Journal of neonatal-perinatal medicine最新文献

{"title":"Use of a weight indexed umbilical artery systolic diastolic ratio to predict the risk for adverse outcomes among growth restricted fetuses.","authors":"Ruby Russell, Katelyn Tessier, Stephen Contag","doi":"10.1177/19345798241292448","DOIUrl":"10.1177/19345798241292448","url":null,"abstract":"<p><p><b>Background and Objectives:</b> To evaluate weight-indexed umbilical systolic diastolic ratio (UASDR) to discriminate risk for adverse outcomes among growth restricted fetuses (FGR).<b>Design and Setting:</b> Retrospective study using prenatal ultrasound data and neonatal outcome data. Two primary outcomes: admission to intensive care and a composite outcome of severe neonatal morbidity. We included births among individuals with a singleton pregnancy at 24-40 weeks gestation without other indications for preterm delivery. We calculated the percentile of the measured standard UASDR, and the same value indexed to the EFW (iUASDR).<b>Results:</b> 296 pregnancies met inclusion criteria. Forty-seven percent required NICU admission and 31% developed a component of the composite outcome. The sensitivity of the iUASDR increased at lower birthweight percentiles. The positive predictive value of the standard UASDR was higher among fetuses with EFW <5th % and <10th % for NICU admission and composite outcome ((EFW <5th %) 0.82 (95% CI: 0.71, 0.91) and 0.60 (95% CI: 0.48, 0.72) and ((EFW <10th %) 0.81 (95% CI: 0.70, 0.89) and 0.58 (95% CI: 0.45, 0.69) compared with indexed values.<b>Discussion:</b> Data does not support use of the iUASDR to improve the test characteristics of the UASDR. Despite a moderate increase in specificity, the positive predictive value was low. UASDR non-indexed or standard values in conjunction with clinical findings and severity of FGR perform best.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"36-45"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A quality improvement project on implementing a standardized pain assessment and opioid stewardship guidance at a level IV NICU.","authors":"Naveed Ur Rehman Durrani, Isam Abdulaziz Badhawi, Simi Kurian, Melanda Vicente, Melyndee Peligrino, Naima Sultan, Elnora Manuzon, Phani Kiran Yajamanyam","doi":"10.1177/19345798241296330","DOIUrl":"10.1177/19345798241296330","url":null,"abstract":"<p><p>BackgroundBalancing between adequate analgesia and preventing the harmful side effects of opioids in the NICU is an important clinical conundrum. Lack of awareness among caregivers and guidance on pain management are the key limiting factors. By initiating this quality improvement (QI) project, we aimed to reduce the usage of opioids in a quaternary NICU care by 5% within 1 year.MethodsA multidisciplinary team developed standardized guidance focusing on regular pain assessment, appropriate initiation, and weaning of opioids for infants undergoing surgical procedures and those requiring mechanical ventilation. The Plan, Do, Study, Act (PDSA) methodology was used for improvement, beginning with a survey and Pareto analysis to identify key drivers. Data were collected for the baseline period and after implementing the QI interventions.ResultsWe demonstrated a significant decrease in the cumulative opioid use measured as morphine equivalent (mg/kg) from a mean of 2.7 to below 0.85 mg/kg, demonstrating a reduction of >50%. There was no worsening in pain or opioid withdrawal scores within three and 5 days after weaning of opioids, a surrogate measure for appropriate weaning.ConclusionImplementation of standardized guidelines for initiating and weaning of opioids can reduce the overall opioid use and thus minimize opioid withdrawal in critically ill neonates.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"61-69"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ping-pong skull fracture in a neonate managed successfully with vacuum-assisted technique.","authors":"Omer Akbar, Khaled Abushafi, Heba AlShaikh, Abdulaziz Al-Khotani, Mansour Al Qurashi","doi":"10.1177/19345798241309879","DOIUrl":"https://doi.org/10.1177/19345798241309879","url":null,"abstract":"<p><p>Ping-pong fractures (PPFs) are rare types of depressed skull fractures that occur in neonates due to mechanical traumatic factors. Such conditions result in inward bowing of the skull bones, but its continuity remains intact. In this paper, we report a case of PPF in a female newborn infant associated with instrumental delivery, which was managed non-surgically with a vacuum extraction method. Because such a condition is uncommon and can be effectively managed with a relatively easy non-invasive method, this case is clinically interesting.