When it came time for Antoinette Jones, MD, to choose a location for her fellowship, she wanted to select an institution that would prepare her for “anything and everything” in the field of Neonatology.
In the process, Jones—who was completing her residency at Penn State Health Children’s Hospital in Hershey, Pennsylvania—had several discussions with Jeff Meyers, MD, associate chief quality officer at GCH and associate professor in the Division of Neonatology; she was drawn in by the opportunities for clinical and translational research.
“We basically did ‘speed dating’ to choose a research mentor as first-year fellows,” said Jones, “I was impressed with how comprehensive GCH’s program was.”
Now a third-year fellow, Jones has indeed engaged in anything and everything, including one significant research project completed and another one potentially on the way.
Jones’ first study examined the effects of caffeine on moderately pre-term infants. Intravenous caffeine is provided to extremely pre-term infants (born at less than 29 weeks) to treat apnea of prematurity as a standard practice in NICUs. But Jones wanted to study the trade-offs for infants born moderately pre-term (between 29 and 33 weeks).
“It has long been thought that caffeine could negatively affect growth and possibly brain development for newborns, and there was a lack of studies on this subject that looked at the length of the neonatal period,” said Jones.
The 29-to-33-week period was critical for the study, since not all infants born during this time are provided with caffeine. There is limited research on its true benefits for slightly older preterm infants, providing an opportunity to explore its potential impact on growth. During the course of a year, Jones studied, through RedCap, the data of hundreds of patients to examine their growth curves and determine when the caffeine was administered, how many milligrams they received, the progression of their growth from birth through discharge versus babies who did not receive caffeine, and many other variables. Jones’ project excluded infants if they had major congenital anomalies, brain malformations, metabolic disorders or chromosomal abnormalities and those with birth length z-score (a metric that documents whether patients’ growth for their gestational age tracks to the average or not) of greater than or less than two standard deviations from the mean. She also accounted for whether the newborns were on oxygen, whether they received fortified feedings, and other predetermined variables.
Jones presented her findings, which detailed whether there was a change in length z-scores from birth to discharge or 37 weeks’ corrected age, at two conferences this fall, and she hasn’t waited a moment to move forward with her next project.
Through the Douglass-Anthony program—an initiative that trains pediatricians and supports their development in understanding and addressing health inequity—Jones will be engaging in a Quality Improvement (QI) project looking at disparate outcomes for breastfeeding in the NICU at GCH. In particular, at GCH 50 percent of babies born to Black women go home feeding on their mother’s breast milk, compared to 75 percent of Caucasian mothers. This inequity is also reflective of national data trends at hospitals.
“Up front, it doesn’t seem that we’re doing anything differently, since it is standard to counsel on providing breast milk, and our lactation consultants come by to offer support,” said Jones, “so this project will aim to look deeper at what factors may influence this difference.”
Jones’ research will look to answer some initial questions, such as whether Black mothers staying in the NICU are initiating breast feeding or pumping less or later or are able to be at the bedside less to pump. It will then assess whether social determinants may explain some of the disparities.
“Some existing research suggests that experiences with breastfeeding in prior pregnancies influence breastfeeding decision-making in subsequent pregnancies. Possibly they felt unsupported. Did they have financial or work-related barriers? Did they have difficulty accessing a pump and being at their baby’s bedside often? Did they encounter episodes of racism? Answering these questions are critical for preventing disenfranchisement in the hospital,” said Jones.