American journal of perinatology最新文献

{"title":"Ambulation during Neuraxial Analgesia in Obese Patients: A Pilot Study.","authors":"Sunitha Suresh, F Arran Seiler, David Arnolds, Maritza Gonzalez, Naida Cole, Richard Silver, Barbara Scavone, Annie Dude","doi":"10.1055/a-2516-2292","DOIUrl":"https://doi.org/10.1055/a-2516-2292","url":null,"abstract":"<p><strong>Objective: </strong> Prior studies have yielded mixed results regarding ambulation with neuraxial analgesia and labor outcomes, and studies did not include a significant obese population. We sought to evaluate the feasibility of ambulation with optimized neuraxial analgesia in laboring nulliparous obese patients.</p><p><strong>Study design: </strong> This was a pilot study at the University of Chicago (approval no.: IRB 19-1600, CT NCT04504682). Inclusion criteria were delivery BMI of ≥35 kg/m², nulliparity, and term gestation. Contraindications to ambulation or vaginal delivery conferred ineligibility. Combined spinal-epidural analgesia was initiated per our institution's policy. Following epidural catheter placement, serial blood pressure measurements and motor assessments including a straight leg test and a step stool test were completed per safety protocol. Patients who passed these assessments were enrolled. Patients were encouraged to ambulate for 20 minutes every hour while on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Our primary objective was to evaluate feasibility through acceptability, and safety via the number of falls, and percentage of patients with any ambulation. The study was closed early due to enrollment difficulties and in the setting of the COVID-19 pandemic.</p><p><strong>Results: </strong> A total of 105 patients were identified for the trial: 20 were ineligible for the study, 20 could not be approached, and 40 declined study participation, leaving 25 patients who consented. Of those 25, 14 completed the study. Out of 14 participants, 11 were ambulated. The average BMI of these participants was 43 kg/m². No patients fell during the trial.</p><p><strong>Conclusion: </strong> A pilot trial of ambulation during neuraxial analgesia among an obese nulliparous population demonstrated no safety concerns, but with concern regarding feasibility as there was low acceptance.</p><p><strong>Key points: </strong>· Pilot trial of ambulation with neuraxial analgesia among obese patients had limited enrollment.. · Trial of ambulation with epidural among obese nulliparous patients demonstrated no safety concerns.. · Further studies are needed for efficacy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389798","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":"Enteral Feeding in Neonatal Hypoxic-Ischemic Encephalopathy.","authors":"Helen Martinovski, Luna Khanal, Debra Kraft, Girija Natarajan","doi":"10.1055/a-2510-1543","DOIUrl":"https://doi.org/10.1055/a-2510-1543","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to describe feeding outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and compare characteristics and outcomes in groups discharged home on oral, total/partial nasogastric, and gastrostomy tube feedings.</p><p><strong>Study design: </strong> This was a retrospective, single-center cohort study of infants diagnosed with moderate or severe HIE using standard criteria who underwent cooling from January 2017 to June 2022. Data were abstracted from hospital course as well as until 6 months follow-up. Statistical analysis included chi-square test and ANOVA with post hoc Bonferroni correction for between-group comparisons.</p><p><strong>Results: </strong> Among 123 included infants, 95 (77%) fed orally, 11 (9%) required total/partial nasogastric feeds and 17 (14%) had gastrostomy tubes at discharge. A significantly greater proportion of infants with gastrostomy-tube feeds at discharge had intrapartum complications, Apgar scores <5 at 5 and 10 minutes, severe rather than moderate HIE, and seizures. They also had a longer hospital stay, prolonged respiratory support and intubated days, and delayed initiation of feeding. Infants discharged on nasogastric feeds all attained oral feeds at a median (IQR) duration of 54 (6-178) days follow-up. Among the 106 (86%) infants with follow-up data, the gastrostomy group had significantly lower median weight and head circumference centiles compared to the others. Criteria for gavage eligibility were met before discharge in 98 (80%) of the cohort; 42% stayed beyond this benchmark.</p><p><strong>Conclusion: </strong> Earlier identification of eventual gastrostomy tube insertion as well as discharge home on nasogastric feedings may reduce duration of hospitalization in infants with HIE. Our data may provide insights to guide practice improvement for enteral feedings in this population.