American Journal Of Perinatology[JOURNAL]
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200 papers
Evaluating the Impact of the Formula Shortage on Feeding Plans of Newborns.
Knapp JL, Grant A, Lackey A … +2 more , Mackley A, Paul DA
Am J Perinatol · 2026 Feb · PMID 41617191 · Publisher ↗
This study aimed to evaluate if the 2022 formula shortage had an impact on current feeding plans.A survey was created and offered to birthing people at a single center from July 2023 through January 2024. Analysis includ...
This study aimed to evaluate if the 2022 formula shortage had an impact on current feeding plans.A survey was created and offered to birthing people at a single center from July 2023 through January 2024. Analysis included descriptive statistics and Chi-square for categorical variables.In the study sample, = 163, 55% planned on exclusively breastfeeding ( = 90), 7% on formula feeding only ( = 11), and 37% on a combination of breastmilk and formula ( = 61). While 84% were aware of the shortage ( = 137), 17% agreed or strongly agreed that the formula shortage impacted their feeding plan ( = 27). There were no differences in responses by race or ethnicity. Participants with older age and higher education level indicated that there were more important factors other than the formula shortage when choosing what they were planning to feed the baby.In our study, while 84% of respondents were aware of the formula shortage, 17% indicated that the 2022 formula shortage continues to impact feeding plans. The main implication is that providers should be aware of our findings and consider integrating a discussion on the formula shortage when supporting and counseling patients on their infant feeding plan. · The 2022 formula shortage continues to have impact on families.. · There were no statistical differences among race, ethnicity, education, or age.. · Majority recognize there are more important factors when choosing their infant's feeding plan..
Perinatal and Maternal Outcomes by Indication for Delivery in the Second Trimester.
Cagino KA, McGee PL, Costantine MM … +14 more , Varner MW, Tita ATN, Longo M, Stoll BJ, Thorp JM, Reddy UM, Grobman WA, Rouse DJ, Simhan HN, Bailit JL, Dugoff L, Saade GR, Sibai BM, Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland, United States
Am J Perinatol · 2026 Feb · PMID 41617190 · Full text
Perinatal and maternal morbidity in the setting of preterm birth may differ by delivery indication. We compared perinatal and maternal outcomes of second-trimester (24-27 weeks of gestation) deliveries indicated for pree...
Perinatal and maternal morbidity in the setting of preterm birth may differ by delivery indication. We compared perinatal and maternal outcomes of second-trimester (24-27 weeks of gestation) deliveries indicated for preeclampsia with severe features (PE-SF), with those following preterm premature rupture of membranes (PPROM).Secondary analysis of an observational cohort study of singleton and twin preterm deliveries before 35 weeks' gestation at 33 hospitals across the United States. Singletons without congenital anomalies who were delivered due to PE-SF or PPROM from 24 to 27 weeks of gestation were included. The primary outcome was a composite of perinatal morbidity or death, defined as fetal or neonatal death, severe bronchopulmonary dysplasia (BPD) grade III, intraventricular hemorrhage (IVH) grade III to IV, necrotizing enterocolitis (NEC) stage IIA or greater, periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) stage III to IV, or culture-proven sepsis. Secondary outcomes included components of the primary outcome, small-for-gestational-age (SGA) birth, and a composite of maternal morbidity. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated.Among the 7,515 in the original cohort, 164 deliveries for PE-SF and 119 deliveries following PPROM were included. Individuals with PE-SF were more likely to have a BMI of ≥30 kg/m, hypertensive disorder of pregnancy in a prior pregnancy, chronic hypertension, and cesarean birth ( < 0.05) compared with those who delivered following PPROM. Composite perinatal morbidity or death did not differ between groups (aOR = 1.60, 95% CI: 0.89, 2.85, = 0.11), but fetal death was significantly higher in the PE-SF group (aOR = 6.04, 95% CI: 1.42, 25.71). Neonates delivered for PE-SF were more likely to be SGA (aOR = 13.45, 95% CI: 2.92, 61.94). Composite maternal morbidity did not differ between groups (aOR = 1.18, 95% CI: 0.62, 2.26).Second-trimester preterm birth indicated for PE-SF was associated with a higher rate of fetal death than birth for PPROM. Composite neonatal and maternal morbidity did not differ by indication. · Fetal death occurred more frequently in individuals with PE-SF compared with PPROM in the second trimester.. · Composite perinatal and maternal outcomes were similar between groups.. · Our findings can be used for risk stratification and survival prediction rates..
Correlation of NICU Withdrawal Assessment Scale with the Finnegan Neonatal Abstinence Scoring Tool in a Cohort of Critically Ill Infants with Opioid Withdrawal.
Herning A, Turcu R, Bleiler C … +4 more , Slater C, Froman A, Mannan J, Wachman EM
Am J Perinatol · 2026 Feb · PMID 41610874 · Publisher ↗
Neonatal opioid withdrawal syndrome (NOWS) is a significant public health concern with associated prolonged neonatal hospitalizations. Although the Finnegan Neonatal Abstinence Scoring Tool (FNAST) is validated for use i...
Neonatal opioid withdrawal syndrome (NOWS) is a significant public health concern with associated prolonged neonatal hospitalizations. Although the Finnegan Neonatal Abstinence Scoring Tool (FNAST) is validated for use in full-term in-utero opioid-exposed infants, there is no validated tool for preterm opioid-exposed or critically ill infants with iatrogenic opioid withdrawal. We aimed to evaluate the concordance of a novel NICU Withdrawal Assessment Scale (NWAS) designed for this critically ill infant cohort with the traditional FNAST. A total of 15 critically ill infants in the NICU with iatrogenic opioid withdrawal were dual assessed with the NWAS and FNAST. Correlation between the scores was determined using Spearman's correlation and linear regression. The mean gestational age of the cohort was 31.9 weeks (standard deviation [SD] = 6.0) with a range of neonatal diagnoses, and average length of opioid treatment of 35.4 days (SD = 17.9). A total of 93 occurrences of simultaneous NWAS and FNAST scores were obtained. The Spearman's correlation coefficient was 0.77 (95% confidence interval [CI]: 0.67-0.84, <0.0001) indicating a strong, positive linear correlation. Linear regression indicated as positive correlation with magnitude of the scores (R = 0.77, y [FNAST score] = 0.85 + 1.49 × [NWAS score], <0.0001). Further examination of the association with management with the NWAS tool and clinical outcomes can inform future creation of evidence-based guidelines for the treatment of NOWS in premature and critically ill infants. · No validated tool for opioid withdrawal in critically ill infants.. · No validated tool for opioid withdrawal in preterm infants.. · The NWAS is a new tool for preterm and critically ill infants.. · The NWAS is highly correlated with the FNAST..
