Journal of Perinatology最新文献

Objective: To study the mechanistic role of neonatal morbidities on language performance in extremely preterm (EP) infants.

Study design: We conducted secondary analyses on EP infants born at a single tertiary care center, investigating whether neonatal morbidities mediated associations between gestational age and language performance at 18-26 months corrected age.

Results: Infants born at 25-26 weeks (n = 298) outperformed those born at 22-24 weeks (n = 177) in expressive communication, receptive communication, composite language, and cognition. Retinopathy of prematurity (ROP), grade 2/3 bronchopulmonary dysplasia (BPD), and cognition partially explained gestational age effects on expressive and receptive communication. In the final sequential path models, infants born 22-24 weeks gestation were more likely to be diagnosed with grade 2/3 BPD, which was linked to diminished cognitive skills, and reduced language skills.

Conclusion: Families of EP infants born under 25 weeks or with ROP and/or grade 2/3 BPD should be counseled about higher language impairment risk and receive proactive intervention.

Objective: To estimate inter-center variation (ICV) in hospital length of stay (LOS) and oral feeding at discharge among infants with gastroschisis.

Study design: The Children's Hospitals Neonatal Consortium's (CHNC) database was used to identify hospitalized survivors with gastroschisis. Two outcomes were evaluated: LOS and discharge without tube feedings. Hospital outcomes were evaluated in unadjusted and adjusted analyses. Generalized linear models with log link for gamma distribution were used to model LOS and logistic regression for discharge without tube feeds.

Results: For 3987 surviving infants with gastroschisis, LOS and discharge within 70 days with exclusively oral feeding both exhibited significant ICV. Differences persisted in multivariable analyses. Risk-adjusted LOS (68% difference) and oral feeding at discharge (6.4-fold difference) varied significantly between centers.

Conclusion: Hospital of care was independently associated with LOS and exclusive oral feeding at discharge rates for infants with gastroschisis. Management differences, potentially influenced by parental preferences, contributed to variation.

Objective: To assess the relationship between 5-min oxygen saturation (SpO2) and outcomes in extremely preterm infants.

Study design: This cohort study included infants ≤28 weeks' gestation across nine hospitals from 2020 to 2022. Death and / or severe intraventricular hemorrhage (IVH) were compared between infants with 5-min SpO2 < 80% and 80-100% using Poisson regression models. Receiver Operating Characteristic (ROC) curve and optimal breakpoint analysis were used to estimate the optimal breakpoint of 5-min SpO2 in relation to outcomes.

Result: Of 390 infants, 184 (47.2%) had 5-min SpO2 < 80%. A 5-min SpO2 < 80% was independently associated with increased risks of death and / or severe IVH, early death, and severe IVH. ROC analysis of 5-min SpO2 identified optimal breakpoint at 81-85%, above which no additional benefit in outcomes was observed.

Conclusion: Our findings support the current recommendation of 5-min SpO2 target of ≥80% for extremely preterm infants.

Background: Newborns with critical congenital heart disease (CCHD) require specialized delivery room management, but varying experience and knowledge can reduce confidence and impact care.

Methods: A pre-delivery, structured huddle checklist was introduced, addressing team roles, expected physiology, and management plans. PDSA cycles incorporated guidelines and simulation-based education to improve confidence in specialized resuscitation strategies. Surveys were conducted at baseline and 6 months.

Results: Baseline, all-respondent confidence in managing "all types of CCHD" was somewhat confident (median 3/5; IQR 2-4) increasing to moderately confident (4/5; IQR 2-4) at 6 months (p = 0.59). Respondents with 0-3 years' experience showed increased confidence over 6 months in identifying unstable infants (from baseline 24% to 67% moderately/very confident, p = 0.005), prostaglandin E1 needs (from 24% to 62%, p = 0.013) and sedation requirements (from 5% to 33%, p = 0.045).

Conclusion: Structured huddles improved confidence among less experienced team members, emphasizing the importance of shared mental models before CCHD deliveries.

Objective: The design, implementation and audit of a multidisciplinary advanced neonatal resuscitation education initiative for "in unit" events in a quaternary NICU over a 9-year period, divided into 3-year epochs of "pre", "implementation" and "maintenance" is described.

Study design: A didactic and simulation quality improvement initiative focused on teaching and reinforcing specific algorithms endorsed by the American Heart Association (AHA) to target resuscitation needs of older neonates including surgical and cardiac conditions. Qualitative and quantitative data pre and post implementation was audited.

Results: Post education implementation, team members performed quicker hemodynamic assessments and applied CPR and/or bolus epinephrine correctly in higher proportions during acute events. During supraventricular tachycardia, vagal maneuver use and medication administration time improved.

Conclusion: Advanced neonatal resuscitation education and reinforcement targeted for event etiology, allow for AHA algorithms to be successfully taught and performed within a quaternary NICU with improvement in hemodynamic assessments and AHA algorithm implementation.

This article reviews the psychological distress experienced by NICU families, including anxiety, postpartum depression (PPD), and post-traumatic stress disorder (PTSD), in addition to providing recommendations for clinicians at the individual, institutional, and national level. Currently, mental health screenings, specialized evaluations, and treatment options are not routinely offered to NICU families and are frequently under-utilized when offered. Here we provide expert opinion recommendations to address challenges in supporting universal screening, offering bedside interventions, including trained mental health professionals in care plans, updating neonatology training competencies, and advocating for policies that support the mental health of NICU families. We advocate that mental health of NICU families be incorporated into the standard of care.

Maternal alloimmunization to paternal blood group antigens is the underlying cause of hemolytic disease of the fetus and newborn. Alloantibodies to the major, clinically significant blood group antigens are readily identified by the blood bank which, in turn, allows for appropriate monitoring of the maternal-fetal unit. However, uncommon blood group antibodies, particularly those directed against low and high prevalence antigens, present a more formidable challenge for obstetricians, neonatologists, and transfusion medicine specialists. This article focuses on these unusual blood group antibodies beginning with a classic case presentation. The identification of these antibodies by the blood bank, their monitoring during pregnancy, and the associated implications for transfusion are then discussed. In these cases, a close collaborative partnership is required to ensure an optimal outcome for mothers and their neonates.