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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 260 Research Studies DisplayedFeldman AG, Sokol RJ
Recent developments in diagnostics and treatment of neonatal cholestasis.
This review discusses recent advances in diagnosis and treatment of neonatal cholestatis, which is a sign common to over 100 hepatobiliary and/or metabolic disorders. Advances in genetic testing and bioinformatics have led to an expanding group of molecularly defined disorders involving bile formation, canalicular transporters, tight junction proteins and inborn errors of metabolism. This has enabled rapid and affordable molecular diagnosis for disorders that cannot be directly diagnosed from standard blood tests or liver biopsy.
AHRQ-funded; HS026510.
Citation: Feldman AG, Sokol RJ .
Recent developments in diagnostics and treatment of neonatal cholestasis.
Semin Pediatr Surg 2020 Aug;29(4):150945. doi: 10.1016/j.sempedsurg.2020.150945..
Keywords: Diagnostic Safety and Quality, Newborns/Infants
Abrams EM, Brough HA, Keet C
Pros and cons of pre-emptive screening programmes before peanut introduction in infancy.
In this review, researchers evaluated the advantages and disadvantages of a pre-emptive screening approach before the early introduction of peanuts in infants at high risk of peanut allergy. The Learning Early About Peanut study and the National Institute of Allergy and Infectious Diseases (NIAID) expert panel recommendations are compared.
AHRQ-funded; HS024599.
Citation: Abrams EM, Brough HA, Keet C .
Pros and cons of pre-emptive screening programmes before peanut introduction in infancy.
Lancet Child Adolesc Health 2020 Jul;4(7):526-35. doi: 10.1016/s2352-4642(20)30029-8..
Keywords: Newborns/Infants, Screening, Guidelines, Evidence-Based Practice
Abreo A, Wu P, Donovan BM
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
This study looked at infant respiratory syncytial virus (RSV) bronchiolitis and its association with increased odds of pneumonia, otitis media, and antibiotic utilization in infants 7-12 months. The data suggested the potential value of future RSV vaccination programs on subsequent respiratory health.
AHRQ-funded; HS026395.
Citation: Abreo A, Wu P, Donovan BM .
Infant respiratory syncytial virus bronchiolitis and subsequent risk of pneumonia, otitis media, and antibiotic utilization.
Clin Infect Dis 2020 Jun 24;71(1):211-14. doi: 10.1093/cid/ciz1033..
Keywords: Newborns/Infants, Antibiotics, Medication, Respiratory Conditions, Pneumonia
Rosenbloom J, Lewkowitz A, Sondgeroth K
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
The purpose of this study was to evaluate whether administration of antenatal late-preterm betamethasone was cost-effective in the immediate neonatal period. Cost-effectiveness analysis of late-preterm betamethasone administration with a time horizon of 7.5 days was conducted using a health-system perspective The investigators concluded that administration of betamethasone in the late-preterm period was likely not cost-effective in the short-term.
AHRQ-funded; HS022330.
Citation: Rosenbloom J, Lewkowitz A, Sondgeroth K .
Antenatal corticosteroid administration in late-preterm gestations: a cost-effectiveness analysis.
J Matern Fetal Neonatal Med 2020 Jun;33(12):2109-15. doi: 10.1080/14767058.2018.1540582..
Keywords: Healthcare Cost and Utilization Project (HCUP), Newborns/Infants, Pregnancy, Respiratory Conditions, Medication, Healthcare Costs, Healthcare Utilization
Brower LH, Wilson PM, Murtagh-Kurowski E
Evaluation for neonatal HSV in infants undergoing workup for serious bacterial infection: a 5-year retrospective review.
The purpose of this study was to describe the characteristics of infants evaluated for serious bacterial infection, focusing on empirical testing and treatment of herpes simplex virus (HSV) and describe the characteristics of HSV-positive patients. The investigators concluded that the absence of fever should not preclude a workup for HSV in neonates, and when a workup is initiated, emphasis should be placed on obtaining samples from serum, cerebrospinal fluid, and surface specimens.
