To estimate the effect of NICU admission of low-acuity infants born at 35 weeks' gestation versus care in a mother/baby unit, on inpatient and outpatient medical outcomes. This retrospective cohort study included 5929 low-acuity infants born at 350/7 to 356/7…
Determine the accuracy of diagnostic codes in identifying Prenatal Opioid Exposure (POE) and Neonatal Opioid Withdrawal Syndrome (NOWS). A cross-sectional study of 374,222 mother-infant dyads with delivery from 01/01/2010 to 12/31/2019. We ascertained maternal diagnostic codes for opioid use during…
Pregnant individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at a higher risk for adverse pregnancy outcomes. Previous small cohort studies have shown increased frequency of placental lesions associated with maternal vascular malperfusion, fetal vascular malperfusion, and inflammation…
The opioid epidemic in the United States has resulted in a significant increase in opioid use disorder among pregnant women and a concomitant increase in the incidence of neonatal opioid withdrawal syndrome. The long-term consequences of prenatal opioid exposure on…
Approximately 5% of global preterm births are extremely premature (EP), defined as occurring at less than 28?weeks gestational age. Advances in care have led to an increase in the survival of EP infants during the neonatal period. However, EP infants…
To determine the time to positivity (TTP) of blood cultures among infants with late-onset bacteraemia and predictors of TTP >36 hours. Retrospective cohort study. 16 birth centres in two healthcare systems. Infants with positive blood cultures obtained >72 hours after birth. The…
Studies in newborns with mild neonatal encephalopathy (mNE) demonstrated normal outcomes, but recent literature suggests otherwise. This retrospective cohort study examined inborn infants between 2014 and 2017. Biochemical and clinical characteristics determined the presence of NE and an encephalopathy score…
Preterm birth is a leading cause of infant mortality, particularly for those born extremely prematurely (EP;
Visual assessment of the evolution of fetal heart rate (FHR) and uterine pressure (UP) patterns is the standard of care in the intrapartum period. Unfortunately, this assessment has high levels of intra- and inter-observer variability. This study processed and analyzed…
Additional research from population-based studies is needed to inform the treatment of SARS-CoV-2 infection during pregnancy and to provide health risk information to pregnant individuals. To assess the risk of perinatal complications associated with SARS-CoV-2 infection and to describe factors…
To estimate the effect of readmission for inpatient phototherapy on parent-reported exclusive and any breast milk feeding at 2-month well-child visits. We performed a retrospective cohort study using electronic health record data. From births at 16 Kaiser Permanente Northern California…
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…
The effect of phototherapy on breastmilk feeding is unclear. To estimate the effect of inpatient phototherapy on breastmilk feeding at 2-month well-child visits. We performed a retrospective cohort study using electronic health record data. From births at 16 Kaiser Permanente Northern…
We aimed to reassess the relationship between phototherapy and cancer in an extended version of a previous cohort and to replicate a report from Quebec of increased cancer risk after phototherapy beginning at age 4 years. This cohort study included…
The neonatal hereditary spherocytosis (HS) index, defined as the mean corpuscular hemoglobin concentration divided by the mean corpuscular volume, has been proposed as a screening tool for HS in neonates. In a population of mostly white infants, an HS Index…
Bilirubin screening before discharge is performed to identify neonates at risk for future hyperbilirubinemia. The American Academy of Pediatrics recommends using a graph of bilirubin levels by age (the Bhutani Nomogram) to guide follow-up and a different graph to determine…
Research on COVID-19 during pregnancy has mainly focused on women hospitalized for COVID-19 or other reasons during their pregnancy. Little is known about COVID-19 in the general population of pregnant women. To describe the prevalence of COVID-19, symptoms, consequent healthcare…
Antibiotics are administered to the vast majority of preterm newborns and to a substantial proportion of term infants in the hours after birth due to risk for early-onset sepsis. The approaches taken to determine which newborns should be evaluated for…
In newborns at risk for early-onset sepsis, empiric antibiotics are often initiated while awaiting the results of blood cultures. The duration of empiric therapy can be guided by the time to positivity (TTP) of blood cultures. The objective of the…
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…
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…
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…
