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Erika M. Edwards
Vermont Oxford Network, Burlington, Vermont

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Journal article
Published: 22 July 2021 in Pediatrics
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Summary measures are used to quantify a hospital's quality of care by combining multiple metrics into a single score. We used Baby-MONITOR, a summary quality measure for NICUs, to evaluate quality by race and ethnicity across and within NICUs in the United States. Vermont Oxford Network members contributed data from 2015 to 2019 on infants from 25 to 29 weeks' gestation or of 401 to 1500 g birth weight who were inborn or transferred to the reporting hospital within 28 days of birth. Nine Baby-MONITOR measures were individually risk adjusted, standardized, equally weighted, and averaged to derive scores for African American, Hispanic, Asian American, and American Indian infants, compared with white infants. This prospective cohort included 169 400 infants at 737 hospitals. Across NICUs, Hispanic and Asian American infants had higher Baby-MONITOR summary scores, compared with those of white infants. African American and American Indian infants scored lower on process measures, and all 4 minority groups scored higher on outcome measures. Within NICUs, the mean summary scores for African American, Hispanic, and Asian American NICU subsets were higher, compared with those of white infants in the same NICU. American Indian summary NICU scores were not different, on average. With Baby-MONITOR, we identified differences in NICU quality by race and ethnicity. However, the summary score masked within-measure quality gaps that raise unanswered questions about the relationships between race and ethnicity and processes and outcomes of care.

ACS Style

Erika M. Edwards; Lucy T. Greenberg; Jochen Profit; David Draper; Daniel Helkey; Jeffrey D. Horbar. Quality of Care in US NICUs by Race and Ethnicity. Pediatrics 2021, 148, 1 .

AMA Style

Erika M. Edwards, Lucy T. Greenberg, Jochen Profit, David Draper, Daniel Helkey, Jeffrey D. Horbar. Quality of Care in US NICUs by Race and Ethnicity. Pediatrics. 2021; 148 (2):1.

Chicago/Turabian Style

Erika M. Edwards; Lucy T. Greenberg; Jochen Profit; David Draper; Daniel Helkey; Jeffrey D. Horbar. 2021. "Quality of Care in US NICUs by Race and Ethnicity." Pediatrics 148, no. 2: 1.

Journal article
Published: 21 March 2021 in Seminars in Perinatology
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The inequalities in income, wealth, and opportunity so deeply ingrained in our society's history of enslavement, genocide, racism, and discrimination are root causes of health disparities. Follow through is a comprehensive approach that begins before birth and continues into childhood, where health professionals, families, and communities partner to meet the social as well as medical needs of infants and families to achieve health equity. This article discusses potentially better practices for follow through, offering neonatal care providers tangible ways to address social determinants of health, the conditions in which people are born, grow, work, live, and age and the systems that creates these conditions.

ACS Style

Erika M. Edwards; Jeffrey D. Horbar. Following through: Interventions to improve long-term outcomes of preterm infants. Seminars in Perinatology 2021, 45, 151414 .

AMA Style

Erika M. Edwards, Jeffrey D. Horbar. Following through: Interventions to improve long-term outcomes of preterm infants. Seminars in Perinatology. 2021; 45 (4):151414.

Chicago/Turabian Style

Erika M. Edwards; Jeffrey D. Horbar. 2021. "Following through: Interventions to improve long-term outcomes of preterm infants." Seminars in Perinatology 45, no. 4: 151414.

Review article
Published: 03 February 2021 in Seminars in Fetal and Neonatal Medicine
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Quality improvement is driven by benchmarking between and within institutions over time and the collaborative improvement efforts that stem from these comparisons. Benchmarking requires systematic collection and use of standardized data. Low- and middle-income countries (LMIC) have great potential for improvements in newborn outcomes but serious obstacles to data collection, analysis, and implementation of robust improvement methodologies exist. We review the importance of data collection, internationally recommended neonatal metrics, selected methods of data collection, and reporting. The transformation from data collection to data use is illustrated by several select data system examples from LMIC. Key features include aims and measures important to neonatal team members, co-development with local providers, immediate access to data for review, and multidisciplinary team involvement. The future of neonatal care, use of data, and the trajectory to reach global neonatal improvement targets in resource-limited settings will be dependent on initiatives led by LMIC clinicians and experts.

ACS Style

Alexander G. Stevenson; Lloyd Tooke; Erika M. Edwards; Marcia Mangiza; Delia Horn; Michelle Heys; Mahlet Abayneh; Simbarashe Chimhuya; Danielle E.Y. Ehret. The use of data in resource limited settings to improve quality of care. Seminars in Fetal and Neonatal Medicine 2021, 26, 101204 .

