National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Adverse Drug Events (ADE) (2)
- Adverse Events (7)
- Antibiotics (6)
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- Behavioral Health (1)
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- Electronic Prescribing (E-Prescribing) (1)
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- (-) Newborns/Infants (52)
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- Respiratory Conditions (4)
- Risk (2)
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- Screening (2)
- Sepsis (2)
- Shared Decision Making (2)
- Simulation (3)
- Skin Conditions (2)
- Sleep Problems (1)
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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
1 to 25 of 52 Research Studies DisplayedKlawetter S, Cetin N, Ilea P
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
The purpose of this qualitative study was to examine the mental health needs of parents of infants in a neonatal intensive care unit (NICU), and the challenges and solutions to meeting those needs. Through interviews with 15 parents and staff at a level IV NICU in the United States, the study found: the relationship between staff and parents filter protect from trauma and distress; information needs and mental health needs change over time, a lack of continuity of care affects response to mental health concerns, and NICU plays a critical role in addressing the mental health of parents. The researchers concluded that mental health support should be integrated into and customized to the entire NICU trajectory, with emphasis on parents living in rural locations and non-English-speaking parents.
AHRQ-funded; HS026370.
Citation: Klawetter S, Cetin N, Ilea P .
"All these people saved her life, but she needs me too": understanding and responding to parental mental health in the NICU.
J Perinatol 2022 Nov;42(11):1496-503. doi: 10.1038/s41372-022-01426-1..
Keywords: Caregiving, Newborns/Infants, Critical Care, Intensive Care Unit (ICU), Behavioral Health
Sullivan BA, Panda A, Wallman-Stokes A
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
This study looked at a new tool called the antibiotic spectrum index (ASI) which quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). This index was tested with very low-birth-weight infants (VLBW, <1500g) in 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. The authors calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. The site with the highest DOT per patient days was found to have the lowest ASI per antibiotic days and the site with the highest mortality and infection rates were found to have the highest ASI per antibiotic days. Antibiotic utilization varied by center.
AHRQ-funded; HS026742.
Citation: Sullivan BA, Panda A, Wallman-Stokes A .
Antibiotic spectrum index: a new tool comparing antibiotic use in three NICUs.
Infect Control Hosp Epidemiol 2022 Nov;43(11):1553-57. doi: 10.1017/ice.2021.467..
Keywords: Antibiotics, Medication, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Antimicrobial Stewardship
Shah SC, Tarassishin L, Eisele C
Breastfeeding is associated with lower likelihood of Helicobacter pylori colonization in babies, based on a prospective USA maternal-infant cohort.
The authors evaluated maternal and baby factors associated with likelihood of H. pylori colonization in the babies. They found that H. pylori prevalence was 31.8% in mothers and 19.7% in their babies. Dominant breastfeeding and maternal IBD were associated with significantly lower likelihood of H. pylori colonization among babies; no other clinical factors were associated with H. pylori colonization in the babies. They concluded that dominant breastfeeding may protect against early H. pylori colonization.
AHRQ-funded; HS026395.
Citation: Shah SC, Tarassishin L, Eisele C .
Breastfeeding is associated with lower likelihood of Helicobacter pylori colonization in babies, based on a prospective USA maternal-infant cohort.
Dig Dis Sci 2022 Nov;67(11):5149-57. doi: 10.1007/s10620-021-07371-x..
Keywords: Newborns/Infants, Breast Feeding, Evidence-Based Practice
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Venkataramani M, Ogunwole SM, Caulfield LE
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
The purpose of this study was to determine whether WIC participation was associated with improved maternal, neonatal-birth, and infant-child health outcomes or differences in outcomes by subgroups and WIC enrollment duration. Findings showed moderate strength of evidence (SOE) that maternal WIC participation during pregnancy is likely associated with lower risk for preterm birth, low birthweight infants, and infant mortality; low SOE that maternal WIC participation may be associated with a lower likelihood of inadequate gestational weight gain, as well as increased well-child visits and childhood immunizations; and low SOE that child WIC participation may be associated with increased childhood immunizations. Further, findings showed low SOE for differences in some outcomes by race and ethnicity but insufficient evidence for differences by WIC enrollment duration.
