloongabbaAustralia
| | - Yaqoot Fatima
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
- ARC Life Course CentreThe University of QueenslandQueenslandBrisbaneAustralia
- Murtupuni Centre for Rural and Remote HealthJames Cook UniversityQueenslandMount IsaAustralia
| | - Janet Cumming
- Health Protection Branch, Queensland Department of HealthQueenslandBrisbaneAustralia
| | - Tuhin Biswas
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
- ARC Life Course CentreThe University of QueenslandQueenslandBrisbaneAustralia
- Science and Math ProgramAsian University for WomenChattogramBangladesh
| | - Gonzalo R. Paz
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
- ARC Life Course CentreThe University of QueenslandQueenslandBrisbaneAustralia
- Facultad de MedicinaUniversidad del ValleCaliColombia
| | - Fran Boyle
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
| | - Peter D. Sly
- Children's Health Research CentreUniversity of QueenslandSouth BrisbaneAustralia
- WHO Collaborating Centre for Children's Health and EnvironmentQueenslandSouth BrisbaneAustralia
| | - Abdullah Al Mamun
- Poche Centre for Indigenous HealthThe University of QueenslandQueenslandBrisbaneAustralia
- ARC Life Course CentreThe University of QueenslandQueenslandBrisbaneAustralia
- Queensland Alliance for Environmental Health Sciences (QAEHS)The University of QueenslandQueenslandWoolloongabbaAustralia
| |
Collapse
|
22
|
Jana A, Saha UR, Reshmi RS, Muhammad T. Relationship between low birth weight and infant mortality: evidence from National Family Health Survey 2019-21, India. Arch Public Health 2023; 81:28. [PMID: 36803539 PMCID: PMC9942291 DOI: 10.1186/s13690-023-01037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) predisposes physical and mental growth failure and premature death among infants. Studies report that LBW predominately explains infant mortality. However, existing studies rarely demonstrate the phenomenon of both observed and unobserved factors, which may influence the likelihood of birth and mortality outcomes simultaneously. In this study, we identified the spatial clustering of the prevalence of LBW along with its determinants. Further, the relationship between of LBW and infant mortality, considering the unobserved factors, has been explored in the study. METHODS Data for this study have been extracted from the National Family Health Survey (NFHS) round 5, 2019-21. We used the directed acyclic graph model to identify the potential predictors of LBW and infant mortality. Moran's I statistics have been used to identify the high-risk areas of LBW. We applied conditional mixed process modelling in Stata software to account for the simultaneous nature of occurrences of the outcomes. The final model has been performed after imputing the missing data of LBW. RESULTS Overall, in India, 53% of the mothers reported their babies' birth weight by seeing health card, 36% reported by recall, and about 10% of the LBW information was observed as missing. The state/union territory of Punjab and Delhi were observed to have the highest levels of LBW (about 22%) which is much higher than the national level (18%). The effect of LBW was more than four times larger compared to the effect in the analysis which does not account for the simultaneous occurrence of LBW and infant mortality (marginal effect; from 12 to 53%). Also, in a separate analysis, the imputation technique has been used to address the missing data. Covariates' effects showed that female children, higher order births, births that occur in Muslim and non-poor families and literate mothers were negatively associated with infant mortality. However, a significant difference was observed in the impact of LBW before and after imputing the missing values. CONCLUSIONS The current findings showed the significant association of LBW with infant deaths, highlighting the importance of prioritising policies that help improve the birth weight of new-born children that may significantly reduce the infant mortality in India.
Collapse
Affiliation(s)
- Arup Jana
- International Institute for Population Sciences, Deonar, Mumbai, 400088, India.
| | - Unnati Rani Saha
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - R. S. Reshmi
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Deonar, Mumbai, 400088 India
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Deonar, Mumbai, 400088 India
| |
Collapse
|
23
|
Community health workers as change agents in improving equity in birth outcomes in Detroit. PLoS One 2023; 18:e0281450. [PMID: 36787290 PMCID: PMC9928129 DOI: 10.1371/journal.pone.0281450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
We examined whether pairing pregnant women with community health workers improved pregnancy outcomes among 254 Black women with singleton pregnancies participating in the Women-Inspired Neighborhood (WIN) Network: Detroit using a case-control design. A subset (N = 63) of women were recontacted and asked about program satisfaction, opportunities, and health behaviors. Michigan Vital Statistics records were used to ascertain controls (N = 12,030) and pregnancy and infant health outcomes. Logistic and linear regression were used to examine the association between WIN Network participation and pregnancy and infant health outcomes. The WIN Network participants were less likely than controls to be admitted to the neonatal intensive care unit (odds ratio = 0.55, 95% CI 0.33-0.93) and had a longer gestational length (mean difference = 0.42, 95% CI 0.02-0.81). Community health workers also shaped participants' view of opportunities to thrive. This study demonstrates that community health workers can improve pregnancy outcomes for Black women.
Collapse
|
24
|
Prematurity and BPD: what general pediatricians should know. Eur J Pediatr 2023; 182:1505-1516. [PMID: 36763190 PMCID: PMC10167192 DOI: 10.1007/s00431-022-04797-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 02/11/2023]
Abstract
More and more very low birth weight (VLBW) infants around the world survive nowadays, with consequently larger numbers of children developing prematurity-related morbidities, especially bronchopulmonary dysplasia (BPD). BPD is a multifactorial disease and its rising incidence in recent years means that general pediatricians are much more likely to encounter a child born extremely preterm, possibly with BPD, in their clinical practice. Short- and long-term sequelae in VLBW patients may affect not only pulmonary function (principally characterized by an obstructive pattern), but also other aspect including the neurological (neurodevelopmental and neuropsychiatric disorders), the sensorial (earing and visual impairment), the cardiological (systemic and pulmonary hypertension, reduced exercise tolerance and ischemic heart disease in adult age), nutritional (feeding difficulties and nutritional deficits), and auxological (extrauterine growth restriction). For the most premature infants at least, a multidisciplinary follow-up is warranted after discharge from the neonatal intensive care unit in order to optimize their respiratory and neurocognitive potential, and prevent respiratory infections, nutritional deficiencies or cardiovascular impairments. Conclusion: The aim of this review is to summarize the main characteristics of preterm and BPD infants, providing the general pediatrician with practical information regarding these patients' multidisciplinary complex follow-up. We explore the current evidence on respiratory outcomes and their management that actually does not have a definitive available option. We also discuss the available investigations, treatments, and strategies for prevention and prophylaxis to improve the non-respiratory outcomes and the quality of life for these children and their families, a critical aspect not always considered. This comprehensive approach, added to the increased needs of a VLBW subjects, is obviously related to very high health-related costs that should be beared in mind. What is Known: • Every day, a general pediatrician is more likely to encounter a former very low birth weight infant. • Very low birth weight and prematurity are frequently related not only with worse respiratory outcomes, but also with neurological, sensorial, cardiovascular, renal, and nutritional issues. What is New: • This review provides to the general pediatrician a comprehensive approach for the follow-up of former premature very low birth weight children, with information to improve the quality of life of this special population.