AHRQ-funded; HS026763.
Citation: Brower LH, Wilson PM, Murtagh-Kurowski E .
Evaluation for neonatal HSV in infants undergoing workup for serious bacterial infection: a 5-year retrospective review.
Hosp Pediatr 2020 Jun;10(6):463-70. doi: 10.1542/hpeds.2020-0033..
Keywords: Newborns/Infants, Infectious Diseases, Diagnostic Safety and Quality
Pruitt LCC, Skarda DE, Barnhart DC
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. In this retrospective cohort study, the authors elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.
AHRQ-funded; HS025776.
Citation: Pruitt LCC, Skarda DE, Barnhart DC .
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
J Pediatr Surg 2020 Jun;55(6):1048-52. doi: 10.1016/j.jpedsurg.2020.02.044..
Keywords: Newborns/Infants, Surgery, Hospitals, Provider: Physician, Provider
Coon ER, Stoddard G, Brady PW
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
This study examined whether the adoption of ward-based high-flow nasal cannula (HFNC) protocol in pediatric intensive care units (ICUs) reduced ICU utilization. This retrospective cohort study included infants aged 3 to 24 months hospitalized with bronchiolitis at hospitals in the Pediatric Health Information System database. There was a 93% response rate with the 44 hospitals contacted for the survey, of which 18 were categorized as non-adopting hospitals and 12 were categorized as adopting hospitals. Ward-based HFNC protocol data were included from the 2010-2011 and 2015-2016 respiratory seasons. Early protocols were paradoxically associated with increased ICU utilization.
AHRQ-funded; HS023827.
Citation: Coon ER, Stoddard G, Brady PW .
Intensive care unit utilization after adoption of a ward-based high-flow nasal cannula protocol.
J Hosp Med 2020 Jun;15(6):325-30. doi: 10.12788/jhm.3417..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Healthcare Utilization, Newborns/Infants, Inpatient Care
Taylor WM, Lu Y, Wang S
Long-term healthcare utilization by Medicaid enrolled children with neonatal abstinence syndrome.
The purpose of this study was to evaluate healthcare utilization in Medicaid enrolled children with neonatal abstinence syndrome (NAS) in the first 2 years of life. The investigators concluded that a diagnosis of NAS did not appear to be an independent predictor of increased healthcare utilization in the first 2 years of life. They indicated that their results differed from some other published studies.
AHRQ-funded; HS022941.
Citation: Taylor WM, Lu Y, Wang S .
Long-term healthcare utilization by Medicaid enrolled children with neonatal abstinence syndrome.
J Pediatr 2020 Jun;221:55-63.e6. doi: 10.1016/j.jpeds.2020.02.077..
Keywords: Children/Adolescents, Healthcare Utilization, Medicaid, Newborns/Infants, Substance Abuse
Murosko D, Passerella M, Lorch S
Racial segregation and intraventricular hemorrhage in preterm infants.
Intraventricular hemorrhage (IVH) disproportionately affects black neonates. Other conditions that are more common in black neonates, including low birth weight and preterm delivery, have been linked with residential racial segregation (RRS). In this study, the authors investigated the association between RRS and IVH. The investigators concluded that RRS was associated with an increased risk of IVH in preterm neonates, but the effect size varied by race. They indicated that this association persisted after balancing for community factors and birth weight, representing a novel risk factor for IVH.
AHRQ-funded; HS018661.
Citation: Murosko D, Passerella M, Lorch S .
Racial segregation and intraventricular hemorrhage in preterm infants.
Pediatrics 2020 Jun;145(6):e20191508. doi: 10.1542/peds.2019-1508..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, Adverse Events
Hansen JE, Brown DW, Hanke SP
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
This study examined trends in the routine use of angiotension-converting enzyme inhibitors (ACEI) during palliation of hypoplastic left heart syndrome, which is considered controversial. The authors used patients enrolled in the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry from 2008 to 2016 who had been prescribed ACEI between stage 1 palliation (stage I Norwood procedure) discharge and stage 2 palliation (stage II superior cavopulmonary anastomosis procedure) admission. ACEI prescriptions declined from 45% in the pre-2010 period to 36.8% from 2011 to 2016. No difference was found in interstage mortality, change in atrioventricular valve regurgitation, or change in ventricular dysfunction between groups. Atrioventricular septal defect, and preoperative mechanical ventilation were associated with increased ACEI prescription.
