American journal of perinatology最新文献

This study aimed to identify unmet health and childcare needs and associations with infant characteristics, parent characteristics, and parent self-efficacy after neonatal intensive care unit (NICU) discharge.We conducted a secondary mixed-methods analysis of data from a single-center randomized control trial. Twelve months after discharge, parents reported if their child did not need, need and received, or needed but did not receive seven health and childcare services. Associations with infant characteristics, parent characteristics, and parent self-efficacy were assessed using logistic regression. Open-ended responses were analyzed for themes.A total of 241 families completed assessments 12 months after discharge. Thirty-three respondents (14%) reported at least one unmet need. Increasing gestational age decreased the odds of unmet needs (odds ratio [OR]: 0.91; 95% confidence interval [CI]: 0.84-0.97), while longer length of stay and moderate or severe infant functional status increased odds (OR: 1.01; 95% CI: 1.01-1.02; OR: 2.93; 95% CI: 1.14-8.17). Greater self-efficacy was associated with lower odds of unmet needs (OR: 0.91; 95% CI: 0.85-0.97). Black parents had 2.8 times the odds of unmet needs compared to White parents after adjusting for length of stay (95% CI: 1.15-7.54). Self-efficacy may have a moderating effect on this racial disparity. Parents reported needing childcare, psychosocial support, and financial assistance in open-ended responses.We found families experienced unmet health and childcare needs with evident racial disparities in the year after NICU discharge. Greater parental self-efficacy may reduce this racial gap. Pediatric practices and health care systems, especially NICU follow-up programs, should continue to screen and connect this high-risk population to support and resources. · Greater unmet needs after NICU discharge were associated with greater infant illness severity.. · Black parents had greater odds of reporting unmet needs compared to White parents.. · Greater parent self-efficacy was associated with lower odds of unmet needs..

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related deaths in the United States and approximately 70% occur after birth. We estimated the crude and adjusted association between elevated postnatal blood pressure (BP) and acute care utilization (visits to the Emergency Department, obstetric triage, urgent care facility, or hospital readmission) in the first 12 weeks after discharge from the birth hospitalization.We constructed a retrospective cohort of birthing people aged ≥18 years who gave birth to ≥1 liveborn infant at >20 weeks of gestation from July 1, 2021, to December 31, 2022, at a quaternary maternity hospital in the Southeastern United States using electronic health records. Elevated BP was defined as ≥3 values of systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg between birth and discharge from the birth hospitalization. Crude and adjusted multivariable binomial regression models estimated risk differences comparing the 12-week risk of the postpartum acute care utilization (PACU) outcomes among birthing people with elevated postnatal BP to those without.In this cohort of 6,041 birthing people, 13.3% (n = 804) had any PACU within 12 weeks of discharge from the birth hospitalization. The unadjusted 12-week risk of PACU was 6.5 percentage points higher among those with elevated postnatal BP compared to those without (95% confidence interval [CI]: 4.7 and 8.4). After adjusting for potential confounders, the 12-week risk of PACU was 6.0 percentage points higher among those with elevated postnatal BP compared to those without (95% CI: 4.2 and 7.8).Postnatal BP is a simple indicator of postpartum health status that may be used to flag individuals in need of more intensive postpartum counseling and follow-up. · Elevated postnatal BP is associated with postpartum acute care use.. · People used acute care for BP-related reasons and reasons not related to BP.. · Tracking postnatal BPs may be a simple way to find people who need extra support..

