American journal of perinatology最新文献

{"title":"Early Effective Antibiotic Therapy and Meningitis Following a Bloodstream Infection in Hospitalized Infants: A Cohort Study.","authors":"Jessica E Ericson, Rachel Greenberg, P Brian Smith, Reese Clark, Daniel K Benjamin, Ryan Kilpatrick","doi":"10.1055/a-2568-7085","DOIUrl":"https://doi.org/10.1055/a-2568-7085","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the role of early effective antibiotic therapy in preventing secondary meningitis as a sequelae of bacterial bloodstream infections (BSI).</p><p><strong>Study design: </strong>In this multicenter cohort study, we identified blood cultures that were positive for Group B Streptococcus (GBS), Staphylococcus aureus, Escherichia coli, and other non-E. coli gram-negative bacteria that had a corresponding cerebrospinal fluid sample collected ≤7 days after the positive blood culture among infants discharged from a neonatal intensive care unit managed by the Pediatrix Medical Group 2002 - 2020. The odds of secondary meningitis for early effective antibiotic therapy vs delayed antibiotic therapy were compared using an adjusted logistic regression model. The odds of secondary meningitis following GBS BSI were compared for infections treated with empirical vancomycin vs beta-lactam antibiotic.</p><p><strong>Results: </strong>Secondary meningitis was identified in 11% of 5967 BSI. Early effective antibiotic therapy was not associated with a reduced odds of secondary meningitis for GBS (aOR 1.17; 95% CI, 0.82-1.66) or E. coli (aOR 1.06; 95% CI, 0.82-1.38); however, was associated with decreased odds for non-E. coli gram-negative bacteria (aOR 0.69; 95% CI, 0.49-0.98) and S. aureus (aOR 0.51; 95% CI, 0.34-0.74). GBS BSI were more often complicated by meningitis when vancomycin was used empirically compared to beta-lactam antibiotic (aOR 2.01; 95% CI, 1.28- 3.14).</p><p><strong>Conclusion: </strong>Early effective antibiotic therapy for BSI in infants did not reduce the odds of secondary meningitis caused by GBS or E. coli; however, early effective antibiotic therapy did reduce episodes due to non-E. coli gram-negative bacteria and S. aureus.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741897","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":"RSV vaccination in pregnancy and social determinants of health .","authors":"Meralis Lantigua-Martinez, Cody Goldberger, Rosanne Vertichio, Julia Kim, Hye Heo, Ashley S Roman","doi":"10.1055/a-2568-8489","DOIUrl":"https://doi.org/10.1055/a-2568-8489","url":null,"abstract":"<p><strong>Objective: </strong>Social determinants of health (SDOH) may impact the incidence of Respiratory Syncytial Virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy.</p><p><strong>Design: </strong>This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving vs not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test.</p><p><strong>Result: </strong>2181 patients met inclusion criteria and RSV vaccination information was available for 1548 patients (71%) with a 14% vaccination rate. Compared to those not vaccinated (n=1332), RSV vaccinated patients (n=216) were more likely to be older (30.7 vs 34.8, p<0.001), have private insurance (42% vs 85%, p<0.001), speak English (82% vs 95%, p<0.001), and deliver at our regional perinatal center (26% vs 77%, p<0.001). 50% of RSV vaccinated patients had a history of COVID vaccination compared to 33% of those not vaccinated against RSV (p<0.001).</p><p><strong>Conclusions: </strong>SDOH were associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741944","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 pre-pregnancy obesity versus excessive gestational weight gain with adverse maternal outcomes in the United States.","authors":"Rodney McLaren, Deepa Rastogi, Shantanu Rastogi","doi":"10.1055/a-2568-9060","DOIUrl":"https://doi.org/10.1055/a-2568-9060","url":null,"abstract":"<p><strong>Objective: </strong>Pre-pregnancy BMI >30 kg/m2 or obesity (PPO) and excessive gestational weight gain (eGWG) are associated with increased risks for adverse maternal outcomes. There is little is known regarding the individual effects of PPO and eGWG. The objective of this study was to compare the effects of PPO and eGWG with adverse maternal outcomes.</p><p><strong>Methods: </strong>This was a retrospective cohort study of singleton, live births in the United States in 2018 using data from the National Vital Statistics System. Pregnancies complicated by pregestational diabetes, chronic hypertension, and with unknown maternal body mass index (BMI) were excluded. IOM recommendations was used to define GWG. These births were divided into four groups: 1) normal pre-pregnancy BMI and normal GWG, 2) normal pre-pregnancy BMI and eGWG, 3) PPO and normal GWG and 4) PPO and eGWG. Outcomes such as Gestational diabetes, hypertensive disorders of pregnancy, cesarean delivery, maternal transfusion, and medical intensive care unit (MICU) admissions were compared among groups using ANOVA, and multivariable.