Journal of Perinatology最新文献

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: 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).

Objective: To compare hospital- and county-level characteristics of rural US hospitals based on distance to the nearest neonatal intensive care unit (NICU).

Study design: Cross-sectional analysis using data from a survey conducted March-August 2021 with administrators and maternity unit managers at rural hospitals with childbirth services (N = 89).

Results: Few hospitals had a locally available NICU (onsite: n = 5, 5.6%; <10 miles: n = 0; 10-29 miles away: n = 5, 5.6%). Most were located ≥30 miles away from the nearest NICU (30-60 miles: n = 29, 32.6%; >60 miles: n = 50, 56.2%). All Critical Access Hospitals and hospitals in noncore (less populated) counties were ≥30 miles from NICUs. Hospitals further from NICUs more often had smaller birth volumes, higher proportions of Medicaid-paid births, fewer beds, and higher county-level proportions of lower income or unemployed residents.

Conclusion: Most surveyed rural hospitals did not have locally available NICUs, and characteristics of those that did suggest more hospital and community resources.

Objective: To assess inter-specialty differences in the management of febrile neonates receiving prostaglandin E1 (PGE1) for duct-dependent congenital heart disease.

Study design: A cross-sectional, web-based survey was distributed to 800 neonatologists and pediatric cardiac intensivists in North America, Europe, and the Middle East. Respondents (n = 526) were queried regarding their management of a clinical vignette involving a febrile neonate on PGE1, including decisions about sepsis work-up, antibiotic administration, and lumbar puncture. Data were analyzed using chi-square tests and multivariate logistic regression.

Result: Pediatric cardiac intensivists were significantly more likely to initiate full sepsis work-up and antibiotic therapy (65.6% vs. 38.7%, p < 0.001). Specialty was the only significant predictor of antibiotic administration (OR = 3.07, 95% CI: 1.76-4.40, p < 0.001). No significant differences were found in lumbar puncture practices.

Conclusion: Significant inter-specialty variation exists in the management of febrile neonates on PGE1, highlighting the need for evidence-based guidelines to standardize care and optimize antimicrobial stewardship.

Objective: Identify overt and latent weaknesses in preliminary plans for initiating a Fetoscopic Endoluminal Tracheal Occlusion program.

Study design: Clinical scenarios involving placement and removal of a fetal tracheal occlusion device for fetuses with severe congenital diaphragmatic hernia were simulated. All sessions took place in the actual hospital environments and were captured on video for later playback, transcription and analysis.

Results: Simulation-based investigation produced: • a list of plausible scenarios • lists of equipment required • diagrams of room setup and positioning of personnel • decision trees for each scenario • situation awareness issues • workflow issues • areas requiring additional planning.

Conclusions: Using appropriate patient simulators and task trainers, teams experienced multiple realistic scenarios that facilitated the development of equipment lists, room setup diagrams, and tactics to remediate identified weaknesses. Simulation is a useful strategy to prepare for the implementation of new, high-risk clinical programs.