Antibiotic Prophylaxis for Children With Sickle Cell Anemia

Abstract

Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.

Hydroxyurea use among children with sickle cell anemia

“…We identified children ages 1 through 17 years with SCA using a case definition of the presence of at least three claims for a child within a calendar year that were SCA related (ICD‐9‐CM codes 282.61, 282.62). This case definition, targeted to specifically identify children with the subtype SCA, was previously demonstrated to have a high sensitivity (91%) and specificity (80%) as compared with the gold standard of newborn screening records . Continuous enrollment in the Medicaid program for at least one calendar year within this time period was required; children could contribute multiple, nonsequential time intervals (i.e., 2009 and 2012).…”

“…Among children with hydroxyurea use, we assessed the proportion of children with at least 300 days of hydroxyurea. A threshold of 300 days’ supply of medication in a calendar year is commonly applied in quality measurement, as it reflects a majority of the year of coverage without requiring perfect adherence …”

“…This case definition, targeted to specifically identify children with the subtype SCA, was previously demonstrated to have a high sensitivity (91%) and specificity (80%) as compared with the gold standard of newborn screening records. 16 Continuous enrollment in the Medicaid program for at least one calendar year within this time period was required; children could contribute multiple, nonsequential time intervals (i.e., 2009 and 2012). We restricted our analysis to children with no other forms of health insurance during the study period to maximize the completeness of Medicaid claims included in this analysis.…”

“…A threshold of 300 days' supply of medication in a calendar year is commonly applied in quality measurement, as it reflects a majority of the year of coverage without requiring perfect adherence. 16…”

Ensuring the Life-Span Benefits of Newborn Screening

“…Unfortunately, the lifelong management of the rare conditions identified through newborn screening can break down at multiple points, even for conditions that have been included in newborn screening for decades. For example, many children with sickle cell disease do not receive life-saving antibiotic prophylaxis 2 ; the management of children with congenital hypothyroidism may be inconsistent with recommended care, undermining optimal cognitive development 3 ; and adults with phenylketonuria often have limited access to the specialists and medical foods necessary to protect against neurocognitive impairment. 4 The complexity of follow-up care has increased with the expansion of newborn screening.…”