Assessment of Kidney Function and Acute Kidney Injury following Transcatheter Patent Ductus Arteriosus Closure in Preterm Infants.
Vyas D, Martin T, Patel A … +2 more , South AM, Garg PM
Am J Perinatol · 2026 Feb · PMID 41610873 · Full text
Transcatheter patent ductus arteriosus closure (TCPC) has been increasingly used in preterm infants. Hemodynamically significant patent ductus arteriosus (hsPDA) owing to ductal steal and changes in kidney perfusion is a...
Transcatheter patent ductus arteriosus closure (TCPC) has been increasingly used in preterm infants. Hemodynamically significant patent ductus arteriosus (hsPDA) owing to ductal steal and changes in kidney perfusion is associated with the risk of acute kidney injury (AKI) and changes in kidney function. There is limited evidence describing changes in kidney function following TCPC and factors affecting the same. We conducted this study with aim of reviewing the prevalence of AKI and changes in kidney function following TCPC in preterm infants.A single-center retrospective cohort study was conducted to collect data from January 1, 2017, to February 29, 2024. Preterm infants born <29 w of gestational age (GA) receiving TCPC were included in the study. The primary outcome was AKI prevalence and kidney function following TCPC. AKI was defined as per the modified neonatal kidney disease: Improving Global Outcomes (KDIGO) criteria using serum creatinine (SCr) and urine output.A total of 89 infants fulfilled inclusion criteria. Included infants were predominantly female (50, 59.7%), had median GA of 25 w (IQR: 24-27), and median birth weight of 700 g (IQR: 600-863). AKI developed in five infants (5.6%) following TCPC using SCr criteria. Four infants (4.5%) had stage 1 and one (1.1%) had stage 2 AKI. Overall, 14% reduction in SCr levels was seen following TCPC (median pre-TCPC, 0.28 mg/dL [IQR: 0.21-0.35], median, 5 to 7 days post-TCPC, 0.24 mg/dL [IQR: 0.18-0.29], < 0.001). Infants who developed AKI had an initial rise in SCr followed by 37% reduction by 5 to 7 days (pre-TCPC: 0.41 mg/dL [IQR: 0.27-0.51]; median, 24 hours post, 0.57 mg/dL [IQR: 0.29-1.22]; median, 5 to 7 days post, 0.26 mg/dL [IQR: 0.19-0.67], = 0.07).In preterm infants undergoing TCPC, a small percentage of infants developed mild AKI which improved quickly within 1 week post-TCPC. Overall, there was a significant and persistent improvement in kidney function following TCPC. · Incidence of AKI following transcatheter PDA closure is low (5%) and majority had grade 1 AKI.. · Serum Cr levels reduced by 14% within 48 hours of TCPC; reduction was higher in infants with AKI.. · Each day increase in age at time of TCPC was associated with 18% lower odds of developing AKI..
Neurodevelopmental Outcome after Late-Onset Bacterial Sepsis in Infants Born before 29 Weeks' Gestation.
Roychoudhury S, Lodha A, Synnes A … +51 more , Ting J, Augustine S, Afifi J, Bizgu V, Ye XY, Shah PS, Soraisham A, Canadian Neonatal Network and Canadian Neonatal Follow-Up Network TM, Shah PS, Beltempo M, Kanungo J, Wong J, Stavel M, Sherlock R, Mehrem AA, Toye J, Ting J, Fajardo C, Bodani J, Strueby L, Seshia M, Louis D, Alvaro R, Yi A, Mukerji A, Da Silva O, Augustine S, Lee KS, Ng E, Lemyre B, Daboval T, Khurshid F, Bizgu V, Barrington K, Lapointe A, Ethier G, Drolet C, Claveau M, St-Hilaire M, Bertelle V, Masse E, de Oliveira CB, Makary H, Ojah C, Newman A, Hudson JA, Afifi J, Kajetanowicz A, Piedboeuf B, Canadian Preterm Birth Network (CPTBN) Participating Site Investigators, Canadian Neonatal Follow-Up Network (CNFUN) Participating Site Investigators
Am J Perinatol · 2026 Jan · PMID 41610863 · Publisher ↗
Neonatal late-onset sepsis is associated with increased mortality and morbidity, adversely impacting long-term outcome. The objective of this study was to examine neurodevelopmental (ND) outcomes at 18 to 24 months' corr...
Neonatal late-onset sepsis is associated with increased mortality and morbidity, adversely impacting long-term outcome. The objective of this study was to examine neurodevelopmental (ND) outcomes at 18 to 24 months' corrected age (CA) in infants with late-onset bacterial sepsis (LOS) and to categorize outcomes based on type of bacterial pathogen in a cohort of preterm infants born less than 29 weeks gestation in Canada.We conducted a retrospective cohort study of all non-anomalous infants born at <29 weeks gestational age (GA) who were admitted to Canadian NICUs, from January 1, 2010, to December 31, 2017, who had an ND assessment at 18 to 24 months' CA at Canadian Neonatal Follow-Up Network clinics. The primary outcome was the composite outcome of death or ND impairment (NDI). Secondary outcomes included significant NDI, and each component of primary outcome. We compared ND outcomes among infants with Gram-positive (GP) sepsis, Gram-negative (GN) sepsis, mixed sepsis, and no sepsis using bivariate and multivariate analyses after adjusting for potential confounders.Of the 3,640 infants included, 823 (22.6%) developed LOS. Of the 823 infants, 569 (69.1%) had GP sepsis, 172 (20.9%) had GN sepsis, and 82 (10%) had mixed sepsis. Infants with LOS had significantly lower birth weight, GA, younger mothers, and significantly higher rates of major neonatal morbidities compared with the no-sepsis group. In multivariable logistic regression, infants with GN sepsis and mixed sepsis had significantly higher odds of death/NDI (GN sepsis, adjusted odds ratio [aOR] = 1.80; 95% CI: 1.27, 2.54; mixed LOS, aOR = 2.38, 95% CI: 1.41, 4.01) as compared with no sepsis.Late-onset bacterial sepsis, particularly Gram-negative and mixed sepsis, was associated with an increased risk of adverse outcomes including death or NDI at 18 to 24 months CA in infants born <29 weeks' GA in Canada. · Late-onset sepsis is an important risk factor for morbidity and mortality in preterm infants.. · The clinical presentations vary depending on the causative bacteria.. · There is limited data on neurodevelopmental outcomes based on type of bacterial pathogen..
