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Sudhakar Ezhuthachan

Publications and source records attributed to Sudhakar Ezhuthachan.

6 recordsLinked to original sources
PubMed2006

The changing face of race: risk factors for neonatal hyperbilirubinemia.

OBJECTIVES: Race is a predictor of health outcomes and risk for some clinical conditions, for example, mother's race predicts risk for hyperbilirubinemia in newborns, with blacks at lowest risk. Little is known about the correlation of race as recorded in medical records with self-reported race. Also, use of maternal race to predict newborn risk for hyperbilirubinemia has not been tested for multiracial mothers and newborns. We sought to examine how maternal race documented in medical records correlates with self-reported race and to examine the correlation between mothers' and newborns' race in the context of risk for neonatal hyperbilirubinemia, focusing on multiracial mothers and newborns. DESIGN: A cohort study with 3021 newborns at > or =35 weeks gestation discharged from normal nursery between January 2001 and October 2002 with a telephone survey of their mothers within 6 months of birth. SETTING: The study was conducted in the Neonatology Department of Henry Ford Hospital. PATIENTS: There were 1773 mothers (58%) with incorrect telephone numbers. Of 1248 mothers contacted, 866 (69%) completed the interview. OUTCOME MEASURES: We measured mother's race in hospital database and mother's reported race for herself, her newborn, and the father, allowing < or =5 responses for each. RESULTS: Of mothers documented in the medical record as white, 64% self-reported as white. Among mothers recorded as black, 70% self-reported as black. Mothers identified 93 newborns as > or =2 races with primary race matching both parents for 41%, father for 25%, mother for 23%, and neither parent for 11%. Of 70 newborns whose parents were not the same race, mothers identified 45 (64%) as > or =2 races. CONCLUSIONS: There is incomplete overlap between racial identification in medical records versus self-report. Given 1 choice, mothers of multiracial infants overselect black in their newborns' ancestry. Because black race is the lowest risk category for neonatal hyperbilirubinemia, this may lead to underestimating their risk.

Female↗
PubMed2004

Barriers to first-week follow-up of newborns: findings from parent and clinician focus groups.

BACKGROUND: Monitoring newborns within the first week is critical to assess the adequacy of feeding and weight gain and to identify instances of hyperbilirubinemia. As systems of maternal and newborn care have become increasingly fragmented, infants are at increased risk of poor outcomes because of poor follow-up. Structured focus groups were conducted in June--July 2001 to provide information about the barriers to timely newborn follow-up and strategies to address them. METHODS: One focus group for physicians and one for nurses were held at the Henry Ford Health System, Detroit, and two focus groups of parents were recruited by Blue Cross Blue Shield of Texas, Dallas. RESULTS: Barriers were identified in communication and information, systems and processes of care, and parental knowledge and education. Concerns raised by clinicians and parents were consistent and complementary. Some organizations have begun implementing some of the suggested strategies to achieve timely follow-up. DISCUSSION: Implementing the AAP guideline and improving safe care in the first week of newborn life will require attention to linkages and transitions between these various microsystems.

Female↗
PubMed2003

Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model.

BACKGROUND: Accreditors hold hospitals accountable for harm from serious newborn hyperbilirubinemia, yet standards for evaluating performance in prevention are lacking. OBJECTIVE: We confirmed prognostic variables for newborn hyperbilirubinemia and developed a benchmarking model for self-evaluation of hyperbilirubinemia management. METHODS: We conducted a 3-year prospective cohort study in the Henry Ford Health System (HFHS) on 5507 healthy newborns of >or=35 weeks' gestational age. HFHS follows a rigorous protocol for hyperbilirubinemia management. Defining hyperbilirubinemia as age-specific levels of total serum bilirubin exceeding American Academy of Pediatrics criteria for considering phototherapy and severe hyperbilirubinemia as total serum bilirubin >or=20 mg/dL, we used logistic and Poisson regressions to determine predictors and estimate parameters for a benchmarking model. We compared incidence rates for severe hyperbilirubinemia from HFHS to aggregate data from 11 hospitals reported to have less rigorous management. RESULTS: Newborns were 52.9% black, 14.4% white, 24.3% Latino, and 2.4% Asian; 30% were exclusively and 28% partially breastfed. Regression analyses revealed associations for hyperbilirubinemia and severe hyperbilirubinemia with black mothers (negative) and exclusive or partial breastfeeding and younger gestational age (positive). Male newborns and older mothers were also associated with severe hyperbilirubinemia. For all 5 variables, we found a lower risk for severe hyperbilirubinemia at HFHS than in the comparison hospital group. To compare hospitals, we developed a benchmarking model for incidence of hyperbilirubinemia adjusting for race, feeding method, and gestational age. CONCLUSIONS: Hospitals with access to newborns' inpatient and postdischarge data can use our benchmarking model to compare their management of hyperbilirubinemia with a reference population that received rigorous care.

Benchmarking↗