Lynne C. Huffman

All Publications

• Applying Large Language Models to Assess Quality of Care: Monitoring ADHD Medication Side Effects. Pediatrics Bannett, Y., Gunturkun, F., Pillai, M., Herrmann, J. E., Luo, I., Huffman, L. C., Feldman, H. M. 2025; 155 (1)

  Abstract

  To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD).Retrospective population-based cohort study of electronic health records. Cohort included children aged 6 to 11 years with ADHD diagnosis and 2 or more ADHD medication encounters (stimulants or nonstimulants prescribed) between 2015 and 2022 in a community-based primary health care network (n = 1201). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n = 15 628 notes). Model performance was assessed using holdout and deployment test sets, compared with manual medical record review.The LLaMA model accurately classified notes that contained side effects inquiry (sensitivity = 87.2, specificity = 86.3, area under curve = 0.93 on holdout test set). Analyses revealed no model bias in relation to patient sex or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; characteristics were mostly similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower for telephone encounters than for in-clinic/telehealth encounters (51.9% vs 73.0%, P < .001). Side effects inquiry was documented in 61.4% of encounters after stimulant prescriptions and 48.5% of encounters after nonstimulant prescriptions (P = .041).Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality of care and uncovered opportunities to improve psychopharmacological medication management in primary care.

  View details for DOI 10.1542/peds.2024-067223

  View details for PubMedID 39701141

• Leveraging Large Language Models to Assess Documentation of Medication Side Effects in Clinical Visits for Children with Attention-Deficit/Hyperactivity Disorder Bannett, Y., Gunturkun, F., Pllai, M., Herrmann, J. E., Huffman, L. C., Feldman, H. M. SAGE PUBLICATIONS LTD. 2024: 624-626

  View details for Web of Science ID 001307337600619

• Anxiety and Depression Treatment in Primary Care Pediatrics. Pediatrics Lester, T. R., Herrmann, J. E., Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. 2023

  Abstract

  Primary care pediatricians (PCP) are often called on to manage child and adolescent anxiety and depression. The objective of this study was to describe PCP care practices around prescription of selective serotonin reuptake inhibitors (SSRI) for patients with anxiety and/or depression by using medical record review.We identified 1685 patients who had at least 1 visit with a diagnosis of anxiety and/or depression in a large primary care network and were prescribed an SSRI by a network PCP. We randomly selected 110 for chart review. We reviewed the visit when the SSRI was first prescribed (medication visit), immediately previous visit, and immediately subsequent visit. We abstracted rationale for prescribing medication, subspecialist involvement, referral for psychotherapy, and medication monitoring practices.At the medication visit, in 82% (n = 90) of cases, PCPs documented reasons for starting an SSRI, most commonly clinical change (57%, n = 63). Thirty percent (n = 33) of patients had documented involvement of developmental-behavioral pediatrics or psychiatry subspecialists at 1 of the 3 visits reviewed. Thirty-three percent (n = 37) were referred to unspecified psychotherapy; 4% (n = 4) were referred specifically for cognitive behavioral therapy. Of 69 patients with a subsequent visit, 48% (n = 33) had documentation of monitoring for side effects.When prescribing SSRIs for children with anxiety and/or depression, PCPs in this network documented appropriate indications for starting medication and prescribed without subspecialist involvement. Continuing medical education for PCPs who care for children with these conditions should include information about evidence-based psychotherapy and strategies for monitoring potential side effects.

  View details for DOI 10.1542/peds.2022-058846

  View details for PubMedID 37066669

• Primary Care Pediatricians Prescribing Selective Serotonin Reuptake Inhibitors for Children with Anxiety and Depression Lester, T., Herrmann, J., Bannett, Y., Gardner, R., Feldman, H., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2023: E149

  View details for Web of Science ID 001002197500009

• Medical genetics education for pediatrics residents: Abrief report. Genetics in medicine : official journal of the American College of Medical Genetics Gates, R. W., Hudgins, L., Huffman, L. C. 2022

  Abstract

  PURPOSE: Genetic testing is ubiquitous in the field of medicine and is often ordered or requested by primary care providers, nongenetics subspecialists, and patients themselves. Other studies have shown that providers are often not comfortable ordering genetic testing. There have been initiatives to teach these concepts via continuing medical education; however, there is not a standardized training program for teaching resident physicians about genetic testing.METHODS: During September to October 2020, we recruited all the pediatrics residents at our institution via email (N= 102). Residents were invited to complete a Qualtrics electronic survey that addressed self-perceived level of knowledge about core concepts of genetic testing, as well as self-perceived confidence discussing these concepts with families.RESULTS: Response rate was 46 to 102 (45%). Proportions of respondents reporting they felt insufficiently knowledgeable ranged from 28% (basic concepts of genetics) to 80% (Genetic Information Nondiscrimination Act). Most pediatrics residents agreed that a curriculum teaching basics of genetic testing would be helpful to them. Desired curricular topics included indications and limitations of genetic testing, testing procedures, and counseling families.CONCLUSION: Despite its expanding importance across medicine, genetics education is lacking in pediatrics residency programs and residents would benefit from a curriculum teaching basic concepts of genetic testing.

  View details for DOI 10.1016/j.gim.2022.08.003

  View details for PubMedID 36029300

• Continuity of Care in Primary Care for Young Children with Chronic Conditions. Academic pediatrics Bannett, Y., Gardner, R. M., Huffman, L. C., Feldman, H. M., Sanders, L. M. 2022

  Abstract

  OBJECTIVES: (1) To assess continuity of care (CoC) within primary-care practices for children with asthma and autism spectrum disorder (ASD) compared to children without chronic conditions, and (2) to determine patient and clinical-care factors associated with CoC.METHODS: Retrospective cohort study of electronic health records from office visits of children <9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary healthcare network in California. Three cohorts were constructed: (1)Asthma: ≥2 visits with asthma visit-diagnoses; (2)ASD: same method; (3)Controls: no chronic conditions. CoC, using Usual Provider of Care measure (range >0-1), was calculated for (1) all visits (overall) and (2) well-care visits. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits.RESULTS: Of 30,678 children, 1875 (6.1%) were classified as Asthma, 294 (1.0%) as ASD, and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean=0.58, SD 0.21) and ASD (M=0.57, SD 0.20) than Controls (M=0.66, SD 0.21); differences in well-care CoC were minimal. In regression models, lower overall CoC was found for Asthma (aOR 0.90, 95% CI 0.85-0.94). Lower overall and well-care CoC were associated with public insurance (aOR 0.77, CI 0.74-0.81; aOR 0.64, CI 0.59-0.69).CONCLUSION: After accounting for patient and clinical-care factors, children with asthma, but not with ASD, in this primary-care network had significantly lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC, emphasizing the need to address disparities in CoC.

  View details for DOI 10.1016/j.acap.2022.07.012

  View details for PubMedID 35858663

• Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study. Frontiers in pediatrics Lester, T. R., Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. 2022; 10: 794722

  Abstract

  Objectives: To describe medication management of children diagnosed with anxiety and/or depression by primary care providers within a primary care network.Study Design/Methods: We performed a retrospective cross-sectional analysis of electronic health record (EHR) structured data from all children seen at least twice in a 4-year observation period within a network of primary care clinics in Northern California. For children who had visit diagnoses of anxiety, depression, anxiety+depression or symptoms characteristic of these conditions, we analyzed the rates and types of medications prescribed. A logistic regression model considered patient variables for the combined sample.Results: Of all patients 6-18 years old (N = 59,484), 4.4% (n = 2,635) had a diagnosis of anxiety only, 2.4% (n = 1,433) depression only, and 1.2% (n = 737) both anxiety and depression (anxiety + depression); 18% of children with anxiety and/or depression had comorbid ADHD. A total of 15.0% with anxiety only (n = 357), 20.5% with depression only (n = 285), and 47.4% with anxiety+depression (n=343) were prescribed a psychoactive non-stimulant medication. For anxiety and depression only, the top three medications prescribed were sertraline, fluoxetine, and citalopram. For anxiety + depression, the top three medications prescribed were citalopram, sertraline, and escitalopram. Frequently prescribed medications also included benzodiazepines. Logistic regression modeling showed that the depression only and anxety + depression categories had increased likelihood of medication prescription. Older age and mental health comorbidities were independently associated with increased likelihood of medication prescription.Conclusions: In this network, ~8% of children carried a diagnosis of anxiety and/or depression. Medication choices generally aligned with current recommendations with the exception of use of benzodiazepines.

  View details for DOI 10.3389/fped.2022.794722

  View details for PubMedID 35372169

• Academic Half-Day Education Experience in Post-graduate Medical Training: A Scoping Review of Characteristics and Learner Outcomes. Frontiers in medicine Choe, M. S., Huffman, L. C., Feldman, H. M., Hubner, L. M. 2022; 9: 835045

  Abstract

  Background: The academic half-day (AHD) has grown in popularity for medical education because it intends to provide learners with uninterrupted, immersive learning time that may promote participant attendance, engagement, and knowledge. Little is known about the extent of use, forms, or effectiveness of AHD in Post-graduate medical education. This scoping review summarizes existing literature and describes the learning outcomes, according to the Kirkpatrick model of learning evaluation, of AHD experiences on Post-graduate medical trainees.Methods: Authors used Arksey and O'Malley's methodological framework, searching electronic scientific literature databases from the years of 1977-2019 with relevant key terms and identifying 735 papers. Two independent raters completed title/abstract screening and then extracted pertinent data from papers meeting specified criteria.Results: Authors identified 38 relevant papers published in English, originating from programs in US (n = 19) and Canada (n = 19), spanning 4 disciplines: Medicine (n = 17, 45%), Pediatrics (n = 10, 26%), Critical Care/Surgery (n = 9, 24%), Radiology (n = 2, 5%). A majority (n = 33, 87%) described specific educational experiences; most focused on residents only (n = 27). The educational experiences included various teaching strategies; few were didactics only (n = 4) and most were multi-modal including simulation, case-based learning, problem-based learning, and/or self-directed online study. AHD size ranged from 5 to 364 participants (median 39). AHD length was 1.5-6 h (median 3). Required resources were inconsistently described. When evaluations of the specific educational experience were reported (n = 35 studies), the majority of studies used weak research designs (e.g., one group, pre/post-test, n = 19); few studies used strong research designs (e.g., randomized controlled trial, n = 2). Positive effects of AHD ranged across Kirkpatrick levels 1-3 learner outcomes.Conclusions: The composition and content of AHD in Post-graduate medical education vary. Few studies of AHD use stringent research designs, and none include learner outcome measures at the highest Kirkpatrick level (i.e., level 4 results/patient outcomes). A consensus definition and further high-quality research on AHD in Post-graduate medical education is needed.

  View details for DOI 10.3389/fmed.2022.835045

  View details for PubMedID 35308489

• PEDIATRICS RESIDENTS AND FUNDAMENTALS OF GENETIC TESTING: SELF-PERCEIVED KNOWLEDGE AND CONFIDENCE Gates, R., Hudgins, L., Huffman, L. C. BMJ PUBLISHING GROUP. 2022: 194-195

  View details for DOI 10.1136/jim-2022-WRMC.163

  View details for Web of Science ID 000737295900184

• Rate of Pediatrician Recommendations for Behavioral Treatment for Preschoolers With Attention-Deficit/Hyperactivity Disorder Diagnosis or Related Symptoms. JAMA pediatrics Bannett, Y., Gardner, R. M., Posada, J., Huffman, L. C., Feldman, H. M. 2021

  View details for DOI 10.1001/jamapediatrics.2021.4093

  View details for PubMedID 34661611

• Autism-Focused Online Training in Shared Decision-Making: A Randomized Controlled Trial. Journal of developmental and behavioral pediatrics : JDBP Huffman, L. C., Hubner, L. M., Hansen, R. L. 2021; 42 (3): 173–81

  Abstract

  OBJECTIVE: This medical education quasi-randomized controlled trial (quasi-RCT), involving 97 developmental-behavioral pediatrics fellows across the United States, examined differential effects of 2 autism-focused, online, interactive case-based trainings on shared decision-making (SDM).METHODS: An intervention case provided direct teaching about SDM, addressing autism treatment options. A comparison case focused on evidence-based practice (EBP) related to medication use in autism with no specific SDM teaching. Measured outcomes included self-reported SDM and attitudes toward concordance in medication-prescribing.RESULTS: After the intervention, both groups showed significantly increased SDM, but not medication-prescribing concordance (controlling for trainee level, autism patient numbers, and past SDM training).CONCLUSION: This quasi-RCT presents evidence that knowledge of SDM in care of children with autism can be enhanced by online case-based training focused either indirectly on evidence-based practice or directly on SDM. Consistent online SDM training can be provided to all trainees, irrespective of the location.

  View details for DOI 10.1097/DBP.0000000000000882

  View details for PubMedID 33759846

• A retrospective observational cohort study: Epidemiology and outcomes of pediatric unintentional falls in US emergency departments. Injury Nguyen, Q. P., Saynina, O., Pirrotta, E. A., Huffman, L. C., Wang, N. E. 2021

  Abstract

  The objective is to determine how outcomes from unintentional falls differ for children with and without developmental disabilities, with a sensitivity analysis specifically examining those with ADHD.This is a retrospective observational cohort study of 2010-2015 data from the Nationwide Emergency Department Sample (NEDS). The NEDS is a sampling of ED visits across 953 hospitals in 36 states. Unintentional falls for children with and without developmental disabilities were compared, adjusting for age, sex, payment source, income, mechanism, injury severity score (ISS). A sensitivity analysis was then performed for children with ADHD (n=139,642) and those without any developmental disabilities. A priori chosen outcomes included hospital admission, length of stay, intubation, and surgery. Logistic regression analysis estimated adjusted odds ratios for outcomes.Among children who presented to the ED with unintentional falls (n=13,217,237), there were 223,445 (1.7%) with developmental disabilities. The majority of those with developmental disabilities were male, ages 10-14 years. Compared to children without developmental disabilities, those with developmental disabilities were more likely to have an inpatient admission (aOR=2.27, 95% CI=2.10-2.44), length of stay more than 2 days (aOR=1.73, 95% CI=1.51-1.98), intubation (aOR=4.77, 95% CI=3.62-6.27) and surgery (aOR=2.11, 95% CI=1.93-2.32). A sensitivity analysis showed that 139,642 (1%) of children ages 5-17 years had ADHD. Of those with ADHD, the majority was also male, ages 10-14 years. Compared to children without ADHD, those with ADHD had a higher odds of inpatient admission (aOR=1.74, 95% CI=1.58-1.91), length of stay greater than 2 days (aOR=1.59, 95% CI=1.37-1.85), intubation (aOR=3.96, 95% CI=2.73-5.73), and surgery (aOR=1.82, 95% CI=1.60-2.06).Children with developmental disabilities, in particular those with ADHD, who experience falls are often older and male. They had greater odds of poor outcomes. These children need additional anticipatory guidance and attention to adequate treatment to prevent injuries from unintentional falls.

  View details for DOI 10.1016/j.injury.2021.05.017

  View details for PubMedID 34099243

• Fellows Front and Center: Tele-Training and Telehealth ACADEMIC PEDIATRICS Huffman, L. C., Feldman, H. M., Hubner, L. M. 2020; 20 (6): 764–65

  View details for Web of Science ID 000567888700018

• PRIMARY CARE MANAGEMENT OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN CHILDREN AGED 2-5 YEARS Bannett, Y., Feldman, H. M., Gardner, R. M., Blaha, O., Huffman, L. C. BMJ PUBLISHING GROUP. 2020: A164

  View details for DOI 10.1136/jim-2019-WMRC.380

  View details for Web of Science ID 000507513300380

• Attention-Deficit/Hyperactivity Disorder in 2- to 5-Year-Olds: A Primary Care Network Experience. Academic pediatrics Bannett, Y. n., Feldman, H. M., Gardner, R. M., Blaha, O. n., Huffman, L. C. 2020

  Abstract

  To assess (1) rates of primary care provider (PCP) diagnosis of attention-deficit/hyperactivity disorder (ADHD) in young children, (2) documented PCP adherence to ADHD clinical practice guidelines, and (3) patient factors influencing PCP variation in diagnosis and management.Retrospective cohort study of electronic health records from all office visits of children aged 2-5 years, seen ≥2 times between 2015 and 2019, in 10 practices of a community-based primary healthcare network. Outcomes included ADHD diagnosis (symptom or disorder), and adherence to guidelines in (1) comorbidity documentation at or after ADHD diagnosis, (2) ADHD medication choice, and (3) follow-up of medicated patients. Logistic regressions assessed associations between outcomes and patient characteristics.Of 29,408 eligible children, 195 (0.7%) had ADHD diagnoses. Of those, 56% had solely symptom-level diagnoses (e.g., hyperactivity); 54% had documented comorbidities. ADHD medications were prescribed only to 4-5-year-olds (40/195 (21%)); 85% received stimulants as first-line medication; 48% had follow-up visits within 2 months. Likelihood of ADHD diagnosis was higher for children with public or military insurance (OR 1.94; 95% CI 1.40-2.66; OR 3.17; 95% CI 1.93-4.96). Likelihood of comorbidity documentation was lower for older ADHD patients (OR 0.48; 95% CI 0.32-0.71) and higher for those with military insurance (OR 3.11; 95% CI 1.13-9.58).PCPs in this network frequently used symptom-level ADHD diagnoses in 2-5-year-olds; ADHD diagnosis rates were below estimated population prevalence, with evidence for sociodemographic disparities. PCP comorbidity documentation and choice of stimulant medications were consistent with guidelines. Rates of timely follow-up were low.

  View details for DOI 10.1016/j.acap.2020.04.009

  View details for PubMedID 32360494

• Fellows Front and Center: Tele-training and Telehealth. Academic pediatrics Huffman, L. C., Feldman, H. M., Hubner, L. M. 2020

  View details for DOI 10.1016/j.acap.2020.05.023

  View details for PubMedID 32574764

• Development and Evaluation of a School Readiness Curriculum for Pediatrics Residents. MedEdPORTAL : the journal of teaching and learning resources Perrin, H. T., Feldman, H. M., Huffman, L. C. 2020; 16: 10976

  Abstract

  The American Academy of Pediatrics (AAP) recommends that pediatricians promote school readiness with children and families. To our knowledge, no published resident-focused curricula addressing school readiness are currently available. We sought to fill this gap by developing and evaluating a school readiness curriculum for pediatrics residents.We conducted a literature review and targeted needs assessment of pediatrics residents. We then developed a school readiness curriculum and piloted it over several months, adjusting it iteratively each month. The final curriculum was delivered to 34 primarily first-year pediatrics residents over 11 months and included three self-guided observations at local preschools using a templated observation guide, followed by a 1.5-hour in-person facilitated workshop with three components: a PowerPoint presentation, a discussion about preschool observations, and a case study with hands-on developmental questionnaire practice. The curriculum was evaluated with preintervention, immediate postintervention, and 2-months delayed postintervention surveys.Our curriculum successfully increased pediatrics residents' knowledge regarding the correct definition of school readiness and appropriate management plan for school readiness concerns, confidence discussing school readiness and addressing families' school readiness concerns, and behavior raising the topic of school readiness with families during well child checks.A school readiness curriculum had a beneficial effect of increasing pediatrics residents' knowledge, confidence, and behavior addressing school readiness in clinical encounters, meeting a priority of the AAP.

  View details for DOI 10.15766/mep_2374-8265.10976

  View details for PubMedID 33015356

  View details for PubMedCentralID PMC7526503

• Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers. Academic pediatrics Bannett, Y. n., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  Abstract

  To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation.Retrospective cohort study of electronic health records (EHR) from all office visits of patients aged 4-17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary healthcare network in California. Outcomes per clinician: (1) % patients seen for ADHD management; (2) % ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation.Of 40,323 patients in the cohort, 2,039 (5.1%) carried an ADHD diagnosis, of which 1,142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0 to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (i.e., sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high percent Full Time Equivalent (OR 1.17; 95% CI 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0 to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R=0.10).Objective EHR measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, % of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.

  View details for DOI 10.1016/j.acap.2019.11.016

  View details for PubMedID 31794864

• Sleep Problem Detection and Documentation in Children With ASD and ADHD by Developmental-Behavioral Pediatricians: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Won, D. C., Feldman, H. M., Huffman, L. C. 2018

  Abstract

  OBJECTIVE: To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.METHODS: Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).RESULTS: Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.CONCLUSION: Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.

  View details for PubMedID 30339559

• Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach FRONTIERS IN PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2018; 6: 60

  Abstract

  Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician.Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17 years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work excuse note if needed. After the visit, SDM was assessed by both parents and DBP clinicians. SDM was scored as present if the respondent answered "strongly agree" to all SDM-related items. Logistic regression tested effects of visit, child, parent, clinician characteristics, and intervention group status on parent-reported SDM. Cohen's kappa assessed alignment between parent and clinician perceptions of SDM.Of 88 parents screened, 50 (61%) met eligibility criteria and agreed to participate (intervention n = 26; comparison n = 24). Eligible participants (parents and clinicians) for analysis completed the surveys with no missing data. Overall, SDM was present in 76% of parents and 34% of clinicians. With high rates of parent-reported SDM in both intervention and comparison groups, no main intervention effect was detected. Compared to the comparison group, there was greater alignment between parent and clinician perception of SDM in the intervention group.Parent and clinician enrollment and data collection with minimal loss suggest that this novel approach is easy to use and could be employed in future outpatient studies exploring SDM. In this clinical setting, both intervention and comparison group parents reported high levels of SDM participation and no main group effect was detected. Further study of this novel parent-directed SDM intervention approach is needed in a larger sample with greater variability in parent-reported SDM to determine its efficacy.

  View details for PubMedID 29616204

• Parent-Reported Shared Decision Making: Autism Spectrum Disorder and Other Neurodevelopmental Disorders JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Hubner, L. M., Feldman, H. M., Huffman, L. C. 2016; 37 (1): 20-32

  Abstract

  Assess differences in parent-reported shared decision making (SDM) based on diagnostic group in a national sample of children with neurodevelopmental disorders (autism spectrum disorder [ASD], cerebral palsy [CP], or Down syndrome [DS]). Assess contribution of medical home and child functional impairment.Secondary analysis of 2009 to 2010 National Survey of Children with Special Health Care Needs explored reports of 3966 children with ASD, CP, or DS. SDM was defined categorically (SDMcat, present or absent) and continuously (SDMcont, score range 0-12). Regression models were adjusted for child/family characteristics, medical home, functional impairment, and diagnostic group.SDMcat and SDMcont were significantly lower in the ASD group (56.7% [95% confidence interval = CI, 53.4-59.9] and mean 8.7 [95% CI, 8.5-9.0]), compared with the CP group (70.5% [95% CI, 63.4-76.7] and mean 9.7 [95% CI, 9.3-10.1]), or the DS group (70.8% [95% CI, 61.2-78.8] and mean 10.0 [95% CI, 9.5-10.4]). In adjusted analyses of SDMcat and SDMcont, SDM was more likely among children with a medical home (adjusted odds ratio 6.6, p < .001, mean = 11.9, and p < .001), and less likely for children with greatest functional impairment (adjusted odds ratio 0.4, p = .002, mean = 10.1, and p = .001). Adjusted analysis of SDMcont also showed differences based on diagnostic group with lower SDMcont scores in the ASD group (mean = 10.1 and p = .005) compared with the DS group.A medical home was associated with higher SDM, whereas greater functional impairment and ASD diagnosis were associated with lower SDM.

  View details for DOI 10.1097/DBP.0000000000000242

  View details for Web of Science ID 000367826900004

• Patient Protection and Affordable Care Act of 2010 and Children and Youth With Special Health Care Needs JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., Loe, I. M. 2015; 36 (3): 207-217

  Abstract

  The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.

  View details for PubMedID 25793891

• Hospitalizations of Children with Autism Increased from 1999 to 2009 JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2014; 44 (5): 1087-1094

  Abstract

  We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

  View details for DOI 10.1007/s10803-013-1965-x

  View details for Web of Science ID 000336330200009

  View details for PubMedID 24122446

• Research Training of Developmental-Behavioral Pediatrics Fellows: A Survey of Fellowship Directors by Developmental-Behavioral Pediatrics Research Network JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Wiley, S., Schonfeld, D. J., Fredstrom, B., Huffman, L. 2013; 34 (6): 406-413

  Abstract

  To describe research training in Developmental-Behavioral Pediatrics (DBP) Fellowship Programs.Thirty-five US-accredited DBP fellowships were contacted through the Developmental-Behavioral Pediatrics Research Network to complete an online survey on scholarly work and research training.With an 83% response rate, responding programs represented 110 (87 filled) fellowship positions. External funding for fellowship positions was minimal (11 positions fully funded, 13 funded above 50% of cost). Structured research training included didactic lectures, web-based training, university courses, direct mentoring, journal clubs, and required reading. Of the 159 fellows described, spanning a 5-year training period, the majority chose projects relying on their own data collection (57%) rather than joining an existing research study and focused on clinical research (86%). Among 96 fellows with completed scholarly work, 29% were observational/epidemiological studies, 22% secondary analyses of large data sets, 16% community-based research, and 15% survey design. A limited number of fellows pursued basic science, meta-analysis/critical appraisal of the literature, or analysis of public policy. Barriers to successful fellow research are as follows: lack of time and money, challenges in balancing clinical demands and protected faculty research time, limited faculty research opportunities, time or expertise, and a lack of infrastructure for fellow research mentoring.The scholarly work of fellows in DBP fellowship programs has primarily focused on clinical research using observational/epidemiological research and secondary analysis of large data set. Barriers largely in faculty time and expertise for research mentoring and inadequate funding in programs that have high clinical demands and little resources for research efforts were noted.