AHRQ-funded; 75Q80120D00003.
Citation: Venkataramani M, Ogunwole SM, Caulfield LE .
Maternal, infant, and child health outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children: a systematic review.
pediatric pediatrics food.
Keywords: Newborns/Infants, Children/Adolescents, Women, Maternal Care, Outcomes, Nutrition
Gutman CK, Lion KC, Aronson P
Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol.
The purpose of this proposed study is to explore the role of implicit racial bias in inequitable implementation of emergency care clinical guidelines for low-risk febrile infants. The researchers will conduct a cross-sectional study of low-risk febrile infants treated in the emergency departments (ED) of 42 participating sites from the Pediatric Emergency Medicine Collaborative Research Committee. The study will evaluate the relationship between 1) race and ethnicity and 2) limited English proficiency with the primary outcome, discharge to home without lumbar puncture or antibiotics. Simultaneously, the researchers will conduct individual semi-structured interviews with 1) minority parents of febrile infants and 2) pediatric ED physicians. The data will be reviewed to assess disparities and bias in communication and medical decision-making.
AHRQ-funded; HS026006.
Citation: Gutman CK, Lion KC, Aronson P .
Disparities and implicit bias in the management of low-risk febrile infants: a mixed methods study protocol.
BMJ Open 2022 Sep 20;12(9):e063611. doi: 10.1136/bmjopen-2022-063611..
Keywords: Newborns/Infants, Disparities
Flannery DD, Passarella M, Mukhopadhyay S
Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit.
The purpose of this retrospective observational study was to determine antibiotic use for Neonatal Intensive Care Unit (NICU) Infants in the first 3 years after birth hospital discharge. Using data for 667,541 newborns discharged from 2007-2011 from Medicaid Analytic Extract, the researchers assessed the relationships between NICU admission and antibiotic prescription. The study reported that 596,999 infants received one or more antibiotics, with a media of 4 prescriptions across 3 person-years. NICU infants (N = 81 314) received more antibiotic prescriptions compared to non-NICU infants. The study concluded that compared to non-NICU infants, antibiotic utilization in early childhood was higher among infants discharged from NICUs.
AHRQ-funded; HS027468.
Citation: Flannery DD, Passarella M, Mukhopadhyay S .
Early childhood antibiotic utilization for infants discharged from the neonatal intensive care unit.
J Perinatol 2022 Jul;42(7):953-58. doi: 10.1038/s41372-022-01380-y..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Antibiotics, Medication
Besagar S, Robles PLA, Rojas C
"What's in a name?" Identification of newborn infants at birth using their given names.
This study’s objective was to determine the proportion of pregnant women who selected names for their babies before they were born or at birth and were willing to disclose them for use in hospital systems, thereby reducing infant identification errors. A survey of pregnant women admitted to postpartum or antepartum units at a large academic hospital was conducted. Of postpartum participants, 79% had names for their newborns at birth. The proportion was significantly lower in self-identified non-Hispanic, white, and married women. Of antepartum participants, 65.7% had selected a name by the time they were surveyed.
AHRQ-funded; HS026121.
Citation: Besagar S, Robles PLA, Rojas C .
"What's in a name?" Identification of newborn infants at birth using their given names.
J Perinatol 2022 Jun;42(6):752-55. doi: 10.1038/s41372-021-01270-9..
Keywords: Newborns/Infants, Patient Safety
Hunte R, Klawetter S, Paul S
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
The purpose of this qualitative study was to examine how Black women’s health, pregnancy and parenting are impacted by racism, and how the relationship between Black women’s health, pregnancy and parenting and racism-related stress are affected by a culturally-specific perinatal care program. The researchers conducted focus groups and utilized a Black Feminist approach to center the perspectives and lived experiences of Black women. Four themes surfaced in the analysis, including: 1) The widespread reach of structural racism, 2) Trust and healing facilitated through shared identities, 3) Racism directly impacts mental health, and 4) Advocacy at all levels is a vital service. The researchers concluded that structural racism has chronic and toxic effects on Black women’s physical and mental health, and Black perinatal care should include: culturally-specific approaches, advocacy, mental health support with specific attention to racism-related stress, and examination of implicit biases.
