American journal of perinatology最新文献

{"title":"Impact of Labor in Primary Cesarean Delivery on Subsequent Risk of Placenta Accreta.","authors":"Lior Kashani Ligumsky, Miriam Lopian, Anhyo Jeong, Angela Desmond, Avshalom Elmalech, Ariel Many, Guadalupe Martinez, Deborah Krakow, Yalda Afshar","doi":"10.1055/a-2693-8599","DOIUrl":"https://doi.org/10.1055/a-2693-8599","url":null,"abstract":"<p><p>This study aimed to evaluate whether a primary cesarean delivery (CD) performed during labor increases the risk of placenta accreta spectrum (PAS) disorders in a high-parity population with a low overall CD rate.This retrospective cohort study included singleton pregnancies with a confirmed International Federation of Gynecology and Obstetrics (FIGO) PAS diagnosis at a single tertiary center (2011-2022). Each PAS case was matched 1:1 to a control without PAS based on parity, number of previous CDs, and history of vaginal birth after cesarean. Multivariable logistic regression assessed the association between labored versus unlabored primary CD and PAS, adjusting for placenta previa, in vitro fertilization, prior postpartum hemorrhage, and prior dilation and curettage.Among 128,485 deliveries, 45 PAS cases (0.04%) were identified and matched to 45 controls. Median parity was 5.0; 34% had three or more prior CDs. Labored primary CD was associated with increased PAS risk (adjusted odds ratio: 6.3, 95% confidence interval [CI]: 1.7-23.3; <i>p</i> < 0.05). Placenta previa and prior postpartum hemorrhage were also independently associated with PAS. No significant differences in maternal or neonatal outcomes were observed between the labored and elective primary cesarean groups.Primary CD during labor increases PAS risk six-fold in subsequent pregnancies, warranting consideration in counseling and surgical decision-making. · A labored CD raises the risk of PAS in the next pregnancy by sixfold.. · No significant differences in maternal or neonatal outcomes in subsequent pregnancy between labored and unlabored cesarean sections.. · The study highlights the importance of recognizing labored cesarean section as a PAS risk factor in future pregnancies..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Subspecialty In-Training Examination Scores and First Attempt Results in Neonatal-Perinatal Medicine Boards.","authors":"Imran N Mir, Riti Chokshi, Jennifer A Wambach, Heather French, Mackenzie Frost, Luc P Brion","doi":"10.1055/a-2697-3426","DOIUrl":"10.1055/a-2697-3426","url":null,"abstract":"<p><p>No multicenter study has examined the relationship between subspecialty in-training examination (SITE) scores and certification exam (CE) outcomes in pediatric subspecialties. This study addresses this gap by investigating whether performance on the Neonatal-Perinatal Medicine (NPM) SITE predicts first-attempt results on the NPM-CE administered by the American Board of Pediatrics.A multicenter, retrospective cohort study was conducted across NPM fellowship programs in the United States. Data from 326 fellows across 15 programs who took the NPM-CE between 2014 and 2024 were analyzed. De-identified SITE scores and CE results were collected via REDCap. Year-specific Z-scores for SITE performance were calculated, and mixed-model generalized linear equations and logistic regression were used to assess the odds ratio (OR) and 95% confidence intervals (CI) for CE failure, adjusting for clustering within programs and program characteristics.Out of 326 fellows in this cohort, 36 failed the CE. Fellows with an average SITE score of < 55% correct answers in the first 2 years of training had four times higher odds of failing the NPM-CE compared with those with ≥ 55% (OR: 4.28; 95% CI: 1.77, 10.33; <i>p</i> < 0.001). Similarly, those with an average SITE Z-score ≤ -1.0 had 12 times higher odds of CE failure compared with those with Z-scores > - 1.0 (OR: 12.12; 95% CI: 5.39, 27.25; <i>p</i> < 0.001). Fellowship program characteristics did not significantly influence CE outcomes.Performance on the NPM SITE during the first 2 years of fellowship predicts first-attempt NPM-CE results. Early identification of at-risk fellows through SITE performance may enable targeted educational interventions to improve certification outcomes. This study highlights the utility of SITE as a predictive tool in pediatric subspecialty training.