{"title":"The characteristics of racial disparity in retinopathy of prematurity outcomes.","authors":"Jack Jacob, Robert W Arnold","doi":"10.1038/s41372-025-02355-5","DOIUrl":"https://doi.org/10.1038/s41372-025-02355-5","url":null,"abstract":"<p><strong>Objective: </strong>To characterize racial disparities in retinopathy of prematurity (ROP) requiring treatment and to investigate specific treatment patterns across racial groups.</p><p><strong>Study design: </strong>Retrospective analysis of de-identified data from ROP Check®, a cloud-based electronic medical record system for neonatology screening and ophthalmology tracking ROP examinations and treatment. Data from 28 hospitals from 2011 to 2022 included 3631 surviving premature infants with recorded race.</p><p><strong>Results: </strong>American Indian/Alaska Native (AI/AN), Asian, and Pacific Islander (PI) infants had the highest rates of ROP treatment at both early (21-25 weeks) and later gestational ages (26-30 weeks) while African American infants had the lowest and most pronounced at later gestational ages (26-30 weeks). AI/AN infants had earlier and more multiple treatments.</p><p><strong>Conclusions: </strong>Our study identifies PI race, alongside AI/AN and Asian backgrounds, as high-risk categories for treatment-warranted ROP. The inclusion of race to gestational age and birthweight enhances the prediction of treatment-warranted ROP.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667853","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}
H Bhullar, A Stritzke, S Makarchuk, S Tang, A Lodha
{"title":"Preterm Premature Rupture of Membranes (PPROM) and Neurodevelopmental Outcomes.","authors":"H Bhullar, A Stritzke, S Makarchuk, S Tang, A Lodha","doi":"10.1038/s41372-025-02360-8","DOIUrl":"https://doi.org/10.1038/s41372-025-02360-8","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667851","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}
Jonathan R Burris, Blair F Germain, Patricia R Chess, Elizabeth A Powers, Rebecca Gillis, Hyacinth G Lewis, Jamey Tulloch, Colby L Day, Andrew M Dylag
{"title":"Less invasive surfactant administration in the delivery room: A quality improvement initiative.","authors":"Jonathan R Burris, Blair F Germain, Patricia R Chess, Elizabeth A Powers, Rebecca Gillis, Hyacinth G Lewis, Jamey Tulloch, Colby L Day, Andrew M Dylag","doi":"10.1038/s41372-025-02350-w","DOIUrl":"https://doi.org/10.1038/s41372-025-02350-w","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate less invasive surfactant administration (LISA) in the delivery room as a part of neonatal stabilization and reduce infants requiring intubation.</p><p><strong>Project design: </strong>A SMART aim was developed to implement LISA in >30% of infants (25.0-31.6 weeks' gestational age) with respiratory distress syndrome (RDS) in the NICU or delivery room (DR) and increase the number of infants never requiring intubation by 50% by 12/31/2023. Three sequential Plan-Do-Study-Act cycles were implemented. Statistical Process Control charts tracked time-ordered data.</p><p><strong>Results: </strong>Over 4 years, 184 patients received LISA (N = 112 in the DR). LISA was safe and successful (98.9%), including DR. DR intubations were reduced (65.5 to 52.6%), infants never requiring intubation increased (22.8 to 38%), and Grade 2 or 3 BPD (12.9 to 8.8%) was reduced.</p><p><strong>Conclusion: </strong>LISA in the delivery room is safe and effective for RDS and associated with reduced need for intubation, mechanical ventilation, and BPD.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608623","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}
Kristen Coletti, Jennifer A Hershey, Matthew Devine, Jennifer Taft, Jeff Schinella, Sekinah Ajiboye, Kathleen Gibbs, Michele P Lambert, David Friedman, Christopher S Thom
{"title":"An improvement project standardizing low prophylactic platelet transfusion dosing for infants.","authors":"Kristen Coletti, Jennifer A Hershey, Matthew Devine, Jennifer Taft, Jeff Schinella, Sekinah Ajiboye, Kathleen Gibbs, Michele P Lambert, David Friedman, Christopher S Thom","doi":"10.1038/s41372-025-02347-5","DOIUrl":"https://doi.org/10.1038/s41372-025-02347-5","url":null,"abstract":"<p><strong>Background: </strong>Platelet transfusions are frequently given to preterm infants to prevent bleeding, but randomized trials demonstrated harmful effects from current practices.</p><p><strong>Problem: </strong>Many platelet transfusions were administered in 15-20 mL/kg doses.</p><p><strong>Methods: </strong>We sought to decrease platelet exposure among neonates by standardizing 10 mL/kg transfusions for non-bleeding thrombocytopenic infants in a level IV NICU.