Prediciting Severe Neonatal Hyperbilirubinemia

Summary

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

Top Publications

  1. pmc Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches
    R Keren
    Division of General Pediatrics, Pediatric Generalist Research Group, The Children s Hospital of Philadelphia, PA, USA
    Arch Dis Child 90:415-21. 2005
  2. ncbi Factors associated with variability in outcomes for children hospitalized with urinary tract infection
    Patrick 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
  3. ncbi Visual assessment of jaundice in term and late preterm infants
    R 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
  4. pmc Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children
    Theoklis 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
  5. ncbi A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants
    Ron 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
  6. ncbi Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations
    Lisa 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
  7. ncbi Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials
    Patrick H Conway
    Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA
    JAMA 298:179-86. 2007
  8. pmc ICD-9 codes for identifying influenza hospitalizations in children
    Ron Keren
    Emerg Infect Dis 12:1603-4. 2006
  9. ncbi Direct medical cost of influenza-related hospitalizations in children
    Ron Keren
    Children s Hospital of Philadelphia, 3535 Market St, Room 1524, Philadelphia, PA 19104, USA
    Pediatrics 118:e1321-7. 2006
  10. ncbi Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis
    Rebecca Ruebner
    Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
    Pediatrics 117:1210-5. 2006

Scientific Experts

Detail Information

Publications13

  1. pmc Identifying newborns at risk of significant hyperbilirubinaemia: a comparison of two recommended approaches
    R Keren
    Division of General Pediatrics, Pediatric Generalist Research Group, The Children s Hospital of Philadelphia, PA, USA
    Arch Dis Child 90:415-21. 2005
    ....
  2. ncbi Factors associated with variability in outcomes for children hospitalized with urinary tract infection
    Patrick 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...
  3. ncbi Visual assessment of jaundice in term and late preterm infants
    R 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...
  4. pmc Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children
    Theoklis 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...
  5. ncbi A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants
    Ron 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...
  6. ncbi Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations
    Lisa 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
    ....
  7. ncbi Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials
    Patrick 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...
  8. pmc ICD-9 codes for identifying influenza hospitalizations in children
    Ron Keren
    Emerg Infect Dis 12:1603-4. 2006
  9. ncbi Direct medical cost of influenza-related hospitalizations in children
    Ron 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...
  10. ncbi Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis
    Rebecca 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)...
  11. ncbi Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection
    Ron 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...
  12. ncbi Evaluation of a novel method for grading heart murmur intensity
    Ron 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...
  13. ncbi Use of antibiotics in children hospitalized with community-acquired, laboratory-confirmed influenza
    Jennifer 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...