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Ferguson AN, Granger M, Olsen IE, Clark RH, Woo JG. Mortality Risk in US Neonatal Intensive Care Unit Infants by Birth Size Classifications Comparing Three Growth Curves. Neonatology 2024:1-9. [PMID: 38621373 DOI: 10.1159/000536180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Three widely referenced growth curves classify infant birth anthropometric measurements as small (SGA), appropriate (AGA), or large (LGA) for gestational age (GA) differently. We assessed how these differences in assignment affect the identification and prediction of neonatal intensive care unit (NICU) mortality risk in US preterm infants. METHODS Birth data of infants admitted to NICUs from the Pediatrix Clinical Data Warehouse (2013-2018) were analyzed. Birth weight, length, and head circumference of 46,724 singleton infants (24-32 weeks GA) were classified as SGA, AGA, or LGA using the Olsen, Fenton, and INTERGROWTH-21st curves. NICU mortality risk based on birth size classification was analyzed using unadjusted and adjusted logistic regression stratified by GA. RESULTS Odds of mortality were increased with SGA classification at all GAs, size measurements, and curve sets, compared with AGA infants. LGA classification for weight was associated with lower mortality risk at 24 weeks GA and higher risk at 30 weeks GA. Odds of mortality did not differ significantly across curve sets. Classification of size at birth alone had relatively low predictive ability to identify mortality risk, with unadjusted AUCs near 0.5 for all analyses. CONCLUSION There were no significant differences across curve sets in predicting mortality. Classification of size at birth is a relatively imprecise method to identify infants at risk for NICU mortality.
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Affiliation(s)
- A Nicole Ferguson
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia, USA
| | - Marion Granger
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia, USA
| | - Irene E Olsen
- Nutrition Sciences Department, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Reese H Clark
- Pediatrix Medical Group, Inc., Sunrise, Florida, USA
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Olague S, Boyle H, Ahmed I, Buchh B, Truong GST, Reyburn B, DeLeon C, Lin GC, Ahmad KA, Carr B, Singhal M, Althouse M, Castro R, Rudine A, Rider E, Macomber-Estill ML, Doles B, Ferry JF, Pierantoni H, Sutherland S, Clark RH, Blackwell CK, Smith PB, Benjamin DK, Greenberg RG. Direct-to-participant recruitment of mothers and infants: A strategic approach during challenging pandemic times. Contemp Clin Trials Commun 2024; 38:101261. [PMID: 38298915 PMCID: PMC10825472 DOI: 10.1016/j.conctc.2024.101261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/03/2024] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
Under traditional circumstances, most clinical trials rely on in-person operations to identify, recruit, and enroll study participants and to complete study-related visits. During unusual circumstances, such as the COVID-19 pandemic, the typical clinical trial model is challenged and forced to explore alternative approaches to implementing study recruitment, participant enrollment, and data collection strategies. One such alternative is a direct-to-participant approach which leverages electronic resources and relevant technological devices (e.g., smart phones) available to researchers and patients. This approach functions under the assumption that a participant has access to a device that connects to the internet such as a smart phone, tablet, or computer. Researchers are then able to transition a typical paper-based, in-person model to an electronic-based, siteless, remote study. This article describes the challenges clinicians and researchers faced when implementing a direct-to-participant study approach during the COVID-19 pandemic. The lessons learned during this study of infant populations could help increase efficiency of future trials, specifically, by lessening the burden on participants and clinicians as well as streamlining the process for enrollment and data collection. While direct-to-adult participant recruitment is not a novel approach, our findings suggest that studies attempting to recruit the infant population may benefit from such a direct-to-participant approach.
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Affiliation(s)
- Stefany Olague
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Helen Boyle
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | | | | | - Brent Reyburn
- North Central Baptist Hospital, San Antonio, TX, USA
| | | | | | | | - Barbara Carr
- Saint Luke's Health System, Kansas City, MO, USA
| | | | | | | | | | - Evelyn Rider
- Providence Alaska Medical Center, Anchorage, AK, USA
| | | | | | | | | | | | - Reese H. Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | | | - P. Brian Smith
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Low JM, Lee JH, Foote HP, Hornik CP, Clark RH, Greenberg RG. Throwing the spotlight on group B streptococcal early onset sepsis prevention: the importance of appropriate second-line antimicrobials. Am J Obstet Gynecol 2024; 230:e62-e63. [PMID: 38128866 DOI: 10.1016/j.ajog.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Jia Ming Low
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore; Department of Paediatrics, Yong Loo Lin School of Singapore, National University of Singapore, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore; Singhealth-Duke NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Henry P Foote
- Department of Pediatrics, Duke University, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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Chou FS, Clark RH, Yeh HW. The association between antenatal corticosteroids exposure and postnatal growth in infants born between 23 and 29 weeks of gestation. J Perinatol 2024; 44:561-567. [PMID: 38228764 DOI: 10.1038/s41372-024-01871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To assess the association between antenatal corticosteroids exposure and postnatal growth in infants born at 23-29 weeks' gestation. STUDY DESIGN This retrospective study used data from the Pediatrix Clinical Data Warehouse. Maternal-infant dyads from 2018 to 2020 were included. Inverse propensity weighting (IPW) was applied to balance pre-treatment confounders. Primary outcomes included postnatal weight, length, and head circumference growth trajectory percentiles. RESULT The unadjusted cohort consisted of 11,912 dyads. After IPW adjustment, there were 23,231 dyads. Exposed infants showed higher postnatal trajectory percentiles for weight (by 3.4%), length (by 1.8%), and head circumference (by 2.5%) when compared to non-exposed infants. The positive association between antenatal corticosteroids and postnatal growth was only observed in infants not exposed to preeclampsia/eclampsia/HELLP syndrome or without fetal growth restriction. CONCLUSION Antenatal corticosteroids exposure is associated with better postnatal growth. The study is limited by its retrospective nature.
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Affiliation(s)
- Fu-Sheng Chou
- Department of Neonatology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
- Southern California Permanente Medical Group, Pasadena, CA, USA.
| | - Reese H Clark
- Center for Research, Education, Quality and Safety, Pediatrix® Medical Group, Sunrise, FL, USA
| | - Hung-Wen Yeh
- Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
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Chou FS, Yeh HW, Clark RH. Postnatal weight growth trajectory in infants born between 30 4/7 weeks and 34 3/7 weeks of gestation. J Perinatol 2024; 44:575-577. [PMID: 38036725 DOI: 10.1038/s41372-023-01837-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Fu-Sheng Chou
- Department of Neonatology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
- Southern California Permanente Medical Group, Pasadena, CA, USA.
| | - Hung-Wen Yeh
- Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Reese H Clark
- Center for Research, Education, Quality and Safety, Pediatrix Medical Group, Sunrise, FL, USA
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Ponnapakkam A, Carr NR, Comstock BA, Perez K, O'Shea TM, Tolia VN, Clark RH, Heagerty PJ, Juul SE, Ahmad KA. Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants. Am J Perinatol 2024; 41:458-469. [PMID: 34753183 DOI: 10.1055/a-1692-0544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Factors influencing utilization of outpatient interventional therapies for extremely low gestational age newborns (ELGANs) after discharge remain poorly characterized, despite a significant risk of neurodevelopmental impairment. We sought to assess the effects of maternal, infant, and environmental characteristics on outpatient therapy utilization in the first 2 years after discharge using data from the Preterm Erythropoietin Neuroprotection (PENUT) Trial. STUDY DESIGN This is a secondary analysis of 818, 24 to 27 weeks gestation infants enrolled in the PENUT trial who survived through discharge and completed at least one follow-up call or in-person visit between 4 and 24 months of age. Utilization of a state early intervention (EI) program, physical therapy (PT), occupational therapy (OT), and speech therapy (ST) was recorded. Odds ratios and cumulative frequency curves for resource utilization were calculated for patient characteristics adjusting for gestational age, treatment group, and birth weight. RESULTS EI was not accessed by 37% of infants, and 18% did not use any service (PT/OT/ST/EI). Infants diagnosed with severe morbidities (intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis), discharged with home oxygen, or with gastrostomy placement experienced increased utilization of PT, OT, and ST compared with peers. However, substantial variation in service utilization occurred by the state of enrollment and selected maternal characteristics. CONCLUSIONS ELGANs with severe medical comorbidities are more likely to utilize services after discharge. Therapy utilization may be impacted by maternal characteristics and state of enrollment. Outpatient therapy services remain significantly underutilized in this high-risk cohort. Further research is required to characterize and optimize the utilization of therapy services following NICU discharge of ELGANs. KEY POINTS · Outpatient therapy is underutilized in ELGANs.. · Medical comorbidities may impact therapy use.. · Maternal characteristics may impact therapy use.. · State of enrollment may impact therapy use..
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Affiliation(s)
- Adharsh Ponnapakkam
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Nicholas R Carr
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Bryan A Comstock
- Center for Biomedical Statistics, University of Washington, Seattle, Washington
| | - Krystle Perez
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - T Michael O'Shea
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Veeral N Tolia
- Pediatrix Medical Group, Dallas TX
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Reese H Clark
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Patrick J Heagerty
- Center for Biomedical Statistics, University of Washington, Seattle, Washington
| | - Sandra E Juul
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Kaashif A Ahmad
- MEDNAX Center for Research, Education, Quality, and Safety, Sunrise, FL
- Pediatrix Medical Group of San Antonio, San Antonio, TX
- Department of Pediatrics, Baylor College of Medicine, San Antonio, TX
- Pediatrix and Obstetrix Specialists of Houston, Houston, TX
- Department of Clinical Sciences, University of Houston, Houston, TX
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Rysavy MA, Bennett MM, Ahmad KA, Patel RM, Shah ZS, Ellsbury DL, Clark RH, Tolia VN. Neonatal Intensive Care Unit Resource Use for Infants at 22 Weeks' Gestation in the US, 2008-2021. JAMA Netw Open 2024; 7:e240124. [PMID: 38381431 PMCID: PMC10882422 DOI: 10.1001/jamanetworkopen.2024.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Importance During the past decade, clinical guidance about the provision of intensive care for infants born at 22 weeks' gestation has changed. The impact of these changes on neonatal intensive care unit (NICU) resource utilization is unknown. Objective To characterize recent trends in NICU resource utilization for infants born at 22 weeks' gestation compared with other extremely preterm infants (≤28 weeks' gestation) and other NICU-admitted infants. Design, Setting, and Participants This is a serial cross-sectional study of 137 continuously participating NICUs in 29 US states from January 1, 2008, through December 31, 2021. Participants included infants admitted to the NICU. Data analysis was performed from October 2022 to August 2023. Exposures Year and gestational age at birth. Main Outcomes and Measures Measures of resource utilization included NICU admissions, NICU bed-days, and ventilator-days. Results Of 825 112 infants admitted from 2008 to 2021, 60 944 were extremely preterm and 872 (466 [53.4%] male; 18 [2.1%] Asian; 318 [36.5%] Black non-Hispanic; 218 [25.0%] Hispanic; 232 [26.6%] White non-Hispanic; 86 [9.8%] other or unknown) were born at 22 weeks' gestation. NICU admissions at 22 weeks' gestation increased by 388%, from 5.7 per 1000 extremely preterm admissions in 2008 to 2009 to 27.8 per 1000 extremely preterm admissions in 2020 to 2021. The number of NICU admissions remained stable before the publication of updated clinical guidance in 2014 to 2016 and substantially increased thereafter. During the study period, bed-days for infants born at 22 weeks increased by 732%, from 2.5 per 1000 to 20.8 per 1000 extremely preterm NICU bed-days; ventilator-days increased by 946%, from 5.0 per 1000 to 52.3 per 1000 extremely preterm ventilator-days. The proportion of NICUs admitting infants born at 22 weeks increased from 22.6% to 45.3%. Increases in NICU resource utilization during the period were also observed for infants born at less than 22 and at 23 weeks but not for other gestational ages. In 2020 to 2021, infants born at less than or equal to 23 weeks' gestation comprised 1 in 117 NICU admissions, 1 in 34 of all NICU bed-days, and 1 in 6 of all ventilator-days. Conclusions and Relevance In this serial cross-sectional study of 137 US NICUs from 2008 to 2021, an increasing share of resources in US NICUs was allocated to infants born at 22 weeks' gestation, corresponding with changes in national clinical guidance.
