Journal of Perinatology最新文献

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.

Background: Monitoring bilirubin in preterm neonates is essential to prevent neurotoxicity. Total serum bilirubin (TSB) remains the diagnostic standard, while transcutaneous bilirubinometry (TcB) offers a rapid, non-invasive, and cost-effective alternative. However, TcB's accuracy in preterm infants, especially during phototherapy and across racial or gestational groups, remains uncertain.

Objective: To assess concordance between TcB and TSB in preterm neonates across gestational ages, racial/ethnic groups, and phototherapy exposure.

Methods: We analyzed 330 paired TcB-TSB readings from 113 preterm infants (postnatal age 5-408 h, mean ± SD: 91.8 ± 64.2) in a NICU. Infants were categorized by gestational age (<28, 28-32, 32-36 weeks), including self-reported maternal race and ethnicity. We employed correlation analysis, paired t-tests, linear regression, and Bland-Altman plots. TcB was evaluated under phototherapy (exposed vs. patched skin) in relation to escalation of care thresholds (ECT).

Results: TcB and TSB were strongly correlated overall (r = 0.822), but the level of agreement varied by gestational age and phototherapy exposure. Accuracy declined with phototherapy, especially on exposed skin. Bland-Altman analysis showed that TSB and TcB are not interchangeable. Finally, TcB-ECT concordance was low.

Conclusion: TcB correlates with TSB but lacks sufficient accuracy for standalone use in preterm infants, particularly during phototherapy. Caution is called for in clinical application.

Bronchopulmonary dysplasia (BPD) remains a prevalent and complex complication of preterm birth, yet current definitions fail to capture the heterogeneous and evolving nature of the disease. Longitudinal studies reveal persistent pulmonary disease throughout the lifespan. Despite progress in identifying phenotypes, biomarkers to characterize disease endotypes to guide effective and precise therapies remain elusive. Precision medicine approaches, including multicenter deep phenotyping and integration of multi-omic data, are essential to identify meaningful disease subtypes that inform individualized care. This perspective traces the evolution of BPD definitions, outlines their limitations, and presents a path forward focused on collaborative data networks, enriched trial designs, and longitudinal outcome measures. Recognizing BPD and subsequent cardiopulmonary disease related to prematurity as a lifelong disease, not just a NICU outcome, is critical to improving long-term care and developing targeted interventions for this vulnerable population.

The American Academy of Pediatrics Trainees and Early Career Neonatologist's National (AAP TECAN) advocacy campaign, Carousel Care, addresses the need for standard of care to support NICU family mental health. The campaign series includes a mental health review, special NICU population considerations, continued mental health support after discharge and the burden of chronic disease. Here, we examine the physical and emotional barriers to bonding when infants are admitted to the NICU, and impacts on the child's mental health and development, parental mental health, and the developing attachment between parent and child. We recommend comprehensive strategies for the provider, institution, and national practices to minimize the impact of separation, maximize bonding and secure attachment while in the NICU to improve mental health for parents and infants.

Clinically significant fetomaternal hemorrhage (FMH) can have devastating consequences on the newborn infant. Acute FMH close to childbirth can present with hypovolemia, shock, metabolic acidosis, and encephalopathy. Chronic FMH can be associated with congestive heart failure, pulmonary edema, hydrops and hepatomegaly. Early recognition and timely management of FMH are crucial in improving outcomes. This review article summarizes the epidemiology, pathogenesis, diagnosis, management and outcomes of clinically significant FMH. Current knowledge gaps in diagnosis and management of FMH are additionally described.

Objective: Improve regional clinical care for infants with neonatal encephalopathy presumed to be due to hypoxic-ischemic encephalopathy (HIE) by developing a clinical data registry.

Study design: We developed a regional multicenter registry of newborns at risk for HIE and leveraged data collected within the registry to design and monitor biannually quality improvement metrics in a collaborative effort among site investigators.

Result: Over the 3 years since beginning our improvement efforts, we have demonstrated positive trends in all three initial metrics decided on by our investigators: increasing the cord blood gas acquisition in high-risk deliveries (median 74-87%); increasing neurological exam and encephalopathy score documentation in infants with perinatal acidosis (17-36%); and decreasing the incidence of infants discharged on anti-seizure medication (60-29%).

Conclusion: In addition to providing hypothesis-generating research data, local and regional registry data can be successfully utilized for quality improvement efforts across multiple hospitals.

Objective: To examine the impact of the virtual reality breastfeeding experience on prenatal breastfeeding self-efficacy and postpartum breastfeeding motivation among primiparous pregnant women.

Methods: This study was conducted as a prospective randomized controlled trial. Both groups received standard breastfeeding education; however, the study group additionally participated in a virtual reality breastfeeding experience at 36 and 38 weeks of gestation. Data were collected using the Personal Information Form, the Prenatal Breastfeeding Self-Efficacy Scale, and the Breastfeeding Motivation Scale.

Results: A total of 52 primiparous pregnant women, 26 in the study group and 26 in the control group, were included in the study. Women in the study group exhibited higher prenatal breastfeeding self-efficacy and greater postpartum breastfeeding motivation compared to those in the control group. Additionally, postpartum breastfeeding motivation increased as prenatal breastfeeding self-efficacy improved.

Conclusion: Breastfeeding experience with virtual reality is associated with higher prenatal breastfeeding self-efficacy and postpartum breastfeeding motivation in women.

Objective: To develop and internally validate a model predicting neonatal mortality in infants with neonatal encephalopathy requiring therapeutic hypothermia (TH), using national data.

Study design: Data from 385 infants treated with TH across 19 hospitals (2016-2021) were analysed. Multivariable logistic regression with backward stepwise selection was applied. Discrimination was assessed using the C-statistic, with internal validation by bootstrapping. The THERM (Therapeutic Hypothermia Early Risk Model for Mortality) tool was developed to calculate individualised mortality risk.

Results: Forty-six infants (11.9%) died within 28 days. Four predictors were retained: prelabour Caesarean section, adrenaline use, base excess ≤-22 mmol/L, and seizures during the first day of life. The model demonstrated excellent discrimination [optimism-adjusted C-statistic 0.885 (95% CI: 0.827-0.936)].

Conclusions: Four routinely collected variables predicted mortality in infants undergoing TH. The THERM tool provides a practical resource for clinicians, enabling personalised risk assessment and supporting parental counselling during the first day of life.