Michael W. Kuzniewicz , MD, MPH

Predictive Analytics for Newborn Bilirubin Management

Our objective is to integrate the bilirubin risk prediction model into the automated bilirubin assessment in the laboratory results and provide follow-up guidance on timing of repeat bilirubin testing. We hypothesize that integration of this model will lead to better risk- stratification and a decline in bilirubin testing without an increase in readmissions for phototherapy or severe hyperbilirubinemia. Our specific aims are to compare the 1) mean number of bilirubin results per infant 2) phototherapy readmissions and 3) incidence of severe hyperbilirubinemia among newborns managed using the bilirubin prediction model and automated follow-up recommendations compared to newborns managed at the discretion of individual physicians.

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Investigator: Kuzniewicz, Michael

Funder: Northern California Community Benefit Programs

Neurodevelopmental outcomes in infants receiving opioid-replacement

Infants with Neonatal Opioid Withdrawal Syndrome (NOWS) are often treated with prolonged opioid-replacement pharmacotherapy. Whether opioid exposure in-utero or significant opioid exposure used to treat withdrawal symptoms impacts neurodevelopmental outcomes is unknown. Our aim is to evaluate neurodevelopmental outcomes at ages 24-72 months in infants who received opioids-replacement pharmacotherapy (treated NOWS infants), compared to those who did not receive pharmacotherapy (untreated NOWS). Our secondary aim is to evaluate maternal demographic and clinical characteristics as potential risk modifiers associated with adverse neurodevelopmental outcomes.

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Investigator: Kuzniewicz, Michael

MAESTRA: Maternal Antecedents of Encephalopathy in Term Infants

This study tests the hypothesis that established NICHD-approved electronic fetal monitoring (EFM) features used as standard care in the U.S. and other developed countries can exhibit improved sensitivity and specificity for predicting HIE when they are combined with novel EFM features that will be discovered by advanced signal processing and machine learning techniques. This study will abstract a large amount of detailed maternal, infant and fetal data from the electronic medical records of infants born at ≥ 36 weeks gestation in 2010-2020 at Kaiser Permanente Northern California.

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Investigator: Kuzniewicz, Michael

Funder: National Institute of Child Health and Human Development

Exogenous surfactant utilization for respiratory failure in late and moderately preterm infants: impact on short- and long-term outcomes

The goal is to define and refine the current epidemiology, clinical characteristics, and treatment practices in respiratory failure in late and moderately preterm Infants. Specific aims include determining the incidence and epidemiology of respiratory failure in the neonates born at 32-36 weeks of gestation, describing disease severity and respiratory support by diagnostic category; describing the use of surfactant replacement therapy; and assessing the impact of surfactant replacement therapy on length of respiratory support, length of hospitalization, and respiratory outcomes in the first year of life.

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Investigator: Kuzniewicz, Michael

Funder: Chiesi USA

Expansion of Division of Research Perinatal Research Unit (EXPPRU)

Dedicated quantitative analytic support for obstetrics has not been available in Kaiser Permanente Northern California. An unusual opportunity has appeared: as a result of a project to develop a predictive model for obstetric complications, considerable development work has been conducted by a Division of Research (DOR) team. If linked to an ongoing program, the DOR Perinatal Research Unit, this development work could permit our region to enhance its ability to conduct sophisticated quantitative quality-assurance and utilization management in obstetrics.

This study will explore the opportunity to expand the extraordinarily successful Perinatal Research Unit so that it could monitor obstetrics, not just neonatology. In addition to the funds requested here, TPMG has committed to providing MD time.

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Investigator: Kuzniewicz, Michael

Funder: Kaiser Permanente Program Offices

Improving Post-Discharge Bilirubin Management in Newborns

There is variation and overuse in bilirubin testing among newborns. Multiple repeat testing occurs despite most newborns being at low risk for reaching bilirubin levels that would require phototherapy. Among the Kaiser Permanente birth population, 45 percent have two or more tests and 10 percent four or more tests. While the tests themselves are relatively inexpensive, the burden on families is significant, given the need to bring their newborns into outpatient clinics for repeat testing and the stress of worrying about hyperbilirubinemia. Evidence-based approaches for repeat testing are lacking. The aims of this study are to develop total serum bilirubin nomograms based upon gestational age, develop predictive models for reaching bilirubin levels above the 95th percentile during the first week of life to guide clinicians on the need and timing of post-discharge bilirubin testing, and assess the utility of bilirubin screening at less than 24 hours of age.

