American journal of perinatology最新文献

{"title":"Associations between Advanced Paternal Age and Adverse Reproductive Outcomes in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b).","authors":"Rachel A Newman, Patrick Conley, Tania Esakoff, William Grobman, David Haas, Ronald Wapner, Judith Chung, George Saade, Natalie A Bello","doi":"10.1055/a-2507-7428","DOIUrl":"10.1055/a-2507-7428","url":null,"abstract":"<p><p>The association between paternal age and adverse pregnancy outcomes (APOs) has not been well studied. We sought to determine whether advanced paternal age (APA) is associated with adverse maternal or neonatal outcomes.Secondary analysis of 8,863 pregnancies from the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) prospective cohort in which both maternal and paternal age at conception were known. APA was defined as age ≥ 40 years and AMA was defined as age ≥ 35 years. Composite maternal and fetal/neonatal APO outcomes were adjudicated by experts using previously defined methods. Univariable and multivariable logistic regression models were used to estimate the associations between APA, AMA, and their combination (AMA and APA), with the outcomes of interest (APO, fetal/neonatal, and combined APO or fetal/neonatal outcomes). Multivariable analyses were adjusted for covariates identified a priori: self-reported race and ethnicity, education, body mass index, maternal medical conditions, assisted reproductive technology (ART), and maternal age in APA only models.APA in isolation was not significantly associated with maternal or fetal/neonatal adverse outcomes (adjusted odds ratio [aOR] = 1.08, 95% confidence interval [CI]: 0.89 - 1.32). In contrast, AMA pregnancies and pregnancies in which both parents were of advanced age were associated with significantly increased risk of maternal or fetal/neonatal adverse outcome (aOR = 1.37, 95% CI: 1.17 - 1.59, <i>p</i> < 0.001 and aOR = 1.60, 95% CI: 1.25 - 2.05, <i>p</i> < 0.001), respectively. Findings were similar when individuals who used assisted reproductive technology (ART) were excluded from analyses.In our study of nulliparous birthing people, in contrast to AMA pregnancies, APA alone was not significantly associated with a heightened risk of maternal or fetal/neonatal APOs. However, pregnancies from both AMA and APA individuals demonstrated a trend toward a higher risk of APOs compared with AMA pregnancies. Further research is needed to delineate the mechanism driving this finding. · There is an established association between older maternal age and increased risk of adverse pregnancy outcomes. Determining the influence of paternal age on pregnancy outcomes is of equal importance.. · Prior data are inconclusive on the association of APA and rates of miscarriage, fertilization rates, and aneuploidy, and to our knowledge, the associations with adverse pregnancy outcomes have not been previously examined.. · This study examines if APA (paternal age ≥ 40 years) is an independent risk factor for adverse pregnancy outcomes in a cohort of nulliparous birthing people..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1445-1451"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062964","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":"Enteral Feeding in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Helen Martinovski, Luna Khanal, Debra Kraft, Girija Natarajan","doi":"10.1055/a-2510-1543","DOIUrl":"10.1055/a-2510-1543","url":null,"abstract":"<p><p>This study aimed to describe feeding outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and compare characteristics and outcomes in groups discharged home on oral, total/partial nasogastric, and gastrostomy tube feedings.This was a retrospective, single-center cohort study of infants diagnosed with moderate or severe HIE using standard criteria who underwent cooling from January 2017 to June 2022. Data were abstracted from hospital course as well as until 6 months follow-up. Statistical analysis included chi-square test and ANOVA with post hoc Bonferroni correction for between-group comparisons.Among 123 included infants, 95 (77%) fed orally, 11 (9%) required total/partial nasogastric feeds and 17 (14%) had gastrostomy tubes at discharge. A significantly greater proportion of infants with gastrostomy-tube feeds at discharge had intrapartum complications, Apgar scores <5 at 5 and 10 minutes, severe rather than moderate HIE, and seizures. They also had a longer hospital stay, prolonged respiratory support and intubated days, and delayed initiation of feeding. Infants discharged on nasogastric feeds all attained oral feeds at a median (IQR) duration of 54 (6-178) days follow-up. Among the 106 (86%) infants with follow-up data, the gastrostomy group had significantly lower median weight and head circumference centiles compared to the others. Criteria for gavage eligibility were met before discharge in 98 (80%) of the cohort; 42% stayed beyond this benchmark.Earlier identification of eventual gastrostomy tube insertion as well as discharge home on nasogastric feedings may reduce duration of hospitalization in infants with HIE. Our data may provide insights to guide practice improvement for enteral feedings in this population. · In neonatal encephalopathy, impaired oral feedings is common.. · Antepartum complications and HIE severity are associated with gastrostomy insertion.. · Discharge home on gavage feeds could shorten hospital stay..