American journal of perinatology最新文献

Aspirin is recommended in high-risk pregnancies for the prevention of preeclampsia/preterm birth; it is unclear whether aspirin's antiplatelet or anti-inflammatory (or both) effects drive its efficacy, and there are no established markers of therapeutic efficacy for pregnancy-specific outcomes. MicroRNAs (miR) are noncoding posttranscriptional modifiers implicated in preeclampsia/preterm birth and platelet function. We aimed to evaluate whether selected platelet-associated miRs were associated with platelet inhibition following aspirin use and associated with perinatal outcomes.This is a planned secondary analysis of a cohort of high-risk singleton pregnancies taking aspirin. Participants had bloodwork done in the first trimester, preaspirin, 2 to 4 weeks after aspirin initiation (follow-up 1), and at 28 to 32 weeks of gestation (follow-up 2). We selected six platelet-associated miRs (16, 18a, 126, 155, 181a, and 223) that are also associated with preeclampsia and reported quantity as fold-change from baseline (follow-up/baseline). We evaluated with univariate analysis the relationship between miR fold-change at follow-up visits 1 and 2 with Platelet Function Assay-100 epinephrine closure time (PFA-100, Siemens), a measure of aspirin response. We also evaluated the relationship between miR fold-change from baseline at each visit and the outcome of (1) hypertensive disorders of pregnancy (HDP): preeclampsia or gestational hypertension and (2) preterm birth < 37 weeks.Of the original cohort, 57 were included in this secondary analysis. The fold-change in miR-223 and miR-18a significantly decreased with increasing PFA-100 epinephrine closure time. Twelve (21%) pregnancies had HDP, and eight (14%) had preterm birth < 37 weeks. Four preterm births were due to severe preeclampsia, and one was preeclampsia without severe features and spontaneous labor. Fold-change in miRs was not associated with HDP, but increased miR-223 at 28 to 32 weeks was significantly associated with an increased risk of preterm birth (odds ratio: 2.77 [1.21-6.87]; p = 0.04).Selected platelet-associated miRs may be promising markers to assess the therapeutic effect of aspirin in pregnancy and warrant further exploration. · Platelet-associated miR decreases in association with platelet inhibition.. · Elevated miR-223 in the third trimester may be associated with preterm birth.. · Platelet-associated miR may be a marker of aspirin therapeutic effect in pregnancy..

Gastroschisis is the most common newborn abdominal wall defect. Gastroschisis classification is based on the absence (simple gastroschisis [SG]) or presence (complex gastroschisis [CG]) of bowel morbidity. The severity of critical organ dysfunction with gastroschisis is unknown.This was a multicenter, retrospective cohort study of infants with gastroschisis (birth weight ≥ 1.8 kg and gestational age ≥ 35 weeks) admitted to the University of Florida Health NICU between January 1, 2012, and April 1, 2023, and the Johns Hopkins NICU between July 1, 2016, and December 31, 2024. All data was collected from the electronic health record. CG was defined as the presence of atresia, necrosis, perforation, volvulus, jejunostomy, resection, or short bowel syndrome. Hourly organ dysfunction was quantified by the neonatal sequential organ failure assessment (nSOFA) score (measures respiratory, cardiovascular, and hematologic dysfunction with a range from 0 to 15 [severe]).We identified 120 patients with gastroschisis (49% male; 90 with SG). Compared with patients with SG, neonates with CG had greater maximum nSOFA scores (median: 2 [IQR]: [0, 4] vs. 3 [1, 7]; p = 0.02). The coefficient of variation on cumulative nSOFA scores calculated at 24-hour intervals after birth as a measure of organ dysfunction heterogeneity for SG patients was 278 to 332% and was 216 to 266% for CG patients.This is the first high-granularity quantification of critical organ dysfunction in gastroschisis patients. We found a low overall severity of critical organ dysfunction among all patients. Substantial heterogeneity was present in both groups. The nSOFA may help to identify a subset of patients with critical organ dysfunction outside of bowel morbidity. · Gastroschisis is the most common abdominal wall defect; the severity of organ dysfunction is unclear.. · nSOFA measures critical organ dysfunction; its role in identifying high-risk gastroschisis is unknown.. · Most infants had minimal organ dysfunction; half of SG and one-third of CG had no organ failure.. · Organ dysfunction varied widely within groups; nSOFA may improve risk detection and trial design..

