This study aimed to determine whether immediate postnatal heart rate (HR) assessment during delayed cord clamping (DCC) influences the clinical decision-making of neonatal resuscitation providers.The decision to perform or defer DCC primarily relies on subjective parameters, potentially leading to variations in subsequent steps of the resuscitation algorithm. In this study, HR, a numerical parameter, was introduced during DCC. Ten subjects completed a total of 60 short scenarios simulating DCC for a 27-week preterm manikin. Each subject experienced two consecutive sets (control vs. test) of three scenarios with predefined HR ranges (<60, 60-99, and ≥ 100/minute) presented in random order. In control scenarios, subjects participated in the DCC procedure per usual practice. In test scenarios, they manually measured HR during DCC. Objective variables and subjective questionnaire responses were collected.The mean DCC duration significantly increased for HR 60 to 99/minute (45.4 vs. 55.3 seconds,  = 0.035) and HR ≥ 100/minute (37.1 vs. 63.7 seconds,  = 0.011) scenarios in the test group compared with the control. For the HR < 60/minute scenario, mean DCC duration and time to ECG attachment tended to be shorter in the test group (45.4 vs. 34.6 and 89.7 vs. 56.3 seconds, respectively). In this HR range, initiation of respiratory support occurred significantly earlier in the test group (mean 72.7 vs. 47.6 seconds,  = 0.020). According to the questionnaire, 2 (20%) subjects believed tone and respiratory effort were sufficient for DCC decision-making. Seven (70%) subjects perceived that HR assessment during DCC had a "strong" or "very strong" impact on the decision to delay or proceed with cord clamping, with confidence levels rising from a median of 3 to 4 on a 5-point Likert scale.Assessing immediate postnatal HR during DCC appears to impact clinical decision-making for providers, implying the potential for enhancing uniformity of decisions among healthcare professionals surrounding DCC. · The decision to perform or defer DCC primarily relies on subjective parameters.. · HR assessment during DCC appears to impact clinical decision-making for providers.. · Assessing HR during DCC may potentially enhance uniformity of decisions among HCPs..

Induction of labor (IOL) and hospitalist coverage are becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains unclear. The objective of this study was to compare the induction time to vaginal delivery across three obstetric coverage models: hospitalists, faculty generalists, and private practice generalists.This single-site retrospective cohort study analyzed singleton, term (≥39 weeks), vertex patients undergoing IOL at NYU Langone Hospital-Long Island from January 1, 2022, to September 30, 2022. Hospitalists at this institution managed high-risk obstetric patients, including those under maternal-fetal medicine care, resident clinic, and unregistered patients who presented to labor and delivery, along with serving as labor and delivery safety officer on the labor floor. Faculty and private practice generalists managed their respective groups. Outcomes included induction time to vaginal delivery, mode of delivery, induction methods, and maternal and neonatal complications. Statistical analyses included chi-square, ANOVA, and multivariable linear regression. A -value of < 0.05 was statistically significant.Among 403 patients, 92 (22.8%) were managed by hospitalists, 115 (28.5%) by faculty, and 196 (48.6%) by private generalists. Median (IQR) induction-to-delivery times were similar across groups: hospitalists 20.5 (15.3-27.5) hours, faculty 23.4 (16.5-31.1) hours, and private 19.7 (14.1-25.6) hours ( = 0.004). However, when limited to vaginal deliveries, no significant difference was observed in induction-to-vaginal-delivery time ( = 0.17). Private generalists had the shortest induction-to-cesarean time and time to membrane rupture leading to cesarean. There were no differences in intrapartum or postpartum complications. Hospitalists had more NICU admissions after vaginal delivery, mostly unrelated to labor.Induction-to-vaginal delivery times and complication rates were similar across coverage models, but differences in NICU admissions and cesarean delivery times highlight care variations. Collaboration and evidence-based standardized induction protocols may optimize outcomes across coverage models. · Induction to vaginal delivery time can be similar across obstetric groups.. · Labor and delivery units with high induction rates may benefit from hospitalists.. · An evidence-based induction protocol may optimize maternal and fetal outcomes..

Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality, with cesarean delivery posing a heightened risk. While interventions such as prophylactic tranexamic acid and balloon tamponade have limitations-especially when the cervix is not dilated-vacuum-assisted uterine tamponade may offer a novel intraoperative approach. This prospective pilot study evaluated the feasibility of the Daisy catheter, a cervical drain device developed by Raydiant Oximetry, Inc., designed to evacuate blood and promote uterine contraction through continuous negative-pressure suction.We enrolled ten pregnant individuals scheduled for cesarean delivery at a tertiary care center, all of whom had at least one PPH risk factor. Following fetal and placental delivery, the Daisy catheter was inserted trans-hysterotomically, advanced through the cervix, and connected to wall suction (-90 to -100 mm Hg) for 2 hours. Quantitative blood loss, perioperative hemoglobin change, ultrasound findings, and adverse events were recorded.Device placement succeeded in 9 of 10 cases; one failure was due to an undiagnosed cervical cerclage. Eight participants completed the full suction protocol. Mean hemoglobin decline from preoperative baseline to postoperative day 1 was 1.36 ± 0.47 g/dL, significantly lower than the 1.9 ± 1.1 g/dL observed in a historical cohort from 31 U.S. hospitals ( = 0.019). Ultrasound at 2 hours postpartum confirmed correct device placement, absence of intrauterine clot, and no evidence of trauma. Device removal was uncomplicated, and no adverse events were reported.These preliminary findings suggest that intraoperative use of the Daisy device is feasible, well-tolerated, and may reduce blood loss after cesarean delivery. Larger, randomized trials are warranted to evaluate its impact on transfusion rates, reoperation, and overall maternal outcomes, particularly in settings where alternative tamponade methods are limited. The ClinicalTrials.gov identifier is NCT06219538. · Vacuum tamponade used during cesarean delivery.. · Daisy device showed safe, feasible deployment.. · Hemoglobin drop was lower than the historical average..

This study aimed to evaluate the feasibility of randomizing patients to weight-based low molecular weight heparin (LMWH) versus no pharmacologic thromboprophylaxis following cesarean delivery (CD).Single-center, open-label pilot randomized controlled trial of individuals aged 18+ undergoing CD at the University of Utah Health from November 2023 to June 2024. Those with a contraindication to anticoagulation, a plan for therapeutic anticoagulation, or considered at highest risk for postpartum venous thromboembolism (VTE; i.e., undergoing cesarean-hysterectomy, high-risk thrombophilia, personal history of thromboembolism) were excluded. Enrolled individuals were randomized in a 1:1 ratio utilizing block randomization with randomly varying block sizes to receive weight-based LMWH for 14 days or no pharmacologic thromboprophylaxis. The primary outcome was feasibility, defined as ≥35% enrollment of eligible individuals and retention of ≥85% of enrolled individuals through all study procedures. Secondary feasibility outcomes included the number of eligible patients per month, approach rate, enrollment rate, and retention rate. Additional outcomes included VTE, wound hematoma, patient-reported symptoms, or a bleeding complication within 6 weeks postpartum. Baseline characteristics were compared between those approached and enrolled and those not enrolled. The proportion meeting each of the outcomes was reported with 95% confidence intervals (CI).Over the 6-month study period, 694 patients were screened and found eligible for an average of 106 eligible patients per month. There were 611 patients approached (88%, 95% CI: 85.6-90.5), of which 64 enrolled (10.5%, 95% CI: 8-12.9), and 61 participants were retained through all study procedures (95.3%, 95% CI: 90-100). Thus, the overall primary outcome feasibility parameters were not met. Among the 64 individuals enrolled and randomized, the mean age was 31.0 years (standard deviation: 5.5 years), and the majority were non-Hispanic White (56%). Baseline characteristics were similar between those who were approached and enrolled compared with those not enrolled. There were no differences in additional clinical outcomes (VTE, wound hematoma, patient-reported symptoms, or bleeding complications) by prophylaxis group.In this pilot trial, individual patient randomization to weight-based LMWH or no pharmacologic thromboprophylaxis after CD was not feasible due to low enrollment rates. Future trials addressing postpartum thromboembolism prevention should consider alternative study designs. · Individual patient randomization to enoxaparin or no therapy after CD was not feasible.. · The approach rate, enrollment rate, and retention rate were 88, 11, and 95%, respectively, in this single-center pilot.. · Future prospective studies may need to consider alternative designs..

