Successful and Rapid Reduction in Neurosedative and Analgesic Medications in Complex Infants with Severe Bronchopulmonary Dysplasia After Tracheostomy Placement: Experience with 24-hour Propofol Infusions.

Infants with severe bronchopulmonary dysplasia may require high doses of neurosedative medications to ensure pain control and stability following tracheostomy placement. Subsequent weaning of these medications safely and rapidly is a challenge. We describe a 24-hour propofol infusion to reduce neurosedative medications in 3 high-risk infants following tracheostomy placement.

The association of maternal country/region of origin and nativity with infant mortality rate among Hispanic preterm infants.

OBJECTIVES: Among US-born preterm infants of Hispanic mothers, we analyzed the unadjusted and adjusted infant mortality rate (IMR) by country/region of origin and maternal nativity status. STUDY DESIGN: Using linked national US birth and death certificate data (2005-2014), we examined preterm infants of Hispanic mothers by subgroup and nativity. Clinical and sociodemographic covariates were included and the main outcome was death in the first year of life. RESULTS: In our cohort of 891,216 preterm Hispanic infants, we demonstrated different rates of infant mortality by country and region of origin, but no difference between infants of Hispanic mothers who were US vs. foreign-born. CONCLUSION: These findings highlight the need to disaggregate the heterogenous Hispanic birthing population into regional and national origin groups to better understand unique factors associated with adverse perinatal outcomes in order to develop more targeted interventions for these subgroups.

Racial and Ethnic Disparities in Sudden Unexpected Infant Death Among US Infants Born Preterm.

OBJECTIVE: To investigate among US infants born at <37 weeks gestation (a) racial and ethnic disparities in sudden unexpected infant death (SUID) and (b) state variation in SUID rates and non-Hispanic Black (NHB)-non-Hispanic White (NHW) SUID disparity ratio. METHODS: In this retrospective cohort analysis of linked birth and death certificates from 50 states from 2005 to 2014, SUID was defined by the following International Classification of Diseases, 9th or 10th edition, codes listed on death certificates: (7980, R95 or Recode 135; ASSB: E913, W75 or Recode 146; Unknown: 7999 R99 or Recode 134). Multivariable models were used to assess the independent association between maternal race and ethnicity and SUID, adjusting for several maternal and infant characteristics. The NHB-NHW SUID disparity ratios were calculated for each state. RESULTS: Among 4 086 504 preterm infants born during the study period, 8096 infants (0.2% or 2.0 per 1000 live births) experienced SUID. State variation in SUID ranged from the lowest rate of 0.82 per 1000 live births in Vermont to the highest rate of 3.87 per 1000 live births in Mississippi. Unadjusted SUID rates across racial and ethnic groups varied from 0.69 (Asian/Pacific Islander) to 3.51 (NHB) per 1000 live births. In the adjusted analysis, compared with NHW infants, NHB and Alaska Native/American Indian preterm infants had greater odds of SUID (aOR, 1.5;[95% CI, 1.42-1.59] and aOR, 1.44 [95% CI, 1.21-1.72]) with varying magnitude of SUID rates and NHB-NHW disparities across states. CONCLUSIONS: Significant racial and ethnic disparities in SUID among preterm infants exist with variation across US states. Additional research to identify the drivers of these disparities within and across states is needed.

Defining an Infant's Race and Ethnicity: A Systematic Review.

CONTEXT: Infant race and ethnicity are used ubiquitously in research and reporting, though inconsistent approaches to data collection and definitions yield variable results. The consistency of these data has an impact on reported findings and outcomes. OBJECTIVE: To systematically review and examine concordance among differing race and ethnicity data collection techniques presented in perinatal health care literature. DATA SOURCES: PubMed, CINAHL, and Ovid were searched on June 17, 2021. STUDY SELECTION: English language articles published between 1980 and 2021 were included if they reported on the United States' infant population and compared 2 or more methods of capturing race and/or ethnicity. DATA EXTRACTION: Two authors independently evaluated articles for inclusion and quality, with disagreements resolved by a third reviewer. RESULTS: Our initial search identified 4329 unique citations. Forty articles passed title/abstract review and were reviewed in full text. Nineteen were considered relevant and assessed for quality and bias, from which 12 studies were ultimately included. Discordance in infant race and ethnicity data were common among multiple data collection methods, including those frequently used in perinatal health outcomes research. Infants of color and those born to racially and/or ethnically discordant parents were the most likely to be misclassified across data sources. LIMITATIONS: Studies were heterogeneous in methodology and populations of study and data could not be compiled for analysis. CONCLUSIONS: Racial and ethnic misclassification of infants leads to inaccurate measurement and reporting of infant morbidity and mortality, often underestimating burden in minoritized populations while overestimating it in the non-Hispanic/Latinx white population.

