Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Therapeutic hypothermia (TH) is standard of care for neonates ≥36 weeks with hypoxic-ischemic encephalopathy (HIE). Although intravenous fluid restriction is common, optimal strategies for parenteral and enteral nutrition remain unclear. This study evaluated the tolerance of parenteral nutrition (PN) and enteral feeding in neonates undergoing TH, as well as the impact of these interventions on clinical outcomes.

Methods: We retrospectively reviewed charts from the Florida Neonatal Neurologic Network (FN3) of neonates who underwent TH for HIE between 2012 and 2020. Collected data included demographics, neurologic assessments, nutritional strategies, laboratory values, and MRI findings. Statistical analysis was performed using one-way ANOVA, with results expressed as Kruskal-Wallis p-values.

Results: Of 170 neonates, 163 met inclusion criteria. Participants were categorized by nutritional approach: intravenous fluids (IVF), PN, or both. Neonates receiving PN had significantly higher blood urea nitrogen (BUN) during TH (p <  0.05), although values remained within acceptable limits. Lipid tolerance did not differ between groups. PN administration was associated with improved glucose regulation at 12 h (p <  0.05). Enteral feeding correlated with reduced brain injury on MRI and improved neurodevelopmental outcomes, including cognitive (p <  0.05) and motor (p <  0.05) function. Neonates receiving both PN and enteral feeding demonstrated significant recovery from malnutrition by the first outpatient follow-up (p <  0.05) and achieved full enteral feeds sooner (p <  0.05).

Conclusions: Early nutritional support, including PN and enteral feeding, appears to be well-tolerated in neonates undergoing TH for HIE. These findings suggest that providing early nutrition may enhance neurodevelopmental outcomes and promote growth during TH.

Background: Postpartum psychiatric disorders (PPDs) have been deemed as a significant public health concern, affecting both maternal health and family dynamics. This study aimed to examine the current status of PPDs, identify the potential risk factors of PPDs, and further develop a clinical nomogram model for predicting PPDs in Chinese women.

Method: In this retrospective cohort study, 1418 postpartum women attending the routine postpartum examination at the 42nd day after delivery in Jiangsu Women and Children Health Hospital were recruited as participants from December 2020 to December 2022. The Symptom Checklist-90 (SCL-90) was utilized to assess the status of postpartum psychiatric disorders. A prediction model was constructed by multivariate logistic regression and presented as a nomogram. The performance of nomogram was measured by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). The relationships between predictive factors of PPDs and SCL-90 were also evaluated using Pearson correlation analysis. The relationships between predictive factors of PPDs and SCL-90 were evaluated using Pearson correlation analysis.

Results: With the SCL-90 cutoff value of 160, the incidence of postpartum psychiatric disorders was 9.17% among Chinese urban women. The univariate and multivariate logistic regression analyses indicated that age ≤ 25 years old (OR = 10.07, 95%CI = 1.83-55.33), prenatal mood disorder (OR = 4.12, 95%CI = 1.99-8.53), invasive prenatal diagnostic procedures (OR = 4.39, 95%CI = 1.16-16.56), poor relationship with husband (OR = 2.86, 95%CI = 1.58-5.16) and poor relationship with mother-in-law (OR = 5.10, 95%CI = 2.70-9.64) were significantly associated with PPDs. A nomogram prediction model for PPDs was further constructed based on these five independent risk factors, and the area under the receiver operating characteristic curve (AUC) of the nomogram model was 0.823 (95% CI = 0.781-0.865). The calibration curves showed remarkable accuracy of the nomogram and the DCA exhibited high clinical net benefit of the nomogram. Besides, we also explored the relationships between the five risk factors and different symptom dimensions of PPDs and found that the five risk factors were almost associated with increased levels of all symptom dimensions.

Conclusions: Five psychosocial risk factors for PPDs were identified in Chinese women and the nomogram prediction model constructed based on these five risk factors could predict the risk of PPDs intuitively and individually. Systematic screening these risk factors and further conducting psychosocial interventions earlier during the pregnancy period are crucial to prevent PPDs. For future research, we intend to incorporate additional risk factors, including blood biomarkers and facial expression indicators, to refine our risk model.