This study aimed to describe neuromonitoring findings and short-term outcomes after the implementation of a digital health strategy comprising continuous, real-time, tele-based video-aEEG/EEG monitoring in a publicly funded NICU in Brazil.Prospective, observational cohort study conducted between July 2017 and June 2021, analyzing neuromonitoring data of high-risk newborns and correlating it with clinical and imaging outcomes.A total of 116 newborns, with a median gestational age of 37 weeks (interquartile range [IQR]: 32-39) and a median birth weight of 2,800 g (IQR: 1,472-3,305), were enrolled with more than 8,000 hours of monitoring. The main indication was suspected seizure ( = 49, 42.2%). A total of 43 (37.1%) neonates presented pathological background activity, and sleep-wake cycle (SWC) was absent in 68 (58.6%). Seizures were identified in 36 (31.0%) neonates, predominantly within the first 12 hours of life ( = 14, 38.9%), electrographic-only ( = 29, 80.6%), and repetitive ( = 24, 66.7%). A total of 47 (40.5%) neonates received antiseizure medications, with phenobarbital being the most frequently used (46; 97.9%). Only one patient (2.1%) was discharged receiving antiseizure medication. Cranial ultrasound (cUS) was performed in 94 (81.0%) infants, with abnormal findings in 34 (36.2%) infants. Pathological background activity, absence of SWC, and seizures were significantly associated with severe abnormalities on cUS, and increased risk of death before discharge.The implementation of a digital health strategy incorporating real-time and continuous video-aEEG/EEG monitoring demonstrated potential to improve diagnostic accuracy for electrographic seizures, optimize antiseizure medication stewardship, and inform early neuroprotective interventions. · Brain monitoring improves seizure diagnosis.. · aEEG/EEG supported antiseizure medication discontinuation.. · Abnormal aEEG/EEG findings are associated with poor outcomes.. · Remote aEEG/EEG monitoring is feasible in LMIC..

Studies have identified increased perinatal risks for young birthing age (≤18 years), but less is known about postpartum outcomes. This study examines postpartum outcomes in a primiparous cohort of young birthing patients as compared to a population aged 25 to 30 years.This retrospective cohort study compares postpartum outcomes in primiparous young birthing age patients ( = 520) compared to birthing patients 25 to 30 years ( = 558). Outcomes are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Primiparous young birthing patients were more likely to be prescribed contraception at hospital discharge (34.4 vs. 16.5%, aOR: 2.07, 95% CI: 1.49-2.89) than primiparous 25- to 30-year-old patients. They were also less likely to breastfeed at hospital discharge (78.4 vs. 97.1%, aOR: 0.09, 95% CI: 0.05-0.17). Additionally, young patients were significantly less likely to attend postpartum visits (39.4 vs. 47.1%, aOR: 0.69, 95% CI: 0.52-0.92), although less than half of participants overall attended a postpartum visit. Differences identified at hospital discharge persisted during postpartum care for contraceptive use (87.2 vs. 77.8%, aOR: 2.43, 95% CI: 1.35-4.51) and for breastfeeding (44.9 vs. 87.2%, aOR: 0.12, 95% CI: 0.07-0.2). There was also a trend toward decreased postpartum depression screening, with 59.5% of the young group screened, and 71.5% of the 25- to 30-year-old group screened.Young birthing age at the time of first birth is associated with lower breastfeeding rates and higher contraception use, compared to primiparous standard risk patients. Furthermore, young birthing patients appear to have a decreased rate of standardized screening for postpartum depression, although screening rates are low in both groups. These data may help tailor birthing and postpartum follow-up programs to better address specific risks for younger patients. · Postpartum outcomes differ with younger birthing age.. · Postpartum care is less likely with a younger birthing age.. · Depression screening is less frequent with younger birthing age..