</p><p><strong>Results: </strong>Of the 1,432,602 births included in the study, 22.2%, 42.3%, 10.1%, and 25.4% were in Groups 1-4 respectively. Compared with pregnancies in Group 1 (adjusted OR (95%CI)), Groups 3 and 4 had higher risk for gestational diabetes (2.80 (2.72-2.88) and 2.28 (2.22-2.34)) respectively, while Groups 2-4 had higher risk of hypertensive disease of pregnancy (1.58 (1.53-1.64), 3.88 (3.74-4.03) and 5.07 (4.90-5.23)); eclampsia (1.61 (1.33-1.95), 2.99 (2.42-3.69) and 3.57, (2.97-4.29)), and cesarean delivery (1.21 (1.19-1.23), 1.97 (1.92-2.02), and 2.45 (2.40-2.50)) respectively.</p><p><strong>Conclusion: </strong>Both PPO and eGWG are independently associated with higher odds of gestational diabetes, gestational hypertension, preeclampsia and cesarean sections, with the highest risk among pregnancies with both PPO and eGWG. This data supports the importance of pre-pregnancy weight management in preventing adverse pregnancy outcomes.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741873","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":"Prevalence and Risk Factors for Depression Among Parents of Children Born Preterm: A Systematic Review and Meta-Analysis of The Evidence Since 2000.","authors":"Megan Moorhouse, Piranavi Jeyagaran, George Okoli, James Bolton, Nicole Askin, Kristene Cheung, Lisa Lix, Allan Garland, Deepak Louis","doi":"10.1055/a-2568-1653","DOIUrl":"https://doi.org/10.1055/a-2568-1653","url":null,"abstract":"<p><strong>Objective: </strong>Previous reviews of depression among parents of preterm children were restricted to mothers within the first year of preterm delivery. We aimed to systematically review the prevalence and risk factors for depressive symptoms among mothers and fathers in the first five years following preterm birth.</p><p><strong>Study design: </strong>This systematic review was undertaken following the Cochrane Handbook for Systematic Reviews of Interventions Guidelines and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. Peer reviewed, all language, observational studies from the year 2000 that assessed the prevalence and/or risk factors for depression among parents of children born preterm (<37 weeks gestation) in the first five years following preterm birth, using validated clinical scales, were included. Medline, Embase, Web of Science Core Collection, CINAHL, PsycINFO and Cochrane Central were searched on July 29, 2021. The NIH quality assessment tool was used. Meta-analysis was performed using inverse variance effects models to estimate prevalence and identify risk factors.</p><p><strong>Results: </strong>Seventy-eight studies were included. The majority were English language (n=71), European (n=32), cross sectional studies (n=44), using the EPDS scale (n=45). The prevalence of depressive symptoms among mothers was 25% (95% CI, 21%-31%; n=72) in the first year, and 20% (13%-30%; n=8) in the second to fifth year, while for fathers, the rates were 13% (8%-22%; n=15) and 11% (2%-50%; n=1) respectively. Eastern Mediterranean region had the highest prevalence of maternal depressive symptoms in the first year [48% (25%-72%; n=3)], while it was the Western Pacific region for fathers [17% (15%-19%)]. Low educational status [Odds ratio 3.5 (95% CI, 1.9-6.5; n=2)] was associated with depressive symptoms among mothers in the first year.</p><p><strong>Conclusion: </strong>Mothers and fathers had a high prevalence of depressive symptoms in the first five years following preterm birth, with region variations in the prevalence. (PROSPERO Registration# CRD42021260748).</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742004","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":"Utility of abdominal near infrared spectroscopy (NIRS) in the management of neonates - A review.","authors":"Dipen Vyas, Jennifer Ware, Lauren Billington, Ricardo Rodriguez, Jeffrey Shenberger, Parvesh Mohan Garg","doi":"10.1055/a-2567-5178","DOIUrl":"https://doi.org/10.1055/a-2567-5178","url":null,"abstract":"<p><p>Near-infrared spectroscopy (NIRS) is a non-invasive technique which utilizes light in the near infrared spectrum to assess regional tissue oxygenation. Initial application of NIRS focused on measuring cerebral oxygenation. Recently, numerous studies focused on the utility of NIRS in measuring abdominal regional perfusion in preterm and full-term neonates - hepatic (right subcostal) and mesenteric (left lower quadrant/infra-umbilical probe). Abdominal NIRS, specifically the infraumbilical values obtained within the first week of life, is a useful tool for the evaluation of feeding