AMA Style

Alexander G. Stevenson, Lloyd Tooke, Erika M. Edwards, Marcia Mangiza, Delia Horn, Michelle Heys, Mahlet Abayneh, Simbarashe Chimhuya, Danielle E.Y. Ehret. The use of data in resource limited settings to improve quality of care. Seminars in Fetal and Neonatal Medicine. 2021; 26 (1):101204.

Chicago/Turabian Style

Alexander G. Stevenson; Lloyd Tooke; Erika M. Edwards; Marcia Mangiza; Delia Horn; Michelle Heys; Mahlet Abayneh; Simbarashe Chimhuya; Danielle E.Y. Ehret. 2021. "The use of data in resource limited settings to improve quality of care." Seminars in Fetal and Neonatal Medicine 26, no. 1: 101204.

Journal article
Published: 28 January 2021 in Pediatrics
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BACKGROUND: A complex set of medical, social, and financial factors underlie decisions to discharge very preterm infants. As care practices change, whether postmenstrual age and weight at discharge have changed is unknown. METHODS: Between 2005 and 2018, 824 US Vermont Oxford Network member hospitals reported 314 811 infants 24 to 29 weeks’ gestational age at birth without major congenital abnormalities who survived to discharge from the hospital. Using quantile regression, adjusting for infant characteristics and complexity of hospital course, we estimated differences in median age, weight, and discharge weight z score at discharge stratified by gestational age at birth and by NICU type. RESULTS: From 2005 to 2018, postmenstrual age at discharge increased an estimated 8 (compatibility interval [CI]: 8 to 9) days for all infants. For infants initially discharged from the hospital, discharge weight increased an estimated 316 (CI: 308 to 324) grams, and median discharge weight z score increased an estimated 0.19 (CI: 0.18 to 0.20) standard units. Increases occurred within all birth gestational ages and across all NICU types. The proportion of infants discharged home from the hospital on human milk increased, and the proportions of infants discharged home from the hospital on oxygen or a cardiorespiratory monitor decreased. CONCLUSIONS: Gestational age and weight at discharge increased steadily from 2005 to 2018 for survivors 24 to 29 weeks’ gestation with undetermined causes, benefits, and costs.

ACS Style

Erika M. Edwards; Lucy T. Greenberg; Danielle E.Y. Ehret; Scott A. Lorch; Jeffrey D. Horbar. Discharge Age and Weight for Very Preterm Infants: 2005–2018. Pediatrics 2021, 147, 1 .

AMA Style

Erika M. Edwards, Lucy T. Greenberg, Danielle E.Y. Ehret, Scott A. Lorch, Jeffrey D. Horbar. Discharge Age and Weight for Very Preterm Infants: 2005–2018. Pediatrics. 2021; 147 (2):1.

Chicago/Turabian Style

Erika M. Edwards; Lucy T. Greenberg; Danielle E.Y. Ehret; Scott A. Lorch; Jeffrey D. Horbar. 2021. "Discharge Age and Weight for Very Preterm Infants: 2005–2018." Pediatrics 147, no. 2: 1.

Review
Published: 16 June 2020 in PEDIATRICS
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ACS Style

Jeffrey D. Horbar; Erika M. Edwards; Yolanda Ogbolu. Our Responsibility to Follow Through for NICU Infants and Their Families. PEDIATRICS 2020, 146, e20200360 .

AMA Style

Jeffrey D. Horbar, Erika M. Edwards, Yolanda Ogbolu. Our Responsibility to Follow Through for NICU Infants and Their Families. PEDIATRICS. 2020; 146 (6):e20200360.

Chicago/Turabian Style

Jeffrey D. Horbar; Erika M. Edwards; Yolanda Ogbolu. 2020. "Our Responsibility to Follow Through for NICU Infants and Their Families." PEDIATRICS 146, no. 6: e20200360.

Research article
Published: 20 December 2019 in Journal of School Health
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BACKGROUND Exercise reduces the odds of sadness and suicidality in bullied students, but the role of the bullying environment on this relationship remains unknown. METHODS Using combined data from the 2013 and 2015 Youth Risk Behavior Survey (N = 29,207), adjusted logistic regression models estimated odds ratios between exercise, sadness, and suicidal ideation and attempt, stratified by bullying exposure (electronically/at school). RESULTS Overall, 40.2% of students bullied at school and 48.3% of students bullied electronically reported feeling sad, compared to 22.6% of those not bullied. Bullied students were 2–3 times more likely to report suicidal ideation, and 3–4 times more likely to report suicidal attempt, regardless of bullying context. Students who were bullied at school and exercised 4–7 days per week had lower odds of sadness (adjusted odds ratio [AOR]: 0.64; 95% confidence interval [CI]: 0.51–0.81), suicidal ideation (AOR: 0.66; 95% CI: 0.53–82), and suicidal attempt (AOR: 0.69; 95% CI: 0.48–0.98) compared to those who exercised 0–3 days. There were no protective effects of exercise for students bullied electronically. CONCLUSIONS Exercise reduced sadness and suicidality in adolescents bullied at school but not for students who were cyberbullied. Bullying environment should be a primary consideration in school mental health treatment and maintenance paradigms.