  View details for DOI 10.1097/DBP.0b013e31829a7bfe

  View details for Web of Science ID 000330358800054

  View details for PubMedID 23838586

• Predictors of Hospitalization After an Emergency Department Visit for California Youths With Psychiatric Disorders PSYCHIATRIC SERVICES Huffman, L. C., Wang, N. E., Saynina, O., Wren, F. J., Wise, P. H., Horwitz, S. M. 2012; 63 (9): 896-905

  Abstract

  This study examined patient, hospital, and county characteristics associated with hospitalization after emergency department visits for pediatric mental health problems.Retrospective analysis of emergency department encounters (N=324,997) of youths age five years to 17 years with psychiatric diagnoses was conducted with 2005-2009 California Office of Statewide Health Planning and Development emergency department statewide data.For youths with any psychiatric diagnosis, 23.4% of emergency department encounters resulted in hospitalization. In these cases, hospitalization largely was predicted by clinical need. Nonclinical factors that decreased the likelihood of hospitalization included demographic characteristics (such as younger age, lack of insurance, and rural residence) and resource characteristics (private hospital ownership, lack of psychiatric consultation in the emergency department, and lack of pediatric psychiatric beds). For youths with a significant psychiatric diagnosis plus a suicide attempt, 53.8% of emergency department encounters resulted in hospitalization. In these presumably more life-threatening cases, nonclinical factors that decreased the likelihood of hospitalization persisted: demographic characteristics (lack of insurance and rural residence) and resource characteristics (public hospital ownership, lack of psychiatric consultation, and lack of pediatric psychiatric beds).Mental health service delivery can improve only by addressing nonclinical demographic and resource obstacles that independently decrease the likelihood of hospitalization after an emergency department visit for a mental health issue; this is true even for the most severely ill youths-those with a suicide attempt as well as a serious psychiatric diagnosis.

  View details for DOI 10.1176/appi.ps.201000482

  View details for PubMedID 22710574

• Respiratory Outcomes of Infants Born Extremely Preterm in the Necrotizing Enterocolitis Surgery Trial. The Journal of pediatrics DeMauro, S. B., Jensen, E. A., McDonald, S. A., Hintz, S., Tyson, J., Stevenson, D. K., Blakely, M. L. 2024: 114391

  Abstract

  The multicenter Necrotizing Enterocolitis Surgery Trial compared initial peritoneal drainage with laparotomy among infants with extremely low birth weight and surgical necrotizing enterocolitis or intestinal perforation. In this post hoc analysis of trial data, initial drainage was associated with adverse respiratory outcomes, both in hospital and through 2 years corrected age.

  View details for DOI 10.1016/j.jpeds.2024.114391

  View details for PubMedID 39521175

• Trends in sex differences in neurodevelopmental outcomes among extremely preterm infants. Archives of disease in childhood. Fetal and neonatal edition Boghossian, N. S., Mack, N., Bell, E. F., Tan, S., Stoll, B., Rysavy, M., Ambalavanan, N., Tyson, J. E., Das, A., Hintz, S. R., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Jobe, A. H., Caplan, M. S., Polin, R. A., Oh, W., Keszler, M., Laptook, A. R., Vohr, B. R., Hensman, A. M., Burke, R. T., Stephens, B. E., Yatchmink, Y., Alksninis, B., Basso, K., Vieira, E., Keszler, L., Knoll, A., Leach, T. M., Leonard, M. R., Noel, L., Pierre, L. S., Vogt, R. A., Watson, V. E., Hibbs, A. M., Fanaroff, A. A., Wilson-Costello, D. E., Newman, N. S., Siner, B. S., Williams, A., Roth, E., Truog, W., Kilbride, H., Parimi, P., Gauldin, C., Scott, A., Johnson, K., Gaetano, L., Merhar, S. L., Poindexter, B. B., Schibler, K., Russell, D., Donovan, E. F., Bridges, K., Steichen, J. J., Yolton, K., Alexander, B., Fischer, E. E., Grisby, C., Mersmann, M. W., Mincey, H. L., Hessling, J., Gratton, T. L., Jackson, L. D., Kirker, K., Muthig, G., Stacey, S., Hayes, D., Thompson, J., Beiersdorfer, T., Goldberg, R. N., Michael Cotten, C., Goldstein, R. F., Auten, K. J., Finkle, J., Fisher, K. A., Foy, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Clark, C. L., Patel, R. M., Carlton, D. P., Adams-Chapman, I., Hale, E. C., Loggins, Y. C., Bottcher, D. I., LaRossa, M. M., Carter, S. L., Sewell, L., Sanders, A., Smikle, G., Mackie, C., Laursen, J., Bremer, A. A., Higgins, R. D., Wright, L. L., McClure, E. M., Archer, S. W., Sokol, G. M., Poindexter, B. B., Lemons, J. A., Dusick, A. M., Papile, L., Harmon, H., Lytle, C., Bohnke, L. G., Eaken, G., Herron, D. E., Hines, A., Miller, L. C., Minnich, H. M., Richard, L., Wilson, L. D., Watkins, D., Gunn, S., Joyce, J., Khan, A. M., Kennedy, K. A., Jones, P. M., Evans, P. W., Akpa, E. G., Alaniz, N. I., Allain, E., Arldt-McAlister, J., Boricha, F., Brandt, P., Burson, K., Guajardo, M. C., Dempsey, A., Dieterich, S. E., Harris, B. F., Franco, C. I., Garcia, C., Green, C., Hall, D., Jiminez, M., John, J., Lis, A. E., Major-Kincade, T., Martin, K., Martin, S. C., Mason, C. M., McDavid, G. E., McKee, S. L., Morris, B. H., Orekoya, P. A., Boral, D. S., Pierce Tate, P. L., Poundstone Lillie, M. L., Reddoch, S., Reddy, T., Rodgers, S., Siddiki, S. K., Simmons, M. C., Sperry, D., Stephens, E., Whitely, L. L., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Kenneth Poole, W., Wallace, D., Newman, J. E., Auman, J. O., Crawford, M. M., Hastings, B. K., McClure, E. M., Petrie Huitema, C. M., Zaterka-Baxter, K. M., Meurs, K. P., Chock, V. Y., Stevenson, D. K., Bethany Ball, M., Adams, M. M., Ahlfors, C. E., Baran, J. M., Bentley, B., Bond, L. E., Brudos, G. K., Davis, A. S., DeAnda, M. E., DeBattista, A. M., Fleisher, B. E., Huffman, L. C., Kohn, J. G., Krueger, C., Lee-Ancajas, J. C., Palmquist, A. W., Proud, M. S., Pyle, R. P., Sivakumar, D., Stebbins, R. D., John, N. H., Weiss, H. E., Frantz, I. D., McGowan, E. C., MacKinnon, B. L., Nylen, E., Furey, A., Brussa, A., Sibley, C., Peralta-Carcelen, M., Nelson, K. G., Bailey, K. J., Biasini, F. J., Chopko, S. A., Collins, M. V., Cosby, S. S., Moses, M. B., Phillips, V. A., Preskitt, J., Rector, R. V., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Rasmussen, M. R., Vaucher, Y. E., Wozniak, P. R., Arnell, K., Bridge, R., Demetrio, C., Fuller, M. G., Rich, W., Colaizy, T. T., Widness, J. A., Harmon, H. M., Brumbaugh, J. E., Acarregui, M. J., Johnson, K. J., Eastman, D. L., Walker, J. R., Goecke, C. A., Schmelzel, M. L., Baack, M. L., Hogden, L. A., Henning, M. M., Elenkiwich, C., Broadbent, M., Muyden, S. V., Ellsbury, D. L., Bass, D. B., Tud, T. L., Duara, S., Bauer, C. R., Everett-Thomas, R., Worth, A. M., Allison, M., Diaz, A. N., Mathews, E. E., Hamlin-Smith, K., Jean-Gilles, L., Calejo, M., Eguaras, S. M., Fajardo-Hiriart, S., Gideon, Y. C., Berkovits, M. H., Stoerger, A., Garcia, A., Pierre, H., Roder, G., Riguad, A., Watterberg, K. L., Fuller, J., Ohls, R. K., Papile, L., Lacy, C. B., Hartenberger, C., Brown, S., Lowe, J. R., Montman, R., Beauman, S., Hanson, M., Kuan, E., DeMauro, S. B., Eichenwald, E. C., Schmidt, B., Kirpalani, H., Chaudhary, A. S., Abbasi, S., Cucinotta, D. M., Bernbaum, J. C., Catts, C., Gerdes, M., Ghavam, S., Hurt, H., Mancini, T., Snyder, J., Ziolkowski, K., D'Angio, C. T., Phelps, D. L., Guillet, R., Lakshminrusimha, S., Myers, G. J., Burnell, E., Guilford, S., Horihan, C. A., Hust, D., Jensen, R. L., Johnson, J. B., Kushner, E., Maffett, D., Merzbach, J., Reubens, L. J., Reynolds, A. M., Rowan, M., Wadkins, H. I., Williams, A., Yost, K., Zwetsch, L., Kent, A., Prinzing, D., Scorsone, A. M., Hunn, J., Bowman, M., Orme, C., Binion, K., Sabaratnam, P., Jones, R., Boylin, E., McKee, K., Sacilowski, M., Rochez, D., Li, E., Kachelmeyer, J., Coleman, K., Hartley-McAndrew, M., Farooq, O., Zorn, W., Korones, S. B., Bada, H. S., Hudson, T., Williams, M., Yolton, K., Wyckoff, M. H., Brion, L. P., Sanchez, P. J., Laptook, A. R., Rosenfeld, C. R., Salhab, W. A., Sue Broyles, R., Heyne, R. J., Ipson, M., Adams, S. S., Jeannette Burchfield, P., Chen, L., Leon, M. D., Dooley, C., Eubanks, F., Guzman, A., Hensley, G., Heyne, E. T., Hickman, J. F., Leps, M. H., Madden, L. A., Madison, S., Rebecca McDougald, E., Miller, N. A., Morgan, J. S., Lee, L. E., Pavageau, L., Puentez, A., Sepulveda, P., Tolentino-Plata, K., Boatman, C. T., Vasil, D. M., Waterbury, J., Yoder, B. A., Baseera, M., Faix, R. G., Minton, S. D., Sheffield, M. J., Rau, C. A., Osborne, K. A., Baker, S., Bird, K., Bledsoe, L. C., Burnett, J., Christensen, S., Cunningham, S. D., Davis, B., Elmont, J. O., Hall, B., Jensen, J. J., Jordan, J., Loertscher, M. C., Marchant, T., Maxson, E., McGrath, K. M., Mickelsen, H. G., Zadeh, G. M., Melody Parry, D., Reich, B. A., Schaefer, S. T., Spencer, C., Steffen, M., Stout, K., Stuart, A. L., Tice, K., Weaver-Lewis, K., Winter, S., Woodbury, K. D., Zanetti, K., Michael O'Shea, T., Dillard, R. G., Peters, N. J., Chiu, K., Allred, D. E., Goldstein, D. J., Fond, R. H., Jackson, B. G., Peterson, C., Roberts, D., Waldrep, E. L., Morris, M. W., Hounshell, G. W., Washburn, L. K., Welch, C. D., Shankaran, S., Sood, B. G., Pappas, A., Barks, J., Johnson, Y. R., Bara, R., Goldston, L., Johnson, M. E., Kennedy, D., Muran, G., Billian, E., Sumner, L., Sawaya, K., Woldt, E., Childs, K., Pinnatisect, B., Agarwal, P., DeJesus, L., Natarajan, G., Chawla, S., Christensen, M. K., Wiggins, S. A., White, D., Ehrenkranz, R. A., Butler, C., Jacobs, H., Cervone, P., Close, N., Getter, P., Gilliam, W., Greisman, S., Konstantino, M., Poulsen, J., Romano, E., Taft, J., Williams, J. 2024

  Abstract

  OBJECTIVE: To examine whether changes in survival without moderate or severe neurodevelopmental impairment (NDI) at 18-26 months' corrected age from 1999 to 2018 differed between male and female infants.DESIGN: This retrospective cohort study used data from the NICHD Neonatal Research Network hospitals. Robust Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% CIs for survival without moderate or severe NDI between males and females. Interactions between sex and time were assessed to evaluate temporal differences in the outcome by sex. Variables adjusted for included centre, maternal age, ethnicity/race, gestational age and small for gestational age.PATIENTS: Inborn infants with gestational age of 22-26 weeks at NICHD Neonatal Research Network hospitals from 1999 to 2018.MAIN OUTCOME MEASURE: Change over time in survival without moderate or severe NDI at 18-26 months' corrected age between male and female infants.RESULTS: Of 26 307 infants, 13 045 (49.6%) were male. Survival without moderate or severe NDI declined for both sexes over time, from 32.9% to 30.6% for males and from 47.4% to 40.0% for females, between 1999-2003 and 2014-2018. Males were less likely than females to survive without moderate or severe NDI (aRR=0.80; 95% CI 0.78 to 0.83). Changes in survival without moderate or severe NDI did not differ between males and females.CONCLUSION: There were no differential changes in survival without moderate or severe NDI between male and female infants.

  View details for DOI 10.1136/archdischild-2024-327239

  View details for PubMedID 39288987

• Surgical Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Lead to Severe Growth Failure in Infants. Annals of surgery Speer, A. L., Lally, K. P., Pedroza, C., Zhang, Y., Poindexter, B. B., Chwals, W. J., Hintz, S. R., Besner, G. E., Stevenson, D. K., Ohls, R. K., Truog, W. E., Stoll, B. J., Rysavy, M. A., Das, A., Tyson, J. E., Blakely, M. L. 2024; 280 (3): 432-443

  Abstract

  We aimed to determine the incidence of growth failure in infants with necrotizing enterocolitis (NEC) or spontaneous intestinal perforation (SIP) and whether initial laparotomy versus peritoneal drainage (PD) impacted the likelihood of growth failure.Infants with surgical NEC and SIP have high mortality, and most have neurodevelopmental impairment and poor growth. Existing literature on growth outcomes for these infants is limited.This is a preplanned secondary study of the Necrotizing Enterocolitis Surgery Trial dataset. The primary outcome was growth failure (Z-score for weight <-2.0) at 18 to 22 months. We used logistic regression, including diagnosis and treatment, as covariates. Secondary outcomes were analyzed using the Fisher exact or Pearson χ2 test for categorical variables and the Wilcoxon rank sum test or one-way ANOVA for continuous variables.Among 217 survivors, 207 infants (95%) had primary outcome data. Growth failure at 18 to 22 months occurred in 24/50 (48%) of NEC infants versus 65/157 (42%) SIP (P=0.4). The mean weight-for-age Z-score at 18 to 22 months in NEC infants was -2.05±0.99 versus -1.84±1.09 SIP (P=0.2), and the predicted mean weight-for-age Z-score SIP (Beta -0.27; 95% CI: -0.53, -0.01; P=0.041). Median declines in weight-for-age Z-score between birth and 18 to 22 months were significant in all infants but most severe (>2) in NEC infants (P=0.2).This first ever prospective study of growth outcomes in infants with surgical NEC or SIP demonstrates that growth failure is very common, especially in infants with NEC, and persists at 18-22 months.

  View details for DOI 10.1097/SLA.0000000000006378

  View details for PubMedID 39264354

• Leveraging a Large Language Model to Assess Quality-of-Care: Monitoring ADHD Medication Side Effects. medRxiv : the preprint server for health sciences Bannett, Y., Gunturkun, F., Pillai, M., Herrmann, J. E., Luo, I., Huffman, L. C., Feldman, H. M. 2024

  Abstract

  To assess the accuracy of a large language model (LLM) in measuring clinician adherence to practice guidelines for monitoring side effects after prescribing medications for children with attention-deficit/hyperactivity disorder (ADHD).Retrospective population-based cohort study of electronic health records. Cohort included children aged 6-11 years with ADHD diagnosis and ≥2 ADHD medication encounters (stimulants or non-stimulants prescribed) between 2015-2022 in a community-based primary healthcare network (n=1247). To identify documentation of side effects inquiry, we trained, tested, and deployed an open-source LLM (LLaMA) on all clinical notes from ADHD-related encounters (ADHD diagnosis or ADHD medication prescription), including in-clinic/telehealth and telephone encounters (n=15,593 notes). Model performance was assessed using holdout and deployment test sets, compared to manual chart review.The LLaMA model achieved excellent performance in classifying notes that contain side effects inquiry (sensitivity= 87.2%, specificity=86.3/90.3%, area under curve (AUC)=0.93/0.92 on holdout/deployment test sets). Analyses revealed no model bias in relation to patient age, sex, or insurance. Mean age (SD) at first prescription was 8.8 (1.6) years; patient characteristics were similar across patients with and without documented side effects inquiry. Rates of documented side effects inquiry were lower in telephone encounters than in-clinic/telehealth encounters (51.9% vs. 73.0%, p<0.01). Side effects inquiry was documented in 61% of encounters following stimulant prescriptions and 48% of encounters following non-stimulant prescriptions (p<0.01).Deploying an LLM on a variable set of clinical notes, including telephone notes, offered scalable measurement of quality-of-care and uncovered opportunities to improve psychopharmacological medication management in primary care.

  View details for DOI 10.1101/2024.04.23.24306225

  View details for PubMedID 38712037

  View details for PubMedCentralID PMC11071552

• Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm. JAMA pediatrics Brumbaugh, J. E., Bann, C. M., Bell, E. F., Travers, C. P., Vohr, B. R., McGowan, E. C., Harmon, H. M., Carlo, W. A., Hintz, S. R., Duncan, A. F., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Polin, R. A., Laptook, A. R., Keszler, M., Mayne, J., Lamberson, V., Keszler, M. L., Hensman, A. M., Vieira, E., St Pierre, L., Burke, R. T., Alksninis, B., Leach, T. M., Watson, V. E., Knoll, A., Moffat, S., Hibbs, A. M., Newman, N. S., Wilson-Costello, D. E., Siner, B. S., Friedman, H. G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Scott, A., Parimi, P. S., Gaetano, L., Merhar, S. L., Schibler, K., Poindexter, B. B., Kim, J., Yolton, K., Cahill, T. E., Russell, D., Dudley, J., Gratton, T. L., Grisby, C., Henkes, L., Kirker, K., Stacey, S., Wuertz, S., Cotten, C. M., Goldberg, R. N., Laughon, M. M., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Mago-Shah, D., Finkle, J., Fisher, K. A., Gustafson, K. E., Bose, C. L., Bernhardt, J., Bose, G., Clark, C., Wereszczak, J., Warner, D., Talbert, J., Kicklighter, S. D., Bentley, A., Edwards, L., Rhodes-Ryan, G., White, D., Patel, R. M., Carlton, D. P., Stoll, B. J., Loggins, Y., Adams-Chapman Deceased, I., Sewell, E., Maitre, N., Bottcher, D., Carter, S. L., Hale, E. C., Kendrick-Allwood, S., Laursen, J., Mulligan LaRossa, M., Mackie, C., Sanders, A., Smikle, G., Wineski, L., Walsh, M. C., Bremer, A. A., Higgins, R. D., Wilson Archer, S., Sokol, G. M., Papile, L., Herron, D. E., Hines, A. C., Lytle, C., Smiley, L., Wilson, L. D., Watkins, D., Gunn, S., Joyce Deceased, J., Tyson, J. E., Khan, A. M., Kennedy, K. A., Rysavy, M. A., Mosquera, R. A., Eason, E., Stephens, E., Alaniz, N. I., Allain, E., Arldt-McAlister, J., Boricha, F., Burson, K., Dempsey, A. G., Garcia, C., Hall, D. J., John, J., Jones, P. M., Lillie, M. L., Mason, C. M., Martin, K., Martin, S. C., McDavid, G. E., McKee, S. L., Poe, M., Rennie, K., Reddy, T., Rodgers, S., Khan Siddiki, S., Sperry, D., Pierce Tate, P. L., White, M., Wright, S. L., Zanger, D., Sanchez, P. J., Slaughter, J. L., Nelin, L. D., Jadcherla, S. R., Maitre, N. L., Timan, C., Yeates, K. O., Luzader, P., Batterson, N., Baugher, H., Beckford, D. R., Burkhardt, S., Carey, H., Chao, M., Cira, C., Clark, E., DeSantis, B., Fortney, C. A., Fowler, A., Gutentag, J., Grothause, J. L., Hague, C. D., Keim, S. A., Levengood, K., Marzec, L., McCool, J., Miller, B., Nelin, M. A., Newton, J., Park, C., Pietruszewski, L., Purnell, J., Seabrook, R., Shadd, J. C., Small, K., Stein, M., Sullivan, M., Sullivan, R. A., Warnimont, K., Yossef-Salameh, L., Fearns, E., Das, A., Gantz, M. G., Wiener, L. E., Wallace, D., O'Donnell Auman, J., Crawford, M., Gabrio, J., Newman, J. E., Parlberg, L., Petrie Huitema, C. M., Zaterka-Baxter, K. M., Van Meurs, K. P., Chock, V. Y., Stevenson, D. K., Ball, M. B., Bahmani, D., Adams, M. M., Bentley, B., DeAnda, M. E., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R. E., Proud, M. S., Reichert, E. N., Taylor, H., Weiss, H. E., Williams, R. J., Ambalavanan, N., Peralta-Carcelen, M., Collins, M. V., Cosby, S. S., Bailey, K. J., Biasini, F. J., Chopko, S. A., Domnanovich, K. A., Jno-Finn, C. J., Ladinsky, M., Moses, M. B., Buie, C., McNair, T. E., Phillips, V. A., Preskitt, J., Rector, R. V., Stringer, K., Whitley, S., York Chapman, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Colaizy, T. T., Widness, J. A., Johnson, K. J., Eastman, D. L., Walker, J. R., Goeke, C. A., Schmelzel, M. L., Faruqui, S. E., Coulter, B. J., Schrimper, B. M., Jellison, S. S., Knosp, L. K., Arnold, S. J., Andrews, H. A., Ellsbury, D. L., Bass, D. B., Tud, T. L., Baack, M. L., Richards, L. A., Henning, M. M., Elenkiwich, C., Broadbent, M., Van Muyden, S., Brodkorb, A. T., Watterberg, K. L., Fuller, J., Ohls, R. K., Backstrom Lacy, C., Hartenberger, C., Sundquist Beauman, S., Hanson, M., Lowe, J. R., Kuan, E., DeMauro, S. B., Eichenwald, E. C., Schmidt, B., Kirpalani, H., Abbasi, S., Chaudhary, A. S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Ghavam, S., Hurt, H., Snyder, J., Ziolkowski, K., Dhawan, M., Booth, L., Catts, C., D'Angio, C. T., Guillet, R., Myers, G. J., Reynolds, A. M., Lakshminrusimha, S., Wadkins, H. I., Sacilowski, M. G., Jensen, R. L., Merzbach, J., Zorn, W., Farooq, O., Maffett, D., Williams, A., Hunn, J., Guilford, S., Yost, K., Rowan, M., Prinzing, D., Bowman, M., Reubens, L. J., Scorsone, A. M., Harley-McAndrew, M., Fallone, C., Binion, K., Orme, C., Sabaratnam, P., Kent, A., Jones, R., Boylin, E., Rochez, D., Li, E., Kachelmeyer, J., McKee, K. G., Coleman, K. R., Moreland, M., Cavanaugh, B., Wyckoff, M. H., Brion, L. P., Heyne, R. J., Vasil, D. M., Adams, S. S., Chen, L., De Leon, M. M., Duran, J., Eubanks, F., McDougald, R., Pavageau, L., Sepulveda, P., Guzman, A., Harrod, M., Heyne, E., Madden, L. A., Lee, L. E., Puentez, A., Tolentino-Plata, K., Twell Boatman, C., Vera, A., Waterbury, J., Yoder, B. A., Baserga, M., Faix, R. G., Minton, S. D., Sheffield, M. J., Rau, C. A., Baker, S., Burnett, J., Christensen, S., Cole Bledsoe, L., Cunningham, S. D., Davis, B., Elmont, J. O., Hall, B., Jensen, E. R., Loertscher, M. C., Marchant, T., Maxson, E., McGrath, K. M., Mickelsen, H. G., Morshedzadeh, G., Parry, D. M., Reich, B. A., Schaefer, S. T., Stout, K., Stuart, A. L., Weaver-Lewis, K., Winter, S., Woodbury, K. D., Osborne, K., Bird, K., Coleman, K., Francom, B. L., Jordan, J., Steffen, M., Tice, K., Shankaran, S., Natarajan, G., Pappas, A., Sood, B. G., Bajaj, M., February, M., Agarwal, P., Chawla, S., Bara, R., Childs, K., Woldt, E., Goldston, L., Wiggins, S. A., Christensen, M. K., Carlson, M., Barks, J., White, D. F. 2024

  Abstract

  Importance: Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding.Objective: To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm.Design, Setting, and Participants: This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks' gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic).Main Outcomes and Measures: The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks' gestation, death and neurodevelopmental impairment at 22 to 26 months' corrected age.Results: Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type.Conclusions and Relevance: For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.

