Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152189
Margaret Nguyen , Suma Bhat Hoffman , Alan Chin , Deborah Lehman , Josephine M. Enciso
Pediatric residency and pediatric subspecialty fellowship programs have seen reduced growth in the number of applicants relative to the increased number of positions over the last 6 years. There are concerns this will lead to a future pediatrician workforce unable to meet the needs of an expanding population of children with highly complex medical conditions. This review will describe the current landscape of the pediatric subspecialty workforce, the factors contributing to pediatric subspecialty applicant shortages, and the potential impacts of these shortfalls on the future of pediatric complex care. Strategies are described to address the insufficient numbers of pediatric subspecialty applicants. Future research is needed to better delineate etiologies and address gaps in the pediatric workforce thus ensuring favorable health outcomes for children.
{"title":"Who you gonna call? Understanding the shortages of the pediatric subspecialty workforce","authors":"Margaret Nguyen , Suma Bhat Hoffman , Alan Chin , Deborah Lehman , Josephine M. Enciso","doi":"10.1016/j.semperi.2025.152189","DOIUrl":"10.1016/j.semperi.2025.152189","url":null,"abstract":"<div><div>Pediatric residency and pediatric subspecialty fellowship programs have seen reduced growth in the number of applicants relative to the increased number of positions over the last 6 years. There are concerns this will lead to a future pediatrician workforce unable to meet the needs of an expanding population of children with highly complex medical conditions. This review will describe the current landscape of the pediatric subspecialty workforce, the factors contributing to pediatric subspecialty applicant shortages, and the potential impacts of these shortfalls on the future of pediatric complex care. Strategies are described to address the insufficient numbers of pediatric subspecialty applicants. Future research is needed to better delineate etiologies and address gaps in the pediatric workforce thus ensuring favorable health outcomes for children.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152189"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152188
Ashley Stoneburner , Ripley Lucas , Jazmin F․ Chestnut , Erin E. Jones , Andrea L. DeMaria
Significant portions of the U.S. population face barriers to maternity care, contributing to rising rates of maternal and infant morbidity and mortality, particularly among rural and historically marginalized communities. Over 35 % of U.S. counties are designated as “maternity care deserts”, lacking obstetric clinicians and birthing facilities. These counties are home to more than 2.3 million reproductive-aged women and account for over 150,000 births annually. Limited access to maternity care is associated with delayed prenatal care, increased preterm birth rates, and higher maternal mortality. Contributing factors include hospital closures, clinician shortages, restrictive policies, and gaps in insurance coverage, disproportionately affecting Medicaid recipients and communities of color. Addressing this crisis requires multifaceted policy solutions. Expanding Medicaid coverage and increasing payment rates can incentivize provider participation and reduce financial barriers to care. Integrating midwifery care offers safe, patient-centered options for low-risk births, yet restrictive state policies and limited training opportunities hinder growth in this workforce. Telehealth presents a promising approach to extending access, particularly in rural areas, by enabling remote consultations, monitoring, and perinatal education. Additionally, fostering regionalized perinatal care networks and investing in workforce development are critical to strengthening the maternity care system. Action is needed to close persistent gaps in maternity care access and ensure equitable, high-quality care for all birthing people. Policymakers, clinicians, and advocates must implement evidence-based solutions to mitigate disparities and improve maternal and infant health outcomes across the U.S.
