American journal of perinatology最新文献

This study aimed to assess the views of parents and neonatal intensive care unit (NICU) health care providers (HCPs) on current wired vital signs monitoring and future wireless alternatives.Prospective cross-sectional survey was conducted between March and July 2023, targeting three groups: (1) NICU parents, (2) physicians, and (3) nurses and respiratory therapists (RT) and physiotherapists (PT). A 17-question survey was developed to assess several perspectives with current vital signs monitoring and a possible wireless monitoring system. NICU parents completed paper surveys and HCPs participated via an anonymous electronic survey. The original English survey was tailored for different respondent groups, translated into French, Spanish, and Portuguese, and distributed through neonatal research networks. Responses from each group were analyzed as totals (%), with within-group comparisons assessed using the Wilcoxon signed-rank test. Additionally, between-group comparisons were conducted using the chi-square test of independence or Fisher's exact test, as appropriate.A total of 1,141 responses were included (25 parents, 438 physicians, and 678 nurses, RTs, and PTs). Only 52% of parents were satisfied with current wired systems; 68% reported wires hindered infant handling, and 52% cited interference with skin-to-skin care. Both physicians and HCPs expressed low satisfaction with the current system. Common concerns included tangling, skin irritation, and workload. Support for wireless technology introduction was high across all groups (parents = 60%, physicians = 91%, and nurses, RTs, and PTs = 87%), with main perceived benefits including improved kangaroo mother care (KMC), reduced patient discomfort, and enhanced bonding. All groups expressed accuracy, safety, battery life, and cost concerns of a possible wireless system.Parents and HCPs are generally dissatisfied with the current NICU vital signs monitoring systems, primarily due to concerns with wires and cables and interference with KMC. Wireless technologies were mostly supported, but data on reliability, safety, and economic feasibility will be critical for development and successful implementation. · Parents and HCPs dislike wired systems due to tangling, skin irritation, and interference with care.. · Support for wireless monitoring was viewed positively by parents and very positively by HCP.. · Wireless systems were seen as beneficial for KC, reducing patient discomfort, and improving bonding.. · However, each group expressed concerns about a potential future wireless monitoring system.. · Accuracy, battery life, radiation, and cost must be addressed before wireless systems can be adopted..

This study aimed to compare the accuracy of three newly proposed definitions of bronchopulmonary dysplasia (BPD) in predicting outcomes, and to investigate the impact of large airway versus parenchymal versus vascular BPD phenotypes on BPD outcomes.Retrospective chart review of 100 infants with severe BPD discharged from a Children's hospital between 2020 and 2021. Multivariable models evaluated the associations between BPD definitions and phenotypes with tracheostomy and death at 6 months and 1 year after NICU discharge. Secondary outcomes included the need for respiratory support, the use of pulmonary medications, and the need for long-term gastrostomy feeding.Neonatal research network (NRN) and BPD collaborative criteria best-predicted outcomes associated with tracheostomy and/or death (p < 0.001). Among the three BPD phenotypes, large airway disease was independently associated with death or tracheostomy (odds ratios [OR]: 10.5; 95% confidence interval [CI]: 1.6, 68.1). The combination of all three phenotypes was also associated with death or tracheostomy (OR: 9.8; 95% CI: 1.0, 93.5). Both NRN and BPD collaborative definitions showed an association with the need for respiratory support, medication use, and need for long-term gastrostomy tube feeding. Among the 29 infants for whom complete information was available, 18 (62%), 20 (69%), and 18 (62%) had parenchymal, central airway and pulmonary vascular phenotype, respectively.Our results indicate that newer definitions of BPD may better predict the severity of BPD and the need for long-term invasive ventilation support compared with the 2001 National Institute of Health definition of BPD phenotypes impacting mortality and short-term outcomes. These data may be useful for counseling families and developing phenotype-based individualized treatment plans. · The current definition of BPD has limitations.. · New definitions of BPD better predict outcomes.. · BPD phenotypes can better predict outcomes..

