American journal of perinatology最新文献

Preeclampsia remains one of the leading causes of perinatal mortality worldwide. Little is known about the modifiable risk factors that can be identified and addressed early in pregnancy to reduce the risk of preeclampsia and its associated adverse outcomes. We sought to determine if there is a synergistic effect of prepregnancy body-mass index and obstructive sleep apnea (OSA) on the risk of preeclampsia.We conducted a retrospective cohort study of singleton pregnancies delivered in Kaiser Permanente Southern California hospitals between January 1, 2010, and December 31, 2020 (n = 342,349). Preeclampsia and sleep apnea were ascertained using clinical diagnosis codes. Body mass index (BMI) in kg/m² measured during prenatal care visits was categorized as normal (18.5-24.9), overweight (25-29.9), and obese (≥30). Multivariable logistic regression was used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI).Compared with normal weight in pregnancy, overweight (aRR : 1.6; 95% CI: 1.5, 1.7) and obese BMI (aRR: 2.5; 95% CI: 2.4, 2.6) were associated with an increased risk of preeclampsia. Independent of prepregnancy body-mass index, a pregnancy with OSA was associated with an increased risk of preeclampsia (aRR: 2.2; 95% CI: 1.8, 2.6). Compared with normal weight without the diagnosis of OSA in a pregnancy, overweight (aRR: 4.6; 95% CI: 2.9, 7.4) and obese BMI (aRR: 3.8; 95% CI: 3.2, 4.6) with the diagnosis of OSA were associated with an increased risk of preeclampsia.OSA and elevated body-mass index have an independent and additive relationship with preeclampsia. Overweight women at risk of preeclampsia should be advised of a higher likelihood of developing preeclampsia when both conditions occur together and may benefit from close monitoring and early interventions for these modifiable risk factors. · There is a dose-dependent association between BMI and the risk of preeclampsia.. · Coexistent obesity and OSA resulted in a stronger risk for preeclampsia.. · The combined effect of obesity and OSA on preeclampsia risk is additive rather than synergistic..

Debriefing can be a powerful tool to facilitate improvement of performance after a resuscitation event. This study characterizes the debriefing experience of neonatal-perinatal medicine (NPM) fellows in the neonatal intensive care unit (NICU), operating room, and delivery room in the United States.An anonymous 13-item electronic survey was distributed to NPM program directors across the United States, who were asked to forward it to their respective NPM fellows. The survey addressed the frequency and timing of debriefings, access to formal training, and comfort levels with debriefing.Ninety-five responses were collected, with all participants having taken part in at least one medical resuscitation. Debriefings occurred approximately 25% of the time following a resuscitation, typically within 6 hours. Twenty percent of respondents reported feeling somewhat or very uncomfortable leading a debriefing, while 84% believed debriefings improve team performance. Despite 72% reporting no formal debriefing training, 94% expressed interest in receiving such training.This national survey on NPM fellows highlights inconsistent debriefing practices despite recognized benefits. Limited formal training remains a barrier, but a strong interest in further education presents an opportunity to improve training through the incorporation of structured debriefing frameworks into fellowship curricula. · Although NPM fellows often debrief resuscitations, 72% reported no formal training.. · Formal debriefing training can improve debriefing quality and enhance patient outcomes.. · NPM programs should implement structured debriefing to better prepare their fellows..

This study aimed to examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care.In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, nontransfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, whereas the dyad measure combined maternal and infant outcomes.Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had nontransfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between nontransfusion SMM and the dyad measure was 0.12, whereas the correlation between the composite infant measure and the dyad measure was 0.86, which was higher than the correlation between the composite maternal measure and the dyad measure (0.47).We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes. · There are minimal correlations among different perinatal quality measures.. · Quality is multifaceted, and hospitals vary in the level of quality they achieve.. · Assessing hospital care for pregnant patients and infants requires multiple quality measures..

