American journal of perinatology最新文献

{"title":"PERINATAL OUTCOMES IN PREGNANCIES IMMEDIATELY FOLLOWING STILLBIRTH - A MULTICENTER, PROSPECTIVE, OBSERVATIONAL STUDY.","authors":"Martina Benuzzi, Riccardo Cuoghi Costantini, Antonio Saddò, Camilla Selleri, Sara Verra, Beatrice Melis, Gloria Guariglia, Laura Avagliano, Caterina Serena, Federico Mecacci, Benedetta Baggio, Benedetta Gabbrielli, Stefania Fieni, Ariane Jeanne Odette Kiener, Caterina Pavan, Marinunzia Salluce, Sabrina Cozzolino, Anna Locatelli, Silvia Alongi, Paola Camponovo, Sara Lazzarin, Isabella Neri, Fabio Facchinetti, Antonio La Marca, Francesca Monari","doi":"10.1055/a-2661-4287","DOIUrl":"https://doi.org/10.1055/a-2661-4287","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of pregnancies immediately following stillbirth in relation to treatments prescribed.</p><p><strong>Study design: </strong>A prospective, observational study was conducted in patients with a history of stillbirth (≥ 22 weeks) between 2014 and 2022 across four Italian University Hospitals. Outcomes were stratified based on the cause of previous fetal death (classified according with ReCoDe classification) and treatment (low dose aspirin (LDA), low molecular weight heparin (LMWH), both, progesterone or other drugs). The main outcome was adverse neonatal outcome, including perinatal death, stillbirth recurrence, intrauterine growth restriction, early preterm birth, Apgar <7 at 5 minutes and need for neonatal resuscitation. The secondary outcome was adverse maternal outcome, including postpartum hemorrhage, emergency cesarean delivery and operative vaginal delivery.</p><p><strong>Results: </strong>Among 308 subsequent pregnancies, 46 (14.94%) had an adverse neonatal outcome, including 4 stillbirths. A total of 76 pregnancies (24.68%) experienced adverse maternal outcome, and 19 pregnancies (6.17%) had both. In individuals with previous placental vascular disorders, adverse neonatal outcomes were reduced by 75% when treated with LDA+ LMWH (OR 0.25, 95% CI 0.06-1.03, p=0.049). However, adverse maternal outcome was significantly higher in individuals who received LDA+LMWH without specific indications (OR 3.07, 95% CI 1.07-8.78, p=0.036).</p><p><strong>Conclusions: </strong>LDA and LMWH should be prescribed only for previous placental vascular disorders to improve adverse neonatal outcome and avoid unnecessary maternal risk.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal timing of delivery in pregnant individuals with pregestational diabetes mellitus.","authors":"Rebecca Fleenor, Victoria C Jauk, Macie Champion, Ashley N Battarbee","doi":"10.1055/a-2657-6130","DOIUrl":"https://doi.org/10.1055/a-2657-6130","url":null,"abstract":"<p><strong>Introduction: </strong>SMFM and ACOG recommend delivery of gravidae with pregestational diabetes at 36-39 6/7 weeks based on glycemic control and vascular complications. The optimal gestational age within this wide range is unknown. Our objective was to evaluate the risk of adverse outcomes with delivery versus expectant management at increasing gestational ages.</p><p><strong>Methods: </strong>Retrospective cohort study of gravidae with pregestational diabetes who delivered a non-anomalous singleton at 36 weeks (2012-2022). The primary outcome was composite neonatal morbidity: hypoglycemia, hyperbilirubinemia, shoulder dystocia, and perinatal death. Secondary outcomes included composite components, composite severe neonatal morbidity, LGA, SGA, NICU admission and cesarean. Poisson regression with robust error variance estimated the association between delivery at 36, 37, and 38 weeks and outcomes, compared with expectant management.</p><p><strong>Results: </strong>843 gravidae met inclusion criteria: 235 (28%) type 1 diabetes and 602 (71%) type 2 diabetes. Overall, 146 (17%) delivered at 36 weeks, 283 (34%) at 37 weeks, 217 (26%) at 38 weeks, and 197 (23%) at 39 weeks. Compared with expectant management, delivery at 36 weeks was associated with higher odds of composite morbidity (aRR 1.31, 95% CI 1.11-1.55) as well as hypoglycemia, hyperbilirubinemia, SGA and NICU admission. At 37 and 38 weeks, there was no significant difference in composite morbidity among those delivered versus expectantly managed. However, delivery at 37 weeks was associated with higher odds of hyperbilirubinemia, compared with expectant management. No other outcomes differed between with delivery versus expectant management at 37 or 38 weeks. Few associations differed by diabetes type.