搜索结果：Journal of neonatal-perinatal medicine

To investigate the effects of different antibiotic regimens used in the treatment of preterm premature rupture of membranes (PPROM) on maternal and fetal outcomes after 34 weeks of gestation. A total of 40 pregnant women diagnosed with PPROM between 34 and 37 weeks of gestation were enrolled in this randomized controlled trial and allocated equally into 2 groups. Group 1 received sulbactam-ampicillin, azithromycin, and amoxicillin, whereas Group-2 received ceftriaxone, clarithromycin, and amoxicillin. The primary outcome was neonatal intensive care unit (NICU) length of stay. Recorded variables included maternal age, gestational age, obstetric history, time of delivery, latency period, infection markers (white blood cell count and C-reactive protein), neonatal birth weight, Apgar scores, NICU admission, mode of delivery, and maternal complications. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 27.0 (Armonk). No statistically significant differences were observed between the groups in terms of age, obstetric age, obstetric history, time of delivery, infection markers (white blood cell, C-reactive protein), and type of delivery (P > .05). The difference between the groups in terms of NICU requirement and stay duration was not statistically significant; Group 1: mean 8.3 ± 6.7 days and Group 2: 4.3 ± 1.9 days (P = .356). The incidence of maternal complications showed no statistically significant difference; chorioamnionitis was observed in 4 patients (20.0%) in Group 1 and in a patient (5.0%) in Group 2 (P = .141). No difference was observed type of delivery and history of PPROM. The 2 different antibiotic regimens administered to pregnant women diagnosed with PPROM after the 34th week of gestation demonstrated similar clinical effects in terms of maternal and neonatal outcomes. Although the differences in NICU stay duration and the number of chorioamnionitis cases were not statistically significant, we believe that these findings could reach significance in studies with larger sample sizes.

Policy Points Certified nurse-midwife (CNM)/certified midwife (CM) care is associated with outcomes that are comparable or improved compared to physician care across multiple domains of health care quality, especially safety and effectiveness. CNM/CM care is consistently associated with lower rates of intrapartum interventions and improved birth outcomes and patient satisfaction. Integration of CNM/CM care remains limited across many US health systems due to scope of practice restrictions and institutional policies. Growing, diversifying, and integrating CNM/CM care offers a critical pathway to advancing health care quality, equity, and efficiency in the United States and addressing the alarming rise in adverse perinatal and sexual and reproductive health outcomes. The alarming rise in US maternal mortality and disparities in perinatal, sexual, and reproductive health outcomes underscores the urgent need for effective, equitable, and evidence-based models of care. Care provided by certified nurse-midwives (CNMs) and certified midwives (CMs) has played a critical role in addressing these disparities, yet a comprehensive synthesis of its impact across health care quality domains is lacking. A scoping review methodology following PRISMA-ScR guidelines was used to assess the association of CNM/CM care and perinatal, sexual, and reproductive health outcomes through the lens of the Institute of Medicine's six domains of health care quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. This review included United States-based studies published since 2012 identified via PubMed and CINAHL. Studies were screened for relevance to the six domains and CNM/CM care. Data were extracted into a spreadsheet, grouped by domains, and analyzed using narrative synthesis. A total of 66 studies met inclusion criteria. Within the safety, effectiveness, and patient-centeredness domains, CNM/CM care was associated with similar or improved perinatal, sexual, and reproductive health outcomes compared to physician care, including lower rates of cesarean birth, fewer interventions, improved neonatal outcomes, greater patient satisfaction, and reduced health care costs. CNM/CM care also demonstrated potential in mitigating racial and geographic maternal health disparities, though scope of practice restrictions and institutional policies limited CNM/CM integration. Despite this evidence, gaps remain in understanding the influence of CNM/CM care on health care quality as it relates to efficiency, timeliness, and equity. These findings highlight the importance of expanding CNM/CM integration within the United States' health care system to improve care delivery and associated health outcomes, reduce health disparities, and advance health equity. Future studies should incorporate standardized outcome measures and explore the role of CNM/CM care within collaborative models to enhance perinatal care quality and accessibility.

