American journal of perinatology最新文献

This study aimed to determine whether immediate postnatal heart rate (HR) assessment during delayed cord clamping (DCC) influences the clinical decision-making of neonatal resuscitation providers.The decision to perform or defer DCC primarily relies on subjective parameters, potentially leading to variations in subsequent steps of the resuscitation algorithm. In this study, HR, a numerical parameter, was introduced during DCC. Ten subjects completed a total of 60 short scenarios simulating DCC for a 27-week preterm manikin. Each subject experienced two consecutive sets (control vs. test) of three scenarios with predefined HR ranges (<60, 60-99, and ≥ 100/minute) presented in random order. In control scenarios, subjects participated in the DCC procedure per usual practice. In test scenarios, they manually measured HR during DCC. Objective variables and subjective questionnaire responses were collected.The mean DCC duration significantly increased for HR 60 to 99/minute (45.4 vs. 55.3 seconds, p = 0.035) and HR ≥ 100/minute (37.1 vs. 63.7 seconds, p = 0.011) scenarios in the test group compared with the control. For the HR < 60/minute scenario, mean DCC duration and time to ECG attachment tended to be shorter in the test group (45.4 vs. 34.6 and 89.7 vs. 56.3 seconds, respectively). In this HR range, initiation of respiratory support occurred significantly earlier in the test group (mean 72.7 vs. 47.6 seconds, p = 0.020). According to the questionnaire, 2 (20%) subjects believed tone and respiratory effort were sufficient for DCC decision-making. Seven (70%) subjects perceived that HR assessment during DCC had a "strong" or "very strong" impact on the decision to delay or proceed with cord clamping, with confidence levels rising from a median of 3 to 4 on a 5-point Likert scale.Assessing immediate postnatal HR during DCC appears to impact clinical decision-making for providers, implying the potential for enhancing uniformity of decisions among healthcare professionals surrounding DCC. · The decision to perform or defer DCC primarily relies on subjective parameters.. · HR assessment during DCC appears to impact clinical decision-making for providers.. · Assessing HR during DCC may potentially enhance uniformity of decisions among HCPs..

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with cesarean delivery posing a heightened risk. While interventions such as prophylactic tranexamic acid and balloon tamponade have limitations-especially when the cervix is not dilated-vacuum-assisted uterine tamponade may offer a novel intraoperative approach. This prospective pilot study evaluated the feasibility of the Daisy catheter, a cervical drain device developed by Raydiant Oximetry, Inc., designed to evacuate blood and promote uterine contraction through continuous negative-pressure suction.We enrolled ten pregnant individuals scheduled for cesarean delivery at a tertiary care center, all of whom had at least one PPH risk factor. Following fetal and placental delivery, the Daisy catheter was inserted trans-hysterotomically, advanced through the cervix, and connected to wall suction (-90 to -100 mm Hg) for 2 hours. Quantitative blood loss, perioperative hemoglobin change, ultrasound findings, and adverse events were recorded.Device placement succeeded in 9 of 10 cases; one failure was due to an undiagnosed cervical cerclage. Eight participants completed the full suction protocol. Mean hemoglobin decline from preoperative baseline to postoperative day 1 was 1.36 ± 0.47 g/dL, significantly lower than the 1.9 ± 1.1 g/dL observed in a historical cohort from 31 U.S. hospitals (p = 0.019). Ultrasound at 2 hours postpartum confirmed correct device placement, absence of intrauterine clot, and no evidence of trauma. Device removal was uncomplicated, and no adverse events were reported.These preliminary findings suggest that intraoperative use of the Daisy device is feasible, well-tolerated, and may reduce blood loss after cesarean delivery. Larger, randomized trials are warranted to evaluate its impact on transfusion rates, reoperation, and overall maternal outcomes, particularly in settings where alternative tamponade methods are limited. The ClinicalTrials.gov identifier is NCT06219538. · Vacuum tamponade used during cesarean delivery.. · Daisy device showed safe, feasible deployment.. · Hemoglobin drop was lower than the historical average..

