Journal of Perinatology最新文献

{"title":"Factorial vignettes describe suspected early onset sepsis practice variation in a multicenter NICU antibiotic stewardship collaborative.","authors":"Neha S Joshi, Kenneth M Zangwill, Henry C Lee, Peter Mendel, Chau Pham, Megan Schuler, Nabeel Qureshi, Natalie Chapkis, Allison Henry, Kurlen S E Payton","doi":"10.1038/s41372-025-02325-x","DOIUrl":"https://doi.org/10.1038/s41372-025-02325-x","url":null,"abstract":"<p><strong>Objective: </strong>To describe provider practice preferences for term infants with suspected early-onset sepsis and preference change over time during a multicenter antibiotic stewardship collaborative.</p><p><strong>Study design: </strong>Factorial case vignette surveys conducted at baseline of a quality improvement collaborative, and follow up after the 12 month collaborative intervention.</p><p><strong>Results: </strong>Baseline and follow up surveys were completed by 252 (72%) and 195 (55%) respondents, respectively. The results describe both areas of compliance and non-compliance with national guidelines. There was a reduction in likelihood of ordering laboratory testing between surveys (p values ranging <0.001-0.033). A stewardship score was calculated and the mean score moved towards more stewardship friendly practices (0.39 vs 0.30).</p><p><strong>Conclusion: </strong>We identified specific antibiotic use practice variations as potential targets for improving clinician prescribing practice in the NICU setting. Respondents moved towards more antibiotic stewardship friendly practices from baseline to the follow up survey. Vignettes methods may help optimize quality improvement.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting discrepancies in linear growth measurements in the neonatal intensive care unit through nursing interventions: a quality improvement initiative.","authors":"Gail Snyder, Rebekah Wilkinson, Raina Evans, Meagan Owen, Akram Yazdani, Covi Tibe, Catherine Perez, Lindsay F Holzapfel","doi":"10.1038/s41372-025-02327-9","DOIUrl":"https://doi.org/10.1038/s41372-025-02327-9","url":null,"abstract":"<p><strong>Objective: </strong>Accurate length measurements are essential for infants to identify growth deficiencies and adjust nutrition accordingly. The gold standard for length measurement in infants is using a length board with two people to obtain an accurate clinical assessment. We aimed to improve the number of measurements with the desired minimal difference, defined as a discrepancy ≤1 cm between nurse and audit measurements, in our center. Our secondary aim was to increase and maintain the number of length boards available.</p><p><strong>Methods: </strong>This quality improvement (QI) study used a before-and-after intervention comparison design in a single-level IV neonatal intensive care unit between June 2023 and December 2023, completing two Plan-Do-Study-Act (PDSA) cycles and one sustainability cycle that targeted nursing interventions. Blinded audits were performed by the QI team < 48 h after bedside nurse measurement and discrepancies between measurements were recorded. Chi-squared testing determined the significance between measurement discrepancies at each time point.</p><p><strong>Results: </strong>The QI team measured 34 infants at each time point for 136 total measurements. There was a significant improvement in the desired minimal difference between the pre-intervention and post-PDSA #2 groups (38% vs 74%, p = 0.003) and between the pre-intervention and sustainability cycle groups (38% vs 71%, p = 0.007). There was no significant difference between PDSA #2 and our sustainability cycle. There was a 32% improvement among infants with consistent length percentiles between nurse and audit measures after PDSA #2 (42% vs 74%, p = 0.012). The number of length boards was increased during the study. Anonymous nursing surveys revealed an improvement in the perceived ease of use of length boards (51-71%) and minimized knowledge gaps.</p><p><strong>Conclusions: </strong>During the time of our intervention, there was an improvement in the precision of linear measurements and length board usage. Future PDSA cycles will focus on increasing the availability of length boards and establishing continued length board education.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of teleneonatology on time to goal temperature in outborn neonates with hypoxic-ischemic encephalopathy requiring therapeutic hypothermia.","authors":"Mark Kaczor, Roland Hentz, Paul E Youssef, Anthony Fine, Jennifer Fang","doi":"10.1038/s41372-025-02324-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02324-y","url":null,"abstract":"<p><strong>Objective: </strong>We assessed whether teleneonatology reduces time to goal temperature and early neurologic morbidity or mortality in outborn neonates with hypoxic-ischemic encephalopathy (HIE) that required therapeutic hypothermia (TH).