Intrafacility Neonatal Intensive Care Unit to Pediatric Intensive Care Unit Transfer in the United States: A Pediatric Health Information Systems Registry Study.

Objective: To describe and trend the frequency of intrafacility neonatal intensive care unit (NICU) to pediatric intensive care unit (PICU) transfers among the US children's hospitals and evaluate potential relationships between patient characteristics, transfer timing, and post-transfer outcomes.

Study Design: We conducted a multicenter retrospective cohort study from 2016 to 2022 of children undergoing intrafacility NICU to PICU transfers using diagnosis and procedure codes from the Pediatric Health Information Systems database. Primary study outcomes were as follows: (1) intrafacility transfer rate, (2) patient age at transfer, and (3) post-transfer length of stay (LOS).

Epidemiology of bacterial and fungal infections among level IV neonatal units in North America.

Background: Neonatal infections cause significant morbidity and mortality. A comprehensive analysis of bloodstream infections (BSI), urinary tract infections (UTI) and meningitis across level IV neonatal intensive care units (NICUs) is lacking.

Methods: This retrospective cohort study utilized data from the Children's Hospitals Neonatal Database (CHND) between January 2011 to December 2022.

Management of asthma exacerbations in pediatric emergency departments across the United States.

Objectives: There are 750,000 emergency department (ED) visits by children for asthma exacerbations in the United States annually. Despite changing evidence and epidemiology, there have not been recent assessments of acute asthma prevalence, management, and outcomes from pediatric EDs. This 40-center retrospective evaluation utilizes the Pediatric Hospital Information System to characterize pediatric ED asthma presentations from 2015-2020.

Use and institutional variation in surgical antibiotic prophylaxis for pediatric clean (class I) penile and groin procedures.

Background: The majority of ambulatory pediatric penile, inguinal and scrotal cases are considered clean (class I) surgical wounds and guidelines do not recommend surgical antibiotic prophylaxis (SAP) use. Despite these recommendations, few data exist that have assessed utilization and outcomes of interest associated with SAP use for ambulatory pediatric urology procedures.

Objective: To better understand national and individual hospital utilization of SAP for common, ambulatory pediatric urologic procedures at lowest risk for surgical site infection (SSI) and for which the benefits of SAP are limited.

Mobile Bearing Total Knee Arthroplasty Is Associated With an Increased Risk of Mechanical Loosening: A Follow-Up Analysis of the American Joint Replacement Registry.

Background: Mobile-bearing (MB) total knee arthroplasty (TKA) designs have proposed biomechanical benefits, including improved patellar tracking and reduction in polyethylene wear. Yet, prior work using the American Joint Replacement Registry (AJRR) has demonstrated an increased risk of all-cause revision with MB-TKA. We therefore utilized the AJRR to further characterize reasons for the increased risk of revision with MB-TKA compared to fixed-bearing (FB) TKA designs.

Management and Outcomes of Neonates with Treacher Collins and Nager Syndromes.

Objective: To compare management and outcomes of infants with mandibulofacial dysostosis syndromes (Treacher Collins and Nager syndromes) admitted to neonatal intensive care units (NICUs) to infants with other causes of micrognathia.

Study Design: The Children's Hospitals Neonatal Database from 2010 to 2023 was queried for infants with diagnoses of Treacher Collins syndrome (TCS), Nager syndrome (NS), and other infants in NICUs with micrognathia (n = 4210).

Results: We identified 103 infants with TCS and 11 with NS to compare with the micrognathia cohort (n = 4210).

Demographic and clinical predictors and inter-center variability of tube feeding in preterm NICU patients.

Objectives: Investigate demographic and clinical factors and inter-center variability associated with home NGT versus GT in preterm infants.

Study Design: Retrospective cohort study of preterm infants in the Children's Hospitals Neonatal Database discharged home with a NGT or GT between 2015-2020. Multivariable logistic regression assessed the independent relationship between infant characteristics and feeding modality.

Decreased Revision Risk With Cementless Collared Metadiaphyseal-Filling Stems Compared to Cemented Fixation in Patients 65 Years and Older.

Background: Compared to other cementless designs, collared metadiaphyseal-filling femoral stems are associated with a lower risk of revision and periprosthetic femoral fracture after total hip arthroplasty (THA) in patients ≥ 65 years. However, it is unclear how these designs compare to cemented femoral stems. We utilized the American Joint Replacement Registry to examine the risk of revision comparing cementless collared metadiaphyseal-filling versus cemented femoral stem designs.

Solution to Improve State Health Outcomes and Access to Care for Medicare Beneficiaries: Full Practice of APRNs.

Objective: To identify the influence of advanced practice registered nurse (APRN) restrictive practice laws on the number of APRNs providing services in various care settings, acute, primary, nursing home (long stay), and skilled nursing facility (short stay); understand the relationship between restrictive practice and number of Medicare beneficiary services across settings; and to understand the relationship between restrictive practice and overall quality of health care as indicated by Commonwealth Report state health rankings.

Design: One large federal data set and 2 national annual reports with state rankings from 2022 were used in this comparative, descriptive study.