ACS Style

Jeremy Sibold; Erika M. Edwards; Linnae O'neil; Dianna Murray-Close; James J. Hudziak. Bullying Environment Moderates the Relationship Between Exercise and Mental Health in Bullied US Children. Journal of School Health 2019, 90, 194 -199.

AMA Style

Jeremy Sibold, Erika M. Edwards, Linnae O'neil, Dianna Murray-Close, James J. Hudziak. Bullying Environment Moderates the Relationship Between Exercise and Mental Health in Bullied US Children. Journal of School Health. 2019; 90 (3):194-199.

Chicago/Turabian Style

Jeremy Sibold; Erika M. Edwards; Linnae O'neil; Dianna Murray-Close; James J. Hudziak. 2019. "Bullying Environment Moderates the Relationship Between Exercise and Mental Health in Bullied US Children." Journal of School Health 90, no. 3: 194-199.

Journal article
Published: 03 December 2019 in The Journal of Pediatrics
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ACS Style

SatyaN Lakshminrusimha; John P. Kinsella; Usha S. Krishnan; Krisa Van Meurs; Erika M. Edwards; Dilip R. Bhatt; Praveen Chandrasekharan; Ju-Lee Oei; Veena Manja; Rangasamy Ramanathan; Steven H. Abman. Just Say No to iNO in Preterms—Really? The Journal of Pediatrics 2019, 218, 243 -252.

AMA Style

SatyaN Lakshminrusimha, John P. Kinsella, Usha S. Krishnan, Krisa Van Meurs, Erika M. Edwards, Dilip R. Bhatt, Praveen Chandrasekharan, Ju-Lee Oei, Veena Manja, Rangasamy Ramanathan, Steven H. Abman. Just Say No to iNO in Preterms—Really? The Journal of Pediatrics. 2019; 218 ():243-252.

Chicago/Turabian Style

SatyaN Lakshminrusimha; John P. Kinsella; Usha S. Krishnan; Krisa Van Meurs; Erika M. Edwards; Dilip R. Bhatt; Praveen Chandrasekharan; Ju-Lee Oei; Veena Manja; Rangasamy Ramanathan; Steven H. Abman. 2019. "Just Say No to iNO in Preterms—Really?" The Journal of Pediatrics 218, no. : 243-252.

Review
Published: 01 October 2019 in Seminars in Perinatology
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Through standardized data collection, benchmark reporting, clinical trials, and quality improvement, neonatal networks play important roles in prevention, screening, and treatment efforts for retinopathy of prematurity.

ACS Style

Erika M. Edwards; Jeffrey D. Horbar. Retinopathy of prematurity prevention, screening and treatment programmes: The role of neonatal networks. Seminars in Perinatology 2019, 43, 341 -343.

AMA Style

Erika M. Edwards, Jeffrey D. Horbar. Retinopathy of prematurity prevention, screening and treatment programmes: The role of neonatal networks. Seminars in Perinatology. 2019; 43 (6):341-343.

Chicago/Turabian Style

Erika M. Edwards; Jeffrey D. Horbar. 2019. "Retinopathy of prematurity prevention, screening and treatment programmes: The role of neonatal networks." Seminars in Perinatology 43, no. 6: 341-343.

Review article
Published: 29 July 2019 in Pediatric Research
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Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.

ACS Style

Andrew F. Beck; Erika M. Edwards; Jeffrey D. Horbar; Elizabeth A. Howell; Marie C. McCormick; DeWayne M. Pursley. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatric Research 2019, 87, 227 -234.

AMA Style

Andrew F. Beck, Erika M. Edwards, Jeffrey D. Horbar, Elizabeth A. Howell, Marie C. McCormick, DeWayne M. Pursley. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatric Research. 2019; 87 (2):227-234.

Chicago/Turabian Style

Andrew F. Beck; Erika M. Edwards; Jeffrey D. Horbar; Elizabeth A. Howell; Marie C. McCormick; DeWayne M. Pursley. 2019. "The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families." Pediatric Research 87, no. 2: 227-234.

