American Journal Of Perinatology[JOURNAL]
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200 papers
Iron Deficiency Screening with Reticulocyte-Hemoglobin Content and 2-Year Neurodevelopmental Outcomes in Extremely Low Birth Weight Infants.
Hulse WN, Bahr TM, Ostrander B … +3 more , Winter S, Ohls RK, DuPont TL
Am J Perinatol · 2026 Feb · PMID 41720462 · Publisher ↗
The objective of this study is to assess reticulocyte-hemoglobin (RET-He) and daily iron dosing with 2-year cognitive outcomes.A multicenter retrospective cohort study of 78 infants born between 2014 and 2018 at less tha...
The objective of this study is to assess reticulocyte-hemoglobin (RET-He) and daily iron dosing with 2-year cognitive outcomes.A multicenter retrospective cohort study of 78 infants born between 2014 and 2018 at less than 28 weeks' gestation or less than 1,250 g birth weight throughout level III or IV neonatal intensive care units (NICUs). RET-He measurement, iron supplementation, and the Bayley Scales of Infant and Toddler Development-III (Bayley-III) test were analyzed using multiple linear regression models.For every 1 mg/kg increase in mean total daily iron supplementation, the Bayley-III cognitive score increased by 2.9 points (95% confidence interval [CI]: 0.4-5.4, = 0.023). No associations were identified between minimum or maximum RET-He and Bayley-III cognitive outcomes. Infants with a RET-He value < 29 pg tended to be 2.53 times more likely to have a Bayley-III language score below 70 (odds ratio: 2.53, 95% CI: 0.92-6.95, = 0.071). Thirty-eight out of 78 (38.4%) infants were iron-deficient during their NICU hospitalization, with at least one RET-He < 29 pg.An association was identified between a higher mean daily iron dose and improved cognitive outcomes for infants, but not between the iron index RET-He and neurodevelopmental outcomes. Iron deficiency remains common among NICU patients undergoing follow-up, suggesting that standard iron dosing may be inadequate for high-risk neonates. · Higher daily iron dose improves cognitive outcomes.. · Reticulocyte-hemoglobin level is not associated with neurodevelopmental outcomes.. · Iron deficiency is common in very low birth weight infants, affecting 38.4%..
Factors Associated with Inpatient COVID-19 Vaccine Uptake for Pregnant and Postpartum People.
Burdette ER, Pelletier A, Freret TS … +2 more , Goldfarb IT, Berhie SH
Am J Perinatol · 2026 Feb · PMID 41720461 · Publisher ↗
This study aimed to evaluate inpatient COVID-19 vaccine uptake among pregnant and postpartum patients.Retrospective cohort study of patients admitted to the antepartum and postpartum services of two academic hospitals be...
This study aimed to evaluate inpatient COVID-19 vaccine uptake among pregnant and postpartum patients.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 -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.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).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. · Inpatient vaccine access did not increase uptake.. · Vaccine uptake was associated with length of stay.. · General vaccine acceptance was linked to inpatient vaccination..
Labor Length Differences in Combination Ripening with 60 versus 30-mL Foley Inflation Volume: A Propensity Score-Matched Study.
Hamm RF, Mccoy J, Nguyen A … +1 more , Levine LD
Am J Perinatol · 2026 Feb · PMID 41713865 · Publisher ↗
Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has e...
Data support shorter time to delivery with 60 versus 30-mL Foley inflation for labor induction. Similarly, combination cervical ripening has a shorter time to delivery compared with single agents. To date, no study has evaluated incremental benefit of higher Foley volume in the setting of combination ripening methods.This is a secondary analysis of a prospective cohort study evaluating standardized induction management at two sites. Any cervical ripening method could be used. Site no. 1 used 60-mL Foley inflation, whereas Site no. 2 used 30 mL. For this analysis, patients were included if they underwent a term (≥37 weeks) induction from 2020 to 2022 with a singleton, intact membranes, and received combination methods of Foley and another agent. A 1:1 propensity score matching balanced baseline parameters.Of 4,295 inductions, 2,117 (49.3%) utilized combination cervical ripening methods. After propensity score matching, 1,480 were included. Even in the context of combined ripening and standardized induction, Foley inflation to 60 mL was associated with a 3-hour shorter labor length than 30 mL (14.6 [10.4-21.3] vs. 17.7 hours [12.4-24.4], < 0.001). When censored for cesarean, patients who received 60-mL Foley inflation delivered 70% faster than those who received 30 mL (hazard ratio: 1.73 [1.36-2.21]). There was no difference in cesarean, maternal morbidity, or neonatal morbidity.Even when using combined cervical ripening methods, 60-mL Foley inflation is associated with reduced time to delivery as compared with 30 mL without increasing morbidity. · No prior study has evaluated incremental benefit of higher Foley volume.. · Combined cervical ripening with 60-mL Foley is associated with reduced time to delivery.. · Combined cervical ripening with 60-mL Foley is not associated with differences in morbidity..
