American journal of perinatology最新文献

{"title":"Perinatal Risk and Outcomes Among Individuals Insured by Medicare.","authors":"Osinakachukwu Mbata, Ayodamope Fawole, Armand Zimmerman, Muskaan Toshniwal, Evan Myers, Maria Small, Osondu Ogbuoji","doi":"10.1055/a-2954-5263","DOIUrl":"https://doi.org/10.1055/a-2954-5263","url":null,"abstract":"<p><strong>Objective: </strong>Pregnant Medicare beneficiaries are typically individuals with chronic conditions causing disability or end-stage organ disease, which may increase obstetric risk. Few studies have examined this population. We compared medical comorbidities and perinatal outcomes between Medicare-insured and non-Medicare-insured obstetric patients.</p><p><strong>Study design: </strong>We performed a cross-sectional analysis of the 2019 Healthcare Cost and Utilization Project National Inpatient Sample, including singleton deliveries (Major Diagnostic Category 14). Using discharge weights, strata, and hospital clusters, we compared Medicare with all other payers across maternal demographics, chronic conditions, and perinatal outcomes, including severe maternal morbidity (SMM). Relative risks (RR) were estimated from survey-weighted log-link quasi-Poisson models; a two-sided α < 0.05 indicated significance.</p><p><strong>Results: </strong>Of 3,697,605 deliveries, 28,855 were Medicare-insured. Medicare beneficiaries were more likely to be Black (33.3 vs. 9.5%) and of advanced maternal age (25.4 vs. 23.4%) and had higher rates of chronic kidney disease, prepregnancy hypertension and diabetes, cesarean delivery (37.7 vs. 35.1%), and preterm birth (13.6 vs. 7.5%) than privately insured patients (all <i>p</i> < 0.001). Relative to Medicare, privately insured patients had lower risk of SMM (RR: 0.28; 95% confidence interval: 0.25-0.32).</p><p><strong>Conclusion: </strong>Pregnant Medicare beneficiaries enter pregnancy with a higher chronic disease burden and experience worse maternal and perinatal outcomes, highlighting the need for targeted support of this vulnerable population.</p><p><strong>Key points: </strong>· Pregnant Medicare beneficiaries enter pregnancy with a higher chronic disease burden.. · Pregnant Medicare beneficiaries experience worse maternal and perinatal outcomes.. · Perinatal racial disparities in the general population persisted within the Medicare cohort..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987675","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":"Reticulocyte Hemoglobin Use for Prediction of Iron Deficiency Anemia in Pregnancy.","authors":"Myah M Griffin, Valeryia Avtushka, Pooja Venkatesh, Steven Friedman, Jennifer Aquino, Ashley S Roman","doi":"10.1055/a-2954-5378","DOIUrl":"https://doi.org/10.1055/a-2954-5378","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to determine the optimal first trimester reticulocyte hemoglobin cutoff to predict iron deficiency anemia at 24 to 28 weeks' gestation and to compare its performance to first trimester ferritin.</p><p><strong>Study design: </strong>This prospective, observational cohort study enrolled pregnant patients in the first trimester (last menstrual period to 13^6/7 weeks) at NYU Langone Health between February 2022 and June 2022. Eligible participants were nonanemic (hemoglobin ≥ 11.0 g/dL), ages 18 to 65, with singleton gestation enrolled before 14^0/7 weeks. Patients with first trimester anemia or blood transfusion 3 months prior to pregnancy were excluded. Iron deficiency anemia was defined as hemoglobin < 10.5 g/dL and ferritin < 30 µg/L. Optimal cutoffs were calculated using the receiver operating characteristic curve and the sensitivity/specificity pairs with the largest Youden index.</p><p><strong>Results: </strong>Of 600 nonanemic, pregnant participants enrolled, 499 participants were eligible for analysis at 24 to 28 weeks' gestation; 40 (8%) had iron deficiency anemia. The area under the curve of reticulocyte hemoglobin was 0.69 (95% confidence interval [CI]: 0.61-0.78) compared with 0.73 (95% CI: 0.65-0.81) for ferritin. The optimal first trimester cutoff was 32.6 pg for reticulocyte hemoglobin (sensitivity 42.5%, specificity 86.9%) and 29 µg/L for ferritin (sensitivity 47.5, specificity 87.6%).