American journal of perinatology最新文献

The Golden Hour is the first 60 minutes of life for extremely preterm infants and represents a critical window where timely stabilization can reduce morbidity such as intraventricular hemorrhage and bronchopulmonary dysplasia. At the University of Virginia, average Golden Hour admission times for infants <28 weeks' gestation were 117 minutes, indicating a major opportunity for improvement. This study aimed to reduce admission time by 25% (to ≤87 min) for infants <28 weeks' gestational age within 1 year of implementation.Using the Institution for Healthcare Improvement methodology, a multidisciplinary team identified key drivers of delay and implemented two Plan-Do-Study-Act (PDSA) cycles. PDSA 1 introduced a designated admission coordinator, structured flowsheet, and visible timer to enhance team awareness. PDSA 2 focused on line-placement efficiency, adding an auditory time, team huddles after 15 minutes, and earlier isolette closure to promote thermoregulation. Statistical process control (SPC) charts (XbarS, XmR) were used to evaluate changes. The outcome measure was time from admission to isolette closure. Process measures were time to glucose, IV dextrose, X-ray, and surfactant administration. Balancing measures were admission temperature, glucose levels, and severe intraventricular hemorrhage (IVH) rates.Among 106 infants, the average admission time decreased from 117 to 59 minutes, resulting in a 50% reduction. The proportion of admissions meeting the SMART aim (<87 min) improved from 8 to 100%. Process variability decreased on both XbarS and XmR charts. Balancing measures remained stable.Two sequential PDSA cycles achieved and sustained a 50% reduction in Golden Hour admission time without adverse effects. Structured team roles, real-time feedback, and workflow redesign produced a more efficient and stable process. This initiative demonstrates that systematic QI can meaningfully optimize Golden Hour care and may be replicable across NICUs. · This is the first reported quality improvement initiative to use admission time as a primary outcome within the neonatal Golden Hour framework.. · The results show a significant and sustained 50% reduction in admission time-from 117 minutes to 59 minutes-exceeding the SMART aim.. · Key drivers of change included defined team roles, visual and auditory cues, and standardization of the umbilical line placement workflow, which can be readily adapted for use in other NICUs seeking to test improvements during Golden Hour admissions..

This study aimed to evaluate the factors associated with completed delayed cord clamping (DCC).We conducted a retrospective review of viable singleton deliveries at a single academic medical center from January 1, 2020 to December 31, 2022. Demographics, obstetric variables, and neonatal data were extracted from the electronic medical record. Patients who received DCC were compared with those who did not. Multivariate logistic regression was used to assess factors associated with completion of 30 to 60 seconds of DCC, with a sub-analysis of preterm deliveries <30 weeks.DCC was completed in 5,018/5,889 (85.2%) eligible deliveries. Lower DCC rates were observed among non-Black, White, or Asian patients versus White patients (82.1 vs. 87.1%; adjusted odds ratio [aOR] = 0.60, 95% CI: 0.47-0.78) and in 2020 versus 2022 (83.6 vs. 86.5%; aOR = 0.74, 95% CI: 0.61-0.91). Patients who completed DCC had lower mean BMI (32.59 vs. 34.53, aOR = 0.99, 95% CI: 0.98-0.996), were less likely to be nulliparous (83.9 vs. 86.4%, aOR = 0.78, 95% CI: 0.66-0.92), less likely to have pregestational diabetes (72.8 vs. 86.1%, aOR = 0.63, 95% CI: 0.45-0.87), chorioamnionitis (72.9 vs. 85.6%, aOR = 0.51, 95% CI: 0.36-0.73), or postpartum hemorrhage (73.0 vs. 85.6%, aOR = 0.59, 95% CI: 0.41-0.86). Preterm (68.5 vs. 87.8%, aOR = 0.50, 95% CI: 0.40-0.63) and cesarean deliveries (77.2 vs. 90.0%, aOR = 0.72, 95% CI: 0.60-0.85), and infants requiring resuscitation (61.7 vs. 91.6%; aOR = 0.20, 95% CI: 0.17-0.23) were less likely to have completed DCC. Among preterm newborns <30 weeks, neonatal resuscitation was the only factor associated with not receiving DCC after adjustment.Race, delivery mode and year, maternal BMI, nulliparity, pregestational diabetes, chorioamnionitis, postpartum hemorrhage, preterm birth, and neonatal resuscitation were independently associated with completed DCC. Strategies to improve DCC execution should target preterm infants and address the challenges of performing DCC in neonates requiring urgent resuscitation. · Preterm births are less likely to receive DCC.. · Infants requiring newborn resuscitation are less likely to receive DCC.. · DCC rates increased after the implementation of an institutional DCC policy..