Racial and Ethnic Disparities in Medical Complexity and In-Hospital Death Among US-Born VLBW Infants.

BACKGROUND AND OBJECTIVE: To assess the racial and ethnic disparity in the prevalence of complex chronic conditions (CCC) and/or in-hospital death among US-born very low birth weight (VLBW, <1500 g) infants. METHODS: This retrospective, cross-sectional analysis of discharge data from the Kids' Inpatient Database, included VLBW infants born in US hospitals in 2009 and 2012 (n = 554825, weighted n = 573693) exlcuding those with missing demographics. The main outcome was CCC or death. Multiple logistic regression modeling estimated the association of various characteristics with CCC or death, considering race and ethnicity. RESULTS: There was heterogeneity in the association of insurance status and hospital region and experiencing CCC or death when compared across races and ethnicities. Infants of all races and ethnicities had higher odds of CCC or death if they had an operative procedure, were outborn, or had a birth weight of <500 g or 500 g to 999 g compared with 1000 g to 1499 g. Non-Hispanic Black infants <500 g, however, had the highest odds of CCC or death compared with those 1000 g to 1499 g (adjusted odds ratio 67.2, 95% confidence interval, 48.6-93.0), 2.3 times higher than the odds for non-Hispanic White infants (AOR 2.32, 95% confidence interval, 1.57-3.42). CONCLUSIONS: Insurance and region were associated with increased prevalence of CCC or death in certain racial and ethnic groups. Additionally, non-Hispanic Black infants <500 g had >2.3 times the odds of CCC or death compared with non-Hispanic White infants, relative to infants 1000 g to 1499 g. Additional investigation is needed to understand the drivers of these disparities.

Ventilatory Strategies in Infants with Established Severe Bronchopulmonary Dysplasia: A Multicenter Point Prevalence Study.

We performed a point prevalence study on infants with severe bronchopulmonary dysplasia (BPD), collecting data on type and settings of ventilatory support; 187 infants, 51% of whom were on invasive positive-pressure ventilation (IPPV), from 15 centers were included. We found a significant center-specific variation in ventilator modes.

Impact of Coronavirus Disease-19 "Stay-At-Home" Orders on Preterm Birth in Colorado.

In this retrospective cohort analysis of Colorado birth certificate records from April to December 2015-2020, we demonstrate that Colorado birthing individuals experienced lower adjusted odds of preterm birth after issuance of coronavirus-19 "stay-at-home" orders. However, this positive birth outcome was experienced only by non-Hispanic white and Hispanic mothers.

Prevalence and Predictors of Medical Complexity in a National Sample of VLBW Infants.

BACKGROUND AND OBJECTIVES: Very low birth weight (VLBW) infants are at high risk for morbidities beyond the neonatal period and ongoing use of health care. Specific morbidities have been studied; however, a comprehensive landscape of medical complexity in VLBW infants has not been fully described. We sought to (1) describe the prevalence of complex chronic conditions (CCCs) and (2) determine the association of demographic, hospital, and clinical factors with CCCs and CCCs or death. METHODS: This retrospective cross-sectional analysis of discharge data from the Kids' Inpatient Database (2009-2012) included infants with a birth weight <1500 g and complete demographics. Outcomes included having CCCs or having either CCCs or dying. Analyses were weighted; univariate and multiple logistic regression models were used to estimate unadjusted and adjusted odds ratios. A dominance analysis with Cox-Snell R 2 determined the relative contribution of demographic, hospital, and clinical factors to the outcomes. RESULTS: Among our weighted cohort of >78 000 VLBW infants, >50% had CCCs or died. After adjustments, the prevalence of CCCs or CCCs or death differed by sex, race and ethnicity, hospital location, US region, receipt of surgery, transfer status, and birth weight. Clinical factors accounted for the highest proportion of the model's ability to predict CCCs and CCCs or death at 93.3% and 96.3%, respectively, whereas demographic factors were 11.5% and 2.3% and hospital factors were 5.2% and 1.4%, respectively. CONCLUSIONS: In this nationally representative analysis, medical complexity is high among VLBW infants. Varying contributions of demographic, hospital, and clinical factors in predicting medical complexity offer opportunities to investigate future interventions to improve care delivery and patient outcomes.

