The overall goal of this research career development award is to promote the development of Dr. Ron Keren as an independent patient-oriented clinical researcher. To achieve this goal, Dr. Keren has framed a comprehensive program that combines a preceptorship with J. Sanford Schwartz, M.D., formal didactic training in health services research and clinical epidemiology, and performance of original research. This combination of didactic and practical research experiences will allow Dr. Keren to expand and strengthen the set of skills he acquired in his fellowship training. Dr. Keren hopes to use this award to establish himself as an academic leader in pediatric outcomes and health services research, with an expertise in predictive modeling and economic evaluation. Dr. Keren's interest is in technology assessment and public health policy as they relate to newborn screening and disease prevention in general, and to the prediction and prevention of severe neonatal hyperbilirubinemia and kernicterus in particular.
The specific aims of the research application are three-fold. First, he will develop a simple and practical clinical prediction rule that pediatricians and neonatologists can use to predict term and near-term newborns' risk of developing severe neonatal hyperbilirubinemia after discharge from the hospital. Second, the clinical prediction rule will be validated in an independent sample of ethnically and geographically diverse newborns, thus demonstrating its generalizability. And finally, a cost-effectiveness model will be developed to simulate the economic costs and clinical harms and benefits of using alternative prediction models in the prevention of extreme hyperbilirubinemia and kernicterus. Future research projects and grant submissions will be aimed at evaluating the effectiveness and cost-effectiveness of these prediction models when coupled with risk-specific preventive services in actual nursery settings. Current preventive services consist of closer out-patient follow-up for infants designated as high risk for the development of severe neonatal hyperbilirubinemia after discharge. However, the imminent availability of drugs, such as tin-mesoporphyrin, that can prevent hyperbilirubinemia in high-risk infants makes the application to develop valid prediction rules to risk stratify infants particularly timely, relevant, and important.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23HD043179-02
Application #
6757207
Study Section
Pediatrics Subcommittee (CHHD)
Program Officer
Vitkovic, Ljubisa
Project Start
2003-06-06
Project End
2008-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
2
Fiscal Year
2004
Total Cost
$158,479
Indirect Cost
Name
Children's Hospital of Philadelphia
Department
Type
DUNS #
073757627
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Wilkes, Jennifer J; Leckerman, Kateri H; Coffin, Susan E et al. (2009) Use of antibiotics in children hospitalized with community-acquired, laboratory-confirmed influenza. J Pediatr 154:447-9
Keren, R; Tremont, K; Luan, X et al. (2009) Visual assessment of jaundice in term and late preterm infants. Arch Dis Child Fetal Neonatal Ed 94:F317-22
Conway, Patrick H; Keren, Ron (2009) Factors associated with variability in outcomes for children hospitalized with urinary tract infection. J Pediatr 154:789-96
Zaoutis, Theoklis; Localio, A Russell; Leckerman, Kateri et al. (2009) Prolonged intravenous therapy versus early transition to oral antimicrobial therapy for acute osteomyelitis in children. Pediatrics 123:636-42
Keren, Ron; Luan, Xianqun; Friedman, Susan et al. (2008) A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics 121:e170-9
Conway, Patrick H; Cnaan, Avital; Zaoutis, Theoklis et al. (2007) Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA 298:179-86
Prosser, Lisa A; Hammitt, James K; Keren, Ron (2007) Measuring health preferences for use in cost-utility and cost-benefit analyses of interventions in children: theoretical and methodological considerations. Pharmacoeconomics 25:713-26
Ruebner, Rebecca; Keren, Ron; Coffin, Susan et al. (2006) Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. Pediatrics 117:1210-5
Keren, Ron; Wheeler, Anna; Coffin, Susan E et al. (2006) ICD-9 codes for identifying influenza hospitalizations in children. Emerg Infect Dis 12:1603-4
Keren, Ron; Zaoutis, Theoklis E; Saddlemire, Stephanie et al. (2006) Direct medical cost of influenza-related hospitalizations in children. Pediatrics 118:e1321-7

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