American journal of perinatology最新文献

{"title":"Timing of Newborn Hearing Screening Effects on Passing Rates: A Prospective Cohort Study.","authors":"Wongsathon Seehiranwong, Pichada Saengrat","doi":"10.1055/a-2675-1768","DOIUrl":"10.1055/a-2675-1768","url":null,"abstract":"<p><p>Newborn hearing screening using transient evoked otoacoustic emissions (TEOAEs) is essential for early detection of hearing impairment. The Joint Committee on Infant Hearing recommends screening near hospital discharge but does not specify an optimal timing. To determine the optimal timing for TEOAE screening in neonates at low risk of hearing impairment and to identify perinatal factors influencing pass rates.Neonates underwent sequential TEOAE screening based on postnatal age at the time of testing: less than 24, 24 to 36, 36 to 48, and more than 48 hours, with follow-up at 1 month for persistent failures. Statistical analyses included Fisher's exact test to compare pass rates across time intervals and multivariate Cox's proportional hazards regression and Laplace regression to assess factors associated with screening outcomes.Among 408 neonates, the median passing age was 23.8 hours (interquartile range: 14.3). Pass rates improved with later screening: 53.7% at less than 24 hours, 80.1% at 24 to 36 hours, 92.6% at 36 to 48 hours, and 99.3% at more than 48 hours. A significant improvement was observed only at more than 48 hours (odds ratio: 5.26; <i>p</i> = 0.0153). Cesarean delivery was associated with delayed passing compared with vaginal delivery (<i>p</i> = 0.036). Late preterm neonates demonstrated a significantly delayed passing time of approximately 12.9 hours (<i>p</i> < 0.01), whereas small for gestational age neonates passed earlier by 8.2 hours (<i>p</i> = 0.021).Screening at greater than or equal to 48 hours significantly improved pass rates. An older age at successful screening was observed among preterm neonates and those delivered by cesarean section, underscoring the need for tailored follow-up protocols. These findings highlight the importance of optimizing screening strategies to enhance early detection and intervention. · The ideal timing for newborn hearing screening remains unclear, affecting accuracy and follow-up rates.. · Early TEOAE screening may lead to high false positives due to residual ear fluid, increasing unnecessary follow-ups.. · Optimizing timing of the hearing screening window can enhance accuracy, reduce false positives, and improve clinical efficiency..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783217","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":"Design of a Phase 3, Multicenter, Randomized, Placebo-Controlled, Double-Blind Study of Nipocalimab in Pregnancies at Risk for Fetal and Neonatal Alloimmune Thrombocytopenia.","authors":"Heidi Tiller, Eleonor Tiblad, Pamela Baker, Hillary Van Valkenburgh, Dirk Heerwegh, Babajide Keshinro","doi":"10.1055/a-2666-5642","DOIUrl":"10.1055/a-2666-5642","url":null,"abstract":"<p><p>Nipocalimab, a neonatal Fc receptor blocker, inhibits transplacental transfer of maternal immunoglobulin G (IgG) and lowers circulating maternal IgG levels. In a phase 2 study, nipocalimab demonstrated evidence of safety and efficacy in delaying or preventing fetal anemia in early-onset severe hemolytic disease of the fetus and newborn, suggesting a potential benefit in other IgG alloantibody-mediated perinatal diseases, including fetal and neonatal alloimmune thrombocytopenia (FNAIT). The phase 3 FREESIA-1 study aims to evaluate the safety and efficacy of nipocalimab in at-risk FNAIT pregnancies.This multicenter, placebo-controlled, double-blind, phase 3 study will enroll human platelet antigen (HPA)-1a-alloimmunized pregnant individuals with an HPA-1a-positive fetus and prior FNAIT-affected pregnancy without intracranial hemorrhage or severe bleeding in the fetus/newborn. Participants will be randomized 2:1 to weekly intravenous nipocalimab or placebo at 13 to 18 weeks of gestation until delivery. Maternal participants will receive ultrasound monitoring approximately every 2 weeks during treatment. Neonates will receive a cranial ultrasound scan, platelet count assessment, and, if needed, platelet