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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 43 Research Studies DisplayedFlannery 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
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
Fris E, Sedlock E, Etchegaray J
Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS).
The authors created a theory-informed survey that quality improvement (QI) teams can use to understand stakeholder perceptions of an intervention. Through a cross-sectional survey of QI stakeholders, they found that The Stakeholder Quality Improvement Perspectives Survey was feasible for QI teams to use, and it identified stakeholder perspectives about QI interventions that leaders used to alter their QI interventions to potentially increase the likelihood of stakeholder acceptance of the intervention.
AHRQ-funded; HS024459.
Citation: Fris E, Sedlock E, Etchegaray J .
Development and testing of the Stakeholder Quality Improvement Perspectives Survey (SQuIPS).
BMJ Open Qual 2021 Dec;10(4). doi: 10.1136/bmjoq-2020-001332..
Keywords: Quality Improvement, Quality of Care, Neonatal Intensive Care Unit (NICU), Patient Safety, Newborns/Infants
Weiss AB, Newnam KW, Wyles C
Exploring internal facilitators' experience with NeoECHO to foster NEC prevention and timely recognition through the iPARIHS lens.
AHRQ-funded; HS022908.
Citation: Weiss AB, Newnam KW, Wyles C .
Exploring internal facilitators' experience with NeoECHO to foster NEC prevention and timely recognition through the iPARIHS lens.
Adv Neonatal Care 2021 Dec 1;21(6):462-72. doi: 10.1097/anc.0000000000000966..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Prevention
Gephart SM, Newnam K, Weiss A
Feasibility and acceptability of a Neonatal Project ECHO (NeoECHO) as a dissemination and implementation strategy to prevent necrotizing enterocolitis.
Investigators examined the feasibility and acceptability of the care tools bundle NeoECHO to disseminate NEC-Zero education and describe the intentions of internal facilitators and clinicians to initiate quality improvement changes. They found that NeoECHO was an acceptable and feasible way to engage under-resourced NICUs and share NEC-Zero evidence and tools. They recommended more research to examine the impact of NeoECHO on care processes and patient outcomes.
AHRQ-funded; HS022908.
Citation: Gephart SM, Newnam K, Weiss A .
Feasibility and acceptability of a Neonatal Project ECHO (NeoECHO) as a dissemination and implementation strategy to prevent necrotizing enterocolitis.
Worldviews Evid Based Nurs 2021 Dec;18(6):361-70. doi: 10.1111/wvn.12529..
Keywords: Newborns/Infants, Quality Improvement, Quality of Care, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Implementation
Parker MG, Garg A, Brochier A
Approaches to addressing social determinants of health in the NICU: a mixed methods study.
The objective of this study was to examine current approaches to addressing social determinants of health (SDOH) in the NICU and perceived appropriateness of a standardized screening and referral process. The investigators performed a mixed methods study in two Massachusetts safety-net NICUs. They concluded that current NICU assessment of SDOH was limited and use of a standardized screening and referral process could be useful.
AHRQ-funded; HS026370.
Citation: Parker MG, Garg A, Brochier A .
Approaches to addressing social determinants of health in the NICU: a mixed methods study.
J Perinatol 2021 Aug;41(8):1983-91. doi: 10.1038/s41372-020-00867-w..
Keywords: Social Determinants of Health, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Brei BK, Sawyer T, Umoren R
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
This study looked at whether the presence of family members had an impact on neonatal tracheal intubation (TI) outcomes. This retrospective analysis looked at TIs performed in NICUs participating in the National Emergency Airway Registry for Neonates (NEAR4NEOS) at 13 academic NICUS from October 2014 to December 2017. Family members were present in less than 10% of TIs, but this varied by site. Success rates were not significantly different, with the first attempt success rate at 55% with family present versus 49% and success within 2 attempts was 74% versus 66%. Adverse TI-associated events (TIAEs) were 17% versus 20% and severe oxygen desaturation was 49% versus 52%. No independent association between any of these outcomes was found with family presence.
AHRQ-funded; HS027259; HS024511.