Acute kidney injury (AKI) is a clinically significant complication in preterm neonates, leading to increased morbidity, mortality, and risk of long-term kidney dysfunction. Within this vulnerable population, the presence of a hemodynamically significant patent ductus arteriosus (PDA) may further exacerbate AKI risk. The relationship between PDA and AKI is complex, involving both the pathophysiological consequences of altered hemodynamics (e.g., ductal steal) causing renal ischemia and the potential nephrotoxic effects of therapeutic interventions. However, the existing literature provided limited insight into the impact of PDA and its management on acute kidney injury in preterm infants, with most studies relying on retrospective designs. There is a notable absence of consensus regarding the comparative effects of conservative, pharmacologic, and surgical PDA management strategies on AKI outcomes. This review article directly addresses these knowledge gaps by synthesizing findings from diverse clinical trials, cohort studies, and meta-analyses into a single, comprehensive resource, aiming to inform future research and guide best practices for managing PDA-related AKI in preterm neonates.

This study aimed to evaluate the diagnostic yield of fetal echocardiography (f-Echo) in detecting significant congenital heart disease (CHD) in pregnancies with a first-degree relative with a history of bicuspid aortic valve (BAV) and a normal level II obstetric ultrasound.A retrospective review was conducted of all f-Echos performed between 2019 and 2023 for the sole indication of family history of BAV. Cases with additional indications or affected nonfirst-degree relative were excluded. Postnatal transthoracic echocardiography (t-Echo) data were reviewed when available. Significant CHD was defined as requiring catheter or surgical intervention in the first year of life.Sixty-five f-Echos were included (mean gestational age: 26.6 ± 3.7 weeks). No significant CHD was identified prenatally. Postnatal t-Echo was performed in 41 (63%) cases, with no significant CHD detected. Two (5%) infants were diagnosed postnatally with BAV, neither requiring intervention during the study interval. Minor findings included one case each of pulmonary valve stenosis and atrial septal defect.In pregnancies with a first-degree relative with BAV and a normal obstetric ultrasound, f-Echo showed no added diagnostic value for detecting significant CHD. Based on the state's birth rate (approximately 35,000/year), BAV prevalence (1-2%), and an average family size of 3.08, an estimated 733 to 1,466 pregnancies annually in Arkansas could qualify for f-Echo under current guidelines. At a cost of $1,000 to 5,000 per study, this translates to an annual healthcare expenditure ranging from $733,000 to 7.33 million. These findings support more targeted screening and the need for multicenter studies. · No significant CHD detected with f-Echo.. · Postnatal t-Echo remains definitive.. · Routine f-Echo may add limited value.. · Cost implications warrant reconsideration.

Despite availability of advanced monitoring tools, most neonatologists still primarily rely on nursing documentation of desaturation and bradycardia events to assess the respiratory status of very low birth weight (VLBW) premature infants. We aimed to compare oxygenation instability as recorded in nursing charts versus SpO₂ histograms in VLBW infants during their first weeks of life.An observational study including VLBW premature infants who required respiratory support on day 1 of life. We recorded the daily number of desaturation events <90% from nursing charts and the cumulative duration of SpO₂ <90% from 24 hours SpO₂ histograms. Data were collected from birth until respiratory support was discontinued.Data from 1,749 chart days of 77 VLBW infants (mean ± SD birth weight 1,040 ± 243 g; gestational age: 28.5 ± 2.1weeks) were analyzed. A strong Pearson correlation was found between the number of desaturation events and total time in SpO₂ <90% (r = 0.8). However, similar event counts often reflected different hypoxemia burden. Eight or more daily desaturation events predict an unstable SpO₂ histogram (sensitivity: 90.3%, specificity: 76.1%).Nursing charts and SpO₂ histograms strongly correlate but offer unique insights-charts capture the frequency and distribution of desaturation events, while histograms quantify overall hypoxemic exposure. Used together, they provide a more comprehensive assessment of respiratory status in VLBW infants. · Oxygenation instability is common among VLBW premature infants.. · We compared oxygenation instability documentation in the NICU by nursing charts versus SpO2 histograms.. · Strong Pearson correlation was found between documented desaturation events and time with SpO2 <90%.. · However, for a given number of desaturation events, the time in SpO2 <90% varied significantly.. · Combining charts and SpO2 histograms gives a more complete respiratory assessment in VLBW infants..