ObjectiveTo determine the effect, if any, of prenatal intervention in fetuses with congenital diaphragmatic hernia (CDH) on the likelihood of attempted trial of resuscitation (TOR) or withdrawal of life-sustaining measures (WLSM) in the postnatal neonatal intensive care environment.Study DesignFour hypothetical patients with either left- or right-sided CDH were devised using prognostic survival data from the literature, depending on whether they received fetoscopic endoluminal tracheal occlusion (FETO) or expectant management in the prenatal setting. Healthcare providers from the CDH Study Group (CDHSG) listserv were surveyed to report their likelihood of offering a trial of resuscitation and obliging a parental request for WLSM for each patient. Response data were analyzed using a Wilcoxon rank sum test, and statistical significance was assumed at p < 0.01.Results39 complete responses (rate = 19%) were comprised primarily of physicians in pediatric surgery and neonatology, with other healthcare roles and specialties represented. A left-sided CDH patient with prenatal intervention was significantly favored for a TOR when compared to a patient without prenatal intervention (69% vs 11%; p < 0.001). Additionally, there was a lower rate of obliging a parental request for WLSM in the patient with prenatal intervention compared to a patient without (19% vs 64%; p < 0.001). In contrast, there was no observed effect of prenatal intervention in patients with right-sided hernias. In a scenario of simultaneous resource utilization, the patient with a left-sided CDH who underwent prenatal intervention was given priority for a TOR.ConclusionsTo our knowledge, this is the first description of the potential impact of prenatal intervention on postnatal decision-making, using the exemplar case of CDH. These findings have profound implications for maternal-fetal surgery providers and patients, raising concerns of equity and justice and providing preliminary empirical evidence for the fetus as a patient in the era of modern prenatal intervention.

Previous work has shown pediatricians the neurological examination in newborn infants because they do not feel confident performing it. In a UK survey about the neurological examination in unwell newborns, 72% wanted a proforma to aid practice. Our aim was to develop a proforma to improve the neonatal neurological examination, alongside a flowchart to aid formulation of differential diagnoses and investigation plans. Four perinatal neurologists and a graphic designer developed a proforma based on existing examinations and data on attitudes toward the examination in the unwell newborn. This was reviewed via qualitative focus groups and interviews with UK health professionals. Thematic analysis was used to gauge attitudes toward and improve the proforma. Two themes arose from the review and interviews: "Neurophobia" about the neurological assessment of the acutely unwell newborn, and ways of improving practice and confidence. Participants suggested improvements to the proforma. They reported it would allow the neurological examination to be performed consistently, and it would improve confidence, documentation, communication, and interpretation of findings. We have developed a proforma for documenting the neurological assessment of the unwell newborn, which participants report will improve reliable identification of abnormal signs, their neuroanatomical siting and significance, and confidence in assessing an unwell newborn neurologically. The proforma is not intended to replace current examinations for the stable term or preterm newborn, for whom appropriate validated tools should be chosen. We plan to undertake further validity testing, including interobserver agreement and data on the value of the interpretive flowchart.

Social determinants of health (SDoH) are associated with the outcome of preterm infants, but data in Switzerland are lacking. The aim of this study was to assess the associations of maternal nationality, parental socioeconomic status (SES) and language, with perinatal and 18-month-old outcomes of extremely preterm infants in Switzerland. Surviving extremely preterm infants born in our tertiary care neonatal centre between 2009-2020 were evaluated at the age of 18 corrected months using Bayley Scales of Infant Development, and neurological examination. We analyzed differences in outcomes according to maternal nationality, socioeconomic status and language. In the neonatal period, among 408 (46% female) patients (median 26 6/7 weeks (25 4/7-27 2/7)), median birthweight 790g (669-942g), nationality was associated with the rate of multiplets, (34% in Swiss vs 27% for European, 14% extra-European, p&#x2009;=&#x2009;.012). Parental SES was associated with the rate of multiplets, (45%, mid SES 28%, low SES 19%, p&#x2009;<&#x2009;0.001), with having oxygen at 36 weeks (high SES 32%, mid SES 56%, low SES 19%, p&#x2009;=&#x2009;.01), and with the rate of feeding with mother's own milk (high SES 80%, mid SES 67%, low SES 42%, p&#x2009;<&#x2009;.001). Parental language was not associated with neonatal outcomes. At 18 months, the rate of neurodevelopmental impairment was similar across the 3 SDoH, but the median cognitive score was significantly higher in Swiss than in extra-European patients (100(95-115) vs 90(85-100), p&#x2009;=&#x2009;.002), and in middle SES compared to low SES patients (100(95-110) vs 95(85-100), p&#x2009;=&#x2009;.031). The median cognitive (100(90-111) vs 95(85-100), p&#x2009;=&#x2009;.009) and language scores (91(83-103) vs 86(77-94), p&#x2009;=&#x2009;.002) of children of French speaking families were higher than non-French speaking families. Maternal nationality, parental SES and parental language were minimally associated with perinatal outcomes of EPT infants. However, these 3 SDoH were significantly associated with neurodevelopmental outcomes at 18 months.

