American journal of perinatology最新文献

{"title":"Postpartum Hemorrhage after Vaginal Delivery Is Associated with a Decrease in Immediate Breastfeeding Success.","authors":"Jacqueline Roig, Patricia Rekawek, Tahera Doctor, Mackenzie N Naert, Julie Cadet, Johanna Monro, Joanne L Stone, Lilly Y Liu","doi":"10.1055/s-0044-1786750","DOIUrl":"10.1055/s-0044-1786750","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success.</p><p><strong>Study design: </strong> This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life.</p><p><strong>Results: </strong> A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (β = -0.06, <i>p</i>-value 0.01) and required more time at each breastfeeding session (β = 0.08, <i>p</i>-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (β = 0.06, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong> Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic-pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period.</p><p><strong>Key points: </strong>· Women who experience PPH after vaginal delivery have decreased breastfeeding success.. · Further work is needed to elicit the mechanism behind this association.. · These women may require additional support for successful breastfeeding initiation postpartum..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2252-2257"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141157361","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":"Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Reducing Variability in Practice through a Collaborative Telemedicine Initiative.","authors":"Danieli M K Leandro, Gabriel F T Variane, Alex Dahlen, Rafaela F R Pietrobom, Jessica A R R de Castro, Daniela P Rodrigues, Mauricio Magalhães, Marcelo J Mimica, Krisa P Van Meurs, Valerie Y Chock","doi":"10.1055/s-0044-1786720","DOIUrl":"10.1055/s-0044-1786720","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess the viability of implementing a tele-educational training program in neurocritical care for newborns diagnosed with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia (TH), with the goal of reducing practice variation.</p><p><strong>Study design: </strong> Prospective study including newborns with HIE treated with TH from 12 neonatal intensive care units in Brazil conducted from February 2021 to February 2022. An educational intervention consisting of 12 biweekly, 1-hour, live videoconferences was implemented during a 6-month period in all centers. Half of the centers had the assistance of a remote neuromonitoring team. The primary outcome was the rate of deviations from TH protocol, and it was evaluated during a 3-month period before and after the intervention. Logistic regression via generalized estimating equations was performed to compare the primary and secondary outcomes. Protocol deviations were defined as practices not in compliance with the TH protocol provided. A subanalysis evaluated the differences in protocol deviations and clinical variables between centers with and without neuromonitoring.</p><p><strong>Results: </strong> Sixty-six (39.5%) newborns with HIE were treated with TH during the preintervention period, 69 (41.3%) during the intervention period and 32 (19.1%) after intervention. There was not a significant reduction in protocol deviations between the pre- and postintervention periods (37.8 vs. 25%, <i>p</i> = 0.23); however, a decrease in the rates of missing Sarnat examinations within 6 hours after birth was seen between the preintervention (<i>n</i> = 5, 7.6%) and postintervention (<i>n</i> = 2, 6.3%) periods (adjusted odds ratio [aOR]: 0.36 [0.25-0.52], <i>p</i> < 0.001). Centers with remote neuromonitoring support had significantly lower rates of seizures (27.6 vs. 57.5%; aOR: 0.26 [0.12-0.55], <i>p</i> < 0.001) and significant less seizure medication (27.6 vs. 68.7%; aOR: 0.17 [0.07-0.4], <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> This study shows that implementing a tele-educational program in neonatal neurocritical care is feasible and may decrease variability in the delivery of care to patients with HIE treated with TH.</p><p><strong>Key points: </strong>· Neurocritical care strategies vary widely in low- and middle-income countries.. · Heterogeneity of care may lead to suboptimal efficacy of neuroprotective strategies.. · Tele-education and international collaboration can decrease the variability of neurocritical care provided to infants with HIE..