American journal of perinatology最新文献

{"title":"Hypoglycemia in Pregnant Women with Type 1 Diabetes: Is It Inevitable?","authors":"Barak M Rosenn, Jane C Khoury, Francis Mimouni, Shelley Ehrlich, Menachem Miodovnik","doi":"10.1055/a-2442-7305","DOIUrl":"https://doi.org/10.1055/a-2442-7305","url":null,"abstract":"<p><p>The human body has abundant mechanisms to counteract hypoglycemia and prevent neuroglycopenia primarily involving the secretion of glucagon and adrenalin. Within several years from the onset of diabetes, people with type 1 diabetes lose their ability to mount a counterregulatory response to hypoglycemia and develop hypoglycemia unawareness, thus being at risk for deteriorating to a state of severe hypoglycemia and neuroglycopenia. Pregnant individuals with type 1 diabetes are particularly prone to experience severe hypoglycemia during the first half of pregnancy. This may be not only due to the institution of strict glycemic control and the nausea and vomiting prevalent during the early months of pregnancy, but also because the counterregulatory responses are further diminished during pregnancy. Severe hypoglycemia during early pregnancy does not appear to increase the risks of spontaneous abortion or congenital fetal malformations, but the potential long-term effects on the fetus are unknown. Recent technological advances have contributed to improved glycemic control and time in range as well as decreased risk of hypoglycemia in people with diabetes. These advances include treatment with insulin analogs, use of continuous glucose monitors, and closed-loop systems for administration of insulin. Limited studies have demonstrated that pregnant individuals with type 1 diabetes may also benefit from these modalities. While ongoing research continues to explore the adjustment of closed-loop systems for optimal use during pregnancy, more effort is needed to explore the optimal use of these modalities in pregnancy. KEY POINTS: · People with type 1 diabetes have diminished counterregulatory responses to hypoglycemia and frequently develop hypoglycemia unawareness.. · Pregnant individuals with type 1 diabetes are at increased risk for severe hypoglycemia particularly during the first half of pregnancy.. · Use of insulin analogs and newer technologies for insulin administration may lower the risk of hypoglycemia in pregnant individuals with type 1 diabetes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Readmission after Unscheduled Cesarean Delivery in Patients with Class 3 Obesity.","authors":"Surabhi Tewari, Meng Yao, Lydia DeAngelo, Victoria Rogness, Lauren Buckley, Swapna Kollikonda, Oluwatosin Goje, Maeve Hopkins","doi":"10.1055/a-2445-3123","DOIUrl":"10.1055/a-2445-3123","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to identify risk factors for postpartum readmission (PPR) in class 3 obese patients undergoing unscheduled cesarean deliveries.</p><p><strong>Study design: </strong> Retrospective cohort study of patients with a body mass index (BMI) of ≥40 kg/m² undergoing unscheduled cesarean delivery from 2017 to 2020 comparing patients with and without PPR (unexpected admission, emergency room/overnight observation visit, unscheduled outpatient visit, or ambulatory surgery within 30 days). Medical history, operative data, and postpartum outcomes were compared between the cohorts.</p><p><strong>Results: </strong> The electronic medical record was queried to identify cesarean deliveries documented as \"unscheduled.\" In total, 255 of 1,273 identified patients (20.0%) had a PPR. Median BMI was similar between the cohorts (44.2 kg/m², interquartile range [IQR]: [41.8, 47.9] vs. 44.8 kg/m² [42.0, 48.9], <i>p</i> = 0.066). Readmitted patients were more likely to have a history of smoking during or prior to pregnancy (<i>p</i> = 0.046). A subgroup exploratory analysis excluding outpatient and emergency room visits demonstrated higher rates of type II diabetes mellitus in patients with PPR (11.5 vs. 4.6%, <i>p</i> = 0.030). Patients with readmission in comparison to those without readmissions were less likely to receive cefazolin prophylaxis (78.0 vs. 84.3%, <i>p</i> = 0.014) in comparison to gentamicin/clindamycin prophylaxis. Patients with readmission were less likely to have had vaginal preparation (56.9 vs. 64.3%, <i>p</i> = 0.027). On multivariable logistic regression analysis, smoking history (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.06-1.96, <i>p</i> = 0.0220) and hypertensive disease (OR = 1.57, 95% CI: 1.18-2.09, <i>p</i> = 0.002) were associated with readmission. Cefazolin preoperative prophylaxis (OR = 0.59, 95% CI: 0.41-0.84, <i>p</i> = 0.004) and vaginal sterile preparation (OR = 0.72, 95% CI: 0.54-0.95, <i>p</i> = 0.022) were associated with decreased risk of readmission.