National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (6)
- Antimicrobial Stewardship (1)
- Asthma (1)
- Breast Feeding (2)
- Cancer (2)
- Care Coordination (1)
- Caregiving (1)
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- Communication (2)
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- Disabilities (2)
- Disparities (3)
- Education: Patient and Caregiver (1)
- Evidence-Based Practice (3)
- Eye Disease and Health (1)
- Family Health and History (1)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (5)
- Healthcare Cost and Utilization Project (HCUP) (2)
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- Intensive Care Unit (ICU) (2)
- Labor and Delivery (5)
- Lifestyle Changes (1)
- Maternal Care (3)
- Medicaid (3)
- Medication (4)
- Medication: Safety (2)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (4)
- Mortality (5)
- Neonatal Intensive Care Unit (NICU) (10)
- Neurological Disorders (1)
- (-) Newborns/Infants (55)
- Nutrition (2)
- Obesity: Weight Management (1)
- Outcomes (3)
- Palliative Care (1)
- Patient-Centered Outcomes Research (4)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (7)
- Payment (1)
- Pregnancy (6)
- Prevention (5)
- Provider: Health Personnel (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (3)
- Respiratory Conditions (3)
- Risk (3)
- Screening (2)
- Sickle Cell Disease (1)
- Social Determinants of Health (2)
- Stress (2)
- Substance Abuse (1)
- Surgery (2)
- Teams (2)
- Transitions of Care (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Vaccination (4)
- Vulnerable Populations (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 55 Research Studies DisplayedGephart SM, Hanson C, Wetzel CM
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.
The purpose of this paper is to present a scoping review with two new meta-analyses, clinical recommendations, and implementation strategies to prevent and foster timely recognition of necrotizing enterocolitis. The researchers conducted a stakeholder-engaged scoping review to classify strength of evidence and form implementation recommendations across subgroup areas: 1) promoting human milk, 2) feeding protocols and transfusion, 3) timely recognition strategies, and 4) medication stewardship.
AHRQ-funded; HS022908.
Citation: Gephart SM, Hanson C, Wetzel CM .
NEC-zero recommendations from scoping review of evidence to prevent and foster timely recognition of necrotizing enterocolitis.
Matern Health Neonatol Perinatol 2017 Dec;3:23. doi: 10.1186/s40748-017-0062-0.
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Keywords: Adverse Events, Digestive Disease and Health, Guidelines, Newborns/Infants, Prevention
Gadepalli SK, Canvasser J, Eskenazi Y
Roles and experiences of parents in necrotizing enterocolitis: an international survey of parental perspectives of communication in the NICU.
The purpose of this study was to characterize parental perceptions of communication and support they were given about necrotizing enterocolitis (NEC). The authors suggest that areas for quality improvement include better communication and collaboration with parents through early engagement in NEC prevention using modalities beyond verbal instruction.
AHRQ-funded; HS022908.
Citation: Gadepalli SK, Canvasser J, Eskenazi Y .
Roles and experiences of parents in necrotizing enterocolitis: an international survey of parental perspectives of communication in the NICU.
Adv Neonatal Care 2017 Dec;17(6):489-98. doi: 10.1097/anc.0000000000000438..
Keywords: Communication, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Experience, Patient and Family Engagement
Parker TC, Mohammed A, Leong T
Rotavirus vaccination rate disparities seen among infants with acute gastroenteritis in Georgia.
The purpose of this study was to determine possible disparities and socio-economic differences in RV vaccination rates. The study conclude that racial disparities and socio-economic differences are not determinants in rotavirus vaccination rates; however, age and ethnicity have an effect on RV vaccine status.
AHRQ-funded; HS024338.
Citation: Parker TC, Mohammed A, Leong T .
Rotavirus vaccination rate disparities seen among infants with acute gastroenteritis in Georgia.
Ethn Health 2017 Dec;22(6):585-95. doi: 10.1080/13557858.2016.1244744..