Citation: Brei BK, Sawyer T, Umoren R .
Associations between family presence and neonatal intubation outcomes: a report from the National Emergency Airway Registry for Neonates: NEAR4NEOS.
Arch Dis Child Fetal Neonatal Ed 2021 Jul;106(4):392-97. doi: 10.1136/archdischild-2020-319709..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Registries, Patient Safety
Ma AL, Loughland MED, Lapcharoensap W
California and Oregon NICU wildfire disaster preparedness tools.
In a follow-up to their previous study, the authors asked, "what tools/strategies do medical professionals deem as important and most helpful as they are preparing for wildfire disaster response?" They conducted surveys in 11 Oregon and Southwest Washington NICUs about their wildfire evacuation preparedness and interviewed two neonatologists about their wildfire disaster evacuation and preparation experiences. Their findings suggested that there is more work needed to fully prepare NICUs for wildfire disasters, and they hope that their work helps to educate and support future NICU disaster preparedness responses.
AHRQ-funded; HS023506.
Citation: Ma AL, Loughland MED, Lapcharoensap W .
California and Oregon NICU wildfire disaster preparedness tools.
Children 2021 Jun;8(6). doi: 10.3390/children8060465..
Keywords: Emergency Preparedness, Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Schuetz CR, Hogan PG, Reich PJ
Factors associated with progression to infection in methicillin-resistant Staphylococcus aureus-colonized, critically ill neonates.
The purpose of this case-control study was to identify factors associated with development of symptomatic infection in infants colonized with methicillin-resistant Staphylococcus aureus (MRSA) in the Neonatal Intensive Care Unit (NICU). The investigators concluded that progression from MRSA colonization to symptomatic infection was associated with increased morbidity and may be mitigated through decolonization.
AHRQ-funded; HS021736; HS024269.
Citation: Schuetz CR, Hogan PG, Reich PJ .
Factors associated with progression to infection in methicillin-resistant Staphylococcus aureus-colonized, critically ill neonates.
J Perinatol 2021 Jun;41(6):1285-92. doi: 10.1038/s41372-021-00944-8..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Critical Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs)
Flannery DD, Akinboyo IC, Mukhopadhyay S
Antibiotic susceptibility of Escherichia coli among infants admitted to neonatal intensive care units across the US From 2009 to 2017.
Investigators assessed the epidemiologic characteristics and antibiotic susceptibility patterns of E coli in infants admitted to neonatal intensive care units in the US over time. Using the Premier Health Database, they found nonsusceptibility to commonly administered antibiotics in substantial proportions of neonatal E coli isolates, with no significant change from 2009 to 2017. They suggested that their findings may inform empirical antibiotic choices for newborn infants.
AHRQ-funded; HS027468.
Citation: Flannery DD, Akinboyo IC, Mukhopadhyay S .
Antibiotic susceptibility of Escherichia coli among infants admitted to neonatal intensive care units across the US From 2009 to 2017.
JAMA Pediatr 2021 Feb;175(2):168-75. doi: 10.1001/jamapediatrics.2020.4719..
Keywords: Newborns/Infants, Antibiotics, Medication, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Infectious Diseases
Umoren RA, Sawyer TL, Ades A
Team stress and adverse events during neonatal tracheal intubations: a report from NEAR4NEOS.
This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. The investigators concluded that high team stress levels during TI were more frequently reported among TIs with adverse events.
AHRQ-funded; HS024511.
Citation: Umoren RA, Sawyer TL, Ades A .
Team stress and adverse events during neonatal tracheal intubations: a report from NEAR4NEOS.
Am J Perinatol 2020 Dec;37(14):1417-24. doi: 10.1055/s-0039-1693698..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Critical Care, Teams, Stress, Adverse Events
Smith JG, Rogowski JA, Lake ET
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes. The purpose of this study was to determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses.
AHRQ-funded; HS024918.
Citation: Smith JG, Rogowski JA, Lake ET .