</p><p><strong>Key points: </strong>· In neonatal encephalopathy, impaired oral feedings is common.. · Antepartum complications and HIE severity are associated with gastrostomy insertion.. · Discharge home on gavage feeds could shorten hospital stay..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389800","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":"Intrapartum Glycemic Control with Insulin Infusion versus Rotating Fluids: A Randomized Controlled Trial.","authors":"Maranda Sullivan, Kajal Angras, Victoria Boyd, Amanda J Young, A Dhanya Mackeen, Michael J Paglia","doi":"10.1055/a-2510-4906","DOIUrl":"https://doi.org/10.1055/a-2510-4906","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate rotating intravenous (IV) fluids compared with insulin infusion for maternal intrapartum glycemic control of neonatal blood glucose within 2 hours of birth.</p><p><strong>Study design: </strong> This randomized controlled trial compared the use of rotating IV fluids to continuous insulin infusion for intrapartum glycemic control for patients with type II diabetes mellitus (DM) or medication-controlled gestational diabetes (A2GDM). A sample size of 74 participants was studied to detect a 10-mg/dL difference in neonatal blood glucose within 2 hours of birth between the groups with a standard deviation of 15, 80% power, and α 0.05. Secondary neonatal outcomes included neonatal blood glucose within 24 hours after birth, Apgar < 7 at 5 minutes, and a composite including neonatal hypoglycemia, NICU admission, hyperbilirubinemia, and respiratory distress syndrome. Secondary maternal outcomes included intrapartum hypoglycemia, blood glucose immediately prior to delivery, mode of delivery, and postpartum complications. Both intention-to-treat (ITT) and per-protocol (PP) analyses were performed.</p><p><strong>Results: </strong> A total of 114 patients were randomized, 57 in each arm. For the PP analysis, 51 patients were analyzed in the rotating IV fluids arm and 32 patients in the insulin infusion arm. There was no significant difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used (ITT: 54.5 mg/dL [IQR: 42.5, 72.5], PP: 56.0 mg/dL [IQR: 42.0, 76.0]) when compared with an insulin infusion (ITT: 59.0 mg/dL [IQR: 41.0, 69.0], PP: 62.5 mg/dL [IQR: 44.5, 68.5], <i>p</i> = 0.89 [ITT] and <i>p</i> = 0.68 [PP]). No significant differences were noted in secondary outcomes. The median intrapartum maternal blood glucose was 98.5 mg/dL (IQR: 90.5, 105.0) in the rotating fluids arm and 96.3 mg/dL (IQR: 90.0, 108.5) in the insulin infusion arm (<i>p</i> = 0.96), and the rate of neonatal hypoglycemia was 11.8 versus 15.6%, respectively (<i>p</i> = 0.61) in the PP analysis.</p><p><strong>Conclusion: </strong> There was no difference in neonatal blood glucose within 2 hours of birth when rotating IV fluids were used for intrapartum glycemic control compared with a continuous insulin infusion.</p><p><strong>Key points: </strong>· There is no optimal option for maternal glycemic control in labor.. · Maternal glycemic control was comparable in the two study arms.. · There was no difference in neonatal blood glucose between study arms..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389589","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":"The Relationship between Various Measures of Perinatal Quality.","authors":"Nansi S Boghossian, Lucy T Greenberg, Jeffrey S Buzas, Ciaran S Phibbs, Molly Passarella, Jeannette Rogowski, George R Saade, Scott A Lorch","doi":"10.1055/a-2517-2501","DOIUrl":"10.1055/a-2517-2501","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to examine the correlations between pairs of maternal, infant, and maternal-infant dyad quality measures to provide a comprehensive assessment of perinatal care.</p><p><strong>Study design: </strong> In a retrospective cohort study using birth and fetal death certificates linked to hospital discharge data from Michigan, Oregon, Pennsylvania, and South Carolina (2016-2018), we examined correlations between pairs of maternal, infant, and maternal-infant dyad quality measures. Maternal quality measures included nulliparous term singleton vertex (NTSV) cesarean birth, nontransfusion severe maternal morbidity (SMM), and a composite maternal outcome. Infant quality was assessed with a composite outcome measure, whereas the dyad measure combined maternal and infant outcomes.</p><p><strong>Results: </strong> Among 955,904 dyads across 266 hospitals, 25.9% had NTSV, 0.7% had nontransfusion SMM, 12.3% had the composite infant measure, and 19.3% had the dyad measure. The correlation between nontransfusion SMM and the dyad measure was 0.12, whereas the correlation between the composite infant measure and the dyad measure was 0.86, which was higher than the correlation between the composite maternal measure and the dyad measure (0.47).