</p><p><strong>Study design: </strong>This retrospective observational study included outborn neonates with HIE treated with TH. The exposure was teleneonatology consultation. The primary outcome was time from birth to goal temperature (33-34 °C). The secondary outcome was a composite of early neurologic morbidity and in-hospital mortality.</p><p><strong>Results: </strong>Of the 77 neonates included in the study, 42 (55%) received teleneonatology consultations. Teleneonatology reduced time to goal temperature (mean ratio 0.76 [95% CI, 0.58, 0.99]). This was partially mediated by earlier transport team activation and more frequent initiation of passive cooling prior to transport team arrival. There was no difference in early neurologic morbidity or mortality.</p><p><strong>Conclusions: </strong>Teleneonatology reduced time to goal temperature in outborn neonates with HIE requiring TH by expediting key steps in care processes.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of first trimester preeclampsia combined screening performances with various approaches in the Indonesian population.","authors":"Adly Nanda Al Fattah, Muhammad Pradhiki Mahindra, Mirani Ulfa Yusrika, Muhammad Pradhika Mapindra, Felix Firyanto Widjaja, Vania Permata Putri, Shinda Marizni, Sara L Hillman, Raden Aditya Kusuma","doi":"10.1038/s41372-025-02316-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02316-y","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare Fetal Medicine Foundation (FMF), Indonesian Maternal and Children Health Handbook (MCH-HB), and Indonesian Prenatal Institute (IPI) models for predicting PE.</p><p><strong>Materials/subjects and methods: </strong>Maternal risk factors, biophysical, and biochemical markers were recorded from women screened for PE at 11-14 gestational weeks. The receiving operator curve (ROC) analysis was used to compare the detection rate (DR) among prediction models.</p><p><strong>Results: </strong>For all PE at a 10% false-positive rate (FPR), FMF had a DR 62.9%; MCH-HB had a DR 50.0%; IPI had a DR 66.9%. For early-onset PE, at 10% FPR FMF had a DR 80.3%; MCH-HB had a DR 71.4%; IPI had a DR 81.5%. For preterm PE at 10% FPR, FMF had a DR 70.2%; MCH-HB had a DR 38.5%; IPI had a DR 66.9%.</p><p><strong>Discussion: </strong>IPI algorithm is comparable to FMF and outperforms MCH-HB algorithm for all, early-onset, and preterm PE screening.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family integrated care reduces stress in transferred parents of preterm infants, but not across all families: a stepped-wedge cluster-randomized trial.","authors":"M T Alferink, H Hoeben, N H Jonkman, J B van Goudoever, A A M W van Kempen, N R van Veenendaal, S R D van der Schoor","doi":"10.1038/s41372-025-02318-w","DOIUrl":"https://doi.org/10.1038/s41372-025-02318-w","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether Family Integrated Care (FICare) model including Family-Centered Rounds (FCR) reduces parental stress in neonatal wards.</p><p><strong>Study design: </strong>A multicenter, stepped-wedge cluster-randomized trial was conducted in ten level II neonatal wards in The Netherlands (March 2022-December 2023). Participants included parents of 613 infants hospitalized for ≥7 days. The primary outcome was parental stress at discharge (PSS:NICU scale). Secondary outcomes included parental participation, anxiety, trauma, depression, shared decision-making, and bonding.</p><p><strong>Results: </strong>FICare significantly increased parental participation (P < 0.001) but did not reduce overall stress at discharge (FICare 61.2 vs. SNC 62.5, P = 0.21). Trauma symptoms in partners decreased (P = 0.03), and parents of transferred infants showed reduced stress (P = 0.01).</p><p><strong>Conclusion: </strong>While FICare improved parental involvement, overall stress reduction was limited, with benefits seen in reduced trauma symptoms in partners and a reduction of stress in parents of transferred infants.</p><p><strong>Trial registration: </strong>The trial has been registered at Clinical Trials.gov under registration number NCT05343403.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey of parental experiences while viewing MRI images at a fetal care center.","authors":"Nicholas D O'Connor, Louis J Martin, Rachel L Tullar, Brandon P Brown, Zeynep N I Salih","doi":"10.1038/s41372-025-02319-9","DOIUrl":"https://doi.org/10.1038/s41372-025-02319-9","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference ranges of left ventricular diastolic multimodal ultrasound parameters in stable preterm infants in the early and late neonatal intensive care admission period.","authors":"Koert de Waal, Enrico Petoello, Edward Crendal, Nilkant Phad","doi":"10.1038/s41372-025-02278-1","DOIUrl":"https://doi.org/10.1038/s41372-025-02278-1","url":null,"abstract":"<p><strong>Background: </strong>Diastolic dysfunction often precedes systolic dysfunction and provides opportunity for management strategies. We aim to present reference ranges for diastolic function parameters in stable preterm infants at 2 timepoints.