Research Overview

Dr. Zupancic’s research focuses on addressing the efficiency with which scarce health care resources are used in improving the health of children, and in particular, newborns. He has completed multiple formal economic evaluations alongside clinical trials of both neonatal and perinatal interventions, including multi-center and multi-national studies of caffeine for apnea of prematurity, transfusion thresholds in premature infants, inhaled nitric oxide for prevention of chronic lung disease and peer counseling at a health systems level for prevention of postpartum depression. In addition to trial-based economic evaluation, he and his collaborators have employed computer simulation modeling to determine best practice when evidence is currently lacking or where empirical studies are infeasible.  

 

Research Background

Dr. Zupancic received his Bachelor of Science degree from Victoria College at the University of Toronto, where he was awarded the G. A. Cox Gold Medal in Life Sciences upon graduation. He undertook his undergraduate medical training and pediatrics residency at McMaster University and completed his fellowship in neonatal-perinatal medicine in the Joint Program in Neonatology at Harvard Medical School. Concurrent with his neonatology fellowship training, he was awarded a Doctorate in Health Policy, with concentrations in Decision Science and Economics, from the Harvard School of Public Health. He is currently Assistant Professor of Pediatrics at Harvard Medical School and Director of the Harvard Neonatal-Perinatal Medicine Fellowship Program.

Alongside his research contributions, Dr. Zupancic has a strong commitment to methodological and clinical teaching, research mentoring and career development. As Director of one of the largest neonatology fellowship programs in the United States, he has primary responsibility for the clinical and scholarly education of trainees as they rotate through the four main Harvard teaching hospitals, numerous research laboratories and ancillary research fellowships. He has regularly mentored fellows in health services research projects and is the recipient of both the Merton R. Bernfield Mentoring Award from the Fellows of the Harvard Neonatal-Perinatal Medicine Fellowship Program and the national John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality.

