Infants' Non-Enrollment in Medicaid after Medicaid-Financed Birth: an Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) Data.

Objectives: To characterize the proportion of Medicaid-eligible infants experiencing gaps in Medicaid coverage during early infancy and to determine whether infants without Medicaid coverage were covered by other plans or not at all.

Study Design: Infants with Medicaid-financed births from three states participating in the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were included (N=3,658). Infant insurance coverage (Medicaid, non-Medicaid, none) was assessed at the time of the PRAMS survey, typically around four months of age.

Scholarly Impact of Quality Improvement Reports in Neonatology.

Objective:  Neonatology quality improvement (QI) projects can improve the safety and value of health care, but the scholarly impact of published QI projects is unclear. We measured scholarly citation and media attention garnered by published neonatology QI projects and analyzed project or publication characteristics associated with increased impact metrics.

Study Design:  We identified publications between 2016 and 2019 using mapping review methodology.

Improving Parental Knowledge of Medically Complex Neonates Through Scheduled Conferences.

Reports of parental dissatisfaction from incomplete or inconsistent information led to a quality improvement (QI) project to establish planned family conferences at 10 days and 1 month of life, for 50% of the medically complex neonates admitted to a neonatal intensive care unit within 1 year. A QI team instituted a system in which social workers scheduled family conferences and a neonatologist conducted the conferences. Team members tracked measures using statistical process control charts over 21 months.

Does greater distance from the hospital exacerbate socioeconomic barriers to neonatal intensive care unit clinic attendance?

To determine if distance from our Neonatal Intensive Care Unit (NICU) follow-up clinic exacerbated risk of clinic non-attendance in high-risk groups defined by socioeconomic status or medical complexity, as geographical distance from the hospital can affect attendance rates at NICU follow-up clinics. We retrospectively identified infants born between January 2014 and June 2018, and subsequently discharged from our 50-bed level IV NICU, which serves a predominantly rural population. Patients were included in our study if they had at least one NICU clinic follow-up visit scheduled at discharge.

A Quality Improvement Project to Decrease Suboptimal Patient Transfers between Two Neonatal Units.

Unlabelled: Poorly executed transitions of care in health care systems are associated with safety concerns and patient dissatisfaction. We noticed several problems in the transfer process between our neonatal intensive care unit (NICU) and special care nursery (SCN) and designed this quality improvement project to address them. The aim was to decrease suboptimal transfers from the NICU to the SCN by 50% over 9 months.

Development of necrotizing enterocolitis after blood transfusion in very premature neonates.

Background: Prior studies report conflicting evidence on the association between packed red blood cell (PRBC) transfusions and necrotizing enterocolitis (NEC), especially in early weeks of life where transfusions are frequent and spontaneous intestinal perforation can mimic NEC. The primary objective of this study was to evaluate the association between PRBC transfusions and NEC after day of life (DOL) 14 in very premature neonates.

Methods: A retrospective cohort analysis of very premature neonates was conducted to investigate association between PRBC transfusions and NEC after DOL 14.

Implementing Volume-targeted Ventilation to Decrease Hypocarbia in Extremely Low Birth Weight Infants during the First Week of Life: A Quality Improvement Project.

Unlabelled: Hypocarbia in neonates increases the risk of poor neurodevelopmental outcomes. Volume-targeted ventilation (VTV) is associated with decreased hypocarbia and other respiratory morbidities. We noticed a high incidence of hypocarbia in extremely low birth weight (ELBW; <1,000 g) neonates in our Neonatal Intensive Care Unit.

Individualized fluid management in extremely preterm neonates to ensure adequate diuresis without increasing complications.

Objective: Decrease the incidence of inadequate diuresis (ID, loss of <6% of birth weight) in extremely preterm neonates (EPT, <28 weeks of gestation at birth) during the first week of life by 50% in 1 year.

Study Design: Quality improvement project in a level IV neonatal intensive care unit. A fluid management protocol was implemented, including the use of a fluid guide sheet and closer monitoring of hydration parameters.

Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects.

This study evaluated progress to publication of pediatric quality improvement (QI) projects initially presented as national conference abstracts, according to project findings and other characteristics. QI abstracts were identified among presentations at the 2010-2015 American Academy of Pediatrics National Conference & Exhibition, and publications were tracked through June 2018. Positive findings (improvement on at least 1 quantitative project outcome), interventions, and analyses were correlated with journal publication.