American journal of perinatology最新文献

Although cesarean hysterectomy (C-HYST) is standard management for placenta accreta spectrum (PAS), the type of hysterectomy performed, total abdominal (TAH), or supracervical (SCH), is left to surgeon discretion. TAH has been previously associated with higher estimated blood loss (EBL), transfusion requirements, and complications compared to SCH.This was a single-site retrospective cohort study examining outcomes of TAH compared to SCH for PAS performed from 2008 to 2023. PAS was confirmed by clinical and pathologic diagnoses. Cervical removal was confirmed by operative report, postoperative exam, and pathology. Associations were assessed using chi-square tests, Fisher's exact tests, Mann-Whitney U tests, or individual t-tests.During the study period, 90 TAH and 54 SCH were performed. There were no significant differences in patient demographics, except that planned C-HYST was more likely to be TAH. TAH was associated with significantly lower transfusion requirements. When unexpected hysterectomies were excluded, there was not a significant difference in blood products transfused between the TAH and SCH groups.In PAS, maternal outcomes after TAH are at least equivalent to SCH. The surgical approach for the management of PAS should be further explored. · In PAS, outcomes are at least equivalent between TAH and SCH.. · C-HYST is optimally performed in a planned manner with all multidisciplinary team members present.. · Vertical skin incision was significantly associated with TAH in this retrospective cohort study..

To estimate the association between maternal body mass index (BMI) at delivery, time from skin incision to infant delivery, and umbilical artery (UA) pH < 7.0.This was a secondary analysis of the Assessment of Perinatal Excellence, a multicenter observational study of an obstetrical cohort of individuals who delivered between 2008 and 2011 in the United States. This analysis included women who delivered via cesarean with known BMI at delivery, skin incision-to-delivery time, and UA pH. Multivariable linear regression assessed the association between BMI and time from skin incision to infant delivery while multivariable logistic regression estimated the associations of BMI and time from skin incision to delivery with UA pH < 7.0. An interaction between BMI and skin incision-to-delivery time was evaluated to examine their combined effect on UA pH < 7.0.A total of 16,723 women were included across five BMI groups. Increasing BMI was associated with longer time intervals from skin incision to delivery and higher rates of UA pH < 7.0. After controlling for potentially confounding factors, all BMI groups ≥25 kg/m² were associated with longer time intervals from skin incision to delivery. Specifically, BMI groups of 40 to 49.9 and ≥50 kg/m² had skin incision-to-delivery times that were 1.30 (95% confidence interval [CI]: 1.23-1.36) and 1.44 (95% CI: 1.34-1.55) times longer, respectively, compared with BMI < 25 kg/m². In the multivariable logistic regression, BMI group ≥50 kg/m² remained associated with higher odds of UA pH < 7.0. There was a significant interaction between BMI and time from skin incision to delivery regarding the risk of UA pH < 7.0 (p for the interaction term = 0.003).Maternal BMI ≥ 50 kg/m² was associated with a longer time from skin incision to infant delivery and higher odds of UA pH < 7.0. BMI differentially impacted UA pH at different skin incision-to-delivery time intervals. · Maternal BMI ≥ 25 kg/m2 was associated with longer skin incision-to-delivery times.. · Maternal BMI ≥ 50 kg/m2 was associated with higher odds of UA pH < 7.0.. · The effect of maternal BMI on UA pH varied at different skin incision-to-delivery time intervals.. · Reducing skin incision-to-delivery time may mitigate the risk of UA pH <7.0 in women with BMI ≥50.

In a survey conducted within the Children's Hospital Neonatal Consortium (CHNC), the Kidney Focus Group aimed to describe the resource and practice variations among participating level IV neonatal intensive care units.A 24-question survey was developed by neonatologists and pediatric nephrologists who belong to the Kidney Support Therapy (KST) subgroup of the CHNC Kidney Focus Group.The majority (89.5%) of responding centers offered some form of KST, with > 90% centers offered prenatal consultations. The most common KST modality offered were peritoneal dialysis (PD) and continuous renal replacement therapy (CRRT) while on ECMO. Prismaflex was the most common device used for stand-alone CRRT. The most common indication for KST initiation was fluid overload and body weight was indicated as the most common limiting factor with the majority of centers reporting weight limitation ≤ 1.5-2 kg.Advances in technology have made it possible to offer KST to a wider neonatal population than before. However, the availability of such technologies can vary significantly among institutions in addition to diversity of clinical experience and standardized protocols. This survey provides valuable insights into current KST practices across 19 level IV NICUs within the CHNC demonstrating expected practice variations amongst centers that may be dependent on location, center resources, and subspecialty providers, among others. · Considerable practice variation exists in KST among NICUs.. · Majority of NICUs utilize multi-disciplinary involvement, but subspecialties vary widely.. · The most common indication for KST initiation was fluid overload..

