Seminars in perinatology最新文献

{"title":"Improving care for obstetric sepsis: Challenges, clinical key points, and innovation","authors":"Lisa Nathan , Melissa E Bauer","doi":"10.1016/j.semperi.2024.151982","DOIUrl":"10.1016/j.semperi.2024.151982","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151982"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353323","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":"Patient and community centered approaches to sepsis among birthing people","authors":"Briana T. Richardson ,&nbsp;Ana Cepin ,&nbsp;Stephanie Grilo ,&nbsp;Regan A. Moss ,&nbsp;Madeleine Dorval Moller ,&nbsp;Sevonna Brown ,&nbsp;Dena Goffman ,&nbsp;Alexander Friedman ,&nbsp;Uma M. Reddy ,&nbsp;Kelli Stidham Hall","doi":"10.1016/j.semperi.2024.151974","DOIUrl":"10.1016/j.semperi.2024.151974","url":null,"abstract":"<div><div>Sepsis is the second leading cause of maternal death in the U.S. For racial and ethnic minoritized birthing people, especially those who are Black and living in underserved communities, labor and postpartum are particularly vulnerable risk periods. To reduce sepsis-related morbidity and mortality and promote maternal health equity, community co-led, and co-designed interventions are urgently needed. In this commentary, we introduce the design and goals of our EnCoRe MoMS study as an exemplar for employing community based participatory research principals iteratively throughout the research process and integrated across all study aims. We also highlight our early lessons learned and recommendations for best practices. Our novel model and ongoing work have implications for scaling academic-community research partnerships for other causes of severe maternal morbidity and maternal health equity nationally.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151974"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353325","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":"Implementing an obstetric sepsis bundle in a large academic hospital system","authors":"Lejdisa Stanaj ,&nbsp;Dena Goffman ,&nbsp;Brianne Genow ,&nbsp;Lynne Meccariello ,&nbsp;Julie Ewing ,&nbsp;Isaac Michaels","doi":"10.1016/j.semperi.2024.151977","DOIUrl":"10.1016/j.semperi.2024.151977","url":null,"abstract":"<div><div>For the purposes of this review, obstetric sepsis refers to sepsis (from all causes, including non-obstetric such as pneumonia) in pregnant or postpartum patients, which was previously described as maternal sepsis. Obstetric sepsis poses a significant threat to pregnant, birthing, and postpartum individuals, contributing prominently to maternal mortality and morbidity despite being largely preventable<span><span>¹</span></span>. In response to identified gaps in sepsis management, particularly the lack of specific protocols tailored to obstetric populations, New York-Presbyterian undertook a system-wide initiative to implement a comprehensive sepsis bundle. This initiative included the development of new criteria for identifying sepsis in obstetric patients, the creation of electronic medical record (EMR) alerts aligned with obstetric-specific indicators, and the establishment of a structured sepsis management algorithm.</div><div>The project involved collaboration across eight hospital campuses within the New York-Presbyterian system, aiming to standardize and improve the early recognition and treatment of sepsis in maternal care. Key components included rigorous data analysis to select appropriate sepsis criteria, simulation-based training to familiarize clinical teams with the new algorithm, and continuous refinement of alert systems to mitigate alarm fatigue and enhance responsiveness.</div><div>Post-implementation evaluation revealed a significant reduction in preventable morbidity related to sepsis, accompanied by the identification of additional gaps in fever and chorioamnionitis management. These findings prompted the development of new clinical guidelines to further enhance patient safety. Challenges encountered included adapting sepsis criteria to balance sensitivity and specificity, as well as integrating trauma-informed care principles into clinical practice.</div><div>This project underscores the effectiveness of tailored quality improvement efforts in maternal health, emphasizing the critical role of proactive interventions in enhancing patient outcomes and safety within obstetric settings. Ongoing efforts focus on monitoring process metrics through a dedicated sepsis dashboard and advancing education on trauma-informed care principles, highlighting the continued commitment to sustained improvement in maternal health outcomes.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151977"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507463","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":"Sepsis as a driver of excess severe maternal morbidity and mortality in the rural United States","authors":"Annika Brakebill ,&nbsp;Hadley R. Katzman ,&nbsp;Lindsay K. Admon","doi":"10.1016/j.semperi.2024.151978","DOIUrl":"10.1016/j.semperi.2024.151978","url":null,"abstract":"<div><div>Obstetric sepsis is a leading cause of preventable maternal morbidity and mortality. Pregnant and postpartum patients in rural settings experience disproportionate rates of sepsis and other forms of severe maternal morbidity. Although there have been recent advances in addressing preventable morbidity and mortality from sepsis in the general adult population, combating excess rates of sepsis in the obstetric population, particularly among rural patients, will require targeted clinical and policy interventions.</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151978"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353327","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":"Disparities in obstetric sepsis and strategies to prevent them","authors":"Dominique Arce ,&nbsp;Allison Lee","doi":"10.1016/j.semperi.2024.151979","DOIUrl":"10.1016/j.semperi.2024.151979","url":null,"abstract":"<div><div>Severe morbidity and mortality associated with sepsis in obstetric care occur even among those presumed to be at low risk, are highly preventable and deserve critical public health prioritization. Continued research is warranted that focuses on the development and performance assessment of screening tools, standardizing diagnostic criteria, and understanding how to implement and sustain quality improvement practices to support timely recognition and treatment, as well as equitable healthcare practices to improve maternal outcomes across diverse populations</div></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 7","pages":"Article 151979"},"PeriodicalIF":3.