AHRQ-funded; HS026370.
Citation: Hunte R, Klawetter S, Paul S .
"Black nurses in the home is working": advocacy, naming, and processing racism to improve Black maternal and infant health.
Matern Child Health J 2022 Apr;26(4):933-40. doi: 10.1007/s10995-021-03283-4..
Keywords: Racial and Ethnic Minorities, Women, Maternal Care, Pregnancy, Newborns/Infants, Cultural Competence
Flannery DD, Puopolo KM, Hansen NI
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
This retrospective review examined antimicrobial susceptibility of infants ≥22 weeks' gestation who were cared for in Neonatal Research Network centers April 2015-March 2017. Nonsusceptibility was defined as intermediate or resistant on treatment results. The authors identified 239 pathogens (235 bacteria, 4 fungi) in 235 EOS cases among 217,480 live-born infants. Antimicrobial susceptibility data was available for 79.1% of isolates. All 81 Gram-positive isolates with ampicillin and gentamicin were susceptible in vitro. Among Gram-negative isolates with ampicillin and gentamicin susceptibility data, 76.6% isolates were nonsusceptible to ampicillin, 8.5% nonsusceptible to gentamicin, and 7.3% isolates were nonsusceptible to both. The authors estimated that overall 8% of EOS cases were caused by isolates nonsceptible to ampicillin and gentamicin and were most likely to occur among preterm, very-low birth weight infants.
AHRQ-funded; HS027468.
Citation: Flannery DD, Puopolo KM, Hansen NI .
Antimicrobial susceptibility profiles among neonatal early-onset sepsis pathogens.
Pediatr Infect Dis J 2022 Mar;41(3):263-71. doi: 10.1097/inf.0000000000003380..
Keywords: Newborns/Infants, Sepsis, Antibiotics, Medication
Ferro DF, Bonafide CP, Fregene N
Parental insights into improving home pulse oximetry monitoring in infants.
Home pulse oximeters prescribed for infants with cardiorespiratory conditions can result in many false alarms, contributing to caregiver stress, sleep disturbance, and potentially unsafe practices. The impact of oximeters, alarms, and daily living demands on caregivers remains unclear. The purpose of this study was to explore parental perspectives on home pulse oximetry monitoring during the problem analysis phase of a quality improvement (QI) initiative. The researchers conducted interviews with a purposive sample of parents whose infants were prescribed home pulse oximeters and were receiving services from a local home care company. The interview questions were based on systems engineering frameworks previously applied in healthcare. Data were coded iteratively and analyzed using both deductive (theoretical frameworks) and inductive (emerging themes) approaches. The study found that the identified themes generally aligned with the theoretical frameworks. Parents expressed dissatisfaction with the frequent false alarms generated by home pulse oximeters, which they primarily attributed to inadequate probe adhesiveness and the devices' inability to account for infant movement. The interviews underscored the burden posed by poor device tones and limited portability. Device-related issues negatively affected the entire family in terms of sleep quality, mobility, and social interactions. All parents developed workarounds, including discontinuing monitoring. The researchers concluded that parents of infants using home pulse oximetry monitoring face numerous challenges, potentially compromising safety.
AHRQ-funded; HS026620.
Citation: Ferro DF, Bonafide CP, Fregene N .
Parental insights into improving home pulse oximetry monitoring in infants.
Pediatr Qual Saf 2022 Mar-Apr; 7(2):e538. doi: 10.1097/pq9.0000000000000538..
Keywords: Newborns/Infants, Respiratory Conditions
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Aronson PL, Fleischer E, Schaeffer P
Development of a parent-reported outcome measure for febrile infants ≤60 days old.