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022687","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":"Organism- and Mortality-Specific Cardiorespiratory Patterns in Late-Onset Neonatal Sepsis: A Four-Neonatal Intensive Care Unit Study of Very Low Birth Weight Infants.","authors":"Sherry L Kausch, Brynne A Sullivan, Rakesh Sahni, Zachary A Vesoulis, Colm P Travers, Douglas E Lake, Karen D Fairchild","doi":"10.1055/a-2693-0426","DOIUrl":"https://doi.org/10.1055/a-2693-0426","url":null,"abstract":"<p><p>Late-onset neonatal sepsis (LOS) in very low birth weight (VLBW) preterm infants varies in severity from mild to fatal and often presents with cardiorespiratory instability. We hypothesized that heart rate (HR) and systemic oxygenation (SpO₂) patterns would differ based on pathogen type and mortality.We analyzed HR and SpO₂ changes before LOS diagnosis for Gram-negative, Coagulase-negative <i>Staphylococcus</i>, and other Gram-positive bacteria (GN, CONS, OGP) and compared survivors and nonsurvivors. Using continuous every-2-second vital sign data from 365 VLBW infants in four neonatal intensive care units, we calculated nine HR and SpO₂ metrics over a 96-hour window.GN LOS was associated with a slightly higher HR, more negative skewness of HR, and higher cross correlation of HR-SpO₂. Mortality was highest in GN LOS (22.7 vs. 4.6% CONS, 8.8% OGP). Nonsurvivors had distinct HR and SpO₂ patterns.These findings highlight critical cardiorespiratory differences at LOS diagnosis associated with mortality risk. · Changes in HR and SpO2 patterns varied by organism type prior to late-onset sepsis in VLBW infants.. · Generally, HR and SpO2 pattern changes showed only small differences based on organism class.. · Patterns associated with fatal sepsis included lower mean SpO2 and lower standard deviation of HR..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051558","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":"Early-Onset Sepsis Evaluation in Persistently Hypothermic Late Preterm and Term Infants: A Single-Center Retrospective Study.","authors":"Amy J Sloane, Justine Pirozzi, Lauren Benzinger, Maria Mattioli, Laura Izzo, David Carola, Kolawole Solarin, Zubair H Aghai","doi":"10.1055/a-2693-0357","DOIUrl":"https://doi.org/10.1055/a-2693-0357","url":null,"abstract":"<p><p>This study aimed to evaluate outcomes and resource utilization in neonates ≥35 weeks' gestation admitted to the neonatal intensive care unit (NICU) for persistent hypothermia, and to assess the incidence of early-onset sepsis (EOS) as well as the potential benefit of using the Kaiser Permanente EOS calculator for risk stratification.This retrospective study included 161 neonates born ≥35 weeks' gestation admitted to the NICU with persistent hypothermia (core temperature <36.5°C on three separate measurements) at a tertiary care hospital between April 2017 and June 2024. Data were collected from medical records, including EOS evaluation via blood cultures, lumbar puncture, complete blood count (CBC), and C-reactive protein (CRP). The incidence of EOS was assessed, and the performance of EOS calculator was evaluated.Among 161 infants with available data, the mean gestational age was 37.9 ± 1.9 weeks, and the average birth weight was 2.72 ± 0.5 kg. There were no cases of culture-positive EOS. Thirty-eight percent of infants were low birth weight and 30% were late preterm. Isolated hypothermia without additional symptoms occurred in 64% of the infants. A blood culture was sent in 62.7% of infants, 60.1% had at least one CBC sent, 26.7% had a CRP sent, and 23.6% were treated with empiric antibiotics. More infants would have managed without blood culture and without empiric antibiotics if the EOS calculator had been used (49.7 vs. 36.0%, <i>p</i> = 