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
J Nurs Manag 2020 Nov;28(8):1940-47. doi: 10.1111/jonm.12943..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Provider: Nurse, Provider, Burnout, Nursing
Lake ET, Smith JG, Staiger DO
Measuring parent satisfaction with care in neonatal intensive care units: the EMPATHIC-NICU-USA questionnaire.
This study’s objective was to adapt the Netherlands-developed parent satisfaction questionnaire on neonatal and pediatric intensive care units EMPATHIC for USA use and translation into English. The researchers selected the EMPATHIC-30 questionnaire due to its’ shorter length and availability of a validated Spanish-language version. Six items from the EMPATHIC-N survey were also added, two of which were split into separate items creating a new EMPATHIC-38 survey which was adapted to USA English. The survey was then tested with NICU and PICU parents. Data from 282 parents (61% White, 61% Black, and 20% Hispanic) was used as a test. Results were positive and indicated acceptable reliability.
Citation: Lake ET, Smith JG, Staiger DO .
Measuring parent satisfaction with care in neonatal intensive care units: the EMPATHIC-NICU-USA questionnaire.
Front Pediatr 2020 Oct 6;8:541573. doi: 10.3389/fped.2020.541573.
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Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Experience, Hospitals
Rossol SL, Yang JK, Toney-Noland C
Non-contact video-based neonatal respiratory monitoring.
Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection to model background noise to be able to amplify and record respiratory motions.
AHRQ-funded; HS023506.
Citation: Rossol SL, Yang JK, Toney-Noland C .
Non-contact video-based neonatal respiratory monitoring.
Children 2020 Oct 6;7(10). doi: 10.3390/children7100171..
Keywords: Newborns/Infants, Health Information Technology (HIT), Respiratory Conditions, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Lake ET, Staiger DO, Cramer E
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. The authors conducted a correlational study of using 2016 NICU registered nurse survey responses from the National Database of Nursing Quality Indicators. They found that 36% of nurses missed one or more care activities on their past shift. The most common activities missed involved patient comfort and counseling and parent education. They recommended that nurses' assignments account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger DO, Cramer E .
Association of patient acuity and missed nursing care in U.S. neonatal intensive care units.
Med Care Res Rev 2020 Oct;77(5):451-60. doi: 10.1177/1077558718806743..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Nursing, Quality Indicators (QIs), Quality of Care
Ma AL, Cohen RS, Lee HC
Learning from wildfire disaster experience in California NICUs.
The authors’ objective was to learn how personnel working in neonatal intensive care units (NICUs) of California hospitals handled issues of neonatal transfer during wildfire disasters in recent years; their ultimate goal was to share lessons learned with healthcare teams on disaster preparedness. They found that while describing disaster preparedness, equipment (such as bassinets and backpacks), ambulance access/transport and documentation/charting were noted as important and essential. They concluded that teamwork, willingness to do other tasks that are not part of typical job descriptions, and unconventional strategies contributed to the success of keeping NICU babies safe when California wildfire strikes.
AHRQ-funded; HS023506.
Citation: Ma AL, Cohen RS, Lee HC .
Learning from wildfire disaster experience in California NICUs.
Children 2020 Oct;7(10):E155. doi: 10.3390/children7100155..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Transitions of Care, Emergency Preparedness, Teams, Healthcare Delivery
Dadiz R, Riccio J, Brown K
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
This study’s objective was to identify 1) latent safety threats (LSTs) in a new neonatal intensive care unit (NICU) through simulation-based pre-occupancy operations testing, and 2) LSTs that remained unresolved 1-year post-occupancy. This qualitative study included 111 healthcare professionals who participated in patient care simulations and debriefings in a new NICU. Debriefing transcripts were analyzed to characterize LSTs. Three-hundred threats with four major themes affecting staff function and patient safety emerged: relay of information, workplace design, patient care processes, and patient family and staff focus. One-year post occupancy 29 (9%) LSTs were still unresolved.
AHRQ-funded; R18 HS023460.
Citation: Dadiz R, Riccio J, Brown K .
Qualitative analysis of latent safety threats uncovered by in situ simulation-based operations testing before moving into a single-family-room neonatal intensive care unit.