This study aimed to determine optimal gestational weight gain (GWG) considering adverse infant and maternal outcomes among individuals with obesity, with detailed classification for body mass index (BMI) of 40 kg/m² or higher.This study was a population-based retrospective cohort study, using U.S. birth certificate data from 2017 to 2021. We included nulliparous individuals with singleton pregnancies delivering live births between 37^0/7 and 41^6/7 weeks' gestation, excluding those with pregestational diabetes or hypertension, gestational diabetes, preeclampsia, major fetal anomalies, or chromosomal disorders. The study focused on three main outcomes: primary cesarean delivery, small for gestational age (SGA), and large for gestational age (LGA). GWG was evaluated in 2-kg increments, from weight loss >8 kg to gains ≥28 kg. Prepregnancy BMI was stratified into four categories: BMI of 30 to <35, 35 to <40, 40 to <50, and ≥50 kg/m². Odds ratios and absolute risk reduction were used to identify GWG ranges with balanced risks for three outcomes within each BMI category.Among 1,677,968 individuals with obesity, increased GWG was associated with higher absolute risks of cesarean delivery and LGA and lower risk of SGA across all BMI categories. Optimal GWG ranges varied by prepregnancy BMI: >12 to ≤14 kg for BMI of 30 to <35 kg/m²; >10 to ≤12 kg for BMI of 35 to <40 kg/m²; >6 to ≤10 kg for BMI of 40 to <50 kg/m²; >0 to ≤8 kg for BMI of 50 kg/m² or higher.We identified higher upper and lower GWG limits for individuals with BMI of 30 to 50 kg/m², and lower limits for those with BMI ≥50 kg/m², compared with the guidelines recommended by the U.S. National Academy of Medicine. These findings suggest the need to tailor GWG recommendations based on the severity of obesity. · Optimal GWG varies by obesity class, requiring tailored guidelines.. · Those with BMI ≥50 kg/m may need lower target for gestational gain than current recommendation.. · The optimal GWG range could be changed based on the outcomes of interest..

This study aimed to evaluate trends in the frequency of pharmacologic prophylaxis following the implementation of a postpartum venous thromboembolism (VTE) prevention protocol. Secondarily, to evaluate the association between protocol implementation and incidence of VTE and complications.Retrospective cohort of patients delivering from 2015 to 2022 at a single academic institution. Those with an antepartum VTE or receiving therapeutic anticoagulation were excluded. An inpatient thromboprophylaxis protocol was implemented in January 2017 and further updated in July 2020 to expand risk factors to qualify for prophylaxis and extend the length of therapy to the outpatient setting (total 14 days). The cohort was divided into three time periods: preimplementation (January 1, 2025-December 31, 2016), initial protocol (January 1, 2017-June 30, 2020), and updated (July 1, 2020-December 31, 2022) protocol. The primary outcome was the receipt of inpatient heparin-based pharmacologic prophylaxis. Secondary outcomes included filling an outpatient pharmacologic prophylaxis prescription, VTE, and wound complications observed through 6 weeks postpartum. Baseline characteristics and outcomes were compared across the three protocol periods. Logistic regression modeling estimated the association between outcomes and the updated protocol period compared with prior periods.Overall, 22.6% (95% confidence interval [CI]: 22.1-23.0) of 34,217 included deliveries received inpatient pharmacologic prophylaxis: 7.7% (7.1-8.2%) preimplementation, 15.8% (15.2-16.4%) initial protocol, and 41.2% (40.4-42.1%) during the updated protocol period. The rates of inpatient and outpatient prophylaxis increased significantly over time (p < 0.001 test of trend). Delivery in the updated protocol period was not associated with differences in VTE (pre: 0.1%, initial: 0.2%, and updated: 0.1%) nor wound complications (pre: 3.4%, initial: 2.7%, and updated: 2.7%).Single-center implementation of a postpartum prophylaxis protocol resulted in increased use of inpatient and outpatient pharmacologic prophylaxis without changes in rates of VTE or wound complications. · Implementation of a postpartum thromboprophylaxis protocol resulted in increased rates of pharmacologic prophylaxis.. · No differences in wound complications were observed by the protocol period.. · Rates of VTE did not change over time..

From 2002 to 2023, palivizumab was the only intervention to reduce respiratory syncytial virus (RSV)-associated hospitalizations in high-risk infants in Canada but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The National Professional Pediatric Association (Canadian Pediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia followed these recommendations the next season. This study aimed to determine if the removal of access to palivizumab in these previously eligible infants was associated with a change in hospital admissions, deaths, or ambulatory visits associated with RSV.We identified a retrospective cohort of Nova Scotia infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking six population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization (RSV-H), ambulatory visits (RSV-A), or death were identified by the International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV-associated diagnostic codes.Of 4,835 infants born during the study period, 250 were 30 to 32 WG and eligible for the cohort. RSV-H increased approximately 10-fold following restricted access to palivizumab (from no RSV-H (0/123) to 9.4%; 95% CI 5.0, 15.9; risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7 to 17.3% (risk difference 11.6).Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of health care policy change on patient well-being is essential to assess the impact and guide future decision-making at the population level. · Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants 30 to 32 WG was associated with a higher risk of RSV-H and RSV-A. Evaluation of changes to health care policy on patient well-being is essential to assess impact and guide future decision-making at the population level.. · Removing access to palivizumab led to higher RSV admissions in 30 to 32 WG infants.. · The effect of health care policy changes on child well-being should be assessed routinely.. · No deaths associated with RSV were identified prior to or after the policy change..

