Browsing by Author "Moore, Paul E."

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    Characteristics of Infants/Children Presenting to Outpatient Bronchopulmonary Dysplasia Clinics in the United States
    (Wiley, 2021) Collaco, Joseph M.; Agarwal, Amit; Austin, Eric D.; Hayden, Lystra P.; Lai, Khanh; Levin, Jonathan; Manimtim, Winston M.; Moore, Paul E.; Sheils, Catherine A.; Tracy, Michael C.; Alexiou, Stamatia; Baker, Christopher D.; Cristea, A. Ioana; Fierro, Julie L.; Rhein, Lawrence M.; Villafranco, Natalie; Nelin, Leif D.; McGrath-Morrow, Sharon A.; Pediatrics, School of Medicine
    Introduction: Bronchopulmonary dysplasia (BPD) is a common respiratory sequelae of preterm birth, for which longitudinal outpatient data are limited. Our objective was to describe a geographically diverse outpatient cohort of former preterm infants followed in BPD-disease specific clinics. Methods: Seven BPD specialty clinics contributed data using standardized instruments to this retrospective cohort study. Inclusion criteria included preterm birth (<37 weeks) and respiratory symptoms or needs requiring outpatient follow-up. Results: A total of 413 preterm infants and children were recruited (mean age: 2.4 ± 2.7 years) with a mean gestational age of 27.0 ± 2.8 weeks and a mean birthweight of 951 ± 429 grams of whom 63.7% had severe BPD. Total, 51.1% of subjects were nonwhite. Severe BPD was not associated with greater utilization of acute care/therapies compared to non-severe counterparts. Of children with severe BPD, differences in percentage of those on any home respiratory support (p = .001), home positive pressure ventilation (p = .003), diuretics (p < .001), inhaled corticosteroids (p < .001), and pulmonary vasodilators (p < .001) were found between centers, however no differences in acute care use were observed. Discussion: This examination of a multicenter collaborative registry of children born prematurely with respiratory disease demonstrates a diversity of management strategies among geographically distinct tertiary care BPD centers in the United States. This study reveals that the majority of children followed in these clinics were nonwhite and that neither variation in management nor severity of BPD at 36 weeks influenced outpatient acute care utilization. These findings suggest that post-neonatal intensive care unit factors and follow-up may modify respiratory outcomes in BPD, possibly independently of severity.
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    Daycare Attendance is linked to Increased Risk of Respiratory Morbidities in Preterm Children with Bronchopulmonary Dysplasia
    (Elsevier, 2022) McGrath-Morrow, Sharon A.; Agarwal, Amit; Alexiou, Stamatia; Austin, Eric D.; Fierro, Julie L.; Hayden, Lystra P.; Lai, Khanh; Levin, Jonathan C.; Manimtim, Winston M.; Moore, Paul E.; Rhein, Lawrence M.; Rice, Jessica L.; Sheils, Catherine A.; Tracy, Michael C.; Bansal, Manvi; Baker, Christopher D.; Cristea, A. Ioana; Popova, Antonia P.; Siddaiah, Roopa; Villafranco, Natalie; Nelin, Leif D.; Collaco, Joseph M.; Pediatrics, School of Medicine
    Objectives: To test the hypothesis that daycare attendance among children with bronchopulmonary dysplasia (BPD) is associated with increased chronic respiratory symptoms and/or greater health care use for respiratory illnesses during the first 3 years of life. Study design: Daycare attendance and clinical outcomes were obtained via standardized instruments for 341 subjects recruited from 9 BPD specialty clinics in the US. All subjects were former infants born preterm (<34 weeks) with BPD (71% severe) requiring outpatient follow-up between 0 and 3 years of age. Mixed logistic regression models were used to test for associations. Results: Children with BPD attending daycare were more likely to have emergency department visits and systemic steroid usage. Children in daycare up to 3 years of age also were more likely to report trouble breathing, having activity limitations, and using rescue medications when compared with children not in daycare. More severe manifestations were found in children attending daycare between 6 and 12 months of chronological age. Conclusions: In this study, children born preterm with BPD who attend daycare were more likely to visit the emergency department, use systemic steroids, and have chronic respiratory symptoms compared with children not in daycare, indicating that daycare may be a potential modifiable risk factor to minimize respiratory morbidities in children with BPD during the preschool years.
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    Implementation of a Professional Society Core Curriculum and Integrated Maintenance of Certification Program
    (ATS, 2017) Carlos, W. Graham; Poston, Jason T.; Michaud, Gaetane C.; Dela Cruz, Charles S.; Luks, Andrew M.; Boyer, Debra; Moore, Paul E.; McSparron, Jakob I.; Hayes, Margaret M.; Balachandran, Jay S.; Wang, Tisha S.; Larsson, Eileen; Siegel-Gasiewski, Jennifer; Kantz, Alan; Beck, James M.; Thomson, Carey C.; Department of Medicine, IU School of Medicine
    Medical professional societies exist to foster collaboration, guide career development, and provide continuing medical education opportunities. Maintenance of certification is a process by which physicians complete formal educational activities approved by certifying organizations. The American Thoracic Society (ATS) established an innovative maintenance of certification program in 2012 as a means to formalize and expand continuing medical education offerings. This program is unique as it includes explicit opportunities for collaboration and career development in addition to providing continuing medical education and maintenance of certification credit to society members. In describing the development of this program referred to as the “Core Curriculum,” the authors highlight the ATS process for content design, stages of curriculum development, and outcomes data with an eye toward assisting other societies that seek to program similar content. The curriculum development process described is generalizable and positively influences individual practitioners and professional societies in general, and as a result, provides a useful model for other professional societies to follow.
