American journal of perinatology最新文献

{"title":"Diabetes Technology Use in Pregnancies with Type 1 Diabetes in the United States from 2009 to 2020.","authors":"Nasim C Sobhani, Yongmei Huang, Kartik K Venkatesh, Jason D Wright, Alexander M Friedman, Timothy Wen","doi":"10.1055/a-2625-6437","DOIUrl":"10.1055/a-2625-6437","url":null,"abstract":"<p><p>The use of continuous glucose monitors (CGM) and insulin pumps has revolutionized the care of patients with type 1 diabetes (T1D). Few data are available regarding the use of diabetes technology use in the pregnant T1D population. This study was conducted to evaluate temporal trends of diabetes technology use and predictors of use among pregnant individuals with TID in the United States from 2009 to 2020.MarketScan Research Databases from 2009 to 2020 were used to identify pregnant individuals with T1D who were and were not using CGM and/or insulin pumps. Joinpoint regression analysis was used to estimate the average annual percent change (AAPC) in diabetes technology use over time. Unadjusted and adjusted log-linear Poisson regression models were developed to assess the associations between the outcomes of CGM and insulin pump use and demographic and clinical predictors. Associations were reported as adjusted risk ratios (ARR) with 95% confidence intervals (CI).Among 9,201 pregnancies with T1D, CGM use increased from 2.3% in 2009 to 13.7% in 2020 (AAPC: 13.9%; 95% CI: 11.7-17.1), while insulin pump use remained unchanged from 10.9% in 2009 to 11.8% in 2020 (AAPC: -2.4%; 95% CI: -4.4 to 0.4). Medicaid insurance and obesity were associated with a lower likelihood of CGM use and insulin pump use, while a high obstetric comorbidity index score was associated with a higher likelihood of insulin pump use (ARR: 1.26; 95% CI: 1.05-1.51).From 2009 to 2020, CGM use among pregnant individuals with T1D increased, while insulin pump use remained unchanged. Use varied by patient demographic and clinical factors, most notable for lower likelihood of CGM use and insulin pump use with Medicaid insurance. Although CGM use increased over time, overall CGM use remained lower than expected despite the known benefits of CGM use in improving neonatal outcomes in pregnancies complicated by T1D. · CGM use in pregnant individuals with T1D increased from 2.3 to 13.7%, but pump use was stable.. · Medicaid and obesity were associated with lower CGM and pump use in pregnant individuals with T1D.. · Low CGM use in pregnant T1D individuals highlights barriers and the need for equitable access..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214650","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 Food Insecurity and Short-Term Kidney Outcomes in Neonates.","authors":"Michelle C Starr, Abigail C Hardy, Paulomi Chaudhry, Cara L Slagle, Stephanie P Gilley, Danielle E Soranno","doi":"10.1055/a-2628-3904","DOIUrl":"https://doi.org/10.1055/a-2628-3904","url":null,"abstract":"<p><p>This study aimed to determine the association between food insecurity (FI) and short-term kidney outcomes in neonates.Single-site prospective cohort study of sequentially admitted neonates to two neonatal intensive care units (NICUs). We collected demographic characteristics and FI status on maternal-neonatal dyads using the Hunger Vital Signs tool. Kidney outcomes (acute kidney injury [AKI]) within the first 14 days, recovery from AKI, and serum creatinine (SCr) at day 14 of age) were compared by FI status.Of the 70 neonates in this study, 39% lived in FI households. Infants from FI households were more likely to have early AKI (56 vs. 14%, <i>p</i> = 0.002) and were more likely to have a slower recovery from AKI (66 vs. 17%, <i>p</i> = 0.035) than those from food-secure households. Neonates from FI households were also more likely to have an abnormally elevated SCr at 2 weeks of age (66 vs. 17%, <i>p</i> = 0.007).FI is common in families with neonates admitted to the NICU. Neonates born into FI households were more likely to have early AKI, slower AKI recovery, and elevated SCr at 2 weeks of age. Our findings emphasize the importance of FI screening and recognition as part of prenatal care and as an essential social determinant of health in studies investigating kidney outcomes. · FI is common in families with neonates admitted to the NICU.. · Neonates born into households with FI were more likely to have early AKI.. · They also had slower AKI recovery and elevated SCr at 2 weeks of age.. · Our findings emphasize the importance of FI screening and recognition as part of prenatal care.. · FI is an essential social determinant of health in studies investigating kidney outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482791","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 Adverse Outcomes and Middle Cerebral Artery Pulsatility