Intravenous Glucagon Infusion in the Management of Hypoglycemia in Infants of Diabetic Mothers.
Luoto R, Lappalainen I, Niinikoski H … +1 more , Korhonen K
Am J Perinatol · 2026 Jan · PMID 41610862 · Publisher ↗
This study aimed to evaluate the efficacy and safety of continuous intravenous (IV) glucagon infusion in the management of neonatal hypoglycemia in infants of diabetic mothers (IDMs).This retrospective case-control study...
This study aimed to evaluate the efficacy and safety of continuous intravenous (IV) glucagon infusion in the management of neonatal hypoglycemia in infants of diabetic mothers (IDMs).This retrospective case-control study included IDMs treated for hypoglycemia at Turku University Hospital, Finland, over 11 years. Sixteen infants received IV glucose and continuous IV glucagon, while 26 matched controls received IV glucose only.Prior to glucagon initiation, cases had higher IV glucose requirements and lower plasma glucose levels than controls. Following infusion, plasma glucose normalized rapidly. The mean (SD) duration of glucagon treatment was 5.6 (1.2) days. Maternal prepregnancy body mass index (BMI) was significantly higher in cases (mean = 35.0 kg/m [SD = 8.2 kg/m]) than in controls (mean = 27.6 kg/m [SD = 7.1 kg/m]), = 0.006. No significant differences in adverse effects were observed.Continuous IV glucagon infusion is an effective and safe treatment for refractory hypoglycemia in IDMs. · There are limited data on glucagon use in neonatal hypoglycemia.. · Newborns of diabetic mothers could be a target population.. · Glucagon infusion may be a valuable adjunctive therapy..
Postpartum Care for Parents of Neonatal Intensive Care Unit Infants before and after Adoption of Telemedicine.
Kwarteng EA, Ledyard RF, Scott K … +6 more , Darden N, Walker L, Lewey J, Power ME, Durnwald CP, Burris HH
Am J Perinatol · 2026 Feb · PMID 41605455 · Publisher ↗
Despite higher morbidity and mortality risks, parents of preterm infants miss postpartum visits more often than parents of full-term infants. Whether the introduction of telemedicine improved access to postpartum care am...
Despite higher morbidity and mortality risks, parents of preterm infants miss postpartum visits more often than parents of full-term infants. Whether the introduction of telemedicine improved access to postpartum care among parents of infants in the neonatal intensive care unit (NICU) is unknown. We aimed to compare postpartum visit attendance and care comprehensiveness for NICU parents before and after the option of telemedicine.We conducted a retrospective cohort study of postpartum parents without a history of hypertension who gave birth <32 weeks at two Philadelphia hospitals. We compared care receipt before and after implementation of telemedicine (2019 and 2023, respectively). Individuals with hypertension were excluded due to eligibility for a remote, text-based blood pressure monitoring program during the study period. Through manual chart review, we ascertained postpartum visit attendance and documentation of three core care elements: depression screening, contraception counseling, and blood pressure measurement.The proportion of parents without postpartum visits was similar in 2019 (13/69, 18.8%) and in 2023 (7/45, 15.6%; = 0.65). While telemedicine was not available in 2019, 42.1% (16/38) of postpartum visits in 2023 were conducted via telemedicine. In 2019 and 2023, the proportion of visits with missed depression screenings (10.7 vs. 0%, = 0.08) and contraception counseling (0 vs. 18.4%, = 0.001) were low. Missed blood pressure measurements increased significantly from 3.9% in 2019 to 36.8% in 2023 ( < 0.0001); all missed measurements were during telemedicine visits.Despite the availability of telemedicine, approximately one in six NICU parents of preterm infants did not attend a postpartum visit. While telemedicine accounted for over one-third of visits in 2023, it was associated with gaps in essential care, specifically blood pressure measurements. Given the benefits of early detection and treatment for postpartum preeclampsia, supplementing telemedicine visits with in-person blood pressure measurements in NICUs may be warranted. · Telemedicine did not change postpartum visit attendance for parents of NICU infants.. · Missed postpartum blood pressures increased significantly after adoption of telemedicine.. · NICU-based blood pressure monitoring may mitigate care gaps introduced by telemedicine visits..
Comparative Risk of Neonatal Ischemic Encephalopathy in Operative Vaginal Delivery versus Cesarean Section at Complete Dilation: A Systematic Review and Meta-analysis.
Sainz K, Herrera DG, Hamilton B … +6 more , Ruffley K, Robinson M, Kline E, Mera S, Pulicherla N, Marchand GJ
Am J Perinatol · 2026 Feb · PMID 41605454 · Publisher ↗
The objective of this study is to assess the risk of neonatal hypoxic-ischemic encephalopathy (HIE) associated with operative vaginal delivery (OVD) compared with cesarean delivery at complete cervical dilation (CDCD) an...