Collapse
|
25
|
King BC, Hagan J, Richardson T, Berry J, Slaughter JL. Hospital variation in neonatal echocardiography among very preterm infants at US children's hospitals. J Perinatol 2023; 43:181-186. [PMID: 36163416 DOI: 10.1038/s41372-022-01522-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Estimate hospital variation in echocardiography (echo) among very preterm infants. STUDY DESIGN Retrospective cohort study of very preterm (<32 weeks) infants discharged between 2012 and 2019 from US children's hospitals. Echo exposure was identified using daily billing, and hospital variation was estimated after adjustment for illness severity. Variation in very early echo use (<3 days of life) was compared to exposure to treatment of a patent ductus arteriosus (PDA), and other practice patterns. RESULTS 27,498 subjects across 39 children's hospitals were included. Very early echo use had the greatest hospital variation (3-34%). Increasing very early echo use was not associated with PDA treatment (p = 0.93), but was associated with nitric oxide (p < 0.01) and vasoactive medications (p < 0.01). CONCLUSIONS Hospital variation in echo use among preterm infants was greatest in the first few days of life and was associated with increasing nitric oxide and vasoactive medication use. The impact of this variation on clinical outcomes is uncertain and warrants further investigation.
Collapse
Affiliation(s)
- Brian C King
- Division of Newborn Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Joseph Hagan
- Newborn Center, Texas Children's Hospital, Houston, TX, USA
| | | | - Jay Berry
- Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan L Slaughter
- Center for Perinatal Research, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine and Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
26
|
Okulu E, Kraja E, Kostekci YE, Aloyeva R, Erdeve O, Atasay B, Arsan S. Comparison of Definitions for Bronchopulmonary Dysplasia: A Cohort Study. Z Geburtshilfe Neonatol 2023; 227:58-63. [PMID: 36070784 DOI: 10.1055/a-1915-5682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We aimed to compare the definitions of National Institute of Child Health and Human Development (NICHD) for bronchopulmonary dysplasia (BPD) for determining the incidences, and predicting late death and respiratory outcome. This retrospective cohort study included infants born at<32 weeks' gestation who survived up to 36 weeks' postmenstrual age (PMA). Infants were classified as having BPD or no BPD per thedefinitions of NICHD 2001 and 2018. The incidences of BPD were 49 and 32% according to the 2001 and 2018 NICHD definitions. Gestational age, birth weight and intubation after birth were associated with BPD by both definitions. The NICHD 2018 definition displayed similar sensitivity (100%) and negative predictive value (100%), and higher specificity (70 vs. 52%) for predicting death after 36 weeks' PMA; a higher specificity (72 vs. 53%), comparable negative predictive value (77 vs.76%), but lower sensitivity for predicting adverse respiratory outcome within 12 months corrected age compared with the NICHD 2001 definition. The NICHD 2018 definition is as powerful as the 2001 definition for predicting late death and seems to be a better indicator for long-term respiratory outcome. The use of supplemental oxygen or oxygen plus respiratory support should be considered while predicting both late death and long-term respiratory outcome.
Collapse
Affiliation(s)
- Emel Okulu
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elvis Kraja
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Ezgi Kostekci
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rana Aloyeva
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Omer Erdeve
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Begum Atasay
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Saadet Arsan
- Department of Pediatrics, Division of Neonatology, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
27
|
Beltempo M, Bresson G, Lacroix G. Using machine learning to predict nosocomial infections and medical accidents in a NICU. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-022-00723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
28
|
Hebballi NB, Avritscher EBC, Garcia E, Bain A, Bartz-Kurycki MA, Tsao K, Austin MT. Healthcare Utilization Among Infants Discharged From the Neonatal Intensive Care Unit: A Descriptive Cost Analysis. Health Serv Insights 2023; 16:11786329231169604. [PMID: 37114206 PMCID: PMC10126788 DOI: 10.1177/11786329231169604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
The cost of readmissions of neonatal intensive care unit (NICU) graduates within 6 months and a year of their life is well-studied. However, the cost of readmissions within 90 days of NICU discharge is unknown. This study's objective was to estimate the overall and mean cost of healthcare use for unplanned hospital visits of NICU graduates within 90 days of discharge A retrospective review of all infants discharged between 1/1/2017 and 03/31/2017 from a large hospital system NICUs was conducted. All unplanned hospital visits (readmissions or stand-alone emergency department (ED) visits) occurring within 90 days post NICU discharge were included. The total and mean cost of unplanned hospital visits were computed and adjusted to 2021 US dollars. The total cost was estimated to be $785 804 with a mean of $1898 per patient. Hospital readmissions accounted for 98% ($768 718) of the total costs and ED visits for 2% ($17 086). The mean cost per readmission and stand-alone ED visit were $25 624 and $475 respectively. The highest mean total cost of unplanned hospital readmission was noted in extremely low birth weight infants ($25 295). Interventions targeted to reduce hospital readmissions after NICU discharge have the potential to significantly reduce healthcare costs for this patient population.
Collapse
Affiliation(s)
- Nutan B Hebballi
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Nutan B Hebballi, Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6410 Fannin Street, Suite 471, Houston, TX 77030, USA.
| | - Elenir BC Avritscher
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elisa Garcia
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andrew Bain
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Marisa A Bartz-Kurycki
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - KuoJen Tsao
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
- Children’s Memorial Hermann Hospital, Houston, TX, USA
| |
Collapse
|
29
|
Lai KC, Lorch SA. Healthcare Costs of Major Morbidities Associated with Prematurity in US Children's Hospitals. J Pediatr 2022; 256:53-62.e4. [PMID: 36509157 DOI: 10.1016/j.jpeds.2022.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/14/2022] [Accepted: 11/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the healthcare costs attributed to major morbidities associated with prematurity, namely, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and nosocomial infections. STUDY DESIGN This was a retrospective analysis of infants born at 24-30 weeks of gestation, admitted to children's hospitals in the Pediatric Health Information System between 2009 and 2018. Charges were adjusted by geographical price index, converted to costs using cost-to-charge ratios, inflated to 2018 US$, and total costs were accumulated for the initial hospitalization. Quantile regressions, which are less prone to bias from extreme outliers, were used to examine the incremental costs attributed to each morbidity across the entire cost distribution, including the median. RESULTS There were 19 232 patients from 30 children's hospitals who were eligible. Higher costs were seen in lower gestational age, more severe morbidity, and those with higher number of comorbidities. Patients with surgical NEC, severe ROP, and severe BPD were the costliest with median total costs of $430 860, $413 825, and $399 495, respectively. Quantile regressions showed surgical NEC had the highest adjusted median incremental total cost ($48 621; 95% CI, $39 617-$57 626) followed by severe BPD ($35 773; 95% CI, $32 018-$39 528) and severe ROP ($22 561; 95% CI, $16 699-$28 423). Quantile regressions also revealed that surgical NEC, severe BPD, and severe ROP had increasing incremental costs at higher total cost percentiles, indicating these morbidities have a greater cost impact on the costliest patients. CONCLUSIONS Severe BPD, surgical NEC, and severe ROP are the costliest morbidities and contribute the most incremental costs especially for the higher costs patients.