Keywords: Disparities, Health Status, Newborns/Infants, Social Determinants of Health, Vaccination
Letourneau LR, Carmody D, Wroblewski K
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
In this study, the largest of its kind, diabetic ketoacidosis (DKA) was more frequent than in other early-onset U.S. studies or other cohorts of patients with neonatal diabetes. The authors argue that continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis.
AHRQ-funded; HS023007.
Citation: Letourneau LR, Carmody D, Wroblewski K .
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
Diabetes Care 2017 Oct;40(10):e147-e48. doi: 10.2337/dc17-1145.
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Keywords: Diabetes, Diagnostic Safety and Quality, Newborns/Infants, Children/Adolescents
Quinn JM, Sparks M, Gephart SM
Discharge criteria for the late preterm infant: a review of the literature.
The purpose of this literature review was to examine differences in late preterm infant (LPI) discharge criteria between the well newborn setting and the NICU by answering the clinical questions, "What are the recommended discharge criteria for the LPI and do they differ if admitted to the well newborn setting versus the NICU?"
AHRQ-funded; HS022908.
Citation: Quinn JM, Sparks M, Gephart SM .
Discharge criteria for the late preterm infant: a review of the literature.
Adv Neonatal Care 2017 Oct;17(5):362-71. doi: 10.1097/anc.0000000000000406..
Keywords: Hospital Discharge, Newborns/Infants, Newborns/Infants
Jonas DE, Amick HR, Wallace IF
Vision screening in children aged 6 months to 5 years: Evidence report and systematic review for the US Preventive Services Task Force.
The researchers reviewed the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force. They concluded that studies directly evaluating the effectiveness of screening were limited and do not establish whether vision screening in preschool children is better than no screening.
AHRQ-funded; 290201200015I.
Citation: Jonas DE, Amick HR, Wallace IF .
Vision screening in children aged 6 months to 5 years: Evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2017 Sep 5;318(9):845-58. doi: 10.1001/jama.2017.9900.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Eye Disease and Health, Children/Adolescents, Screening, Newborns/Infants
Lapcharoensap W, Lee HC
Tackling quality improvement in the delivery room.
Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally. This article discusses how the delivery room is a unique environment and presents examples on how to approach delivery room quality improvement (QI). Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.
AHRQ-funded; HS023506.
Citation: Lapcharoensap W, Lee HC .
Tackling quality improvement in the delivery room.
Clin Perinatol 2017 Sep;44(3):663-81. doi: 10.1016/j.clp.2017.05.003.
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Keywords: Communication, Labor and Delivery, Newborns/Infants, Quality Improvement, Patient Safety
Pierce R, Bryant K, Elward A
Bacterial infections in neonates following mupirocin-based MRSA decolonization: a multicenter cohort study.
This study characterized the risk of infection after MRSA decolonization with intranasal mupirocin. It concluded that in a multicentered cohort of MRSA-colonized neonates, mupirocin-based decolonization treatment appeared to decrease the risk of infection with select gram-positive organisms as intended, and the treatment was not significantly associated with risk of subsequent infections with organisms not covered by mupirocin's spectrum of activity.
AHRQ-funded; HS022872.
Citation: Pierce R, Bryant K, Elward A .
Bacterial infections in neonates following mupirocin-based MRSA decolonization: a multicenter cohort study.
Infect Control Hosp Epidemiol 2017 Aug;38(8):930-36. doi: 10.1017/ice.2017.108.
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Keywords: Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Newborns/Infants, Patient Safety
Jensen EA, Lorch SA
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
This study assessed the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. It found that very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.
AHRQ-funded; HS015696.
Citation: Jensen EA, Lorch SA .
Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants.
J Pediatr 2017 Jul;186:41-48.e4. doi: 10.1016/j.jpeds.2017.02.007.
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Keywords: Labor and Delivery, Mortality, Newborns/Infants, Adverse Events
Ing C, Sun LS, Friend AF
Differences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy.
The purpose of this study is to evaluate hemodynamic effects of spinal anesthesia compared to general anesthesia in a cohort of healthy infants. Its findings show that spinal anesthesia performed in healthy infants undergoing pyloromyotomy results in reduced intraoperative blood pressure changes from baseline, significantly higher blood pressure readings, and no increased bradycardia compared to general anesthesia.
