Journal of Perinatology最新文献

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.

Objective: Optimize use of rapid genomic sequencing (rGS) in a level IV NICU.

Study design: We designed interventions to improve patient identification, ordering processes, and provider education for rGS in our level IV NICU. We measured the percentage of infants eligible for rGS by internal criteria who had rGS sent, diagnostic yield of rGS (balancing measure), and days from genetics consult to rGS result (balancing measure).

Result: Our study included 560 infants undergoing genetics evaluation. The percentage of eligible infants who had rGS sent significantly increased from 37% pre-intervention (January 2019-March 2021) to 54% post-intervention (April 2021-September 2024) (p < 0.001). Diagnostic yield of rGS remained stable (32% vs 34%). Time from genetics consult to rGS result significantly decreased from median 32 to 27 days (p = 0.04).

Conclusion: Our quality improvement initiative increased rGS use with stable diagnostic yield and decreased time to rGS result for critically ill infants with suspected genetic disorders.

Objective: To investigate single versus combination hemodynamic parameters on intraventricular hemorrhage (IVH) or mortality in preterm infants.

Study design: Data from 482 infants under 32 weeks gestational age were analyzed, including cerebral oximetry, mean arterial pressure (MAP), cardiac output, and systemic blood flow within the first 24 h. Wilcoxon Rank-Sum and chi-squared tests compared variables. Multivariable logistic regression and receiver operator curve (ROC) analyses assessed predictive value.

Results: Each additional gestational week was associated with lower odds of IVH (OR = 0.66; 95% CI: 0.57-0.75) and mortality (OR = 0.56; 95% CI: 0.45-0.69). Adjusted for covariates, right ventricular output (RVO) was associated with reduced IVH odds (AOR = 0.996; 95% CI: 0.991-0.999), and higher MAP with reduced mortality (AOR = 0.81; 95% CI: 0.68-0.94). Average NIRS < 74% in 24 h increased mortality risk (OR = 4.16; 95% CI: 1.46-11.0; P = 0.005).

Conclusion: Select hemodynamic measures are associated with IVH and death. Combining factors did not enhance early risk prediction.

Objective: We assessed the utility of lung ultrasound scores (LUSs) to predict extubation readiness in VLBW infants and determined the effect of postnatal steroids on LUSs in babies who were chronically ventilated for > 30 days.

Study design: We measured infants' LUS scores before planned extubations and determined the success of the subsequent extubation attempts.

Results: Overall, LUSs were lower in successfully extubated compared with unsuccessfully extubated infants in the entire population. Similar differences were seen in LUSs between successfully and unsuccessfully extubated chronically ventilated infants. In chronically ventilated infants, LUSs did not differ between infants who did and did not receive dexamethasone. However, dexamethasone-treated infants who extubated successfully had lower scores compared to those who did not.

Conclusions: While LUS scores do not predict the need for dexamethasone treatment to promote successful extubation, they do predict subsequent extubation success, irrespective of both dexamethasone treatment and duration of ventilation.

Background: Parental presence at bedside is a critical component of family-centered care for infants admitted to Neonatal Intensive Care Units (NICUs) and their caregivers, allowing for engagement with baby as well as education from the care team.

Local problem: Many families face barriers to physical presence, including transportation, childcare responsibilities, work, and illness, among others.

Interventions: Telehealth can be an avenue for parents to be engaged while not directly at bedside. This project details efforts to launch virtual visits in a Level III NICU, including challenges and lessons learned, across 4 PDSA cycles.

Methods: We measured the percentage of families on the NICU who attended 4 or more cares sessions per week. We obtained survey responses and open-ended feedback about the implementation from staff and patients.

Results: Family engagement rates were higher during active PDSA cycles at trending significance level. Most providers and parents rated the intervention as highly feasible and satisfying. Attendance in cares sessions improved across the QI project, especially for families with public insurance.

Conclusions: We found that telehealth visits were able to lessen the disparities in cares participation rates between families with private insurance and families with public insurance.

Increased survival of preterm infants born <28 weeks' gestation brings new challenges for healthcare teams and families, particularly in the absence of high-quality, population-specific evidence to guide optimal skin care. Skin integrity is critical for preventing infection, reducing pain, and minimizing fluid loss. However, variations in care, delivery models, geographic settings, and clinician expertise continue to influence outcomes-impacting both immediate survival, long-term morbidity and mortality. This review outlines the key challenges associated with delivering safe and effective skin care for extremely preterm infants; identifies priority areas for research and benchmarking, and proposes a collaborative approach to address these gaps. The Skin InteGrity in extreme preterms research NETwork (SIGNET) collaborative seeks to align outcome measures, generate essential physiological data, promote knowledge exchange, and develop practical, evidence-based tools to support consistent, high-quality care for these uniquely vulnerable patients.

Objective: To evaluate perceptions of providers regarding the best course of action for resuscitation of infants born at 22 weeks gestational age (GA).

Study design: Anonymous survey of providers caring for infants born at 22^0/7 to 22^6/7weeks GA at the University of Texas Southwestern Medical Center including: Parkland Health and Hospital System (PHHS), Clements University Hospital (CUH), and Texas Health Dallas (THD).

Results: Neonatal nurses were more likely to favor comfort care at 22 weeks GA than neonatologists (36% vs 4.3%; P < 0.05). Providers at PHHS were more likely to think comfort care at 22 weeks GA was appropriate than providers at CUH (35% vs 17%; P <0.05). Providers at THD were more likely to think deferral to parental wishes was appropriate for infants born at 22 weeks than providers at PHHS (71% vs 48%; P < 0.05).

Conclusion: Provider perspectives on decision-making surrounding resuscitation at 22 weeks GA vary significantly by healthcare profession and practicing hospital.