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1477-1484"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389800","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":"Prospective Cohort Study Investigating Polyunsaturated Fatty Acids and Chronic Lung Disease in Preterm Infants.","authors":"Teryn Igawa, Tessa C Gillespie, Esther S Kim, Lauren J Lee, Tristan Grogan, Alison Chu, Kara L Calkins","doi":"10.1055/a-2496-2310","DOIUrl":"10.1055/a-2496-2310","url":null,"abstract":"<p><p>Chronic lung disease (CLD) is a complication of prematurity. Studies examining the effects of long-chain polyunsaturated fatty acids (LC-PUFAs) on CLD are conflicting. This study investigated LC-PUFAs in the red blood cell membrane (RBCM) in preterm infants.This prospective observational study included infants with gestational age <32 weeks or birth weight <2 kg and at least one LC-PUFA measurement in the first month of life. Subjects without CLD (CON group) were compared with those with CLD (CLD group) and then by CLD severity.Seventy infants were included (CON <i>n</i> = 29; CLD <i>n</i> = 41). Twenty-six infants had Grade 1 CLD; 12 had Grade 2 CLD; 3 had Grade 3 CLD. When the CLD group was compared with the CON group, the overall mean (95% confidence interval) RBCM% for linoleic acid (LA) was similar (CLD vs. CON 12.5% [11.7-13.4%] vs. 11.2% [10.2-12.3%], <i>p</i> = 0.06) but the overall mean arachidonic acid (ARA) was lower (17.6% [17.1-18.0%] vs. 18.6% [18.1-19.2%], <i>p</i> < 0.01). During weeks 1 to 4, LA% was similar, while ARA% was lower in weeks 2 and 3 (18.8 ± 2.2% vs. 20.0 ± 1.5%, <i>p</i> = 0.05, 16.8 ± 2.0% vs. 18.3 ± 1.6%, <i>p</i> = 0.01). A similar trend was noted when groups were compared by CLD severity. The CLD group had a higher overall mean α-linolenic acid (ALA) compared with the CON group (0.4% [0.3-0.4%] vs. 0.2% [0.2-0.3%], <i>p</i> < 0.01) but no difference in docosahexaenoic acid (DHA; 3.8% [3.4-4.1%] vs. 3.8% [3.4-4.3%], <i>p</i> = 0.80). During weeks 1 to 4, ALA% was higher during week 1 only (0.4 ± 0.3% vs. 0.2 ± 0.1%, <i>p</i> < 0.01), and DHA% was similar for weeks 1 to 4. Results were similar when groups were compared by CLD severity.In this study, low ARA status was associated with CLD. · In this study, infants with CLD had a similar RBCM% of LA, but a lower percentage of its downstream LC-PUFA, ARA, compared with infants without CLD.. · In this study, infants with CLD had a higher RBCM% of α-linolenic acid, but a similar percentage of its downstream LC-PUFA, DHA, compared with infants without CLD.. · In this study, these trends were similiar when groups were compared by CLD severity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1400-1408"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783870","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":"Intrapartum Glycemic Control with Insulin Infusion versus Rotating Fluids: A Randomized Controlled Trial.","authors":"Maranda Sullivan, Kajal Angras, Victoria Boyd, Amanda J Young, A Dhanya Mackeen, Michael J Paglia","doi":"10.1055/a-2510-4906","DOIUrl":"10.1055/a-2510-4906","url":null,"abstract":"<p><p>This study aimed to evaluate rotating intravenous (IV) fluids compared with insulin infusion for maternal intrapartum glycemic control of neonatal blood glucose within 2 hours of birth.This randomized controlled trial compared the use of rotating IV fluids to continuous insulin infusion for intrapartum glycemic control for patients with type II diabetes mellitus (DM) or medication-controlled gestational diabetes (A2GDM). A sample size of 74 participants was studied to detect a 10-mg/dL difference in neonatal blood glucose within 2 hours of birth between the groups with a standard deviation of 15, 80% power, and α 0.05. Secondary neonatal outcomes included neonatal blood glucose within 24 hours after birth, Apgar < 7 at 5 minutes, and a composite including neonatal hypoglycemia, NICU admission, hyperbilirubinemia, and respiratory distress syndrome. Secondary maternal outcomes included intrapartum hypoglycemia, blood glucose immediately prior to delivery, mode of delivery, and postpartum complications. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed.A total of 114 patients were randomized, 57 in each arm. For the PP analysis, 51 patients were analyzed in the rotating IV fluids arm and 32 patients in the insulin infusion arm. There was no significant difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used (ITT: 54.5 mg/dL [IQR: 42.5, 72.5], PP: 56.0 mg/dL [IQR: 42.0, 76.0]) when compared with an insulin infusion (ITT: 59.0 mg/dL [IQR: 41.0, 69.0], PP: 62.5 mg/dL [IQR: 44.5, 68.5], <i>p</i> = 0.89 [ITT] and <i>p</i> = 0.68 [PP]). No significant differences were noted in secondary outcomes. The median intrapartum maternal blood glucose was 98.5 mg/dL (IQR: 90.5, 105.0) in the rotating fluids arm and 96.3 mg/dL (IQR: 90.0, 108.5) in the insulin infusion arm (<i>p</i> = 0.96), and the rate of neonatal hypoglycemia was 11.8 versus 15.6%, respectively (<i>p</i> = 0.61) in the PP analysis.There was no difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used for intrapartum glycemic control compared with a continuous insulin infusion. · There is no optimal option for maternal glycemic control in labor.. · Maternal glycemic control was comparable in the two study arms.. · There was no difference in neonatal blood glucose between study arms..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1491-1499"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389589","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":"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":"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. · 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":"1381-1388"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","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":"Cerebrospinal Fluid Composition of Infants with Ischemic Stroke.","authors":"Katherine B Daniel, Daniel K Benjamin, P Brian Smith, C Michael Cotten, Reese H Clark, Rachel G Greenberg","doi":"10.1055/a-2511-8842","DOIUrl":"10.1055/a-2511-8842","url":null,"abstract":"<p><p>This study aimed to characterize the cerebrospinal fluid (CSF) of infants with stroke and compare those findings to the CSF of infants with bacterial meningitis and neither condition in the first 14 postnatal days.Cohort study of 30,092 infants who received a lumbar puncture in the first 14 postnatal days discharged from >400 neonatal intensive care units from 1997 to 2020. CSF parameters were compared between infants with stroke and bacterial meningitis using non-parametric hypothesis testing and quantile regression.Compared to infants with bacterial meningitis, infants with stroke had a significantly lower median protein concentration, higher median glucose concentration, higher median red blood cell count, and higher median monocyte count. Using quantile regression at the 75th percentile, infants with stroke had a significantly lower white blood cell count, segmented neutrophil count, and lymphocyte count than infants with bacterial meningitis.This study addresses the paucity of literature describing the CSF of infants with ischemic stroke. Knowledge of the differences in CSF parameters between infants with stroke and meningitis may allow for faster recognition and intervention before CSF culture results are available. · Neonatal stroke is a serious and morbid event.. · Neonatal stroke and meningitis can present similarly.. · The CSF of neonatal stroke is poorly described..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1500-1510"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942628","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 Management of Hypertensive Disorders of Pregnancy in Six Large U.S. Hospital Systems: Descriptive Review and Identification of Clinical and Research Gaps.","authors":"Anna Palatnik, Alisse Hauspurg, Kara K Hoppe, Lynn M Yee, Jacqueline Kulinski, Sadiya S Khan, Bethany Sabol, Christina D Yarrington, Priya M Freaney, Samantha E Parker","doi":"10.1055/a-2416-5974","DOIUrl":"10.1055/a-2416-5974","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDPs) are a key contributor to maternal morbidity and mortality. Several gaps in knowledge remain regarding best practices in the postpartum management of HDPs. In this review, we describe postpartum HDPs management among six large academic U.S. hospital systems: Medical College of Wisconsin, University of Pittsburgh, University of Wisconsin-Madison, Northwestern University, University of Minnesota, and Boston Medical Center. We identified that all six health systems discharge patients with HDPs diagnosed with a blood pressure (BP) cuff and use the same two antihypertensive medications, nifedipine and labetalol, as first- and second-line treatment of HDPs. Northwestern University routinely adds oral furosemide for 5 days for patients with BP that exceeds 150/100 mm Hg. Most hospital systems administer magnesium sulfate routinely when readmission for HDPs occurs. In contrast, there was variation in BP threshold for antihypertensive treatment initiation, use of remote BP monitoring program, use of a transition clinic, delivery or lack of education on long-term cardiovascular disease risk, and BP management through the first 6 weeks postpartum and beyond. Based on the clinical review, we identified clinical gaps and formulated considerations for research priorities in the field of postpartum HDPs management. · Several gaps in knowledge remain regarding best practices in postpartum management of HDPs.. · There is a variation in the BP threshold for antihypertensive treatment initiation.. · Data are lacking on the reduction in severe maternal morbidity (SMM) and racial disparities in SMM with remote monitoring..