Journal of Perinatology最新文献

{"title":"When external factors limit care options for complex fetal and neonatal diagnoses.","authors":"DonnaMaria E Cortezzo, Ashley Waddell Tingstad, Terri L Major-Kincade, April R Dworetz","doi":"10.1038/s41372-025-02394-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02394-y","url":null,"abstract":"<p><p>Each year in the United States, many individuals receive a complex fetal or neonatal diagnosis. Amidst grief and processing, they are faced with making difficult and multifaceted medical decisions for the pregnancy and, at times, neonatal care. Care options often include abortion, fetal interventions, palliative and hospice care, and invasive neonatal interventions. These incredibly personal resolutions about the most appropriate care path are often based on multiple influences beyond the medical information and prognosis. External factors (geography, finances, provider bias, institutional policies, and legislation) may limit the availability of certain care options patients would prefer. This article explores how each of these external factors may limit the choices of abortion, fetal interventions, palliative and hospice care, and invasive neonatal interventions for patients facing a complex fetal or neonatal diagnosis. Further, it discusses the implications of restricted options and suggests strategies to continue to provide complete, comprehensive counseling and care.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131147","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":"Prophylactic surfactant therapy in the era of less invasive surfactant delivery.","authors":"Dinushan C Kaluarachchi, Anup Katheria, Patrick J Peebles, Scott O Guthrie, Venkatakrishna Kakkilaya, Peter A Dargaville","doi":"10.1038/s41372-025-02420-z","DOIUrl":"https://doi.org/10.1038/s41372-025-02420-z","url":null,"abstract":"<p><p>Pulmonary surfactant is a lifesaving treatment for preterm infants with respiratory distress syndrome (RDS). With the advent of less-invasive surfactant delivery techniques that minimize or eliminate exposure to invasive mechanical ventilation, the question of prophylactic surfactant administration has reemerged. This review discusses the evidence for less-invasive surfactant therapy applied prophylactically. In summary, prophylactic surfactant administration by pharyngeal deposition or brief intubation are not recommended. Surfactant delivery via supraglottic airway or by aerosolization have not been investigated as prophylaxis for RDS. Recent evidence suggests that prophylactic surfactant administration via thin catheter is safe and effective. Several ongoing randomized clinical trials are further evaluating the efficacy of prophylactic surfactant administration via thin catheter. Prophylactic surfactant administration via supraglottic airway devices and aerosolization should be evaluated in future studies.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131118","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":"Neurodevelopmental outcome in infants with neonatal encephalopathy receiving hydrocortisone during therapeutic hypothermia: follow-up of the extended-CORTISoL trial.","authors":"Kata Kovacs, Eniko Szakmar, Marianna Dobi, Zsuzsanna Varga, Unoke Meder, Attila J Szabo, Patrick J McNamara, Miklos Szabo, Agnes Jermendy","doi":"10.1038/s41372-025-02428-5","DOIUrl":"https://doi.org/10.1038/s41372-025-02428-5","url":null,"abstract":"<p><strong>Objective: </strong>To investigate neurodevelopmental outcome after hydrocortisone (HC) supplementation in infants with neonatal encephalopathy (NE) and hypotension.</p><p><strong>Study design: </strong>Fifty-five infants with volume-resistant hypotension during hypothermia were enrolled between 2016 and 2020. Eligible patients were randomly assigned to receive 0.5 mg/kg HC every 6 h or placebo along with standard dopamine treatment. Composite adverse outcome was defined as death or neurodevelopmental impairment, ascertained using the Bayley-II test.</p><p><strong>Result: </strong>At median 20 months of age, death, or severe neurodevelopmental impairment occurred in 40% in the HC group, compared to 18% in the placebo group (p = 0.13). Multiple logistic regression analysis showed that for every 1 mg/kg increase in cumulative HC dose, the odds of adverse cognitive outcome increased by 16% (95% CI 1.01-1.37; p = 0.04).</p><p><strong>Conclusion: </strong>The composite outcomes were similar in the HC-treated and placebo groups, however cumulative HC dose was associated with adverse cognitive outcome in infants with NE and hypotension.</p><p><strong>Clinical trial registration: </strong>Hydrocortisone treatment in systemic low blood pressure during hypothermia in asphyxiated newborns (CORTISoL), ClinicalTrials.gov ID: NCT02700828 https://clinicaltrials.gov/ct2/show/NCT02700828 , date of registration: 2016-02-24.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124417","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":"An integrative review of the impact of International Board Certified Lactation Consultants in outpatient postnatal settings in the United States.","authors":"Anita Lugo, Helene Moriarty, Kimberly K Trout, Diane L Spatz","doi":"10.1038/s41372-025-02425-8","DOIUrl":"https://doi.org/10.1038/s41372-025-02425-8","url":null,"abstract":"<p><p>Breastfeeding provides substantial health benefits to both the lactating parent and child, yet most dyads in the U.S. do not meet the American Academy of Pediatrics recommendations to exclusively breastfeed to 6 months and with the addition of solids, continue to breastfeed to 24 months. Outpatient lactation support, such as highly trained International Board Certified Lactation Consultants (IBCLCs), may be key to assisting dyads to overcome breastfeeding difficulties that lead to cessation. In this review, we synthesize studies within the United States that report on breastfeeding outcomes from outpatient postnatal IBCLC interventions in articles published from 2000 to 2024. Our findings revealed that implementation of postnatal outpatient IBCLC consultations and optional access to an IBCLC in a practice setting or via telehealth were associated with increased breastfeeding intensity and duration. Policy changes and accessibility to IBCLCs are needed to ensure all mothers have the option to obtain IBCLC or equivalent services.