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    Insurance coverage and respiratory morbidities in bronchopulmonary dysplasia
    (Wiley, 2022) Collaco, Joseph M.; Tracy, Michael C.; Sheils, Catherine A.; Rice, Jessica L.; Rhein, Lawrence M.; Nelin, Leif D.; Moore, Paul E.; Manimtim, Winston M.; Levin, Jonathan C.; Lai, Khanh; Hayden, Lystra P.; Fierro, Julie L.; Austin, Eric D.; Alexiou, Stamatia; Agarwal, Amit; Villafranco, Natalie; Siddaiah, Roopa; Popova, Antonia P.; Cristea, Ioana A.; Baker, Christopher D.; Bansal, Manvi; McGrath‐Morrow, Sharon A.; Pediatrics, School of Medicine
    Introduction: Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge. Methods: Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart review. Surveys for clinical outcomes were administered to caregivers. Results: Of the 470 subjects included in this study, 249 (53.0%) received employer-based insurance coverage and 221 (47.0%) received Medicaid as sole coverage at least once between 0 and 3 years of age. The Medicaid group was twice as likely to have sick visits (adjusted odd ratio [OR]: 2.06; p = 0.009) and emergency department visits (aOR: 2.09; p = 0.028), and three times more likely to be admitted for respiratory reasons (aOR: 3.04; p = 0.001) than those in the employer-based group. Additionally, those in the Medicaid group were more likely to have nighttime respiratory symptoms (aOR: 2.62; p = 0.004). Conclusions: Children with BPD who received Medicaid coverage were more likely to utilize acute care and have nighttime respiratory symptoms during the first 3 years of life. More comprehensive studies are needed to determine whether the use of Medicaid represents a barrier to accessing care, lower socioeconomic status, and/or a proxy for detrimental environmental exposures.
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    Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement
    (AAP, 2018-03) Boesch, R. Paul; Balakrishnan, Karthik; Acra, Sari; Benscoter, Dan T.; Cofer, Shelagh A.; Collaco, Joseph M.; Dahl, John P.; Daines, Cori L.; DeAlarcon, Alessandro; DeBoer, Emily M.; Deterding, Robin R.; Friedlander, Joel A.; Gold, Benjamin D.; Grothe, Rayna M.; Hart, Catherine K.; Kazachkov, Mikhail; Lefton-Greif, Maureen A.; Miller, Claire Kane; Moore, Paul E.; Pentiuk, Scott; Peterson-Carmichael, Stacey; Piccione, Joseph; Prager, Jeremy D.; Putnam, Philip E.; Rosen, Rachel; Rutter, Michael J.; Ryan, Matthew J.; Skinner, Margaret L.; Torres-Silva, Cherie; Wootten, Christopher T.; Zur, Karen B.; Cotton, Robin T.; Wood, Robert E.; Pediatrics, School of Medicine
    Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions. After 3 iterations of survey, consensus was obtained by either a supermajority of 75% or stability in median ranking on 33 of 36 items. This included a standard definition of an aerodigestive patient, level of participation of specific pediatric disciplines in a program, essential components of the care cycle and functions of the program, feeding and swallowing assessment and therapy, procedural scope and volume, research priorities and outcome measures, certification, coding, and funding. We propose the first consensus definition of the aerodigestive care model with specific recommendations regarding associated personnel, infrastructure, research, and outcome measures. We hope that this may provide an initial framework to further standardize care, develop clinical guidelines, and improve outcomes for aerodigestive patients.
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    Tidal Breathing Measurements at Discharge and Clinical Outcomes in Extremely Low Gestational Age Neonates
    (ATA, 2018-03) Ren, Clement L.; Feng, Rui; Davis, Stephanie D.; Eichenwald, Eric; Jobe, Alan; Moore, Paul E.; Panitch, Howard B.; Sharp, Jack K.; Kisling, Jeff; Clem, Charles; Kemp, James S.; Pediatrics, School of Medicine
    Rationale: The relationship between respiratory function at hospital discharge and the severity of later respiratory disease in extremely low gestational age neonates is not well defined. Objectives: To test the hypothesis that tidal breathing measurements near the time of hospital discharge differ between extremely premature infants with BPD or respiratory disease in the first year of life compared to those without these conditions. Methods: Study subjects were part of the Prematurity and Respiratory Outcomes Program (PROP) study, a longitudinal cohort study of infants born <29 gestational weeks followed from birth to 1 year of age. Respiratory inductance plethysmography was used for tidal breathing measurements before and after inhaled albuterol 1 week prior to anticipated hospital discharge. Infants were breathing spontaneously and were receiving ≤1 liter per minute (lpm) nasal cannula flow at 21-100% FiO2. A survey of respiratory morbidity was administered to caregivers at 3, 6, 9, and 12 months corrected age to assess for respiratory disease. We compared tidal breathing measurements in infants with and without bronchopulmonary dysplasia (BPD, oxygen requirement at 36 wk) and with and without respiratory disease in the first year of life. Measurements were also performed in a comparison cohort of term infants. Results: 765 infants survived to 36 weeks post-menstrual age, with research-quality tidal breathing data in 452 out of 564 tested (80.1%). Among these 452 infants, the rate of post-discharge respiratory disease was 65.7%. Compared to a group of 18 term infants, PROP infants had abnormal tidal breathing patterns. However, there were no significant differences in tidal breathing measurements in PROP infants who had BPD or who had respiratory disease in the first year of life compared to those without these diagnoses. Bronchodilator response was not significantly associated with respiratory disease in the first year of life. Conclusions: Extremely premature infants receiving <1 lpm nasal cannula support at 21-100% FiO2 have tidal breathing measurements that differ from term infants, but these measurements do not differentiate those preterm infants who have BPD or will have respiratory disease in the first year of life from those who do not.