transfusion. Maternal participants will be followed for 24 weeks and neonates/infants for 104 weeks.The primary endpoint is an adverse outcome of fetal death or adjudicated severe bleeding in utero up to 1 week postbirth, or neonatal platelet count at birth < 30 × 10⁹/L. Key secondary endpoints include adjudicated bleeding in utero up to the first week postbirth in fetuses/neonates and platelet count at birth in neonates. Additional secondary endpoints in fetuses/neonates include death; platelet count at birth <10, <30, <50, and <150 × 10⁹/L; nadir platelet count over the first week postbirth; platelet transfusion; adjudicated severe bleeding up to the first week postbirth; and postnatal intravenous immunoglobulin for thrombocytopenia. Other assessments include safety, patient/caregiver-reported outcomes, pharmacokinetics, pharmacodynamics, and immunogenicity of nipocalimab.FREESIA-1 is the first placebo-controlled, randomized, multicenter trial designed to evaluate the safety and efficacy of nipocalimab in at-risk FNAIT pregnancies. (ClinicalTrials.gov Identifier: NCT06449651. Accessed at: https://clinicaltrials.gov/study/NCT06449651. Date of registration: June 10, 2024.) · FNAIT can lead to fetal/neonatal mortality and morbidity.. · Nipocalimab blocks IgG recycling and placental transfer.. · Nipocalimab may reduce adverse outcomes of FNAIT.. · FREESIA-1 will evaluate nipocalimab in FNAIT..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726514","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":"Critical Organ Dysfunction in Newborns with Gastroschisis.","authors":"Diomel de la Cruz, Erin Kaufmann, Lara Nicolas, Marjan Davoodi, James L Wynn, Khyzer Aziz","doi":"10.1055/a-2677-7102","DOIUrl":"10.1055/a-2677-7102","url":null,"abstract":"<p><p>Gastroschisis is the most common newborn abdominal wall defect. Gastroschisis classification is based on the absence (simple gastroschisis [SG]) or presence (complex gastroschisis [CG]) of bowel morbidity. The severity of critical organ dysfunction with gastroschisis is unknown.This was a multicenter, retrospective cohort study of infants with gastroschisis (birth weight ≥ 1.8 kg and gestational age ≥ 35 weeks) admitted to the University of Florida Health NICU between January 1, 2012, and April 1, 2023, and the Johns Hopkins NICU between July 1, 2016, and December 31, 2024. All data was collected from the electronic health record. CG was defined as the presence of atresia, necrosis, perforation, volvulus, jejunostomy, resection, or short bowel syndrome. Hourly organ dysfunction was quantified by the neonatal sequential organ failure assessment (nSOFA) score (measures respiratory, cardiovascular, and hematologic dysfunction with a range from 0 to 15 [severe]).We identified 120 patients with gastroschisis (49% male; 90 with SG). Compared with patients with SG, neonates with CG had greater maximum nSOFA scores (median: 2 [IQR]: [0, 4] vs. 3 [1, 7]; <i>p</i> = 0.02). The coefficient of variation on cumulative nSOFA scores calculated at 24-hour intervals after birth as a measure of organ dysfunction heterogeneity for SG patients was 278 to 332% and was 216 to 266% for CG patients.This is the first high-granularity quantification of critical organ dysfunction in gastroschisis patients. We found a low overall severity of critical organ dysfunction among all patients. Substantial heterogeneity was present in both groups. The nSOFA may help to identify a subset of patients with critical organ dysfunction outside of bowel morbidity. · Gastroschisis is the most common abdominal wall defect; the severity of organ dysfunction is unclear.. · nSOFA measures critical organ dysfunction; its role in identifying high-risk gastroschisis is unknown.. · Most infants had minimal organ dysfunction; half of SG and one-third of CG had no organ failure.. · Organ dysfunction varied widely within groups; nSOFA may improve risk detection and trial design..