Collapse
Affiliation(s)
- Kuan-Chi Lai
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Neonatology, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Scott A Lorch
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA
| |
Collapse
|
30
|
Coomes KE, Buonocore JJ, Levy JI, Arter C, Arunachalam S, Buckley L, Berberian A, Gunasti J, Perera F. Assessment of the health benefits to children of a transportation climate policy in New York City. ENVIRONMENTAL RESEARCH 2022; 215:114165. [PMID: 36087775 DOI: 10.1016/j.envres.2022.114165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Assessments of health and environmental effects of clean air and climate policies have revealed substantial health benefits due to reductions in air pollution, but have included few pediatric outcomes or assessed benefits at the neighborhood level. OBJECTIVES We estimated benefits across a suite of child health outcomes in 42 New York City (NYC) neighborhoods under the proposed regional Transportation and Climate Initiative. We also estimated their distribution across racial/ethnic and socioeconomic groups. METHODS We estimated changes in ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations associated with on-road emissions under nine different predefined cap-and-invest scenarios. Health outcomes, including selected adverse birth, respiratory, and neurodevelopmental outcomes, were estimated using a program similar to the U.S. EPA BenMAP program. We stratified the associated monetized benefits across racial/ethnic and socioeconomic groups. RESULTS The benefits varied widely over the different cap-and-investment scenarios. For a 25% reduction in carbon emissions from 2022 to 2032 and a strategy prioritizing public transit investments, NYC would have an estimated 48 fewer medical visits for childhood asthma, 13,000 avoided asthma exacerbations not requiring medical visits, 640 fewer respiratory illnesses unrelated to asthma, and 9 avoided adverse birth outcomes (infant mortality, preterm birth, and term low birth weight) annually, starting in 2032. The total estimated annual avoided costs are $22 million. City-wide, Black and Hispanic children would experience 1.7 times the health benefits per capita than White and Non-Hispanic White children, respectively. Under the same scenario, neighborhoods experiencing the highest poverty rates in NYC would experience about 2.5 times the health benefits per capita than the lowest poverty neighborhoods. CONCLUSION A cap-and-invest strategy to reduce carbon emissions from the transportation sector could provide substantial health and monetized benefits to children in NYC through reductions in criteria pollutant concentrations, with greater benefits among Black and Hispanic children.
Collapse
Affiliation(s)
- Kaitlyn E Coomes
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | | | | | - Calvin Arter
- Institute for the Environment, University of North Carolina, Chapel Hill, NC, USA
| | | | - Laura Buckley
- School of Public Health, Boston University, Boston, MA, USA
| | - Alique Berberian
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Jonathan Gunasti
- Rollins School of Public Health, Emory Univerity, Atlanta, GA, USA
| | - Frederica Perera
- Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York City, NY, USA.
| |
Collapse
|
31
|
Balsa AI, Triunfo P. The COVID-19 pandemic and birth outcomes in 2020: The role of prenatal care and other channels. ECONOMICS AND HUMAN BIOLOGY 2022; 47:101167. [PMID: 35930987 PMCID: PMC9338169 DOI: 10.1016/j.ehb.2022.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
We use national birth data to assess the associations between the COVID-19 pandemic during 2020 and birth outcomes in Uruguay. Employing interrupted time series difference-in-differences techniques, we find mixed results, with some pregnancies showing increases in the likelihood of very preterm or very-low-weight births, and some others showing decreases in the incidence of moderate prematurity and moderate low birth weight. Adverse outcomes are more likely among women with low education, women with previous children, and with risk factors, such as smoking or being older than 34. We observe improvements in health at birth for children of non-smokers, women younger than 35, and women with no other children. We underscore the role of health care by showing that women in the private sector, who suffered the strongest contraction in face-to-face prenatal care use, experienced more adverse birth outcomes. Our results also suggest that the economic recession and an increased burden of childcare were behind the increases in preterm and very-low-weight births. Because pollution is an unlikely channel for the positive results, we hypothesize that for some pregnancies, the pandemic improved the intrauterine habitat by leading to a quieter and healthier lifestyle.
Collapse
Affiliation(s)
- Ana I Balsa
- Department of Economics and Center for Research in Applied Economics, School of Business and Economics, University of Montevideo, Montevideo, Uruguay.
| | - Patricia Triunfo
- Department of Economics, School of Social Sciences, University of the Republic, Montevideo, Uruguay.
| |
Collapse
|
32
|
Model-Base Estimation of Non-Invasive Ventilation Weaning of Preterm Infants Exposed to Osteopathic Manipulative Treatment: A Propensity-Score-Matched Cohort Study. Healthcare (Basel) 2022; 10:healthcare10122379. [PMID: 36553903 PMCID: PMC9777985 DOI: 10.3390/healthcare10122379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
Ventilation weaning is a key intensive care event influencing preterm infants’ discharge from a neonatal intensive care unit (NICU). Osteopathic manipulative treatment (OMT) has been recently introduced in some Italian NICUs. This retrospective cohort study tested if OMT is associated with faster non-invasive ventilation (NIV) weaning. The time to NIV weaning was assessed in very preterm and very low birth weight infants who either received or did not receive OMT. The propensity score model included gender, antenatal steroids, gestational age (GA), birth weight (BW), and Apgar score 5′. Out of 93 infants, 40 were included in the multilevel survival analysis, showing a reduction of time to NIV weaning for GA (HR: 2.58, 95%CI: 3.91 to 1.71, p < 0.001) and OMT (HR: 3.62, 95%CI: 8.13 to 1.61, p = 0.002). Time to independent ventilation (TIV) was modeled with GA and BW as dependent variables and OMT as the factor. A negative linear effect of GA and BW on TIV was shown. OMT exposure studied as the factor of GA had effects on TIV in infants born up to the 32nd gestational week. Preterm infants exposed to OMT were associated with earlier achievement of NIV weaning. This result, together with the demonstrated OMT safety, suggests the conduct of clinical trials in preterm infants younger than 32 weeks of GA.