</p><p><strong>Conclusion: </strong>Based on these results and supporting literature, elective delivery at 36 weeks should be avoided unless necessary. Although the data are inconclusive regarding delivery at 37 weeks, delivery at 38 weeks should be evaluated further for gravidae with pregestational diabetes. Confirmation in a large, contemporary cohort or a randomized trial are needed.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658142","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":"Microplastics and the Placenta: A Call to Action for Perinatal Research.","authors":"Jamie Kim, Marcia Chen, Robert S White","doi":"10.1055/a-2657-6249","DOIUrl":"https://doi.org/10.1055/a-2657-6249","url":null,"abstract":"<p><p>Microplastics have been detected in human placental and neural tissues, raising urgent concerns about their potential effects on maternal and fetal health. Emerging evidence links microplastics to systemic inflammation, neurotoxicity, and endocrine disruption, yet their impact on pregnancy outcomes and fetal development remains poorly understood. Given the placenta's central role in early-life health, perinatal researchers are uniquely positioned to lead investigations into this environmental threat. We call for collaborative, multidisciplinary research to better understand and mitigate the effects of microplastic exposure during pregnancy.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658141","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":"Predictive factors of fetal cardiac manifestations of neonatal lupus in anti-SSA and/or Ro-SSB/La antibody-positive pregnant women.","authors":"Jian Wu, Yanping Ruan, Hairui Wang, Xiaoyan Gu, Jiancheng Han, Yihua He","doi":"10.1055/a-2657-6178","DOIUrl":"https://doi.org/10.1055/a-2657-6178","url":null,"abstract":"<p><strong>Objective: </strong>The factors associated with the development of cardiac manifestations of neonatal lupus (cardiac-NL) in fetuses with positive anti-SSA/Ro and/or SSB/La (anti-SSA/SSB) antibodies are unclear. This study aimed to investigate the predictive factors of fetal cardiac-NL in anti-SSA/SSB antibody-positive pregnant women.</p><p><strong>Study design: </strong>A total of 669 pregnant women with positive anti-SSA/SSB antibodies were retrospectively included. We determined whether the fetus had cardiac-NL and collected relevant clinical data. Univariate and multivariate analyses were performed to analyze the correlation between fetal cardiac-NL and clinical characteristics.</p><p><strong>Results: </strong>Among 669 pregnant women with positive anti-SSA/SSB antibody tests, 26 cases of fetal cardiac-NL occurred. Univariate analysis showed that fetal cardiac-NL was positively correlated with the assisted reproduction (OR 2.824, P = 0.045), strong positive anti-SSA/SSB antibody (OR 6.437, P < 0.001), and clinical diagnosis of connective tissue disease (CTD) (OR 4.701, P = 0.037); it was negatively correlated with the use of hydroxychloroquine (HCQ) (OR 0.187, P < 0.001) and aspirin (OR 0.369, P = 0.048). Multivariate analysis showed that the assisted reproduction (OR 4.110, P = 0.029), strong positive anti-SSA/SSB antibody (OR 8.691, P < 0.001), and clinical diagnosis of CTD (OR 8.614, P = 0.010) were risk factors for fetal cardiac-NL; while HCQ (OR 0.091, P < 0.001) and aspirin (OR 0.318, P = 0.035) were protective factors for fetal cardiac-NL.</p><p><strong>Conclusion: </strong>This study determined that assisted reproduction, strong positive anti-SSA/SSB antibody, and clinical diagnosis of CTD are independent risk factors for fetal cardiac-NL. The use of HCQ and aspirin are independent protective factors for fetal cardiac-NL.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658143","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":"Minimally Invasive Adhesiolysis for the Incarcerated Gravid Uterus: A Case Report of Early Second Trimester Intervention.","authors":"Michelle Wenjing Hsia, Andrew Greene, Sarah White, Sierra Mims, Eva Reina","doi":"10.1055/a-2640-3131","DOIUrl":"https://doi.org/10.1055/a-2640-3131","url":null,"abstract":"<p><strong>Introduction: </strong>Incarceration of the gravid uterus is a rare obstetric complication in which the retroverted uterus becomes trapped in the pelvis, often resulting in maternal and fetal morbidity if not recognized and managed early.