Publications by authors named "McAdams R"

Article Synopsis
  • Artificial intelligence (AI) is increasingly being used in healthcare, particularly in neonatal intensive care units (NICUs), where large data sets can improve the diagnosis and treatment of conditions like sepsis and bronchopulmonary dysplasia.
  • The article discusses various machine learning (ML) models, their development process, and the need for a standardized framework to evaluate their performance in clinical settings, emphasizing how this understanding is key for effective implementation.
  • Challenges such as ensuring model generalizability, ethical issues, and the importance of regular performance monitoring are highlighted, along with future directions calling for collaboration and equitable access to AI technologies in healthcare.
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Background: Predicting mortality risk in neonatal intensive care units (NICUs) is challenging due to complex, variable clinical and physiological data. Machine learning (ML) offers potential for more accurate risk stratification.

Objective: To compare the performance of various ML models in predicting NICU mortality using a team-based modeling competition.

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Objective: This study aimed to develop an artificial intelligence (AI) method to augment video laryngoscopy (VL) by automating the detection of the glottic opening in neonates, as a step toward future studies on improving intubation outcomes.

Study Design: A deep learning model, YOLOv8, was trained on 1623 video frames from 84 neonatal intubations to detect the glottic opening and evaluated using 14-fold cross-validation on metrics like precision and recall. Additionally, it was compared with 25 medical providers of varied intubation experience to assess its relative performance.

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The development of fetal organs can be impacted by systemic changes in maternal circulation, with the placenta playing a pivotal role in maintaining pregnancy homeostasis and nutrient exchange. In clinical obstetrics, oxytocin (OXT) is commonly used to induce labor. To explore the potential role of OXT in the placental homeostasis of OXT, we compared OXT levels in neonatal cord blood among neonates (23-42 weeks gestation) whose mothers either received prenatal OXT or experienced spontaneous labor.

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Objective: This pilot implementation study introduces a novel, neonatal-specific virtual reality (VR) simulation platform for resuscitation training and assesses its initial feasibility and reception in a neonatal intensive care unit setting.

Study Design: We developed a custom VR model simulating a resuscitation scenario for a 30-week neonate. Neonatal providers completed individualized training sessions and post-training surveys.

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Article Synopsis
  • Delayed cord clamping (DCC) is a common practice during preterm births, but its effects on kidney health are uncertain.
  • A study evaluated DCC against early cord clamping (ECC) in preterm infants, focusing on acute kidney injury (AKI) and kidney function at two years.
  • Findings indicated that DCC did not reduce the risk of AKI but was linked to a significantly higher chance of reduced kidney function (eGFR <90 mL/min/1.73m) after two years.
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Purpose: To examine Pinterest pins to discern the content, messaging and claims, and engagement with pins regarding formula hacking and homemade formula.

Background: The American Academy of Pediatrics and the Centers for Disease Control and Prevention discourage formula hacking (ie, preparing formula not according to directions to extend its use) and making homemade infant formula due to its associated health risks. Yet, caregivers are using social media platforms to find information on these topics.

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In this article, we investigate the incorporation of virtual reality (VR) into Neonatal Resuscitation Program (NRP) training. We describe the potential advantages and challenges of the use of VR with NRP. We compare conventional training approaches to VR-based simulation, reviewing diverse VR platforms and their specific roles in neonatal resuscitation education.

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Background: Delayed cord clamping (DCC) occurs in most preterm births.

Objective: Evaluate the association of DCC with acute kidney injury (AKI) and two-year kidney outcomes.

Methods: Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates born 24 to 27 weeks' gestation.

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Early-life exposure to stress results in significantly increased risk of neurodevelopmental impairments with potential long-term effects into childhood and even adulthood. As a crucial step towards monitoring neonatal stress in neonatal intensive care units (NICUs), our study aims to quantify the duration, frequency, and physiological responses of care manipulation activities, based on bedside videos and physiological signals. Leveraging 289 h of video recordings and physiological data within 330 sessions collected from 27 neonates in 2 NICUs, we develop and evaluate a deep learning method to detect manipulation activities from the video, to estimate their duration and frequency, and to further integrate physiological signals for assessing their responses.

