{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:19:34Z","timestamp":1784027974724,"version":"3.55.0"},"reference-count":20,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,7,1]]},"abstract":"<jats:p>OBJECTIVE: The purpose of this work was to compare the processes of care and to evaluate outcomes of premature neonates delivered to women with Medicaid managed care versus private insurance.<\/jats:p>\n               <jats:p>DESIGN\/METHODS: All of the infants born at &amp;lt;37 weeks' gestation between January 2001 and August 2005 in the ParadigmHealth database were included in these analyses (n = 24151). Infants were categorized by maternal health insurance status as private insurance or Medicaid managed care and analyzed for differences in demographic data and length of stay. For survivors, differences in respiratory care, nutritional, and maturational milestones were assessed. In addition, age to wean to open crib, weight gain, home oxygen, and apnea monitor use were compared. Adverse outcomes, including necrotizing enterocolitis, sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, bronchopulmonary dysplasia, apnea, and mortality, were compared. Statistical tests used were Students t test, \u03c72, and Kruskall-Wallis test. Multiple logistic regression was performed after controlling for demographic variables.<\/jats:p>\n               <jats:p>RESULTS: Of the 24151 infants studied, 19046 (78.9%) had private insurance, and 5105 (21.1%) had Medicaid managed care. There were no differences in gestational age at birth; however, Medicaid managed care infants had lower birth weight, lower Apgar score at 5 minutes, increased incidence of necrotizing enterocolitis and bacterial sepsis, and longer length of stay. Of the surviving infants, more neonates with private insurance went home on oxygen and apnea monitors despite no differences found in the incidences of apnea or bronchopulmonary dysplasia between the groups. There were no differences in processes of care for feeding and respiratory milestones, but infants with Medicaid managed care weaned to an open crib later and had greater overall weight gain compared with infants with private insurance.<\/jats:p>\n               <jats:p>CONCLUSIONS: We speculate that, in addition to the known impact of insurance status on well-being at birth, Medicaid managed care is independently associated with adverse neonatal outcomes in preterm infants, as well as differences in neonatal intensive care discharge processes.<\/jats:p>","DOI":"10.1542\/peds.2008-1318","type":"journal-article","created":{"date-parts":[[2009,6,29]],"date-time":"2009-06-29T15:18:44Z","timestamp":1246288724000},"page":"122-127","source":"Crossref","is-referenced-by-count":30,"title":["Are Outcomes and Care Processes for Preterm Neonates Influenced by Health Insurance Status?"],"prefix":"10.1542","volume":"124","author":[{"given":"Gwieneverea D.","family":"Brandon","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Thomas Jefferson University\/Nemours Children's Clinics, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Adeniyi-Jones","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Thomas Jefferson University\/Nemours Children's Clinics, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Kirkby","sequence":"additional","affiliation":[{"name":"Alere (formerly ParadigmHealth), Upper Saddle River, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Webb","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F.","family":"Culhane","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay S.","family":"Greenspan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Thomas Jefferson University\/Nemours Children's Clinics, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,7,1]]},"reference":[{"key":"2021120902454599500_R1","unstructured":"Furdon SA, Clark DA. Prematurity. E-medicine. October 16, 2006. Available at: www.emedicine.medscape.com\/article\/975909. Accessed May 13, 2009"},{"key":"2021120902454599500_R2","unstructured":"Snyder U. Preterm birth as a social disease. Medscape Ob\/Gyn Women Health.\u20082004;9(2). Available at: www.medscape.com\/viewarticle\/481732. Accessed May 13, 2009"},{"key":"2021120902454599500_R3","doi-asserted-by":"crossref","unstructured":"Haggstrom DA, Quale C, Smith-Bindman R. Differences in the quality of breast cancer care among vulnerable populations. Cancer.\u20082005;104(11):2347\u20132358","DOI":"10.1002\/cncr.21443"},{"key":"2021120902454599500_R4","doi-asserted-by":"crossref","unstructured":"Gilligan T, Wang PS, Levin R, et al. Racial differences in screening for prostate cancer in the elderly. Arch Intern Med.\u20082004;164(17):1830\u20131832","DOI":"10.1001\/archinte.164.17.1830"},{"key":"2021120902454599500_R5","doi-asserted-by":"crossref","unstructured":"Godley PA, Schenck AP, Amamoo MA, et al. Racial differences in mortality among medicare recipients after treatment for localized prostate cancer. J Natl Cancer Inst.