November 8, 2019
In This Issue

Research Spotlight: Assessment and management of infection in newborns

CPCE In the News:
Immigrants Fearing Deportation May Delay or Avoid Seeking Medical Care 

CPCE In the News:
Vaping is blamed for mounting deaths, lung injuries. Here's what it's doing to kids' brains.

Upcoming Events

Recent Publications
Assessment and management of infection in newborns
CPCE is honoring Prematurity Awareness Month with a roundup of our recent work on caring for premature infants. 

This month, the American Academy of Pediatrics Committee on Fetus and Newborn, of which Karen Puopolo, MD, PhD is a member, published Updates on an At-Risk Population: Late-Preterm and Early-Term Infants. The report provides a review of current terminology as well as the short- and long-term medical, neurodevelopmental, behavioral, and social challenges associated with late preterm and early term birth. The authors make several recommendations for reducing at-risk births and caring for these patients.

Dr. Puopolo’s body of work has included the epidemiology and risk assessment of neonatal infection, with important contributions to the management of neonatal early onset sepsis (EOS). Earlier this year, the AAP and the American College of Obstetricians and Gynecologists put out collaborative guidance for prevention of group B streptococcal (GBS) infection, the leading cause of neonatal EOS, including separate considerations for infants born at less than 35 weeks' gestation or at 35 or more weeks' gestation.

Newborns, especially those who are born preterm, are often administered empiric antibiotics at birth, in order to prevent infection. While antibiotics can be lifesaving, their use is associated with short- and long-term adverse effects ranging from necrotizing enterocolitis to asthma, plus public health concerns about antimicrobial resistance. Prior work by Dr. Puopolo with Sagori Mukhopadhyay, MD, MMSc and others identified delivery and microbiologic characteristics associated with low risk of neonatal infection, which provide parameters for antibiotic stewardship in NICUs.

In another study, Dustin Flannery, DO, MSCE with Drs. Puopolo and Mukhopadhyay and Jeffrey Gerber, MD, PhD, MSCE looked at rates of empirical antibiotic use among premature infants over time, from 2009 to 2015, and found continued high rates of early antibiotic use over time. They also looked across 297 academic and community hospitals from 2014 to 2015 and found wide variation across centers. These findings further support the need for antibiotic stewardship in NICUs to prevent exposure of low-risk infants to non-indicated antibiotics.  

Read more about this research here, and look for the next CPCE E-News issue in two weeks, when we will cover racial and socioeconomic disparities in premature births.
Immigrants Fearing Deportation May Delay or Avoid Seeking Medical Care

Researchers in California recently published a study in PLOS One in which they surveyed undocumented adult emergency department (ED) patients about their reactions to comments from the Trump campaign and presidency against immigrants. Some undocumented Latino immigrants reported that these comments made them afraid to come to the ED. Coverage of this study in Scientific American pointed out that while this effect may be exacerbated under the current administration, undocumented immigrants' fear of seeking treatment isn't new. CPCE and PolicyLab Core Faculty member Katherine Yun, MD, MHS commented about a 1996 welfare reform that barred newly arrived immigrants from Medicaid coverage for their first five years in the country, leading families to believe their immigration status would be compromised if they sought public benefits. “It took a lot of clarification and public outreach,” Dr. Yun said. “It can take time for people to feel safe again.”

Vaping is blamed for mounting deaths, lung injuries. Here's what it's doing to kids' brains.

With media attention primarily focused on the pulmonary effects of vaping, effects of nicotine on the brain are a growing concern. “We have this burgeoning evidence base that nicotine exposure, especially early on, might increase your brain’s risk of getting addicted to not only nicotine but other substances like marijuana, alcohol, and cocaine,” CPCE and PolicyLab Core Faculty member Brian Jenssen, MD, MSHP told the Philadelphia Inquirer. Moreover, while low-doses of nicotine may aid concentration, with high doses the opposite may be true. E-cigarettes deliver a high dose of nicotine; one pod can contain as much nicotine as a pack of cigarettes.