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Investigator: Kuzniewicz, Michael

Funder: Northern California Community Benefit Programs

Medical Burden Associated with Preterm Labor and Preterm Birth in Kaiser Northern California

The aims of this study are to: 1) Characterize women in the Northern California Kaiser Permanente Medical Care Program (KPMCP) who received a diagnosis of preterm labor (PTL) between January 2001 and December 2010 and compare them to women without PTL who deliver at term. 2) Compare maternal and infant outcomes of pregnancies complicated by preterm labor versus those unaffected by PTL. 3) Evaluate the incremental cost of preterm delivery by week of gestational age. 4) Compare the maternal costs of pregnancies with PTL and without PTL.

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Investigator: Kuzniewicz, Michael

Funder: GlaxoSmithKline PLC

NICU Versus Mother/Baby Unit Admission for Low-Acuity Infants Born at 35 Weeks’ Gestation

Authors: Wickremasinghe, Andrea C; Kuzniewicz, Michael W; Walsh, Eileen M; Li, Sherian; Newman, Thomas B

Pediatrics. 2023 Apr 01;151(4).

PubMed abstract

Accuracy of diagnostic codes for prenatal opioid exposure and neonatal opioid withdrawal syndrome

Authors: Kuzniewicz, Michael W; Campbell, Cynthia I; Li, Sherian; Walsh, Eileen M; Croen, Lisa A; Comer, Sandra D; Pimentel, Samuel D; Hedderson, Monique; Sun, Lena S

J Perinatol. 2023 Mar;43(3):293-299. Epub 2022-09-21.

PubMed abstract

Placental Histopathologic Findings of a Large Cohort of Patients With SARS-CoV-2 Infection During Pregnancy

Authors: Lin, Ruby; Forquer, Heather; Cviko-Pajt, Aida; Schauer, Galen M; Abellar, Rosanna G; Hedderson, Monique; Kuzniewicz, Michael W; Greenberg, Mara B

Int J Gynecol Pathol. 2023 Jan 25.

PubMed abstract

Prenatal Opioid Exposure and Neurodevelopmental Outcomes

Authors: Lee, Jennifer J; Saraiya, Neeta; Kuzniewicz, Michael W

J Neurosurg Anesthesiol. 2023 Jan 01;35(1):142-146. Epub 2022-12-06.

PubMed abstract

The clinical burden of extremely preterm birth in a large medical records database in the United States: complications, medication use, and healthcare resource utilization

Authors: Siffel, Csaba; Hirst, Andrew K; Sarda, Sujata P; Chen, Hong; Ferber, Jeannette; Kuzniewicz, Michael W; Li, De-Kun

J Matern Fetal Neonatal Med. 2022 Dec;35(26):10271-10278. Epub 2022-09-28.

PubMed abstract

Time to positivity of blood cultures in neonatal late-onset bacteraemia

Authors: Mukhopadhyay, Sagori; Briker, Sara M; Flannery, Dustin D; Dhudasia, Miren B; Coggins, Sarah A; Woodford, Emily; Walsh, Eileen M; Li, Sherian; Puopolo, Karen M; Kuzniewicz, Michael W

Arch Dis Child Fetal Neonatal Ed. 2022 Nov;107(6):583-588. Epub 2022-03-10.

PubMed abstract

Predicting the Need for Phototherapy After Discharge: Update for 2022 Phototherapy Guidelines

Authors: Kuzniewicz, Michael W; Li, Sherian Xu; McCulloch, Charles E; Newman, Thomas B

Pediatrics. 2022 09 01;150(3).

