Journal of Perinatology最新文献

Objective: Assess postpartum care attendance among parents of infants in a large, urban, children's hospital level IV NICU with an on-site delivery unit.

Study design: 86 postpartum parents of infants continuously hospitalized ≥six weeks and

Results: 26 (30%) did not attend a postpartum visit by six weeks, significantly more common among parents of transferred (41%) than parents of (10%) inborn infants (aRR 4.5, 95% CI: 1.3-15.6). Health concerns were common in both groups.

Conclusion: Parents of transferred infants had a higher risk of not attending a postpartum visit by six weeks compared to parents of inborn infants, highlighting the need for children's hospitals to measure and address postpartum healthcare gaps.

Objective: To evaluate the effectiveness of implementing American Academy of Pediatrics (AAP) discharge guidelines in reducing unplanned hospital readmissions within 30 days post-discharge among term ansd late preterm newborns.

Study design: Retrospective observational study analyzing unplanned readmissions at a single-center neonatal unit from January 1, 2021, to December 31, 2024. Data were compared before (January 1, 2021-June 30, 2022) and after (July 1, 2022-December 31, 2024) guideline implementation, with subgroup analysis for the period after addition of structured support (July 1, 2023-December 31, 2024).

Result: AAP guideline implementation was associated with a statistically significant reduction in unplanned readmission rates among term infants (0.66% vs. 0.33%; P = 0.008). No reduction was evident among late preterm infants. Subgroup analysis showed further reductions post-structured support addition, though confounding by provider changes limits attribution.

Conclusion: The adoption of the AAP discharge guidelines, along with a structured process of mother and infant readiness, significantly decreassed unplanned readmission rates among term newborns.

Neonatal brain MRI is standard of care for neuroimaging in infants with neonatal encephalopathy (NE); no international consensus exists on scoring systems to predict neurodevelopmental outcomes. This systematic review evaluates the predictive performance of existing neonatal MRI scoring systems for NE. Cochrane and PRISMA guidelines were adhered to and the study was registered with PROSPERO. Key outcomes included MRI scoring correlation in infants born at ≥36 weeks with neurodevelopmental outcomes. Of 1525 studies retrieved, and 16 met the inclusion criteria, totalling 1925 participants with follow-up data. Scoring systems evaluated included NICHD, Rutherford, Weeke, Trivedi, Barkovich, and one newly developed score. Fifteen studies found an association with outcomes; one found no correlation with IQ or typical development. All MRI scoring systems have similar predictive accuracy. Simpler systems, such as NICHD, performed on par with more complex counterparts, suggesting they may offer a more efficient option in clinical settings.

Objectives: To investigate the effects of maternal guilt on depression, anxiety, and stress among mothers of infants in neonatal intensive care units, and to explore the moderating roles of parity, type of delivery, and sex of the baby.

Method: The study was conducted with 332 mothers in a training and research hospital in Türkiye. Direct and moderating effects among variables were tested using Model 1 of the PROCESS macro v4.

Results: The analysis revealed that maternal guilt had a significant positive direct effect on levels of depression, anxiety, and stress. The parity, type of delivery, and sex of the baby were found to moderate the impact of guilt on stress. In contrast, only the type of delivery moderated the effect of guilt on anxiety.

Conclusion: The results may contribute to the development of targeted interventions aimed at improving the mental health of mothers with babies in neonatal intensive care units.

Objective: To quantify inter-center variation (ICV) in non-elective removal (NER) of central venous catheters (CVCs) in level 4 Neonatal Intensive Care Units (NICUs).

Study design: Using the Children's Hospitals Neonatal Database (CHND), we identified CVCs in infants admitted 2017-2023. The primary outcome was CVC NER, and the primary exposure was CHND center. We quantified unadjusted and adjusted ICV in NER.

Result: We analyzed 71,865 patients and 135,671 CVCs. Median gestational age was 36 weeks and birth weight 2450 g. Over 50% infants (28,077) received >1 CVC. Centers placed 196-7120 catheters with a median dwell time of 7 (IQR 4-14) days. The overall NER rate was 11.7%, with significant ICV (unadjusted ICV: 3-19%, p < 0.001; adjusted center-level odds of NER: 0.26-2.03, p < 0.001).

Conclusion: There is significant ICV in NER between level IV NICUs. Reducing modifiable NER may increase safety for patients with CVCs. Center-specific NER metrics may serve as clinical benchmarks.

Objective: To evaluate the utility of N-terminal pro-brain natriuretic peptide (NT pro-BNP) for screening and diagnosis of chronic pulmonary hypertension (cPH) in extremely low gestational age neonates (ELGANs < 28 weeks gestational age [GA]).

Methods: We conducted a retrospective cohort study analyzing paired echocardiogram results and serum NT pro-BNP concentrations (ng/L) in ELGANs. The accuracy of NT pro-BNP for diagnosing cPH and determining the optimal cut-off for cPH screening and diagnosis was evaluated using receiver operating characteristics (ROC) curves and Youden's index, respectively.

Results: Among the 35 included ELGANs, the area under the ROC curve for diagnosing cPH using NT pro-BNP levels combined with GA < 25 weeks and BPD was 0.70 (95% CI: 0.51-0.89). An NT pro-BNP value of 1129 showed a sensitivity of 85%, while a value of 2674 demonstrated a specificity of 95%, indicating its potential role in screening and diagnosing cPH.

Conclusions: NT pro-BNP is a promising biomarker for screening and diagnosing cPH in ELGANs.

Objective: This study examines associations between opioid use disorder (OUD) treatment and pregnancy outcomes among Medicaid enrollees.

Study design: Using 2021 Medicaid claims, we identified 29,193 women with OUD and a pregnancy-related outcome receiving (1) Medication Only, (2) Behavioral Therapy Only, (3) Medication and Behavioral Therapy, or (4) No Treatment. Multivariable logistic regression estimated adjusted odds ratios (ORs) for outcomes.

Results: Among pregnant women with OUD, over half (52.5%) received no treatment; 27.9% received medication and therapy, 12.5% received medication only, and 7.0% received therapy only. Any form of treatment was linked to reduced risk of fetal death. Medication, alone or with therapy, was associated with lower risk of preterm labor, and medication alone was linked to reduced risk of abruptio placentae.

Conclusion: Receiving treatment for OUD is significantly associated with better pregnancy outcomes. Expanding access to medication for OUD and integrating therapy are crucial for improving maternal health.

Objective: To examine associations between oxidative stress and fetal weight across pregnancy.

Study design: Cohort study of pregnant participants from 2016-2021 in New York City with urinary lipid, protein, and DNA oxidative stress biomarkers (<18, 18-25, >25 weeks) and estimated fetal weight from ultrasound fetal biometry with the HadlockIII formula (20, 30, 36 weeks).

Result: Among 1408 participants, oxidative stress biomarkers of lipid peroxidation and DNA damage were associated with smaller estimated fetal weight at 30 and 36 weeks (ranging from B = -3.9 grams/unit increase [95% CI: -6.9, -0.9; 8,15 - PGF2α] to -20.3 [95% CI: -27.9, -12.8; 8 - OHdG]), particularly among fetuses at the 25^th percentile. Oxidative stress biomarkers of protein damage were associated with larger estimated fetal weight at 20 (3.4 [95% CI: 1.2, 5.7]) and 36 weeks (16.5 [95% CI: 5.2, 27.8]).

Conclusion: These findings advance our understanding of different oxidative stress pathways and their potential role in fetal growth.