Seminars in perinatology最新文献

Neonatal Opioid Withdrawal Syndrome (NOWS) is a group of clinical withdrawal signs occurring in prenatally opioid-exposed newborns and manifesting as neurobehavioral dysregulation, including extreme irritability such as excessive crying, rigid muscle tone, and difficulty feeding and sleeping. One U.S. infant experiencing NOWS is born every 25 min. Clinical management of these infants has traditionally occurred in the high-acuity environment of a neonatal intensive care unit (NICU), which contributes to separation of infants from their parents and increases the likelihood of pharmacological intervention to manage withdrawal. Over the past decade, more holistic approaches, such as the Eat, Sleep, and Console method, have focused on parents' active participation in care, rooming-in, and implementation of non-pharmacologic soothing techniques to reduce medication use, hospital length of stay, and healthcare expenditures. These distinctly different management approaches have contributed to unique experiences for parents and healthcare providers involved in infants' care; therefore, the purpose of this paper is to review the experiences of parents and healthcare providers as they relate to management approaches for infants with NOWS.

Obstetric sepsis is a leading cause of maternal mortality and severe maternal morbidity in the United States. However, it is uncommon, and diagnosis and treatment are often delayed. This report summarizes recent work to develop a patient-centered approach for the care of patients with obstetric sepsis. To support patients, educational materials to identify warning signs paired with advocacy tips are important. Following an adverse event, outlines and checklists for patient support are provided. These tools have been developed to address a variety of obstetric conditions and have utility beyond sepsis. On the clinical side, new data to establish a standardized approach to screening and diagnosis is covered in detail. This "two-step" approach has been supported by national obstetric organizations and has similarities to the algorithm used to screen neonates for term early onset sepsis. In addition, the approach for implementation of a sepsis care bundle by the California/Michigan Obstetric Sepsis Quality Collaborative is discussed.

Sepsis remains a leading cause of mortality among pregnant and recently pregnant patients, rendering it a subject of vital importance to emergency clinicians in the US. However, death by sepsis has been found to be largely preventable with prompt and appropriate intervention. This narrative review provides a summary of the physiologic, epidemiologic, and systemic factors specific to obstetric sepsis that contribute to delays in diagnosis and treatment. Additionally, it provides a framework for emergency department providers to approach infection identification, antimicrobial selection, and appropriate resuscitation prior to disposition.

The long-term consequences of obstetric sepsis have been a growing area of concern requiring attention. This narrative review summarizes the existing literature on the long-term sequelae of sepsis, with a focus on the antepartum and postpartum periods. In this article, we discuss risk factors for and epidemiology of post-sepsis syndrome (PSS) and related long-term medical conditions. We include recommendations for screening for PSS and management strategies involving multidisciplinary teams. PSS and other long-term medical and psychological sequelae of sepsis impact individuals and their communities greatly, including the obstetric population. There is a need for improved identification, management, and coordination of care for long-term complications of sepsis. Gaps in the literature for future study include identifying specific needs of the obstetric population in the weeks, months, and years following a sepsis event.

Sepsis is a leading cause of maternal morbidity and mortality worldwide. Early recognition and treatment improve outcomes. Multiple sepsis diagnostic screening tools are available and may be used in clinical practice; however, early thorough bedside evaluation of the patient is fundamental. Obstetricians should be able to recognize sepsis and promptly initiate potentially life-saving treatments, such as fluid resuscitation, vasopressors, broad-spectrum antibiotics, and early source control. It is recommended that obstetrical care, including delivery timing, not be altered solely due to the diagnosis of sepsis.

Obstetric sepsis is a significant cause of morbidity and mortality in pregnant people worldwide. Initial evaluation and timely intervention are crucial to improving outcomes for birthing persons and their newborns. While many of the therapies and interventions for peripartum sepsis are consistent with the general population, there are considerations unique to pregnancy. Stabilization of the septic pregnant or immediately postpartum patient requires an understanding of the physiologic changes of pregnancy, hemodynamic changes during labor, and infections specific to pregnancy. We will review the interaction between pregnant physiology and sepsis pathophysiology, and how this can guide screening and diagnosis.

Sepsis is the second leading cause of maternal death in the U.S. For racial and ethnic minoritized birthing people, especially those who are Black and living in underserved communities, labor and postpartum are particularly vulnerable risk periods. To reduce sepsis-related morbidity and mortality and promote maternal health equity, community co-led, and co-designed interventions are urgently needed. In this commentary, we introduce the design and goals of our EnCoRe MoMS study as an exemplar for employing community based participatory research principals iteratively throughout the research process and integrated across all study aims. We also highlight our early lessons learned and recommendations for best practices. Our novel model and ongoing work have implications for scaling academic-community research partnerships for other causes of severe maternal morbidity and maternal health equity nationally.