PubMed abstract

Adverse short- and long-term outcomes among infants with mild neonatal encephalopathy

Authors: Akula, Vishnu-Priya; Sriram, Achyuth; Xu, Sherian; Walsh, Eileen; Van Meurs, Krisa; Cranshaw, Matthew; Kuzniwiecz, Michael

Pediatr Res. 2022 Aug 23.

PubMed abstract

The clinical burden of extremely preterm birth in a large medical records database in the United States: Mortality and survival associated with selected complications

Authors: Siffel, Csaba; Hirst, Andrew K; Sarda, Sujata P; Kuzniewicz, Michael W; Li, De-Kun

Early Hum Dev. 2022 08;171:105613. Epub 2022-06-22.

PubMed abstract

Multi-Chain Semi-Markov Analysis of Intrapartum Cardiotocography

Authors: Vargas-Calixto, Johann; Wu, Yvonne; Kuzniewicz, Michael; Cornet, Marie-Coralie; Forquer, Heather; Gerstley, Lawrence; Hamilton, Emily; Warrick, Philip A; Kearney, Robert E

Annu Int Conf IEEE Eng Med Biol Soc. 2022 Jul;2022:1948-1952.

PubMed abstract

The Effect of Readmission for Phototherapy on Early Breast Milk Feeding

Authors: Digitale, Jean C; Chang, Pearl W; Li, Sherian X; Kuzniewicz, Michael W; Newman, Thomas B

Hosp Pediatr. 2022 05 01;12(5):e146-e153.

PubMed abstract

Perinatal Complications in Individuals in California With or Without SARS-CoV-2 Infection During Pregnancy

Authors: Ferrara, Assiamira; Hedderson, Monique M; Zhu, Yeyi; Avalos, Lyndsay A; Kuzniewicz, Michael W; Myers, Laura C; Ngo, Amanda L; Gunderson, Erica P; Ritchie, Jenna L; Quesenberry, Charles P; Greenberg, Mara

JAMA Intern Med. 2022 05 01;182(5):503-512.

PubMed abstract

Update on Phototherapy and Childhood Cancer in a Northern California Cohort

Authors: Digitale, Jean C; Kim, Mi-Ok; Kuzniewicz, Michael W; Newman, Thomas B

Pediatrics. 2021 11;148(5). Epub 2021-10-29.

PubMed abstract

The effect of hospital phototherapy on early breastmilk feeding

Authors: Digitale, Jean C; Chang, Pearl W; Li, Sherian X; Kuzniewicz, Michael W; Newman, Thomas B

Paediatr Perinat Epidemiol. 2021 11;35(6):717-725. Epub 2021-06-29.

PubMed abstract

Use of Complete Blood Cell Count Components to Screen for Hereditary Spherocytosis in Neonates

Authors: Weiss, Nicole M; Kuzniewicz, Michael W; Shimano, Kristin A; Walsh, Eileen M; Newman, Thomas B

Pediatrics. 2021 09;148(3). Epub 2021-08-10.

PubMed abstract

Predicting the Need for Phototherapy After Discharge

Authors: Kuzniewicz, Michael W; Park, Jina; Niki, Hamid; Walsh, Eileen M; McCulloch, Charles E; Newman, Thomas B

Pediatrics. 2021 05;147(5).

PubMed abstract

COVID-19 prevalence, symptoms, and sociodemographic disparities in infection among insured pregnant women in Northern California

Authors: Ames, Jennifer L; Ferrara, Assiamira; Avalos, Lyndsay A; Badon, Sylvia E; Greenberg, Mara B; Hedderson, Monique M; Kuzniewicz, Michael W; Young-Wolff, Kelly C; Zerbo, Ousseny; Zhu, Yeyi; Croen, Lisa A; et al.

PLoS One. 2021;16(9):e0256891. Epub 2021-09-03.

PubMed abstract

Antibiotic stewardship for early-onset sepsis

Authors: Kuzniewicz, Michael W; Puopolo, Karen M

Semin Perinatol. 2020 Dec;44(8):151325. Epub 2020-10-12.