AHRQ-funded; HS022941.
Citation: Ing C, Sun LS, Friend AF .
Differences in intraoperative hemodynamics between spinal and general anesthesia in infants undergoing pyloromyotomy.
Paediatr Anaesth 2017 Jul;27(7):733-41. doi: 10.1111/pan.13156.
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Keywords: Adverse Drug Events (ADE), Newborns/Infants, Medication, Patient Safety, Surgery
Rice WS, Goldfarb SS, Brisendine AE
Disparities in infant mortality by race among Hispanic and non-Hispanic infants.
This study explored possible implications of racial identification for the health of U.S. born Hispanic compared to non-Hispanic infants. It concluded that the risk of infant mortality varies among Hispanic infants by race, with poorer outcomes experienced by Hispanic black infants. Compared to non-Hispanic infants of the same race, Hispanic black infants experience a smaller health disadvantage and Hispanic white infants have better or similar infant health outcomes.
AHRQ-funded; HS013852.
Citation: Rice WS, Goldfarb SS, Brisendine AE .
Disparities in infant mortality by race among Hispanic and non-Hispanic infants.
Matern Child Health J 2017 Jul;21(7):1581-88. doi: 10.1007/s10995-017-2290-3.
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Keywords: Disparities, Newborns/Infants, Mortality, Newborns/Infants, Racial and Ethnic Minorities
Niles DE, Cines C, Insley E
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
The Neonatal Resuscitation Program (NRP) guidelines recommend positive pressure ventilation (PPV) in the first 60s of life to support perinatal transition in non-breathing newborns. The aim of this study was to describe the incidence and characteristics of newborn PPV using real-time observation in the delivery unit. The authors suggest that compliance with current NRP guidelines is difficult, and assert that it's not clear whether it is the recommendations or the training to achieve PPV recommendations that should be modified.
AHRQ-funded; HS022469.
Citation: Niles DE, Cines C, Insley E .
Incidence and characteristics of positive pressure ventilation delivered to newborns in a US tertiary academic hospital.
Resuscitation 2017 Jun;115:102-09. doi: 10.1016/j.resuscitation.2017.03.035..
Keywords: Guidelines, Newborns/Infants, Respiratory Conditions
Abrams EM, Greenhawt M, Fleischer DM
Early solid food introduction: role in food allergy prevention and implications for breastfeeding.
The authors explore the evidence suggesting that introduction of solid foods before age 6 months might reduce the risk of food allergy. In addition, they review the possible implications of earlier solid food introduction on both the benefits of exclusive breastfeeding and the total duration of breastfeeding. Finally, they argue that harmonization of early introduction guidelines with breastfeeding guidelines is needed to maximize the benefits of both exclusive breastfeeding and early complementary food introduction
AHRQ-funded; HS024599.
Citation: Abrams EM, Greenhawt M, Fleischer DM .
Early solid food introduction: role in food allergy prevention and implications for breastfeeding.
J Pediatr 2017 May;184:13-18. doi: 10.1016/j.jpeds.2017.01.053.
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Keywords: Breast Feeding, Newborns/Infants, Newborns/Infants, Nutrition, Prevention
Travers CP, Carlo WA
How to save 1 million lives in a year in low- and middle-income countries.
This review focuses on educational programs developed to reduce preventable deaths in newborn infants in low- and middle-income countries, including Essential Newborn Care and Helping Babies Breathe, a simplified version of the Neonatal Resuscitation Program. Innovative pragmatic large-scale trials have evaluated these programs in low-resource settings. The results of these studies and the implications for future programs designed to decrease childhood mortality are reviewed.
AHRQ-funded; HS013852.
Citation: Travers CP, Carlo WA .
How to save 1 million lives in a year in low- and middle-income countries.
Neonatology 2017;111(4):431-36. doi: 10.1159/000460512.
