{"title":"The effect of using dexmedetomidine versus morphine as sedation on long-term neurodevelopmental outcomes of encephalopathic neonates undergoing therapeutic hypothermia.","authors":"Tatiana A Nuzum, Sadaf H Kazmi, Elena V Wachtel","doi":"10.1038/s41372-025-02227-y","DOIUrl":"https://doi.org/10.1038/s41372-025-02227-y","url":null,"abstract":"<p><strong>Objective: </strong>To compare neurodevelopmental outcomes using Bayley Scales of Infant Development (BSID), between encephalopathic neonates undergoing therapeutic hypothermia (TH), sedated with either continuous dexmedetomidine or intermittent morphine.</p><p><strong>Study design: </strong>Retrospective, observational cohort study including encephalopathic neonates born between 2014 - 2022 that underwent TH at two Regional Perinatal Centres, and completed neurodevelopmental follow-up assessments.</p><p><strong>Results: </strong>There were no significant differences in demographics or short-term neurologic outcomes between morphine (n = 30) and dexmedetomidine (n = 32) groups. At 12 months, median motor composite scores (104 vs 98.5, p = 0.02) and median fine motor scaled scores (SS) (11 vs 10, p = 0.01) were significantly higher in the dexmedetomidine group. Median expressive language SS were slightly higher in the morphine group (11 v 10, p = 0.05). BSID scores at 18-24 months were similar.</p><p><strong>Conclusion: </strong>This study supports the use of dexmedetomidine as first-line sedation agent during TH, given comparable 18-24 month neurodevelopmental outcomes.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468178","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}
Anne M Mullin, Abby F Fleisch, Clementina Mesaros, Rachel Ledyard, Michele R Hacker, Heather H Burris
{"title":"Perfluoroalkyl substances and preterm birth.","authors":"Anne M Mullin, Abby F Fleisch, Clementina Mesaros, Rachel Ledyard, Michele R Hacker, Heather H Burris","doi":"10.1038/s41372-025-02231-2","DOIUrl":"10.1038/s41372-025-02231-2","url":null,"abstract":"","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449198","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}
Kata Kovacs, Regan E Giesinger, Zsuzsanna Varga, Miklos Szabo, Agnes Jermendy, Patrick J McNamara
{"title":"Association between cardiovascular care and neurodevelopmental outcomes in infants with neonatal encephalopathy and hemodynamic instability.","authors":"Kata Kovacs, Regan E Giesinger, Zsuzsanna Varga, Miklos Szabo, Agnes Jermendy, Patrick J McNamara","doi":"10.1038/s41372-025-02230-3","DOIUrl":"https://doi.org/10.1038/s41372-025-02230-3","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the approach to cardiovascular care and long-term outcomes in infants undergoing hypothermia for neonatal encephalopathy (NE).</p><p><strong>Study design: </strong>This is a retrospective cohort study of 152 infants with NE [SickKids Hospital (Center A, n = 74) or Semmelweis University (Center B, n = 78)], who developed hypotension and underwent neonatal follow-up. Primary outcome was defined as death or neurodevelopmental impairment (<70 on Bayley-II or <85 points on Bayley-III test).</p><p><strong>Result: </strong>The presence of hypoxic injury in the brain MRI increased the odds of adverse outcome by 10.5 fold. In addition, for every 24 h increase in the duration of cardiovascular support the odds of adverse outcome increased by 12%. In a subgroup of patients with detailed echocardiography evaluation lower tricuspid annulus plane systolic excursion was noted in the non-survivors.</p><p><strong>Conclusion: </strong>Hypoxic brain injury and longer cardiovascular therapy are independently associated with the adverse long-term outcome in patients with NE.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441282","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}
Sarah M Tweddell, Thomas M Morelli, Timothy M Bahr, Ashley Krueger, Robert D Christensen, Robin K Ohls
{"title":"Identifying barriers to complying with new restrictive NICU transfusion guidelines.","authors":"Sarah M Tweddell, Thomas M Morelli, Timothy M Bahr, Ashley Krueger, Robert D Christensen, Robin K Ohls","doi":"10.1038/s41372-025-02225-0","DOIUrl":"https://doi.org/10.1038/s41372-025-02225-0","url":null,"abstract":"<p><strong>Objectives: </strong>Our NICU transfusion stewardship group proposed new, more restrictive guidelines for red blood cell and platelet transfusions. To evaluate our clinician's support for these, we conducted a series of structured interviews.</p><p><strong>Study design: </strong>We presented 11 scenarios involving the new guidelines to each of 24 clinicians. After every scenario we asked whether they would abide by the guideline, and if not, why.</p><p><strong>Results: </strong>For 88% of scenarios, participants said they supported the guideline and would not transfuse. The most common reasons for wanting to transfuse when the guidelines said not to were; 1) the scenario-patient did not meet the guideline but was \"close\" and 2) the guideline was insufficiently explicit.