Seminars in perinatology最新文献_第4页

Nutrition beyond the neonatal intensive care unit: Best practices and optimal outcome measures 新生儿重症监护病房以外的营养：最佳做法和最佳结果措施。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-08-01 Epub Date: 2026-06-20 DOI: 10.1016/j.semperi.2026.152272

Catherine O Buck, Margaret L Ong

{"title":"Nutrition beyond the neonatal intensive care unit: Best practices and optimal outcome measures","authors":"Catherine O Buck, Margaret L Ong","doi":"10.1016/j.semperi.2026.152272","DOIUrl":"10.1016/j.semperi.2026.152272","url":null,"abstract":"<div><div>Despite advancements in nutritional management during the neonatal intensive care unit hospitalization, preterm infants remain smaller than term-born counterparts at the time of hospital discharge. The goal for nutritional management after discharge from the neonatal intensive care unit is to address ongoing nutrient and growth catch-up requirements and support growth and neurodevelopment while balancing the potential risks of too much growth. The current standard of care approach to post-hospitalization nutrition includes an individualized approach to nutritional supplementation with human milk fortification and/or nutrient enriched formulas, and incorporation of parental feeding choice and support of breastfeeding if desired into clinical decisions. Key gaps in the current literature include a need for evidence-based lactation and feeding support methods, and studies on a broad range of neonatal intensive care unit graduates, including those across the spectrum of prematurity and infants with other complex medical needs. Future research should aim for consistency in definitions of nutritional exposures and growth and developmental outcomes, involve parents in study design and choice of outcomes, and consider study design strategies which optimize longitudinal attrition rates. Addressing these gaps will provide clearer insights into the optimal nutritional strategy to improve long-term health outcomes for infants at the highest risk.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 5","pages":"Article 152272"},"PeriodicalIF":3.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284353","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}

引用次数: 0

Does Low-dose Aspirin prevent preeclampsia or merely delay it? 低剂量阿司匹林是预防先兆子痫还是仅仅延缓它？

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-07-10 DOI: 10.1016/j.semperi.2026.152279

Avinash Kavi, Shivaprasad S Goudar, Mrityunjay C Metgud, Manjunath S Somannavar, Ashalata M Mallapur, Umesh Y Ramadurg, Janet L Moore, Elizabeth M McClure, Richard J Derman, Matthew K Hoffman

引用次数: 0

Low-dose aspirin in pregnancy: 81 mg vs 162 mg - Is there a role for personalized medicine? 妊娠期低剂量阿司匹林：81毫克vs 162毫克——个体化用药是否有作用？

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-19 DOI: 10.1016/j.semperi.2026.152268

Annabeth Brewton, Kara M Rood

{"title":"Low-dose aspirin in pregnancy: 81 mg vs 162 mg - Is there a role for personalized medicine?","authors":"Annabeth Brewton, Kara M Rood","doi":"10.1016/j.semperi.2026.152268","DOIUrl":"https://doi.org/10.1016/j.semperi.2026.152268","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP), including preeclampsia, remain major contributors to maternal and perinatal morbidity and mortality worldwide. Low-dose aspirin is the primary pharmacologic strategy for preeclampsia prevention in high-risk pregnancies; however, uncertainty persists regarding the optimal dose. In the United States, 81 mg daily remains standard practice, whereas emerging international evidence supports higher-dose strategies, including 150-162 mg. This review examines the biologic rationale, clinical evidence, and implementation considerations surrounding aspirin dosing in pregnancy, with emphasis on the potential role of personalized medicine. Mechanistically, aspirin exerts pleiotropic effects beyond platelet inhibition, including modulation of inflammatory and angiogenic pathways implicated in preeclampsia pathogenesis. Increasing evidence suggests that aspirin responsiveness may vary according to patient-level factors such as obesity, multifetal gestation, chronic hypertension, prior severe preeclampsia, and biologic variability in platelet turnover. Randomized trials and meta-analyses demonstrate a consistent signal toward improved efficacy with higher-dose aspirin in selected high-risk populations without clear increases in major adverse safety outcomes. Emerging biomarker-based screening models and implementation strategies, including electronic health record-supported risk stratification, may further enable individualized prophylaxis approaches. Future large pragmatic trials are needed to define optimal dosing strategies and ensure equitable implementation across diverse populations.</p>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":" ","pages":"152268"},"PeriodicalIF":3.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148284286","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}