</p><p><strong>Case report: </strong>We present the case of a 36-year-old multigravida at 15 weeks' gestation with no prior abdominal surgeries who initially presented with urinary retention and was diagnosed with an incarcerated gravid uterus. Multiple attempts at manual reduction under spinal and general anesthesia were unsuccessful. Intraoperative transabdominal ultrasound demonstrated a live intrauterine pregnancy with normal fetal heart rate, a uterine fundus wedged behind the sacral promontory consistent with persistent incarceration and raised concern for a Grade 1 (minor) placenta previa. Diagnostic laparoscopy revealed dense posterior adhesions between the uterus and sigmoid mesentery. Adhesiolysis was performed, resulting in successful uterine repositioning and symptom resolution. Although the patient initially recovered well, she re-presented with vaginal bleeding with resolution of her previa but with evidence of chorion-amnion separation. Ultimately, she experienced previable preterm premature rupture of membranes and was subsequently diagnosed with intrauterine fetal demise at 22 weeks and 4 days. Placental pathology demonstrated severe acute chorioamnionitis, funisitis, umbilical vasculitis, and features of uteroplacental underperfusion.</p><p><strong>Conclusion: </strong>This case demonstrates the role of laparoscopy in management of gravid uterine incarceration refractory to manual reduction. It also underscores that technically successful surgical intervention may not preclude adverse pregnancy outcomes, emphasizing the importance of close antenatal surveillance.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648211","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":"Evaluation of Oxidative Stress, Antioxidant Capacity, Thiol/Disulfide Homeostasis, and HO-1 Levels in Neonates with Cyanotic Congenital Heart Disease: A Prospective Case-Control Study.","authors":"Abdullah Kurt, Cuneyt Tayman, Ufuk Cakir, İsmail Koyuncu","doi":"10.1055/a-2656-9689","DOIUrl":"https://doi.org/10.1055/a-2656-9689","url":null,"abstract":"<p><strong>Objective: </strong>Oxidative stress is a major contributor to the pathogenesis of cyanotic congenital heart disease (CCHD), yet data in neonates are limited. This study aimed to assess oxidative stress markers, thiol/disulfide homeostasis, and heme oxygenase-1 (HO-1) levels in neonates with CCHD.</p><p><strong>Study design: </strong>A prospective case-control study was conducted including 62 term neonates with CCHD and 63 healthy controls. Serum levels of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), native and total thiol, disulfide (SS), and HO-1 were measured within 72 hours of birth. Thiol/disulfide ratios were calculated. Survival-based subgroup and receiver operating characteristic (ROC) analyses were performed.</p><p><strong>Results: </strong>CCHD neonates had significantly elevated TAS, TOS, and OSI levels, and reduced HO-1, native thiol, and total thiol levels compared to controls (p<0.001) CCHD neonates had significantly decreased TAS, elevated TOS and OSI levels, and reduced HO-1, native thiol, and total thiol levels compared to controls (p<0.001). Disulfide/native thiol and disulfide/total thiol ratios were significantly increased, while the native thiol/total thiol ratio was decreased (p<0.05), indicating oxidative imbalance. Among non-survivors, lower HO-1 and thiol levels and higher oxidative stress markers were observed, though not all reached statistical significance (p<0.05) (p>0.05). ROC analysis showed that TOS (cut-off >12.96; sensitivity 96.83%) and OSI (cut-off >0.86; specificity 86.96%) were strong predictors. HO-1 showed excellent diagnostic accuracy (The area under the curve (AUC): 0.980)HO-1 and oxidative stress parameters showed excellent diagnostic accuracy(OSI[AUC: 0.942], TOS [AUC: 0.927], TAS [AUC: 0.904], HO-1 [AUC: 0.859]).</p><p><strong>Conclusion: </strong>Neonates with CCHD exhibit significant oxidative stress and impaired antioxidant defense early in life. Suppressed HO-1 expression and disturbed thiol/disulfide balance suggest increased vulnerability to oxidative injury. These biomarkers may serve as early indicators for clinical risk stratification and could guide antioxidant-based therapeutic strategies.