BACKGROUND: Given the incidence and impact of postpartum depression (PPD) on families in the NICU, we aimed to increase the percentage of birthing parents screened for PPD from 0 to 90% over 18-months and provide psychos...BACKGROUND: Given the incidence and impact of postpartum depression (PPD) on families in the NICU, we aimed to increase the percentage of birthing parents screened for PPD from 0 to 90% over 18-months and provide psychosocial support. METHODS: Planned experimentation was used to design an effective screening framework in a level IV NICU. Interventions included process standardization, electronic health record (EHR) support, and data visualization for feedback. Data were displayed on a control chart and stratified for race and language to ensure equitable delivery. RESULTS: Provider screening utilizing the PHQ-2 proved the most reliable screening framework in our context. Screening rates increased to a mean of 75%, with 90% of positive screens referred to a unit psychologist; rates were comparable across stratified groups. CONCLUSION: Successful implementation of PPD screening in tertiary NICUs requires planning to ensure efficient and equitable processes and adequate psychosocial support.
Vergales B, Scala M, Bruno C
… +27 more, Crabtree C, Gray M, Hoffman S, McLean C, O'Reilly D, Quinones Cardona V, Bergner EM, Brady JM, Johnston L, Myers P, Good M, McNamara PJ, DeMauro S, Loyd J, Maron J, Martin CR, McElroy SJ, Stroustrup A, Taylor SN, Tipple TE, Patel RM, Shah S, Song C, Davis A, Gupta M, Escobedo M, French H
J Perinatol
· 2026 Jun · PMID 42236995
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The American Board of Pediatrics (ABP) has proposed a competency-based fellowship model offering a 2-year clinical pathway with 18 training blocks and no scholarly requirement. This position statement, representing neona...The American Board of Pediatrics (ABP) has proposed a competency-based fellowship model offering a 2-year clinical pathway with 18 training blocks and no scholarly requirement. This position statement, representing neonatal-perinatal medicine (NPM) training program directors, division leaders, and key stakeholders, contends that the model is not viable for NPM training. Compressing 18 clinical blocks into 24 months would require approximately 3500 annual training hours, nearly double a sustainable NICU workload, approaching Accreditation Council for Graduate Medical Education duty-hour limits, while reducing didactic education by one-third. Survey data from 110 of 111 NPM programs show 76% opposition. Concerns include trainee wellness, reduction in program complement, workforce and funding implications, and the erosion of scholarly training essential to advancing neonatal care. We propose alternatives, including a 2-year residency + 3-year fellowship (2 + 3) pathway and restructured residency tracks, addressing competency gaps while preserving training quality, duration, and collaborative governance.
OBJECTIVE: Evaluate whether minimally invasive surfactant therapy (MIST) reduces respiratory support duration in infants born at 28-37 weeks' gestation with respiratory distress syndrome (RDS). STUDY DESIGN: Retrospectiv...OBJECTIVE: Evaluate whether minimally invasive surfactant therapy (MIST) reduces respiratory support duration in infants born at 28-37 weeks' gestation with respiratory distress syndrome (RDS). STUDY DESIGN: Retrospective cohort study of infants with RDS born between 28- 36 6/7 weeks' gestation at a single center level III NICU between 2016-2024. MIST was implemented in 2020. Primary outcome was total days of respiratory support. Secondary outcomes included intubation rates, length of stay, corrected gestational age (cGA) at discharge, and incidence of bronchopulmonary dysplasia (BPD). RESULTS: Of 218 infants with RDS, the post MIST group had fewer days of respiratory support (8.8 vs 11 days), significantly lower rate of intubation (39% vs 100%), and shorter NICU stay (35.5 vs 41.2 days). BPD among infants <32 weeks' gestation decreased from 43% to 29%. CONCLUSION: MIST was associated with reduced respiratory support and hospitalization duration in this population.