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Affiliation(s)
- Matthew A Rysavy
- Department of Pediatrics, McGovern Medical School at UTHealth Houston, Houston, Texas
| | | | - Kaashif A Ahmad
- The Woman's Hospital of Texas, Houston, Texas
- Department of Clinical Sciences, University of Houston, Houston, Texas
- Pediatrix Center for Research Education, Quality, and Safety, Sunrise, Florida
| | - Ravi M Patel
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Zubin S Shah
- Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
- Texas A&M Health Science Center School of Medicine, Dallas, Texas
| | - Dan L Ellsbury
- Pediatrix Center for Research Education, Quality, and Safety, Sunrise, Florida
- MercyOne Children's Hospital, Des Moines, Iowa
| | - Reese H Clark
- Pediatrix Center for Research Education, Quality, and Safety, Sunrise, Florida
| | - Veeral N Tolia
- Pediatrix Center for Research Education, Quality, and Safety, Sunrise, Florida
- Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
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Tang M, Ibrahim A, Laughon C, Moore K, Tejada A, Tran D, Kilpatrick R, Greenberg RG, Hornik CP, Zimmerman K, Laughon MM, Clark RH, Lang JE. Prescribing practices of inhaled corticosteroids for premature infants in the neonatal intensive care unit. J Perinatol 2024:10.1038/s41372-024-01891-w. [PMID: 38297180 DOI: 10.1038/s41372-024-01891-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/05/2024] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Despite limited safety and efficacy data, inhaled corticosteroids (ICS) are prescribed to premature infants in the neonatal intensive care unit (NICU). We examined contemporary use and risk factors for ICS use in the NICU. STUDY DESIGN Infants <33 weeks gestational age and <1500 gm birth weight discharged from Pediatrix Medical Group NICUs between 2010 and 2020 were included. We evaluated the association between ICS prescription and clinical characteristics using univariable and multivariable logistic regression. RESULTS Of 74,123 infants from 308 NICUs, 9253 (12.5%) were prescribed ICS: budesonide, fluticasone, or beclomethasone. Diagnosis of bronchopulmonary dysplasia (BPD), earlier gestational age, male sex, longer mechanical ventilation, oxygen support, and systemic steroids were independent risk factors for ICS prescription. CONCLUSIONS Use of ICS is common in many NICUs and is associated with a diagnosis of BPD and healthcare utilization. Prospective trials are needed to establish the safety, efficacy, and optimal indication in this vulnerable population.
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Affiliation(s)
- Monica Tang
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Anna Ibrahim
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Kaila Moore
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Dean Tran
- Duke Clinical Research Institute, Durham, NC, USA
| | - Ryan Kilpatrick
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Kanecia Zimmerman
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Matthew M Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Reese H Clark
- Pediatrix Center for Research and Education, Pediatrix Medical Group, Inc, Sunrise, FL, USA
| | - Jason E Lang
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
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Heyward EB, Clark RH, Smith PB, Benjamin DK, Zimmerman KO, Ahmad KA, Blackwell CK, Won H, Ssengonzi R, Belbase A, Ndalama CO, An J, Nwaezeigwe O, Greenberg RG. Trends in COVID-19 diagnoses and outcomes in infants hospitalized in the neonatal intensive care unit. J Perinatol 2024; 44:35-39. [PMID: 37452116 DOI: 10.1038/s41372-023-01725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Characterize the prevalence of coronavirus disease 2019 (COVID-19) diagnosis among mothers with infants hospitalized in 294 neonatal intensive care units (NICUs), and demographics and outcomes of infants with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure in utero. STUDY DESIGN Cohort study of infants discharged from NICUs 01/2020-09/2021. We defined groups based on infant diagnosis, infant testing, and maternal SARS-CoV-2 infection status. We compared demographics, clinical characteristics, and outcomes. RESULTS Of 150,924 infants, 94% had no COVID-related diagnosis or test; 247 (0.2%) infants tested positive for COVID-19 and were more likely to require mechanical ventilation. Infants with unknown maternal status and negative testing were more commonly premature, outborn, and had longer hospitalizations. CONCLUSION In this large cohort of hospitalized infants, most had no known exposure to COVID-19. Adverse outcomes and mortality were rare. Further studies are needed to evaluate the long-term effects of COVID-19 in this population.
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Affiliation(s)
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kaashif A Ahmad
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
- Pediatrix Neonatology of San Antonio, San Antonio, TX, USA
- Pediatrix Neonatology of Houston, Houston, TX, USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hannah Won
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Avi Belbase
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Jennifer An
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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..
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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
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Thakkar PV, Sutton KF, Detwiler CAB, Henegar JG, Narayan JR, Perez-Romero M, Strausser CM, Clark RH, Benjamin DK, Zimmerman KO, Goldberg RN, Younge N, Tanaka D, Brian Smith P, Greenberg RG, Kilpatrick R. Risk factors and epidemiology of spontaneous intestinal perforation among infants born at 22-24 weeks' gestational age. J Perinatol 2024; 44:94-99. [PMID: 37759034 DOI: 10.1038/s41372-023-01782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To describe the epidemiology, risk factors, and timing of spontaneous intestinal perforation (SIP) among infants born at 22-24 weeks' gestational age (GA). STUDY DESIGN Observational cohort study among infants born at 22-24 weeks' GA in 446 neonatal intensive care units. RESULTS We identified 9712 infants, of whom 379 (3.9%) developed SIP. SIP incidence increased with decreasing GA (P < 0.001). Antenatal magnesium (odds ratio (OR) 1.42; 95% confidence interval (CI), 1.09-1.85), antenatal indomethacin (OR 1.40; 95% CI, 1.06-1.85), postnatal indomethacin (OR 1.61; 95% CI, 1.23-2.11), and postnatal hydrocortisone exposure (OR 2.02; 95% CI 1.50-2.73) were associated with SIP. Infants who lost 15-20% (OR 1.77; 95% CI, 1.28-2.44) or >20% (OR 2.04; 95% CI, 1.46-2.85) of birth weight had higher odds of SIP than infants with weight loss <10%. CONCLUSIONS Antenatal magnesium exposure, antenatal indomethacin exposure, postnatal hydrocortisone exposure, postnatal indomethacin exposure, and weight loss ≥15% were associated with SIP.
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Affiliation(s)
- Pavan V Thakkar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Chloe-Ann B Detwiler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Julia G Henegar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jai R Narayan
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Melanie Perez-Romero
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ciara M Strausser
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Reese H Clark
- Pediatrix Center for Research Education, Quality, and Safety, Sunrise, FL, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ronald N Goldberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - David Tanaka
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Ryan Kilpatrick
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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12
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Speier RL, Cotten CM, Benjamin DK, Lewis K, Keeler K, Kidimbu G, Roberts W, Clark RH, Zimmerman KO, Stark A, Greenberg RG. Late-Onset Sepsis Evaluation and Empiric Therapy in Extremely Low Gestational Age Newborns. J Pediatric Infect Dis Soc 2023; 12:S37-S43. [PMID: 38146858 DOI: 10.1093/jpids/piad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/12/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Little is known about late-onset sepsis (LOS) evaluations in extremely low gestational age newborns (ELGANs). We describe frequencies of LOS evaluation in ELGANs, infant characteristics, and empiric therapy choices during evaluations. METHODS Cohort study of infants 22-28 weeks gestational age (GA) discharged from 243 centers from 2009 to 2018, excluding infants with congenital anomalies, discharged or deceased prior to postnatal day (PND) 2, or admitted after PND 2. A new LOS evaluation was defined as the first blood culture obtained between PND 3 and 90, or one obtained ≥1 day following a negative culture and ≥10 days from prior positive cultures. We determined numbers of evaluations and percentage positive by GA, center, and over time. We described characteristics associated with positive evaluations, infants with LOS, and empiric antimicrobials. We calculated descriptive and comparative statistics using Wilcoxon rank sum, Fisher's exact, or Pearson chi-square tests, as appropriate. RESULTS Of 47,187 included infants, 67% had ≥1 LOS evaluation and 21% of evaluated infants had ≥1 LOS (culture positive) episode; 1.6 evaluations occurred per infant and 10% were positive. The percentage of infants evaluated and positive for LOS was higher at earlier GA. LOS was associated with inotrope support (15% vs. 9%; p < .001) and invasive mechanical ventilation (66% vs. 51%; p < .001). Infants with positive cultures were more likely than infants with negative cultures to receive empiric antimicrobials during the LOS evaluation (95% vs. 73%; p < .001). CONCLUSIONS Among ELGANs, earlier GA and postnatal age were associated with LOS evaluation and positive cultures. Most infants undergoing evaluation were started on empiric antimicrobials.
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Affiliation(s)
| | | | - Daniel K Benjamin
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kelsey Lewis
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Kanecia O Zimmerman
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
| | - Ashley Stark
- Department of Medicine, Duke University School of Medicine
| | - Rachel G Greenberg
- Department of Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Durham, NC, USA
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13
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Kumar KR, Shah SJ, Fayyad RM, Turla TM, O'Sullivan LM, Wallace B, Clark RH, Benjamin DK, Greenberg RG, Hornik CP. Association Between Hypoglycemia and the Occurrence of Early Onset Sepsis in Premature Infants. J Pediatric Infect Dis Soc 2023; 12:S28-S36. [PMID: 38146863 DOI: 10.1093/jpids/piad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/08/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND We examined the association between hypoglycemia and the occurrence of early onset sepsis (EOS) in premature infants admitted to the neonatal intensive care unit (NICU). METHODS We included infants discharged from 358 NICUs between 1997 and 2020 with gestational age <34 weeks, ≥1 culture collected in the first 3 days of life, and ≥1 serum glucose value recorded on the day of or day prior to culture collection. We used multivariable logistic regression and inverse probability weighting (IPW) and constructed models for three definitions of hypoglycemia: American Academy of Pediatrics (AAP), Pediatric Endocrine Society, and a definition based on neurodevelopmental studies. We performed subgroup analysis in EOS episodes caused by Gram-negative and Gram-positive organisms. RESULTS Of the 62,178 infants and 64,559 cultures that met study inclusion criteria, 739 (1%) cultures were positive. The median (25th, 75th percentile) glucose value was 75 mg/dL (50, 106) on the day of or day prior to a positive culture versus 70 mg/dL (50, 95) on the day of or day prior to a negative culture. We found that hypoglycemia was not associated with the occurrence of EOS for all organisms and Gram-positive organisms, whereas there was a small but significant association between the lower AAP glucose cutoff value and EOS due to Gram-negative organisms (logistic regression: risk difference [RD] 0.24% [95% CI, 0.01-0.47]; IPW: RD 0.22% [95% CI, 0.00-0.43]). CONCLUSIONS Hypoglycemia may be an early marker of EOS, particularly in episodes caused by Gram-negative organisms and when using a stricter definition of hypoglycemia.
