American journal of perinatology最新文献

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..

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).

There has been a marked increase in the number of infants admitted to neonatal intensive care units (NICUs) in Canada for treatment of congenital syphilis. We studied the impact on resource utilization from using the Centers for Disease Control (CDC) guidelines that allow use of a single-dose intramuscular benzathine penicillin G (BPG), as compared with 10-day course of intravenous penicillin G (PG), in infants considered at low risk for congenital syphilis.This was a retrospective cohort study enrolling infants born to mothers with reactive syphilis serology and admitted for management to two Level 2 NICUs in Edmonton, Alberta, Canada, over a 2-year period. Data were extracted for key NICU resources that are used in managing these infants. We then estimated the resources that would be utilized if the entire cohort was managed per the current CDC guidelines.Forty-nine infants met the study criteria of which 42 were treated with 10-day course of PG. Of these 42 infants, 21 (50%) met the CDC criteria for a single dose of BPG. The use of the CDC criteria to manage this cohort could have avoided 244 hospital days, 128 central line days, 168 antibiotic days related to congenital syphilis treatment, 23 long bones X-rays, and 17 lumbar punctures, for an estimated savings of CDC $ 263,000 to the provincial health system.Using the current CDC guidelines, half of the infants exposed to maternal syphilis and treated with a 10-day course of PG in our cohort could have been managed with a single dose of BPG, resulting in a significant saving of health care resources and in hospital costs. · Cases of congenital syphilis have risen sharply in parts of Canada.. · Frequent admissions of such cases in the Canadian NICUs have aggravated bed capacity challenges.. · Applying the current CDC guidelines could reduce the NICU length of stay, the use of central lines, and other invasive procedures in this population..

Anemia in pregnancy affects 30 to 40% of women globally, with iron deficiency (ID) accounting for half of the cases. In the United States, iron-deficiency anemia (IDA) prevalence during pregnancy is approximately 5%. ID and IDA negatively affect the maternal-fetal dyad. Reticulocyte hemoglobin equivalent (RET-He) estimates functional iron stores without additional blood sampling. Monitoring RET-He in pregnant women and neonates may facilitate earlier interventions with iron supplementation. The aim is to evaluate RET-He's utility in identifying pregnant women and neonates at risk for ID and IDA.This prospective, observational study followed pregnant women with anemia. RET-He and hemoglobin (HgB) values were measured during the first and third trimesters and at delivery (umbilical cord blood). Exclusions included preterm birth, monochorionic twin gestations, and conditions complicating cord blood collection.One hundred and seventy-seven dyads were included in the study. Maternal mean HgB was 12.2 ± 1.1 and 10.8 ± 1.2 g/dL, with RET-He values of 32.7 ± 3.2 and 30.5 ± 3.6 pg in the first and third trimesters, respectively. Neonatal mean cord HgB was 15.0 ± 1.6 g/dL with RET-He of 32.9 ± 2.6 pg. Thirteen percent (n = 23) of newborns were anemic (cord HgB < 13.5 g/dL), and 7% (n = 13) of the newborns were iron-deficient (RET-He < 29 pg). Only two of these iron-deficient infants were also anemic. Maternal HgB and RET-He values were not associated with neonatal anemia. Sensitivity and specificity of maternal RET-He for predicting neonatal anemia were not helpful, but improved when predicting neonatal ID, especially in the third trimester. RET-He indicating ID in pregnant women was associated with anemia during their pregnancy.Maternal RET-He does not predict neonatal anemia but may aid in earlier maternal ID diagnoses. Most infants are born with normal HgB and RET-He values. RET-He may be useful for monitoring women with IDA during their pregnancies. · Maternal reticulocyte hemoglobin does not predict neonatal anemia.. · Maternal reticulocyte hemoglobin may aid in diagnosing neonatal ID without anemia.. · Reticulocyte hemoglobin may be used to monitor ID among pregnant women with anemia..