</p><p><strong>Conclusion: </strong>First trimester reticulocyte hemoglobin did not outperform ferritin in predicting iron deficiency anemia at 24 to 28 weeks' gestation. Both reticulocyte hemoglobin and ferritin were weak predictors of iron deficiency anemia at 24 to 28 weeks and were more effective in identifying patients at low risk of iron deficiency anemia at 24 to 28 weeks.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981819","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":"Microbiology Trends among Postcesarean Surgical Site Infections at a Large Public Hospital.","authors":"Allison Kurzeja, Isabelle Mulder, Amanda Zofkie, Dena Taherzadeh, Darlene Madriz, Kristi Morgan, Scott W Roberts, April Gorman, Jessica E Pruszynski, Emily H Adhikari","doi":"10.1055/a-2952-2152","DOIUrl":"https://doi.org/10.1055/a-2952-2152","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to characterize a decade-long trajectory of pathogen distribution and antimicrobial resistance among postcesarean surgical site infections (SSIs) at a high-volume safety-net hospital preceding widespread adoption of adjunctive azithromycin prophylaxis and standardized infection-prevention bundles.</p><p><strong>Study design: </strong>Retrospective cohort study of cesarean deliveries from October 2009 through October 2019. For patients with multiple deliveries, the initial cesarean during this period was analyzed. Patient and obstetric characteristics and neonatal outcomes were compared between individuals with and without SSI, identified by hospital Infection-Prevention surveillance. Wound culture pathogens and susceptibilities were characterized. Logistic regression with year as a covariate estimated odds of SSI, culture positivity, and infection with predominant pathogens.</p><p><strong>Results: </strong>Of 30,501 initial cesareans, 550(1.8%) were complicated by SSI; 484 (88%) had complete records and were included in the analysis. Odds of SSI increased 5% per year (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08, <i>p</i> = 0.001), and culture positivity increased by 13% per year (OR 1.13, 95% CI 1.06-1.21, <i>p</i> < 0.001). Individuals with SSI were younger, had higher body mass indices (BMIs), more pregestational diabetes, labor induction, and chorioamnionitis. Neonates of mothers with SSI experienced more sepsis evaluations and culture-positive sepsis. Most SSIs were superficial (404 [83.5%]), with 63 (13.0%) as deep incisional, and 17 (3.5%) as organ/space. <i>Escherichia coli</i> (13.8%) and methicillin-sensitive <i>Staphylococcus aureus</i> (13.8%) were most common. Odds of <i>E. coli</i> increased by 15% each year (OR 1.15, 95% CI 1.05-1.26, <i>p</i> = 0.004) and <i>Enterococcus faecalis</i> by 16% (OR 1.16, 95% CI 1.03-1.31, <i>p</i> = 0.014). Seven extended-spectrum beta-lactamase (ESBL)-producing <i>E. coli</i> were identified, all in the past 2 years of the study.</p><p><strong>Conclusion: </strong>Across a prebundle/pre-azithromycin decade, cesareans complicated by SSIs gradually increased and were associated with maternal and neonatal morbidity. Odds of <i>E.</i> <i>coli</i> and <i>E. faecalis</i> identification rose significantly, and cases of ESBL <i>E. coli</i> emerged. These findings establish a baseline against which postbundle and azithromycin surveillance can be compared and underscore the need for cesarean-specific antimicrobial resistance reporting in national surveillance systems.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between the Number of US Food and Drug Administration-Warned Anesthetic Exposures and Full-Scale Intelligence Quotient at Age 3 Years in Very Preterm Infants.","authors":"Marika K Grant, Joanna J Fifen, Andrew M Walker, Amina A Benlamri, Selphee Tang, Sue Makarchuk, Majeeda Kamaluddeen, Debbie McAllister, Abhay Lodha","doi":"10.1055/a-2952-2056","DOIUrl":"https://doi.org/10.1055/a-2952-2056","url":null,"abstract":"<p><strong>Objective: </strong>In 2016, the US Food and Drug Administration (FDA) warned that general anesthetics and sedative agents in children younger than 3 years may impair neurodevelopment. Very preterm infants could be especially vulnerable because of brain immaturity. We examined the association between the number of US FDA-warned anesthetic and sedative agents and full-scale intelligence quotient (FSIQ) at age 3 years in infants born < 29 weeks' gestational age (GA).