American journal of perinatology最新文献

{"title":"Early Speech Therapy Is Associated with Decreased Length of Stay in Preterm Infants <28 Weeks Gestational Age.","authors":"Amanda M Mosher, Jennifer Check, Kaylee Freid, Jessica Walker, Peter Porcelli, Parvesh M Garg","doi":"10.1055/a-2943-4846","DOIUrl":"10.1055/a-2943-4846","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to assess the timing of speech therapy (ST) on the length of stay (LOS) and developmental outcomes at 6 and 12 months in preterm infants.</p><p><strong>Study design: </strong>Infants delivered at 24 to 28 weeks gestational age (GA) who received ST from 2022 to 2025 were enrolled. Analysis comparing postmenstrual age (PMA) at ST initiation determined two cohorts. Demographic, imaging studies, and clinical outcomes were compared between cohorts using R software. Multivariable regression adjusting for comorbidities was analyzed using SAS. <i>p</i>-Value < 0.05 was considered significant.</p><p><strong>Results: </strong>Eighty-four infants initiated ST < 40 weeks PMA (group A) compared with thirty infants ≥ 40 weeks PMA (group B). Comorbidities including bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH) were more prevalent in group B (BPD: <i>n</i> = 32, 42.9% group A vs. <i>n</i> = 18, 60.6% group B, <i>p</i> < 0.01; IVH: <i>n</i> = 11, 13.1% group A vs. <i>n</i> = 7, 22.3%, <i>p</i> < 0.01). Group B had more occupational therapy (OT) and ST visits during their hospital stay (OT: 13.2 vs. 20.7, ST: 11.6 vs. 18.2, <i>p</i> < 0.01). Barium swallow studies showed there was less aspiration described in group A (<i>p</i> < 0.01), but no difference in laryngeal penetration (<i>p</i> = 0.14). Group B was tube-fed more often at the 6-month follow-up (<i>n</i> = 8, 10.3% vs. <i>n</i> = 12, 41.4%, <i>p</i> < 0.01) and at the 12-month follow-up (<i>n</i> = 13, 21% vs. <i>n</i> = 8, 66.7%, <i>p</i> < 0.01). Group A had higher developmental scores on their Ages and Stages Questionnaire (ASQ) at their 12-month follow-up. Group A had a shorter LOS using multivariable linear regression (standard error of the mean: 32.8 [ ± 12.2], 95% CI [8.4, 57.7], <i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Infants who initiated ST before 40 weeks PMA (group A) had a shorter LOS, decreased risk of aspiration and lower rates of comorbidities during their neonatal intensive care unit stay, and higher ASQ scores at 12 months compared with group B.</p><p><strong>Key points: </strong>· LOS was decreased in infants who initiated ST before 40 weeks PMA.. · Early ST is associated with higher rates of oral feeds at 6- and 12-month follow-up.. · Infants with later ST implementation had higher risk of aspiration on barium swallow studies.. · Delayed oral skills maturation is common in preterm infants and should be evaluated by ST..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811696","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 Prepregnancy Body Mass Index in Low-Risk Pregnancies with Adequate Gestational Weight Gain: Trend and Adverse Outcomes.","authors":"Han-Yang Chen, Irene A Stafford, Suneet P Chauhan","doi":"10.1055/a-2936-5889","DOIUrl":"10.1055/a-2936-5889","url":null,"abstract":"<p><strong>Objective: </strong>To examine the temporal trend of prepregnancy body mass index (BMI) and the association between prepregnancy BMI and adverse outcomes in low-risk pregnancies with adequate gestational weight gain (GWG).</p><p><strong>Study design: </strong>We conducted a retrospective cohort study using U.S. vital statistics data (2016-2023). We included low-risk pregnancies with adequate GWG that delivered nonanomalous, singleton live births at 37 to 41 weeks of gestation in a hospital; those with diabetes or hypertensive disorders were excluded. The exposure variable was prepregnancy BMI. Adverse outcomes were examined. The average annual percent change (AAPC) was calculated to assess the trend of prepregnancy BMI. Multivariable Poisson regression models with robust error variance were used to examine the association. Adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>Of 29,972,027 live births during the study period, 6,741,787 (22.5%) were included; among them, prepregnancy BMI distribution was as follows: 4.4% underweight, 52.9% normal weight, 23.3% overweight, and 19.4% obese. Over the 8 years, there was a significantly increased trend in the prevalence of maternal prepregnancy overweight (AAPC = 2.6; 95% CI: 2.1-3.2) and obesity (AAPC = 3.6; 95% CI: 2.9-4.4) in low-risk pregnancies with adequate GWG. Compared with women with prepregnancy normal weight, those with prepregnancy obesity were associated with a higher risk of primary cesarean delivery (aRR = 1.57, 95% CI = 1.56-1.58). Importantly, those with prepregnancy obesity class III were associated with the highest risk of primary cesarean delivery (aRR = 2.01, 95% CI = 1.99-2.02). Similar results were also noted in 5-minute Apgar < 5, assisted ventilation > 6 hours, neonatal seizure, neonatal ICU, neonatal death, and infant death.