Background: Excessive Gestational Weight Gain is a global public health problem with serious and long-term effects on maternal and offspring health. Early identification of at-risk groups and interventions is crucial for controlling weight gain and reducing the prevalence of excessive gestational weight gain. Currently, tools for predicting the risk of excessive gestational weight gain are lacking in China. This study aimed to develop a risk-prediction model and screening tool to identify high-risk groups in the early stages.

Methods: A total of 306 pregnant women were randomly selected who underwent regular obstetric checkups at a tertiary-level hospital in China between January and March 2023. Logistic regression analysis was used to construct the risk-prediction model. The goodness of fit of the model was assessed using the Hosmer-Lemeshow test, and the predictive performance was evaluated using the area under the receiver operating characteristic (ROC) curve, calibration plots, and k-fold cross-validation. R4.3.1 software was used to create a nomogram.

Results: The prevalence of excessive gestational weight gain was 50.32%. Logistic regression analysis revealed that pre-pregnancy overweight (OR = 2.563, 95% CI: 1.043-6.299), obesity (OR = 4.116, 95% CI: 1.396-12.141), eating in front of a screen (OR = 6.230, 95% CI: 2.753 - 14.097); frequency of weekly consumption of sugar-sweetened beverages/desserts/western fast food (OR = 1.948, 95% CI: 1.363-2.785); and pregnancy body image (OR = 1.030, 95% CI: 1.014-1.047) were risk factors for excessive gestational weight gain. Parity (OR = 0.452, 95% CI: 0.275 - 0.740), protective motivation to manage pregnancy body mass (OR = 0.979, 95% CI: 0.958-1), and the time of daily moderate-intensity physical activity (OR = 0.228, 95% CI: 0.113-0.461) were protective factors against excessive gestational weight gain. The area under the ROC curve of the model was 0.885, the mean value of ten-fold cross-validation was 0.857 for AUC.

Conclusion: The nomogram model developed in this study has a good degree of discrimination and calibration, providing a valuable basis for early identification and precise intervention in individuals at risk of excessive gestational weight gain.

Purpose: The main objective of this study was to assess the impact of a composite quality improvement intervention on mode of birth in nullipara term singleton vertex (NTSVs).

Material and methods: This was an ambidirectional study following the implementation of the intervention to reduce cesarean section rate in NSTV by comparing two birth cohorts, pre-composite quality improvement intervention cohort (January 2013-December 2015) and post-composite quality improvement intervention cohort (January 2018-December 2020).

Results: In the studied periods, there was a total of 7713 NTSV births. Compared to pre-composite quality improvement intervention, there was a post-composite quality improvement intervention reduction in NTSV cesarean section rate from 30.89% to 13.31% (p < 0.0001). Obstetric and non-obstetric indications for elective cesarean sections decreased from 5.52% to 1.04% (p < 0.0001) and from 4.82% to 0.52% (p < 0.0001), respectively. The frequency of emergency cesarean sections in this group decreased from 20.56% to 11.75% (p < 0.0001), especially those performed for failure to progress in labor (from 13.69% to 7.30%; p < 0.0001). There has been a rising trend with regards to maternal age. However, the proportion of mothers aged 35 years and more giving birth by cesarean section reduced from 46.94% to 20.28%. These reductions in cesarean section rates occurred without any negative impact on core fetal outcomes.

Conclusions: This quality improvement study demonstrates that it is feasible to significantly reduce cesarean section rate in NTSV by adopting specific composite measures. However, this requires the understanding of the inherent problems and barriers within the unit and the involvement of all stake holders.

Objective: Even with all the worldwide effort in the care of pregnant women and newborns in the last 10 years, perinatal asphyxia remains a crucial public health problem worldwide, being responsible for the high rates of morbidity and mortality in term and preterm newborns. In this perspective, research was carried out which aimed to investigate the prevalence and analyze the environmental and maternal-fetal risk factors associated with perinatal asphyxia.