</p><p><strong>Study design: </strong>In this retrospective study, all infants born (< 29 weeks' gestation) between January 2006 and December 2012 were evaluated for exposure to FDA-warned anesthetic and sedative agents from birth through 45 weeks' postconceptual age. The agents included volatile anesthetics, propofol, benzodiazepines, ketamine, chloral hydrate, and barbiturates. Exposure count was defined by the number of different agents administered: 1 exposure (1 agent); 2 exposures (2 agents); and ≥ 3 exposures (≥ 3 agents), irrespective of the number of procedures. We analyzed the association between FSIQ and exposure count using imputed and complete case univariable and multivariable linear regressions adjusted for neonatal and maternal factors.</p><p><strong>Results: </strong>Of 650 eligible infants, 435 (67%) had FSIQ assessed at 3 years. Imputed adjusted associations (95% confidence interval, <i>p</i>-value) between FSIQ and exposure to 1, 2, or ≥ 3 different agents were - 3 (- 7 to 2, <i>p</i> = 0.284), - 4 (- 9 to 1, <i>p</i> = 0.101), and - 7 (- 15 to 1, <i>p</i> = 0.079) points, respectively.</p><p><strong>Conclusion: </strong>Exposure to 1, 2, or ≥ 3 different FDA-warned anesthetic and sedative agents (volatile anesthetics, propofol, benzodiazepines, barbiturates, and ketamine) in very preterm infants born < 29 weeks' GA was not associated with a clinically meaningful decrease in FSIQ points at 36 months' corrected age.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966042","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 Cerebral Hemodynamics among Hemodynamically Stable Preterm Small for Gestational Age and Appropriate for Gestational Age Neonates: A Prospective Cohort Study.","authors":"Priyanka Gupta, Sruthi Nair, Saikiran Deshabhotla, Venkateshwarlu Vardhelli, Sadhana Narala, Sushama Pawar, Tejo Pratap Oleti","doi":"10.1055/a-2938-3495","DOIUrl":"https://doi.org/10.1055/a-2938-3495","url":null,"abstract":"<p><strong>Objective: </strong>Postnatal cerebral circulation and autoregulation are influenced by the degree of prematurity and fetal hypoxia. Currently, data on postnatal changes in cerebral blood flow indices in preterm and small for gestational age (SGA) neonates are limited. This study aimed to investigate the differences in cerebral hemodynamics between preterm (28^0/6-34^6/7 weeks), SGA, and appropriate for gestational age (AGA) neonates.</p><p><strong>Study design: </strong>In this prospective cohort study conducted at a tertiary care center in South India in 2020-2021, cerebral hemodynamic parameters assessed by Doppler sonography findings in the first 72 hours of life were compared between hemodynamically stable SGA (<i>n</i> = 39) and AGA preterm neonates (<i>n</i> = 69) admitted to the neonatal intensive care unit.</p><p><strong>Results: </strong>Preterm SGA neonates demonstrated significantly lower pulsatility index (PI) and resistive index (RI) in the middle cerebral artery (MCA) on days 2 and 3. Linear mixed-effects analysis adjusted for gestational age, abnormal antenatal Doppler, multifetal gestation, antepartum hemorrhage, pregnancy-induced hypertension, preterm prelabor rupture of membranes, and mode of delivery showed significant differences in MCA RI between SGA and AGA preterm neonates. A significant group effect (<i>p</i> = 0.005) and group-time interaction (<i>p</i> = 0.009) were observed. The group effect for MCA PI remained statistically significant even after correction (adjusted <i>p</i> = 0.018), while all other Doppler variable associations lost statistical significance.</p><p><strong>Conclusion: </strong>Low PI and RI in the MCA suggest altered cerebral hemodynamics in preterm SGA neonates with lower vascular impedance and cerebral vasodilation compared with AGA neonates.</p><p><strong>Key points: </strong>· Studies on postnatal changes in cerebral blood flow in SGA neonates are limited.. · SGA preterm infants have lower MCA RI and PI, indicating lower vascular impedance.. · Further studies are needed to understand the long-term impact..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966054","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":"Biostatistical Knowledge and Training in Neonatal-Perinatal Medicine Fellowship: A National Needs Assessment of Fellows and Early Career Faculty.","authors":"Jeanne A Krick, Margarita M Vasquez, Deirdre O'Reilly, Nicole E Lock, Megan M Gray","doi":"10.1055/a-2950-0669","DOIUrl":"10.1055/a-2950-0669","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the experiences of Neonatal-Perinatal Medicine (NPM) fellows and early career neonatologists with biostatistics education during fellowship training and to evaluate their confidence in using common biostatistical methods.