</p><p><strong>Conclusion: </strong>Among low-risk pregnancies with adequate GWG, there was an upward trend in prepregnancy overweight and obesity from 2016 to 2023. The risks of adverse outcomes were the highest among pregnancies with prepregnancy obesity, especially with class III obesity.</p><p><strong>Key points: </strong>· In 6.7 million low-risk pregnancies with adequate GWG, 19.4% were obese prior to pregnancy.. · During 2016 to 2023, the trend of prepregnancy obesity increased.. · Adverse outcomes were the highest in pregnancies with class III obesity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817175","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 Comparison of Postnatal Factors between Infants with a Delayed TSH Rise on the Newborn Screen and those with a Timely Diagnosis of Congenital Hypothyroidism.","authors":"Preet K Matharu, Louis J Martin, Erica A Eugster","doi":"10.1055/a-2943-5102","DOIUrl":"https://doi.org/10.1055/a-2943-5102","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to identify postnatal factors that may confer an increased risk for having a delayed thyroid-stimulating hormone (TSH) rise on the newborn screen (NBS) in infants admitted to the neonatal intensive care unit (NICU).</p><p><strong>Study design: </strong>NBS results were collected from the Indiana State Department of Health (ISDH) for all cases of congenital hypothyroidism (CH) from 2012 to 2022 and used to identify infants who had a delayed TSH rise (<i>N</i> = 73). Thirty-six infants with a delayed diagnosis were matched by gestational age and birth weight Z-scores to infants with CH who were diagnosed in a timely manner per their initial NBS. A retrospective chart review was performed to compare postnatal factors between these two groups and to determine the treatment outcome in infants with a delayed versus timely diagnosis of CH.</p><p><strong>Results: </strong>Infants with a delayed TSH rise had significantly higher odds of medication exposures, invasive surgical procedures, and complications related to the renal, gastrointestinal, and hematologic systems. Delayed infants had 3.02 times the number of bedside procedures that involved iodine-containing sterile preparation (95% confidence interval [CI]: 1.31-6.93, <i>p</i> = 0.009) compared with the timely cohort. Within the delayed cohort, 38% of infants were found to have transient CH as compared with 27% of infants in the timely cohort.</p><p><strong>Conclusion: </strong>Several postnatal factors appear to play a role in conferring a risk for a delayed TSH rise, implying that the etiology of this phenomenon is multifactorial. Our findings suggest the need for more targeted screening for CH within the NICU.</p><p><strong>Key points: </strong>· The delayed cohort had a higher likelihood of medication exposure and multiorgan system complications.. · The delayed cohort had a greater degree of iodine exposure than the timely cohort.. · More than a third of infants in the delayed cohort were found to have transient CH..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878890","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":"Factors Associated with Inpatient COVID-19 Vaccine Uptake for Pregnant and Postpartum People.","authors":"Emily R Burdette, Andrea Pelletier, Taylor S Freret, Ilona T Goldfarb, Saba H Berhie","doi":"10.1055/a-2798-2960","DOIUrl":"10.1055/a-2798-2960","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate inpatient COVID-19 vaccine uptake among pregnant and postpartum patients.</p><p><strong>Study design: </strong>Retrospective cohort study of patients admitted to the antepartum and postpartum services of two academic hospitals between April 2021 and July 2022. Patients were classified as \"sufficiently vaccinated\" (fully vaccinated or not yet due for an additional dose) or \"eligible for vaccination\" on admission. We used chi-square, independent samples <i>t</i>-test, and Wilcoxon's rank sum test to compare characteristics between the groups on admission. We used logistic regression to analyze factors associated with inpatient vaccination for antepartum and postpartum patients.