A Pathophysiological Approach for Early Detection and Prevention of AKI in the NICU.
Gunasekaran V, Woo S, Krishnan P … +4 more , South AM, Shenberger J, Askenazi D, Garg PM
Am J Perinatol · 2026 Feb · PMID 41713864 · Full text
This study aimed to summarize contemporary evidence on the definition, epidemiology, risk factors, and prevention of acute kidney injury (AKI) in critically ill and preterm infants in the neonatal intensive care unit (NI...
This study aimed to summarize contemporary evidence on the definition, epidemiology, risk factors, and prevention of acute kidney injury (AKI) in critically ill and preterm infants in the neonatal intensive care unit (NICU), and to highlight prevention-focused strategies to improve outcomes. Narrative review of current literature evaluating AKI burden, diagnostic criteria, modifiable and nonmodifiable risk factors, and preventive interventions in neonatal intensive care settings. AKI is common in critically ill and preterm infants and is associated with increased mortality, prolonged hospitalization, neurodevelopmental impairment, and progression to chronic kidney disease. Modified Kidney Disease: Improving Global Outcomes criteria have improved diagnostic consistency and revealed particularly high AKI prevalence in extremely low birth weight infants. Key modifiable risk factors include hemodynamic instability, patent ductus arteriosus, nephrotoxic drug exposure, fluid overload, and sepsis, while preventive strategies span optimized antenatal management, therapeutic hypothermia for hypoxic ischemic encephalopathy, careful postnatal hemodynamic and fluid management, nephrotoxic drug stewardship, early infection control, individualized ductus arteriosus therapy, and potential use of caffeine, alongside emerging urinary biomarkers for earlier detection. Given limited therapeutic options once AKI occurs, prevention through structured surveillance, timely identification of high-risk states, and rigorous implementation of kidney protective practices is essential. Integrating quality improvement, protocolized care pathways, and educational outreach within NICUs offers the greatest promise for improving short and long-term outcomes in infants with AKI. · Structured post-AKI monitoring and quality improvement protocols reduce AKI incidence.. · Nephrotoxic medication protocols reduce AKI through proactive monitoring and dose optimization.. · Neonatal AKI is common and serious; prevention via fluids, hemodynamics, and med stewardship is key..
Assessing the Reliability of Large Language Models for Evaluation of Risk of Bias in Randomized Clinical Trials.
Nagao T, Kawakita T
Am J Perinatol · 2026 Mar · PMID 41713863 · Publisher ↗
Systematic reviews depend on rigorous risk-of-bias (RoB) assessments to ensure credibility, yet manual evaluation using the Cochrane RoB 2 tool is resource-intensive. While large language models (LLMs) offer potential fo...
Systematic reviews depend on rigorous risk-of-bias (RoB) assessments to ensure credibility, yet manual evaluation using the Cochrane RoB 2 tool is resource-intensive. While large language models (LLMs) offer potential for automation, their alignment with human judgment remains underexplored. This study evaluates the reliability of ChatGPT-4o, ChatGPT-5, and Claude 3.5 Sonnet in assessing RoB in randomized controlled trials (RCTs), comparing their agreement with human reviewers and internal consistency.We retrospectively analyzed 180 RCTs from systematic reviews published in the American Journal of Obstetrics and Gynecology (2021-2023) reporting complete human RoB 2 ratings. Each LLM processed full-text PDFs using a standardized prompt incorporating the complete RoB 2 algorithm. Model performance was evaluated against human benchmarks using Cohen's kappa and prevalence- and bias-adjusted kappa. Intramodel reliability was assessed across three independent runs to measure consistency.ChatGPT-5 consistently outperformed other models, achieving the highest agreement in randomization (Domain 1; 76%), missing outcome data (Domain 3; 80%), and outcome measurement (Domain 4; 76%). It showed moderate concordance for deviations from intended interventions (69%). However, all models struggled with selective reporting (Domain 5), where agreement dropped to 47 to 51%. For overall RoB judgments, ChatGPT-5 demonstrated superior concordance (60-62%, κ = 0.36-0.40) compared with ChatGPT-4o (45%) and Claude 3.5 Sonnet (43%). ChatGPT-5 also exhibited substantial to near-perfect internal consistency.Among the evaluated models, ChatGPT-5 most closely approximated human RoB 2 assessments and achieved superior internal consistency, suggesting it could serve as a practical first-pass tool to reduce reviewer burden. However, persistent limitations in detecting selective reporting-likely due to the inability to cross-reference external trial registries-highlight that expert human oversight remains essential for accurate evidence synthesis. · GPT-5, GPT-4o, and Claude evaluated 180 RCTs.. · GPT-5 outperformed GPT-4o and Claude models.. · Models struggled with selective reporting bias..