INTRODUCTION: Echocardiographic algorithm based assessment of diastolic function during neonatal period could help in early identification of left ventricular diastolic dysfunction (LVDD) in infants with bronchopulmonary...INTRODUCTION: Echocardiographic algorithm based assessment of diastolic function during neonatal period could help in early identification of left ventricular diastolic dysfunction (LVDD) in infants with bronchopulmonary dysplasia (BPD). AIM: To screen infants with BPD at 36 weeks postmenstrual age for LVDD. METHODS: We used conventional Doppler and myocardial deformation parameters suggested in the latest American Society of Echocardiography algorithm to evaluate LV function. Tricuspid-regurgitation velocity, LV shape, LV eccentricity and pulmonary ejection pattern were used to diagnose pulmonary hypertension (PH). The algorithm was then followed using age appropriate cut-off values to identify and grade LVDD. RESULTS: Scans of 71 control infants and 93 infants with BPD were analysed. We noted PH in 15% infants with BPD and 7% control infants. Grade 2 LVDD was seen in 5% infants with BPD compared to 1.4% control infants. CONCLUSION: Rate of PH and grade 2 LVDD was significantly higher in infants with moderate to severe BPD.
OBJECTIVE: Determine the association of infant mortality (IM) and gentrification, a composite measure of rising neighborhood income, education, and housing costs. STUDY DESIGN: Retrospective cohort analysis of 672,432 in...OBJECTIVE: Determine the association of infant mortality (IM) and gentrification, a composite measure of rising neighborhood income, education, and housing costs. STUDY DESIGN: Retrospective cohort analysis of 672,432 infants born 2010-2019 across metropolitan Michigan. Multilevel multivariable regression models examined the association of gentrification and IM. Gentrification components were evaluated in separate models. RESULTS: Gentrification was not associated with IM, but some of its components were. Living in a census tract with an above median rise in income or education attainment was associated with lower odds of IM, compared to below median change (Income: aOR=0.88; 95% CI: 0.82-0.95; Education: aOR=0.93; 95% CI: 0.86-0.997). Rent increases above the median were linked to higher IM among term infants and lower IM among infants <32 weeks' gestation. The association of IM with rising home values varied by maternal insurance status. CONCLUSIONS: Indicators of increasing community affluence, often combined to define gentrification, have opposing relationships with IM.
OBJECTIVE: To identify risk factors for bag and mask ventilation (BMV) and compare mortality outcomes between infants who did and did not receive BMV. STUDY DESIGN: Secondary analysis of data from the seven sites of the...OBJECTIVE: To identify risk factors for bag and mask ventilation (BMV) and compare mortality outcomes between infants who did and did not receive BMV. STUDY DESIGN: Secondary analysis of data from the seven sites of the Global Network Maternal Newborn Health registry, including fresh stillbirths and live births ≥ 1500 grams from 2017 to 2023. RESULTS: A total of 171 279 births (98.9% live births, 1.1% fresh stillbirths) were included. BMV was administered in 3.9% of cases. Maternal education, labor complications, delivery location, and prematurity were identified as major risk factors for receiving BMV. Adjusted relative risks (95% CI) for very early neonatal mortality with BMV was 26.18 (23.02-29.79), early neonatal mortality 19.08 (17.40-20.93), neonatal mortality 14.23 (13.08,15.49, mortality < 42 days 12.86 (11.84,13.97) and asphyxia-related deaths was and 2.42 (2.11, 2.77). CONCLUSION: These finding underscore the importance of early identification of maternal and perinatal factors associated with receiving BMV to improve neonatal outcomes.