Given the potential of enteral zinc to reduce enterohepatic circulation of unconjugated bilirubin, we aimed to synthesize evidence from randomized controlled trials (RCTs) on zinc supplementation for prevention of neonatal hyperbilirubinemia (NNH). We searched PubMed, Embase, Scopus, and CENTRAL for RCTs evaluating zinc supplementation in healthy or at-risk neonates for prevention of NNH. Primary outcomes were incidence of significant NNH and requirement for phototherapy. Secondary outcomes included duration of phototherapy, bilirubin levels, and adverse effects. Two reviewers independently screened, extracted data and assessed risk of bias. Random-effects meta-analysis was performed with RevMan 5.4. The certainty of evidence was assessed using the GRADE approach. We included six RCTs, enrolling 725 neonates, in this review. Four trials were judged to have high risk, while two had some concerns of bias. Low certainty evidence suggested no significant effect of zinc on the incidence of significant NNH (RR 0.91, 95% CI 0.58 to 1.44; five trials, 657 participants) or need for phototherapy (RR 0.73, 95% CI 0.42 to 1.28; five trials, 618 participants). Zinc supplementation was associated with a shorter duration of phototherapy (MD -14.79, 95% CI -21.27 to -8.30; four trials, 108 participants). No significant differences were observed in bilirubin levels on day 3 or 7. Adverse events were rare and comparable between groups. In conclusion, there is limited evidence to support or refute the role of zinc supplementation in the prevention of NNH. Rigorous multicenter RCTs with standardized dosing and outcome definitions are needed to further explore its utility.

Premature rupture of membranes (PROM) refers to the spontaneous rupture of membranes before the onset of labor. PROM, regardless of gestational age, is linked to increased risks of perinatal infections and umbilical cord compression. Amniotic fluid plays a crucial role in fetal development and growth, and its volume is essential for proper fetal well-being. Measurement of amniotic fluid volume (AFV) through prenatal ultrasound has become a standard practice in fetal monitoring. While numerous studies have explored the relationship between AFV and preterm PROM, few have focused on its association with term PROM. The aim of our study was to evaluate the relationship and predictive value of ultrasound-measured AFV in relation to adverse pregnancy outcomes. This retrospective study included women with singleton pregnancies with PROM admitted to Meir Medical Center, a tertiary academic medical center. Term PROM was defined as occurring between 37+0 and 41+6 weeks of gestation. The study received approval from the Research Ethics Committee of Meir Medical Center (MMC-0125-24). The women were divided into two groups based on their amniotic fluid index: normal AFV (&#x2265;5 cm) and oligohydramnios (<5 cm). A total of 537 women were admitted with PROM during the study period, and 402 met the inclusion criteria. Among them, 319 (79.4%) had normal AFV, and 83 (20.6%) had oligohydramnios. No significant differences were found between the two groups regarding maternal outcomes (postpartum hemorrhage, amnionitis, meconium-stained fluid, or placental abruption() or neonatal outcomes (respiratory distress, fetal sepsis, or neonatal intensive care unit (NICU) admission). Women presenting with PROM and oligohydramnios can be reassured, as no association was found between AFV at the time of presentation and adverse pregnancy outcomes. Further research is needed to deepen our understanding of the relationship between amniotic fluid volume and membrane rupture at term.