Index Change Based on Maternal Position Change.","authors":"Itamar D Futterman, Rodney A McLaren, Meghna Ramaswamy, Rohit Iyer, Shoshana Haberman","doi":"10.1055/a-2626-3232","DOIUrl":"https://doi.org/10.1055/a-2626-3232","url":null,"abstract":"<p><p>We have previously demonstrated that maternal position changes directly affect the fetal middle cerebral artery (MCA) Doppler pulsatility indices (PI) and may serve as a predictor for adverse pregnancy outcomes. We sought to confirm whether changes in fetal MCA Doppler PI due to position changes are associated with adverse outcomes.We conducted a prospective cohort study of pregnant people with a singleton, nonanomalous fetus, recruited between 18 and 24 weeks of gestation, in a single tertiary care center from December 2021 to February 2022. MCA Dopplers were obtained, and PI indices were measured and recorded, first in the supine position and then in the maternal left lateral (LL) position. The primary outcome was a composite of adverse outcomes (preeclampsia, fetal growth restriction, and oligohydramnios). Based on our prior findings suggesting that a PI Δ of 0.22 may serve as a dividing threshold between low- high-risk pregnancies, we divided the cohort into those above and below Δ = 0.22. Demographics were compared using univariable analyses. Multivariable logistic regression was performed comparing the composite and individual pregnancy outcomes controlling for statistically significant variables.We recruited 228 patients and followed them to delivery. There were 107 that had a PI Δ < 0.22 and 121 that had a PI Δ ≥0.22. The primary outcome of composite adverse outcomes did not differ between the groups (adjusted odd ratio [aOR]: 0.53; 95% confidence interval [CI]: 0.26-1.08). However, pregnancies with PI Δ ≥0.22 were more likely to develop preeclampsia than pregnancies with PI Δ < 0.22 (aOR: 3.30; 95% CI: 1.02-10.69).The primary outcome of composite adverse outcomes did not differ between the groups. However, we did find that a second trimester fetal MCA PI Δ ≥0.22 with maternal position changes at anatomy ultrasound was associated with developing preeclampsia. This data suggests that there may be an association between early decreased fetoplacental reserve and the development of preeclampsia. · Second trimester MCA PI Δ ≥0.22 with maternal position changes was associated with preeclampsia.. · There may be a link between decreased fetoplacental reserve and developing preeclampsia.. · Aside from preeclampsia there were no differences in adverse outcomes between the two groups..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482843","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 Measures of Psychological Resilience to Predict Burnout among NICU Nurses.","authors":"Timothy G Elgin, Emily Spellman, Emily O'Dowd, Paul O'Connor, Angela O'Dea","doi":"10.1055/a-2607-2706","DOIUrl":"10.1055/a-2607-2706","url":null,"abstract":"<p><p>Psychological resilience (PR) is a trait that supports individuals as they attempt to overcome the negative factors and stressors experienced in life. Neonatal intensive care unit (NICU) nurses encounter considerable stress while providing care for medically vulnerable infants and because of this, are at risk for emotional burnout (EB). Literature suggests that PR may protect against burnout but investigation of PR and its relationship with EB in NICU nurses is limited.The ResMed PR questionnaire and the Emotional Burnout scale (EBS) were distributed to both day and night-shift neonatal nurses with over 6 months of experience working at a large academic NICU in order to investigate the relationship between these two concepts.In total 92 of 124 NICU nurses returned the survey, resulting in a response rate of 74%. The mean years of NICU nursing experience was 9.30. The average total ResMed score was 68.65 with domain scores of 21.78 for job-related gratification, 28.69 for protective practices, and 18.2 for protective attitudes. Regression analysis demonstrated a negative relationship between PR and EB, indicating that higher PR was associated with lower EB and suggesting a protective effect of PR against EB.This study provides insight into levels of PR and burnout amongst NICU nurses within a large academic NICU. These findings allow for the development of programs and strategies by healthcare leaders and institutions to maximize neonatal nursing health and well-being. · This study found a negative relationship between PR subscales and EB.. · This indicates that higher PR is associated with lower burnout.. · In this study, 40% of nurses tested positive for EB.. · Interventions targeted at improving nursing PR may be effective in managing EB..