American journal of perinatology最新文献

{"title":"Impact of the ARRIVE Trial on Stillbirth Rates in Nulliparous Individuals.","authors":"Rula Atwani, George Saade, Tetsuya Kawakita","doi":"10.1055/s-0044-1789018","DOIUrl":"10.1055/s-0044-1789018","url":null,"abstract":"<p><strong>Objective: </strong> We aim to examine the population-level rates of induction, stillbirth, perinatal mortality, and neonatal death before and after the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial.</p><p><strong>Study design: </strong> This study was a cross-sectional analysis of publicly available U.S. Live Birth data linked with Infant Death and Fetal Death certificate data from National Vital Statistics Online. We limited analyses to nulliparous individuals with singleton pregnancy and cephalic presentation who delivered at 39 weeks or greater. The pre- and post-ARRIVE periods spanned from August 2016 to July 2018, and from January 2019 to December 2020, respectively. Our primary outcome was a stillbirth. Secondary outcomes included induction of labor, perinatal mortality, and neonatal death. Outcomes were compared between the pre- and post-ARRIVE periods. Modified Poisson regression was used to calculate adjusted relative risks (aRRs).</p><p><strong>Results: </strong> Of 2,817,071 births, there were 1,454,346 births in the pre-ARRIVE period and 1,362,725 in the post-ARRIVE period; there were 1,196 and 1,062 stillbirths in the pre- and post-ARRIVE periods, respectively. Compared to the pre-ARRIVE period, the post-ARRIVE period was not associated with a significant decrease in the risk of stillbirth at 39 weeks or greater (aRR = 0.92 [95% confidence interval (95% CI): 0.85-1.00]) and stillbirth at 40 weeks or greater (aRR = 0.92 [95% CI: 0.82-1.04]). Compared to the pre-ARRIVE trial period, the post-ARRIVE trial was associated with increased rates of induction of labor at 39 weeks (aRR = 1.37 [95% CI: 1.37-1.38]) and 40 weeks (aRR = 1.24 [95% CI: 1.24-1.25]. Similar to stillbirth, there was no significant decrease in the risk of perinatal mortality at 39 weeks or greater or 40 weeks or greater. There was also no statistically significant change in neonatal death rates at 39 weeks or greater or at 40 weeks or greater.</p><p><strong>Conclusion: </strong> The increase in induction of labor at 39 weeks was not large enough to impact the stillbirth rate at 39 weeks or greater.</p><p><strong>Key points: </strong>· Post-ARRIVE trial, rate of induction of labor increased at 39 and 40 weeks.. · Post-ARRIVE trial, stillbirth and perinatal mortality rates remained unchanged.. · Induction rate rise post-ARRIVE trial did not impact neonatal death rates..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"401-408"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974841","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":"Mental Health Support and Screening for Mood Disorders for Caregivers in the Neonatal Intensive Care Unit: Is the Call to Arms Being Answered?","authors":"Megan Lagoski, Lamia Soghier, Joanne Lagata, Miller Shivers, Erin Sadler, Elizabeth Fischer, Adrienne Borschuk, Melissa House","doi":"10.1055/a-2353-0993","DOIUrl":"10.1055/a-2353-0993","url":null,"abstract":"<p><strong>Objective: </strong> Perinatal mood and anxiety disorders (PMADs) affect many neonatal intensive care unit (NICU) parents and are a significant risk factor for maternal suicide. Lack of screening and treatment interferes with infant development and bonding, compounding risks in fragile infants. We aim to describe PMAD screening in level IV NICUs across the Children's Hospitals Neonatal Consortium (CHNC) and to determine the relationship between standardized screening and mental health professionals (MHPs) presence.</p><p><strong>Study design: </strong> We surveyed experts at 44 CHNC NICUs about PMADs screening practices and presence of NICU-specific MHPs. Kruskal-Wallis test was used to examine relationships.</p><p><strong>Results: </strong> Of 44 centers, 34 (77%) responded. Fourteen centers (41%) perform screening with validated tools. Thirteen (38%) centers have NICU-dedicated psychologists. Formally screening centers tend to have higher cumulative MHPs (<i>p</i> = 0.089) than informally screening centers. Repeat screening practices were highly variable with no difference in the number of cumulative MHPs.</p><p><strong>Conclusion: </strong> Screening practices for PMADs vary across CHNC centers; less than half have additional MHPs beyond social workers. Creating a sustainable model to detect PMADs likely requires more MHPs in NICUs.