A193 TIMELY HEPATITIS B IMMUNIZATION OF THE AT-RISK NEONATE: A QUALITY ASSURANCE REVIEW
Bibliographic record
Abstract
Hepatitis B is an infectious disease that affects approximately 257 million people worldwide and is ranked as the fourth most burdensome pathogen in Ontario, with clinical sequelae including liver cirrhosis, organ failure, and cancer. Although Ontario offers routine hepatitis B vaccination in adolescence, infants born to infected mothers remain at risk due to vertical transmission of the virus during childbirth. This necessitates routine HBsAg screening in the first trimester of pregnancy. According to the Canadian Immunization Guide (CIG), all infants born to HBsAg+ mothers should receive hepatitis B immune globulin (HBIg) and vaccine within 12 hours of age. It is unclear whether these measures are administered in a timely manner. The purpose of this study was to retrospectively review the time to administer HBIg and vaccine for infants born to HBsAg+ mothers. Following REB approval, mother-infant charts were selected by identifying orders for hepatitis B vaccine in infants between 2010 and 2015. Mother-infant dyads were excluded if the mother was HBsAg- or status unknown. Paired charts were retrospectively reviewed at 6 hospital sites in Ontario including 2 community hospitals, 2 academic hospitals, and 2 affiliated teaching hospitals. Non-parametric analysis of variance (ANOVA) and correlation tests were run at a significance of p<0.05. 460 mother-infant dyads were included for full chart review across 6 hospital sites. The mean vaccination time was 5.0 hours (95% CI [4.4, 5.2]) with significant differences between sites (WF5,58=21.3, p<0.001, η2= 0.31). The mean time of HBIg administration was also 5.0 hours (95% CI [4.5, 5.2]) with significant differences between sites (Welch’s F5,61=18.7, p<0.001, η2= 0.23). 23 infant charts (5.0%) documented late hepatitis B vaccination and 22 infant charts (4.8%) documented late HBIg administration, with 2.4% of at-risk infant charts documenting both late vaccine and HBIg administration. On average, infants born to married mothers were vaccinated earlier (x=-65 mins). Early morning delivery (2400-0800) tended to result in later vaccination times (x=+66 mins). 10.8% of at-risk infant charts had at least one undocumented time of HBIg or vaccine administration. At-risk newborns for the vertical transmission of hepatitis B infrequently encounter immunization delays, including the late administration of HBIg or vaccine within the first 12 hours of life. A focus on standardizing care pathways regardless of site or time of delivery may help to improve the timeliness of hepatitis B immunization. Further study could explore the cost-benefits of universal neonatal hepatitis B immunization. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.025 | 0.080 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.010 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".