Journal of Perinatology最新文献

{"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}

{"title":"Threshold to initiate chest compressions for bradycardia at birth: A narrative review.","authors":"Mathijs Binkhorst, Elroy van Elsäcker, René P Matthijsse, Tim Antonius, Nienke A Timmermans, Arjan B Te Pas, Willem P de Boode, Marije Hogeveen","doi":"10.1038/s41372-025-02320-2","DOIUrl":"https://doi.org/10.1038/s41372-025-02320-2","url":null,"abstract":"<p><p>Neonatal resuscitation guidelines recommend initiating chest compressions (CC) in newborns at birth if heart rate (HR) remains <60 bpm after 30 s of ventilation. This threshold is based on expert opinion and scant animal data. Our aim was to systematically evaluate the existing evidence and appraise current insights regarding thresholds for starting CC during bradycardia at birth. A recent scoping review synthesized the evidence on various aspects of neonatal CC until November 2021. We updated this review, focusing on HR thresholds for CC, with a new systematic literature search in MEDLINE, Embase, and the Cochrane Database of Systematic Reviews until March 2024. No studies comparing HR thresholds for CC commencement at birth were identified. Consequently, we decided to review the literature more narratively, covering a wider range of topics within this subject matter. Relevant papers from the initial search were used and additional sources of information were sought using snowballing procedures. Numerous publications were identified, containing pathophysiological considerations, in vitro experiments, animal data, and some human data. Preliminary findings from a recent mathematical model study conducted in our center were also briefly considered. All this information enabled a thorough discussion on the rationale for CC during neonatal bradycardia. Finally, a survey was disseminated among knowledgeable neonatal clinicians and researchers to evaluate their perspectives on initiating CC for neonatal bradycardia. Of 183 survey respondents, 137 (74.9%) indicated they would wait longer than the currently recommended 30 s of assisted ventilation before starting CC in newborns with a HR (rising) between 30 and 60 bpm, acknowledging effective ventilation as a priority. We conclude that clinical evidence is lacking, though reconsideration of the threshold to initiate CC for bradycardia at birth seems justified based on available data. This is supported by the views of many surveyed professionals. Randomized trials in human infants and appropriate newborn animal models are warranted.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988095","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":"Diagnostic and therapeutic precision in cardiovascular diseases in the neonatal intensive care.","authors":"Arvind Sehgal, Matthew R Buckingham, Rachael M Hyland, Patrick J McNamara","doi":"10.1038/s41372-025-02317-x","DOIUrl":"https://doi.org/10.1038/s41372-025-02317-x","url":null,"abstract":"<p><p>While patent ductus arteriosus, pulmonary hypertension, and systemic hypotension are key medical issues amongst neonates, there are other common biological conditions which present with distinct physiological diagnostic and therapeutic challenges. This review focuses on such hemodynamic considerations in cardiomyopathy accompanying infants of diabetic mothers, twin-to-twin transfusion syndrome, and left heart pathology in infants with severe chronic lung disease. It details the pathophysiological mechanisms, diagnostic approaches, and therapeutic strategies essential for optimizing cardiovascular stability in this fragile cohort. A regimented, protocol-driven approach may lead to an increased risk of unintended treatment side effects in patients where diagnostic precision is low. This review provides a rational basis of the management of hemodynamic instability, at the same time laying out knowledge gaps and considerations for future research.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970856","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":"Amniotic fluid: its role in fetal development and beyond.","authors":"B Adam Crosland, Madeline A Hedges, Kimberly S Ryan, Rahul J D'mello, Owen J T Mccarty, Sanjay V Malhotra, Eliot R Spindel, Lyndsey E Shorey-Kendrick, Brian P Scottoline, Jamie O Lo","doi":"10.1038/s41372-025-02313-1","DOIUrl":"https://doi.org/10.1038/s41372-025-02313-1","url":null,"abstract":"<p><p>Amniotic fluid is a complex biological medium that surrounds the fetus and offers not only mechanical protection but also provides nutrition and plays a critical role in normal fetal growth, organogenesis, and potentially fetal programming. Despite its importance, the biology of amniotic fluid has been understudied because of ethical and technical challenges in obtaining amniotic fluid samples from healthy human pregnancies, translational limitations of animal models to humans due to species-specific differences. Recent progress in understanding its dynamic physiology, composition, and clinical applications has advanced prenatal care and facilitated improved diagnostic and therapeutic strategies. As research continues to elucidate the complexities and evolutionary function of amniotic fluid, its increasingly recognized role in maternal-fetal medicine and its potential to transform clinical practice will only become more evident. The purpose of this review is to underscore the key roles of amniotic fluid in shaping fetal development and therapeutic potential.