Journal of Perinatology最新文献

{"title":"Implementation of an EOS calculator-based protocol decreased infant antibiotic exposure in chorioamnionitis without correlation with placental histopathology.","authors":"Tonya Robinson, Kimberly Knott, Zhanxu Liu, Maiying Kong, Sucheta Telang","doi":"10.1038/s41372-024-02167-z","DOIUrl":"https://doi.org/10.1038/s41372-024-02167-z","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of the Early Onset Sepsis (EOS) calculator on antibiotic exposure in infants born to mothers with clinical chorioamnionitis and correlate EOS calculator-guided recommendations with placental histopathology.</p><p><strong>Study design: </strong>Retrospective observational study comparing infants ≥ 36 weeks gestation exposed to maternal clinical chorioamnionitis admitted to the neonatal intensive care unit (NICU) before (Group 1, n = 69) and after (Group 2, n = 139) implementation of an EOS calculator protocol for chorioamnionitis. Infant antibiotic exposure and placental pathology were reviewed. Comparisons were made using Mann-Whitney and chi-square tests.</p><p><strong>Results: </strong>There was a statistically significant decrease in antibiotic exposure from Group 1 to Group 2 (p < 0.001) with no EOS cases missed. No correlation was found between EOS calculator-based treatment and participant placental histopathology (p = 0.966).</p><p><strong>Conclusion: </strong>Implementation of an EOS calculator protocol specific to our study population reduced antibiotic exposure. No correlations were found between EOS calculator-based antibiotic treatment and histological chorioamnionitis.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622559","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":"Balancing survival and suffering: factors influencing parental decision making after periviable consultation.","authors":"Eric A Raynal, Isabella K Pallotto, Jennifer M Brady, DonnaMaria E Cortezzo, Ellen A Lipstein","doi":"10.1038/s41372-024-02166-0","DOIUrl":"https://doi.org/10.1038/s41372-024-02166-0","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to identify factors birthing parents consider related to potential resuscitation of a periviable infant.</p><p><strong>Study design: </strong>Birthing parents who received a prenatal consult from a newborn intensive care unit provider between 22.0 and 24.6 weeks gestational age were eligible to participate in a semi-structured interview focused on their periviable decision making. Interview transcripts were coded and analyzed using thematic content analysis.</p><p><strong>Result: </strong>Qualitative analysis shows that birthing parents attribute their decision to a balance between vitality and suffering, with the balance point influenced by various elements. While parents described the choice they made, none reported that the information they received during the prenatal consult had a significant impact.</p><p><strong>Conclusion: </strong>This study highlights the minimal impact that information given during a periviable consult has on parental decision making. Information from this study can be used to develop an improved model of perinatal consultation.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622596","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":"Effects of rapid enteral feed advancement with early human milk fortification in very low birth weight preterm infants > 30 weeks gestation in a resource limited setting- a randomized controlled trial.","authors":"Anitha Ananthan, Ganesh Bhatkar, Haribalakrishna Balasubramanian, Muthu Vijayanathan, Lakshmi Srinivasan","doi":"10.1038/s41372-024-02164-2","DOIUrl":"https://doi.org/10.1038/s41372-024-02164-2","url":null,"abstract":"<p><strong>Objective: </strong>To study the effects of rapid enteral feed advancement with early feed fortification in stable very low birth weight (VLBW) infants >30 weeks gestation.</p><p><strong>Study design: </strong>Preterm infants (N = 92) were randomized to a) rapid feed advancement-early fortification - REF group (enteral feed advanced at 25-30 ml/kg/day, fortification at 50 ml/kg/day) or b) slow feed advancement-late fortification-SLF group (feed advanced at 15-20 ml/kg/day, fortification at 100 ml/kg/day).</p><p><strong>Results: </strong>The primary outcome-time to regain birth weight was significantly lower in REF group (9 days vs 13 days, P = 0.02). REF group reached full enteral feeds earlier (6 days vs 9 days, P = 0.001), had lower rates of sepsis (13% vs 38%, P = 0.007) and shorter hospital stay (10 days vs 15 days, P = 0.01). At one year, the median Z-scores for weight [-1.5 vs -2.2, P < 0.001] and head circumference [1.1 vs 0, P < 0.001) were significantly higher in the REF group.</p><p><strong>Conclusions: </strong>In VLBW preterm infants >30 weeks, rapid feed advancement with early fortification resulted in early postnatal regain of birth weight with positive effects on growth at one year.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605048","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 furosemide versus chlorothiazide exposures with serum sodium, potassium, and chloride among infants with bronchopulmonary dysplasia.","authors":"Timothy D Nelin, Matthew Huber, Erik A Jensen, Sara B DeMauro, Heidi Morris, Scott A Lorch, Kathleen Gibbs, Stamatia Alexiou, Natalie Napolitano, Anna Bustin, Nicolas A Bamat","doi":"10.1038/s41372-024-02159-z","DOIUrl":"10.1038/s41372-024-02159-z","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association of novel furosemide versus thiazide diuretic exposure with changes in serum sodium, potassium, and chloride levels among infants with grade 2/3 bronchopulmonary dysplasia (BPD).