Postpartum measles, mumps, rubella (MMR), and varicella vaccination is critical for nonimmune mothers to prevent severe maternal and neonatal complications. Despite recommendations, vaccination rates remain suboptimal, particularly in completing the two-dose series. This study evaluates the impact of an electronic medical record (EMR)-based intervention on postpartum MMR and varicella vaccination rates.A retrospective cohort study was conducted at two urban tertiary care centers. Nonimmune postpartum patients with public insurance who delivered between January 2021 and June 2022 and February 2023 and October 2024 were included in the pre- and postintervention groups, respectively. The intervention, implemented in April 2023, modified the mandated postpartum checklist in the EMR to include measles immunity status and emphasize the necessity of completing the two-dose series for MMR and varicella. The primary outcome was the completion rate of the two-dose series, with secondary outcomes assessing provider adherence and patient acceptance. Statistical analyses included chi-squared and t-tests to compare pre- and postintervention cohorts.A total of 468 patients were included (220 preintervention and 248 postintervention). MMR series completion significantly increased from 2.3 to 34.9% (p < 0.001). Varicella series completion showed a nonsignificant upward trend from 27.0 to 36.5% (p = 0.112). Provider adherence improved, with fewer missed opportunities to offer the second dose at the postpartum visit (49.6 vs. 32.9%; p = 0.004 for MMR). Patient declination rates remained stable.Integrating vaccination reminders into the EMR significantly improved postpartum MMR series completion. While varicella rates showed a modest increase, persistent provider follow-up and patient education remain crucial. Future efforts should focus on addressing systemic barriers and enhancing patient outreach to further optimize postpartum vaccination completion. · EMR checklist improved MMR series completion rates.. · Varicella series completion showed modest improvement.. · Provider adherence to vaccine guidelines increased.. · Barriers to postpartum vaccine completion still exist..

This study aimed to assess the impact of an opt-out consent process compared with the opt-in consent process for using pasteurized donor human milk (PDHM) on feeding practices and growth in preterm neonates.A retrospective study of 200 neonates ≤28 weeks' gestation compared the effects of opt-in versus opt-out consent processes on time to first enteral feed, feeding types, growth trajectories, and prematurity-related morbidities. Descriptive statistics were used to compare the two groups.The opt-out process did not significantly alter the time to the first enteral feed (range opt-in: 0-12 days vs. opt-out 0-5 days, Mann-Whitney U; p = 0.295). Compared with the opt-in process, the opt-out process was associated with less formula use, less mother's milk use, and more PDHM/mixed mom's milk-PDHM use in the first 4 weeks of life (p < 0.01). Unadjusted analyses showed a greater weight gain in the opt-out group on days of life/DOLs 14 and 28 (2.49 [0.20, 4.78] and 3.94 [0.07, 7.80]%, p < 0.05), and following adjustment, it remained significant for DOL 14 (1.87 [0.02, 3.71]). Prematurity-related morbidities were similar between the two groups.The opt-out consent process may impart short-term growth benefits in preterm infants. However, long-term outcomes require further study. · Opt-out is an alternative to the traditional opt-in consent for donor milk use in preterm infants.. · It is associated with better growth by day 14.. · Less formula use, and more donor/mixed milk use by day 28.. · Mother's milk use at discharge and short-term outcomes are similar for both consent types.. · Future studies will focus on the long-term effects and benefits of the opt-out consent process..

This study aimed to summarize contemporary evidence on the definition, epidemiology, risk factors, and prevention of acute kidney injury (AKI) in critically ill and preterm infants in the neonatal intensive care unit (NICU), and to highlight prevention-focused strategies to improve outcomes. Narrative review of current literature evaluating AKI burden, diagnostic criteria, modifiable and nonmodifiable risk factors, and preventive interventions in neonatal intensive care settings. AKI is common in critically ill and preterm infants and is associated with increased mortality, prolonged hospitalization, neurodevelopmental impairment, and progression to chronic kidney disease. Modified Kidney Disease: Improving Global Outcomes criteria have improved diagnostic consistency and revealed particularly high AKI prevalence in extremely low birth weight infants. Key modifiable risk factors include hemodynamic instability, patent ductus arteriosus, nephrotoxic drug exposure, fluid overload, and sepsis, while preventive strategies span optimized antenatal management, therapeutic hypothermia for hypoxic ischemic encephalopathy, careful postnatal hemodynamic and fluid management, nephrotoxic drug stewardship, early infection control, individualized ductus arteriosus therapy, and potential use of caffeine, alongside emerging urinary biomarkers for earlier detection. Given limited therapeutic options once AKI occurs, prevention through structured surveillance, timely identification of high-risk states, and rigorous implementation of kidney protective practices is essential. Integrating quality improvement, protocolized care pathways, and educational outreach within NICUs offers the greatest promise for improving short and long-term outcomes in infants with AKI. · Structured post-AKI monitoring and quality improvement protocols reduce AKI incidence.. · Nephrotoxic medication protocols reduce AKI through proactive monitoring and dose optimization.. · Neonatal AKI is common and serious; prevention via fluids, hemodynamics, and med stewardship is key..

Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has evaluated incremental benefit of higher Foley volume in the setting of combination ripening methods.This is a secondary analysis of a prospective cohort study evaluating standardized induction management at two sites. Any cervical ripening method could be used. Site no. 1 used 60-mL Foley inflation, whereas Site no. 2 used 30 mL. For this analysis, patients were included if they underwent a term (≥37 weeks) induction from 2020 to 2022 with a singleton, intact membranes, and received combination methods of Foley and another agent. A 1:1 propensity score matching balanced baseline parameters.Of 4,295 inductions, 2,117 (49.3%) utilized combination cervical ripening methods. After propensity score matching, 1,480 were included. Even in the context of combined ripening and standardized induction, Foley inflation to 60 mL was associated with a 3-hour shorter labor length than 30 mL (14.6 [10.4-21.3] vs. 17.7 hours [12.4-24.4], p < 0.001). When censored for cesarean, patients who received 60-mL Foley inflation delivered 70% faster than those who received 30 mL (hazard ratio: 1.73 [1.36-2.21]). There was no difference in cesarean, maternal morbidity, or neonatal morbidity.Even when using combined cervical ripening methods, 60-mL Foley inflation is associated with reduced time to delivery as compared with 30 mL without increasing morbidity. · No prior study has evaluated incremental benefit of higher Foley volume.. · Combined cervical ripening with 60-mL Foley is associated with reduced time to delivery.. · Combined cervical ripening with 60-mL Foley is not associated with differences in morbidity..

This study aimed to compare the antenatal and intrapartum characteristics of newborns at ≥36.0 weeks, who underwent whole-body hypothermia for hypoxic-ischemic encephalopathy (HIE) and had either cesarean or vaginal deliveries.Retrospectively, we identified all non-anomalous singletons at ≥36.0 weeks who had HIE and underwent whole-body hypothermia at a community teaching hospital. Differences in baseline characteristics and intrapartum factors were compared among the cesarean versus vaginal deliveries using chi-square tests. Multivariable Poisson regression models were used to estimate the association between delivery route and various outcomes with adjustment for potential confounders.Of the 32,765 deliveries during the study period, 132 (0.4%) met the inclusion criteria, and among them, 79 (59.8%) had cesarean deliveries, and the remaining 53 (40.1%) had vaginal births. The prenatal care providers (i.e., private, community hospital faculty, or others) differed significantly between the two groups (p = 0.013). Within 60 minutes of hospitalization, the characteristics of fetal heart rate tracing (FHRT) and its category (I, II, or III) did not differ between the groups. Sentinel events occurred among 25.3% of those who had cesarean and 30.2% of those who delivered vaginally (p = 0.556). FHRT 60 minutes prior to delivery did not differ with regard to the presence of decelerations (p = 0.409), and variability (p = 0.199), but whether it was category I, II, or III (p = 0.030) did vary significantly. The likelihood of neonatal seizure (adjusted incidence rate ratio = 1.03; 95% confidence interval: 0.41-2.58) and mortality (1.10; 0.03-45.5) were similar between the groups.Occurring in approximately 4 per 1,000 deliveries at a community teaching hospital, the majority of singletons who had whole-body cooling had cesarean delivery. While the category of FHRT did not differ significantly within 60 minutes of admission, it did differ 60 minutes before birth. · Whole-body hypothermia (WBH) occured in 4/1,000 births.. · About 60% of newborns with WBH had cesarean delivery.. · Neither braddycardia nor tachycardia was noted with 132 cases of WBH.. · Categories of fetal heart rate tracing differed significantly among those delivered vaginal versus cesarean..

The objective of this study was to compare delivery outcomes among women in Northern Manhattan undergoing Centering versus routine prenatal care.This retrospective cohort study analyzed prenatal care and delivery hospitalizations among women receiving prenatal care at two ambulatory clinics in Northern Manhattan from 2013 to 2018. The exposure of interest was Centering versus routine prenatal care. The primary outcome of interest was preterm birth <37 weeks. Other clinical outcomes analyzed included number of prenatal visits, birth weight including very low birth weight (<1,500 g), cesarean versus vaginal delivery, and preterm birth at <32 weeks. Unadjusted and adjusted logistic regression models (accounting for demographic factors) were performed to analyze the association between the exposure of Centering prenatal care and the primary outcome with unadjusted (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association.A total of 714 women undergoing Centering prenatal care and 9,469 women undergoing traditional prenatal care were included in the analysis. Evaluating the primary outcome of preterm birth at <37 weeks, Centering was associated with a 5.9% risk of preterm birth compared to 7.1% with routine prenatal care (OR = 0.84, 95% CI: 0.53-1.30). Centering prenatal care was also not significantly associated with very low birth weight (OR = 0.4, 95% CI: 0.1-1.7), birth weight <2,500 g (OR = 0.65, 95% CI: 0.40, 1.06), or preterm birth at 32 to 36 weeks (OR = 1.0, 95% CI: 0.8, 1.2). Centering prenatal care was associated with lower odds of cesarean delivery (OR = 0.71, 95% CI: 0.60-0.84) and more frequent prenatal visits.Centering prenatal care was associated with lower likelihood of cesarean delivery and more frequent prenatal visits, while likelihood of preterm birth and low birth weight were not significantly more or less likely with Centering. · Centering prenatal care was associated with lower likelihood of cesarean delivery.. · Centering prenatal care was associated with more frequent prenatal visits.. · Preterm birth and low birth weight were not significantly more or less likely with Centering..