</p><p><strong>Study design: </strong>This was an observational, cross-sectional survey study of U.S.-based NPM fellows and early career faculty. The survey instrument was designed to assess confidence in various biostatistical techniques and training experience. The anonymous survey was distributed to members of the American Academy of Pediatrics Organization of Neonatal Training Program Directors (ONTPD) and Trainee and Early Career Neonatologists (TECAN) listservs in September 2022, and responses were recorded in the Research Electronic Data Capture (REDCap) software.</p><p><strong>Results: </strong>There were 148 responses to the survey, with 87 (59%) being current fellows and 61 (41%) being early career faculty. Only 16 (11%) respondents felt their biostatistical training was adequate for their scholarly work and future career, while 57 (38%) felt it was inadequate to meet their needs, and 50 (34%) felt it met just their basic needs. Most respondents reported being at a novice or beginner level for most biostatistical techniques. Despite many reported challenges to incorporating a dedicated curriculum into the didactic schedule, 85 (57%) felt it should be required for all NPM fellows. When comparing groups, early career faculty rated their confidence with various biostatistical techniques as higher than current fellows. There were no differences between respondents from smaller or larger programs in their evaluation of the quality of their training, access to statistical programs, or availability of mentorship.</p><p><strong>Conclusion: </strong>There are significant gaps in current biostatistical training for NPM fellows. This gap could lead to significant downstream effects in the field of Neonatology, including poor ability to assess research findings, inability to engage in meaningful quality improvement, and a lack of available mentors in the future. These gaps may be addressed by a targeted curriculum that is readily available for all NPM training programs.</p><p><strong>Key points: </strong>· There are gaps in current biostatistical training for NPM fellows.. · Suggestions for a curriculum could help address gaps.. · A targeted curriculum is needed for the health of the field..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878993","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":"Improving Survival in the 22-24 Weeks Gestation Newborn: A Single-center Quality Improvement Initiative.","authors":"William Frank Liu, Harshit Doshi","doi":"10.1055/a-2943-5054","DOIUrl":"10.1055/a-2943-5054","url":null,"abstract":"<p><strong>Objective: </strong>To review the impact of a quality improvement initiative upon survival and key in-house morbidities.</p><p><strong>Study design: </strong>A prospective cohort with retrospective baseline, quality improvement initiative, with key drivers for improvement focused on perinatal, delivery room, and neonatal care management, comparing 2016 to 2019 (baseline) and 2020 to 2023 (intervention).</p><p><strong>Results: </strong>Survival rates (discharge to home) improved at 22 weeks (14.3%, 71.4%; <i>p</i> = 0.002), and at 22 to 24 weeks (60.2%, 76.9%; <i>p</i> = 0.018). At 22 to 24 weeks 1- and 5-minute Apgar scores (2 [1-4], 3 [2-5]; <i>p</i> = 0.031) improved. At 22 weeks, there was an increase in use of post-natal steroids (11.1%, 63.2%; <i>p</i> = 0.016). At 22 to 24 weeks, there was an increase in the placement of a gastrostomy tube (9.1%, 20.2%; <i>p</i> = 0.045) and tracheostomy tube (0%, 9%; <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>A single-center experience implementing a quality improvement initiative that employed active management, and updating our standardized care guidelines, demonstrated improved survival rates at 22 weeks and combined 22 to 24 weeks gestation. Key morbidities remain high and unchanged, with an increased need for gastrostomy and tracheostomy tube placement.</p><p><strong>Key points: </strong>· Factors for survival at 22 to 24 weeks includes active management at 22-weeks gestation, and a culture of team building.. · Evidence-based guidelines remains limited for this gestational age population.. · Standardized clinical practices with consistent implementation may contribute to improved outcomes..