\u20082003;95(22):1702\u20131710.","DOI":"10.1093\/jnci\/djg094"},{"key":"2021120902454599500_R6","unstructured":"Agency for Healthcare Quality and Research. The National Healthcare Disparities Report 2006. Rockville, MD: Agency for Healthcare Quality and Research; 2008. Available at: http:\/\/hcup.ahrq.gov\/HCUPnet.asp. Accessed November 1, 2007"},{"key":"2021120902454599500_R7","doi-asserted-by":"crossref","unstructured":"Matthews B, Anderson R, Nattinger A. Colorectal cancer screening behavior and health insurance status (United States). Cancer Causes Control.\u20082005;16(6):735\u2013742","DOI":"10.1007\/s10552-005-1228-z"},{"key":"2021120902454599500_R8","doi-asserted-by":"crossref","unstructured":"Rao SV, Schulman KA, Curtis LH, et al. Socioeconomic status and outcome following acute myocardial infarction in elderly patients. Arch Intern Med.\u20082004;164(10):1128\u20131133","DOI":"10.1001\/archinte.164.10.1128"},{"key":"2021120902454599500_R9","doi-asserted-by":"crossref","unstructured":"O'Malley AS, Forrest CB, Feng S, Mandelblatt J. Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries. Arch Intern Med.\u20082005;165(18):2129\u20132135","DOI":"10.1001\/archinte.165.18.2129"},{"key":"2021120902454599500_R10","doi-asserted-by":"crossref","unstructured":"Davis MM, Ndiaye SM, Freed GL, Kim CS, Clark SJ. Influence of insurance status and vaccine cost on physicians' administration of pneumococcal conjugate vaccine. Pediatrics.\u20082003;112(3 pt 1):521\u2013526","DOI":"10.1542\/peds.112.3.521"},{"key":"2021120902454599500_R11","doi-asserted-by":"crossref","unstructured":"Lopez AM, Tilford JM, Anand KJ, et al. Variation in pediatric intensive care therapies and outcomes by race, gender, and insurance status. Pediatr Crit Care Med.\u20082006;7(1):2\u20136","DOI":"10.1097\/01.PCC.0000192319.55850.81"},{"key":"2021120902454599500_R12","doi-asserted-by":"crossref","unstructured":"Weck RL, Paulose T, Flaws JA. Impact of environmental factors and poverty on pregnancy outcomes. Clin Obstet Gynecol.\u20082008;51(2):349\u2013359","DOI":"10.1097\/GRF.0b013e31816f276e"},{"key":"2021120902454599500_R13","doi-asserted-by":"crossref","unstructured":"O'Campo P, Burke JG, Culhane J, et al. Neighborhood deprivation and preterm birth among non-Hispanic black and white women in eight geographic areas in the United States. Am J Epidemiol.\u20082008;167(2):155\u2013163","DOI":"10.1093\/aje\/kwm277"},{"key":"2021120902454599500_R14","doi-asserted-by":"crossref","unstructured":"Messer LC, Kaufman JS, Dole N, et al. Neighborhood crime, deprivation, and preterm birth. Ann Epidemiol.\u20082006;16(6):455\u2013462","DOI":"10.1016\/j.annepidem.2005.08.006"},{"key":"2021120902454599500_R15","doi-asserted-by":"crossref","unstructured":"Kupperman M, Gates E, Washington AE. Racial-ethnic differences in prenatal diagnostic test use and outcomes: preferences, socioeconomics, or patient knowledge?Obstet Gynecol.\u20081996;87(5 pt 1):675\u2013682","DOI":"10.1016\/0029-7844(96)00017-8"},{"key":"2021120902454599500_R16","doi-asserted-by":"crossref","unstructured":"Gennaro S. Overview of current state of research on pregnancy outcomes in minority populations. Am J Obstet Gynecol.\u20082005;192(5 suppl):S3\u2013S10","DOI":"10.1016\/j.ajog.2005.02.014"},{"key":"2021120902454599500_R17","doi-asserted-by":"crossref","unstructured":"Brett KM, Schoendorf KC, Kiely JL. Differences between black and white women in the use of prenatal care technologies. Am J Obstet Gynecol.\u20081994;170(1 pt 1)41\u201346","DOI":"10.1016\/S0002-9378(94)70381-7"},{"key":"2021120902454599500_R18","doi-asserted-by":"crossref","unstructured":"Dobie S, Hart LG, Fordyce M, Andrilla CH, et al. Obstetric care and payment source: do low-risk Medicaid women get less care?Am J Public Health.\u20081998;88(1):51\u201356","DOI":"10.2105\/AJPH.88.1.51"},{"key":"2021120902454599500_R19","doi-asserted-by":"crossref","unstructured":"Denboba D, McPherson MG, Kenney MK, Stirckland B, Newacheck PW. Achieving family and provider partnerships for children with special health care needs. Pediatrics.\u20082006;118(4):1607\u20131615","DOI":"10.1542\/peds.2006-0383"},{"key":"2021120902454599500_R20","unstructured":"US Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2004. Washington, DC: US Census Bureau; 2005:19"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/1\/122\/1031936\/zpe00709000122.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/124\/1\/122\/1031936\/zpe00709000122.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T15:35:00Z","timestamp":1639064100000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/124\/1\/122\/71624\/Are-Outcomes-and-Care-Processes-for-Preterm"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,7,1]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2009,7,1]]},"published-print":{"date-parts":[[2009,7,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2008-1318","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,7,1]]}}}