  View details for DOI 10.1001/jamapediatrics.2024.0125

  View details for PubMedID 38466268

• Primary Care Physician Identification of Developmental Delays in the COVID-19 Era: A Quantitative Review of Electronic Health Record Data Frelinger, C., Bannett, Y., Gunturkun, F., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2024: E103-E104

  View details for Web of Science ID 001165262900010

• Leveraging Large Language Models to Assess Medication Side Effects Documentation in Children with Attention-Deficit/Hyperactivity Disorder Bannett, Y., Gunturkun, F., Pillai, M., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2024: E119

  View details for Web of Science ID 001165262900046

• Tissue Oxygenation Changes After Transfusion and Outcomes in Preterm Infants: A Secondary Near-Infrared Spectroscopy Study of the Transfusion of Prematures Randomized Clinical Trial (TOP NIRS). JAMA network open Chock, V. Y., Kirpalani, H., Bell, E. F., Tan, S., Hintz, S. R., Ball, M. B., Smith, E., Das, A., Loggins, Y. C., Sood, B. G., Chalak, L. F., Wyckoff, M. H., Kicklighter, S. D., Kennedy, K. A., Patel, R. M., Carlo, W. A., Johnson, K. J., Watterberg, K. L., Sánchez, P. J., Laptook, A. R., Seabrook, R. B., Cotten, C. M., Mancini, T., Sokol, G. M., Ohls, R. K., Hibbs, A. M., Poindexter, B. B., Reynolds, A. M., DeMauro, S. B., Chawla, S., Baserga, M., Walsh, M. C., Higgins, R. D., Van Meurs, K. P. 2023; 6 (9): e2334889

  Abstract

  Preterm infants with varying degrees of anemia have different tissue oxygen saturation responses to red blood cell (RBC) transfusion, and low cerebral saturation may be associated with adverse outcomes.To determine whether RBC transfusion in preterm infants is associated with increases in cerebral and mesenteric tissue saturation (Csat and Msat, respectively) or decreases in cerebral and mesenteric fractional tissue oxygen extraction (cFTOE and mFTOE, respectively) and whether associations vary based on degree of anemia, and to investigate the association of Csat with death or neurodevelopmental impairment (NDI) at 22 to 26 months corrected age.This was a prospective observational secondary study conducted among a subset of infants between August 2015 and April 2017 in the Transfusion of Prematures (TOP) multicenter randomized clinical trial at 16 neonatal intensive care units of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Preterm neonates with gestational age 22 to 28 weeks and birth weight 1000 g or less were randomized to higher or lower hemoglobin thresholds for transfusion. Data were analyzed between October 2020 and May 2022.Near-infrared spectroscopy monitoring of Csat and Msat.Primary outcomes were changes in Csat, Msat, cFTOE, and mFTOE after transfusion between hemoglobin threshold groups, adjusting for age at transfusion, gestational age, birth weight stratum, and center. Secondary outcome at 22 to 26 months was death or NDI defined as cognitive delay (Bayley Scales of Infant and Toddler Development-III score <85), cerebral palsy with Gross Motor Function Classification System level II or greater, or severe vision or hearing impairment.A total of 179 infants (45 [44.6%] male) with mean (SD) gestational age 25.9 (1.5) weeks were enrolled, and valid data were captured from 101 infants during 237 transfusion events. Transfusion was associated with a significant increase in mean Csat of 4.8% (95% CI, 2.7%-6.9%) in the lower-hemoglobin threshold group compared to 2.7% (95% CI, 1.2%-4.2%) in the higher-hemoglobin threshold group, while mean Msat increased 6.7% (95% CI, 2.4%-11.0%) vs 5.6% (95% CI, 2.7%-8.5%). Mean cFTOE and mFTOE decreased in both groups to a similar extent. There was no significant change in peripheral oxygen saturation (SpO2) in either group (0.2% vs -0.2%). NDI or death occurred in 36 infants (37%). Number of transfusions with mean pretransfusion Csat less than 50% was associated with NDI or death (odds ratio, 2.41; 95% CI, 1.08-5.41; P = .03).In this secondary study of the TOP randomized clinical trial, Csat and Msat were increased after transfusion despite no change in SpO2. Lower pretransfusion Csat may be associated with adverse outcomes, supporting further investigation of targeted tissue saturation monitoring in preterm infants with anemia.ClinicalTrials.gov Identifier: NCT01702805.

  View details for DOI 10.1001/jamanetworkopen.2023.34889

  View details for PubMedID 37733345

• Use of term reference infants in assessing the developmental outcome of extremely preterm infants: lessons learned in a multicenter study. Journal of perinatology : official journal of the California Perinatal Association Green, C. E., Tyson, J. E., Heyne, R. J., Hintz, S. R., Vohr, B. R., Bann, C. M., Das, A., Bell, E. F., Debsareea, S. B., Stephens, E., Gantz, M. G., Petrie Huitema, C. M., Johnson, K. J., Watterberg, K. L., Mosquera, R., Peralta-Carcelen, M., Wilson-Costello, D. E., Colaizy, T. T., Maitre, N. L., Merhar, S. L., Adams-Chapman, I., Fuller, J., Hartley-McAndrew, M. E., Malcolm, W. F., Winter, S., Duncan, A. F., Myer, G. J., Kicklighter, S. D., Wyckoff, M. H., DeMauro, S. B., Hibbs, A. M., Stoll, B. J., Carlo, W. A., Van Meurs, K. P., Rysavy, M. A., Patel, R. M., Sánchez, P. J., Laptook, A. R., Cotten, C. M., D'Angio, C. T., Walsh, M. C. 2023

  Abstract

  Extremely preterm (EP) impairment rates are likely underestimated using the Bayley III norm-based thresholds scores and may be better assessed relative to concurrent healthy term reference (TR) infants born in the same hospital.Blinded, certified examiners in the Neonatal Research Network (NRN) evaluated EP survivors and a sample of healthy TR infants recruited near the 2-year assessment age.We assessed 1452 EP infants and 183 TR infants. TR-based thresholds showed higher overall EP impairment than Bayley norm-based thresholds (O.R. = 1.86; [95% CI 1.56-2.23], especially for severe impairment (36% vs. 24%; p ≤ 0.001). Difficulty recruiting TR patients at 2 years extended the study by 14 months and affected their demographics.Impairment rates among EP infants appear to be substantially underestimated from Bayley III norms. These rates may be best assessed by comparison with healthy term infants followed with minimal attrition from birth in the same centers.Term Reference (under the Generic Database Study): NCT00063063.

  View details for DOI 10.1038/s41372-023-01729-x

  View details for PubMedID 37542155

  View details for PubMedCentralID 3796892

• Heterogeneity of Treatment Effects of Hydrocortisone by Risk of Bronchopulmonary Dysplasia or Death Among Extremely Preterm Infants in the National Institute of Child Health and Human Development Neonatal Research Network Trial: A Secondary Analysis of a Randomized Clinical Trial. JAMA network open Gentle, S. J., Rysavy, M. A., Li, L., Laughon, M. M., Patel, R. M., Jensen, E. A., Hintz, S., Ambalavanan, N., Carlo, W. A., Watterberg, K. 2023; 6 (5): e2315315

  Abstract

  Extremely preterm infants who develop bronchopulmonary dysplasia (BPD) are at a higher risk for adverse pulmonary and neurodevelopmental outcomes. In the National Institute of Child Health and Human Development Neonatal Research Network (NICHD NRN) Hydrocortisone Trial, hydrocortisone neither reduced rates of BPD or death nor increased rates of neurodevelopmental impairment (NDI) or death.To determine whether estimated risk for grades 2 to 3 BPD or death is associated with the effect of hydrocortisone on the composite outcomes of (1) grades 2 to 3 BPD or death and (2) moderate or severe NDI or death.This secondary post hoc analysis used data from the NICHD NRN Hydrocortisone Trial, which was a double-masked, placebo-controlled, randomized clinical trial conducted in 19 US academic centers. The NICHD HRN Hydrocortisone Trial enrolled infants born at a gestational age of less than 30 weeks who received mechanical ventilation for at least 7 days, including at the time of enrollment, and who were aged 14 to 28 postnatal days. Infants were enrolled between August 22, 2011, and February 4, 2018, with follow-up between 22 and 26 months of corrected age completed on March 29, 2020. Data were analyzed from September 13, 2021, to March 25, 2023.Infants were randomized to 10 days of hydrocortisone or placebo treatment.Infants' baseline risk of grades 2 to 3 BPD or death was estimated using the NICHD Neonatal BPD Outcome Estimator. Differences in absolute and relative treatment effects by baseline risk were evaluated using interaction terms in models fitted to the efficacy outcome of grades 2 to 3 BPD or death and the safety outcome of moderate or severe NDI or death by follow-up.Among the 799 infants included in the analysis (421 boys [52.7%]), the mean (SD) gestational age was 24.9 (1.5) weeks, and the mean (SD) birth weight was 715 (167) g. The mean estimated baseline risk for grades 2 to 3 BPD or death was 54% (range, 18%-84%) in the study population. The interaction between treatment group and baseline risk was not statistically significant on a relative or absolute scale for grades 2 to 3 BPD or death; the size of the effect ranged from a relative risk of 1.13 (95% CI, 0.82-1.55) in quartile 1 to 0.94 (95% CI, 0.81-1.09) in quartile 4. Similarly, the interaction between treatment group and baseline risk was not significant on a relative or absolute scale for moderate or severe NDI or death; the size of the effect ranged from a relative risk of 1.04 (95% CI, 0.80-1.36) in quartile 1 to 0.99 (95% CI, 0.80-1.22) in quartile 4.In this secondary analysis of a randomized clinical trial, the effect of hydrocortisone vs placebo was not appreciably modified by baseline risk for grades 2 to 3 BPD or death.ClinicalTrials.gov Identifier: NCT01353313.

  View details for DOI 10.1001/jamanetworkopen.2023.15315

  View details for PubMedID 37256621

• Early Life Outcomes in Relation to Social Determinants of Health for Children Born Extremely Preterm. The Journal of pediatrics Brumbaugh, J. E., Vohr, B. R., Bell, E. F., Bann, C. M., Travers, C. P., McGowan, E. C., Harmon, H. M., Carlo, W. A., Duncan, A. F., Hintz, S. R. 2023: 113443

  Abstract

  To characterize the relationships between social determinants of health (SDOH) and outcomes for children born extremely preterm.This is a cohort study of infants born at 22-26 weeks' gestation in NICHD Neonatal Research Network centers (2006-2017) who survived to discharge. Infants were classified by three maternal SDOH: education, insurance, and race. Outcomes included postmenstrual age (PMA) at discharge, readmission, neurodevelopmental impairment (NDI), and death post-discharge. Regression analyses adjusted for center, perinatal characteristics, neonatal morbidity, ethnicity, and two SDOH (eg, group comparisons by education adjusted for insurance and race).Of 7438 children, 5442 (73%) had at least one risk-associated SDOH. PMA at discharge was older (adjusted mean difference 0.37 weeks, 95% confidence interval (CI) 0.06-0.68) and readmission more likely (adjusted odds ratio (aOR) 1.27, 95% CI 1.12-1.43) for infants whose mothers had public/no insurance versus private. Neither PMA at discharge nor readmission varied by education or race. NDI was twice as likely (aOR 2.36, 95% CI 1.86-3.00) and death five times as likely (aOR 5.22, 95% CI 2.54-10.73) for infants with three risk-associated SDOH compared with those with none.Children born to mothers with public/no insurance were older at discharge and more likely to be readmitted than those born to privately insured mothers. NDI and death post-discharge were more common among children exposed to multiple risk-associated SDOH at birth compared with those not exposed. Addressing disparities due to maternal education, insurance coverage, and systemic racism are potential intervention targets to improve outcomes for children born preterm.

  View details for DOI 10.1016/j.jpeds.2023.113443

  View details for PubMedID 37105408

• Detection of Speech-Language Delay in the Primary Care Setting: An Electronic Health Record Investigation. Journal of developmental and behavioral pediatrics : JDBP Frelinger, C., Gardner, R. M., Huffman, L. C., Whitgob, E. E., Feldman, H. M., Bannett, Y. 2023; 44 (3): e196-e203

  Abstract

  The purpose of this study is to determine the rate and age at first identification of speech-language delay in relation to child sociodemographic variables among a pediatric primary care network.We analyzed a deidentified data set of electronic health records of children aged 1- to 5-years-old seen between 2015 and 2019 at 10 practices of a community-based pediatric primary health care network. Primary outcomes were numbers (proportions) of patients with relevant ICD-10 visit-diagnosis codes and patient age (months) at first documentation of speech-language delay. Regression models estimated associations between outcomes and patient characteristics, adjusting for practice affiliation.Of 14,559 included patients, 2063 (14.1%) had speech-language delay: 68.4% males, 74.4% with private insurance, and 96.1% with English as a primary household language. Most patients (60%) were first identified at the 18- or 24-month well-child visit. The mean age at first documentation was 25.4 months (SD = 9.3), which did not differ between practices reporting the use of standardized developmental screener and those using surveillance questionnaires. Regression models showed that males were more than twice as likely than females to be identified with speech-language delay (adjusted odds ratio [aOR] = 2.05, 95% CI: [1.86-2.25]); publicly insured were more likely than privately insured patients to be identified with speech-language delay (aOR = 1.48, 95% CI: [1.30-1.68]). Females were older than males at first identification (+1.2 months, 95% CI: [0.3-2.1]); privately insured were older than military insured patients (private +3.3 months, 95% CI: [2.2-4.4]).Pediatricians in this network identified speech-language delays at similar rates to national prevalence. Further investigation is needed to understand differences in speech-language delay detection across patient subgroups in practices that use developmental screening and/or surveillance.

  View details for DOI 10.1097/DBP.0000000000001167

  View details for PubMedID 36978234

• Incidence of and Neurodevelopmental Outcomes After Late-Onset Meningitis Among Children Born Extremely Preterm. JAMA network open Brumbaugh, J. E., Bell, E. F., Do, B. T., Greenberg, R. G., Stoll, B. J., DeMauro, S. B., Harmon, H. M., Hintz, S. R., Das, A., Puopolo, K. M. 2022; 5 (12): e2245826

  Abstract

  Late-onset meningitis (LOM) has been associated with adverse neurodevelopmental outcomes in children born extremely preterm.To report the incidence of LOM during birth hospitalization and neurodevelopmental outcomes at 18 to 26 months' corrected age.This cohort study is a secondary analysis of a multicenter prospective cohort of children born at 22 to 26 weeks' gestation between 2003 and 2017 with follow-up from 2004 to 2021. The study was conducted at 25 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers.Culture-confirmed LOM.Incidence and microbiology of LOM (2003-2017); lumbar puncture (LP) performance in late-onset sepsis (LOS) evaluations (2011-2017); composite outcome of death or neurodevelopmental impairment (NDI; 2004-2021).Among 13 372 infants (median [IQR] gestational age, 25.4 [24.4-26.1] weeks; 6864 [51%] boys), LOM was diagnosed in 167 (1%); LOS without LOM in 4564 (34%); and neither LOS nor LOM in 8641 (65%). The observed incidence of LOM decreased from 2% (95% CI, 1%-3%) in 2003 to 0.4% (95% CI, 0.7%-1.0%) in 2017 (P < .001). LP performance in LOS evaluations decreased from 36% (95% CI, 33%-40%) in 2011 to 24% (95% CI, 21%-27%) in 2017 (P < .001). Among infants with culture-confirmed LOS, LP performance decreased from 58% (95% CI, 51%-65%) to 45% (95% CI, 38%-51%; P = .008). LP performance varied by center among all LOS evaluations (10%-59%, P < .001) and among those with culture-confirmed LOS (23%-79%, P < .001). LOM occurred in the absence of concurrent LOS in 27 of 167 cases (16%). The most common LOM isolates were coagulase-negative Staphylococcus (98 [59%]), Candida albicans (38 [23%]), and Escherichia coli (27 [16%]). Death or NDI occurred in 22 of 46 children (48%) with LOM due to coagulase-negative Staphylococcus, 43 of 67 (64%) due to all other bacterial pathogens, and 26 of 33 (79%) due to fungal pathogens. The adjusted relative risk of death or NDI was increased among children with LOM (aOR, 1.53; 95% CI, 1.04-2.25) and among those with LOS without LOM (aOR, 1.41; 95% CI, 1.29-1.54) compared with children with neither infection.In this cohort study, LP was performed with decreasing frequency, and the observed incidence of LOM also decreased. Both LOM and LOS were associated with increased risk of death or NDI; risk varied by LOM pathogen. The full association of LOM with outcomes of children born extremely preterm may be underestimated by current diagnostic practices.

  View details for DOI 10.1001/jamanetworkopen.2022.45826

  View details for PubMedID 36480199

• Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic. Journal of developmental and behavioral pediatrics : JDBP Bannett, Y., Dahlen, A., Huffman, L. C., Feldman, H. M. 2022

  Abstract

  OBJECTIVE: The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care.METHOD: We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared.RESULTS: ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years.CONCLUSION: Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

  View details for DOI 10.1097/DBP.0000000000001087

  View details for PubMedID 35503665

• Hydrocortisone to Improve Survival without Bronchopulmonary Dysplasia. The New England journal of medicine Watterberg, K. L., Walsh, M. C., Li, L., Chawla, S., D'Angio, C. T., Goldberg, R. N., Hintz, S. R., Laughon, M. M., Yoder, B. A., Kennedy, K. A., McDavid, G. E., Backstrom-Lacy, C., Das, A., Crawford, M. M., Keszler, M., Sokol, G. M., Poindexter, B. B., Ambalavanan, N., Hibbs, A. M., Truog, W. E., Schmidt, B., Wyckoff, M. H., Khan, A. M., Garg, M., Chess, P. R., Reynolds, A. M., Moallem, M., Bell, E. F., Meyer, L. R., Patel, R. M., Van Meurs, K. P., Cotten, C. M., McGowan, E. C., Hines, A. C., Merhar, S., Peralta-Carcelen, M., Wilson-Costello, D. E., Kilbride, H. W., DeMauro, S. B., Heyne, R. J., Mosquera, R. A., Natarajan, G., Purdy, I. B., Lowe, J. R., Maitre, N. L., Harmon, H. M., Hogden, L. A., Adams-Chapman, I., Winter, S., Malcolm, W. F., Higgins, R. D., Eunice Kennedy Shriver NICHD Neonatal Research Network, Polin, R. A., Laptook, A. R., Vohr, B. R., Hensman, A. M., Vieira, E., Pierre, L. S., Burke, R. T., Alksninis, B., Caskey, M., Hoffman, L., Johnson, K., Keszler, M. L., Knoll, A., Leach, T. M., Little, E., Stephens, B. E., Watson, V. E., Payne, A. H., Newman, N. S., Siner, B. S., Bhola, M., Yalcinkaya, G., Pallotto, E. K., Gauldin, C., Holmes, A., Johnson, K., Scott, A., Schibler, K., Yolton, K., Beiersdorfer, T., Cahill, T. E., Dudley, J., Gratton, T. L., Grisby, C., Kirker, K., Thompson, J., Wuertz, S., Goldstein, R. F., Ashley, P. L., Mago-Shah, D., Warren, M., Finkle, J., Fisher, K. A., Gustafson, K. E., Bose, C. L., Bernhardt, J., Bose, G., Wereszczak, J., Warner, D., Talbert, J., Clark, C., Kicklighter, S. D., Bentley, A., Edwards, L., Rhodes-Ryan, G., White, D., Carlton, D. P., Stoll, B. J., Hale, E. C., Loggins, Y., Bottcher, D., Carter, S. L., Kendrick-Allwood, S., Mulligan LaRossa, M., Mackie, C., Smikle, G., Comerford, L. C., Laursen, J., Sanders, A., Bremer, A. A., Wilson Archer, S., Papile, L. A., Harmon, H., Lytle, C., Herron, D. E., Gunn, S., Smiley, L., Wilson, L. D., Tyson, J. E., Duncan, A. F., Alaniz, N., Allain, E., Arldt-McAlister, J., Boral, D. S., Burson, K., Dempsey, A. G., Eason, E., Evans, P. W., Garcia, C., Green, C., Hall, D. J., Jiminez, M., John, J., Jones, P. M., Lillie, M. L., Martin, K., Martin, S. C., Mason, C. M., McDavid, G. E., McKee, S. L., Poe, M., Rennie, K., Rodgers, S. L., Siddiki, S. K., Sperry, D., Stephens, E. K., Pierce Tate, P. L., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Slaughter, J. L., Luzader, P., Burkhardt, S., Carey, H., Chao, M., Clark, E., Fearns, E., Fortney, C. A., Fowler, A., Grothause, J., Gutentag, J., Hague, C., McCool, J., Nelin, M. A., Park, C., Pietruszewski, L., Purnell, J., Shadd, J., Small, K., Stein, M., Sullivan, M., Sullivan, R. A., Timan, C. J., Yeates, K. O., Yoseff-Salameh, L., Keim, S. A., Newton, J., Levengood, K., Batterson, N., Rice, C., Wallace, D., Bann, C. M., Gantz, M. G., O'Donnell Auman, J., Gabrio, J., Leblond, D., Newman, J. E., Petrie Huitema, C. M., vonLehmden, A., Zaterka-Baxter, K. M., Stevenson, D. K., Chock, V. Y., Ball, M. B., Bentley, B., Chitkara, R., Davis, A. S., DeAnda, M. E., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R. E., Proud, M. S., Hitchner Reichert, E. N., Sivakumar, D., Taylor, H., Weiss, H. E., Carlo, W. A., Collins, M. V., Cosby, S. S., Biasini, F. J., Domnanovich, K. A., McNair, T. E., Phillips, V. A., Whitley, S., York Chapman, S., Devaskar, U., Chanlaw, T., Geller, R., Colaizy, T. T., Widness, J. A., Brumbaugh, J. E., Harmon, H. M., Johnson, K. J., Walker, J. R., Goeke, C. A., Schmelzel, M. L., Eastman, D. L., Baack, M. L., Hogden, L. A., Meyer, L., Henning, M. M., Elenkiwich, C., Broadbent, M., Van Muyden, S., Ellsbury, D. L., Campbell, D. B., Tud, T. L., Fuller, J., Hartenberger, C., Kuan, E., Sundquist Beauman, S., Kirpalani, H., Eichenwald, E. C., Abbasi, S., Mancini, T., Chaudhary, A. S., Cucinotta, D. M., Bernbaum, J. C., Freeman Duncan, A., Dysart, K., Gerdes, M., Hurt, H., Jensen, E. A., Snyder, J., Ziolkowski, K., Guillet, R., Myers, G. J., Binion, K., Fallone, C., Farooq, O., Jensen, R. L., Kent, A., Maffett, D., Merzbach, J., Orme, C., Sacilowski, M. G., Sabaratnam, P., Scorsone, A. M., Wadkins, H. I., Wynn, K., Yost, K., Lakshminrusimha, S., Chandrasekharan, P., Guilford, S., Hartley-McAndrews, M. E., Williams, A., Zorn, W., Li, E., Donato, J., McKee, K. G., Coleman, K. R., Bean, S. A., Cole, C. A., Horihan, C. A., Brion, L. P., Vasil, D. M., Adams, S. S., Boss, L., Chen, L., De Leon, M. M., Eubanks, F., Guzman, A., Heyne, E., Lee, L. E., Lira, H., Madden, L. A., McDougald, E. R., Mozaffari, A., Pavageau, L., Sepulveda, P., Twell Boatman, C., Tolentino-Plata, K., Vera, A., Waterbury, J., Wright, R., Ohls, R. K., Baserga, M., Minton, S. D., Sheffield, M. J., Rau, C. A., Burnett, J., Christensen, S., Cole Bledsoe, L., Cunningham, S., Davis, B., Elmont, J. O., Hall, B., Loertscher, M. C., Marchant, T., Maxson, E., McGrath, K. M., Mickelsen, H. G., Morshedzadeh, G., Parry, D. M., Reich, B. A., Schaefer, S. T., Stout, K., Stuart, A. L., Weaver-Lewis, K., Woodbury, K. D., Shankaran, S., Sood, B. G., Bara, R., Agarwal, P., Bajaj, M., Childs, K., February, M., Goldston, L., Johnson, M. E., Panaitescu, B., Hinz Woldt, E., Barks, J., Carlson, M., Christensen, M. K., White, D. F., Wiggins, S. A., Gleason, C. A., Allen, M. C., Boyle, R. J., Clemons, T., D'Alton, M. E., Das, A., O'Shea, T. M., Steinhorn, R., Weiner, S. J., Willinger, M. 2022; 386 (12): 1121-1131

  Abstract

  BACKGROUND: Bronchopulmonary dysplasia is a prevalent complication after extremely preterm birth. Inflammation with mechanical ventilation may contribute to its development. Whether hydrocortisone treatment after the second postnatal week can improve survival without bronchopulmonary dysplasia and without adverse neurodevelopmental effects is unknown.METHODS: We conducted a trial involving infants who had a gestational age of less than 30 weeks and who had been intubated for at least 7 days at 14 to 28 days. Infants were randomly assigned to receive either hydrocortisone (4 mg per kilogram of body weight per day tapered over a period of 10 days) or placebo. Mandatory extubation thresholds were specified. The primary efficacy outcome was survival without moderate or severe bronchopulmonary dysplasia at 36 weeks of postmenstrual age, and the primary safety outcome was survival without moderate or severe neurodevelopmental impairment at 22 to 26 months of corrected age.RESULTS: We enrolled 800 infants (mean [±SD] birth weight, 715±167 g; mean gestational age, 24.9±1.5 weeks). Survival without moderate or severe bronchopulmonary dysplasia at 36 weeks occurred in 66 of 398 infants (16.6%) in the hydrocortisone group and in 53 of 402 (13.2%) in the placebo group (adjusted rate ratio, 1.27; 95% confidence interval [CI], 0.93 to 1.74). Two-year outcomes were known for 91.0% of the infants. Survival without moderate or severe neurodevelopmental impairment occurred in 132 of 358 infants (36.9%) in the hydrocortisone group and in 134 of 359 (37.3%) in the placebo group (adjusted rate ratio, 0.98; 95% CI, 0.81 to 1.18). Hypertension that was treated with medication occurred more frequently with hydrocortisone than with placebo (4.3% vs. 1.0%). Other adverse events were similar in the two groups.CONCLUSIONS: In this trial involving preterm infants, hydrocortisone treatment starting on postnatal day 14 to 28 did not result in substantially higher survival without moderate or severe bronchopulmonary dysplasia than placebo. Survival without moderate or severe neurodevelopmental impairment did not differ substantially between the two groups. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01353313.).