Education

Undergraduate School

Victoria College, University of Toronto
1988 Toronto, Ontario Canada

Medical School

McMaster University
1991 Toronto, Ontario Canada

Internship

Pediatrics McMaster University
1991 Toronto, Ontario Canada

Residency

Pediatrics McMaster University
1995 Toronto, Ontario Canada

Fellowship

Harvard Neonatal-Perinatal Medicine Training Program
1995 Boston MA

Graduate School

ScD, Health Policy Harvard School of Public Health
2001 Boston MA

Publications

  1. Clinical Characteristics of Necrotizing Enterocolitis Diagnosed by Independent Adjudication of Abdominal Radiographs, Laparotomy, or Autopsy in Preterm Infants in the "Connection Trial". Am J Perinatol. 2025 Jan; 42(2):268-280. View Abstract
  2. Measuring practice preference variation for quality improvement in neonatal respiratory care. J Perinatol. 2024 Jul; 44(7):1001-1008. View Abstract
  3. Community Considerations for Aggressive Intensive Care Therapy for Infants <24+0 Weeks of Gestation. J Pediatr. 2024 May; 268:113948. View Abstract
  4. Measuring practice preference variation for quality improvement: development of the Neonatology Survey of Interdisciplinary Groups in Healthcare Tool (NSIGHT). BMJ Open Qual. 2023 12 14; 12(4). View Abstract
  5. Asperger's syndrome - about time to rename it? Pediatr Res. 2024 Feb; 95(3):582-584. View Abstract
  6. Systemic corticosteroids for the prevention of bronchopulmonary dysplasia, a network meta-analysis. Cochrane Database Syst Rev. 2023 08 31; 8:CD013730. View Abstract
  7. Prediction and Prevention of Preterm Birth: Secondary Analysis of a Randomized Intervention Trial. J Clin Med. 2023 Aug 23; 12(17). View Abstract
  8. Economic considerations for resuscitative interventions in the immediate newborn period. Semin Perinatol. 2023 08; 47(5):151783. View Abstract
  9. Machine learning: remember the fundamentals. Pediatr Res. 2023 01; 93(2):291-292. View Abstract
  10. Change in neurodevelopmental outcomes for extremely premature infants over time: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2023 Sep; 108(5):458-463. View Abstract
  11. Using the Neonatal Intensive Care Unit Wisely: A National Survey of Clinicians Regarding Practices for Lower-Acuity Care. J Pediatr. 2023 02; 253:165-172.e1. View Abstract
  12. The Trend in Costs of Tertiary-Level Neonatal Intensive Care for Neonates Born Preterm at 220/7-286/7 Weeks of Gestation from 2010 to 2019 in Canada. J Pediatr. 2022 06; 245:72-80.e6. View Abstract
  13. A Blueprint for Advocacy in Neonatology. Neoreviews. 2022 02 01; 23(2):e74-e81. View Abstract
  14. Study protocol for reducing disparity in receipt of mother's own milk in very low birth weight infants (ReDiMOM): a randomized trial to improve adherence to sustained maternal breast pump use. BMC Pediatr. 2022 01 07; 22(1):27. View Abstract
  15. Clinical and economic evaluation of a proteomic biomarker preterm birth risk predictor: cost-effectiveness modeling of prenatal interventions applied to predicted higher-risk pregnancies within a large and diverse cohort. J Med Econ. 2022 Jan-Dec; 25(1):1255-1266. View Abstract
  16. Economic considerations at the threshold of viability. Semin Perinatol. 2022 03; 46(2):151547. View Abstract
  17. Physician wellbeing during the COVID-19 pandemic: an acute on chronic condition. Pediatr Res. 2022 01; 91(1):19-20. View Abstract
  18. Cost-Effectiveness of a Proteomic Test for Preterm Birth Prediction. Clinicoecon Outcomes Res. 2021; 13:809-820. View Abstract
  19. Quantifying the variation in neonatal transport referral patterns using network analysis. J Perinatol. 2021 12; 41(12):2795-2803. View Abstract
  20. COVID-19 preparedness-a survey among neonatal care providers in low- and middle-income countries. J Perinatol. 2021 05; 41(5):988-997. View Abstract
  21. Broadening the scope and scale of quality improvement in neonatology. Semin Fetal Neonatal Med. 2021 02; 26(1):101228. View Abstract
  22. The financial burden on families of infants requiring neonatal intensive care. Semin Perinatol. 2021 04; 45(3):151394. View Abstract
  23. Unbiasing costs? An appraisal of economic assessment alongside randomized trials in neonatology. Semin Perinatol. 2021 04; 45(3):151391. View Abstract
  24. Introduction: Harnessing economic assessment to improve outcomes in neonatology. Semin Perinatol. 2021 04; 45(3):151388. View Abstract
  25. Higher or Lower Hemoglobin Transfusion Thresholds for Preterm Infants. N Engl J Med. 2020 12 31; 383(27):2639-2651. View Abstract
  26. A Graded Approach to Intravenous Dextrose for Neonatal Hypoglycemia Decreases Blood Glucose Variability, Time in the Neonatal Intensive Care Unit, and Cost of Stay. J Pediatr. 2021 04; 231:74-80. View Abstract