</p><p><strong>Conclusion: </strong> We observed minimal correlations among these perinatal quality measures, especially when aggregated beyond individual outcomes.</p><p><strong>Key points: </strong>· There are minimal correlations among different perinatal quality measures.. · Quality is multifaceted, and hospitals vary in the level of quality they achieve.. · Assessing hospital care for pregnant patients and infants requires multiple quality measures..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997707","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":"Impact of Coronavirus Disease-2019 on Influenza and Tdap Vaccination Rates in Pregnant Patients.","authors":"Ravyn Njagu, Katherine Freedy, Amanda Brucker, Kelvin Feng, Siera Lunn, Melissa Greene, Geeta K Swamy, Sarah Dotters-Katz","doi":"10.1055/a-2510-3783","DOIUrl":"https://doi.org/10.1055/a-2510-3783","url":null,"abstract":"<p><strong>Objective: </strong> Influenza and tetanus toxoid reduced diphtheria toxoid, and acellular pertussis (Tdap) are safe and effective vaccines that are recommended in pregnancy. Despite this, significant vaccine hesitancy exists in pregnancy. However, impact of the coronavirus disease 2019 (COVID-19) pandemic on vaccine hesitancy is not well understood. Thus, we sought to describe impact of the COVID-19 pandemic on influenza and Tdap vaccination rates in pregnant patients.</p><p><strong>Study design: </strong> Retrospective cohort study of patients delivering at single academic center from October 1, 2017 to August 31, 2021. Patients with missing vaccine data or delivering before 28 weeks (Tdap range) excluded. Patients delivering pre-COVID (October 1, 2017-August 31, 2019) compared with those delivering mid-COVID (October 1, 2020-August 31, 2021). Primary outcomes were vaccination rates for Tdap and influenza. Secondary outcome was rate of dual vaccination (receiving both) and variation by race/ethnicity. Chi-square tests and logistic regression were used to test for changes in vaccination rates.</p><p><strong>Results: </strong> Of 8,650 unique patient pregnancies, 5,925(68.5%) occurred pre-COVID. Median patient age (30 years) and gestational age at delivery (39 weeks) not clinically different between groups. Patients in mid-COVID group had lower numbers of government-assisted insurance (47.3%) and higher non-Hispanic Black compared with pre-COVID (31.5%). The rate of influenza vaccination decreased 8.2 percentage points from pre-COVID to mid-COVID (69.9 vs. 61.7%, <i>p</i> < 0.001). Tdap vaccination rates also decreased, although less-so (88.5 vs. 85.1%, <i>p</i> < 0.001). The rate of patients receiving both vaccines during pregnancy decreased from 66.0 to 58.4% (<i>p</i> < 0.001). Significant decreases in influenza vaccination rates mid-COVID versus pre-COVID was seen in all race-ethnicity groups except non-Hispanic White patients. For Tdap vaccinations, the effect of COVID on the odds of receiving Tdap did not differ across race-ethnicity groups.</p><p><strong>Conclusion: </strong> Rates of influenza, Tdap, and dual vaccination in pregnancy dropped significantly during the COVID-19 pandemic. For influenza, these were most pronounced in all race-ethnicities included with exception of non-Hispanic White. These data emphasize the importance of continued counseling and education on vaccinations in pregnancy and raise important questions regarding vaccine access and patient hesitancy during pandemic-mediated prenatal care.</p><p><strong>Key points: </strong>· Influenza vaccination decreased with COVID-19.. · Tdap vaccination decreased with COVID-19.. · Decrease in flu vaccination in most race-ethnicity groups..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370117","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":"Recurrence Risk of Pregnancy Complications in Twin and Singleton Deliveries.","authors":"Marion Granger, Maria Sevoyan, Nansi S Boghossian","doi":"10.1055/a-2358-9770","DOIUrl":"10.1055/a-2358-9770","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to estimate and compare the recurrence risk of preterm birth (PTB), gestational diabetes mellitus (GDM), gestational hypertension (GH), and preeclampsia and eclampsia (PE and E) in subsequent pregnancy groups (index-subsequent) of singleton-singleton (<i>n</i> = 49,868), twin-singleton (<i>n</i> = 448), and singleton-twin (<i>n</i> = 723) pregnancies.