</p><p><strong>Conclusion: </strong> In class 3 obese patients, a history of smoking and a diagnosis of hypertensive disease are associated with an increased risk of PPR. Perioperative antibiotic prophylaxis with cefazolin along with vaginal sterile preparation associate with a decreased risk of PPR.</p><p><strong>Key points: </strong>· Class 3 obesity and unscheduled cesarean deliveries are high risks for postpartum complications.. · Hypertensive disorders and smoking are associated with PPR.. · Cefazolin prophylaxis and vaginal preparation are associated with decreased PPR..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic and Environmental Pollutant Impact of Maternal-Fetal Telemedicine.","authors":"Valeria M Li Valverde, Elizabeth Althaus, Lauren Horton, Mauricio F La Rosa, Sina Haeri","doi":"10.1055/a-2447-0069","DOIUrl":"10.1055/a-2447-0069","url":null,"abstract":"<p><strong>Objective: </strong> The global issue of greenhouse gas emissions has significant implications for the environment and human health. Telemedicine provides a valuable tool for delivering health care while reducing gas emissions by limiting the need for patient travel. However, the environmental effects of telemedicine in high-risk pregnancy populations remain unassessed. The aim of this study was to estimate the economic and environmental impact of an outpatient teleMFM program.</p><p><strong>Study design: </strong> This retrospective cohort study examined all visits at three teleMFM clinics more than 90 miles away from the nearest in-person MFM office between October 1, 2021, and May 1, 2022. Travel distances and times were calculated for each appointment between the patient's home, telemedicine clinic, and nearest in-person clinics, using zip code data and Google Maps web-based map calculator tools. Travel cost savings and environmental impact were calculated by determining differences in mileage reimbursement rate and emissions between those incurred in attending telemedicine appointments and those that would have been incurred if in-person using inflation-adjusted Internal Revenue Service annual standard mileage reimbursement rate ($0.58 per mile), and the U.S. Environmental Protection Agency Office of Transportation and Air Quality's average annual emissions and fuel consumption for gasoline-fueled passenger vehicles.</p><p><strong>Results: </strong> During the study period, a total number of 2,712 appointments were scheduled, of which 2,454 were kept (cancellations removed) and analyzed. Visiting a teleMFM clinic resulted in 204 miles, 200 minutes, and $118.32 saved per patient visit compared with visiting the nearest in-person clinic. Over a 7-month period, a total of 96.6 metric tons of emissions were saved.</p><p><strong>Conclusion: </strong> This study demonstrates the positive economic and environmental impact of teleMFM utilization in communities remote from in-person care. Given the contribution of greenhouse gas emissions to climate change, such findings may provide strategies for our specialty to make informed policy, advocacy, and business decisions.</p><p><strong>Key points: </strong>· Telemedicine is a growing and accessible healthcare option; however, current research on this topic primarily focuses on clinical outcomes and patient satisfaction, overlooking the its environmental impacts.. · Visiting a teleMFM clinic resulted in 204 miles, 200 minutes and 118.32 dollars saved per patient during their pregnancy compared to visiting the nearest in-person clinic. Over the study period a total of 94.6 metric tons of emissions were saved.. · We demonstrate that the widespread deployment of teleMFM programs can not only address the current MFM supply-demand mismatch, but also save families valuable windshield time (travel time and cost) while having a positive impact on the environment..