AHRQ-funded; HS021114.
Citation: Hansen JE, Brown DW, Hanke SP .
Angiotensin-converting enzyme inhibitor prescription for patients with single ventricle physiology enrolled in the NPC-QIC registry.
J Am Heart Assoc 2020 May 18;9(10):e014823. doi: 10.1161/jaha.119.014823..
Keywords: Newborns/Infants, Medication, Heart Disease and Health, Cardiovascular Conditions, Practice Patterns, Registries, Quality Improvement, Quality of Care
Herrick HM, Lorch S, Hsu JY
Impact of flow disruptions in the delivery room.
The goal of this study was to identify the impact of flow disruptions during neonatal resuscitation and to determine their association with key process and outcome measures. Delivery-room resuscitations of neonates less 32 weeks gestational age were video recorded for observation. Results showed that flow disruptions occurred frequently during neonatal resuscitation and recommendations included measuring flow disruptions as a feasible method to assess the impact of human factors in the delivery room and to identify modifiable factors and practices to improve patient care.
AHRQ-funded; HS023538; HS026491; HS026625; HS023806.
Citation: Herrick HM, Lorch S, Hsu JY .
Impact of flow disruptions in the delivery room.
Resuscitation 2020 May;150:29-35. doi: 10.1016/j.resuscitation.2020.02.037.
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Keywords: Workflow, Labor and Delivery, Newborns/Infants, Patient Safety, Healthcare Delivery, Quality Improvement, Quality of Care
Henry MK, Feudtner C, Fortin K
Occult head injuries in infants evaluated for physical abuse.
Abusive head injuries in infants may be occult but clinically or forensically important. Data conflict regarding yield of neuroimaging in detecting occult head injuries in infants evaluated for physical abuse, with prior studies identifying yields of 4.3-37.3 %. The objectives of this study were (1) To quantify yield of computed tomography or magnetic resonance imaging in identification of occult head injuries in infants with concerns for physical abuse and (2) To evaluate risk factors for occult head injuries.
AHRQ-funded; HS024194.
Citation: Henry MK, Feudtner C, Fortin K .
Occult head injuries in infants evaluated for physical abuse.
Child Abuse Negl 2020 May;103:104431. doi: 10.1016/j.chiabu.2020.104431..
Keywords: Newborns/Infants, Brain Injury, Domestic Violence, Imaging, Diagnostic Safety and Quality, Injuries and Wounds
Sherman JP, Hedli LC, Kristensen-Cabrera AI
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
There is limited research exploring the relationship between design and patient safety outcomes, especially in maternal and neonatal care. In this study, the investigators employed design thinking methodology to understand how the design of labor and delivery units impacted safety and identified spaces and systems where improvements are needed.
AHRQ-funded; HS023506.
Citation: Sherman JP, Hedli LC, Kristensen-Cabrera AI .
Understanding the heterogeneity of labor and delivery units: using design thinking methodology to assess environmental factors that contribute to safety in childbirth.
Am J Perinatol 2020 May;37(6):638-46. doi: 10.1055/s-0039-1685494..
Keywords: Labor and Delivery, Pregnancy, Patient Safety, Maternal Care, Women, Newborns/Infants
Donovan BM, Abreo A, Ding T
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
This study examined the association between dose, timing and type of infant antibiotic use and the risk of childhood asthma. The study examined a cohort of 152,622 children enrolled in the Tennessee Medicaid Program. At least 79% had at least one antibiotic prescription fill during infancy. There was a 20% increase in odds of childhood asthma for each additional antibiotic filled. There was no significant association between timing, formulation, anaerobic coverage and class of antibiotics and childhood asthma. However, broad spectrum antibiotic fills increased the odds of development of childhood asthma compared to narrow spectrum only fills.