0.01).The prevalence of EOS in persistently hypothermic infants is low despite widespread laboratory testing and empiric antibiotic use. NICU admission and laboratory workup and empiric antibiotics is probably unnecessary in persistently hypothermic infants who are otherwise well appearing. A management approach guided by EOS calculator may help to reduce evaluation and empiric antibiotics, but many persistently hypothermic late preterm and term infants will still be evaluated and treated with empiric antibiotics. · Neonatal hypothermia is common and can be a sign of early onset sepsis.. · The incidence of culture-positive early-onset sepsis in late preterm and term infants is very low.. · The Kaiser Permanente EOS calculator may reduce help unnecessary testing and antibiotic exposure..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032614","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":"Fetal Body Composition and Organ Growth in Pregnancies Complicated by First-Trimester Vaginal Bleeding Status: NICHD Fetal 3D Study.","authors":"Alexandra Jean-Louis, Jessica L Gleason, Zhen Chen, Kathryn A Wagner, Dian He, Roger Newman, William A Grobman, Robert Gore-Langton, Seth Sherman, Magdalena Sanz Cortes, Edward K Chien, Luis F Goncalves, Jagteshwar Grewal, Katherine L Grantz","doi":"10.1055/a-2682-5886","DOIUrl":"10.1055/a-2682-5886","url":null,"abstract":"<p><p>This study aimed to explore associations between self-reported first-trimester vaginal bleeding status and fetal body composition and organ volumes measured by three-dimensional (3D) ultrasound across pregnancy.The NICHD Fetal 3D Study (2015-2019) included individuals with singleton pregnancies at low risk for fetal growth abnormalities (<i>n</i> = 2,634). Fetal body composition measures of arm, abdomen, and thigh, and organ volumes including cerebellum, lung, kidney, and liver, were measured up to five times between 15 and 40 weeks using 3D ultrasound. Women were grouped by cumulative days of self-reported first-trimester vaginal bleeding: 0 (no bleeding, reference), 1, or >1 day. Linear mixed models, with quadratic and cubic terms for gestational age, including global tests for overall differences in trajectories and weekly pairwise comparisons, were fit to compare groups by fetal anthropometric measures, adjusted for maternal age, race/ethnicity, prepregnancy body mass index, parity, and infant sex.Most women had no bleeding (<i>n</i> = 2,144, 81.4%), whereas 211 (8.0%) reported 1 day and 279 (10.6%) reported >1 day. Compared with no bleeding, fetuses of women with >1 day of bleeding had 75.1 to 264.0 mm² smaller abdominal area between 30 and 40 weeks, 1.1 to 4.0 cm³ smaller fractional thigh volume between 33 and 40 weeks, 0.4 to 2.4 cm³ smaller fractional fat thigh volumes between 30 and 40 weeks, and 0.8 to 1.6 cm³ larger cerebellar volumes between 35 and 40 weeks. Fetuses of women with 1 day of bleeding had 2.6 to 4.8 cm³ smaller liver volume between 26 and 35 weeks compared with no bleeding.First-trimester bleeding was associated with smaller fetal abdominal area and decreased adiposity compared with no bleeding, whereas organ growth trajectories were increased for the cerebellum and decreased for the liver. Fetal 3D measures may provide insight into how first-trimester gestational bleeding potentially influences fetal growth and development with implications for possible postnatal health outcomes. · First trimester bleeding group had smaller abdomen and liver and larger cerebellum.. · Thigh fat was smaller in women with moderate/severe and consistent bleeding across pregnancy.. · Fetal volume differences may improve understanding of bleeding and fetal growth..