Development of Vaccine Preferences in Parents of Newborns

Introduction: The resurgence in cases of vaccine-preventable childhood diseases in the U.S. may be associated with increasing rates of vaccine hesitancy. Although previous research has sought to identify attributes of non-vaccinating parents, the timing in which parents make such vaccination decisions has yet to be explored. Our goal is to identify when first-time parents develop their vaccination preferences: before, after, or during pregnancy. Methods: A cross sectional survey was conducted using a convenience sample of 73 first time parents at Thomas Jefferson University Hospital. Survey questions addressed timing of vaccination decisions and projected compliance with vaccine schedules. Eligibility for the study included delivery within 72 hours, newborn gestational age of at least 37 weeks, maternal age of at least 18 years, and primary language of English or Spanish. Statistical analysis included chi-squared test and descriptive statistics to compare vaccine hesitancy and timing of vaccination decisions. Results: The pre-conception period was when most first time parents formed their vaccine preferences (n=45, 61%). The decision to give all vaccines was the highest, 84%, if their decision was made pre-conception. This proportion fell to 60% among those who made their decision during or after pregnancy (chi-square p-value 0.02). Discussion: This study confirms that most first time parents develop their vaccination preferences before pregnancy. Pre-conception decisions were associated with decreased vaccine hesitancy, which indicates that distributing vaccine information to new families before they conceive may assist with achieving higher vaccination rates

Stronger instruments via integer programming in an observational study of late preterm birth outcomes

In an optimal nonbipartite match, a single population is divided into matched pairs to minimize a total distance within matched pairs. Nonbipartite matching has been used to strengthen instrumental variables in observational studies of treatment effects, essentially by forming pairs that are similar in terms of covariates but very different in the strength of encouragement to accept the treatment. Optimal nonbipartite matching is typically done using network optimization techniques that can be quick, running in polynomial time, but these techniques limit the tools available for matching. Instead, we use integer programming techniques, thereby obtaining a wealth of new tools not previously available for nonbipartite matching, including fine and near-fine balance for several nominal variables, forced near balance on means and optimal subsetting. We illustrate the methods in our on-going study of outcomes of late-preterm births in California, that is, births of 34 to 36 weeks of gestation. Would lengthening the time in the hospital for such births reduce the frequency of rapid readmissions? A straightforward comparison of babies who stay for a shorter or longer time would be severely biased, because the principal reason for a long stay is some serious health problem. We need an instrument, something inconsequential and haphazard that encourages a shorter or a longer stay in the hospital. It turns out that babies born at certain times of day tend to stay overnight once with a shorter length of stay, whereas babies born at other times of day tend to stay overnight twice with a longer length of stay, and there is nothing particularly special about a baby who is born at 11:00 pm.Comment: Published in at http://dx.doi.org/10.1214/12-AOAS582 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Pediatric Group Well Care within the Maternal Treatment Education & Research (MATER) Program

Introduction: This project aims to develop and implement group well care for mothers and infants receiving care for opioid use disorder (OUD). Groups would be composed of 5-7 mothers and infants of similar age with extension of sessions to allow group activities and parenting discussions. To evaluate acceptability and feasibility of this care model, we sought to examine attitudes and beliefs from these mothers, in particular the impacts of the COVID-19 pandemic. Methods: A qualitative interview study of women receiving treatment for OUD at Maternal Addiction Treatment Education and Research at Thomas Jefferson University from October – December 2020 was conducted. Participants were eligible if they had a child \u3c 2 years of age. Study procedures including recruitment, consent, and data collection were conducted by telephone. Participants were administered a 24-item survey to asses demographic and clinical information. This was followed by a semi-structured, open-ended interview to collect information on (1) priorities for pediatric care (2) attitudes toward a group care, and (3) potential barriers– including COVID-19. Percentages from survey items were calculated. Thematic analysis is planned to identify meaningful patterns in interview responses. Results: Among the 22 participants with completed data collection, 40.9% were “very likely” and 18.2% “likely” to bring their child to participate. Themes describing mother’s feelings towards group-care during the COVID-19 pandemic will be identified upon study completion. Conclusion: In a sample of mothers in treatment for OUD, interest in group well care was identified. Further thematic analysis will assess attitudes and beliefs towards the intervention related to COVID-19

Introduction to and Screening Visit Results of the Multicenter Pediatric Crohn's Disease Growth Study.

BackgroundStatural growth impairment is more common in males with Crohn's disease (CD). We assessed sex differences in height Z score differences and bone age (BA) Z scores and characterized age of menarche in a novel contemporary cohort of pediatric CD patients undergoing screening for enrollment in the multicenter longitudinal Growth Study.MethodsCrohn's disease patients (females with chronological age [CA] 5 years and older and younger than 14 years; males with CA 6 years and older and younger than 16 years) participated in a screening visit for the Growth Study. Height BA-Z scores are height Z scores calculated based on BA. Height CA-Z scores are height Z scores calculated based on CA. The height Z score difference equals height CA-Z score minus height BA-Z score.ResultsOne hundred seventy-one patients (60% male) qualified for this analysis. Mean CA was 12.2 years. Mean height CA-Z score was -0.4, and mean height BA-Z score was 0.4 in females. Mean height CA-Z score was -0.1, and mean height BA-Z score was 0.2 in males. The absolute value of the mean height Z score difference was significantly greater in females (0.8) than males (0.3; P = 0.005). The mean BA-Z score in females (-1.0) was significantly lower than in males (-0.2; P = 0.002). The median CA at menarche was 13.6 (95% CI, 12.6-14.6) years.ConclusionsOur screening visit data suggest that standardized height gain is lower in males with skeletal maturation and delayed puberty is common in females in CD. We are investigating these findings in the ongoing Growth Study

Identified gaps and opportunities in perinatal healthcare delivery for women in treatment for opioid use disorder.

