American journal of perinatology最新文献

This study aimed to assess the relationship between placental lesions, antibiotic exposure duration, and necrotizing enterocolitis (NEC) severity in preterm infants.In this single-center, case-control study, 107 infants with NEC and 130 controls were grouped by antibiotic exposure after birth: ≤3 or >3 days.Of 212 infants, 103 (48.5%) received antibiotics for ≤3 days, while 109 (51.5%) received antibiotics for >3 days. Multivariate regression analysis demonstrated that prolonged antibiotic duration (>3 vs. ≤3 days) was significantly associated with increased severity of NEC, with adjusted odds ratios (aORs) of 2.65 (95% confidence interval [CI]: 1.36-5.16; p = 0.004) for medical NEC and 3.36 (95% CI: 1.56-7.23; p = 0.002) for surgical NEC. However, prolonged antibiotic duration was not significantly associated with overall mortality (aOR = 1.16, 95% CI: 0.58-2.34; p = 0.7). Among infants diagnosed with NEC (n = 97), antibiotic duration of >3 days significantly increased the odds of mortality (aOR = 7.34, 95% CI: 1.94-48.3; p = 0.011) but was not significantly associated with NEC severity (aOR = 1.20, 95% CI: 0.49-2.94; p = 0.7). Among 64 infants with acute histologic chorioamnionitis, 37 (58%) received antibiotics for >3 days. Longer antibiotic exposure was linked to higher risks of medical NEC (79 vs. 38%; p = 0.021) and surgical NEC (62 vs. 38%; p = 0.021) compared with shorter exposure. In 134 infants with maternal vascular malperfusion (MVM), prolonged antibiotics were also associated with increased risks for medical (60 vs. 36%; p = 0.007) and surgical NEC (67 vs. 36%; p = 0.007). Concordance between clinical and pathologic chorioamnionitis was moderate (first-order agreement coefficient [AC1] = 0.60), while agreement for pregnancy-induced hypertension versus MVM was minimal (AC1 = 0.07).Prolonged antibiotic exposure (>3 days) in infants with chorioamnionitis or MVM is most likely associated with increased NEC severity. Limiting antibiotic duration may reduce severe NEC risk in preterm infants. · Prolonged antibiotics following birth are associated with NEC severity.. · Infants exposed to chorioamnionitis and receiving prolonged antibiotics are more likely at NEC risk.. · Shorter duration of antibiotics following birth may reduce NEC risk..

We aimed to assess neonatal outcomes by mode of delivery and to evaluate the value of achieving daytime delivery among neonates undergoing a planned induction of labor (IOL).This was a retrospective study of pregnancies with prenatally diagnosed d-TGA with an IVS receiving care at a single tertiary care referral center from 2020 to 2023. Inclusion required prenatal diagnosis of d-TGA with an IVS and surgical care at the referral center. The primary outcome was a composite of neonatal outcomes, including preoperative inhaled nitric oxide use, inotrope use, preoperative mortality, reoperation, readmission, delayed sternal closure, diaphragmatic paralysis, and postoperative mortality. Secondary surgical outcomes and composite neurological morbidity, including hypoxic-ischemic encephalopathy, seizures, intraventricular hemorrhage, or stroke, were collected. Pearson's chi-square or Fisher's exact test was performed as appropriate.We identified 90 cases of prenatally diagnosed d-TGA, of which 68 (76%) underwent timed IOL and 46 (68%) achieved vaginal delivery. The primary outcome occurred in 16 neonates (89%) who were delivered by cesarean and 47 neonates (78%) who underwent a planned timed IOL (p = 0.26). Among individuals undergoing IOL, the primary outcome occurred in 29 neonates (73%) who delivered during the daytime and 18 (90%) who delivered after-hours (p = 0.19).We found that in cases of prenatally diagnosed d-TGA with an IVS, IOL is feasible. Neonates with d-TGA with an IVS had similar surgical outcomes when induced and delivered at this single tertiary care center, regardless of delivery time. · Induction is feasible, and daytime delivery was achieved in the majority of cases of TGA.. · Neonates with d-TGA with an IVS have similar surgical outcomes regardless of delivery time.. · There was no clear benefit to achieving strict daytime delivery in cases of TGA..