</p><p><strong>Conclusions: </strong>Structured interviews like these can identify barriers to complying with transfusion guidelines and can suggest guideline modifications. Future studies will determine the effect of this discovery process on guideline adherence and patient outcomes.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425606","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":"Early hydrocortisone verses placebo in neonatal shock- a double blind Randomized controlled trial","authors":"Sankalp Dudeja, Shiv Sajan Saini, Venkataseshan Sundaram, Sourabh Dutta, Naresh Sachdeva, Praveen Kumar","doi":"10.1038/s41372-025-02222-3","DOIUrl":"10.1038/s41372-025-02222-3","url":null,"abstract":"To compare early hydrocortisone (initiated along with vasoactive therapy) vs. placebo for all-cause mortality within next 14 days among neonates with fluid-refractory shock. Neonates with fluid-refractory shock were randomly assigned to receive hydrocortisone or saline placebo alongside vasoactive drugs. If they developed catecholamine-resistant shock, the study drug was replaced with open-label hydrocortisone. Eighty-four neonates were randomized (early hydrocortisone=43 and placebo=41). Median gestational age of our cohort (n = 84) was 30.3 weeks [interquartile range (IQR): 27.7, 32.5] and median birth weight was 1148 grams (IQR: 860, 1419). The 14-day all-cause mortality was comparable between early hydrocortisone and placebo groups [OR 0.53 (95% CI 0.19, 1.52)]. Both groups had similar duration of vasoactive drugs and vasoactive-inotrope scores, incidence of adverse effects of hydrocortisone and incidence of medium-term complications. We did not observe a significant reduction in 14-day mortality with early hydrocortisone compared to placebo in fluid-refractory neonatal shock.","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":"45 3","pages":"342-349"},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414615","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":"Immediate heart rate changes in late preterm infants receiving resuscitation in the delivery room.","authors":"Yafa Davydova, Dina Elachi, Rebecca Miller, Charlene Thomas, Corrina Oxford, Jeffrey Perlman","doi":"10.1038/s41372-025-02220-5","DOIUrl":"https://doi.org/10.1038/s41372-025-02220-5","url":null,"abstract":"<p><strong>Objectives: </strong>Assess heart rate (HR) trends in the minutes following delivery in late preterm infants 34-36 6/7 weeks with spontaneous respirations and compare trends in infants with delayed transition requiring interventions and assess the direct potential impact of these interventions on HR changes.</p><p><strong>Design: </strong>Prospective observational single center study in 20 late preterm infants born via cesarean section utilizing the NeoBeat which uses dry electrode technology to obtain blinded HR measures in infants with spontaneous respirations versus infants requiring interventions i.e.: positive pressure ventilation, continuous positive airway pressure or suctioning.</p><p><strong>Results: </strong>Initial HR in spontaneously breathing infants (n = 8) was higher versus those requiring interventions, differences that persisted through five minutes. Iatrogenic bradycardia ranging from 65 to 90 beats/minute was induced by interventions in five(42%) of 12 infants.</p><p><strong>Conclusions: </strong>Initial HR in spontaneously breathing late preterm infants was significantly higher compared to infants who received interventions. Respiratory interventions induced sudden unanticipated bradycardia in many cases.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414617","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}
Caroline Massarelli, Andrea Weintraub, Douglas Bush, Veniamin Ratner, Courtney Juliano
{"title":"Duration of continuous positive airway pressure: associations with length of stay and oral feeding patterns in a level IV neonatal intensive care unit.","authors":"Caroline Massarelli, Andrea Weintraub, Douglas Bush, Veniamin Ratner, Courtney Juliano","doi":"10.1038/s41372-025-02221-4","DOIUrl":"https://doi.org/10.1038/s41372-025-02221-4","url":null,"abstract":"<p><strong>Objective: </strong>Examine associations between postmenstrual age (PMA) at CPAP discontinuation, length of stay (LOS) and PMA at achievement of oral feeds in preterm infants.</p><p><strong>Study design: </strong>Retrospective chart review of infants <33 weeks gestational age was performed over a period of practice change (2017-2022) implementing extended CPAP use. Clinical interventions, outcomes and LOS were reviewed.</p><p><strong>Results: </strong>The study population included 571 infants. Over the study period, PMA at CPAP discontinuation significantly increased as did PMA at full oral feeds but there were no significant differences in LOS. Linear regression modeling identified that older age at CPAP discontinuation was a predictor of longer LOS but effect size was small at 14 h per week of CPAP.</p><p><strong>Conclusions: </strong>LOS was not prolonged in a clinically meaningful way following extended CPAP use, despite delayed oral feeding, in our study cohort.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399398","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}