To review the current role of soluble fms-like tyrosine kinase-1 (sFLT1) and placental growth factor (PlGF) in the pathophysiology, diagnosis, prediction, and treatment of preeclampsia. Preeclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide and has increased in prevalence in the United States. It is characterized by new-onset hypertension, proteinuria, and/or end-organ dysfunction, with early-onset disease often associated with placental ischemia, placental insufficiency, and fetal growth restriction. A central mechanism in preeclampsia is angiogenic imbalance, characterized by increased antiangiogenic factors, particularly sFLT1, and reduced proangiogenic signaling mediated by VEGF and PlGF. This review summarizes current evidence regarding sFLT1 biology, the clinical utility of the sFLT1/PlGF ratio, and emerging therapeutic strategies targeting sFLT1 in preeclampsia. sFLT1 is a soluble splice variant of VEGF receptor-1 that binds circulating VEGF and PlGF, thereby promoting endothelial dysfunction, vasoconstriction, and systemic manifestations of preeclampsia. The sFLT1/PlGF ratio has emerged as a clinically useful biomarker, particularly for short-term risk stratification in women with suspected preeclampsia, with strong negative predictive value for ruling out progression to severe disease within 1 to 2 weeks in appropriately selected patients. The ratio has been incorporated into clinical practice in multiple countries and was approved by the US Food and Drug Administration in 2023 for inpatient risk assessment in singleton pregnancies between 23 and 34 weeks and 6 days of gestation with hypertensive disorders of pregnancy. In parallel, therapeutic approaches targeting sFLT1, including small interfering RNA, antibodies, VEGF or PlGF-based molecular strategies, and apheresis, have shown promise in preclinical and early translational studies. sFLT1 is central to the pathophysiology of preeclampsia and has substantial clinical relevance as both a biomarker and a potential therapeutic target. The sFLT1/PlGF ratio is reshaping risk assessment and management of preeclampsia, while sFLT1-directed therapies may offer future disease-modifying treatment options. Further refinement of biomarker-guided use and therapeutic development is needed before broader implementation.

ObjectivesThis study aims to investigate the correlation of Doppler ultrasound indices of umbilical artery (UA), middle cerebral artery (MCA), cerebro-placental ratio (CPR), length of umbilical cord (UC) coiling, and birthweight, as well as the predictors of these parameters for small for gestational age (SGA).MethodsThis cross-sectional study was conducted between June 2022 and June 2024 at Hue University of Medicine and Pharmacy Hospital, Vietnam. The study enrolled 337 full-term primigravida with uncomplicated singleton pregnancies who underwent Doppler transabdominal ultrasound between 37+0 and 41+0 weeks of gestation to assess fetal Doppler indices and length of UC coiling. Birthweight was collected at delivery.ResultsThe study found significant differences relating birthweight and resistance index of umbilical artery (RI-UA) between abnormal and normal coiling groups (3028.83 &#xb1; 469.81 vs 3129.52 &#xb1; 378.82 and 0.604 &#xb1; 0.087 vs 0.579 &#xb1; 0.073). There was a significantly weak negative correlation between RI of umbilical artery Doppler and birth weight (r = -0.178). Additionally, a significantly weak positive correlation coefficient between CPR and birth weight (r = 0.111) was found. Length of umbilical cord coiling had a weak positive correlation with pulsatility index of uterine artery (PI-UA). RI of umbilical artery Doppler helps in predicting the small gestational age at birth with AUC: 0.72 (0.57-0.87).ConclusionRI-UA and birthweight were significantly different between abnormal and normal coiling pregnancies. The higher RI-UA is more related to lower birthweight. RI-UA helps in predicting the small gestational age at birth better than other parameters.

Postnatal care (PNC) plays a crucial role in averting newborn mortality, yet its use remains low, particularly in regions with the highest mortality. While demographic and social determinants of PNC use have been well studied and have informed current strategies focused on changing care-seeking behaviors, the stagnating decline in neonatal mortality highlights the need for upstream and system-wide approaches to increase PNC uptake. Limited evidence exists to guide system-level reforms; therefore, we investigated whether health systems that ensure high-quality perinatal care are associated with increased use of PNC. We performed a cross-sectional observational study using Demographic and Health Survey data from 38 countries that had not met SDG neonatal mortality targets by 2020. The study population comprised women aged 15-49 years whose most recent live birth occurred within five years preceding the survey. We employed logistic regression models with country fixed effects to examine associations between: (1) perinatal service utilization, (2) service quality; and their relationship with postnatal checkups for newborns within 28 days. We analyzed utilization-quality interactions to determine how the effects of service coverage on PNC use varied by care quality and conducted wealth-stratified analyses to assess how quality effects on PNC use differed across socioeconomic groups. High-quality perinatal care was associated with a 2-fold increase in the probability of postnatal checkups within 28 days (0.406 in the highest quality tertile versus 0.221 in the lowest quality tertile). For mothers who received the lowest tertile of service quality, full utilization of perinatal services yielded negligible changes in postnatal checkup probability (0.217 to 0.216). Conversely, for mothers who received the highest quality of antenatal and perinatal care, full access to perinatal care improved the probability of postnatal check-ups (0.392 to 0.428). Notably, women in the lowest wealth quintile experienced a substantial increase in postnatal checkup probability from 0.224 to 0.481 between low and high-quality care cohorts, while this differential was less pronounced in the highest wealth quintile (0.236 to 0.450). Key limitations include restricted quality indicators, potential recall bias from self-reported measures, limited information on follow-up care, and the cross-sectional nature of the data, which limits causal interpretation. Our interaction analysis reveals a critical insight: high-quality care substantially enhanced the magnitude of the association between expanded perinatal service use and PNC use, whereas increased utilization alone was not linked to higher PNC uptake. Notably, the impact of improved care quality was most pronounced among the lowest wealth groups, highlighting its potential as a mechanism for promoting equity. By demonstrating the central role of care quality in promoting PNC utilization, particularly among disadvantaged populations, our findings suggest that improving health system quality could be a more effective strategy for achieving universal maternal healthcare coverage than traditional access-focused approaches.