Presently, societal guidelines differ regarding evaluation and management of variations in placental cord insertion (PCI). This variation may in part be secondary to inconsistency in reported risk associated with marginal and velamentous cord insertion (VCI). The objective of this study is to compare perinatal outcomes based on PCI site in pregnancies at risks for fetal growth disorders.This was a secondary analysis of singletons with growth assessment between 26 and 36 weeks of gestation. Fetuses with chromosomal or congenital malformations were excluded. The primary outcomes studied were neonatal small for gestational age (SGA), birth weight, and gestational age (GA) at delivery. Other outcomes included a composite of adverse neonatal outcomes, a composite score of obstetrical outcomes, and hypoglycemia. Categorical data were analyzed with χ² and continuous data with Kruskal-Wallis tests. Pairwise comparisons and Bonferroni corrections were utilized. Logistic regression model was applied to assess the association of hypoglycemia with VCI.Of the 1,054 fetuses, 660 had confirmed PCI site by pathology review. Of those, 609 (92%) had central cord insertion, 37 (5.6%) had marginal, and 14 (2.1%) had velamentous. There was no difference in SGA or preterm birth. Those with a VCI had lower GA at delivery than placentas with central cord insertion (37.6 vs. 38.6, p = 0.032) and higher rates of hypoglycemia than those with other types of PCIs, 26.2% for central cord insertion, 20% for marginal cord insertion, and 71.4% for VCI (p < 0.001). After controlling for confounders, VCI remained significantly associated with hypoglycemia (adjusted odds ratio = 5.52; 95% confidence interval: 1.54-19.82).VCI was associated with lower GA at delivery and higher rates of neonatal hypoglycemia compared with other PCIs. Additional studies are needed to assess the association of marginal cord insertion and VCI and adverse perinatal outcomes. · VCI was associated with neonatal hypoglycemia.. · VCI is associated with earlier gestational age at delivery.. · The rate of VCI is 2.1% in this cohort..

All children, including infants admitted to the neonatal intensive care unit (NICU) require health insurance. However, despite eligibility for Medicaid, many children are uninsured due to barriers in the enrollment process. Therefore, we studied the prevalence of and reasons for delayed insurance enrollment among families with Medicaid-eligible infants admitted to the NICU.This was a single-center, prospective survey study conducted in a seventy-one-bed level IV NICU. All neonates eligible for Medicaid enrollment and hospitalized for at least 21 days were eligible for the study. The primary outcome variable was enrollment in public insurance by the time of survey completion. We also examined the reported barriers to insurance enrollment.We enrolled 102 infants in this study, 76% of whom were already enrolled in Medicaid at survey completion. Common barriers to Medicaid enrollment reported by infants' parents were difficulty understanding the application process and the Medicaid application forms.Although most Medicaid-eligible neonates in the NICU had obtained insurance coverage prior to the fourth week of life, simplifying the application process (including the application forms) can remove the remaining barriers to coverage enrollment. · Health insurance coverage is vital for all children.. · Medicaid is the largest insurer of children.. · Identifying barriers to insurance enrollment is critical..

This study aimed to determine the temporal trends and racial differences in the infant mortality rate (IMR) in preterm infants with birth weight <500 g in the United States from 2005 through 2022.This was a retrospective cross-sectional study of data from the CDC's Wide-ranging Online Data for Epidemiologic Research. Infants with gestational age (GA) 22 to 28 weeks, with birth weight of <500 g, and deaths up to 1 year of age were included. IMR was calculated as deaths per 1,000 live births for each GA and year, and further stratified by maternal race. We evaluated trends with Joinpoint regression and IMR trends were reported using average annual percentage change (AAPC) with 95% confidence intervals (CI). The fetuses-at-risk approach was used to examine racial/ethnic differences in IMR.During the study period, 39,511 out of 50,855 infants born at 22 to 28 weeks GA with birth weight <500 g died within the first year (overall IMR 776.93 per 1,000). The IMR was inversely related to gestational age. The overall IMR decreased significantly from 817.48 to 714.51 (AAPC of -0.8%; CI, -1.0, -0.6) and in all the three racial/ethnic groups. As per the fetuses-at-risk approach, non-Hispanic Black (NHB) infants had the highest IMR of 1.33 per 1,000 fetuses-at-risk compared with 0.39 for non-Hispanic White (NHW) and 0.46 for Hispanic infants (p < 0.01).The IMR in extremely preterm infants weighing <500 g at birth decreased significantly, overall, and in all racial/ethnic groups. However, significant racial/ethnic differences persist. · Infant mortality rate decreased significantly in preterm infants with birth weight <500 g.. · The IMR decreased significantly in the three racial/ethnic groups studied.. · The IMR was significantly higher in non-Hispanic Black infants..