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648210","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 Caregiver Interaction with the NICU Environment during Medication Administration May Contribute to Higher Infection Rates: A Pilot Observational Study.","authors":"Mark Nolan, Belinda Chan, Catherine Loc-Carrillo, Angela Parker, Dan France, Peter H Grubb, Frank Drews","doi":"10.1055/a-2641-9863","DOIUrl":"https://doi.org/10.1055/a-2641-9863","url":null,"abstract":"<p><p>After nearly 3 years without a single central line-associated bloodstream infection (CLABSI), our neonatal intensive care unit (NICU) experienced a significant rise in CLABSI rates beginning in 2019. The increase coincided with changes made to the intravenous (IV) medication pump integration process, which added more safety checks and procedural steps. This study aimed to investigate the potential association between these process changes and increased CLABSI and non-CLABSI (bloodstream infection, BSI) rates prior to inclusion in a future QI project Key Driver Diagram.This observational pilot study used a mixed-methods approach, including statistical process control analysis to confirm a special-cause increase in CLABSI rate, human factors observations, and environmental microbiome sampling focusing on the equipment involved in the IV pump integration. We compared these findings to the CLABSI and BSI rates to identify temporal and geographic associations.Following the 2019 implementation of IV pump integration, statistically significant increases in CLABSI and BSI rates were observed. The enhanced safety checks added steps to IV medication administrations, with timestamp observation indicating up to 14 location changes around the bed spaces and a mean of 5.5 minutes for any IV medication administration. Environmental microbial sampling showed a 27% positivity rate. The highest microbial burden was found on patient-specific mobile equipment (30%) used during IV medication administration, including isolettes, IV hubs, and glove boxes, compared with other equipment (26%) like nursing computers or ventilators (<i>p</i> = 0.093). A strong overlap was observed between the microorganisms found in the NICU environment and those responsible for positive patient blood cultures, particularly coagulase-negative <i>Staphylococcus</i> (CONS).Though not statistically significant, the findings suggest that the added complexity and extended duration of the modified IV pump integration process may have increased the frequency of caregiver interactions with the NICU environment, exposing immune-vulnerable NICU patients to a higher risk of infection. Further human factors analysis and quality improvement efforts are necessary to simplify the IV medication administration process, reduce environmental microbial loads, and decrease infection rates. · Increased CLABSI/BSI rates post-IV pump integration.. · High microbial load on equipment related to the IV medication administration process.. · Process changes with IV pump integration to enhance patient safety may have unintended consequences, like increasing caregiver-environment interaction and patient infection rates..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635885","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":"Increasing the Rates of Postpartum Measles, Rubella, and Varicella Vaccination in Non-Immune Mothers: an Electronic Medical Record-Based Quality Improvement Intervention.","authors":"Jiwoo Park, Daniel Kwon, Rachel Sue, Kajol Bahl, Anya Wang, Sophia Gamboa, Anne S Linker, Reem Aoun, Cynthia Abraham","doi":"10.1055/a-2651-6147","DOIUrl":"https://doi.org/10.1055/a-2651-6147","url":null,"abstract":"<p><strong>Objective: </strong>Postpartum measles, mumps, rubella (MMR) and varicella vaccination is critical for non-immune mothers to prevent severe maternal and neonatal complications. Despite recommendations, vaccination rates remain suboptimal, particularly in completing the two-dose series. This study evaluates the impact of an electronic medical record (EMR)-based intervention on postpartum MMR and varicella vaccination rates.