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854247","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":"Decomposing the Disparity in 1-Year Postpartum Readmission between People with and without a Potentially Traumatic Birth Event.","authors":"Kaitlyn K Stanhope, Marisa R Young, Sheree L Boulet, Danielle Vuncannon, Vasiliki Michopoulos, Abigail Powers, Suchitra Chandrasekaran","doi":"10.1055/a-2693-1734","DOIUrl":"10.1055/a-2693-1734","url":null,"abstract":"<p><p>Traumatic birth, characterized by high perceived risk to the life of the birthing person or fetus and intense fear, is associated with poor postpartum mental health. However, little is known about the relationship between potentially traumatic birth and postpartum physical health. The goal of this study was to estimate the difference in 1-year postpartum readmission between individuals who experienced a potentially traumatic birth event (severe maternal morbidity [SMM], stillbirth, extremely preterm birth [EPTB]) and those who did not, and to quantify the proportion explained by medical, demographic, and care use variables.We used data from deliveries at Grady and Emory Health Systems between 2016 and 2021 to identify deliveries to individuals who experienced a potentially traumatic birth (stillbirth, SMM, or EPTB <28 weeks) or did not. We fit Blinder-Oaxaca decomposition models to estimate the proportion of the disparity in 1-year postpartum readmissions explained by pre-existing obstetric and medical risk (Obstetric Comorbidity Index [OCI], psychiatric diagnoses at delivery, delivery mode), sociodemographic characteristics (age, parity, race, insurance, delivery hospital), and perinatal care use (postpartum visit timing [early, late, on time, and/or none], prenatal care use [any/none], postpartum contraceptive receipt [any/none]).We included 33,153 deliveries, 2498 of which were characterized as a potentially traumatic birth due to stillbirth (331, 1.0%), SMM (1957, 5.9%), and/or EPTB (344, 1.0%). People experiencing any one of these events were more likely to be readmitted in the 12 months postpartum (6.4 vs. 2.4%, risk difference: 4.01 per 100 deliveries, 95% CI: 3.03, 4.99). 54.3% of this excess risk was explained by medical, demographic, and site of care variables, with the largest percent explained by the OCI (46.4%).People who experience SMM, stillbirth, or EPTB experienced elevated postpartum readmission risk, half of which cannot be explained by medical risk or demographics. · Postpartum risk is elevated following poor delivery outcomes, yet the reasons are not well-characterized.. · Medical, psychiatric, demographic, and site of care factors explained 54% of the excess postpartum readmission risk among individuals following stillbirth, EPTB, or SMM at delivery.. · Unexplained risk of readmission in the postpartum year cannot be fully explained by medical risk, demographics, or care use..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939168","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":"Adverse Pregnancy Outcomes in Patients with Congenital Uterine Anomalies: Evaluation of a Population Dataset.","authors":"Zoe O Silsby, Jessica Abou Zeki, Anna Swensen, Stephen Rhodes, David C Kaelber, David Sheyn, Justin R Lappen","doi":"10.1055/a-2682-6137","DOIUrl":"https://doi.org/10.1055/a-2682-6137","url":null,"abstract":"<p><p>This study aimed to characterize the risk of adverse pregnancy outcomes among patients with congenital uterine anomalies (CUA) using electronic health record data.Retrospective cohort study utilizing the TriNetX analytics research network, including female patients aged 10 to 55 with a documented singleton and intrauterine pregnancy.A total of 561,440 patients met inclusion criteria, of whom 3,381 (0.6%) had one or more International Classification of Diseases (ICD) encounter diagnosis codes for CUA. Compared with patients with no documented ICD encounter diagnosis of CUA, patients with CUA had lower rates of live birth (odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.33-0.38). CUA patients had higher rates of preterm labor (OR: 1.41, 95% CI: 1.20-1.65), fetal malpresentation (OR: 2.48, 95% CI: 2.16-2.85), and postpartum hemorrhage (OR: 1.54, 95% CI: 1.31-1.80). Severe maternal morbidity (SMM) was increased in patients with CUA, including for hysterectomy (OR: 3.41, 95% CI: 1.26-9.17) and acute renal failure (OR: 1.97, 95% CI: 1.08-3.57).Patients with CUA are at higher risk of adverse pregnancy outcomes compared with patients with normal uterine anatomy, including for SMM and postpartum complications. These patients should be counseled about these possible risks, and CUA should be incorporated into risk-stratification and prevention strategies. · Adversary pregnancy outcomes are higher with CUAs.. · CUA patients have higher risk of preterm delivery.. · CUAs are linked to higher rates of fetal malpresentation.. · Markers of SMM increased in patients with CUA.. · Enhanced screening and high-risk delivery care are encouraged..