Collapse
|
33
|
Trends in Retinopathy of Prematurity Care in the US 2009-2018: A Nationwide Analysis using National Inpatient Sample. Ophthalmol Retina 2022; 7:360-366. [PMID: 36280204 DOI: 10.1016/j.oret.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Retinopathy of prematurity (ROP) represents a leading cause of childhood blindness. The purpose of our study was to evaluate incidence, trends in cost and length of hospital stay, and risk factors for ROP using a publicly available population-based dataset, the National Inpatient Sample. DESIGN This cross-sectional study analyzed data from 2009 to 2018 using the National Inpatient Sample. PARTICIPANTS Premature neonates (n = 717 277) who met the screening criteria for ROP with gestational age of ≤ 30 weeks or birthweight (BW) of ≤ 1500 g were identified. METHODS Database analysis. MAIN OUTCOME MEASURES Incidence, demographics, risk factors for ROP development, trends in cost, and length of stay were evaluated. RESULTS In total, incidence of ROP increased from 11% in 2009 to 15% in 2018 (P < 0.001). Multivariate logistic regression model of ROP development showed its associations with female sex (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.10-1.17), Hispanic (OR, 1.10; 95% CI, 1.03-1.18), and Black (OR, 0.91; 95% CI 0.86-0.96) ethnicity. Neonates with lower BWs, particularly those in the 500- to 999-g subgroup (OR, 2.64; 95% CI, 2.44-2.85) and younger gestational ages, particularly those born between 25 and 28 weeks gestational age (OR, 2.41; 95% CI, 2.25-2.58), had increased risk of developing ROP. Comorbidities associated with the development of ROP were perinatal jaundice (OR, 1.84; 95% CI, 1.74-1.94), patent ducts arteriosus (OR, 1.67; 95% CI, 1.60-1.75), intraventricular hemorrhage (OR, 1.41; 95% CI, 1.35-1.48), perinatal infection (OR, 1.84; 95% CI, 1.74-1.94), and respiratory distress syndrome (OR, 1.05; 95% CI, 1.01-1.10). CONCLUSIONS Retinopathy of prematurity develops in about 1 of 10 premature infants and incidence has been shown to be increasing. Significant risk factors were female sex, Hispanic ethnicity, lower BW, younger gestational age, and systemic comorbidities, including perinatal jaundice, patent ductus arteriosus, intraventricular hemorrhage, perinatal sepsis, and respiratory distress syndrome. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
|
34
|
Roland H, Brown A, Rousselot A, Freeman N, Wieting JM, Bergman S, Mondal D. Osteopathic Manipulative Treatment Decreases Hospital Stay and Healthcare Cost in the Neonatal Intensive Care Unit. MEDICINES (BASEL, SWITZERLAND) 2022; 9:49. [PMID: 36286582 PMCID: PMC9607199 DOI: 10.3390/medicines9100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/08/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Osteopathic manipulative treatment (OMT) is used in both inpatient and outpatient settings. Evidence suggests that OMT can reduce both patients' recovery time and the financial cost of their acute medical treatment and rehabilitation. Multiple studies from neonatal intensive care units (NICUs) are presented in this article that demonstrate infants treated with OMT recover faster, are discharged earlier, and have lower healthcare costs than their non-OMT-treated counterparts. Data clearly show that adjunctive OMT facilitates feeding coordination in newborns, such as latching, suckling, swallowing, and breathing, and increases long-term weight gain and maintenance, which reduces hospital length of stay (LOS). Osteopathic techniques, such as soft tissue manipulation, balanced ligamentous tension, myofascial release, and osteopathic cranial manipulation (OCM), can reduce regurgitation, vomiting, milky bilious, or bloody discharge and decrease the need for constipation treatment. OMT can also be effective in reducing the complications of pneumonia in premature babies. Studies show the use of OCM and lymphatic pump technique (LPT) reduces the occurrence of both aspiration and environmentally acquired pneumonia, resulting in significantly lower morbidity and mortality in infants. Based on published findings, it is determined that OMT is clinically effective, cost efficient, a less invasive alternative to surgery, and a less toxic choice to pharmacologic drugs. Therefore, routine incorporation of OMT in the NICU can be of great benefit in infants with multiple disorders. Future OMT research should aim to initiate clinical trial designs that include randomized controlled trials with larger cohorts of infants admitted to the NICU. Furthermore, a streamlined and concerted effort to elucidate the underlying molecular mechanisms associated with the beneficial effects of OMT will aid in understanding the significant value of incorporating OMT into optimal patient care.
Collapse
Affiliation(s)
- Hannah Roland
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amanda Brown
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Amy Rousselot
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - Natalie Freeman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| | - J. Michael Wieting
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Stephen Bergman
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 6965 Cumberland Gap Parkway, Harrogate, TN 37752, USA
| | - Debasis Mondal
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, 9737 Cogdill Road, Knoxville, TN 37932, USA
| |
Collapse
|
35
|
Li Y, Fu X, Guo X, Liang H, Cao D, Shi J. Maternal preterm birth prediction in the United States: a case-control database study. BMC Pediatr 2022; 22:547. [PMID: 36104673 PMCID: PMC9472432 DOI: 10.1186/s12887-022-03591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Preterm birth is serious public health worldwide, and early prediction of preterm birth in pregnant women may provide assistance for timely intervention and reduction of preterm birth. This study aimed to develop a preterm birth prediction model that is readily available and convenient for clinical application.
Methods
Data used in this case-control study were extracted from the National Vital Statistics System (NVSS) database between 2018 and 2019. Univariate and multivariate logistic regression analyses were utilized to find factors associated with preterm birth. Odds ratio (OR) and 95% confidence interval (CI) were used as effect measures. The area under the curve (AUC), accuracy, sensitivity, and specificity were utilized as model performance evaluation metrics.
Results
Data from 3,006,989 pregnant women in 2019 and 3,039,922 pregnant women in 2018 were used for the model establishment and external validation, respectively. Of these 3,006,989 pregnant women, 324,700 (10.8%) had a preterm birth. Higher education level of pregnant women [bachelor (OR = 0.82; 95%CI, 0.81–0.84); master or above (OR = 0.82; 95%CI, 0.81–0.83)], pre-pregnancy overweight (OR = 0.96; 95%CI, 0.95–0.98) and obesity (OR = 0.94; 95%CI, 0.93–0.96), and prenatal care (OR = 0.48; 95%CI, 0.47–0.50) were associated with a reduced risk of preterm birth, while age ≥ 35 years (OR = 1.27; 95%CI, 1.26–1.29), black race (OR = 1.26; 95%CI, 1.23–1.29), pre-pregnancy underweight (OR = 1.26; 95%CI, 1.22–1.30), pregnancy smoking (OR = 1.27; 95%CI, 1.24–1.30), pre-pregnancy diabetes (OR = 2.08; 95%CI, 1.99–2.16), pre-pregnancy hypertension (OR = 2.22; 95%CI, 2.16–2.29), previous preterm birth (OR = 2.95; 95%CI, 2.88–3.01), and plurality (OR = 12.99; 95%CI, 12.73–13.24) were related to an increased risk of preterm birth. The AUC and accuracy of the prediction model in the testing set were 0.688 (95%CI, 0.686–0.689) and 0.762 (95%CI, 0.762–0.763), respectively. In addition, a nomogram based on information on pregnant women and their spouses was established to predict the risk of preterm birth in pregnant women.
Conclusions
The nomogram for predicting the risk of preterm birth in pregnant women had a good performance and the relevant predictors are readily available clinically, which may provide a simple tool for the prediction of preterm birth.
Collapse
|
36
|
Malaza N, Masete M, Adam S, Dias S, Nyawo T, Pheiffer C. A Systematic Review to Compare Adverse Pregnancy Outcomes in Women with Pregestational Diabetes and Gestational Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710846. [PMID: 36078559 PMCID: PMC9517767 DOI: 10.3390/ijerph191710846] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/15/2022] [Accepted: 08/22/2022] [Indexed: 05/14/2023]
Abstract
Pregestational type 1 (T1DM) and type 2 (T2DM) diabetes mellitus and gestational diabetes mellitus (GDM) are associated with increased rates of adverse maternal and neonatal outcomes. Adverse outcomes are more common in women with pregestational diabetes compared to GDM; although, conflicting results have been reported. This systematic review aims to summarise and synthesise studies that have compared adverse pregnancy outcomes in pregnancies complicated by pregestational diabetes and GDM. Three databases, Pubmed, EBSCOhost and Scopus were searched to identify studies that compared adverse outcomes in pregnancies complicated by pregestational T1DM and T2DM, and GDM. A total of 20 studies met the inclusion criteria and are included in this systematic review. Thirteen pregnancy outcomes including caesarean section, preterm birth, congenital anomalies, pre-eclampsia, neonatal hypoglycaemia, macrosomia, neonatal intensive care unit admission, stillbirth, Apgar score, large for gestational age, induction of labour, respiratory distress syndrome and miscarriages were compared. Findings from this review confirm that pregestational diabetes is associated with more frequent pregnancy complications than GDM. Taken together, this review highlights the risks posed by all types of maternal diabetes and the need to improve care and educate women on the importance of maintaining optimal glycaemic control to mitigate these risks.