To evaluate, in a cohort of children born extremely preterm, the hypothesis that increasing severity of retinopathy of prematurity (ROP) is associated with less optimal vision, neurodevelopmental outcomes, and parent-reported quality of life.The Extremely Low Gestational Age Newborn study is a multicenter, longitudinal cohort study. Study participants were born before 28 completed weeks of gestation during the years 2002 to 2004 and were enrolled at birth at 14 U.S. hospitals. Based on retinal examinations by ophthalmologists, participants were classified during their initial hospitalization according to the severity of ROP. At 10 years of age, study psychologists evaluated participants' cognitive abilities, academic achievement, and behaviors indicative of autism spectrum disorder. Participants were classified with regard to gross motor function, anxiety, depression, and quality of life based on parents' responses on standardized questionnaires.After adjustment for confounders, increased severity of ROP was associated with increased severity of vision/eye problems, worse scores on math achievement tests, as well as higher prevalence of anxiety and lower quality of life as reported by the parent when the child was 10 years old. A history of blindness in one or both eyes was associated with these same outcomes, as well as worse scores on assessments of cognitive function, reading ability, and social responsiveness.Among extremely preterm children, severe ROP and severe eye or vision problems are associated with adverse neurodevelopmental outcomes and lower quality of life. · Severe retinopathy of prematurity in extremely low gestational age neonates (ELGANs) is likely to have adverse outcomes at 10 years of age.. · Severe ROP in ELGANs is associated with parent-reported lower quality of life at 10 years.. · Blindness in one or both eyes following ROP is associated with multiple adverse outcomes at 10 years..

The American Academy of Pediatrics (AAP) provides guidelines for managing hyperbilirubinemia in term newborns ≥35 weeks' gestation to prevent kernicterus. In 2022, the AAP revised these guidelines by raising thresholds for serum bilirubin testing and phototherapy. This study compares newborn outcomes before and after implementing the 2022 guidelines.A retrospective chart review of 2,087 newborns, with 1,058 in the "before" group, using the 2004 guidelines, and 1,029 in the "after" group, using the 2022 guidelines. Data collected included demographics, number of heel sticks for serum bilirubin, incidence of phototherapy, and incidence of readmission for hyperbilirubinemia.There was a 64% reduction in serum bilirubin draws, a 51% decrease in phototherapy sessions, and a 35% reduction in readmissions for phototherapy in the "after" group.The 2022 AAP guidelines streamlined the management of hyperbilirubinemia, leading to fewer interventions without affecting patient safety. · The recent AAP newborn jaundice guidelines result in fewer serum bilirubin levels being drawn.. · The recent AAP newborn jaundice guidelines result in less phototherapy.. · The recent AAP newborn jaundice guidelines result in fewer readmissions for jaundice..

Bronchopulmonary dysplasia (BPD) is the most common adverse outcome of neonatal intensive care and is increasing. Our objective was to determine if temporal trends in BPD were associated with changes in neonatal care practices.The outcomes of infants born at less than 32 weeks of gestation in two study periods, 2012 to 2014 and 2020 to 2022, were compared. The results were divided into those born between 28 and 32 weeks of gestation and less than 28 weeks of gestation. Data were collected from the patient records and an electronic record system, BadgerNet.There were 213 infants and 161 infants in the first and second epoch, respectively; the latter group was of lower gestational age (mean: 28.4 vs. 29.6 weeks, p = 0.03) and birth weight (1,000 vs. 1,124 g, p = 0.01). A greater proportion of the more mature group were growth retarded in the second epoch (23 vs. 12%, p = 0.028). Overall, moderate/severe BPD was higher in the more recent epoch (64 vs. 39%, p < 0.001), but infants were not discharged at a later corrected gestation age, nor was there an increase in use of home oxygen. Mortality, ventilation days, and inotropic support were similar in the two time periods. At all gestations, hydrocortisone use in the first week was higher in the more recent epoch (25 vs. 7%, p < 0.001), as was diuretic use (54 vs. 30%, p < 0.001), paracetamol administration (22 vs. 0%, p < 0.001) and less invasive surfactant administration (41 vs. 0%, p < 0.001). Postnatal dexamethasone use was higher in infants less than 28 weeks of gestation during the most recent epoch (50 vs. 34%, p = 0.034).Over the 10-year period, the BPD incidence increased, likely reflecting that in the latter epoch, infants were more immature and growth retarded. Greater use of hydrocortisone and diuretics was not associated with improved outcomes. · An increase in BPD between 2012 to 2014 and 2020 to 2022.. · Infants were more immature and small for gestational age in 2020 to 2022.. · Greater use of hydrocortisone and dexamethasone.. · Greater use of less invasive surfactant administration and diuretics..