This study’s aim was to develop a patient-reported outcome measure for febrile infants 60 days or younger evaluated in the emergency department. This 3-part study included: 1) individual, semistructured interviews with parents of febrile infants 60 days or younger to generate potential items for the measure; 2) expert review with pediatric emergency medicine physicians and member checking with parents, and 3) cognitive interviews with a new sample of parents who gave feedback and rated the measure’s ease of use on a 4-point scale. In part 1 24 parents of 21 infants were interviewed. The interviews revealed several themes: parents' experiences with medical care, communication, and decision making; parents' emotions, particularly worry, fear, and stress; the infant's outcomes valued by parents; and the impact of the infant's illness on the family, from which 22 potential items for inclusion were identified. In part 2, 10 items were revised for clarity based on feedback from physicians and parents. In part 3, the authors further revised the measure for clarity and added an item. The final measure included 23 items.
AHRQ-funded; HS026006.
Citation: Aronson PL, Fleischer E, Schaeffer P .
Development of a parent-reported outcome measure for febrile infants ≤60 days old.
Pediatr Emerg Care 2022 Feb;38(2):e821-e27. doi: 10.1097/pec.0000000000002378.
Keywords: Newborns/Infants, Patient-Centered Outcomes Research, Outcomes
Fraiman YS, Stewart JE, Litt JS
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
This study investigated whether infants born to Black mothers, non-English speaking mothers, and mothers who live in “Very Low” Child Opportunity Index (COI) neighborhoods would have decreased odds of using the Infant Follow Up Program (IFUP) for their preterm infants after discharge from a NICU. A total of 477 infants eligible for IFUP between 2015 and June 2017 from a single large academic Level III NICU were included. Primary outcome considered was at least one visit to IFUP. Two hundred infants (41.9%) participated in IFUP, with the odds of participation lower for Black compared to white race, “Very Low” COI compared to “Very High”, and primary non-English speaking.
AHRQ-funded; HS000063.
Citation: Fraiman YS, Stewart JE, Litt JS .
Race, language, and neighborhood predict high-risk preterm infant follow up program participation.
J Perinatol 2022 Feb;42(2):217-22. doi: 10.1038/s41372-021-01188-2..
Keywords: Newborns/Infants, Hospital Discharge, Transitions of Care, Racial and Ethnic Minorities
Montoya-Williams D, Fraiman YS, Peña MM
Antiracism in the field of neonatology: a foundation and concrete approaches.
The aim of this article was to provide neonatal clinicians with a foundational understanding of race, racism, and antiracism within medicine, as well as concrete ways in which neonatology health care professionals can contribute to antiracism and health equity in their professional careers. The focus on the NICU was a unique opportunity to intervene with regards to the ways racism acts as a social determinant of health.
AHRQ-funded; HS000063.
Citation: Montoya-Williams D, Fraiman YS, Peña MM .
Antiracism in the field of neonatology: a foundation and concrete approaches.
Neoreviews 2022 Jan;23(1):e1-e12. doi: 10.1542/neo.23-1-e1..
Keywords: Newborns/Infants
Ong T, Onchiri FM, Britto MT
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
This study’s purpose was to characterize nutrition management for infants with cystic fibrosis (CF) with inadequate weight gain and to assess association of dietitian assessments and center-level weight-for-age Z-scores (WAZ). Encounter data from 226 infants was used from across 28 US CF Centers from the Baby Observational Nutritional study between January 2012 through December 2017. The authors identified dietitian assessments and consensus guideline-recommended responses to inadequate weight gain: calorie increases, pancreatic enzyme replacement therapy (PERT) increases, or shortened time to next visit. They compared center assessments by funnel plot and summarized median WAZ by center. Of 2,527 visits, 808 visits had identified inadequate weight gain, distributed in 216 infants. Assessments occurred in 77% of visits but varied widely between centers (range 17% - 98%). They used funnel plot analysis to identify high-performers for frequent dietitian assessments (range 92% - 98%) and 4 under-performers (range 17% - 56%). High-performers treated inadequate weight gain more often with adequate calories (80% vs 52%) and closer follow-up (63% vs 49%) compared to underperformers. Three of 4 high-performing sites met center nutrition goals for positive median WAZ at 2 years old unlike 3 under-performers, despite similar patient characteristics.
AHRQ-funded; HS026393.
Citation: Ong T, Onchiri FM, Britto MT .
Impact of guideline-recommended dietitian assessments on weight gain in infants with cystic fibrosis.
J Cyst Fibros 2022 Jan; 21(1):115-22. doi: 10.1016/j.jcf.2021.08.005..