The Equivalence of Fetal Heart Rate Variability and Accelerations in the Interpretation of Non-Stress Tests.
Johnson GJ, Goulding AN, Denning SG … +1 more , Clark SL
Am J Perinatol · 2026 Mar · PMID 41707684 · Publisher ↗
Accelerations were initially chosen as the basis for non-stress test (NST) interpretation against a background of significant artifact present in the first-generation, non-autocorrelated fetal monitors that made the inte...
Accelerations were initially chosen as the basis for non-stress test (NST) interpretation against a background of significant artifact present in the first-generation, non-autocorrelated fetal monitors that made the interpretation of variability with external fetal heart rate (FHR) monitoring unreliable. Since moderate variability and accelerations are both physiologically similar and equally indicative of a non-acidemic fetus, we hypothesized that interpreting NSTs based on variability rather than accelerations would produce similar results.We performed a retrospective cohort study of singleton fetuses undergoing antenatal testing in our system between 2011 and 2022. Data regarding the interpretation of NSTs were extracted and non-reactive tests were identified. For patients with non-reactive NSTs, data regarding follow-up testing were collected.Our cohort included 76,232 total NSTs performed on 22,619 patients at increased risk of fetal demise, of which 1,662 (2%) were found to be non-reactive. Of the non-reactive tests, 1,499 (90%) were interpreted as having moderate variability, 114 (7%) had minimal or absent variability, and in 49 (3%), the variability was uncertain. Data regarding follow-up testing were available for 1,480 of the 1,499 non-reactive tests with moderate variability. In this group, 1,476 (99%) went on to have either reassuring follow-up testing. The four infants (0.3%) who failed to have a reassuring follow-up test all had major anomalies.In nonanomalous fetuses, moderate variability in an otherwise non-reactive NST was invariably followed by a reassuring test of fetal well-being. These data confirm basic science observations regarding FHR regulation and suggest that, in the presence of moderate variability during an otherwise non-reactive NST, additional follow-up testing may not be necessary. Such an approach would avoid the need for additional testing in 90% of fetuses with non-reactive NSTs. · A clinical distinction between moderate variability and an acceleration represents historical artifact.. · Nonanomalous fetuses with a nonreactive nonstress test but moderate variability invariably had reassuring subsequent testing.. · These clinical observations confirm known basic science physiology.. · In the antepartum evaluation of fetal well- being, moderate variability and accelerations are clinically equivalent..
HomeSafe: Postpartum Hypertensive Care Enabled by Electronic Health Record Digital Blood Pressure Capture and Population Health Management.
Berhie S, Harper E, Anwer T … +7 more , Gupta S, Cantonwine D, Suliman S, Celi AC, Diouf K, Seely EW, Wilkins-Haug L
Am J Perinatol · 2026 Mar · PMID 41707683 · Publisher ↗
The objective is to present stepwise refinements to , an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure (BP) surveillance after hypertensive disease of pregnancy (HDP). was designed f...
The objective is to present stepwise refinements to , an Epic-tethered, population-health-coordinated postpartum pathway for blood pressure (BP) surveillance after hypertensive disease of pregnancy (HDP). 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.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% ( = 0.0006). Program enrollment increased from 245 to 485 ( < 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. engagement strongly predicted 6-week postpartum visit attendance (89.9 vs. 65.4%, < 0.0001). , 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. · HomeSafe-Epic-linked monitoring of postpartum blood pressure.. · Population health tenets improve postpartum surveillance.. · Gaps in postpartum surveillance of high-risk person remain..
Whole-Body Hypothermia for Hypoxic-Ischemic Encephalopathy and Route of Delivery.
Paranandi S, Zullo F, Kovatis KZ … +3 more , Sciscione AC, Hoffman MK, Chauhan SP
Am J Perinatol · 2026 Feb · PMID 41698415 · Publisher ↗
This study aimed to compare the antenatal and intrapartum characteristics of newborns at ≥36.0 weeks, who underwent whole-body hypothermia for hypoxic-ischemic encephalopathy (HIE) and had either cesarean or vaginal deli...