Maternal health outcomes are essential indicators of overall health care quality and societal well-being. However, in the United States, the maternal health surveillance is often inaccurate, restricting the clinical utility of the data gathered. The limits imposed by these inaccuracies restrict timely policy responses and hinder effective innovations, despite the increasing availability of electronic health records. This paper explores the potential use of natural language processing in improving maternal health surveillance. By combining rule-based linguistic processing with machine learning, natural language processing can transform narrative text into structured, analyzable data, allowing it to be used for predictive purposes, as well as the development of real-time public health surveillance systems. · Maternal health surveillance is often inaccurate, restricting the clinical utility of the data.. · Natural language processing can extract key insights from unstructured clinical notes.. · Artificial intelligence-driven surveillance in obstetrics may improve data accuracy and timeliness.. · Ethical use of natural language processing needs to ensure privacy, bias control, and validation..

Bronchiolitis is the leading cause of hospitalization in infants, and early detection of clinical deterioration remains a major challenge in pediatric wards. The objective is to analyze continuous longitudinal telemetry data (heart rate [HR] and oxygen saturation [SpO₂]) in infants hospitalized with bronchiolitis, and to evaluate whether this monitoring allows early prediction of the need for high-flow nasal cannula (HFNC) therapy or pediatric intensive care unit (PICU) admission.Retrospective, observational study in infants admitted for bronchiolitis (October 2021-January 2022). Clinical, epidemiological, and longitudinal data were collected using minute-by-minute HR and SpO₂ during the first 24 hours of admission using Vital Sync (Medtronic). A mixed model (restricted maximum likelihood; REML) was constructed to model the longitudinal HR and SpO₂ data.About 79 patients with 113,760 longitudinal HR and SpO₂ data were included. A total of 16.5% required HFNC, and 9% were admitted to PICU. A higher HR was observed in the first hours of admission in those patients who required PICU (163 ± 5 vs. 146 ± 4 bpm; p < 0.01) and in those who required HFNC (158  ± 6 vs. 144 ± 5 bpm; p < 0.01). In the mixed model (REML), we found differences in HR (p < 0.01) between groups (PICU yes/no and HFNC yes/no) and over time (p < 0.01). The mixed model allowed prediction of the mean HR of patients admitted to PICU (162 bpm) and those requiring HFNC (159 bpm).Continuous monitoring of HR in infants hospitalized for bronchiolitis in pediatric wards may be a useful tool to help anticipate clinical deterioration. · Longitudinal continuous telemetry in infants with bronchiolitis may be a useful tool.. · Centralized telemetry monitoring may be promising in pediatric wards outside intensive care units.. · HR monitoring may be useful for the need for admission to the PICU..

Intimate partner violence (IPV) victimization during pregnancy is a pervasive public health problem that is associated with mental health difficulties and increased rates of substance use, including cannabis. Despite being contraindicated by medical professionals, cannabis use during pregnancy is on the rise. Preliminary research among the general population suggests that cannabis use is associated with later mental health difficulties. While pregnancy IPV is associated with poorer postpartum mental health, less is known about the effects of pregnancy cannabis use on postpartum mental health. This study aims to investigate the combined effects of IPV victimization and cannabis use during pregnancy on postpartum mental health.In this study, 257 women were assessed at three points during pregnancy to measure IPV victimization and cannabis use. Then, at 6 months postpartum, women's posttraumatic stress disorder (PTSD), depression, and anxiety symptoms were assessed.Linear regression analyses revealed that pregnancy IPV victimization was significantly associated with elevated postpartum PTSD (β = 0.21, p = 0.005), depression (β = 0.17, p = 0.022), and anxiety symptoms (β = 0.21, p = 0.008). Pregnancy cannabis use was associated with elevated postpartum PTSD (β = 0.25, p < 0.001) and depression (β = 0.25, p < 0.001) symptoms. The interaction between pregnancy IPV and cannabis use was not significantly associated with postpartum mental health symptoms.Results suggest that cannabis use during pregnancy, as well as IPV victimization, are independent risk factors for specific postpartum mental health problems. Suggestions for nurses and other medical providers on how to best screen for and counsel pregnant women on cannabis use are discussed. · IPV during pregnancy is associated with elevated postpartum PTSD, depression, and anxiety symptoms.. · Cannabis use during pregnancy is associated with elevated postpartum PTSD and depression symptoms.. · IPV and cannabis use during pregnancy are independent risk factors for postpartum mental health difficulties.. · Medical professionals should screen for and discuss IPV and cannabis use with pregnant women..