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OBJECTIVES/GOALS: Premature birth and its complications are among the largest contributions to infant death within the US. The rates of premature birth and infant death are significantly higher among African Americans. Therefore, there is an urgent need to understand the biological and social drivers of this health disparities to improve birth outcomes. METHODS/STUDY POPULATION: This is a retrospective cohort study of premature infants (< 28 weeks estimated gestational age, birth weight < 1500g) born within 2018 and 2021 to mothers who identify as either African American, or White/Caucasian Non-Hispanic and are cared for at Saint Louis Children’s Hospital Neonatal Intensive Care Unit. EPIC collected data will include maternal and fetal factors and social determinants of health (SDOH). ICD-9, ICD-10 codes for primary outcomes include grade 3-4 Interventricular Hemorrhage, moderate-severe Bronchopulmonary Dysplasia, Stage 2+ Necrotizing Enterocolitis, and moderate-severe Retinopathy of Prematurity. Will develop a composite variable score using the SDOH for risk/no risk using that for each disease outcome and mortality. Will use Chi-square test or T-test to compare groups. RESULTS/ANTICIPATED RESULTS: We are currently in the data collection phase of the study, but we anticipate seeing an increase in risk of all-cause morbidity as well as all-cause mortality for infants born to Black mothers compared to infants born to White mothers. We anticipate higher levels of disadvantage (increased area deprivation scores) and lower access to the goods and services deemed necessary for appropriate care of Black mothers and subsequent relation to outcomes for their infants. DISCUSSION/SIGNIFICANCE: Following analysis and assessment of that analysis we will discuss these findings and the impact on the general population and the needs for improvement and implementation of interventions upstream in the care of the vulnerable and special mother-baby-dyad population.
Antibiotics are widely used in very low-birth-weight infants (VLBW, <1500 g), and excess exposure, particularly to broad-spectrum antibiotics, is associated with significant morbidity. An antibiotic spectrum index (ASI) quantifies antibiotic exposure by relative antimicrobial activity, adding information to exposure measured by days of therapy (DOT). We compared ASI and DOT across multiple centers to evaluate differences in antibiotic exposures.
We extracted data from patients admitted to 3 level-4 NICUs for 2 years at 2 sites and for 1 year at a third site. We calculated the ASI per antibiotic days and DOT per patient days for all admitted VLBW infants <32 weeks gestational age. Clinical variables were compared as percentages or as days per 1,000 patient days. We used Kruskal-Wallis tests to compare continuous variables across the 3 sites.
Demographics were similar for the 734 VLBW infants included. The site with the highest DOT per patient days had the lowest ASI per antibiotic days and the site with the highest mortality and infection rates had the highest ASI per antibiotic days. Antibiotic utilization varied by center, particularly for choice of broad-spectrum coverage, although the organisms causing infection were similar.
An antibiotic spectrum index identified differences in prescribing practice patterns among 3 NICUs unique from those identified by standard antibiotic use metrics. Site differences in infection rates and unit practices or guidelines for prescribing antibiotics were reflected in the ASI. This comparison uncovered opportunities to improve antibiotic stewardship and demonstrates the utility of this metric for comparing antibiotic exposures among NICU populations.
Optimizing pediatric antimicrobial stewardship is challenging. In this retrospective study, we evaluated 515 original e-mails to 482 members of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative electronic mailing list (firstname.lastname@example.org). The plurality of threads discussed clinical practice guidelines, and pharmacists were most likely to initiate and respond. Representation was geographically diverse within and outside the United States.
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