American journal of perinatology最新文献

{"title":"Outcomes of Total Abdominal Hysterectomy Compared to Supracervical Hysterectomy for Management of Placenta Accreta Spectrum.","authors":"Alexandra D Forrest, Debra Eluobaju, Amanda Finney, Laura Prichett, Nicole R Gavin, Christopher Novak, Kristin Martin, Arthur Jason Vaught","doi":"10.1055/a-2615-5098","DOIUrl":"10.1055/a-2615-5098","url":null,"abstract":"<p><p>Although cesarean hysterectomy (C-HYST) is standard management for placenta accreta spectrum (PAS), the type of hysterectomy performed, total abdominal (TAH), or supracervical (SCH), is left to surgeon discretion. TAH has been previously associated with higher estimated blood loss (EBL), transfusion requirements, and complications compared to SCH.This was a single-site retrospective cohort study examining outcomes of TAH compared to SCH for PAS performed from 2008 to 2023. PAS was confirmed by clinical and pathologic diagnoses. Cervical removal was confirmed by operative report, postoperative exam, and pathology. Associations were assessed using chi-square tests, Fisher's exact tests, Mann-Whitney U tests, or individual <i>t</i>-tests.During the study period, 90 TAH and 54 SCH were performed. There were no significant differences in patient demographics, except that planned C-HYST was more likely to be TAH. TAH was associated with significantly lower transfusion requirements. When unexpected hysterectomies were excluded, there was not a significant difference in blood products transfused between the TAH and SCH groups.In PAS, maternal outcomes after TAH are at least equivalent to SCH. The surgical approach for the management of PAS should be further explored. · In PAS, outcomes are at least equivalent between TAH and SCH.. · C-HYST is optimally performed in a planned manner with all multidisciplinary team members present.. · Vertical skin incision was significantly associated with TAH in this retrospective cohort study..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101181","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 Is Intensive Care Warranted for the Most Immature Infants?","authors":"Joseph W Kaempf, Luca Brunelli, Alex Vidaeff, Susan Albersheim","doi":"10.1055/a-2605-7881","DOIUrl":"https://doi.org/10.1055/a-2605-7881","url":null,"abstract":"<p><p>Withholding or starting, withdrawing or continuing, high-technology interventions available to extremely premature newborns is a fundamental challenge in obstetrics and neonatology. Attempting to save an infant's life is a judgment fraught with uncertainty and risk because suffering can be prolonged, long-term outcomes are frequently unfavorable, and socio-economic inequities are burdensome to families. Survival rates of 22-23-24-week infants are increasing in hospitals that promote \"active care,\" yet morbidity rates and long-term neurodevelopmental impairments remain substantial and not improving. Outcomes acceptable to some pregnant women and families are not to others. Delivery of premature infants, particularly by cesarean section, is associated with maternal health risks. Intensive care of extremely premature infants is expensive, and lost opportunity costs are under-appreciated. Autonomy of pregnant women contrasted with the rights of the fetus and infant are culture and religion-affected, technology-influenced, and powerfully persuaded by physicians and institutions who possess a conflict of interest related to career goals, research, and income, all factors not necessarily shared by pregnant women.Physicians should resist dogmatic positions tethered to unproven technologies and nonrigorous evidence. Some hospitals promote near-universal intensive care of 22-23-24-week infants while others recommend palliative care, differences curiously seen between and within countries, even cities. The legitimate zone of parental discretion is characterized by the value pluralistic shared decision-making of informed consent and is endorsed by the American Academy of Pediatrics, the Canadian Paediatric Society, and the American College of Obstetricians and Gynecologists. Physicians should objectively provide clinical outcomes, compassionately listen to pregnant women's concerns and preferences, and resist presenting care options as a restrictive protocol, or a wide-open menu. Because there is no unifying cultural or bioethical ethos, we should embrace shared decision-making recognizing inherent contingencies and tensions, with humble circumspection of possible nihilism (which might influence palliative care), and therapeutic fury (which might promote unreasonable zeal for interventional care). · Extreme prematurity requires knowing outcomes.. · Parental discretion may broaden with uncertainty.. · Shared decision-making assumes informed consent.. · Parental values differ from the values of physicians.. · Asymmetry of responsibility supports parental values..