Journal of Perinatology最新文献

Objective: In 2022, the U.S. Supreme Court decision on Dobbs v. Jackson Women's Health Organization changed abortion access. We evaluated birth rates of Down syndrome (DS) before and after the Dobbs decision hypothesizing similarity to cyanotic congenital heart disease.

Study design: Retrospective cohort study of live births utilizing 2016 - 2025 CDC birth certificate registry data stratified by DS and by state abortion access categories (restrictive and protective) based on the Guttmacher Institute. Incidence of DS and the difference in incidence between state cohorts were modeled and compared between pre- and post-Dobbs periods using segmented linear regression.

Results: Incidence of DS live births remained stable in restrictive and protective states pre- and post-Dobbs. Segmented regression models revealed no significant changes in monthly incidence in the post-Dobbs era nationally compared to pre-Dobbs.

Conclusions: Mean monthly incidence of DS in live-born infants using CDC birth certificate data did not increase after the Dobbs decision.

Objective: To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events.

Study design: Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014-December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes.

Results: Among 12,652 intubation encounters, attendings were present for 8391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with higher first attempt intubation success (OR 1.11, 95% CI 1.04-1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70-0.86) and intubation requiring ≥3 intubation attempts (aOR 1.39, 95% CI 1.21-1.60).

Conclusion: After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.

Objective: To develop an organizational framework that examines the individual contributions of modifiable clinical interventions and non-modifiable physiologic variables on the fluctuating rate of intraventricular hemorrhage (grades 3/4) or death<4 days over time.

Study design: We developed the Frequency-Adjusted-Risk-difference-versus-OUTcome (FAR-Out) approach to examine risk-differences and risk-frequencies during defined study epochs. We used FAR-Out to study changes in sIVH/death<4 d rates after implementing a set of improved-practice guidelines in a preterm population (23^0/7-27^6/7 weeks, n = 537).

Results: Epoch-to-epoch variations in FAR-Out Risk Scores track closely (Pearson's r = 0.974) with epoch-to-epoch variations in sIVH/death<4 d rates. Post-implementation changes in sIVH/death <4 d rates were mostly associated with fluctuations in individual non-modifiable risks (immaturity/illness severity) rather than with changes in adherence to the guidelines' modifiable practices.

Conclusion: Close correlation between FAR-Out Risk Scores and sIVH/death < 4 d rates supports the FAR-Out approach's potential usefulness in examining the relative influence of individual risk factors on the incidence of sIVH/death <4 d.

Objectives: The objective of this study is to identify the populations at greatest risk for COVID-19 complications during pregnancy and determine their adverse maternal and neonatal outcomes in a time period prior to vaccine availability.

Study design: Cohort study using delivery hospitalization discharge data linked to vital records for all births in California during the baseline pre-COVID-19 period and for all births during the COVID-19 Study period.

Results: Among 344,894 deliveries, a total of 7181 (2.08%) hospitalized patients tested positive for COVID-19 during pregnancy. Of these, 571 (0.17%) patients were hospitalized with severe respiratory illness. Rate of severe maternal morbidity (242/571, 42%) and maternal death (10/571, 1.8%) were markedly elevated in those hospitalized patients with COVID-19 related respiratory disease compared to both uninfected parturients and infected parturients with less severe disease. Higher rates of COVID-19 related respiratory conditions were associated with Hispanic ethnicity, Native American race, state-funded insurance, and lower education levels.

Conclusion: In pregnancies complicated by COVID-19, the excess risks of maternal mortality, SMM, and adverse neonatal outcomes were restricted to the patients with COVID-19 related respiratory conditions. Significant disparities were noted for respiratory conditions, mortality and SMM related to race-ethnicity and socioeconomic status.

Objectives: Despite the stress of having a baby in a Neonatal Intensive Care Unit (NICU), factors that promote adjustment remain unclear. We examined which resiliency factors were associated with family adjustment across the NICU journey.

Study design: Parents with a baby in the NICU (≤2 weeks) completed surveys at three timepoints (during admission (N = 165); 1 month later (N = 85); 3 months later (N = 55)). Surveys included sociodemographics and validated measures of emotional distress, relational outcomes, and resiliency.

Results: Mixed models revealed that lower parental distress was associated with: (1) higher mindfulness; (2) more adaptive coping; (3) greater parental self-efficacy (only anxiety); and (4) increased parental time for themselves (only posttraumatic stress). Higher couple satisfaction was associated with more dyadic coping and social support. Stronger parent-child bonding was associated with greater parental self-efficacy.

Conclusion: Mindfulness and coping are important for parental distress. Building parental efficacy, encouraging self-care, and promoting shared coping and social support is important.

Objective: The objective of this study was to characterize the neonatal intensive care unit (NICU) course and outcomes for infants with neonatal-onset urea cycle disorders (UCDs).

Study design: Using the multicenter Children's Hospitals Neonatal Database, a descriptive, retrospective cohort study was performed to characterize the presentation, interventions, comorbidities, and hospital outcomes for 176 patients with neonatal-onset UCDs that required level IV NICU care.

Results: The median age of presentation was 5 [3,7] days, with 167 (95%) infants requiring transfer to a level IV NICU. Renal replacement therapy was undertaken for at least 34 (20%) patients. Neurologic complications occurred most frequently, with 71 (40%) patients affected. Twenty-one (12%) infants experienced in-hospital mortality. Interventions, complications, and mortality were observed most frequently in the ornithine transcarbamylase deficiency group.

Conclusion: Neonatal-onset UCDs are associated with significant morbidity and mortality, but heterogeneity exists among the specific named UCDs.