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294951","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 pain, sedation and analgesia on neonatal brain injury and brain development","authors":"","doi":"10.1016/j.semperi.2024.151928","DOIUrl":"10.1016/j.semperi.2024.151928","url":null,"abstract":"<div><p>Critically ill newborns experience numerous painful procedures as part of lifesaving care in the Neonatal Intensive Care Unit. However, painful exposures in the neonatal period have been associated with alterations in brain maturation and poorer neurodevelopmental outcomes in childhood. The most frequently used medications for pain and sedation in the NICU are opioids, benzodiazepines and sucrose; these have also been associated with abnormalities in brain maturation and neurodevelopment making it challenging to know what the best approach is to treat neonatal pain. This article provides clinicians with an overview of how neonatal exposure to pain as well as analgesic and sedative medications impact brain maturation and neurodevelopmental outcomes in critically ill infants. We also highlight areas in need of future research to develop standardized neonatal pain monitoring and management strategies.</p></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 5","pages":"Article 151928"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0146000524000624/pdfft?md5=d710888fa8c40a2ddbb5249b10529286&pid=1-s2.0-S0146000524000624-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141394217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental impact during and after neonatal intensive care admission","authors":"","doi":"10.1016/j.semperi.2024.151926","DOIUrl":"10.1016/j.semperi.2024.151926","url":null,"abstract":"<div><p><span>Parents play a pivotal role in neurodevelopmental outcomes of their children in the neonatal intensive care unit (NICU) and beyond. Integration of parents in clinical care and research is synergistic. Engaged parents yield more comprehensive clinical care and more robust and meaningful research products. Subsequently, successful clinical and research efforts improve outcomes for children. We review strategies for parental integration into NICU clinical care and research, including parental involvement in therapeutic interventions and neurodevelopmental care, and effective communication strategies for clinicians and researchers. We discuss challenges in neonatal trials and emphasize the need for building a culture of research, collaborative partnerships with </span>patient advocacy organizations, and ongoing support beyond the NICU. Overall, we call for recognizing and fostering the impactful role of parents as teammates with clinicians and researchers in optimizing neurodevelopmental outcomes in the NICU and beyond.</p></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 5","pages":"Article 151926"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141393235","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":"Racial and geographic disparities in neonatal brain care","authors":"","doi":"10.1016/j.semperi.2024.151925","DOIUrl":"10.1016/j.semperi.2024.151925","url":null,"abstract":"<div><p>In this review, we explore race-based disparities in neonatology and their impact on brain injury and neurodevelopmental outcomes. We discuss the historical context of healthcare discrimination, focusing on the post-Civil War era and the segregation of healthcare facilities. We highlight the increasing disparity in infant mortality rates between Black and White infants, with premature birth being a major contributing factor, and emphasize the role of prenatal factors such as metabolic syndrome and toxic stress in affecting neonatal health. Furthermore, we examine the geographic and historical aspects of racial disparities, including the consequences of redlining and limited access to healthcare facilities or nutritious food options in Black communities. Finally, we delve into the higher incidence of brain injuries in Black neonates, as well as disparities in adverse neurodevelopmental outcome. This evidence underscores the need for comprehensive efforts to address systemic racism and provide equitable access to healthcare resources.</p></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 5","pages":"Article 151925"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0146000524000594/pdfft?md5=22f404a6ca4e469dd12b81fe680a8f89&pid=1-s2.0-S0146000524000594-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protecting and healing the newborn brain through non-pharmacologic and pharmacologic measures","authors":"","doi":"10.1016/j.semperi.2024.151931","DOIUrl":"10.1016/j.semperi.2024.151931","url":null,"abstract":"","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 5","pages":"Article 151931"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408686","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":"How do we reach the goal of personalized medicine for neuroprotection in neonatal hypoxic-ischemic encephalopathy?","authors":"","doi":"10.1016/j.semperi.2024.151930","DOIUrl":"10.1016/j.semperi.2024.151930","url":null,"abstract":"<div><p>Therapeutic hypothermia is now standard of care for neonates with hypoxic-ischemic encephalopathy (HIE) in high income countries (HIC). Conversely, compelling trial evidence suggests that hypothermia is ineffective, and may be deleterious, in low- and middle-income countries (LMIC), likely reflecting the lower proportion of infants who had sentinel events at birth, suggesting that injury had advanced to a stage when hypothermia is no longer effective. Although hypothermia significantly reduced the risk of death and disability in HICs, many infants survived with disability and in principle may benefit from targeted add-on neuroprotective or neurorestorative therapies. The present review will assess biomarkers that could be used to personalize treatment for babies with HIE – to determine first whether an individual infant is likely to respond to hypothermia, and second, whether additional treatments may be beneficial.</p></div>","PeriodicalId":21761,"journal":{"name":"Seminars in perinatology","volume":"48 5","pages":"Article 151930"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0146000524000648/pdfft?md5=ead39b4a98d93ad966f805f4f2126896&pid=1-s2.0-S0146000524000648-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}