  View details for DOI 10.1056/NEJMoa2114897

  View details for PubMedID 35320643

• Behavioral Treatment Recommendation for Preschoolers with ADHD Symptoms: How Are Primary Care Pediatricians Doing? Bannett, Y., Gardner, R. M., Posada, J. D., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2022: E123-E124

  View details for Web of Science ID 000797424900043

• Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA Bell, E. F., Hintz, S. R., Hansen, N. I., Bann, C. M., Wyckoff, M. H., DeMauro, S. B., Walsh, M. C., Vohr, B. R., Stoll, B. J., Carlo, W. A., Van Meurs, K. P., Rysavy, M. A., Patel, R. M., Merhar, S. L., Sanchez, P. J., Laptook, A. R., Hibbs, A. M., Cotten, C. M., D'Angio, C. T., Winter, S., Fuller, J., Das, A., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Ambalavanan, N. M., Bailey, K. J., Biasini, F. J., Chopko, S. A., Collins, M. V., Cosby, S. S., Domnanovich, K. A., Jno-Finn, C. J., Ladinsky, M. M., McNair, T. E., Moses, M. B., Peralta-Carcelen, M. M., Phillips, V. A., Preskitt, J. P., Rector, R. V., Stringer, K. M., Whitley, S. M., York Chapman, S. P., Alksninis, B. R., Burke, R. T., Hensman, A. M., Keszler, M. M., Keszler, M. L., Knoll, A. M., Leach, T. M., McGowan, E. C., St Pierre, L. B., Vieira, E. R., Watson, V. E., Guilford, S. B., Hartley-McAndrew, M. E., Lakshminrusimha, S. M., Li, E. B., Reynolds, A. M., Sacilowski, M. G., Williams, A. M., Zorn, W. A., Friedman, H. G., Newman, N. S., Siner, B. S., Wilson-Costello, D. E., Cahill, T. E., Gratton, T. L., Grisby, C. B., Kirker, K. C., Poindexter, B. B., Schibler, K. M., Wuertz, S. R., Yolton, K. P., Polin, R. A., Adams, S. S., Brion, L. P., De Leon, M. M., Eubanks, F. R., Guzman, A., Heyne, E. T., Heyne, R. J., Lee, L. E., McDougald, E. R., Pavageau, L. M., Sepulveda, P. R., Twell Boatman, C. M., Vasil, D. M., Vera, A. A., Waterbury, J. D., Ashley, P. L., Finkle, J. R., Fisher, K. A., Goldberg, R. N., Goldstein, R. F., Gustafson, K. E., Mago-Shah, D. M., Malcolm, W. F., Adams-Chapman Deceased, I. M., Bottcher, D. I., Carlton, D. P., Carter, S. L., Hale, E. C., Kendrick-Allwood, S. M., Laursen, J. R., Loggins, Y. C., Mackie, C. B., Mulligan LaRossa, M. R., Sanders, A. P., Smikle, G. V., Wineski, L. N., Allain, E. P., Arldt-McAlister, J. M., Boricha, F. M., Dempsey, A. G., Duncan, A. F., Garcia, C. R., Hall, D. J., John, J. C., Kennedy, K. A., Khan, A. M., Lillie, M. L., Martin, K. R., McDavid, G. E., McKee, S. L., Mosquera, R. A., Poe, M. P., Reddy, T. M., Rennie, K. P., Rodgers, S. R., Sperry, D. K., Stephens, E. K., Tyson, J. E., Wright, S. L., Harmon, H. M., Herron, D. E., Hines, A. C., Lytle, C. M., Papile, L. M., Smiley, L. C., Sokol, G. M., Brumbaugh, J. E., Colaizy, T. T., Eastman, D. L., Goeke, C. A., Johnson, K. J., Schmelzel, M. L., Walker, J. R., Widness, J. A., Bass, D. B., Ellsbury, D. L., Tud, T. L., Gaetano, L. R., Gauldin, C. R., Holmes, A. M., Johnson, K. R., Kilbride, H. W., Pallotto, E. K., Parimi, P. S., Scott, A. R., Truog, W. E., Batterson, N. O., Baugher, H. B., Beckford, D. R., Burkhardt, S. M., Carey, H. P., Chao, M. B., Cira, C. B., Clark, E. B., DeSantis, B. B., Fearns, E., Fortney, C. A., Fowler, A. B., Grothause, J. L., Gutentag, J. R., Hague, C. D., Jadcherla, S. R., Keim, S. A., Levengood, K. P., Luzader, P. R., Maitre, N. L., Marzec, L. M., McCool, J., Miller, B. R., Nelin, L. D., Nelin, M. A., Newton, J. M., Park, C. R., Pietruszewski, L. P., Purnell, J. B., Shadd, J. C., Slaughter, J. L., Small, K. L., Stein, M. R., Sullivan, M. B., Sullivan, R. A., Timan, C. J., Warnimont, K. B., Yeates, K. O., Yossef-Salameh, L. M., Bremer, A. A., Higgins, R. D., Wilson Archer, S. M., Abbasi, S. M., Bernbaum, J. C., Chaudhary, A. S., Cucinotta, D. M., Eichenwald, E. C., Gerdes, M. P., Ghavam, S. M., Hurt, H. M., Kirpalani, H. B., Mancini, T. R., Schmidt, B. M., Snyder, J. M., Ziolkowski, K. C., Binion, K. B., Bowman, M. R., Boylin, E. B., Coleman, K. R., Fallone, C. M., Farooq, O. M., Guillet, R. M., Horihan, C. A., Hunn, J. M., Jensen, R. L., Jones, R., Kachelmeyer, J. B., Kent, A. B., McKee, K. G., Merzbach, J. L., Myers, G. J., Orme, C. B., Prinzing, D. M., Rochez, D. B., Rowan, M. R., Sabaratnam, P. M., Scorsone, A. M., Wadkins, H. I., Yost, K. P., Crawford, M. M., Gabrio, J. M., Gantz, M. G., Newman, J. E., O'Donnell Auman, J. B., Parlberg, L. B., Petrie Huitema, C. M., Wallace, D. P., Zaterka-Baxter, K. M., Baack, M. L., Broadbent, M. R., Elenkiwich, C. R., Henning, M. M., Hogden, L. A., Adams, M. M., Bahmani, D. M., Ball, M. B., Bentley, B. P., Chock, V. Y., DeAnda, M. E., DeBattista, A. M., Earhart, B. A., Huffman, L. C., Krueger, C. E., Lucash, R. E., Proud, M. S., Reichert, E. N., Stevenson, D. K., Taylor, H. L., Weiss, H. E., Williams, R. J., Chanlaw, T. M., Devaskar, U. M., Garg, M. M., Geller, R. R., Purdy, I. B., Bernhardt, J. M., Bose, C. L., Bose, G. R., Laughon, M. M., Talbert, J. M., Warner, D. D., Wereszczak, J. K., Backstrom Lacy, C. R., Hartenberger, C. H., Kuan, E. R., Lowe, J. R., Ohls, R. K., Ruffner Hanson, M. R., Sundquist Beauman, S. M., Watterberg, K. L., Barks, J. M., Carlson, M. D., Christensen, M. K., White, D. F., Wiggins, S. A., Baker, S. R., Baserga, M. M., Burnett, J. R., Christensen, S. R., Cunningham, S. D., Davis, B. R., Elmont, J. O., Faix, R. G., Hall, B. A., Jensen, E. R., Loertscher, M. C., Marchant, T. R., Maxson, E. B., McGrath, K. M., Mickelsen, H. G., Minton, S. D., Morshedzadeh, G. B., Parry, D. M., Rau, C. A., Schaefer, S. T., Sheffield, M. J., Stout, K. P., Stuart, A. L., Weaver-Lewis, K. R., Woodbury, K. D., Yoder, B. A., Bentley, A. M., Edwards, L. M., Kicklighter, S. D., Rhodes-Ryan, G. A., White, D. R., Agarwal, P. M., Bajaj, M. M., Bara, R. R., Chawla, S. M., Childs, K. R., February, M. M., Goldston, L. A., Hinz Woldt, E. R., Natarajan, G. M., Pappas, A. M., Shankaran, S. M., Sood, B. G. 1800; 327 (3): 248-263

  Abstract

  Importance: Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity.Objective: To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants.Design, Setting, and Participants: Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age.Exposures: Extremely preterm birth.Main Outcomes and Measures: Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices.Results: The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment.Conclusions and Relevance: Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

  View details for DOI 10.1001/jama.2021.23580

  View details for PubMedID 35040888

• Association of Increased Seizures During Rewarming With Abnormal Neurodevelopmental Outcomes at 2-Year Follow-up: A Nested Multisite Cohort Study. JAMA neurology Chalak, L. F., Pappas, A., Tan, S., Das, A., Sanchez, P. J., Laptook, A. R., Van Meurs, K. P., Shankaran, S., Bell, E. F., Davis, A. S., Heyne, R. J., Pedroza, C., Poindexter, B. B., Schibler, K., Tyson, J. E., Ball, M. B., Bara, R., Grisby, C., Sokol, G. M., D'Angio, C. T., Hamrick, S. E., Dysart, K. C., Cotten, C. M., Truog, W. E., Watterberg, K. L., Timan, C. J., Garg, M., Carlo, W. A., Higgins, R. D., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Ambalavanan, N., Collins, M. V., Cosby, S. S., Peralta-Carcelen, M., Phillips, V. A., Randolph, D. A., Alksninis, B., Burke, R. T., Caskey, M., Guerina, N., Hensman, A. M., Keszler, M., Keszler, M. L., Knoll, A. M., Little, E., McGowan, E. C., Oh, W., Shah, B. A., Sommers, R., Vieira, E., Vohr, B. R., Guilford, S., Lakshminrusimha, S., Reynolds, A. M., Sacilowski, M. G., Williams, A., Wynn, K., Hibbs, A. M., Newman, N. S., Siner, B. S., Stork, E. K., Walsh, M. C., Zadell, A., Caplan, M. S., Polin, R. A., Adams, S. S., Brion, L. P., Chen, L., Guzman, A., Heyne, E. T., Lee, L. E., Madden, L. A., Ramon, E., Sanchez, P. J., Twell Boatman, C., Vasil, D. M., Wyckoff, M. H., Ashley, P. L., Finkle, J., Fisher, K. A., Goldberg, R. N., Goldstein, R. F., Grimes, S., Gustafson, K. E., Malcolm, W. F., Adams-Chapman Deceased, I., Bottcher, D. I., Carlton, D. P., Carter, S. L., Hale, E. C., Loggins, Y. C., Mackie, C., Patel, R. M., Stoll, B. J., Wineski, L., Gunn, S., Harmon, H. M., Herron, D. E., Hines, A. C., Joyce, J., Lytle, C., Miller, L. C., Minnich, H. M., Papile, L., Poindexter, B. B., Richard, L., Smiley, L. C., Wilson, L. D., Acarregui, M. J., Bhavsar, V., Brumbaugh, J. E., Colaizy, T. T., Dagle, J. M., Eastman, D. L., Johnson, K. J., Klein, J. M., Lindower, J. B., McElroy, S. J., Murphy, C. R., Rabe, G. K., Roghair, R. D., Segar, J. L., Walker, J. R., Widness, J. A., Ellsbury, D. L., Gauldin, C., Holmes, A. M., Johnson, K., Kilbride, H. W., Pallotto, E. K., Scott, A., Bapat, R., Bartman, T., Bonachea, E., Carey, H., Chao, M., Chicoine, L. G., Clifford, B., Dion Nist, M., Fearns, E., Fortney, C. A., Fowler, A., Fuller, J., Grothause, J. L., Gulati, I., Gutentag, J., Hague, C. D., Haines, K., Hart, B., Hokenson, M., Jadcherla, S. R., Jones, M. E., Keim, S. A., Luzader, P., Maitre, N. L., McGregor, S., Moorehead, P., Nelin, L. D., Nelin, M. A., Parikh, N. A., Rodgers, E., Seabrook, R., Sharp, T., Shepherd, E. G., Slaughter, J. L., Stein, M., Sullivan, R. A., Ulloa, J. A., Wispe, J., Wolfe, T., Yeates, K. O., Yossef-Salameh, L., Zaghoul, N., Wilson Archer, S., Abbasi, S., Bernbaum, J. C., Chaudhary, A. S., Cucinotta, D. M., DeMauro, S. B., Gerdes, M., Hurt, H., Kirpalani, H., Mancini, T., Schmidt, B., Binion, K., Conway, P., Farooq, O., Guillet, R., Horihan, C. A., Jensen, R. L., Laroira, N., Merzbach, J., Myers, G. J., Sabaratnam, P., Scorsone, A. M., Wadkins, H. I., Yost, K., Bann, C. M., Crawford, M. M., Gabrio, J., Gantz, M. G., McDonald, S. A., Newman, J. E., O'Donnell Auman, J., Petrie Huitema, C. M., Pickett, J. W., VonLehmden, A. M., Wallace, D., Zaterka-Baxter, K. M., Chock, V. Y., DeAnda, M. E., DeBattista, A. M., Huffman, L. C., Krueger, C. E., Lucash, R. E., Proud, M. S., Stevenson, D. K., Taylor, H. L., Weiss, H. E., Chanlaw, T., Devaskar, U., Geller, R., Purdy, I. B., Aliaga, S., Bernhardt, J., Bose, C. L., Clark, C. L., Laughon, M. M., Warner, D. D., Wereszczak, J. K., Backstrom Lacy, C., Duncan, A. F., Fuller, J., Hartenberger, C. H., Lowe, J. R., Ohls, R. K., Sundquist Beauman, S., Barks, J., Christensen, M. K., Wiggins, S. A., Bajaj, M., Chawla, S., Childs, K., De Jesus, L. C., Hinz Woldt, E., Johnson, M. E., Natarajan, G., Panaitescu, B., Prentice, J. E., Sood, B. G. 2021

  Abstract

  Importance: Compared with normothermia, hypothermia has been shown to reduce death or disability in neonatal hypoxic ischemic encephalopathy but data on seizures during rewarming and associated outcomes are scarce.Objective: To determine whether electrographic seizures are more likely to occur during rewarming compared with the preceding period and whether they are associated with abnormal outcomes in asphyxiated neonates receiving hypothermia therapy.Design, Setting, and Participants: This prespecified nested cohort study of infants enrolled in the Optimizing Cooling (OC) multicenter Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network trial from December 2011 to December 2013 with 2 years' follow-up randomized infants to either 72 hours of cooling (group A) or 120 hours (group B). The main trial included 364 infants. Of these, 194 were screened, 10 declined consent, and 120 met all predefined inclusion criteria. A total of 112 (90%) had complete data for death or disability. Data were analyzed from January 2018 to January 2020.Interventions: Serial amplitude electroencephalography recordings were compared in the 12 hours prior and 12 hours during rewarming for evidence of electrographic seizure activity by 2 central amplitude-integrated electroencephalography readers blinded to treatment arm and rewarming epoch. Odds ratios and 95% CIs were evaluated following adjustment for center, prior seizures, depth of cooling, and encephalopathy severity.Main Outcomes and Measures: The primary outcome was the occurrence of electrographic seizures during rewarming initiated at 72 or 120 hours compared with the preceding 12-hour epoch. Secondary outcomes included death or moderate or severe disability at age 18 to 22 months. The hypothesis was that seizures during rewarming were associated with higher odds of abnormal neurodevelopmental outcomes.Results: A total of 120 newborns (70 male [58%]) were enrolled (66 in group A and 54 in group B). The mean (SD) gestational age was 39 (1) weeks. There was excellent interrater agreement (kappa, 0.99) in detection of seizures. More infants had electrographic seizures during the rewarming epoch compared with the preceding epoch (group A, 27% vs 14%; P=.001; group B, 21% vs 10%; P=.03). Adjusted odd ratios (95% CIs) for seizure frequency during rewarming were 2.7 (1.0-7.5) for group A and 3.2 (0.9-11.6) for group B. The composite death or moderate to severe disability outcome at 2 years was significantly higher in infants with electrographic seizures during rewarming (relative risk [95% CI], 1.7 [1.25-2.37]) after adjusting for baseline clinical encephalopathy and seizures as well as center.Conclusions and Relevance: Findings that higher odds of electrographic seizures during rewarming are associated with death or disability at 2 years highlight the necessity of electroencephalography monitoring during rewarming in infants at risk.Trial Registration: ClinicalTrials.gov Identifier: NCT01192776.

  View details for DOI 10.1001/jamaneurol.2021.3723

  View details for PubMedID 34661629

• A Text-Based Intervention to Promote Literacy: An RCT. Pediatrics Chamberlain, L. J., Bruce, J., De La Cruz, M., Huffman, L., Steinberg, J. R., Bruguera, R., Peterson, J. W., Gardner, R. M., He, Z., Ordaz, Y., Connelly, E., Loeb, S. 2021

  Abstract

  BACKGROUND AND OBJECTIVES: Children entering kindergarten ready to learn are more likely to thrive. Inequitable access to high-quality, early educational settings creates early educational disparities. TipsByText, a text-message-based program for caregivers of young children, improves literacy of children in preschool, but efficacy for families without access to early childhood education was unknown.METHODS: We conducted a randomized controlled trial with caregivers of 3- and 4-year-olds in 2 public pediatric clinics. Intervention caregivers received TipsByText 3 times a week for 7 months. At pre- and postintervention, we measured child literacy using the Phonological Awareness Literacy Screening Tool (PALS-PreK) and caregiver involvement using the Parent Child Interactivity Scale (PCI). We estimated effects on PALS-PreK and PCI using multivariable linear regression.RESULTS: We enrolled 644 families, excluding 263 because of preschool participation. Compared with excluded children, those included in the study had parents with lower income and educational attainment and who were more likely to be Spanish speaking. Three-quarters of enrollees completed pre- and postintervention assessments. Postintervention PALS-PreK scores revealed an unadjusted treatment effect of 0.260 (P = .040); adjusting for preintervention score, child age, and caregiver language, treatment effect was 0.209 (P = .016), equating to 3 months of literacy gains. Effects were greater for firstborn children (0.282 vs 0.178), children in 2-parent families (0.262 vs 0.063), and 4-year-olds (0.436 vs 0.107). The overall effect on PCI was not significant (1.221, P = .124).CONCLUSIONS: The health sector has unique access to difficult-to-reach young children. With this clinic-based texting intervention, we reached underresourced families and increased child literacy levels.

  View details for DOI 10.1542/peds.2020-049648

  View details for PubMedID 34544847

• Neurodevelopmental outcome of preterm infants enrolled in myo-inositol randomized controlled trial. Journal of perinatology : official journal of the California Perinatal Association Adams-Chapman, I., Watterberg, K. L., Nolen, T. L., Hirsch, S., Cole, C. A., Cotten, C. M., Oh, W., Poindexter, B. B., Zaterka-Baxter, K. M., Das, A., Lacy, C. B., Scorsone, A. M., Duncan, A. F., DeMauro, S. B., Goldstein, R. F., Colaizy, T. T., Wilson-Costello, D. E., Purdy, I. B., Hintz, S. R., Heyne, R. J., Myers, G. J., Fuller, J., Merhar, S., Harmon, H. M., Peralta-Carcelen, M., Kilbride, H. W., Maitre, N. L., Vohr, B. R., Natarajan, G., Mintz-Hittner, H., Quinn, G. E., Wallace, D. K., Olson, R. J., Orge, F. H., Tsui, I., Gaynon, M., Hutchinson, A. K., He, Y., Winter, T. W., Yang, M. B., Haider, K. M., Cogen, M. S., Hug, D., Bremer, D. L., Donahue, J. P., Lucas, W. R., Phelps, D. L., Higgins, R. D., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Archer, S. W., Sokol, G. M., Gunn, S., Herron, D. E., Hines, A. C., Hynes, E., Papile, L., Smiley, L., Tyson, J. E., Kennedy, K. A., Khan, A. M., Duncan, A., Mosquera, R., Allain, E., Arldt-McAlister, J., Brown, S., Dempsey, A. G., Eason, E., El-Ali, F., Garcia, C., Kumar, K., John, J., Jones, P. M., Lillie, M. L., Martin, K., Martin, S. C., McDavid, G. E., EdS, S. M., Ozsoy, H., Rodgers, S., Sperry, D., Stephens, E. K., Ta, V., Wong, C., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Graf, A. E., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Rogers, D. L., Golden, R. P., Jordan, C. O., Wallace, D., Gantz, M. G., Bann, C. M., Auman, J. O., Crawford, M. M., Gabrio, J., Huitema, C. M., Pickett, J. W., VonLehmden, A. M., Van Meurs, K. P., Stevenson, D. K., Ball, M. B., Chinn, S., Proud, M. S., Bentley, B., DeAnda, M. E., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R., Weiss, H. E., Carlo, W. A., Ambalavanan, N., Collins, M. V., Cosby, S. S., Quinn, R. J., Denson, B. R., Arciniegas-Bernal, A. M., Biasini, F. J., Johnston, K. C., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Chanlaw, T., Geller, R., Bell, E. F., Brumbaugh, J. E., Johnson, K. J., Walker, J. R., Goeke, C. A., Johnson, K. M., Merriss, A., Nohr, J. L., Longmuir, S. Q., Drack, A. V., Eastman, D. L., Larson, S. A., Gertsch, K. R., Bell, V. P., Ohls, R. K., Beauman, S. S., Dupont, T., Hanson, M. R., Hartenberger, C. H., Kuan, E., Kunkel, S. J., Lowe, J., Morgan, N. A., Hallman, M. K., Schmidt, B., Kirpalani, H., Abbasi, S., Chaudhary, A. S., Mancini, T., Anninger, W. V., Bernbaum, J. C., Binenbaum, G., Cook, N., Davidson, S. L., Gerdes, M., Hurt, H., Mills, M. D., Ricciardelli, M., Rockwell, K. J., Snyder, J., Yau, S. M., D'Angio, C., Lakshminrusimha, S., Reynolds, A. M., Bean, S. A., Carmen, M. F., Chess, P. R., Jensen, R., Ramchandran, R. S., Turner, A. M., Williams, A., Sacilowski, M. G., Wadkins, H., Hunn, J., Horan, A., Bowman, M., Hartley-McAndrew, M., Zorn, W., Farooq, O., Yost, K., Merzbach, J., Fallone, C., Binion, K., Orme, C., Sabaratnam, P., Wyckoff, M. H., Brion, L. P., Vasil, D. M., Adams, S. S., Cha, C., Cisneros, J., De Leon, M. M., Eubanks, F., Godowic, L., Grau, L., Guzman, A., Heyne, E., Lee, L. E., Lira, H. C., Mozaffari, A., Pavageau, L., Boatman, C. T., Wright, R., Shankaran, S., Sood, B. G., Bara, R., Agarwal, P., Bajaj, M., Chawla, S., Childs, K., February, M., Goldston, L. A., Johnson, M. E., Lulic-Botica, M., Panaitescu, B., Woldt, E., Gleason, C. A., Allen, M. C., Boyle, R. J., Clemons, T., D'Alton, M. E., Das, A., Everett, D., Kauffman, R. E., Miodovnik, M., O'Shea, T. M., Smith, L., Weiner, S. J., Willinger, M. 2021

  Abstract

  OBJECTIVE: This study evaluates the 24-month follow-up for the NICHD Neonatal Research Network (NRN) Inositol for Retinopathy Trial.STUDY DESIGN: Bayley Scales of Infants Development-III and a standardized neurosensory examination were performed in infants enrolled in the main trial. Moderate/severe NDI was defined as BSID-III Cognitive or Motor composite score <85, moderate or severe cerebral palsy, blindness, or hearing loss that prevents communication despite amplification were assessed.RESULTS: Primary outcome was determined for 605/638 (95%). The mean gestational age was 25.8±1.3 weeks and mean birthweight was 805±192g. Treatment group did not affect the risk for the composite outcome of death or survival with moderate/severe NDI (60% vs 56%, p=0.40).CONCLUSIONS: Treatment group did not affect the risk of death or survival with moderate/severe NDI. Despite early termination, this study represents the largest RCT of extremely preterm infants treated with myo-inositol with neurodevelopmental outcome data.