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Borderline Fetal Growth with Progression with Fetal Growth Restriction.","authors":"Baillie A Bronner, Monique Holod, Margaret Schermerhorn, Juliana Sung, Anna C Mccormick, Samantha De Los Reyes","doi":"10.1055/a-2451-9118","DOIUrl":"10.1055/a-2451-9118","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate if an estimated fetal weight (EFW) between 10 and 15th percentiles at the time of anatomy ultrasound, referred to as borderline fetal growth, is associated with progression to fetal growth restriction (FGR) on subsequent ultrasound, delivery of a small for gestational age (SGA) neonate, or neonatal intensive care (NICU) admission.</p><p><strong>Study design: </strong> We performed a secondary analysis using the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMom2b) data. The exposures were normotensive pregnancies with non-anomalous singleton gestations with normal growth, defined as EFW >15th percentile at the anatomy scan compared to borderline fetal growth fetuses defined as those with an EFW in the 10 to 15th percentiles. The primary outcome was FGR at subsequent ultrasound, defined as EFW or AC <10%. The secondary outcomes were NICU admission and SGA neonate. Univariable analyses were performed comparing maternal baseline demographic and clinical characteristics. Multivariable analysis was performed for the primary outcome with variables adjusted a priori for body mass index, smoking status, race/ethnicity, insurance status, and drug use.</p><p><strong>Results: </strong> In total, 4,883 patients met inclusion criteria with 114 in the borderline fetal growth group and 4,769 in the normal growth group. There were no significant differences in maternal demographic or medical characteristics. In adjusted multivariable analysis, patients with borderline growth had significantly higher odds of being diagnosed with FGR at their subsequent scan (adjusted odds ratio [aOR] = 6.68, confidence interval [CI]: 3.98-11.20) compared to those with normal growth. For secondary outcomes, patients with borderline fetal growth were significantly more likely to have SGA neonates (6.14 vs. 2.67%, <i>p</i> = 0.025). There was no difference in admissions to the NICU between groups.</p><p><strong>Conclusion: </strong> Diagnosis of borderline fetal growth at the time of the anatomy scan was associated with significantly increased odds of progression to FGR at subsequent scans and delivery of an SGA neonate.</p><p><strong>Key points: </strong>· Patients with EFWs between the 10th and 15th percentiles, referred to as borderline fetal growth, are at an increased risk of progression to FGR compared to those with EFWs >15th percentile.. · Patients with borderline fetal growth are more likely to deliver SGA neonates compared to those with EFWs >15th percentile.. · Providers should consider follow-up antenatal growth assessment in patients with borderline fetal growth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Gabapentin Use in Neonatal Intensive Care Units from 2005 to 2020.","authors":"Annette G Roberts, Ryan Kilpatrick, Lindsey D Diaz, Scott Benjamin, Athziry J Espinoza Santiago, Bubacarr Jallow, Madison F Monteith, Sarah Rumsey, Reese H Clark, Kanecia Zimmerman, Daniel K Benjamin, Rachel G Greenberg","doi":"10.1055/a-2451-9925","DOIUrl":"https://doi.org/10.1055/a-2451-9925","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to analyze trends in gabapentin use in neonatal intensive care units (NICUs) and examine demographic characteristics, diagnoses, and concomitant medications associated with its use.</p><p><strong>Study design: </strong> Cohort study of 987,181 infants hospitalized in the NICU from 2005 to 2020.</p><p><strong>Results: </strong> Eighty-five infants (<0.01%) received gabapentin. From 2009 to 2020, there was a 1,055% relative increase in gabapentin use (<i>p</i> < 0.01). The median birth weight was 2,160 g (25th, 75th percentiles: 875, 3,080 g) in gabapentin-exposed infants compared with 2,498 g (1,890, 3,210 g) in unexposed infants (<i>p</i> < 0.001). Over half (55%) of infants receiving gabapentin were born prematurely, 54% (<i>n</i> = 45) had chronic lung disease, 46% (<i>n</i> = 39) had gastrostomy tubes, and 34% (<i>n</i> = 29) had drug withdrawal syndrome; 49% (<i>n</i> = 42) and 27% (<i>n</i> = 23) received opioids and benzodiazepines, respectively.</p><p><strong>Conclusion: </strong> Use of gabapentin was rare but increased over time despite limited research on its safety and efficacy in infants, illuminating the need for further studies.