</p><p><strong>Study design: </strong>Retrospective cohort study of infants admitted to a level IV neonatal intensive care unit (NICU) with grade 2/3 BPD. We measured within-subject change in serum sodium, potassium, and chloride before and after diuretic initiation using multivariable regression to adjust for differences in dosing and clinical covariates.</p><p><strong>Results: </strong>We identified 94 infants contributing 137 novel diuretic exposures. No significant difference was noted in the association between chlorothiazide versus furosemide and serum sodium, potassium, or chloride change in multivariable modeling.</p><p><strong>Conclusions: </strong>Changes in serum electrolytes were similar for chlorothiazide and furosemide, questioning the perception that chlorothiazide leads to less electrolyte derangement among preterm infants with grade 2/3 BPD.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583363","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":"Point-of-care lung ultrasound for continuous positive airway pressure discontinuation in preterm infants.","authors":"Faith Myers, Reedhi Dasani, Jacklin Tong, Shelby Vallandingham-Lee, Christine Manipon, Alex Dahlen, Daniele De Luca, Yogen Singh, Alexis S Davis, Valerie Y Chock, Shazia Bhombal","doi":"10.1038/s41372-024-02157-1","DOIUrl":"10.1038/s41372-024-02157-1","url":null,"abstract":"<p><strong>Objective: </strong>To determine if the lung ultrasound score (LUS) is predictive of successful continuous positive airway pressure (CPAP) discontinuation in preterm neonates born <32 weeks' gestation with history of respiratory distress syndrome.</p><p><strong>Study design: </strong>Retrospective study of preterm infants requiring CPAP. Univariate and multivariate logistic regression performed to formulate a predictive score using clinical variables with and without LUS. Area under the curve (AUC) was compared to determine the added predictive ability of LUS.</p><p><strong>Results: </strong>Forty-one patients with discontinuation attempts associated with a LUS were included. Lower LUS obtained within 0-7 days prior to CPAP discontinuation was associated with successful CPAP discontinuation (OR 0.46 [0.23, 0.91]; p = 0.025). Cross-validated AUC for clinical variables alone (Model 1) was 0.85 (95% CI: 0.74-0.93) versus 0.90 (95% CI: 0.81-0.97) when LUS was incorporated (Model 2, p < 0.001). AUC of LUS alone was 0.83 (95% CI: 0.68-0.93, p < 0.0001).</p><p><strong>Conclusions: </strong>In preterm infants requiring CPAP, LUS aids in the prediction of successful CPAP discontinuation and may significantly improve a predictive tool.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576299","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 positivity of Coagulase Negative Staphylococcus In Neonatal Blood Cultures as an adjunct tool to help discriminate between sepsis and contamination.","authors":"Silvia Carbonell-Sahuquillo, Beatriz Olea, Raquel Pérez-Suárez, Estela Giménez, Javier Colomina, David Navarro, Javier Estañ-Capell","doi":"10.1038/s41372-024-02158-0","DOIUrl":"https://doi.org/10.1038/s41372-024-02158-0","url":null,"abstract":"<p><strong>Objective: </strong>To assess the usefulness of time to positivity (TTP) to distinguish between sepsis and contamination in coagulase-negative staphylococci (CoNS) isolates.</p><p><strong>Study design: </strong>Unicentric retrospective observational. Medical records of 168 patients with suspected sepsis and positive blood culture for CoNS were reviewed. Patients were subdivided into sepsis (29%) and probable contamination (71%). Logistic regression analyses were performed to evaluate different risk factors and clinical signs and symptoms associated with sepsis.</p><p><strong>Results: </strong>TTP cut-off value that best discriminated sepsis from contamination was found to be 18 h. Regression analysis revealed that TTP ≤ 18 h, gestational age ≤32 weeks, taquycardia/bradycardia and hypoactivity/lethargy were independent predictors of sepsis.</p><p><strong>Conclusion: </strong>TTP is useful in distinguishing sepsis from contamination, especially in neonates with lower gestational age (<32 weeks). The clinical signs that most increase the discriminatory power of TTP are the presence of tachycardia/bradycardia or hypoactivity.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563862","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":"Perspectives and needs of neonatology division directors regarding gender equity.","authors":"Kerri Z Machut, Lisa Owens, Lauren Gadek, Jasmeet Kataria-Hale, Krithika Lingappan, Renate Savich, Alla Kushnir, Dena Hubbard, Christiane E L Dammann","doi":"10.1038/s41372-024-02126-8","DOIUrl":"https://doi.org/10.1038/s41372-024-02126-8","url":null,"abstract":"<p><p>Gender inequities in pediatrics are extensively documented despite women predominating the workforce. As a landscape assessment of gender equity in university-based neonatology divisions in the United States, we collected gender equity measures from academic neonatology division directors; 83% (n = 106) participated. The majority recognized addressing gender inequity was a middle-to-top priority, though they reported minimal gender inequities in their division. Most division directors are men and a higher proportion of full professors are men, but they reported minimal differences in time to promotion, leadership positions, and awards. Half of centers analyzed compensation by gender; all reported no gender difference. The existence of gender-equity-promoting strategies was variable and uncertain by many directors. They reported lack of bandwidth, personnel, and resources as the largest barriers to tracking and addressing gender inequities. These perceived minimal gender inequities diverge from published objective data and highlight the need to track and report metrics accurately and systematically.