  View details for DOI 10.1038/s41372-021-01018-5

  View details for PubMedID 33758387

• Continuity of Care by Primary Care Provider in Young Children with Autism Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S2

  View details for Web of Science ID 000670615500017

• Diagnosis of Language Delay in the Primary Care Setting: An Electronic Health Record Investigation Frelinger, C., Gardner, R. M., Huffman, L., Whitgob, E., Feldman, H. M., Bannett, Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: S1-S2

  View details for Web of Science ID 000656627200016

• Characteristics and Effects of the Academic Half Day Model in Post-graduate Medical Training: A Scoping Review Choe, M., Huffman, L., Hubner, L. LIPPINCOTT WILLIAMS & WILKINS. 2021: S7

  View details for Web of Science ID 000656627200031

• Shared Decision Making in Neurosurgery Clinic Visits: General Descriptions and a Randomized Controlled Trial Hubner, L. M., Gardner, R. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S6

  View details for Web of Science ID 000656627200029

• Continuity of Care by Primary Care Provider in Young Children with Autism Bannett, Y., Gardner, R. M., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S2

  View details for Web of Science ID 000656627200017

• Diagnosis of Language Delay in the Primary Care Setting: An Electronic Health Record Investigation Frelinger, C., Gardner, R. M., Huffman, L., Whitgob, E., Feldman, H. M., Bannett, Y. LIPPINCOTT WILLIAMS & WILKINS. 2021: S1-S2

  View details for Web of Science ID 000670615500016

• Characteristics and Effects of the Academic Half Day Model in Post-graduate Medical Training: AScoping Review Choe, M., Huffman, L., Hubner, L. LIPPINCOTT WILLIAMS & WILKINS. 2021: S7

  View details for Web of Science ID 000670615500031

• Shared Decision Making in Neurosurgery Clinic Visits: General Descriptions and a Randomized Controlled Trial Hubner, L. M., Gardner, R. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2021: S6

  View details for Web of Science ID 000670615500029

• Limitations of Conventional Magnetic Resonance Imaging as a Predictor of Death or Disability Following Neonatal Hypoxic-Ischemic Encephalopathy in the Late Hypothermia Trial. The Journal of pediatrics Laptook, A. R., Shankaran, S., Barnes, P., Rollins, N., Do, B. T., Parikh, N. A., Hamrick, S., Hintz, S. R., Tyson, J. E., Bell, E. F., Ambalavanan, N., Goldberg, R. N., Pappas, A., Huitema, C., Pedroza, C., Chaudhary, A. S., Hensman, A. M., Das, A., Wyckoff, M., Khan, A., Walsh, M. C., Watterberg, K. L., Faix, R., Truog, W., Guillet, R., Sokol, G. M., Poindexter, B. B., Higgins, R. D., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2020

  Abstract

  OBJECTIVE: To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours.STUDY DESIGN: Sub-group analysis of infants ≥ 36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by two central readers using the NICHD injury score (six levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age.RESULTS: Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n=119) or died (n=9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted Kappa 0.56, 95% confidence interval 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% confidence interval 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively.CONCLUSION: MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia-ischemia.

  View details for DOI 10.1016/j.jpeds.2020.11.015

  View details for PubMedID 33189747

• A Clinic-Based School Readiness Coaching Intervention for Low-Income Latino Children: An Intervention Study. Clinical pediatrics Peterson, J. W., Huffman, L. C., Bruce, J., Prata, N., Harley, K. G., Chamberlain, L. J. 2020: 9922820941230

  Abstract

  This intervention study assessed school readiness (SR)-related parent behaviors and perceived barriers for Latino parent-child pairs (N = 149, Mage = 4.5) after a clinic-based SR intervention (n = 74) or standard well-child care (n = 75). Intervention was a 1-hour visit with a community health worker (CHW) to assess child SR, model SR interactions, and provide SR tools and resources. Primary outcomes were parent behaviors and barriers collected by phone questionnaire. Regression analyses revealed that parents in the intervention were more likely to tell their child a story and visit the library in the last week and less likely to report barriers of limited SR knowledge. A brief, SR coaching intervention with a CHW increased SR-related parent behaviors and reduced barriers to SR. Evaluation with school entry data is underway.

  View details for DOI 10.1177/0009922820941230

  View details for PubMedID 32696662

• Timing of postnatal steroids for bronchopulmonary dysplasia: association with pulmonary and neurodevelopmental outcomes JOURNAL OF PERINATOLOGY Harmon, H. M., Jensen, E. A., Tan, S., Chaudhary, A. S., Slaughter, J. L., Bell, E. F., Wyckoff, M. H., Hensman, A. M., Sokol, G. M., DeMauro, S. B., Caplan, M. S., Laptook, A. R., Keszler, M., Vohr, B. R., Alksninis, B., Basso, K. M., Burke, R., Caskey, M., Johnson, K., Keszler, M., Knoll, A. M., Leach, T. M., Little, E., McGowan, E. C., Vieira, E., Watson, V. E., Ventura, S., Walsh, M. C., Hibbs, A., Wilson-Costello, D. E., Newman, N. S., Payne, A. H., Siner, B. S., Bhola, M., Yalcinkaya, G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Scott, A., Schibler, K., Donovan, E. F., Grisby, C., Bridges, K., Alexander, B., Fischer, E. E., Mincey, H. L., Hessling, J., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Steichen, J. J., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C., Goldstein, R. F., Ashley, P. L., Malcolm, W. F., Auten, K. J., Fisher, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Finkle, J., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Warner, D., Wereszczak, J., Carlton, D. P., Stoll, B. J., Adams-Chapman, I., Hale, E. C., Loggins, Y., Blackwelder, A., Wineski, L. C., LaRossa, M., Carter, S. L., Higgins, R. D., Archer, S., Poindexter, B. B., Dusick, A. M., Papile, L., Gunn, S., Hamer, F., Herron, D. E., Hines, A. C., Lytle, C., Minnich, H. M., Smiley, L., Wilson, L., Kennedy, K. A., Tyson, J. E., McDavid, G. E., Alaniz, N., Arldt-McAlister, J., Burson, K., Dempsey, A. G., Duncan, A. F., Evans, P. W., Green, C. E., Harris, B., Jiminez, M., John, J., Jones, P. M., Lillie, L. M., Lis, A. E., Martin, S. C., Morris, B. H., Poundstone, M., Rodgers, S., Siddiki, S., Simmons, M. C., Sperry, D., Tate, P., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Das, A., Wallace, D., Gantz, M. G., Poole, W., Newman, J. E., Auman, J., Crawford, M. M., Gabrio, J., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Hintz, S. R., Ball, M., Davis, A. S., Palmquist, A. W., Proud, M. S., Bentley, B., Bruno, E., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Kohn, J. G., Krueger, C., Weiss, H. E., Frantz, I. D., Fiascone, J. M., MacKinnon, B. L., Furey, A., Nylen, E., Sibley, C. E., Brussa, A. K., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Nelson, K. G., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Vaucher, Y. E., Kaegi, D., Rasmussen, M. R., Arnell, K., Demetrio, C., Fuller, M. G., Rich, W., Colaizy, T. T., Acarregui, M. J., Brumbaugh, J. E., Ellsbury, D. L., Widness, J. A., Johnson, K. J., Campbell, D. B., Eastman, D. L., Walker, J. R., Duara, S., Bauer, C. R., Everett-Thomas, R., Fajardo-Hiriart, S., Rigaud, A., Calejo, M., Eguaras, S., Berkowits, M., Garcia, A., Pierre, H., Stoerger, A., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C., Montman, R., Beauman, S., Schmidt, B., Kirpalani, H., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., D'Angio, C. T., Phelps, D. L., Guillet, R., Lakshminrusimha, S., Johnson, J., Reubens, L. J., Horihan, C. A., Hust, D., Jensen, R. L., Kushner, E., Merzbach, J., Myers, G. J., Wadkins, H. M., Guilford, S., Maffett, D., Farooq, O., Prinzing, D., Reynolds, A., Rowan, M., Sacilowski, M. G., Williams, A., Wynn, K., Yost, K., Zorn, W., Zwetsch, L., Brion, L. P., Heyne, R. J., Salhab, W. A., Rosenfeld, C. R., Vasil, D. M., Chen, L., Guzman, A., Hensley, G., Leps, M. H., Miller, N. A., Morgan, J. S., Adams, S. S., Boatman, C., Heyne, E. T., Madden, L. A., Lee, L. E., Faix, R. G., Yoder, B. A., Osborne, K. A., Spencer, C., Weaver-Lewis, K., Baker, S., Bird, K., Burnett, J., Steffen, M., Jensen, J. J., Winter, S., Zanetti, K., O'Shea, T., Dillard, R. G., Washburn, L. K., Jackson, B. G., Peters, N., Chiu, K., Allred, D., Goldstein, D. J., Halfond, R., Peterson, C., Waldrep, E. L., Welch, C. D., Morris, M., Hounshell, G., Shankaran, S., Pappas, A., Barks, J., Bara, R., Goldston, L. A., Natarajan, G., Bajaj, M., Chawla, S., De Jesus, L. C., Sood, B. G., Christensen, M., Wiggins, S. A., White, D., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Williams, J., Romano, E., Eunice Kennedy Shriver Natl Inst 2020

  Abstract

  To determine the associations between age at first postnatal corticosteroids (PNS) exposure and risk for severe bronchopulmonary dysplasia (BPD) and neurodevelopmental impairment (NDI).Cohort study of 951 infants born <27 weeks gestational age at NICHD Neonatal Research Network sites who received PNS between 8 days of life (DOL) and 36 weeks' postmenstrual age was used to produce adjusted odds ratios (aOR).Compared with infants in the reference group (22-28 DOL-lowest rate), aOR for severe BPD was similar for children given PNS between DOL 8 and 49 but higher among infants treated at DOL 50-63 (aOR 1.77, 95% CI 1.03-3.06), and at DOL ≥64 (aOR 3.06, 95% CI 1.44-6.48). The aOR for NDI did not vary significantly by age of PNS exposure.For infants at high risk of BPD, initial PNS should be considered prior to 50 DOL for the lowest associated odds of severe BPD.

  View details for DOI 10.1038/s41372-020-0594-4

  View details for Web of Science ID 000511094300001

  View details for PubMedID 32020038

• Behavior Profiles at 2Years for Children Born Extremely PretermwithBronchopulmonary Dysplasia. The Journal of pediatrics Brumbaugh, J. E., Bell, E. F., Grey, S. F., DeMauro, S. B., Vohr, B. R., Harmon, H. M., Bann, C. M., Rysavy, M. A., Logan, J. W., Colaizy, T. T., Peralta-Carcelen, M. A., McGowan, E. C., Duncan, A. F., Stoll, B. J., Das, A., Hintz, S. R., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Caplan, M. S., Polin, R. A., Laptook, A. R., Keszler, M., Hensman, A. M., Vieira, E., Little, E., Burke, R. T., Stephens, B. E., Alksninis, B., Bishop, C., Keszler, M. L., Leach, T. M., Watson, V. E., Knoll, A. M., Walsh, M. C., Fanaroff, A. A., Newman, N. S., Wilson-Costello, D. E., Payne, A., Bhola, M., Yalcinkaya, G., Siner, B. S., Friedman, H. G., Roth, E., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Schibler, K., Poindexter, B. B., Merhar, S., Yolton, K., Gratton, T. L., Grisby, C., Kirker, K., Wuertz, S., Carlton, D. P., Adams-Chapman, I., Hale, E. C., Loggins, Y. C., Bottcher, D. I., Mackie, C., Carter, S. L., LaRossa, M. M., Wineski, L. C., Smikle, G. V., Leon-Hernandez, A., Kendrick-Allwood, S., Cotten, C. M., Goldberg, R. N., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Finkle, J., Fisher, K. A., Grimes, S., Gustafson, K. E., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Warner, D., Wereszczak, J., Kicklighter, S. D., Rhodes-Ryan, G., Higgins, R. D., Wilson Archer, S., Poindexter, B. B., Sokol, G. M., Papile, L. A., Hines, A. C., Herron, D. E., Gunn, S., Smiley, L., Kennedy, K. A., Tyson, J. E., Arldt-McAlister, J., Burson, K., Dempsey, A. G., Evans, P. W., Garcia, C., Jiminez, M., John, J., Jones, P. M., Lillie, M. L., Martin, K., Martin, S. C., McDavid, G. E., Rodgers, S., Siddiki, S. K., Sperry, D., Pierce Tate, P. L., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Wallace, D., Gantz, M. G., Newman, J. E., Auman, J. O., Crawford, M., Gabrio, J., Leblond, D., Petrie Huitema, C. M., Zaterka-Baxter, K. M., Van Meurs, K. P., Chock, V. Y., Stevenson, D. K., Adams, M. M., Ball, M. B., Bentley, B., DeAnda, M. E., Debattista, A. M., Earhart, B., Huffman, L. C., Ismael, M., Krueger, C. E., Palmquist, A. W., Proud, M. S., Reichert, E. N., Sankar, M. N., St John, N. H., Taylor, H. L., Weiss, H. E., Frantz, I. D., Fiascone, J. M., MacKinnon, B. L., Nylen, E., Furey, A., Sibley, C. E., Brussa, A. K., Carlo, W. A., Ambalavanan, N., Bailey, K. J., Biasini, F. J., Collins, M. V., Cosby, S. S., Phillips, V. A., Rector, R. V., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Vaucher, Y. E., Kaegi, D., Rasmussen, M. R., Arnell, K., Demetrio, C., Fuller, M. G., Rich, W., West, R., Baack, M. L., Ellsbury, D. L., Hogden, L. A., Klein, J. M., Dagle, J. M., Johnson, K. J., Tud, T. L., Elenkiwich, C., Henning, M. M., Broadbent, M., Schmelzel, M. L., Walker, J. R., Goeke, C. A., Baack, M. L., Ellsbury, D. L., Hogden, L. A., Klein, J. M., Dagle, J. M., Johnson, K. J., Tud, T. L., Elenkiwich, C., Henning, M. M., Broadbent, M., Schmelzel, M. L., Walker, J. R., Goeke, C. A., Watterberg, K. L., Ohls, R. K., Backstrom Lacy, C., Brown, S., Fuller, J., Hartenberger, C., Lowe, J. R., Sundquist Beauman, S., Hanson, M. R., Dupont, T., Kuan, E., Schmidt, B., Kirpalani, H., Chaudhary, A. S., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., D'Angio, C. T., Guillet, R., Myers, G. J., Lakshminrusimha, S., Reynolds, A. M., Hartley-McAndrew, M. E., Wadkins, H. I., Sacilowski, M. G., Reubens, L. J., Jensen, R. L., Merzbach, J., Zorn, W., Farooq, O., Maffett, D., Williams, A., Hunn, J., Guilford, S., Yost, K., Rowan, M., Prinzing, D. M., Wynn, K., Fallone, C., Scorsone, A. M., Wyckoff, M. H., Sanchez, P. J., Brion, L. P., Heyne, R. J., Vasil, D. M., Adams, S. S., Chen, L., De Leon, M. M., Eubanks, F., Guzman, A., Heyne, E. T., Madden, L. A., Miller, N. A., Lee, L. E., Pavageau, L., Sepulveda, P., Boatman, C. T., Faix, R. G., Yoder, B. A., Baserga, M., Osborne, K. A., Baker, S., Bird, K., Burnett, J., Christensen, S., Davis, B., Elmont, J. O., Jensen, J. J., Loertscher, M. C., Marchant, T., Maxson, E., Minton, S. D., Parry, D. M., Rau, C. A., Schaefer, S. T., Sheffield, M. J., Spencer, C., Steffen, M., Weaver-Lewis, K., Winter, S., Woodbury, K. D., Zanetti, K., Shankaran, S., Chawla, S., Sood, B. G., Pappas, A., Natarajan, G., Bajaj, M., Bara, R., Johnson, M. E., Goldston, L., Wiggins, S. A., Christensen, M. K., Carlson, M., Barks, J., White, D. F., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Romano, E. 2020

  Abstract

  OBJECTIVE: To characterize behavior of 2-year-old children based on the severity of bronchopulmonary dysplasia (BPD).STUDY DESIGN: We studied children born at 22-26weeks of gestation and assessed at 22-26months of corrected age with the Child Behavior Checklist (CBCL). BPD was classified by the level of respiratory support at 36weeks of postmenstrual age. CBCL syndrome scales were the primary outcomes. The relationship between BPD grade and behavior was evaluated, adjusting for perinatal confounders. Mediation analysis was performed to evaluate whether cognitive, language, or motor skills mediated the effect of BPD grade on behavior.RESULTS: Of 2310 children, 1208 (52%) had no BPD, 806 (35%) had grade 1 BPD, 177 (8%) had grade 2 BPD, and 119 (5%) had grade 3 BPD. Withdrawn behavior (P<.001) and pervasive developmental problems (P<.001) increased with worsening BPD grade. Sleep problems (P=.008) and aggressive behavior (P=.023) decreased with worsening BPD grade. Children with grade 3 BPD scored 2 points worse for withdrawn behavior and pervasive developmental problems and 2 points better for externalizing problems, sleep problems, and aggressive behavior than children without BPD. Cognitive, language, and motor skills mediated the effect of BPD grade on the attention problems, emotionally reactive, somatic complaints, and withdrawn CBCL syndrome scales (P values<.05).CONCLUSIONS: BPD grade was associated with increased risk of withdrawn behavior and pervasive developmental problems but with decreased risk of sleep problems and aggressive behavior. The relationship between BPD and behavior is complex. Cognitive, language, and motor skills mediate the effects of BPD grade on some problem behaviors.

  View details for DOI 10.1016/j.jpeds.2019.12.028

  View details for PubMedID 32008764

• School Readiness Coaching in the Pediatric Clinic: Latinx Parent Perspectives. Academic pediatrics Peterson, J. W., Almanzar, N. n., Chamberlain, L. J., Huffman, L. n., Butze, T. n., Marin-Nevarez, P. n., Bruce, J. S. 2020

  Abstract

  Children who enter school developmentally ready for kindergarten are more likely to succeed academically, be healthy and lead productive lives. However, low-income and minority children often enter kindergarten behind their more affluent peers. Pediatric clinics, as trusted family partners, are well positioned to provide school readiness (SR) support.To explore Latinx parent perceptions of a clinic-based SR coaching intervention using qualitative methods. Intervention was a 1-hour visit with an SR coach (bilingual community health worker trained to assess child SR, role model SR skills and provide educational tools and community resources).Qualitative theme analysis of Latinx parent semi-structured interviews completed 6-9 months after SR coaching intervention (June 2016 - February 2017). Parent-child pairs received the SR coaching intervention (N=74), post-intervention interviews (N=50) were completed, audio recorded and transcribed. Iterative team-based coding and inductive thematic analysis of interviews were conducted.Three domains emerged and included the SR coaching model, community SR resources, and parent SR knowledge. Sub-themes included 1) Parents valued the one-to-one SR coaching intervention, were receptive to coach recommendations and believed other parents would benefit from SR coaching; 2) Parents tried new early literacy activities with their child; 3) Despite positive intervention effects, parents lacked a comprehensive understanding of SR.A brief clinic-based SR coaching intervention with a bilingual SR coach was well received by low-income Latinx parents and increased parent SR behaviors. Expanded implementation and further quantitative evaluation using school entry child-specific data are needed to quantify effects.

  View details for DOI 10.1016/j.acap.2020.10.009

  View details for PubMedID 33096288

• Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. The New England journal of medicine Kirpalani, H. n., Bell, E. F., Hintz, S. R., Tan, S. n., Schmidt, B. n., Chaudhary, A. S., Johnson, K. J., Crawford, M. M., Newman, J. E., Vohr, B. R., Carlo, W. A., D'Angio, C. T., Kennedy, K. A., Ohls, R. K., Poindexter, B. B., Schibler, K. n., Whyte, R. K., Widness, J. A., Zupancic, J. A., Wyckoff, M. H., Truog, W. E., Walsh, M. C., Chock, V. Y., Laptook, A. R., Sokol, G. M., Yoder, B. A., Patel, R. M., Cotten, C. M., Carmen, M. F., Devaskar, U. n., Chawla, S. n., Seabrook, R. n., Higgins, R. D., Das, A. n. 2020; 383 (27): 2639–51

  Abstract

  Limited data suggest that higher hemoglobin thresholds for red-cell transfusions may reduce the risk of cognitive delay among extremely-low-birth-weight infants with anemia.We performed an open, multicenter trial in which infants with a birth weight of 1000 g or less and a gestational age between 22 weeks 0 days and 28 weeks 6 days were randomly assigned within 48 hours after delivery to receive red-cell transfusions at higher or lower hemoglobin thresholds until 36 weeks of postmenstrual age or discharge, whichever occurred first. The primary outcome was a composite of death or neurodevelopmental impairment (cognitive delay, cerebral palsy, or hearing or vision loss) at 22 to 26 months of age, corrected for prematurity.A total of 1824 infants (mean birth weight, 756 g; mean gestational age, 25.9 weeks) underwent randomization. There was a between-group difference of 1.9 g per deciliter (19 g per liter) in the pretransfusion mean hemoglobin levels throughout the treatment period. Primary outcome data were available for 1692 infants (92.8%). Of 845 infants in the higher-threshold group, 423 (50.1%) died or survived with neurodevelopmental impairment, as compared with 422 of 847 infants (49.8%) in the lower-threshold group (relative risk adjusted for birth-weight stratum and center, 1.00; 95% confidence interval [CI], 0.92 to 1.10; P = 0.93). At 2 years, the higher- and lower-threshold groups had similar incidences of death (16.2% and 15.0%, respectively) and neurodevelopmental impairment (39.6% and 40.3%, respectively). At discharge from the hospital, the incidences of survival without severe complications were 28.5% and 30.9%, respectively. Serious adverse events occurred in 22.7% and 21.7%, respectively.In extremely-low-birth-weight infants, a higher hemoglobin threshold for red-cell transfusion did not improve survival without neurodevelopmental impairment at 22 to 26 months of age, corrected for prematurity. (Funded by the National Heart, Lung, and Blood Institute and others; TOP ClinicalTrials.gov number, NCT01702805.).