This study aimed to compare the antenatal and intrapartum characteristics of newborns at ≥36.0 weeks, who underwent whole-body hypothermia for hypoxic-ischemic encephalopathy (HIE) and had either cesarean or vaginal deliveries.Retrospectively, we identified all non-anomalous singletons at ≥36.0 weeks who had HIE and underwent whole-body hypothermia at a community teaching hospital. Differences in baseline characteristics and intrapartum factors were compared among the cesarean versus vaginal deliveries using chi-square tests. Multivariable Poisson regression models were used to estimate the association between delivery route and various outcomes with adjustment for potential confounders.Of the 32,765 deliveries during the study period, 132 (0.4%) met the inclusion criteria, and among them, 79 (59.8%) had cesarean deliveries, and the remaining 53 (40.1%) had vaginal births. The prenatal care providers (i.e., private, community hospital faculty, or others) differed significantly between the two groups ( = 0.013). Within 60 minutes of hospitalization, the characteristics of fetal heart rate tracing (FHRT) and its category (I, II, or III) did not differ between the groups. Sentinel events occurred among 25.3% of those who had cesarean and 30.2% of those who delivered vaginally ( = 0.556). FHRT 60 minutes prior to delivery did not differ with regard to the presence of decelerations ( = 0.409), and variability ( = 0.199), but whether it was category I, II, or III ( = 0.030) did vary significantly. The likelihood of neonatal seizure (adjusted incidence rate ratio = 1.03; 95% confidence interval: 0.41-2.58) and mortality (1.10; 0.03-45.5) were similar between the groups.Occurring in approximately 4 per 1,000 deliveries at a community teaching hospital, the majority of singletons who had whole-body cooling had cesarean delivery. While the category of FHRT did not differ significantly within 60 minutes of admission, it did differ 60 minutes before birth. · Whole-body hypothermia (WBH) occured in 4/1,000 births.. · About 60% of newborns with WBH had cesarean delivery.. · Neither braddycardia nor tachycardia was noted with 132 cases of WBH.. · Categories of fetal heart rate tracing differed significantly among those delivered vaginal versus cesarean..
Clinical Judgement of Comfort in Preterm Infants by Neonatal Intensive Care Unit Nurses Accurately Reflects Neonatal Stress Exposure.
van Dokkum NH, Koning E, Lani A … +2 more , Bouma HA, Bos AF
Am J Perinatol · 2026 Feb · PMID 41688048 · Publisher ↗
We aimed to investigate whether there was a correlation between the clinical judgement of comfort by neonatal intensive care unit (NICU) nurses and the daily stress exposure in the first 28 days of life in extremely to v...
We aimed to investigate whether there was a correlation between the clinical judgement of comfort by neonatal intensive care unit (NICU) nurses and the daily stress exposure in the first 28 days of life in extremely to very preterm infants born before 30 weeks' gestation.We included 45 infants born <30 weeks' gestation and/or <1,000 g of birth weight in an observational cohort study. Nurses' clinical judgement of comfort was based on a 10-point numeric rating scale. We quantified exposure to neonatal stress using the Neonatal Infant Stressor Scale. We calculated Spearman's correlation coefficients to determine the strength of the association between the two for each day between birth and 28 days of life.Average clinical judgement scores ranged from 4 to 10, with means mainly between 7 and 8. Days 1 to 3 were excluded because of missing data. For days 4 to 20, we found moderate to high correlation coefficients. After day 21, we did not identify significant correlations anymore, possibly due to less variance in data.Clinical judgment of comfort in preterm infants by NICU nurses adequately reflects neonatal stress exposure. Our findings call for more research into the best measure of neonatal stress that encompasses both exposure to stressors and experience of stress. · Measuring neonatal stress is difficult, and exposure may not be the same as experience.. · NICU nurses' judgement of stress and comfort accurately reflects exposure to stress.. · Exposure to stress and experience of stress are therefore related.. · Future studies should focus on creating a gold standard for measuring neonatal stress..
Trends and Contributing Factors Affecting Survival and Neurodevelopmental Outcomes in Infants Born at ≤25 Weeks' Gestation: A Retrospective Single-Center Study.
Dolma K, Shrestha D, Bhat R … +3 more , Ramani M, Eyal F, Zayek M
Am J Perinatol · 2026 Feb · PMID 41679328 · Publisher ↗
Previous data from our institution demonstrated a decline in mortality among infants born at 22 weeks' gestation from 1998 to 2008, alongside a reduction in neurodevelopmental impairment in infants born at 23 to 24 weeks...