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022692","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":"Forward Weight Prediction among Small for Gestational Age, Average for Gestational Age, and Large for Gestational Age Neonates.","authors":"Stephanie Masters, Nneoma Edokobi, Chloe Lessard, Benny Antony Amaraselvam, Ryan Bradley, Monica Ahrens, Megan Whitham","doi":"10.1055/a-2689-2368","DOIUrl":"10.1055/a-2689-2368","url":null,"abstract":"<p><p>This study was aimed to evaluate the accuracy of the gestation-adjusted projection (GAP) forward projection model among neonates classified as small (SGA), appropriate (AGA), or large for gestational age (LGA), and to assess the impact of elevated maternal body mass index (BMI) on prediction accuracy. The GAP model uses percentile-based extrapolation to predict birth weight from remote ultrasounds, maintaining fetal weight percentile from scan to delivery, unlike traditional methods relying on static weight estimates near delivery.We conducted a retrospective review (2016-2023) of singleton, liveborn, nonanomalous pregnancies delivered after 28 weeks. Exclusions included multiples, major anomalies, stillbirth, and missing third-trimester growth ultrasounds or mid-gestational anatomical surveys. Among 1,559 records reviewed, 554 (35.5%) met inclusion criteria, with exclusions primarily due to missing third-trimester growth ultrasounds and mid-gestational anatomical surveys. This represents approximately 5.6% of total deliveries during the study period, reflecting our specific inclusion requirement for third-trimester growth assessments beyond routine prenatal care. GAP prediction accuracy was defined as birth weight prediction within 10% of actual, consistent with prior literature. Percent error and absolute percent error were also evaluated.Median absolute percent error for the cohort was 8.56% (interquartile range: 3.9, 15.2). Accuracy within 10% of actual birth weight was achieved in 51.4% of normal weight, 64.1% of overweight, and 58.0% of obese patients (<i>p</i> = 0.031). SGA infants were more often underestimated (median error: -15.79%) than AGA (-5.05%) or LGA (1.18%) infants (<i>p</i> < 0.001). Accuracy within 10% was achieved in 64.8% of AGA, 29.9% of SGA, and 66.9% of LGA infants (<i>p</i> < 0.001).The GAP model demonstrates better accuracy in pregnancies with elevated maternal BMI and similar accuracy for LGA and AGA infants. Findings support its potential value in high-risk groups, such as those with obesity or suspected LGA. · GAP model shows 8.6% median error in weight estimate.. · SGA often underestimated; LGA more accurate.. · GAP performs well in overweight and obese patients..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939175","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":"Prevention of Neonatal Infections in Newborns Using Kangaroo Care Method: A Systematic Review and Meta-analysis.","authors":"Leni M Anchieta, Vinícius D Araújo, Letícia T Sobreira, Henrique N Neumann, Hyan B Tavares, Bruno C F de Araújo, Gabriel R de Lima, Roberta M de C Romanelli, Maria C F Bouzada","doi":"10.1055/a-2687-0626","DOIUrl":"https://doi.org/10.1055/a-2687-0626","url":null,"abstract":"<p><p>This study aimed to investigate the impact of KC on the prevention of neonatal infections. Initial article screening by title and abstract was performed independently by paired reviewers utilizing the RAYYAN tool, with conflicts resolved by a senior