This study aimed to describe neuromonitoring findings and short-term outcomes after the implementation of a digital health strategy comprising continuous, real-time, tele-based video-aEEG/EEG monitoring in a publicly funded NICU in Brazil.Prospective, observational cohort study conducted between July 2017 and June 2021, analyzing neuromonitoring data of high-risk newborns and correlating it with clinical and imaging outcomes.A total of 116 newborns, with a median gestational age of 37 weeks (interquartile range [IQR]: 32^2/7-39^2/7) and a median birth weight of 2,800 g (IQR: 1,472-3,305), were enrolled with more than 8,000 hours of monitoring. The main indication was suspected seizure (n = 49, 42.2%). A total of 43 (37.1%) neonates presented pathological background activity, and sleep-wake cycle (SWC) was absent in 68 (58.6%). Seizures were identified in 36 (31.0%) neonates, predominantly within the first 12 hours of life (n = 14, 38.9%), electrographic-only (n = 29, 80.6%), and repetitive (n = 24, 66.7%). A total of 47 (40.5%) neonates received antiseizure medications, with phenobarbital being the most frequently used (46; 97.9%). Only one patient (2.1%) was discharged receiving antiseizure medication. Cranial ultrasound (cUS) was performed in 94 (81.0%) infants, with abnormal findings in 34 (36.2%) infants. Pathological background activity, absence of SWC, and seizures were significantly associated with severe abnormalities on cUS, and increased risk of death before discharge.The implementation of a digital health strategy incorporating real-time and continuous video-aEEG/EEG monitoring demonstrated potential to improve diagnostic accuracy for electrographic seizures, optimize antiseizure medication stewardship, and inform early neuroprotective interventions. · Brain monitoring improves seizure diagnosis.. · aEEG/EEG supported antiseizure medication discontinuation.. · Abnormal aEEG/EEG findings are associated with poor outcomes.. · Remote aEEG/EEG monitoring is feasible in LMIC..

Induction of labor (IOL) and hospitalist coverage are becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains unclear. The objective of this study was to compare the induction time to vaginal delivery across three obstetric coverage models: hospitalists, faculty generalists, and private practice generalists.This single-site retrospective cohort study analyzed singleton, term (≥39 weeks), vertex patients undergoing IOL at NYU Langone Hospital-Long Island from January 1, 2022, to September 30, 2022. Hospitalists at this institution managed high-risk obstetric patients, including those under maternal-fetal medicine care, resident clinic, and unregistered patients who presented to labor and delivery, along with serving as labor and delivery safety officer on the labor floor. Faculty and private practice generalists managed their respective groups. Outcomes included induction time to vaginal delivery, mode of delivery, induction methods, and maternal and neonatal complications. Statistical analyses included chi-square, ANOVA, and multivariable linear regression. A p-value of < 0.05 was statistically significant.Among 403 patients, 92 (22.8%) were managed by hospitalists, 115 (28.5%) by faculty, and 196 (48.6%) by private generalists. Median (IQR) induction-to-delivery times were similar across groups: hospitalists 20.5 (15.3-27.5) hours, faculty 23.4 (16.5-31.1) hours, and private 19.7 (14.1-25.6) hours (p = 0.004). However, when limited to vaginal deliveries, no significant difference was observed in induction-to-vaginal-delivery time (p = 0.17). Private generalists had the shortest induction-to-cesarean time and time to membrane rupture leading to cesarean. There were no differences in intrapartum or postpartum complications. Hospitalists had more NICU admissions after vaginal delivery, mostly unrelated to labor.Induction-to-vaginal delivery times and complication rates were similar across coverage models, but differences in NICU admissions and cesarean delivery times highlight care variations. Collaboration and evidence-based standardized induction protocols may optimize outcomes across coverage models. · Induction to vaginal delivery time can be similar across obstetric groups.. · Labor and delivery units with high induction rates may benefit from hospitalists.. · An evidence-based induction protocol may optimize maternal and fetal outcomes..