Previous data from our institution demonstrated a decline in mortality among infants born at 22 weeks' gestation from 1998 to 2008, alongside a reduction in neurodevelopmental impairment in infants born at 23 to 24 weeks' gestation. This study aimed to analyze temporal trends and identify clinical and perinatal factors associated with survival and neurodevelopmental outcomes in periviable infants (gestational age ≤25 weeks) born between 2009 and 2020.This retrospective cohort study was conducted at a single level III neonatal intensive care unit. Infants born at ≤25 weeks' gestation were grouped into two epochs: 2009 to 2014 and 2015 to 2020. Survival, major in-hospital morbidities, and neurodevelopmental outcomes at 2 years' corrected age were compared. Clinical practice changes during the study period were evaluated as potential contributors to variations in outcome.A total of 672 infants were included (Epoch 1 [E1]: = 316; Epoch 2 [E2]: = 356) during the study period. Survival rates were similar between epochs (E1 vs. E2; 76 vs. 78%; = 0.42). However, rates of grade 2 or 3 bronchopulmonary dysplasia (41 vs. 57%; < 0.01) and oxygen use at discharge (23 vs. 47%; < 0.01) increased significantly in Epoch 2. The prevalence of severe neurodevelopmental impairment also rose substantially (19 vs. 38%; < 0.01). Follow-up at 2 years declined markedly in Epoch 2 (75 vs. 40%; < 0.01), limiting confidence in long-term outcome estimates. Notably, a shift in clinical practice toward higher oxygen saturation targets was associated with this increase in pulmonary and neurodevelopmental morbidity.Although survival rates for infants born at ≤25 weeks' gestation have stabilized, the concurrent rise in pulmonary and neurodevelopmental morbidities signals the need for improved care strategies, particularly oxygen management, and emphasizes the importance of long-term monitoring for this vulnerable population. · Survival rates at ≤25 weeks have plateaued at our single center over the past decade.. · Pulmonary morbidities have increased, likely influenced by evolving care practices.. · Neurodevelopmental outcomes are worsening, highlighting the need to improve intact survival..
Female versus Male Fetuses-Variation in Fetal Heart Rate Tracing and Adverse Outcomes at Term.
Roberts AW, Cagino KA, Wiley RL … +3 more , Zullo F, Mendez-Figueroa H, Chauhan SP
Am J Perinatol · 2026 Feb · PMID 41672444 · Publisher ↗
This study aimed to compare the fetal heart rate tracing (FHRT) and composite adverse outcomes among female versus male newborns delivered at term.The inclusion criteria of the retrospective study were non-anomalous sing...
This study aimed to compare the fetal heart rate tracing (FHRT) and composite adverse outcomes among female versus male newborns delivered at term.The inclusion criteria of the retrospective study were non-anomalous singletons, delivered at ≥37 weeks after labor, whose sex assignment at birth was either female or male. The consecutive deliveries occurred over 15 months. Obstetricians-blinded to maternal characteristics and outcomes-interpreted the FHRT for the last 20 to 120 minutes of labor. Composite neonatal and maternal adverse outcomes (CNAO and CMAO) were compared between the groups. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Of the 5,160 deliveries during the study period, 3,165 (61.3%) met the inclusion criteria, and among them, 1,514 (47.8%) were females, and 1,651 newborns (52.2%) were males. Obstetricians reviewed 358,620 minutes of FHRT. Compared to females, the FHRT among males was significantly more likely to have severe late decelerations (aOR = 5.25; 95% CI: 1.16-23.83) or any severe decelerations (aOR = 1.21; 95% CI: 1.03-1.42). Whether the tracing was category I, II, or III, the incidence was similar. Cesarean delivery for non-reassuring FHRT was more common among male than female newborns (aOR = 1.21; 95% CI: 1.03-1.41). CNAO for male newborns was significantly higher than that for female newborns (aOR = 2.55; 95% CI: 1.35-4.84). Apgar score <7 at 5 minutes was the component of the CNAO that differed significantly (aOR = 3.16; 95% CI: 1.27-7.86). CMAO was also significantly higher for individuals who delivered male (9.3%) versus female (6.3%) newborns (aOR = 1.51, 95% CI: 1.16-1.98). Estimated blood loss ≥1,000 mL was significantly more likely among male than female newborns (aOR = 1.51; 95% CI: 1.09-2.08).Among singleton pregnancies delivered at term, male fetuses, compared to females, are significantly more likely to have abnormalities of FHRTs and adverse outcomes. · Male fetuses have more severe decelerations, including severe late decelerations, than females.. · Cesarean delivery for non-reassuring FHRT is significantly more common in male than female fetuses.. · CNAO is significantly more common in male than female fetuses.. · CMAO is significantly more common in male than female fetuses..
Expectant Management Beyond 34 Weeks' Gestation Should Be Offered for Preterm Premature Rupture of Membranes.
Sarker M, Sperling JD, Emeruwa UN … +1 more , Teal EN
Am J Perinatol · 2026 Feb · PMID 41672443 · Full text
Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased...
