American journal of perinatology最新文献

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..

ACOG publications on stillbirth or postpartum hemorrhage (PPH) do not consider stillbirth as a risk factor for postpartum hemorrhagic morbidity. This study aimed to ascertain the likelihood of composite maternal hemorrhagic outcome (CMHO) among individuals who delivered vaginally with livebirth versus a stillbirth.This was a retrospective cohort study of all parturients greater than 20 weeks gestation who delivered vaginally at a single level IV site within 24 months. Demographic differences and baseline PPH risks were analyzed. CMHO included any of the following: estimated blood loss ≥1,000 mL, use of uterotonics (beyond prophylactic oxytocin), Bakri balloon, surgical management of PPH, blood transfusion, hysterectomy, venous thromboembolism (VTE), admission to the intensive care unit (ICU), or maternal death. Statistical analysis included chi-squared, Kruskal-Wallis, and Poisson regression with robust error variance for risk ratios, adjusting for gestational age (GA), bleeding on admission, chorioamnionitis, and prior uterine surgery.Of 8,623 consecutive vaginal births ≥20 weeks gestation, 89 (1.9%) were stillbirths. Maternal age, marital status, GA at delivery, and PPH risk stratification at admission differed significantly. Bleeding at admission (p < 0.001), prior uterine surgery (p < 0.001), magnesium sulfate use (p = 0.006), chorioamnionitis (p < 0.001), platelet count <100 (p = 0.001), platelet count <50 (p < 0.001), and retained products of conception (p < 0.001) were different in the two groups. CMHO was significantly higher with a stillbirth delivery (32.6 vs. 16.8%; aRR: 1.56, 95% CI: 1.01-2.46). After adjustment, the components of the CMHO that differed significantly were estimated blood loss ≥1,000 mL and ICU admission. Tamponade, surgical intervention, VTE, hysterectomy, and maternal death did not differ between the two groups.Pregnancies with stillbirth, compared with livebirth, had an increased risk of hemorrhagic related morbidity. In addition to being useful in shared decision-making, our results can be nidus for intervention trials to decrease the hemorrhagic morbidity associated with stillbirth. · The risk of CMHO was significantly higher in the stillbirth group even after adjustment for potential confounders (32.6% vs. 16.8%).. · Stillbirth was associated with a significantly higher risk of blood loss of ≥1,000 mL.. · Stillbirth was also associated with higher likelihood of uterotonic use, transfusion, and admission to ICU..

Nipocalimab, a neonatal Fc receptor blocker, showed evidence of efficacy and safety in preventing or delaying fetal anemia in a phase 2 study of early-onset severe hemolytic disease of the fetus and newborn, demonstrating potential for treatment of other maternal immunoglobulin G alloantibody-mediated fetal diseases. The phase 3 FREESIA-3 study aims to evaluate the efficacy and safety of nipocalimab or intravenous immunoglobulin (IVIG) with prednisone in pregnancies with a previous occurrence of fetal and neonatal alloimmune thrombocytopenia (FNAIT) with or without intracranial hemorrhage or severe fetal/neonatal bleeding (high- or standard-risk, respectively).FREESIA-3 is a phase 3, open-label, randomized, multicenter study in pregnant individuals at risk for FNAIT. Participants are randomized 4:1 to receive either weekly 45 mg/kg intravenous nipocalimab or weekly IVIG with prednisone starting at 13 to 18 weeks of gestational age (standard-risk) or 12 weeks of gestational age (high-risk) until delivery. During treatment, pregnant participants will receive ultrasound monitoring every 2 weeks for fetal bleeding, growth, and development. Postnatal follow-up is 24 weeks for maternal participants and 104 weeks for neonates/infants.The primary endpoint is an adverse outcome of death or adjudicated severe bleeding in utero up to 1 week postbirth, or platelet count at birth of < 30 × 10⁹/L in a fetus/neonate. Secondary endpoints include fetal/neonatal death, neonatal platelet count at birth, nadir neonatal platelet count over 1 week postbirth, neonate requiring platelet transfusion(s), adjudicated fetal and neonatal bleeding up to 1 week postbirth, neonate receiving IVIG for thrombocytopenia, safety in maternal participants and neonates/infants, and immunogenicity of nipocalimab. Exploratory endpoints include patient- and caregiver-reported outcome assessments and nipocalimab pharmacokinetics and pharmacodynamics.FREESIA-3, an open-label, multicenter, randomized, phase 3 study, will evaluate the efficacy and safety of nipocalimab in both standard- and high-risk pregnancies for FNAIT. · FNAIT is a transplacental alloantibody-driven disease.. · Nipocalimab blocks IgG recycling, lowering IgG levels.. · Nipocalimab blocks IgG placental transfer to the fetus.. · Nipocalimab reduced adverse outcomes in EOS-HDFN.. · FREESIA-3 studies nipocalimab efficacy/safety in FNAIT..

