Jochen Profit, Postdoctoral Faculty Sponsor
Delayed Cord Clamping Uptake and Outcomes for Infants Born Very Preterm in California.
American journal of perinatology
OBJECTIVE: To investigate whether the purported benefits of DCC translate into a reduction in mortality and intraventricular hemorrhage (IVH) among preterm neonates in practice.DESIGN: This was a prospective cohort study of very preterm infants constructed from data from the California Perinatal Quality Collaborative for infants admitted into 130 California neonatal intensive care units (NICUs) within the first 28 days of life from 2016 through 2020. Individual-level analyses were conducted using log-binomial regression models controlling for confounders and allowing for correlation within hospitals to examine the relationship of DCC to the outcomes of mortality and IVH. Hospital-level analyses were conducted using Poisson regression models with robust variance controlling for confounders Results: Among 13,094 included very preterm infants (5,856 with DCC and 7,220 without), DCC was associated with a 44% lower risk of mortality (adjusted RR: 0.56, 95% CI: 0.47 - 0.66). Furthermore, every 10% increase in the hospital rate of DCC among preterm infants was associated with a 5% lower hospital mortality rate among preterm infants (aRR: 0.95, 95% CI: 0.92 - 0.98). DCC was associated with severe IVH at the individual-level, but not at the hospital-level.CONCLUSIONS AND RELEVANCE: At the individual-level and hospital-level, the use of DCC was associated with lower mortality among preterm infants admitted to NICUs in California. These findings are consistent with clinical trial results, suggesting that the effects of DCC seen in clinical trials are translating to improved survival in practice.
View details for DOI 10.1055/a-1975-4607
View details for PubMedID 36351446
Health insurance coverage, clinical outcomes, and health-related quality of life among youth born to women living with HIV.
Journal of acquired immune deficiency syndromes (1999)
BACKGROUND: While sustained access to health care is essential, little is known about the relationship between insurance coverage and health among people born to women living with HIV (WLHIV).SETTING: Prospective cohort studies of youth and young adults born to WLHIV from 2007-2019.METHODS: We used adjusted generalized estimating equation models to estimate mean differences in, and relative risks of, health-related quality of life (HR-QoL) and HIV disease measures over time by insurance status. HR-QoL scales with limited variability were dichotomized. Modified Poisson models were used to estimate relative risks (RRs).RESULTS: Six hundred sixty-nine Adolescent Master Protocol (AMP) youth (66% living with perinatally-acquired HIV [PHIV], 72% Black) and 939 AMP Up/AMP Up Lite young adults (89% PHIV, 68% Black) reported insurance. Most were publicly insured (87% youth, 67% young adults). Privately insured young adults living with PHIV (YAPHIV) had lower risk of antiretroviral therapy (ART) nonadherence (adjusted RR [aRR]: 0.82, 95%CI: 0.70, 0.97) than those with public insurance. There was a lower risk of suboptimal role functioning for young adults with private insurance (aRR: 0.58, 95% CI: 0.35, 0.97) and those unaware of their coverage (aRR: 0.41, 95%CI: 0.21, 0.78). Young adults with private insurance had higher health perception scores than those with public insurance (adjusted mean difference: 3.87, 95%CI: 0.37, 7.38). For youth, we observed no differences in HR-QOL and HIV disease measures by insurance.CONCLUSION: These findings suggest meaningful differences in ART adherence and some HR-QoL outcomes by health insurance coverage among young adults born to WLHIV.
View details for DOI 10.1097/QAI.0000000000003100
View details for PubMedID 36150048
Neonatal abstinence syndrome and mother's own milk at discharge.
Journal of perinatology : official journal of the California Perinatal Association
OBJECTIVE: To describe factors impacting receipt of mother's own milk (MOM) at discharge among California infants diagnosed with neonatal abstinence syndrome (NAS).STUDY DESIGN: Cohort study of the California Perinatal Quality Care Collaborative's Maternal Substance Exposure Database for infants with NAS and gestational age ≥ 34 weeks from 2019 to 2020.RESULT: 245 infants with NAS were identified. Variables with an increased likelihood of being discharged on MOM included maternal medication assisted treatment (p=0.001), use of maternal addiction services (p<0.001), receiving donor human milk (p=0.001), being treated in the well baby unit (p<0.001), rooming-in (p<0.001), and kangaroo care (p<0.001). Among infants with NAS for whom MOM was recommended (n=84), rooming-in was the only factor associated with being discharged on MOM (p=0.002); receiving formula was the only inversely associated factor (p<0.001).CONCLUSION: Results suggest supporting the mother-infant dyad and using non-pharmacologic treatment methods, such as rooming-in, increase receipt of MOM at discharge.
View details for DOI 10.1038/s41372-022-01430-5
View details for PubMedID 35725804
Timing of antiretroviral therapy initiation and birth outcomes among pregnant women living with HIV in Tanzania.
The Journal of infectious diseases
BACKGROUND: Combination antiretroviral therapy (cART) initiation during pregnancy reduces the risk of perinatal HIV transmission; however, studies have suggested that there may be unintended adverse consequences on birth outcomes for selected cART regimens.METHODS: We analyzed adverse birth outcomes among a prospective cohort of 1307 pregnant women living with HIV in Dar es Salaam who initiated cART during the first or second trimester of a singleton pregnancy. Our primary analysis compared birth outcomes by gestational age at cART initiation among these women initiating cART in pregnancy.RESULTS: Among women who initiated cART in pregnancy, there was no relationship of gestational age at cART initiation with the risk of fetal death or stillbirth. However, women who initiated cART before 20 weeks of gestation as compared to after 20 weeks had increased risk of preterm birth (RR: 1.30, 95% CI: 1.03-1.67), but decreased risk of small-for-gestational age birth (RR: 0.71, 95% CI: 0.55-0.93).CONCLUSIONS: With increasing use of cART preconception and early in pregnancy, clinicians should be aware of the benefits and potential risks of cART regimens to optimize birth outcomes.
View details for DOI 10.1093/infdis/jiac224
View details for PubMedID 35678698