</p><p><strong>Study design: </strong> Birthing individuals from the <i>Eunice Kennedy Shriver</i> National Institute of Child Health and Human Development (NICHD) Consecutive Pregnancy Study (2002-2010) with ≥ 2 singleton or twin deliveries were examined. Adjusted relative risks (aRR) and 95% confidence intervals (CI) for recurrent PTB, GDM, GH, and PE and E were estimated using Poisson regression models with robust variance estimators.</p><p><strong>Results: </strong> The aRR of PTB and GDM ranged from 1.4 to 5.1 and 5.2 to 22.7, respectively, with the greatest recurrence relative risk for both conditions in singleton-singleton subsequent pregnancies (PTB: aRR = 5.1 [95% CI: 4.8-5.5], GDM: aRR = 22.7 [95% CI: 20.8-24.8]). The aRR of GH and PE and E ranged from 2.8 to 7.6 and 3.2 to 9.2, respectively, with the greatest recurrence relative risk for both conditions in twin-singleton subsequent pregnancies (GH: aRR = 7.6 [95% CI: 2.8-20.5], PE and E: aRR = 9.2 [95% CI: 2.9-28.6]).</p><p><strong>Conclusion: </strong> Recurrence relative risk was increased for PTB, GDM, GH, and PE and E in all subsequent pregnancy groups, which varied in magnitude based on the birth number of the index and subsequent pregnancy. This information provides insight into risk management for subsequent pregnancies including multiples.</p><p><strong>Key points: </strong>· Recurrence risk for all conditions is persistent in all subsequent pregnancy groups.. · The magnitude of risk varies by the presence of multiples in the index or subsequent pregnancy.. · Singleton-singleton pregnancies are at the greatest risk of PTB.. · Singleton-singleton pregnancies are at the greatest risk of GDM.. · Twin-singleton pregnancies are at the greatest risk of hypertensive disorders..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"355-362"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141490546","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":"Sex-Related Differences in the Severity of Neonatal Opioid Withdrawal Syndrome: A Single-Center, Retrospective Cohort Study.","authors":"Victoria A Anderson, Saminathan Anbalagan, Michael T Favara, Daniela Stark, David Carola, Kolawole O Solarin, Susan Adeniyi-Jones, Zubair H Aghai","doi":"10.1055/s-0044-1788717","DOIUrl":"10.1055/s-0044-1788717","url":null,"abstract":"<p><strong>Objective: </strong> Factors associated with the development and expression of Neonatal Opioid Withdrawal Syndrome (NOWS) are poorly understood. There are conflicting data on the role of infant sex in NOWS. Some studies have suggested that infant sex predicts NOWS severity and adverse outcomes, with male infants being more vulnerable. This study aimed to analyze if infant sex is associated with the severity of NOWS among those who require pharmacologic treatment.</p><p><strong>Study design: </strong> This is a retrospective cohort study of term and late-preterm infants (≥35 weeks gestation) exposed to in utero opioids, born between September 2006 and August 2022, and required pharmacologic treatment for NOWS. Maternal and infant demographics were collected. Indicators of the severity of NOWS (duration of medical treatment (DOT), duration of hospitalization, maximum dose of opioid treatment, and use of secondary medications) were compared between male and female infants. Standard statistical tests and regression analysis were used to establish the differences in outcomes after accounting for confounders and baseline differences.</p><p><strong>Results: </strong> Out of the 1,074 infants included in the study, 47.9% were female, and 52.1% were male. There was no significant difference in demographic and baseline clinical characteristics between groups except for anthropometry (birth weight, head circumference, and length) and Apgar score at 5 minutes. The median DOT (25 days [14, 39] vs. 23 days [13, 39], <i>p</i> = 0.57), length of hospital stay (31.5 days [20, 44] vs. 28 days [20, 44], <i>p</i> = 0.35), treatment with phenobarbital (24.7 vs. 26.3%, <i>p</i> = 0.56), and clonidine (3.9 vs. 3.8%, <i>p</i> = 0.9) were similar in both groups. The differences remained nonsignificant after adjusting for birth anthropometric measurements, gestational age, 5-minute Apgar score, small for gestational age status, and maternal exposure to benzodiazepines.</p><p><strong>Conclusion: </strong> In this cohort of neonates, sex-related differences were not identified to influence the severity of NOWS among those who required pharmacological treatment.</p><p><strong>Key points: </strong>· Vulnerability to NOWS is multifactorial.. · The role of infant sex in the severity of NOWS is not concrete.. · We noted that sex did not impact NOWS severity in those treated..