Keywords: Newborns/Infants, Respiratory Conditions, Chronic Conditions, Nutrition, Evidence-Based Practice, Guidelines
Nether KG, Thomas EJ, Khan A
Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm.
This article describes the results of a robust process improvement (RPI) program implemented in a hospital neonatal intensive care unit (NICU) to improve processes and reduce harm. A total of 67 participants completed pretraining and post-training surveys after initiatives for improvements in central line blood stream infection handling, very low birth weight infant nutrition, and unplanned extubations. Training scores (0-10 scale) improved from an average of 4.45-7.60 for confidence in leading process improvement work, 2.36 to 7.49 for RPI knowledge, and 2.19 to 7.30 for confidence in using RPI tools.
AHRQ-funded; HS024459.
Citation: Nether KG, Thomas EJ, Khan A .
Implementing a robust process improvement program in the neonatal intensive care unit to reduce harm.
J Healthc Qual 2022 Jan-Feb;44(1):23-30. doi: 10.1097/jhq.0000000000000310..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Quality Improvement, Quality of Care
Flannery DD, Chiotos K, Gerber JS
Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management.
This literature review reviewed the epidemiology of multidrug-resistant-gram-negative (MDR-GN) infections in neonates in the United States and internationally, with a focus on extended extended-spectrum β-lactamase (ESBL)-producing Enterobacterales and carbapenem-resistant Enterobacterales (CRE). There has been a rising prevalence of MDR-GN neonatal infections, specifically ESBL-producing Enterobacterales and CRE which compounds the challenge of optimal management of suspected and confirmed neonatal infection. The authors included published single-center studies, neonatal collaborative reports, and national surveillance data. They also discussed current recommendations for empiric antibiotic therapy for suspected infections, as well as definitive treatment options for key MDR organisms.
AHRQ-funded; HS027468; HS026393.
Citation: Flannery DD, Chiotos K, Gerber JS .
Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management.
Pediatr Res 2022 Jan;91(2):380-91. doi: 10.1038/s41390-021-01745-7..
Keywords: Newborns/Infants, Medication
Zhou NY, Nili A, Blackwell CK
Parent report of sleep health and attention regulation in a cross-sectional study of infants and preschool-aged children with atopic dermatitis.
Older children with atopic dermatitis (AD) suffer from poor sleep and attention problems. However, until recently, the dearth of developmentally sensitive assessment tools impeded characterization in younger children. In this study the investigators aimed to characterize sleep and attention problems in young children with AD and identify modifiable factors. The investigators concluded that more severe AD correlates with poor sleep health and attention dysregulation.
AHRQ-funded; HS023011.
Citation: Zhou NY, Nili A, Blackwell CK .
Parent report of sleep health and attention regulation in a cross-sectional study of infants and preschool-aged children with atopic dermatitis.
Pediatr Dermatol 2022 Jan;39(1):61-68. doi: 10.1111/pde.14889..
Keywords: Children/Adolescents, Newborns/Infants, Sleep Problems, Skin Conditions
Kuijpers L, Binkhorst M, Yamada NK
Validation of an instrument for real-time assessment of neonatal intubation skills: a randomized controlled simulation study.
This study’s aim was to evaluate the construct validity and reliability of real-time assessment of a previously developed neonatal intubation scoring instrument (NIST). This randomized controlled simulation study was performed at a simulation-based research and training facility. Twenty-four experienced clinicians and 11 medical students performed two identical elective intubations on a neonatal patient simulation. The subjects were randomly assigned to either the intervention group, who received predefined feedback between the two intubations, or the control group who received no feedback. There was a statistically significant different median change in percentage scores between the intervention and control groups between the first and second intubations. Construct validity was proven for the neonatal scoring instrument.
AHRQ-funded; HS023506.
Citation: Kuijpers L, Binkhorst M, Yamada NK .
Validation of an instrument for real-time assessment of neonatal intubation skills: a randomized controlled simulation study.
Am J Perinatol 2022 Jan;39(2):195-203. doi: 10.1055/s-0040-1715530..
Keywords: Newborns/Infants, Simulation, Education: Continuing Medical Education
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