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811693","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":"Smartphone-Based Screening for Neonatal Hyperbilirubinemia in a U.S. Tertiary Center.","authors":"Jeanmarie Schied, Elizabeth Onishchenko, Caden Traversari, Matthew Louzon, Deborah Hill","doi":"10.1055/a-2950-6398","DOIUrl":"https://doi.org/10.1055/a-2950-6398","url":null,"abstract":"<p><strong>Objective: </strong>Noninvasive screening for neonatal hyperbilirubinemia typically requires dedicated transcutaneous bilirubin devices, which may not be universally available. Smartphone-based screening tools offer a potential alternative but remain incompletely validated in U.S. clinical settings. We evaluated the accuracy of the Picterus Jaundice Pro smartphone application (app) compared with total serum bilirubin (TSB) in a diverse U.S. newborn population.</p><p><strong>Study design: </strong>A prospective, cross-sectional study of 74 newborns (gestational age ≥35 weeks, birth weight ≥1,800 g, age >21 hours to 14 days) admitted to the nursery or neonatal intensive care unit (NICU) was performed. Within 60 minutes of clinically indicated TSB collection, trained staff placed a calibration card on the infant's chest and used the smartphone Picterus Jaundice Pro app to obtain two scans (six images per scan). Images were analyzed by an algorithm to estimate bilirubin levels. Staff were blinded to application results.</p><p><strong>Results: </strong>App estimates correlated with TSB (<i>r</i> = 0.72, <i>p</i> < 0.001). Using 2022 American Academy of Pediatrics (AAP) phototherapy criteria, the app correctly identified all infants requiring phototherapy (sensitivity 100%; 95% confidence interval [CI] 54.1-100%) with 78% specificity (95% CI 67.8-87.0%) and 100% negative predictive value (95% CI 94.2-100%). Bland-Altman analysis yielded a mean bias of -2.1 mg/dL (95% limits of agreement: -7.8 to +3.6 mg/dL). These results provide an indirect comparison with performance for currently reported transcutaneous devices.</p><p><strong>Conclusion: </strong>The Picterus Jaundice Pro app correlated with TSB and identified all infants requiring phototherapy based on current AAP thresholds, suggesting potential utility as a noninvasive smartphone-based screening tool for neonatal hyperbilirubinemia.</p><p><strong>Conclusion: </strong>KEY POINTS.</p><p><strong>Conclusion: </strong>· Current neonatal hyperbilirubinemia tools can be costly.. · Access may be limited in low-resource settings.. · Mobile health may expand hyperbilirubinemia screening.. · Picterus Jaundice Pro showed safe screening performance.. · The app may also offer a low-cost alternative..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928788","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":"Transforming Obstetric Care Through an MFM-led Architectural System: A Proposed Model for High-value Care.","authors":"Brian K Iriye, Manijeh K Kamyar","doi":"10.1055/a-2949-9626","DOIUrl":"10.1055/a-2949-9626","url":null,"abstract":"<p><strong>Objective: </strong>To describe a maternal-fetal medicine (MFM)-led, protocolized, integrated care model in which subspecialists serve as system-level clinical governors, and to present associated outcomes relative to regional, national, and published benchmarks and existing maternity care models.</p><p><strong>Study design: </strong>We conducted a single-system descriptive analysis of a moderately sized, integrated, MFM-led women's health organization with more than 3,500 annual deliveries during 2024-2025. Outcomes were evaluated across five domains: preterm birth (PTB) prevention, low-risk cesarean reduction, diabetes management, maternal opioid use disorder (OUD), and low-dose aspirin (LDASA) use for preeclampsia prevention. Performance was compared with Clark County, Nevada, national, and literature-based benchmarks, and the organizational structure with existing maternity care models.