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546065","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":"Supporting parents' emotional and mental health in the antenatal consultation.","authors":"S K Kukora, T Branche, E R Miller, N Henner, V Kapadia, M F Haward","doi":"10.1038/s41372-024-02156-2","DOIUrl":"https://doi.org/10.1038/s41372-024-02156-2","url":null,"abstract":"<p><p>Supporting parents' emotional and mental health is crucial during antenatal consultations, in which expectant parents often receive serious news about their infant and sometimes face complex antenatal or postnatal decision-making. Being considerate of the circumstances to mitigate barriers and stressors, utilizing clear and sensitive language, and personalizing counseling and decision-making to support parents' pluralistic values are strategies that individual neonatologists can use to promote parents' mental wellness in these encounters. Partnership with clinicians of other disciplines and professions in antenatal consultations can help in providing additional medical information and parent support; however, care must be coordinated within the team to ensure that confusing or conflicting counseling is avoided. In addition to improving communication skills for these encounters as individuals and teams, opportunities also exist to enhance support of parents' mental health at the institutional and national level.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502497","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":"Universal cord blood screening for G6PD deficiency in Qatar.","authors":"Jon F Watchko","doi":"10.1038/s41372-024-02146-4","DOIUrl":"https://doi.org/10.1038/s41372-024-02146-4","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502498","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":"Necrotizing enterocolitis following spontaneous intestinal perforation in very low birth weight neonates.","authors":"Goeto Dantes, Olivia A Keane, Swathi Raikot, Louis Do, Savanah Rumbika, Zhulin He, Amina M Bhatia","doi":"10.1038/s41372-024-02155-3","DOIUrl":"https://doi.org/10.1038/s41372-024-02155-3","url":null,"abstract":"<p><strong>Purpose: </strong>Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are severe gastrointestinal complications of prematurity. The clinical presentation and treatment of NEC and SIP (peritoneal drain vs laparotomy) can overlap; however, the pathogenesis is distinct. Therefore, a patient initially treated for SIP can subsequently develop NEC. This phenomenon has only been described in case reports, and no risk factor evaluation exists. We evaluate clinical characteristics, risk factors, and outcomes of patients treated for a distinct episode of NEC after SIP.</p><p><strong>Methods: </strong>We performed a retrospective review of very low birth weight (<1500 g) neonates who presented with pneumoperitoneum between 07/2004 and 09/2022. Data was obtained from two separate neonatal intensive care units that were part of the same institution. Patients with an initial preoperative, intraoperative, or pathological diagnosis of NEC were excluded. Patients with an intraoperative diagnosis of SIP or preoperative diagnosis of SIP successfully treated with a peritoneal drain (PD) were evaluated. Patients subsequently treated (medically or surgically) for NEC after SIP were then compared to SIP-alone patients. Clinical characteristics included demographics, gestational age (GA), birth weight (BW), perinatal risk factors (chorioamnionitis, steroids, indomethacin), postoperative feeding regimen, and length of stay (LOS) were compared.</p><p><strong>Results: </strong>Of the 278 patients included, 31 (11.2%) patients had NEC after SIP. There was no difference in GA (25 weeks vs 25 weeks, p = 0.933) or BW (760 g vs 735 g, p = 0.370) between NEC after SIP vs SIP alone cohorts, respectively. Twenty (64%) of NEC after-SIP patients were previously treated with LP. NEC after SIP occurred with a median onset of 56 days. Pneumatosis was the most frequent (81%) presenting symptom and 12 (39%) patients had hematochezia. Four (12.9%) patients required LP for NEC and all had NEC intraoperatively and on pathology. A majority (77.4%) of patients were on breast milk (BM) at time of NEC diagnosis. NEC after SIP patients had lower maternal age at delivery (29.0 vs 25.0, p = 0.055) and the incidence of NEC after LP (primary or failed drain) was higher than PD alone (16.7% vs 6.2%, p = 0.007). NEC after SIP patients had longer LOS (135 vs 81, p < 0.001).</p><p><strong>Conclusion: </strong>We report an 11.2% incidence of NEC at a median of 56 days following successful treatment of SIP, resulting in increased LOS. SIP patients are a high-risk cohort and protocols to prevent this phenomenon should be investigated.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502487","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}