intolerance and an early marker of the development of necrotizing enterocolitis (NEC) as changes in NIRS in the first 24 hours of abdominal symptoms helps define NEC severity. In addition, NIRS holds promise in identifying changes in abdominal regional perfusion with blood transfusion. The goal of this review is to summarize the current knowledge of factors affecting abdominal NIRS measurements, specifically alterations associated with feeding, blood transfusion, and necrotizing enterocolitis (NEC). We present information from the published clinical research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727466","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":"Anemia Biomarkers in Pregnant People with Pyelonephritis.","authors":"Noor K Al-Shibli, Kristin E Weaver, Matthew R Grace, Jeffrey A Kuller, R Phillips Heine, Shakthi Unnithan, Sarah K Dotters-Katz","doi":"10.1055/a-2547-4135","DOIUrl":"https://doi.org/10.1055/a-2547-4135","url":null,"abstract":"<p><p>Anemia is observed in 30% of pregnancies with pyelonephritis, yet little is known about the underlying etiology. Erythropoietin (EPO) is renally produced in response to hypoxic and inflammatory conditions. Changes in serum EPO have been demonstrated in infectious conditions in the nonpregnant population. EPO levels have been measured in healthy pregnancy cohorts, but little is known about patterns in the setting of renal inflammation. Our primary objective was to compare EPO levels in pregnant patients at diagnosis of acute pyelonephritis to established trimester-specific norms. Secondary objectives included assessing iron deficiency and hemolysis markers as alternate etiologies of anemia.Prospective cohort study of pregnant people aged ≥ 18 years diagnosed with pyelonephritis, defined as the presence of urinary tract infection symptoms plus flank pain, fever, or nausea/vomiting. Blood samples including EPO, iron, transferrin, lactate dehydrogenase (LDH), and haptoglobin were obtained within 72 hours of diagnosis. Demographics and clinical data were abstracted from medical records. Wilcoxon Signed-Rank test compared study EPO levels to noninfected pregnancy values established in the literature. Secondary outcomes included number of patients with iron/hemolysis laboratories within trimester-specific reference ranges.The study cohort included 17 patients with pyelonephritis in the second or third-trimester. There were no eligible first-trimester patients during the study period. Anemia was present on admission in 35.3% (6/17) of patients. EPO levels were significantly higher in pyelonephritis patients during the second-trimester compared with literature-established EPO levels in noninfected controls: 48.6 versus 10.6 mU/mL, (<i>p</i> = 0.0001). Secondary analysis demonstrated normal iron and haptoglobin levels in most patients, and normal LDH in all patients.EPO levels in pregnant pyelonephritis patients were significantly higher compared with trimester-specific normative levels established in the literature. Evaluation of iron and hemolysis studies showed inconsistent results but were often normal. This pilot study may suggest a relationship between ineffective erythropoiesis and renal inflammation in pregnancies complicated by pyelonephritis. · Anemia is present in 30 to 50% of pregnant patients with pyelonephritis.. · EPO was higher in the pyelonephritis cohort compared with normal pregnancy values.. · Iron and haptoglobin were normal in most patients, LDH was normal in all patients..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727429","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":"Risk Factors, Trends, and Outcomes Associated with Rural Delivery Hospitalizations Complicated by Hypertensive Disorders of Pregnancy.","authors":"Mary M Carmack, Joel Agarwal, Timothy Wen, Yongmei Huang, Alexander M Friedman","doi":"10.1055/a-2547-4267","DOIUrl":"10.1055/a-2547-4267","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP) may account for a considerable and growing clinical burden at rural hospitals which have been providing fewer obstetric services over the past two decades. The objectives of this analysis were to evaluate trends, risk factors, and outcomes associated with HDP during delivery hospitalizations at rural hospitals in the United States.The 2000 to 2020 National Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations at rural hospitals to women 15 to 54 years of age with and without HDP (including preeclampsia and gestational hypertension) were identified. Trends in HDP were characterized with joinpoint regression and estimated as the average annual percent change (AAPC) with 95% confidence intervals (CIs). The associations between (i) HDP risk factors and HDP and (ii) HDP and adverse maternal outcomes were estimated with adjusted logistic regression