</p><p><strong>Results: </strong>The PTB rate was 10.0%, compared with 11.4% in Clark County. The nulliparous, term, singleton, vertex cesarean rate was 24.6%, compared with 28.5% in Clark County; the Society for Maternal Fetal Medicine (SMFM) cesarean rate was 12.0%, compared with 16.7% in Nevada. Self-monitored blood glucose adherence was 96% versus 68% nationally. Pharmacologic treatment for neonatal opioid withdrawal syndrome was 11.1%, versus published rates of 50 to 85%. LDASA self-reported use reached 95% among eligible patients. Applying published per-case costs, estimated annual savings from PTB prevention and low-risk cesarean reduction were $4.03 million. Unlike other models, this architecture places MFM subspecialists in system-level governance roles, designing and disseminating protocols across all obstetric provider types while integrating high- and low-risk care.</p><p><strong>Conclusion: </strong>This community-based model operationalizes the SMFM call for a transformed maternity care team by combining subspecialist governance with multi-domain protocol implementation. It is designed to identify and treat at-risk patients before progression to high-risk status and adverse outcomes.</p><p><strong>Key points: </strong>· MFM-led implementation of protocols reduces unwarranted clinical variation across all obstetrician (OB) providers.. · The model targets at-risk patients before they progress to high risk, preventing adverse outcomes.. · MFM-led community model aligns maternal care with value-based goals, improving outcomes and cost..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879058","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":"Phototherapy for Neonatal Hyperbilirubinemia: Vitamin D, Calcium, and Magnesium: A Systematic Review and Meta-analysis.","authors":"Arezoo Ghavi, Kathleen L Meert, Rebecca Renirie, Mohammad Asghari-Jafarabadi","doi":"10.1055/a-2943-4904","DOIUrl":"https://doi.org/10.1055/a-2943-4904","url":null,"abstract":"<p><strong>Objective: </strong>Phototherapy (PT) is the first-line treatment for neonatal hyperbilirubinemia, yet concerns persist regarding its effects on mineral and vitamin homeostasis. The aim of this study was to evaluate the effects of PT on serum levels of vitamin D, Ca, and Mg in newborns with hyperbilirubinemia.</p><p><strong>Study design: </strong>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted a systematic review and meta-analysis of studies from PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, and Medline (through June 2025). The quantitative studies that investigated relation to PT with vitamin D, Ca, ionized calcium (iCa), and Mg levels by random-effects models pooled mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using ROBINS-E (Risk Of Bias In Non-randomized Studies of Exposures) and RoB 2 (Risk of Bias Assessment Tool-2) tools; evidence certainty was rated using the Grading of Recommendations Assessment Development and Evaluation.</p><p><strong>Results: </strong>Fifty-three studies involving 5,413 newborns were included. PT was associated with significant reductions in serum Ca (MD: -0.66 mg/dL, 95% CI: -0.82 to -0.51; <i>I</i> ² = 95.56%), iCa (MD: -0.11 mmol/L, 95% CI: -0.15 to -0.06; <i>I</i> ² = 95.63%), and Mg (MD: -0.70 mg/dL, 95% CI: -1.14 to -0.27; <i>I</i> ² = 96.06%), with moderate-certainty evidence. The effect on vitamin D levels remained inconclusive due to very low-certainty evidence (⊕◯◯◯; MD: 2.34 ng/mL, 95% CI: -2.22 to 6.89; <i>I</i> ² = 97.39%). Subgroup analysis revealed that head covering significantly attenuated Ca decline (MD: +0.82 mg/dL, 95% CI: 0.23-1.41). Meta-regression identified younger age and longer PT duration as significant predictors of electrolyte reductions.</p><p><strong>Conclusion: </strong>PT induces predominantly asymptomatic reductions in serum Ca, iCa, and Mg levels in newborns with hyperbilirubinemia. Head covering is a promising, low-cost preventive strategy to mitigate Ca decline. Selective electrolyte monitoring in newborns with hyperbilirubinemia, especially in high-risk newborns represents prudent practice.</p><p><strong>Key points: </strong>· This systematic review demonstrates phototherapy induces statistically significant but predominantly asymptomatic reductions in serum Ca, iCa, and Mg levels in neonates with hyperbilirubinemia.. · Head covering emerges as a promising simple, low-cost preventive strategy to mitigate Ca decline.. · The effect of phototherapy on vitamin D levels remains inconclusive due to substantial heterogeneity and conflicting results across studies.. · Selective electrolyte monitoring in high-risk neonates represents prudent practice..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904804","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}