American journal of perinatology最新文献

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..

This study was conducted to compare the Bhutani nomogram and the difference between the total serum bilirubin measurement at discharge and the AAP phototherapy threshold at the time of measurement (Δ-TSB) for predicting the postdischarge bilirubin level that will exceed the phototherapy threshold.Healthy neonates born at ≥35 weeks of gestation, followed in the newborn nursery, who did not receive phototherapy during hospital stay after birth, and who followed up in the outpatient clinic at least for 1 month from 2019 to 2024 were included in the study. Four logistic models were compared (D-TSB-plus,which encompassed additional variables such as gestational age, delivery type, and blood incompatibility, and DAT positivity, the Bhutani risk zones, and Bhutani-plus which encompassed additional variables such as gestational age, delivery type, and blood incompatibility) to predict postdischarge phototherapy requirement.Of the 2,040 neonates included in the study, 208 were readmitted for phototherapy treatment after discharge. ABO and/or Rh incompatibility, Bhutani risk zone, lower gestational age, and being born vaginally increased the need for phototherapy. Δ-TSB was the strongest predictor of postdischarge phototherapy requirement (p < 10^-50). Among the logistic models, the Δ-TSB-plus model had the highest predictive power (AUC: 0.83), followed by Δ-TSB alone (AUC: 0.82), Bhutani-plus (AUC: 0.80) and Bhutani alone (AUC: 0.74) models, respectively.Δ-TSB models had higher predictive ability regarding postdischarge phototherapy requirement compared with Bhutani models. Combining Bhutani risk zones with risk factors, especially with gestational age, increased the discrimination but did not reach the success of Δ-TSB models. · It is important to predict neonates likely to develop jaundice to start treatment in a timely manner.. · Combining bilirubin measurement with hemolysis findings and clinical parameters improves the prediction of postdischarge phototherapy.. · Δ-TSB model appears to be the strongest model for the prediction of postdischarge phototherapy requirement..

Psychological resilience (PR) is a trait that supports individuals as they attempt to overcome the negative factors and stressors experienced in life. Neonatal intensive care unit (NICU) nurses encounter considerable stress while providing care for medically vulnerable infants and because of this, are at risk for emotional burnout (EB). Literature suggests that PR may protect against burnout but investigation of PR and its relationship with EB in NICU nurses is limited.The ResMed PR questionnaire and the Emotional Burnout scale (EBS) were distributed to both day and night-shift neonatal nurses with over 6 months of experience working at a large academic NICU in order to investigate the relationship between these two concepts.In total 92 of 124 NICU nurses returned the survey, resulting in a response rate of 74%. The mean years of NICU nursing experience was 9.30. The average total ResMed score was 68.65 with domain scores of 21.78 for job-related gratification, 28.69 for protective practices, and 18.2 for protective attitudes. Regression analysis demonstrated a negative relationship between PR and EB, indicating that higher PR was associated with lower EB and suggesting a protective effect of PR against EB.This study provides insight into levels of PR and burnout amongst NICU nurses within a large academic NICU. These findings allow for the development of programs and strategies by healthcare leaders and institutions to maximize neonatal nursing health and well-being. · This study found a negative relationship between PR subscales and EB.. · This indicates that higher PR is associated with lower burnout.. · In this study, 40% of nurses tested positive for EB.. · Interventions targeted at improving nursing PR may be effective in managing EB..

This study aimed to describe the epidemiology, pathogens, and outcomes associated with early-onset and late-onset sepsis among newborns admitted to the leading public neonatal hospital in Mexico.We conducted a retrospective cohort study of infants admitted to the neonatal intensive care unit (NICU) at the Instituto Nacional de Perinatología in Mexico City from 2018 to 2023. Early-onset sepsis (EOS) was defined as a culture-confirmed bacterial infection of blood or cerebrospinal fluid within 3 days of birth, and late-onset sepsis (LOS) as culture-confirmed bacterial or fungal infection after day 3. Descriptive statistics and logistic regression were used to compare characteristics and outcomes among infants with and without EOS/LOS.Among 4,381 admitted infants, 23 (0.5%) had EOS (5.2 per 1,000 admissions), and 444 of 3,950 (11.2%) who survived >3 days had LOS (112.4 per 1,000). Prematurity was a major risk factor. Escherichia coli accounted for 70% of EOS, and coagulase-negative staphylococci and Klebsiella spp. were the leading causes of LOS. Infections were associated with higher morbidity, longer hospitalization, and reduced survival, though mortality differences were not statistically significant after adjustment.Neonatal sepsis remains a major burden in this Mexican NICU, with a predominance of gram-negative organisms and incidence rates higher than recent U.S. reports. Continued surveillance and antimicrobial stewardship are warranted to guide empiric therapy and track resistance patterns. · Prematurity was a major risk factor for both early- and late-onset sepsis.. · Gram-negative organisms, especially Escherichia coli and Klebsiella species, were the predominant pathogens.. · Sepsis was associated with increased morbidity, prolonged hospitalization, and lower survival..