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2263-2270"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875591","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":"Critical Organ Dysfunction and Preoperative Mortality in Newborns with Hypoplastic Left Heart Syndrome.","authors":"Matthew D Durbin, James L Wynn, Paulomi Chaudhry, Alyx Posorske, Ellen Voskoboynik, Woo Y Park, Orlyn Lavilla, Khyzer B Aziz","doi":"10.1055/s-0044-1787009","DOIUrl":"10.1055/s-0044-1787009","url":null,"abstract":"<p><p>Hypoplastic left heart syndrome (HLHS) is fatal without surgical intervention. An important subset of HLHS patients die prior to surgical intervention, but this population is underevaluated. The neonatal sequential organ failure assessment score (nSOFA) is an operational definition of organ dysfunction that can identify those with a high risk of mortality among neonatal intensive care unit (NICU) patients. The utility of the nSOFA to predict preoperative mortality in the unique HLHS population is unknown and could inform care, particularly care provided by neonatology staff. We performed a multicenter retrospective cohort study of HLHS cases across three level IV NICUs from January 1, 2009, to December 3, 2023. Patients were classified as either survived or died prior to surgical intervention. Demographic variables were curated from medical records including the maximum nSOFA (nSOFAmax) before surgical intervention or death. We identified 265 patients with HLHS over the study period. The nSOFAmax was greater in patients who died preoperatively (14/265; 5%) compared with survivors to surgical intervention (median 8 [interquartile range, 6, 12] vs. 2 [0, 4]; <i>p</i> < 0.001). The area under receiver operating characteristics curve for the nSOFAmax to discriminate for mortality was 0.93 (95% confidence interval, 0.88-0.98; <i>p</i> < 0.001). Compared with an nSOFAmax of 0, the likelihood ratio for preoperative death doubled at 2, tripled at 4, and was 10-fold at 9. This is the first demonstration of nSOFA utility in specific to congenital heart disease and HLHS. The nSOFAmax represents a novel, electronic health record-compatible, and generalizable method to identify patient-level organ dysfunction and risk for preoperative mortality in HLHS patients. KEY POINTS: · An important subset of HLHS patients die preoperatively.. · nSOFA can be used to measure preoperative HLHS severity.. · nSOFA predicts preoperative mortality risk in HLHS patients..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2308-2311"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140915640","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":"Prediction of COVID-19 Severity at Delivery after Asymptomatic or Mild COVID-19 during Pregnancy.","authors":"Grecio J Sandoval, Torri D Metz, William A Grobman, Tracy A Manuck, Brenna L Hughes, George R Saade, Monica Longo, Hyagriv N Simhan, Dwight J Rouse, Hector Mendez-Figueroa, Cynthia Gyamfi-Bannerman, Angela C Ranzini, Maged M Costantine, Harish M Sehdev, Alan T N Tita","doi":"10.1055/s-0044-1786868","DOIUrl":"10.1055/s-0044-1786868","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to develop a prediction model that estimates the probability that a pregnant person who has had asymptomatic or mild coronavirus disease 2019 (COVID-19) prior to delivery admission will progress in severity to moderate, severe, or critical COVID-19.</p><p><strong>Study design: </strong> This was a secondary analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients who delivered from March through December 2020 at hospitals across the United States. Those eligible for this analysis presented for delivery with a current or previous asymptomatic or mild SARS-CoV-2 infection. The primary outcome was moderate, severe, or critical COVID-19 during the delivery admission through 42 days postpartum. The prediction model was developed and internally validated using stratified cross-validation with stepwise backward elimination, incorporating only variables that were known on the day of hospital admission.