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Artificial intelligence (AI) offers potential benefits in the interconnected fields of obstetrics, maternal-fetal medicine, and neonatology to bridge disciplinary silos for a unified approach. Artificial intelligence has the capacity to improve diagnostic accuracy and clinical decision making for the birthing parent-neonate dyad. There is an inherent risk of ingrained biases in AI that perpetuate existing inequalities; thus, care must be taken to include diverse data sets with interdisciplinary collaboration that centers equitable AI implementation.

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Objectives: To understand tension mothers experience when attempting to follow American Academy of Pediatrics safe sleep guidelines and enhancing infant and parental sleep.

Methods: Surveys and focus groups were conducted from November 2022 and March 2023 with United States-based English-speaking mothers of infants <6 months of age recruited via social media and who reported a nonrecommended sleep position and/or location ≥2 times the prior week.

Results: Twenty-five mothers participated in focus groups and surveys.

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Objective:  This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers.

Study Design:  This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC).

Results:  Survey response rate was 76%, and 97% of respondents had a formal NDFU program.

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Article Synopsis
  • AI has the potential to significantly improve neonatology through better diagnostics, personalized treatments, and proactive care, but several challenges must be addressed before it can be implemented in clinical settings.
  • Ethical concerns and biases related to AI in healthcare are important to consider, and understanding these issues is essential for responsible integration in neonatology.
  • Ongoing research is exploring various AI applications, such as predicting sepsis and analyzing medical images, and fostering collaboration among stakeholders is vital to realize AI's full potential in neonatal care.
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This study evaluates the epidemiology of nonfatal head injuries among children aged 1 to 4 years associated with consumer products and identifies the specific consumer products associated with these injuries. Data for children aged 1 to 4 years who presented to emergency departments (EDs) from 2015 to 2019 for a nonfatal head injury were extracted from the National Electronic Injury Surveillance System. An estimated 1 032 429 (95% confidence interval [CI]: 675 822-1 389 063) children presented to US EDs for head injuries, averaging 566 injuries daily.

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Sleep deprivation is a major challenge for neonatologists, who face increasing demands in the complex healthcare system. Current neonatal intensive care unit (NICU) schedule models often include extended shifts and overnight call, which can lead to sleep deprivation. This lack of sufficient sleep poses adverse health risks to neonatologists and can impair cognitive function, which increases the risk of medical errors and compromises patient safety.

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Article Synopsis
  • Participation in martial arts has grown significantly, with millions of children involved, but the most thorough study of related injuries was conducted nearly 20 years ago.
  • A study analyzed data from 2004 to 2021, revealing around 176,947 children were treated for martial arts injuries in US emergency departments, with injury rates peaking in 2013 and showing a decrease by 2021.
  • Common injuries were strains/sprains, particularly in children aged 6-11, and competitive events had a much higher risk for serious injuries like head/neck trauma, highlighting the need for uniform safety regulations across martial arts disciplines.
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Delayed umbilical cord clamping, DCC, a practice in which the umbilical cord is not clamped immediately after birth, promotes placental transfusion to preterm and term neonates. DCC may improve outcomes in preterm neonates by reducing mortality and blood transfusion requirements and increasing iron stores. Despite the recommendations from multiple governing bodies, including the World Health Organization, research on DCC in LMICs remains limited.

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Objective: To describe the epidemiology of field hockey-related injuries of patients aged 6 to 24 years who were treated in US emergency departments from 2000 to 2020.

Design: The researchers conducted a retrospective analysis using data from the National Electronic Injury Surveillance System (NEISS).

Setting: The NEISS collects data on recreational activity-related and consumer product-related injuries treated in US Eds.

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Background: To slow the spread of COVID-19, many nonessential businesses, daycares, and schools closed, and areas imposed "stay-at-home" orders. Closures led to young children spending more time at home, traditionally, the place where more than one-half of unintentional pediatric injuries occur. The objective of the current study was to describe parental safety perceptions and confidence, safety device purchase and installation, and injury prevention practices and behaviors, in homes with children 6 years of age and younger, before and during the COVID-19 pandemic.

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