OBJECTIVE: To evaluate changes in probiotic use and necrotizing enterocolitis (NEC) in preterm infants following the 2023 FDA actions. STUDY DESIGN: Natural experiment observational study of preterm infants from the Pedi...OBJECTIVE: To evaluate changes in probiotic use and necrotizing enterocolitis (NEC) in preterm infants following the 2023 FDA actions. STUDY DESIGN: Natural experiment observational study of preterm infants from the Pediatrix Clinical Data Warehouse comparing NEC among infants in high probiotic-use (HUC) centers versus low-use centers (LUC) using difference-in-differences analyses from October 2022-September 2023 to April 2024-March 2025. RESULTS: There were 2785 infants in the HUCs and 7298 infants in the LUCs. After FDA action, probiotic use decreased in HUCs (86-6.9%); the decrease was smaller in LUCs (13-0.1%). NEC incidence increased in HUCs (2.7-4.4%), but remained unchanged in LUCs at 3.6% (adjusted difference-in-difference in NEC in HUCs compared to LUCs: 1.18%; 95% CI 0.03-2.33%, P = 0.045). CONCLUSION: NEC incidence increased in centers routinely using probiotics after rapid cessation of use following FDA actions.
Carr NR, Fulmer ML, Rumpel J
… +13 more, Makkar A, Mahmood B, Keene S, Rintoul N, Taylor Wild K, Ashrafi A, Gogcu S, Rau C, Pattison D, Best H, Boyden SE, Mao R, Brunelli L
OBJECTIVE: To evaluate the feasibility and diagnostic yield of universal genome sequencing (GS) in infants receiving extracorporeal membrane oxygenation (ECMO). STUDY DESIGN: Prospective multicenter study across eight Ch...OBJECTIVE: To evaluate the feasibility and diagnostic yield of universal genome sequencing (GS) in infants receiving extracorporeal membrane oxygenation (ECMO). STUDY DESIGN: Prospective multicenter study across eight Children's Hospital Neonatal Consortium sites (October 2021-August 2023). Infants initiated on ECMO were enrolled for GS regardless of suspected genetic disease. Demographics, ECMO indications, and results from standard-care testing and study-based GS were analyzed. RESULTS: Twenty-five infants were enrolled. Primary ECMO indications included congenital diaphragmatic hernia (28%), meconium aspiration syndrome (24%), and primary respiratory failure (20%). GS identified pathogenic or likely pathogenic variants in 6/25 infants (24%), including three cytogenetic-confirmed diagnoses and three molecular diagnoses identified only by GS. Variants of uncertain significance were identified in 44% of infants, while 32% had negative results. CONCLUSION: Universal GS during ECMO is feasible and yields a relatively high rate of clinically relevant diagnoses, supporting further assessment of the integration of genomic testing into ECMO care pathways.
BACKGROUND: Neonates with congenital heart disease may require delivery room interventions beyond standard care. Because existing guidelines and educational programs rarely address these needs, we developed and evaluated...BACKGROUND: Neonates with congenital heart disease may require delivery room interventions beyond standard care. Because existing guidelines and educational programs rarely address these needs, we developed and evaluated targeted educational modules. METHODS: Teams were randomized to online eLearning modules or directed readings. Individual pre-/post-knowledge scores were compared. Team performance was tested in simulated delivery scenarios including abruption, hypoplastic left heart syndrome, d-transposition of great arteries and congenital complete heart block. RESULTS: 32 teams from 9 centers participated. The module group had improved knowledge scores (mean change 6% vs -0.3% e-Learning group, p = 0.01). Simulation performance was similar between groups except for hypoplastic left heart syndrome, where module groups scored lower, performing less bag-mask ventilation before intubation (82% vs 88%, p < 0.05). CONCLUSION: eLearning modules were well-accepted and improved knowledge scores. Simulation performance was similar between groups. Ongoing educational development of CCHD DR adaptations and their incorporation within standard NRP is required.