This study aimed to evaluate whether a custom warmer height improves the quality and consistency of chest compressions (CCs) compared with a standard warmer height during simulated neonatal resuscitation.Cross-over study using simulated neonatal resuscitation. A controlled research environment equipped with a 12-camera motion capture system, four in-floor multi-axis force plates, a neonatal manikin, and resuscitation equipment. Biomechanical assessments were recorded every 2 minutes during a 20-minute simulation for each condition. Twenty Neonatal Resuscitation Program (NRP)-trained providers. Each participant performed two 20-minute CC sessions-one with the warmer at the standard 100 cm height and one at a custom height selected by the participant. CC depth, force, and rate; participant back angle, heart rate, and self-reported exertion, were analyzed at 2-minute intervals.Compared with the standard height, the custom height resulted in greater and more consistent CC depth and force while maintaining compression rate. Participants also exhibited a greater back angle, and lower heart rate, and reported reduced exertion under the custom height condition.Allowing NRP-trained providers to adjust warmer heights led to improved CC quality and consistency, suggesting that customizable warmer heights may enhance neonatal resuscitation performance. KEY POINTS: · Custom warmer height chosen by NRP-trained providers resulted in more consistent and greater CC depth and force.. · It also was associated with less provider fatigue, compared with standard height.. · During neonatal resuscitation, frontline healthcare professionals changed.. · Participant heart rate was lower when using the custom versus standard height.. · Our findings support the need for guidelines on adjusting warmer height during neonatal cardiopulmonary resuscitation..

The goal of this study is to evaluate whether adjuvant progesterone following cerclage affords a reduction in the rate of preterm delivery.This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary care academic medical center between 2005 and 2021. The rate of delivery prior to 37 weeks and several secondary maternal and neonatal outcomes were compared between patients with and without progesterone supplementation after cerclage. Multivariable regression, subgroup, and matched pairs analyses were performed in order to account for the formulation of progesterone, indication for cerclage, and other potential confounding variables. The study was powered a priori to detect a difference in our primary outcome.Among 451 patients, there were 163 history-, 135 ultrasound-, and 153 examination-indicated cerclages. Overall, 284 (63%) received adjuvant progesterone. Adjuvant progesterone was associated with an increased rate of preterm delivery before 37 weeks (45 vs. 34%, p = 0.03) with an adjusted odds ratio of 1.78 (95% confidence interval: 1.14 and 2.80) in our multivariable model. The median latency from cerclage placement to delivery was shorter when progesterone was used (119 vs. 139 days, p < 0.001). There was no benefit of adjuvant progesterone when analyzed by formulation of progesterone or indication for cerclage or when analyzing pairs matched based on propensity score matching. There were no differences in secondary outcomes for pregnant patients or their offspring.Adjuvant progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. Maternal and neonatal outcomes do not vary with supplemental progesterone after cerclage. Our data do not support a synergistic benefit of cerclage and postcerclage progesterone. · There are currently no guidelines for the use of progesterone after cerclage.. · Adjuvant progesterone does not decrease the preterm birth rate.. · Secondary maternal and neonatal outcomes do not improve with adjuvant progesterone..

Microplastics have been detected in human placental and neural tissues, raising urgent concerns about their potential effects on maternal and fetal health. Emerging evidence links microplastics to systemic inflammation, neurotoxicity, and endocrine disruption, yet their impact on pregnancy outcomes and fetal development remains poorly understood. Given the placenta's central role in early-life health, perinatal researchers are uniquely positioned to lead investigations into this environmental threat. We call for collaborative, multidisciplinary research to better understand and mitigate the effects of microplastic exposure during pregnancy. · Microplastics can cross the placenta and blood-brain barrier, reaching fetal tissues.. · Microplastics trigger inflammation, oxidative stress, and endocrine disruption in human cells.. · Perinatal research should explore links between microplastics and fetal development risks..

This study aimed to determine the association between food insecurity (FI) and short-term kidney outcomes in neonates.Single-site prospective cohort study of sequentially admitted neonates to two neonatal intensive care units (NICUs). We collected demographic characteristics and FI status on maternal-neonatal dyads using the Hunger Vital Signs tool. Kidney outcomes (acute kidney injury [AKI]) within the first 14 days, recovery from AKI, and serum creatinine (SCr) at day 14 of age) were compared by FI status.Of the 70 neonates in this study, 39% lived in FI households. Infants from FI households were more likely to have early AKI (56 vs. 14%, p = 0.002) and were more likely to have a slower recovery from AKI (66 vs. 17%, p = 0.035) than those from food-secure households. Neonates from FI households were also more likely to have an abnormally elevated SCr at 2 weeks of age (66 vs. 17%, p = 0.007).FI is common in families with neonates admitted to the NICU. Neonates born into FI households were more likely to have early AKI, slower AKI recovery, and elevated SCr at 2 weeks of age. Our findings emphasize the importance of FI screening and recognition as part of prenatal care and as an essential social determinant of health in studies investigating kidney outcomes. · FI is common in families with neonates admitted to the NICU.. · Neonates born into households with FI were more likely to have early AKI.. · They also had slower AKI recovery and elevated SCr at 2 weeks of age.. · Our findings emphasize the importance of FI screening and recognition as part of prenatal care.. · FI is an essential social determinant of health in studies investigating kidney outcomes..

