American journal of perinatology最新文献

{"title":"Transvaginal Cervical Screening in Individuals with Previous Late Preterm Birth.","authors":"Diana Aboukhater, Amira Elzarea, Shaida Campbell, Wave Hatton, Tracey DeYoung, Jerri Waller, Tetsuya Kawakita","doi":"10.1055/a-2526-5492","DOIUrl":"10.1055/a-2526-5492","url":null,"abstract":"<p><p>This study aimed to assess the effectiveness of ultrasound cervical length (CL) screening in reducing preterm births among individuals with various preterm birth histories, aiming to optimize prevention strategies.This retrospective cohort study included 576 pregnant individuals with singleton pregnancies and a history of preterm birth, who underwent transvaginal ultrasound CL screening between January 2014 and December 2020. The primary outcome was the detection of a short cervix (≤2.5 cm). We compared outcomes among individuals with a previous gestational age (GA) of 34 to 36, 28 to 33, 24 to 27, and <24 weeks. Adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs) were calculated using modified Poisson's regression with robust variance, controlling for predefined confounders.Of 576 (35%), 139 (24.1%) had a previous birth at 34 to 36 weeks, 129 (22.4%) had a previous birth at 28 to 33 weeks, 90 (15.6%) had a previous birth at 24 to 27 weeks, and 218 (37.8%) had a previous birth <24 weeks. Compared with individuals with a previous GA 34 to 36 weeks, the risk of short cervix was higher in those with a previous <24 weeks (21.6 vs. 52.8%, aRR = 2.56, 95% CI: 1.81-3.62) and GA 24 to 27 weeks (40.0%, aRR = 1.80, 95% CI: 1.20-2.71), but no difference was found with those with previous GA 28 to 33 weeks (24.8%, aRR = 1.12, 95% CI: 0.72-1.72). Compared with individuals with previous GA 28 to 33 weeks, individuals with prior GA 34 to 36 weeks had the same risk of cerclage placement and preterm birth <34 weeks, but a lower risk of composite neonatal outcomes.Based on our results of similar incidence of the short cervix between individuals with previous GA 34 to 36 weeks and those with previous GA 28 to 33 weeks, individuals with a history of late preterm birth should receive CL screening in a similar manner. · Similar short cervix for prior 34 to 36 versus 28 to 33 weeks.. · Lower risk of neonatal outcomes in the prior 34 to 36 weeks of birth.. · Screening is warranted for any prior preterm birth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1714-1720"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490510","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":"Preterm Births and Maternal-Fetal Medicine Physician Workforce Location in the United States.","authors":"Andrea L Greiner, Sina Haeri, Nichole L Nidey","doi":"10.1055/a-2531-2783","DOIUrl":"10.1055/a-2531-2783","url":null,"abstract":"<p><p>Examine for association between geographic disparity in the national maternal-fetal medicine (MFM) physician workforce distribution and preterm birth (PTB) rate in counties without MFM presence.Cohort study of PTBs in the United States from 2015 to 2019, utilizing National Center for Health Statistics natality data. The independent risk factor is the presence of an MFM physician in the county or county equivalent where the pregnant woman resides. Bivariate logistic regression analysis estimated the odds of county-level PTB rates higher than the national average (10.2%, March of Dimes 2019 national data) by MFM physician location.The Northeast, Southeast, and Pacific Coast regions of the United States had the highest density of physician practice locations whereas regions in the Midwest and Western United States had the lowest density. Of the 2,981 counties with PTB rates available, 90.3% (<i>n</i> = 2,691) did not have a practicing MFM physician. U.S. counties without an MFM physician are more likely to have a PTB rate higher than the national average, operating room (OR) = 1.56 (95% confidence interval [CI], 1.22-1.99), compared with a county with at least one MFM physician.Counties with no practicing MFM physician had a 56% increase in the odds of having PTB rates higher than the national average. The lack of proximate high-risk obstetric care is a geographic health disparity associated with PTB. The location of the MFM workforce has implications for both clinical care and health policy. These data suggest that attention should be directed toward where physicians practice and to increase access to care for at-risk pregnant women. · U.S. regions with the highest concentration of MFM physicians remain unchanged from prior publications.. · Only 9.7% of counties reporting PTB data have practicing MFM physicians.. · Counties without an MFM physician have 56% higher odds of exceeding national PTB rates.. · Regional disparities in MFM physician distribution may impact maternal and neonatal outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1738-1742"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571845","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":"1875-1884"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","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}