Review
Published: 01 July 2019 in Translational Pediatrics
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A health care learning community engages providers and families in a collaborative environment to improve outcomes. Vermont Oxford Network (VON), a voluntary organization dedicated to improving the quality, safety and value of care through a coordinated program of data-driven quality improvement, education, and research, is a worldwide learning community in newborn medicine. Through collection of pragmatic structured data items and benchmarking reports, quality improvement collaboratives, pragmatic trials, and observational research, VON facilitates quality improvement by multidisciplinary teams and families in neonatal intensive care units (NICU) in low, middle, and high resource countries. By bringing health professionals and families together across disciplines and geographies to enable shared learning and knowledge dissemination, VON empowers individuals, organizations, and systems to meet the shared vision that every infant around the world can and should achieve their full potential.

ACS Style

Erika M. Edwards; Danielle E. Y. Ehret; Roger F. Soll; Jeffrey D. Horbar. Vermont Oxford Network: a worldwide learning community. Translational Pediatrics 2019, 8, 182 -192.

AMA Style

Erika M. Edwards, Danielle E. Y. Ehret, Roger F. Soll, Jeffrey D. Horbar. Vermont Oxford Network: a worldwide learning community. Translational Pediatrics. 2019; 8 (3):182-192.

Chicago/Turabian Style

Erika M. Edwards; Danielle E. Y. Ehret; Roger F. Soll; Jeffrey D. Horbar. 2019. "Vermont Oxford Network: a worldwide learning community." Translational Pediatrics 8, no. 3: 182-192.

Journal article
Published: 07 May 2019 in Children
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The Textbook of Neonatal Resuscitation, seventh edition, does not suggest routine endotracheal suctioning for non-vigorous infants born through meconium-stained amniotic fluid. We compared 301,150 infants at ≥35 weeks’ gestational age inborn at 311 Vermont Oxford Network member centers in the United States (U.S.) and admitted to neonatal intensive care units (NICU) who were born before (2013 to 2015) and after (2017) the guideline change. Logistic regression models adjusting for clustering of infants within centers were used to calculate risk ratios. NICU admissions for infants with a diagnosis of meconium aspiration syndrome (MAS) decreased from 1.8% to 1.5% (risk ratio: 0.82; 95% confidence interval: 0.68, 0.97) and delivery room endotracheal suctioning in this group decreased from 57.0% to 28.9% (0.51; 0.41, 0.62). Treatment with conventional or high frequency ventilation, inhaled nitric oxide, or extracorporeal membrane oxygenation remained unchanged 42.3% vs. 40.3% (0.95; 0.80, 1.13) among infants with MAS and 9.1% vs. 8.2% (0.91; 0.87, 0.95) among infants without MAS. The use of surfactant among infants with MAS increased from 24.6% to 30% (1.22; 1.02, 1.48). Mortality (2.6 to 2.9%, 1.12; 0.74, 1.69) and moderate/severe hypoxic-ischemic encephalopathy (5.4 to 6.8%, 1.24; 0.91, 1.69) increased slightly in 2017. Subgroup analyses of infants with 1 min Apgar scores of ≤3 found similar results. While NICU admissions for MAS and tracheal suctioning decreased after the introduction of the new guideline with no subsequent increase in severe respiratory distress among infants with and without a MAS diagnosis, limitations in our study preclude inferring that the new guideline is safe or effective.

ACS Style

Erika Edwards; SatyaN Lakshminrusimha; Danielle Ehret; Jeffrey Horbar. NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change. Children 2019, 6, 68 .

AMA Style

Erika Edwards, SatyaN Lakshminrusimha, Danielle Ehret, Jeffrey Horbar. NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change. Children. 2019; 6 (5):68.

Chicago/Turabian Style

Erika Edwards; SatyaN Lakshminrusimha; Danielle Ehret; Jeffrey Horbar. 2019. "NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change." Children 6, no. 5: 68.

Comparative study
Published: 17 April 2019 in The American Journal of Clinical Nutrition
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The benefits of human milk for hospitalized preterm infants are well documented, but the extent to which current human milk diets adequately support growth is uncertain. 1) To quantify differences in weight gain and head growth between very preterm infants fed human milk compared with infant formula; and 2) to describe trends in the magnitude of these differences over time. We studied infants from 777 US NICUs in the Vermont Oxford Network database. We included all surviving infants 23-29 weeks of gestation or 401-1500 g birth weight (maximum gestational age 32 wk) and excluded infants discharged >42 weeks of gestation or with congenital anomalies. In diet-growth analyses, we included infants born 2012-2016 (n = 138,703) to reflect current practice. In trend analyses, we included a 10-y cohort (n = 263,367). We categorized diet at NICU discharge/transfer as: 1) human milk only (no formula or fortifier); 2) human milk with formula or fortifier (mixed); or 3) infant formula only. Outcomes were weight and head circumference z-score change from birth to discharge relative to a fetal reference. Diet at discharge/transfer was human milk only for 18,274 (6.6%), mixed for 121,621 (44%), and formula only for 137,067 (49%). Weight deviated more from the fetal reference for infants fed both human milk diets compared with formula only (weight z-score change for infants fed human milk only, -0.88; mixed, -0.82; formula only -0.80; P < 0.0001 for diet overall). There were also differences by diet in head z-score change (human milk only, -0.52; mixed, -0.49; formula only, -0.45; P < 0.0001 for diet overall). The magnitude of these differences has diminished substantially over 10 y. Very preterm infants receiving human milk compared with infant formula diets have a slower weight gain and head growth at hospital discharge.