Delivery timing for preterm prelabor rupture of membranes (PPROM) was historically recommended at 34 weeks' gestation. Recent studies have shown expectant management of PPROM beyond 34 weeks is associated with increased antepartum or intrapartum hemorrhage and intrapartum fever and decreased risk of newborn respiratory distress, admission to neonatal intensive care unit, and cesarean delivery. Despite the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), and the Society of Obstetricians and Gynaecologists of Canada (SOGC) embracing expectant management as an option to consider for PPROM, widespread uptake and implementation of this management and the nuanced discussion remain mixed. With this clinical opinion, we highlight the outcomes associated with expectant management of PPROM beyond 34 weeks, summarize the current state of the controversy, review the nationally published guidelines, and discuss our opinion on the controversy as well as future directions for research endeavors. Given the data present at this time, we believe that providers should at least routinely offer, but not necessarily recommend, the option of expectant management for PPROM beyond 34 weeks in the absence of contraindications. Foregoing this discussion limits patients' ability to make informed decisions and, worse, if not universally offered in the absence of contraindications to expectant management, may be an area of inequitable or biased care. · Recent studies have characterized outcomes with expectant management of PPROM after 34 weeks.. · There remains controversy regarding delivery timing for pregnancies complicated by PPROM.. · Expectant management should be routinely offered for PPROM in the absence of contraindications..
Transient Abnormal Myelopoiesis with Myeloid Cell Thrombus in a Case of Down Syndrome: A Rare Placental Finding.
Kamath PS, Ravikumar G, Shanthaladevi AM … +2 more , Tilak VP, Chandrakala BS
Am J Perinatol · 2026 Feb · PMID 41667077 · Publisher ↗
This study was aimed to underscore the value of placental examination in identifying transient abnormal myelopoiesis (TAM), particularly in neonates with previously unsuspected Down syndrome (DS), and to demonstrate how...
This study was aimed to underscore the value of placental examination in identifying transient abnormal myelopoiesis (TAM), particularly in neonates with previously unsuspected Down syndrome (DS), and to demonstrate how such placental findings can guide timely clinical diagnosis when there is no antenatal suspicion.This short communication describes the clinical, hematological, and placental pathological findings in a neonate born without prior antenatal suspicion of DS. Particular emphasis is placed on the identification of TAM and associated myeloid cell thrombus (MCT) within the placenta and their relevance in prompting further clinical evaluation.The placental weight and dimensions were 330 g and 13 cm × 12 cm, and the disc was unremarkable on macroscopic examination. The umbilical cord showed thrombus in one of the vessels. On microscopy, the muscularized placental fetal vessels showed evidence of leukocytosis with left shift of hematopoietic elements inclusive of blast forms. Many nucleated red blood cells along with platelets and fibrin were also noted. These hematopoietic precursors were seen forming organized thrombi causing segmental high-grade lesions of fetal vascular malperfusion. The umbilical artery in the umbilical cord showed MCT (positive for CD 34 and CD 117 on immunohistochemistry). Hematological investigations with flow cytometry assisted in diagnosis, which was confirmed by genetic testing.In situations where DS is not clinically suspected antenatally, recognition of TAM-especially when accompanied by MCT-on placental examination may serve as the first and only clue prompting clinicians to investigate for DS. This case underscores the pivotal role of placental pathology in facilitating early detection and appropriate management of such neonates. · Placental transient abnormal myelopoiesis in an unsuspected case of Down syndrome.. · Myeloid cell thrombus in placental and umbilical cord vessels.. · Flowcytometry along with genetic testing, confirming diagnosis of Transient abnormal myelopoiesis and Down syndrome..
Antenatal Estimation of Placental Weight and Its Relationship with Adverse Fetal Outcome.
Yogi I, Kumar M, Ravi V … +2 more , Nangia S, Yadav R
Am J Perinatol · 2026 Feb · PMID 41663084 · Publisher ↗
This study aimed to estimate placental weight (EPW) antenatally in the third trimester and to evaluate its role in predicting adverse fetal outcome.A total of 190 antenatal women from 28 to 40 weeks of gestation, expecte...
This study aimed to estimate placental weight (EPW) antenatally in the third trimester and to evaluate its role in predicting adverse fetal outcome.A total of 190 antenatal women from 28 to 40 weeks of gestation, expected to deliver within 72 hours of examination, were included. The placental length, breadth, thickness, and estimated fetal weight (EFW) were noted in ultrasound. After delivery, the placental dimensions, including fetal weight, were recorded. The fetal outcome was noted. Multivariate regression was used for antenatal EPW calculation, and its correlation with actual placental weight (APW) was done.The mean age of women was 27.9 ± 3.9 years. The mean estimated and actual placental lengths at term were 15.0 ± 2.69 cm (range 9-22.8 cm) and 14.4 ± 2.70 cm (range 8-21.2 cm). The Spearman coefficient of correlation (ρ) between all placental dimensions was found to be statistically significant ( = 0.001); the best correlation was observed between EPW and APW (ρ = 0.840). The centile chart of placental weight was drawn using multivariate regression analysis. The EPW and placental length was significantly less at all gestations in cases with adverse fetal outcome compared with normal outcome; however, the area under curve (AUC) for EPW at 30 to 34 weeks was the best ( = 960), taking the EPW cut-off of 345 g; the sensitivity and specificity of predicting adverse fetal outcome were 80 and 100%, respectively.To the best of our knowledge, it is the first study to attempt antenatal estimation of placental weight, and has shown it to be valuable in predicting adverse fetal outcome. · Novel study to attempt antenatal estimation of placental weight.. · Third trimester assessment of placental weight was done with good accuracy.. · Placental weight had good accuracy in predicting adverse fetal outcome..