Collapse
Affiliation(s)
- Nompumelelo Malaza
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Matladi Masete
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Sumaiya Adam
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
- Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
| | - Stephanie Dias
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Thembeka Nyawo
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
| | - Carmen Pheiffer
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa
- Centre for Cardio-Metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town 7505, South Africa
- Correspondence:
| |
Collapse
|
37
|
Chitale R, Ferguson K, Talej M, Yang WC, He S, Edmond KM, Smith ER. Early Enteral Feeding for Preterm or Low Birth Weight Infants: a Systematic Review and Meta-analysis. Pediatrics 2022; 150:188642. [PMID: 35921673 DOI: 10.1542/peds.2022-057092e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early enteral feeding has been associated with adverse outcomes such as necrotizing enterocolitis in preterm and low birth weight infants. OBJECTIVES To assess effects of early enteral feeding initiation within the first days after birth compared to delayed initiation. DATA SOURCES Medline, Scopus, Web of Science, CINAHL from inception to June 30, 2021. STUDY SELECTION Randomized trials (RCTs) were included. Primary outcomes were mortality, morbidity, growth, neurodevelopment, feed intolerance, and duration of hospitalization. DATA EXTRACTION Data were extracted and pooled with random-effects models. RESULTS We included 14 randomized controlled trials with 1505 participants in our primary analysis comparing early (<72 hours) to delayed (≥72 hours) enteral feeding initiation. Early initiation likely decreased mortality at discharge and 28 days (1292 participants, 12 trials, relative risk 0.69, 95% confidence interval [95% CI] 0.48-0.99, moderate certainty evidence) and duration of hospitalization (1100 participants, 10 trials, mean difference -3.20 days, 95%CI -5.74 to -0.66, moderate certainty evidence). The intervention may also decrease sepsis and weight at discharge. Based on low certainty evidence, early feeding may have little to no effect on necrotizing enterocolitis, feed intolerance, and days to regain birth weight. The evidence is very uncertain regarding the effect of initiation time on intraventricular hemorrhage, length, and head circumference at discharge. CONCLUSIONS Enteral feeding within 72 hours after birth likely reduces the risk of mortality and length of hospital stay, may reduce the risk of sepsis, and may reduce weight at discharge.
Collapse
Affiliation(s)
- Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Megan Talej
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Karen M Edmond
- World Health Organization, Department of Maternal, Child, Adolescent Health and Aging, Geneva, Switzerland
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| |
Collapse
|
38
|
Postnatal Cytomegalovirus Infection: Is it Important? A 10-Year Retrospective Case-control Study of Characteristics and Outcomes in Very Preterm and Very Low Birth Weight Infants. Pediatr Infect Dis J 2022; 41:579-586. [PMID: 35389941 DOI: 10.1097/inf.0000000000003531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To determine the characteristics and outcomes of postnatal cytomegalovirus (pCMV) infection in preterm infants in a neonatal intensive care unit (NICU). METHODS A retrospective, matched case-control study in a tertiary NICU. Infants born between January 2009 and December 2019, <32 weeks' gestational age (GA) and/or birth weight (BW) <1500 g with pCMV infection were matched 1:1 with cytomegalovirus-(CMV)-negative infants by year of admission, gender, GA and BW. Primary outcome was death ≤36 weeks' postmenstrual age or bronchopulmonary dysplasia (BPD). Secondary outcomes were length of ventilation (LOV), length of stay (LOS) and neurodevelopmental impairment (NDI) at corrected age 1 and 2 years. RESULTS Forty-eight pCMV-positive infants (median GA 25.3 weeks, BW 695 g, age 58 days) were identified from 1659 infants (incidence 2.9%). The most common symptoms of pCMV infection were abdominal distension (43.8%), sepsis-like syndrome (29.2%), thrombocytopenia (60.5%) and conjugated hyperbilirubinemia (60.9%). Compared with controls, there were no significant differences in the composite outcome of death or BPD (56.3% vs. 37.5%; P = 0.1) or NDI at 1 and 2 years (51.9% vs. 44%; P = 0.8; 71.4% vs. 50%; P = 0.4). pCMV-positive infants had a significantly longer median LOV (23.5 vs. 12 days)* and LOS (140 vs. 110.5 days)*. Eleven (22.9%) infants received antivirals. Ten improved and 1 died. Two untreated infants died (1 from pCMV infection). CONCLUSIONS Clinically identifiable pCMV infections are significant and associated with increased respiratory support and prolonged hospital stay in vulnerable infants. pCMV screening and preventive measures against transmission merit consideration.*P < 0.05.
Collapse
|
39
|
de Melo TFM, Carregaro RL, de Araújo WN, da Silva EN, de Toledo AM. Direct costs of prematurity and factors associated with birth and maternal conditions. Rev Saude Publica 2022; 56:49. [PMID: 35703603 PMCID: PMC9239337 DOI: 10.11606/s1518-8787.2022056003657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To estimate the direct costs due to hospital care for extremely, moderate, and late preterm newborns, from the perspective of a public hospital in 2018. The second objective was to investigate whether factors associated with birth and maternal conditions explain the costs and length of hospital stay. METHODS This is a cost-of-illness study, with data extracted from hospital admission authorization forms and medical records of a large public hospital in the Federal District, Brazil. The association of characteristics of preterm newborns and mothers with costs was estimated by linear regression with gamma distribution. In the analysis, the calculation of the parameters of the estimates (B), with a confidence interval of 95% (95%CI), was adopted. The uncertainty parameters were estimated by the 95% confidence interval and standard error using the Bootstrapping method, with 1,000 samples. Deterministic sensitivity analysis was performed, considering lower and upper limits of 95%CI in the variation of each cost component. RESULTS A total of 147 preterm newborns were included. We verified an average cost of BRL 1,120 for late preterm infants, BRL 6,688 for moderate preterm infants, and BRL 17,395 for extremely preterm infants. We also observed that factors associated with the cost were gestational age (B = -123.00; 95%CI: -241.60 to -4.50); hospitalization in neonatal ICU (B = 6,932.70; 95%CI: 5,309.40-8,556.00), and number of prenatal consultations (B = -227.70; 95%CI: -403.30 to -52.00). CONCLUSIONS We found a considerable direct cost resulting from the care of preterm newborns. Extreme prematurity showed a cost 15.5 times higher than late prematurity. We also verified that a greater number of prenatal consultations and gestational age were associated with a reduction in the costs of prematurity.
