Journal of Perinatology最新文献

Umbilical arterial catheters (UAC) in neonates are used for blood pressure monitoring, blood sampling, administration of fluids, nutrition, and medications. As UAC applications evolve, enteral nutrition practices vary in neonates in the presence of a UAC. The theoretical concern for mesenteric ischemia when a UAC is in place led to early nil per os approaches, delaying the initiation of enteral nutrition. More contemporary practices have favored introducing enteral feeding in neonates with UACs. However, there remains a paucity of data to guide clinical practice approaches regarding enteral feeding in neonates with a UAC in place. In this perspective article, we examine the physiological effects of UACs and review existing literature on feeding practices in neonates with a UAC. We offer an approach to managing enteral feeding in neonates with a UAC, addressing the central question: Is routine feeding in neonates with a UAC in place justified in current clinical practice?

Background: Tracheal intubation in very low birth weight (VLBW) infants is a high-risk procedure associated with tracheal intubation adverse events (TIAEs). Premedication for non-emergent intubations typically includes a vagolytic and analgesic agent. Rapid sequence intubation (RSI), defined as premedication with a vagolytic, analgesic, and paralytic agent, is used to enhance procedural safety and reduce complications. Premedication without paralysis was used for infants receiving surfactant with immediate extubation.

Objective: To increase the use of premedication and RSI in VLBW infants and reduce adverse events.

Methods: A QI initiative targeting VLBW infants at a level IV NICU undergoing non-emergent intubations. Interventions included forming a multidisciplinary team, education, and implementing an EHR-pathway with embedded orders.

Results: Premedication use increased from 25.7% to 93.4%, and RSI use from 14.6% to 77.3%. TIAEs decreased from 41.4% to 14.4%, and severe desaturations from 32% to 11.2%.

Conclusions: Standardizing premedication practices, including RSI, can improve neonatal safety.

Objective: To reduce necrotizing enterocolitis (NEC) in infants born <32 weeks or <1500 g by implementing probiotics protocol using quality improvement (QI) methodology. Probiotics were discontinued following the FDA warning.

Methods: Multidisciplinary team developed an evidence-based protocol and identified key drivers for implementation. Protocol compliance was the process measure. NEC rate was the outcome measure tracked at baseline, during the QI initiative, and after the FDA warning. Death and sepsis were the balancing measures.

Results: Protocol compliance was 84.5%. The baseline NEC rate was 4.6%, decreased in the post-implementation group to 0.6%, then increased following the FDA warning to 3.8% (p = 0.045). Two special cause variations were observed in relation to implementing and discontinuing probiotics. None of the infants who received probiotics died or developed probiotics associated sepsis.

Conclusions: QI initiative safely implemented probiotics and reduced NEC. The regulatory ban of probiotics was associated with a rebound in NEC rate.

Objective: Assess postpartum care attendance among parents of infants in a large, urban, children's hospital level IV NICU with an on-site delivery unit.

Study design: 86 postpartum parents of infants continuously hospitalized ≥six weeks and

Results: 26 (30%) did not attend a postpartum visit by six weeks, significantly more common among parents of transferred (41%) than parents of (10%) inborn infants (aRR 4.5, 95% CI: 1.3-15.6). Health concerns were common in both groups.

Conclusion: Parents of transferred infants had a higher risk of not attending a postpartum visit by six weeks compared to parents of inborn infants, highlighting the need for children's hospitals to measure and address postpartum healthcare gaps.

Objective: To evaluate the effectiveness of implementing American Academy of Pediatrics (AAP) discharge guidelines in reducing unplanned hospital readmissions within 30 days post-discharge among term ansd late preterm newborns.

Study design: Retrospective observational study analyzing unplanned readmissions at a single-center neonatal unit from January 1, 2021, to December 31, 2024. Data were compared before (January 1, 2021-June 30, 2022) and after (July 1, 2022-December 31, 2024) guideline implementation, with subgroup analysis for the period after addition of structured support (July 1, 2023-December 31, 2024).

Result: AAP guideline implementation was associated with a statistically significant reduction in unplanned readmission rates among term infants (0.66% vs. 0.33%; P = 0.008). No reduction was evident among late preterm infants. Subgroup analysis showed further reductions post-structured support addition, though confounding by provider changes limits attribution.

Conclusion: The adoption of the AAP discharge guidelines, along with a structured process of mother and infant readiness, significantly decreassed unplanned readmission rates among term newborns.

Neonatal brain MRI is standard of care for neuroimaging in infants with neonatal encephalopathy (NE); no international consensus exists on scoring systems to predict neurodevelopmental outcomes. This systematic review evaluates the predictive performance of existing neonatal MRI scoring systems for NE. Cochrane and PRISMA guidelines were adhered to and the study was registered with PROSPERO. Key outcomes included MRI scoring correlation in infants born at ≥36 weeks with neurodevelopmental outcomes. Of 1525 studies retrieved, and 16 met the inclusion criteria, totalling 1925 participants with follow-up data. Scoring systems evaluated included NICHD, Rutherford, Weeke, Trivedi, Barkovich, and one newly developed score. Fifteen studies found an association with outcomes; one found no correlation with IQ or typical development. All MRI scoring systems have similar predictive accuracy. Simpler systems, such as NICHD, performed on par with more complex counterparts, suggesting they may offer a more efficient option in clinical settings.

Objective: We describe a novel strategy of nasal intermittent positive pressure ventilation (NIPPV) to support patients with Grade 3 bronchopulmonary dysplasia (BPD).

Study design: This is a retrospective study of Grade 3 BPD patients treated with NIPPV and discharged from a single center from January 2020 to May 2024. Patients were grouped into discharged without tracheostomy vs with tracheostomy. Groups were assessed for clinical differences, and the NIPPV strategy is described.

Results: There were 28 non-tracheostomy and 17 tracheostomy patients. There were no differences in gestational age, birthweight, or respiratory severity score at key dates. Tracheostomy patients were more likely to have subglottic stenosis (53% vs 3.6%, p = 0.0001) and were older at discharge home [median 447 (411-479) vs 252 (184-309) days, p < 0.0001].

Conclusion: A subset of Grade 3 BPD patients can be supported with NIPPV. The non-tracheostomy group had decreased length of stay compared to the tracheostomy group.

Objectives: To investigate the effects of maternal guilt on depression, anxiety, and stress among mothers of infants in neonatal intensive care units, and to explore the moderating roles of parity, type of delivery, and sex of the baby.

Method: The study was conducted with 332 mothers in a training and research hospital in Türkiye. Direct and moderating effects among variables were tested using Model 1 of the PROCESS macro v4.

Results: The analysis revealed that maternal guilt had a significant positive direct effect on levels of depression, anxiety, and stress. The parity, type of delivery, and sex of the baby were found to moderate the impact of guilt on stress. In contrast, only the type of delivery moderated the effect of guilt on anxiety.

Conclusion: The results may contribute to the development of targeted interventions aimed at improving the mental health of mothers with babies in neonatal intensive care units.