</p><p><strong>Interventions: </strong>We created evidence-based platelet dosing guidelines and changed practices in 3 plan-do-study-act cycles focused on education, reinforcement and electronic clinical decision support.</p><p><strong>Results: </strong>We reviewed 240 transfusions over 3 years. The percentage of 10 mL/kg transfusions improved from 17.6% to 100%, without increasing major bleeding and repeat transfusion rates. Monthly transfused platelet volumes decreased from 2269 ± 334 mL to 857 ± 181 mL (p < 0.001), conserving limited platelet resources and saving $2746-$4942 per month in platelets.</p><p><strong>Conclusions: </strong>This study improved our platelet transfusion practices and can facilitate similar transfusion guideline adoption to benefit neonates at other institutions.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144600827","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}
María Carmen Bravo, Emilio Parrado-Hernández, Patrick J McNamara, Adelina Pellicer
{"title":"Predictive model of ibuprofen treatment failure in very preterm infants with patent ductus arteriosus using machine learning techniques.","authors":"María Carmen Bravo, Emilio Parrado-Hernández, Patrick J McNamara, Adelina Pellicer","doi":"10.1038/s41372-025-02346-6","DOIUrl":"https://doi.org/10.1038/s41372-025-02346-6","url":null,"abstract":"<p><strong>Background: </strong>The approach to patent ductus arteriosus (PDA) remains controversial. We aim to develop an algorithm to predict ibuprofen treatment failure (TF) using machine learning (ML) techniques.</p><p><strong>Methods: </strong>Secondary analysis of a trial of very preterm infants receiving intravenous ibuprofen to treat PDA. A predictive model on TF was developed with ML. The impact of TF on outcomes was analyzed.</p><p><strong>Results: </strong>One hundred forty-six infants were included. ML techniques showed that a logistic regression model predicted TF with an AUC 0.65. A multiple regression model found that bronchopulmonary dysplasia (BPD) was associated with TF, p = 0.03. Other neonatal outcomes did not differ between the study groups.</p><p><strong>Conclusions: </strong>It is feasible to build a predictive model of ibuprofen TF with ML that could assist clinicians during the PDA treatment decision-making process. The identification of responders prior to intervention would mitigate adverse effects in non-responders, providing them with an alternative approach.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591506","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}
Alexa K Craig, Anya Cutler, Jay Kerecman, Misty Melendi, Leah Marie Seften, Matthew Ryzewski, Allison Zanno, Deirdre O'Reilly
{"title":"Association of low hospital birth volume and adverse short-term outcomes for neonates treated with therapeutic hypothermia in rural states.","authors":"Alexa K Craig, Anya Cutler, Jay Kerecman, Misty Melendi, Leah Marie Seften, Matthew Ryzewski, Allison Zanno, Deirdre O'Reilly","doi":"10.1038/s41372-025-02352-8","DOIUrl":"10.1038/s41372-025-02352-8","url":null,"abstract":"<p><strong>Objective: </strong>We hypothesized that outborn neonates in three rural states would have more frequent adverse short-term outcomes following therapeutic hypothermia (TH).</p><p><strong>Study design: </strong>Multicenter retrospective study comparing outcomes for low (<500 births/year), medium (501-1500 births/year), and high (>1500 births/year) birth volume hospitals in Northern New England. Multivariable logistic regression assessed the combined outcome of death/severe gray matter injury on MRI, controlling for encephalopathy severity and time to initiation of TH.</p><p><strong>Results: </strong>Death occurred for 35/531 neonates: 15/120 (12%) low, 7/193 (4%) medium, and 13/218 (6%) for high birth volume hospitals (p = 0.008). Severe gray matter injury occurred in 8%, 6% and 7% of low, medium, and high birth volume hospitals, respectively (p = 0.7). Odds of the combined outcome were 4.3-fold higher in low versus high volume hospitals (95% CI = 1.6, 12.1, p = 0.004).</p><p><strong>Conclusion: </strong>Neonates born in low volume birth hospitals had significantly higher odds of death following treatment with TH.