</p><p><strong>Key points: </strong>· Gabapentin safety in infants is not well understood.. · Gabapentin use increased despite limited safety research.. · Further studies on gabapentin use in infants are needed..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Troponin-I Level at 24 hours of Age in Stable Newborn Infants Born at ≥35 Weeks of Gestation.","authors":"David C Rosario, Chad Pezzano, Lesa Ward, Jennifer Cerone, Jess Randall, Upender K Munshi","doi":"10.1055/a-2448-0330","DOIUrl":"https://doi.org/10.1055/a-2448-0330","url":null,"abstract":"<p><strong>Objective: </strong> Cardiac troponin-I is a known biomarker of myocardial injury in adults and children but its diagnostic utility is unclear in newborns.This study aimed to establish normative data for troponin-I in stable newborns and assess any variation due to maternal diabetes status, mode of delivery, and Apgar scores.</p><p><strong>Study design: </strong> Prospective, observational study of stable newborn ≥35 weeks gestation admitted to a well-baby nursery at a single institution. Infants with respiratory distress, congenital infections, malformations, or syndromes were excluded. Troponin-I values were obtained by a validated point-of-care capillary blood sample at 24 hours of age.</p><p><strong>Results: </strong> A total of 132 patients were included for analysis. Thirteen infants were born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and analyzed as a subgroup, with the remaining 119 infants comprising the base cohort to establish baseline normative troponin-I levels in stable newborn infants. The mean (standard deviation) troponin-I level of infants in the base cohort group was 0.019 ± 0.018 ng/mL and in infants born with maternal SARS-CoV-2 infection during pregnancy troponin-I level was 0.081 ± 0.1 ng/mL (<i>p</i> < 0.001). In infants of the base cohort, there was no significant difference in troponin-I levels between diabetic versus nondiabetic mothers, vaginal birth versus cesarean section, and 5-minute Apgar score of <7 versus ≥7.</p><p><strong>Conclusion: </strong> Cardiac troponin-I level in healthy term newborns was 0.019 ± 0.018 ng/mL, which conforms to healthy children and adult lab values. There was no statistically significant difference in troponin-I levels in infants of maternal diabetes or normal glucose status, mode of delivery, cesarean versus vaginal, or 5-minute Apgar score of <7 or ≥7. Troponin-I levels in asymptomatic neonates born to mothers with a history of SARS-CoV-2 during pregnancy demonstrated an elevation when compared to the baseline group of infants.</p><p><strong>Key points: </strong>· Troponin-I level, biomarker of myocardial injury, in newborns not requiring delivery-room.. · Resuscitation is comparable to normal pediatric & adult population independent of mode of delivery or maternal diabetes status..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual and County-level Factors Associated with Severe Maternal Morbidity at Delivery: An Investigation of a Privately Insured Population in the United States, 2008-2018.","authors":"Jennifer Matas, Laura E Mitchell, Jason L Salemi, Cici X Bauer, Cecilia Ganduglia Cazaban","doi":"10.1055/a-2483-5842","DOIUrl":"https://doi.org/10.1055/a-2483-5842","url":null,"abstract":"<p><strong>Objective: </strong>Few studies have explored the impact of county-level variables on severe maternal morbidity (SMM) subtypes. To address this gap, this study used a large commercial database to examine the associations between individual and county-level factors and SMM.</p><p><strong>Study design: </strong>This retrospective cohort study used data from the Optum's de-identified Clinformatics® Data Mart Database (CDM) from 2008 to 2018. The primary outcomes of this study were any SMM, non-transfusion SMM, and nine specific SMM subtypes. Temporal trends in the prevalence of SMM and SMM subtypes were assessed using Joinpoint Regression. Multilevel logistic regression models were used to investigate the association of individual and county-level factors with SMM.