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124377","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":"\"Each family has a story:\" lived experiences of NICU families from staff perspectives.","authors":"Elise M Belkin, Paul H Lerou, Ana-Maria Vranceanu, Victoria A Grunberg","doi":"10.1038/s41372-025-02435-6","DOIUrl":"https://doi.org/10.1038/s41372-025-02435-6","url":null,"abstract":"<p><strong>Objective: </strong>Most Neonatal Intensive Care Unit (NICU) literature focuses on parent perspectives, overlooking how staff perceive and respond to family needs. We examined NICU staff perceptions to understand family experiences through a relational and systemic lens.</p><p><strong>Design: </strong>We conducted five focus groups (N = 22) with multidisciplinary staff and used an inductive-deductive approach to identify themes.</p><p><strong>Results: </strong>Staff emphasized that families have both unique journeys and common experiences. Staff described how sociocultural barriers, trauma histories, and the reproductive/NICU journey shape family stress. Common stressors include multiple traumas, grief and guilt, and ongoing uncertainty. Although coping strategies are influenced by family values/goals and prior experiences, staff commonly observed emotion-driven behaviors, involvement in care, and less self-care. Staff also noted that the NICU can disrupt family dynamics and communication, yet existing relationship dynamics shape family impact.</p><p><strong>Conclusion: </strong>Staff perspectives provide additional context for understanding family experiences and highlight the need for tailored family-centered care.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102787","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":"Mentoring the future of neonatology: program director advice for fellowship applicants and their advisors.","authors":"Morgan Hill, Brooke Vergales, Suma Hoffman, Nicolle Fernández Dyess, Rita Dadiz, Vilmaris Quinones Cardona, Beverley Robin, Margarita Vasquez, Samia Aleem, Heather French, Kristin Glass, Imran Nazir Mir, Deirdre O'Reilly, Megan Gray, Jacqueline Meadow, Jennifer M Brady, Thitinart Sithisarn, Cindy Crabtree, Patrick Myers","doi":"10.1038/s41372-025-02426-7","DOIUrl":"https://doi.org/10.1038/s41372-025-02426-7","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102816","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":"Association of low shunt burden from PDA and adverse outcomes in premature infants.","authors":"Chase Brandt, Hatice Dilara Mat, Adrianne R Bischoff, Patrick J McNamara, Danielle R Rios","doi":"10.1038/s41372-025-02437-4","DOIUrl":"https://doi.org/10.1038/s41372-025-02437-4","url":null,"abstract":"<p><strong>Objective: </strong>Compare the incidence of death or adverse respiratory outcome in patients with low shunt burden from PDA to those with no PDA and evaluate secondary outcomes associated with PDA between groups.</p><p><strong>Study design: </strong>Retrospective cohort study of all infants born <30 weeks gestation from 8/2018 to 5/2023 with TNE in the first postnatal week. Two groups: no PDA burden and low PDA burden. Primary outcome was composite of death or adverse respiratory outcome.</p><p><strong>Results: </strong>112 infants [no PDA (n = 69), low PDA burden (n = 43)] with mean gestational age and birth weight 27 ± 2 weeks and 1006 ± 310 g, respectively, were included. Baseline demographics were comparable with no difference in primary outcome (p = 0.2).</p><p><strong>Conclusion: </strong>Prolonged exposure to low-volume PDA shunt was not associated with increased risk of death or abnormal respiratory outcome. Findings highlight the importance of redefining eligibility criteria for PDA trials, based on adjudication of shunt volume, to limit enrollment to patients with moderate- to high-volume shunts.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102746","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":"Use of hydrocortisone in extremely preterm infants: emphasis on those born least mature.","authors":"Erik A Jensen, Matthew A Rysavy, Satoshi Kusuda","doi":"10.1038/s41372-025-02424-9","DOIUrl":"https://doi.org/10.1038/s41372-025-02424-9","url":null,"abstract":"<p><p>The steroid hormone cortisol plays crucial roles in innate stress response, downregulation of inflammation, and promotion of glucose homeostasis. Infants born extremely preterm may be prone to cardiovascular compromise and inflammation-mediated respiratory disease due in part to insufficient cortisol production. Current data show that hydrocortisone, the exogenous medication form of cortisol, may help prevent or treat complications associated with relative adrenal insufficiency, although the full balance of treatment risks and benefits is uncertain. Prophylactic administration of hydrocortisone beginning in the first 1-2 postnatal days in extremely preterm infants likely