</p><p><strong>Results: </strong> Of the 2,818 patients included, 26 (0.9%; 95% confidence interval [CI], 0.6-1.3%) developed moderate-severe-critical COVID-19 during the study period. Variables in the prediction model were gestational age at delivery admission (adjusted odds ratio [aOR], 1.15; 95% CI, 1.08-1.22 per 1-week decrease), a hypertensive disorder in a prior pregnancy (aOR 3.05; 95% CI, 1.25-7.46), and systolic blood pressure at admission (aOR, 1.04; 95% CI, 1.02-1.05 per mm Hg increase). This model yielded an area under the receiver operating characteristic curve of 0.82 (95% CI, 0.72-0.91).</p><p><strong>Conclusion: </strong> Among individuals presenting for delivery who had asymptomatic-mild COVID-19, gestational age at delivery admission, a hypertensive disorder in a prior pregnancy, and systolic blood pressure at admission were predictive of delivering with moderate, severe, or critical COVID-19. This prediction model may be a useful tool to optimize resources for SARS-CoV-2-infected pregnant individuals admitted for delivery.</p><p><strong>Key points: </strong>· Three factors were associated with delivery with more severe COVID-19.. · The developed model yielded an area under the receiver operating characteristic curve of 0.82 and model fit was good.. · The model may be useful tool for SARS-CoV-2 infected pregnancies admitted for delivery..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2290-2297"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903844","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":"Association between Gestational Age and Perinatal Outcomes in Women with Late Preterm Premature Rupture of Membranes.","authors":"Eleanor M Schmidt, Jacqueline M Powell, Bharti Garg, Aaron B Caughey","doi":"10.1055/a-2328-6192","DOIUrl":"10.1055/a-2328-6192","url":null,"abstract":"<p><strong>Objective: </strong> The American College of Obstetricians and Gynecologists (ACOG) suggests expectant management until 34 weeks for patients with preterm premature rupture of membranes (PPROM). New data suggest extending to 37 weeks might enhance neonatal outcomes, reducing prematurity-linked issues. This study aims to assess adverse neonatal outcomes across gestational ages in women with PPROM.</p><p><strong>Study design: </strong> A retrospective cohort study was performed using linked vital statistics and the International Classification of Diseases, Ninth Revision data. Gestational age at delivery ranged from 32 to 36 weeks. Outcomes include neonatal intensive care unit (NICU) admission >24 hours, neonatal sepsis, respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Multivariate regression analyses and chi-square tests were employed for statistical comparisons.</p><p><strong>Results: </strong> In this cohort of 28,891 deliveries, there was a statistically significant decline in all studied adverse neonatal outcomes with increasing gestational age, without an increase in neonatal sepsis. At 32 weeks, 93% of newborns were in the NICU >24 hours compared with 81% at 34 weeks and 22% at 36 weeks (<i>p</i> < 0.001). At 32 weeks, 20% had neonatal sepsis compared with 11% at 34 weeks and 3% at 36 weeks (<i>p</i> < 0.001). At 32 weeks, 67% had respiratory distress syndrome compared with 44% at 34 weeks and 12% at 36 weeks (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong> In the setting of PPROM, later gestational age at delivery is associated with decreased rates of adverse neonatal outcomes without an increase in neonatal sepsis.</p><p><strong>Key points: </strong>· The ACOG recommends expectant management until 34 weeks for patients with PPROM.. · However, expectant management to 37 weeks might improve neonatal outcomes.. · Later gestational age at delivery was associated with decreased rates of adverse neonatal outcomes.. · Later gestational age at delivery was not associated with an increase in neonatal sepsis.. · The management of PPROM is complex and should be individualized..