Insufficient access to healthy food has been linked to poor health outcomes in under-resourced communities. The relationship between neighborhood-level food insecurity and diabetes in pregnancy remains understudied, with previous studies reporting inconsistent results. This study examined the association between living in a low-income, low access (LILA) census tract and the prevalence of pregestational type 2 diabetes (T2D) and gestational diabetes (GDM) among pregnant individuals.This cross-sectional study included patients who delivered a singleton pregnancy at ≥20 weeks' gestation at Henry Ford Hospital between January 2014 and December 2019 and resided within Detroit city limits at the time of delivery. Residence in a LILA census tract, as designated by the USDA Food Access Research Atlas, was the exposure, and prevalences of pregestational T2D and GDM were the outcomes, which were collected retrospectively from patient records. A total of 117 census tracts were designated as LILA. Covariates that were adjusted for included maternal age at delivery, race, body mass index (BMI), insurance status, and substance use during pregnancy (drug, alcohol, and tobacco). Multivariate logistic regression models were used to analyze the data.Of the 3,897 patients included in this study, 1,377 (35.3%) resided in LILA tracts and 2,520 (64.7%) resided in non-LILA tracts. When individuals residing in LILA and non-LILA tracts were compared, there were no significant differences in the prevalences of pregestational T2D (4.8 vs. 4.6%, adjusted prevalence odds ratio [aPOR] = 1.00, 95% CI: 0.72-1.38, p = 0.99) and GDM (11.3 vs. 13.7%, aPOR = 0.96, 95% CI: 0.78-1.20, p = 0.74). Maternal age at delivery, maternal BMI, race, and insurance status were all significantly associated with the prevalences of GDM and pregestational T2D.Our results suggest that a LILA tract is not significantly associated with the prevalences of T2D and GDM during pregnancy. · Living in a LILA tract was not linked with GDM or T2D in pregnancy.. · Age and BMI were significantly associated with T2D and GDM.. · Race and insurance status were significantly associated with T2D and GDM..

Coordination of sucking-swallowing-breathing matures at 32 to 34 weeks' gestation; early oral feeds risk aspiration, while delays may increase oral aversion and length of stay. Safety of feeding on high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) is uncertain, and practice variations are common. This study describes the U.S. neonatal intensive care unit (NICU) practices for oral feeding during HFNC/CPAP and decision criteria.National cross-sectional telephone survey (July 2024-February 2025) of key informants from level III and IV NICUs.Of 159 NICUs, 83.0% routinely permitted oral feeding on HFNC, 10.7% sometimes, and 6.3% never. Only 9.4% routinely allowed CPAP feeding, 7.5% sometimes, and 83.0% never. Units allowing CPAP feeding used stricter readiness criteria, continuous monitoring, and involved speech-language pathology/occupational therapy.Oral feeding on HFNC is common; CPAP feeding is rare and criteria-bound, with regional variation. Heterogeneity underscores the need for consensus guidance and trials evaluating CPAP feeding effects on feeding outcomes, length of stay, and neurodevelopment. · Oral feeding during noninvasive support is widespread for HFNC but far more selective on CPAP.. · Units that permit CPAP feeding use strict criteria and multidisciplinary evaluation.. · Considerable variability across units and regions highlights the need for standardized guidance..

We describe and evaluate an innovative, longitudinal 3-year simulation-based boot camp curriculum designed to enhance neonatology fellows' cognitive, technical, and communication skills throughout their training.The Midwest Neonatal Simulation Boot Camp (MNSBC) was developed by a multi-institutional executive committee composed of stakeholders from various Chicago-area neonatology programs. The curriculum was introduced in phases, starting with a first-year boot camp in 2019, followed by second- and third-year boot camps in subsequent years. Utilizing Kern's approach to curriculum development, the content and structure of each boot camp were designed to meet the learners' needs as they progressed through fellowship training. The evaluation of this curriculum consisted of pre- and postprogram surveys completed by participants.Since its inception, the MNSBC curriculum has trained 152 first-, 88 second-, and 57 third-year fellows from 12 programs across five Midwestern states. Participants demonstrated statistically significant improvements in self-assessed proficiency following each boot camp. Anonymous evaluations collected from fellow participants consistently highlighted enhanced clinical skills, knowledge, and confidence in managing low-frequency, high-stakes procedures and clinical scenarios.The MNSBC demonstrates that a longitudinal, multi-institutional, 3-year simulation-based curriculum is both feasible and effective in improving neonatology fellows' self-perceived proficiency in cognitive, technical, and communication skills. As pediatric residency and subspecialty fellowship training requirements evolve, the MNSBC offers a sustainable model to address educational gaps throughout fellowship training. · Longitudinal multi-center simulation boot camp.. · Educational experience for Neonatology fellows.. · Bridging educational gaps during fellowship.. · Resource pooling and allocation..

