Journal of Perinatology最新文献

Objective: To decrease the time to achieve a reliable EKG signal in the delivery room from 102 s to 60 s.

Methods: Single center quality improvement (QI) initiative in a Fetal Care Center Special Delivery Unit (SDU) from May 2023 to March 2024. Key drivers were identified and PDSA cycles were performed; interventions included purchasing new leads, implementation of a new lead placement process, and institution of a Delivery Room Time Out. Time to reliable EKG signal and effective positive pressure ventilation (PPV) were monitored using run charts with data obtained from review of routine video recordings of resuscitation.

Results: Median time to EKG signal decreased from 102 to 58 s. Median time to effective PPV decreased from 92 to 44 s.

Conclusions: We successfully obtained EKG signals within 60 s in the delivery room; ongoing education was necessary to sustain this improvement.

Objective: The Ethiopian Newborn Quality Improvement (EN-QI) Extension for Community Healthcare Outcomes (ECHO) promoted the implementation of Helping Babies Survive training in eight Ethiopian health facilities. The initiative incorporated U.S based Neonatal-Perinatal Medicine (NPM) fellows into the ECHO Expert Hub. This study evaluates the experiences of the NPM fellows.

Study design: This mixed-methods study incorporated objective data, survey responses, and qualitative focus group analysis from the eight participating fellows.

Results: Fellows described benefits including mentoring, networking, career development, and quality improvement experience. Their experience would have been improved with more thorough onboarding and clarification of the fellow role at the start of the project.

Conclusion: This study demonstrates a model for inclusion of fellows in a virtual partnership as a low-cost and high value approach to global health work. This project was well-received and highly valued by fellows as a meaningful training opportunity.

Objective: To determine if implementing the revised 2022 AAP hyperbilirubinemia guidelines had an impact on post-discharge clinic visits and Neonatal Intensive Care Unit readmissions related to hyperbilirubinemia.

Methods: A single-center retrospective study at a birth hospital including a level III NICU. Data was collected on all newborns, who were born at 35 weeks or more gestational age, (inborn and outborn infants), one year before (September 2021-August 2022, period 1) and one year after (September 2022-August 2023, period 2) the implementation of the revised AAP clinical guidelines. Patient charts were reviewed to collect demographic information, serial bilirubin levels, use of phototherapy, discharge bilirubin levels, bilirubin checks as an outpatient, and readmission secondary to hyperbilirubinemia.

Results: A total of 1577 infants were included in our study. Period 1 had 763 infants and period 2 had 814 infants. In period 2, there was a statistically significant decrease in the rate of hyperbilirubinemia diagnosis by 6.6%, a reduction in the use of phototherapy before discharge by 8.4%, and a reduction in the number of TSB checks >6 in the first week of postnatal life by about 4%. Importantly, there was no increase in post-discharge clinic visits for hyperbilirubinemia or readmission rate in period 2.

Conclusion: Implementation of the 2022 revised AAP guidelines for neonatal hyperbilirubinemia led to reduced diagnosis, phototherapy use during birth hospitalization and fewer TSB checks in the first week of life, without increasing readmission rates or post-discharge clinic visits for jaundice.

Background: Intermittent hypoxemia events (IH) in preterm infants may alter airway function manifesting as childhood wheezing.

Objective: Characterize the relationship between IH (first month of life) and wheezing through 12/24 months corrected age.

Study design: IH < 80% and <90% and number of wheezing episodes were documented in infants <31 weeks gestation discharged prior to and during COVID-19 social isolation.

Results: A greater % time with hypoxemia was associated with increased rates of wheezing through 12 months in infants discharged during COVID-19, (IRRs ranging from 1.07 to 1.32, IH < 80 and 90%, all p < 0.05) and through 24 months in infants <28wks GA discharged during COVID-19 isolation (IRRs, 1.03-1.25, IH < 80 and 90%, all p < 0.05).

Conclusion: Associations were seen between IH and wheezing at 12 and 24 months of age predominantly in infants discharged during COVID-19 isolation. No associations were seen through 12 months corrected age in infants discharged during the Pre COVID-19 epoch.

Objective: This study aimed to compare the concentrations of ten metals in meconium samples from an urban and a suburban hospital in New York State.

Study design: A cross-sectional study was conducted on mother-child pairs. Meconium metal concentrations were quantified using inductively coupled plasma mass spectrometry (ICP-MS) and samples were compared using Wilcoxon rank-sum tests. Additionally, a scoping review was conducted to compare literature concentrations.

Results: The findings of the cross-sectional study indicated significantly higher levels of toxic metals, lead, and cadmium (p < 0.05), in the urban samples, but higher copper, chromium, iron, and molybdenum (p < 0.001) were identified in suburban samples. The scoping review identified studies in low and high pollution areas. Our study findings were comparable with the results from low pollution locations.

Conclusion: Understanding metal concentrations in newborns, both toxic and nutritionally necessary, from different geographic areas is an important step in the assessment of prenatal exposure.

Objective: To identify nursing and parent-perceived barriers and facilitators to adherence to safe sleep practices in a level IV NICU.

Study design: 20 NICU nurses and 10 parents of infants who were hospitalized in a level IV NICU within the past year participated in this qualitative study. Themes from coded interview transcripts were identified utilizing deductive thematic analysis.

Results: Barriers and facilitators to safe sleep practices spanned across individual-, unit-, and community-levels. The significance of cultural preferences and traditions, hands-on practice and direct modeling, developmental positioning tools and reflux precautions, inter-team communication and consistency, different learning styles, and caregiver stress associated with NICU stays emerged as key themes.

Conclusion: We identified several barriers and facilitators of effective safe sleep modeling in the NICU from both nursing and parent perspectives. These insights will help to inform a collaborative, family-centered, and sustainable approach to integrating safe sleep practices in the NICU.

Perinatal asphyxia is a critical event causing variable degrees of multiorgan dysfunction. Hypoxemic ischemic encephalopathy (HIE) features the brain exposure to asphyxia, and most of the underlying pathophysiology is a related to impaired blood flow and oxygen delivery to the brain. Cardiovascular compromise is common in this context and often necessitates initiation of inotropic support. In this article, we highlight the neonatal hemodynamics and its derangements, following asphyxia, and we highlight the pitfalls in the current hemodynamic approach.