The objective of this study is to assess the risk of neonatal hypoxic-ischemic encephalopathy (HIE) associated with operative vaginal delivery (OVD) compared with cesarean delivery at complete cervical dilation (CDCD) and spontaneous vaginal delivery (SVD), with subgroup analyses by OVD type (vacuum- and forceps-assisted).PubMed, Cochrane Library, Web of Science, Medline, ClinicalTrials.gov, and Scopus were searched from inception to October 1, 2024. Cohort studies reporting HIE incidence in OVD (vacuum or forceps) compared with CDCD or SVD were included. Data were extracted by two independent reviewers following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models. Primary outcomes were HIE incidence in OVD versus SVD and CDCD. Secondary outcomes included HIE risk by OVD type (vacuum- vs. forceps-assisted).Five studies (141,774 deliveries) met the inclusion criteria. OVD was associated with a significantly higher HIE risk compared with SVD (RR: 3.36, 95% CI: 2.52-4.50, < 0.001). No significant difference was observed between OVD and CDCD (RR: 0.77, 95% CI: 0.50-1.19, = 0.24). Subgroup analysis showed forceps-assisted delivery had a lower HIE risk compared with CDCD (RR: 0.29, 95% CI: 0.15-0.43, < 0.001), whereas vacuum-assisted delivery showed no significant difference (RR: 0.89, 95% CI: 0.56-1.42, = 0.63).OVD is associated with a higher HIE risk than SVD but not CDCD. Forceps-assisted delivery may reduce HIE risk compared with CDCD, unlike vacuum-assisted delivery. These findings highlight the importance of careful delivery method selection when SVD is not feasible, balancing risks and benefits to optimize neonatal outcomes. · OVD raises HIE risk versus SVD but not CDCD in 141,774 deliveries.. · Forceps-assisted delivery lowers HIE risk versus CDCD (RR = 0.29).. · First meta-analysis comparing HIE in OVD, CDCD, and SVD..
Risk Factors and Pregnancy Outcomes Associated with Insulin Addition to Metformin Therapy in Gestational Diabetes.
Pandit R, Drusini FS, Wu J … +11 more , Guhde H, Nwosu O, Kinghorn T, Steinbrunner A, Gregory D, Vickers S, Landon MB, Gabbe SG, Grobman WA, Field C, Venkatesh KK
Am J Perinatol · 2026 Jan · PMID 41571015 · Publisher ↗
Metformin is increasingly being used to treat gestational diabetes mellitus (GDM). But pharmacotherapy with metformin frequently requires insulin supplementation to achieve glucose control, and this remains poorly charac...
Metformin is increasingly being used to treat gestational diabetes mellitus (GDM). But pharmacotherapy with metformin frequently requires insulin supplementation to achieve glucose control, and this remains poorly characterized. We identified factors associated with insulin supplementation of metformin versus receipt of metformin alone, and then examined whether these two groups differed in the frequency of adverse pregnancy outcomes (APOs) among individuals with GDM.We conducted a retrospective analysis of a U.S. GDM care program from 2018 to 2021, which first initiated metformin.Modified Poisson regression was used to identify risk factors associated with later insulin supplementation after initial metformin treatment, and stepwise regression was used to identify the most predictive factors. A propensity matched analysis was used to examine the association between metformin with insulin supplementation versus metformin alone (reference) with APOs (hypertensive disorders of pregnancy [HDP], preterm birth [PTB], small for gestational age [SGA], large for gestational age [LGA], and neonatal intensive care unit [NICU] admission).Among 399 deliveries with GDM that initiated metformin, 28.8% required insulin supplementation. Factors associated with an increased risk of insulin supplementation were older age, private insurance, and a higher mean screening glucose tolerance test; factors associated with a decreased risk were later GDM diagnosis and Black and Hispanic race and ethnicity. Individuals who required metformin with insulin supplementation had a higher risk of LGA birth (28.6 vs. 13.9%; adjusted risk ratio [aRR]: 1.89; 95% CI: 1.18, 3.02) and NICU admission (25.8 vs. 13.5%; aRR: 1.79; 95% CI: 1.11, 2.88).Multiple patient characteristics were associated with insulin supplementation after starting metformin to treat GDM. Pregnant individuals with GDM who required insulin supplementation of metformin had a higher risk of LGA and NICU admission. · Multiple patient characteristics were associated with insulin supplementation of metformin for GDM.. · Individuals treated with insulin supplementation of metformin had a higher risk of LGA and NICU admission versus those treated with metformin alone.. · Data about whether identification of individuals who require metformin supplementation with insulin results in improved outcomes are needed..
The Relationship between Social Vulnerability Index, Area Deprivation Index, and Child Opportunity Index, and Treatment Course Characteristics in Infants with Surgically Intervenable Congenital Anomalies.
Bigej RD, Ondusko DS, Oran A … +6 more , Ward L, Beatie N, Jenkins TK, Chon AH, Rincón M, Sun RC
Am J Perinatol · 2026 Jan · PMID 41558511 · Full text
The social vulnerability index (SVI) is a place-based index used to stratify community risk. We evaluated the impact of SVI on pregnancy and infant outcomes in patients with surgically treatable congenital anomalies.This...
The social vulnerability index (SVI) is a place-based index used to stratify community risk. We evaluated the impact of SVI on pregnancy and infant outcomes in patients with surgically treatable congenital anomalies.This is a retrospective study of pregnant patients and infant dyads diagnosed from 2014 to 2022 with congenital anomalies amenable to surgical treatment. Dyads were grouped into SVI quartiles. Primary outcomes were infant morbidity and mortality, and secondary outcomes included prenatal care services, pregnancy course characteristics, and pregnant person co-morbidities. The area deprivation index and child opportunity index were also collected. Bivariate comparisons of patient characteristics and unadjusted odds ratios for death or morbidity stratified by SVI quartile were performed.Two hundred and ninety-five dyads met the inclusion criteria. Ten point two percent had low SVI, 23.7% low-medium, 35.3% medium-high, and 30.9% high. The only prenatal care service associated with SVI quartile was fetal MRI ( = 0.038), but no directional trend was observed. Infant diagnoses included 11.5% congenital diaphragmatic hernia, 27.5% gastroschisis, 18.6% intestinal atresia, 9.2% lower urinary tract obstruction, 20.3% myelomeningocele, 9.2% omphalocele, 0.3% sacrococcygeal teratoma, 8.5% tracheoesophageal fistula. The odds ratio of poor infant outcomes by SVI quartile showed a nonsignificant elevated odds ratio in the highest quartile SVI (low-medium SVI OR: 0.66 [95% CI: 0.14, 2.35], medium-high SVI OR: 0.78 [95% CI: 0.17, 2.63], and high SVI OR: 1.57 [95% CI: 0.32, 6.4]).SVI quartile was not associated with infant outcomes in patients with surgically treatable congenital anomalies. Future studies should examine the impact of SVI or other indices of social vulnerability on perinatal and long-term postnatal outcomes in these high-risk patients. · Healthcare inequities warrant exploration in congenital surgical pathologies.. · Explored SVI quartile association with infant outcomes.. · Primary outcomes were not associated with SVI quartile.. · Nonsignificantly higher odds of poor outcome in patients with high SVI quartile..
