Journal of Perinatology最新文献

Families of infants hospitalized in the neonatal intensive care unit (NICU) are at an increased risk for depression, anxiety, and trauma symptoms that often persist well beyond transition from the NICU. While NICU professionals provide vital medical care for high-risk infants, they also offer interdisciplinary support for families, including collaboration with psychosocial and psychiatric services in select settings. Despite psychosocial support systems often being present during NICU hospitalization, significant gaps remain in post-NICU mental health support for parents. Comprehensive discharge preparation and outpatient follow-up planning for infants, as well as their families, are essential to optimize both long-term outcomes and the well-being of the entire family unit. In this paper, we review current evidence regarding mental health risks for families during transitions of care and highlight practice recommendations and advocacy opportunities for enhanced family-centered, interdisciplinary follow-up care after transition from the NICU.

Objectives: To evaluate the safety and efficacy of dexmedetomidine as the primary sedative in neonates.

Study design: Single center, retrospective study of mechanically ventilated neonates sedated with dexmedetomidine (study group) or opioids/benzodiazepines (control group). Primary outcome was requirement of opioids/benzodiazepines. Secondary outcomes included duration of mechanical ventilation, time to full feeds, bradycardia/hypotension, and unplanned extubation. A subgroup analysis was conducted in premature neonates.

Results: There were 148 patients (study group n = 91, control group n = 57) included. Patients who received dexmedetomidine had less cumulative exposure to opioids/benzodiazepines. The median opioid/benzodiazepine requirement was 0 mg/kg/day in the study group compared to the control group with 0.36-0.96 mg/kg/day midazolam equivalents and 1.75-4.1 mg/kg/day morphine equivalents. Unplanned extubations were not different between groups indicating similar efficacy. The study group reached full feeds faster than the control group.

Conclusion: Dexmedetomidine as the primary sedative in neonates is safe and efficacious at minimizing opioids and benzodiazepines in both term and premature neonates.

Clinical trial registration: N/A.

Objective: Quantify opioid and sedative medication exposures in preterm infants receiving mechanical ventilation.

Study design: Cohort study of infants <28 weeks' gestation receiving any mechanical ventilation in the first 28 postnatal days. We examined exposure to morphine, fentanyl, midazolam, and lorazepam. We used logistic regression to examine the association between daily respiratory support and probability of medication administration.

Results: Of 36,067 infants, 15,025 (42%) received one or more medications. There was a decrease in exposure to fentanyl and benzodiazepines from 2012 to 2020. Major morbidities were lower in unexposed infants. The odds of receiving target medications were more than twice as high on high frequency mechanical ventilation days compared to conventional mechanical ventilation days (unadjusted odds ratio 2.47, 95% CI 2.36-2.59).

Conclusion: In preterm infants receiving mechanical ventilation, the use of opioids or sedatives was common and high frequency ventilation was associated with higher exposure to medications.

Objectives: To ascertain the impact of skin to skin contact (SSC) on cardiac and cerebral indices in infants with severe perinatal asphyxia.

Study design: Prospective comparison of cardiac function and cerebral perfusion-oxygenation in incubator care with SSC using echocardiography and near infrared spectroscopy (NIRS).

Results: 13 infants formed the study cohort; gestation and birthweight were 38.6 ± 1 weeks and 3173 ± 724 g, respectively. All infants were cooled for 72 h and the study intervention was done on day 6 of life (range 4-7). Right ventricular output was higher (231 ± 60 vs 296 ± 72 ml/kg/min, P = 0.03) and pulmonary vascular resistance index was lower (3.5 ± 0.6 vs 3 ± 0.16, P = 0.01) after SSC. Middle cerebral artery resistive index trended lower (0.72 ± 0.05 vs 0.65 ± 0.1, P = 0.07). Six infants had NIRS measurement; cerebral tissue oxygenation index during SSC was significantly higher than pre-SSC (68.6 ± 6.6 vs 63.7 ± 4.7%, P = 0.03).

