The goal of this proposal is to provide a pathway to independence as a clinical investigator in healthcare utilization and health-related quality of life (HRQL) assessment, applied to outcomes research for infants with bronchopulmonary dysplasia (BPD). Infants with BPD are at high risk for prolonged NICU stays, readmissions, and developmental delay. Home oxygen is used commonly to facilitate earlier hospital discharge, but there is wide variation across U.S. hospitals in use of this therapy. My recent study showed that infants with BPD in centers using more frequent home oxygen had a 1.2-week shorter average NICU stay than infants in centers using less frequent home oxygen, adjusted for illness severity. There is a gap in knowledge of how home oxygen impacts infant outcomes after NICU discharge, and how it affects their families. I would like to develop a unique niche assessing healthcare utilization and HRQL after NICU discharge, to generate evidence-based NICU discharge guidelines that optimize infant health outcomes with minimal undue burden on families. I will begin to achieve these goals by engaging in a career development plan that logically extends my prior training in neonatology and epidemiology. I will build skills in prospective study leadership, health services outcomes measurement, and developmental and HRQL assessment. This career development plan will be guided by experienced mentors and a scientific advisory committee at the Medical College of Wisconsin with expertise in pediatric healthcare utilization, HRQL for children with chronic illness, BPD clinical outcomes research, advanced quantitative analysis, developmental assessment, and neonatal bioethics. This mentorship and career development plan are integrated with research investigating outcomes of infants with BPD after NICU discharge, focusing on differences following home oxygen use.
The first aim seeks to determine whether home oxygen use for infants with BPD is associated with increased readmissions in the year after NICU discharge, matched on illness severity and demographic risk factors. This will be assessed via a secondary analysis of data from the Children?s Hospitals Neonatal Database, a multi-center cohort of 25 Level IV children?s hospital NICUs with linked post-discharge readmission data available via the Pediatric Health Information System.
The second aim will prospectively compare infant and parent outcomes for infants with BPD discharged from the Children?s Hospital of Wisconsin NICU with and without home oxygen from NICU discharge through 2 years of age. The prospective study will measure infant healthcare utilization and parent HRQL over time after NICU discharge, and study the relationship between those factors and 2-year outcomes. Results will provide outcome comparisons for infants with BPD discharged with and without home oxygen therapy, and assess how a specific NICU therapy affects parent HRQL over time. This can be used in making evidence-based decisions about NICU discharge planning. Results and expertise acquired during this award will be used to test the impact of a multi-center intervention implementing consistent guidelines for home oxygen use.

Public Health Relevance

Although bronchopulmonary dysplasia (BPD) can lead to worse long-term health of preterm infants, there is a lack of understanding of how medical therapies such as home oxygen affect the health and development of infants with BPD after they leave the NICU, or how such therapies affect families. The proposed research will compare infants who went home on oxygen with those who did not, in terms of health, development, and quality of life. Infants with BPD and their families will be followed from NICU discharge through 2 years of age.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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NHLBI Mentored Patient-Oriented Research Review Committee (MPOR)
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Natarajan, Aruna R
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Medical College of Wisconsin
Schools of Medicine
United States
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Lagatta, Joanne M; Hysinger, Erik B; Zaniletti, Isabella et al. (2018) The Impact of Pulmonary Hypertension in Preterm Infants with Severe Bronchopulmonary Dysplasia through 1 Year. J Pediatr 203:218-224.e3