Journal of Perinatology最新文献

Objective: Determine the impact of standardization of care and counseling on survival and morbidities of neonates born at 22-23 weeks gestation.

Design: Retrospective cohort study of 244 neonates born at 22-23 weeks gestation between 2015 and 2023 in a large healthcare system. The primary outcome was survival of neonates receiving intensive care to NICU discharge. Secondary outcomes included morbidities and resource utilization.

Results: Neonates born at 22-23 weeks received more intensive care after care standardization (OR 5.4 (95% CI 2.3-12.6), p < 0.0001). Survival remained stable (aOR 0.93 (95% CI 0.32-2.7), p = 0.89) despite more neonates born at 22 weeks receiving intensive care. Resource utilization remained stable.

Conclusions: Standardizing counseling and care increased the provision of antenatal steroids and intensive care for neonates born at 22 weeks gestation. This allowed neonates born at 22 weeks to survive to discharge without increasing morbidity and resource utilization.

Recent changes in pediatric residency curriculum require reductions in the duration of NICU rotations. Low interest in pediatrics among medical students coupled with reduced exposure to neonatology during residency are likely to decrease applications to neonatology fellowships. We propose a separate neonatal critical care residency combining 1-2 years of pediatrics followed by 3 years of neonatology rotations (total 4-5 years) to enhance recruitment. There is also a need to reengage the neonatology community to be role models and inspire and attract medical students to neonatology. Academic neonatology is facing a crisis. Long hours, high productivity expectations, and significantly lower compensation compared to non-academic settings is contributing to physician disengagement. A transparent cFTE definition, better governing structure, strategic allocation of resources to recruit, retain and nurture neonatal physician-scientists and engaged clinician-educators are needed. If these measures are not effective, a separate department of neonatal critical care medicine should be considered.

Objective: To evaluate feasibility and efficacy of early exclusive enteral feeding (EEEF) in reducing time to achieve full enteral feeds.

Methods: A pragmatic randomized controlled trial of infants born at 30^0/7-33^6/7 weeks gestation. Infants were randomly assigned to receive EEEF (60-80 mL/kg/day) or conventional feeding (20-30 mL/kg/day) with intravenous fluids after birth. Feed volumes were increased by 20-30 mL/kg/day. Primary outcome was time to reach full enteral feeds.

Results: Seventy infants were enrolled. Infants in EEEF group achieved full feeds sooner [Mean difference (MD) -1.2 (95%CI -1.8, -0.7)], required fewer hours of parenteral nutrition [0 (IQR 0, 19) vs. 91 (IQR 48, 132) hours, P < 0.001], had less need for central venous access (11.4% vs. 37.1%, P = 0.01) and had shorter hospital stays [MD -6.6 (95%CI -12.9, -0.2) days].

Conclusion: Early exclusive enteral feeding in 30^0/7-33^6/7 weeks gestation infants is feasible and reduces time required to achieve full enteral feeds and length of hospital stay.

Trial registration: ClinicalTrials.gov: NCT03708068.

Neonatal-perinatal medicine (NPM) fellowship training aims to educate fellows and enable them to move into successful independent neonatal practice. To reach this goal, every fellow must acquire a wide range of clinical, scholarly, and professional skills that require assessment and evaluation by the fellowship program. The assessment and evaluation of fellow progression and promotion must rely on a rigorous educational framework. The goal of this article is to illustrate the process of NPM fellow assessment and evaluation, introduce the educational framework utilized, describe challenges inherent to the process, and discuss opportunities to improve how NPM fellows are evaluated.

Objective: Evaluate the changes in management and outcomes of Californian infants with hypoxic ischemic encephalopathy (HIE).

Study design: Infants with HIE were identified from a California administrative birth cohort using ICD codes and divided into two epochs, Epoch 1 (2010-2015) and Epoch 2 (2016-2019). Risk ratios (RR) for induced hypothermia (IH) in each epoch and their outcomes were calculated using log-linear regression.

Results: In this cohort, 4779 infants with HIE were identified. Incidence of HIE in California increased yearly from 0.5/1000 California births to a peak of 1.5/1000 births in 2018. The use of IH in infants with mild HIE increased in Epoch 2 compared to Epoch 1. There was no significant difference in outcomes between epochs for infants with mild HIE that received IH including no difference in neonatal seizures.

Conclusion: Significantly more infants with mild HIE received IH since 2015 in California, but no significant difference in outcomes.