  27. Cost-effectiveness and pricing of caffeine. Semin Fetal Neonatal Med. 2020 12; 25(6):101179. View Abstract
  28. Neonates in the COVID-19 pandemic. Pediatr Res. 2021 04; 89(5):1038-1040. View Abstract
  29. Quantifying the Where and How Long of Newborn Care. Pediatrics. 2020 08; 146(2). View Abstract
  30. International comparison of guidelines for managing neonates at the early phase of the SARS-CoV-2 pandemic. Pediatr Res. 2021 03; 89(4):940-951. View Abstract
  31. Using Neonatal Intensive Care Units More Wisely for At-Risk Newborns and Their Families. JAMA Netw Open. 2020 06 01; 3(6):e205693. View Abstract
  32. A trial comparing continuous positive airway pressure (CPAP) devices in preterm infants. J Perinatol. 2020 08; 40(8):1193-1201. View Abstract
  33. Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers. Pediatrics. 2020 08; 146(2). View Abstract
  34. Ten-year trends in infant neuroimaging from US Neonatal Intensive Care Units. J Perinatol. 2020 09; 40(9):1389-1393. View Abstract
  35. Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. Br J Psychiatry. 2020 04; 216(4):189-196. View Abstract
  36. Evaluation of the economic impact of modified screening criteria for retinopathy of prematurity from the Postnatal Growth and ROP (G-ROP) study. J Perinatol. 2020 07; 40(7):1100-1108. View Abstract
  37. Estimates of healthcare spending for preterm and low-birthweight infants in a commercially insured population: 2008-2016. J Perinatol. 2020 07; 40(7):1091-1099. View Abstract
  38. A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns. Pediatrics. 2019 12; 144(6). View Abstract
  39. Cost-effectiveness of Antenatal Corticosteroid Therapy vs No Therapy in Women at Risk of Late Preterm Delivery: A Secondary Analysis of a Randomized Clinical Trial. JAMA Pediatr. 2019 05 01; 173(5):462-468. View Abstract
  40. Evaluating the efficacy of Seattle-PAP for the respiratory support of premature neonates: study protocol for a randomized controlled trial. Trials. 2019 Jan 18; 20(1):63. View Abstract
  41. Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations. Pediatrics. 2018 12; 142(6). View Abstract
  42. Factors influencing decision making in neonatology: inhaled nitric oxide in preterm infants. J Perinatol. 2019 01; 39(1):86-94. View Abstract
  43. Predicting Successful Neonatal Retro-Transfer to a Lower Level of Care. J Pediatr. 2019 02; 205:272-276.e1. View Abstract
  44. Burdens Beyond Biology for Sick Newborn Infants and Their Families. Clin Perinatol. 2018 09; 45(3):557-563. View Abstract
  45. The cost of necrotizing enterocolitis in premature infants. Semin Fetal Neonatal Med. 2018 12; 23(6):416-419. View Abstract
  46. Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low Birth Weight Infants. Pediatrics. 2018 03; 141(3). View Abstract
  47. Value-based care: the preference of outcome over prediction. J Pediatr. 2018 05; 196:330-331. View Abstract
  48. Do trials reduce uncertainty? Assessing impact through cumulative meta-analysis of neonatal RCTs. J Perinatol. 2017 11; 37(11):1215-1219. View Abstract
  49. Improving Value in Neonatal Intensive Care. Clin Perinatol. 2017 09; 44(3):617-625. View Abstract
  50. Network analysis: a novel method for mapping neonatal acute transport patterns in California. J Perinatol. 2017 06; 37(6):702-708. View Abstract
  51. Longer and deeper cooling for hypoxic ischemic encephalopathy in neonates does not reduce mortality. Acta Paediatr. 2017 07; 106(7):1200. View Abstract
  52. Should we believe in transfusion-associated enterocolitis? Applying a GRADE to the literature. Semin Perinatol. 2017 02; 41(1):80-91. View Abstract
  53. Clinical and Cost Impact Analysis of a Novel Prognostic Test for Early Detection of Preterm Birth. AJP Rep. 2016 Oct; 6(4):e407-e416. View Abstract
  54. Prospective economic evaluation alongside the non-invasive ventilation trial. J Perinatol. 2017 01; 37(1):61-66. View Abstract
  55. Evidence, Quality, and Waste: Solving the Value Equation in Neonatology. Pediatrics. 2016 Mar; 137(3):e20150312. View Abstract
  56. "Waste not, want not", or the cost of doing the wrong thing. J Pediatr (Rio J). 2016 Jan-Feb; 92(1):1-3. View Abstract
  57. Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value. Pediatrics. 2015 Aug; 136(2):e482-9. View Abstract
  58. Resource distribution in neonatology: beyond the Pareto principle. Arch Dis Child Fetal Neonatal Ed. 2015 Nov; 100(6):F472-3. View Abstract
  59. A risk-adjusted, composite outcomes score and resource utilization metrics for very low-birth-weight infants. JAMA Pediatr. 2015 May; 169(5):459-65. View Abstract