High Altitude and Duration of Respiratory Support in Preterm Infants: A Multicenter, Observational Cohort from Latin America.
Hoyos AB, Vasquez-Hoyos P, Osiovich H … +6 more , Fajardo CA, Salas AA, Villegas C, Aguinaga F, Baez M, Martinini MI
Am J Perinatol · 2026 Jan · PMID 41534868 · Publisher ↗
Respiratory support use in neonatal intensive care units (NICUs) varies worldwide, influenced by clinical practices, resources, and patient populations. Whether high-altitude independently affects the duration of respira...
Respiratory support use in neonatal intensive care units (NICUs) varies worldwide, influenced by clinical practices, resources, and patient populations. Whether high-altitude independently affects the duration of respiratory support in preterm infants remains unclear. This study aimed to determine whether altitude is independently associated with the duration of respiratory support in preterm infants ≤32 weeks' gestational age (GA) admitted to Latin American NICUs.We performed a multicenter, observational cohort study by secondary analysis of prospectively collected data from the EpicLatino Network, a registry of NICUs across Latin America (2015-2022). Infants ≤32 weeks who received invasive or non-invasive respiratory support were included; supplemental oxygen delivered via low-flow nasal cannula or oxygen hood was not considered respiratory support, and those with missing outcome data were excluded. The primary outcome was total duration of respiratory support, measured as total days of support until discontinuation, discharge, transfer, or truncation by death. Altitude was classified as high (≥2,000 m) or low (<2,000 m). Multivariable analyses were adjusted for neonatal, maternal, and unit characteristics.A total of 4,428 infants were included; 2,723 (61.5%) in low-altitude NICUs and 1,705 (38.5%) in high-altitude NICUs. Overall, 81.4% discontinued respiratory support and 18.6% died. Mortality was 19.1% in low-altitude and 17.9% in high-altitude NICUs. Median duration of support was 8 days (interquartile range [IQR]: 5-14) overall, with 9 days (IQR: 4-27) in low-altitude and 7 days (IQR: 3-17) in high-altitude NICUs. High-altitude centers showed shorter respiratory support in unadjusted analyses. After adjustment for neonatal, maternal, and unit factors, altitude was not independently associated with support duration.After adjustment for neonatal, maternal, and unit factors, altitude was not independently associated with the duration of respiratory support. Importantly, high altitude was never associated with worse outcomes. · High-altitude NICUs showed shorter respiratory support use, likely reflecting environmental hypoxemia, but this association disappeared after adjusting for clinical and unit factors.. · Mortality was similar at high and low altitudes, indicating that shorter duration at altitude was not explained by earlier deaths.. · Altitude may influence initial decisions on invasive support, but patient and institutional characteristics appear more relevant in determining total duration..
Pregnancy Outcomes in Patients with Type 1 Diabetes Using Continuous Glucose Monitoring.
McCloskey SM, Biggio JR, Morgan JA … +8 more , Mussarat N, Toppin JD, Sternlieb SJ, Manuel NE, Juracek K, Shu SW, Stone J, Williams FB
Am J Perinatol · 2026 Jan · PMID 41525796 · Publisher ↗
Continuous glucose monitoring (CGM) use among patients with type 1 diabetes mellitus (T1DM) has been associated with improved glycemic control, though improvement in non-glycemic outcomes is less consistent. We hypothesi...
Continuous glucose monitoring (CGM) use among patients with type 1 diabetes mellitus (T1DM) has been associated with improved glycemic control, though improvement in non-glycemic outcomes is less consistent. We hypothesize that CGM use in patients with T1DM in a real-world clinical setting is associated with both improved glycemic and clinical outcomes.This was a retrospective cohort study of patients with T1DM receiving care at a large health system from 2016 to 2023. Primary outcomes included (1) glycemic control and (2) a composite comprising severe maternal morbidity, preeclampsia with severe features, delivery prior to 34 weeks, and admission for diabetic ketoacidosis. Primary glycemic outcome was hemoglobin A (HbA) <6% in the second trimester. We compared patients using CGM, our exposure group, to patients using traditional blood glucose monitoring (TBGM). During initial data abstraction, we noted variation in CGM target blood glucose settings. A subgroup analysis was performed in which patients using CGM were evaluated by device setting, with those set to targets consistent with American Diabetes Association (ADA) recommendations compared with those with more permissive goals. Adjusted odds ratios were calculated using multivariable logistic regression to adjust for potential confounding variables.Among 288 patients with T1DM, there were 145 deliveries in the CGM group and 143 in the traditional capillary blood glucose monitoring group. Midtrimester on-target glycemic control was improved in the CGM group compared with traditional monitoring (40.7 vs. 17.5%, adjusted odds ratio [aOR] = 2.32; 95% confidence interval [CI]: 1.21-4.12). There was no difference in the rate of the composite outcome (CGM: 42.8% vs. TBGM: 49.0%, aOR = 0.70; 95% CI: 0.40-1.22), nor was there a difference in secondary outcomes. In patients using CGM, those with stricter targets had improved glycemic control as well as reduced rates of preterm delivery prior to 37 weeks (18.8 vs. 56.9%, aOR = 0.16, 95% CI: 0.05-0.48) and neonatal intensive care unit admission (37.5 vs. 60.0%, aOR = 0.37, 95% CI: 0.14-0.96).CGM use in T1DM is associated with improved glycemic control throughout pregnancy; however, this does not uniformly translate to improved clinical outcomes. Lack of adherence to ADA blood glucose targets may contribute to these findings. · Glycemic control in pregnancy is improved with CGM use in patients with T1DM.. · CGM use does not translate to consistent improvement in clinical outcomes.. · Stricter CGM targets are associated with improvement in glycemic control and some clinical outcomes.. · Simply prescribing an intervention does not automatically lead to benefit..
Neonatal Postresuscitation Care in Brazil: A National Overview.