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…
Objective This study was aimed to compare health care costs and utilization at birth through 1 year, between preterm and term infants, by week of gestation. Methods A cross-sectional study of infants born at ≥ 23 weeks of gestational age (GA) at Kaiser…
To identify risk factors for hypoxic-ischemic encephalopathy (HIE) within a recent US birth cohort. In a retrospective cohort study of 44 572 singleton infants ?36 weeks of gestation born at Kaiser Permanente Northern California in 2008-2015, we identified all infants…
Our aim was to quantify the associations of both hyperbilirubinemia and phototherapy with childhood asthma using a population-based cohort with total serum bilirubin (TSB) levels. Retrospective cohort study of infants born at ?35 weeks' gestation in the Kaiser Permanente Northern…
: media-1vid110.1542/5804915133001PEDS-VA_2018-0648Video Abstract BACKGROUND AND OBJECTIVES: In a recent Danish study, researchers found an increased risk of childhood epilepsy after phototherapy but only in boys. We investigated this association in a Kaiser Permanente Northern California cohort. From 499?642 infants born…
Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated…
There is unexplained variation in length of stay (LOS) across NICUs, suggesting that there may be practices that can optimize LOS. Three groups of NICUs in the California Perinatal Quality Care Collaborative were followed: (1) collaborative centers participating in an…
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…
Determining the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes for postpartum hemorrhage (PPH) is vital for reaching valid conclusions about the epidemiology of PPH. Our primary objectives were to assess the performance characteristics of ICD-9…
Treatment of jaundiced newborns with subthreshold phototherapy (phototherapy given to newborns with bilirubin levels below those recommended in American Academy of Pediatrics [AAP] guidelines) is common. However, the use of subthreshold phototherapy may have risks and increase costs, and, to…
Current algorithms for management of neonatal early-onset sepsis (EOS) result in medical intervention for large numbers of uninfected infants. We developed multivariable prediction models for estimating the risk of EOS among late preterm and term infants based on objective data…
Objective This study aims to quantitate the incidence of preterm labor (PTL) admissions and determine the frequency and predictors of preterm delivery (PTD) during these admissions. Study Design Retrospective cohort of singleton pregnancies within Kaiser Permanente Northern California, 2001 to…
The American Academy of Pediatrics provides little guidance on when to discontinue phototherapy in newborns treated for hyperbilirubinemia. We sought to develop a prediction rule to estimate the probability of rebound hyperbilirubinemia after inpatient phototherapy. Subjects for this retrospective cohort…
Weight loss is universal for exclusively breastfed newborns in the first few days after birth. Many newborns exclusively breastfed during birth hospitalization receive formula in the first month after discharge and thus cease exclusive breastfeeding. However, the relationship between early…
Despite concern for adverse perinatal outcomes in women with diabetes mellitus before pregnancy, recent data on the prevalence of pregestational type 1 and type 2 diabetes mellitus in the United States are lacking. The purpose of this study was to…
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…
Clinicians expect newborns to surpass birth weight by age 10 to 14 days, yet few studies have examined the natural history of weight change in the weeks after birth. We sought to determine the distribution of weight loss and subsequent…
Increases in both phototherapy use and the incidence of type 1 diabetes mellitus (DM-1) have been reported. One large study has suggested a strong association between them. Our objective was to quantify any association between neonatal phototherapy and DM-1 in…
Whether neonatal hyperbilirubinemia and/or phototherapy increase the risk of autism spectrum disorder (ASD) is unclear. We sought to quantify the risk of ASD associated with elevated total serum bilirubin (TSB) levels and with phototherapy. In a retrospective cohort study of…
To determine whether neonatal phototherapy is associated with cancer in the first year after birth. We analyzed a data set from the California Office of Statewide Health Planning and Development that was created by linking birth certificates, death certificates, and…
The American Academy of Pediatrics treatment recommendations for neonatal jaundice are based on age-specific total serum bilirubin (TSB) levels. In May 2012, Ortho Clinical Diagnostics adjusted the calibrator values for Vitros Chemistry Products BuBc Slides (Ortho Clinical Diagnostics), a widely…