results in earlier initial weaning from invasive ventilation and may reduce in-hospital mortality and the composite outcome of death or bronchopulmonary dysplasia (BPD). However, such use may increase the risk of sepsis in infants born less than 26 weeks' gestation and gastrointestinal perforation with concurrent exposure to indomethacin. Whether prophylactic hydrocortisone affects childhood neurodevelopment has not been adequately studied. Initiation of hydrocortisone after the first postnatal week in infants receiving invasive ventilation promotes successful extubation but does not affect risks of mortality, BPD, or neurodevelopmental impairment. In extremely preterm infants with hypotension, hydrocortisone can increase blood pressure, but short- and long-term safety for this indication and usefulness compared to other anti-hypotensive agents are not well established.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102814","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":"Reporting of management and outcomes in the hemolytic disease of the fetus and newborn: a systematic literature review.","authors":"Ejt Verweij, Enrico Lopriore, Marie Fitzgibbon, Jenny Noack, Thomas Wilke, Wim Noel, Jeanine van Klink","doi":"10.1038/s41372-025-02366-2","DOIUrl":"https://doi.org/10.1038/s41372-025-02366-2","url":null,"abstract":"<p><strong>Objective: </strong>This systematic literature review aimed to identify outcomes and provide a foundation for the development of a core outcome set in HDFN applicable for use in future clinical trials.</p><p><strong>Study design: </strong>The bibliographic databases MEDLINE, Embase, EBM Reviews, and EconLit were searched from 2005 until 2023. Primary research studies were included. Outcomes were systematically extracted from the publications' abstract and categorized into maternal, obstetric, neonatal, long-term, and patient-reported outcomes (PROs).</p><p><strong>Results: </strong>238 included studies reported 104 different outcomes. Outcomes related to HDFN-specific treatments were the most frequently reported across studies. Long-term outcomes as well as PROs were underutilized in the screened literature.</p><p><strong>Conclusion: </strong>This SLR showed that a substantial majority of outcomes reported in HDFN-related studies are clinically-centred. PROs and long-term outcomes beyond the neonatal phase are rarely reported in the current literature emphasizing the need to better incorporate those into future clinical practice.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091990","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":"The analgesic effects of human milk odor in preterm neonates: a systematic review and meta-analysis.","authors":"Ana Beatriz Bertol, Barkhá Vijendra, Pedro Henrique Aquino Gil de Freitas, Áurea Maria Salomão Simão, Bianca Lisa de Faria, Rodrigo da Rosa Iop","doi":"10.1038/s41372-025-02432-9","DOIUrl":"https://doi.org/10.1038/s41372-025-02432-9","url":null,"abstract":"<p><p>Preterm neonates frequently undergo a variety of painful and invasive procedures. Neonatal pain has been associated with changes in hormone levels, tissue damage, and brain development. Nonpharmacological approaches, such as the use of breast milk odor, have been investigated as a strategy to reduce those effects. However, its efficacy remains unclear, and further research is needed to establish its true therapeutic value.</p><p><strong>Purpose: </strong>Evaluate the analgesic effects of breast milk odor in premature neonates.</p><p><strong>Methods: </strong>We systematically searched PubMed, EMBASE, and Cochrane for randomized controlled trials (RCTs) assessing the effects of human milk odor compared with no aromatherapy (control) or placebo (odorless diffuser/distilled water/saline) on pain relief, oxygen saturation (SaO₂), and heart rate in preterm neonates undergoing invasive procedures. Two independent reviewers screened studies and extracted data up to July 5, 2025. Statistical analyses were conducted using RevMan Web (version 8.0.0) for the primary meta-analyses, and R software was used to perform sensitivity analyses.</p><p><strong>Results: </strong>Among 460 references identified, eight randomized controlled trials met the inclusion criteria, totaling 451 preterm neonates, of whom 225 (49.9%) were exposed to human milk odor. The mean gestational age was 33.56 ± 2.58 weeks, and 226 (50.1%) were male. Two studies were conducted using venipuncture as a painful procedure, four used the heel prick test, one used peripheral catheterization, and one used vaccination. Compared with the control group and the placebo, the group exposed to the milk odor showed a reduction in pain scores during the painful procedure (SMD = -0.95; 95% CI: -1.45 to -0.45; p = 0.0002; I² = 84%). The subgroup analysis of the five RCTs that used the PIPP score for the pain assessment showed similar results; the human milk odor-exposed group showed a lower pain score compared with the control group (MD -2.66; 95% CI -4.25 to -1.06; p = 0.001). Secondary outcomes included physiological parameters such as heart rate and oxygen saturation (SaO₂). Neonates exposed to breast milk odor exhibited lower heart rates compared to control (MD = -9.26; 95% CI: -14.28 to -4.24; p = 0.0003; I² = 27%). Oxygen saturation was also higher in the intervention group (MD = 2.40; 95% CI: 0.68-4.12; p = 0.006; I² = 53%) CONCLUSION: Aromatherapy with human breast milk reduces pain in neonates. Larger studies are needed to validate our results.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091949","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}