</p><p><strong>Results: </strong>Among 886 antepartum and 12,036 postpartum patients, 341 (38.5%) and 6,327 (52.6%) were sufficiently vaccinated at the time of admission, respectively. Factors associated with vaccination status on admission included age, race, ethnicity, marital status, insurance, smoking status, trimester of prenatal care initiation, obstetric history, comorbidities, and receipt of Tdap and influenza vaccinations during pregnancy. Among 545 eligible antepartum patients, 30 (5.5%) were vaccinated inpatient. Factors associated with inpatient antepartum vaccination included receipt of influenza vaccination during pregnancy (adjusted odds ratio [aOR] = 7.95, 95% confidence interval [CI]: 2.94-21.46), length of stay (aOR = 1.07, 95% CI: 1.03-1.11), and abruption (aOR = 6.20, 95% CI: 1.78-21.62). Among 5,709 eligible postpartum patients, 527 (9.2%) were vaccinated inpatient. Factors associated with inpatient postpartum vaccination included Black race (aOR = 1.45, 95% CI: 1.09-1.95), initiation of prenatal care in the second trimester compared with the first (aOR = 1.38, 95% CI: 1.08-1.77), gestational diabetes (aOR = 1.70, 95% CI: 1.25-2.30), receipt of Tdap (aOR = 1.47, 95% CI: 1.02-2.13) and influenza (aOR = 1.66, 95% CI: 1.32-2.09) vaccinations during pregnancy, and length of stay (aOR = 1.05, 95% CI: 1.00-1.11).</p><p><strong>Conclusion: </strong>Despite the availability of inpatient vaccination, COVID-19 vaccine uptake in this peripartum population was low. General vaccine acceptance and increased length of stay were associated with inpatient vaccination.</p><p><strong>Key points: </strong>· Inpatient vaccine access did not increase uptake.. · Vaccine uptake was associated with length of stay.. · General vaccine acceptance was linked to inpatient vaccination..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1561-1571"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257086","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":"Acceptability and Feasibility of an Educational Intervention to Improve Researcher-Participant Interactions in a Neonatal Intensive Care Unit Clinical Trial: Research Team Feedback on the BRIEF Intervention.","authors":"Stephanie A Kraft, Devan M Duenas, Andrea Kelsh, Ellie Oslin, Megan M Gray, Sandra E Juul, Elliott M Weiss","doi":"10.1055/a-2811-5163","DOIUrl":"10.1055/a-2811-5163","url":null,"abstract":"<p><strong>Objective: </strong>Interactions with families are essential to successful recruitment conversations that promote informed decision-making about clinical research enrollment. However, there is little evidence about how to implement communication-oriented recruitment training among pediatric clinical research teams. Our objective was to evaluate the feasibility and acceptability of Better Research Interactions for Every Family (BRIEF), a multipart educational intervention to improve relationship-based conversations about clinical trial enrollment with families in the neonatal setting.</p><p><strong>Study design: </strong>We piloted BRIEF in partnership with a neonatal clinical research team. Research team members completed surveys following the BRIEF intervention's online module and the BRIEF group training session. They completed self-assessments after consent discussions before and after the BRIEF intervention, in which they rated their achievement of recruitment skills taught in BRIEF. Research team members also completed a final study interview to provide feedback on the intervention components, training content, and use of skills in practice.</p><p><strong>Results: </strong>All nine research team members completed all components of BRIEF. Survey responses showed moderate to low satisfaction with previous recruitment training before BRIEF and high satisfaction with the BRIEF training. Self-assessments showed significant increases in reported partnership with bedside nursing (<i>p</i> = 0.02) and confirmation of family names (<i>p</i> = 0.05) after BRIEF training. Interviews provided further evidence of overall satisfaction with the BRIEF training, its content, and the skills learned, as well as opportunities for improvement, particularly in supporting challenging conversations.</p><p><strong>Conclusion: </strong>This pilot study demonstrated the feasibility and acceptability of the BRIEF intervention, as well as opportunities for improvement in future training.