AHRQ-funded; HS018454.
Citation: Donovan BM, Abreo A, Ding T .
Dose, timing, and type of infant antibiotic use and the risk of childhood asthma.
Clin Infect Dis 2020 Apr 10;70(8):1658-65. doi: 10.1093/cid/ciz448..
Keywords: Newborns/Infants, Children/Adolescents, Antibiotics, Medication, Asthma, Respiratory Conditions, Risk, Chronic Conditions
Beam K, Wojcik MH, Agrawal PB
Prenatal diagnosis of a ventral abdominal wall defect.
This paper is a case study describing an infant diagnosed prenatally with fetal ultrasonography with multiple abnormalities including a ventral abdominal wall defect and confirmed herniation of the liver with the portal vein extending outside the abdomen, stomach, small bowel, and majority of the large bowel without an overlying membrane. The kidneys were enlarged as well. Multiple surgeries were performed. Ultimately the infant died 38 days after birth.
AHRQ-funded; HS000063.
Citation: Beam K, Wojcik MH, Agrawal PB .
Prenatal diagnosis of a ventral abdominal wall defect.
Neoreviews 2020 Apr;21(4):e286-e92. doi: 10.1542/neo.21-4-e286..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Case Study
Pfeifer E, Lozovatsky M, Abraham J
Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study.
Newborns are often assigned temporary names at birth. Temporary newborn names-often a combination of the mother's last name and the newborn's gender-are vulnerable to patient misidentification due to similarities with other newborns or between a mother and her newborn. In this study, the investigators developed and implemented an alternative distinct naming strategy, and then compared its effectiveness on reducing the number of wrong-patient orders with the standard distinct naming strategy.
AHRQ-funded; HS025443.
Citation: Pfeifer E, Lozovatsky M, Abraham J .
Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study.
Appl Clin Inform 2020 Mar;11(2):235-41. doi: 10.1055/s-0040-1705175..
Keywords: Newborns/Infants, Medical Errors, Adverse Events, Patient Safety
Neu M, Klawetter S, Greenfield JC
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.
AHRQ-funded; HS026370.
Citation: Neu M, Klawetter S, Greenfield JC .
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Adv Neonatal Care 2020 Feb;20(1):68-79. doi: 10.1097/anc.0000000000000671.
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Keywords: Newborns/Infants, Patient-Centered Healthcare, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Caregiving, Shared Decision Making, Patient Experience, Patient and Family Engagement
Haidari ES, Lee HC, Illuzzi JL
Utility of birth certificate data for evaluating hospital variation in admissions to NICUs.
Efforts to study potential overuse of NICU admissions and hospital variation in practice are often hindered by a lack of an appropriate data source. In this study, the investigators examined the concordance of hospital-level NICU admission rates between birth certificate data and California Children's Services (CCS) data to inform the utility of birth certificate data in studying hospital variation in NICU admissions.
AHRQ-funded; HS023801.
Citation: Haidari ES, Lee HC, Illuzzi JL .
Utility of birth certificate data for evaluating hospital variation in admissions to NICUs.
Hosp Pediatr 2020 Feb;10(2):190-94. doi: 10.1542/hpeds.2019-0116..
Keywords: Newborns/Infants, Hospitalization, Hospitals
Milstone AM, Voskertchian A, Koontz DW
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
This study examined the effect of treating parents of neonates in the intensive care unit (NICUs) with intranasal mupirocin and topical chlorhexidine compared with a placebo treatment and whether it reduces transmission of Staphlyococcus aureus to their babies. A double-blind randomized trial was conducted at 2 tertiary NICUs in Baltimore, MD from November 2014 to December 2018. Parents were given intranasal treatments for 5 days. Of the intervention group 13 of 89 neonates acquired S aureus, and in the control group 29 of 101 neonates acquired S aureus with the same strain as their parents. The results showed a significant reduction in transmission.
AHRQ-funded; HS022872.