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803261","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":"Changes in Neonatal Practice and Temporal Trends in Bronchopulmonary Dysplasia.","authors":"Georgina Dickenson, Oishi Sikdar, Ravi Bhat, Mahesh Nanjundapa, Christopher Harris, Anne Greenough","doi":"10.1055/a-2672-2769","DOIUrl":"10.1055/a-2672-2769","url":null,"abstract":"<p><p>Bronchopulmonary dysplasia (BPD) is the most common adverse outcome of neonatal intensive care and is increasing. Our objective was to determine if temporal trends in BPD were associated with changes in neonatal care practices.The outcomes of infants born at less than 32 weeks of gestation in two study periods, 2012 to 2014 and 2020 to 2022, were compared. The results were divided into those born between 28 and 32 weeks of gestation and less than 28 weeks of gestation. Data were collected from the patient records and an electronic record system, BadgerNet.There were 213 infants and 161 infants in the first and second epoch, respectively; the latter group was of lower gestational age (mean: 28.4 vs. 29.6 weeks, <i>p</i> = 0.03) and birth weight (1,000 vs. 1,124 g, <i>p</i> = 0.01). A greater proportion of the more mature group were growth retarded in the second epoch (23 vs. 12%, <i>p</i> = 0.028). Overall, moderate/severe BPD was higher in the more recent epoch (64 vs. 39%, <i>p</i> < 0.001), but infants were not discharged at a later corrected gestation age, nor was there an increase in use of home oxygen. Mortality, ventilation days, and inotropic support were similar in the two time periods. At all gestations, hydrocortisone use in the first week was higher in the more recent epoch (25 vs. 7%, <i>p</i> < 0.001), as was diuretic use (54 vs. 30%, <i>p</i> < 0.001), paracetamol administration (22 vs. 0%, <i>p</i> < 0.001) and less invasive surfactant administration (41 vs. 0%, <i>p</i> < 0.001). Postnatal dexamethasone use was higher in infants less than 28 weeks of gestation during the most recent epoch (50 vs. 34%, <i>p</i> = 0.034).Over the 10-year period, the BPD incidence increased, likely reflecting that in the latter epoch, infants were more immature and growth retarded. Greater use of hydrocortisone and diuretics was not associated with improved outcomes. · An increase in BPD between 2012 to 2014 and 2020 to 2022.. · Infants were more immature and small for gestational age in 2020 to 2022.. · Greater use of hydrocortisone and dexamethasone.. · Greater use of less invasive surfactant administration and diuretics..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752086","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":"When Should I Rotate? Clerkship Timing of Students Who Successfully Match in OBGYN.","authors":"Sarah K Dotters-Katz, Brooke Schroeder, Debra Rusk, Lori Avery, Jill M Sutton, Melody Y Hou, Anthony Shanks","doi":"10.1055/a-2673-4067","DOIUrl":"10.1055/a-2673-4067","url":null,"abstract":"<p><p>Medical students are routinely advised to rotate into their specialty of interest later in the year, likely to gain clinical experience, improve their clerkship performance, and therefore garner positive recommendations or performance reviews. However, there is little research to support this guidance. This study aims to examine a large multi-institutional cohort of students who matched into obstetrician and gynecologist (OBGYN) programs, to determine if there are any differences in match rates based on rotation timing.In this IRB-approved retrospective cohort study, we included 204 students who matched in OBGYN from five geographically diverse medical schools between 2019 and 2023. The academic year was divided into trimesters due to varied rotation lengths among schools. We utilized bivariate statistics and regression models to examine the percentage of students matching in each trimester, as well as the percentage of students rotating during the first block of the academic year.After controlling for race and gender identity, there was no significant difference in match rates for OBGYN between those who rotated early in the clerkship year and those who rotated later. Students from schools without choice in timing were more likely to rotate in the first trimester.For this cohort, there is no difference in match rates into OBGYN based on the timing of their core rotation. · Clerkship timing was not linked to match success among OBGYN applicants.. · Students without choice rotated earlier but matched at similar rates.. · Findings may reassure students concerned about when to schedule OBGYN clerkships..