Perinatal hypoxic-ischemic encephalopathy (HIE) is a major contributor to infant death and neurological injury worldwide. Both neuroglia and infiltrating peripheral immune cells contribute to inflammation and oxidative stress, which leads to neuronal loss and cerebral tissue necrosis in neonates with HIE. To date, there are no approved pharmacological interventions to treat inflammatory responses in infants affected by HIE. Therapeutic hypothermia (TH) remains the only effective treatment option. Therefore, novel pharmacotherapeutics that interrupt immune-mediated brain inflammation in HIE represent a promising target for intervention. To meet this unmet need, this study tested the hypothesis that a novel anti-inflammatory peptide, RLS-0071 (pegtarazimod), could modulate neuroinflammation in a neonatal rat model of HIE.RLS-0071 was evaluated in the acute stages of hypoxic-ischemic injury utilizing the well-established Vannucci rat pup model of HIE. Rat pups subject to hypoxia-ischemic brain insult received three interventions: normothermia, hypothermia, and RLS-0071. Histopathological effects were assessed via fluorescence microscopy of the hypoxic-ischemic induced cerebral infarct in the cortex at 24 and 48 hours after controlled oxygen deprivation.Increased surviving neurons were seen at 48 hours for RLS-0071 treatment compared with hypothermia treatment as assessed by neuronal nuclear protein (NeuN) staining. Ionized calcium-binding adaptor molecule 1 (Iba1)-positive microglial recruitment was reduced by fourfold in RLS-0071 treatment or hypothermia-treated rats between 24 and 48 hours, compared to normothermia controls. Likewise, myeloperoxidase (MPO) staining showed a twofold decrease in RLS-0071 or hypothermia-treated rats between 24 and 48 hours compared to normothermia controls.Our findings suggest that RLS-0071 decreases immune cell recruitment and oxidative damage to levels comparable to TH in an animal model of HIE. · No pharmacologic interventions for HIE currently exist.. · TH is the current standard of care.. · RLS-0071 increases neuron survival and lowers microglial cell influx in a HIE rat model.. · RLS-0071 limits oxidative damage in a HIE rat model.. · RLS-0071 may provide an orthogonal treatment for HIE..

Determine the relationship between maternal Social Deprivation Index (SDI), a composite measure of area-level deprivation, and maternal characteristics and infant outcomes for mother-infant dyads with perinatal opioid exposure.Post hoc secondary analysis of 1,298 mother-infant dyads in the ESC-NOW study, a multicenter, stepped-wedge cluster-randomized controlled trial (2020-2022) conducted at 26 U.S. study hospitals. The 2016 American Community Survey was used to develop SDI scores based on the maternal zip code of residence at the time of delivery. Outcomes evaluated included receipt of pharmacologic treatment for neonatal opioid withdrawal syndrome (PT), receipt of breastmilk during hospital stay, direct breastfeeding at discharge, discharge disposition, and length of stay for infants who received PT (length of hospital stay, LOS).The median SDI score was 62 on a scale of 100. The high SDI group, with a score above the SDI median and more social deprivation, was less likely to receive adequate prenatal care or medication for opioid use disorder and more likely to be Black and/or Hispanic. The mean proportion of infants in the high SDI group was 6.2% points (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.80, 0.98) less likely to receive breastmilk during the newborn hospitalization and 7.3% points (RR: 0.91; 95% CI: 0.87, 0.96) less likely to be discharged home with a biological parent. There was no difference between the high and low SDI groups in receipt of PT, direct breastfeeding at discharge, or LOS.Mothers from high SDI communities with opioid exposure during pregnancy were less likely to receive the established standard of care and more likely to be Black and/or Hispanic. Infants born to these mothers were less likely to receive breastmilk and/or to be discharged home with a biological parent. Targeting interventions to mitigate the impact of social deprivation in high SDI communities may improve outcomes for opioid-exposed infants and their mothers. · Living in an area with high social deprivation was associated with differences in health outcomes.. · Mothers were more likely to be Black and/or Hispanic.. · Mothers were less likely to receive the standard of care during pregnancy.. · Infants were less likely to receive breastmilk and/or be discharged home with a biological parent.. · Interventions designed to address community social deprivation may improve outcomes..