John A. F. Zupancic

Objective To determine how the likelihood of acute transfer for very low birth weight (VLBW) infants differs by race and ethnicity. Study design This retrospective cohort study used data for VLBW, preterm ( < 37 weeks) infants p = 0.01) after risk adjustment. Hospital-level factors (e.g. NICU level) were most significantly associated with transfer likelihood. Conclusion The likelihood of acute transfer for VLBW infants differs by race and ethnicity, which may reflect underlying inequities and implicit biases in the system of care.

Objective To characterize and compare direct medical costs, cost drivers, and diagnoses among term newborns admitted to neonatal and non-neonatal ICUs at U.S. children’s hospitals. Study Design Retrospective cohort study of term newborns (≥ 37 weeks’ gestation) admitted to ICUs within 7 days of birth between 1/1/2022 and 12/31/2024, using the Pediatric Health Information System. Results Among 45,738 term infants at 42 hospitals, non-neonatal ICU admissions represented 8% of encounters but 25% of costs ($912 million). Median cost was $20,367 [IQR: $8,336 - $59,887], with room and board as the primary driver in both settings. Higher costs were independently associated with medical complexity (≥ 4 chronic conditions; RR 6.05, 95% CI 5.15–7.09) and illness severity (RR 1.07 per unit increase, 95% CI 1.07–1.07). Conclusions Term newborns requiring intensive care incurred high costs, driven by medical complexity and acuity, providing national benchmark data to inform future efforts to optimize care delivery.

Enrollment in neonatal research is challenging due to time-limited decisions and consent complexity, contributing to biased samples. In our NICU, research consent approaches were inconsistent, participation data were limited, and multiple studies occurred concurrently. We conducted a quality improvement initiative (January 2022-December 2023) with secondary analysis of sociodemographic factors. Primary measures were the percent of eligible families approached and consenting; subgroup analyses examined language, gestational age, and insurance. Seven PDSA cycles targeted staffing, language-concordant and antenatal approaches, team coordination, and standardized training. The approach rate increased from 52% to 66% with special cause variation. Overall, 65% of families consented. Observational studies enrollment showed special cause variation; interventional enrollment remained stable. Antenatal approaches yielded a 91% consent. Language-concordant approaches were associated with higher consent among Spanish- (88%) and Portuguese-speaking (83%) families (p = 0.047). Structured team processes and language-concordant, antenatal approaches improved rates and supported more equitable participation.

Objectives The authors sought to measure and compare practice preference variation in neonatal respiratory care within and between neonatal intensive care units (NICUs) using the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT). Study design Eleven NICUs completed the NSIGHT between 2019 and 2021. Net preference was measured by mean response; agreement was ranked by standard distribution of response values. Heat maps showed comparisons between NICUs and disciplines. Results NICUs and individuals agreed most often on use of pressure support with mandatory ventilation and on use of non-invasive positive pressure ventilation for apnea. High preference variation surrounded decisions for invasive ventilation versus continuous positive airway pressure for extremely low birth weight infants. Preference difference was most frequent between neonatologists and nurses. Conclusions Patterns of practice preference variation in neonatal respiratory care are specific to clinical scenario. Measuring preference variation may inform psychology of change and strengthen quality improvement efforts.

Our objective was to evaluate whether pregnancy is prolonged by the use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in the preterm birth rate. Rather than considering a dichotomous outcome (preterm versus term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with the PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36–0.78, p < 0.01). Newborns of screened subjects had significantly shorter NICU stays but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We conclude that screening with the PreTRM test followed by interventions for screen-positive pregnancies may prolong pregnancy and reduce NICU LOS, but these observations need to be confirmed by additional research.

Our objective was to evaluate whether pregnancy is prolonged by use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in preterm birth rate. Rather than considering a dichotomous outcome (preterm vs term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, P <0.01). Newborns of screened subjects had significantly shorter NICU stay but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We concluded that screening with the PreTRM test followed by interventions for screen-positive pregnancies can prolong pregnancy and reduce NICU-LOS.

Preterm birth, defined as delivery before 37 weeks' gestation, is the leading cause of illness and death in newborns. In the United States, more than 10% of infants are born prematurely, and this rate is substantially higher in lower-income, inner-city and Black populations. Prematurity associates with substantially increased risk of short- and long-term medical complications and can generate significant costs throughout the lives of affected children. Annual U.S. health care costs to manage short- and long-term prematurity complications are estimated to exceed $25 billion. Clinical interventions, including case management (increased patient outreach, education and specialist care), pharmacological treatment and their combination, can provide benefit to pregnancies at higher risk for preterm birth. Early and sensitive risk detection, however, remains a challenge. We have developed and validated a proteomic biomarker risk predictor for early identification of pregnancies at increased risk of preterm birth. The ACCORDANT study modeled treatments with real-world patient data from a racially and ethnically diverse U.S. population to compare the benefits of risk predictor testing plus clinical intervention for higher-risk pregnancies versus no testing and standard care. Measured outcomes included neonatal and maternal length of hospital stay, associated costs and neonatal morbidity and mortality. The model projected improved outcomes and reduced costs across all subjects, including ethnic and racial populations, when predicted higher-risk pregnancies were treated using case management with or without pharmacological treatment. The biomarker risk predictor shows high potential to be a clinically important component of risk stratification for pregnant women, leading to tangible gains in reducing the impact of preterm birth.