To investigate the association between neonatal phototherapy use and childhood cancer. This retrospective cohort study included 499?621 children born at ?35 weeks' gestation from 1995 to 2011 in Kaiser Permanente Northern California hospitals, who survived to hospital discharge and were…
Nomograms that show hour-by-hour percentiles of weight loss during the birth hospitalization were recently developed to aid clinical care of breastfeeding newborns. The nomograms for breastfed neonates were based on a sample of 108,907 newborns delivered at 14 Kaiser Permanente…
De novo mutations of the gene sodium channel 1? (SCN1A) are the major cause of Dravet syndrome, an infantile epileptic encephalopathy. US incidence of DS has been estimated at 1 in 40?000, but no US epidemiologic studies have been performed…
High bilirubin levels are associated with sensorineural hearing loss (SNHL). However, few large studies of relative and excess risk exist. We sought to quantify the risk of SNHL in newborns who had bilirubin levels at or above American Academy of…
This cohort study examines medication use in term neonates with hypoxic-ischemic encephalopathy and seizures before and after implementation of a Neonatal Neurocritical Care Service (N = 108), which included increased seizure monitoring. Nearly all neonates received phenobarbital (96% pre- vs…
Increasing attention has focused on the prevalence and outcomes of hyperthyroidism in pregnancy, given concerns for hepatotoxicity and embryopathy associated with antithyroid drugs (ATDs). In an integrated health care delivery system, we examined the prevalence of thyrotoxicosis and gestational ATD…
To develop nomograms depicting percentiles of weight loss by hour of age for both vaginal and cesarean-delivered newborns who are exclusively formula fed. Data regarding delivery mode, race/ethnicity, feeding type, and weights were extracted from electronic medical records of the…
To determine if temperature regulation is improved during neonatal transport using a servo-regulated cooling device when compared with standard practice. We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive…
Exchange transfusion is recommended for newborns with total serum bilirubin (TSB) levels thought to place them at risk for cerebral palsy (CP). However, the excess risk for CP among these infants is unknown. To quantify the risks for CP and…
The majority of newborns are exclusively breastfed during the birth hospitalization, and weight loss is nearly universal for these neonates. The amount of weight lost varies substantially among newborns with higher amounts of weight loss increasing risk for morbidity. No…
Total serum bilirubin (TSB) levels ? 30 mg/dL are rare but potentially hazardous. A better understanding of their incidence, causes, and outcomes could help inform preventive efforts. We identified infants born ? 35 weeks' gestational age from 1995-2011 in Kaiser…
To determine the prevalence of autism spectrum disorders (ASD) across gestational age, examine the risk of ASD by gestational age controlling for other risk factors, and identify potential risk factors in the neonatal intensive care unit. A retrospective cohort of…
In an analysis of data from the US Collaborative Perinatal Project, Huang et al. (Am J Epidemiol. 2013;178(12):1691-1697) report an association between neonatal total serum bilirubin levels and childhood asthma. To consider the implications of this finding, we need to…
The increased vulnerability of late preterm infants is no longer a novel concept in neonatology, with many studies documenting excess morbidity and mortality in these infants during the birth hospitalization. Because outcomes related to gestational age constitute a continuum, it…
Although black race is considered protective against hyperbilirubinemia, black infants appear at increased risk of kernicterus. We found that although black infants have a lower risk of developing total serum bilirubin levels >/= 20 mg/dL than white infants, they appear…
OBJECTIVE: To determine whether race/ethnicity and sex independently increase risk of respiratory distress syndrome (RDS) in late preterm and term infants. STUDY DESIGN: Using a cohort design, we studied the risk of RDS associated with race/ethnicity and sex in infants…
OBJECTIVE: The goal was to assess the impact of universal bilirubin screening on severe hyperbilirubinemia and phototherapy use. METHODS: In this retrospective cohort study of 358086 infants of > or =35 weeks and > or =2000 g born between January…
OBJECTIVE: To estimate the effect of phototherapy and other predictors on the risk of total serum bilirubin (TSB) >or= 25 mg/dL in infants with a TSB of 17 to 22.9 mg/dL at age >or= 48 hours. STUDY DESIGN: From a…
OBJECTIVE: To evaluate whether physiological trends and interaction terms could enhance predictive ability in a variant of the Richardson Score. METHOD: We conducted a retrospective cohort study using data from 2,222 newborns of 34 weeks or more gestation with respiratory…
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