</p><p><strong>Study design: </strong>A retrospective cohort study was conducted at two care centers within an urban tertiary healthcare system. Non-immune postpartum patients with public insurance who delivered between January 2021 and June 2022 and February 2023 and October 2024 were included in the pre- and post-intervention groups, respectively. The intervention, implemented in April 2023, modified the mandated postpartum checklist in the EMR to include measles immunity status and emphasize the necessity of completing the two-dose series for MMR and varicella. The primary outcome was the completion rate of the two-dose series, with secondary outcomes assessing provider adherence and patient acceptance. Statistical analyses included chi-squared and t-tests to compare pre- and post-intervention cohorts.</p><p><strong>Results: </strong>A total of 468 patients were included (220 pre-intervention, 248 post-intervention). MMR series completion significantly increased from 2.3% to 34.9% (p<0.001). Varicella series completion showed a non-significant upward trend from 27.0% to 36.5% (p=0.112). Provider adherence improved, with fewer missed opportunities to offer the second dose at the postpartum visit (49.6% vs. 32.9%, p=0.004 for MMR). Patient declination rates remained stable.</p><p><strong>Conclusion: </strong>Integrating vaccination reminders into the EMR significantly improved postpartum MMR series completion. While varicella rates showed a modest increase, persistent provider follow-up and patient education remain crucial. Future efforts should focus on addressing systemic barriers and enhancing patient outreach to further optimize postpartum vaccination completion.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599102","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 toward Evidence-Based Management\".","authors":"Saketh S Mandiga, Rachana Mehta, Ranjana Sah","doi":"10.1055/a-2640-3185","DOIUrl":"10.1055/a-2640-3185","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-08","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":"ECMO Use in Neonates with Hypoxic-Ischemic Encephalopathy: A State-of-the-Art Narrative Review of Feasibility, Efficacy, and Safety.","authors":"Efren Diaz, Rafael Lemus, Syed Talha Ahmed, Stephen Couch, Lina Chalak, Robert Digeronimo, Abhishek Makkar","doi":"10.1055/a-2632-9833","DOIUrl":"10.1055/a-2632-9833","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is an important rescue strategy for neonates with severe cardiorespiratory failure, yet its role in the management of hypoxic-ischemic encephalopathy (HIE) remains subject to debate. Historically, clinicians have been reluctant to offer ECMO to infants with significant neurological injury because of concerns related to poor neurodevelopmental outcomes and elevated risk of complications such as hemorrhage and stroke. Over the past two decades, however, accumulating evidence has suggested that many neonates with HIE not only tolerate ECMO well but may also achieve meaningful survival and functional recovery. In this state-of-the-art narrative review, we surveyed and synthesized observational studies, retrospective cohorts, and case series published since 2000 that evaluated ECMO in neonates with HIE. While randomized controlled trials dedicated exclusively to this population remain scarce, the available data indicate that ECMO can be safely implemented alongside standard therapies-including therapeutic hypothermia-without uniformly prohibitive rates of bleeding or adverse neurodevelopment. Although small sample sizes and single-center experiences limit the strength of these conclusions, survival rates in combined TH-ECMO cohorts are often reported above 80 to 90%, with a substantial proportion of survivors demonstrating acceptable early neurodevelopmental outcomes. Overall, the growing clinical acceptance of ECMO in HIE highlights the need for careful, individualized assessment of benefits and risks, as well as transparent discussions with families. Future multicenter collaborations focusing on robust longitudinal follow-up and evidence-based protocols will be essential to guide best practices and optimize outcomes for this high-risk neonatal population.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281974","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}