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2312-2314"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140955412","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":"Management, Utilization, and Outcomes of Preterm Labor in an Integrated Health Care System.","authors":"Darios Getahun, David A Sacks, Jiaxiao Shi, Fagen Xie, Nehaa Khadka, Vicki Y Chiu, Nana A Mensah, Chantal C Avila, Meiyu Yeh, Aniket A Kawatkar, Michael S Ruma, Derek Joyce, Michael J Fassett","doi":"10.1055/s-0044-1786545","DOIUrl":"10.1055/s-0044-1786545","url":null,"abstract":"<p><strong>Objective: </strong> Fetal fibronectin (fFN) testing and transvaginal ultrasound (TVUS) are diagnostic tools used to predict impending spontaneous preterm birth (sPTB) among women presenting with preterm labor (PTL). We evaluated the association between fFN testing or TVUS cervical length (CL) measurement in predicting sPTB, respiratory distress syndrome (RDS), neonatal intensive care unit (NICU) admission, and sPTB-related costs.</p><p><strong>Study design: </strong> We conducted a retrospective cohort study using data from the Kaiser Permanente Southern California electronic health system (January 1, 2009-December 31, 2020) using diagnostic and procedure codes, along with a natural language processing algorithm to identify pregnancies with PTL evaluations. PTL evaluation was defined as having fFN and/or TVUS assessment. Outcomes were ascertained using diagnostic, procedural, and diagnosis-related group codes. Multivariable logistic regression assessed the association between fFN and/or TVUS results and perinatal outcomes.</p><p><strong>Results: </strong> Compared with those without PTL evaluations, those with positive fFN tests had higher adjusted odds ratio (adj.OR) for sPTB (2.95, 95% confidence interval [CI]: 2.64, 3.29), RDS (2.34, 95% CI: 2.03, 2.69), and NICU admission (2.24, 95% CI: 2.01, 2.50). In contrast, those who tested negative had lower odds for sPTB (adj.OR: 0.75, 95% CI: 0.70, 0.79), RDS (adj.OR: 0.67, 95% CI: 0.61, 0.73), and NICU admission (adj.OR: 0.74, 95% CI: 0.70, 0.79). Among those with positive fFN results, the odds of sPTB was inversely associated with CL. Health care costs for mothers and neonates were lowest for those with fFN testing only.</p><p><strong>Conclusion: </strong> This study demonstrates that positive fFN results were associated with an increased odds of sPTB, RDS, and NICU admission and the association with sPTB was inversely proportional to CL. Additionally, negative fFN results were associated with decreased odds of sPTB, RDS, and NICU admissions. fFN testing may predict these and other sPTB-related adverse outcomes hence its utility should be explored further. Moreover, fFN testing has some cost savings over TVUS.</p><p><strong>Key points: </strong>· Patients with positive fFN tests had higher odds of sPTB, RDS, and NICU admission.. · Inverse relationship between sPTB and CL among those with positive fFN tests was observed.. · Health care costs for mothers and neonates were lowest for those with fFN testing only..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2214-2221"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875590","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":"Treatment for Neonatal Abstinence Syndrome Using Nonpharmacological Interventions.","authors":"Tonya W Robinson, Reetta Stikes, Jaki Sorrell, Amanda Gater, Adam T Booth, Amanda Gardner, Colleen Greenwell, Shannon Businger, Ryan Low, Rachael Petrie","doi":"10.1055/s-0044-1786744","DOIUrl":"10.1055/s-0044-1786744","url":null,"abstract":"<p><strong>Objective: </strong> Management of neonatal abstinence syndrome includes nonpharmacological interventions, but their effectiveness may not be verified before implemented. The objective of this study is to evaluate the effectiveness of a type of bassinet in the treatment of infants with neonatal abstinence syndrome.</p><p><strong>Study design: </strong> This is a retrospective observational cohort study. Study setting involved a 24-bed open-bay Level III neonatal intensive care unit located in a metropolitan academic trauma facility. Participant inclusion criteria involved prenatally opioid-exposed infants ≥ 35 weeks with confirmed maternal opioid urine toxicology, required pharmacological treatment for withdrawal symptoms, and were admitted to the neonatal intensive care unit. Three subsets of study participants were analyzed over three different time periods: Group 1 were infants admitted during 2019 without nonpharmacological intervention, Group 2 who were admitted from September 2021 to February 2022 and received nonpharmacological interventions, and Group 3 included those admitted from February 2022 to March 2023 who received the same interventions as Group 2 but were managed in bassinets being used in other local facilities for neonatal abstinence syndrome.