Delivery Outcomes after Centering versus Routine Prenatal Care.
Kelly SH, Agarwal J, Goldstein I … +3 more , Gary D, Wynne A, Friedman A
Am J Perinatol · 2026 Feb · PMID 41663083 · Publisher ↗
The objective of this study was to compare delivery outcomes among women in Northern Manhattan undergoing Centering versus routine prenatal care.This retrospective cohort study analyzed prenatal care and delivery hospita...
The objective of this study was to compare delivery outcomes among women in Northern Manhattan undergoing Centering versus routine prenatal care.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.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.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. · 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..
Brain Natriuretic Peptide Screening in Pregnancy and Association with Severe Maternal Morbidity during Delivery Hospitalization.
Denoble AE, Federspiel JJ, Goldstein SA … +2 more , Culhane J, Dysart KC
Am J Perinatol · 2026 Feb · PMID 41643727 · Publisher ↗
This study aimed to describe patterns of outpatient natriuretic peptide (NP) testing and levels, including brain NP (BNP) and N-terminal pro-BNP (NT-proBNP), among pregnant patients with and without heart disease (HD) an...
This study aimed to describe patterns of outpatient natriuretic peptide (NP) testing and levels, including brain NP (BNP) and N-terminal pro-BNP (NT-proBNP), among pregnant patients with and without heart disease (HD) and the association between NP and severe maternal morbidity (SMM).A nationwide sample of pregnant patients delivering at ≥20 weeks in the Epic Cosmos dataset from 2017 to 2023 was extracted. Outpatient NP levels drawn between 24 and 34 weeks' gestation were identified, categorized as normal or elevated (BNP ≥ 100 or NT-proBNP ≥ 300 pg/mL), and described according to the presence or absence of congenital or acquired HD based on ICD-10 codes. The primary outcomes were CDC-defined SMM and nontransfusion SMM. Among those with NP testing, the association between elevated levels and SMM was assessed using logistic regression after applying stabilized inverse probability treatment weights (SIPTW) that included demographic characteristics, HD, obesity, and other medical comorbidities.Of 3,935,745 unique pregnancies, 3,920,088 (99.6%) had no NP testing, 14,180 (0.4%) had normal NP, and 1,477 (0.04%) had elevated NP. Of those with any HD, 1.6% underwent NP testing. A greater proportion of those with normal NP ( = 1,287 [9.1%]) and elevated NP ( = 406 [27.5%]) experienced SMM compared with those without NP testing ( = 99,176 [2.5%]; < 0.001), with similar results for nontransfusion SMM. The odds of SMM and nontransfusion SMM were higher in patients with elevated NP levels; this association persisted, but was attenuated, in SIPTW-adjusted models (SMM crude odds ratio [OR]: 14.6, 95% confidence interval [CI]: 13.0, 16.4, and adjusted odds ratio [aOR]: 1.2, 95% CI: 1.1, 1.2; nontransfusion SMM crude OR: 25.4, 95% CI: 22.6, 28.6 and aOR: 1.2, 95% CI: 1.2, 1.2).NP testing remains underutilized during pregnancy, even among patients with heart disease. Elevated levels are associated with higher SMM risk, although the attenuation in association after covariate adjustment suggests its additive value in predicting SMM may be limited. · BNP testing remains underutilized in pregnancy.. · BNP testing ranged from only 1 to 6% of individuals with heart disease in pregnancy.. · Elevated BNP levels obtained prior to delivery are associated with SMM, although this association is attenuated after adjustment for other clinical risk factors..
Cue-Based and Volume-Based Oral Feeding Progression Strategies and Outcomes in Extremely Premature Infants.
Diaz M, Nandula P, Kumar VHS … +3 more , Gautam S, Hudak ML, Shah SD
Am J Perinatol · 2026 Feb · PMID 41643714 · Publisher ↗
This study aimed to compare the feeding outcomes of extremely premature infants (EPI, <28 weeks' gestational age) cared for by the same neonatology group at two tertiary neonatal intensive care units that employed two di...