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567561","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":"Drivers of care and outcomes for people facing fetal conditions in the United States: a conceptual framework.","authors":"Abigail B Wilpers, Scott A Lorch","doi":"10.1038/s41372-025-02340-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02340-y","url":null,"abstract":"<p><p>Congenital anomalies, affecting 3-5% of pregnancies annually in the United States, are a leading cause of fetal and infant mortality. Despite advancements in fetal care, disparities in care access, quality, and outcomes persist and remain poorly understood. This perspective introduces the Fetal Condition Care and Outcomes (FCCO) Framework, a conceptual model that integrates contextual, individual, structural, and process-level factors influencing care and outcomes. We build on prior adaptations of Andersen's Behavioral Model of Health Service Use and the Donabedian Structure, Process, and Outcomes Model, expanding their application from risk-appropriate neonatal care to individuals' whose pregnancies are complicated by severe fetal conditions. By synthesizing evidence across disciplines, we highlight critical gaps in understanding the drivers of disparities, including barriers to timely diagnosis, variations in counseling practices, and inequities in access to specialized services. This article calls for interdisciplinary research to ensure risk-appropriate, person-centered care for this high-risk population.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553821","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}
Carrie Moore, Lori A Devlin, Cynthia Crabtree, Amanda Farris, Joshua Kurtz, Keri Marques
{"title":"Disposable pressure transducer to identify central pressure measurements in umbilical lines for preterm and term infants in the neonatal intensive care unit.","authors":"Carrie Moore, Lori A Devlin, Cynthia Crabtree, Amanda Farris, Joshua Kurtz, Keri Marques","doi":"10.1038/s41372-025-02338-6","DOIUrl":"https://doi.org/10.1038/s41372-025-02338-6","url":null,"abstract":"<p><strong>Objectives: </strong>Assess the feasibility of using a disposable pressure transducer with integrated digital display to differentiate arterial versus venous line placement in neonates.</p><p><strong>Study design: </strong>Infants ≥23 weeks' gestation with appropriately placed umbilical catheters were enrolled. A single baseline pressure reading was obtained, hypothesizing that arterial placement could be differentiated with a pressure ≥12 mmHg.</p><p><strong>Results: </strong>Forty-five infants were enrolled to obtain 62 measurements, 31 from both umbilical artery catheters(UAC) and umbilical venous catheters(UVC). 100% of UAC were ≥12 mmHg and 87% of UVC were <12 mmHg. Median device pressures for UAC and UVC were 41 mmHg (IQR 31-45 mmHg) and 5 mmHg (IQR 3-9 mmHg) (p-value < 0.0001). An optimal venous device pressure cut point was determined to be 21 mmHG (97% sensitivity, 100% specificity, AUC 0.98).</p><p><strong>Conclusion: </strong>This transducer is likely safe and can differentiate line placement in arterial and venous systems. 12 mmHg appears to reliably identify lines placed in the arterial system, but 21 mmHG was found to be the optimal venous cut point.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553808","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}
Eric Kalimi, Emily Zhao, Brittany Wise-Oringer, Ronald J Wapner, Lorraine Dugoff, Caitlin Baptiste, Alex Lyford, Thomas Hays
{"title":"The role of genetic testing in small for gestational age infants.","authors":"Eric Kalimi, Emily Zhao, Brittany Wise-Oringer, Ronald J Wapner, Lorraine Dugoff, Caitlin Baptiste, Alex Lyford, Thomas Hays","doi":"10.1038/s41372-025-02343-9","DOIUrl":"https://doi.org/10.1038/s41372-025-02343-9","url":null,"abstract":"<p><p>Small for gestational age (SGA) infants face increased morbidity, mortality, and long-term health risks, yet causes of SGA remain unclear. While placental insufficiency and environmental factors contribute, genetic disorders play a significant role. Syndromes like Silver-Russell and Noonan are linked to SGA, but the overall genetic contribution remains uncertain. We reviewed literature on genomic sequencing in SGA and fetal growth restriction (which often precedes SGA) and identified 161 single-gene disorders. The top ten genes explained one-third of cases, but half were attributable to unique genes. Genetic disorders were frequently accompanied by congenital anomalies (often skeletal dysplasia) and developmental delays. Current guidelines for genetic evaluation of SGA are limited. Our findings support consideration of exome or genome sequencing, particularly in the setting of congenital anomalies or developmental delays. Early identification of genetic disorders can enable tailored therapy. Given the complexity of the SGA genetic landscape, prospective genomic studies are urgently needed.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144506025","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}