</p><p><strong>Key points: </strong>· It was feasible to implement the BRIEF researcher training in a single-site NICU trial.. · BRIEF training was acceptable to research team members.. · BRIEF training shows potential to improve relationship-based research communication..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1678-1687"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13055289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic Testing and Challenges in a Level IV Midwestern NICU: Who, What, When, and Then?","authors":"Hannah McBride, Jessica Scott Schwoerer, Erin Rholl, Krishna Acharya","doi":"10.1055/a-2800-4140","DOIUrl":"10.1055/a-2800-4140","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to examine genetic testing strategies and their impact on redirection of care and on reducing prognostic uncertainty in the NICU.</p><p><strong>Study design: </strong>This is a retrospective cohort study from 2020 to 2021.</p><p><strong>Results: </strong>Out of 774 NICU infants, 133 (17%) received genetic testing, most commonly whole exome sequencing. A genetic diagnosis was achieved in 33% of cases. About 70% of infants who received genetic testing were not critically ill. Decisions about redirection of care were associated with presence of critical illness and not presence of genetic diagnosis. Many rare diagnoses were made through genetic testing in the NICU, but except for certain chromosomal anomalies, these diagnoses had wide variability in reported phenotypic presentations.</p><p><strong>Conclusion: </strong>Genetic testing achieves a unifying diagnosis for many NICU patients, yet many of these diagnoses have variable clinical presentations. Redirection of care in the NICU is reliant on clinical illness severity more often than achievement of a genetic diagnosis. Clinicians must provide meaningful interpretation of genetic test results to families and be prepared to confront uncertainty even after pathogenic variants are found.</p><p><strong>Key points: </strong>· One-fifth of NICU patients received genetic testing.. · Often, these patients were not critically ill.. · Genetic diagnosis was made in a third of patients tested.. · Most diagnoses had variable phenotypic presentations.. · Redirection of care was associated with critical illness..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1597-1605"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146091660","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":"HomeSafe: Postpartum Hypertensive Care Enabled by Electronic Health Record Digital Blood Pressure Capture and Population Health Management.","authors":"Saba Berhie, Erin Harper, Tooba Anwer, Seema Gupta, David Cantonwine, Sahara Suliman, Ann C Celi, Khady Diouf, Ellen W Seely, Louise Wilkins-Haug","doi":"10.1055/a-2807-4609","DOIUrl":"10.1055/a-2807-4609","url":null,"abstract":"<p><strong>Objective: </strong>The objective is to present stepwise refinements to <i>HomeSafe</i>, an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure (BP) surveillance after hypertensive disease of pregnancy (HDP).</p><p><strong>Study design: </strong><i>HomeSafe</i> was designed for HDP people identified during their delivery hospitalization. The program incorporated prepopulated orders for home BP measurement and submission through a smartphone application linked to the electronic health record (Epic). A population health coordinator (PHC) was integrated at Year 2 to support registry tracking, expanded digital support and metric-driven reviews. Study data were managed using REDCap (Research Electronic Data Capture); a secure, web-based application hosted by the Massachusetts General Brigham Digital Research Applications team. Year-to-year analyses were performed for BP submission and route, predictors of timely BP return (≥1 BP in 7 days), 6-week postpartum visit attendance, and clinical and demographic variables.