PubMed abstract

Time to Positivity of Neonatal Blood Cultures for Early-onset Sepsis

Authors: Kuzniewicz MW; Mukhopadhyay S; Li S; Walsh EM; Puopolo KM

Pediatr Infect Dis J. 2020 07;39(7):634-640.

PubMed abstract

Incremental Cost of Prematurity by Week of Gestational Age

Authors: Walsh EM; Li SX; Black LK; Kuzniewicz M

AJP Rep. 2019 Jan;9(1):e76-e83. Epub 2019-03-19.

PubMed abstract

Antenatal and Intrapartum Risk Factors for Hypoxic-Ischemic Encephalopathy in a US Birth Cohort

Authors: Parker SJ; Kuzniewicz M; Niki H; Wu YW

J Pediatr. 2018 12;203:163-169. Epub 2018-09-27.

PubMed abstract

Hyperbilirubinemia, Phototherapy, and Childhood Asthma

Authors: Kuzniewicz MW; Niki H; Walsh EM; McCulloch CE; Newman TB

Pediatrics. 2018 10;142(4). Epub 2018-09-12.

PubMed abstract

Childhood Seizures After Phototherapy

Authors: Newman TB; Wu YW; Kuzniewicz MW; Grimes BA; McCulloch CE

Pediatrics. 2018 10;142(4).

PubMed abstract

Health Care Utilization in the First Month after Birth and Its Relationship to Newborn Weight Loss and Method of Feeding

Authors: Flaherman V; Schaefer EW; Kuzniewicz MW; Li SX; Walsh EM; Paul IM

Acad Pediatr. 2018 08;18(6):677-684. Epub 2017-12-02.

PubMed abstract

Comparison of Collaborative Versus Single-Site Quality Improvement to Reduce NICU Length of Stay

Authors: Lee HC; Kuzniewicz M; Sharek PJ; et al.

Pediatrics. 2018 07;142(1). Epub 2018-06-13.

PubMed abstract

Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy

Authors: Wickremasinghe AC; Kuzniewicz MW; McCulloch CE; Newman TB

JAMA Pediatr. 2018 04 01;172(4):378-385.

PubMed abstract

Accuracy of international classification of diseases, ninth revision, codes for postpartum hemorrhage among women undergoing cesarean delivery

Authors: Butwick AJ; Walsh EM; Kuzniewicz M; Li SX; Escobar GJ

Transfusion. 2018 04;58(4):998-1005. Epub 2018-01-26.

PubMed abstract

Outcomes of Admissions for Preterm Labor

Authors: Kuzniewicz MW; Black L; Walsh EM; Li SX; Greenberg M

AJP Rep. 2017 Apr;7(2):e106-e113. Epub 2017-06-22.

PubMed abstract

A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis

Authors: Kuzniewicz MW; Puopolo KM; Fischer A; Walsh EM; Li S; Newman TB; Kipnis P; Escobar GJ

JAMA Pediatr. 2017 Apr 01;171(4):365-371.

PubMed abstract

A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy

Authors: Chang PW; Kuzniewicz MW; McCulloch CE; Newman TB

Pediatrics. 2017 Mar;139(3). Epub 2017-02-14.

PubMed abstract

Trends and racial and ethnic disparities in the prevalence of pregestational type 1 and type 2 diabetes in Northern California: 1996-2014

Authors: Peng TY; Ehrlich SF; Crites Y; Kitzmiller JL; Kuzniewicz MW; Hedderson MM; Ferrara A

Am J Obstet Gynecol. 2017 Feb;216(2):177.e1-177.e8. Epub 2016-10-15.

PubMed abstract

Newborn Weight Loss During Birth Hospitalization and Breastfeeding Outcomes Through Age 1 Month

Authors: Flaherman VJ; Schaefer EW; Kuzniewicz MK; Li S; Walsh E; Paul IM

J Hum Lact. 2017 Feb;33(1):225-230. Epub 2017-01-20.

PubMed abstract

Weight Change Nomograms for the First Month After Birth

Authors: Paul IM; Schaefer EW; Miller JR; Kuzniewicz MW; Li SX; Walsh EM; Flaherman VJ

Pediatrics. 2016 Dec;138(6). Epub 2016-11-09.