Lyra JC, Rugolo LMSS, Anchieta LM … +2 more , Guinsburg R, de Almeida MFB
Am J Perinatol · 2026 Jan · PMID 41525795 · Publisher ↗
Postresuscitation care (PRC) encompasses structured and systematic interventions aimed at promptly stabilizing at-risk newborns in order to improve clinical outcomes. This study aimed to assess PRC practices as reported...
Postresuscitation care (PRC) encompasses structured and systematic interventions aimed at promptly stabilizing at-risk newborns in order to improve clinical outcomes. This study aimed to assess PRC practices as reported by pediatricians who serve as instructors in the Brazilian Neonatal Resuscitation Program (BNRP) of the Brazilian Pediatric Society.We conducted a cross-sectional, descriptive survey among BNRP instructors. Data were collected via a 55-item online questionnaire (Google Forms), covering respondents' professional background, primary work setting, and specific PRC practices. A convenience sample was used, and descriptive statistics summarized the findings.A total of 740 responses were obtained, representing 63% of BNRP instructors. Of these, 79% were neonatologists, 88% with over 10 years of professional experience. Most worked in public (61%) and teaching hospitals (76%). Only 41% had received targeted PRC training; of these, 56% had exclusively theoretical instruction. Regarding the scope of PRC, 37% believed interventions were indicated solely for newborns requiring intubation, chest compression, or medications in the delivery room. Overall, 49% of respondents reported having written PRC protocols at their institutions, though their content and implementation varied considerably.PRC practices in Brazil are neither homogeneous nor systematically implemented across most neonatology services involving BNRP instructors. These findings highlight the pressing need for enhanced dissemination of standardized PRC protocols and comprehensive training for pediatricians engaged in neonatal care. · PRC can improve outcomes in high-risk newborns, but its real-world application remains poorly described in middle-income countries.. · This is the largest study to date on PRC practices, based on responses from instructors of the Brazilian Neonatal Resuscitation Program.. · Findings reveal the need for structured training and underscore the importance of further research on the impact of standardized PRC on neonatal outcomes..
First-Trimester Machine Learning to Predict Preeclampsia in Normotensive Pregnancies by American Heart Association Guidelines.
Horgan R, Kalafat E, Sinkovskaya E … +2 more , Abuhamad AZ, Saade G
Am J Perinatol · 2026 Jan · PMID 41525794 · Publisher ↗
This study aimed to determine whether unsupervised machine learning can identify phenotypically distinct subgroups at increased risk for preeclampsia among pregnant individuals with American Heart Association (AHA)-defin...
This study aimed to determine whether unsupervised machine learning can identify phenotypically distinct subgroups at increased risk for preeclampsia among pregnant individuals with American Heart Association (AHA)-defined normal blood pressure in the first trimester.This was a secondary analysis of a prospective cohort study of singleton pregnancies enrolled at ≤13 weeks' gestation at two academic centers. Participants with prepregnancy chronic hypertension or major fetal/placental abnormalities were excluded. First-trimester blood pressure was categorized using the 2017 AHA guidelines. Among individuals with AHA-defined normal blood pressure (<120/80 mm Hg), unsupervised machine learning (k-means clustering) was applied to systolic, diastolic, and mean arterial pressure to identify distinct hemodynamic phenotypes. The primary outcome was preeclampsia; secondary outcomes included hypertensive disorders of pregnancy (HDP) and small-for-gestational age (SGA) neonates. Associations were assessed using multivariable Cox regression and Kaplan-Meier analyses.Of 570 participants, 378 (66.3%) had AHA-normal blood pressure. Among these, machine learning identified a high-risk cluster (7.4%) and a low-risk cluster (92.6%). Despite normotensive values, individuals in the high-risk cluster had a significantly higher incidence of preeclampsia (25.0 vs. 3.1%; < 0.001) and HDP (28.6 vs. 5.7%; < 0.001) compared to the low-risk cluster. After adjustment, the high-risk normotensive cluster had an eight-fold increased hazard of preeclampsia (adjusted hazard ratio [aHR] = 8.01; 95% CI: 3.09-20.74) and increased risk of SGA (adjusted odds ratio [aOR] = 3.36; 95% CI: 1.36-8.31). Risk within this group exceeded that of individuals with AHA-abnormal blood pressure.Among pregnant individuals with first-trimester AHA-normal blood pressure, unsupervised clustering identified a distinct subgroup at elevated risk for preeclampsia and SGA. These findings suggest that conventional thresholds may overlook early vascular risk and support further investigation into machine learning-based risk stratification in pregnancy. · Machine learning identified a distinct high-risk cluster (7.4%) within normotensive pregnancies.. · This cluster had an eight-fold higher risk of preeclampsia and a three-fold increased risk of SGA neonate.. · Machine learning may enhance early pregnancy risk stratification..
Perinatal Death in Triplets by Gestational Age: A Retrospective Cohort from Two Tertiary Hospitals.
Tipiani-Rodriguez O
Am J Perinatol · 2026 Jan · PMID 41512911 · Publisher ↗
This study aimed to describe a contemporary cohort of triplet pregnancies from two tertiary centers in a middle-income country and evaluate the association between gestational age (GA) at birth and perinatal death. We de...