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075431","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":"Frequency of Fentanyl-Adulterated Street Drugs Consumed by Mothers with Substance Use: The Value of Umbilical Cord Testing.","authors":"Divya Rana, Linda DeBaer, Massroor Pourcyrous","doi":"10.1055/a-2624-3880","DOIUrl":"https://doi.org/10.1055/a-2624-3880","url":null,"abstract":"<p><p>Reports indicate that street drugs are frequently adulterated with fentanyl. However, standard urine drug toxicology may not detect fentanyl, and neonates with prenatal fentanyl exposure often experience severe withdrawal. This study aimed to determine the frequency of fentanyl-adulterated street drugs consumed by mothers with substance use disorders (SUD) using umbilical cord tissue toxicology (UCT).This retrospective observational study (2020-2022) analyzed mothers with SUD and their neonates, utilizing UCT to confirm fentanyl exposure. Additionally, we compared maternal characteristics between those who acknowledged fentanyl use during pregnancy and those who did not, along with neonatal outcomes.Among 353 infants born to 342 mothers with opioid use, 21.8% (77/353) had in-utero fentanyl exposure confirmed by UCT. Notably, 54% (40/74) of mothers in the fentanyl-positive group did not acknowledge fentanyl use. However, these mothers more frequently reported using other substances, including marijuana (<i>p </i>< 0.01) and cocaine (<i>p </i>< 0.03), suggesting fentanyl adulteration in street drugs. Umbilical cord fentanyl concentrations were similar between groups, though variance was higher among those who did not report fentanyl use, indicating potential inconsistent exposure. No significant differences were observed in neonatal characteristics.Our study highlights the high frequency of prenatal fentanyl exposure due to adulterated street drugs used by mothers. Although the infant's characteristics and the severity of NOWS were similar in both groups, long-term outcomes may depend on UCT fentanyl concentrations. Therefore, umbilical cord drug screening is a crucial tool for detecting fetal exposure to fentanyl and appropriate neonatal assessment and intervention. · Fentanyl, a potent synthetic opioid, is increasingly found in street drugs, often unbeknownst to users.. · Mothers struggling with substance use may be exposed to illicit fentanyl without their knowledge.. · Umbilical cord testing is crucial for identifying substance exposures in newborns.. · Newborn assessment and treatment can differ and impact their short- and long-term outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482792","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":"Fetal Weight Extrapolation Following a Third-Trimester Ultrasound Examination Using the Gestation-Adjusted Projection Method: A Systematic Review and Meta-analysis.","authors":"Micah M Vaughn-Valencia, Yan D Zhao, Rodney K Edwards, Shari Clifton, Hugh C G Nadeau","doi":"10.1055/a-2628-2364","DOIUrl":"10.1055/a-2628-2364","url":null,"abstract":"<p><p>Using systematic review and meta-analysis methodology, we sought to evaluate the accuracy of the gestation-adjusted projection (GAP) method of fetal weight extrapolation in the prediction of actual birth weight.A systematic literature search was performed using MEDLINE/PubMed, Embase, Scopus, and Web of Science for studies published from database inception to June 2023. Studies were compiled that assessed the accuracy of the GAP method in pregnant women at term (≥37 weeks gestation) with an ultrasound performed at 34 to 36 weeks gestation. Quality was assessed using the Newcastle-Ottawa scale, and risk of bias was assessed using the risk of bias in nonrandomized studies of interventions (ROBINS-I) tool. Meta-analysis was performed to evaluate the agreement between the GAP method and the actual birth weight using the mean percent error, mean absolute error, and mean absolute percent error. Means and 95% confidence intervals (95% CI) were calculated. Heterogeneity between studies was assessed using <i>I</i> ² and tau² statistics.The search identified 949 records. After a full-text review, a total of eight studies with 5,306 subjects were included. Studies were retrospective and prospective cohort studies. All studies were deemed high quality and determined to have a low risk of bias. Five studies were performed in the United States, one in Italy, one in Spain, and one in the United Kingdom. Four studies included patients with pregestational or gestational diabetes and obesity. Due to substantial heterogeneity, the random-effects model was used to estimate the effects of studies. The mean percent error was 3.1% (95% CI: 1.1-5.2), the mean absolute error was 240 g (95% CI: 205-275 g), and the mean absolute percent error was 8.0% (95% CI: 6.9-9.1).The GAP method of fetal weight extrapolation is an accurate approach to birth weight prediction and is suitable for use in a diverse population. The study protocol was submitted for online registration in the International Register of Prospective Systematic Reviews (PROSPERO) before the literature review was undertaken (registration number: CRD42023392977). · Estimation of fetal weight is useful for delivery planning.. · The GAP method uses third-trimester ultrasound data.. · The GAP method is an accurate approach to birth weight prediction..