PubMed abstract

Phototherapy and Risk of Type 1 Diabetes

Authors: Newman TB; Wickremasinghe AC; Walsh EM; Grimes BA; McCulloch CE; Kuzniewicz MW

Pediatrics. 2016 Nov;138(5). Epub 2016-10-19.

PubMed abstract

Risk of Autism Associated With Hyperbilirubinemia and Phototherapy

Authors: Wu YW; Kuzniewicz MW; Croen L; Walsh EM; McCulloch CE; Newman TB

Pediatrics. 2016 Oct;138(4).

PubMed abstract

Association Between Laboratory Calibration of a Serum Bilirubin Assay, Neonatal Bilirubin Levels, and Phototherapy Use

Authors: Kuzniewicz MW; Greene DN; Walsh EM; McCulloch CE; Newman TB

JAMA Pediatr. 2016 Jun 01;170(6):557-61.

PubMed abstract

Neonatal Phototherapy and Infantile Cancer

Authors: Wickremasinghe AC; Kuzniewicz MW; Grimes BA; McCulloch CE; Newman TB

Pediatrics. 2016 Jun;137(6).

PubMed abstract

Retrospective Cohort Study of Phototherapy and Childhood Cancer in Northern California

Authors: Newman TB; Wickremasinghe AC; Walsh EM; Grimes BA; McCulloch CE; Kuzniewicz MW

Pediatrics. 2016 Jun;137(6).

PubMed abstract

Development and Implementation of an Early-Onset Sepsis Calculator to Guide Antibiotic Management in Late Preterm and Term Neonates

Authors: Kuzniewicz MW; Walsh EM; Li S; Fischer A; Escobar GJ

Jt Comm J Qual Patient Saf. 2016 May;42(5):232-9.

PubMed abstract

External Validation of Early Weight Loss Nomograms for Exclusively Breastfed Newborns

Authors: Schaefer EW; Flaherman VJ; Kuzniewicz MW; Li SX; Walsh EM; Paul IM

Breastfeed Med. 2015 Dec;10(10):458-63. Epub 2015-11-13.

PubMed abstract

Incidence of Dravet Syndrome in a US Population

Authors: Wu YW; Sullivan J; McDaniel SS; Meisler MH; Walsh EM; Li SX; Kuzniewicz MW

Pediatrics. 2015 Nov;136(5):e1310-5. Epub 2015-10-05.

PubMed abstract

Risk of Sensorineural Hearing Loss and Bilirubin Exchange Transfusion Thresholds

Authors: Wickremasinghe AC; Risley RJ; Kuzniewicz MW; Wu YW; Walsh EM; Wi S; McCulloch CE; Newman TB

Pediatrics. 2015 Sep;136(3):505-12. Epub 2015-08-17.

PubMed abstract

Neonatal Neurocritical Care Service Is Associated With Decreased Administration of Seizure Medication

Authors: Wietstock SO; Bonifacio SL; McCulloch CE; Kuzniewicz MW; Glass HC

J Child Neurol. 2015 Aug;30(9):1135-41. Epub 2014-11-07.

PubMed abstract

Differentiating Sepsis From Adverse Events After Immunization in the Neonatal Intensive Care Unit: How Is a Physician to Know?

Authors: Kuzniewicz MW; Klein NP

JAMA Pediatr. 2015 Aug;169(8):718-9.

PubMed abstract

Gestational Thyrotoxicosis, Antithyroid Drug Use and Neonatal Outcomes within an Integrated Healthcare Delivery System

Authors: Lo JC; Rivkees SA; Chandra M; Gonzalez JR; Korelitz JJ; Kuzniewicz MW

Thyroid. 2015 Jun;25(6):698-705. Epub 2015-04-14.

PubMed abstract

Early weight loss nomograms for formula fed newborns

Authors: Miller JR; Flaherman VJ; Schaefer EW; Kuzniewicz MW; Li SX; Walsh EM; Paul IM

Hosp Pediatr. 2015 May;5(5):263-8.

