Journal of Perinatology最新文献

Objective: This pilot implementation study introduces a novel, neonatal-specific virtual reality (VR) simulation platform for resuscitation training and assesses its initial feasibility and reception in a neonatal intensive care unit setting.

Study design: We developed a custom VR model simulating a resuscitation scenario for a 30-week neonate. Neonatal providers completed individualized training sessions and post-training surveys.

Results: Thirty-eight neonatal providers participated in the study. The VR platform was well-received, with 97% willing to use it again and 95% recommending it. Most participants (70.3%) found VR more realistic than traditional methods, with an average usefulness rating of 4.5/5. However, 40.5% reported adverse effects like eye strain and motion sickness. Feedback led to three significant VR platform upgrades.

Conclusion: This study demonstrates strong enthusiasm for VR among neonatal providers. While promising, further research with larger samples and comparisons to traditional methods is needed to fully evaluate VR's effectiveness in neonatal resuscitation training.

Neonatal-perinatal medicine (NPM) lacks a racially and ethnically diverse physician workforce. Fewer trainees from groups underrepresented in medicine (URiM) are entering NPM due to declining match rates in general pediatrics, financial burdens from delaying workforce entry, and ineffective recruitment into NPM. Annual surveys from the Organization of Neonatology Training Program Directors (ONTPD) were analyzed to assess URiM recruitment trends between 2021 and 2023. Concerningly, the number of URiM candidates applying to NPM fellowship programs remains low, highlighting the need for investment in pathway programming and enhanced recruitment strategies to diversify the NPM workforce. A multifaceted approach, including promoting early interest in pediatrics, minimizing financial disincentives, collecting robust URiM trainee and workforce data, and creating inclusive, diverse educational environments will be critical to increasing URiM representation in NPM and ultimately improving health outcomes for neonates.

Objective: We compared neonatal (<28 days) mortality rates (NMRs) across disaggregated Asian American and Native Hawaiian/Pacific Islander (AANHPI) groups using recent, national data.

Study design: We used 2015-2019 cohort-linked birth-infant death records from the National Vital Statistics System. Our sample included 61,703 neonatal deaths among 18,709,743 births across all racial and ethnic groups. We compared unadjusted NMRs across disaggregated AANHPI groups, then compared NMRs adjusting for maternal sociodemographic, maternal clinical, and neonatal risk factors.

Results: Unadjusted NMRs differed by over 3-fold amongst disaggregated AANHPI groups. Native Hawaiian/Pacific Islander neonates in aggregate had the highest fully-adjusted odds of mortality (OR: 1.08 [95% CI: 0.89, 1.31]) compared to non-Hispanic White neonates. Filipino, Asian Indian, and Other Asian neonates experienced significant decreases in odds ratios after adjusting for neonatal risk factors.

Conclusion: Aggregating AANHPI neonates masks large heterogeneity and undermines opportunities to provide targeted care to higher-risk groups.

Objective: To compare real-time ultrasound (RT-US) use as an adjunct tool to verify umbilical catheter placement versus standard care without ultrasound.

Study design: Neonates requiring umbilical venous catheter (UVC) and umbilical artery catheter (UAC) placement were randomized into the standard formula (No-US) and the RT-US groups. X-rays were used to confirm the catheter position.

Result: Fifty and forty-nine neonates were in the RT-US and No-US groups, respectively. RT- US showed a significantly higher rate of initial X-ray-confirmed proper catheter position than No-US (p < 0.001). The rates of proper positions of UVCs and UACs were significantly higher in the RT-US group than in the No-US group (both p < 0.001). Neonates in the RT-US group required fewer catheter adjustments and subsequent X-rays than those in the No-US group.

Conclusion: RT-US enhances the accuracy of UVC and UAC placement, reduces catheter adjustments, and the number of X-rays required.

Trial registration: TCTR20190622001.

Objective: Intraventricular hemorrhage (IVH) is a common cause of brain injury in preterm infants. Fresh human milk (HM) contains stem cells (SCs) that could potentially be delivered via intranasal HM (IHM). In this IHM pilot study, we describe outcomes.

Study design: Infants <33 weeks gestation with IVH were given IHM until maximum 28 days of age. Short-term neurologic outcomes and follow-up testing were compared to historic HM-fed infants. Longitudinal outcomes were plotted using linear mixed models. Weighted G-computation quantified treatment effects. Propensity score models calculated inverse probability weights for IVH grade, gestational age, and sex.

Result: 37 infants (35.1% grade 3-4 IVH) were compared to 191 historic controls (17.8% grade 3-4 IVH). Post-hemorrhagic ventricular dilatation was common (25.7% IHM patients). Most weighted outcomes, although not significant, favored IHM at 4-12 and 18 months corrected age.

Conclusion: This phase 1 study suggests powered trials of IHM for brain injury are needed. CLINICAL TRIAL REGISTRY NAME: clinicaltrials.gov identifier NCT04225286.

Quality improvement collaboratives (QICs) use their collective experiences from participating centers to accelerate the translation of evidence into practice, resulting in reduced variation and improved clinical outcomes. There are several regional, national, and international QICs in neonatology. In this review, we discuss the framework and evaluate national QICs primarily based in US and share the contributions of selected studies. We found that the QICs in neonatology play a significant role in identification of target topics, developing best practices, improving provider knowledge, building QI capacity, and improving outcomes. The key strengths of QICs are that they produce more generalizable learnings, involve a larger patient population which enhances statistical analysis, and offer resources to smaller institutions. Limitations include institutions contributing unequally to the overall results, difficulty in interpreting results when multiple improvement strategies are applied simultaneously, and the possible lack of academic recognition for individual center leadership.