</p><p><strong>Methods: </strong>Ultrasound scans of clinically stable preterm infants < 30 weeks gestation with no antenatal or postnatal complications were analysed for left heart size, mitral blood flows, myocardial velocities and shortening during the early (3 to 21 days) and late (corrected gestation 34 to 37 weeks) neonatal period.</p><p><strong>Results: </strong>92 early scans and 64 late scans were included. Mitral blood flow and myocardial velocities increased with augmented atrial function leading to higher EA and e'a' ratios and with relatively high Ee' ratio.</p><p><strong>Conclusion: </strong>We present reference values for many left ventricular multimodal diastolic ultrasound parameters in preterm infants with uncomplicated fetal and neonatal development to guide prospective studies that explore diastolic function and diastolic heart failure in preterm infants.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to positive blood cultures in neonatal sepsis evaluations.","authors":"Emily Willey, Michelle Mitchell, Carey Ehlert, Jacob Swoveland, Tracy Zembles","doi":"10.1038/s41372-025-02323-z","DOIUrl":"https://doi.org/10.1038/s41372-025-02323-z","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluates the time to blood culture positivity among neonates evaluated for sepsis to determine when antibiotics may be safely discontinued.</p><p><strong>Study design: </strong>Retrospective review of clinically relevant blood culture time to positivity from infants in a neonatal intensive care unit. The primary endpoint was overall median time to blood culture positivity. Secondary endpoints compared time to positivity among gram-positive versus gram-negative organisms, early versus late onset sepsis, and a sub-analysis excluding contaminants.</p><p><strong>Result: </strong>Among 151 cultures, the overall median time to positivity was 17 h (IQR 12-23). Most (47/48, 97.9%) gram-negative organisms resulted within 24 h and most (88/94, 93.6%) gram-positive by 36 h. All (13/13, 100%) early onset cultures resulted within 24 h and most (132/138, 95.7%) late onset by 36 h.</p><p><strong>Conclusion: </strong>Antibiotics for neonatal sepsis evaluation may be safely discontinued in well-appearing infants without an identified infection source with negative cultures at 36 h.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the womb: prenatal MRI's prognostic abilities for morbidity and mortality in neonates with omphaloceles.","authors":"Krishna Manohar, Fikir M Mesfin, Jessica Belchos, Brandon P Brown, Cameron Colgate, Lava Timsina, Joshua Brown, Rachel Tullar, Brian W Gray","doi":"10.1038/s41372-025-02321-1","DOIUrl":"https://doi.org/10.1038/s41372-025-02321-1","url":null,"abstract":"<p><strong>Background: </strong>Managing omphaloceles poses challenges in prenatal consultation and perinatal care. We hypothesized that specific fetal MRI findings could predict morbidity and mortality in these patients.</p><p><strong>Methods: </strong>We analyzed fetal MRI studies demonstrating omphaloceles from 2006 to 2022 and conducted a retrospective review of medical records. Predictor variables were correlated with outcomes using univariate and multivariate analyses, and Receiver Operating Characteristic (ROC) curves were optimized with Youden's J statistic.</p><p><strong>Results: </strong>Among 46 omphalocele patients, 89% survived to birth, with an overall mortality rate of 37%. Significant predictors of mortality included stomach/spleen herniation, severe anomalies, omphalocele-associated syndromes, membrane rupture, lower observed/expected total fetal lung volume (O/E TFLV), and increased percentage of liver herniation. The need for deferred repair correlated with liver/stomach herniation and \"giant-omphalocele.\" ROC analysis identified mortality cut points at O/E TFLV < 42% and liver herniation >77%, while deferred repair was indicated at liver herniation >51%.</p><p><strong>Conclusion: </strong>This study identified prenatal MRI findings associated with mortality and deferred repair, aiding in risk prediction and family counseling.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot clinical trial on supportive rehabilitation care in neonatal intensive unit. Influence of ambient noise on premature infants.","authors":"Rita Chiaramonte, Matteo Cioni, Giorgia Fiorenza, Patrizia Finocchiaro, Maria Annunziata Conversano, Carmine Loretta Mattia, Maria Carmela Caracciolo, Chiara Di Marco, Venerando Rapisarda, Pasqua Maria Betta, Michele Vecchio","doi":"10.1038/s41372-025-02322-0","DOIUrl":"https://doi.org/10.1038/s41372-025-02322-0","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}