PubMed abstract

A Randomized Clinical Trial of Therapeutic Hypothermia Mode during Transport for Neonatal Encephalopathy

Authors: Akula VP; Kuzniewicz M; Van Meurs K; et al.

J Pediatr. 2015 Apr;166(4):856-61.e1-2. Epub 2015-02-12.

PubMed abstract

Follow-up of extreme neonatal hyperbilirubinemia: more reassuring results from Denmark

Authors: Newman TB; Kuzniewicz MW

Dev Med Child Neurol. 2015 Apr;57(4):314-5. Epub 2014-10-28.

PubMed abstract

Risk for Cerebral Palsy in Infants With Total Serum Bilirubin Levels at or Above the Exchange Transfusion Threshold: A Population-Based Study

Authors: Wu YW; Kuzniewicz MW; Wickremasinghe AC; Walsh EM; Wi S; McCulloch CE; Newman TB

JAMA Pediatr. 2015 Mar;169(3):239-46.

PubMed abstract

Early weight loss nomograms for exclusively breastfed newborns

Authors: Flaherman VJ; Schaefer EW; Kuzniewicz MW; Li SX; Walsh EM; Paul IM

Pediatrics. 2015 Jan;135(1):e16-23. Epub 2014-12-01.

PubMed abstract

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

Authors: Kuzniewicz MW; Wickremasinghe AC; Wu YW; McCulloch CE; Walsh EM; Wi S; Newman TB

Pediatrics. 2014 Sep;134(3):504-9. Epub 2014-08-04.

PubMed abstract

Prevalence and Neonatal Factors Associated with Autism Spectrum Disorders in Preterm Infants

Authors: Kuzniewicz MW; Wi S; Qian Y; Walsh EM; Armstrong MA; Croen LA

J Pediatr. 2014 Jan;164(1):20-5. Epub 2013-10-22.

PubMed abstract

Invited Commentary: Does Neonatal Hyperbilirubinemia Cause Asthma?

Authors: Kuzniewicz MW; Wickremasinghe AC; Newman TB

Am J Epidemiol. 2013 Dec 15;178(12):1698-701. Epub 2013-10-31.

PubMed abstract

Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants

Authors: Kuzniewicz MW; Parker SJ; Schnake-Mahl A; Escobar GJ

Clin Perinatol. 2013 Dec;40(4):753-75. Epub 2013-09-20.

PubMed abstract

Black Race Is Not Protective Against Hazardous Bilirubin Levels

Authors: Wickremasinghe AC; Kuzniewicz MW; Newman TB

J Pediatr. 2013 May;162(5):1068-9. Epub 2013 Feb 10.

PubMed abstract

Increased risk for respiratory distress among white, male, late preterm and term infants

Authors: Anadkat JS; Kuzniewicz MW; Chaudhari BP; Cole FS; Hamvas A

J Perinatol. 2012 Oct;32(10):780-5. Epub 2012 Jan 5.

PubMed abstract

Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use

Authors: Kuzniewicz MW; Escobar GJ; Newman TB

Pediatrics. 2009 Oct;124(4):1031-9. Epub 2009 Sep 28.

PubMed abstract

No association between hyperbilirubinemia and attention-deficit disorder

Authors: Kuzniewicz M; Escobar GJ; Newman TB

Pediatrics. 2009 Feb;123(2):e367-8.

PubMed abstract

Risk factors for severe hyperbilirubinemia among infants with borderline bilirubin levels: a nested case-control study

Authors: Kuzniewicz MW; Escobar GJ; Wi S; Liljestrand P; McCulloch C; Newman TB

J Pediatr. 2008 Aug;153(2):234-40. Epub 2008 Mar 21.

PubMed abstract

Incorporation of physiological trend and interaction effects in neonatal severity of illness scores: an experiment using a variant of the Richardson score

Authors: Kuzniewicz M; Draper D; Escobar GJ

Intensive Care Med. 2007 Sep;33(9):1602-8. Epub 2007 Jun 19.

PubMed abstract