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Affiliation(s)
- Karan R Kumar
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Sonam J Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Rawan M Fayyad
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Toby M Turla
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Laura M O'Sullivan
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Beatriz Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida, USA
| | - Daniel K Benjamin
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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14
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Lamb AE, Rent S, Brannon AJ, Greer JL, Ndey-Bongo NP, Cho SH, Greenberg RG, Benjamin DK, Clark RH, Kumar KR. Diagnostic Utility of Cerebrospinal Fluid White Blood Cell Components for the Identification of Bacterial Meningitis in Infants. J Pediatric Infect Dis Soc 2023; 12:S44-S52. [PMID: 38146862 PMCID: PMC10750308 DOI: 10.1093/jpids/piad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND To evaluate the diagnostic and predictive utility of cerebrospinal fluid (CSF) white blood cell (WBC) components in the diagnosis of bacterial meningitis in infants discharged from the neonatal intensive care unit (NICU). METHODS We identified a cohort of infants discharged from a Pediatrix NICU between 1997 and 2020 who did not have an immunodeficiency, had at least 1 CSF culture collected within the first 120 days of life, and at least 1 CSF laboratory specimen obtained on the day of culture collection. We only included an infant's first CSF culture and excluded cultures from CSF reservoirs and those growing contaminants or nonbacterial organisms. We examined the utility of CSF WBC components to diagnose or predict bacterial meningitis by calculating sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the receiver operating curve (AUC) at different cutoff values for each parameter. We performed subgroup analysis excluding infants treated with antibiotics the day before CSF culture collection. RESULTS Of the 20 756 infants that met the study inclusion criteria, 320 (2%) were diagnosed with bacterial meningitis. We found (AUC [95% CI]) CSF WBC count (0.76 [0.73-0.79]), CSF neutrophil count (0.74 [0.70-0.78]), and CSF neutrophil percent (0.71 [0.67-0.75]) had the highest predictive values for bacterial meningitis, even when excluding infants with early antibiotic administration. CONCLUSIONS No single clinical prediction rule had the optimal discriminatory power for predicting culture-proven bacterial meningitis, and clinicians should be cautious when interpreting CSF WBC parameters in infants with suspected meningitis.
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Affiliation(s)
- Ashley E Lamb
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sharla Rent
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Asia J Brannon
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | - Stephen H Cho
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida, USA
| | - Karan R Kumar
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
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15
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Shah ZS, Clark RH, Patt HA, Backes CH, Tolia VN. Trends in Procedural Closure of the Patent Ductus Arteriosus among Infants Born at 22 to 30 Weeks' Gestation. J Pediatr 2023; 263:113716. [PMID: 37659585 DOI: 10.1016/j.jpeds.2023.113716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/10/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE To describe recent trend in procedural closure of the patent ductus arteriosus (PDA) among premature infants and compare the clinical characteristics of infants receiving surgical vs transcatheter closure. STUDY DESIGN We conducted a descriptive, retrospective cohort study of preterm infants born between 220/7 and 296/7 weeks' gestation from 2014 through 2021. Infants were identified from the Pediatrix Clinical Data Warehouse. We excluded infants with any major congenital anomaly. We identified all preterm infants with a PDA and all those who underwent procedural closure (surgical ligation or transcatheter occlusion) and compared changes over time using ANOVA for continuous variables and the Cochran-Armitage trend test to evaluate time-related changes in proportions. RESULTS The study cohort included 64 580 infants, of whom 24 028 (37.2%) were diagnosed with a PDA. The number of infants receiving any procedural closure of the PDA decreased from 371 (4.4%) in 2014 to 144 (1.9%) in 2021. During the same period, number of surgical ligations decreased from 369 (4.36%) to 64 (0.84%), and the number of transcatheter occlusions increased from 2 (0.02%) to 80 (1.05% p for all < 0.001). The median age at time of surgical ligation increased from 25 days (10th and 90th percentile, 10, 61) to 31 days (10th and 90th percentile, 16, 66), and the median age of transcatheter occlusion decreased from 103 days (10th and 90th percentile, 32, 150) to 43 days (10th and 90th percentile, 22, 91). CONCLUSIONS There was a decrease in surgical closure and an increase in transcatheter occlusion of the PDA in infants born at 22-30 weeks' gestation from 2014 to 2021. Despite the decline in overall procedural closure, the rate of transcatheter occlusion surpassed surgical ligation by 2021. Narrowing differences in the median age and weight at closure suggest increasing overlap in the types of infants who received each type of procedural closure.
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Affiliation(s)
- Zubin S Shah
- Department of Pediatrics, Baylor University Medical Center, Dallas, TX; Department of Pediatrics, Texas A&M School of Medicine, Dallas, TX
| | - Reese H Clark
- The Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL
| | - Hanoch A Patt
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX; Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX
| | - Carl H Backes
- Divisions of Neonatology and Cardiology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Veeral N Tolia
- Department of Pediatrics, Baylor University Medical Center, Dallas, TX; The Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL.
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Buck CO, Shabanova V, Clark RH, Taylor SN. Diabetes in Pregnancy, Neonatal Morbidities, and Early Growth in Moderate or Late Preterm Infants. Pediatrics 2023; 152:e2023061285. [PMID: 37969002 DOI: 10.1542/peds.2023-061285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES To compare differences in short term morbidities and early growth among moderate and late preterm infants of mothers with and without diabetes (DM) in pregnancy. METHODS In a longitudinal analysis using data from the Pediatrix Clinical Data Warehouse of preterm infants (born 32 0/7 to 36 6/7 weeks) discharged from neonatal intensive care units from 2008 to 2019, health characteristics were compared between DM exposure groups. Change in growth from birth to discharge were compared using linear mixed effects modeling. RESULTS Among 301 499 moderate and late preterm infants in the analysis, 14% (N = 42 519) were exposed to DM in pregnancy. Incidence of congenital anomalies, hypoglycemia, and hyperbilirubinemia were higher in DM-group (P < .001), and DM-group was more likely to need respiratory support in the first postnatal days (P = .02). Percent weight change from birth differed by gestational age, such that 36-week DM-group infants remained on average 2% (95% confidence interval [CI]: 1.57 to 2.41) below birth weight on day 14, whereas 32-week DM-group infants were on average 2.1% (95% CI: 1.69 to 2.51) above birth weight on day 14. In the regression analysis, DM-group had faster weight loss in the first postnatal week when stratified by gestational age. The adjusted difference in weight velocity (g per day) from days 0 to 3 was -4.5 (95% CI: -5.1 to -3.9), -6.5 (95% CI: -7.4 to -5.7), and -7.2 (95% CI: -8.2 to -6.2) for infants born 34-, 35-, and 36-weeks, respectively. CONCLUSIONS In moderate or late preterm infants, diabetes in pregnancy is associated with common neonatal morbidities. Examination of intensive care nutritional practices may identify reasons for observed differences in weight trajectories by gestational age and diabetes exposure.
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Affiliation(s)
- Catherine O Buck
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Veronika Shabanova
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, Florida
| | - Sarah N Taylor
- Yale University School of Medicine, Department of Pediatrics, New Haven, Connecticut
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17
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Lockyear C, Coe K, Greenberg RG, Clark RH, Aleem S. Trends in morbidities of late preterm infants in the neonatal intensive care unit. J Perinatol 2023; 43:1379-1384. [PMID: 37393396 DOI: 10.1038/s41372-023-01705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/20/2023] [Accepted: 06/15/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To characterize demographics and trends in length of stay (LOS), morbidities, and mortality in late preterm infants. STUDY DESIGN Cohort study of infants born between 34 0/7 and 36 6/7 weeks gestation between 1999 and 2018 without major congenital anomalies at Pediatrix Medical Group neonatal intensive care units (NICUs). RESULTS 307,967 infants from 410 NICUs met inclusion criteria. The median (25th-75th percentile) LOS was 11 (8-16) days in the entire period. Postmenstrual age (PMA) at discharge increased during the cohort for all gestational ages (p < 0.001). There was a decrease in invasive ventilation, receipt of phototherapy, and reflux medications observed (p < 0.001). CONCLUSION In this large cohort, given 20 years of time for medical advancement, there was no significant improvement in the LOS of late preterm infants. All infants had an increased PMA at discharge, despite multiple practice changes that were observed.
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Affiliation(s)
| | - Kristi Coe
- Duke School of Nursing, Duke University, Durham, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA
| | - Samia Aleem
- Department of Pediatrics, Duke University, Durham, NC, USA.
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18
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Dyess NF, Palmer C, Soll RF, Clark RH, Abman SH, Kinsella JP. Practices and Outcomes from a Prospective, Multicenter Registry for Preterm Newborns with Pulmonary Hypertension. J Pediatr 2023; 262:113614. [PMID: 37478902 DOI: 10.1016/j.jpeds.2023.113614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To describe current treatment practices of preterm infants with early hypoxemic respiratory failure (HRF) and pulmonary hypertension (PH) and their association with patient outcomes. STUDY DESIGN We developed a prospective, observational, multicenter clinical registry of preterm newborns <34 weeks' gestation with HRF and PH, based on either clinical or echocardiographic evidence during the first 72 hours of life, from 28 neonatal intensive care units in the US from 2017 through 2022. The primary end point was mortality among those who did or did not receive PH-targeted treatment, and the secondary end points included comparisons of major morbidities. Variables were compared using t tests, Wilcoxon rank-sum tests, Fisher exact tests, and χ² tests. RESULTS We analyzed the results of 224 preterm infants enrolled in the registry. Of which, 84% (188/224) received PH-targeted treatment, most commonly inhaled nitric oxide (iNO). Early mortality in this cohort was high, as 33% (71/224) of this sample died in the first month of life, and 77% of survivors (105/137) developed bronchopulmonary dysplasia. Infants who received PH-targeted treatment had higher oxygenation indices at the time of enrollment (28.16 [IQR: 13.94, 42.5] vs 15.46 [IQR: 11.94, 26.15]; P = .0064). Patient outcomes did not differ between those who did or did not receive PH-targeted therapy. CONCLUSIONS Early-onset HRF with PH in preterm infants is associated with a high early mortality and a high risk of developing bronchopulmonary dysplasia. iNO is commonly used to treat early-onset PH in preterm infants with HRF. In comparison with untreated infants with lower oxygenation indices, iNO treatment in severe PH may prevent poorer outcomes.
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Affiliation(s)
- Nicolle Fernández Dyess
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO.
| | - Claire Palmer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
| | - Roger F Soll
- Department of Pediatrics, Division of Neonatology, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality and Safety (CREQS), Pediatrix Medical Group, Sunrise, FL
| | - Steven H Abman
- Department of Pediatrics, Section of Pulmonology, University of Colorado School of Medicine, Aurora, CO
| | - John P Kinsella
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO
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Low JM, Lee JH, Foote HP, Hornik CP, Clark RH, Greenberg RG. Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study. Am J Obstet Gynecol 2023:S0002-9378(23)00771-8. [PMID: 37890649 DOI: 10.1016/j.ajog.2023.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The difference in the incidence of early-onset sepsis caused by group B streptococcus among term neonates whose mothers received first-line vs second-line intrapartum prophylaxis is poorly described. OBJECTIVE This study aimed to compare the incidence of group B streptococcus early-onset sepsis among term neonates born to mothers who receive first-line, second-line, or no intrapartum antibiotics and to describe the short-term and survival outcomes of neonates who developed group B streptococcus early-onset sepsis stratified by maternal antepartum prophylaxis. STUDY DESIGN This was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to group B streptococcus positive mothers between 2003 and 2020 and compared the incidence and outcomes of neonates with group B streptococcus early-onset sepsis whose mothers received first-line vs second-line or no intrapartum prophylaxis. RESULTS Among the 496,180 neonates, 104,196 (21%) were born to mothers who were group B streptococcus positive. Of 97,983 mothers who were group B streptococcus positive with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%), and 36,070 (37%) received first-line, second-line, and no intrapartum prophylaxis, respectively. The incidence of group B streptococcus early-onset sepsis among all neonates with maternal group B streptococcus carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had a higher risk for group B streptococcus early-onset sepsis infection than those whose mothers received first-line intrapartum antibiotics (adjusted odds ratio, 4.12; 95% confidence interval, 2.66-6.38 and adjusted odds ratio, 3.80; 95% confidence interval, 2.66-5.44, respectively). There was no statistically significant difference in the risk for group B streptococcus early-onset sepsis among neonates born to mothers who received second-line vs no antibiotics (adjusted odds ratio, 0.92; 95% confidence interval, 0.64-1.33). CONCLUSION Neonates exposed to second-line maternal group B streptococcus prophylaxis had an increased risk for group B streptococcus early-onset sepsis when compared with those exposed to first-line maternal group B streptococcus prophylaxis. There was no statistically significant difference in group B streptococcus early-onset sepsis incidence between second-line antibiotic prophylaxis and no antibiotics in mothers with group B streptococcus carriage.