Settings And Participants: We summarized number of services × APRN × 1000 patients by state practice restriction (full, reduced, or restricted) and setting of care.

Risk of Early Manipulation in Cemented Versus Cementless Total Knee Arthroplasty: An Analysis of the American Joint Replacement Registry.

Background: Cementless total knee arthroplasty (TKA) has recently regained popularity, yet data has raised concerns about rates of arthrofibrosis following these procedures. The purpose of this study was to utilize the American Joint Replacement Registry to compare rates of early manipulation under anesthesia (MUA) in cementless and cemented primary TKAs that use technology or manual instrumentation.

Methods: We queried the American Joint Replacement Registry for all patients ages 18 to 95 years who underwent cemented or cementless primary TKA over a 7-year period.

Management of the patent ductus arteriosus among infants born at 23 to 32 weeks' gestation between 2011 to 2022: a report from in the Children's Hospitals Neonatal Consortium.

Objective: This study reports on patent ductus arteriosus (PDA) therapy trends across the Children's Hospital Neonatal Consortium.

Study Design: We performed a 12-year (2011-2022) retrospective study of premature infants (< 33 weeks) with a PDA. We utilized descriptive statistics to compare demographic, inpatient, and discharge characteristics in 3-year epochs.

Body Mass Index Is Not Associated With Risk for Mechanical Loosening Following Primary Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry.

Background: Conflicting evidence leaves surgeons without clarity on the association of elevated body mass index (BMI) with the risk of mechanical loosening after total knee arthroplasty (TKA). This investigation examined the associated risk of mechanical loosening following TKA based on BMI.

Methods: We analyzed American Joint Replacement Registry data in patients aged 65 years or more from January 2012 to March 2022 who had a minimum of 2-year follow-up linked to supplemental Centers for Medicare and Medicaid data.

Congenital diaphragmatic hernia outcomes: navigating center-to-center variability in level 4 NICUs in the Children's Hospitals Neonatal Consortium.

Background: This study examined inter-center variation (ICV) in inpatient outcomes for infants with congenital diaphragmatic hernia (CDH), aiming to contribute to quality metrics and clinical benchmarks in neonatal care.

Methods: We retrospectively analyzed CDH cases from the Children's Hospitals Neonatal Consortium (CHNC) database (2010-2022), focusing on infants without prior surgical repair or discharge. Our outcomes of interest included inpatient survival, survival without ECMO, and hospital length of stay (LOS).

Inter-center variations in inpatient outcomes for infants with gastroschisis from the Children's Hospitals Neonatal Consortium.

Objective: To estimate inter-center variation (ICV) in hospital length of stay (LOS) and oral feeding at discharge among infants with gastroschisis.

Study Design: The Children's Hospitals Neonatal Consortium's (CHNC) database was used to identify hospitalized survivors with gastroschisis. Two outcomes were evaluated: LOS and discharge without tube feedings.

Leaving the Patella Unresurfaced Does Not Increase the Risk of Short-Term Revision Following Total Knee Arthroplasty: An Analysis from the American Joint Replacement Registry.

The benefit of patellar resurfacing in total knee arthroplasty (TKA) remains uncertain, with conflicting evidence regarding associated revision rates and clinical outcomes. Although initial studies have reported higher revision rates associated with unresurfaced patellae, recent evidence questions the necessity of routine patellar resurfacing. This study aimed to evaluate the risk of revision following TKA performed with and without patellar resurfacing using data from the American Joint Replacement Registry (AJRR).

Liberation from Respiratory Support in Bronchopulmonary Dysplasia.

Objective: To estimate the association between the mode of respiratory support administered at 36 weeks' post-menstrual age (PMA) with time-to-liberation from respiratory support (LRS) in infants with grade 2/3 bronchopulmonary dysplasia (BPD).

Study Design: Daily respiratory support data were abstracted for infants born <32 weeks' gestation with grade 2/3 BPD enrolled in the Children's Hospital's Neonatal Database between 2017 and 2022. The main exposure was the mode of respiratory support received at 36 weeks' PMA: high-flow nasal cannula >2 L/min (HFNC), continuous positive airway pressure (CPAP), non-invasive positive pressure ventilation (NIPPV), or mechanical ventilation (MV).

Substance Use Emergency Department Visits Among Youths With Chronic Conditions During COVID-19.

Importance: Pediatric emergency department (ED) visits for substance use (SU) increased during COVID-19. Better understanding of trends associated with SU ED visits among youths with a chronic medical condition (CMC) is needed to target SU screening, prevention, and intervention efforts in this population.

Objective: To describe trends in pediatric SU ED visits before and during COVID-19 among youths in the US with and without CMCs and by race and ethnicity.

Parental Health Literacy and Acute Care Utilization in Children With Medical Complexity.

Objective: Health literacy is the ability to find, understand, and use information and services to inform health-related decisions and actions. Inadequate health literacy is associated with health disparities, poor health outcomes, and increased emergency department (ED) visits and hospitalizations. Children with medical complexity (CMC) have high rates of acute health care utilization.