ACS Style

Mandy B Belfort; Erika M Edwards; Lucy T Greenberg; Margaret G Parker; Danielle Y Ehret; Jeffrey D Horbar. Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study. The American Journal of Clinical Nutrition 2019, 109, 1373 -1379.

AMA Style

Mandy B Belfort, Erika M Edwards, Lucy T Greenberg, Margaret G Parker, Danielle Y Ehret, Jeffrey D Horbar. Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study. The American Journal of Clinical Nutrition. 2019; 109 (5):1373-1379.

Chicago/Turabian Style

Mandy B Belfort; Erika M Edwards; Lucy T Greenberg; Margaret G Parker; Danielle Y Ehret; Jeffrey D Horbar. 2019. "Diet, weight gain, and head growth in hospitalized US very preterm infants: a 10-year observational study." The American Journal of Clinical Nutrition 109, no. 5: 1373-1379.

Journal article
Published: 20 November 2018 in PEDIATRICS
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Video Abstract BACKGROUND: The Centers for Disease Control and Prevention (CDC) published the Core Elements of Hospital Antibiotic Stewardship Programs (ASPs), while the Choosing Wisely for Newborn Medicine Top 5 list identified antibiotic therapy as an area of overuse. We identify the baseline prevalence and makeup of newborn-specific ASPs and assess the variability of NICU antibiotic use rates (AURs). METHODS: Data were collected using a cross-sectional audit of Vermont Oxford Network members in February 2016. Unit measures were derived from the 7 domains of the CDC’s Core Elements of Hospital ASPs, including leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Patient-level measures included patient demographics, indications, and reasons for therapy. An AUR, defined as the number of infants who are on antibiotic therapy divided by the census that day, was calculated for each unit. RESULTS: Overall, 143 centers completed structured self-assessments. No center addressed all 7 core elements. Of the 7, only accountability (55%) and drug expertise (62%) had compliance >50%. Centers audited 4127 infants for current antibiotic exposure. There were 725 infants who received antibiotics, for a hospital median AUR of 17% (interquartile range 10%–26%). Of the 412 patients on >48 hours of antibiotics, only 26% (107 out of 412) had positive culture results. CONCLUSIONS: Significant gaps exist between CDC recommendations to improve antibiotic use and antibiotic practices during the newborn period. There is wide variation in point prevalence AURs. Three-quarters of infants who received antibiotics for >48 hours did not have infections proven by using cultures.

ACS Style

Timmy Ho; Madge E. Buus-Frank; Erika M. Edwards; Kate A. Morrow; Karla Ferrelli; Arjun Srinivasan; Daniel A. Pollock; Dmitry Dukhovny; John A.F. Zupancic; DeWayne M. Pursley; Roger F. Soll; Jeffrey D. Horbar. Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations. PEDIATRICS 2018, 142, e20174322 .

AMA Style

Timmy Ho, Madge E. Buus-Frank, Erika M. Edwards, Kate A. Morrow, Karla Ferrelli, Arjun Srinivasan, Daniel A. Pollock, Dmitry Dukhovny, John A.F. Zupancic, DeWayne M. Pursley, Roger F. Soll, Jeffrey D. Horbar. Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations. PEDIATRICS. 2018; 142 (6):e20174322.

Chicago/Turabian Style

Timmy Ho; Madge E. Buus-Frank; Erika M. Edwards; Kate A. Morrow; Karla Ferrelli; Arjun Srinivasan; Daniel A. Pollock; Dmitry Dukhovny; John A.F. Zupancic; DeWayne M. Pursley; Roger F. Soll; Jeffrey D. Horbar. 2018. "Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations." PEDIATRICS 142, no. 6: e20174322.