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1371-1380"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Placental Pathology and antibiotic exposure after birth with the Severity of Necrotizing Enterocolitis in Preterm infants: A Case-Control Study.","authors":"Parvesh Mohan Garg, Robin Riddick, Md Yusuf Ansari, Aubrey Rebentisch, Avinash K Shetty, Kristin Adams, William Hillegass, Padma Parvesh Garg","doi":"10.1055/a-2663-5723","DOIUrl":"https://doi.org/10.1055/a-2663-5723","url":null,"abstract":"<p><strong>Objective: </strong>To assess the relationship between placental lesions, antibiotic exposure duration, and necrotizing enterocolitis (NEC) severity in preterm infants.</p><p><strong>Methods: </strong>In this single-center, case-control study, 107 infants with NEC and 130 controls were grouped by antibiotic exposure after birth: ≤3 days or >3 days.</p><p><strong>Results: </strong>Of 212 infants, 103 (48.5%) received antibiotics for ≤3 days, while 109 (51.5%) received antibiotics for >3 days. Multivariate regression analysis demonstrated that prolonged antibiotic duration (>3 days vs. ≤3 days) was significantly associated with increased severity of NEC, with adjusted odds ratios (aOR) of 2.65 (95% CI: 1.36-5.16; p=0.004) for medical NEC and 3.36 (95% CI: 1.56-7.23; p=0.002) for surgical NEC. However, prolonged antibiotic duration was not significantly associated with overall mortality (aOR 1.16, 95% CI: 0.58-2.34; p=0.7). Among infants diagnosed with NEC (n=97), antibiotic duration >3 days significantly increased the odds of mortality (aOR 7.34, 95% CI: 1.94-48.3; p=0.011) but was not significantly associated with NEC severity (aOR 1.20, 95% CI: 0.49-2.94; p=0.7). Among 64 infants with acute histologic chorioamnionitis, 37 (58%) received antibiotics >3 days. Longer antibiotic exposure was linked to higher risks of medical NEC (79% vs. 38%; p=0.021) and surgical NEC (62% vs. 38%; p=0.021) compared to shorter exposure. In 134 infants with maternal vascular malperfusion, prolonged antibiotics were also associated with increased risks for medical (60% vs. 36%; p=0.007) and surgical NEC (67% vs. 36%; p=0.007). Concordance between clinical and pathologic chorioamnionitis was moderate (AC₁ 0.60), while agreement for PIH versus maternal vascular malperfusion was minimal (AC₁ 0.07).</p><p><strong>Conclusion: </strong>Prolonged antibiotic exposure (>3 days) in infants with chorioamnionitis or maternal vascular malperfusion is most likely associated with increased NEC severity. Limiting antibiotic duration may reduce severe NEC risk in preterm infants.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697381","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, D Schutzman","doi":"10.1055/a-2663-5668","DOIUrl":"https://doi.org/10.1055/a-2663-5668","url":null,"abstract":"<p><strong>Background and objectives: </strong>The American Academy of Pediatrics 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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The 2022 AAP guidelines streamlined the management of hyperbilirubinemia, leading to fewer interventions without affecting patient safety.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","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":"Using the cerebrovascular time constant to assess cerebral perfusion in neonates.","authors":"Daisuke Uda, Masashi Zuiki, Mikito Ohta, Akio Yamano, Norihiro Iwata, Naoe Fujita, Kazunori Watanabe, Rika Kume, Madoka Uesugi, Eisuke Ichise, Kanae Hashiguchi, Kinoshita Daisuke, Tatsuji Hasegawa, Tomoko Iehara","doi":"10.1055/a-2662-8394","DOIUrl":"https://doi.org/10.1055/a-2662-8394","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between the cerebrovascular time constant (Tau) and estimated cerebral perfusion pressure (CPPe) in neonates and clarify the normative reference data of Tau for different gestational ages.</p><p><strong>Study design: </strong>This multicenter, prospective study included infants with arterial lines who were admitted to neonatal intensive care units between December 2021 and May 2024. Tau and CPPe were calculated based on middle cerebral artery waveforms obtained using transcranial Doppler ultrasonography when clinicians collected arterial blood samples.</p><p><strong>Results: </strong>A total of 432 samples were obtained from 127 infants with a median gestational age of 32 weeks (interquartile range [IQR], 28-37 weeks) and a median birth weight of 1,566 g (IQR, 932-2,334 g). Tau demonstrated a significant correlation with CPPe across the following gestational age groups: ≤29 weeks, r=-0.49 and p<0.001; 30-36 weeks, r=-0.61 and p<0.001; and ≥37 weeks, r=-0.56 and p<0.001. Despite this correlation, the median Tau was consistent across gestational ages, and the following normative reference values were observed: ≤29 weeks, 0.178 ± 0.046 s; 30-36 weeks, 0.186 ± 0.045 s; ≥37 weeks, 0.176 ± 0.037 s; and all weeks, 0.180 ± 0.044 s.</p><p><strong>Conclusion: </strong>Tau may serve as an effective parameter for evaluating cerebral perfusion in neonates.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697383","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}