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Keywords: Newborns/Infants, Mortality, Newborns/Infants, Pregnancy, Prevention
Greenhawt M, Venter C
Having your cake and EATing it too: early timing of multiple allergen introduction does not increase the risk of developing food allergy in standard risk, breastfed infants.
This study sought to determine if there is a protective association between early allergen introduction and a reduced risk of developing food allergy in high-risk infants, but not in standard-risk children. Overall, it found no difference in the rate of food allergy development with introduction of potentially allergenic solids at 3 vs 6 months.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Venter C .
Having your cake and EATing it too: early timing of multiple allergen introduction does not increase the risk of developing food allergy in standard risk, breastfed infants.
Evid Based Med 2017 Apr;22(2):60. doi: 10.1136/ebmed-2016-110488.
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Keywords: Breast Feeding, Newborns/Infants, Newborns/Infants
Chang PW, Kuzniewicz MW, McCulloch CE
A clinical prediction rule for rebound hyperbilirubinemia following inpatient phototherapy.
The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. In this study, the investigators sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy. They concluded that the risk of rebound hyperbilirubinemia can be quantified according to an infant's gestational age, age at phototherapy initiation, and total serum bilirubin relative to the treatment threshold at phototherapy termination.
AHRQ-funded; HS020618.
Citation: Chang PW, Kuzniewicz MW, McCulloch CE .
A clinical prediction rule for rebound hyperbilirubinemia following inpatient phototherapy.
Pediatrics 2017 Mar;139(3):1-9. doi: 10.1542/peds.2016-2896..
Keywords: Decision Making, Evidence-Based Practice, Newborns/Infants, Risk
Gephart SM, Fleiner M, Kijewski A
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important. The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.
AHRQ-funded; HS022908.
Citation: Gephart SM, Fleiner M, Kijewski A .
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Newborns/Infants
Pierce R, Lessler J, Popoola VO
Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme.
The researchers measured the association between colonization pressure from decolonized and non-decolonized neonates and methicillin-resistant staphylococcus aureus (MRSA) and MRSA acquisition to inform use of this strategy for control of endemic MRSA. They concluded that untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission.
AHRQ-funded; HS022872.
Citation: Pierce R, Lessler J, Popoola VO .
Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme.
J Hosp Infect 2017 Jan;95(1):91-97. doi: 10.1016/j.jhin.2016.10.022.
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Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Neonatal Intensive Care Unit (NICU), Prevention, Newborns/Infants
Carroll KN, Gebretsadik T, Escobar GJ
Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma.
This study sought to determine whether greater adherence to immunoprophylaxis in infants at high risk for severe respiratory syncytial virus (RSV) would be associated with decreased childhood asthma in a Medicaid population. The investigation of RSV immunoprophylaxis in high-risk children primarily found nonsignificant associations on prevention of asthma in specific preterm groups .
AHRQ-funded; HS018454.
Citation: Carroll KN, Gebretsadik T, Escobar GJ .
Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma.
J Allergy Clin Immunol 2017 Jan;139(1):66-71.e3. doi: 10.1016/j.jaci.2016.01.055.
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Keywords: Asthma, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Vaccination
Burstein PD, Zalenski DM, Edwards JL
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
The researchers established a multifactorial shoulder dystocia response and management protocol to promote sustainable practice change. In the first year, there was a threefold increase in shoulder dystocia reporting, which continued in years 2 and 3. In the first year, 96 percent of clinicians completed all training elements. Overall teams reached a 99 percent adoption rate of the shoulder dystocia protocol.
AHRQ-funded; HS019608.
Citation: Burstein PD, Zalenski DM, Edwards JL .
Changing labor and delivery practice: focus on achieving practice and documentation standardization with the goal of improving neonatal outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2472-86. doi: 10.1111/1475-6773.12589.
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Keywords: Labor and Delivery, Newborns/Infants, Adverse Events, Quality Improvement, Quality of Care, Patient Safety, Patient-Centered Outcomes Research, Outcomes, Guidelines, Evidence-Based Practice, Pregnancy, Teams
Profit J, Lee HC, Sharek PJ
Comparing NICU teamwork and safety climate across two commonly used survey instruments.
