Journal of Perinatology最新文献

Objectives: Describe the prevalence, health, and birth outcomes of incarcerated pregnant individuals in California between 2011 and 2015.

Study design: A population-based cohort study was performed using linked birth certificate and hospital discharge data. Associations between incarceration and birth outcomes were examined, including multivariable logistic regression to estimate odds ratios and 95% confidence intervals.

Results: Amongst 1401 incarcerated and 551,029 nonincarcerated pregnant people across 112 delivery hospitals, 33% of incarcerated individuals had late initiation of prenatal care; 2.4% experienced severe maternal morbidity, compared to 18.9% and 1.6% of controls, respectively (p < 0.05). Births to incarcerated individuals had higher adjusted likelihoods of prematurity (OR 1.42, 95% CI 1.21, 1.67), small for gestational age (OR 1.31, 95% CI 1.11, 1.56), and NICU admission (OR 1.64, 95% CI, 1.40, 1.93) relative to controls.

Conclusion: Incarcerated individuals have greater likelihood of negative birth outcomes. Identification of approaches to reduce these harms is warranted.

Metabolic acidosis is common in preterm and term newborn infants and may be attributed to a variety of etiologies, potentially requiring base therapy such as acetate or bicarbonate. However, concerns exist regarding potential harm of sodium bicarbonate due to intracellular acidosis, fluctuations in cerebral blood flow, and osmolar load with rapid infusions, with no improvement in survival when used during resuscitation. Alternative approaches to correct metabolic acidosis include the addition of acetate in parenteral nutrition, intravenous lactated Ringer's (LR) solution, and use of oral citrate. Current guidelines focus on addressing the underlying cause of acidosis, reserving the use of sodium bicarbonate (NaHCO₃) for severe cases requiring acute correction, LR instead of saline for volume boluses and using acetate or citrate for slow correction to stabilize acid-base status. Further research is necessary to better understand the efficacy and safety of acetate, NaHCO₃, and other base sources in treating metabolic acidosis in neonates.

Objective: The objective of this study was to identify factors birthing parents consider related to potential resuscitation of a periviable infant.

Study design: Birthing parents who received a prenatal consult from a newborn intensive care unit provider between 22.0 and 24.6 weeks gestational age were eligible to participate in a semi-structured interview focused on their periviable decision making. Interview transcripts were coded and analyzed using thematic content analysis.

Result: Qualitative analysis shows that birthing parents attribute their decision to a balance between vitality and suffering, with the balance point influenced by various elements. While parents described the choice they made, none reported that the information they received during the prenatal consult had a significant impact.

Conclusion: This study highlights the minimal impact that information given during a periviable consult has on parental decision making. Information from this study can be used to develop an improved model of perinatal consultation.

Objective: To study the effects of rapid enteral feed advancement with early feed fortification in stable very low birth weight (VLBW) infants >30 weeks gestation.

Study design: Preterm infants (N = 92) were randomized to a) rapid feed advancement-early fortification - REF group (enteral feed advanced at 25-30 ml/kg/day, fortification at 50 ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15-20 ml/kg/day, fortification at 100 ml/kg/day).

Results: The primary outcome-time to regain birth weight was significantly lower in REF group (9 days vs 13 days, P = 0.02). REF group reached full enteral feeds earlier (6 days vs 9 days, P = 0.001), had lower rates of sepsis (13% vs 38%, P = 0.007) and shorter hospital stay (10 days vs 15 days, P = 0.01). At one year, the median Z-scores for weight [-1.5 vs -2.2, P < 0.001] and head circumference [1.1 vs 0, P < 0.001) were significantly higher in the REF group.

Conclusions: In VLBW preterm infants >30 weeks, rapid feed advancement with early fortification resulted in early postnatal regain of birth weight with positive effects on growth at one year.

Objectives: To examine the association of novel furosemide versus thiazide diuretic exposure with changes in serum sodium, potassium, and chloride levels among infants with grade 2/3 bronchopulmonary dysplasia (BPD).

Study design: Retrospective cohort study of infants admitted to a level IV neonatal intensive care unit (NICU) with grade 2/3 BPD. We measured within-subject change in serum sodium, potassium, and chloride before and after diuretic initiation using multivariable regression to adjust for differences in dosing and clinical covariates.

Results: We identified 94 infants contributing 137 novel diuretic exposures. No significant difference was noted in the association between chlorothiazide versus furosemide and serum sodium, potassium, or chloride change in multivariable modeling.

Conclusions: Changes in serum electrolytes were similar for chlorothiazide and furosemide, questioning the perception that chlorothiazide leads to less electrolyte derangement among preterm infants with grade 2/3 BPD.

Gender inequities in pediatrics are extensively documented despite women predominating the workforce. As a landscape assessment of gender equity in university-based neonatology divisions in the United States, we collected gender equity measures from academic neonatology division directors; 83% (n = 106) participated. The majority recognized addressing gender inequity was a middle-to-top priority, though they reported minimal gender inequities in their division. Most division directors are men and a higher proportion of full professors are men, but they reported minimal differences in time to promotion, leadership positions, and awards. Half of centers analyzed compensation by gender; all reported no gender difference. The existence of gender-equity-promoting strategies was variable and uncertain by many directors. They reported lack of bandwidth, personnel, and resources as the largest barriers to tracking and addressing gender inequities. These perceived minimal gender inequities diverge from published objective data and highlight the need to track and report metrics accurately and systematically.

Supporting parents' emotional and mental health is crucial during antenatal consultations, in which expectant parents often receive serious news about their infant and sometimes face complex antenatal or postnatal decision-making. Being considerate of the circumstances to mitigate barriers and stressors, utilizing clear and sensitive language, and personalizing counseling and decision-making to support parents' pluralistic values are strategies that individual neonatologists can use to promote parents' mental wellness in these encounters. Partnership with clinicians of other disciplines and professions in antenatal consultations can help in providing additional medical information and parent support; however, care must be coordinated within the team to ensure that confusing or conflicting counseling is avoided. In addition to improving communication skills for these encounters as individuals and teams, opportunities also exist to enhance support of parents' mental health at the institutional and national level.