  View details for DOI 10.1056/NEJMoa2020248

  View details for PubMedID 33382931

• EPIDEMIOLOGY OF UNINTENTIONAL FALLS IN US EMERGENCY DEPARTMENTS: DOES ADHD PLAY A ROLE? Quynh Nguyen, Saynina, O., Huffman, L., Pirrotta, E., Wang, N. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000530000202348

• Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision JOURNAL OF PEDIATRICS McGowan, E. C., Laptook, A. R., Lowe, J., Peralta-Carcelen, M., Chowdhury, D., Higgins, R. D., Hintz, S. R., Vohr, B. R., Polin, R. A., Laptook, A. R., Keszler, M., Hensman, A. M., Alksninis, B., Basso, K. M., Burke, R., Caskey, M., Johnson, K., Keszler, M., Knoll, A. M., Leach, T. M., Little, E., Vieira, E., Watson, V. E., Ventura, S., Walsh, M. C., Fanaroff, A. A., Hibbs, A., Wilson-Costello, D. E., Newman, N. S., Payne, A. H., Siner, B. S., Bhola, M., Yalcinkaya, G., Friedman, H. G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Schibler, K., Donovan, E. F., Grisby, C., Bridges, K., Alexander, B., Fischer, E. E., Mincey, H. L., Hessling, J., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Steichen, J. J., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C., Goldstein, R. F., Ashley, P. L., Malcolm, W. F., Auten, K. J., Fisher, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Finkle, J., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Clark, C., Manor, L., Warner, D., Wereszczak, J., Carlton, D. P., Stoll, B. J., Adams-Chapman, I., Hale, E. C., Loggins, Y., Archer, S., Sokol, G. M., Poindexter, B. B., Dusick, A. M., Papile, L., Gunn, S., Hamer, F., Herron, D. E., Hines, A. C., Lytle, C., Minnich, H. M., Smiley, L., Wilson, L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Das, A., Wallace, D., Gantz, M. G., Poole, W., Newman, J. E., Auman, J., Crawford, M. M., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Ball, M., Davis, A. S., Palmquist, A. W., Proud, M. S., Bentley, B., Bruno, E., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Kohn, J. G., Krueger, C., Weiss, H. E., Frantz, I. D., Fiascone, J. M., MacKinnon, B. L., Furey, A., Nylen, E., Carlo, W. A., Ambalavanan, N., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Nelson, K. G., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Vaucher, Y. E., Kaegi, D., Rasmussen, M. R., Arnell, K., Demetrio, C., Fuller, M. G., Rich, W., Bell, E. F., Colaizy, T. T., Acarregui, M. J., Ellsbury, D. L., Widness, J. A., Johnson, K. J., Campbell, D. B., Eastman, D. L., Walker, J. R., Brumbaugh, J. E., Duara, S., Bauer, C. R., Everett-Thomas, R., Fajardo-Hiriart, S., Rigaud, A., Calejo, M., Eguaras, S., Berkowits, M., Garcia, A., Pierre, H., Stoerger, A., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C., Duncan, A. F., Montman, R., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., D'Angio, C. T., Phelps, D. L., Guillet, R., Lakshminrusimha, S., Johnson, J., Reubens, L. J., Horihan, C. A., Hust, D., Jensen, R. L., Kushner, E., Merzbach, J., Myers, G. J., Rowan, M., Wadkins, H. M., Bowman, M., Hunn, J., Guilford, S., Maffett, D., Osman, F., Prinzing, D., Reynolds, A., Sacilowski, M. G., Williams, A., Wynn, K., Yost, K., Zorn, W., Zwetsch, L., Kennedy, K. A., Tyson, J. E., McDavid, G. E., Alaniz, N., Arldt-McAlister, J., Burson, K., Evans, P. W., Garcia, C., Green, C., Harris, B., Jiminez, M., John, J., Jones, P. M., Lillie, L. M., Lis, A. E., Martin, K., Martin, S. C., Morris, B. H., Poundstone, M., Robichaux, P., Rodgers, S., Siddiki, S., Simmons, M. C., Sperry, D., Tate, P., Wright, S. L., Wyckoff, M. H., Brion, L. P., Heyne, R. J., Salhab, W. A., Rosenfeld, C. R., Vasil, D. M., Chen, L., Guzman, A., Hensley, G., Leps, M. H., Miller, N. A., Morgan, J. S., Adams, S. S., Boatman, C., Heyne, E. T., Madden, L. A., Torres, L. E., Faix, R. G., Yoder, B. A., Osborne, K. A., Spencer, C., Weaver-Lewis, K., Baker, S., Bird, K., Burnett, J., Steffen, M., Jensen, J. J., Winter, S., Zanetti, K., O'Shea, T., Dillard, R. G., Washburn, L. K., Jackson, B. G., Peters, N., Chiu, K., Allred, D., Goldstein, D. J., Halfond, R., Peterson, C., Waldrep, E. L., Welch, C. D., Morris, M., Hounshell, G., Shankaran, S., Pappas, A., Barks, J., Bara, R., Goldston, L. A., Natarajan, G., Christensen, M., Wiggins, S. A., White, D., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Williams, J., Romano, E., Eunice Kennedy Shriver Natl Inst C 2019; 215: 41-+

  View details for DOI 10.1016/j.jpeds.2019.01.063

  View details for Web of Science ID 000498003100010

• Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes JOURNAL OF PEDIATRICS Warren, M. G., Do, B., Das, A., Smith, P., Adams-Chapman, I., Jadcherla, S., Jensen, E. A., Goldstein, R. F., Goldberg, R. N., Cotten, C., Bell, E. F., Malcolm, W. F., Caplan, M. S., Laptook, A. R., Keszler, M., Vohr, B. R., Hensman, A. M., Alksninis, B., Basso, K. M., Burke, R., Caskey, M., Johnson, K., Keszler, M., Knoll, A. M., Leach, T. M., Little, E., McGowan, E. C., Vieira, E., Watson, V. E., Ventura, S., Walsh, M. C., Hibbs, A., Wilson-Costello, D. E., Newman, N. S., Payne, A. H., Siner, B. S., Bhola, M., Yalcinkaya, G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Scott, A., Schibler, K., Donovan, E. F., Grisby, C., Bridges, K., Alexander, B., Fischer, E. E., Mincey, H. L., Hessling, J., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Steichen, J. J., Tepe, S., Yolton, K., Ashley, P. L., Auten, K. J., Fisher, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Finkle, J., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Warner, D., Wereszczak, J., Carlton, D. P., Stoll, B. J., Hale, E. C., Loggins, Y., Blackwelder, A., Wineski, L. C., LaRossa, M., Carter, S. L., Higgins, R. D., Archer, S., Sokol, G. M., Poindexter, B. B., Dusick, A. M., Papile, L., Gunn, S., Hamer, F., Harmon, H. M., Herron, D. E., Hines, A. C., Lytle, C., Minnich, H. M., Smiley, L., Wilson, L., Kennedy, K. A., Tyson, J. E., McDavid, G. E., Alaniz, N., Arldt-McAlister, J., Burson, K., Dempsey, A. G., Duncan, A. F., Evans, P. W., Green, C. E., Harris, B., Jiminez, M., John, J., Jones, P. M., Lillie, L. M., Lis, A. E., Martin, S. C., Morris, B. H., Poundstone, M., Rodgers, S., Siddiki, S., Simmons, M. C., Sperry, D., Tate, P., Wright, S. L., Sanchez, P. J., Nelin, L. D., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Wallace, D., Gantz, M. G., Poole, W., Newman, J. E., Auman, J., Crawford, M. M., Gabrio, J., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Hintz, S. R., Ball, M., Davis, A. S., Palmquist, A. W., Proud, M. S., Bentley, B., Bruno, E., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Kohn, J. G., Krueger, C., Weiss, H. E., Frantz, I. D., Fiascone, J. M., MacKinnon, B. L., Furey, A., Nylen, E., Sibley, C. E., Brussa, A. K., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Nelson, K. G., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Vaucher, Y. E., Kaegi, D., Rasmussen, M. R., Arnell, K., Demetrio, C., Fuller, M. G., Rich, W., Colaizy, T. T., Acarregui, M. J., Brumbaugh, J. E., Ellsbury, D. L., Widness, J. A., Johnson, K. J., Campbell, D. B., Eastman, D. L., Walker, J. R., Duara, S., Bauer, C. R., Everett-Thomas, R., Fajardo-Hiriart, S., Rigaud, A., Calejo, M., Eguaras, S., Berkowits, M., Garcia, A., Pierre, H., Stoerger, A., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C., Montman, R., Beauman, S., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., D'Angio, C. T., Phelps, D. L., Guillet, R., Lakshminrusimha, S., Johnson, J., Reubens, L. J., Horihan, C. A., Hust, D., Jensen, R. L., Kushner, E., Merzbach, J., Myers, G. J., Wadkins, H. M., Guilford, S., Maffett, D., Farooq, O., Prinzing, D., Reynolds, A., Rowan, M., Sacilowski, M. G., Williams, A., Wynn, K., Yost, K., Zorn, W., Zwetsch, L., Wyckoff, M. H., Brion, L. P., Heyne, R. J., Salhab, W. A., Rosenfeld, C. R., Vasil, D. M., Chen, L., Guzman, A., Hensley, G., Leps, M. H., Miller, N. A., Morgan, J. S., Adams, S. S., Boatman, C., Heyne, E. T., Madden, L. A., Lee, L. E., Faix, R. G., Yoder, B. A., Osborne, K. A., Spencer, C., Weaver-Lewis, K., Baker, S., Bird, K., Burnett, J., Steffen, M., Jensen, J. J., Winter, S., Zanetti, K., O'Shea, T., Dillard, R. G., Washburn, L. K., Jackson, B. G., Peters, N., Chiu, K., Allred, D., Goldstein, D. J., Halfond, R., Peterson, C., Waldrep, E. L., Welch, C. D., Morris, M., Hounshell, G., Shankaran, S., Pappas, A., Barks, J., Bara, R., Goldston, L. A., Natarajan, G., Bajaj, M., Chawla, S., De Jesus, L. C., Sood, B. G., Christensen, M., Wiggins, S. A., White, D., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Williams, J., Romano, E., Eunice Kennedy Shriver Natl Inst 2019; 214: 41-+

  Abstract

  To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated comorbidities, and long-term outcomes.Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network's Generic Database and Follow-up Registry from 2006 to 2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months of corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common co-variables.Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed postdischarge. Of infants with GTs, 11% had birth weights small for gestational age, 77% had bronchopulmonary dysplasia, and 29% severe intraventricular hemorrhage or periventricular leukomalacia. At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, small for gestational age, bronchopulmonary dysplasia, intraventricular hemorrhage/periventricular leukomalacia, poor growth, and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up.GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI, and chronic respiratory and feeding problems at follow-up. The frequency of GT placement postneonatal discharge indicates the need for close nutritional follow-up of ELBW infants.ClinicalTrials.gov: NCT00063063.

  View details for DOI 10.1016/j.jpeds.2019.06.066

  View details for Web of Science ID 000492192700010

  View details for PubMedID 31427096

  View details for PubMedCentralID PMC6815700

• Developmental Outcomes of Extremely Preterm Infants with a Need for Child Protective Services Supervision. The Journal of pediatrics McGowan, E. C., Laptook, A. R., Lowe, J., Peralta-Carcelen, M., Chowdhury, D., Higgins, R. D., Hintz, S. R., Vohr, B. R., Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Polin, R. A., Abbott R Laptook, Martin Keszler, Angelita M Hensman, Alksninis, B., Basso, K. M., Burke, R., Caskey, M., Johnson, K., Keszler, M. L., Knoll, A. M., Leach, T. M., Little, E., McGowan, E. C., Vieira, E., Watson, V. E., Ventura, S., Walsh, M. C., Fanaroff, A. A., Hibbs, A. M., Wilson-Costello, D. E., Newman, N. S., Payne, A. H., Siner, B. S., Bhola, M., Yalcinkaya, G., Friedman, H. G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Schibler, K., Donovan, E. F., Grisby, C., Bridges, K., Alexander, B., Fischer, E. E., Mincey, H. L., Hessling, J., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Steichen, J. J., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C. M., Goldstein, R. F., Ashley, P. L., Malcolm, W. F., Auten, K. J., Fisher, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Finkle, J., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Clark, C., Manor, L., Warner, D., Wereszczak, J., Carlton, D. P., Stoll, B. J., Adams-Chapman, I., Hale, E. C., Loggins, Y., Archer, S. W., Sokol, G. M., Poindexter, B. B., Dusick, A. M., Papile, L., Gunn, S., Hamer, F., Herron, D. E., Hines, A. C., Lytle, C., Minnich, H. M., Smiley, L., Wilson, L. D., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Das, A., Wallace, D., Gantz, M. G., Poole, W. K., Newman, J. E., O'Donnell Auman, J., Crawford, M. M., Petrie Huitema, C. M., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Hintz, S. R., Ball, M. B., Davis, A. S., Palmquist, A. W., Proud, M. S., Bentley, B., Bruno, E., DeAnda, M. E., DeBattista, A. M., Earhart, B., Huffman, L. C., Kohn, J. G., Krueger, C., Weiss, H. E., Frantz, I. D., Fiascone, J. M., MacKinnon, B. L., Furey, A., Nylen, E., McGowan, E. C., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M. V., Cosby, S. S., Biasini, F. J., Johnston, K. C., Nelson, K. G., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Finer, N. N., Vaucher, Y. E., Kaegi, D., Rasmussen, M. R., Arnell, K., Demetrio, C., Fuller, M. G., Rich, W., Bell, E. F., Colaizy, T. T., Acarregui, M. J., Ellsbury, D. L., Widness, J. A., Johnson, K. J., Campbell, D. B., Eastman, D. L., Walker, J. R., Brumbaugh, J. E., Duara, S., Bauer, C. R., Everett-Thomas, R., Fajardo-Hiriart, S., Rigaud, A., Calejo, M., Frade Eguaras, S. M., Berkowits, M. H., Garcia, A., Pierre, H., Stoerger, A., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C. B., Duncan, A. F., Montman, R., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., D'Angio, C. T., Phelps, D. L., Guillet, R., Lakshminrusimha, S., Johnson, J. B., Reubens, L. J., Horihan, C. A., Hust, D., Jensen, R. L., Kushner, E., Merzbach, J., Myers, G. J., Rowan, M., Wadkins, H. I., Bowman, M., Hunn, J., Guilford, S., Maffett, D., Osman, F., Prinzing, D., Reynolds, A. M., Rowan, M., Sacilowski, M. G., Williams, A., Wynn, K., Yost, K., Zorn, W., Zwetsch, L., Kennedy, K. A., Tyson, J. E., McDavid, G. E., Alaniz, N. I., Arldt-McAlister, J., Burson, K., Evans, P. W., Duncan, A. F., Garcia, C., Green, C., Harris, B. F., Jiminez, M., John, J., Jones, P. M., Lillie, L. M., Lis, A. E., Martin, K., Martin, S. C., Morris, B. H., Poundstone, M. L., Robichaux, P., Rodgers, S., Siddiki, S., Simmons, M. C., Sperry, D., Pierce Tate, P. L., Wright, S. L., Wyckoff, M. H., Brion, L. P., Heyne, R. J., Salhab, W. A., Rosenfeld, C. R., Vasil, D. M., Chen, L., Guzman, A., Hensley, G., Leps, M. H., Miller, N. A., Morgan, J. S., Adams, S. S., Boatman, C. T., Heyne, E. T., Madden, L. A., Torres, L. E., Faix, R. G., Yoder, B. A., Osborne, K. A., Spencer, C., Weaver-Lewis, K., Baker, S., Bird, K., Burnett, J., Steffen, M., Jensen, J. J., Winter, S., Zanetti, K., O'Shea, T. M., Dillard, R. G., Washburn, L. K., Jackson, B. G., Peters, N., Chiu, K., Allred, D. E., Goldstein, D. J., Halfond, R., Peterson, C., Waldrep, E. L., Welch, C. D., Morris, M. W., Hounshell, G. W., Shankaran, S., Pappas, A., Barks, J., Bara, R., Goldston, L. A., Natarajan, G., Christensen, M., Wiggins, S. A., White, D., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Williams, J., Romano, E. 2019

  Abstract

  OBJECTIVE: To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision.STUDY DESIGN: For infants born at <27weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital.RESULTS: Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = -1.94; 95% CI, -3.88 to -0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (beta=-4.76; 95% CI, -7.47 to -2.05; P<.001) and language scores were 5 points lower (beta=-4.93; 95% CI, -8.00 to -1.86; P=.002).CONCLUSION: Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.

  View details for DOI 10.1016/j.jpeds.2019.07.063

  View details for PubMedID 31500860

• Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g JAMA PEDIATRICS Brumbaugh, J. E., Hansen, N. I., Bell, E. F., Sridhar, A., Carlo, W. A., Hintz, S. R., Vohr, B. R., Colaizy, T. T., Duncan, A. F., Wyckoff, M. H., Baack, M. L., Rysavy, M. A., DeMauro, S. B., Stoll, B. J., Das, A., Higgins, R. D., Polin, R. A., Caplan, M. S., Laptook, A. R., Keszler, M., Hensman, A. M., Alksninis, B., Burke, R. T., Caskey, M., Hoffman, L., Johnson, K., Keszler, M., Leach, T. M., McGowan, E. C., Stephens, B. E., Basso, K., Vieira, E., Little, E., St Pierre, L., Watson, V. E., Walsh, M. C., Hibbs, A., Newman, N. S., Wilson-Costello, D. E., Skier, B. S., Bhola, M., Yalcinkaya, G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Scott, A., Parimi, P. S., Gaetano, L., Poindexter, B. B., Schibler, K., Kallapur, S. G., Yolton, K., Alexander, B., Gratton, T. L., Grisby, C., Kirker, K., Jackson, L. D., Steichen, J. J., Wuertz, S., Cotten, C., Goldberg, R. N., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Finkle, J., Fisher, K. A., Grimes, S., Gustafson, K. E., Lohmeyer, M. B., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Wereszczak, J., Kicklighter, S. D., Rhodes-Ryan, G., Archer, S., Carlton, D. P., Adams-Chapman, I., Hale, E. C., Loggins, Y., Bottcher, D., Carter, S. L., Kendrick-Allwood, S., LaRossa, M., Mackie, C., Seabrook, I., Smikie, G., Wineski, L., Sokol, G. M., Poindexter, B. B., Dusick, A. M., Hamer, F., Herron, D. E., Hines, A. C., Lytle, C., Miller, L. C., Minnich, H. M., Papile, L., Richard, L., Smiley, L., Wilson, L., Kennedy, K. A., Tyson, J. E., Arldt-McAlister, J., Burson, K., Dempsey, A. G., Eason, E., Evans, P. W., Garcia, C., Green, C., Hall, D., Harris, B., Jiminez, M., John, J., Jones, P. M., Lillie, M., Martin, K., Martin, S. C., McDavid, G. E., Rodgers, S., Siddiki, S., Sperry, D., Stephens, E. K., Tate, P., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Luzader, P., Fortney, C. A., Besner, G. E., Parikh, N. A., Wallace, D., Gantz, M. G., Auman, J., Crawford, M., Gabrio, J., Newman, J. E., Huitema, C., Poole, W., Zaterka-Baxter, K. M., Frantz, I. D., Fiascone, J. M., McGowan, E. C., MacKinnon, B. L., Furey, A., Nylen, E., Church, P. T., Van Meurs, K. P., Stevenson, D. K., Adams, M. M., Ball, M., Bentley, B., Bruno, E., DeAnda, M., DeBattista, A. M., Huffman, L. C., Ismael, M., Kohn, J. G., Krueger, C., Palmquist, A., Proud, M. S., St John, N. H., Weiss, H., Ambalavanan, N., Peralta-Carcelen, M., Nelson, K. G., Bailey, K. J., Biasini, F. J., Chopko, S. A., Collins, M. V., Cosby, S. S., Johnston, K. C., Moses, M., Patterson, C. S., Phillips, V. A., Preskitt, J., Rector, R. V., Whitley, S., Devaskar, U., Gary, M., Purdy, I. B., Chanlaw, T., Geller, R., Widness, J. A., Acarregui, M. J., Ellsbury, D. L., Johnson, K. J., Walker, J. R., Goeke, C. A., Eastman, D. L., Campbell, D. B., Tud, T. L., Watterberg, K. L., Ohls, R. K., Lacy, C., Brown, S., Fuller, J., Hartenberger, C., Lowe, J. R., Thomson, R. A., Beauman, S., Hanson, M., Kuan, E., Schmidt, B., Kirpalani, H., Chaudhary, A. S., Abbasi, S., Mancini, T., Cucinotta, D. M., Bernbaum, J. C., Gerdes, M., Hurt, H., Snyder, J., D'Angio, C. T., Phelps, D. L., Guillet, R., Myers, G. J., Lakshminrusimha, S., Reynolds, A., Reubens, L. J., Burnell, E., Scorsone, A., Binion, K., Orme, C., Wadkins, H. M., Sacilowski, M. G., Jensen, R. L., Merzbach, J., Zorn, W., Farooq, O., Maffett, D., Williams, A., Hunn, J., Guilford, S., Yost, K., Rowan, M., Prinzing, D., Wynn, K., Bowman, M., Brion, L. P., Sanchez, P. J., Heyne, R. J., Vasil, D. M., Adams, S. S., Chen, L., De Leon, M. M., Eubanks, F., Guzman, A., Heyne, E. T., Lee, L. E., Leps, M. H., Madden, L. A., Miller, N. A., Morgan, J. S., Pavageau, L., Sepulveda, P., Boatman, C., Yoder, B. A., Baserga, M., Faix, R. G., Minton, S. D., Sheffield, M. J., Rau, C. A., Winter, S., Osborne, K. A., Spencer, C., Weaver-Lewis, K., Baker, S., Burnett, J., Steffen, M., Loertscher, M. C., Woodbury, K. D., Reich, B. A., Schaefer, S. T., Cole-Bledsoe, L., Elmont, J. O., Parry, D., Marchant, T., Christensen, S., Maxson, E., Davis, B., Shankaran, S., Sood, B. G., Pappas, A., Natarajan, G., Chawla, S., Bajaj, M., Bara, R., Childs, K., Panaitescu, B., Johnson, M. E., Goldston, L. A., Wiggins, S. A., Christensen, M. K., Carlson, M., Barks, J., Ehrenkranz, R. A., Jacobs, H., Butler, C. G., Cervone, P., Greisman, S., Konstantino, M., Poulsen, J., Taft, J., Williams, J., Romano, E., Natl Inst Child Hlth Human Dev 2019; 173 (5): 434–45

  View details for DOI 10.1001/jamapediatrics.2019.0180

  View details for Web of Science ID 000467505200011

• Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g. JAMA pediatrics Brumbaugh, J. E., Hansen, N. I., Bell, E. F., Sridhar, A., Carlo, W. A., Hintz, S. R., Vohr, B. R., Colaizy, T. T., Duncan, A. F., Wyckoff, M. H., Baack, M. L., Rysavy, M. A., DeMauro, S. B., Stoll, B. J., Das, A., Higgins, R. D., National Institute of Child Health and Human Development Neonatal Research Network 2019

  Abstract

  Importance: Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation.Objective: To characterize outcomes of liveborn infants with a BW less than 400 g.Design, Setting, and Participants: This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018.Exposures: Birth weight less than 400 g.Main Outcomes and Measures: The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit.Results: Of the 205 included infants, 121 (59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101 of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%).Conclusions and Relevance: Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.

  View details for PubMedID 30907941

• Neurodevelopmental outcomes among extremely premature infants with linear growth restriction JOURNAL OF PERINATOLOGY Meyers, J. M., Tan, S., Bell, E. F., Duncan, A. F., Guillet, R., Stoll, B. J., D'Angio, C. T., Caplan, M. S., Laptook, A. R., Keszler, M., Vohr, B. R., Hensman, A. M., Vieira, E., Little, E., Alksninis, B., Keszler, M., Knoll, A. M., Leach, T. M., McGowan, E. C., Watson, V. E., Walsh, M. C., Fanaroff, A. A., Hibbs, A., Newman, N. S., Payne, A. H., Wilson-Costello, D. E., Siner, B. S., Bhola, M., Yalcinkaya, G., Friedman, H. G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Poindexter, B. B., Schibler, K., Alexander, B., Grisby, C., Gratton, T. L., Jackson, L., Kirker, K., Muthig, G., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Fisher, K. A., Finkle, J., Gustafson, K. E., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Wereszczak, J., Carlton, D. P., Hale, E. C., Adams-Chapman, H., Loggins, Y., Carter, S. L., LaRossa, M., Wineski, L. C., Bottcher, D., Mackie, C., Higgins, R. D., Archer, S., Sokol, G. M., Papile, L., Harmon, H. M., Hines, A. C., Wilson, L., Herron, D. E., Gunn, S., Smiley, L., Kennedy, K. A., Tyson, J. E., Allain, E., Arldt-McAlister, J., Dempsey, A. G., Garcia, C., John, J., Jones, P. M., Lillie, L. M., Martin, K., Martin, S. C., McDavid, G. E., Rodgers, S., Siddiki, S., Sperry, D., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Fortney, C. A., Luzader, P., Besner, G. E., Parikh, N. A., Das, A., Wallace, D., Newman, J. E., Auman, J., Crawford, M., Gabrio, J., Gantz, M. G., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Hintz, S. R., Ball, M., Proud, M. S., Bentley, B., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R., Weiss, H. E., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Colaizy, T. T., Brumbaugh, J. E., Ellsbury, D. L., Johnson, K. J., Walker, J. R., Campbell, D. B., Eastman, D. L., Watterberg, K. L., Lowe, J. R., Fuller, J. F., Ohls, R. K., Lacy, C., Duncan, A. F., Dupont, T., Kuan, E., Beauman, S., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Bernbaum, J. C., Gerdes, M., Hurt, H., Cook, N., Cucinotta, D. M., Lakshminrusimha, S., Reynolds, A., Jensen, R. L., Merzbach, J., Myers, G. J., Williams, A., Yost, K., Zorn, W., Wynn, K., Maffett, D., Prinzing, D., Hunn, J., Guilford, S., Osman, F., Rowan, M., Sacilowski, M. G., Wadkins, H. M., Bowman, M., Fallone, C., Binion, K., Orme, C., Scorsone, A., Andrews-Hartley, M., Wyckoff, M. H., Brion, L. P., Vasil, D. M., Chen, L., Heyne, R. J., Adams, S. S., Heyne, E., Guzman, A., Lee, L. E., Boatman, C., Shankaran, S., Pappas, A., Natarajan, G., Chawla, S., Bajaj, M., February, M., Agarwal, P., Childs, K., Woldt, E., Bara, R., Goldston, L. A., Barks, J., Christensen, M., Wiggins, S., White, D., Eunice Kennedy Shriver Natl Inst 2019; 39 (2): 193–202

  Abstract

  To compare neurodevelopmental outcomes in linear growth-restricted (LGR) infants born <29 weeks with and without weight gain out of proportion to linear growth.We compared 2-year neurodevelopmental outcomes between infants with and without LGR and between LGR infants with and without weight gain out of proportion to linear growth. The outcomes were Bayley-III cognitive, motor, and language scores, cerebral palsy, Gross Motor Function Classification System (GMFCS) level ≥ 2, and neurodevelopmental impairment.In total, 1227 infants were analyzed. LGR infants were smaller and less mature at birth, had higher BMI, and had lower Bayley-III language scores (82.3 vs. 85.0, p < 0.05). Among infants with LGR, infants with high BMI had lower language scores compared with those with low-to-normal BMI (80.8 vs. 83.3, p < 0.05), and were more likely to have GMFCS level ≥2 and neurodevelopmental impairment.Among infants with LGR, weight gain out of proportion to linear growth was associated with poorer neurodevelopmental outcomes.

