Journal of Perinatology最新文献

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.

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.