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Affiliation(s)
- Jia Ming Low
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Singapore, National University of Singapore, Singapore, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore; Singhealth-Duke NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Henry P Foote
- Department of Pediatrics, Duke University, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
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20
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Foote HP, Benjamin DK, Greenberg RG, Clark RH, Hornik CP. Use of vasopressors for septic shock in the neonatal intensive care unit. J Perinatol 2023; 43:1274-1280. [PMID: 37055478 DOI: 10.1038/s41372-023-01667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE To describe outcomes for infants in the neonatal intensive care unit with septic shock based on the vasopressor administered. METHODS This is a multicenter cohort study of infants with an episode of septic shock. We evaluated the primary outcomes of mortality and pressor-free days alive in the first week after shock using multivariable logistic and Poisson regressions. RESULTS We identified 1592 infants. Mortality was 50%. Dopamine was the most used vasopressor (92% of episodes) and hydrocortisone was co-administered with a vasopressor in 38% of episodes. Compared to infants treated with dopamine alone, adjusted odds of mortality were significantly higher for those treated with epinephrine alone (aOR 4.7 [95% CI: 2.3-9.2]). Adjuvant hydrocortisone was associated with significantly lower adjusted odds of mortality (aOR 0.60 [0.42-0.86]) CONCLUSIONS: The use of epinephrine as either a solo agent or in combination therapy was associated with significantly worse outcomes, while adjuvant hydrocortisone was associated with decreased mortality.
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Affiliation(s)
- Henry P Foote
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
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21
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Combs CA, Handler DL, Clark RH. Antenatal corticosteroids before early preterm birth: interval from administration to birth in contemporary practice and association with neonatal mortality. Am J Obstet Gynecol MFM 2023; 5:101130. [PMID: 37574048 DOI: 10.1016/j.ajogmf.2023.101130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Affiliation(s)
- C Andrew Combs
- Pediatrix Center for Research, Education, Quality and Safety, Pediatrix Medical Group, Sunrise, FL.
| | - Darren L Handler
- Pediatrix Center for Research, Education, Quality and Safety, Pediatrix Medical Group, Sunrise, FL
| | - Reese H Clark
- Pediatrix Center for Research, Education, Quality and Safety, Pediatrix Medical Group, Sunrise, FL
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Chou FS, Yeh HW, Clark RH. A comparative study of postnatal anthropometric growth in very preterm infants and intrauterine growth. Nat Commun 2023; 14:5626. [PMID: 37726287 PMCID: PMC10509139 DOI: 10.1038/s41467-023-41069-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023] Open
Abstract
Most growth references for very preterm infants were developed using measurements taken at birth, and were thought to represent intrauterine growth. However, it remains unclear whether the goal of approximating an intrauterine growth rate as stated by the American Academy of Pediatrics is attainable by very preterm infants. Using real-world measurement data from very preterm infants born between 2010 through 2020, we develop models to characterize the patterns of postnatal growth, and compare them to intrauterine growth. By assessing the weight growth rate, we show three phases of postnatal growth not evident in intrauterine growth. Furthermore, postnatal length and head circumference growth exhibit a slow rate after birth, followed by an acceleration. Collectively, postnatal and intrauterine growth are distinctly different. Although postnatal growth models do not represent optimal growth of very preterm infants, they can serve as a practical tool for clinical assessment of growth and for nutrition research.
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Affiliation(s)
- Fu-Sheng Chou
- Department of Neonatology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
- Clinician Investigator Program, Southern California Permanente Medical Group, Pasadena, CA, USA.
| | - Hung-Wen Yeh
- Division of Health Services and Outcomes Research, Children's Mercy Research Institute, Kansas City, MO, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Reese H Clark
- Center for Research, Education, Quality and Safety, Pediatrix® Medical Group, Sunrise, FL, USA
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Olsen IE, Granger M, Masoud W, Clark RH, Ferguson AN. Defining Body Mass Index Using Weight and Length for Gestational Age in the Growth Assessment of Preterm Infants at Birth. Am J Perinatol 2023. [PMID: 37683671 DOI: 10.1055/s-0043-1774316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The objectives of this study were to describe (1) body mass indexes (BMIs) using weight and length for gestational age (GA) classifications, and (2) the additional information BMI, as a measure of body proportionality, provides for preterm infant growth assessment and care plans at birth. STUDY DESIGN Birth weight, length, and BMI of 188,646 preterm infants (24-36 weeks gestation) admitted to U.S. neonatal intensive care units (Pediatrix Clinical Data Warehouse, 2013-2018) were classified (Olsen curves) as small, appropriate, or large for GA (SGA < 10th, AGA 10-90th, LGA > 90th percentile for GA, respectively). The distribution for the 27 weight-length-BMI combinations was described. RESULTS At birth, most infants were appropriate for weight (80.0%), length (82.2%), head circumference (82.9%), and BMI (79.9%) for GA. Birth weight for GA identified approximately 20% of infants as SGA or LGA. Infants born SGA (or LGA) for both weight and length ("proportionate" in size) were usually appropriate for BMI (59.0% and 75.6%). BMI distinguished disproportionate weight for length in infants with SGA or LGA weight at birth (58.3%, 49.9%). BMI also identified 11.4% of AGA weight infants as small or large for BMI ("disproportionate" in size) at birth; only using weight for GA missed these underweight/overweight for length infants. CONCLUSION The unique, additional information provided by birth BMI further informs individualized preterm infant growth assessment by providing an assessment of an infant's body proportionality (weight relative to its length) in addition to the routine assessment of weight, length, and head circumference for GA and may better inform care plans and impact outcomes. KEY POINTS · Most preterm infants were born AGA for all growth measures.. · AGA weight infants may be under- or overweight for length.. · BMI distinguished body disproportionality in SGA/LGA infants.. · Recommend BMI assessed along with weight, length and head.. · Further research on BMI in preterm infants is needed..
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Affiliation(s)
- Irene E Olsen
- Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Marion Granger
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
| | - Waleed Masoud
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
| | - Reese H Clark
- The Pediatrix Center for Research, Education, Quality, and Safety (CREQS), Pediatrix Medical Group, Inc., Sunrise, Florida
| | - A Nicole Ferguson
- School of Data Science and Analytics, Kennesaw State University, Kennesaw, Georgia
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Everett SS, Bomback M, Sahni R, Wapner RJ, Tolia VN, Clark RH, Lyford A, Hays T. Prevalence and Clinical Significance of Commonly Diagnosed Genetic Disorders in Preterm Infants. medRxiv 2023:2023.07.14.23292662. [PMID: 37503109 PMCID: PMC10370234 DOI: 10.1101/2023.07.14.23292662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background and Objectives Preterm infants (<34 weeks' gestation) experience high rates of morbidity and mortality before hospital discharge. Genetic disorders substantially contribute to morbidity and mortality in related populations. The prevalence and clinical impact of genetic disorders is unknown in this population. We sought to determine the prevalence of commonly diagnosed genetic disorders in preterm infants, and to determine the association of disorders with morbidity and mortality. Methods This was a retrospective multicenter cohort study of infants born from 23 to 33 weeks' gestation between 2000 and 2020. Genetic disorders were abstracted from diagnoses present in electronic health records. We excluded infants transferred from or to other health care facilities prior to discharge or death when analyzing clinical outcomes. We determined the adjusted odds of pre-discharge morbidity or mortality after adjusting for known risk factors. Results Of 320,582 infants, 4196 (1.3%) had genetic disorders. Infants with trisomy 13, 18, 21, or cystic fibrosis had greater adjusted odds of severe morbidity or mortality. Of the 17,427 infants who died, 566 (3.2%) had genetic disorders. Of the 65,968 infants with a severe morbidity, 1319 (2.0%) had genetic disorders.ConclusionsGenetic disorders are prevalent in preterm infants, especially those with life-threatening morbidities. Clinicians should consider genetic testing for preterm infants with severe morbidity and maintain a higher index of suspicion for life-threatening morbidities in preterm infants with genetic disorders. Prospective genomic research is needed to clarify the prevalence of genetic disorders in this population, and the contribution of genetic disorders to preterm birth and subsequent morbidity and mortality. Article Summary Genetic disorders were found in 1.3% of preterm infants and at a higher rate (2.0%) in infants who died or developed severe morbidity. What’s Known on This Subject Previous research described the prevalence and associated short-term morbidity and mortality of trisomy 13, 18, and 21 in preterm infants. The prevalence of other commonly diagnosed genetic disorders and associated short-term morbidity and mortality in preterm infants is unknown. What This Study Adds In a multicenter, retrospective cohort of 320,582 preterm (<34 weeks' gestation) infants, we found that 1.3% had genetic disorders diagnosed through standard care. Multiple disorders were associated with increased adjusted odds of morbidities or mortality prior to hospital discharge. Contributors Statement Page Selin S. Everett conceptualized and designed the study, conducted analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript.Dr. Thomas Hays conceptualized and designed the study, drafted the initial manuscript, and critically reviewed and revised the manuscript.Miles Bomback conceptualized and designed the study and critically reviewed and revised the manuscript.Drs. Veeral N. Tolia and Reese H. Clark coordinated and supervised data collection and critically reviewed and revised the manuscript.Dr. Rakesh Sahni conceptualized and designed the study and critically reviewed and revised the manuscript.Dr. Alex Lyford conducted analyses and critically reviewed and revised the manuscript. Dr. Ronald J. Wapner reviewed and critically revised the manuscript.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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Coggins SA, Willis Z, Benjamin DK, Mukhopadhyay S, Laughon M, Greenberg RG, Clark RH, Puopolo KM. Early antibiotic exposure in very-low birth weight infants and infection risk at 3-7 days after birth. J Perinatol 2023; 43:1158-1165. [PMID: 37491474 PMCID: PMC10529484 DOI: 10.1038/s41372-023-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To determine rates of late-onset infection (LOI) during postnatal days 3-7 among preterm infants, based on antibiotic exposure during days 0-2. STUDY DESIGN Retrospective cohort study of infants born <1500 grams and ≤30 weeks gestation, 2005-2018. We analyzed the incidence and microbiology of LOI at days 3-7 based on antibiotic exposure during postnatal days 0-2. RESULTS The cohort included 88,574 infants, of whom 85% were antibiotic-exposed. Fewer antibiotic-exposed compared to unexposed infants developed LOI (1.5% vs. 2.1%; adjusted hazard ratio, 0.28, 95% CI 0.24-0.33). Among antibiotic-exposed compared to unexposed infants, Gram-negative (38% vs. 28%, p = 0.002) and fungal (11% vs. 1%, p < 0.001) species were more commonly isolated, and gram-positive organisms (49% vs. 70%, p < 0.001) were less commonly isolated. CONCLUSIONS We observed low overall rates of LOI at days 3-7 after birth, but antibiotic exposure from birth was associated with lower rates, and with differing microbiology, compared to no exposure.
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Affiliation(s)
- Sarah A Coggins
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Zachary Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Sagori Mukhopadhyay
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Reese H Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | - Karen M Puopolo
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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26
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Kilpatrick R, Boutzoukas AE, Chan E, Girgis V, Kinduelo V, Kwabia SA, Yan J, Clark RH, Zimmerman KO, Greenberg RG. Urinary Tract Infection Epidemiology in NICUs in the United States. Am J Perinatol 2023. [PMID: 37429320 DOI: 10.1055/s-0043-1771015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Our objective was to characterize the incidence, associated clinical factors, timing of infection, microbiology, and incidence of concordant blood culture of urinary tract infections (UTIs) in very low birth weight (VLBW <1,500g) infants. STUDY DESIGN Multicenter observational cohort study of VLBW infants with gestational age (GA) ≤32 weeks, still hospitalized on postnatal day 7, and discharged 2010 to 2018 from Pediatrix Medical Group neonatal intensive care units. Demographic and clinical characteristics of infants with and without UTI were compared. Multivariable logistic regression evaluated adjusted odds of UTI diagnosis. RESULTS Of 86,492 included infants, 5,988 (7%) had a UTI. The most common pathogen was Enterococcus spp. (20%), followed by Escherichia coli (19%) and Klebsiella spp. (18%). Candida spp. (6%) was the most common nonbacterial pathogen. Concordant-positive blood culture was present in 8% of infants with UTI diagnoses. UTI was associated with lower GA, male sex, vaginal delivery, prenatal steroid exposure, and longer duration of hospitalization. CONCLUSION UTI is a common cause of infection in VLBW infants, especially among the smallest, most premature, male infants, and those with a longer duration of hospitalization. Neonatal clinicians should consider obtaining urine culture in the setting of late-onset sepsis evaluations in VLBW infants. KEY POINTS · UTI is a common cause of LOS in VLBW infants.. · The most common pathogens are Enterococcus spp. and E. coli.. · UTI risk varies among different VLBW infant populations.. · Next steps should include evaluation of preventative measures..