OBJECTIVE: To conduct a detailed epidemiological exploration of the relative contributions of cannabis and ethnicity to US atrial septal defect (ASD) rates (ASDR). STUDY DESIGN: State-based ASDR data from the US National...OBJECTIVE: To conduct a detailed epidemiological exploration of the relative contributions of cannabis and ethnicity to US atrial septal defect (ASD) rates (ASDR). STUDY DESIGN: State-based ASDR data from the US National Births Defects Prevention Network, substance use, income and ethnicity data analyzed in RStudio. RESULTS: Ethnic effects were significant with relative risks amongst African Americans and American Indians and Alaskan Natives of 2·40 (95%C.I. 2·27, 2·54) and 2·31 (2·19, 21·43), Cohen's D of 1·44 and 1·46 and P values of 2·94 × 10 and 3·01 × 10 compared to others, respectively. In general, additive models inclusion of ethnicity:cannabinoid and ethnicity:tobacco interactions were significant down to P=zero for cannabis, Δ9THC and cannabidiol. Sequentially doubly robust targeted multiple likelihood estimations confirmed epidemiologically causal relationships under standard assumptions. ASDR amongst Asians and Pacific Islanders in Nevada showed an exponential doubling time of 2.83 years. CONCLUSIONS: Cannabinoid and cannabinoid:ethnicity interactions drive ASDR and meet epidemiological causal criteria.
OBJECTIVE: To design and evaluate a systems-based approach for safe, efficient, and family-centered mass intrahospital transport (M-IHT) of critically ill neonates during two planned NICU relocations. METHODS: This prosp...OBJECTIVE: To design and evaluate a systems-based approach for safe, efficient, and family-centered mass intrahospital transport (M-IHT) of critically ill neonates during two planned NICU relocations. METHODS: This prospective QI initiative followed SQUIRE 2.0 guidelines. Work system design was guided by systems-based patient safety frameworks, Operations/Management Science principles, integrating context evaluation with proactive, multidisciplinary, simulation-based planning to mitigate risk and ensure real-time adaptability. Outcomes were evaluated using prospectively collected multi-source data. RESULTS: Both relocations were completed without clinical complications, equipment failures, or service disruption. Staff surveys showed >90% positive responses across domains. Parents reported high satisfaction, perceived safety, and effective communication. Direct observations confirmed smooth coordination, role clarity, workflow adherence, and real-time responsiveness. The work system was successfully reapplied with consistent performance and improved efficiency. CONCLUSIONS: M-IHT of critically ill infants was conducted safely and efficiently using a reliable, adaptable, and sustainable system-based framework offering transferable lessons for complex operations.
OBJECTIVE: Describe the golden hour and hospital outcomes of conjoined twins METHODS: Retrospective single center study of conjoined twins. Main outcome measures included delivery room characteristics. Secondary outcomes...OBJECTIVE: Describe the golden hour and hospital outcomes of conjoined twins METHODS: Retrospective single center study of conjoined twins. Main outcome measures included delivery room characteristics. Secondary outcomes included survival and length of stay. RESULTS: From 2013-2025, there were 19 sets of conjoined twins (active resuscitation in 13; palliative in 6). Respiratory interventions in the delivery room were frequently needed including continuous positive airway pressure (75%), positive pressure ventilation (67%), and endotracheal intubation (25%). There were two sets with emergency separation, each with one surviving twin. For the 10 sets who underwent separation, survival at NICU discharge was 80% (twin A) and 100% (twin B). CONCLUSION: The delivery room resuscitation of conjoined twins is complex with high rates of advanced respiratory intervention. These deliveries necessitate an experienced multidisciplinary team and an individualized delivery plan based on specific anatomy and reinforced with simulation. Survival is high among twins who undergo separation.
BACKGROUND/OBJECTIVE: Lean body mass is linked to improved outcomes, but infant muscle-specific tools are limited. Bedside ultrasound measurements of muscle cross-sectional area (CSA) may overcome these limitations. STUD...BACKGROUND/OBJECTIVE: Lean body mass is linked to improved outcomes, but infant muscle-specific tools are limited. Bedside ultrasound measurements of muscle cross-sectional area (CSA) may overcome these limitations. STUDY DESIGN: A prospective cohort of 60 infants at two neonatal intensive care units (NICUs) underwent serial ultrasound biceps CSA, rectus femoris CSA, and anthropometric measurements. Intraclass correlation coefficients (ICC) assessed measurement reliability. Spline mixed models examined associations between muscle CSA and birth gestational age, growth, postmenstrual age (PMA), and nutrition. RESULTS: Intra- and inter-rater ICCs ranged from 0.92 to 0.99 and from 0.77 to 0.91. No safety events occurred. Biceps CSA correlated with birth gestational age, PMA, weight, length, head circumference, and mid-upper arm circumference (p ≤ 0.01). Rectus femoris CSA correlated with birth gestational age, weight, length, head circumference, and mid-thigh circumference (p < 0.05). CONCLUSION: Bedside ultrasound is feasible, safe, and reliable for muscle CSA measurement in NICU infants.