Multicenter study
Published: 14 November 2018 in PEDIATRICS
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OBJECTIVE: To examine whether changes in mortality and morbidities have benefited male more than female infants. METHODS: Infants of gestational ages 22 to 29 weeks born between January 2006 and December 2016 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals by sex and birth year. We tested temporal differences in mortality and morbidity rates between boys and girls by means of a likelihood ratio test (LRT) on nested binomial regression models with log links. RESULTS: A total of 205 750 infants were studied; 97 048 (47.2%) infants were girls. The rate for mortality and chronic lung disease decreased over time faster for boys than for girls (LRT P < .001 for mortality; P = .006 for lung disease). Restricting to centers that remained throughout the entire study period did not change all the above but additionally revealed a significant year-sex interaction for respiratory distress syndrome, with a faster decline among boys (LRT P = .04). Morbidities, including patent ductus arteriosus, necrotizing enterocolitis, early-onset sepsis, late-onset sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and pneumothorax, revealed a constant rate difference between boys and girls over time. CONCLUSIONS: Compared with girls, male infants born at <30 weeks’ gestation experienced faster declines in mortality, respiratory distress syndrome, and chronic lung disease over an 11-year period. Future research should investigate which causes of death declined among boys and whether their improved survival has been accompanied by a change in their neurodevelopmental impairment rate.

ACS Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation. PEDIATRICS 2018, 142, e20182352 .

AMA Style

Nansi S. Boghossian, Marco Geraci, Erika M. Edwards, Jeffrey D. Horbar. Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation. PEDIATRICS. 2018; 142 (6):e20182352.

Chicago/Turabian Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. 2018. "Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation." PEDIATRICS 142, no. 6: e20182352.

Journal article
Published: 03 October 2018 in Pediatrics
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Video Abstract BACKGROUND: Increased admissions of higher birth weight and less acutely ill infants to NICUs suggests that intensive care may be used inappropriately in these populations. We describe variation in use of NICU services by gestational age and NICU type. METHODS: Using the Vermont Oxford Network database of all NICU admissions, we assessed variation within predefined gestational age categories in the following proportions: admissions, initial NICU hospitalization days, high-acuity cases ≥34 weeks’ gestation, and short-stay cases ≥34 weeks’ gestation. High acuity was defined as follows: death, intubated assisted ventilation for ≥4 hours, early bacterial sepsis, major surgery requiring anesthesia, acute transport to another center, hypoxic-ischemic encephalopathy or a 5-minute Apgar score ≤3, or therapeutic hypothermia. Short stay was defined as an inborn infant staying 1 to 3 days with discharge from the hospital. RESULTS: From 2014 to 2016, 486 741 infants were hospitalized 9 657 508 days at 381 NICUs in the United States. The median proportions of admissions, initial hospitalized days, high-acuity cases, and short stays varied significantly by NICU types in almost all gestational age categories. Fifteen percent of the infants ≥34 weeks were high acuity, and 10% had short stays. CONCLUSIONS: There is substantial variation in use among NICUs. A campaign to focus neonatal care teams on using the NICU wisely that addresses the appropriate use of intensive care for newborn infants and accounts for local context and the needs of families is needed.

ACS Style

Erika M. Edwards; Jeffrey D. Horbar. Variation in Use by NICU Types in the United States. Pediatrics 2018, 142, e20180457 .

AMA Style

Erika M. Edwards, Jeffrey D. Horbar. Variation in Use by NICU Types in the United States. Pediatrics. 2018; 142 (5):e20180457.

Chicago/Turabian Style

Erika M. Edwards; Jeffrey D. Horbar. 2018. "Variation in Use by NICU Types in the United States." Pediatrics 142, no. 5: e20180457.

Journal article
Published: 10 August 2018 in EPJ Data Science
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Very low birth weight (VLBW) infants require specialized care in neonatal intensive care units. In the United States (U.S.), such infants frequently are transferred between hospitals. Although these neonatal transfer networks are important, both economically and for infant morbidity and mortality, the national level pattern of neonatal transfers is largely unknown. Using data from Vermont Oxford Network on 44,753 births, 2122 hospitals, and 9722 interhospital infant transfers from 2015, we performed the largest analysis to date on the interhospital transfer network for VLBW infants in the U.S. We find that transfers are organized around regional communities, but that despite being largely within state boundaries, most communities often contain at least two hospitals in different states. To classify the structural variation in transfer pattern amongst these communities, we applied a spectral measure for regionalization and found an association between a community’s degree of regionalization and their infant transfer rate, which was not utilized in detecting communities. We also demonstrate that the established measures of network centrality and hierarchy, e.g., the community-wide entropy in PageRank or betweenness centrality and number of distinct “layers,” within a community, correlate weakly with our regionalization index and were not significantly associated with metrics on infant transfer rate. Our results suggest that the regionalization index captures novel information about the structural properties of VLBW infant transfer networks, have the practical implication of characterizing neonatal care in the U.S., and may apply more broadly to the role of centralizing forces in organizing complex adaptive systems.

ACS Style

Munik Shrestha; Samuel V. Scarpino; Erika M. Edwards; Lucy T. Greenberg; Jeffrey D. Horbar. The interhospital transfer network for very low birth weight infants in the United States. EPJ Data Science 2018, 7, 27 .