</p><p><strong>Results: </strong>Across 24 months, 640 postpartum HDP individuals were enrolled; 68.6% (439/640) submitted BP in a timely fashion. In Year 1, 44.9% of BPs submission was by Epic (44.9%), portal (8.2%), or phone (15.5%). No BP was submitted by 31.4%. With a PHC (Year 2), Epic-routed capture increased to 56.5%, and phone/portal-dependent routes decreased to 11.6% (<i>p</i> = 0.0006). Program enrollment increased from 245 to 485 (<i>p</i> < 0.001) without changes in delivery volume. Independent negative predictors of BP return were Black non-Hispanic race, public insurance, and multiparity; HDP subtype, delivery mode, antihypertensive use, and neonatal intensive care unit admission were not predictive. <i>HomeSafe</i> engagement strongly predicted 6-week postpartum visit attendance (89.9 vs. 65.4%, <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong><i>HomeSafe</i>, an EHR-tethered, postpartum BP surveillance pathway, when partnered with a population health management approach and a coordinator provides significant improvements in BP ascertainment, enrollment scalability, and 6-week postpartum engagement. Persistent disparities by race and insurance status highlight a need for equity-focused approaches.</p><p><strong>Key points: </strong>· HomeSafe-Epic-linked monitoring of postpartum blood pressure.. · Population health tenets improve postpartum surveillance.. · Gaps in postpartum surveillance of high-risk person remain..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1648-1656"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13503027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of NICU Withdrawal Assessment Scale with the Finnegan Neonatal Abstinence Scoring Tool in a Cohort of Critically Ill Infants with Opioid Withdrawal.","authors":"Ana Herning, Rodica Turcu, Carolyn Bleiler, Cheryl Slater, Allison Froman, Javed Mannan, Elisha M Wachman","doi":"10.1055/a-2798-8383","DOIUrl":"10.1055/a-2798-8383","url":null,"abstract":"<p><p>Neonatal opioid withdrawal syndrome (NOWS) is a significant public health concern with associated prolonged neonatal hospitalizations. Although the Finnegan Neonatal Abstinence Scoring Tool (FNAST) is validated for use in full-term in-utero opioid-exposed infants, there is no validated tool for preterm opioid-exposed or critically ill infants with iatrogenic opioid withdrawal. We aimed to evaluate the concordance of a novel NICU Withdrawal Assessment Scale (NWAS) designed for this critically ill infant cohort with the traditional FNAST. A total of 15 critically ill infants in the NICU with iatrogenic opioid withdrawal were dual assessed with the NWAS and FNAST. Correlation between the scores was determined using Spearman's correlation and linear regression. The mean gestational age of the cohort was 31.9 weeks (standard deviation [SD] = 6.0) with a range of neonatal diagnoses, and average length of opioid treatment of 35.4 days (SD = 17.9). A total of 93 occurrences of simultaneous NWAS and FNAST scores were obtained. The Spearman's correlation coefficient was <i>Rho =</i> 0.77 (95% confidence interval [CI]: 0.67-0.84, <i>p</i> <0.0001) indicating a strong, positive linear correlation. Linear regression indicated as positive correlation with magnitude of the scores (R = 0.77, y [FNAST score] = 0.85 + 1.49 × [NWAS score], <i>p</i> <0.0001). Further examination of the association with management with the NWAS tool and clinical outcomes can inform future creation of evidence-based guidelines for the treatment of NOWS in premature and critically ill infants. · No validated tool for opioid withdrawal in critically ill infants.. · No validated tool for opioid withdrawal in preterm infants.. · The NWAS is a new tool for preterm and critically ill infants.. · The NWAS is highly correlated with the FNAST..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1693-1696"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146083858","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 an Infection Prevention Bundle Modification on Post-Cesarean Delivery Surgical Site Infections.","authors":"Morgan Steelman, Desmond Sutton, Nathan S Fox","doi":"10.1055/a-2800-4105","DOIUrl":"10.1055/a-2800-4105","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the impact of a modified surgical site infection (SSI) prevention bundle, focused on closing-phase equipment changes, on post-cesarean SSI rates.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of cesarean deliveries performed by a single, large, obstetrical and maternal-fetal medicine practice from April 1, 2018, to February 28, 2025. The amended bundle, implemented in September 2021, introduced universal glove changes, light handle replacement, suction catheter tip removal, Bovie replacement, sterile re-draping, and a new surgical tray and instruments for fascial closure. Standardized prophylactic antibiotics, abdominal and vaginal preparation, and dressing protocols remained unchanged. Deliveries were categorized as preimplementation (April 2018-August 2021) and postimplementation (October 2021-February 2025). SSI was defined as wound separation requiring packing or wound infection necessitating antibiotics within 30 days. Logistic regression models adjusted for maternal age and gestational age. Subgroup analyses stratified by labor status, primary versus repeat cesarean, and body mass index (BMI).