Michael W. Kuzniewicz, MD, MPH

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

(510) 891-5994 (phone)
michael.w.kuzniewicz@kp.org
Kaiser Permanente Researcher Profiles

Michael Kuzniewicz, MD, MPH, is director of the Perinatal Research Unit at the Kaiser Permanente Northern California Division of Research, and assistant professor in neonatology at the University of California, San Francisco. Dr. Kuzniewicz's research interests include perinatal health services research, clinical epidemiology, and genetic determinants of respiratory distress in neonates.

Current Position(s):

Director, Perinatal Research Unit, Division of Research, Kaiser Permanente Northern California
Assistant Professor, Neonatology, Department of Pediatrics, University of California School of Medicine, San Francisco

Section Affiliations:

Women's and Children's Health

Primary Research Interests:

Perinatal Health Services Research
Perinatal Clinical Epidemiology
Genetic determinants of respiratory distress in neonates

Studies

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.
Investigator: Kuzniewicz, Michael
Funder: Northern California Community Benefit Programs

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.
Investigator: Kuzniewicz, Michael
Funder: National Institute of Child Health and Human Development

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.
Investigator: Kuzniewicz, Michael
Funder:

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.
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.
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.
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.
Investigator: Kuzniewicz, Michael
Funder: GlaxoSmithKline PLC

Highlighted Publications

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

Author(s): 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.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Studies

Predictive Analytics for Newborn Bilirubin Management

MAESTRA: Maternal Antecedents of Encephalopathy in Term Infants

Neurodevelopmental outcomes in infants receiving opioid-replacement

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

Expansion of Division of Research Perinatal Research Unit (EXPPRU)

Improving Post-Discharge Bilirubin Management in Newborns

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

Highlighted Publications

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

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

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use

Publications

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

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

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

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

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

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

Multi-Chain Semi-Markov Analysis of Intrapartum Cardiotocography

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

The Effect of Readmission for Phototherapy on Early Breast Milk Feeding

The effect of hospital phototherapy on early breastmilk feeding

Update on Phototherapy and Childhood Cancer in a Northern California Cohort

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

Predicting the Need for Phototherapy After Discharge

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

Antibiotic stewardship for early-onset sepsis

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

Incremental Cost of Prematurity by Week of Gestational Age

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

Childhood Seizures After Phototherapy

Hyperbilirubinemia, Phototherapy, and Childhood Asthma

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

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

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

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

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

Outcomes of Admissions for Preterm Labor

A Clinical Prediction Rule for Rebound Hyperbilirubinemia Following Inpatient Phototherapy

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

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

Weight Change Nomograms for the First Month After Birth

Phototherapy and Risk of Type 1 Diabetes

Risk of Autism Associated With Hyperbilirubinemia and Phototherapy

Retrospective Cohort Study of Phototherapy and Childhood Cancer in Northern California

Neonatal Phototherapy and Infantile Cancer

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

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

External Validation of Early Weight Loss Nomograms for Exclusively Breastfed Newborns

Incidence of Dravet Syndrome in a US Population

Risk of Sensorineural Hearing Loss and Bilirubin Exchange Transfusion Thresholds

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

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

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

Early weight loss nomograms for formula fed newborns

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

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

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

Early weight loss nomograms for exclusively breastfed newborns

Incidence, Etiology, and Outcomes of Hazardous Hyperbilirubinemia in Newborns

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

Invited Commentary: Does Neonatal Hyperbilirubinemia Cause Asthma?

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

Black Race Is Not Protective Against Hazardous Bilirubin Levels

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

Impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use

No association between hyperbilirubinemia and attention-deficit disorder

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

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