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241309879"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal cerebral venous sinus thrombosis in the setting of maternal SARS-CoV-2 infection: Case report.","authors":"Maksim Parfyonov, Dakota Peacock, Jonathan Smith","doi":"10.1177/19345798241308492","DOIUrl":"https://doi.org/10.1177/19345798241308492","url":null,"abstract":"<p><p>Coronavirus 19 disease (COVID-19) is a known risk factor for venous thromboembolism, and vertical transmission of SARS-CoV-2 has been shown to cause neurological insult to the developing fetus. We describe the case of a late preterm neonate with maternal history of third trimester COVID-19 who was found to have cerebral venous sinus thrombosis. We demonstrate for the first time an association between neonatal cerebral venous sinus thrombosis and placental abnormalities related to COVID-19 and posit this as a possible mechanistic link.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241308492"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of serum interleukin-6 for neonatal encephalopathy outcomes.","authors":"Junichi Saito, Jun Shibasaki, Kouji Yamamoto, Maya Fujita, Katsuaki Toyoshima","doi":"10.1177/19345798241297068","DOIUrl":"https://doi.org/10.1177/19345798241297068","url":null,"abstract":"<p><p><b>Background:</b> Serum interleukin-6 (IL-6) may predict adverse outcomes of neonatal encephalopathy (NE); however, limited data regarding the predictive utility of IL-6 during neurodevelopmental follow-up are available. We aimed to determine the utility of IL-6 for predicting adverse outcomes at 18 to 22 months of age.<b>Methods:</b> Eighty-seven patients with NE who received therapeutic hypothermia were enrolled in this study. Serial serum IL-6 levels during the first 3 postnatal days were collected. Patients were classified into three groups: (1) death, (2) survival with moderate to severe neurodevelopmental disability (NDD) at 18-22 months of age, and (3) survival without NDD (favorable outcome). The predictive ability of IL-6 was determined by the area under the receiver-operating characteristic curve (AUC).<b>Results:</b> Serial IL-6 data of 80 patients with NE were available and showed peak levels on postnatal day 1; these levels gradually decreased toward day 3. By 18-22 months of age, 13 and 17 patients died and experienced moderate to severe NDD without death, respectively. Fifty patients experienced favorable outcomes. Higher IL-6 levels on day 1 predicted the composite adverse outcome (including death and survival with NDD; <i>n</i> = 30; AUC, 0.648). Higher IL-6 levels on day 1 predicted death (<i>n</i> = 13; AUC, 0.799), whereas higher IL-6 levels on day 1 predicted survival with NDD (<i>n</i> = 17; AUC, 0.536).<b>Conclusions:</b> The AUC of IL-6 that predicted survival with NDD was lower than the AUC of IL-6 that predicted death; therefore, IL-6 may have insufficient utility for predicting NDD without death.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241297068"},"PeriodicalIF":0.0,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of stress in mothers of babies admitted to neonatal intensive care unit and the influence of maternal and infant characteristics on the stress levels.","authors":"Anitha Haribalakrishna, Alpana Utture, Ruchi Nanavati","doi":"10.1177/19345798241290904","DOIUrl":"https://doi.org/10.1177/19345798241290904","url":null,"abstract":"<p><strong>Objectives: </strong>The study was aimed to assess the maternal stress level due to their infant's neonatal intensive care stay and to understand the factors contributing to it.</p><p><strong>Method: </strong>This prospective observational study was conducted in the level III neonatal intensive care unit (NICU) of a tertiary level public hospital in India. Mothers (<i>N</i> = 100) were interviewed according to the Parental Stress Score (PSS) questionnaire, during days 6-8 of their infant's admission to the NICU.</p><p><strong>Results: </strong>Maternal stress was found to be highest due to sights and sounds in the NICU followed by alteration of the parental role. Stress due to staff behaviour and communication was least stressful followed by baby look and behaviour. The stress due to sights and sounds was significantly higher than stress due to baby's look and behaviour [(2.7 ± 1.4 vs 1.98 ± 2.02), <i>p</i> = 0.004] and staff behaviour [(2.7 ± 1.4 vs 1.58 ± 1.31), <i>p</i> = 0.00] while was not significantly higher than stress due to parental role [(2.7 ± 1.4 vs 2.29 ± 1.60), <i>p</i> = 0.055]. The stress level due to baby's look and behaviour was not significantly higher than parental role [(1.98 ± 2.02 vs 2.29 ± 1.60), F = 1.4, <i>p</i> = 0.23] or staff behaviour [(1.98 ± 2.02 vs 1.58 ± 1.31), F = 2.7, <i>p</i> = 0.09]. The demographic characteristics such as maternal age, parity, educational stress, type of delivery, gestation, need of ventilatory support, feed intolerance and kangaroo mother care (KMC) in infants individually did not significantly affect the stress scores.