{"title":"Nowhere to go: An overview of maternity care access across the U.S․","authors":"Ashley Stoneburner , Ripley Lucas , Jazmin F․ Chestnut , Erin E. Jones , Andrea L. DeMaria","doi":"10.1016/j.semperi.2025.152188","DOIUrl":"10.1016/j.semperi.2025.152188","url":null,"abstract":"<div><div>Significant portions of the U.S. population face barriers to maternity care, contributing to rising rates of maternal and infant morbidity and mortality, particularly among rural and historically marginalized communities. Over 35 % of U.S. counties are designated as “maternity care deserts”, lacking obstetric clinicians and birthing facilities. These counties are home to more than 2.3 million reproductive-aged women and account for over 150,000 births annually. Limited access to maternity care is associated with delayed prenatal care, increased preterm birth rates, and higher maternal mortality. Contributing factors include hospital closures, clinician shortages, restrictive policies, and gaps in insurance coverage, disproportionately affecting Medicaid recipients and communities of color. Addressing this crisis requires multifaceted policy solutions. Expanding Medicaid coverage and increasing payment rates can incentivize provider participation and reduce financial barriers to care. Integrating midwifery care offers safe, patient-centered options for low-risk births, yet restrictive state policies and limited training opportunities hinder growth in this workforce. Telehealth presents a promising approach to extending access, particularly in rural areas, by enabling remote consultations, monitoring, and perinatal education. Additionally, fostering regionalized perinatal care networks and investing in workforce development are critical to strengthening the maternity care system. Action is needed to close persistent gaps in maternity care access and ensure equitable, high-quality care for all birthing people. Policymakers, clinicians, and advocates must implement evidence-based solutions to mitigate disparities and improve maternal and infant health outcomes across the U.S.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152188"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152191
Rasheda J. Vereen , Jeanne Krick , Caitlin M. Drumm
Climate change threatens human health, particularly vulnerable populations like pregnant individuals, children, and infants. This article examines the multifaceted impacts of climate change on pregnancy and neonatal health. Therefore, we discuss climate vulnerability as a social determinant of health and advocate for integrating climate change screening and counseling into routine perinatal care. As a result, climate health education is critical for both healthcare providers and families, and there is a need for climate-resilient healthcare systems. Furthermore, climate change education is necessary in the NICU, and we advocate for a comprehensive curriculum to equip healthcare professionals with the knowledge and skills to address the unique challenges posed by climate change to this vulnerable population.
{"title":"Integrating climate vulnerability as a social determinant of health: Screening, counseling, and promoting resilience for pregnant people, neonates and families","authors":"Rasheda J. Vereen , Jeanne Krick , Caitlin M. Drumm","doi":"10.1016/j.semperi.2025.152191","DOIUrl":"10.1016/j.semperi.2025.152191","url":null,"abstract":"<div><div>Climate change threatens human health, particularly vulnerable populations like pregnant individuals, children, and infants. This article examines the multifaceted impacts of climate change on pregnancy and neonatal health. Therefore, we discuss climate vulnerability as a social determinant of health and advocate for integrating climate change screening and counseling into routine perinatal care. As a result, climate health education is critical for both healthcare providers and families, and there is a need for climate-resilient healthcare systems. Furthermore, climate change education is necessary in the NICU, and we advocate for a comprehensive curriculum to equip healthcare professionals with the knowledge and skills to address the unique challenges posed by climate change to this vulnerable population.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152191"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152193
Shetal Shah
Perinatal health outcomes directly relate to insurance coverage. The Medicaid program is the single largest health insurer of children, providing coverage to almost half of births nationally. Organized as a federal-state partnership, Medicaid allows states to modify minimum standards of eligibility and coverage created by the federal government. The dual funding structure of Medicaid, however, exposes the program to national and local politics, often placing funding in jeopardy. This paper reviews the history, basic design and scope of Medicaid coverage for infants and birthing people. It introduces policy tools such as waivers and amendments used by states to alter their programs and reviews funding threats that may reduce benefits. Recent history related to the impact of the Affordable Care Act and its effect on the number of insured individuals will be discussed as well as 2025 changes to Medicaid funding. Ultimately, physician advocacy is required to ensure Medicaid continues to protect families.
{"title":"Delivering health insurance coverage for babies: A primer on Medicaid for perinatal care providers","authors":"Shetal Shah","doi":"10.1016/j.semperi.2025.152193","DOIUrl":"10.1016/j.semperi.2025.152193","url":null,"abstract":"<div><div>Perinatal health outcomes directly relate to insurance coverage. The Medicaid program is the single largest health insurer of children, providing coverage to almost half of births nationally. Organized as a federal-state partnership, Medicaid allows states to modify minimum standards of eligibility and coverage created by the federal government. The dual funding structure of Medicaid, however, exposes the program to national and local politics, often placing funding in jeopardy. This paper reviews the history, basic design and scope of Medicaid coverage for infants and birthing people. It introduces policy tools such as waivers and amendments used by states to alter their programs and reviews funding threats that may reduce benefits. Recent history related to the impact of the Affordable Care Act and its effect on the number of insured individuals will be discussed as well as 2025 changes to Medicaid funding. Ultimately, physician advocacy is required to ensure Medicaid continues to protect families.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152193"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152194
Elissa Dunlap, Heather L. Brumberg
Preferring a language other than English (LOE) is associated with numerous disparities across healthcare. Despite the federally mandated requirement for use of medical interpreters, utilization is suboptimal. Families facing language barriers experience difficulties in accessing care, receive inadequate counselling, and are at high risk for preventable medical errors. Emerging evidence suggests maternal and infant health outcomes surrounding childbirth are worse for patients with a LOE preference. This review will address the impact of preferring a LOE on perinatal health outcomes from preconception care, throughout pregnancy, and into the neonatal period. We discuss quality improvement initiatives that promote language equity by sustainably increasing interpreter use. Future directions and opportunities will be explored.