Methods: This cohort study (2013-2018), corresponding to six years, was conducted in Fortaleza, Ceará, Brazil. The study involved 480 postpartum women living in a capital in the Northeast of Brazil, whose newborns were admitted to the neonatal intensive care unit of a private referral hospital for high-risk pregnancies. Perinatal asphyxia in live births was taken as the dependent variable. To identify risk factors associated with perinatal asphyxia, bivariate and multivariate analyses were performed.

Results: The research showed a high prevalence of perinatal asphyxia. The final multivariate analysis showed a significant association between perinatal asphyxia and eclampsia and complications in labor (p < 0.05), these being preventable causes of this outcome. The research demonstrated a high prevalence of perinatal asphyxia and a significant association between perinatal asphyxia and complications in labor, eclampsia, and cesarean sections (p < 0.05), being preventable causes of this outcome.

Conclusion: The study gave greater visibility to prenatal care, and understanding complications during pregnancy and childbirth care. The publication of the results signaled to managers the need to implement public and private politics to face this problem, which promoted improvements in the living conditions of the population and the care of pregnant women, to reduce the births of babies with perinatal asphyxia, consequently, reducing neonatal and infant mortality.

Objective: Bronchopulmonary dysplasia (BPD) remains a common pathology in very preterm infants. The risk of complications increases with the severity of the disease.The study aimed to determine the factors affecting the formation of moderate/severe BPD in the modern population of very preterm infants.

Methods: Data from 201 very low birth weight infants < 32 weeks of gestation were used in a retrospective cohort study. Infants were retrospectively divided into two groups based on the type of respiratory support at 36 weeks of postmenstrual age (PMA) - mild BPD (133 infants) and moderate/severe BPD (68 infants). The influence of major perinatal risk factors, neonatal morbidity, and medical interventions on the development of moderate/severe BPD was assessed.

Results: The groups were different in the incidence of intrauterine growth restriction (5% vs. 15%; p = 0.02), maternal hypertension (5% vs. 18%; p = 0.004), cesarean section (29% vs. 43%; p = 0.04), severe intraventricular hemorrhage (9% vs. 19%; p = 0.04), and retinopathy of prematurity (5% vs. 18%; p = 0.002), as well as in need for chest compressions during resuscitation at birth (2% vs. 9%; p = 0.01) for mild and moderate/severe BPD, respectively. Infants in the moderate/severe BPD group had lower Apgar scores at 1 and 5 min, required longer mechanical ventilation (220 (10-1904) hours vs. 72 (1-614) hours; p < 0.0001), CPAP duration (456 (16-1320) hours vs. 278 (10-1200) hours; p = 0.0002), oxygen supply (50 (3-146) days vs. 29 (2-68) days; p < 0.0001), as well as antibacterial therapy (61 (16-177) days vs. 52 (9-121) days; p = 0.0001) and hospital stay (109 (59-321) days vs. 85 (45-205) days; p < 0.0001). Infants with more severe BPD were also significantly more likely to die after reaching the PMA of 36 weeks (12% vs. 1%; p = 0.0003).According to the multivariable logistic regression analysis, the moderate/severe BPD was reliably and independently determined by maternal hypertension (aOR 4.53, 95% CI 1.48-13.91) and genitourinary infections (aOR 4.41, 95% CI 1.41-13.78), as well as the duration of CPAP (aOR 1.002, 95% CI 1.001-1.004) and mechanical ventilation (aOR 1.006, 95% CI 1.004-1.009).

Conclusions: Duration of respiratory support is the main risk factor that determines the development of moderate/severe BPD in the modern population of very preterm infants. Maternal hypertension and genitourinary infections may influence the severity of lung injury.

Purpose: Placenta accreta (PA) significantly increases the risk of life-threatening maternal outcomes, and its rising prevalence, driven by the increase in cesarean deliveries, underscores the need for precise diagnostic tools to improve clinical management and outcomes. This study aims to evaluate the advanced diagnostic capabilities of prenatal ultrasound and magnetic resonance imaging (MRI) in the detection of PA, a severe obstetric complication characterized by abnormal adherence of the placenta to the myometrium.