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Affiliation(s)
- Ryan Kilpatrick
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Angelique E Boutzoukas
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Elizabeth Chan
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Valerie Girgis
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Vincent Kinduelo
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Sarah Ama Kwabia
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Jenny Yan
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Reese H Clark
- Center for Research, Education, Quality, and Safety, Pediatrix Medical Group, Inc, Sunrise, Florida
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
- Department of Pediatrics, Duke Clinical Research Institute, Durham, North Carolina
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Srivatsa B, Srivatsa KR, Clark RH. Assessment of validity and utility of a bronchopulmonary dysplasia outcome estimator. Pediatr Pulmonol 2023; 58:788-793. [PMID: 36444479 DOI: 10.1002/ppul.26254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/16/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the validity and utility of the bronchopulmonary dysplasia (BPD) outcome estimator developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). METHODS This retrospective study correlated the BPD and mortality outcomes of 23-28-week prematurely born infants with those predicted by the 2022 NICHD BPD outcome estimator. In addition, evidence-based recommended postnatal steroid administration using risk predictions by the BPD estimator was compared with actual postnatal steroid use. RESULTS Among the 223 infants enrolled in the study, 139 did not develop BPD, 64 babies developed BPD, and 20 babies died. BPD estimator predicted outcomes correctly in 74% of cases who did not develop BPD, 48% of cases with Grade 1 BPD, and 35% of deaths. Only 6% of cases with Grade 2 BPD and none of the babies with Grade 3 BPD were identified correctly. The predicted and actual steroid use for BPD prevention/treatment were 37.2% and 29.6%, respectively (p = 0.18). The BPD estimator had a sensitivity of 72.7%, specificity of 77.7%, positive predictive value of 57.8%, and negative predictive value of 87.1% to predict actual postnatal steroid use. CONCLUSIONS In this cohort, the 2022 NICHD BPD estimator underestimated probabilities for babies who did not develop BPD, may overestimate probabilities for babies who develop BPD and had low sensitivity to predict mortality. In addition, the application of the BPD estimator may result in an overestimation of postnatal steroid use.
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Affiliation(s)
- Bharath Srivatsa
- Neonatology Associates of Atlanta, P.C., Atlanta, Georgia, USA.,Northside Hospital, Atlanta, Georgia, USA.,Pediatrix Medical Group, Sunrise, Florida, USA
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28
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Leow EH, Lee JH, Hornik CP, Ng YH, Hays T, Clark RH, Tolia VN, Greenberg RG. Congenital anomalies of the kidney and urinary tract (CAKUT) in critically ill infants: a multicenter cohort study. Pediatr Nephrol 2023; 38:161-172. [PMID: 35467155 DOI: 10.1007/s00467-022-05542-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/02/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to determine the prevalence of congenital anomalies of the kidney and urinary tract (CAKUT) in the neonatal intensive care unit (NICU) and to evaluate risk factors associated with worse outcomes. We hypothesized that infants with CAKUT with extra-renal manifestations have higher mortality. METHODS This is a cohort study of all inborn infants who were diagnosed with any form of CAKUT discharged from NICUs managed by the Pediatrix Medical Group from 1997 to 2018. Logistic and linear regression models were used to analyze risk factors associated with in-hospital mortality. RESULTS The prevalence of CAKUT was 1.5% among infants hospitalized in 419 NICUs. Among the 13,383 infants with CAKUT analyzed, median gestational age was 35 (interquartile range [IQR] 31-38) weeks and median birth weight was 2.34 (IQR 1.54-3.08) kg. Overall in-hospital mortality for infants with CAKUT was 6.8%. Oligohydramnios (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 2.2-9.1, p < 0.001), extra-renal anomalies (aOR 2.5, 95% CI 2.0-3.1, p < 0.001), peak SCr (aOR 1.02, 95% CI 1.01-1.03, p < 0.001) and exposure to nephrotoxic medications (aOR 1.4, 95% CI 1.1-1.7, p = 0.01) were associated with increased mortality, while a history of urological surgery or intervention was associated with lower mortality (aOR 0.6, 95% CI 0.4-0.7, p < 0.001). CONCLUSIONS Infants hospitalized in the NICU who have CAKUT and the independent risk factors for mortality (e.g., oligohydramnios and presence of extra-renal anomalies) require close monitoring, minimizing of exposure to nephrotoxic drugs, and timely urological surgery or intervention. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Esther Huimin Leow
- Paediatric Nephrology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Yong Hong Ng
- Paediatric Nephrology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Thomas Hays
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York City, NY, USA
| | - Reese H Clark
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | - Veeral N Tolia
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
- Department of Neonatology, Baylor University Medical Center and Pediatrix Medical Group, Dallas, TX, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Commander SJ, Benjamin DK, Wu H, Thompson EJ, Lane M, Clark RH, Greenberg RG, Hornik CP. Exposure-response Relationships of Metronidazole in Infants: Integration of Electronic Health Record Data With Population Pharmacokinetic Modeling-derived Exposure Simulation. Pediatr Infect Dis J 2023; 42:27-31. [PMID: 36201670 PMCID: PMC9742159 DOI: 10.1097/inf.0000000000003726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Infants frequently receive metronidazole at variable doses and duration for surgical site infection prophylaxis and treatment of intra-abdominal infections. Seizures are a rare (but potentially devastating) side effect of metronidazole, yet the prevalence of seizures in infants, as well as the relationship with metronidazole dose and exposure, are unknown. METHODS We examined the Pediatrix Clinical Data Warehouse for infants in neonatal intensive care units from 1997 to 2018 who received at least 1 dose of metronidazole during their first 120 days of life. We used an existing population pharmacokinetic model to simulate exposure parameters, estimating multivariable associations between metronidazole dosing and exposure parameters, and the occurrence of seizure. RESULTS There were 19,367 intravenous doses of metronidazole given to 1546 infants, and 31 experienced a seizure. Infants with a seizure had a longer median (interquartile values) duration of metronidazole exposure than those without (11 days [6, 15] vs. 7 [4, 11], P = 0.01). Each added day of metronidazole (OR = 1.06, 95% CI: 1.02-1.10), and each standard deviation increase in cumulative area under the plasma concentration-time curve (OR = 1.27, 95% CI: 1.11-1.45) were associated with increased odds of seizure. Higher simulated maximum plasma concentration was associated with lower odds of seizure (OR = 0.88, 95% CI: 0.81-0.96). CONCLUSIONS Longer metronidazole exposure and higher cumulative exposure could be associated with increased odds of infant seizures. Using a large observational dataset allowed us to identify a rare adverse event, but prospective studies are needed to validate this finding and further characterize metronidazole dose- and exposure-safety relationships.
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Affiliation(s)
- Sarah Jane Commander
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Huali Wu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Elizabeth J. Thompson
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Morgan Lane
- Duke Clinical Research Institute, Durham, North Carolina
| | - Reese H. Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida
| | - Rachel G. Greenberg
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
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30
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Srivatsa B, Wesolowski A, Srivatsa KR, Bennett MM, Clark RH, Kupke KG. Transpyloric Feeding is Associated With Improved Oxygenation Compared With Gastric Feeding Among Nonintubated Extremely Low Birth Weight Infants. J Pediatr 2022; 255:175-180.e1. [PMID: 36462688 DOI: 10.1016/j.jpeds.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To study the impact of transpyloric (TP) feed initiation on short-term oxygenation and manual oxygen blender titration among extremely low birth weight infants. STUDY DESIGN This retrospective study evaluated several measures of oxygenation among extremely low birth weight infants receiving positive pressure respiratory support for 96 hours before and after TP tube placement in a single neonatal intensive care unit during the years 2017- 2020. The measures included the achieved oxygen saturation (SpO2), the baseline fraction of inspired oxygen (FiO2), the SpO2/FiO2 ratio, the number and severity of hypoxemic episodes and the frequency of manual oxygen titrations (titration index) and were analyzed using an interrupted time series regression approach. RESULTS A total of 56 infants were evaluated. No significant differences were observed in any oxygenation measures during TP vs gastric feeding among 14 intubated infants. However, among 42 nonintubated patients, significant improvements were observed in the median SpO2/FiO2 ratios (P = .001), median titration index (P = .05), median number of hypoxemic episodes (P = .02), and median severity of hypoxemic episodes (P = .008) after TP tube placement. CONCLUSIONS The transition from gastric to TP tube feeding was temporally associated with acute improvement in oxygenation for nonintubated infants, but not for intubated infants.
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Affiliation(s)
- Bharath Srivatsa
- Neonatology Associates of Atlanta, P.C, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL.
| | - Agnieszka Wesolowski
- Neonatology Associates of Atlanta, P.C, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL
| | | | | | | | - Kenneth G Kupke
- Neonatology Associates of Atlanta, P.C, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL
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31
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Jarman ML, Bennett MM, Louis JM, Clark RH, Tolia VN, Ahmad KA. Changing Tocolytic Exposures among Neonatal Intensive Care Unit Admitted Preterm Infants. Am J Perinatol 2022; 39:1745-1749. [PMID: 35045576 DOI: 10.1055/a-1745-3262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants. STUDY DESIGN Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate. RESULTS A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period. CONCLUSION For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation. KEY POINTS · Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants.. · Concurrently, the use of other tocolytics decreased significantly.. · The use of antenatal steroids has been rising over time..
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Affiliation(s)
- Meghan L Jarman
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - Monica M Bennett
- Research Analytics and Development Cores, Baylor Scott and White Research Institute, Dallas, Texas
| | - Judette M Louis
- Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Reese H Clark
- MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida
| | - Veeral N Tolia
- Department of Pediatrics, Baylor University Medical Center, Dallas, Texas.,Pediatrix Medical Group, Dallas, Texas
| | - Kaashif A Ahmad
- Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas.,MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida.,Pediatrix Medical Group of San Antonio, San Antonio, Texas.,Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas.,Pediatrix and Obstetrix Specialists of Houston, Houston, Texas.,Department of Neonatology, The Woman's Hospital of Texas, Houston, Texas
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Fenrich AL, Shmorhun DP, Martin GC, Young JA, Cohen MI, Kelleher AS, Anyebuno MA, Rider ED, Motta CL, Clark RH. Long QT and Hearing Loss in High-Risk Infants Prospective Study Registry. Pediatr Cardiol 2022; 43:1898-1902. [PMID: 35661239 DOI: 10.1007/s00246-022-02939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
The objective of this study is to determine the prevalence of an abnormal electrocardiogram showing a prolonged QTc greater than 450 ms in infants with unilateral or bilateral sensorineural hearing loss. We conducted a prospective study of healthy term infants (≥37 weeks gestational age) who failed their newborn auditory brainstem response hearing screen, were seen by an audiologist and diagnosed as having sensorineural hearing loss during follow-up to 1 year of age. In infants with a diagnosis of hearing loss, we collected a detailed family history and performed an ECG between 2 and 6 months of age. We obtained follow-up for 1 year by calling the parent requesting the hearing and cardiac status of their child. Two of the 40 infants with sensorineural hearing loss (5%) had a QTc greater than 450 ms. Both had mild bilateral hearing loss and genetic testing did not identify a known mutation for long QT syndrome. The remaining 38 infants had QTc intervals of ≤ 450 ms. One patient diagnosed with bilateral severe sensorineural hearing loss had a normal ECG (QTc = 417 ms). Several months after the ECG was performed, the infant's mother contacted the study cardiologist after she learned that the infant's maternal grandmother was diagnosed with a cardiomyopathy and arrhythmias. Genetic testing was recommended even though the child was asymptomatic and was positive for a pathogenic mutation in the KCNQ1 gene. We speculate that molecular genetic testing in infants with hearing loss may become the standard of care rather than targeted electrocardiograms.Clinical Trial Registration NCT02082431 https://www.clinicaltrials.gov/ct2/show/NCT02692521?cond=NCT02692521&rank=1 .