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764369","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":"Neonatal Outcomes in Transposition of the Great Arteries by Mode and Timing of Delivery.","authors":"Helen B Gomez Slagle, Maria Andrikopoulou, Russell Miller, Yijia Zhang, Angelica M Vasquez, Lynn L Simpson","doi":"10.1055/a-2672-2713","DOIUrl":"10.1055/a-2672-2713","url":null,"abstract":"<p><p>We aimed to assess neonatal outcomes by mode of delivery and to evaluate the value of achieving daytime delivery among neonates undergoing a planned induction of labor (IOL).This was a retrospective study of pregnancies with prenatally diagnosed d-TGA with an IVS receiving care at a single tertiary care referral center from 2020 to 2023. Inclusion required prenatal diagnosis of d-TGA with an IVS and surgical care at the referral center. The primary outcome was a composite of neonatal outcomes, including preoperative inhaled nitric oxide use, inotrope use, preoperative mortality, reoperation, readmission, delayed sternal closure, diaphragmatic paralysis, and postoperative mortality. Secondary surgical outcomes and composite neurological morbidity, including hypoxic-ischemic encephalopathy, seizures, intraventricular hemorrhage, or stroke, were collected. Pearson's chi-square or Fisher's exact test was performed as appropriate.We identified 90 cases of prenatally diagnosed d-TGA, of which 68 (76%) underwent timed IOL and 46 (68%) achieved vaginal delivery. The primary outcome occurred in 16 neonates (89%) who were delivered by cesarean and 47 neonates (78%) who underwent a planned timed IOL (<i>p</i> = 0.26). Among individuals undergoing IOL, the primary outcome occurred in 29 neonates (73%) who delivered during the daytime and 18 (90%) who delivered after-hours (<i>p</i> = 0.19).We found that in cases of prenatally diagnosed d-TGA with an IVS, IOL is feasible. Neonates with d-TGA with an IVS had similar surgical outcomes when induced and delivered at this single tertiary care center, regardless of delivery time. · Induction is feasible, and daytime delivery was achieved in the majority of cases of TGA.. · Neonates with d-TGA with an IVS have similar surgical outcomes regardless of delivery time.. · There was no clear benefit to achieving strict daytime delivery in cases of TGA..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752087","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":"Oral versus Intravenous Iron for Anemia in Pregnancy: A Cost-Effectiveness Analysis.","authors":"Wayde D H Dazelle, Meghan K Ebner, Savita N Potarazu, Jamil Kazma, Homa K Ahmadzia","doi":"10.1055/a-2257-3586","DOIUrl":"10.1055/a-2257-3586","url":null,"abstract":"<p><p>Pregnancy is associated with increased risk for the development of iron deficiency anemia. Pregnant patients with anemia are at increased risk for significant morbidity and mortality. Iron therapies for the correction of anemia during pregnancy are available in intravenous and oral formulations; however, the cost-effectiveness of these therapies in the United States has not been previously evaluated. The objective of this study is to estimate the cost-effectiveness of oral and intravenous iron therapies as treatments for prepartum anemia in the United States.We constructed a Markov decision-analytic model to evaluate the cost-effectiveness of three common therapies for repleting iron in patients with prepartum anemia in the United States: oral iron, intravenous iron sucrose, and intravenous ferric carboxymaltose. Each strategy differentially modified the proportion of patients with anemia at time of delivery by the therapeutic efficacy of each treatment option demonstrated in the literature. Outcomes of interest included net costs, quality-adjusted life-years, and adverse outcomes averted. Costs were considered from the health system and societal perspectives over a lifetime time horizon for a hypothetical cohort of 3.8 million pregnant patients. Deterministic and Monte Carlo probabilistic sensitivity analyses were conducted to evaluate the robustness of the model.All iron therapies were dominant versus the \"do