Collapse
Affiliation(s)
- Thamires Francelino Mendonça de Melo
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
| | - Rodrigo Luiz Carregaro
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
| | - Wildo Navegantes de Araújo
- Universidade de Brasília.Faculdade de CeilândiaBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Curso de Saúde Coletiva. Brasília, DF, Brasil
| | - Everton Nunes da Silva
- Universidade de Brasília.Faculdade de CeilândiaBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Curso de Saúde Coletiva. Brasília, DF, Brasil
| | - Aline Martins de Toledo
- Universidade de BrasíliaFaculdade de CeilândiaPrograma de Pós-Graduação em Ciências da ReabilitaçãoBrasíliaDFBrasil Universidade de Brasília. Faculdade de Ceilândia. Programa de Pós-Graduação em Ciências da Reabilitação. Brasília, DF, Brasil
| |
Collapse
|
40
|
Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration. Am J Obstet Gynecol 2022; 226:B2-B10. [PMID: 35189094 DOI: 10.1016/j.ajog.2022.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Preterm birth is a leading cause of perinatal morbidity and mortality. Antenatal corticosteroid administration before preterm birth reduces the risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and reduces the costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, in part because it is difficult to predict the precise timing of preterm birth. Until 2020, The Joint Commission had a Perinatal Care quality metric measuring the rate of antenatal corticosteroid administration at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached more than 97% in The Joint Commission-accredited hospitals. However, the metric did not evaluate whether the timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multistakeholder Cooperative Workshop recommended the development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. Furthermore, we propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that the use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates.
Collapse
|
41
|
Beltempo M, Bresson G, Étienne JM, Lacroix G. Infections, accidents and nursing overtime in a neonatal intensive care unit. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:627-643. [PMID: 34665324 DOI: 10.1007/s10198-021-01386-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
The paper investigates the effects of nursing overtime on nosocomial infections and medical accidents in a neonatal intensive care unit (NICU). The literature lacks clear evidence on this issue and we conjecture that this may be due to empirical and methodological factors. We model the occurrences of both events using a sample of 3979 neonates who represents over 84,846 observations (infant/days). We exploit an important change in workforce arrangement that was implemented in June 2012, and which aimed at reducing overtime hours to identify a causal impact between the latter and the two outcomes of interest. We contrast the results using a standard mixed-effects logit model with those of a semiparametric mixed-effects logit model. Contrary to the mixed-effects logit model, the semiparametric model unequivocally shows that both adverse events are impacted by nursing overtime as well as being highly sensitive to infant and NICU-related characteristics. Furthermore, the mixed-effects logit model is rejected in favour of the semiparametric one.
Collapse
Affiliation(s)
- Marc Beltempo
- Department of Pediatrics, McGill University Health Centre, Montréal, QC, Canada
| | | | | | - Guy Lacroix
- Department of Economics, Université Laval, Québec, Canada.
| |
Collapse
|
42
|
Lao JC, Bui CB, Pang MA, Cho SX, Rudloff I, Elgass K, Schröder J, Maksimenko A, Mangan NE, Starkey MR, Skuza EM, Sun YBY, Beker F, Collins CL, Kamlin OF, König K, Malhotra A, Tan K, Theda C, Young MJ, McLean CA, Wilson NJ, Sehgal A, Hansbro PM, Pearson JT, Polo JM, Veldman A, Berger PJ, Nold-Petry CA, Nold MF. Type 2 immune polarization is associated with cardiopulmonary disease in preterm infants. Sci Transl Med 2022; 14:eaaz8454. [PMID: 35385341 DOI: 10.1126/scitranslmed.aaz8454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Postnatal maturation of the immune system is poorly understood, as is its impact on illnesses afflicting term or preterm infants, such as bronchopulmonary dysplasia (BPD) and BPD-associated pulmonary hypertension. These are both cardiopulmonary inflammatory diseases that cause substantial mortality and morbidity with high treatment costs. Here, we characterized blood samples collected from 51 preterm infants longitudinally at five time points, 20 healthy term infants at birth and age 3 to 16 weeks, and 5 healthy adults. We observed strong associations between type 2 immune polarization in circulating CD3+CD4+ T cells and cardiopulmonary illness, with odds ratios up to 24. Maternal magnesium sulfate therapy, delayed hepatitis B vaccination, and increasing fetal, but not maternal, chorioamnionitis severity were associated with attenuated type 2 polarization. Blocking type 2 mediators such as interleukin-4 (IL-4), IL-5, IL-13, or signal transducer and activator of transcription 6 (STAT6) in murine neonatal cardiopulmonary disease in vivo prevented changes in cell type composition, increases in IL-1β and IL-13, and losses of pulmonary capillaries, but not gains in larger vessels. Thereby, type 2 blockade ameliorated lung inflammation, protected alveolar and vascular integrity, and confirmed the pathological impact of type 2 cytokines and STAT6. In-depth flow cytometry and single-cell transcriptomics of mouse lungs further revealed complex associations between immune polarization and cardiopulmonary disease. Thus, this work advances knowledge on developmental immunology and its impact on early life disease and identifies multiple therapeutic approaches that may relieve inflammation-driven suffering in the youngest patients.
Collapse
Affiliation(s)
- Jason C Lao
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Christine B Bui
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Merrin A Pang
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Steven X Cho
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Ina Rudloff
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Kirstin Elgass
- Monash Micro Imaging, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Jan Schröder
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Anton Maksimenko
- Imaging and Medical Beamline, Australian Synchrotron, Melbourne, Victoria 3168, Australia
| | - Niamh E Mangan
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Department of Molecular and Translational Science, Monash University, Melbourne, Victoria 3168, Australia
| | - Malcolm R Starkey
- Priority Research Centres for Healthy Lungs and GrowUpWell, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales 2308, Australia.,Department of Immunology and Pathology, Monash University, Melbourne, Victoria 3004, Australia
| | - Elisabeth M Skuza
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Yu B Y Sun
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia
| | - Friederike Beker
- Mater Research Institute, University of Queensland, Brisbane, Queensland 4101, Australia.,Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
| | - Clare L Collins
- Neonatal Services, Mercy Hospital for Women, Melbourne, Victoria 3084, Australia
| | - Omar F Kamlin
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,University of Melbourne, Melbourne, Victoria 3010, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Kai König
- Department of Paediatrics, Medicum Wesemlin, Lucerne 6006, Switzerland
| | - Atul Malhotra
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Christiane Theda
- Department of Newborn Research, Royal Women's Hospital, Melbourne, Victoria 3052, Australia.,University of Melbourne, Melbourne, Victoria 3010, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Morag J Young
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria 3004, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria 3800, Australia
| | - Nicholas J Wilson
- CSL Limited, Bio21 Institute, Parkville, Melbourne, Victoria 3052, Australia
| | - Arvind Sehgal
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| | - Philip M Hansbro
- Priority Research Centres for Healthy Lungs and GrowUpWell, Hunter Medical Research Institute and University of Newcastle, Newcastle, New South Wales 2308, Australia.,Centre for Inflammation, Centenary Institute and University of Technology Sydney, Faculty of Science, School of Life Sciences, Ultimo, Sydney, New South Wales 2007, Australia
| | - James T Pearson