We describe and evaluate an innovative, longitudinal 3-year simulation-based boot camp curriculum designed to enhance neonatology fellows' cognitive, technical, and communication skills throughout their training.The Midwest Neonatal Simulation Boot Camp (MNSBC) was developed by a multi-institutional executive committee composed of stakeholders from various Chicago-area neonatology programs. The curriculum was introduced in phases, starting with a first-year boot camp in 2019, followed by second- and third-year boot camps in subsequent years. Utilizing Kern's approach to curriculum development, the content and structure of each boot camp were designed to meet the learners' needs as they progressed through fellowship training. The evaluation of this curriculum consisted of pre- and postprogram surveys completed by participants.Since its inception, the MNSBC curriculum has trained 152 first-, 88 second-, and 57 third-year fellows from 12 programs across five Midwestern states. Participants demonstrated statistically significant improvements in self-assessed proficiency following each boot camp. Anonymous evaluations collected from fellow participants consistently highlighted enhanced clinical skills, knowledge, and confidence in managing low-frequency, high-stakes procedures and clinical scenarios.The MNSBC demonstrates that a longitudinal, multi-institutional, 3-year simulation-based curriculum is both feasible and effective in improving neonatology fellows' self-perceived proficiency in cognitive, technical, and communication skills. As pediatric residency and subspecialty fellowship training requirements evolve, the MNSBC offers a sustainable model to address educational gaps throughout fellowship training. · Longitudinal multi-center simulation boot camp.. · Educational experience for Neonatology fellows.. · Bridging educational gaps during fellowship.. · Resource pooling and allocation..

This study aims to compare the diagnostic utility of umbilical cord blood culture (UCBC) versus neonatal blood culture (NBC) in the evaluation and management of early-onset neonatal sepsis (EONS) in late preterm and term infants and determine the contamination rate of UCBC.A retrospective analysis was conducted on late preterm and term neonates born between December 2020 and January 2025, who underwent EONS evaluation with UCBCs and NBCs. The study assessed detection rates of true-positive cultures, contamination rates (false positives), and incidence of culture-negative sepsis.A total of 336 infants had UCBCs performed, with 223 undergoing concomitant NBCs. Positive culture rates were similar: Four UCBCs (1.2%) and three NBCs (1.3%) were positive. UCBC had two contaminants (0.6%) while NBC had one (0.45%). One infant had both cultures positive for . No infants required prolonged antibiotics for culture-negative sepsis.The contamination rate of UCBC was extremely low in the cohort of infants at high risk for EONS. Our protocol and collection technique may serve as a model for others aiming to reduce contamination rates. While NBC can be positive despite a negative UCBC, and vice versa, obtaining both UCBC and NBC can improve the sensitivity of EONS diagnosis and help minimize prolonged antibiotic use in cases of culture-negative sepsis. UCBC demonstrated a low contamination rate and comparable diagnostic yield to NBC. UCBC may be considered a reliable alternative or adjunct to NBC in the evaluation and management of EONS. · UCBC and NBC together improve sepsis detection sensitivity.. · UCBC provides adequate volume for reliable neonatal cultures.. · UCBC offers a less invasive option for neonatal sepsis evaluation.. · Standardized UCBC technique reduces false-positive culture risk.. · UCBC shows low contamination in assessing early-onset sepsis..

This study aimed to evaluate the factors associated with completed delayed cord clamping (DCC).We conducted a retrospective review of viable singleton deliveries at a single academic medical center from January 1, 2020 to December 31, 2022. Demographics, obstetric variables, and neonatal data were extracted from the electronic medical record. Patients who received DCC were compared with those who did not. Multivariate logistic regression was used to assess factors associated with completion of 30 to 60 seconds of DCC, with a sub-analysis of preterm deliveries <30 weeks.DCC was completed in 5,018/5,889 (85.2%) eligible deliveries. Lower DCC rates were observed among non-Black, White, or Asian patients versus White patients (82.1 vs. 87.1%; adjusted odds ratio [aOR] = 0.60, 95% CI: 0.47-0.78) and in 2020 versus 2022 (83.6 vs. 86.5%; aOR = 0.74, 95% CI: 0.61-0.91). Patients who completed DCC had lower mean BMI (32.59 vs. 34.53, aOR = 0.99, 95% CI: 0.98-0.996), were less likely to be nulliparous (83.9 vs. 86.4%, aOR = 0.78, 95% CI: 0.66-0.92), less likely to have pregestational diabetes (72.8 vs. 86.1%, aOR = 0.63, 95% CI: 0.45-0.87), chorioamnionitis (72.9 vs. 85.6%, aOR = 0.51, 95% CI: 0.36-0.73), or postpartum hemorrhage (73.0 vs. 85.6%, aOR = 0.59, 95% CI: 0.41-0.86). Preterm (68.5 vs. 87.8%, aOR = 0.50, 95% CI: 0.40-0.63) and cesarean deliveries (77.2 vs. 90.0%, aOR = 0.72, 95% CI: 0.60-0.85), and infants requiring resuscitation (61.7 vs. 91.6%; aOR = 0.20, 95% CI: 0.17-0.23) were less likely to have completed DCC. Among preterm newborns <30 weeks, neonatal resuscitation was the only factor associated with not receiving DCC after adjustment.Race, delivery mode and year, maternal BMI, nulliparity, pregestational diabetes, chorioamnionitis, postpartum hemorrhage, preterm birth, and neonatal resuscitation were independently associated with completed DCC. Strategies to improve DCC execution should target preterm infants and address the challenges of performing DCC in neonates requiring urgent resuscitation. · Preterm births are less likely to receive DCC.. · Infants requiring newborn resuscitation are less likely to receive DCC.. · DCC rates increased after the implementation of an institutional DCC policy..