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214651","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":"Progesterone Supplementation After Cerclage Does Not Improve the Preterm Birth Rate.","authors":"Lauren C Sayres, Natalie T Simon, Virginia A Lijewski, Jeanelle Sheeder, Shane A Reeves","doi":"10.1055/a-2605-7721","DOIUrl":"10.1055/a-2605-7721","url":null,"abstract":"<p><p>The goal of this study is to evaluate whether adjuvant progesterone following cerclage affords a reduction in the rate of preterm delivery.This is a retrospective cohort review of all individuals who underwent transvaginal cerclage placement at a tertiary care academic medical center between 2005 and 2021. The rate of delivery prior to 37 weeks and several secondary maternal and neonatal outcomes were compared between patients with and without progesterone supplementation after cerclage. Multivariable regression, subgroup, and matched pairs analyses were performed in order to account for the formulation of progesterone, indication for cerclage, and other potential confounding variables. The study was powered a priori to detect a difference in our primary outcome.Among 451 patients, there were 163 history-, 135 ultrasound-, and 153 examination-indicated cerclages. Overall, 284 (63%) received adjuvant progesterone. Adjuvant progesterone was associated with an increased rate of preterm delivery before 37 weeks (45 vs. 34%, <i>p</i> = 0.03) with an adjusted odds ratio of 1.78 (95% confidence interval: 1.14 and 2.80) in our multivariable model. The median latency from cerclage placement to delivery was shorter when progesterone was used (119 vs. 139 days, <i>p</i> < 0.001). There was no benefit of adjuvant progesterone when analyzed by formulation of progesterone or indication for cerclage or when analyzing pairs matched based on propensity score matching. There were no differences in secondary outcomes for pregnant patients or their offspring.Adjuvant progesterone does not decrease the preterm delivery rate and may in fact cause harm by decreasing latency from cerclage to delivery. Maternal and neonatal outcomes do not vary with supplemental progesterone after cerclage. Our data do not support a synergistic benefit of cerclage and postcerclage progesterone. · There are currently no guidelines for the use of progesterone after cerclage.. · Adjuvant progesterone does not decrease the preterm birth rate.. · Secondary maternal and neonatal outcomes do not improve with adjuvant progesterone..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960941","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":"The Anti-inflammatory Peptide RLS-0071 Reduces Immune Cell Recruitment and Oxidative Damage in a Neonatal Rat Model of Hypoxic-Ischemic Encephalopathy.","authors":"Kaitlyn G Jackson, Alana C Sampson, Kenji M Cunnion, Zachary A Vesoulis, Neel K Krishna","doi":"10.1055/a-2607-2619","DOIUrl":"10.1055/a-2607-2619","url":null,"abstract":"<p><p>Perinatal hypoxic-ischemic encephalopathy (HIE) is a major contributor to infant death and neurological injury worldwide. Both neuroglia and infiltrating peripheral immune cells contribute to inflammation and oxidative stress, which leads to neuronal loss and cerebral tissue necrosis in neonates with HIE. To date, there are no approved pharmacological interventions to treat inflammatory responses in infants affected by HIE. Therapeutic hypothermia (TH) remains the only effective treatment option. Therefore, novel pharmacotherapeutics that interrupt immune-mediated brain inflammation in HIE represent a promising target for intervention. To meet this unmet need, this study tested the hypothesis that a novel anti-inflammatory peptide, RLS-0071 (pegtarazimod), could modulate neuroinflammation in a neonatal rat model of HIE.RLS-0071 was evaluated in the acute stages of hypoxic-ischemic injury utilizing the well-established Vannucci rat pup model of HIE. Rat pups subject to hypoxia-ischemic brain insult received three interventions: normothermia, hypothermia, and RLS-0071. Histopathological effects were assessed via fluorescence microscopy of the hypoxic-ischemic induced cerebral infarct in the cortex at 24 and 48 hours after controlled oxygen deprivation.Increased surviving neurons were seen at 48 hours for RLS-0071 treatment compared with hypothermia treatment as assessed by neuronal nuclear protein (NeuN) staining. Ionized calcium-binding adaptor molecule 1 (Iba1)-positive microglial recruitment was reduced by fourfold in RLS-0071 treatment or hypothermia-treated rats between 24 and 48 hours, compared to normothermia controls. Likewise, myeloperoxidase (MPO) staining showed a twofold decrease in RLS-0071 or hypothermia-treated rats between 24 and 48 hours compared to normothermia controls.Our findings suggest that RLS-0071 decreases immune cell recruitment and oxidative damage to levels comparable to TH in an animal model of HIE. · No pharmacologic interventions for HIE currently exist.. · TH is the current standard of care.. · RLS-0071 increases neuron survival and lowers microglial cell influx in a HIE rat model.. · RLS-0071 limits oxidative damage in a HIE rat model.. · RLS-0071 may provide an orthogonal treatment for HIE..