AMA Style

Munik Shrestha, Samuel V. Scarpino, Erika M. Edwards, Lucy T. Greenberg, Jeffrey D. Horbar. The interhospital transfer network for very low birth weight infants in the United States. EPJ Data Science. 2018; 7 (1):27.

Chicago/Turabian Style

Munik Shrestha; Samuel V. Scarpino; Erika M. Edwards; Lucy T. Greenberg; Jeffrey D. Horbar. 2018. "The interhospital transfer network for very low birth weight infants in the United States." EPJ Data Science 7, no. 1: 27.

Journal article
Published: 20 July 2018 in The American Journal of Cardiology
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Prematurity increases pre- and post- operative mortality in children with congenital heart disease. There are no large, multi-centered, studies that have evaluated this relationship specifically in neonates with Hypoplastic Left Heart Syndrome (HLHS). We sought to determine the impact of gestational age (GA) on survival to Stage 1 palliation surgery and hospital discharge in infants with HLHS. We reviewed data from 1,913 neonates with HLHS born at or transferred to a Vermont Oxford Network (VON) expanded member hospital in the United States from 2009 to 2014. Demographic, diagnostic and surgical codes, and outcome data within the VON database were used to determine the effect of GA and birth weight on survival to Stage 1 palliation surgery and hospital discharge. Risk models were developed controlling for common confounders to determine the relative risk of GA on the observed outcomes. These data demonstrate that, when compared to 39 week infants, those born at earlier GA were less likely to survive until surgery; < 34 weeks adjusted risk ratio (ARR) for survival: 0.47 (95% CI: 0.37-0.60), 34-35 weeks ARR 0.73 (0.62-0.87), and 36-37 weeks ARR 0.88 (0.83-0.94). Higher GA also positively correlated with survival to hospital discharge, though there was no difference between 34-35 week infants and 36-37 week infants. In conclusion, these data show that GA was an independent risk factor for survival to Stage 1 palliation surgery and survival to hospital discharge. However, there is no significant difference in survival to hospital discharge between infants born between 34-37 weeks gestation.

ACS Style

Joseph T. Mechak; Erika M. Edwards; Kate A. Morrow; Jonathan R. Swanson; Jeffrey Vergales. Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome. The American Journal of Cardiology 2018, 122, 1222 -1230.

AMA Style

Joseph T. Mechak, Erika M. Edwards, Kate A. Morrow, Jonathan R. Swanson, Jeffrey Vergales. Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome. The American Journal of Cardiology. 2018; 122 (7):1222-1230.

Chicago/Turabian Style

Joseph T. Mechak; Erika M. Edwards; Kate A. Morrow; Jonathan R. Swanson; Jeffrey Vergales. 2018. "Effects of Gestational Age on Early Survivability in Neonates With Hypoplastic Left Heart Syndrome." The American Journal of Cardiology 122, no. 7: 1222-1230.

Journal article
Published: 08 May 2018 in American Journal of Obstetrics and Gynecology
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It is unclear whether a neonatal or a fetal growth standard is a better predictor of adverse in-hospital newborn infant outcomes. We aimed to evaluate and compare the power of birthweight for gestational age to predict adverse neonatal outcomes using neonatal and fetal growth charts. Gestational age–specific birthweight was examined either as a percentile score or as a binary indicator for birthweight <10th percentile (small for gestational age) with the use of 3 fetal growth charts (National Institute of Child Health and Human Development, World Health Organization, and Intergrowth-21st) and 1 neonatal sex-specific birthweight chart. Inborn singleton infants from 2006–2014 with gestational age between 22 and 29 weeks and who were enrolled at 1 of the 852 US centers that were participating in the Vermont Oxford Network were studied. Outcomes included death, necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and chronic lung disease. Receiver operating characteristic curve analysis was used to assess the predictive power of birthweight for gestational age, either as a score or as a small-for-gestational-age indicator, with the use of the 4 charts. We also examined the relative risks of the outcomes by comparing small-for-gestational-age and non–small-for-gestational-age infants with the use of the 4 charts. The percentage of small-for-gestational-age newborn infants ranged from 25.9–29.7% when with used the fetal growth charts. In contrast, the percentage was 10% when we used the neonatal charts. The areas under the receiver operating characteristic curves were similar across the 4 classification methods and were all <0.60, which suggests a poor predictive power. Small-for-gestational-age status, as classified by the neonatal chart, showed stronger associations with death, necrotizing enterocolitis, severe retinopathy of prematurity, and chronic lung disease, compared with those associations that were based on the other classification methods. Neither the neonatal nor the fetal growth charts are predictive of adverse infant in-hospital outcomes. In contrast to fetal charts, the use of the neonatal charts results in stronger associations between small-for-gestational-age and adverse outcomes.