This study aimed to evaluate the association between the Child Opportunity Index (COI) and postdischarge oxygen use in infants with bronchopulmonary dysplasia (BPD).Retrospective study of infants < 32 weeks' gestation with BPD, discharged on home oxygen from 2010 to 2022 and followed in a BPD clinic. Primary outcome was duration of oxygen use, secondary outcomes were emergency room (ER) visits, missed BPD appointments, and readmission.Of 145 infants included in the study, 88 (60.3%) infants were in the very low COI category. Mean (standard deviation) duration of home oxygen was 89.5 (92) days. Regression analysis did not show any significant association between COI and duration of home oxygen use. Number of ER visits, unplanned readmissions, and missed BPD appointments also did not vary significantly between the COI groups.Our study did not show any significant association between COI and duration of home oxygen use in infants with BPD. · COI not associated with duration of oxygen use.. · Uneven groups may have affected our results.. · Additional research in this area is needed..

The Golden Hour is the first 60 minutes of life for extremely preterm infants and represents a critical window where timely stabilization can reduce morbidity such as intraventricular hemorrhage and bronchopulmonary dysplasia. At the University of Virginia, average Golden Hour admission times for infants <28 weeks' gestation were 117 minutes, indicating a major opportunity for improvement. This study aimed to reduce admission time by 25% (to ≤87 min) for infants <28 weeks' gestational age within 1 year of implementation.Using the Institution for Healthcare Improvement methodology, a multidisciplinary team identified key drivers of delay and implemented two Plan-Do-Study-Act (PDSA) cycles. PDSA 1 introduced a designated admission coordinator, structured flowsheet, and visible timer to enhance team awareness. PDSA 2 focused on line-placement efficiency, adding an auditory time, team huddles after 15 minutes, and earlier isolette closure to promote thermoregulation. Statistical process control (SPC) charts (XbarS, XmR) were used to evaluate changes. The outcome measure was time from admission to isolette closure. Process measures were time to glucose, IV dextrose, X-ray, and surfactant administration. Balancing measures were admission temperature, glucose levels, and severe intraventricular hemorrhage (IVH) rates.Among 106 infants, the average admission time decreased from 117 to 59 minutes, resulting in a 50% reduction. The proportion of admissions meeting the SMART aim (<87 min) improved from 8 to 100%. Process variability decreased on both XbarS and XmR charts. Balancing measures remained stable.Two sequential PDSA cycles achieved and sustained a 50% reduction in Golden Hour admission time without adverse effects. Structured team roles, real-time feedback, and workflow redesign produced a more efficient and stable process. This initiative demonstrates that systematic QI can meaningfully optimize Golden Hour care and may be replicable across NICUs. · This is the first reported quality improvement initiative to use admission time as a primary outcome within the neonatal Golden Hour framework.. · The results show a significant and sustained 50% reduction in admission time-from 117 minutes to 59 minutes-exceeding the SMART aim.. · Key drivers of change included defined team roles, visual and auditory cues, and standardization of the umbilical line placement workflow, which can be readily adapted for use in other NICUs seeking to test improvements during Golden Hour admissions..