Materials and methods: The study utilized a review of current literature and clinical studies to assess the diagnostic accuracy and clinical utility of ultrasound and MRI in identifying PA. Both imaging modalities were evaluated for their ability to assess the depth and extent of placental invasion, as well as their complementary roles in prenatal diagnosis. The experimental system included detailed imaging protocols for ultrasound and MRI, focusing on placental and uterine structures, and their application in real-world clinical settings.

Results: The findings demonstrate that ultrasound and MRI are highly effective in diagnosing PA, with each modality offering unique advantages. Ultrasound is widely accessible and serves as the first-line diagnostic tool, providing detailed visualization of placental adherence and vascular patterns. MRI, on the other hand, offers superior soft tissue contrast and is particularly valuable in complex cases or when ultrasound findings are inconclusive. Together, these imaging techniques enable accurate evaluation of placental invasion, facilitating timely and targeted prenatal interventions. The study also highlights the potential for improved maternal and fetal outcomes through early diagnosis and optimized pregnancy management.

Conclusions: Prenatal ultrasound and MRI are indispensable tools in the diagnosis and management of placenta accreta, offering complementary insights that enhance diagnostic precision. Their combined use allows for detailed assessment of placental and uterine structures, guiding clinical decision-making and improving outcomes for both mothers and infants. Future advancements in imaging technology and research hold promise for further enhancing diagnostic accuracy and expanding clinical applications, ultimately contributing to safer and more effective care for patients with PA.

Background: Placenta accreta spectrum disorders (PAS), a devastating obstetric complication, has increased dramatically in recent decades along with the growing rate of cesarean worldwide. Various conservative management techniques, aimed to avoid hysterectomy and potentially preserve fertility, have been implemented in the management of PAS. However, reports on subsequent pregnancy outcomes following conservative management for PAS are limited.

Objective: To systematically evaluate the subsequent pregnancy outcomes in PAS patients undergoing conservative management.

Methods: This was a single-center, ambispective cohort study conducted between January 2013 to March 2021. Follow-ups were conducted annually, extending until March 2023. Eligible patients were PAS patients who underwent successful conservative treatment and had intentions for future fertility. Baseline characteristics, conservative management strategies, and subsequent pregnancy outcomes were collected and analyzed. Primary outcome was the subsequent pregnancy outcomes, including interpregnancy interval, conceive method, pregnancy success rate, pregnancy and delivery outcomes, and major maternal morbidities.

Results: A total of 40 patients with conservatively managed PAS and attempting subsequent pregnancies were included. These patients were further divided into the subsequent pregnancy group (n = 28) and non-pregnancy group (n = 12). There were no significant differences in term of baseline characteristics, conservative management, and delivery outcome between the two groups(All p < 0.05). The menstrual resumption time was 4.5 (2.25-6.00) months, and the interpregnancy interval was 39.7 ± 26.4 months. In the subsequent pregnancy, 28 patients experienced at least one pregnancy, with a total of 43 subsequent pregnancies. Ultimately, 60% (24/40) of patients successfully delivered but with a PAS recurrence of 33.3% (8/24). Major maternal morbidity included postpartum hemorrhage (PPH) (25%), disseminated intravascular coagulation (12.5%), uterine rupture (4.2%) and hysterectomy (4.2%). Furthermore, the incidence of composite adverse delivery outcomes was 45.8% (11/24). Neonatal outcomes were generally favorable, with a full-term birth rate of 87.5% and live birth rate of 95.8% (23/24).

Conclusion: Our findings reveal that while conservative management for PAS does not compromise subsequent fertility, it does pose substantial risks in subsequent pregnancies, including high recurrence rates of PAS, significant PPH, and increased incidence of composite adverse delivery outcomes. Patients should be thoroughly informed of the related risks and subsequent pregnancies necessitate comprehensive preconception counseling, meticulous antenatal care and individualized management strategies to minimize these risks.