We aimed to determine if the implementation of teleconsults in the community hospital would decrease the time to initiation of therapeutic hypothermia (TH).We compared neonates treated with TH prior to implementation of the teleconsult program (pretele) to those treated after (posttele) for the outcomes of time to initiation of TH, seizures, and death/severe injury on brain MRI. We controlled for confounders using multivariable linear and logistic regression models.There were 52 pretele neonates and 49 posttele who were all born in community hospitals and treated with TH. Mothers in the posttele group were older and had higher rates of gestational diabetes. Fewer neonates with mild encephalopathy were cooled in the posttele period (13 [25.0%] pretele vs. 2 [4.1%] posttele). After controlling for gestational diabetes, maternal age, and severity of encephalopathy, there was no difference in time to TH initiation (p = 0.445), brain injury or death (p = 0.136), or seizure (p = 0.433) between the pre-and posttele groups. In the sub-analysis of the posttele group, the time to initiation was 4.50 hours (3.75, 5.00) for those with teleconsults versus 3.25 (2.12, 4.00) hours (p = 0.007) for those without.When comparing pre- to posttele groups, teleconsults in the community hospital did not significantly change the time to initiate TH or result in more adverse short-term outcomes of seizures or death/brain injury. In the sub-analysis of the posttele group, teleconsults did result in delayed initiation of TH but also possibly improved patient selection with fewer mildly encephalopathic neonates treated. · Telemedicine did not reduce the time to initiate TH.. · Fewer mild NE neonates received TH posttele.. · Multiple NE exams increased for the posttele group.. · No short-term adverse outcome differences were found..

Social determinants of health (SDOH) may impact the incidence of respiratory syncytial virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy.This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving versus not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID-19 vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test.A total of 2,181 patients met inclusion criteria and RSV vaccination information was available for 1,548 patients (71%) with a 14% vaccination rate. Compared with those not vaccinated (n = 1,332), RSV-vaccinated patients (n = 216) were more likely to be older (30.7 vs. 34.8, p < 0.001), have private insurance (42 vs. 85%, p < 0.001), speak English (82 vs. 95%, p < 0.001), and deliver at our regional perinatal center (26 vs. 77%, p < 0.001). Fifty percent of RSV-vaccinated patients had a history of COVID-19 vaccination compared with 33% of those not vaccinated against RSV (p < 0.001).SDOH was associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID-19 vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations. · The rate of RSV vaccination in pregnant patients is low.. · Patients vaccinated against RSV tended to be older, privately insured, and English-speaking.. · SDOH and COVID-19 vaccination status are associated with RSV vaccination rates..

This study aimed to examine whether newborns with orofacial clefts are at increased prevalence of poor birth health outcomes.This is a population-based cross-sectional study, conducted with information from 25,879,282 live births registered in the U.S. Vital Statistics Natality Birth Data from 2017 to 2023. The prevalence ratios and logistic regression models between orofacial cleft status (all, isolated, or nonisolated) and each child's birth health variables (delivery method, maternal morbidity, 5-minute Apgar score, gestational age, birth weight, abnormal conditions, infant breastfed at discharge) were calculated, assuming a p ≤ 0.05 as statistically significant.The prevalence ratios showed that newborns with orofacial clefts were more susceptible to being born by cesarean section (prevalence ratio [PR] = 1.18, p = 0.000, 95% confidence interval [CI] = 1.16-1.21), having lower birth weight (PR = 2.18, p = 0.000, 95% CI = 2.11-2.25), lower Apgar 5 score (PR = 4.08, p = 0.000, 95% CI = 4.08-4.50), prematurity (PR = 1.55, p = 0.000, 95% CI = 1.50-1.60), experiencing more abnormal conditions at birth (PR = 3.72, p = 0.000, 95% CI = 3.64-3.80), and having more difficulty to be breastfed (PR = 2.16, p = 0.000, 95% CI = 2.11-2.22) than newborns without clefts. These ratios were even higher among those with nonisolated orofacial clefts. Associations were statistic significant even after adjustments.This study provides evidence that newborns with orofacial clefts are at increased prevalence of poor birth health outcomes. · Orofacial clefts are associated to higher prevalence of birth outcomes.. · Newborns with orofacial clefts were more susceptible to have low birth weight.. · Newborns with orofacial clefts were more susceptible to preterm birth..