This study aimed to explore the fetal heart rate trend in the week before birth, the transition from fetal to neonatal heart rate, and the neonatal heart rate trend in the week after birth in preterm neonates admitted to a tertiary care hospital, considering maternal and neonatal factors.A retrospective cohort study was conducted, including neonates born between 24 and 34 weeks of gestation. Baseline heart rate, average deceleration capacity, standard deviation, skewness, and sample entropy were assessed using interrupted time series and difference-in-differences analyses. Subgroup analyses were performed according to gestational age at birth, sex, birth weight, mode of delivery, Apgar score at 5 minutes, umbilical cord pH, and neonatal medication.The fetal and neonatal heart rate of 123 patients was analyzed. After birth, step change of baseline (2.23 bpm, p < 0.05), average deceleration capacity (0.43 bpm, p < 0.001), and skewness (0.47 nu, p < 0.001) increased, while sample entropy (-0.68 bits, p < 0.001) and standard deviation (-1.15 bpm, p < 0.001) decreased. Postnatally, baseline increased in linear slope and decreased in quadratic slope (both p < 0.001). Average deceleration capacity decreased in linear slope (p < 0.001). Sample entropy and standard deviation increased in linear slopes (both p < 0.001). Skewness increased in quadratic slope (p < 0.05). Subgroup analyses revealed that delivery mode, medication, and birth weight modulated these trends.This study provides unique insights into heart rate frequency and variability trends during the period around preterm birth. It highlights the dynamic physiological adaptation that occurs during the transition from intrauterine to extrauterine life in preterm infants and may help inform future research on fetal and neonatal monitoring and clinical management. · Heart rate frequency and variability dynamics were assessed around preterm birth in a NICU cohort.. · After birth, heart rate frequency increased while variability measures decreased.. · Heart rate frequency and variability differed by gestational age, birth weight, medication, and delivery mode..

This study aimed to evaluate inpatient COVID-19 vaccine uptake among pregnant and postpartum patients.Retrospective cohort study of patients admitted to the antepartum and postpartum services of two academic hospitals between April 2021 and July 2022. Patients were classified as "sufficiently vaccinated" (fully vaccinated or not yet due for an additional dose) or "eligible for vaccination" on admission. We used chi-square, independent samples t-test, and Wilcoxon's rank sum test to compare characteristics between the groups on admission. We used logistic regression to analyze factors associated with inpatient vaccination for antepartum and postpartum patients.Among 886 antepartum and 12,036 postpartum patients, 341 (38.5%) and 6,327 (52.6%) were sufficiently vaccinated at the time of admission, respectively. Factors associated with vaccination status on admission included age, race, ethnicity, marital status, insurance, smoking status, trimester of prenatal care initiation, obstetric history, comorbidities, and receipt of Tdap and influenza vaccinations during pregnancy. Among 545 eligible antepartum patients, 30 (5.5%) were vaccinated inpatient. Factors associated with inpatient antepartum vaccination included receipt of influenza vaccination during pregnancy (adjusted odds ratio [aOR] = 7.95, 95% confidence interval [CI]: 2.94-21.46), length of stay (aOR = 1.07, 95% CI: 1.03-1.11), and abruption (aOR = 6.20, 95% CI: 1.78-21.62). Among 5,709 eligible postpartum patients, 527 (9.2%) were vaccinated inpatient. Factors associated with inpatient postpartum vaccination included Black race (aOR = 1.45, 95% CI: 1.09-1.95), initiation of prenatal care in the second trimester compared with the first (aOR = 1.38, 95% CI: 1.08-1.77), gestational diabetes (aOR = 1.70, 95% CI: 1.25-2.30), receipt of Tdap (aOR = 1.47, 95% CI: 1.02-2.13) and influenza (aOR = 1.66, 95% CI: 1.32-2.09) vaccinations during pregnancy, and length of stay (aOR = 1.05, 95% CI: 1.00-1.11).Despite the availability of inpatient vaccination, COVID-19 vaccine uptake in this peripartum population was low. General vaccine acceptance and increased length of stay were associated with inpatient vaccination. · Inpatient vaccine access did not increase uptake.. · Vaccine uptake was associated with length of stay.. · General vaccine acceptance was linked to inpatient vaccination..