In 2020, the Society of Maternal Fetal Medicine refined fetal growth restriction (FGR) diagnostic criteria by temporal (early-, <32 weeks 0 days [32⁰] weeks; late-onset, ≥32⁰ weeks) and measurement-specific definitions (severe, estimated fetal weight <3rd; mild, estimated fetal weight 3rd-9th percentile and/or abdominal circumference <10th percentile). Using these updated clinical definitions, we sought to determine the association of timing and severity of FGR diagnosis with, and their discriminatory ability for, adverse pregnancy outcomes.This retrospective cohort study included singleton, non-anomalous pregnancies with sonographic FGR diagnosis at ≥18⁰ weeks' gestation from May 2020 to December 2021. We evaluated four FGR classification exposure groups: (1) early-onset, severe FGR; (2) early-onset, mild FGR; (3) late-onset, severe FGR; and (4) late-onset, mild FGR. Outcomes assessed were hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age. Multivariable logistic regression estimated the odds of each outcome associated with each exposure, adjusted for maternal age, insurance, and parity. Receiver-operating characteristic analysis determined test characteristics for the ability of these FGR classification groups to identify the postnatal outcomes, using late-onset, mild FGR as the reference group.Among 566 eligible pregnancies, early-onset, severe FGR had higher adjusted odds of hypertensive disorders of pregnancy (aOR = 1.3, 95% CI: 1.1-1.7), preterm birth (aOR = 2.1, 95% CI: 1.6-2.6), and small-for-gestational age (aOR = 1.6, 95% CI: 1.3-1.9), compared to late-onset, mild FGR. Late-onset, severe FGR also had higher adjusted odds of preterm birth (aOR = 7.2, 95% CI: 2.9-18.3) and small-for-gestational age (aOR = 5.8, 95% CI: 2.5-13.6). Odds of adverse pregnancy outcomes were similar with early- and late-onset mild FGR. Overall, discriminatory ability of these FGR classification groups for adverse pregnancy outcomes were poor.Early- and late-onset, severe FGR (versus late-onset, mild FGR) are positively associated with, but have poor discriminatory ability for, adverse pregnancy outcomes. · Early-onset, severe FGR (vs. late-onset, mild FGR) is significantly associated with hypertensive disorders of pregnancy.. · Compared to late-onset mild FGR, severe FGR, whether early- or late-onset, has greater odds of preterm birth and small-for-gestational age.. · All FGR classification groups had weak discriminatory ability for identification of these adverse pregnancy outcomes..

Pregnant persons historically have been excluded from clinical trials. Recently, there has been a shift from exclusion toward inclusion of pregnant persons in research while acknowledging the complexity of reproductive ethics and the intertwined interests of the pregnant person and fetus. Our objective was to use a principle-based approach to review the ethics of clinical research concerning pregnancy-related disorders that predominantly affect fetal well-being.Ethical principles are applied to the design of interventional trials in two rare conditions of pregnancy, hemolytic disease of the fetus and newborn (HDFN) and fetal and neonatal alloimmune thrombocytopenia (FNAIT).Severe HDFN and FNAIT are fetal and neonatal diseases caused by maternal alloantibodies with potential outcomes including maternal and neonatal morbidity, preterm delivery, and fetal or neonatal death. Early-onset severe HDFN was the initial indication for a phase 2 open-label study of nipocalimab in pregnancy, given poor outcomes after prior severe HDFN pregnancy(s). After establishing proof of concept, a phase 3 randomized placebo-controlled study was initiated based on the ethical principles of equipoise and generating socially valuable data to support the efficacy and safety of nipocalimab in severe HDFN. However, off-label use of antenatal intravenous immunoglobulin (IVIg) in standard-risk FNAIT pregnancies made a randomized placebo-controlled study challenging. Thus, the FNAIT clinical program for nipocalimab in pregnant persons with standard-risk FNAIT includes a randomized, placebo-controlled study limited to sites that do not use antenatal IVIg, and a global randomized open-label study of nipocalimab or IVIg.Knowledge of the clinical course and management of severe HDFN and FNAIT, the non-clinical and non-pregnant human clinical evidence, and input from physicians, patients, and health authorities permitted the design of clinical protocols that satisfy the principles of beneficence and non-maleficence in these rare and complex diseases. · Ethical principles apply to pregnancy-related disorders affecting fetal well-being.. · Placebo-controlled randomized trials in HDFN are based on equipoise.. · FNAIT programs must account for the off-label use of IVIg..