nothing\" strategy in the majority of simulations, implying that they were simultaneously more effective and cost-saving. Ferric carboxymaltose produced the most favorable results overall, with $696,920,137 in cost-savings and 26,660 postpartum hemorrhage cases, 888 hysterectomies, and 43 postnatal suicides averted per cohort. Threshold analysis suggested that oral iron was cost-saving below a threshold of $14.40 per 325 mg, and iron sucrose and ferric carboxymaltose were cost-saving below thresholds of $1996.86 and $2,893.97 per course, respectively.Our findings suggest that treating prepartum anemia with currently available iron therapies would result in significant cost-savings and reductions in adverse outcomes associated with anemia in this context. Ferric carboxymaltose likely confers the greatest overall benefit among competing options. This conclusion is robust to parameter uncertainty, even when the cost of these therapies is significantly higher than demonstrated in the literature. · Oral and intravenous iron therapies are likely cost-effective for the treatment of antepartum anemia.. · Intravenous ferric carboxymaltose is likely the most clinically and economically favorable treatment.. · This is the first U.S. estimate of the cost-effectiveness of oral and intravenous iron for antepartum anemia..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139641484","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":"Effect of the 2022 AAP Guideline for Managing Hyperbilirubinemia in the Newborn.","authors":"Ramya Balasubramanian, Khang Nguyen, Shanice Wells, David L Schutzman","doi":"10.1055/a-2663-5668","DOIUrl":"10.1055/a-2663-5668","url":null,"abstract":"<p><p>The American Academy of Pediatrics (AAP) provides guidelines for managing hyperbilirubinemia in term newborns ≥35 weeks' gestation to prevent kernicterus. In 2022, the AAP revised these guidelines by raising thresholds for serum bilirubin testing and phototherapy. This study compares newborn outcomes before and after implementing the 2022 guidelines.A retrospective chart review of 2,087 newborns, with 1,058 in the \"before\" group, using the 2004 guidelines, and 1,029 in the \"after\" group, using the 2022 guidelines. Data collected included demographics, number of heel sticks for serum bilirubin, incidence of phototherapy, and incidence of readmission for hyperbilirubinemia.There was a 64% reduction in serum bilirubin draws, a 51% decrease in phototherapy sessions, and a 35% reduction in readmissions for phototherapy in the \"after\" group.The 2022 AAP guidelines streamlined the management of hyperbilirubinemia, leading to fewer interventions without affecting patient safety. · The recent AAP newborn jaundice guidelines result in fewer serum bilirubin levels being drawn.. · The recent AAP newborn jaundice guidelines result in less phototherapy.. · The recent AAP newborn jaundice guidelines result in fewer readmissions for jaundice..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697382","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":"Perinatal Outcomes in Pregnancies Immediately following Stillbirth: A Multicenter, Prospective, Observational Study.","authors":"Martina Benuzzi, Riccardo Cuoghi Costantini, Antonio Saddò, Camilla Selleri, Sara Verra, Beatrice Melis, Gloria Guariglia, Laura Avagliano, Caterina Serena, Federico Mecacci, Benedetta Baggio, Benedetta Gabbrielli, Stefania Fieni, Ariane J O Kiener, Caterina Pavan, Marinunzia Salluce, Sabrina Cozzolino, Anna Locatelli, Silvia Alongi, Paola Camponovo, Sara Lazzarin, Isabella Neri, Fabio Facchinetti, Antonio La Marca, Francesca Monari","doi":"10.1055/a-2661-4287","DOIUrl":"10.1055/a-2661-4287","url":null,"abstract":"<p><p>This study aimed to evaluate the outcomes of pregnancies immediately following stillbirth in relation to treatments prescribed.A prospective, observational study was conducted in patients with a history of stillbirth (≥22 weeks) between 2014 and 2022 across four Italian University Hospitals. Outcomes were stratified based on the cause of previous fetal death (classified according to ReCoDe classification) and treatment (low dose aspirin [LDA], low molecular weight heparin [LMWH], both, progesterone, or