Upcoming Events

American College of Rheumatology Annual Meeting
Dates: November 8-13, 2019
Location: Georgia World Congress Center, Atlanta, GA
The ACR annual meeting kicks off today in Atlanta and several of CPCE's rheumatology researchers will be presenting. Follow us on Twitter for live updates.

Diagnostic Error in Medicine 12th Annual International Conference
Dates: November 10-13, 2019
Location: Hyatt Regency Washington on Capitol Hill
The annual conference of the Society to Improve Diagnosis in Medicine (SIDM) is for patients, physicians, nurses, quality and safety professionals, healthcare executives, risk managers, laboratory scientists, policymakers, medical students, residents, fellows, researchers, and leaders from around the world who are passionate about improving diagnosis and shaping a safer healthcare system for everyone. CPCE Core Faculty member and current SIDM Fellow Irit Rasooly, MD, MSCE will present an oral abstract on Developing a Tool for Evaluation of Diagnostic Decision Making in Simulation on Tuesday afternoon, November 12, in the 2:20 - 3:20 pm session.

PolicyLab Morning Speaker Series featuring Gregory Tasian, MD, MSc, MSCE
Date: November 14, 2019
Time: 9:00 - 10:00 AM
Location: Roberts Center for Pediatric Research, 1st floor, 1-120A
PolicyLab's Morning Speaker Series every Thursday at 9am allows the CHOP community to learn from colleagues and partners in related fields of work. To learn more, contact Lindsay Capozzi.

American Heart Association Scientific Sessions
Dates: November 16-18, 2019
Location: Pennsylvania Convention Center, 1101 Arch St. Philadelphia
The scope and quality of the scientific programming make Scientific Sessions the premier cardiovascular research and instructional meeting in the world. General information is available here, or view our summary of CPCE speakers.
Recent Publications

Although there has been much progress with antibiotic stewardship over the past decade, gaps in optimizing the reach and effectiveness of antibiotic stewardship remain. Julia Szymczak, PhD and colleagues sought to delineate and prioritize these research gaps from a US human health perspective. They highlight four categories: (1) a scientifically rigorous evidence base to define optimal antibiotic prescribing practices, which adequately inform AS interventions across a variety of patient populations and settings; (2) effective AS approaches to recognize effective interventions, knowledge of how these interventions can be adapted for implementation both locally and across diverse settings, and an understanding of how interventions can be sustained once implemented; (3) standardized process and outcome metrics; and (4) advanced study designs with appropriate analytic methods, accompanied by infrastructure to support data collection and sharing.

The risks and benefits of pharmacologic treatment and operative closure of patent ductus arteriosus (O-PDA) in premature infants remain controversial. Recent series have demonstrated the feasibility of transcatheter PDA closure (TC-PDA) in increasingly small infants. A multidisciplinary team including Michael O’Byrne MD, MSCE, Nicolas Bamat, MD, MSCE, and Andrew Glatz, MD, MSCE sought to evaluate the effect of this change on practice, using data from the Pediatric Health Information Systems Database from January 2007 to December 2017. They found that while the proportion of all neonatal intensive care unit patients undergoing either O-PDA or TC-PDA decreased over the study period, the proportion in which TC-PDA was used increased significantly, with significant variability across practices. Their findings demonstrate equipoise for potential clinical trials.

A team including Pamela Weiss, MD, MSCE aimed to estimate the incidence rate of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor-alpha inhibitor (TNFi) exposure as compared to those without TNFi exposure and to the general pediatric population. They performed a single-center retrospective cohort study from 2008 to 2018. Their analysis showed that children with ID, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.

About CPCE

We are a pediatric research center dedicated to discovering and sharing knowledge about best practices in pediatric care by facilitating, organizing and centralizing the performance of clinical effectiveness research -- research aimed at understanding the best ways to prevent, diagnose and treat diseases in children. CPCE’s multidisciplinary team conducts research on a diverse range of clinical effectiveness topics.

CPCE E-News is edited by Holly Burnside. Please feel free to contact us with questions or feedback.