引用次数: 0

Further defining the role of low-dose aspirin in pregnancy: Addressing the current controversies. 进一步确定低剂量阿司匹林在妊娠中的作用：解决当前的争议。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-19 DOI: 10.1016/j.semperi.2026.152266

Matthew K Hoffman

引用次数: 0

Aspirin and bleeding risk in pregnancy: a clinical review. 阿司匹林与妊娠出血风险：临床回顾。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-18 DOI: 10.1016/j.semperi.2026.152267

Cassidy O' Sullivan, Audrey A Merriam, Matthew K Hoffman

引用次数: 0

Enteral nutrition in neonates: current evidence from clinical trials and evolving strategies 新生儿肠内营养：来自临床试验的最新证据和不断发展的策略。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-01 Epub Date: 2026-04-17 DOI: 10.1016/j.semperi.2026.152236

Mar Romero-Lopez , Ariel A. Salas

{"title":"Enteral nutrition in neonates: current evidence from clinical trials and evolving strategies","authors":"Mar Romero-Lopez , Ariel A. Salas","doi":"10.1016/j.semperi.2026.152236","DOIUrl":"10.1016/j.semperi.2026.152236","url":null,"abstract":"<div><div>Despite advances in neonatal intensive care and increased availability of randomized clinical trial data, optimal enteral nutrition strategies remain debated, with significant gaps between evidence and practice. We reviewed current evidence for enteral feeding in neonates. Recent clinical trials support the early progression of enteral feeding within 96 h of birth and faster advancement rates of 30–40 mL/kg/day in preterm infants. Evidence demonstrates that these strategies reduce the time to full feeds and decrease the risk of sepsis without increasing the risk of necrotizing enterocolitis. A recent multicenter trial confirmed that, when maternal milk supply is limited, donor human milk reduces necrotizing enterocolitis incidence compared to formula, however, without neurodevelopmental advantages. Multiple trials found no superiority of human milk-based over bovine-based fortifiers. Abandoning routine gastric residual assessment reduces time to full feeds without increasing complications, but a large confirmatory trial is underway. Evidence now supports low-volume feeding during therapeutic hypothermia for hypoxic-ischemic encephalopathy, with fed infants achieving full feeds earlier and having a shorter hospital stay. For congenital heart disease, hemodynamically stable infants can safely receive minimal human milk feeding pre and post-operatively within 5–7 days. Future trials need to focus on precision nutrition, optimal fortification strategies, and long-term effects.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 4","pages":"Article 152236"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147718013","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}

引用次数: 0

Social drivers in lactation for mothers of very premature infants 非常早产儿母亲哺乳的社会驱动因素。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-01 Epub Date: 2026-04-22 DOI: 10.1016/j.semperi.2026.152232

Nikita S. Kalluri , Michelle-Marie Peña , Margaret G. Parker

{"title":"Social drivers in lactation for mothers of very premature infants","authors":"Nikita S. Kalluri , Michelle-Marie Peña , Margaret G. Parker","doi":"10.1016/j.semperi.2026.152232","DOIUrl":"10.1016/j.semperi.2026.152232","url":null,"abstract":"<div><div>Provision of mother’s milk for very premature infants (≤32 weeks’ gestation) is a critical, modifiable factor that improves outcomes in this highly vulnerable population. Despite this, however, longstanding lactation disparities persist. Mothers who are non-Hispanic Black, non-English speaking, have lower income, lower educational attainment, or public insurance are less likely to provide mother’s milk, and these inequities have remained largely unchanged over decades.</div><div>For mothers of very preterm infants, sustaining lactation presents unique challenges. Mothers are typically dependent on breast pumps to express milk every 3–4 h due to infant physiologic immaturity and prolonged hospitalization. They must do so while navigating the physical separation from their infant, transportation barriers, and financial strain from a NICU admission. Although NICUs commonly provide hospital-grade pumps and specialized lactation support in the hospital, mothers may face multi-level barriers to lactation, including limited access to equipment at home, difficulty visiting the NICU, and inadequate social or resource support. These barriers often intersect to contribute to disparate lactation outcomes, as racially and ethnically minoritized mothers are disproportionately affected by adverse social drivers of health. Addressing inequities in lactation requires multilevel, evidence-based interventions. In this report, we structure barriers and proposed interventions within a socio-ecological framework.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 4","pages":"Article 152232"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780056","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}