</p><p><strong>Key points: </strong>· PMADs affect many NICU parents.. · Systematic screening for PMADs is limited in level IV children's hospital NICUs.. · Additional MHPs may contribute to enhanced screening and support of parents.. · Hospitals should prioritize funds for NICU-specific MHPs to optimize outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"320-326"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454643","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":"Renal Regional Oxygen Saturation and Acute Kidney Injury in Neonates with Perinatal Asphyxia.","authors":"Sergio Agudelo-Pérez, Gloria Troncoso, Daniel Botero-Rosas, Christian Muñoz, Andrés Rodríguez, Andrea Valentina Gómez, Jennifer León","doi":"10.1055/a-2369-6811","DOIUrl":"10.1055/a-2369-6811","url":null,"abstract":"<p><strong>Objective: </strong> Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO₂) during TH and AKI in neonates with moderate and severe perinatal asphyxia.</p><p><strong>Study design: </strong> This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO₂ was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO₂ levels into 12-hour periods. We analyzed the association between AKI and rSrO₂ levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO₂ for AKI by analyzing the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong> Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO₂ levels during TH. Specifically, rSrO₂ levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO₂ levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01-1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78-0.92) were significantly associated with AKI.</p><p><strong>Conclusion: </strong> An increase in rSrO₂ during the first 12 hours of TH and lower rSrO₂ levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH.</p><p><strong>Key points: </strong>· Neonates with asphyxia often develop AKI.. · Renal saturations are affected by hypothermia and asphyxia. · Patients with AKI initially show higher rSrO2, then lower rSrO2.. · Monitoring rSrO2 identifies early AKI..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"379-386"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726747","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":"Utilizing Fetal Echocardiography to Risk Stratify and Predict Neonatal Outcomes in Fetuses Diagnosed with Congenital Heart Disease.","authors":"Sanghee S Ro, Ian Milligan, Joe Kreeger, Michelle E Gleason, Andrew Porter, William Border, M Eric Ferguson, Ritu Sachdeva, Erik Michelfelder","doi":"10.1055/s-0044-1788718","DOIUrl":"10.1055/s-0044-1788718","url":null,"abstract":"<p><strong>Objective: </strong> Risk stratification of fetuses diagnosed with congenital heart disease (CHD) helps provide a delivery plan and prepare families and medical teams on expected course in the delivery room. Our aim was to assess the accuracy of echocardiographically determined risk-stratification assignments in predicting postnatal cardiac outcomes beyond the delivery room.</p><p><strong>Study design: </strong> This was a retrospective study at a single center evaluating all fetuses with CHD who were risk-stratified by echocardiographically determined level of care (LOC) assignment, ranging from 1a (lowest risk) to 4 (highest risk). All data were collected from January 1, 2017, to November 1, 2021. Outcomes included any unexpected cardiac interventions and neonatal clinical outcomes including in-hospital mortality, the need for prostaglandins or inotropes, and defined critical illness. These outcomes were assessed for each LOC assignment by Fisher's exact test.</p><p><strong>Results: </strong> Out of 817 patients assigned a LOC, a total of 747 fetuses were included in our final cohort with a separate subanalysis of 70 fetuses diagnosed with coarctation of the aorta. The sensitivity and specificity were high for all LOC levels in predicting delivery room needs (93-100%). Higher LOC levels (3-4) had a lower positive predictive value (66-67%) indicating a high false-positive rate. Subjects with higher LOC assignments had a greater frequency of critical illness, hospital mortality, need for inotropes, need for neonatal surgical or catheterization interventions, and need for prostaglandins (<i>p</i> < 0.001 for all outcomes). A post-hoc analysis reviewing LOC assignments revealed a greater tendency to over-assign LOC at higher assignments (19% for LOC 3 and 4) compared to lower assignments (4% for LOC 1 and 2).</p><p><strong>Conclusion: </strong> Risk stratification based on fetal echocardiography can predict neonatal clinical outcomes and acuity of postnatal management needs. However, there is greater variability in expected clinical events and an expected degree of false positives for those with higher LOC assignments.