This study aimed to determine the association of neonatal intensive care unit (NICU) admission with subsequent postpartum care among Medicaid recipients.Retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2020. Outcomes were postpartum care attendance, contraception, emergency department (ED) utilization, and readmission. Linear regression models evaluated the association between NICU admission and postpartum care.Our sample included 457,102 birthing people, 37,035 (8.1%) of which had a NICU-admitted infant. Medicaid recipients with NICU-admitted infants had higher rates of cesarean section, pregnancy complications, postpartum mental health conditions, and substance use. No significant differences in postpartum care attendance were noted, but NICU admission was associated with 6% greater ED use (95% CI: 0.052, 0.068,  < 0.001) and 3% higher readmission (95% CI: 0.026, 0.034,  < 0.001).Postpartum care receipt was similar, but ED and readmission rates are higher among those with NICU-admitted infants. Preventative postpartum care approaches must improve for at-risk populations. · Medicaid recipients have similar routine postpartum care attendance regardless of NICU admission.. · Postpartum patients with a NICU-admitted infant have greater ED utilization.. · Postpartum patients with a NICU-admitted infant have higher readmission rates..

The objective of this study is to determine if patterns of fetal heart rate tracings (FHRT) were associated with an increased rate of composite adverse neonatal outcomes (CANO) among preterm deliveries at 32 to 36 weeks.This was a retrospective review of intrapartum FHRT between 20 and 120 minutes before birth, among nonanomalous singletons delivered at 32 to 36 weeks. The study was conducted at a Level IV maternal center during a consecutive 15-month period. Obstetricians reviewing FHRT were blinded to the maternal characteristics, intrapartum course, and neonatal outcomes. FHRT patterns were categorized based on time spent in the final 2 hours before delivery (<50 vs. ≥50%). The primary outcome was the CANO, which included any of the following: 5-minute Apgar < 7, mechanical ventilation > 6 hours, umbilical artery pH < 7.00, bronchopulmonary dysplasia, interventricular hemorrhage, necrotizing enterocolitis, neonatal seizures, neonatal confirmed sepsis, hypoxic ischemic encephalopathy, birth injury, meconium aspiration syndrome, or neonatal death.Of 5,160 patients, 672 (13%) met the inclusion criteria. CANO occurred in 57 (8.5%) newborns. Overall, FHRT patterns that differed significantly between those without versus with CANO included minimal variability (8.8 vs. 19.3%,  = 0.01, PLR = 2.2 [positive likelihood ratio], PPTP 17% [positive posttest probability]), moderate variability (76.4 vs. 52.6%,  < 0.001, NLR = 2.01 [negative likelihood ratio], NPTP 15.7% [negative posttest probability]), accelerations (58.4 vs. 40.4%,  = 0.009, NLR = 1.43, NPTP = 11.7%), and severe variable decelerations (3.5%  = 0.003, PLR = 10.79, PPTP = 50.1%). Category III FHRT pattern was also associated with an increased posttest probably of CANO (0.3 vs. 1.8%,  = 0.12, PLR = 5.39, PPTP = 27%).While moderate variability and accelerations were associated with significantly lower likelihood of CANO among newborns delivered at 32 to 36 weeks, minimal variability and severe variable decelerations were significantly more common in preterm newborns with CANO. · At 32 to 36 weeks, CANO occur in approximately 8% of neonates.. · Severe variable decelerations and minimal variability increase risk of CANO.. · The PPTP of CANO is 33%, if Category III FHRT is noted before birth.. · The PPTP is 13%, if there is persistent Category II FHRT in the last 120 minutes..