Postpartum pain management practices have significant variation and are known to be influenced by nonclinical factors. We aimed to examine factors that contribute to clinicians' assessment and management of postpartum pain, including the role of opioids.We conducted a qualitative study of obstetric clinicians providing postpartum care at a single, large, tertiary care center (November 2021-June 2022). Attending and trainee OB/GYN physicians and advanced practice providers (APPs) completed in-depth interviews using a semistructured interview guide. Purposive sampling was employed to ensure a representative sample of each clinician type was included. Participants were asked about factors that influence postpartum pain management. Data were analyzed using the constant comparative method.Of 46 participants, 48% were attending physicians, 32% trainee physicians, and 20% APPs. The analysis demonstrated three key themes related to postpartum assessment and management: influencing factors (knowledge or experiences that influence practice), objective findings, and the role of counseling. While clinicians reported guidelines and patient satisfaction as major influencing factors, several also shared the inherent conflict that may arise between them. Objective findings, specifically the impact of pain on patients achieving functional goals, also influenced clinician decision-making. Conversely, many participants reported the limited utility of the numeric pain scale as an objective metric. Additionally, the role of counseling in shared decision-making and providing anticipatory guidance was emphasized. Finally, clinicians had a range of opinions on the role of opioids in pain management, but many spoke to the value of opioids as second-line treatment and the impact of the opioid epidemic on prescribing practices.The factors that influence clinicians' assessment and management of postpartum pain are occasionally in conflict. Furthermore, objective measures, such as the numeric pain scale, have significant limitations. · Guidelines and patient satisfaction influence care.. · Guidelines and patient satisfaction can conflict.. · The numeric pain scale has significant limitations.. · Opioids are valuable as second-line pain treatment..

Prior studies have yielded mixed results regarding ambulation with neuraxial analgesia and labor outcomes, and studies did not include a significant obese population. We sought to evaluate the feasibility of ambulation with optimized neuraxial analgesia in laboring nulliparous obese patients.This was a pilot study at the University of Chicago (approval no.: IRB 19-1600, CT NCT04504682). Inclusion criteria were delivery BMI of ≥35 kg/m², nulliparity, and term gestation. Contraindications to ambulation or vaginal delivery conferred ineligibility. Combined spinal-epidural analgesia was initiated per our institution's policy. Following epidural catheter placement, serial blood pressure measurements and motor assessments including a straight leg test and a step stool test were completed per safety protocol. Patients who passed these assessments were enrolled. Patients were encouraged to ambulate for 20 minutes every hour while on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Our primary objective was to evaluate feasibility through acceptability, and safety via the number of falls, and percentage of patients with any ambulation. The study was closed early due to enrollment difficulties and in the setting of the COVID-19 pandemic.A total of 105 patients were identified for the trial: 20 were ineligible for the study, 20 could not be approached, and 40 declined study participation, leaving 25 patients who consented. Of those 25, 14 completed the study. Out of 14 participants, 11 were ambulated. The average BMI of these participants was 43 kg/m². No patients fell during the trial.A pilot trial of ambulation during neuraxial analgesia among an obese nulliparous population demonstrated no safety concerns, but with concern regarding feasibility as there was low acceptance. · Pilot trial of ambulation with neuraxial analgesia among obese patients had limited enrollment.. · Trial of ambulation with epidural among obese nulliparous patients demonstrated no safety concerns.. · Further studies are needed for efficacy..