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Affiliation(s)
| | | | - Gregory C Martin
- Banner University Medical Center, Phoenix, AZ, USA.,Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | | | - Amy S Kelleher
- The MEDNAX Center for Research, Education, Quality and Safety, 1301 Concord Ter, Sunrise, FL, 33323, USA.
| | | | - Evelyn D Rider
- Childrens Hospital at Providence Alaska Medical Center, Anchorage, AK, USA
| | - Cheryl L Motta
- The Childrens Hospital of San Antonio, San Antonio, TX, USA
| | - Reese H Clark
- The MEDNAX Center for Research, Education, Quality and Safety, 1301 Concord Ter, Sunrise, FL, 33323, USA
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Curtis SF, Cotten CM, Laughon M, Younge N, Peterson J, Clark RH, Greenberg RG. Indomethacin Prophylaxis in Preterm Infants: Changes over Time. Am J Perinatol 2022. [PMID: 35973793 DOI: 10.1055/a-1925-5173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective was to examine changes in the use of indomethacin prophylaxis in the neonatal intensive care unit (NICU) between 2008 and 2018. STUDY DESIGN The design of the study included cohort of 19,715 infants born between 220/7 and 266/7 weeks' gestation from 213 NICUs. A nonparametric trend test evaluated indomethacin prophylaxis and the percentage of sites using any prophylaxis over time. We evaluated the prevalence of indomethacin prophylaxis by the center and the correlation between indomethacin prophylaxis and severe intraventricular hemorrhage prevalence among 12 centers with the largest relative change in indomethacin prophylaxis prevalence. RESULTS In total, 16% of infants received indomethacin prophylaxis. The use of indomethacin prophylaxis did not significantly decrease between 2008 and 2018 but it significantly decreased between 2014 and 2018 (p = 0.046). Among 74 centers with ≥10 infants included, 20% increased the use of indomethacin prophylaxis, while 57% decreased the use over the study period. Of the 12 centers with the largest relative change in indomethacin prophylaxis prevalence, 50% showed an inverse correlation between indomethacin prophylaxis prevalence and severe intraventricular hemorrhage, while 50% showed a positive correlation. CONCLUSION Receipt of indomethacin prophylaxis remained similar until 2014, decreased from 2014 to 2018, and varied by the center.Key Points · The receipt of indomethacin prophylaxis decreased over time.. · Center change in the use of indomethacin prophylaxis does not correlate with the center prevalence of IVH.. · Variability in the use of indomethacin prophylaxis across centers persists..
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Affiliation(s)
- Samantha F Curtis
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Noelle Younge
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer Peterson
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Curtis SF, Cotten CM, Laughon M, Younge N, Peterson J, Clark RH, Greenberg RG. Indomethacin Prophylaxis in Preterm Infants: Changes over Time. Am J Perinatol 2022. [PMID: 36174589 DOI: 10.1055/s-0042-1756678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Our objective was to examine changes in the use of indomethacin prophylaxis in the neonatal intensive care unit (NICU) between 2008 and 2018. STUDY DESIGN The design of the study included cohort of 19,715 infants born between 220/7 and 266/7 weeks' gestation from 213 NICUs. A nonparametric trend test evaluated indomethacin prophylaxis and the percentage of sites using any prophylaxis over time. We evaluated the prevalence of indomethacin prophylaxis by the center and the correlation between indomethacin prophylaxis and severe intraventricular hemorrhage prevalence among 12 centers with the largest relative change in indomethacin prophylaxis prevalence. RESULTS In total, 16% of infants received indomethacin prophylaxis. The use of indomethacin prophylaxis did not significantly decrease between 2008 and 2018 but it significantly decreased between 2014 and 2018 (p = 0.046). Among 74 centers with ≥10 infants included, 20% increased the use of indomethacin prophylaxis, while 57% decreased the use over the study period. Of the 12 centers with the largest relative change in indomethacin prophylaxis prevalence, 50% showed an inverse correlation between indomethacin prophylaxis prevalence and severe intraventricular hemorrhage, while 50% showed a positive correlation. CONCLUSION Receipt of indomethacin prophylaxis remained similar until 2014, decreased from 2014 to 2018, and varied by the center.Key Points · The receipt of indomethacin prophylaxis decreased over time.. · Center change in the use of indomethacin prophylaxis does not correlate with the center prevalence of IVH.. · Variability in the use of indomethacin prophylaxis across centers persists..
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Affiliation(s)
- Samantha F Curtis
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Noelle Younge
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer Peterson
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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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..
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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
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Hays T, Thompson MV, Bateman DA, Sahni R, Tolia VN, Clark RH, Gharavi AG. The Prevalence and Clinical Significance of Congenital Anomalies of the Kidney and Urinary Tract in Preterm Infants. JAMA Netw Open 2022; 5:e2231626. [PMID: 36103177 PMCID: PMC9475384 DOI: 10.1001/jamanetworkopen.2022.31626] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE The prevalence and importance of congenital anomalies of the kidney and urinary tract (CAKUT) in preterm infants is unknown. OBJECTIVE To determine the prevalence of CAKUT in preterm infants and association with in-hospital morbidity and mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study included infants cared for in neonatal intensive care units managed by a large US network of hospitals and doctors. Eligible participants were infants born at 23 to 33 weeks' gestation between 2000 and 2020. Infants transferred from or to other health care facilities prior to discharge or death were excluded in analysis of outcomes. Data were analyzed from December 2021 until May 2022. EXPOSURES The presence of anomalies of the kidneys, ureters, bladder, or urethra was assessed. Covariates were discharge year, exposure to antenatal steroids, sex, maternal race, gestational age, birthweight, mechanical ventilation in first 72 hours of life, genetic disorders, and extrarenal anomalies. MAIN OUTCOMES AND MEASURES Death or in-hospital severe illness (acute kidney injury, kidney failure, intracranial hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, bacterial sepsis, or administration of inotrope or vasopressor). RESULTS In this cohort of 409 704 infants, 191 105 (46.6%) were girls, mean (SD) gestational age was 30.1 (2.84) weeks, and mean (SD) birth weight was 1.49 (0.53) kg. A total of 8093 infants (2.0%) had CAKUT, with urinary tract dilation comprising the majority of cases (5669 [70.0%]). The presence of CAKUT correlated with earlier gestational age and was associated with genetic disorders and extrarenal anomalies. Analysis of 323 957 infants after exclusions demonstrated an adjusted odds ratio of 3.96 (95% CI, 3.70-4.24) of death or severe illness. This risk was found across all forms of CAKUT including isolated urinary tract dilation. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that clinicians caring for preterm infants should have higher suspicion for CAKUT and consider screening, particularly those with extrarenal anomalies or genetic disorders, as preterm infants with CAKUT appear to be at significantly higher risk of death or severe illness. Detection of CAKUT can inform risk stratification and clinical decision making, and should also prompt clinicians to consider a genetic evaluation.
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Affiliation(s)
- Thomas Hays
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Michaela V. Thompson
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - David A. Bateman
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Rakesh Sahni
- Division of Neonatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Veeral N. Tolia
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida
- Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
- Pediatrix Medical Group, Dallas, Texas
| | - Reese H. Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, Florida
| | - Ali G. Gharavi
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
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Ye C, Wu J, Reiss JD, Sinclair TJ, Stevenson DK, Shaw GM, Chace DH, Clark RH, Prince LS, Ling XB, Sylvester KG. Progressive Metabolic Abnormalities Associated with the Development of Neonatal Bronchopulmonary Dysplasia. Nutrients 2022; 14:nu14173547. [PMID: 36079804 PMCID: PMC9459725 DOI: 10.3390/nu14173547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the longitudinal metabolic patterns during the evolution of bronchopulmonary dysplasia (BPD) development. Methods: A case-control dataset of preterm infants (<32-week gestation) was obtained from a multicenter database, including 355 BPD cases and 395 controls. A total of 72 amino acid (AA) and acylcarnitine (AC) variables, along with infants’ calorie intake and growth outcomes, were measured on day of life 1, 7, 28, and 42. Logistic regression, clustering methods, and random forest statistical modeling were utilized to identify metabolic variables significantly associated with BPD development and to investigate their longitudinal patterns that are associated with BPD development. Results: A panel of 27 metabolic variables were observed to be longitudinally associated with BPD development. The involved metabolites increased from 1 predominant different AC by day 7 to 19 associated AA and AC compounds by day 28 and 16 metabolic features by day 42. Citrulline, alanine, glutamate, tyrosine, propionylcarnitine, free carnitine, acetylcarnitine, hydroxybutyrylcarnitine, and most median-chain ACs (C5:C10) were the most associated metabolites down-regulated in BPD babies over the early days of life, whereas phenylalanine, methionine, and hydroxypalmitoylcarnitine were observed to be up-regulated in BPD babies. Most calorie intake and growth outcomes revealed similar longitudinal patterns between BPD cases and controls over the first 6 weeks of life, after gestational adjustment. When combining with birth weight, the derived metabolic-based discriminative model observed some differences between those with and without BPD development, with c-statistics of 0.869 and 0.841 at day 7 and 28 of life on the test data. Conclusions: The metabolic panel we describe identified some metabolic differences in the blood associated with BPD pathogenesis. Further work is needed to determine whether these compounds could facilitate the monitoring and/or investigation of early-life metabolic status in the lung and other tissues for the prevention and management of BPD.
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Affiliation(s)
- Chengyin Ye
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou 311100, China
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Jinghua Wu
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou 311100, China
| | - Jonathan D. Reiss
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
- Stanford Metabolic Health Center, Stanford Children’s Hospital, Stanford, CA 94304, USA
| | - Tiffany J. Sinclair
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - David K. Stevenson
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
- Stanford Metabolic Health Center, Stanford Children’s Hospital, Stanford, CA 94304, USA
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | | | - Reese H. Clark
- Pediatrix-Obstetrix Center for Research, Education and Quality, Sunrise, FL 33323, USA
| | - Lawrence S. Prince
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Xuefeng Bruce Ling
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94304, USA
- Clinical and Translational Research Program, Betty Irene Moore Children’s Heart Center, Lucile Packard Children’s Hospital, Palo Alto, CA 94304, USA
- Correspondence: (X.B.L.); (K.G.S.); Tel.: +1-650-723-6439 (K.G.S.); Fax: +1-650-725-5577 (K.G.S.)
| | - Karl G. Sylvester
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94304, USA
- Stanford Metabolic Health Center, Stanford Children’s Hospital, Stanford, CA 94304, USA
- Department of Surgery, Division of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA 94304, USA
- Correspondence: (X.B.L.); (K.G.S.); Tel.: +1-650-723-6439 (K.G.S.); Fax: +1-650-725-5577 (K.G.S.)
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Srivatsa B, Hagan JL, Clark RH, Kupke KG. Oxygenation Factors Associated with Retinopathy of Prematurity in Infants of Extremely Low Birth Weight. J Pediatr 2022; 247:46-52.e4. [PMID: 35427689 DOI: 10.1016/j.jpeds.2022.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/06/2022] [Accepted: 03/21/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study characteristics of oxygenation during the first 2 postnatal months and correlation with the occurrence and severity of retinopathy of prematurity (ROP) among infants of extremely low birth weight. STUDY DESIGN This retrospective study analyzed the incidence and severity of hyperoxemia and hypoxemia while on respiratory support with or without supplemental oxygen among infants of extremely low birth weight (birth weight <1000 g) admitted to the neonatal intensive care unit during 2016-2020. The findings were correlated with the occurrence and severity of ROP after adjusting for baseline covariates. RESULTS After adjusting for differences in baseline demographic and clinical features, the group with severe ROP was exposed to greater fraction of inspired oxygen (FiO2) (P = .001) and experienced more frequent FiO2 titration adjustments (P = .001) compared with the group without ROP. Ambient air hyperoxemia occurred more frequently in the group without ROP (P = .003), and iatrogenic hyperoxemia occurred more frequently in the group with severe ROP (P = .046). There were no differences in the severity of ambient and iatrogenic hyperoxemia in the study population. The group with severe ROP demonstrated more hypoxemic episodes (P = .01) and longer time spent in the severe hypoxemic range (P = .005) compared with the group without ROP. CONCLUSIONS Severe ROP is associated with greater FiO2 exposure, increased iatrogenic hyperoxemia, decreased ambient air hyperoxemia, and increased hypoxemia in infants of extremely low birth weight despite a greater frequency of FiO2 titration. This study illustrates the need for automated closed loop FiO2 delivery systems to further optimize oxygen saturation targeting in this high-risk population.
