Outcome, Economics and Health Policy Research - Fetal and Neonatal Institute

Supported by the Teresa and Byron Pollitt Family Chair in Fetal & Neonatal Medicine and its mission to develop new knowledge to impact neonates with complex health issues, the Fetal and Neonatal Institute brings together collaborations in the areas of neonatal outcomes research, healthcare economics and policies at Children’s Hospital Los Angeles, the Keck School of Medicine and the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. The mission of the section of epidemiology and outcomes is to promote the health of children through epidemiologic research investigating the impact of environmental, genetic and clinical factors on pregnancy, birth and childhood.

Current research at the Fetal and Neonatal Institute focuses on neonatal outcomes. We have evaluated the impact of caregiver stress and burden on neurodevelopmental outcomes, studied the environmental and genetic causes of disease during pregnancy, in the perinatal period, during infancy and childhood and evaluated resource utilization for various disease processes and the effects on cost. By integrating faculty from several disciplines including pediatrics, neonatology, developmental pediatrics, epidemiology, biostatistics, maternal-fetal medicine and environmental health, we have created a robust research section that also will train the next generation of scientists.

As the Section Head for Epidemiology and Outcomes and director of the laboratory for fetal and neonatal health care delivery and outcomes, Ashwini Lakshmanan, MD, MPH oversees the projects for the section and is particularly interested in social determinants of health.  

Improving Health Equity During Transition Using Mobile Health

This study partnered with two technology companies – Sidebench and Qolty – to develop an mHealth patient navigation platform for Neonatal Intensive Care Unit (NICU) families. Based on feedback from NICU parents and medical staff, the platform will include information related to accessing public services such as community based developmental programs and food and income assistance. In addition, it will offer curated libraries with easy to understand information about use of equipment, care for high risk infants (e.g., nutrition, developmental milestones) and telehealth support for maternal depression and other mental health concerns. This platform will also incorporate a component of peer support or capability for parent navigation as well (where a parent who has had a child with similar medical issues can “guide” a family after discharge). CHLA patient families and staff provided input to develop this new mHealth platform in order to produce an app that is useful and relevant for NICU families’ unique medical situations. We also believe that this app will help empower and increase parents’ confidence in taking care of a child with special health care and developmental needs.

An example is shown here:  https://vimeo.com/310900917/65da39d4f2

Dr. Lakshmanan’s work is funded by the National Center for Advancing Translational Science (NCATS) Grant KL2TR001854 of the U.S. National Institutes of Health, the Sharon D. Lund Foundation and the Zumberge Diversity and Inclusion Award at the University of Southern California.

Cost-effectiveness of Therapeutic Hypothermia in Neonates with Mild Hypoxic Ischemic Encephalopathy

Neonatal hypoxic ischemic encephalopathy (HIE) has an incidence of 1.5 per 1000 livebirths and results in significant sequelae, including death, cerebral palsy, epilepsy, and intellectual disability. Therapeutic hypothermia is now standard of care for moderate to severe HIE as it has been shown to reduce death or disability in survivors. However, hypothermia is commonly being utilized in mild cases of HIE despite a lack of evidence of clinical efficacy. The study aims to characterize the long-term neurodevelopmental outcomes of infants with mild HIE who undergo hypothermia versus those who do not while quantifying the economic burden of mild HIE over a lifetime. The study will use this data to build an economic model and compare the incremental cost per quality-adjusted life year between those who undergo therapeutic hypothermia versus standard care. Findings of this analysis will aid stakeholders in understanding the economic implications and incremental benefits, if any, of inducing hypothermia in neonates with mild HIE. 

Principal Investigator: Dr. Yieh

Co-investigators: Dr. Hay, Dr. Wu, Dr. Lakshmanan, Dr. Friedlich, Dr. Dukhovny, Dr. Gong, Dr. Padula

Cynthia L. Gong, PharmD, PhD conducts health economics research on neonatal congenital diseases. Her research includes the cost-effectiveness of various treatments and interventions in the NICU, such as the use of extracorporeal membrane oxygenation (ECMO) and whole exome sequencing, including the economic implications of changes in clinical guidelines and policies.  In addition, she is exploring the impact of environmental and socioeconomic factors on neonatal health outcomes, and clinician and patient/family preferences for various programs and treatments in the NICU.

Leah Yieh, MD, MPH focuses research using decision-analytic modeling and cost-effectiveness analysis to understand the clinical and financial implications of perinatal interventions at the population level that will produce optimal outcomes for patients and caregivers. Her research aims to provide a framework for standardized clinical practices and inform health policy.