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Determinants of Newborn Health and Health Care Trajectories in the First Year of Life

Funding Agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development
Funding Period: June 1, 2021 - May 31, 2025
PI: David Goodman, MD, MS

Background

Newborn health has improved in the United States in recent decades yet still lags behind that of other high-income countries.  A critically important yet understudied reason for this disappointing gap is the nature of the inpatient care received by newborns and the effects this has on health during the first year of life.  Using a population-based cohort of 1.13 million Medicaid-insured Texas newborns, our long-term goal is to understand the temporal sequences of risk, medical care, and outcomes through the first years of life to identify modifiable factors associated with better health.

Motivation and Aims

The overall objective of this application is to exploit hospital-level variation to investigate maternal, neonatal, and health service factors associated with health outcomes through age 365 days, particularly in lower-risk newborns. We will achieve this objective through the following specific aims:

  1. For the period from birth until 7 days post-discharge, evaluate the association of utilization, mortality and morbidity with birth hospital characteristics.
  2. For the period from 7 days post post-discharge through the first year of life, evaluate the association of one-year health outcomes as measured by utilization, diagnoses, and growth with hospital characteristics, neonatal care, and post-neonatal care.
  3. Evaluate the associations of the above inpatient and post-discharge outcomes with hospital level maternal race and ethnicity composition.

In preliminary studies, we have found marked TX regional and hospital variation in healthcare interventions including rates of NICU admission, length of stay, and services such as imaging. This project will extend this work through unique hypothesis-focused inferential analyses that identify opportunities for clinical improvement and policy development for five cohorts: (1) very preterm, (2) moderately preterm (3) late preterm, (4) early term, and (5) term.