The study aimed to combine prenatal risk factors associated with early survival of patients with prenatally diagnosed congenital diaphragmatic hernia (CDH) into a predictive nomogram.We retrospectively analyzed 217 neonates with prenatally diagnosed CDH. The patients who underwent surgery in an earlier period comprised the training cohort (n = 158) for nomogram development, while those who underwent surgery subsequently constituted the validation cohort (n = 59) to verify the model's performance. The survival rate at discharge was regarded as the primary outcome. Multivariate Logistic analysis was performed, and a nomogram was developed using data from the training cohort. The performance of the nomogram was determined. We also evaluated the nomogram's performance in the independent validation cohorts.On multiple analyses, independent factors for early survival were O/E LHR, presence of liver herniation, and gestational age at diagnosis, which were all selected into the nomogram. The nomogram had good discrimination with an area under the receiver operator curve of 0.875 (95% confidence interval [CI]: 0.819-0.930). The nomogram was calibrated to predict survival in the best possible way compared with the actual results. Using the decision curve analysis, the nomogram was proved to be useful in clinical practice. In the validation cohort, the nomogram model was also found with good discrimination with an area under the receiver operator curve of 0.917 (95% CI: 0.847-0.986).The proposed nomogram incorporating prenatal risk factors offered an individualized predictive tool for early survival of patients with CDH, which will help guide prenatal counseling and perinatal management.

This study aimed to compare the axial cranial ultrasound images of normal and open neural tube defect (NTD) fetuses using a deep learning (DL) model and to assess its predictive accuracy in identifying open NTD.It was a prospective case-control study. Axial trans-thalamic fetal ultrasound images of participants with open fetal NTD and normal controls between 14 and 28 weeks of gestation were taken after consent. The images were divided into training, testing, and validation datasets randomly in the ratio of 70:15:15. The images were further processed and classified using DL convolutional neural network (CNN) transfer learning (TL) models. The TL models were trained for 50 epochs. The data was analyzed in terms of Cohen kappa score, accuracy score, area under receiver operating curve (AUROC) score, F1 score validity, sensitivity, and specificity of the test.A total of 59 cases and 116 controls were fully followed. Efficient net B0, Visual Geometry Group (VGG), and Inception V3 TL models were used. Both Efficient net B0 and VGG16 models gave similar high training and validation accuracy (100 and 95.83%, respectively). Using inception V3, the training and validation accuracy was 98.28 and 95.83%, respectively. The sensitivity and specificity of Efficient NetB0 was 100 and 89%, respectively, and was the best.The analysis of the changes in axial images of the fetal cranium using the DL model, Efficient Net B0 proved to be an effective model to be used in clinical application for the identification of open NTD. · Open spina bifida is often missed due to the nonrecognition of the lemon sign on ultrasound.. · Image classification using DL identified open spina bifida with excellent accuracy.. · The research is clinically relevant in low- and middle-income countries..

This study aimed to systematically document the reported omega-3 levels in commercially available prenatal supplements in the United States and Canada, and compare these levels to recommended intakes in pregnancy.Commercial prenatal supplements were identified using the Dietary Supplement Label Database (n = 50) and the Licensed Natural Health Products Database (n = 18). Mean omega-3 levels and the proportion of products meeting recommendations for pregnant women were tabulated.Average omega-3 levels were 368 ± 33 mg in the United States and 404 ± 72 mg in Canada. Seventy percent of products in the United States and 61% in Canada contained the amount of omega-3 levels recommended for pregnant women with sufficient intakes. Sixteen percent of products in the United States and 28% in Canada contained the dose recommended for pregnant women with insufficient intakes.These results illustrate that commercial prenatal supplements contain a wide variety of omega-3 fatty acid levels that may or may not be consistent with recommended intake levels. · most pregnant women consume inadequate amounts of omega-3 fatty acids.. · omega-3 fatty acids can help prevent preterm birth.. · new guidelines recommend increased intakes of omega-3 fatty acids during pregnancy.. · prenatal supplements contain a wide variety of omega-3 fatty acid levels.. · omega-3 levels in prenatal supplements may or may not be consistent with recommended intake levels..