This study aimed to compare the feeding outcomes of extremely premature infants (EPI, <28 weeks' gestational age) cared for by the same neonatology group at two tertiary neonatal intensive care units that employed two different oral feeding strategies (cue-based oral feeding progression [CB-OFP] and volume-based oral feeding progression [VB-OFP]).We conducted a retrospective cohort study of EPI (July 1, 2022, and April 12, 2024) patients discharged on full oral feedings. The primary outcome was postmenstrual age (PMA) when full oral feeding was achieved. Secondary outcomes included time to full oral feeds, PMA and weight at initiation and discharge, growth velocity, and length of hospital stay.Baseline characteristics were similar among 119 EPIs (CB-OFP: = 61; VB-OFP: = 58) except for maternal magnesium sulfate exposure and postnatal steroid use. CB-OFP infants achieved full oral feeding at an earlier PMA (median: 37.6 vs. 40.1 weeks; < 0.001) and in fewer median days (20 vs. 27 days; = 0.03). CB-OFP was also associated with earlier discharge (median PMA at discharge: 38.6 vs. 41.3 weeks; < 0.001) and shorter length of stay (93 vs. 111.5 days; < 0.001). Growth velocity and discharge weight z-scores did not differ significantly between groups.Our experience suggests that a CB-OFP strategy may be associated with earlier attainment of full oral feeds and a shorter length of stay compared with VB-OFP. Future randomized controlled trials are warranted to validate these findings and to assess potential long-term neurodevelopmental outcomes with different feeding strategies. · There is no consensus on the optimal oral feeding progression strategy for EPIs.. · A CB-OFP strategy was associated with earlier achievement of full oral feeding and a shorter length of stay.. · Oral motor interventions, including stimulation exercises, may play a role in improving oral feeding abilities in EPIs..
From Pathway to Practice: Implementing Evidence-Based Quality Improvement for ELBW Care.
Bedwell SM, Pogribna U
Am J Perinatol · 2026 Feb · PMID 41643713 · Publisher ↗
Structured clinical guidelines improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and...
Structured clinical guidelines improve outcomes in neonatal care. At Oklahoma Children's Hospital, the need for a standardized approach to extremely low birth weight (ELBW) infants became urgent due to rising acuity and care variability. Despite existing nursing protocols, the unit lacked comprehensive interdisciplinary guidelines for ELBW infants. Key goals included reducing intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP).Multidisciplinary teams developed eight clinical pathways using evidence-based models. The Appreciative Inquiry framework was used to engage staff and build consensus. The interdisciplinary workgroups conducted literature reviews, developed system-based protocols, and facilitated iterative revisions. Pathways were implemented and were supported by education, exposure, and saturation strategies. Key metrics were benchmarked using Vermont Oxford Network (VON) data, with IVH, BPD, and ROP as outcome measures and mortality as a balancing measure. Real-time data collection was used to drive further improvement. PDSA (plan, do, study, act) cycles targeted thermoregulation, line placement, early surfactant administration, and glucose and oxygen management.Post implementation data ( = 130) showed a reduction in severe IVH (from 25 to ∼20%), a 7% reduction in grade 2 and grade 3 BPD, consistently low ROP rates (<3%), and a downward mortality trend in 2023.ELBW pathways improved care standardization and outcomes without increasing mortality. Continued efforts beyond the first week of life are needed to sustain and expand improvements. · Multidisciplinary pathways improved standardization and care for ELBW infants.. · Pathways led to modest gains in BPD and IVH, guiding future quality improvement priorities.. · Education and teamwork drove adoption and sustainability without major resource needs..
Impact of an Infection Prevention Bundle Modification on Post-Cesarean Delivery Surgical Site Infections.
Steelman M, Sutton D, Fox NS
Am J Perinatol · 2026 Feb · PMID 41617193 · Publisher ↗
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.We conducted a retrospective cohort study of c...
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.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).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; = 0.313). No significant temporal trends were observed before ( = 0.151) or after ( = 0.221) bundle implementation. Subgroup analyses by labor status, prior cesarean, and BMI similarly showed no significant associations between the bundle and SSI risk.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. · 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..
Genetic Testing and Challenges in a Level IV Midwestern NICU: Who, What, When, and Then?
McBride H, Schwoerer JS, Rholl E … +1 more , Acharya K
Am J Perinatol · 2026 Feb · PMID 41617192 · Publisher ↗
This study aimed to examine genetic testing strategies and their impact on redirection of care and on reducing prognostic uncertainty in the NICU.This is a retrospective cohort study from 2020 to 2021.Out of 774 NICU inf...
This study aimed to examine genetic testing strategies and their impact on redirection of care and on reducing prognostic uncertainty in the NICU.This is a retrospective cohort study from 2020 to 2021.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.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. · 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..
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