The objectives of this study were to assess variation in safety and teamwork climate and in the neonatal intensive care unit (NICU) setting, and compare measurement of safety culture scales using two different instruments (Safety Attitudes Questionnaire (SAQ) and Hospital Survey on Patient Safety Culture (HSOPSC)). It concluded that large variation and opportunities for improvement in patient safety culture exist across NICUs. Important systematic differences exist between SAQ and HSOPSC.
AHRQ-funded; HS014246.
Citation: Profit J, Lee HC, Sharek PJ .
Comparing NICU teamwork and safety climate across two commonly used survey instruments.
BMJ Qual Saf 2016 Dec;25(12):954-61. doi: 10.1136/bmjqs-2014-003924.
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Keywords: Hospitals, Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Safety, Teams
Quinn M, Gephart S
Evidence for implementation strategies to provide palliative care in the neonatal intensive care unit.
The authors sought to answer the clinical question: In neonatal intensive care, what evidence can be used to guide implementation of palliative care protocols? They found that successful team approaches included standardized order sets to initiate neonatal palliative care (NPC), NPC education for staff, and references to NPC guidelines or protocols.They recommended that barriers such as lack of interdisciplinary cooperation, lack of appropriate physical space, and lack of education be addressed during program development.
AHRQ-funded; HS022908.
Citation: Quinn M, Gephart S .
Evidence for implementation strategies to provide palliative care in the neonatal intensive care unit.
Adv Neonatal Care 2016 Dec;16(6):430-38. doi: 10.1097/anc.0000000000000354.
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Keywords: Evidence-Based Practice, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Palliative Care
Sobotka SA, Msall ME
Supporting vulnerable children after life-threatening neonatal illness: opportunities for improving outcomes.
This article discusses two articles in the same issue, one involving kindergarten readiness after prematurity, and the other examining medical and surgical factors impacting children with congenital heart disease (CHD) and their later school age achievement test performance. The authors state that these two articles provide evidence for longitudinal support of infants who survive critical illness.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Msall ME .
Supporting vulnerable children after life-threatening neonatal illness: opportunities for improving outcomes.
J Pediatr 2016 Nov;178:12-14. doi: 10.1016/j.jpeds.2016.07.037.
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Keywords: Children/Adolescents, Newborns/Infants, Patient-Centered Outcomes Research, Children/Adolescents, Vulnerable Populations
Garfield CF, Simon CD, Rutsohn J
Paternal and maternal testosterone in parents of NICU infants transitioning home.
This study examined testosterone levels for parents of very low-birth-weight infants, including links between salivary testosterone and infant factors (such as breast-feeding), psychosocial stress, and changes over time. Using multilevel modeling approaches, the researchers reported significant associations between paternal testosterone by time and psychosocial adjustment and between both paternal and maternal testosterone and infant feeding mode.
AHRQ-funded; R21 HS020316.
Citation: Garfield CF, Simon CD, Rutsohn J .
Paternal and maternal testosterone in parents of NICU infants transitioning home.
J Perinat Neonatal Nurs 2016 Oct/Dec;30(4):349-58. doi: 10.1097/jpn.0000000000000218.
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Keywords: Newborns/Infants, Stress, Caregiving, Hospital Discharge
Carmody D, Pastore AN, Landmeier KA
Patients with KCNJ11-related diabetes frequently have neuropsychological impairments compared with sibling controls.
This study compared neurodevelopmental outcomes in patients with KCNJ11 mutations and their sibling controls. It found that patients with KCNJ11-related diabetes without global developmental delay had significant differences compared with sibling controls on a range of assessments including IQ, measures of academic achievement and executive function.
AHRQ-funded; HS023007.
Citation: Carmody D, Pastore AN, Landmeier KA .
Patients with KCNJ11-related diabetes frequently have neuropsychological impairments compared with sibling controls.
Diabet Med 2016 Oct;33(10):1380-6. doi: 10.1111/dme.13159.
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Keywords: Children/Adolescents, Diabetes, Disabilities, Neurological Disorders, Newborns/Infants