Henry Chong Lee

To predict mortality of 22-25 weeks' gestation neonates in a population-based cohort using characteristics available at birth. This observational study included 8981 actively treated 22-25 weeks' gestation infants born between 2008 and 2018 at CPQCC hospitals. Proposed models were used to relate maternal, infant, and birth hospital factors to the primary outcome of death before hospital discharge. These models were compared based on predictive discrimination and calibration. Death before hospital discharge occurred in 2824 (32%) infants. In addition to the five factors in the NICHD model, we found two additional variables, receipt of prenatal care and maternal age, were associated with death. The c-statistics ranged from 0.72 to 0.75 across all models. When compared to the NICHD 5-factor model, our models showed similar discrimination. We found additional factors to the NICHD 5-factor model associated with death before hospital discharge, although these factors did not improve prediction performance.

Objective: Staffing needs for an antimicrobial stewardship program (ASP) in the neonatal intensive care unit setting are undefined. Study design: In an ASP collaborative of 29 California NICUs, we surveyed sites to determine full-time equivalents (FTE) for ASP implementation effort by clinical role, clinical acuity, patient volume, and other NICU characteristics. Results: 146 staff members performed ASP implementation, including neonatologists, nurses, hospitalists, nurse practitioners, pharmacists, information technology personnel, and infectious disease specialists. The 8-month preparation and 12-month intervention phases required a median (IQR) of 0.015 (0.011–0.025) and 0.071 (0.056–0.091) FTEs (0.6 and 2.8 hours per week), respectively. Neonatologists and nurses performed 43% and 19% of the workload, respectively; effort for site-level stewardship activities and collaborative learning dissemination varied 3.3-fold over the collaborative. Higher clinical acuity and patient volume were associated with higher neonatologist effort. Conclusion: Driven by neonatologists and nurses, NICU ASP requires demonstrable effort, and staff needs vary considerably.

To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous neonates. We conducted a multicenter retrospective cohort study across three centers comparing two eras. Neonates born through MSAF at ≥36 weeks' gestation were included. Multivariable regression adjusted for sex and birth center. Among 8635 neonates (5554 Era 1; 3081 Era 2), including 1053 non-vigorous neonates, unadjusted MAS incidence did not differ between eras overall (4.8% vs. 5.5%, p = 0.17) or among non-vigorous neonates (21.0% vs. 22.8%, p = 0.55). After adjustment, Era 2 was associated with higher odds of MAS overall (aOR 1.37, 95% CI 1.11-1.69) and among non-vigorous neonates (aOR 1.54, 95% CI 1.07-2.22). Respiratory distress was higher in Era 2, while other outcomes assessed were unchanged. Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.

Objectives: To evaluate trends in neonatal intensive care unit (NICU) admissions, illness acuity, and hospitalization costs among U.S. children’s hospitals from 2017 to 2022. Methods: This retrospective cohort study used data from the Pediatric Health Information System (PHIS) and included all NICU admissions. We examined trends in patient characteristics (e.g., gestational age, complex chronic conditions), illness severity scores, and standardized hospital costs. Interrupted time series analyses assessed changes in NICU costs over time. Results: There were 234,571 infants admitted to NICUs in US children’s hospitals between 2017 and 2022. NICU admissions shifted significantly by gestational age with admissions increasing by 10–18% among extremely, very, and late preterm infants. Term infants remained the largest admission group, averaging 45% annually ( p < 0.001). Infants with ≥1 complex chronic condition increased from 46.6% in 2017 to 50.9% in 2022 ( p < 0.001). NICU-specific illness severity increased modestly over time (1.14–1.24, p  < 0.001). Median standardized NICU hospital costs rose by approximately 20% over the study period, with notable inflections in early 2020 and 2021. Conclusions: Among US children’s hospitals in the PHIS database, NICU admissions were increasingly complex and costly. These findings highlight the importance of ongoing monitoring of resource use and patient mix in specialized NICU settings.

Neonatal prematurity leads to considerable morbidity and mortality, partly because of acquired conditions such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). Standard gestational age and birthweight-based classifications of prematurity inadequately capture the variation in newborns’ health outcomes, creating an urgent need to develop risk stratification tools for vulnerable newborn infants to initiate the most appropriate care pathways as early as possible. We hypothesized that the metabolic profiles of newborn infants capture additional risk information beyond current measures. A total of 13,536 newborn screening (NBS) blood spot tests from preterm infants in California with linked clinical outcomes of prematurity were used to develop an NBS-based metabolic health index to stratify preterm infants at risk for BPD, IVH, NEC, and ROP (12,096 cases with one or more conditions and 1440 controls) through a deep learning model that provides a single index score in tandem with subgroup discovery to identify individuals with the strongest metabolite biomarker signals for adverse outcomes of prematurity. This metabolic health index captured risk signals that were distinct from gestational age and birthweight and outperformed other machine learning algorithms and clinical risk variable-based models in stratifying at-risk individuals for adverse outcomes of prematurity. The metabolic health index was externally validated in an independent retrospective cohort of 3299 very premature newborns from Ontario, Canada (2117 cases and 1182 controls), which recapitulated common metabolic risk subgroups. In summary, combining widespread metabolite screening with deep learning established a generalizable biological risk metric of prematurity.

Objective: To investigate single versus combination hemodynamic parameters on intraventricular hemorrhage (IVH) or mortality in preterm infants. Study design: Data from 482 infants under 32 weeks gestational age were analyzed, including cerebral oximetry, mean arterial pressure (MAP), cardiac output, and systemic blood flow within the first 24 h. Wilcoxon Rank-Sum and chi-squared tests compared variables. Multivariable logistic regression and receiver operator curve (ROC) analyses assessed predictive value. Results: Each additional gestational week was associated with lower odds of IVH (OR = 0.66; 95% CI: 0.57–0.75) and mortality (OR = 0.56; 95% CI: 0.45–0.69). Adjusted for covariates, right ventricular output (RVO) was associated with reduced IVH odds (AOR = 0.996; 95% CI: 0.991–0.999), and higher MAP with reduced mortality (AOR = 0.81; 95% CI: 0.68–0.94). Average NIRS < 74% in 24 h increased mortality risk (OR = 4.16; 95% CI: 1.46–11.0; P = 0.005). Conclusion: Select hemodynamic measures are associated with IVH and death. Combining factors did not enhance early risk prediction.