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To determine the rates of high-risk infant follow-up (HRIF) attendance and the characteristics associated with follow-up among infants with hypoxic-ischemic encephalopathy (HIE) in California.Using population-based datasets, 1314 infants with HIE born in 2010-2016 were evaluated. The characteristics associated with follow-up were identified through multivariable logistic regression.73.9% of infants attended HRIF by age 1. Follow-up rates increased and variation in follow-up by clinic decreased over time. Female infants; those born to African-American, single, less than college-educated, or publicly insured caregivers; and those referred to high-volume or regional programs had lower follow-up rates. In multivariable analysis, Asian and Pacific Islander race/ethnicity had lower odds of follow-up; infants with college- or graduate school-educated caregivers or referred to mid-volume HRIF programs had greater odds.Sociodemographic and program-level characteristics were associated with lack of follow-up among HIE infants. Understanding these characteristics may improve the post-discharge care of HIE infants.

OBJECTIVES: This study aimed to identify community-level actions to decrease racial disparities in infant mortality (IM). DESIGN: Six urban multidisciplinary teams generated ideas for decreasing racial disparities in IM using a mixed methods concept mapping approach. Participants rated each idea as to its necessity and action potential and grouped ideas by theme. A cluster analysis produced a series of visual representations, showing relationships between the identified actions and the clustering of actions into themes. Multidimensional scaling techniques were used to produce analyses describing the necessity of and action potential for implementing the proposed ideas. Participants identified actions communities could take to decrease racial disparities in IM and suggested applications of the knowledge gained from the mapping process. RESULTS: Participants produced a total of 128 actions, within 11 thematic clusters, for decreasing racial disparities in IM. The thematic clusters contained a range of elements designed to promote knowledge and understanding of the relationship between health and racism; improve educational systems and community opportunities; facilitate community-driven health promotion, marketing, and research; improve health services for women; address physical and social environments that impact community health; prioritize resource allocation of community-based services; institutionalize strategies that promote equity across all systems; and create and support legislation and policies that address social determinants of health. Correlation coefficients of the clusters ranged from 0.17 to 0.90. Average necessity ratings ranged from 2.17 to 3.73; average action potential ratings ranged from 1.64 to 3.61. CONCLUSION: Findings suggest that thematic clusters with high action potential usually represented ongoing community activities or actions communities could easily initiate. Community size, existing programs, partnerships, policies, and influential advocates were among the factors cited affecting feasibility of implementation. Clusters with lower action potential require broader, longer term, policy, institutional or system-wide changes, and significant resources. High necessity clusters often contained actions perceived as essential for change, but sometimes outside of a community’s control. Participants identified a number of practical actions that were considered to hold potential for individual, community, and institutional changes which could result in decreasing racial disparities in IM.

Objective. Data are scarce regarding the effects of nutrient fortification and storage on the immu- noprotective properties of human milk. These effects are important considerations when feeding premature in- fants. We hypothesized that total bacterial colony counts (TBCC) and immunoglobulin A (IgA) concentration were not affected by the addition of fortifier even when tested under extreme storage conditions and that osmolality of fortified human milk does not increase with storage. Methods. Ten frozen and five fresh milk samples from mothers of premature infants were divided into fortified and unfortified milk, and stored for 72 hours at either refrigerator or room temperature. Aliquots were obtained at 0 to 72 hours for TBCC, osmolality, and total IgA, and analyzed by repeated measures analysis of vari- ance (ANOVA). Results. Log10 TBCC in milk stored at refrigerator temperature for 0, 24, 48, and 72 hours were significantly greater in fortified vs unfortified milk; both increased similarly with storage. Osmolality was greater in forti- fied than unfortified milk; both increased by approxi- mately 4% with storage. IgA concentration was not af- fected by fortification or storage. To simulate the usual nursery use of fortified human milk, a separate evalua- tion was performed. Fortified milk was stored at refrig- erator temperature for 20 hours, warmed in a 40°C labo- ratory incubator for 20 minutes, and placed in a 34°C infant incubator for 4 hours. Samples for TBCC were obtained at 0, 20, and 24 hours and analyzed by repeated measures ANOVA. Log10 TBCC in fortified, refrigerated milk did not change over the 20-hour storage but in- creased during the simulated 4-hour usage. Conclusions. These findings may warrant consider- ation when using human milk in the neonatal nursery but support recommendations to use commercially forti- fied human milk within 24 hours. Pediatrics 1997;100: 240 -243; fortified human milk, immunoprotective proper- ties, premature infants.