</p><p><strong>Key points: </strong>· Risk stratification utilizing fetal echocardiography can be used to predict neonatal needs.. · Complex heart disease has lower positive predictive value in predicting postnatal clinical needs.. · There is a tendency to over-assign risk of acute hemodynamic instability for complex heart disease.. · False positives are expected when planning high-risk deliveries to avoid compromising situations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"369-378"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791678","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":"Affordable Implementation of a Point-of-Care Ultrasound Program in a Large Tertiary Neonatal Intensive Care Unit to Assess Umbilical Venous Catheter Tips and Aid Central Placement.","authors":"John T Wren, Azadeh Eslambolchi, Kristen Clark, Tasnim Najaf","doi":"10.1055/a-2358-6632","DOIUrl":"10.1055/a-2358-6632","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to implement a point-of-care ultrasound (POCUS) program into a large neonatal intensive care unit (NICU) to enhance care by improving (1) umbilical venous catheter (UVC) tip identification and (2) central placement.</p><p><strong>Study design: </strong> A POCUS program was established with core providers who received training from external and internal experts. A prospective study (<i>n</i> = 94) compared the accuracy of UVC identification between neonatology-performed ultrasound (NeoUS) and X-ray relative to a referent of radiology-interpreted ultrasound. Finally, an ultrasound-guided UVC insertion protocol was introduced to rescue noncentral traditionally placed catheters (<i>n</i> = 37).</p><p><strong>Results: </strong> Program implementation trained six providers for a total cost of approximately $10,500 USD. NeoUS was more accurate than X-ray at identifying UVC location (81.9 vs. 60.6%) with improved sensitivity and specificity (80.0 and 84.6 vs. 52.5 and 66.7%, respectively). POCUS guidance was able to rescue 89.2% of catheters that were originally noncentral.</p><p><strong>Conclusion: </strong> POCUS implementation in a large NICU is feasible, affordable, and can improve quality of care.</p><p><strong>Key points: </strong>· POCUS implementation is feasible and affordable.. · POCUS is more accurate than X-ray at monitoring UVCs.. · Central UVC placement can be increased with POCUS..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"334-341"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490544","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":"Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis.","authors":"Salma El Emrani, Lotte E van der Meeren, Esther J S Jansen, Jelle J Goeman, Jacqueline U M Termote, Enrico Lopriore, Nicoline E Schalij-Delfos","doi":"10.1055/a-2369-6690","DOIUrl":"10.1055/a-2369-6690","url":null,"abstract":"<p><strong>Objective: </strong> Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP.</p><p><strong>Study design: </strong> Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration.</p><p><strong>Results: </strong> Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96-3.79, <i>p</i> = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68-2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis.</p><p><strong>Conclusion: </strong> Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP.</p><p><strong>Key points: </strong>· This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.. · Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.. · Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"387-394"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11793952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726746","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":"Maternal Preconception Omega-6, Omega-3, and Omega-6:Omega-3 Intake and Uterine Artery Indices in Mid-Gestation.","authors":"Amara Finch, Lisa Joss-Moore, Amanda A Allshouse, Nathan Blue, David M Haas, William Grobman, Samuel Parry, George Saade, Robert M Silver","doi":"10.1055/a-2351-9810","DOIUrl":"10.1055/a-2351-9810","url":null,"abstract":"<p><strong>Objective: </strong> Maternal preconception diet influences pregnancy health and fetal outcomes. We examined the relationship between preconception fatty acid (FA) intake and uterine artery indices in mid-gestation in a large, heterogeneous cohort of nulliparous individuals.</p><p><strong>Study design: </strong> This is a secondary analysis of the nuMom2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be) study. Dietary ω-6 and ω-3 FA intake was assessed with food frequency questionnaires and uterine artery indices were obtained via Doppler studies in the second trimester. For our primary outcome of pulsatility index (PI) > 1.6, we compared proportions by each dichotomous FA exposure and tested differences with chi-square test.</p><p><strong>Results: </strong> For PI > 1.6, odds ratio for the unfavorable FA quartile compared with remaining quartiles for the exposures were 0.96 to 1.25, <i>p</i> = 0.157 (ω-6 FA); 0.97 to 1.26, <i>p</i> = 0.124 (ω-3 FA); 0.87 to 1.14, <i>p</i> = 1.00 (ω-6:ω-3 FA ratio).</p><p><strong>Conclusion: </strong> No significant associations between self-reported maternal preconception ω-6 and ω-3 FA intake and uterine artery Doppler indices measured during the second trimester were observed.