Heidi J. Steflik

Objective : Investigate associations between proactive vs. historical neonatal post-hemorrhagic hydrocephalus (PHH) surgical management and subsequent neurodevelopmental impairment (NDI). Study Design : Single-center retrospective, matched cohort of VLBW infants with PHH. Cases underwent earlier ventricular reservoir placement, serial imaging-guided cerebrospinal fluid withdrawal, reservoir weaning. Controls received historical management with later reservoir placement, symptom-driven cerebrospinal fluid withdrawal, earlier shunt conversion. Capute Cognitive Adaptive Test (CAT), Clinical Linguistic and Auditory Milestone Scale (CLAMS), Modified Peabody Developmental Motor Scale (PDMS-M)and Ages and Stages Questionnaires®, (ASQ) neurodevelopmental assessments during first two years compared between groups using Sign, McNemar-Bowker, Wilcoxon signed-rank and matched t-tests. Result : 48 subjects (24/group) included. NDI was common (67% Cases, 75% Controls). Composite NDI, individual NDI composite outcome components (CAT/CLAMS/PDMS-M), nor ASQ scores differed between groups. Conclusion : Proactive management was not associated with worse NDI, supporting its potential safety. Higher-powered studies with longer follow-up intervals are needed to assess potential developmental benefits.

Objective: Associations between neonatal acute kidney injury (AKI) and neurodevelopmental impairment (NDI) remains understudied. We hypothesized AKI is associated with NDI in very low birthweight (VLBW) infants. Study design: A single-center, retrospective cohort study of VLBW infants with and without AKI during hospitalization evaluated in developmental clinic at 18 to 35 months of age. Associations between AKI and NDI were examined using bivariate and multivariable generalized linear mixed modeling. Result: Of 203 infants included, 64 (32%) experienced neonatal AKI and 76 (37%) developed NDI. The relative risk of NDI was significantly higher in those with AKI (RR 1.67, 95% CI 1.18–2.36; p < 0.01). In multivariable analysis, AKI was not an independent predictor of NDI (aRR 1.07, 95% CI 0.68–1.68; p = 0.77). Conclusion: In bivariate analyses, AKI was a significant predictor of NDI. In a multivariable model, AKI was no longer an independent predictor of NDI. Further investigation is warranted.

The impact of race on extracorporeal life support (ECLS) availability, morbidity, and mortality remains poorly defined. We sought to define the impact of race/ethnicity, sex, and location on ECLS outcomes, and identify potential disparities that remain intact using a modern, inclusive cohort of neonates receiving ECLS in the United States. Data were extracted from the Children’s Hospital Association Pediatric Health Information System (PHIS) database on neonates who received ECLS from January 1, 2010–December 31, 2020. Both adjusted and unadjusted regression models were fitted to study the association between neonatal ECLS outcomes and covariates. During the study period, 6,695 neonates from 47 hospitals met the inclusion criteria. Non-Hispanic White neonates (45%), males (57%), and hospitals in the Southern region (32%) compromised the largest proportions of ECLS cases and cardiac disease (44%) was the most common indication for ECLS. Hospital region was associated with ECLS duration with hospitals in the Midwest (median 6 days) and West (6 days) having significantly shorter courses than those in the Northeast (7 days) and South (7 days) (p < 0.01). Associations between race/ethnicity, sex, hospital region, and mortality were detected. Non-Hispanic Black neonates (35% mortality), males (37%), and neonates in the Midwest region (34%) experienced lower ECLS mortality rates (all p < 0.05).

Objective: Compare neonatal intensive care unit hospitalization costs between neonates with and without AKI; identify predictors of AKI-associated costs. We hypothesized neonates with AKI would amass more costs than those without AKI. Study design: Retrospective, multicenter cohort study of surviving neonates cared for 2015–2021 in Pediatric Health Information System database. The primary outcome was estimated hospitalization costs. Results: Data from 304,725 neonates were evaluated, 8774 (3%) with AKI and 295,951 (97%) without AKI. Neonates with AKI had $58,807 greater adjusted costs than those without AKI. AKI-associated costs were most strongly driven by Feudtner Pediatric Complex Chronic Conditions Classifications (cardiovascaular, congenital/genetic, gastrointestinal, medical technology) and gestational age. Adjusted costs decreased with increasing gestational age, regardless of AKI status. Conclusions: AKI is independently associated with increased hospital costs. Knowledge of these drivers can help in identifying high-value practices for cost mitigation strategies.

Objective: The relationship between adrenal insufficiency (AI), post-natal steroids (PNS) and neonatal acute kidney injury (AKI) remains understudied. We investigated associations between PNS and AKI in very low birthweight (VLBW) neonates, hypothesizing PNS is associated with reduced AKI. Study design: We conducted a single-center retrospective review of VLBW infants comparing those with and without PNS exposure. Associations between PNS exposure and AKI were evaluated using generalized linear mixed-modeling adjusted for confounders. Result: Of 567 neonates, 97 (17.1%) were exposed to PNS and 130 (22.9%) experienced AKI. Infants with PNS had lower gestational age, birthweight, Apgar scores, and experienced more AI versus those without PNS (all p < 0.05). PNS was associated with AKI (aRR 1.72, 95% CI 1.09–2.72) though hydrocortisone alone was not. Conclusion: PNS exposure, but not hydrocortisone alone, is associated with increased AKI in VLBW neonates. Further analysis is needed to investigate the role of AI and AKI.

Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

Background: The birthrate of Black preterm (BPT) infant is 65% higher than White preterm (WPT) infants with BPT mortality 2.3 times higher. The incidence of culture positive sepsis is as high as 41% in preterms. This study aimed to examine infections and mortality in BPTs and WPTs. Methods: We enrolled 362 preterms born < 32 weeks gestational age (GA) between 2019-2023 in 5 neonatal intensive care unit (NICU)s to study onset of infections, and dispositions; RedCap data were analyzed for descriptive statistics. Results: 226 BPTs (63.5%) and 107 WPTs (30.8%) enrolled, with 29 other than White or Black, 50.5% female, mean GA of 27.67 weeks and 986.74 grams birthweight. Of 426 suspected infections evaluated in enrolled infants, there were 7 infants with early onset sepsis (EOS) and 39 infants with late onset sepsis (LOS). The incidence of EOS was 1.9% overall, 2.2% in BPTs vs 0.9% in WPTs. LOS incidence was 10.8% overall, 11.9% in BPTs and 9.3% in WPTs. Both BPT and WPT infants had ~ 8% gram-positive LOS events and 3% gram-negative LOS events; however, 82% of all gram-negative LOS episodes occurred in BPTs. There were 27 urinary tract infections and 78% were in BPTs. Two cerebral spinal fluid cultures were positive in BPTs. Necrotizing enterocolitis was diagnosed in 5.8% of the sample, with an incidence of 6.1% in BPTs versus 4.7% in WPTs. Death occurred in 6.0% of the enrolled infants with the rate of death being slightly higher in BPTs (7.0%) versus WPTs (5.6%). Conclusions: BPTs had a higher rate of positive cultures, double the gram-negative infections, a much higher rate of urinary tract infec-tions and a higher rate of mortality than their WPT counterparts. This study emphasizes higher risk of morbidity and mortality for BPTs.