Darshan Shah, Rakesh Adelli, Alyson Chroust, Nicole Lewis, Martin Olsen
{"title":"Outpatient tapering of buprenorphine in opioid use disorder pregnancies may improve neonatal outcomes.","authors":"Darshan Shah, Rakesh Adelli, Alyson Chroust, Nicole Lewis, Martin Olsen","doi":"10.1038/s41372-025-02211-6","DOIUrl":"10.1038/s41372-025-02211-6","url":null,"abstract":"<p><strong>Objective: </strong>The main objective of the study was to compare neonatal outcomes: the incidence of NOWS, length of hospital stay (LOS), admission to neonatal intensive care (NICU), birth weight, treatment with morphine, and head circumference between newborns of mothers who had tapering of buprenorphine (T group) during pregnancy to non-tapering of buprenorphine (NT group).</p><p><strong>Study design: </strong>It was a prospective, pilot, case-control trial of pregnant women done in North-East Tennessee in pregnancy with opioid use disorder (OUD) in the tapered (T) group as a part of clinical care while the NT group did not taper medication.</p><p><strong>Results: </strong>Significant differences were observed among neonatal outcomes; average birth weight and head circumference (p < 0.05) and admission to NICU (p < 0.05) between the two groups by t-test, and in maternal buprenorphine doses, 1.47 versus 7.6 (p < 0.0001).</p><p><strong>Conclusion: </strong>Comprehensive outpatient buprenorphine tapering can be done in OUD pregnancy with improved neonatal outcomes after careful discussion with providers of the risks and benefits.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391171","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}
Olivia Ruth, Sasha Amiri, Amy E Baughcum, Christine A Fortney, Janell Robinson, Sara Munoz-Blanco, Stephanie K Kukora
{"title":"Meeting the emotional and behavioral health needs of bereaved NICU parents.","authors":"Olivia Ruth, Sasha Amiri, Amy E Baughcum, Christine A Fortney, Janell Robinson, Sara Munoz-Blanco, Stephanie K Kukora","doi":"10.1038/s41372-025-02218-z","DOIUrl":"10.1038/s41372-025-02218-z","url":null,"abstract":"<p><p>Parents who experience the death of a child in the neonatal intensive care unit (NICU) are at high risk for adverse behavioral health outcomes. For many parents, their child may have never lived outside of the hospital and the grief and loss this subset of bereaved parents' experience is unique. NICU parents may feel robbed of traditional parenthood and lean on NICU providers for support, creating a dynamic in which the care team plays a key role in shaping the parents' experience of their child's life and death. In this perspective, opportunities to support NICU parents in their bereavement are reviewed alongside recommendations at the individual, institutional, and national level to work toward a gold standard for neonatal bereavement care.</p>","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391170","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}
Adrianne R. Bischoff, Amy A. Hobson, Patrick J. McNamara, Danielle R. Rios
{"title":"Impact of a patent ductus arteriosus on non-invasive pre- and post-ductal blood pressures in extremely preterm infants during the first two postnatal weeks","authors":"Adrianne R. Bischoff, Amy A. Hobson, Patrick J. McNamara, Danielle R. Rios","doi":"10.1038/s41372-025-02223-2","DOIUrl":"10.1038/s41372-025-02223-2","url":null,"abstract":"To evaluate pre- and post-ductal blood pressure (BP) in preterm infants according to patent ductus arteriosus (PDA) status obtained from targeted neonatal echocardiography (TnECHO). Retrospective cohort study of infants born at 22–28 weeks divided according to three groups: (i) No PDA, (ii) Low volume shunt, (iii) Moderate-high volume shunt. BP parameters, demographics, and clinical characteristics were compared. A total of 373 TnECHOs were included: 98 no PDA, 152 low volume shunt, and 123 moderate-high volume shunt. TnECHOs with no PDA had higher systolic, diastolic, and mean BP. Diastolic flow reversal in the post-ductal descending aorta was associated with lower post-ductal diastolic (p < 0.001) and mean BP (p < 0.001). Moderate-high volume shunt had higher rates of diastolic hypotension. BP patterns varied according to PDA status. Post-ductal hypotension was more common with a moderate-high volume shunt. PDA status in this population may be the strongest influencer of BP variability.","PeriodicalId":16690,"journal":{"name":"Journal of Perinatology","volume":"45 3","pages":"326-333"},"PeriodicalIF":2.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391169","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}