Pregnancy and the delivery of an infant mark a unique time of engagement in healthcare for women in treatment for opioid use disorder (OUD). The American College of Obstetrics and Gynecology calls for a comprehensive approach to perinatal healthcare delivery for pregnant women with OUD in order to facilitate improved health outcomes and increase patient-provider collaboration. Yet, there is little knowledge regarding the perceptions of women with OUD regarding the current delivery of healthcare which could inform a personalized, tailored approach to perinatal healthcare delivery. Methods: Four focus groups consisting of 22 women with OUD were conducted, transcribed, and analysed using qualitative thematic analysis methodology. Results: Women reported an overall lack of preparation for the birth and neonatal healthcare experiences and identified opportunities for greater support by the healthcare team. Women emphasized the desire for evidence-based preparation from trusted sources about delivery, neonatal abstinence syndrome, breastfeeding, and how their medications affect their pregnancy and baby. Women reported receiving a varied amount of support from healthcare providers in their transition to motherhood, but women predominantly reported receiving emotional and informational support from their mothers and partners. Conclusions: The knowledge obtained in this study points to gaps in perinatal healthcare delivery for women with OUD. Improving the delivery of perinatal healthcare may contribute to increased engagement by women with OUD, and ultimately improve outcomes for a vulnerable population

The Child Healthcare at MATER Pediatric Study (CHAMPS): A 2-Arm Cluster Randomized Control Trial of Group Well Child Care For Mothers in Treatment for Opioid Use Disorder and Their Children

BACKGROUND: Studies suggest that group-based well child care-a shared medical appointment where families come together as a group to receive pediatric primary care-increases patient-reported satisfaction and adherence to recommended care. Evidence supporting the use of group well child care for mothers with opioid use disorder, however, is lacking. The overall objective of the Child Healthcare at MATER Pediatric Study (CHAMPS) trial is to evaluate a group model of well child care for mothers with opioid use disorder and their children. METHODS: CHAMPS is a single-site 2-arm cluster randomized controlled trial. A total of 108 mother-child dyads will be enrolled into the study. Twenty-six clusters of approximately 4 mother-infant dyads each will be randomized 1:1 to one of two study arms (intervention or control). Clustering will be based on child\u27s month of birth. In the intervention arm, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother-child dyads in the control arm will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study arms will be followed prospectively for 18 months, and data will be compared between the two study arms. Primary outcomes include well child care quality and utilization, child health knowledge, and parenting quality. DISCUSSION: The CHAMPS trial will provide evidence to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care for families impacted by maternal opioid use disorder. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05488379. Registered on Aug. 04, 2022

Hospital Readmission Among Late Preterm Infants: New Insights and Remaining Questions.

Late preterm infants (LPIs), those born at 34 to 36 6/7 weeks' gestation, account for the majority of preterm births (73%).1 Given their physiologic immaturity, LPIs are at increased risk of respiratory distress, hyperbilirubinemia, hypoglycemia, and other complications in the neonatal period, and are at increased risk of hospital readmission in the first month of life.2 As Amsalu and colleagues describe in this month's issue of Hospital Pediatrics,3 identification of a predictive model to differentiate LPI at higher risk of complications would help inform tailored discharge plans and prevent readmissions

The Child Healthcare at MATER Pediatric Study (CHAMPS): a 2-arm cluster randomized control trial of group well child care for mothers in treatment for opioid use disorder and their children

Abstract Background Studies suggest that group-based well child care—a shared medical appointment where families come together as a group to receive pediatric primary care—increases patient-reported satisfaction and adherence to recommended care. Evidence supporting the use of group well child care for mothers with opioid use disorder, however, is lacking. The overall objective of the Child Healthcare at MATER Pediatric Study (CHAMPS) trial is to evaluate a group model of well child care for mothers with opioid use disorder and their children. Methods CHAMPS is a single-site 2-arm cluster randomized controlled trial. A total of 108 mother–child dyads will be enrolled into the study. Twenty-six clusters of approximately 4 mother-infant dyads each will be randomized 1:1 to one of two study arms (intervention or control). Clustering will be based on child’s month of birth. In the intervention arm, group well child care will be provided on-site at a maternal substance use disorder treatment program. Mother–child dyads in the control arm will receive individual well child care from one nearby pediatric primary care clinic. Dyads in both study arms will be followed prospectively for 18 months, and data will be compared between the two study arms. Primary outcomes include well child care quality and utilization, child health knowledge, and parenting quality. Discussion The CHAMPS trial will provide evidence to determine if a group well child care offered on-site at an opioid treatment program for pregnant and parenting women is beneficial over individual well child care for families impacted by maternal opioid use disorder. Trial registration ClinicalTrials.gov identifier: NCT05488379. Registered on Aug. 04, 2022