  60. Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness: a randomized clinical trial. JAMA. 2014 Dec 24-31; 312(24):2640-8. View Abstract
  61. Baby-MONITOR: a composite indicator of NICU quality. Pediatrics. 2014 Jul; 134(1):74-82. View Abstract
  62. DoMINO: Donor milk for improved neurodevelopmental outcomes. BMC Pediatr. 2014 May 13; 14:123. View Abstract
  63. Stratification of risk of early-onset sepsis in newborns = 34 weeks' gestation. Pediatrics. 2014 Jan; 133(1):30-6. View Abstract
  64. Developing a quality and safety curriculum for fellows: lessons learned from a neonatology fellowship program. Acad Pediatr. 2014 Jan-Feb; 14(1):47-53. View Abstract
  65. Nurse-to-patient ratios and neonatal outcomes: a brief systematic review. Neonatology. 2013; 104(3):179-83. View Abstract
  66. Prospective economic evaluation of a peer support intervention for prevention of postpartum depression among high-risk women in Ontario, Canada. Am J Perinatol. 2013 Sep; 30(8):631-42. View Abstract
  67. Correlation of neonatal intensive care unit performance across multiple measures of quality of care. JAMA Pediatr. 2013 Jan; 167(1):47-54. View Abstract
  68. Do transfusions cause necrotizing enterocolitis? The complementary role of randomized trials and observational studies. Semin Perinatol. 2012 Aug; 36(4):269-76. View Abstract
  69. Variations in definitions of mortality have little influence on neonatal intensive care unit performance ratings. J Pediatr. 2013 Jan; 162(1):50-5.e2. View Abstract
  70. The effect of telephone-based interpersonal psychotherapy for the treatment of postpartum depression: study protocol for a randomized controlled trial. Trials. 2012 Apr 19; 13:38. View Abstract
  71. Relationship between attrition and neurodevelopmental impairment rates in extremely preterm infants at 18 to 24 months: a systematic review. Arch Pediatr Adolesc Med. 2012 Feb; 166(2):178-84. View Abstract
  72. Neonatal intensive care unit discharge preparedness: primary care implications. Clin Pediatr (Phila). 2012 May; 51(5):454-61. View Abstract
  73. The impact of maternal characteristics on the moderately premature infant: an antenatal maternal transport clinical prediction rule. J Perinatol. 2012 Jul; 32(7):532-8. View Abstract
  74. Development and pretesting of a decision-aid to use when counseling parents facing imminent extreme premature delivery. J Pediatr. 2012 Mar; 160(3):382-7. View Abstract
  75. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011 Nov; 128(5):e1155-63. View Abstract
  76. Economic evaluation alongside the Premature Infants in Need of Transfusion randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2012 Mar; 97(2):F93-8. View Abstract
  77. Survival rates in extremely low birthweight infants depend on the denominator: avoiding potential for bias by specifying denominators. Am J Obstet Gynecol. 2011 Oct; 205(4):329.e1-7. View Abstract
  78. Formal selection of measures for a composite index of NICU quality of care: Baby-MONITOR. J Perinatol. 2011 Nov; 31(11):702-10. View Abstract
  79. Health state preferences associated with weight status in children and adolescents. BMC Pediatr. 2011 Feb 07; 11:12. View Abstract
  80. Prematurity: an overview and public health implications. Annu Rev Public Health. 2011; 32:367-79. View Abstract
  81. Variation in diagnosis of apnea in moderately preterm infants predicts length of stay. Pediatrics. 2011 Jan; 127(1):e53-8. View Abstract
  82. Economic evaluation of caffeine for apnea of prematurity. Pediatrics. 2011 Jan; 127(1):e146-55. View Abstract
  83. Clinical benefits, costs, and cost-effectiveness of neonatal intensive care in Mexico. PLoS Med. 2010 Dec 14; 7(12):e1000379. View Abstract
  84. Patient-to-nurse ratios and outcomes of moderately preterm infants. Pediatrics. 2010 Feb; 125(2):320-6. View Abstract
  85. Interinstitutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants. Pediatrics. 2009 Nov; 124(5):e1001-6. View Abstract
  86. Economic evaluation of inhaled nitric oxide in preterm infants undergoing mechanical ventilation. Pediatrics. 2009 Nov; 124(5):1325-32. View Abstract
  87. Are families prepared for discharge from the NICU? J Perinatol. 2009 Sep; 29(9):623-9. View Abstract
  88. Economic evaluation of recombinant human copper zinc superoxide dismutase administered at birth to premature infants. J Perinatol. 2009 May; 29(5):364-71. View Abstract
  89. Are we satisfied with the way we review an article? Adv Neonatal Care. 2009 Feb; 9(1):40-2. View Abstract
  90. Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial. BMJ. 2009 Jan 15; 338:a3064. View Abstract