Coordination of sucking-swallowing-breathing matures at 32 to 34 weeks' gestation; early oral feeds risk aspiration, while delays may increase oral aversion and length of stay. Safety of feeding on high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) is uncertain, and practice variations are common. This study describes the U.S. neonatal intensive care unit (NICU) practices for oral feeding during HFNC/CPAP and decision criteria.National cross-sectional telephone survey (July 2024-February 2025) of key informants from level III and IV NICUs.Of 159 NICUs, 83.0% routinely permitted oral feeding on HFNC, 10.7% sometimes, and 6.3% never. Only 9.4% routinely allowed CPAP feeding, 7.5% sometimes, and 83.0% never. Units allowing CPAP feeding used stricter readiness criteria, continuous monitoring, and involved speech-language pathology/occupational therapy.Oral feeding on HFNC is common; CPAP feeding is rare and criteria-bound, with regional variation. Heterogeneity underscores the need for consensus guidance and trials evaluating CPAP feeding effects on feeding outcomes, length of stay, and neurodevelopment. · Oral feeding during noninvasive support is widespread for HFNC but far more selective on CPAP.. · Units that permit CPAP feeding use strict criteria and multidisciplinary evaluation.. · Considerable variability across units and regions highlights the need for standardized guidance..

Nipocalimab, a neonatal Fc receptor blocker, showed evidence of efficacy and safety in preventing or delaying fetal anemia in a phase 2 study of early-onset severe hemolytic disease of the fetus and newborn, demonstrating potential for treatment of other maternal immunoglobulin G alloantibody-mediated fetal diseases. The phase 3 FREESIA-3 study aims to evaluate the efficacy and safety of nipocalimab or intravenous immunoglobulin (IVIG) with prednisone in pregnancies with a previous occurrence of fetal and neonatal alloimmune thrombocytopenia (FNAIT) with or without intracranial hemorrhage or severe fetal/neonatal bleeding (high-risk or standard-risk, respectively).

The aim of the study is to evaluate the association between platelet (PLT) parameters and the need for treatment of retinopathy of prematurity (ROP) in preterm infants.This single-center, retrospective cohort study was conducted at the Neonatal Intensive Care Unit of Fukushima Medical University Hospital between January 1, 2011, and December 31, 2023. The present study included preterm infants born before 30 weeks of gestation. Medical records were reviewed for 1,836 infants, of whom 187 met the inclusion criteria. Data on PLT parameters and ROP treatment were extracted from the medical records. Receiver operating characteristic analysis was used to determine cutoff values for PLT parameters associated with the need for ROP treatment. Multiple logistic regression analyses were performed to assess the association between ROP treatment and PLT parameters at birth and on day of life 28.Among the 187 infants included, 42.8% required treatment for ROP. After adjusting for confounders, an association was found between ROP treatment and plateletcrit (PCT) values < 0.23% (odds ratio [OR]: 3.44; 95% confidence interval [CI]: 1.37-8.63) and platelet mass index (PMI) values < 2,303.0 fL/nL (OR: 4.50; 95% CI: 1.77-11.41) at birth.Infants born before 30 weeks of gestation with PCT values < 0.23% and PMI values < 2,303.0 fL/nL at birth had an increased risk of developing ROP warranting treatment. · ROP is a leading cause of preventable blindness in preterm infants.. · There are no reliable early postnatal biomarkers that can predict ROP outcomes.. · We evaluated the association between PLT parameters and the ROP treatment in preterm infants.. · PCT < 0.23% and PMI < 2,303 fL/nL at birth were associated with a risk of requiring ROP treatment.. · PLT parameters may be useful in determining the ROP screening schedule and treatment for ROP..

Insufficient access to healthy food has been linked to poor health outcomes in under-resourced communities. The relationship between neighborhood-level food insecurity and diabetes in pregnancy remains understudied, with previous studies reporting inconsistent results. This study examined the association between living in a low-income, low access (LILA) census tract and the prevalence of pregestational type 2 diabetes (T2D) and gestational diabetes (GDM) among pregnant individuals.This cross-sectional study included patients who delivered a singleton pregnancy at ≥20 weeks' gestation at Henry Ford Hospital between January 2014 and December 2019 and resided within Detroit city limits at the time of delivery. Residence in a LILA census tract, as designated by the USDA Food Access Research Atlas, was the exposure, and prevalences of pregestational T2D and GDM were the outcomes, which were collected retrospectively from patient records. A total of 117 census tracts were designated as LILA. Covariates that were adjusted for included maternal age at delivery, race, body mass index (BMI), insurance status, and substance use during pregnancy (drug, alcohol, and tobacco). Multivariate logistic regression models were used to analyze the data.Of the 3,897 patients included in this study, 1,377 (35.3%) resided in LILA tracts and 2,520 (64.7%) resided in non-LILA tracts. When individuals residing in LILA and non-LILA tracts were compared, there were no significant differences in the prevalences of pregestational T2D (4.8 vs. 4.6%, adjusted prevalence odds ratio [aPOR] = 1.00, 95% CI: 0.72-1.38,  = 0.99) and GDM (11.3 vs. 13.7%, aPOR = 0.96, 95% CI: 0.78-1.20,  = 0.74). Maternal age at delivery, maternal BMI, race, and insurance status were all significantly associated with the prevalences of GDM and pregestational T2D.Our results suggest that a LILA tract is not significantly associated with the prevalences of T2D and GDM during pregnancy. · Living in a LILA tract was not linked with GDM or T2D in pregnancy.. · Age and BMI were significantly associated with T2D and GDM.. · Race and insurance status were significantly associated with T2D and GDM..