models.Among 8,885,683 deliveries that occurred at rural hospitals, the proportion with a HDP diagnosis increased significantly from 6.0% in 2000 to 11.1% in 2020 (AAPC: 3.1%; 95% CI: 2.8 and 3.4%). Preeclampsia with severe features (AAPC: 5.5%; 95% CI: 4.8 and 6.2%) and superimposed preeclampsia (AAPC: 6.5%; 95% CI: 5.6 and 7.5%) underwent the largest relative increases over the study period. Obesity, pregestational diabetes, chronic hypertension, multiple gestation, and chronic kidney disease were all associated with increased adjusted odds of HDP. HDP diagnoses were significantly associated with severe maternal morbidity (SMM), transfusion, stroke, and disseminated intravascular coagulation. The proportion of overall delivery SMM associated with HDP more than doubled from 11.3% in 2000 to 24.7% in 2020.Among delivery hospitalizations at rural hospitals, HDP, and associated risk factors increased significantly over the study period. Deliveries with HDP accounted for an increasing proportion of population-level SMM. HDP is a major, growing contributor to maternal risk and adverse outcomes during deliveries at rural hospitals. · Hypertensive disorders accounted for an increasing proportion of population-level severe morbidity.. · Hypertensive disorders increased among rural delivery hospitalizations.. · Risk factors associated with hypertensive disorders increased among rural delivery hospitalizations..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522422","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":"Comparison of Infants Discharged from Birth Hospitalization with Gastrostomy versus Nasogastric Feeding Tube.","authors":"Hartlee Lidsky, Emily Anderson, Neal A deJong, Adriana Herrera, Ashley G Sutton","doi":"10.1055/a-2550-5510","DOIUrl":"10.1055/a-2550-5510","url":null,"abstract":"<p><p>Many infants, particularly those born premature or with medical complexity, require supplemental enteral nutrition upon discharge from birth hospitalization. Recent literature supports the safety of discharging infants with nasogastric tube (NG) feeding. However, further evidence is needed to characterize populations suited for home NG feeding compared to gastrostomy tube (GT) placement. This study aimed to describe demographic and clinical differences between infants discharged from birth hospitalization with NG versus GT feeding.This retrospective cohort study included infants discharged from birth hospitalization with NG or GT feeding between April 2014 and December 2022 at a single quaternary care hospital with a neonatal intensive care unit (NICU). Routinely collected health data were used to investigate associations between patient characteristics and discharge feeding modality, as well as assess feeding outcomes 12 months after discharge.Of 346 infants, 72 (20.8%) were discharged with NG and 274 (79.2%) with GT. Infants with GT were more often discharged from the NICU (71.2 vs. 26.4%) with lower birth weights (median 2.40 vs. 2.92 kg) and longer hospitalizations (median 84 vs. 51.5 days). Twelve months after discharge, 77.4% of NG infants achieved full oral feeding compared to 16.6% of GT infants with earlier tube discontinuation in NG infants (19 vs. 236 days).Home NG feeding is a viable, less invasive alternative to GT for selected infants, particularly those with less medical complexity. Prospective studies are needed to further delineate optimal discharge feeding modalities for various infant subpopulations. · Infants discharged with gastrostomies had lower birth weights.. · More NG tube infants achieved oral feeding than gastrostomy infants.. · NG tubes were removed much sooner than GT.. · Home NG feeding is an alternative to gastrostomy for less medically complex infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555477","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 versus Late Brain Magnetic Resonance Imaging and Spectroscopy in Infants with Neonatal Encephalopathy following Therapeutic Hypothermia.","authors":"Tatiana A Nuzum, Pradeep Mally, Elena V Wachtel","doi":"10.1055/a-2540-2956","DOIUrl":"https://doi.org/10.1055/a-2540-2956","url":null,"abstract":"<p><p>This study aimed to evaluate the utility of early and late magnetic resonance imaging (MRI) in infants with neonatal encephalopathy (NE) after therapeutic hypothermia (TH), and to determine the concordance between magnetic resonance spectroscopy (MRS) and early MRI findings.We conducted a retrospective, observational study including encephalopathic neonates born between 2017 and 2023 at two regional perinatal centers. All subjects underwent early diffusion-weighted MRI (DWI) with or without MRS (day: 4-5), and late conventional T1/T2-weighted MRI (day: 12-14). Both MRIs were assigned an injury severity score based on the National Institute of Child