  91. Cost-effectiveness of early treatment for retinopathy of prematurity. Pediatrics. 2009 Jan; 123(1):262-9. View Abstract
  92. The economics of elective cesarean section. Clin Perinatol. 2008 Sep; 35(3):591-9, xii. View Abstract
  93. Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care. A North American perspective. Semin Fetal Neonatal Med. 2008 Oct; 13(5):335-40. View Abstract
  94. CoolSim: using industrial modeling techniques to examine the impact of selective head cooling in a model of perinatal regionalization. Pediatrics. 2008 Jan; 121(1):28-36. View Abstract
  95. Implementing pay-for-performance in the neonatal intensive care unit. Pediatrics. 2007 May; 119(5):975-82. View Abstract
  96. Neonatal intensive care unit census influences discharge of moderately preterm infants. Pediatrics. 2007 Feb; 119(2):314-9. View Abstract
  97. Resuscitation and ventilation strategies for extremely preterm infants: a comparison study between two neonatal centers in Boston and Stockholm. Acta Paediatr. 2007 Jan; 96(1):10-6; discussion 8-9. View Abstract
  98. Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network. Pediatrics. 2007 Jan; 119(1):e156-63. View Abstract
  99. Early labor assessment and support at home versus telephone triage: a randomized controlled trial. Obstet Gynecol. 2006 Dec; 108(6):1463-9. View Abstract
  100. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006 Jul; 91(4):F238-44. View Abstract
  101. Retrospective economic evaluation of a controlled trial of indomethacin prophylaxis for patent ductus arteriosus in premature infants. Early Hum Dev. 2006 Feb; 82(2):97-103. View Abstract
  102. Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom. Arch Dis Child Fetal Neonatal Ed. 2006 Jul; 91(4):F245-50. View Abstract
  103. Prenatal consultation practices at the border of viability: a regional survey. Pediatrics. 2005 Aug; 116(2):407-13. View Abstract
  104. Trends in severe bronchopulmonary dysplasia rates between 1994 and 2002. J Pediatr. 2005 Apr; 146(4):469-73. View Abstract
  105. Richardson score predicts short-term adverse respiratory outcomes in newborns >/=34 weeks gestation. J Pediatr. 2004 Dec; 145(6):754-60. View Abstract
  106. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr. 2004 Jun; 144(6):799-803. View Abstract
  107. Internet use and perceptions of information reliability by parents in a neonatal intensive care unit. J Perinatol. 2003 Jul-Aug; 23(5):420-4. View Abstract
  108. Daily cost prediction model in neonatal intensive care. Int J Technol Assess Health Care. 2003; 19(2):330-8. View Abstract
  109. Cost-effectiveness analysis of predischarge monitoring for apnea of prematurity. Pediatrics. 2003 Jan; 111(1):146-52. View Abstract
  110. Characterization of neonatal personnel time inputs and prediction from clinical variables--a time and motion study. J Perinatol. 2002 Dec; 22(8):658-63. View Abstract
  111. Characterising doctor-parent communication in counselling for impending preterm delivery. Arch Dis Child Fetal Neonatal Ed. 2002 Sep; 87(2):F113-7. View Abstract
  112. Cost-effectiveness and choice of infant transport systems. Med Care. 2002 Aug; 40(8):705-16. View Abstract
  113. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr. 2001 Aug; 139(2):220-6. View Abstract
  114. A critical review of cost reduction in neonatal intensive care. I. The structure of costs. J Perinatol. 2001 Mar; 21(2):107-15. View Abstract
  115. A critical review of cost reduction in neonatal intensive care. II. Strategies for reduction. J Perinatol. 2001 Mar; 21(2):121-7. View Abstract
  116. Economics of prematurity in the era of managed care. Clin Perinatol. 2000 Jun; 27(2):483-97. View Abstract
  117. Cost-effectiveness and implications of newborn screening for prolongation of QT interval for the prevention of sudden infant death syndrome. J Pediatr. 2000 Apr; 136(4):481-9. View Abstract
  118. Characterization of the triage process in neonatal intensive care. Pediatrics. 1998 Dec; 102(6):1432-6. View Abstract
  119. Informed consent for randomised controlled trials in neonates. Arch Dis Child Fetal Neonatal Ed. 1998 Mar; 78(2):F156-7. View Abstract
  120. Determinants of parental authorization for involvement of newborn infants in clinical trials. Pediatrics. 1997 Jan; 99(1):E6. View Abstract
  121. Intussusception in a child with cytomegalovirus infection. Pediatr Infect Dis J. 1994 Jun; 13(6):548-9. View Abstract
  122. Home esophageal self-dilatation in children. Gastroenterol Nurs. 1993 Aug; 16(1):5-8. View Abstract
  123. Dangerous economics: resource allocation in the NICU. CMAJ. 1992 Mar 15; 146(6):1073-6. View Abstract

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