</p><p><strong>Key points: </strong>· Maternal diet impacts pregnancy health/fetal outcomes.. · ω-3 and ω-6 FA intake influences cardiovascular health.. · FA intake may affect blood flow to fetoplacental unit.. · Results are limited by inadequate adherence to dietary recommendations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"310-319"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141449413","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":"Outcomes in Pregnancies Complicated with Preterm Hypertensive Disorders with and without Late Antenatal Corticosteroids.","authors":"Noam Regev, Michal Axelrod, Chen Berkovitz, Rakefet Yoeli-Ulman, Shali Mazaki-Tovi, Eyal Sivan, Baha Sibai, Michal Fishel Bartal","doi":"10.1055/s-0044-1788609","DOIUrl":"10.1055/s-0044-1788609","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to determine whether administration of a late preterm (34-36 weeks) course of antenatal corticosteroids (ACS) is associated with improved short-term neonatal outcomes among pregnancies complicated with hypertensive disorders of pregnancy (HDP) who delivered in the late preterm period.</p><p><strong>Study design: </strong> A single tertiary center retrospective cohort study, including pregnant individuals with singleton fetuses who delivered between 34.0 and 36.6 weeks following an HDP diagnosis. Exclusion criteria were major fetal anomalies and treatment with ACS before 34 weeks. Cases were divided into two groups: exposed group, consisting of individuals treated with a late ACS course, and nonexposed group, receiving no ACS. The primary outcome was a composite adverse neonatal outcome, including intensive care unit admission, oxygen treatment, noninvasive positive pressure ventilation, mechanical ventilation, respiratory distress syndrome, transient tachypnea, or apnea of prematurity. Secondary neonatal outcomes included birth weight, Apgar score, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, surfactant use, hypoglycemia, hyperbilirubinemia, sepsis, and neonatal death. Multivariable regression models were used to determine adjusted odds ratio (aOR)and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Of 7,624 preterm singleton deliveries during the study period, 438 (5.7%) were diagnosed with HDP and delivered between 34.0 and 36.6 weeks. Infants who received ACS were diagnosed more commonly with fetal growth restriction (16.0 vs. 5.6%, <i>p</i> < 0.01) and were delivered at an earlier gestational age (GA) (mean GA: 35.6 vs. 36.3 weeks, <i>p</i> < 0.01). The composite neonatal morbidity did not differ between the groups after adjustments (aOR: 0.97, 95% CI: 0.47, 1.98). Neonatal hypoglycemia and hyperbilirubinemia were more common in the exposed group than in the nonexposed group (46.9 vs. 27.4%; aOR: 2.27; 95% CI: 1.26, 4.08 and 64.2 vs. 46.5%; aOR: 2.08; 95% CI: 1.16, 3.72 respectively).</p><p><strong>Conclusion: </strong> In people with HDP, a course of ACS given in the late preterm period did not improve neonatal morbidity.</p><p><strong>Key points: </strong>· In people with HDP, a late preterm ACS course did not improve neonatal morbidity.. · Respiratory morbidity rate was similar between infants who received late ACS and those who did not.. · Neonatal hypoglycemia and hyperbilirubinemia were more common in infants who received late ACS..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"342-349"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756589","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":"Increased Respiratory Syncytial Virus-Associated Hospitalizations and Ambulatory Visits in Very Preterm Infants in the First Year of Life following Discontinuation of Access to Palivizumab.","authors":"Yolanda Evong, Jiaxin Luo, Lingyun Ye, John Fahey, Janis L Breeze, Rebecca Attenborough, Kenny Wong, Joanne M Langley","doi":"10.1055/a-2512-9453","DOIUrl":"10.1055/a-2512-9453","url":null,"abstract":"<p><strong>Objective: </strong> From 2002 to 2023, palivizumab was the only intervention to reduce respiratory syncytial virus (RSV)-associated hospitalizations in high-risk infants in Canada but advances in RSV prevention are drastically changing this landscape. Eligibility criteria for this monoclonal antibody for preterm infants varied over time across each of 10 Canadian provinces and 3 territories. The National Professional Pediatric Association (Canadian Pediatric Society) revised its eligibility recommendations in 2015, removing access for preterm infants 30 to 32 weeks gestation (WG). The province of Nova Scotia followed these recommendations the next season. This study aimed to determine if the removal of access to palivizumab in these previously eligible infants was associated with a change in hospital admissions, deaths, or ambulatory visits associated with RSV.