Extracorporeal membrane oxygenation (ECMO) is an important rescue strategy for neonates with severe cardiorespiratory failure, yet its role in the management of hypoxic-ischemic encephalopathy (HIE) remains subject to debate. Historically, clinicians have been reluctant to offer ECMO to infants with significant neurological injury because of concerns related to poor neurodevelopmental outcomes and elevated risk of complications such as hemorrhage and stroke. Over the past two decades, however, accumulating evidence has suggested that many neonates with HIE not only tolerate ECMO well but may also achieve meaningful survival and functional recovery. In this state-of-the-art narrative review, we surveyed and synthesized observational studies, retrospective cohorts, and case series published since 2000 that evaluated ECMO in neonates with HIE. While randomized controlled trials dedicated exclusively to this population remain scarce, the available data indicate that ECMO can be safely implemented alongside standard therapies-including therapeutic hypothermia-without uniformly prohibitive rates of bleeding or adverse neurodevelopment. Although small sample sizes and single-center experiences limit the strength of these conclusions, survival rates in combined TH-ECMO cohorts are often reported above 80 to 90%, with a substantial proportion of survivors demonstrating acceptable early neurodevelopmental outcomes. Overall, the growing clinical acceptance of ECMO in HIE highlights the need for careful, individualized assessment of benefits and risks, as well as transparent discussions with families. Future multicenter collaborations focusing on robust longitudinal follow-up and evidence-based protocols will be essential to guide best practices and optimize outcomes for this high-risk neonatal population.

This study aimed to evaluate the role of early effective antibiotic therapy in preventing secondary meningitis as a sequelae of bacterial bloodstream infections (BSI).In this multicenter cohort study, we identified blood cultures that were positive for Group B Streptococcus (GBS), Staphylococcus aureus, Escherichia coli, and other non-E. coli gram-negative bacteria that had a corresponding cerebrospinal fluid sample collected ≤7 days after the positive blood culture among infants discharged from a neonatal intensive care unit managed by the Pediatrix Medical Group 2002 to 2020. The odds of secondary meningitis for early effective antibiotic therapy versus delayed antibiotic therapy were compared using an adjusted logistic regression model. The odds of secondary meningitis following GBS BSI were compared for infections treated with empirical vancomycin versus β-lactam antibiotic.Secondary meningitis was identified in 11% of 5,967 BSI. Early effective antibiotic therapy was not associated with a reduced odds of secondary meningitis for GBS (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 0.82-1.66) or E. coli (aOR: 1.06; 95% CI: 0.82-1.38); however, was associated with decreased odds for non-E. coli gram-negative bacteria (aOR: 0.69; 95% CI: 0.49-0.98) and S. aureus (aOR: 0.51; 95% CI: 0.34-0.74). GBS BSIs were more often complicated by meningitis when vancomycin was used empirically compared with β-lactam antibiotic (aOR: 2.01; 95% CI: 1.28-3.14).Early effective antibiotic therapy for BSI in infants did not reduce the odds of secondary meningitis caused by GBS or E. coli; however, early effective antibiotic therapy did reduce episodes due to non-E. coli gram-negative bacteria and S. aureus. · Early effective antibiotic therapy in the setting of non-E. coli gram-negative bacteria and S. aureus BSI was associated with reduced odds of secondary meningitis.. · Early effective antibiotic therapy for BSI in infants was not found to reduce the odds of secondary meningitis caused by GBS or E. coli.. · GBS BSIs were more commonly complicated by meningitis when vancomycin was used empirically compared with a β-lactam antibiotic..

This study aimed to compare neonatal and maternal outcomes for mothers with gestational hypertension delivered at 37 weeks' gestation compared with 38 to 40 weeks.Single-center, retrospective chart review of women with gestational hypertension delivered between 37^0/7 and 40^6/7 weeks' gestation over a 29-month period.A total of 337 mother-infant dyads with gestational hypertension were included: 194 delivered at 37 weeks' gestation (cohort 1) and 143 delivered at 38 to 40 weeks' gestation (cohort 2). Preeclampsia developed in 12% of cohort 1 and 8% of cohort 2 (p = 0.242). No significant differences in severe hypertensive-related complications were found between the cohorts. Neonatal outcomes including neonatal intensive care unit admission, respiratory support, phototherapy, and length of stay were all more frequent in cohort 1.For women with gestational hypertension, delivery at 38 to 40 weeks was not associated with increased maternal complications but was associated with fewer neonatal complications when compared with delivery at 37 weeks. · Gestational hypertension is a common complication of pregnancy.. · Mothers with gestational hypertension are often induced early.. · Neonatal adverse outcomes increase with early delivery.. · Optimal timing of delivery for pregnancies complicated by gestational hypertension is unknown..