  View details for PubMedID 30353080

• Behavioral problems are associated with cognitive and language scores in toddlers born extremely preterm EARLY HUMAN DEVELOPMENT Lowe, J. R., Fuller, J. F., Do, B. T., Vohr, B. R., Das, A., Hintz, S. R., Watterberg, K. L., Higgins, R. D., Caplan, M. S., Laptook, A. R., Keszler, M., Hensman, A. M., Vieira, E., Little, E., Alksninis, B., Keszler, M., Knoll, A. M., Leach, T. M., McGowan, E. C., Watson, V. E., Walsh, M. C., Hibbs, A., Newman, N. S., Payne, A. H., Wilson-Costello, D. E., Siner, B. S., Bhola, M., Ross, E., Taylor, H., Yalcinkaya, G., Truog, W. E., Pallotto, E. K., Kilbride, H. W., Gauldin, C., Holmes, A., Johnson, K., Knutson, A., Poindexter, B. B., Schibler, K., Merhar, S., Grisby, C., Gratton, T. L., Tepe, S., Yolton, K., Goldberg, R. N., Cotten, C., Goldstein, R. F., Malcolm, W. F., Ashley, P. L., Fisher, K. A., Finkle, J., Gustafson, K. E., Laughon, M. M., Bose, C. L., Bernhardt, J., Bose, G., Wereszczak, J., Carlton, D. P., Hale, E. C., Adams-Chapman, I., Loggins, Y., Carter, S. L., LaRossa, M., Wineski, L. C., Bottcher, D., Mackie, C., Archer, S., Sokol, G. M., Poindexter, B. B., Papile, L., Harmon, H. M., Hines, A. C., Wilson, L., Herron, D. E., Gunn, S., Smiley, L., Kennedy, K. A., Tyson, J. E., Allain, E., Arldt-McAlister, J., Dempsey, A. G., Duncan, A. F., Garcia, C., Eason, E., John, J., Jones, P. M., Lillie, M., Martin, K., Martin, S. C., McDavid, G. E., McKee, S., Rodgers, S., Sperry, D., Wright, S. L., Sanchez, P. J., Nelin, L. D., Jadcherla, S. R., Fortney, C. A., Luzader, P., Besner, G. E., Parikh, N. A., Wallace, D., Newman, J. E., Auman, J., Crawford, M., Gabrio, J., Gantz, M. G., Huitema, C., Zaterka-Baxter, K. M., Van Meurs, K. P., Stevenson, D. K., Ball, M., Proud, M. S., Bentley, B., DeAnda, M., DeBattista, A. M., Earhart, B., Huffman, L. C., Krueger, C. E., Lucash, R., Weiss, H. E., Carlo, W. A., Ambalavanan, N., Peralta-Carcelen, M., Collins, M., Cosby, S. S., Biasini, F. J., Johnston, K. C., Patterson, C. S., Phillips, V. A., Whitley, S., Devaskar, U., Garg, M., Purdy, I. B., Chanlaw, T., Geller, R., Bell, E. F., Colaizy, T. T., Brumbaugh, J. E., Ellsbury, D. L., Johnson, K. J., Walker, J. R., Campbell, D. B., Eastman, D. L., Tud, T. L., Ohis, R. K., Lacy, C., Duncan, A. F., Dupont, T., Kuan, E., Beauman, S., Hanson, M., Schmidt, B., Kirpalani, H., DeMauro, S. B., Chaudhary, A. S., Abbasi, S., Mancini, T., Bernbaum, J. C., Gerdes, M., Hurt, H., Cook, N., Cucinotta, D. M., D'Angio, C. T., Lakshminrusintha, S., Guillet, R., Reynolds, A., Jensen, R. L., Merzbach, J., Myers, G. J., Williams, A., Yost, K., Zorn, W., Wynn, K., Maffett, D., Prinzing, D., Hunn, J., Guilford, S., Farooq, O., Rowan, M., Sacilowski, M. G., Wadkins, H. M., Bowman, M., Fallone, C., Binion, K., Orme, C., Scorsone, A., Andrews-Hartley, M., Wyckoff, M. H., Sanchez, P. J., Brion, L. P., Vasil, D. M., Chen, L., Heyne, R. J., Adams, S. S., Heyne, E., Guzman, A., Lee, L. E., Boatman, C., Shankaran, S., Pappas, A., Natarajan, G., Chawla, S., Bajaj, M., February, M., Agarwal, P., Childs, K., Woldt, E., Bara, R., Goldston, L. A., Barks, J., Christensen, M., Wiggins, S., White, D., Eunice Kennedy Shriver Natl Inst, Human Dev Neonatal Res Network 2019; 128: 48–54

  View details for DOI 10.1016/j.earlhumdev.2018.11.007

  View details for Web of Science ID 000458094300008

• Brain Development in School-Age and Adolescent Girls: Effects of Turner Syndrome, Estrogen Therapy, and Genomic Imprinting. Biological psychiatry O'Donoghue, S. n., Green, T. n., Ross, J. L., Hallmayer, J. n., Lin, X. n., Jo, B. n., Huffman, L. C., Hong, D. S., Reiss, A. L. 2019

  Abstract

  The study of Turner syndrome (TS) offers a unique window of opportunity for advancing scientific knowledge of how X chromosome gene imprinting, epigenetic factors, hormonal milieu, and chronologic age affect brain development in females.We described brain growth trajectories in 55 girls with TS and 53 typically developing girls (258 magnetic resonance imaging datasets) spanning 5 years. Using novel nonparametric and mixed effects analytic approaches, we evaluated influences of X chromosome genomic imprinting and hormone replacement therapy on brain development.Parieto-occipital gray and white matter regions showed slower growth during typical pubertal timing in girls with TS relative to typically developing girls. In contrast, some basal ganglia, cerebellar, and limited cortical areas showed enhanced volume growth with peaks around 10 years of age.The parieto-occipital finding suggests that girls with TS may be particularly vulnerable to altered brain development during adolescence. Basal ganglia regions may be relatively preserved in TS owing to their maturational growth before or early in typical pubertal years. Taken together, our findings indicate that particular brain regions are more vulnerable to TS genetic and hormonal effects during puberty. These specific alterations in neurodevelopment may be more likely to affect long-term cognitive behavioral outcomes in young girls with this common genetic condition.

  View details for DOI 10.1016/j.biopsych.2019.07.032

  View details for PubMedID 31561860

• Variation in Primary Care Management of Attention-Deficit/Hyperactivity Disorder by Primary Care Providers Academic Pediatrics Bannett, Y., Feldman, H. M., Bentley, J. P., Ansel, D. A., Wang, C. J., Huffman, L. C. 2019

  View details for DOI 10.1016/j.acap.2019.11.016

• Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study. Journal of developmental and behavioral pediatrics : JDBP Won, D. C., Feldman, H. M., Huffman, L. C. 2019; 40 (1): 20–31

  Abstract

  To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.

  View details for PubMedID 30589766

• Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Won, D. C., Feldman, H. M., Huffman, L. C. 2019; 40 (1): 20–31

  View details for DOI 10.1097/DBP.0000000000000624

  View details for Web of Science ID 000467812700003

• Behavioral problems are associated with cognitive and language scores in toddlers born extremely preterm. Early human development Lowe, J. R., Fuller, J. F., Do, B. T., Vohr, B. R., Das, A., Hintz, S. R., Watterberg, K. L., Higgins, R. D., Eunice Kennedy Shriver National Institute of Child Health, Human Development Neonatal Research Network 2018; 128: 48–54

  Abstract

  OBJECTIVE: To evaluate the relationship of parent-reported child behaviors on the Child Behavior Checklist (CBCL) to cognition, language, and motor skills on the Bayley Scales of Infant and Toddler Development - III (Bayley-III) in toddlers born extremely preterm.STUDY DESIGN: Toddlers born extremely preterm (gestational ages 22 0/7 to 26 6/7 weeks) were tested at 22-26 months corrected age with Bayley-III while parents completed the CBCL. Socio-demographic variables and medical history were recorded. Linear regression models were used to assess the relationship of Bayley-III cognitive, motor, and language scores with CBCL scores, adjusting for medical and socio-demographic factors.RESULTS: Internalizing, affective, and pervasive development problem behavior scores on the CBCL correlated significantly with lower Bayley-III cognitive, language, and motor scores on unadjusted and adjusted analyses. Although externalizing and anxiety problems were significantly associated with cognitive and language scores on unadjusted analysis, the relationships were not significant after adjusting for socio-economic factors. CBCL scores were similar for boys and girls, with the exception of the pervasive developmental problem scale; boys had significantly more problems than girls (p = 0.02).CONCLUSIONS: This study showed that parent reported behavior problems were related to lower cognitive, language, and motor development in toddlers born extremely preterm. Early findings of behavioral problems in toddlers born extremely premature may help identify children at greater risk for later learning difficulties. Adding a measure of behavior to the evaluation of these children may help better understand factors that can contribute to delays, especially in cognition and language.

  View details for PubMedID 30522091

• Shared Decision Making in the Care of Children with Autism Spectrum Disorder JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C. 2018; 39 (4): 343–44

  View details for DOI 10.1097/DBP.0000000000000582

  View details for Web of Science ID 000441392100010

• Shared Decision Making in the Care of Children with Autism Spectrum Disorder. Journal of developmental and behavioral pediatrics : JDBP Huffman, L. C. 2018; 39 (4): 343–44

  View details for PubMedID 29708909

• Outcome of Preterm Infants with Transient Cystic Periventricular Leukomalacia on Serial Cranial Imaging Up to Term Equivalent Age JOURNAL OF PEDIATRICS Sarkar, S., Shankaran, S., Barks, J., Do, B. T., Laptook, A. R., Das, A., Ambalavanan, N., Van Meurs, K. P., Bell, E. F., Sanchez, P. J., Hintz, S. R., Wyckoff, M. H., Stoll, B. J., Carlo, W. A., Eunice Kennedy Shriver Natl Inst C 2018; 195: 59-+

  Abstract

  To determine the outcome of preterm infants whose cystic periventricular leukomalacia "disappeared" on serial screening cranial imaging studies.Infants ≤26 weeks of gestation born between 2002 and 2012 who had cranial imaging studies at least twice, the most abnormal study at <28 days of age and another closest to 36 weeks, were reviewed. The outcome of late death (after 36 weeks postmenstrual age) or neurodevelopmental impairment (NDI) in surviving infants at 18-26 months corrected age was compared between the infants with no cystic periventricular leukomalacia on both studies and cystic periventricular leukomalacia that disappeared (cystic periventricular leukomalacia at <28 days but not at 36 weeks), persisted (cystic periventricular leukomalacia on both studies), or appeared late (cystic periventricular leukomalacia only at 36 weeks). Predictors of NDI were evaluated by logistic regression.Of 7063 eligible infants, 433 (6.1%) had cystic periventricular leukomalacia. Among the 433 infants with cystic periventricular leukomalacia, cystic periventricular leukomalacia disappeared in 76 (18%), persisted in 87 (20%), and 270 (62%) had late cystic periventricular leukomalacia. Loss to follow-up ranged between 3% and 13%. Death or NDI was more common in infants with disappeared cystic periventricular leukomalacia compared with those with no cystic periventricular leukomalacia (38 of 72 [53%] vs 1776 of 6376 [28%]; OR [95% CI] 2.8 [1.8-4.6]). Disappeared, persistent, and late cystic periventricular leukomalacia were all also independently associated with NDI (OR 1.17, 1.21, and 1.16, respectively).Infants with "disappeared" cystic periventricular leukomalacia are at increased risk of adverse outcome similar to infants with persistent or late cystic periventricular leukomalacia.

  View details for PubMedID 29398046

• Effects of a Disability Education Module During Pediatrics Clerkship: A Randomized Controlled Trial Whitgob, E., Santoro, J., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2018: S6

  View details for Web of Science ID 000429375100020

• Online Training in Shared Decision-Making: A DBPNet Medical Education RCT Huffman, L., Hubner, L., Hansen, R. LIPPINCOTT WILLIAMS & WILKINS. 2018: S2

  View details for Web of Science ID 000429375100007

• DEVELOPMENT AND BEHAVIOUR DIAGNOSES USED BY PAEDIATRIC PRIMARY CARE PROVIDERS: EXPLORING INTER-CLINICIAN VARIATION Bannett, Y., Feldman, H. M., Ansel, D., Huffman, L. C. BMJ PUBLISHING GROUP. 2018: 184

  View details for DOI 10.1136/jim-2017-000663.282

  View details for Web of Science ID 000432007400294

• A Novel Approach to Increasing Access to Developmental-Behavioral Pediatrics Subspecialty Care JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C. 2017; 38 (6): 429–30

  View details for PubMedID 28661953

• Beyond immigrant status: Book-sharing in low-income Mexican-American families JOURNAL OF EARLY CHILDHOOD RESEARCH Salinas, M., Perez-Granados, D. R., Feldman, H. M., Huffman, L. C. 2017; 15 (1): 17–33

  View details for DOI 10.1177/1476718X15577007

  View details for Web of Science ID 000411711300002

• Documentation of Sleep Problems in Children with ASD and ADHD by Developmental-Behavioral Pediatricians in DBPNet Won, D. C., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2017: S20–S21

  View details for Web of Science ID 000393951000071

• Multi-Table Differential Correlation Analysis of Neuroanatomical and Cognitive Interactions in Turner Syndrome. Neuroinformatics Seiler, C. n., Green, T. n., Hong, D. n., Chromik, L. n., Huffman, L. n., Holmes, S. n., Reiss, A. L. 2017

  Abstract

  Girls and women with Turner syndrome (TS) have a completely or partially missing X chromosome. Extensive studies on the impact of TS on neuroanatomy and cognition have been conducted. The integration of neuroanatomical and cognitive information into one consistent analysis through multi-table methods is difficult and most standard tests are underpowered. We propose a new two-sample testing procedure that compares associations between two tables in two groups. The procedure combines multi-table methods with permutation tests. In particular, we construct cluster size test statistics that incorporate spatial dependencies. We apply our new procedure to a newly collected dataset comprising of structural brain scans and cognitive test scores from girls with TS and healthy control participants (age and sex matched). We measure neuroanatomy with Tensor-Based Morphometry (TBM) and cognitive function with Wechsler IQ and NEuroPSYchological tests (NEPSY-II). We compare our multi-table testing procedure to a single-table analysis. Our new procedure reports differential correlations between two voxel clusters and a wide range of cognitive tests whereas the single-table analysis reports no differences. Our findings are consistent with the hypothesis that girls with TS have a different brain-cognition association structure than healthy controls.

  View details for PubMedID 29270892

• DOCUMENTATION OF SLEEP PROBLEMS IN CHILDREN WITH ASD AND ADHD: A DEVELOPMENTAL-BEHAVIORAL PEDIATRICS RESEARCH NETWORK STUDY Won, D. C., Feldman, H. M., Huffman, L. C. BMJ PUBLISHING GROUP. 2017: 260–61

  View details for DOI 10.1136/jim-2016-000365.382

  View details for Web of Science ID 000433055100376

• Survival and Neurodevelopmental Outcomes among Periviable Infants. New England journal of medicine Younge, N., Goldstein, R. F., Bann, C. M., Hintz, S. R., Patel, R. M., Smith, P. B., Bell, E. F., Rysavy, M. A., Duncan, A. F., Vohr, B. R., Das, A., Goldberg, R. N., Higgins, R. D., Cotten, C. M. 2017; 376 (7): 617-628

  Abstract

  Data reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes.We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008-2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death.Data on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P<0.001). The percentage of infants who survived without neurodevelopmental impairment increased from 16% (217 of 1391) in epoch 1 to 20% (276 of 1348) in epoch 3 (P=0.001), whereas the percentage of infants who survived with neurodevelopmental impairment did not change significantly (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P=0.29). After adjustment for changes in the baseline characteristics of the infants over time, both the rate of survival with neurodevelopmental impairment (as compared with death) and the rate of survival without neurodevelopmental impairment (as compared with death) increased over time (adjusted relative risks, 1.27 [95% confidence interval {CI}, 1.01 to 1.59] and 1.59 [95% CI, 1.28 to 1.99], respectively).The rate of survival without neurodevelopmental impairment increased between 2000 and 2011 in this large cohort of periviable infants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov numbers, NCT00063063 and NCT00009633 .).

  View details for DOI 10.1056/NEJMoa1605566

  View details for PubMedID 28199816

• Growth Outcomes of Preterm Infants Exposed to Different Oxygen Saturation Target Ranges from Birth. journal of pediatrics Navarrete, C. T., Wrage, L. A., Carlo, W. A., Walsh, M. C., Rich, W., Gantz, M. G., Das, A., Schibler, K., Newman, N. S., Piazza, A. J., Poindexter, B. B., Shankaran, S., Sánchez, P. J., Morris, B. H., Frantz, I. D., Van Meurs, K. P., Cotten, C. M., Ehrenkranz, R. A., Bell, E. F., Watterberg, K. L., Higgins, R. D., Duara, S. 2016; 176: 62-68 e4

  Abstract

  To test whether infants randomized to a lower oxygen saturation (peripheral capillary oxygen saturation [SpO2]) target range while on supplemental oxygen from birth will have better growth velocity from birth to 36 weeks postmenstrual age (PMA) and less growth failure at 36 weeks PMA and 18-22 months corrected age.We evaluated a subgroup of 810 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial, randomized at birth to lower (85%-89%, n = 402, PMA 26 ± 1 weeks, birth weight 839 ± 186 g) or higher (91%-95%, n = 408, PMA 26 ± 1 weeks, birth weight 840 ± 191 g) SpO2 target ranges. Anthropometric measures were obtained at birth, postnatal days 7, 14, 21, and 28; then at 32 and 36 weeks PMA; and 18-22 months corrected age. Growth velocities were estimated with the exponential method and analyzed with linear mixed models. Poor growth outcome, defined as weight <10th percentile at 36 weeks PMA and 18-22 months corrected age, was compared across the 2 treatment groups by the use of robust Poisson regression.Growth outcomes including growth at 36 weeks PMA and 18-22 months corrected age, as well as growth velocity were similar in the lower and higher SpO2 target groups.Targeting different oxygen saturation ranges between 85% and 95% from birth did not impact growth velocity or reduce growth failure in preterm infants.

  View details for DOI 10.1016/j.jpeds.2016.05.070

  View details for PubMedID 27344218

• Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants. Journal of perinatology Wallenstein, M. B., Birnie, K. L., Arain, Y. H., Yang, W., Yamada, N. K., Huffman, L. C., Palma, J. P., Chock, V. Y., Shaw, G. M., Stevenson, D. K. 2016; 36 (2): 112-115

  Abstract

  To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.A retrospective chart review was conducted for all ELBW infants ⩽1000 g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5 min of life or if intubation was attempted during the first 10 min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.Journal of Perinatology advance online publication, 5 November 2015; doi:10.1038/jp.2015.158.

  View details for DOI 10.1038/jp.2015.158

  View details for PubMedID 26540244

• Mental Illness Drives Hospitalizations for Detained California Youth. journal of adolescent health Anoshiravani, A., Saynina, O., Chamberlain, L., Goldstein, B. A., Huffman, L. C., Wang, N. E., Wise, P. H. 2015; 57 (5): 455-461

  Abstract

  The purpose of the study was to describe inpatient hospitalization patterns among detained and nondetained youth in a large, total population of hospitalized adolescents in California.We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997 to 2011. We considered hospitalized youth aged 11-18 years "detained" if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay between detained youth and their nondetained counterparts in the general population.There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus nondetained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared with 19.8% of nondetained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median length of stay compared with nondetained inpatient youth with mental illness (≥ 6 days vs. 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥ 43 days).Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention.

  View details for DOI 10.1016/j.jadohealth.2015.05.006

  View details for PubMedID 26208862

• Sensory processing in preterm preschoolers and its association with executive function EARLY HUMAN DEVELOPMENT Adams, J. N., Feldman, H. M., Huffman, L. C., Loe, I. M. 2015; 91 (3): 227-233

  Abstract

  Symptoms of abnormal sensory processing have been related to preterm birth, but have not yet been studied specifically in preterm preschoolers. The degree of association between sensory processing and other domains is important for understanding the role of sensory processing symptoms in the development of preterm children.To test two related hypotheses: (1) preterm preschoolers have more sensory processing symptoms than full term preschoolers and (2) sensory processing is associated with both executive function and adaptive function in preterm preschoolers.Cross-sectional study.Preterm children (≤34weeks of gestation; n=54) and full term controls (≥37weeks of gestation; n=73) ages 3-5years.Sensory processing was assessed with the Short Sensory Profile. Executive function was assessed with (1) parent ratings on the Behavior Rating Inventory of Executive Function - Preschool version and (2) a performance-based battery of tasks. Adaptive function was assessed with the Vineland Adaptive Behavior Scales-II.Preterm preschoolers showed significantly more sensory symptoms than full term controls. A higher percentage of preterm than full term preschoolers had elevated numbers of sensory symptoms (37% vs. 12%). Sensory symptoms in preterm preschoolers were associated with scores on executive function measures, but were not significantly associated with adaptive function.Preterm preschoolers exhibited more sensory symptoms than full term controls. Preterm preschoolers with elevated numbers of sensory symptoms also showed executive function impairment. Future research should further examine whether sensory processing and executive function should be considered independent or overlapping constructs.

  View details for DOI 10.1016/j.earlhumdev.2015.01.013

  View details for Web of Science ID 000352042600011

  View details for PubMedID 25706317

• EXPLORING SHARED DECISION-MAKING IN CHILDREN WITH NEURODEVELOPMENTAL DISORDERS Hubner, L. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2015: 111

  View details for Web of Science ID 000346600700099

• INTERACTIVE AND TRADITIONAL BOOKS Literacy Beliefs and Practices in Latino Families RESEARCH ON TECHNOLOGY USE IN MULTICULTURAL SETTINGS Perez-Granados, D. R., Huffman, L. C., Ganesh, T. G., Boriack, A. W., Stillisano, Davis, T. J., Waxman, H. C. 2015: 11–44

  View details for Web of Science ID 000354423400002

• Respiratory Outcomes of the Surfactant Positive Pressure and Oximetry Randomized Trial (SUPPORT). journal of pediatrics Stevens, T. P., Finer, N. N., Carlo, W. A., Szilagyi, P. G., Phelps, D. L., Walsh, M. C., Gantz, M. G., Laptook, A. R., Yoder, B. A., Faix, R. G., Newman, J. E., Das, A., Do, B. T., Schibler, K., Rich, W., Newman, N. S., Ehrenkranz, R. A., Peralta-Carcelen, M., Vohr, B. R., Wilson-Costello, D. E., Yolton, K., Heyne, R. J., Evans, P. W., Vaucher, Y. E., Adams-Chapman, I., McGowan, E. C., Bodnar, A., Pappas, A., Hintz, S. R., Acarregui, M. J., Fuller, J., Goldstein, R. F., Bauer, C. R., O'Shea, T. M., Myers, G. J., Higgins, R. D. 2014; 165 (2): 240-249 e4

  Abstract

  To explore the early childhood pulmonary outcomes of infants who participated in the National Institute of Child Health and Human Development's Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial (SUPPORT), using a factorial design that randomized extremely preterm infants to lower vs higher oxygen saturation targets and delivery room continuous positive airway pressure (CPAP) vs intubation/surfactant.The Breathing Outcomes Study, a prospective secondary study to the Surfactant Positive Airway Pressure and Pulse Oximetry Randomized Trial, assessed respiratory morbidity at 6-month intervals from hospital discharge to 18-22 months corrected age (CA). Two prespecified primary outcomes-wheezing more than twice per week during the worst 2-week period and cough longer than 3 days without a cold-were compared for each randomized intervention.One or more interviews were completed for 918 of the 922 eligible infants. The incidences of wheezing and cough were 47.9% and 31.0%, respectively, and did not differ between the study arms of either randomized intervention. Infants randomized to lower vs higher oxygen saturation targets had a similar risk of death or respiratory morbidity (except for croup and treatment with oxygen or diuretics at home). Infants randomized to CPAP vs intubation/surfactant had fewer episodes of wheezing without a cold (28.9% vs 36.5%; P < .05), respiratory illnesses diagnosed by a doctor (47.7% vs 55.2%; P < .05), and physician or emergency room visits for breathing problems (68.0% vs 72.9%; P < .05) by 18-22 months CA.Treatment with early CPAP rather than intubation/surfactant is associated with less respiratory morbidity by 18-22 months CA. Longitudinal assessment of pulmonary morbidity is necessary to fully evaluate the potential benefits of respiratory interventions for neonates.

  View details for DOI 10.1016/j.jpeds.2014.02.054

  View details for PubMedID 24725582

• Executive function is associated with social competence in preschool-aged children born preterm or full term. Early human development Alduncin, N., Huffman, L. C., Feldman, H. M., Loe, I. M. 2014; 90 (6): 299-306

  Abstract

  Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.Cross-sectional study.Study subjects had a history of preterm birth (≤34weeks of gestation) and birth weight <2500g (n=70). Controls were born full term (≥37weeks) (n=79).Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.

  View details for DOI 10.1016/j.earlhumdev.2014.02.011

  View details for PubMedID 24661446

• Executive function mediates effects of gestational age on functional outcomes and behavior in preschoolers. Journal of developmental and behavioral pediatrics Loe, I. M., Feldman, H. M., Huffman, L. C. 2014; 35 (5): 323-333

  Abstract

  To investigate the role of executive function (EF) skills, measured by parent-rating and performance-based instruments, as mediators of the effects of gestational age (GA) on functional outcomes and behavior symptoms in preterm (PT) and full-term (FT) preschoolers.Children born PT (n = 70; mean GA, 29.6 weeks; mean birth weight, 1365 g) were compared to children born FT (n = 79) on composite measures of EF (using the Behavior Rating Inventory of Executive Function and a performance-based EF battery), adaptive function, prereading skills, and behavior symptoms. For the entire sample, mediation analyses examined the effect of GA on the outcomes with EF as mediator.Compared to children born FT, children born PT had significantly higher parent-rated EF scores and lower performance-based EF scores, both indicating more problems; furthermore, children born PT had lower adaptive function and prereading scores and more problematic behavior. GA contributed to adaptive function, prereading skills, and behavior symptoms for all children. EF acted as a mediator of GA for all 3 outcomes; different patterns emerged for parent-rated and performance-based EF evaluations. For adaptive function, both EF measures significantly mediated the effects of GA; for prereading skills, only performance-based EF was significant; for behavior symptoms, only parent-rated EF was significant.We propose standard assessment of EF, using both parent-rating and performance-based EF measures, in young PT children and other children at the risk of EF impairments. EF skills are measurable, mediate important functional outcomes, and may serve as intervention targets.