researcher. Statistical analysis was conducted using the Review Manager and R version 4.4.1 software. A 95% confidence interval (95% CI) was established for calculating risk ratios (RR) to analyze outcomes. The <i>I</i> ² statistic and Cochran's <i>Q</i> test were applied to evaluate heterogeneity. A total of 6,894 patients were included, of which 3,572 (51.81%) were part of the KC group, and 3,322 (48.19%) were in the control group (conventional care). Compared with traditional methods, KC reduced the risk of neonatal infections up to 28 days after birth (RR: 0.71; 95% CI: 0.59-0.87; <i>p</i> = 0.001; <i>I</i> ² = 44. The KC method significantly reduced the risk of neonatal sepsis, particularly in RCTs. While reductions in total hospital stay and mortality were observed, they were not statistically significant. Nonetheless, KC appears to be a safe, effective, and low-cost method for preventing infections during the neonatal period. · Neonatal sepsis is a major cause of mortality in the first 28 days of life.. · The KC method is largely used in preterms worldwide.. · The KC method has been shown to decrease sepsis mortality..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005778","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":"Pathohistological Changes in the Lungs of Very Preterm Infants with Bronchopulmonary Dysplasia Depending on the Clinical Features.","authors":"Anna O Menshykova, Dmytro O Dobryanskyy","doi":"10.1055/a-2511-8702","DOIUrl":"10.1055/a-2511-8702","url":null,"abstract":"<p><p>Establishing clinical factors associated with histological changes in the lungs of very preterm infants with evolving or established bronchopulmonary dysplasia (BPD) is essential for the development of more effective preventive interventions.Thirty-two infants with a gestational age (GA) of <32 weeks who died of BPD or had BPD but died due to other causes were included in the study. The associations of clinical data with histopathological changes in the lungs were assessed.The mean (standard deviation) GA of infants was 26.7 (1.9) weeks, and the mean birth weight was 919.7 (242.9) g. We revealed significant associations of maternal smoking with vascular hypertension lesions (<i>r</i> _s = 0.5, <i>p</i> < 0.05) in infants' lungs. Intrauterine growth retardation increased the risk of extensive fibroproliferation (<i>r</i> _s = 0.4, <i>p</i> < 0.05). In infants with patent ductus arteriosus (PDA) requiring treatment, muscle hyperplasia (<i>r</i> _s = 0.5, <i>p</i> < 0.05) was detected more often. The longer duration of mechanical ventilation (MV) correlated with diffuse interstitial fibroproliferation (<i>r</i> _s = 0.5, <i>p</i> < 0.05), airway epithelial lesions (<i>r</i> _s = 0.3, <i>p</i> < 0.05), and airway muscle hyperplasia (<i>r</i> _s = 0.4, <i>p</i> < 0.05). In infants who needed the longer MV and/or oxygen supplementation, an increased incidence of extensive fibroproliferation was found (<i>r</i> _s = 0.4 and <i>r</i> _s = 0.4 respectively, <i>p</i> < 0.05). Antenatal steroids decreased the incidence of diffuse interstitial fibrosis (<i>r</i> _s = - 0.4, <i>p</i> < 0.05).In very preterm infants with a GA of less than 32 weeks, lack of antenatal steroid prophylaxis, intrauterine growth restriction, presence of hemodynamically significant PDA, and prolonged MV or oxygen supplementation are associated with the pathomorphological lung changes that are more typical for \"old\" BPD. Traditional preventive measures against BPD remain essential in a modern population of very preterm infants. · Pathomorphological lung changes correlate with clinical data in very preterm infants who died of BPD.. · Lack of antenatal steroids prophylaxis, growth retardation, PDA, and prolonged mechanical ventilation affect lungs.. · Traditional BPD preventive measures remain essential in the modern population of preterm infants..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1550-1556"},"PeriodicalIF":1.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073281","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}