This study aimed to describe a contemporary cohort of triplet pregnancies from two tertiary centers in a middle-income country and evaluate the association between gestational age (GA) at birth and perinatal death. We developed and internally validated a GA-based risk model.Retrospective cohort from two tertiary hospitals (2015-2024). The unit of analysis was the fetus/neonate, with cluster-robust standard errors at the mother level. Primary outcome: Perinatal death (stillbirth ≥23 weeks or neonatal death ≤28 days). GA was modeled with logistic regression using restricted cubic splines; Firth penalization addressed separation where applicable. Internal validation used 200 bootstrap resamples.The cohort included 150 neonates; perinatal death occurred in 23 (15.4%). Median GA was 33 (31-34) weeks overall, 34.0 (32.0-34.0) in survivors, and 25.0 (24.0-28.0) in perinatal deaths. In the adjusted spline model, GA was the dominant predictor (overall Wald χ = 1,473.66, df = 3, < 0.001; non-linearity χ = 424.92, df = 2, < 0.001), while severe preeclampsia was not significant (χ = 0.10, = 0.750). The category-based Firth model showed markedly elevated odds of perinatal death at earlier gestations versus ≥34 weeks: <28 weeks; adjusted odds ratio (aOR) = 871.15 (95% confidence interval [CI]: 81.25-124,006.80, < 0.001); 28 to <32 weeks, aOR = 50.22 (5.45-6,682.53, < 0.001); 32 to <34 weeks, aOR = 5.34 (0.26-804.14, = 0.278); and severe preeclampsia, aOR = 1.02 (0.09-7.17, = 0.984). The internally validated model demonstrated excellent discrimination (optimism-corrected area under the receiver operating characteristic curve [AUROC], 0.972) and good overall performance (Brier score, 0.047), with a calibration intercept of -0.129, a slope of 0.696, and a maximum absolute calibration error ( ) of 0.104.In triplet pregnancies, GA at birth is the dominant determinant of perinatal death, with a steep risk gradient at earlier gestations. A GA-based model demonstrates excellent discrimination and acceptable calibration following bootstrap internal validation, supporting its use in informing counseling and timing-of-delivery decisions in this high-risk population. · Perinatal mortality in triplet pregnancies decreases sharply after 32 weeks.. · Most perinatal deaths occur before 32 weeks of gestation.. · These findings support delivery planning around 32 to 33 weeks.. · Data from low- and middle-income countries' settings provide guidance for counseling and NICU planning.. · A simple GA-only model showed excellent discrimination (area under the curve = 0.97)..
The Impact of Offspring Sex on Pregnancy and Neonatal Outcomes in Individuals with Pregestational Diabetes.
Delgado A, James KE, Hsu S … +3 more , Edlow AG, Powe CE, Shook LL
Am J Perinatol · 2026 Jan · PMID 41500257 · Publisher ↗
Pregestational diabetes mellitus (PGDM) is increasing in prevalence among pregnant individuals and is associated with adverse outcomes. Prior work suggests that offspring sex influences placental responses and may impact...
Pregestational diabetes mellitus (PGDM) is increasing in prevalence among pregnant individuals and is associated with adverse outcomes. Prior work suggests that offspring sex influences placental responses and may impact risk for adverse outcomes. We sought to assess the impact of offspring sex on adverse pregnancy and neonatal outcomes in individuals with PGDM.We conducted a retrospective cohort study of 503 pregnant individuals with PGDM and known offspring sex with care at a major urban academic center between 1998 and 2016. We assessed two co-primary composite outcomes: (1) a composite adverse pregnancy outcome of small for gestational age (SGA), hypertensive disorder of pregnancy (HDP), and stillbirth and (2) a composite adverse neonatal outcome of large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, shoulder dystocia, and respiratory distress syndrome (RDS). Secondary outcomes of spontaneous preterm birth (PTB) and admission to the neonatal intensive care unit (NICU) were assessed. Mixed effects logistic regression models, accounting for multiple pregnancies and adjusting for first trimester body mass index (BMI), insurance, parity, and maternal race/ethnicity, were analyzed.Of the 503 pregnant individuals with PGDM, 67% had a diagnosis of type 2 DM and 33% had type 1 DM. The composite adverse pregnancy outcome occurred in 79 of 258 (31%) pregnancies with a female fetus and 76 of 245 (31%) pregnancies with a male fetus. The composite neonatal outcome occurred in 163 of 245 males (67%) and 154 of 258 females (60%). Male infants had significantly higher odds of requiring admission to the NICU (adjusted odds ratio 1.79 [95% confidence interval: 1.13, 2.80], = 0.01). There were no observed sex differences in the incidence of spontaneous PTB.We identified high rates of both composite outcomes in pregnancies with PGDM, regardless of fetal sex. The significantly higher rate of NICU admission among males suggests an increased risk of neonatal morbidity in males exposed to PGDM. · A high incidence of adverse outcomes was observed in PGDM pregnancies.. · Male neonates are at greater risk of NICU admission.. · In individuals with type 2 DM, a trend toward increased risk of LGA was observed in male neonates..
Health Care-Associated Infections following Major Neonatal Surgery in a Resource-Limited Setting: Risk Factors and Outcomes from Southern Tunisia.
Zouari M, Belhajmansour M, Hbaieb M … +3 more , Jarboui O, Dhaou MB, Mhiri R
Am J Perinatol · 2026 Jan · PMID 41494623 · Publisher ↗
Health care-associated infections (HAIs) remain among the most serious complications in neonatal surgery, particularly in resource-limited settings where infection control is often suboptimal. This study aimed to identif...
Health care-associated infections (HAIs) remain among the most serious complications in neonatal surgery, particularly in resource-limited settings where infection control is often suboptimal. This study aimed to identify risk factors for HAIs following major thoracic and abdominal neonatal surgery in southern Tunisia.We conducted a retrospective cohort study of neonates who underwent major non-cardiac abdominal or thoracic surgery at Hedi Chaker University Hospital, Sfax, Tunisia, between April 2015 and March 2025.A total of 361 neonates underwent major abdominal or thoracic surgery during the 10-year study period. The male-to-female ratio was 1.3:1. The most common surgical conditions were esophageal atresia ( = 105), duodenal atresia ( = 42), and anorectal malformations ( = 39). Overall, 99 neonates (27.4%) developed one or more HAIs during their postoperative course. On multivariable logistic regression, four variables were independently associated with HAIs. These variables included cardiac comorbidities (odds ratio [OR] = 2.205; = 0.007), gestational age <37 weeks (OR = 2.448; = 0.009), postoperative intubation time >30 hours (OR = 2.338; = 0.002), and surgery duration >120 minutes (OR = 2.471; = 0.006).HAIs in neonatal surgery remain a major challenge in resource-constrained settings. In addition to patient- and surgery-related factors, structural limitations in perioperative care and infection control play a crucial role. Strengthening neonatal intensive care unit (NICU) capacity, ensuring consistent access to antibiotics and antiseptics, and optimizing perioperative protocols are essential to reduce infection rates and improve outcomes. · Cardiac anomalies emerged as a significant independent predictive factor of HAIs in our cohort.. · Prematurity is an independent risk factor for HAIs following neonatal surgery.. · Prolonged surgical duration was independently associated with an increased risk of HAIs.. · Prolonged postoperative intubation emerged as a strong independent predictive factor of HAIs..