引用次数: 0

Fortifying the future: updates in knowledge and practice principles of human milk fortification 强化未来：人乳强化的知识和实践原则的更新。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-01 Epub Date: 2026-05-15 DOI: 10.1016/j.semperi.2026.152247

Stephanie Q. Zhang , Fernando R. Moya , Sarah N. Taylor

{"title":"Fortifying the future: updates in knowledge and practice principles of human milk fortification","authors":"Stephanie Q. Zhang , Fernando R. Moya , Sarah N. Taylor","doi":"10.1016/j.semperi.2026.152247","DOIUrl":"10.1016/j.semperi.2026.152247","url":null,"abstract":"<div><div>Human milk (HM) is the preferred source of nutrition for preterm infants given its well-established clinical benefits. However, unfortified HM does not provide sufficient protein, energy, and micronutrients to meet the metabolic demands of very low birth weight infants, making fortification necessary to support optimal growth and reduce the risk of adverse outcomes.</div><div>This review examines contemporary strategies in human milk fortification, including the timing of initiation, differences between human milk–derived and bovine milk–derived fortifiers, with particular attention to the micronutrients essential for preterm infant growth. Current evidence supports the routine use of fortification to improve growth, and earlier initiation of fortification appears safe in stable preterm infants. However, available data do not consistently demonstrate superiority of one type of fortifier across all clinical outcomes, underscoring the importance of context-specific decision making.</div><div>Increasingly, individualized approaches such as adjustable and targeted fortification, guided by human milk analysis, are being explored to address variability in milk composition and infant nutritional requirements. Future strategies will likely emphasize precision nutrition while preserving the biologic integrity of HM, ensuring that growth optimization and intestinal protection remain aligned rather than competing priorities.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 4","pages":"Article 152247"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147949508","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}

引用次数: 0

Optimizing human milk provision: Review of QI best practices 优化母乳供应：QI最佳实践回顾。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-01 Epub Date: 2026-04-20 DOI: 10.1016/j.semperi.2026.152229

Anthony J. Piazza , Christine Bixby , Allison Black , Natasia Felmet , Kaitlin Hannan , Christina Marie Hulgan , Eugenia Jean Pallotto

{"title":"Optimizing human milk provision: Review of QI best practices","authors":"Anthony J. Piazza , Christine Bixby , Allison Black , Natasia Felmet , Kaitlin Hannan , Christina Marie Hulgan , Eugenia Jean Pallotto","doi":"10.1016/j.semperi.2026.152229","DOIUrl":"10.1016/j.semperi.2026.152229","url":null,"abstract":"<div><div>This review examines how Quality Improvement (QI) methodology bridges the gap between evidence-based research and bedside practice to optimize human milk provision. Even though data shows significant improved clinical outcomes, support for neurodevelopment, and reduces comorbidities with breast milk provision to NICU patients, there remains varying breast milk utilization and discharge rates. Successful initiatives apply QI framework including multidisciplinary stakeholders’ engagement, plan-do-study-act cycles, collaboration, guideline, education to implement strategies for successful outcomes and across neonatal care continuum: antenatal education, peripartum initiation, and postpartum maintenance. Key interventions include early pumping initiation, oral immune therapy, skin-to-skin care, lactation support, and standardized feeding protocols. This review highlights impactful projects which improved the provision of breast milk. Furthermore, targeted QI efforts in diverse populations have shown success clinically and with hospital resource utilization. Ultimately, systematic QI efforts that address cultural barriers and redefine provider roles are essential to decreasing institutional variation and ensuring the most vulnerable infants receive optimal nutrition.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"50 4","pages":"Article 152229"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147780069","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}

引用次数: 0

Composition and biology of human milk 母乳的组成和生物学。

IF 3.2 3区医学

Seminars in perinatology Pub Date : 2026-06-01 Epub Date: 2026-04-16 DOI: 10.1016/j.semperi.2026.152234

Brian K. Stansfield, Amy Gates

引用次数: 0