Health and Human Development (NICHD) neonatal research network (NRN) pattern of injury, reflecting the injury apparent on the MR modality obtained. MRS injury was defined as the presence of a lactate peak.The majority of the cohort (<i>n</i> = 98) was moderately encephalopathic (78%). Early and late MR imaging was performed at an average of 5.7 and 13.6 days, respectively. Fifteen percent of infants had evidence of hypoxic-ischemic (HI) injury on early imaging only, and 6% on late imaging only. Forty percent of infants exhibited a change in NICHD score severity between early and late MRI. Twenty-three infants (24%) were found to have a milder injury and 16 (16%) were found to have more severe injury on late imaging, when scores were compared with early imaging scores. The concordance of injury between early MRS and MRI was 62.5%. Among the cases of discordant MRI/MRS, MRS detected additional injury in 70% of cases, and MRI detected additional injury in 30% of cases.Both early and late imaging are important to fully define injury and provide accurate neurodevelopmental prognoses in cases of encephalopathic infants following TH. Failure to perform imaging at two intervals would have potentially resulted in missed diagnoses in 6 to 15% of cases and misestimation of injury in up to 40% of cases. · Early and late neuroimaging is important for accurate neurodevelopmental prognostication of encephalopathic neonates.. · The NICHD NRN MRI scoring system is a helpful tool for clinical practice.. · MR spectroscopy shows promise for HI injury but requires more validation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727446","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":"Mode of Delivery Outcomes of Induced versus Spontaneous Labor in Individuals with Dichorionic Twins.","authors":"Manasa G Rao, Chelsea A DeBolt, Kelly Wang, Alexandra Mills, Sonia G Khurana, Isabelle Band, Elianna Kaplowitz, Andrei Rebarber, Nathan S Fox, Joanne Stone","doi":"10.1055/a-2547-4074","DOIUrl":"10.1055/a-2547-4074","url":null,"abstract":"<p><p>This study aimed to investigate odds of vaginal delivery comparing induced versus spontaneous labor in nulliparas and multiparas with dichorionic twins.A retrospective review of dichorionic twin pregnancies from 2008 to 2021. Those with scheduled or elective cesarean, malpresentation, prior uterine surgery, fetal anomaly, gestational age (GA) at delivery <34 weeks, and multifetal reduction were excluded. Nulliparas and multiparas were analyzed separately. The primary outcome was vaginal delivery of both twins. Secondary outcomes included preterm delivery, postpartum hemorrhage, and hypertensive disorders of pregnancy (HDP). Outcomes were compared among induced versus spontaneous labor and assessed using univariable and multivariable logistic regression.Among 258 nulliparas, 176 (68.2%) were induced, and 82 (31.8%) spontaneously labored. Induced patients were older (<i>p</i> = 0.048), had a higher proportion of intrahepatic cholestasis of pregnancy (IHCP; <i>p</i> = 0.04), HDP (<i>p</i> < 0.0001), and later GA at delivery (<i>p</i> < 0.0001). Patients who spontaneously labored had a higher proportion of preterm delivery at <37 weeks (<i>p</i> < 0.0001) and a higher proportion of at least one twin admitted to the neonatal intensive care unit (<i>p</i> = 0.01). On univariable analysis, induction was associated with decreased likelihood of vaginal delivery of both twins (<i>p</i> = 0.01). However, after adjusting for augmentation, GA at delivery, gestational diabetes, and HDP/chronic hypertension, this was no longer statistically significant (<i>p</i> = 0.14). Among 239 multiparas, 108 (45.2%) were induced, and 131 (54.8%) spontaneously labored. Induced patients had a higher proportion of IHCP (<i>p</i> = 0.02), chronic hypertension (<i>p</i> = 0.02), HDP (<i>p</i> < 0.0001), and later GA at delivery (<i>p</i> < 0.0001). Spontaneous labor patients had higher proportion of preterm delivery at <37 weeks (<i>p</i> < 0.0001). There was no significant difference in odds of vaginal delivery between spontaneous versus induced labor on univariate (<i>p</i> = 0.74) or adjusted analysis after controlling for augmentation, GA at delivery, gestational diabetes and HDP/chronic hypertension (<i>p</i> = 0.40) among multiparas.Among nulliparas and multiparas with dichorionic twins, induction of labor does not appear to be associated with decreased odds of vaginal delivery. · Spontaneous labor patients had a higher proportion of preterm delivery <37 weeks.. · Induction of labor and spontaneous labor had similar odds of vaginal delivery.. · Induction of labor may be offered as a safe option in delivery counseling of DCDA twins..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522407","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}