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Purpose The purpose of the current study was to identify and describe strategies available to optimize retention of a high-risk research cohort and assist in the recovery of study participants following participant dropout. Design and Methods The Maternal Lifestyle Study (MLS), which investigated the effects of prenatal substance exposure (cocaine or opiates) on child outcome, is a prospective longitudinal follow-up study that extended from birth through 15 years of age. Retention strategies to maximize participation and factors that might negatively impact compliance were examined over the course of five follow-up phases. Findings At the conclusion of the 15-year visits, MLS had successfully maintained compliance at 76%. Retention rates did not differ by exposure group. Conclusions Maintaining ongoing participation of enrolled study subjects is a critical element of any successful longitudinal study. Strategies that can be used to reengage and maintain participants in longitudinal research include persistence, flexibility with scheduling, home visits, long-distance trips, increased incentives, and development of a computerized tracking system. Establishing rapport with families and ensuring confidentiality contributed to overall participant retention. The use of multiple tracking techniques is essential. Clinical Relevance Researchers are challenged to maintain participants in longitudinal studies to ensure the integrity of their research.

Background Prenatal cocaine exposure has been linked to intrauterine growth retardation and poor birth outcomes; little is known about the effects on longer-term medical outcomes, such as overweight status and hypertension in childhood. Our objective was to examine the association between prenatal cocaine exposure and body mass index and blood pressure at 9 years of age among children followed prospectively in a multi-site longitudinal study evaluating the impact of maternal lifestyle during pregnancy on childhood outcome. Design/Methods This analysis includes 880 children (277 cocaine exposed and 603 with no cocaine exposure) with blood pressure, height, and weight measurements at 9 years of age. Regression analyses were conducted to explore the relationship between prenatal cocaine exposure and body mass index and blood pressure at 9 years of age after controlling for demographics, other drug exposure, birth weight, maternal weight, infant postnatal weight gain, and childhood television viewing, exercise and dietary habits at 9 years. Path analyses were used to further explore these relationships. Results At 9 years of age, 15% of the children were pre-hypertensive and 19% were hypertensive; 16% were at risk for overweight status and 21% were overweight. A small percentage of women were exposed to high levels of prenatal cocaine throughout pregnancy. Among children born to these women, a higher body mass index was noted. Path analysis suggested that high cocaine exposure has an indirect effect on systolic and diastolic blood pressure that is mediated through its effect on body mass index. Conclusion High levels of in-utero cocaine exposure are a marker for elevated body mass index and blood pressure among children born full term.

Introduction: Unplanned extubation (UE) is a common adverse event in the neonatal intensive care unit (NICU). At our level IV NICU, we initiated a quality improvement project in 2012 to reduce UE rates from 7.47 to below 100 intubated days. We describe the strategies used. Methods: Multiple plan-do-study-act cycles were performed to address key drivers. Important interventions focused on staff education, consistent use of a new endotracheal (ET) tube securing device, 2 providers during bedside activities, documentation of ET tube position, and targeted sedation. Process measures included immediate root cause analyses for UE events and the use of the endotracheal tube securing device. The primary outcome was the UE rate per 100 intubated days. Results: Over a nearly 6-year study period, quarterly UE rates decreased from 7.19 to 0.66 per 100 intubated days. The proportion of neonates requiring reintubation remained stable (64%–76%). Rates of root cause analysis completion and use of the ET securing device were more than 90% in the last 3 years of the study. The majority (61%) of UE events occurred in infants with birth weights greater than 2 kg, and 46% of infants had a prior UE. UE was associated with desaturation (50%), bradycardia (22%), and the need for resuscitation (7%). Conclusions: This quality improvement effort in a level IV NICU achieved a reduction in UE rates to below 1 per 100 intubated days after more than 5 years. Consistency in practices and widespread communication with the staff was critical to the effort.