</p><p><strong>Study design: </strong> We identified a retrospective cohort of Nova Scotia infants born between 30 and 32 WG, without other risk factors for RSV-H, from April 2012 to September 2019 by linking six population-based provincial databases, and followed each infant through the first year of life. Episodes of RSV-associated hospitalization (RSV-H), ambulatory visits (RSV-A), or death were identified by the International Statistical Classification of Diseases and Related Health Disorders (ICD) RSV-associated diagnostic codes.</p><p><strong>Results: </strong> Of 4,835 infants born during the study period, 250 were 30 to 32 WG and eligible for the cohort. RSV-H increased approximately 10-fold following restricted access to palivizumab (from no RSV-H (0/123) to 9.4%; 95% CI 5.0, 15.9; risk difference 9.4), but no RSV-associated deaths occurred. RSV-A also increased from 5.7 to 17.3% (risk difference 11.6).</p><p><strong>Conclusion: </strong> Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants was associated with a higher risk of RSV-H and RSV-A. Evaluation of health care policy change on patient well-being is essential to assess the impact and guide future decision-making at the population level.</p><p><strong>Key points: </strong>· Discontinuation of access to a prophylactic anti-RSV monoclonal antibody in very preterm infants 30 to 32 WG was associated with a higher risk of RSV-H and RSV-A. Evaluation of changes to health care policy on patient well-being is essential to assess impact and guide future decision-making at the population level.. · Removing access to palivizumab led to higher RSV admissions in 30 to 32 WG infants.. · The effect of health care policy changes on child well-being should be assessed routinely.. · No deaths associated with RSV were identified prior to or after the policy change..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942631","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":"Pathohistological Changes in the Lungs of Very Preterm Infants with Bronchopulmonary Dysplasia Depending on the Clinical Features.","authors":"Anna O Menshykova, Dmytro O Dobryanskyy","doi":"10.1055/a-2511-8702","DOIUrl":"https://doi.org/10.1055/a-2511-8702","url":null,"abstract":"<p><strong>Objective: </strong> Establishing clinical factors associated with histological changes in the lungs of very preterm infants with evolving or established bronchopulmonary dysplasia (BPD) is essential for the development of more effective preventive interventions.</p><p><strong>Study design: </strong> Thirty-two infants with a gestational age (GA) of <32 weeks who died of BPD or had BPD but died due to other causes were included in the study. The associations of clinical data with histopathological changes in the lungs were assessed.</p><p><strong>Results: </strong> The mean (standard deviation) GA of infants was 26.7 (1.9) weeks, and the mean birth weight was 919.7 (242.9) g. We revealed significant associations of maternal smoking with vascular hypertension lesions (<i>r</i> _s = 0.5, <i>p</i> < 0.05) in infants' lungs. Intrauterine growth retardation increased the risk of extensive fibroproliferation (<i>r</i> _s = 0.4, <i>p</i> < 0.05). In infants with patent ductus arteriosus (PDA) requiring treatment, muscle hyperplasia (<i>r</i> _s = 0.5, <i>p</i> < 0.05) was detected more often. The longer duration of mechanical ventilation (MV) correlated with diffuse interstitial fibroproliferation (<i>r</i> _s = 0.5, <i>p</i> < 0.05), airway epithelial lesions (<i>r</i> _s = 0.3, <i>p</i> < 0.05), and airway muscle hyperplasia (<i>r</i> _s = 0.4, <i>p</i> < 0.05). In infants who needed the longer MV and/or oxygen supplementation, an increased incidence of extensive fibroproliferation was found (<i>r</i> _s = 0.4 and <i>r</i> _s = 0.4 respectively, <i>p</i> < 0.05). Antenatal steroids decreased the incidence of diffuse interstitial fibrosis (<i>r</i> _s = - 0.4, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong> In very preterm infants with a GA of less than 32 weeks, lack of antenatal steroid prophylaxis, intrauterine growth restriction, presence of hemodynamically significant PDA, and prolonged MV or oxygen supplementation are associated with the pathomorphological lung changes that are more typical for \"old\" BPD. Traditional preventive measures against BPD remain essential in a modern population of very preterm infants.</p><p><strong>Key points: </strong>· Pathomorphological lung changes correlate with clinical data in very preterm infants who died of BPD.. · Lack of antenatal steroids prophylaxis, growth retardation, PDA, and prolonged mechanical ventilation affect lungs.. · Traditional BPD preventive measures remain essential in the modern population of preterm infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073281","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}