The Society for Maternal-Fetal Medicine and American College of Obstetricians and Gynecologists recommend delivery of gravidae with pregestational diabetes at 36 to 39^6/7 weeks based on glycemic control and vascular complications. The optimal gestational age within this wide range is unknown. Our objective was to evaluate the risk of adverse outcomes with delivery versus expectant management at increasing gestational ages.Retrospective cohort study of gravidae with pregestational diabetes who delivered a nonanomalous singleton at ≥36 weeks (2012-2022). The primary outcome was composite neonatal morbidity: hypoglycemia, hyperbilirubinemia, shoulder dystocia, and perinatal death. Secondary outcomes included composite components, composite severe neonatal morbidity, large-for-gestational-age, small-for-gestational-age (SGA), NICU admission, and cesarean. Poisson regression with robust error variance estimated the association between delivery at 36, 37, and 38 weeks and outcomes, compared with expectant management.Eight hundred forty-three gravidae met inclusion criteria: 235 (28%) type 1 diabetes and 602 (71%) type 2 diabetes. Overall, 146 (17%) delivered at 36 weeks, 283 (34%) at 37 weeks, 217 (26%) at 38 weeks, and 197 (23%) at ≥39 weeks. Compared with expectant management, delivery at 36 weeks was associated with higher odds of composite morbidity (adjusted risk ratio: 1.31; 95% confidence interval: 1.11-1.55) as well as hypoglycemia, hyperbilirubinemia, SGA, and NICU admission. At 37 and 38 weeks, there was no significant difference in composite morbidity among those delivered versus expectantly managed. However, delivery at 37 weeks was associated with higher odds of hyperbilirubinemia, compared with expectant management. No other outcomes differed between delivery versus expectant management at 37 or 38 weeks. Few associations differed by diabetes type.Based on these results and supporting literature, elective delivery at 36 weeks should be avoided unless necessary. Although the data are inconclusive regarding delivery at 37 weeks, delivery at 38 weeks should be evaluated further for gravidae with pregestational diabetes. Confirmation in a large, contemporary cohort or a randomized trial is needed. · Elective delivery of gravidae with diabetes at 36 weeks should be avoided given neonatal morbidity.. · Delivery of gravidae with diabetes at 37 weeks versus expectant management may increase morbidity.. · Delivery of gravidae with diabetes at 38 weeks didn't increase morbidity but needs further study..

This study aimed to evaluate the outcomes of pregnancies immediately following stillbirth in relation to treatments prescribed.A prospective, observational study was conducted in patients with a history of stillbirth (≥22 weeks) between 2014 and 2022 across four Italian University Hospitals. Outcomes were stratified based on the cause of previous fetal death (classified according to ReCoDe classification) and treatment (low dose aspirin [LDA], low molecular weight heparin [LMWH], both, progesterone, or other drugs). The main outcome was adverse neonatal outcome, including perinatal death, stillbirth recurrence, intrauterine growth restriction, early preterm birth, Apgar < 7 at 5 minutes, and need for neonatal resuscitation. The secondary outcome was adverse maternal outcome, including postpartum hemorrhage, emergency cesarean delivery, and operative vaginal delivery.Among 308 subsequent pregnancies, 46 (14.94%) had an adverse neonatal outcome, including 4 stillbirths. A total of 76 pregnancies (24.68%) experienced adverse maternal outcome, and 19 pregnancies (6.17%) had both. In individuals with previous placental vascular disorders (PVDs), adverse neonatal outcomes were reduced by 75% when treated with LDA + LMWH (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.06-1.03; p = 0.049). However, adverse maternal outcome was significantly higher in individuals who received LDA + LMWH without specific indications (OR: 3.07; 95% CI: 1.07-8.78; p = 0.036).LDA and LMWH should be prescribed only for previous PVDs to improve adverse neonatal outcome and avoid unnecessary maternal risk. · LDA + LMWH reduces neonatal risk after placental stillbirths.. · Unnecessary LDA + LMWH increases maternal complications.. · Prescribe LDA + LMWH only with placental indications..

Newborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing recommends screening near hospital discharge but does not specify an optimal timing. To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates.Neonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24, 24 to 36, 36 to 48, and more than 48 hours, with follow-up at 1 month for persistent failures. Statistical analyses included Fisher's exact test to compare pass rates across time intervals and multivariate Cox's proportional hazards regression and Laplace regression to assess factors associated with screening outcomes.Among 408 neonates, the median passing age was 23.8 hours (interquartile range: 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24 to 36 hours, 92.6% at 36 to 48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (odds ratio: 5.26; p = 0.0153). Cesarean delivery was associated with delayed passing compared with vaginal delivery (p = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (p < 0.01), whereas small for gestational age neonates passed earlier by 8.2 hours (p = 0.021).Screening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention. · The ideal timing for newborn hearing screening remains unclear, affecting accuracy and follow-up rates.. · Early TEOAE screening may lead to high false positives due to residual ear fluid, increasing unnecessary follow-ups.. · Optimizing timing of the hearing screening window can enhance accuracy, reduce false positives, and improve clinical efficiency..