The perinatal period is associated with high antibiotic exposure, which raises concerns about antimicrobial resistance (AMR) and future health impacts. The aim of this comprehensive systematic review, including publications from 2000 to 2022, is to describe the current evidence and state of antimicrobial stewardship (AMS) in the perinatal period and to identify gaps in knowledge for future research. The review included 36 studies from the Americas, Europe, Asia and Australia, involving a total of 64,798 pregnant women and 84,137 newborns. 33 out of 36 studies reported reduced antibiotic use, suggesting the potential to reduce antibiotic exposure. There is a lack of studies in the antepartum and intrapartum periods, of comprehensive AMS strategies across the entire perinatal period, and from low- and middle-income countries with a high burden of maternal and neonatal morbidity and mortality. Future research should include prospective, adequately powered studies including safety endpoints, clinical outcomes and AMR reports.

Background: Training with high-technology manikins improves cardio-pulmonary resuscitation (CPR) skill retention, but a checklist to assess both technical and non-technical skills is lacking. This study aimed to develop a standardized checklist to evaluate healthcare's performance during simulated Neonatal Resuscitation Program (NRP) scenarios.

Materials and methods: Twenty-two international neonatal resuscitation experts participated in a two-step modified Delphi process, rating each checklist item on a scale of 1-5 and providing feedback. Items with a mean rating below 4 or receiving comments were reviewed. Inter-rater reliability (IRR) of the final tool was assessed using video-recordings of simulated scenarios.

Results: The final checklist, validated by 15 experts, includes 33 items. Mean expert rating of all items was 4.35. The checklist showed moderate inter-rater reliability (ICC = 0.67) overall, with excellent reliability (ICC = 0.8) for technical skills.

Conclusion: The tool effectively evaluates technical skills but requires further refinement for non-technical skills assessment.

Objective: To characterize long-term feeding outcomes in infants who underwent tracheostomy prior to their first birthday.

Study design: Retrospective review of feeding outcomes at initial hospital discharge and age 5 in a cohort of infants who underwent tracheostomy at a children's hospital over a 16-year period.

Results: 145 infants met inclusion criteria. In this cohort, 117 were feeding tube dependent at time of initial hospital discharge and 71 were feeding tube dependent age 5. Cardiovascular comorbidities (p = 0.009), long-term tracheostomy dependence (p < 0.001), higher birth weight (p = 0.011), older age at tracheostomy decannulation (p < 0.001) and older gestational age (p = 0.007) were factors associated with feeding tube dependence at age 5.

Conclusion: The long-term feeding outcomes of infants who require tracheostomy demonstrate high levels of feeding impairment at age 5.

Objective: To evaluate the effect of age correction up to 36 months of age for growth assessments of extremely preterm (<28 weeks) and very preterm (28 to <32 weeks) infants.

Study design: This longitudinal analysis used data from the Preterm Infant Multicenter Growth Study (2001-2014).

Results: 1,416 children were included (Median gestational age = 27 weeks). Chronological age-based weight, height, and head circumference z-scores were consistently lower than those based on corrected age for all ages (0, 4, 8, 21 and 36 months) by up to -5.2 (95% confidence interval -5.4, -5.1) z-scores for length at term. Using chronological age, higher proportions of children were misclassified as having suboptimal growth (up to 72.9% misdiagnosed as stunted and 89.8% misdiagnosed as underweight at term).

Conclusion: For extremely and very preterm children, age correction is required for all growth measures through 36 months of corrected age.

Objective: The aim of this study was to examine the predictive value of the lung ultrasound score (LUS) for successful extubation in preterm infants born at ≤25⁺⁶ weeks.

Methods: This was a single-center, prospective cohort study. Preterm infants with gestational age (GA) ≤ 25⁺⁶ weeks who received invasive mechanical ventilation (IMV) for ≥72 h were included. Lung ultrasound was performed every day. Multivariate logistic regression analysis was used to evaluate factors that predict extubation outcomes.

Results: Ninety-three infants with GA ≤ 25⁺⁶ weeks were included. The mean GA was 24.5 ± 1.2 weeks. Extubation failure occurred in 55 (59.1%) neonates, and success occurred in 38 (40.9%) neonates. The LUS was significantly lower in the successful group than in the failed group (24.0 ± 2.5 vs. 32.1 ± 3.1 p < 0.001). Logistic regression analysis showed that LUS was an independent predictor of successful extubation (odd ratio 0.15 [95% CI 0.045-0.508], P = 0.002). The area under the receiver operating characteristic curve was 0.98 (p < 0.001) for LUS, and a cutoff value of ≥ 28 had 94.6% sensitivity and 92.7% specificity in detecting extubation failure.

Conclusion: The LUS has good accuracy for predicting successful extubation in extremely preterm infants with GA ≤ 25⁺⁶ weeks.