{"title":"The impact of preferred language on perinatal health","authors":"Elissa Dunlap, Heather L. Brumberg","doi":"10.1016/j.semperi.2025.152194","DOIUrl":"10.1016/j.semperi.2025.152194","url":null,"abstract":"<div><div>Preferring a language other than English (LOE) is associated with numerous disparities across healthcare. Despite the federally mandated requirement for use of medical interpreters, utilization is suboptimal. Families facing language barriers experience difficulties in accessing care, receive inadequate counselling, and are at high risk for preventable medical errors. Emerging evidence suggests maternal and infant health outcomes surrounding childbirth are worse for patients with a LOE preference. This review will address the impact of preferring a LOE on perinatal health outcomes from preconception care, throughout pregnancy, and into the neonatal period. We discuss quality improvement initiatives that promote language equity by sustainably increasing interpreter use. Future directions and opportunities will be explored.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152194"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152198
Heather L. Brumberg, Shetal Shah
{"title":"Mitigating threats, maximizing opportunities: Harnessing post-pandemic heath services to strengthen the safety net for perinatal patients","authors":"Heather L. Brumberg, Shetal Shah","doi":"10.1016/j.semperi.2025.152198","DOIUrl":"10.1016/j.semperi.2025.152198","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152198"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145775557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152187
Helen O. Williams , Melanie Schmidt
Medication, equipment, and formula shortages have become commonplace in the neonatal intensive care unit (NICU). These shortages challenge clinicians to provide optimal care despite suboptimal resources. The effects of these shortages can impact morbidity and mortality and may extend beyond the NICU admission with consequences for the patient’s growth and development. We will review the causes of medication, equipment, and formula shortages and discuss ethical approaches to allocating scarce resources.
{"title":"Perinatal equipment, medication and specialized formula shortages: Defining the challenge and exploring ethical solutions","authors":"Helen O. Williams , Melanie Schmidt","doi":"10.1016/j.semperi.2025.152187","DOIUrl":"10.1016/j.semperi.2025.152187","url":null,"abstract":"<div><div>Medication, equipment, and formula shortages have become commonplace in the neonatal intensive care unit (NICU). These shortages challenge clinicians to provide optimal care despite suboptimal resources. The effects of these shortages can impact morbidity and mortality and may extend beyond the NICU admission with consequences for the patient’s growth and development. We will review the causes of medication, equipment, and formula shortages and discuss ethical approaches to allocating scarce resources.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152187"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152192
Christine C. Pazandak , Michelle Alden , Steven Schulman , Shetal Shah , Susan Schoppa
Medical-legal partnerships (MLPs) are healthcare delivery models that involve a multi-disciplinary team including clinicians, lawyers, social workers, and case managers, working together to address legal issues of vulnerable patient populations. This practice model aims to improve patient outcomes and population health by integrating legal services into clinical settings to address health-harming legal needs. This article will review the history of MLPs in the United States and the status of the MLPs in the NICU setting. In addition, this article will describe the benefits and challenges of implementing a MLP and offer insights into how this partnership assists NICU patients and their families.