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232946","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 Impact of Opt-In versus Opt-Out Consent Process for the Use of Donor Human Milk on Feeding Practice and Growth Pattern in Preterm Neonates.","authors":"Christhian Cano-Guerra, Meghan I Short, Elizabeth Yen","doi":"10.1055/a-2624-7278","DOIUrl":"10.1055/a-2624-7278","url":null,"abstract":"<p><p>This study aimed to assess the impact of an opt-out consent process compared with the opt-in consent process for using pasteurized donor human milk (PDHM) on feeding practices and growth in preterm neonates.A retrospective study of 200 neonates ≤28 weeks' gestation compared the effects of opt-in versus opt-out consent processes on time to first enteral feed, feeding types, growth trajectories, and prematurity-related morbidities. Descriptive statistics were used to compare the two groups.The opt-out process did not significantly alter the time to the first enteral feed (range opt-in: 0-12 days vs. opt-out 0-5 days, Mann-Whitney U; <i>p</i> = 0.295). Compared with the opt-in process, the opt-out process was associated with less formula use, less mother's milk use, and more PDHM/mixed mom's milk-PDHM use in the first 4 weeks of life (<i>p</i> < 0.01). Unadjusted analyses showed a greater weight gain in the opt-out group on days of life/DOLs 14 and 28 (2.49 [0.20, 4.78] and 3.94 [0.07, 7.80]%, <i>p</i> < 0.05), and following adjustment, it remained significant for DOL 14 (1.87 [0.02, 3.71]). Prematurity-related morbidities were similar between the two groups.The opt-out consent process may impart short-term growth benefits in preterm infants. However, long-term outcomes require further study. · Opt-out is an alternative to the traditional opt-in consent for donor milk use in preterm infants.. · It is associated with better growth by day 14.. · Less formula use, and more donor/mixed milk use by day 28.. · Mother's milk use at discharge and short-term outcomes are similar for both consent types.. · Future studies will focus on the long-term effects and benefits of the opt-out consent process..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207373","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":"Prenatal Diagnosis and 10-Year Follow-up of Type-II Generalized Arterial Calcification of the Infancy.","authors":"Daniele De Luca, Daniela Laux, Giulia Regiroli, Alexandra Benachi, Alexandre J Vivanti","doi":"10.1055/a-2628-9607","DOIUrl":"10.1055/a-2628-9607","url":null,"abstract":"<p><p>Generalized arterial calcification of infancy (GACI) is an ultra-rare, potentially life-threatening disorder of the mineralization of which obstetricians and neonatologists shall be aware.This study aimed to describe twins with ATP binding cassette subfamily C member-6 (ABCC6) mutations leading to type II-GACI phenotype in one of them, their multidisciplinary management, and very long-term (10 years) follow-up.One of the twins had typical calcifications in the ascending aorta and the aortic arc, leading to severe neonatal arterial hypertension needing anti-hypertensive treatment. A therapy with bisphosphonates was also provided for 3 weeks with the disappearance of calcifications and resolution of hypertension. Ten-year follow-up was completely normal. Patients were found to carry a heterozygous mutation of ABCC6.Type II-GACI can be managed with a multi-disciplinary approach and good long-term outcomes despite the occurrence of severe neonatal arterial hypertension. · GACI is an ultra-rare, potentially life-threatening disorder of the mineralization processes of which obstetricians and neonatologists shall be aware.. · Type II-GACI can be managed with a multi-disciplinary approach and good long-term outcome despite the occurrence of severe neonatal arterial hypertension.. · Type-II GACI phenotype can be similar to that of pseudoxanthoma elasticum due to heterozygous mutations of the ABCC6 gene.. · Further research is needed to understand the pathobiology of this disorder..