OBJECTIVE: To assess the validity of NICU admission reporting on birth certificates in a large dataset. STUDY DESIGN: We compared NICU admissions on birth certificates to actual NICU admissions for all potentially viable...OBJECTIVE: To assess the validity of NICU admission reporting on birth certificates in a large dataset. STUDY DESIGN: We compared NICU admissions on birth certificates to actual NICU admissions for all potentially viable in-hospital deliveries in Pennsylvania and South Carolina from 2006 to 2018 (n = 2,470,917). We used data from linked birth certificate and hospital discharge records to identify actual NICU admissions and evaluated missed NICU admissions by gestational age, mother's race and ethnicity, and other factors. RESULTS: 38% of infants who were truly admitted to a NICU did not have a NICU admission on their birth certificates. Missed NICU admission occurred across all gestational ages. Birth certificates missed more than half of NICU admissions among term infants (37+ weeks), including among those with conditions considered to be severe. CONCLUSIONS: NICU admission reporting on birth certificates grossly underestimates utilization of NICU care and can have serious implications for research, resource allocation, and policy.
OBJECTIVE: As the prevalence of cannabis use continues to increase among women of reproductive age, studies exploring the impact of in utero cannabis exposure on birth outcomes are warranted. STUDY DESIGN: Using data fro...OBJECTIVE: As the prevalence of cannabis use continues to increase among women of reproductive age, studies exploring the impact of in utero cannabis exposure on birth outcomes are warranted. STUDY DESIGN: Using data from the National Birth Defects Prevention Study, logistic regression was used to assess the relationship between maternal self-report of cannabis use during early pregnancy and 1) preterm birth, and 2) being born SGA. Patterns of cannabis use during the first six months of pregnancy were also assessed. RESULTS: Three percent of the sample (n = 324) reported cannabis use in early pregnancy. A slight majority (56%) of users ceased the use of cannabis after the second month of pregnancy. No significant association was observed between cannabis use and preterm birth (aOR = 1.27, 95% CI: 0.88-1.83) or SGA (aOR = 1.00, 95% CI: 0.68-1.47). CONCLUSION: Cannabis use in early pregnancy was not significantly associated with preterm birth or SGA in this sample.
OBJECTIVE: To evaluate intubation success and safety among extremely low birthweight (ELBW) infants before, during, and after the introduction of a new video laryngoscope (VL) in a Level 3 neonatal intensive care unit. S...OBJECTIVE: To evaluate intubation success and safety among extremely low birthweight (ELBW) infants before, during, and after the introduction of a new video laryngoscope (VL) in a Level 3 neonatal intensive care unit. STUDY DESIGN: Single-center retrospective cohort study. Three phases (pre-introduction, introduction, and post-introduction), each with 40 intubations, were analyzed. Primary success and safety outcomes included first-attempt success and any tracheal intubation-associated events (TIAEs), respectively. Univariable analyses were used to compare patient, provider, and practice characteristics and outcomes by phase. RESULTS: No significant differences were observed between the pre-introduction and introduction phases. The post-introduction phase had significantly fewer TIAEs compared to both the pre-introduction (2 [5%] vs 8 [20%]; p = 0.04) and introduction phases (2 [5%] vs 8 [20%]; p = 0.04). CONCLUSION: Safety outcomes improved with continued use of the new VL among ELBW intubations. Further research is needed to explore the role of training and experience with new airway technologies.