  View details for DOI 10.1097/DBP.0000000000000063

  View details for PubMedID 24906034

• Psychosocial Changes Associated With Participation in Art Therapy Interventions for Siblings of Pediatric Hematopoietic Stem Cell Transplant Patients ART THERAPY Wallace, J., Packman, W., Huffman, L., Horn, B., Cowan, M., Amylon, M., Kahn, C., Cordova, M., Moses, J. 2014; 31 (1): 4–11

  View details for DOI 10.1080/07421656.2014.873685

  View details for Web of Science ID 000210631400002

• SENSORY PROBLEMS IN PRETERM CHILDREN ARE ASSOCIATED WITH INCREASED RISK OF EXECUTIVE FUNCTION IMPAIRMENT Adams, J. N., Feldman, H. M., Huffman, L. C., Loe, I. M. LIPPINCOTT WILLIAMS & WILKINS. 2014: 169–70

  View details for Web of Science ID 000336284900100

• Associations Between First-Time Expectant Women's Representations of Attachment and Their Physiological Reactivity to Infant Cry. Child development Ablow, J. C., Marks, A. K., Shirley Feldman, S., Huffman, L. C. 2013; 84 (4): 1373-91

  Abstract

  Associations among 53 primiparous women's Adult Attachment Interview classifications (secure-autonomous vs. insecure-dismissing) and physiological and self-reported responses to infant crying were explored. Heart rate, skin conductance levels, and respiratory sinus arrhythmia (RSA) were recorded continuously. In response to the cry, secure-autonomous women demonstrated RSA declines, consistent with approach-oriented responses. Insecure-dismissing women displayed RSA and electrodermal increases, consistent with behavioral inhibition. Furthermore, insecure-dismissing women rated the cries as more aversive than secure-autonomous women. Nine months postpartum, secure-autonomous women, who prenatally manifested an approach-oriented response to the unfamiliar cry stimulus, were observed as more sensitive when responding to their own distressed infant, whereas women classified prenatally as insecure-dismissing were observed as less sensitive with their own infants.

  View details for DOI 10.1111/cdev.12135

  View details for PubMedID 23786152

• Research Experience and Efforts by Developmental-Behavioral Pediatrics Fellows: A Survey of Fellowship Directors by DBPNet Schonfeld, D. J., Wiley, S., Huffman, L. LIPPINCOTT WILLIAMS & WILKINS. 2013: S4

  View details for Web of Science ID 000330358800014

• Executive Function Skills in Preterm Preschool Children Loe, I. M., Chatav, M., Alduncin, N., Chang, W. S., Feldman, H. M., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2013: S7

  View details for Web of Science ID 000330358800023

• Does Multiple Language Exposure Influence Executive Function Skills in Preschool Children? Loe, I. M., Alduncin, N., Chatav, M., Chang, W. S., Huffman, L. C., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S4

  View details for Web of Science ID 000330358800012

• A Systematic Review of Interventions for Adults with ASD Huffman, L. C., Slay, J. A., Feldman, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2013: S10

  View details for Web of Science ID 000330358800035

• Tetrahydrobiopterin as a treatment for autism spectrum disorders: a double-blind, placebo-controlled trial. Journal of child and adolescent psychopharmacology Klaiman, C., Huffman, L., Masaki, L., Elliott, G. R. 2013; 23 (5): 320-328

  Abstract

  Abstract Objective: The purpose of this study was to determine if tetrahydrobiopterin (BH4) reduced core symptoms of autism spectrum disorder (ASD). Method: In this study, 46 children, 3-7 years of age diagnosed with an ASD were randomly assigned to double-blind treatment with 20 mg/kg/day BH4 or placebo for 16 weeks. The primary outcome measure was the Clinical Global Impressions Improvement and Severity Scales (CGI-I and CGI-S); secondary outcomes were the Preschool Language Scale-4 (PLS-4), Social Responsiveness Scale (SRS), Aberrant Behavior Checklist (ABC), and Vineland Adaptive Behavior Scales (Vineland). Results: Overall, no differences were found on global improvement as measured with the CGI-I or CGI-S. Secondary measures indicated significant improvements for BH4 relative to placebo with regard to social awareness, autism mannerisms, hyperactivity, and inappropriate speech. Side effects were minimal and similar between both active medication and placebo. Conclusions: These results indicate that BH4 offers promise in reducing symptoms of ASD. Clinical Trials.gov Identifier: NCT00850070.

  View details for DOI 10.1089/cap.2012.0127

  View details for PubMedID 23782126

• Improving Healthy Eating in Families With a Toddler at Risk for Overweight: A Cluster Randomized Controlled Trial JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Agras, W. S., Hammer, L. D., Huffman, L. C., Mascola, A., Bryson, S. W., Danaher, C. 2012; 33 (7): 529-534

  Abstract

  To ascertain whether a parent education program based on Satter's division of responsibility in feeding children (DOR) is effective in enhancing parent/child feeding interactions for children with an overweight/obese parent. The primary hypothesis was that the intervention would decrease parental pressure to eat.Sixty-two families with a child between 2 and 4 years with at least 1 overweight/obese parent were randomly allocated using a cluster design to either the DOR intervention or a control group. The control group focused on increasing family consumption of healthy foods and activity levels and enhancing child sleep duration. The primary outcome was parent pressure on their child to eat.The DOR intervention was superior to the control group in reducing the pressure to eat. Two moderators of pressure to eat were found: disinhibition of eating and hunger. The parents in the DOR group, irrespective of disinhibition levels, lowered the pressure to eat, whereas those in the control group with low disinhibition increased the pressure to eat. There were similar findings for hunger. Gender moderated restrictive feeding with DOR parents lowering restriction more than parents of the control group in girls only.The DOR intervention was more effective in reducing the parent pressure to eat and food restriction (in girls only) than the control group.

  View details for DOI 10.1097/DBP.0b013e3182618e1f

  View details for PubMedID 22947882

• Missed Opportunities in the Referral of High-Risk Infants to Early Intervention PEDIATRICS Tang, B. G., Feldman, H. M., Huffman, L. C., Kagawa, K. J., Gould, J. B. 2012; 129 (6): 1027-1034

  Abstract

  Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California.From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening.Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit.In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.

  View details for DOI 10.1542/peds.2011-2720

  View details for PubMedID 22614772

• REASONS FOR HOSPITALIZATION IN CHILDREN WITH CEREBRAL PALSY AND DOWN SYNDROME ACROSS CHILDHOOD Western Regional Meeting of the American-Federation-for-Medical-Research Nayfack, A., Chan, J., Huffman, L., Feldman, H., Wise, P. LIPPINCOTT WILLIAMS & WILKINS. 2012: 131–32

  View details for Web of Science ID 000298634401021

• Activation During Observed Parent-Child Interactions with Anxious Youths: A Pilot Study JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT Gonzalez, A., Moore, P. S., Garcia, A. M., Thienemann, M., Huffman, L. 2011; 33 (2): 159-170

  Abstract

  Parent-child interaction paradigms are often used to observe dysfunctional family processes; however, the influence of such tasks on a participant's level of activation remain unclear. The aim of this pilot project is to explore the stimulus value of interaction paradigms that have been commonly used in child anxiety research. Twenty-nine parent-child dyads with clinically anxious (n = 16) and non-anxious (n = 13) youths engaged in a series of tasks (threat and non-threat) used in previous studies of parenting and youth anxiety. Heart rate (HR) data, as an indicator of physiological activation, were collected across tasks, and participants rated the perceived representativeness of their interactions in the laboratory to their usual behavior at home. Significant HR changes were observed for both parent and child. Change in child HR from baseline to non-threat task was smaller than change in HR from baseline to threat tasks. Change in parent HR from baseline to ambiguous situations tasks was smaller than changes from baseline to other threat tasks. Differences in HR change between anxious and non-anxious children were explored. Participants rated laboratory interactions as similar to those experienced in the home. Results suggest that presumably emotionally-charged discussion tasks may produce increased activation compared to tasks that were designed to be more neutral. Implications for future research and limitations are discussed.

  View details for DOI 10.1007/s10862-011-9216-y

  View details for Web of Science ID 000291169600002

  View details for PubMedCentralID PMC3105235

• Management of Symptoms in Children With Autism Spectrum Disorders: A Comprehensive Review of Pharmacologic and Complementary-Alternative Medicine Treatments JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C., Sutcliffe, T. L., Tanner, I. S., Feldman, H. M. 2011; 32 (1): 56-68

  Abstract

  In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms.

  View details for DOI 10.1097/DBP.0b013e3182040acf

  View details for PubMedID 21160435

• MISSED OPPORTUNITIES IN HIGH RISK INFANT FOLLOW-UP? Tang, B., Huffman, L., Feldman, H., Gray, E., Kagawa, K., Gould, J. B. LIPPINCOTT WILLIAMS & WILKINS. 2011: 95

  View details for Web of Science ID 000285542500042

• Tetrahydrobiopterin as a Novel Therapeutic Intervention for Autism NEUROTHERAPEUTICS Frye, R. E., Huffman, L. C., Elliott, G. R. 2010; 7 (3): 241-249

  Abstract

  Tetrahydrobiopterin (BH(4)) is an essential cofactor for several critical metabolic pathways that have been reported to be abnormal in autism spectrum disorder (ASD). In addition, the cerebrospinal fluid concentration of BH(4) is reported to be depressed in children with ASD. Over the past 25 years, several clinical trials have suggested that treatment with BH(4) improves ASD symptomatology in some individuals. Two ongoing clinical protocols may help further define the efficacy of BH(4) treatment in children with ASD. First, children with ASD who had low concentrations of cerebrospinal fluid or urine pterins were treated in an open-label manner with 20 mg/kg per day of BH(4). The majority of children (63%) responded positively to treatment, with minimal adverse events (AEs). Second, a double-blind placebo-controlled study examining the efficacy of 20 mg/kg per day of BH(4) treatment in children with ASD is currently underway. Safety studies from the commercially available forms of BH(4) document the low incidence of AEs, particularly serious AEs. Studies have also documented the ability of BH(4) to cross the blood-brain barrier. Based on the importance of BH(4) in neurodevelopmental metabolic pathways, the safety of BH(4) treatment, and the evidence for a therapeutic benefit of BH(4) treatment in children with ASD, we conclude that BH(4) represents a novel therapy for ASD, one that may gain wider use after further clinical studies have established efficacy and treatment guidelines.

  View details for Web of Science ID 000280063300004

  View details for PubMedID 20643376

  View details for PubMedCentralID PMC2908599

• Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access, Health Care Utilization, and Health Status MATERNAL AND CHILD HEALTH JOURNAL Javier, J. R., Huffman, L. C., Mendoza, F. S., Wise, P. H. 2010; 14 (4): 567-579

  Abstract

  To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0-11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent's language, parental education, ethnicity, and children's insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.

  View details for DOI 10.1007/s10995-009-0487-9

  View details for Web of Science ID 000279477400010

  View details for PubMedID 19554437

• Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California PEDIATRICS Chamberlain, L. J., Chan, J., Mahlow, P., Huffman, L. C., Chan, K., Wise, P. H. 2010; 125 (6): 1190-1199

  Abstract

  Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

  View details for DOI 10.1542/peds.2009-1109

  View details for PubMedID 20439593

• Examining Depressive Symptoms and Use of Counseling in the Past Year Among Filipino and Non-Hispanic White Adolescents in California JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Javier, J. R., Lahiff, M., Ferrer, R. R., Huffman, L. C. 2010; 31 (4): 295-303

  Abstract

  We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California.This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed.Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score > or = 7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes > or = 300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004-0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00-15.89).Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

  View details for DOI 10.1097/DBP.0b013e3181dbadc7

  View details for Web of Science ID 000277769600005

  View details for PubMedID 20431400

• Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of health care for the poor and underserved Weintraub, D., Rodgers, M. A., Botcheva, L., Loeb, A., Knight, R., Ortega, K., Heymach, B., Sandel, M., Huffman, L. 2010; 21 (2): 157-168

  Abstract

  As a preliminary investigation of the effectiveness of medical-legal partnership in pediatrics, we conducted a 36-month prospective cohort study of the impact of clinic- and hospital-based legal services. We hypothesized that integration of legal services into pediatric settings would increase families' awareness of and access to legal and social services, decrease barriers to health care for children, and improve child health.Health care providers referred families with legal or social needs to the Peninsula Family Advocacy Program (FAP).Fifty four families completed both baseline and six-month follow-up assessments. Comparison of follow-up with baseline demonstrated significantly increased proportions of families who utilized food and income supports and significantly decreased proportions of families avoiding health care due to lack of health insurance or concerns about cost. Two-thirds of respondents reported improved child health and well-being.This study suggests that adding an attorney to the medical team increases awareness of and access to social and legal services.

  View details for DOI 10.1353/hpu.0.0311

  View details for PubMedID 20453383

• Impact of Managed Care on Publicly Insured Children with Special Health Care Needs ACADEMIC PEDIATRICS Huffman, L. C., Brat, G. A., Chamberlain, L. J., Wise, P. H. 2010; 10 (1): 48-55

  Abstract

  The aim of this review was to evaluate the impact of managed care on publicly insured children with special health care needs (CSHCN).We conducted a review of the extant literature. Using a formal computerized search, with search terms reflecting 7 specific outcome categories, we summarized study findings and study quality.We identified 13 peer-reviewed articles that evaluated the impact of Medicaid and State Children's Health Insurance program (SCHIP) Managed Care (MSMC) on health services delivery to populations of CSHCN, with all studies observational in design. Considered in total, the available scientific evidence is varied. Findings concerning care access demonstrate a positive effect of MSMC; findings concerning care utilization were mixed. Little information was identified concerning health care quality, satisfaction, costs, or health status, whereas no study yielded evidence on family impact.The available studies suggest that the evaluated record of MSMC for CSHCN has been mixed, with considerable heterogeneity in the definition of CSHCN, program design, and measured outcomes. These findings suggest caution should be exercised in implementing MSMC for CSHCN and that greater emphasis on health outcomes and cost evaluations is warranted.

  View details for PubMedID 20129481

• Lessons learned from a community-academic partnership addressing adolescent pregnancy prevention in Filipino American families. Progress in community health partnerships : research, education, and action Javier, J. R., Chamberlain, L. J., Rivera, K. K., Gonzalez, S. E., Mendoza, F. S., Huffman, L. C. 2010; 4 (4): 305-313

  Abstract

  Filipino Americans have more adolescent pregnancies than other Asian-Pacific Islanders (APIs). Few community-academic collaborations have addressed adolescent pregnancy prevention in this community.We sought to describe the lessons learned from and impact of a community-based teen pregnancy prevention program for Filipino Americans implemented by a Filipina pediatrics resident.We formed a community-academic partnership between the Filipino Youth Coalition, a community-based organization (CBO) in San Jose, California, and the Stanford School of Medicine's Pediatric Advocacy Program. We developed a culturally tailored parent-teen conference addressing adolescent pregnancy prevention in Filipino Americans. We qualitatively and quantitatively evaluated this intervention by collecting both pre- and post-conference data using a convenience sample design.Engaging particular aspects of Filipino culture (i.e., religion and intergenerational differences) helped to make this community-academic partnership successful. For physicians-in-training who are conducting community-based participatory research (CBPR), project challenges may include difficulties in building and maintaining academic- community relationships, struggles to promote sustainability, and conflicting goals of "community insiders" and "academic outsiders." Authors offer insights and implications for residents interested in practicing CBPR.CBPR is a key tool for exploring health issues in understudied populations. CBPR experiences can provide meaningful educational opportunities for physicians-in-training and can build sustained capacity in CBOs. They can also help residents to develop analytic skills, directly affect the health of the communities they serve, and, for minority physicians, give back to the communities they call home.

  View details for DOI 10.1353/cpr.2010.0023

  View details for PubMedID 21169708

• Emphasizing Cultural Competence in Evaluation A Process-Oriented Approach AMERICAN JOURNAL OF EVALUATION Botcheva, L., Shih, J., Huffman, L. C. 2009; 30 (2): 176-188

  View details for DOI 10.1177/1098214009334363

  View details for Web of Science ID 000266568600003

• Physiological Correlates of Social Avoidance Behavior in Children and Adolescents With Fragile X Syndrome JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Hall, S. S., Lightbody, A. A., Huffman, L. C., Lazzeroni, L. C., Reiss, A. L. 2009; 48 (3): 320-329

  Abstract

  To investigate whether eye-gaze avoidance, a striking phenotypic feature in fragile X syndrome (FXS), is associated with high levels of "hyperarousal" during social interactions with others. To date, almost all studies in this area have been confounded by inclusion of task demands in addition to social demands.We monitored the cardiovascular activity and eye-gaze avoidance of 50 boys and girls with FXS aged 5 to 20 years during a 25-minute intensive social interaction session with an unfamiliar experimenter. To control for possible family and genetic factors in cardiovascular activity, we compared each child with FXS with their same-sex typically developing biological sibling.Participants with FXS obtained significantly higher heart rates, lower vagal tone, and lower heart rate variability estimates both at baseline and during the social interaction session compared with their typically developing siblings. Although eye-gaze avoidance occurred at significantly higher levels in the children with FXS, this behavior decreased slightly over the course of the session (a "warm-up" effect) and did not seem to be associated with cardiovascular activity. In the girls with FXS, higher levels of the fragile X mental retardation protein were associated with higher (and more typical) heart rate variability.These data suggest that both sympathetic and parasympathetic nervous systems are dysregulated in FXS. However, given that prolonged exposure to social demands does not inevitably lead to increased anxiety or "hyperarousal," professionals should not be deterred from providing much needed social skills interventions for individuals with FXS.

  View details for DOI 10.1097/CHI.0b013e318195bd15

  View details for PubMedID 19182690

• AGE ADJUSTMENT: A POOR STRATEGY FOR PREDICTING OUTCOME IN CHILDREN BORN PREMATURELY Raj, K. S., Sutcliffe, T. L., Debattista, A. M., Goldfarb-Greenwood, C., Huffman, L. C. LIPPINCOTT WILLIAMS & WILKINS. 2009: 155–56

  View details for Web of Science ID 000270092400217

• Is Child Psychiatric Service Different When Provided by Attendings Versus Clinicians-in-Training? ACADEMIC PSYCHIATRY Williams, S. E., Martin, J. L., Dyer-Friedman, J., Huffman, L. C. 2008; 32 (5): 400-404

  Abstract

  This study examines the clinical management characteristics of outpatient child and adolescent psychiatric care provided by attendings and clinicians-in-training in an academic institution. The authors hypothesized that no significant differences would exist between initial evaluations conducted by attendings and those conducted by clinicians-in-training.The amount of information obtained during an initial evaluation and the number and type of services recommended postevaluation were assessed for 429 patients treated in the child and adolescent psychiatry clinics at Stanford University by attending psychiatrists and clinicians-in-training.No significant differences were found for the evaluations conducted by attendings and clinicians-in-training for the amount of data collected during an evaluation of the number or type of recommendations made postevaluation.These findings lend themselves to the conclusion that attendings and clinicians-in-training offer comparable services in the assessment of new patients. Study limitations and future areas of study are discussed.

  View details for PubMedID 18945979

• Filipino child health in the United States: do health and health care disparities exist? Preventing chronic disease Javier, J. R., Huffman, L. C., Mendoza, F. S. 2007; 4 (2): A36-?

  Abstract

  Filipinos are the second largest Asian subgroup in the United States, but few studies have examined health and health care disparities in Filipino children. The objectives of this review are 1) to appraise current knowledge of Filipino children's health and health care and 2) to present the implications of these findings for research, clinical care, and policy.We identified articles for review primarily via a Medline search emphasizing the terms Filipino and United States crossed with specific topics in child and adolescent health that fall under one of Healthy People 2010's 28 focus areas.Filipino children are underrepresented in medical research. Studies that compare Filipino children and adolescents with white children or children of other Asian Pacific Islander subgroups suggest disparities with regard to gestational diabetes, rates of neonatal mortality and low birth weight, malnutrition in young children, overweight, physical inactivity and fitness, tuberculosis, dental caries, and substance abuse. Studies that compare Filipino adults with white adults describe adult Filipino health problems similar to those of Filipino children, including higher rates of diabetes, hypertension, and metabolic syndrome. Health care disparities remain to be determined.Health and health care disparities appear to exist for Filipino children, but more research is needed to confirm these findings. Practitioners serving this population need to consider social and cultural factors that can increase or diminish risk for health problems. There are priorities in research and policy that, if pursued, may improve the health care and health outcomes of Filipino children.

  View details for PubMedID 17362627

• Psychometric properties of the Peer Interactions in Primary School (PIPS) Questionnaire JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tarshis, T. P., Huffman, L. C. 2007; 28 (2): 125-132

  Abstract

  Recently, national and international scientific and popular press has focused on bullying and victimization. Unfortunately, many interventions that address bullying and victimization are yet to be empirically validated. One problem is the lack of a psychometrically sound instrument for the measurement of bullying and victimization.To alleviate this shortcoming, the Peer Interactions in Primary School Questionnaire (PIPS) was developed and tested. Twenty-two questions designed to capture direct and indirect forms of bullying and victimization were created at a third-grade reading level. Psychometric data were collected from administration of the questionnaire to 270 students in third through sixth grades at three different elementary schools. An exploratory factor analysis yielded two factors (bullying and victimization).Internal consistency for the questionnaire was high (Cronbach's alpha = .90). Intraclass correlation coefficients (ICCs) and Spearman's rho established that test-retest reliability was high for both scales: bullying (ICC = .84; rho = .76) and victimization (ICC = .88; rho = .87). Significant Kruskal-Wallis tests of relationships between PIPS scales and items on the Olweus Bullying/Victimization Questionnaire and the Strengths and Difficulties Questionnaire supported concurrent validity. Bullying and victimization were widespread, as 89.5% of children experienced some form of victimization and 59.0% of students participated in some form of bullying.With these data, the PIPS is the first self-report bullying and victimization measure designed for elementary school use determined reliable (internally consistent and reproducible) and valid. The PIPS is a tool that could be used in the design and evaluation of school-based bullying/victimization interventions.

  View details for PubMedID 17435463

• A Critical Analysis of Care Coordination Strategies for Children AHRQ Technical Reviews Wise, P. H., Huffman, L. C., Brat, G. 2007; 07-0054 (14)
• Provider recognition of psychosocial problems in low-income Latino children JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Tarshis, T. P., Jutte, D. P., Huffman, L. C. 2006; 17 (2): 342-357

  Abstract

  The purpose of this study was to determine the frequency of identification of psychosocial problems in Latino children by primary care providers (PCPs). This was a cross-sectional study of 269 low-socioeconomic status (SES), Latino children, ages 2-16 years, seen at a community clinic for well-child care. Primary care providers completed a World Health Organization checklist, which organized provider assessment of child psychosocial problems. Clinicians identified one or more psychosocial problems in 39.8% of children. Clinicians recognized only 20% of children with clinically significant aggression symptoms, 18% of children with clinically significant attention/hyperactivity symptoms, and none (0%) of the children with clinically significant anxiety/depression symptoms with clinical data from parent-completed child-behavior checklists used as the benchmark. Despite high rates of identification of psychosocial problems in a low-SES, Latino population, PCPs still miss symptoms of mental health difficulties, especially anxiety and depression. Since symptoms of anxiety and depression are likely to be more pronounced in Latino populations, there is a continued need for improvement in detection of mental health concerns among these children.

  View details for PubMedID 16702719

• Filipino American families and intergenerational communication about sex. Ambulatory pediatrics Javier, J. R., Chamberlain, L., Huffman, L., Mendoza, F. 2006; 6 (2): 120-?

  View details for PubMedID 16530151

• Are residents ready for self-directed learning? A pilot program of individualized learning plans in continuity clinic AMBULATORY PEDIATRICS Stuart, E., Sectish, T. C., Huffman, L. C. 2005; 5 (5): 298-301

  Abstract

  Changes in training and certification requirements demand that trainees and practitioners take charge of planning and documenting their ongoing learning. Individualized learning plans (ILPs) have been proposed as a tool to guide this process. We report on a pilot program using ILPs as part of the pediatric continuity clinic experience.The goal of the project was to explore residents' and faculty members' reactions to using ILPs when ILPs were offered as an optional tool.A group of 42 residents and 13 faculty members volunteered to use ILPs in continuity clinic. Nine months into the intervention, residents and faculty completed questionnaires about their experiences using ILPs. We performed a content analysis of questionnaire responses to identify perceived benefits and barriers to using ILPs.ILP users reported that the program was helpful in providing a framework and focus for learning and in amplifying their awareness of the learning process. Barriers to using ILPs included lack of time and difficulty establishing and working with learning goals.Our results suggest that residents are unaccustomed to taking active roles in planning their own learning. To prepare trainees for lifelong learning and continuous professional development, residency programs need to provide explicit education in the process of self-directed learning.

  View details for PubMedID 16167854

• Impact of child advocacy training on pediatric residents Chamberlain, L. J., Huffman, L. C., Shocket, S., Sanders, L. M., Sectish, T. C., Mendoza, F. S., Takayama, J. I. INT PEDIATRIC RESEARCH FOUNDATION, INC. 2002: 77A

  View details for Web of Science ID 000174714600451

• Child behavior symptoms and parental stress: Findings from a community behavioral healthcare agency out-patient population Huffman, L. C., Blasey, C., Nichols, M. J., McNee INT PEDIATRIC RESEARCH FOUNDATION, INC. 2000: 27A

  View details for Web of Science ID 000086155300159