Prediciting Severe Neonatal Hyperbilirubinemia
Principal Investigator: Ron Keren
Abstract: DESCRIPTION (provided by applicant): The overall goal of this research career development award is to promote the development of Dr. Ron Keren as an independent patient-oriented clinical researcher. To achieve this goal, Dr. Keren has framed a comprehensive program that combines a preceptorship with J. Sanford Schwartz, M.D., formal didactic training in health services research and clinical epidemiology, and performance of original research. This combination of didactic and practical research experiences will allow Dr. Keren to expand and strengthen the set of skills he acquired in his fellowship training. Dr. Keren hopes to use this award to establish himself as an academic leader in pediatric outcomes and health services research, with an expertise in predictive modeling and economic evaluation. Dr. Keren's interest is in technology assessment and public health policy as they relate to newborn screening and disease prevention in general, and to the prediction and prevention of severe neonatal hyperbilirubinemia and kernicterus in particular. The specific aims of the research application are three-fold. First, he will develop a simple and practical clinical prediction rule that pediatricians and neonatologists can use to predict term and near-term newborns' risk of developing severe neonatal hyperbilirubinemia after discharge from the hospital. Second, the clinical prediction rule will be validated in an independent sample of ethnically and geographically diverse newborns, thus demonstrating its generalizability. And finally, a cost-effectiveness model will be developed to simulate the economic costs and clinical harms and benefits of using alternative prediction models in the prevention of extreme hyperbilirubinemia and kernicterus. Future research projects and grant submissions will be aimed at evaluating the effectiveness and cost-effectiveness of these prediction models when coupled with risk-specific preventive services in actual nursery settings. Current preventive services consist of closer out-patient follow-up for infants designated as high risk for the development of severe neonatal hyperbilirubinemia after discharge. However, the imminent availability of drugs, such as tin-mesoporphyrin, that can prevent hyperbilirubinemia in high-risk infants makes the application to develop valid prediction rules to risk stratify infants particularly timely, relevant, and important.
Funding Period: 2003-06-06 - 2009-05-31
more information: NIH RePORT
- Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approachesR Keren
Division of General Pediatrics, Pediatric Generalist Research Group, The Children s Hospital of Philadelphia, PA, USA
Arch Dis Child 90:415-21. 2005....
- Factors associated with variability in outcomes for children hospitalized with urinary tract infectionPatrick H Conway
Center for Health Care Quality and Division of Health Policy and Clinical Effectiveness, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
J Pediatr 154:789-96. 2009..To describe the variability in outcomes and care processes for children hospitalized for urinary tract infection (UTI), and to identify patient and hospital factors that may account for variability...
- Visual assessment of jaundice in term and late preterm infantsR Keren
Division of General Pediatrics and the Center for Pediatric Clinical Effectiveness, The Children s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
Arch Dis Child Fetal Neonatal Ed 94:F317-22. 2009..To determine the accuracy of predischarge visual assessment of jaundice for estimating bilirubin concentration and predicting risk of significant neonatal hyperbilirubinaemia...
- Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in childrenTheoklis Zaoutis
Division of Infectious Diseases, Children s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, CHOP North, Suite 1527, Philadelphia, PA 19104, USA
Pediatrics 123:636-42. 2009..We sought to compare the effectiveness of early transition from intravenous to oral antimicrobial therapy versus prolonged intravenous antimicrobial therapy for the treatment of children with acute osteomyelitis...
- A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infantsRon Keren
Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children s Hospital of Philadelphia, 3535 Market St, Philadelphia, PA 19104, USA
Pediatrics 121:e170-9. 2008..The purpose of this work was to compare the predictive accuracy of alternative risk-assessment strategies used to screen for the risk of significant neonatal hyperbilirubinemia...
- Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerationsLisa A Prosser
Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA
Pharmacoeconomics 25:713-26. 2007....
- Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobialsPatrick H Conway
Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA
JAMA 298:179-86. 2007..The evidence regarding risk factors for recurrent urinary tract infection (UTI) and the risks and benefits of antimicrobial prophylaxis in children is scant...
- ICD-9 codes for identifying influenza hospitalizations in childrenRon Keren
Emerg Infect Dis 12:1603-4. 2006
- Direct medical cost of influenza-related hospitalizations in childrenRon Keren
Children s Hospital of Philadelphia, 3535 Market St, Room 1524, Philadelphia, PA 19104, USA
Pediatrics 118:e1321-7. 2006..Our goal was to determine the cost of influenza-related hospitalization in children with community-acquired laboratory-confirmed influenza and to identify predictors of high hospitalization costs...
- Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitisRebecca Ruebner
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Pediatrics 117:1210-5. 2006..To determine the complications and risk factors for complications associated with using central venous catheters (CVCs) for the treatment of acute hematogenous osteomyelitis (AHO)...
- Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infectionRon Keren
Division of General Pediatrics, Pediatric Generalist Research Group, Department of Medicine, The Children s Hospital of Philadelphia, PA 19104, USA
JAMA 294:2188-94. 2005..Little is known about the relative contribution of each of these chronic medical conditions to the development of serious influenza-associated complications...
- Evaluation of a novel method for grading heart murmur intensityRon Keren
Division of General Pediatrics, Pediatric Generalist Research Group, Children s Hospital of Philadelphia, 3535 Market Street, Philadelphia, PA 19104, USA
Arch Pediatr Adolesc Med 159:329-34. 2005..To determine if heart murmur intensity grading performance can be improved using the heart sounds as an internal reference...
- Use of antibiotics in children hospitalized with community-acquired, laboratory-confirmed influenzaJennifer J Wilkes
Division of Infectious Diseases, The Children s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
J Pediatr 154:447-9. 2009..A total of 333 of 729 (46%) patients received >2 days of treatment with antibacterial medications, of whom 36% did not have an apparent indication for therapy...