Journal of Perinatology最新文献

Objective: To study duration of hemodynamically significant patent ductus arteriosus (HPDA) exposure increases the risk of late acute kidney injury (AKI) and severity of AKI.

Study design: This was a single-center retrospective cohort study. Included infants born between 22 and 28.6 weeks' gestation with >1 echocardiographic finding for HPDA were stratified by HPDA duration: 4-7 weeks, 8-11 weeks, and greater than 12 weeks. AKI was determined utilizing KDIGO AKI criteria. Logistic regression analysis was used to evaluate odds ratios of each HPDA exposure groups for any AKI and severe (stage 2 or 3) AKI.

Results: Among the 216 infants, 39(18%) developed AKI and 27(13%) developed severe AKI. Infants exposed to ≥12 weeks of HPDA exposure had a 3.96 (95% CI 1.32-11.87) higher odds of AKI, which was nonsignificant after adjustment for gestational age (aOR 2.37; 95% CI 0.72-7.78).

Conclusion: Whether longer HPDA exposure increases risk for AKI development requires further investigation from trials of late PDA closure.

Objectives: To explore the clinical and hemodynamic effects of sildenafil in extreme premature population with bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH).

Study design: Single-centre retrospective study on infants born <28 weeks with BPD-PH on sildenafil. The respiratory severity score was assessed at four time points (72 h-4wks). Echocardiographic data were compared before and after sildenafil.

Results: Sixty-four infants were included. The mean gestational age was 26.1 ± 1.6 weeks. 30(47%) infants showed improvement in RSS, 17(26%) had no change and 17(26%) showed poor RSS. 15(88) in the poor RSS group had an early onset PH. The improved RSS group reduced tricuspid regurgitation (3.3 ± 0.6 to 2.7 ± 0.5 m/s, p = 0.007). The pulmonary acceleration time (PAAT), PAAT/RVET (right ventricular ejection time), and RV fractional area change showed improvement in all groups. The poor RSS group had high pretreatment systolic blood pressure (90.7 ± 8.8 vs 82.7 ± 4.4 mmHg, p = 0.04).

Conclusion: Variable clinical response to sildenafil warrants close monitoring of respiratory status.

Objective: To assess racial and ethnic disparities in birth weight (BW), time to BW regain, and mean growth velocity during the accelerated weight gain phase.

Study design: A retrospective study was conducted using a de-identified dataset from the Pediatrix Medical Group from 2010 to 2020. The dataset categorizes infants into five racial and ethnic groups: Asian, Hispanic, Black, White, and Other, based on maternal report. The study included infants born between 23 and 29 weeks' gestation and excluded infants without weight data.

Results: This study included 76,145 infants. Antenatal confounders were balanced using inverse propensity weighting. Black infants had lowest, while Hispanic infants had higher BW z-scores, when compared to White infants. Black infants took the shortest time to regain BW. Hispanic infants had the lowest mean growth velocity.

Conclusion: Racial and ethnic disparities in postnatal growth of infants born before 30 weeks of gestation manifest differently across growth phases.

Objective: To understand characteristics associated with additional operative encounters following tracheostomy to inform the timing of gastrostomy tube (GT) placement in neonates.

Study design: Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) and including neonates who underwent tracheostomy with either concurrent or subsequent GT from 1/2015-12/2022. The primary outcome was the number of subsequent operative encounters following tracheostomy. Bivariate analysis and logistic regression assessed for patient characteristics associated with subsequent operative encounters.

Results: Of 2395 neonates, 1693 (71%) underwent concurrent procedures, and 702 (29%) underwent initial tracheostomy alone with subsequent GT (p < 0.001). The median number of operative encounters for the entire cohort following tracheostomy was 3 events (IQR 1-6). Infants with prematurity, cardiac valve malformations, and pulmonary hypertension were more likely to have additional operative encounters.

Conclusion: Neonates born prematurely with cardiovascular comorbidities will likely return to the operating room after tracheostomy placement, presenting an opportunity for GT placement.

Objective: Study the association of residential distance in the context of other socioeconomic factors with the availability of maternal breast milk (MBM) to reduce barriers and improve outcomes for very low birthweight preterm infants.

Study design: This prospective cohort study analyzed demographic, socioeconomic, and clinical data from 300 maternal-preterm infant dyads with infants born <1500 g. Data included residential distance from the hospital, comorbidities, and infant MBM intake measured as a percentage of total enteral intake.

Results: Bivariate analysis revealed that maternal race, median income by zip code, marital status, and residential distance were significantly associated with MBM intake. In a multivariate regression model, only residential distance and marital status remained significant predictors, with greater distance from the hospital and marriage status associated with higher MBM intake.

Conclusion: Residential distance from the studied hospital was not a significant barrier to breastfeeding. Hospitals need to examine their own barriers to breastfeeding.

Objective: Diazoxide is used to treat infants with persistent hyperinsulinemic hypoglycemia. While recent studies have highlighted its adverse effects and variable usage, further characterization is needed. We report the demographic and clinical characteristics of infants exposed to diazoxide across NICUs.

Study design: Cohort study including infants born 24-41 weeks gestation and admitted to 345 NICUs from 2017-2022. Comparisons were made between hypoglycemic infants exposed to diazoxide and those not, collecting data on adverse events and additional therapies.

Results: Among 545,065 infants, 22% were diagnosed with hypoglycemia, and 0.16% were exposed to diazoxide. Diazoxide use remained stable, with variability across NICUs (0-16%). Among infants exposed to diazoxide, 13% started new diuretic courses, 10% had new oxygen supplementation, and 3% needed ventilator support.

Conclusions: Diazoxide use in NICUs has remained stable over time. Although some infants received additional therapies, namely diuretics, most were able to discontinue diazoxide prior to discharge.

Objective: Evaluate the impact of prenatal workshops for parents whose baby would be admitted to the NICU because of prematurity or congenital anomalies.

Study design: The workshop was developed and optimized in a needs assessment and pilot phase. During the prospective phase, future NICU parents were offered participation in the workshop; their perspectives were investigated using mixed methods.

Results: A total of 152 parents participated. They evaluated the workshop at 9.6/10 on average. Almost all (98%) agreed/strongly agreed that the workshop was useful, that it helped them prepare for the birth (95%), made them feel less lonely (90%) and that exchanges with other parents were beneficial (92%). All answers to open-ended questions were positive. After the birth, 90% remembered the workshop and 90% would recommend it to other parents.

Conclusion: Prenatal educational workshop provides a unique and useful means to support future NICU parents and prepare them for the NICU hospitalization.

Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in preterm infants, leading to high mortality and long-term complications. Probiotics have been extensively studied and shown in multiple randomized trials and meta-analyses to significantly reduce the incidence of severe NEC, all-cause mortality, and late-onset sepsis. Despite strong evidence and international guidelines supporting their use, probiotic administration in US neonatal intensive care units has sharply declined following a 2023 FDA advisory. The FDA cited safety concerns, lack of product quality control, and the unapproved drug status of probiotics as reasons for this warning. This paper reviews the compelling evidence for probiotic efficacy, examines the FDA's rationale, and contrasts US policy with global practices. It highlights the risk-benefit imbalance of withholding probiotics, analyzes the resulting clinical dilemma, and proposes a path forward through regulatory reform, ongoing research, and stakeholder collaboration to ensure access to this potentially life-saving intervention for preterm infants.