Citation: Milstone AM, Voskertchian A, Koontz DW .
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
JAMA 2020 Jan;323(4):295-386. doi: 10.1001/jama.2019.20785..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Shaker M .
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Stoops C, Stone S, Evans E
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
The purpose of this study was to test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. The authors concluded that a systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
AHRQ-funded; HS023763.
Citation: Stoops C, Stone S, Evans E .
Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit.
J Pediatr 2019 Dec;215:223-28.e6. doi: 10.1016/j.jpeds.2019.08.046..
Keywords: Newborns/Infants, Medication, Medication: Safety, Patient Safety, Kidney Disease and Health, Intensive Care Unit (ICU), Critical Care, Quality Improvement, Quality of Care, Prevention, Adverse Drug Events (ADE), Adverse Events
Fleischer E, Neuman MI, Wang ME
Cerebrospinal fluid profiles of infants </=60 days of age with bacterial meningitis.
This study’s aim was to describe the cerebrospinal fluid (CSF) profiles in infants 60 days old or younger with bacterial meningitis and characteristics of infants with bacterial meningitis who do not have CSF abnormalities. Infants with culture-positive bacterial meningitis were evaluated in emergency departments of 11 children’s hospitals between 2011 and 2016. Clinical and laboratory data were abstracted from their medical records. Sensitivity of a CFS Gram-stain and corrected CSF pleocytosis was calculated for bacterial meningitis. Most infants 60 days or younger with bacterial meningitis have CSF pleocytosis or a positive Gram-stain result. Bacterial meningitis was unlikely in infants with no CSF pleocytosis and a negative Gram-stain result.
AHRQ-funded; HS026006.
Citation: Fleischer E, Neuman MI, Wang ME .
Cerebrospinal fluid profiles of infants </=60 days of age with bacterial meningitis.
Hosp Pediatr 2019 Dec;9(12):979-82. doi: 10.1542/hpeds.2019-0202..
Keywords: Newborns/Infants, Children/Adolescents, Infectious Diseases
Shafer G, Singh H, Suresh G
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
In this narrative review, the authors discuss how the concept of diagnostic errors framed as missed opportunities can be applied to the non-linear nature of diagnosis in a critical care environment such as the NICU. They then explore how the etiology of an error in diagnosis can be related to both individual cognitive factors as well as organizational and systemic factors - all of which often contribute to the error.
AHRQ-funded; HS022087.
Citation: Shafer G, Singh H, Suresh G .
Diagnostic errors in the neonatal intensive care unit: state of the science and new directions.
Semin Perinatol 2019 Dec;43(8):151175. doi: 10.1053/j.semperi.2019.08.004..
Keywords: Newborns/Infants, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Medical Errors, Adverse Events, Patient Safety
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
AHRQ-funded; HS022981.
Citation: Williams CN, Eriksson CO, Kirby A .
Hospital mortality and functional outcomes in pediatric neurocritical care.
Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Cruz AT, Nigrovic LE, Xie J
Predictors of invasive herpes simplex virus infection in young infants.
This study’s objective was to identify independent predictors of invasive herpes simplex virus (HSV) infection in infants aged 60 days or less. This 23-center nested case-control study matched 149 infants with HSV to 1340 controls. All were 60 days or less old and had cerebrospinal fluid obtained within 24 hours of presentation or had HSV detected. Of the 149 infants with HSV, 90 had invasive and 59 had skin, eyes, and mouth disease. Predictors independently associated with invasive HSV included younger age (<28 days), prematurity, seizure at home, ill appearance, abnormal triage temperature, vesicular rash, thrombocytopenia, and cerebrospinal fluid pleocytosis. Infants with invasive HSV had a higher median risk score than those without invasive HSV.
AHRQ-funded; HS026006; HS025138.
Citation: Cruz AT, Nigrovic LE, Xie J .
Predictors of invasive herpes simplex virus infection in young infants.
Pediatrics 2021 Sep;148(3). doi: 10.1542/peds.2021-050052..
Keywords: Newborns/Infants, Infectious Diseases, Risk