This study aims to compare the diagnostic utility of umbilical cord blood culture (UCBC) versus neonatal blood culture (NBC) in the evaluation and management of early-onset neonatal sepsis (EONS) in late preterm and term infants and determine the contamination rate of UCBC.A retrospective analysis was conducted on late preterm and term neonates born between December 2020 and January 2025, who underwent EONS evaluation with UCBCs and NBCs. The study assessed detection rates of true-positive cultures, contamination rates (false positives), and incidence of culture-negative sepsis.A total of 336 infants had UCBCs performed, with 223 undergoing concomitant NBCs. Positive culture rates were similar: Four UCBCs (1.2%) and three NBCs (1.3%) were positive. UCBC had two contaminants (0.6%) while NBC had one (0.45%). One infant had both cultures positive for Escherichia coli. No infants required prolonged antibiotics for culture-negative sepsis.The contamination rate of UCBC was extremely low in the cohort of infants at high risk for EONS. Our protocol and collection technique may serve as a model for others aiming to reduce contamination rates. While NBC can be positive despite a negative UCBC, and vice versa, obtaining both UCBC and NBC can improve the sensitivity of EONS diagnosis and help minimize prolonged antibiotic use in cases of culture-negative sepsis. UCBC demonstrated a low contamination rate and comparable diagnostic yield to NBC. UCBC may be considered a reliable alternative or adjunct to NBC in the evaluation and management of EONS. · UCBC and NBC together improve sepsis detection sensitivity.. · UCBC provides adequate volume for reliable neonatal cultures.. · UCBC offers a less invasive option for neonatal sepsis evaluation.. · Standardized UCBC technique reduces false-positive culture risk.. · UCBC shows low contamination in assessing early-onset sepsis..

The aim of the study is to evaluate the association between platelet (PLT) parameters and the need for treatment of retinopathy of prematurity (ROP) in preterm infants.This single-center, retrospective cohort study was conducted at the Neonatal Intensive Care Unit of Fukushima Medical University Hospital between January 1, 2011, and December 31, 2023. The present study included preterm infants born before 30 weeks of gestation. Medical records were reviewed for 1,836 infants, of whom 187 met the inclusion criteria. Data on PLT parameters and ROP treatment were extracted from the medical records. Receiver operating characteristic analysis was used to determine cutoff values for PLT parameters associated with the need for ROP treatment. Multiple logistic regression analyses were performed to assess the association between ROP treatment and PLT parameters at birth and on day of life 28.Among the 187 infants included, 42.8% required treatment for ROP. After adjusting for confounders, an association was found between ROP treatment and plateletcrit (PCT) values < 0.23% (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.37-8.63) and platelet mass index (PMI) values < 2,303.0 fL/nL (OR: 4.50; 95% CI: 1.77-11.41) at birth.Infants born before 30 weeks of gestation with PCT values < 0.23% and PMI values < 2,303.0 fL/nL at birth had an increased risk of developing ROP warranting treatment. · ROP is a leading cause of preventable blindness in preterm infants.. · There are no reliable early postnatal biomarkers that can predict ROP outcomes.. · We evaluated the association between PLT parameters and the ROP treatment in preterm infants.. · PCT < 0.23% and PMI < 2,303 fL/nL at birth were associated with a risk of requiring ROP treatment.. · PLT parameters may be useful in determining the ROP screening schedule and treatment for ROP..