</p><p><strong>Results: </strong> Group 3 had significant increases in length of stay compared with Group 1 (<i>p</i> = 0.006) and Group 2 (<i>p</i> = 0.013). Group 3 had a significantly greater length of treatment than Group 1 (<i>p</i> = 0.041) and a significantly higher total mg/kg morphine exposure than Group 1 (<i>p</i> = 0.006).</p><p><strong>Conclusion: </strong> Addition of the bassinet for nonpharmacological management of infants with neonatal abstinence syndrome appeared to prolong length of stay, length of treatment, and increase total mg/kg morphine exposure. As a retrospective nonrandomized study, weakness of low certainty of causality is of concern but findings strongly warrant further research before devices such as the bassinet used in this study are adopted for routine neonatal abstinence syndrome care.</p><p><strong>Key points: </strong>· Special bassinets are promoted to enhance sleep and decrease agitation.. · Such bassinets may assist infants undergoing drug withdrawal.. · Study of the bassinet failed to show benefit to this population..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2198-2205"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140903798","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":"Satisfaction with Continuous Glucose Monitoring in Pregnant Patients with Type 1 and Type 2 Diabetes.","authors":"Kevin S Shrestha, Ashley N Battarbee","doi":"10.1055/a-2442-7090","DOIUrl":"10.1055/a-2442-7090","url":null,"abstract":"<p><strong>Objective: </strong> Continuous glucose monitoring (CGM) improves pregnancy outcomes in type 1 diabetes. Given the rapid uptake of CGM in pregnancies complicated by both type 1 and type 2 diabetes, our objective was to determine if CGM satisfaction and use differed between type 1 and type 2 diabetes.</p><p><strong>Study design: </strong> Cross-sectional survey study of 100 patients with pregestational diabetes who used Dexcom G6 CGM during pregnancy and received prenatal care at a single tertiary care center. Participants completed the validated 15-question Glucose Monitoring Satisfaction Survey (GMSS) and other questions about CGM use. The primary outcome was high satisfaction with CGM, defined as a total GMSS score of 4 or greater. Secondary outcomes included GMSS subscales, frequency of CGM app use, and CGM features used. Outcomes were compared between type 1 and type 2 diabetes, and logistic and ordinal regression estimated the association between type 2 diabetes and outcomes.</p><p><strong>Results: </strong> Of 100 surveyed patients, 45 had type 1 and 55 had type 2 diabetes. Patients with type 1 diabetes were more likely to use CGM before pregnancy and use an insulin pump. CGM satisfaction did not differ between type 1 and type 2 diabetes (74.5 vs. 56.6%; adjusted odds ratio [aOR] = 0.54, 95% [confidence interval] CI: 0.21-1.36). High openness, low behavioral burden, low emotional burden, and high worthwhileness also did not differ between groups after adjustment for CGM use before pregnancy. Reported CGM app use was high and did not differ between groups. Patients with type 2 diabetes were less likely to use arrows and/or graphs on the CGM app compared to type 1 diabetes.</p><p><strong>Conclusion: </strong> In this cohort, patients with type 2 diabetes appear to be similarly satisfied with CGM compared to those with type 1 diabetes. Future efforts focused on CGM education for new users may help increase the use of CGM app features, maximize satisfaction, and minimize technology burden.</p><p><strong>Key points: </strong>· CGM satisfaction was similar between pregnant patients with type 1 and type 2 diabetes.. · Patients with both diabetes types thought that CGM was worthwhile and of low burden during pregnancy.. · Patients with type 2 diabetes were less likely to report using CGM features during pregnancy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455971","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":"Transplacental Transport Rates of Anti-pertussis Toxin-IgG and Anti-filamentous Hemagglutinin-IgG Antibodies in Newborns by Week of Birth.","authors":"Oguzhan Inceli, Cemile Sonmez, Elif Ece İnceli, Hasan Onur Topçu, Mujde Can Ibanoglu, Yaprak Engin-Ustun","doi":"10.1055/a-2457-2721","DOIUrl":"https://doi.org/10.1055/a-2457-2721","url":null,"abstract":"<p><strong>Objective: </strong> The aim of this study is to investigate the lack of knowledge about the transplacental transport of antibodies in unvaccinated term and preterm infants and possible differences in antibody-mediated immunity in the fetus depending on maternal vaccination in their own infancy.