Association between Neonatal Intensive Care Unit Admission and Supine Sleep Positioning, Breastfeeding, and Postnatal Smoking among Mothers of Late Preterm Infants.

OBJECTIVE: To evaluate the association between neonatal intensive care unit (NICU) admission and breastfeeding practices, infant supine sleep positioning, and postnatal smoking among mothers of late preterm infants. STUDY DESIGN: Data from 36 states using the 2000-2013 Pregnancy Risk Assessment Monitoring System were analyzed. χ2 tests and 95% CI assessed infant and maternal characteristics and recommended care practices for late preterm infants based on NICU admission after birth. Adjusted prevalence ratios (APR) for breastfeeding initiation and continuation at 10 weeks, supine sleep position, and postnatal smoking were estimated using multivariable logistic regression models, controlling for infant and maternal characteristics. Analyses were weighted and SEs accounted for the complex survey design. RESULTS: Our sample included 62 494 late preterm infants, representing a weighted population of 1 441 451 late preterm infants. In the adjusted analysis, mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding (APR 1.07; 95% CI 1.05-1.09) and place their infants in supine sleep position (1.04; 95% CI 1.01-1.06) than mothers of late preterm infants not admitted to a NICU. There was no significant difference between groups for breastfeeding continuation or postnatal smoking. CONCLUSIONS: Mothers of late preterm infants admitted to a NICU were more likely to initiate breastfeeding and practice supine sleep position than mothers of late preterm infants not admitted to a NICU. Future work should seek to identify the drivers of these differences to develop effective strategies to engage mothers in these health promoting infant care practices.

Readmissions among NICU graduates: Who, when and why?

Readmission amongst previous neonatal intensive care unit (NICU) graduates, especially for preterm infants, is common and remains a significant risk for these infants beyond the neonatal period. This review explores risk factors for readmissions, common reasons for requiring rehospitalization and explores opportunities for improving the transition from discharge to home with the ultimate goal of reducing readmissions for these high risk infants.

Impact of NICU admission on Colorado-born late preterm infants: breastfeeding initiation, continuation and in-hospital breastfeeding practices.

OBJECTIVE: Compare breastfeeding initiation and continuation rates, and in-hospital breastfeeding practices, of late preterm infants (LPIs) cared for in a NICU versus those cared for exclusively in the nursery (non-NICU). STUDY DESIGN: Using data from the 2009-2014 Colorado Pregnancy Risk Assessment Monitoring System (PRAMS), breastfeeding initiation, continuation, and in-hospital breastfeeding practices of NICU versus non-NICU LPIs (34 0/7 to 36 6/7 weeks gestation, n = 20,767) were analyzed, and multivariate models were created controlling for maternal and infant characteristics. RESULTS: Mothers of NICU LPIs were equally likely to initiate breastfeeding (APR 1.0; 95% CI 0.95-1.06) but less likely to continue breastfeeding at 10 weeks (APR 0.86; 95% CI 0.76-0.99) compared to mothers of non-NICU LPIs. Mothers of NICU LPIs were less likely to breastfeed in the hospital, less likely to be told to feed infants on demand, and more likely to be given a breast pump during hospitalization. CONCLUSIONS: There are significant differences in both breastfeeding continuation and several in-hospital breastfeeding practices for NICU versus non-NICU LPIs. Further research is needed so that targeted policies and programs can be developed to improve breastfeeding rates in this vulnerable population.