Prepregnancy obesity (PPO) and excessive gestational weight gain (eGWG) during pregnancy, both are associated with adverse neonatal outcomes. The objective of this study was to compare the independent associations of PPO and eGWG with adverse neonatal outcomes.This was a retrospective cohort study of singleton, live births in the United States in 2018 using National Vital Statistics System data. These were divided into four groups: 1) normal prepregnancy BMI and normal GWG, 2) normal prepregnancy BMI and eGWG, 3) prepregnancy BMI >30 kg/m² (PPO) and normal GWG and 4) PPO and eGWG. The adverse neonatal outcomes, including preterm delivery, large for gestational age (LGA) infants, assisted neonatal ventilation, low 5-minute Apgar scores, neonatal intensive care unit (NICU) admissions, and surfactant use were studied. These outcomes were compared among groups using ANOVA and multivariable analyses.Of the 1,477,062 births included, 21.8, 41.6, 10.4, and 26.3% were in groups 1 to 4, respectively. With group 1 as the reference group after correcting for significant factors, groups 2 to 4 had a higher risk (adjusted odds ratio with 95% confidence interval), for preterm delivery of <37 weeks 1.17 (1.14-1.20), 1.05 (1.02-1.09), and 1.14 (1.11-1.18) and for LGA infants 2.38 (2.31-2.44), 2.37 (2.29-2.45), and 3.91 (3.80-4.02) in groups 2 to 4, respectively. Further, patients with PPO with and without eGWG also had increased risk of immediate assisted neonatal ventilation 1.07 (1.02-1.12) and 1.16 (1.12-1.22), for 5-minute Apgar score <3 1.40 (1.19-1.65) and 1.38 (1.20-1.58), and for NICU admission in 1.04, (1.01-1.08) and 1.12 (1.09-1.15) for groups 3 and 4, respectively.Both PPO and eGWG were independently associated with preterm delivery and LGA infants. PPO with or without excessive GWG was also associated with low Apgar scores, more NICU admissions, and a higher need for immediate ventilatory support. This data supports the importance of prepregnancy weight loss to prevent or decrease adverse neonatal outcomes. · Maternal obesity is associated with adverse neonatal outcomes.. · Maternal obesity is due to PPO or eGWG.. · To study the contribution of adverse neonatal outcomes by PPO as distinct from excessive GWG.. · To study the increasing maternal prepregnancy BMI to the incidence of adverse neonatal outcomes..

Late-onset sepsis (LOS), which occurs 72 hours after birth, remains an important cause of mortality and morbidity in the neonatal intensive care unit (NICU). Differences in infant populations and the complexity of care at various NICU levels may result in varying bacteriological profiles and antibiotic susceptibility patterns. The objective of the current study was to determine and compare the bacteriological profiles, antibiotic susceptibility, and risk factors for LOS in levels III and IV NICU within a single hospital system. This was a retrospective study of infants with LOS and positive blood cultures, admitted to levels III and IV NICUs between 2012 and 2021. Of the 173 infants included in our study, 105 were admitted to the level IV NICU and 68 to the level III NICU. Infants in the level III NICU had a lower gestational age and birth weight at the time of LOS. Seventy percent of the infants had a central line. Gram-positive organisms were responsible for the vast majority of infections (75%), with coagulase-negative Staphylococcus (CoNS) being the most common bacteria in both units. Gram-negative bacteria were more frequently isolated from the level IV NICU (36.2%) compared to the level III NICU (8.8%). Escherichia coli (E. coli) and Enterobacter sp. were the most frequently isolated gram-negative bacteria. All gram-positive bacteria were susceptible to vancomycin, and all gram-negative bacteria were susceptible to meropenem. The prevalent bacteriological profile and antibiotic susceptibility patterns in the NICU should guide the choice of empiric antibiotics for LOS. It is important to monitor sepsis and antimicrobial resistance patterns in the NICU and implement risk-specific strategies to reduce the burden of LOS. · LOS in NICUs is predominantly caused by gram-positive bacteria, mainly CoNS.. · Higher frequency of gram-negative bacteria, including E. coli and Enterobacter, in level IV NICU.. · All gram-negative isolates were meropenem-sensitive; vancomycin effective for gram-positives..