Understanding the Impact of Patent Ductus Arteriosus and Treatment Strategies on Acute Kidney Injury in Preterm Infants.
Gunasekaran V, Woo S, South AM … +3 more , Shenberger J, Askenazi D, Garg PM
Am J Perinatol · 2026 Jan · PMID 41475417 · Full text
Acute kidney injury (AKI) is a clinically significant complication in preterm neonates, leading to increased morbidity, mortality, and risk of long-term kidney dysfunction. Within this vulnerable population, the presence...
Acute kidney injury (AKI) is a clinically significant complication in preterm neonates, leading to increased morbidity, mortality, and risk of long-term kidney dysfunction. Within this vulnerable population, the presence of a hemodynamically significant patent ductus arteriosus (PDA) may further exacerbate AKI risk. The relationship between PDA and AKI is complex, involving both the pathophysiological consequences of altered hemodynamics (e.g., ductal steal) causing renal ischemia and the potential nephrotoxic effects of therapeutic interventions. However, the existing literature provided limited insight into the impact of PDA and its management on AKI in preterm infants, with most studies relying on retrospective designs. There is a notable absence of consensus regarding the comparative effects of conservative, pharmacologic, and surgical PDA management strategies on AKI outcomes. This study directly addresses these knowledge gaps by synthesizing findings from diverse clinical trials, cohort studies, and meta-analyses into a single, comprehensive resource, aiming to inform future research and guide best practices for managing PDA-related AKI in preterm neonates. · AKI in PDA involves ductal steal and nephrotoxic treatment effects.. · Early AKI detection in hsPDA requires monitoring and balanced treatment.. · hsPDA is a major risk factor for AKI in preterm infants.. · Understanding intervention impact on AKI needs well-designed studies..
Utility of Fetal Echocardiography in First-Degree Relatives with Bicuspid Aortic Valve and Normal Obstetric Ultrasound.
Ismail A, Schmidt J, Bolin E … +1 more , Ittleman B
Am J Perinatol · 2026 Jul · PMID 41475401 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the diagnostic yield of fetal echocardiography (f-Echo) in detecting significant congenital heart disease (CHD) in pregnancies with a first-degree relative with a history of bicusp...
OBJECTIVE: This study aimed to evaluate the diagnostic yield of fetal echocardiography (f-Echo) in detecting significant congenital heart disease (CHD) in pregnancies with a first-degree relative with a history of bicuspid aortic valve (BAV) and a normal level II obstetric ultrasound. STUDY DESIGN: A retrospective review was conducted of all f-Echos performed between 2019 and 2023 for the sole indication of family history of BAV. Cases with additional indications or affected nonfirst-degree relative were excluded. Postnatal transthoracic echocardiography (t-Echo) data were reviewed when available. Significant CHD was defined as requiring catheter or surgical intervention in the first year of life. RESULTS: Sixty-five f-Echos were included (mean gestational age: 26.6 ± 3.7 weeks). No significant CHD was identified prenatally. Postnatal t-Echo was performed in 41 (63%) cases, with no significant CHD detected. Two (5%) infants were diagnosed postnatally with BAV, neither requiring intervention during the study interval. Minor findings included one case each of pulmonary valve stenosis and atrial septal defect. CONCLUSION: In pregnancies with a first-degree relative with BAV and a normal obstetric ultrasound, f-Echo showed no added diagnostic value for detecting significant CHD. Based on the state's birth rate (approximately 35,000/year), BAV prevalence (1-2%), and an average family size of 3.08, an estimated 733 to 1,466 pregnancies annually in Arkansas could qualify for f-Echo under current guidelines. At a cost of $1,000 to 5,000 per study, this translates to an annual healthcare expenditure ranging from $733,000 to 7.33 million. These findings support more targeted screening and the need for multicenter studies. KEY POINTS: · No significant CHD detected with f-Echo.. · Postnatal t-Echo remains definitive.. · Routine f-Echo may add limited value.. · Cost implications warrant reconsideration.
Assessing Oxygenation Instability in Premature Infants <1,500 Grams: Nursing Charts versus SpO2 Histograms-Is Two Better Than One?
Leikin Zach V, Riskin A, Raizberg I … +3 more , Hochwald O, Kugelman A, Borenstein-Levin L
Am J Perinatol · 2025 Dec · PMID 41475400 · Publisher ↗
Despite availability of advanced monitoring tools, most neonatologists still primarily rely on nursing documentation of desaturation and bradycardia events to assess the respiratory status of very low birth weight (VLBW)...
Despite availability of advanced monitoring tools, most neonatologists still primarily rely on nursing documentation of desaturation and bradycardia events to assess the respiratory status of very low birth weight (VLBW) premature infants. We aimed to compare oxygenation instability as recorded in nursing charts versus SpO histograms in VLBW infants during their first weeks of life.An observational study including VLBW premature infants who required respiratory support on day 1 of life. We recorded the daily number of desaturation events <90% from nursing charts and the cumulative duration of SpO <90% from 24 hours SpO histograms. Data were collected from birth until respiratory support was discontinued.Data from 1,749 chart days of 77 VLBW infants (mean ± SD birth weight 1,040 ± 243 g; gestational age: 28.5 ± 2.1weeks) were analyzed. A strong Pearson correlation was found between the number of desaturation events and total time in SpO <90% (r = 0.8). However, similar event counts often reflected different hypoxemia burden. Eight or more daily desaturation events predict an unstable SpO histogram (sensitivity: 90.3%, specificity: 76.1%).Nursing charts and SpO histograms strongly correlate but offer unique insights-charts capture the frequency and distribution of desaturation events, while histograms quantify overall hypoxemic exposure. Used together, they provide a more comprehensive assessment of respiratory status in VLBW infants. · Oxygenation instability is common among VLBW premature infants.. · We compared oxygenation instability documentation in the NICU by nursing charts versus SpO2 histograms.. · Strong Pearson correlation was found between documented desaturation events and time with SpO2 <90%.. · However, for a given number of desaturation events, the time in SpO2 <90% varied significantly.. · Combining charts and SpO2 histograms gives a more complete respiratory assessment in VLBW infants..
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