{"title":"Optimizing RhD Immune Globulin Use in Pregnancy.","authors":"Elizabeth Miller, Lana El-Kassis, George Saade, Rebecca Horgan","doi":"10.1055/a-2550-5130","DOIUrl":"10.1055/a-2550-5130","url":null,"abstract":"<p><p>The global shortage of RhD immune globulin, formally acknowledged by the Food and Drug Administration in 2023, is ongoing but has improved in recent months. In response, the American College of Obstetricians and Gynecologists (ACOG) issued guidance in March 2024 on alternative strategies to conserve RhD immune globulin supplies. Our objective is to evaluate strategies for optimizing RhD immune globulin use in pregnancy amidst a global shortage.This clinical opinion reviews guidance on strategies to conserve RhD immune globulin. These include targeted administration based on non-invasive fetal RhD genotyping using cell-free DNA (cfDNA), the use of alternative RhD immune globulin products, and selective withholding of prophylaxis in early pregnancy loss under 12 weeks' gestation. ACOG guidance on the administration of RhD immune globulin in pregnancy differs from many countries worldwide, as well as the World Health Organization and the American Society of Family Planning.Targeted administration and the use of non-invasive cell-free DNA (cfDNA) testing for fetal RhD status have shown promising accuracy and reliability in studies across multiple countries, leading to reduced unnecessary prophylaxis and potential cost savings. Additionally, withholding RhD immune globulin in select early pregnancy losses could further conserve resources without increasing alloimmunization risk.This review underscores the need for evidence-based approaches to manage limited RhD immune globulin supplies effectively and suggests that targeted prophylaxis could benefit both patient outcomes and healthcare resource allocation in the face of global shortages. · Alternative RhD immune globulin strategies are vital amid ongoing global shortages.. · Targeted administration using cfDNA testing reduces unnecessary RhD immune globulin use.. · Consider withholding RhD immune globulin in <12-week pregnancy loss without instrumentation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1928-1934"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555481","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":"Vascular Air Embolism in Neonates: A Literature Review.","authors":"Qi Zhou, Shoo K Lee","doi":"10.1055/a-2508-2733","DOIUrl":"10.1055/a-2508-2733","url":null,"abstract":"<p><p>Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment, and prognosis. We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL, and EMBASE, and the keywords \"neonates\" and \"vascular air embolism.\" Results were summarized. There were 117 cases of neonatal vascular air embolism, with a mean gestational age of 30.4 weeks (range: 23-40), mean birth weight of 1,422 g (range 830-3,844), and median age of occurrence of 2 days (range: 1-540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and a decrease in end-tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors was 73.9 and 16.6%, respectively, overall, but significantly (<i>p</i> < 0.05) higher among preterm infants (81.8 and 31.2%, respectively) and lower among surgical infants (23.8 and 0%, respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, a decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography, or computed tomography (CT) imaging. The prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive. · Vascular air embolism is a rare but often fatal neonatal condition that is often underrecognized.. · Preterm infants on mechanical ventilation and with air leak syndromes are at particular risk.. · Prognosis is poor, prevention is key, and treatment is supportive..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1819-1824"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891410","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":"Reoperation following Cesarean Birth: An Analysis of Incidence, Indications, and Procedures Using a National Surgical Database.","authors":"Luke P Burns, Jourdan E Triebwasser, Christopher X Hong","doi":"10.1055/a-2542-9318","DOIUrl":"10.1055/a-2542-9318","url":null,"abstract":"<p><p>This study aimed to determine the incidence of reoperation after uncomplicated cesarean birth, describe the types of procedures and indications for reoperation, and identify risk factors associated with reoperation using a national surgical database.A retrospective cross-sectional study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database, encompassing data from January 1, 2019, to December 31, 2021. A total of 43,492 patients who underwent cesarean birth were included. Patients who underwent concurrent nongynecologic procedures or hysterectomies were excluded. The primary outcomes measured were the incidence of unplanned reoperation within 30 days of cesarean birth, types of reoperative procedures, indications for reoperation, and associated risk factors. Statistical analyses included Student's <i>t</i>-test, Wilcoxon rank-sum test, chi-squared test, and multivariable logistic regression.Out of 43,492 cesarean deliveries, 397 (0.9%) required unplanned reoperation. Significant risk factors for reoperation included smoking (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.49-1.56), hypertension (aOR: 1.83, 95% CI: 1.27-2.62), bleeding disorders (aOR: 2.11, 95% CI: 1.15-3.89), American Society of Anesthesiologists (ASA) class > 3 (aOR: 2.23, 95% CI: 1.29-3.84), and concurrent myomectomy (aOR: 4.39, 95% CI: 1.06-18.2). The most common indications for reoperation were postpartum hemorrhage (47%), wound disruption or