Conclusion: In severely asphyxiated infants, 60 min of SSC confers significant haemodynamic benefits.

Objective: Adverse Childhood Experiences (ACEs) are linked to various negative health outcomes. Although research typically focuses on ACEs during childhood and adulthood, emerging studies indicate that the effects of ACEs may affect neonates before birth. This study aimed to increase the percentage of neonates fully screened for ACEs in a Level III NICU from 2% to 50%.

Design: The project involved developing and implementing a neonatal ACEs screening tool integrated into the electronic medical record. The screening process was refined through a series of Plan-Do-Study-Act (PDSA) cycles to improve the consistency of screening.

Results: Over six months, the proportion of neonates screened for ACEs increased from 2% to 75%. Implementing a separate progress note for ACEs assessments enhanced confidentiality, with 60% of screenings documented privately.

Conclusions: This quality improvement project successfully established a standardized neonatal ACEs screening process, resulting in a higher identification rate of neonates at social risk.

Background: Given the multiple risk factors associated with bronchopulmonary dysplasia, the impact of advances in early respiratory management, particularly non-invasive ventilation, remains uncertain.

Methods: The early respiratory management and outcomes in 593 infants born at less than 32 weeks' gestational age were retrospectively analyzed. The combined rate of bronchopulmonary dysplasia-mortality was compared across four propensity score-matched periods (2007-2010, 2011-2014, 2015-2018, 2019-2022).

Results: Delivery room intubation rate decreased from 54% to 36.7% (P < 0.001). Surfactant administration was delayed in the first three periods from 0.33 to 1.5 h (P < 0.001). The composite outcome of death or bronchopulmonary dysplasia rose from 14.9% to 39.8% over time, while mortality alone remained stable. In parallel, non-invasive ventilation duration increased with an adjusted mean difference of 21.98 days in 2019-2022.

Conclusion: The incidence of bronchopulmonary dysplasia continues to rise for very preterm infants, despite changes in early respiratory management and the increased use of non-invasive ventilation.

Background: A hemodynamically significant patent ductus arteriosus (hsPDA) is common in preterm infants and may impact systemic and cerebral blood flow. This study explores Doppler flow patterns in systemic arteries including celiac artery/trunk (CeT), superior mesenteric artery (SMA) and middle cerebral artery (MCA) in preterm neonates with varying PDA shunt patterns, utilizing targeted neonatal echocardiography (TNE).

Methods: Retrospective multicenter study of preterm infants (born <32 weeks gestation, <40 days of life) who underwent comprehensive TNE. Infants were categorized into 3 groups based on PDA shunt characteristics as follows: (1) No transductal shunt or trivial PDA with PDA score <6, (2) Left-to-right PDA (L-R PDA) and PDA score ≥8 and (3) Bidirectional PDA shunt with at least 10% of time spent right-to-left (R-L) and PDA score <6.

Results: In total, 86 patients with a median [IQR] gestational age of 26.1 weeks [23.8-27.7] weeks and birth weight of 767 [596, 1016] grams were included and classified into 3 groups: No PDA (n = 29), hsPDA (n = 48) and bidirectional PDA (n = 27). Abnormal systemic arterial Doppler patterns (absent or reversed diastolic flow in the Celiac artery) were present in 2 (5.7%), 15 (44.1%), and 1 (5.9%) of the patients in the no PDA, hsPDA, and bidirectional PDA groups respectively. Diastolic flow reversal in any of the systemic vessels evaluated was demonstrated only in the hsPDA group.

Conclusion: This physiologic study demonstrates altered systemic Doppler patterns, which suggests a decreased ability to preserve lower body blood flow in premature infants with hsPDA. Further prospective studies are warranted to describe the association of these physiologic findings with clinical outcomes such as necrotizing enterocolitis.

Clinical trial registration (if any): None (not applicable).