</p><p><strong>Results: </strong>A total of 2,467 cesarean deliveries were included, with 1,271 in the preimplementation and 1,196 in the postimplementation group. SSI occurred in 2.6% of preimplementation versus 3.3% of postimplementation deliveries (adjusted OR = 1.27, 95% CI: 0.80-2.04; <i>p</i> = 0.313). No significant temporal trends were observed before (<i>p</i> = 0.151) or after (<i>p</i> = 0.221) bundle implementation. Subgroup analyses by labor status, prior cesarean, and BMI similarly showed no significant associations between the bundle and SSI risk.</p><p><strong>Conclusion: </strong>Introducing closing-phase equipment changes on top of standardized SSI prevention practices did not reduce post-cesarean SSI rates. These findings suggest that once core measures such as antibiotics, prep, and dressings are standardized, additional equipment changes alone may not provide incremental benefit. These findings highlight the importance of rigorously evaluating process changes before widespread implementation.</p><p><strong>Key points: </strong>· Closing-phase equipment changes did not lower cesarean SSI rates.. · Bundle showed no effect in subgroup analyses by labor status, prior cesarean, and BMI.. · Findings question the value of costly closure-phase SSI prevention bundles..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1697-1699"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146091730","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":"Delivery Outcomes after Centering versus Routine Prenatal Care.","authors":"Sarah H Kelly, Joel Agarwal, Ilya Goldstein, Dahsan Gary, Alyssa Wynne, Alexander Friedman","doi":"10.1055/a-2807-4439","DOIUrl":"10.1055/a-2807-4439","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to compare delivery outcomes among women in Northern Manhattan undergoing Centering versus routine prenatal care.</p><p><strong>Study design: </strong>This retrospective cohort study analyzed prenatal care and delivery hospitalizations among women receiving prenatal care at two ambulatory clinics in Northern Manhattan from 2013 to 2018. The exposure of interest was Centering versus routine prenatal care. The primary outcome of interest was preterm birth <37 weeks. Other clinical outcomes analyzed included number of prenatal visits, birth weight including very low birth weight (<1,500 g), cesarean versus vaginal delivery, and preterm birth at <32 weeks. Unadjusted and adjusted logistic regression models (accounting for demographic factors) were performed to analyze the association between the exposure of Centering prenatal care and the primary outcome with unadjusted (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association.</p><p><strong>Results: </strong>A total of 714 women undergoing Centering prenatal care and 9,469 women undergoing traditional prenatal care were included in the analysis. Evaluating the primary outcome of preterm birth at <37 weeks, Centering was associated with a 5.9% risk of preterm birth compared to 7.1% with routine prenatal care (OR = 0.84, 95% CI: 0.53-1.30). Centering prenatal care was also not significantly associated with very low birth weight (OR = 0.4, 95% CI: 0.1-1.7), birth weight <2,500 g (OR = 0.65, 95% CI: 0.40, 1.06), or preterm birth at 32 to 36 weeks (OR = 1.0, 95% CI: 0.8, 1.2). Centering prenatal care was associated with lower odds of cesarean delivery (OR = 0.71, 95% CI: 0.60-0.84) and more frequent prenatal visits.</p><p><strong>Conclusion: </strong>Centering prenatal care was associated with lower likelihood of cesarean delivery and more frequent prenatal visits, while likelihood of preterm birth and low birth weight were not significantly more or less likely with Centering.</p><p><strong>Key points: </strong>· Centering prenatal care was associated with lower likelihood of cesarean delivery.. · Centering prenatal care was associated with more frequent prenatal visits.. · Preterm birth and low birth weight were not significantly more or less likely with Centering..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1635-1639"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148667","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}