Studies have identified increased perinatal risks for young birthing age (≤18 years), but less is known about postpartum outcomes. This study examines postpartum outcomes in a primiparous cohort of young birthing patients as compared to a population aged 25 to 30 years.This retrospective cohort study compares postpartum outcomes in primiparous young birthing age patients (n = 520) compared to birthing patients 25 to 30 years (n = 558). Outcomes are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Primiparous young birthing patients were more likely to be prescribed contraception at hospital discharge (34.4 vs. 16.5%, aOR: 2.07, 95% CI: 1.49-2.89) than primiparous 25- to 30-year-old patients. They were also less likely to breastfeed at hospital discharge (78.4 vs. 97.1%, aOR: 0.09, 95% CI: 0.05-0.17). Additionally, young patients were significantly less likely to attend postpartum visits (39.4 vs. 47.1%, aOR: 0.69, 95% CI: 0.52-0.92), although less than half of participants overall attended a postpartum visit. Differences identified at hospital discharge persisted during postpartum care for contraceptive use (87.2 vs. 77.8%, aOR: 2.43, 95% CI: 1.35-4.51) and for breastfeeding (44.9 vs. 87.2%, aOR: 0.12, 95% CI: 0.07-0.2). There was also a trend toward decreased postpartum depression screening, with 59.5% of the young group screened, and 71.5% of the 25- to 30-year-old group screened.Young birthing age at the time of first birth is associated with lower breastfeeding rates and higher contraception use, compared to primiparous standard risk patients. Furthermore, young birthing patients appear to have a decreased rate of standardized screening for postpartum depression, although screening rates are low in both groups. These data may help tailor birthing and postpartum follow-up programs to better address specific risks for younger patients. · Postpartum outcomes differ with younger birthing age.. · Postpartum care is less likely with a younger birthing age.. · Depression screening is less frequent with younger birthing age..

This study aimed to evaluate the association between the Child Opportunity Index (COI) and postdischarge oxygen use in infants with bronchopulmonary dysplasia (BPD).Retrospective study of infants < 32 weeks' gestation with BPD, discharged on home oxygen from 2010 to 2022 and followed in a BPD clinic. Primary outcome was duration of oxygen use, secondary outcomes were emergency room (ER) visits, missed BPD appointments, and readmission.Of 145 infants included in the study, 88 (60.3%) infants were in the very low COI category. Mean (standard deviation) duration of home oxygen was 89.5 (92) days. Regression analysis did not show any significant association between COI and duration of home oxygen use. Number of ER visits, unplanned readmissions, and missed BPD appointments also did not vary significantly between the COI groups.Our study did not show any significant association between COI and duration of home oxygen use in infants with BPD. · COI not associated with duration of oxygen use.. · Uneven groups may have affected our results.. · Additional research in this area is needed..

This study aimed to evaluate the association of increasing birth weight above 4,000 grams and adverse obstetric outcomes and explore the influence of key maternal risk factors, including prepregnancy body mass index (BMI) and gestational weight gain (GWG), among births not complicated by diabetes.This was a retrospective cohort study of singleton, non-anomalous, live births between 37 and 42 weeks' gestation in the United States between 2012 and 2021. Births complicated by diabetes or with birth weights less than 3,000 g were excluded. Births were stratified into four weight categories: 3,000 to 3,999 g (referent group), 4,000 to 4,499, 4,500 to 4,999, and ≥5,000 g. We performed stratified analyses by prepregnancy BMI and GWG per the National Academy of Medicine guideline recommendations. Analyses were performed via chi-square and adjusted incidence risk ratios for statistical comparisons.There were 23,487,820 births included in this analysis. Higher birth weights were significantly associated with a higher risk of adverse perinatal outcomes, including cesarean delivery, blood transfusion, unplanned hysterectomy, maternal ICU admission, and obstetric anal sphincter injury. Additionally, the adjusted risk of all adverse neonatal outcomes also increased with increasing birth weight. When stratified by maternal risk factors, including BMI and GWG groups, we similarly found higher risk of adverse outcomes among higher birth weight categories, particularly among births complicated by maternal obesity or GWG above the National Academies of Medicine (NAM) recommendations.Among births without diabetes, birth weights above 4,000 g were associated with an increasingly higher risk of adverse perinatal outcomes, and adverse outcomes remained higher even after stratification by BMI and GWG. · Increasing birth weight is associated with higher rates of adverse outcomes.. · Perinatal outcomes by severity of macrosomia have not been thoroughly studied.. · Obesity and excessive weight gain in pregnancy is associated with adverse neonatal outcomes..