infection (18%), and hematoma or hemoperitoneum (14%). The most frequently performed reoperative procedures were exploratory laparotomy without hysterectomy (27%), uterine curettage (23%), and wound debridement or drainage (22%).Reoperation following cesarean birth is a relatively uncommon but significant event, occurring in 0.9% of cases. Key risk factors include smoking, hypertension, bleeding disorders, ASA class > 3, and concurrent myomectomy. This study provides comprehensive data on the clinical characteristics and indications for reoperation following cesarean birth in a diverse, multi-institutional US cohort. The findings highlight the need for enhanced perioperative monitoring and targeted interventions for high-risk patients to improve maternal outcomes. · In this retrospective cross-sectional study of 43,492 cesarean deliveries, the incidence of unplanned reoperation was found to be 0.9%.. · Significant risk factors for reoperation included smoking, hypertension, bleeding disorders, American Society of Anesthesiologists (ASA) class > 3, and concurrent myomectomy at the time of cesarean birth.. · The most common indications for reoperation were postpartum hemorrhage, wound disruption or infection, and hematoma or hemoperitoneum.. · The most common reoperative procedures were exploratory laparotomy without hysterectomy, uterine curettage, and wound debridement or drainage..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1657-1663"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466552","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":"A Queen City Legacy: 45 Years of Research in Pregnant Women with Insulin-Dependent Diabetes Mellitus, The Diabetes in Pregnancy Program Project Grant.","authors":"Jane C Khoury, Menachem Miodovnik, Francis B Mimouni, Shelley Ehrlich, Rhonda Szcznesiak, Barak Rosenn","doi":"10.1055/a-2490-3118","DOIUrl":"10.1055/a-2490-3118","url":null,"abstract":"<p><p>The Diabetes in Pregnancy Program Project Grant (PPG) was a 15-year program focused on enhancing the care for women with insulin-dependent diabetes mellitus (IDDM) during pregnancy and improving the well-being of their offspring. Launched in July 1978 at the University of Cincinnati, the PPG pursued a multifaceted research agenda encompassing basic science, animal and placental studies, and maternal and neonatal clinical trials to understand the physiological and pathophysiological aspects of IDDM during pregnancy. A total of 402 singleton pregnancies in 259 women with IDDM were enrolled prior to 10 weeks gestation over the 15-year period. Of the 402 pregnancies, there were 295 live births, 1 stillbirth, 4 neonatal deaths, and 15 infants were born with major congenital malformations. Central to the program's methodology was the management of diabetes during pregnancy, involving intensive insulin therapy and meticulous monitoring using the cutting-edge technology of the time to achieve glycemic control. The extensive research of the PPG yielded profound insights into the effects of maternal diabetes on embryonic and fetal development and neonatal health. Through animal studies, notably using pregnant sheep, the program clarified the mechanisms of fetal hypoxia and metabolic disorders. Clinical trials underscored the significance of early glycemic control in mitigating the risks of spontaneous abortions, congenital malformations, and neonatal complications. The program also examined the influence of pregnancy on the progression of microvascular diseases, the role of maternal weight and weight gain in pregnancy outcomes, and the distinctive growth patterns of fetuses in IDDM pregnancies. Furthermore, the PPG probed the incidence and underlying mechanisms of hypoglycemia during pregnancy and the heightened risk of obstetric complications in IDDM patients. Our findings established a foundation of knowledge to aid clinicians, researchers, and health care providers in best practices and ensure a lasting impact on the care of pregnant women with pregestational diabetes. · Prepregnancy management reduces maternal, fetal, and neonatal complications in IDDM.. · Strict glycemic control improves many pregnancy outcomes in IDDM.. · Fetal glycemic exposure may have lifelong effects..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1681-1703"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885231","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":"Maternal and Neonatal Risk Factors Associated with Positive Toxicology Results.","authors":"Hannah Pee, Karen Hussein, Gina Del Savio, Prabhakar Kocherlakota","doi":"10.1055/a-2535-5895","DOIUrl":"10.1055/a-2535-5895","url":null,"abstract":"<p><p>The incidence of substance use disorder (SUD) during pregnancy continues to increase; however, the identification of SUD is challenging. The significance of individual risk factors and their association with toxicology is contentious. To identify maternal and neonatal risk factors associated with positive toxicology results for nonprescribed substance use during pregnancy.This retrospective study included pregnant persons and their infants, who were screened for predetermined risk factors for SUD during pregnancy. The toxicology test results of pregnant persons' urine and infants' urine, meconium/umbilical cord were correlated with risk factors.Maternal risk factors (history of prepregnancy or current SUD, on medication for opioid use disorders, insufficient prenatal care, sexually transmitted and blood-borne infections) and neonatal risk factors (neonatal opioid withdrawal syndrome, intrauterine growth restriction) showed a correlation with toxicology results.Combining maternal and neonatal risk factors with toxicology testing may accurately identify SUD in pregnancy. · Minimal prenatal care can be associated with positive infant toxicology.. · Intrauterine growth restriction/small for gestational age can be associated with positive infant toxicology.. · Combined maternal and infant testing is more sensitive at detecting prenatal substance use..