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria 3800, Australia.,Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Suita, Osaka 564-8565, Japan.,Victorian Heart Institute, Melbourne, Victoria 3168, Australia
| | - Jose M Polo
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia.,Development and Stem Cells Program, Monash Biomedicine Discovery Institute, Victoria 3800, Australia.,Australian Regenerative Medicine Institute, Monash University, Melbourne, Victoria 3800, Australia.,Adelaide Centre for Epigenetics, University of Adelaide, Adelaide, South Australia 5005, Australia.,South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Alex Veldman
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Department of Pediatrics, Helios HSK, Wiesbaden 65199, Germany.,Department of Pediatric Cardiology, J. Liebig University, Gießen 35392, Germany
| | - Philip J Berger
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Claudia A Nold-Petry
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia
| | - Marcel F Nold
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia.,Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria 3168, Australia.,Monash Newborn, Monash Children's Hospital, Melbourne, Victoria 3168, Australia
| |
Collapse
|
43
|
Jin JH, Lee SA, Yoon SW. Medical Utilization and Costs in Preterm Infants in the First 6 Years of Life After Discharge From Neonatal Intensive Care Unit: A Nationwide Population-Based Study in Korea. J Korean Med Sci 2022; 37:e93. [PMID: 35347901 PMCID: PMC8960936 DOI: 10.3346/jkms.2022.37.e93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The improvement in the survival rate of preterm infants has paradoxically raised the risk of morbidities in childhood. Our objectives were to assess the medical utilization and costs in preterm infants following discharge from the neonatal intensive care unit in the first 6 years of life. METHODS We conducted a population-based study using the National Health Information Database (2011-2017) provided by the Korean National Health Insurance Service (NHIS). A total of 361,190 children born in Korea between January 1 and December 31, 2011 were divided into four groups according to the gestational age at birth: extremely preterm (less than 28 weeks), very preterm (28-31 weeks), moderate to late preterm (32-36 weeks), and full term (37-41 weeks). The cumulative number of outpatient visits, cumulative length of hospital stay, rate of hospital and intensive care unit admissions, and cumulative medical costs for inpatients and outpatients were compared for each gestational age group. RESULTS Earlier gestational age was significantly associated with an increased risk of the cumulative number of outpatient visits, cumulative length of hospital stay, and rate of hospital and intensive care unit admissions for the first 6 years of life. The mean cumulative inpatient and outpatient costs per child significantly decreased with increasing gestational age. When assessed based on population size, the total cumulative medical costs were highest for moderate to late preterm children. CONCLUSION Earlier gestational age was strongly associated with increased healthcare resource utilization and medical costs. Our findings on the potential long-term socioeconomic impact on public health are expected to aid the development of future health care policies for preterm children.
Collapse
Affiliation(s)
- Ju Hyun Jin
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang Ah Lee
- Big DATA Strategy Department, National Health Insurance Service, Wonju, Korea
| | - Shin Won Yoon
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| |
Collapse
|
44
|
A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030394. [PMID: 35327766 PMCID: PMC8947729 DOI: 10.3390/children9030394] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 12/21/2022]
Abstract
Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.
Collapse
|
45
|
Thao V, Dholakia R, Kreofsky BL, Moriarty JP, Colby CE, Demaerschalk BM, Borah BJ, Fang JL. Modeling the Cost of Teleneonatology from the Health System Perspective. Telemed J E Health 2022; 28:1464-1469. [PMID: 35235430 DOI: 10.1089/tmj.2021.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Teleneonatology (TN) allows remote neonatologists to provide real-time audio-video telemedicine support to community hospitals when neonates require advanced resuscitation or critical care. Currently, there are no published economic evaluations of U.S. TN programs. Objective: To evaluate the cost of TN from the perspective of the health care system. Methods: We constructed a decision tree comparing TN to usual care for neonates born in hospitals without a neonatal intensive care unit (NICU) who require consultation. Our outcome of interest was total cost per patient, which included the incremental cost of a TN program, the cost of medical transport, and the cost of NICU or non-NICU hospitalization. We performed threshold sensitivity analyses where we varied each parameter to determine whether the base-case finding reverted. Results: For neonates requiring consultation after birth in a hospital without a NICU, TN was less costly ($16,878) than usual care ($28,047), representing a cost-savings of $11,168 per patient. Sensitivity analyses demonstrated that at least one of the following conditions would need to be met for TN to no longer be cost saving compared to usual care: transfer rate with usual care <12% (base-case = 82%), TN reducing the odds of transfer by <8% (base-case = 52%), or TN cost exceeding $12,989 per patient (base-case = $1,821 per patient). Conclusions: Economic modeling from the health system perspective demonstrated that TN was cost saving compared to usual care for neonates requiring consultation following delivery in a non-NICU hospital. Understanding the cost savings associated with TN may influence organizational decisions regarding implementation, diffusion, and retention of these programs.
Collapse
Affiliation(s)
- Viengneesee Thao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ruchita Dholakia
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Beth L Kreofsky
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Bart M Demaerschalk
- Department of Neurology and Center for Digital Health, Mayo Clinic, Scottsdale, Arizona, USA
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Fang
- Division of Neonatal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
46
|
Gregory EF, Passarella M, Levine LD, Lorch SA. Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women. J Womens Health (Larchmt) 2022; 31:826-833. [PMID: 35231191 DOI: 10.1089/jwh.2021.0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pregnancy complications may recur and are associated with potentially modifiable risks. The role of interconception preventive care in reducing repeat pregnancy complications is understudied. Materials and Methods: This retrospective cohort used 2007-2012 Medicaid claims from 12 states. Included women who had an index birth complicated by prematurity, hypertension, or diabetes, a subsequent birth within 36 months, and Medicaid eligibility for ≥11 of 12 months after index birth. Logistic regression assessed for an association between the exposure of preventive visits in the year after index birth and primary outcomes of prematurity, hypertension, or diabetes in the subsequent pregnancy. Regression adjusted for confounders including demographics (age, race and ethnicity, rural residence, state), index pregnancy features (complications, prenatal visits, multiple gestation, maternal and infant length of stay, year), visits to address complications in the index birth, and interpregnancy interval. Results: Of 17,372 women, mean age was 24.3 ± 5.3 years, and race/ethnicity was 50.3% non-Hispanic White, 27.2% non-Hispanic Black, and 11.9% Hispanic. In the index pregnancy 43.3% experienced prematurity, 39.2% experienced hypertension, and 34.2% experienced diabetes. In the year after the index pregnancy, 54.7% had at least one preventive visit. In the second pregnancy, 47.7% experienced prematurity, hypertension, or diabetes. Recurrence rates were 28.1% for preterm birth, 38.0% for hypertension, and 48.3% for diabetes. Preventive visits were associated with reduced hypertension in the subsequent pregnancy (OR 0.88, 95% CI 0.82-0.97) but not reduced preterm birth or diabetes. Conclusions: Preventive visits after an index birth complicated by prematurity, hypertension, or diabetes were associated with 10% lower odds of hypertension in a subsequent pregnancy, but not with reductions in diabetes or prematurity. Some complications may be more amenable to interconception preventive services than others.