</p><p><strong>Results: </strong>Between 2008 and 2018, there was not a significant change in the prevalence of any SMM (Annual Percent Change (APC): -0.9, 95% CI: -2.2, 0.5). Significant increases in prevalence were identified for three SMM subtypes: other obstetric (OB) SMM (APC: 10.3, 95% CI: 0.1, 21.5) from 2013 to 2018, renal SMM (APC: 8.5, 95% CI: 5.5, 11.6) from 2008 to 2018, and sepsis (APC: 23.0, 95% CI: 6.5, 42.1) from 2014 to 2018. Multilevel logistic regression models revealed variability in individual and county risk factors across different SMM subtypes. Adolescent mothers (OR: 2.10, 95% CI: 1.29, 3.40) and women in the 40 to 55 (OR: 1.67, 95% CI: 1.12, 2.51) age group were found to be at significant risk of other OB SMM and renal SMM, respectively. For every increase in rank within a county's socioeconomic social vulnerability index (SVI), the risk of respiratory SMM increased 2.8-fold whereas an increase in rank in the racial/ethnic minority SVI was associated with a 1.6-fold elevated risk of blood transfusion.</p><p><strong>Conclusion: </strong>This study underscores the complex association between individual and county factors associated with SMM, emphasizing the need for multifaced approaches to improve maternal care.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Validation of the fullPIERS Risk Prediction Model in a U.S. Cohort of Individuals with Preeclampsia.","authors":"Danielle Long, Kari Flicker, Maya Vishnia, Madeleine Wright, Matilda Francis, Kenyone S King, Lauren Gilgannon, Aref Rastegar, Neha Gupta, Rohini Kousalya Siva, Lea Nehme, Tetsuya Kawakita","doi":"10.1055/a-2452-8220","DOIUrl":"10.1055/a-2452-8220","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to externally validate the Preeclampsia Integrated Estimate of Risk (fullPIERS) risk prediction model in a cohort of pregnant individuals with preeclampsia in the United States.</p><p><strong>Study design: </strong> This was a retrospective study of individuals with preeclampsia who delivered at 22 weeks or greater from January 1, 2010, to December 31, 2020. The primary outcome was a composite of maternal mortality or other serious complications of preeclampsia occurring within 48 hours of admission. We calculated the probability of the composite outcome using the fullPIERS prediction model based on data available within 12 hours of admission, including gestational age, chest pain or dyspnea, serum creatinine levels, platelet count, aspartate transaminase levels, and oxygen saturation. We assessed the model performance using the area under the curve (AUC) of the receiver operating characteristic curve. The optimal cutoff point was determined using Liu's method. A calibration plot was used to evaluate the model's goodness-of-fit.</p><p><strong>Results: </strong> Among 1,510 individuals with preeclampsia, 82 (5.4%) experienced the composite outcome within 48 hours. The fullPIERS model achieved an AUC of 0.80 (95% confidence interval [CI]: 0.75-0.86). The predicted probability for individuals with the composite outcome (median: 18.8%; interquartile range: 2.9-59.1) was significantly higher than those without the outcome (median: 0.9%; interquartile range: 0.4-2.7). The optimal cutoff point of 5.5% yielded a sensitivity of 70.7% (95% CI: 59.6-80.3), a specificity of 85% (95% CI: 82.7-86.5), a positive likelihood ratio of 4.6 (95% CI: 3.8-5.5), and an odds ratio of 13.3 (95% CI: 8.1-21.8). The calibration plot indicated that the model underestimated risk when the predicted probability was below 1% and overestimated risk when the predicted probability exceeded 5%.</p><p><strong>Conclusion: </strong> The fullPIERS model demonstrated good discrimination in this U.S. cohort of individuals with preeclampsia, suggesting it may be a useful tool for health care providers to identify individuals at risk for severe complications.</p><p><strong>Key points: </strong>· The fullPIERS risk prediction model has not been validated in a U.S.</p><p><strong>Cohort: </strong>. · The model showed good predictive accuracy (AUC: 0.80) for severe maternal complications but had calibration issues at extreme-risk levels.. · This study confirms the fullPIERS model's applicability in the United States..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142520715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Apgar Score and Risk of Neonatal Mortality among Infants with Birth Defects.","authors":"Katherine L Ludorf, Renata H Benjamin, Mark Canfield, Charles Shumate, Tina O Findley, Anthony Johnson, KuoJen Tsao, A J Agopian","doi":"10.1055/a-2452-0047","DOIUrl":"https://doi.org/10.1055/a-2452-0047","url":null,"abstract":"<p><strong>Objective: </strong> The Apgar score is a clinical tool to assess newborn health at delivery and has shown utility in predicting neonatal mortality in the general population, but its predictive ability in neonates with birth defects remains unexplored. As such, we aimed to investigate the performance of the 5-minute Apgar score in predicting neonatal mortality among neonates with a spectrum of major birth defects.