ACS Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. Neonatal and fetal growth charts to identify preterm infants <30 weeks gestation at risk of adverse outcomes. American Journal of Obstetrics and Gynecology 2018, 219, 195.e1 -195.e14.

AMA Style

Nansi S. Boghossian, Marco Geraci, Erika M. Edwards, Jeffrey D. Horbar. Neonatal and fetal growth charts to identify preterm infants <30 weeks gestation at risk of adverse outcomes. American Journal of Obstetrics and Gynecology. 2018; 219 (2):195.e1-195.e14.

Chicago/Turabian Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. 2018. "Neonatal and fetal growth charts to identify preterm infants <30 weeks gestation at risk of adverse outcomes." American Journal of Obstetrics and Gynecology 219, no. 2: 195.e1-195.e14.

Journal article
Published: 06 April 2018 in The Journal of Pediatrics
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To estimate the risks of mortality and morbidities in large for gestational age (LGA) infants relative to appropriate for gestational age infants born at 22-29 weeks of gestation. Data on 156 587 infants were collected between 2006 and 2014 in 852 US centers participating in the Vermont Oxford Network. We defined LGA as sex-specific birth weight above the 90th centile for gestational age measured in days. Generalized additive models with smoothing splines on gestational age by LGA status were fitted on mortality and morbidity outcomes to estimate adjusted relative risks and their 95% CIs. Compared with appropriate for gestational age infants, being born LGA was associated with decreased risks of mortality, respiratory distress syndrome, patent ductus arteriosus, necrotizing enterocolitis, late-onset sepsis, severe retinopathy of prematurity, and chronic lung disease. Early onset sepsis and severe intraventricular hemorrhage were increased among LGA infants, but these risks were not homogeneous across the gestational age range. Being born LGA was associated with lower risks for all the examined outcomes except for early onset sepsis and severe intraventricular hemorrhage.

ACS Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. In-Hospital Outcomes in Large for Gestational Age Infants at 22-29 Weeks of Gestation. The Journal of Pediatrics 2018, 198, 174 -180.e13.

AMA Style

Nansi S. Boghossian, Marco Geraci, Erika M. Edwards, Jeffrey D. Horbar. In-Hospital Outcomes in Large for Gestational Age Infants at 22-29 Weeks of Gestation. The Journal of Pediatrics. 2018; 198 ():174-180.e13.

Chicago/Turabian Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. 2018. "In-Hospital Outcomes in Large for Gestational Age Infants at 22-29 Weeks of Gestation." The Journal of Pediatrics 198, no. : 174-180.e13.

Journal article
Published: 18 January 2018 in PEDIATRICS
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OBJECTIVES: To identify the relative risks of mortality and morbidities for small for gestational age (SGA) infants in comparison with non-SGA infants born at 22 to 29 weeks’ gestation. METHODS: Data were collected (2006–2014) on 156 587 infants from 852 US centers participating in the Vermont Oxford Network. We defined SGA as sex-specific birth weight <10th centile for gestational age (GA) in days. Binomial generalized additive models with a thin plate spline term on GA by SGA were used to calculate the adjusted relative risks and 95% confidence intervals for outcomes by GA. RESULTS: Compared with non-SGA infants, the risk of patent ductus arteriosus decreased for SGA infants in early GA and then increased in later GA. SGA infants were also at increased risks of mortality, respiratory distress syndrome, necrotizing enterocolitis, late-onset sepsis, severe retinopathy of prematurity, and chronic lung disease. These risks of adverse outcomes, however, were not homogeneous across the GA range. Early-onset sepsis was not different between the 2 groups for the majority of GAs, although severe intraventricular hemorrhage was decreased among SGA infants for only gestational week 24 through week 25. CONCLUSIONS: SGA was associated with additional risks to mortality and morbidities, but the risks differed across the GA range.

ACS Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. Morbidity and Mortality in Small for Gestational Age Infants at 22 to 29 Weeks’ Gestation. PEDIATRICS 2018, 141, e20172533 .

AMA Style

Nansi S. Boghossian, Marco Geraci, Erika M. Edwards, Jeffrey D. Horbar. Morbidity and Mortality in Small for Gestational Age Infants at 22 to 29 Weeks’ Gestation. PEDIATRICS. 2018; 141 (2):e20172533.

Chicago/Turabian Style

Nansi S. Boghossian; Marco Geraci; Erika M. Edwards; Jeffrey D. Horbar. 2018. "Morbidity and Mortality in Small for Gestational Age Infants at 22 to 29 Weeks’ Gestation." PEDIATRICS 141, no. 2: e20172533.