Congenital syphilis presents a significant public health problem. Since 2012, there has been a dramatic increase in reported cases of congenital syphilis. However, characteristics of these cases have not been well detailed. This study sought to describe recent trends in the incidence of congenital syphilis, demographic characteristics, hospital treatment, and outcomes of these infants.A retrospective cohort study of all infants in the Pediatrix Clinical Data Warehouse (CDW; a large multicenter de-identified dataset) from 2011 to 2020 was performed. We identified infants with a diagnosis of congenital syphilis and evaluated trends in overall prevalence, as well as changes in maternal and infant characteristics over time.Of 842,928 infants discharged over the study period, we identified 1,625 infants with congenital syphilis. Between 2011 and 2020, the prevalence of congenital syphilis increased from 0.8 to 4.6 per 1,000 neonatal intensive care unit (NICU) admissions (p < 0.05). Most infants were treated with penicillin for 10 days, and the median length of stay was 10 days. Mortality was 0.9% in this cohort. Maternal coinfection with Hepatitis C was unchanged but remained significantly above national rates of Hepatitis C infection in pregnant women. Maternal drug use in infants born with congenital syphilis increased from 6.1 to 24.6% over the decade of the study. The distribution of maternal race changed over the decade, with significantly more mothers identified as White or Other in 2019 to 2020 as compared to the earlier cohorts. There was a concurrent decrease in mothers who identified as Hispanic or African American.From 2011 to 2020, the prevalence of congenital syphilis in the Pediatrix CDW increased by 475%. Although infant characteristics remained similar over time, there was a notable increase in maternal drug use and a persistently elevated risk of other sexually transmitted diseases. Further research examining the association between maternal comorbidities and congenital syphilis is necessary. · Between 2011 and 2020, the prevalence of congenital syphilis increased by 475%.. · Mortality of congenital syphilis in live-borns stayed steady at 0.9%.. · Maternal coinfection with other sexually transmitted diseases remained high over the decade.. · Maternal drug use in infants with congenital syphilis increased significantly over the decade..

Nipocalimab, a neonatal Fc receptor blocker, inhibits transplacental transfer of maternal immunoglobulin G (IgG) and lowers circulating maternal IgG levels. In a phase 2 study, nipocalimab demonstrated evidence of safety and efficacy in delaying or preventing fetal anemia in early-onset severe hemolytic disease of the fetus and newborn, suggesting a potential benefit in other IgG alloantibody-mediated perinatal diseases, including fetal and neonatal alloimmune thrombocytopenia (FNAIT). The phase 3 FREESIA-1 study aims to evaluate the safety and efficacy of nipocalimab in at-risk FNAIT pregnancies.This multicenter, placebo-controlled, double-blind, phase 3 study will enroll human platelet antigen (HPA)-1a-alloimmunized pregnant individuals with an HPA-1a-positive fetus and prior FNAIT-affected pregnancy without intracranial hemorrhage or severe bleeding in the fetus/newborn. Participants will be randomized 2:1 to weekly intravenous nipocalimab or placebo at 13 to 18 weeks of gestation until delivery. Maternal participants will receive ultrasound monitoring approximately every 2 weeks during treatment. Neonates will receive a cranial ultrasound scan, platelet count assessment, and, if needed, platelet transfusion. Maternal participants will be followed for 24 weeks and neonates/infants for 104 weeks.The primary endpoint is an adverse outcome of fetal death or adjudicated severe bleeding in utero up to 1 week postbirth, or neonatal platelet count at birth < 30 × 10⁹/L. Key secondary endpoints include adjudicated bleeding in utero up to the first week postbirth in fetuses/neonates and platelet count at birth in neonates. Additional secondary endpoints in fetuses/neonates include death; platelet count at birth <10, <30, <50, and <150 × 10⁹/L; nadir platelet count over the first week postbirth; platelet transfusion; adjudicated severe bleeding up to the first week postbirth; and postnatal intravenous immunoglobulin for thrombocytopenia. Other assessments include safety, patient/caregiver-reported outcomes, pharmacokinetics, pharmacodynamics, and immunogenicity of nipocalimab.FREESIA-1 is the first placebo-controlled, randomized, multicenter trial designed to evaluate the safety and efficacy of nipocalimab in at-risk FNAIT pregnancies. (ClinicalTrials.gov Identifier: NCT06449651. Accessed at: https://clinicaltrials.gov/study/NCT06449651. Date of registration: June 10, 2024.) · FNAIT can lead to fetal/neonatal mortality and morbidity.. · Nipocalimab blocks IgG recycling and placental transfer.. · Nipocalimab may reduce adverse outcomes of FNAIT.. · FREESIA-1 will evaluate nipocalimab in FNAIT..