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1763-1770"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389593","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":"Leadership Challenges in Neonatal Services during the COVID-19 Pandemic.","authors":"Kanekal Suresh Gautham, Lakshmi Katakam, Jens Eickhoff, Ryan McAdams","doi":"10.1055/a-2551-5143","DOIUrl":"10.1055/a-2551-5143","url":null,"abstract":"<p><p>This study aimed to identify key challenges, barriers, personal experiences, coping mechanisms, and lessons learned by neonatal health care leaders during the COVID-19 pandemic, because they are not well documented.Voluntary, anonymous, online survey of leaders in perinatal care systems.A total of 154 leaders responded. The exact number of survey recipients could not be enumerated because the survey was sent via email distribution lists (listservs). The key challenges reported included managing patient and family-centered care, staffing shortages, education and training, resource allocation, communication, support systems, and maintaining trust in a time of uncertainty. Common self-care techniques included exercise, sleep, meditation, social support, and taking time off. Respondents highlighted lessons such as the critical importance of effective communication, flexibility, teamwork, resilience, and the prioritization of self-care for sustainable leadership.These findings underscore the need for structured crisis management strategies and proactive support systems to strengthen resilience in neonatal health care leaders, enhancing preparedness for future systemic crises. · Leaders in perinatal care faced significant challenges during the COVID-19 pandemic.. · Key challenges were managing patient/family-centered care, staffing shortages, communication, and trust.. · Structured crisis management strategies and proactive support systems for resilience are required..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1918-1927"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571839","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":"Loss to Follow-up and Developmental Delay in the Neonatal High-Risk Infant Follow-up Clinic.","authors":"Lilia P Christner, Emman Dabaja, Mohammad Attar","doi":"10.1055/a-2551-4622","DOIUrl":"10.1055/a-2551-4622","url":null,"abstract":"<p><p>Neonatal follow-up (NFU) clinics provide developmental assessments for infants at high risk for developmental delays. Disparities in NFU attendance and loss to follow-up (LTF) are well documented, but it is not known whether patients who are LTF have different developmental outcomes. The population of patients LTF from the NFU clinic is assumed to be homogenous, but we hypothesize there is a subpopulation of patients LTF who are receiving developmental care elsewhere. Our objective was to compare the baseline characteristics and developmental outcomes of infants who completed follow-up, infants who were LTF but seen by others in the community, and infants who were LTF but not seen by others (true LTF).Retrospective cohort study at a regional specialty center, including 262 patients referred to the NFU clinic who were born between 2014 and 2017, with a 24-month total follow-up period, such that assessment of all follow-up outcomes (NFU clinic attendance outcome, and clinician assessed developmental delay) was complete prior to March 2020. Multivariable logistic regression was used to model the odds of developmental delay, true LTF, and referral to developmental services at initial hospital discharge.Of 262 patients, 86 (33%) were LTF from the NFU clinic. Of these, 55 (64%) had developmental assessments by other providers. Of those LTFs from NFU but seen by other providers, the prevalence of clinician-assessed developmental delay at 24 months was 67%, compared with 45% of those who completed the NFU clinic (<i>p</i> < 0.001). Social risk factors (younger mothers, late or no prenatal care, maternal smoking, or referral for a social reason) were associated with higher odds of true LTF, but no different odds of referral to developmental services at hospital discharge.A majority of patients LTF from the NFU clinic had developmental assessments by others (64%). Social risk factors were associated with true LTF and missed developmental assessments. · Sixty-four percent of patients with LTF had developmental assessments by other providers.. · Social risk factors were associated with higher odds of true LTF.. · Infants with social risk factors were not referred to developmental services early..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1908-1917"},"PeriodicalIF":1.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810227","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}