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"363-368"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791677","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":"The Association between the Social Vulnerability Index and Adverse Neonatal Outcomes.","authors":"Charlotte B McCarley, Christina T Blanchard, Ariann Nassel, Macie L Champion, Ashley N Battarbee, Akila Subramaniam","doi":"10.1055/a-2419-8539","DOIUrl":"10.1055/a-2419-8539","url":null,"abstract":"<p><strong>Objective: </strong> Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission.</p><p><strong>Study design: </strong> Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared.</p><p><strong>Results: </strong> From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes.</p><p><strong>Key points: </strong>· Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"293-300"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543110","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":"When Are Pregnant Patients Receiving Tranexamic Acid during Delivery Hospitalization in the United States?","authors":"Julia Whitley, Seyedeh A Miran, Phillip Ma, George Saade, Ian Roberts, Homa K Ahmadzia","doi":"10.1055/a-2353-0832","DOIUrl":"10.1055/a-2353-0832","url":null,"abstract":"<p><strong>Objective: </strong> The World Health Organization recommends tranexamic acid (TXA) in the management of postpartum hemorrhage (PPH). However, the role of TXA in PPH prevention and the optimal timing of TXA administration remain unknown. Our objective was to describe the timing of TXA administration, differences in timing of TXA administration by mode of delivery, and current trends in TXA administration in the United States.</p><p><strong>Study design: </strong> We conducted a descriptive study of trends in TXA administration using the Cerner Real-World Database. We identified 1,544,712 deliveries occurring at greater than 24 weeks' gestation from January 1, 2016, to February 21, 2023. Demographic data were collected including gestational age, mode of delivery, and comorbidities. The timing of TXA administration and differences in TXA timing by mode of delivery were also collected.</p><p><strong>Results: </strong> In our cohort, 21,433 patients (1.39%) received TXA. The majority of patients who received TXA were between ages 25 and 34 years old (55.3%), White (60.7%), and delivered between 37 and 41^6/7 weeks (81.4%). The TXA group had a higher prevalence of medical comorbidities including obesity (32.9 vs. 19.0%, <i>p</i> < 0.00001), preeclampsia (19.6 vs. 6.81%, <i>p</i> < 0.00001), and pregestational diabetes (3.27 vs. 1.36%, <i>p</i> < 0.00001). Among women who received TXA, 15.4% received it within 3 hours before delivery. Among patients who received TXA after delivery, 23.6% received TXA within 3 hours after delivery, whereas 35.7% received TXA between 10 and 24 hours after delivery. A total of 80.4% of patients who received TXA before delivery had a cesarean delivery.</p><p><strong>Conclusion: </strong> While TXA is most commonly administered after delivery, many patients are receiving TXA prior to delivery in the United States without clear evidence to guide the timing of administration. A randomized trial is urgently needed to determine the safety and efficacy of TXA when administered prior to delivery.</p><p><strong>Key points: </strong>· TXA is used in the treatment of PPH.. · The role of TXA in prevention of PPH is unclear.. · Fewer than 2% of patients in the United States receive TXA at delivery.. · TXA administration before delivery in the United States is rising..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"327-333"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454644","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 Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia.","authors":"Allison C Young, Joseph L Hagan, Shweta S Parmekar, Pamela M Ketwaroo, Nathan C Sundgren","doi":"10.1055/a-2370-2035","DOIUrl":"10.1055/a-2370-2035","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates.</p><p><strong>Study design: </strong> This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates.</p><p><strong>Results: </strong> The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, <i>p</i> < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, <i>p</i> < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, <i>p</i> < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, <i>p</i> < 0.001) estimates.</p><p><strong>Conclusion: </strong> Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH.</p><p><strong>Key points: </strong>· CDH patients present unique stabilization challenges.. · Standard ETT depth estimates are too shallow.. · Resuscitation teams should cautiously choose ETT depth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"395-400"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747227","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}