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Affiliation(s)
- Bharath Srivatsa
- Neonatology Associates of Atlanta, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL.
| | | | | | - Kenneth G Kupke
- Neonatology Associates of Atlanta, Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Sunrise, FL
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Le J, Greenberg RG, Yoo Y, Clark RH, Benjamin DK, Zimmerman KO, Cohen-Wolkowiez M, Wade KC. Ampicillin dosing in premature infants for early-onset sepsis: exposure-driven efficacy, safety, and stewardship. J Perinatol 2022; 42:959-964. [PMID: 35210541 PMCID: PMC9262754 DOI: 10.1038/s41372-022-01344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/06/2022] [Accepted: 02/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Define optimal ampicillin dosing for empiric early-onset sepsis (EOS) therapy in preterm neonates. STUDY DESIGN We simulated ampicillin concentrations in newborns (birthweight < 1500 g; gestational age 22-27 weeks), summarizing three 48 h regimens: high 100 mg/kg Q8hr, medium 100 mg/kg Q12hr, and standard 50 mg/kg Q12hr. Concentration data were analyzed for concentration above minimum inhibitory concentration (MIC), below neurotoxicity threshold (Cmax ≤ 140 mcg/mL), and duration limited to 48 h. RESULTS Among 34,689 newborns, all dosing regimens provided concentrations above MIC through 48 h, but Cmax exceeded the neurotoxicity threshold. With the 4-dose standard regimen, >90% maintained concentrations >MIC beyond 48 h. With the 2-dose regimen, newborns maintained the mean concentration >MIC within the 48 h culture window and below neurotoxicity level. Infants 22-24 weeks' gestation had higher drug concentrations and more prolonged exposure duration than 25-27 weeks' gestation. CONCLUSIONS For EOS in preterm infants, two ampicillin doses (50 mg/kg) provided optimal bactericidal exposures, while minimizing potential toxicity.
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Affiliation(s)
- Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California, San Diego, La Jolla, CA, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - YoungJun Yoo
- Skaggs School of Pharmacy and Pharmaceutical Science, University of California, San Diego, La Jolla, CA, USA
| | | | - Daniel K Benjamin
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Michael Cohen-Wolkowiez
- Department of Pediatrics, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Kelly C Wade
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Bamat NA, Thompson EJ, Greenberg RG, Lorch SA, Zuppa AF, Eichenwald EC, Tolia VN, Clark RH, Smith PB, Hornik CP, Lang JE, Laughon MM. Association between postmenstrual age and furosemide dosing practices in very preterm infants. J Perinatol 2022; 42:461-467. [PMID: 35075306 PMCID: PMC9007841 DOI: 10.1038/s41372-022-01320-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/17/2021] [Accepted: 01/14/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Furosemide renal clearance is slow after very preterm (VP) birth and increases with postnatal maturation. We compared furosemide dose frequency and total daily dose between postmenstrual age (PMA) groups in VP infants. STUDY DESIGN Observational cohort study of VP infants exposed to a repeated-dose course of furosemide in Pediatrix neonatal intensive care units (NICU) from 1997 to 2016. RESULTS We identified 6565 furosemide courses among 4638 infants. There were no statistically significant differences between PMA groups on the odds of receiving more frequent furosemide dosing. Furosemide courses initiated at <28 weeks PMA were associated with a higher total daily dose than those initiated at a later PMA. CONCLUSIONS Furosemide dosing practices in the NICU are similar across PMA groups, despite maturational changes in drug disposition. Research is needed to identify and test rational dosing strategies across the PMA spectrum for this commonly used but unproven pharmacotherapy.
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Affiliation(s)
- Nicolas A Bamat
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Scott A Lorch
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Athena F Zuppa
- Center for Clinical Pharmacology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eric C Eichenwald
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Veeral N Tolia
- Department of Neonatology, Baylor University Medical Center, Dallas, TX, USA
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | - Reese H Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Swanson JR, Hair A, Clark RH, Gordon PV. Spontaneous intestinal perforation (SIP) will soon become the most common form of surgical bowel disease in the extremely low birth weight (ELBW) infant. J Perinatol 2022; 42:423-429. [PMID: 35177793 DOI: 10.1038/s41372-022-01347-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 12/12/2022]
Abstract
Recent data have revealed declines in the prevalence rates of NEC over the last decade in premature infants. In contrast, SIP has either remained steady or risen during the same epoch. These trends are consistent with our knowledge of the clinical arena. The ability to discern SIP contamination within NEC datasets has slowly improved. Additionally, quality improvement efforts are being utilized to reduce NEC through stewardship of antibiotics, acid inhibitors, central lines and blood products, as well as optimization of human milk diets. These forces are moving us to a new era, where NEC will no longer be the dominant surgical intestinal disease of the extremely preterm neonate. Indeed, in the extremely low birth weight (ELBW) population, SIP may already be the most prevalent reason for abdominal surgery. In this perspective, the reader will find supporting data and references for these assertions as well as predictions for the future.
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Affiliation(s)
- Jonathan R Swanson
- Division of Neonatology, University of Virginia Children's Hospital, Charlottesville, VA, USA.
| | - Amy Hair
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, USA
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Sanderson K, Warady B, Carey W, Tolia V, Boynton MH, Benjamin DK, Jackson W, Laughon M, Clark RH, Greenberg RG. Mortality Risk Factors among Infants Receiving Dialysis in the Neonatal Intensive Care Unit. J Pediatr 2022; 242:159-165. [PMID: 34798078 PMCID: PMC8882152 DOI: 10.1016/j.jpeds.2021.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To identify risk factors associated with mortality for infants receiving dialysis in the neonatal intensive care unit (NICU). STUDY DESIGN In this retrospective cohort study, we extracted data from the Pediatrix Clinical Data Warehouse on all infants who received dialysis in the NICU from 1999 to 2018. Using a Cox proportional hazards model with robust SEs we estimated the mortality hazard ratios associated with demographics, birth details, medical complications, and treatment exposures. RESULTS We identified 273 infants who received dialysis. Median gestational age at birth was 35 weeks (interquartile values 33-37), median birth weight was 2570 g (2000-3084), 8% were small for gestational age, 41% white, and 72% male. Over one-half of the infants (59%) had a kidney anomaly; 71 (26%) infants died before NICU hospital discharge. Factors associated with increased risk of dying after dialysis initiation included lack of kidney anomalies, Black race, gestational age of <32 weeks, necrotizing enterocolitis, dialysis within 7 days of life, and receipt of paralytics or vasopressors (all P < .05). CONCLUSION In this cohort of infants who received dialysis in the NICU over 2 decades, more than 70% of infants survived. The probability of death was greater among infants without a history of a kidney anomaly and those with risk factors consistent with greater severity of illness at dialysis initiation.
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Affiliation(s)
- Keia Sanderson
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC
| | - Bradley Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - William Carey
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN
| | - Veeral Tolia
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL,Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Dallas, TX
| | - Marcella H. Boynton
- Department of Medicine-Internal Medicine, University of North Carolina, Chapel Hill, NC,North Carolina Translational and Clinical Sciences Institute, Chapel Hill, NC
| | | | - Wesley Jackson
- Division of Neonatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Matthew Laughon
- Division of Neonatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Reese H. Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL,Greenville Health System, Greenville, SC
| | - Rachel G. Greenberg
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, NC,Duke Clinical Research Institute, Durham, NC
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Beckstrom AC, Lin G, Ngoche L, Perla S, Clark RH, Kamitsuka M. Effect of an Alternate Definition for a Clinically Significant Cardiopulmonary Event on Discharge. J Pediatr 2022; 242:25-31.e2. [PMID: 34748739 DOI: 10.1016/j.jpeds.2021.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/15/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate a precise definition of a clinically significant cardiopulmonary event (CSCPE) on the hospital length of stay (LOS), medical provider satisfaction, and discharge complications. STUDY DESIGN This is a single-center, observational study that included 139 infants before and 134 infants after the new definition was implemented in December 2017. Retrospective data collected November 2015 to November 2017 (before) was compared with prospective data from June 2018 to July 2020 (after). Outcome measures were the proportion of infants waiting to outgrow CSCPE, LOS, provider satisfaction with the definition, and discharge complications. Multivariate regression modeling was used to evaluate variables on LOS and postmenstrual age at discharge. RESULTS The proportion waiting to outgrow CSCPE decreased from 68.4% to 31.7% (P < .0001). The LOS was similar between groups; however, multivariate analysis correcting for gestational age and reason awaiting discharge estimated 3.5 days (95% CI, 1.4-5.8 days; P = .0017) decrease in LOS, and 0.92 weeks (95% CI, 0.29-1.56; P = .005) younger postmenstrual age at discharge in the after group. There was no difference in the number of readmissions or emergency room visits for apnea or deaths. Provider satisfaction improved with discharge planning after the implementation of the definition. CONCLUSIONS We developed an alternate definition for a CSCPE that decreased the proportion of infants waiting to outgrow a CSCPE but not LOS. There was no difference in the number of readmissions or emergency room visits for apnea or deaths, and provider satisfaction in management and discharge planning was greater. CLINICAL TRIAL REGISTRATION INFORMATION This study was registered under the ClinicalTrial.gov Protocol ID: 5892S-15. "The effect of standardizing the definition and approach to a clinically significant cardiopulmonary event in infants less than 30 weeks on length of stay." Recorded Nov 2017.
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Affiliation(s)
- Andrew C Beckstrom
- Division of Neonatology, Swedish Medical Center, Seattle, WA; Pediatrix Medical Group, Center for Research and Education, Sunrise, FL.
| | - Grace Lin
- Division of Neonatology, Swedish Medical Center, Seattle, WA; Pediatrix Medical Group, Center for Research and Education, Sunrise, FL
| | - Leah Ngoche
- Division of Neonatology, Swedish Medical Center, Seattle, WA; Pediatrix Medical Group, Center for Research and Education, Sunrise, FL
| | - Sally Perla
- Division of Neonatology, Swedish Medical Center, Seattle, WA
| | - Reese H Clark
- Pediatrix Medical Group, Center for Research and Education, Sunrise, FL
| | - Michael Kamitsuka
- Division of Neonatology, Swedish Medical Center, Seattle, WA; Pediatrix Medical Group, Center for Research and Education, Sunrise, FL
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Stark A, Smith PB, Hornik CP, Zimmerman KO, Hornik CD, Pradeep S, Clark RH, Benjamin DK, Laughon M, Greenberg RG. Medication Use in the Neonatal Intensive Care Unit and Changes from 2010 to 2018. J Pediatr 2022; 240:66-71.e4. [PMID: 34481808 PMCID: PMC9394450 DOI: 10.1016/j.jpeds.2021.08.075] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide up-to-date medication prescribing patterns in US neonatal intensive care units (NICUs) and to examine trends in prescribing patterns over time. STUDY DESIGN We performed a cohort study of 799 016 infants treated in NICUs managed by the Pediatrix Medical Group from 2010 to 2018. We used 3 different methods to report counts of medication: exposure, courses, and days of use. We defined the change in frequency of medication administration by absolute change and relative change. We examined the Food and Drug Administration (FDA) package insert for each medication to determine whether a medication was labeled for use in infants and used PubMed to search for pharmacokinetics (PK) studies. RESULTS The most frequently prescribed medications included ampicillin, gentamicin, caffeine citrate, poractant alfa, morphine, vancomycin, furosemide, fentanyl, midazolam, and acetaminophen. Of the top 50 medications used in infants with extremely low birth weight, only 20 (40%) are FDA-labeled for use in infants; of the 30 that are not labeled for use in infants, 13 (43%) had at least 2 published PK studies. The medications with the greatest relative increase in use from 2010 to 2018 included dexmedetomidine, clonidine, rocuronium, levetiracetam, atropine, and diazoxide. The medications with the greatest relative decrease in use included tromethamine acetate, pancuronium, chloral hydrate, imipenem + cilastatin, and amikacin. CONCLUSION Trends of medication use in the NICU change substantially over time. It is imperative to identify changes in medication use in the NICU to better inform further prospective studies.