The clinically-modified obstetric comorbidity index (OB-CMI) is a comorbidity-based scoring system that has been validated to predict severe maternal morbidity (SMM) in a single tertiary, academic hospital using an internal SMM definition. We aimed to validate the OB-CMI for the prediction of SMM as defined by the CDC during delivery admissions across a diverse health system.This is a retrospective cohort study evaluating all deliveries in a large health system encompassing academic and community hospitals. Data from 2019 to 2021 were extracted from the electronic health record (EHR) and validated with chart review. An OB-CMI score was calculated for each patient using established diagnosis codes and EHR data. The primary outcome was nontransfusion SMM (defined by the CDC) during the delivery admission. Patient characteristics were evaluated by the hospital, and hospital-specific receiver-operator characteristic (ROC) curves were constructed and compared.In total, 42,130 deliveries were included with significant differences in all demographic, clinical, and obstetric characteristics across the hospitals including age, BMI, race/ethnicity, insurance type, preterm birth, and preeclampsia rates. Median OB-CMI score and rate of elevated OB-CMI score (≥6) were also significantly different. ROC curves for OB-CMI and SMM for each hospital are noted in the figure with an area under the curve range from 0.77 to 0.83, and no significant differences across hospitals (p = 0.32).In a large cohort of patients delivering across a diverse hospital system, the clinical OB-CMI score similarly predicted SMM despite differences in demographic and clinical characteristics among the hospitals. This validation of the OB-CMI supports the use of this scoring system in variegated clinical settings, which can inform widescale uptake and clinical integration of OB-CMI scoring to improve obstetric risk stratification. · The clinically-modified OB-CMI consistently predicted nontransfusion SMM across multiple hospitals.. · This OB-CMI can be used for obstetric risk stratification across different clinical settings.. · Future research should explore the impact of using the OB-CMI to mitigate risk in clinical practice..

Most shoulder dystocia (SD) cases do not have associated adverse outcomes. The objective was to assess whether SD relieved with ≥3 maneuvers, compared with fewer, is associated with a higher likelihood of adverse outcomes. The secondary objective was to examine if postpartum hemorrhage is associated with SD managed with ≥3 maneuvers versus fewer.This was a secondary analysis of the assessment of perinatal excellence (APEX) study, an observational cohort of over 115,000 deliveries in 25 U.S. hospitals from 2008 to 2011. We included individuals with singleton, vertex, and nonanomalous fetuses at ≥34 weeks who had SD requiring at least one maneuver. We stratified participants according to if ≥3 maneuvers, versus fewer, were utilized to resolve the SD. The primary outcome was the incidence of a neonatal composite adverse outcome including APGAR <5 at 5 minutes, fetal fractures, intracranial hemorrhage, brachial plexus palsy, facial nerve palsy, hypotension treated, hypoxic-ischemic encephalopathy, or neonatal death. Using modified-Poisson-regression, we calculated adjusted incidence relative risk (aIRR) with 95% confidence intervals (CI).The rate of SD in APEX was 1.9% (2,138/118,422). Of 2,138 cases of SD, 96% met the inclusion criteria. ≥3 maneuvers were utilized in 18.9% (391/2,062) of SD cases. The composite neonatal adverse outcome occurred in 8.1% (168/2,062) of cases, and in adjusted models, the risk for the composite outcome was significantly higher with SD requiring ≥3 maneuvers (15.1%) versus <3 maneuvers (6.5%; aIRR: 2.08; 95% CI: 1.50-2.89). Additionally, APGAR <5 at 5 minutes (aIRR: 4.10; 95% CI: 1.18-14.25), neonatal brachial plexus palsy (aIRR: 2.58; 95% CI: 1.45-4.60), and hypoxic-ischemic encephalopathy (aIRR: 2.83; 95% CI: 1.36 and 5.89) were significantly more likely when ≥3 were used. No significant difference was noted for postpartum hemorrhage (PPH) by number of maneuvers (aIRR: 0.74; 95% CI: 0.44 and 1.21).SD relieved by ≥3 maneuvers, compared with <3, was associated with a 2-fold-increased risk for the composite neonatal adverse outcome, with no difference in risk for PPH. · ≥3 Maneuvers increase neonatal adverse outcomes.. · With ≥3 maneuvers, higher risk of low APGAR and HIE.. · PPH rates similar for ≥3 versus <3 maneuvers..