</p><p><strong>Conclusion: </strong>The involvement of mothers in neonatal care while the infants were in the NICU, early KMC and involvement of mothers in enteral feeding practices may alleviate her stress levels.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241290904"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimized control of gas temperature and relative humidity during non-invasive respiratory support in preterm infants: A simple and low-cost intervention.","authors":"Karina Segatto, Renata Monteiro Weigert, Mariane Ferreira da Silveira, Fabiano Frâncio, Kelen Salvagni, Simone Caldeira Silva, Sergio Tadeu Martins Marba, Guilherme Sant'Anna","doi":"10.1177/19345798241291348","DOIUrl":"https://doi.org/10.1177/19345798241291348","url":null,"abstract":"<p><p><b>Background:</b> During non-invasive respiratory support, administration of gases at high flow rates requires proper air conditioning to avoid upper airways complications. However, closed-loop control of temperature & relative humidity (T&RH) of mixed gases systems with wired-heated circuits are not commonly available in low-middle income countries (LMIC). Thus, a policy for close control of gas T&RH to overcome our system limitations was implemented. The objective of this study was to evaluate the impact of this intervention.<b>Method:</b> Single center retrospective study including preterm infants admitted to a level II unit (June 2019-2020). Close control of gas T&RH was implemented in Dec 2019 and consisted of starting with the heater at a set number higher than previously and followed by adjustments every 6 h based on intermittent temperature checks (target: 36.5°C-37°C). Humidity was controlled by adjusting the water level every 6 h and checking for the presence of condensation. Two groups were identified: infants treated with or without the close T&RH control. Primary outcome was the occurrence of nasal bleeding. Secondary outcomes were adherence to the policy, need to change the original mode of respiratory support or endotracheal intubation. Appropriate statistical tests were applied.<b>Results:</b> A total of 128 neonates were included: 63 managed without and 65 with close gas T&RH control. Rates of nasal bleeding decreased significantly with the close T&RH control, from 30% to 14% (<i>p</i> = 0.026) despite longer duration of non-invasive support (CPAP: 1.8 ± 1.9 vs 4.3 ± 5.8 days; <i>p</i> = 0.002 and NIPPV: 1.8 ± 1.4 vs 4.2 ± 5.2; <i>p</i> = 0.009). Adherence to the policy was 93%. Changes of the original mode of respiratory support also decreased significantly (14% vs 3%; 0.024) with no intubation.<b>Conclusion:</b> In the absence of advanced and expensive systems, a simple and low-cost intervention to optimize gas T&RH during non-invasive respiratory support in LMIC is feasible and associated with clinical improvements.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":" ","pages":"19345798241291348"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of timing of surgery and outcomes in preterm infants with surgical necrotizing enterocolitis and intestinal perforation.","authors":"Parvesh Mohan Garg, Robin Riddick, Md Abu Yusuf Ansari, Joe Yi, Isabella Pittman, Peter Porcelli, Neha Varshney, David Sawaya, Jeffrey Shenberger, William B Hillegass, Padma P Garg","doi":"10.1177/19345798241310112","DOIUrl":"10.1177/19345798241310112","url":null,"abstract":"<p><p><b>Background:</b> To investigate the association between the timing of surgery from the day of NEC/SIP diagnosis and clinical outcomes in preterm infants. <b>Study Design:</b> A retrospective cohort study comparing clinical outcomes of infants undergoing laparotomy at three clinically relevant time points (less and more than 48 hours, 96 hours, and 168 hours [7 days]) following NEC/SIP diagnosis. <b>Results:</b> Infants with NEC/SIP (<i>N</i> = 97) receiving surgical invention >96 hours (34/97) had significantly lower gestational age (25.5 weeks [24.0; 26.9] vs 27.0 [25.0; 31.3]; <i>p</i> = 0.006), had lower birth weight (687 grams [600; 902] vs 940 [710; 