When vasa previa is diagnosed, guidelines support recommendations about timing and route of delivery, as well as steroid administration. While elective admission to ensure proximity to care is common, the evidence does not support a clear recommendation. Our objective was to compare patients with vasa previa managed as inpatients versus outpatients.This is a single-institution cohort study of patients with a prenatal diagnosis of vasa previa from 2013 to 2023. Decisions about inpatient versus outpatient management and delivery planning were made by physicians and patients. Data was obtained through chart review. Cohorts managed with elective admission for vasa previa were compared with those managed as outpatients. Mann-Whitney U and Fisher's Exact test were used for statistical comparison.Eighty-nine patients were included, including 72 (80.9%) electively admitted versus 17 (19.1%) managed as outpatients. The groups were of similar age and parity. A higher proportion of patients managed as outpatients had public insurance. There were no differences in the rate of short cervix or vaginal bleeding between the cohorts, and the rates of nonscheduled cesarean delivery were similar. Betamethasone was administered at a median gestational age of 32 to 33 weeks in both groups. Elective admission was associated with earlier delivery overall, as well as earlier scheduled delivery. There were no stillbirths or neonatal deaths, and the rates of NICU admission were not significantly different.Patients electively admitted for vasa previa do not appear to have been at higher risk for emergent delivery, though admission was associated with earlier delivery, including scheduled deliveries. The lower rate of admission in those with public insurance could indicate a disparity in management, though further study is necessary. While our data do not rule out a benefit to routine admission, the benefits remain unproven. · Inpatient admission was associated with earlier gestational age at delivery.. · Inpatient versus outpatient management showed no difference in neonatal morbidity.. · Rates of unscheduled (urgent or emergent) delivery were not significantly different between groups..

The objective of this study was to estimate the average hospitalization cost (AHC) for deliveries affected by severe maternal morbidity (SMM) and analyze trends from 2014 to 2019. The study also aimed to explore cost stratification based on patient, delivery, and hospital characteristics.Using the National Inpatient Sample dataset, all delivery hospitalizations from 2014 to 2019 were identified. Deliveries affected by SMM were determined based on the Centers for Disease Control definition. Deliveries were categorized into three groups: no SMM (nSMM), any SMM (aSMM), and SMM excluding cases with blood transfusion as the only indicator (SMMeBTo). A regression model accounting for survey design and adjusting for variables including age, race/ethnicity, primary payer, income, delivery method, hospital location/teaching status, and hospital region was used to test the trends in incidence. Hospital charges were adjusted using cost-to-charge ratios and presented in 2022 U.S. dollars ($). A regression model adjusting for the same variables was used to assess costs.From 2014 to 2019, 4,444,957 deliveries were identified, with a weighted estimate of 22,224,775. The rates of aSMM and SMMeBTo were 1.9 and 0.7%, respectively. AHC was $5,218 (95% confidence intervals [CI]: $5,200-5,235) for nSMM, $11,101 (95% CI: $11,038-11,165) for aSMM, and $11,541 (95% CI: $114,330-11,650) for SMMeBTo. Hospitalization costs across all SMM categories rose annually from 2014 to 2017, decreased in 2018, and peaked in 2019. All races had significantly higher costs than non-Hispanic Whites across all SMM categories. SMM costs were higher for cesarean deliveries. The highest cost was in deliveries involving a temporary tracheostomy. Urban teaching hospitals and those in the Northeast had the highest SMM costs.Deliveries affected by SMM incur significantly higher costs, with these costs increasing over time. Understanding disparities across patient factors, delivery methods, and hospital characteristics can inform interventions aimed at addressing inequities. · Costs of SMM hospitalizations are rising, even after adjusting for inflation.. · The escalating cost burden is disproportionately shouldered by different racial groups.. · Factors in delivery and hospital settings contribute to the variation in cost..