</p><p><strong>Study design: </strong> The study was conducted as a prospective cross-sectional study between 2017 and 2018 and included a total of 334 participants. The study included 194 pregnant women with a preterm birth (before 37 weeks) and 140 pregnant women with a term birth. Both umbilical cord blood and maternal blood were used to measure serum levels of anti-pertussis toxin (PT) immunoglobulin (Ig) G and anti-filamentous hemagglutinin (FHA) IgG.</p><p><strong>Results: </strong> The results showed that anti-FHA IgG antibody levels in the cord blood of women who had delivered at term were significantly higher than those of preterm infants (<i>p</i> = 0.002). The placental transfer rate of anti-PT IgG was higher in women who delivered prematurely, but this difference was not statistically significant (<i>p</i> = 0.128). However, transfer rates for anti-FHA were significantly higher in women who had delivered prematurely (<i>p</i> = 0.001). In addition, transmission rates for both antibodies were found to be significantly lower in women who delivered before 32 weeks gestation than in women who delivered at term (<i>p</i> = 0.006, <i>p</i> < 0.001). Antibody transfer rates were found to be positively correlated with both gestational age and birth weight.</p><p><strong>Conclusion: </strong> In summary, although placental antibody transfer rates increased with gestational age, transfer rates and antibody levels were low in pregnant women, particularly in women who had given birth before 32 weeks gestation.</p><p><strong>Key points: </strong>· Transport. · Anti-PT IgG. · Anti-FHA IgG antibodies.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754569","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":"Cardiorespiratory Stability in Critically Ill Preterm Infants following Dexmedetomidine Initiation.","authors":"Brynne A Sullivan, Paige Howard, Hayley Kendrick, Brandy Zeller, Christopher McPherson, Zachary A Vesoulis","doi":"10.1055/a-2445-3010","DOIUrl":"10.1055/a-2445-3010","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate cardiorespiratory status in preterm infants receiving dexmedetomidine using high-resolution physiologic data.</p><p><strong>Study design: </strong> We analyzed preterm infants with continuous heart rate (HR) and oxygen saturation (SpO₂) data for 24 hours preceding and 48 hours following dexmedetomidine initiation. Invasive arterial blood pressure (ABP), when available, was analyzed.</p><p><strong>Results: </strong> In 100 infants with a mean gestational age of 28 weeks and high baseline illness severity, mean HR decreased from 152 to 141 beats per minute while mean SpO₂ increased from 91 to 93% in the 48 hours after dexmedetomidine initiation (<i>p</i> < 0.01). In 57 infants with continuous ABP monitoring, mean ABP increased from 40 to 42 mm Hg (<i>p</i> = 0.01). Vasoactive-inotropic support increased before and after initiation.</p><p><strong>Conclusion: </strong> We observed cardiorespiratory changes in critically ill preterm infants following dexmedetomidine initiation; mean HR decreased and mean SpO₂ increased in the 48 hours after initiation. In a subset, mean ABP increased along with vasoactive-inotropic support.</p><p><strong>Key points: </strong>· Limited evidence exists on the acute cardiorespiratory effects of dexmedetomidine in preterm infants.. · Evaluation of continuous HR, blood pressure, and oxygenation from two centers provides useful data.. · Dexmedetomidine consistently decreased the HR of preterm infants.. · Dexmedetomidine initiation during critical illness complicated the interpretation of physiologic effects.. · Oxygenation stabilized after initiation during invasive mechanical ventilation..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455953","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}