1495]; <i>p</i><0.001), had pneumoperitoneum less often on the abdominal x-ray (29.4% vs 57.1%, <i>p</i> = 0.017), had hemorrhagic (<i>p</i> = 0.04) and reparative (<i>p</i> = 0.003) lesions more often on intestinal histopathology, had PDA diagnosed more often (76.5% vs 50.8%, <i>p</i> = 0.02), required assisted ventilation more frequently (<i>p</i> = 0.013), and received parenteral nutrition for longer duration (112 days [76.5; 145] vs 65.0 [23.0; 112], <i>p</i> = 0.004) following surgery compared to the infants receiving surgical intervention before 96 hours (<i>n</i> = 63/97). In NEC-only sub-cohort, infants receiving laparotomy >48 hours (<i>n</i> = 29/75) had lower median gestational age, lower birth weight, less pneumoperitoneum, and higher acute kidney injury than those receiving surgery <48 hours. On logistic regression, the odds of death were not significantly different (OR 0.65 [0.28, 1.54], <i>p</i> = 0.32) for infants receiving laparotomy ≤48 hours following NEC/SIP compared to subjects undergoing surgery >48 hours. The odds of intestinal failure (>60 days of parenteral nutrition) were 4.5 times (CI 1.56, 14.3), <i>p</i> = 0.005) higher for those having surgery >96 hours from NEC/SIP diagnosis. <b>Conclusion:</b> There was no significant difference in death among infants receiving surgery within 48 hours following surgical NEC/SIP diagnosis compared to those receiving surgery at ≥ 48 hours of diagnosis. However, infants receiving surgery >96 hours were more likely to receive parenteral nutrition for longer time. A prospective study is needed to understand the continuous relationship between time to surgery and outcomes.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":"17 6","pages":"795-809"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11875456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and practices surrounding obstetric hemorrhage among patients and providers.","authors":"Joaquin A Calderon, Savita Potarazu, Jaclyn M Phillips, Charles J Macri, Homa K Ahmadzia","doi":"10.1177/19345798241291325","DOIUrl":"https://doi.org/10.1177/19345798241291325","url":null,"abstract":"<p><strong>Background: </strong>Postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality worldwide and the second most frequent cause of pregnancy related death in the United States. There are discernible differences among healthcare providers in identifying risk factors and managing obstetric hemorrhage. Furthermore, there is limited data on patient's awareness and attitudes toward hemorrhage risk factors and preventive measures, as well as their involvement in clinical decisions. This project aimed to identify educational gaps for providers and patients in preventing and managing postpartum hemorrhage to optimally reduce maternal morbidity and mortality.</p><p><strong>Methods: </strong>Cross-sectional anonymous surveys were distributed among obstetric patients and providers at a single maternity healthcare center from November 2022 to June 2023.</p><p><strong>Results: </strong>The study cohort included 629 patients and 22 providers. Most of participants, 84% (<i>n</i> = 526), lack knowledge or are uncertain about the risk factors associated with postpartum hemorrhage. When participants were asked how likely they would be willing to accept a preventative medication to reduce the risk of postpartum hemorrhage, 55% (<i>n</i> = 344) responded \"very likely\" followed by 28% (<i>n</i> = 176) as \"somewhat likely\". Patients are likely to accept preventative medications to reduce the risk of postpartum hemorrhage. The majority of providers, 73% (<i>n</i> = 16), express confidence in using tranexamic acid for postpartum hemorrhage treatment.</p><p><strong>Conclusion: </strong>There is lack of knowledge among pregnant patients about the risk factors for hemorrhage and the standard medications to prevent it. Despite this, most participants are willing to receive preventive medication. Practice patterns regarding the prevention and management of hemorrhage should be part of a shared decision making between patients and providers.</p>","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":"17 6","pages":"838-845"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to: Proceedings of the 15th International Newborn Brain Conference.","authors":"","doi":"10.1177/19345798241311373","DOIUrl":"https://doi.org/10.1177/19345798241311373","url":null,"abstract":"","PeriodicalId":16537,"journal":{"name":"Journal of neonatal-perinatal medicine","volume":"17 6","pages":"869-873"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}