Collapse
Affiliation(s)
- Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Passarella
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa D Levine
- Department of Obstetrics and Gynecology, Maternal and Child Health Research Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
47
|
Shen M, Liang X, Wu Y, Fang S. Estimates of inpatient admission rates and associated costs for infants before and after China's universal two-child policy. BMC Health Serv Res 2022; 22:163. [PMID: 35135539 PMCID: PMC8826662 DOI: 10.1186/s12913-022-07571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background China implemented a universal two-child policy in 2015. It is important to understand infants’ medical utilization in the context of this policy to inform health policies and resource allocation. Methods This study utilized a 20% random sample of administrative data from China’s Urban and Rural Basic Medical Insurance (URBMI) in one of the largest southern Chinese cities from January 2015 to June 2018. Ordinary least squares models were used to estimate changes in inpatient admission rates and costs for infants between 0 and 6 months old after the implementation of China’s universal two-child policy. Results The overall inpatient admission rate was 27.2% in 2015 and 31.3% in 2017. Compared with 2015, there was an increase in inpatient admission rates for infants 1 month old or younger (coef = 0.038, 95% CI = 0.029 to 0.047, p < .001) and infants 6 months old or younger (coef = 0.041, 95% CI = 0.030 to 0.052, p < .001) in 2017. The increase was larger for male infants than for female ones. The average inpatient admission cost was 8412.3 RMB ($1320.61) (SD = 15,088.2). There was no increase in inpatient admission costs overall. The average length of hospital stay was 7.3 days, the probability of going to a tertiary hospital was 76.2%, and the share of out-of-pocket costs was 53.0% for all diseases. Conclusion After the implementation of the universal two-child policy in China, there was a significant increase in inpatient admission rates, especially for male infants. The overall associated costs did not change, but the increase in admission rates caused additional economic burdens for families and for social health insurance. Understanding the healthcare utilization of infants in the universal two-child period can provide insight for healthcare resource allocation in a time of dramatic changes in population policy. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07571-9.
Collapse
Affiliation(s)
- Menghan Shen
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, 510275, China
| | - Xiaoxia Liang
- Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, Guangzhou, 510275, China
| | - Yushan Wu
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong, 999077, Hong Kong
| | - Shixin Fang
- Institute of Higher Education, Shanghai Center for Innovation and Governance, Fudan University, 220 Handan Road, Shanghai, 200433, China.
| |
Collapse
|
48
|
Kang X, Ranganathan S, Kang L, Gohlke J, Deng X. Bayesian auxiliary variable model for birth records data with qualitative and quantitative responses. J STAT COMPUT SIM 2022; 91:3283-3303. [PMID: 35001987 DOI: 10.1080/00949655.2021.1926459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many applications involve data with qualitative and quantitative responses. When there is an association between the two responses, a joint model will produce improved results than fitting them separately. In this paper, a Bayesian method is proposed to jointly model such data. The joint model links the qualitative and quantitative responses and can assess their dependency strength via a latent variable. The posterior distributions of parameters are obtained through an efficient MCMC sampling algorithm. The simulation is conducted to show that the proposed method improves the prediction capacity for both responses. Further, the proposed joint model is applied to the birth records data acquired by the Virginia Department of Health for studying the mutual dependence between preterm birth of infants and their birth weights.
Collapse
Affiliation(s)
- Xiaoning Kang
- Institute of Supply Chain Analytics and International Business College, Dongbei University of Finance and Economics, China
| | - Shyam Ranganathan
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Lulu Kang
- Department of Applied Mathematics, Illinois Institute of Technology. Chicago, IL, USA
| | - Julia Gohlke
- Department of Population Health Sciences, Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Xinwei Deng
- Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, USA
| |
Collapse
|
49
|
Lakshmanan A, Song AY, Belfort MB, Yieh L, Dukhovny D, Friedlich PS, Gong CL. The financial burden experienced by families of preterm infants after NICU discharge. J Perinatol 2022; 42:223-230. [PMID: 34561556 PMCID: PMC8460846 DOI: 10.1038/s41372-021-01213-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Describe the financial burden and worry that families of preterm infants experience after discharge from the neonatal intensive care unit (NICU). METHODS We surveyed 365 parents of preterm infants in a cross-sectional study regarding socio-demographics, supplemental security income (SSI), and financial worry. We completed a multivariable logistic regression model to examine the adjusted association of financial worry with modifiable factors. RESULTS We found that 53% of participants worried about healthcare costs after NICU discharge. After adjusting for socio-demographic and infant characteristics, we identified that, aOR (95% CI), out-of-pocket costs from the NICU index hospitalization, 3.51 (1.7, 7.26) and durable medical equipment use, 2.41 (1.11, 5.23) was associated with increased financial worry while enrollment in SSI, 0.38 (0.19, 0.76) was associated with decreased financial worry. CONCLUSIONS We identified factors that could contribute to financial burden after NICU discharge that may advise future work to target financial support systems.
Collapse
Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Ashley Y. Song
- grid.21107.350000 0001 2171 9311Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Mandy B. Belfort
- grid.62560.370000 0004 0378 8294Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Leah Yieh
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
| | - Dmitry Dukhovny
- grid.5288.70000 0000 9758 5690Division of Neonatology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR USA
| | - Philippe S. Friedlich
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA
| | - Cynthia L. Gong
- grid.42505.360000 0001 2156 6853Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA USA ,grid.42505.360000 0001 2156 6853Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA USA
| |
Collapse
|
50
|
Kehl S, Weiss C, Pretscher J, Baier F, Faschingbauer F, Beckmann MW, Stumpfe FM. The use of PAMG-1 testing in patients with preterm labor, intact membranes and a short sonographic cervix reduces the rate of unnecessary antenatal glucocorticoid administration. J Perinat Med 2021; 49:1135-1140. [PMID: 34271603 DOI: 10.1515/jpm-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the frequency of antenatal corticosteroid (ACS) administration in cases with shortened cervical length by addition of placental alpha-microglobulin-1 (PAMG-1) testing to sonographic examination. METHODS Single centre retrospective cohort study. Rate of ACS administration was compared between cases with cervical length between 15 and 25 mm and cases with positive PAMG-1 testing and cervical length between 15 and 25 mm. We evaluated the following outcome parameters: Rate of ACS administration, gestational age at delivery, time to delivery, delivery within seven days, delivery <34 and <37 weeks' gestation, rate of admission to neonatal intensive care unit (NICU). RESULTS In total, 130 cases were included. "PAMG-1 group" consisted of 68 women, 62 cases built the "historical control group". ACS administration was performed less frequently in the "PAMG-1 cohort" (18 (26%) vs. 46 (74%); p<0.001). The rate of delivery within seven days did not differ (2 (3%) vs. 4 (6.5%); p=0.4239). The rates of delivery <34 weeks' gestation (7 (10%) vs. 9 (15%); p=0.4643) and <37 weeks' gestation (19 (28%) vs. 26 (42%); p=0.0939) did not differ. Time to delivery interval was longer in the PAMG-1 group (61.5 vs. 43 days, p=0.0117). NICU admission occurred more often in the "historical control group" (22 (38%) vs. 28 (60%); p=0.0272). CONCLUSIONS Addition of biomarker testing can help to avoid unnecessary ACS administrations in women with shortened cervical length.
Collapse
Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Friederike Baier
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian M Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| |
Collapse
|