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075371","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><p>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.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.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.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. · 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":"1012-1016"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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":"Association between Slow and Rapid Weight Gain before 36 Weeks of Corrected Age and 6-Year-Developmental Quotient in Infants Born at <26 Weeks of Gestation.","authors":"Masashi Hotta, Katsuya Hirata, Shinya Hirano, Kazuko Wada","doi":"10.1055/a-2462-5220","DOIUrl":"10.1055/a-2462-5220","url":null,"abstract":"<p><p>The postnatal growth of preterm infants is influenced by various factors; however, the association between growth and long-term outcomes in extremely preterm infants remains unclear. Therefore, we aimed to determine the association between 6-year development and body weight (BW) at 36 weeks of corrected age (CA) in extremely preterm infants.We conducted a retrospective observational study including extremely preterm infants born at < 26 weeks of gestation. We defined the key standard deviation score (SDS) using BW at birth and evaluated the association between BW-related values at 36 weeks of CA and the 6-year developmental quotient (DQ).This study included 90 infants. The absolute difference between changes in the BW SDS from birth and the median changes in DQ ≥ 85 infants was significantly greater in infants with a DQ < 85 than ≥85 (median [interquartile range]: 0.80 [0.29, 1.31] vs. 0.34 [0.13, 0.55]; <i>p</i> = 0.001). After adjustment by the logistic regression analysis for DQ < 85, the absolute difference was statistically significant (odds ratio: 4.99, 95% confidence interval: 1.71-14.5). The correlation coefficient between the absolute difference and DQ was -0.35 (<i>p</i> < 0.001). There were no significant associations between a DQ < 85 and SDS or changes in SDS from birth.For infants born at <26 weeks of gestation, slow and rapid weight gain were associated with a low 6-year DQ when using values representing individual body sizes at birth. Individual backgrounds should be considered to avoid both slow and rapid weight gain for the growth management of these infants for at least up to 36 weeks of CA. Further research is needed to determine which body size has a positive impact on the long-term outcomes of infants. · The median change in BW SDS was a key factor for DQ.. · Slow/rapid weight gain were related to a low 6-year DQ.. · Individual backgrounds may be important in neonatal intensive care unit care..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1073-1082"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779179","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":"10.1055/a-2451-9925","url":null,"abstract":"<p><p>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.Cohort study of 987,181 infants hospitalized in the NICU from 2005 to 2020.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.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. · 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":"1017-1023"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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":"10.1055/a-2448-0330","url":null,"abstract":"<p><p>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.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.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.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. · 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":"997-1002"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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":"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><p>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.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.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%.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. · The fullPIERS risk prediction model has not been validated in a U.S. cohort.. · 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":"1035-1042"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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":"10.1055/a-2452-0047","url":null,"abstract":"<p><p>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.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.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.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. · 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":"1024-1034"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","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}