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245779","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":"Comment on \"Intrapartum Care for People with Diabetes-Working towards Evidence-Based Management\".","authors":"Saketh Sainag Mandiga, Rachana Mehta, Ranjana Sah","doi":"10.1055/a-2640-3185","DOIUrl":"10.1055/a-2640-3185","url":null,"abstract":"<p><p>We read with great interest the study by Fishel Bartal et al. [1], which investigated prevailing assumptions regarding intrapartum glycemic control in diabetic pregnancies. While the review is timely, given the ongoing clinical ambiguity surrounding maternal glucose management during labor, it raises critical concerns regarding the evidentiary basis and conceptual framing of its conclusions. From a methodological perspective, the review draws primarily on observational data and retrospective cohorts, yet does not systematically stratify evidence quality using formal hierarchies, such as GRADE or Oxford CEBM levels [2]. This omission limits interpretive rigor and weakens the central thesis that strict glycemic control lacks demonstrable neonatal benefits. The cited trials used disparate diagnostic thresholds for neonatal hypoglycemia (e.g., <40 mg/dL vs. <45 mg/dL), divergent insulin infusion algorithms, and inconsistent measurement timing. Moreover, maternal BMI and antenatal glycemic profiles, both potent modifiers of neonatal glucose homeostasis, are insufficiently controlled across the primary studies reviewed, a critical oversight given the metabolic continuum from gestational to overt type 2 diabetes [3]. Pathophysiologically, this article underexamines placental nutrient transport dynamics and neonatal counter-regulatory hormone responses, both of which modulate postnatal glycemia independent of intrapartum glucose trends [4]. This is conceptually underdeveloped in the framework of the review. While emerging data suggest a narrower-than-expected impact on neonatal glucose outcomes, such conclusions require prospective validation using standardized glycemic cutoffs, uniform timing of neonatal glucose sampling, and adjustment for feeding practices [5]. In the absence of such controls, the call to liberalize intrapartum glucose management may introduce iatrogenic risk. In summary, Bartal et al. provided an initial investigation into the evidence gap surrounding intrapartum glycemic thresholds. However, their argument requires bolstering through more rigorous evidence appraisal, biological contextualization, and data harmonization to support meaningful revisions in labor-ward protocols.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336229","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 Predictors and Outcomes of Early Noninvasive Positive Pressure Ventilation Failure in Very Preterm Infants: A Prospective Study.","authors":"Mustafa Senol Akin, Fatma Nur Sari, Aslihan Kose Cetinkaya, Ismail Cagri Acikgoz, Evrim Alyamac Dizdar","doi":"10.1055/a-2624-5642","DOIUrl":"https://doi.org/10.1055/a-2624-5642","url":null,"abstract":"<p><p>Limited data exist on predicting nasal intermittent positive pressure ventilation (NIPPV) failure in very preterm infants. This study aimed to identify factors predicting NIPPV failure, focusing on the fraction of inspired oxygen (FiO₂), and evaluating associated outcomes.This prospective observational study included infants with gestational ages between 23^0/7 and 31^6/7 weeks, who were managed with NIPPV as the initial respiratory support. Infants were categorized as either successfully managed with NIPPV (NIPPV-S) or failed and required intubation within the first 72 hours of life (NIPPV-F). Predictors of NIPPV failure and clinical outcomes were evaluated. ROC curve analysis was used to determine FiO₂ thresholds in the first and second hours of life. Demographic, perinatal, and respiratory parameters were analyzed using univariate and multivariate logistic regression models.Of the 397 infants, 121 (30.5%) failed NIPPV and required intubation. Multivariate analysis revealed that FiO₂ in the first hour, FiO₂ in the second hour, and mean airway pressure were independent predictors of NIPPV failure. The optimal FiO₂ threshold was 0.32 (sensitivity, 79% and specificity, 50%) for the first hour and 0.31 (sensitivity, 75% and specificity, 55%) for the second hour of life. NIPPV failure was associated with an increased risk of pneumothorax (adjusted odds ratio [aOR]: 16.83; 95% confidence interval [CI]: 2.05-138.45; <i>p</i> < 0.001), BPD (aOR: 2.61; 95% CI: 1.47-4.62; <i>p</i> < 0.001), and mortality (aOR: 2.37; 95% CI: 1.32-4.23; <i>p</i> < 0.001).FiO₂ is a valuable predictor of NIPPV success in the early hours of life. NIPPV failure, predicted by a FiO₂ exceeding 0.30 within the first 2 hours of life, is associated with adverse neonatal outcomes. · FiO2 > 0.30 in first 2 hours predicts NIPPV failure in very preterm infants.. · Early NIPPV failure is linked to increased risks of BPD, pneumothorax, and death.. · FiO2 and MAP are independent predictors of NIPPV failure..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309356","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}