This study aimed to compare temperature control during therapeutic hypothermia (TH) in neonates with moderate or severe hypoxic-ischemic encephalopathy (HIE) using manual cooling (MC) or a servo-controlled (SC) system.Retrospective cohort study including neonates with ≥ 35 weeks' gestation with moderate or severe HIE who were treated with TH between 2018 and 2020, using MC with ice packs or a SC system. Temperature curves and clinical outcomes were compared between the two methods of cooling. Data were summarized using descriptive statistics. Groups were compared with appropriate parametric or nonparametric tests. Temperature stability and rewarming variability were evaluated, and secondary outcomes were analyzed using risk ratios with 95% confidence intervals and logistic regression adjusted for encephalopathy severity.During the study period, 56 neonates with moderate or severe HIE were cooled, 31 (55.4%) with MC and 25 (44.6%) with a SC system. Baseline characteristics and time to target temperature were similar. SC achieved more stable hypothermia, with less variability (p = 0.014) and reduced time outside the therapeutic range (2.7 vs. 8.1%, p = 0.005). Extreme temperature deviations occurred only in the MC group. Rewarming rates were comparable, although variability was greater with MC. Clinical outcomes showed lower risk of hypotension (RR: 0.647, 95% CI: 0.409-1.02; p = 0.044), inotrope use (RR: 0.647, 95% CI: 0.409-1.02; p = 0.044), and abnormal magnetic resonance imaging (MRI) findings (12.0 vs. 46.2%; RR: 0.26, 95% CI: 0.08-0.81; p = 0.013) in the SC group. After adjusting for clinical encephalopathy severity, SC remained independently protective against abnormal MRI (aOR: 0.19; 95% CI: 0.04-0.865; p = 0.03) and hypotension (aOR: 0.27; 95% CI: 0.08-0.95; p = 0.04). Mortality occurred only in the MC group.While both methods were effective, the SC system offered more stable temperature control and may reduce complications during and after TH. · Temperature stability is critical for the effectiveness of TH.. · SC cooling provided more stable temperature control than MC.. · SC cooling and MC were feasible in a neonatal intensive care unit setting.. · SC cooling may reduce neurological complications during and after TH..

This study aimed to evaluate the feasibility of randomizing patients to weight-based low molecular weight heparin (LMWH) versus no pharmacologic thromboprophylaxis following cesarean delivery (CD).Single-center, open-label pilot randomized controlled trial of individuals aged 18+ undergoing CD at the University of Utah Health from November 2023 to June 2024. Those with a contraindication to anticoagulation, a plan for therapeutic anticoagulation, or considered at highest risk for postpartum venous thromboembolism (VTE; i.e., undergoing cesarean-hysterectomy, high-risk thrombophilia, personal history of thromboembolism) were excluded. Enrolled individuals were randomized in a 1:1 ratio utilizing block randomization with randomly varying block sizes to receive weight-based LMWH for 14 days or no pharmacologic thromboprophylaxis. The primary outcome was feasibility, defined as ≥35% enrollment of eligible individuals and retention of ≥85% of enrolled individuals through all study procedures. Secondary feasibility outcomes included the number of eligible patients per month, approach rate, enrollment rate, and retention rate. Additional outcomes included VTE, wound hematoma, patient-reported symptoms, or a bleeding complication within 6 weeks postpartum. Baseline characteristics were compared between those approached and enrolled and those not enrolled. The proportion meeting each of the outcomes was reported with 95% confidence intervals (CI).Over the 6-month study period, 694 patients were screened and found eligible for an average of 106 eligible patients per month. There were 611 patients approached (88%, 95% CI: 85.6-90.5), of which 64 enrolled (10.5%, 95% CI: 8-12.9), and 61 participants were retained through all study procedures (95.3%, 95% CI: 90-100). Thus, the overall primary outcome feasibility parameters were not met. Among the 64 individuals enrolled and randomized, the mean age was 31.0 years (standard deviation: 5.5 years), and the majority were non-Hispanic White (56%). Baseline characteristics were similar between those who were approached and enrolled compared with those not enrolled. There were no differences in additional clinical outcomes (VTE, wound hematoma, patient-reported symptoms, or bleeding complications) by prophylaxis group.In this pilot trial, individual patient randomization to weight-based LMWH or no pharmacologic thromboprophylaxis after CD was not feasible due to low enrollment rates. Future trials addressing postpartum thromboembolism prevention should consider alternative study designs. · Individual patient randomization to enoxaparin or no therapy after CD was not feasible.. · The approach rate, enrollment rate, and retention rate were 88, 11, and 95%, respectively, in this single-center pilot.. · Future prospective studies may need to consider alternative designs..