Objectives: To describe and evaluate our single-center practice of serial cranial ultrasound (CUS) in preterm infants following the 2020 American Academy of Pediatrics (AAP) clinical report. To evaluate the rate of cranial abnormalities following the first normal scan and identify risk factors for severe intraventricular hemorrhage (IVH) in the first week of life.

Methods: A single-center retrospective study over an eight-year study period, from 2016-2023. Rates and types of CUS are described and compared over pre- and post-AAP clinical report time epochs. Risk factors associated with severe IVH were analyzed with logistic regression.

Results: A total of 727 infants were included. Median number of CUS was 3 (2, 4, IQR) in both pre- and post-AAP cohort periods. CUS were performed in 289 (39.8%) infants before 7 days of life (DOL), 595 (81.8%) at 7-10 DOL, 623 (85.7%) at 4-6 weeks, and 361 (49.7%) at term equivalent age (TEA). The rates of abnormal CUS were 139 (48.1%), 364 (61.2%), 401 (64.4%), and 227 (62.9%) of the infants who had CUS at less than 7 days, 7-10 days, 4-6 weeks, and TEA, respectively. New abnormalities were detected in 13% (48/364) infants following a normal 7-10 DOL scan and 3% (9/290) following a normal 7-10 days and 4-6 weeks scan. Decreased birth gestational age (Odds Ratio, OR = 0.7) advanced resuscitation (OR = 3.4) and birth at outside hospital (OSH) (OR = 2.6) were associated with severe IVH before 7 DOL.

Conclusion: Our single-center practice of serial CUS was largely consistent with the AAP clinical report. We report that new findings of abnormality following a normal 7-10 DOL scan are infrequent and limited to grade 1 IVH and benign cysts. We identified birth gestation below 25 weeks, birth at an OSH, and advanced resuscitation as risk factors for severe IVH.

This article is a plain language summary of publication (PLSP) of the following articles: "Design of a Phase 3, Multicenter, Randomized, Placebo-Controlled, Double-Blind Study of Nipocalimab in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia (FREESIA-1)" by Tiller et al published in American Journal of Perinatology on July 28, 2025 (doi:10.1055/a-2666-5642) and "Design of a Phase 3, Multicenter, Randomized, Open-Label Study of Nipocalimab or IVIG and Prednisone in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia (FREESIA-3)" by Bussel et al published in American Journal of Perinatology on November 25, 2025 (doi: 10.1055/a-2753-9323). This PLSP describes the design of the phase 3, placebo-controlled FREESIA-1 and open-label FREESIA-3 trials, which will help researchers understand if nipocalimab, an investigational treatment, can be used to safely treat pregnant individuals who are at risk for fetal and neonatal alloimmune thrombocytopenia (FNAIT). This PLSP will help the general public, including those affected by FNAIT, and health care professionals understand the two studies. It provides information on the eligibility criteria, study design, treatments, and outcomes of interest. An infographic summary of this article is available in the Supplementary Material (available in the online version only).