</p><p><strong>Study design: </strong> Data for neonates with birth defects born between 1999 and 2017 were obtained from the Texas Birth Defect Registry. We generated receiver operating characteristic curves and corresponding area under the curve (AUC) values for neonatal mortality (death within the first 28 days of life) by 5-minute Apgar score (<7 vs. ≥7) to measure discrimination capacity. We performed secondary analyses to determine the predictive ability of the Apgar score: (1) among infants with an isolated birth defect and (2) separately in preterm and term neonates.</p><p><strong>Results: </strong> Low Apgar score yielded substantial predictive ability for neonatal mortality, with 25 out of 26 AUC values > 0.70 across a spectrum of defect categories. High predictive ability was consistent among neonates with isolated defects, and preterm and term neonates.</p><p><strong>Conclusion: </strong> The Apgar score is likely useful for predicting neonatal mortality among most neonates with birth defects. Despite small sample sizes limiting some secondary analyses, the findings emphasize the potential continued use of the Apgar score as a rapid clinical assessment tool for newborns with birth defects. Continued research may refine the Apgar score's application in this important population, both in clinical practice and population health research.</p><p><strong>Key points: </strong>· Predictive models suggest the 5-minute Apgar score (<7) is predictive of neonatal mortality.. · Consistent results were observed across spectrum of birth defect categories.. · Secondary analyses (e.g., preterm infants) yielded similarly consistent results..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Hospital Outcomes of Neonates with Hypoxic-Ischemic Encephalopathy Receiving Sedation-Analgesia during Therapeutic Hypothermia.","authors":"Mary E Pease, Erica Yi, Swosti Joshi, Erica Poletto, Ogechukwu Menkiti, Vilmaris Quiñones Cardona","doi":"10.1055/a-2461-5295","DOIUrl":"https://doi.org/10.1055/a-2461-5295","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to compare magnetic resonance imaging (MRI) severity scores and in-hospital outcomes among neonates with perinatal hypoxic-ischemic encephalopathy (HIE) with and without exposure to sedation-analgesia (SA) during therapeutic hypothermia (TH).</p><p><strong>Study design: </strong> A single-center, retrospective cohort study of neonates with perinatal HIE undergoing TH between January 2010 and December 2020. Demographics, clinical characteristics, MRI scores, and in-hospital outcomes were compared between patients without SA exposure and those with SA use.</p><p><strong>Results: </strong> Of the 131 neonates, 55 (42%) did not have SA exposure, and 76 (58%) had SA during TH. Groups were similar in birth weight, gestational age, and severity of HIE. A higher proportion of neonates in the SA group received inhaled nitric oxide (iNO, 39.4% vs. 2%, <i>p</i> < 0.001) and vasopressors (41% vs. 20%, <i>p</i> = 0.012) compared to no SA group. There was no difference in median MRI severity scores for neither T1 (2 [2, 4.25] vs. 3 [2, 6], <i>p</i> = 0.295), T2 (2 [0, 3] vs. 3 [1.5, 5.5], <i>p</i> = 0.088) nor diffusion-weighted images (0 [0, 2] vs. 0 [0, 4.25], <i>p</i> = 0.090) between SA and no SA groups, respectively. In-hospital outcomes were similar between groups except for lower survival to discharge (87% vs. 98%, <i>p</i> = 0.020) in the SA group compared to those without SA. A regression analysis showed death was associated with the concomitant use of iNO (<i>p</i> < 0.001) and inotropes (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> SA during TH for perinatal HIE did not alter early MRI severity scores. A lower survival to discharge in the SA group may be related to illness severity rather than SA use alone.</p><p><strong>Key points: </strong>· Conflicting studies exist regarding the efficacy of SA use during TH.. · SA use during TH did not alter in-hospital MRI severity scores.. · SA use was associated with a lower survival to discharge, correlated to the severity of illness rather than SA use alone..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}