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Affiliation(s)
- Ashley Stark
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Chi D Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | | | - Daniel K Benjamin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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Tolia VN, Powers GC, Kelleher AS, Walker MW, Herrman KK, Ahmad KA, Buchh B, Egalka MC, Hinkes M, Ma M, Richards M, Rudine AC, Sato RY, Shaffer KM, Clark RH. Low Rate of Spontaneous Closure in Premature Infants Discharged with a Patent Ductus Arteriosus: A Multicenter Prospective Study. J Pediatr 2022; 240:31-36.e2. [PMID: 34293369 DOI: 10.1016/j.jpeds.2021.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the rate of spontaneous closure and the incidence of adverse events in infants discharged home with a patent ductus arteriosus. STUDY DESIGN In a prospective multicenter study, we enrolled 201 premature infants (gestational age of 23-32 weeks at birth) discharged home with a persistently patent ductus arteriosus (PDA) and followed their PDA status at 6-month intervals through 18 months of age. The primary study outcome was the rate and timing of spontaneous ductal closure. Secondary outcomes included rate of assisted closure and the incidence of serious adverse events. RESULTS Spontaneous ductal closure occurred in 95 infants (47%) at 12 months and 117 infants (58%) by 18 months. Seventeen infants (8.4%) received assisted closure with surgical ligation or device assisted occlusion. Three infants died (1.5%). Although infants with spontaneous closure had a higher mean birth weight and gestational age compared with infants with a persistent PDA or assisted closure, we did not identify other factors predictive of spontaneous closure. CONCLUSIONS Spontaneous closure of the PDA occurred in slightly less than one-half of premature infants discharged with a patent ductus by 1 year, lower than prior published reports. The high rate of assisted closure and/or adverse events in this population warrants close surveillance following discharge. TRIAL REGISTRATION ClinicalTrials.gov: NCT02750228.
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Affiliation(s)
- Veeral N Tolia
- Department of Neonatology, Baylor University Medical Center and Pediatrix Medical Group, Dallas, TX; The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL.
| | - George C Powers
- Department of Pediatrics, Baylor College of Medicine and Pediatrix Medical Group, San Antonio, TX
| | - Amy S Kelleher
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL
| | | | - Kristy K Herrman
- Seton Medical Center and Dell Children's Medical Center, Austin, TX
| | - Kaashif A Ahmad
- Department of Pediatrics, Baylor College of Medicine and Pediatrix Medical Group, San Antonio, TX
| | | | | | | | - Meiyun Ma
- Summerlin Hospital Medical Center, Summerlin, NV
| | | | | | | | - Kenneth M Shaffer
- Pediatric and Congenital Cardiology Associates, Texas Center for Pediatric and Congenital Heart Disease, University of Texas - Dell Medical School, Austin, TX
| | - Reese H Clark
- The MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL; Greenville Memorial Hospital, Greenville, SC
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46
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Lane MD, Kishnani S, Udemadu O, Danquah SE, Treadway RM, Langman A, Balevic S, Jackson WM, Laughon M, Hornik CP, Greenberg RG, Clark RH, Zimmerman KO. Comparative efficacy and safety of late surfactant preparations: a retrospective study. J Perinatol 2021; 41:2639-2644. [PMID: 34285358 PMCID: PMC8290378 DOI: 10.1038/s41372-021-01142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Characterize the use, efficacy, and safety of poractant alfa and calfactant surfactants compared to beractant in preterm infants receiving late surfactant. STUDY DESIGN We included infants <37 weeks gestational age (GA) discharged from Pediatrix Medical Group-managed neonatal intensive care units (1997-2017). Efficacy and safety outcomes of interest were analyzed. RESULTS Of 184,770 infants administered surfactant at any time, 7846 (4.23%) received late surfactant at a median (25th, 75th percentile) PNA of 8 days (3, 22); specifically, 2976 received poractant alfa (38%), 2890 beractant (37%), and 1936 calfactant (25%). We identified no significant differences in composite efficacy or safety outcomes between surfactants in the primary analysis, but 33-36 week GA infants administered poractant alfa had significantly greater odds of developing a safety event. CONCLUSIONS Compared to beractant, there is no evidence of overall superior efficacy or safety of poractant alfa.
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Affiliation(s)
- Morgan D Lane
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Sujata Kishnani
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Obianuju Udemadu
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | | | | | - Aaliyah Langman
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Stephen Balevic
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Wesley M Jackson
- Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Laughon
- Neonatal-Perinatal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Rachel G Greenberg
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Department of Pediatrics, Duke University, Durham, NC, USA
| | | | - Kanecia O Zimmerman
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.
- Department of Pediatrics, Duke University, Durham, NC, USA.
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Abstract
IMPORTANCE In preterm infants, mechanical ventilation (MV) is associated with adverse pulmonary and neurodevelopmental outcomes. Multiple randomized clinical trials over the past 2 decades have shown the effectiveness of early noninvasive ventilation (NIV) in decreasing the use of MV in preterm infants. The epidemiologic factors associated with respiratory support in US preterm infants and any temporal changes after these trials is unknown. OBJECTIVE To evaluate temporal changes in MV and noninvasive respiratory support in US preterm infants. DESIGN, SETTING, AND PARTICIPANTS In a cohort design, 2 large national data sets (Pediatrix Clinical Data Warehouse for the clinical cohort and National Inpatient Sample for the national cohort) were used to collect data on preterm infants (<35 weeks' gestation) without congenital anomalies who received active intensive care and were discharged home or died in the birth hospital from January 1, 2008, to December 31, 2018. Data analysis was conducted from December 10, 2019, to December 16, 2020. EXPOSURE Discharge year. MAIN OUTCOME AND MEASURES In the clinical cohort, detailed respiratory support data were generated, including days of MV and NIV modalities, and temporal trends were evaluated using multivariable modified Poisson or negative binomial regression models with discharge year as a continuous variable. In the national cohort, observed and expected national MV use were calculated. RESULTS Among 259 311 infants (47.2% female) in 359 neonatal intensive care units in the clinical cohort, decreases were noted in the use (from 29.4% of infants in 2008 to 18.5% in 2018, relative risk for annual change, 0.96; 95% CI, 0.95-0.96) and duration (mean days, from 10.3 in 2008 to 9.7 in 2018; rate ratio for annual change, 0.98; 95% CI, 0.97-0.98) of MV. Noninvasive ventilation use increased from 57.9% of infants in 2008 to 67.4% in 2018 (adjusted relative risk for annual change, 1.02; 95% CI, 1.02-1.03), and mean NIV duration increased by 3.2 days (95% CI, 2.9-3.6 days). With increased use of continuous positive airway pressure and nasal intermittent positive-pressure ventilation as the main factors in the increase, the mean duration of respiratory support increased from 13.8 to 15.4 days (adjusted rate ratio for annual change, 1.03; 95% CI, 1.02-1.04) from 2008 to 2018. Among 1 169 441 infants in the national cohort, MV use decreased from 22.0% in 2008 to 18.5% in 2018, with an estimated 29 700 fewer ventilated infants and 142 000 fewer days of MV than expected during this period. CONCLUSIONS AND RELEVANCE These findings suggest that preterm respiratory support changed significantly from 2008 to 2018, with decreased use and duration of MV, increased use and duration of NIV, and an overall increase in respiratory support duration.
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Affiliation(s)
- L. Dupree Hatch
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee,Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reese H. Clark
- Mednax Center for Research, Education, Quality and Safety, Sunrise, Florida
| | | | - Ann R. Stark
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - E. Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee,Center for Health Services Research, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee,Veteran’s Affairs Tennessee Valley Geriatric Research Education and Clinical Center, Nashville, Tennessee
| | - Stephen W. Patrick
- Division of Neonatology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
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48
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Srivatsa B, Clark RH, Kupke KG. Reply. J Pediatr 2021; 235:304. [PMID: 33940016 DOI: 10.1016/j.jpeds.2021.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
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Srivatsa B, Malcolm K, Clark RH, Kupke KG. Effect of a Novel Oxygen Saturation Targeting Strategy on Mortality, Retinopathy of Prematurity, and Bronchopulmonary Dysplasia in Neonates Born Extremely Preterm. J Pediatr 2021; 234:33-37.e3. [PMID: 33737029 DOI: 10.1016/j.jpeds.2021.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To study the impact of an oxygen management strategy incorporating oxygen saturation (SpO2) targeting and fraction of inspired oxygen monitoring on the incidence of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and mortality. STUDY DESIGN This retrospective cohort study analyzed the incidence of any ROP, severe ROP, ROP requiring treatment (surgery and/or bevacizumab), BPD, and mortality among 23-28 weeks of gestational age infants admitted to the neonatal intensive care unit in 3 epochs: Epoch 1 (2007-2010) before implementation of SpO2 histograms; Epoch 2 (2012-2014), with development of a software tool capable of generating automatic bedside SpO2 histograms; and Epoch 3 (2016-2019), with further software enhancements, incorporating simultaneous SpO2 and fraction of inspired oxygen measurements. RESULTS During Epochs 1, 2, and 3, there were 601, 381, and 550 eligible infants, respectively, for a total of 1532 eligible infants. Mortality, any ROP, severe ROP, ROP needing treatment, and BPD all showed significant downward trends across the 3 epochs. The aOR of mortality was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.48). The aORs of any ROP and of BPD were significantly lower in Epochs 2 and 3 compared with Epoch 1 (respectively, ROP aORs 0.53 and 0.38; BPD aOR 0.43 and 0.43). The aOR of ROP needing treatment was significantly lower in Epoch 3 compared with Epoch 1 (aOR 0.43). CONCLUSIONS We have demonstrated improvement in rates of mortality, any ROP, ROP requiring treatment, and BPD after implementation of a novel oxygen management strategy.
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Affiliation(s)
- Bharath Srivatsa
- Neonatology Associates of Atlanta, P.C., Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Atlanta, GA.
| | | | | | - Kenneth G Kupke
- Neonatology Associates of Atlanta, P.C., Atlanta, GA; Northside Hospital, Atlanta, GA; Pediatrix Medical Group, Atlanta, GA
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50
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Miller LE, DeRienzo C, Smith PB, Bose C, Clark RH, Cotten CM, Benjamin DK, Hornik CD, Greenberg RG. Association between neonatal intensive care unit medication safety practices, adverse events, and death. J Perinatol 2021; 41:1739-1744. [PMID: 33033390 DOI: 10.1038/s41372-020-00857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine the associations between neonatal intensive care unit (NICU) medication safety practices, laboratory-based adverse events (lab-AEs), and death. STUDY DESIGN We combined data from a 2016 survey of Pediatrix NICUs on use of medication safety practices with 2014-2016 infant data. We grouped NICUs based on the number of safety practices used (≤5, 6-7, and 8-10) and evaluated the association between the number of safety practices used and lab-AEs and deaths using logistic regressions. RESULTS Of the 94 NICUs included, 17% used ≤5 medication safety practices, 51% used 6-7, and 32% used 8-10. NICUs with more safety practices did not have a difference in lab-AEs or death. CONCLUSION In this cohort, the use of more medication safety practices was not associated with fewer lab-AEs or decreased death.
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Affiliation(s)
- Laura E Miller
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Chris DeRienzo
- Department of Medicine, Division of Population Health, Stanford University, Stanford, CA, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - C Michael Cotten
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Chi D Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA. .,Duke Clinical Research Institute, Durham, NC, USA.
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