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023277","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":"Implementation of perinatal mental health screening for parents of infants in a level IV neonatal intensive care unit: A quality improvement initiative.","authors":"Sarah A Swenson, Megan E Paulsen, Kelsey Carrigan, Rachael Stover-Haney, Delaney Wilton, Brittney Skalland, Andrea L Lampland, Ellen Diego, Maria Kroupina, Erin A Osterholm, Ann Downey","doi":"10.1038/s41372-025-02315-z","DOIUrl":"https://doi.org/10.1038/s41372-025-02315-z","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to establish standardized perinatal mental health (PMH) screening performed by social workers for parents in the neonatal intensive care unit (NICU) at 1, 2, 4, and 6 months, increasing screening rates from 0% to 70% within 6 months.</p><p><strong>Study design: </strong>Baseline data evaluated informal PMH assessments. Primary measure was percent of parents screened and was monitored by statistical process control charts. Process measures were percent of parents with scores above threshold for referral for further evaluation and/or treatment, appropriately referred, and declining screening. Balancing measures were negative perceptions of screening.</p><p><strong>Results: </strong>The centerline for screening rate was 80% for mothers and 72% for partners. Screening increased concerns detected beyond 1 month from 12 to 60. Concerns representing partners increased from 3/52 (6%) to 18/60 (30%).</p><p><strong>Conclusion: </strong>Standardized NICU PMH screening improved identification of PMH concerns beyond the first weeks of admission for both mothers and partners.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007953","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":"Response to hemolysis and DAT positivity.","authors":"Shanice Wells, Ramya Balasubramanian, Khang Nguyen, David L Schutzman","doi":"10.1038/s41372-025-02308-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02308-y","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972493","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":"Pulmonary vasodilator use in very preterm infants in United States children's hospitals.","authors":"Tomas F Vega, Matthew Huber, Erik A Jensen, Catherine M Avitabile, Scott A Lorch, Kathleen A Gibbs, Michael L O'Byrne, David B Frank, Nicolas A Bamat","doi":"10.1038/s41372-025-02309-x","DOIUrl":"https://doi.org/10.1038/s41372-025-02309-x","url":null,"abstract":"<p><strong>Objectives: </strong>To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated with their use in very preterm (VP) infants.</p><p><strong>Study design: </strong>Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure.</p><p><strong>Results: </strong>Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8).</p><p><strong>Conclusions: </strong>Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm and SGA infants and late studies enrolling infants with early PV exposure and high-grade BPD would target current evidence gaps.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970674","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":"Updated and endorsed newborn screening guidelines in the United States for critical congenital heart disease from the American Academy of Pediatrics.","authors":"Philip T Levy, Alyssa R Thomas, Shawn Sen, Molly K Ball","doi":"10.1038/s41372-025-02312-2","DOIUrl":"https://doi.org/10.1038/s41372-025-02312-2","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998441","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 shift durations on sleep, fatigue, and wellness among neonatologists: a cross-sectional survey analysis.","authors":"Ryan M McAdams, Renate Savich, Patrick J McNamara, Lily Lou, Jens C Eickhoff, Satyan Lakshminrusimha","doi":"10.1038/s41372-025-02310-4","DOIUrl":"https://doi.org/10.1038/s41372-025-02310-4","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effects of shift durations on sleep, fatigue, and wellness among U.S. neonatologists in diverse settings.</p><p><strong>Methods: </strong>A cross-sectional survey of U.S. neonatologists yielded 810 responses from 4400 recipients. Statistical analyses included ANOVA, logistic regression, and cluster analysis.</p><p><strong>Results: </strong>Younger neonatologists (<35 years) reported the highest fatigue levels, with females more affected than males (p = 0.0185). Male neonatologists were less likely than females (OR 0.55, p = 0.0013), and those in university settings more likely than non-university settings (OR 1.43, p = 0.0389), to report adverse effects of shifts >16 h. Cluster analysis identified three fatigue patterns, with the most severe among younger neonatologists working shifts >16 h.</p><p><strong>Conclusion: </strong>Long shifts (>16 h) negatively affect neonatologists' wellness, particularly younger and female clinicians. With most neonatal-perinatal medicine fellows being female, policies addressing shift duration are needed.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041075","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}