{"title":"Medical legal partnerships in the neonatal intensive care unit","authors":"Christine C. Pazandak , Michelle Alden , Steven Schulman , Shetal Shah , Susan Schoppa","doi":"10.1016/j.semperi.2025.152192","DOIUrl":"10.1016/j.semperi.2025.152192","url":null,"abstract":"<div><div>Medical-legal partnerships (MLPs) are healthcare delivery models that involve a multi-disciplinary team including clinicians, lawyers, social workers, and case managers, working together to address legal issues of vulnerable patient populations. This practice model aims to improve patient outcomes and population health by integrating legal services into clinical settings to address health-harming legal needs. This article will review the history of MLPs in the United States and the status of the MLPs in the NICU setting. In addition, this article will describe the benefits and challenges of implementing a MLP and offer insights into how this partnership assists NICU patients and their families.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152192"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152190
Ashley D. Osborne , William Corder , Jason Z. Stoller , Karena Lawrence , Cara Beth Carr , María V. Fraga , Sandy Johng
Point-of-care ultrasound (POCUS) is an increasingly utilized bedside imaging modality in the neonatal intensive care unit, offering procedural, diagnostic and therapeutic guidance for clinicians. This narrative review explores the key technical aspects of POCUS use in neonates and the expanding body of research supporting its use for both procedural guidance and diagnostic applications. Despite its growing potential to enhance neonatal care, widespread implementation remains challenged by lack of consensus and guidance related to training, credentialing, quality assurance and assessment of competency. A framework for curriculum development is proposed to support the integration of POCUS into neonatology practice. As its role continues to expand, addressing these challenges will be critical to optimizing the benefits of POCUS and improving neonatal outcomes.
{"title":"Technical considerations and applications of point-of-care ultrasound in the NICU","authors":"Ashley D. Osborne , William Corder , Jason Z. Stoller , Karena Lawrence , Cara Beth Carr , María V. Fraga , Sandy Johng","doi":"10.1016/j.semperi.2025.152190","DOIUrl":"10.1016/j.semperi.2025.152190","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) is an increasingly utilized bedside imaging modality in the neonatal intensive care unit, offering procedural, diagnostic and therapeutic guidance for clinicians. This narrative review explores the key technical aspects of POCUS use in neonates and the expanding body of research supporting its use for both procedural guidance and diagnostic applications. Despite its growing potential to enhance neonatal care, widespread implementation remains challenged by lack of consensus and guidance related to training, credentialing, quality assurance and assessment of competency. A framework for curriculum development is proposed to support the integration of POCUS into neonatology practice. As its role continues to expand, addressing these challenges will be critical to optimizing the benefits of POCUS and improving neonatal outcomes.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152190"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.semperi.2025.152209
Sarah M. Sánchez , Shetal Shah
Mental illness affects up to 20 % of women of reproductive age. Maternal mental illness pre-pregnancy and/or during pregnancy is an independent risk factor for prematurity, stillbirth and small for gestational age. Data on maternal mental illness and other birth outcomes are mixed. There are several different screening tools available to identify mothers with mental illness. Although the timing of screening varies among providers, antenatal screening provides more opportunities to identify and support mothers with mental illness. If identified prior to potential maternal mental illness exacerbations complicating decision-making capacity there may be an opportunity for advanced directives. This review focuses on the impact of maternal mental illness on delivery mode and timing, birth outcomes, and breastfeeding. We discuss maternal mental illness screening tools, relevant benefits and disadvantages as well as timing and location (obstetric and pediatric settings). Finally, ethical and policy implications are detailed.
{"title":"Perinatal mental health: Screening and impact on health outcomes","authors":"Sarah M. Sánchez , Shetal Shah","doi":"10.1016/j.semperi.2025.152209","DOIUrl":"10.1016/j.semperi.2025.152209","url":null,"abstract":"<div><div>Mental illness affects up to 20 % of women of reproductive age. Maternal mental illness pre-pregnancy and/or during pregnancy is an independent risk factor for prematurity, stillbirth and small for gestational age. Data on maternal mental illness and other birth outcomes are mixed. There are several different screening tools available to identify mothers with mental illness. Although the timing of screening varies among providers, antenatal screening provides more opportunities to identify and support mothers with mental illness. If identified prior to potential maternal mental illness exacerbations complicating decision-making capacity there may be an opportunity for advanced directives. This review focuses on the impact of maternal mental illness on delivery mode and timing, birth outcomes, and breastfeeding. We discuss maternal mental illness screening tools, relevant benefits and disadvantages as well as timing and location (obstetric and pediatric settings). Finally, ethical and policy implications are detailed.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 1","pages":"Article 152209"},"PeriodicalIF":3.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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