Liza M. Creel

Multicenter neonatal databases: Trends in research uses

BackgroundIn the US, approximately 12.7% of all live births are preterm, 8.2% of live births were low birth weight (LBW), and 1.5% are very low birth weight (VLBW). Although technological advances have improved mortality rates among preterm and LBW infants, improving overall rates of prematurity and LBW remains a national priority. Monitoring short- and long-term outcomes is critical for advancing medical treatment and minimizing morbidities associated with prematurity or LBW; however, studying these infants can be challenging. Several large, multi-center neonatal databases have been developed to improve research and quality improvement of treatments for and outcomes of premature and LBW infants. The purpose of this systematic review was to describe three multi-center neonatal databases.MethodsWe conducted a literature search using PubMed and Google Scholar over the period 1990 to August 2014. Studies were included in our review if one of the databases was used as a primary source of data or comparison. Included studies were categorized by year of publication; study design employed, and research focus.ResultsA total of 343 studies published between 1991 and 2014 were included. Studies of premature and LBW infants using these databases have increased over time, and provide evidence for both neonatology and community-based pediatric practice.ConclusionsResearch into treatment and outcomes of premature and LBW infants is expanding, partially due to the availability of large, multicenter databases. The consistency of clinical conditions and neonatal outcomes studied since 1990 demonstrates that there are dedicated research agendas and resources that allow for long-term, and potentially replicable, studies within this population.

A Multicenter Initiative for Critical Congenital Heart Disease Newborn Screening in Texas Neonatal Intensive Care Units

Objective The objective of this study was to implement a strategy for critical congenital heart disease (CCHD) newborn screening in the neonatal intensive care unit (NICU). Design A NICU‐specific curriculum, screening algorithm, slide presentations, and templates of orders, policies, and procedures were developed into a toolkit for training NICU personnel. Screening was conducted on first and second screen pre‐ and postductal oxygen saturations (SpO2) on newborns admitted or transferred to the NICU. Results We trained 347 NICU personnel in 13 Texas hospitals, representing rural, suburban, and metropolitan settings. Key hospital staff submitted deidentified, case‐based screening data. Of 4,621 NICU admissions, 80% received a first screen. Second screening rates were substantially lower in all gestational age groups. Screening rates on first and second screens were lowest among infants born < 28 weeks. For the first screen, SpO2 was lowest among the youngest gestational ages. The false positive rate was 2.3%. Conclusion CCHD screening in the NICU is challenging, given the complexities of the NICU population. A modified screening protocol that recognizes special circumstances of neonatal intensive care could facilitate a more efficient system.

Who and Where are Kentucky's Remaining Uninsured?

Background: While most research has focused on insurance uptake and describing the makeup of the newly insured, less is known about the characteristics among the remaining uninsured in expansion states. Objectives: Using Kentucky as a case study, we evaluate individual and contextual characteristics to learn more about groups who—despite expanded access to coverage options through US health care reform—reported being uninsured at the end of 2014. Research Design: Cross-sectional data from Kentucky’s Behavioral Risk Factor Surveillance System was linked to county data from the Area Health Resource File, and we used logistic regression models to assess relationships between both person-level and county-level characteristics with uninsured status. Subjects: The study sample included nonelderly adults aged 18–64 residing in Kentucky during the time of the survey. Results: Before the implementation of the Medicaid expansion and rollout of the state-based health insurance marketplace, adults who were younger (aged 18–47), unmarried, had lower levels of educational attainment, and considered to be low income were more likely to be uninsured. However, many but not all of these differences faded away by the end of 2014 when only unemployment, low-income status, and Hispanic ethnicity were positively correlated with being uninsured. Conclusions: At the end of 2014, Kentucky’s adult uninsured rate was below 5% and few statistically meaningful coverage gaps remain, suggesting Kentucky’s experience under health reform may contribute to long-run closures in disparities in health care access and outcomes.

Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial

To assess the efficacy of a patient navigator intervention to decrease nonadherence to obtain audiological testing following failed screening, compared to those receiving the standard of care.