This study aimed to assess whether pregnant patients with antenatal anemia in the setting of cardiac disease experience an increased risk of severe maternal morbidity (SMM) and other adverse pregnancy outcomes.This retrospective cohort study used the 2016-2021 National Readmissions Database to identify patients with cardiac disease delivering a singleton infant between 24 and 41 weeks gestation. Cardiac disease was identified by diagnosis codes and categorized based on modified World Health Organization (mWHO) criteria. Modified Poisson regression was used to assess the association between anemia and severe maternal morbidity, stratified by mWHO criteria. In a secondary analysis, iron deficiency anemia alone was considered the exposure of interest. Models were adjusted for age, median household income by ZIP code, primary payer, hospital size, hospital teaching status, delivery mode, and other comorbid conditions.Cardiac disease was identified in 61,542 patients in our cohort (47,767 [77.6%] with mWHO I-II disease and 13,775 [22.4%] with mWHO II/III+ disease). Of these patients, 10,257 (16.7%) had anemia. Weighted to provide national estimates, this sample results in a national estimate of 115,347 deliveries complicated by cardiac disease during the study period in the United States, of which 19,439 (16.7%) also had anemia. Anemia was associated with higher odds of SMM/mortality in people with mWHO I-II (aRR = 1.90, 95% CI: 1.73, 2.09) and mWHO II/III+ (aRR = 1.24, 95% CI: 1.18, 1.31) cardiac disease. Antenatal anemia was also associated with blood product transfusion, non-transfusion SMM/mortality, cardiac SMM, preterm birth, and cesarean delivery. This relationship persisted for the subgroup of patients with iron deficiency anemia.Antenatal anemia, including iron deficiency anemia, adversely impacts pregnancy outcomes in pregnant patients with cardiac disease. Identifying and treating this modifiable risk factor potentially offer an opportunity to reduce morbidity in this high-risk population. · SMM is observed in nearly half of patients with severe cardiac disease and anemia in pregnancy.. · Antenatal anemia is associated with SMM or mortality for patients of all mWHO cardiac risk groups.. · Anemia is associated with other adverse pregnancy outcomes for patients with cardiac disease..

Vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited connective tissue disorder associated with significant maternal morbidity and mortality during pregnancy. Conflicting recommendations exist for management, particularly in patients with variant of uncertain significance (VUS).We present a 39-year-old G2P1011 with a strong family history suggestive of vEDS who experienced an uncomplicated vaginal delivery followed by a large retroperitoneal hematoma requiring interventional radiology embolization and intensive care management for a postprocedural femoral pseudoaneurysm.Postpartum genetic testing revealed a heterozygous VUS in (c.1297G>A [p.Glu433Lys]).This case illustrates the challenges of counseling and managing pregnancy in patients with suspected vEDS and VUS, highlighting the importance of risk mitigation strategies, multidisciplinary care, and nuanced interpretation of genetic results. · Risk stratification imaging: Whole-body vascular imaging beyond echocardiography may identify silent arterial lesions.. · Variant reclassification: Reporting pregnancy phenotypes linked to VUS in databases (ClinVar, LOVD) can accelerate variant reclassification and improve counseling.. · Structured counseling for uncertainty: Use a systematic approach when counseling patients with both a suspicious phenotype and a VUS, incorporating multidisciplinary perspectives and clearly communicating knowns and unknowns..