J Perinatol 2020 Sep;40(Suppl 1):29-35. doi: 10.1038/s41372-020-0749-3..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Patient Safety, Simulation
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, Decision Making, Patient Experience, Patient and Family Engagement
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
Gephart SM, Quinn MC
Relationship of necrotizing enterocolitis rates to adoption of prevention practices in US neonatal intensive care units.
Applying quality improvement methods has reduced necrotizing enterocolitis (NEC) in some neonatal intensive care units (NICUs) by 40% to 90%. This study was conducted to (1) examine relationships between adoption of prevention practices using the NEC-Zero adherence score and NEC rates, and (2) describe implementation strategies NICUs use to prevent NEC. The investigators concluded that broader use of evidence-based implementation strategies could bolster delivery of NEC prevention practices. The indicated that maternal lactation support is paramount.
AHRQ-funded; HS022908.
Citation: Gephart SM, Quinn MC .
Relationship of necrotizing enterocolitis rates to adoption of prevention practices in US neonatal intensive care units.
Adv Neonatal Care 2019 Aug;19(4):321-32. doi: 10.1097/anc.0000000000000592..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Prevention
Akinboyo IC, Voskertchian A, Gorfu G
Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU.
In this single center retrospective cohort study, the investigators sought to examine neonatal risk factors associated with recurrent Staphylococcus aureus colonization and to determine the genetic relatedness of S. aureus strains cultured from neonates before and after decolonization.
AHRQ-funded; HS022872.
Citation: Akinboyo IC, Voskertchian A, Gorfu G .
Epidemiology and risk factors for recurrent Staphylococcus aureus colonization following active surveillance and decolonization in the NICU.
Infect Control Hosp Epidemiol 2018 Nov;39(11):1334-39. doi: 10.1017/ice.2018.223..
Keywords: Healthcare-Associated Infections (HAIs), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Risk
Pouppirt NR, Nassar R, Napolitano N
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
The purpose of this single-site retrospective cohort study was to consider the possible effect of video laryngoscopy on adverse events during neonatal tracheal intubation. The researchers conclude that video laryngoscopy was independently associated with decreased risk for adverse events.
AHRQ-funded; HS022464; HS024511.
Citation: Pouppirt NR, Nassar R, Napolitano N .
Association between video laryngoscopy and adverse tracheal intubation-associated events in the neonatal intensive care unit.
J Pediatr 2018 Oct;201:281-84.e1. doi: 10.1016/j.jpeds.2018.05.046..
Keywords: Adverse Events, Diagnostic Safety and Quality, Neonatal Intensive Care Unit (NICU), Newborns/Infants, Patient Safety
Voskertchian A, Akinboyo IC, Colantuoni E
Association of an active surveillance and decolonization program on incidence of clinical cultures growing Staphylococcus aureus in the neonatal intensive care unit.
In this article, the authors discuss the association of an active surveillance and decolonization program on incidence of clinical cultures growing Staphylococcus aureus in the neonatal intensive care unit (NICU). They suggest that incorporating methicillin-susceptible S. aureus (MSSA) screening into a NICU’s infection control protocol may be an important step to reduce S. aureus infections in the vulnerable neonatal population.
AHRQ-funded; HS022872.
Citation: Voskertchian A, Akinboyo IC, Colantuoni E .
Association of an active surveillance and decolonization program on incidence of clinical cultures growing Staphylococcus aureus in the neonatal intensive care unit.
Infect Control Hosp Epidemiol 2018 Jul;39(7):882-84. doi: 10.1017/ice.2018.81..
Keywords: Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Infectious Diseases, Neonatal Intensive Care Unit (NICU), Newborns/Infants
Dudding KM, Gephart SM, Carrington JM
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record.
AHRQ-funded; HS022908.
Citation: Dudding KM, Gephart SM, Carrington JM .
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
Comput Inform Nurs 2018 Apr;36(4):167-76. doi: 10.1097/cin.0000000000000406.
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Keywords: Electronic Health Records (EHRs), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Nursing, Patient Safety
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