other drugs). The main outcome was adverse neonatal outcome, including perinatal death, stillbirth recurrence, intrauterine growth restriction, early preterm birth, Apgar < 7 at 5 minutes, and need for neonatal resuscitation. The secondary outcome was adverse maternal outcome, including postpartum hemorrhage, emergency cesarean delivery, and operative vaginal delivery.Among 308 subsequent pregnancies, 46 (14.94%) had an adverse neonatal outcome, including 4 stillbirths. A total of 76 pregnancies (24.68%) experienced adverse maternal outcome, and 19 pregnancies (6.17%) had both. In individuals with previous placental vascular disorders (PVDs), adverse neonatal outcomes were reduced by 75% when treated with LDA + LMWH (odds ratio [OR]: 0.25; 95% confidence interval [CI]: 0.06-1.03; <i>p</i> = 0.049). However, adverse maternal outcome was significantly higher in individuals who received LDA + LMWH without specific indications (OR: 3.07; 95% CI: 1.07-8.78; <i>p</i> = 0.036).LDA and LMWH should be prescribed only for previous PVDs to improve adverse neonatal outcome and avoid unnecessary maternal risk. · LDA + LMWH reduces neonatal risk after placental stillbirths.. · Unnecessary LDA + LMWH increases maternal complications.. · Prescribe LDA + LMWH only with placental indications..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688643","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":"Incidence and Characteristics of Infants with Congenital Syphilis in U.S. NICUs from 2011 to 2020.","authors":"Tala Brack, Monica Bennett, Sameera Chiruvolu, Kaashif Ahmad, Veeral Tolia","doi":"10.1055/a-2663-5613","DOIUrl":"https://doi.org/10.1055/a-2663-5613","url":null,"abstract":"<p><p>Congenital syphilis presents a significant public health problem. Since 2012, there has been a dramatic increase in reported cases of congenital syphilis. However, characteristics of these cases have not been well detailed. This study sought to describe recent trends in the incidence of congenital syphilis, demographic characteristics, hospital treatment, and outcomes of these infants.A retrospective cohort study of all infants in the Pediatrix Clinical Data Warehouse (CDW; a large multicenter de-identified dataset) from 2011 to 2020 was performed. We identified infants with a diagnosis of congenital syphilis and evaluated trends in overall prevalence, as well as changes in maternal and infant characteristics over time.Of 842,928 infants discharged over the study period, we identified 1,625 infants with congenital syphilis. Between 2011 and 2020, the prevalence of congenital syphilis increased from 0.8 to 4.6 per 1,000 neonatal intensive care unit (NICU) admissions (<i>p</i> < 0.05). Most infants were treated with penicillin for 10 days, and the median length of stay was 10 days. Mortality was 0.9% in this cohort. Maternal coinfection with Hepatitis C was unchanged but remained significantly above national rates of Hepatitis C infection in pregnant women. Maternal drug use in infants born with congenital syphilis increased from 6.1 to 24.6% over the decade of the study. The distribution of maternal race changed over the decade, with significantly more mothers identified as White or Other in 2019 to 2020 as compared to the earlier cohorts. There was a concurrent decrease in mothers who identified as Hispanic or African American.From 2011 to 2020, the prevalence of congenital syphilis in the Pediatrix CDW increased by 475%. Although infant characteristics remained similar over time, there was a notable increase in maternal drug use and a persistently elevated risk of other sexually transmitted diseases. Further research examining the association between maternal comorbidities and congenital syphilis is necessary. · Between 2011 and 2020, the prevalence of congenital syphilis increased by 475%.. · Mortality of congenital syphilis in live-borns stayed steady at 0.9%.. · Maternal coinfection with other sexually transmitted diseases remained high over the decade.. · Maternal drug use in infants with congenital syphilis increased significantly over the decade..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144797972","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}