IntroductionAcute kidney injury is a frequent but often underrecognized complication in very low birth weight preterm infants. In addition to its established respiratory benefits, caffeine has been suggested to have potential renal-protective effects. The aim of this study was to evaluate the association between early caffeine administration and the incidence of acute kidney injury in preterm infants with a birth weight of 1250g or less.MethodsThis retrospective cohort study included 156 preterm infants with a gestational age of 30 weeks or less and a birth weight of 1250g or less. Infants were divided into two groups according to caffeine exposure. The caffeine group received prophylactic caffeine within the first 24 h of life, while the control group did not receive caffeine. Acute kidney injury was defined using serum creatinine measurements during the first 14 postnatal days.ResultsAcute kidney injury occurred in 10.3% of infants who received caffeine and in 28.2% of those who did not receive caffeine (p = 0.004). Early caffeine administration was independently associated with a significantly lower risk of acute kidney injury (adjusted odds ratio 0.29; 95% confidence interval 0.11-0.74). No infants in the caffeine group developed stage 2 or stage 3 acute kidney injury.ConclusionsEarly prophylactic caffeine administration is associated with a reduced incidence of acute kidney injury in very low birth weight preterm infants. These findings suggest a potential renal-protective role of caffeine in this vulnerable population. Prospective multicenter studies are needed to confirm these results and evaluate long-term safety.

To investigate the effect of antenatal corticosteroids (ACS) on the risk of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) within 24 hours after birth in late preterm infants born to mothers with gestational diabetes mellitus (GDM). Clinical data of mothers with GDM and their late preterm infants admitted to the Department of Obstetrics, Xiamen Maternal and Child Health Hospital, from January 2017 to December 2023 were retrospectively reviewed. Based on whether mechanical ventilation was required within 24 hours after birth, infants were classified into a mechanical ventilation group (n=322) and a control group (n=1 098), and perinatal and maternal characteristics were compared. According to the interval from the first ACS dose to delivery, infants were categorized into <2 days (n=399), 2-7 days (n=305), and >7 days (n=60) groups; according to ACS dosage, they were categorized into no ACS (n=656), incomplete course (<2 doses; n=399), and complete course (&#x2265;2 doses; n=365) groups. Associations between ACS timing/dose and TTN and RDS were analyzed. A total of 1 420 infants were included. Multivariable logistic regression showed that ACS administration was a protective factor against the need for mechanical ventilation within 24 hours after birth (OR=0.125, 95%CI: 0.085-0.183). A complete ACS course was associated with a more pronounced reduction in the mechanical ventilation rate (OR=0.080, 95%CI: 0.049-0.130) and a lower incidence of TTN (P<0.001), while the incidence of RDS did not differ significantly (P>0.05). An interval of >7 days from the first ACS dose to delivery had the most marked association with reduced postnatal mechanical ventilation (OR=0.127, 95%CI: 0.047-0.348). ACS does not reduce the incidence of RDS in late preterm infants of mothers with GDM, but it effectively reduces TTN and the need for mechanical ventilation within 24 hours after birth. A complete ACS course and an interval of >7 days from the first dose to delivery provide the greatest benefit in reducing TTN and early postnatal mechanical ventilation. &#x76ee;&#x7684;: &#x63a2;&#x8ba8;&#x4ea7;&#x524d;&#x7cd6;&#x76ae;&#x8d28;&#x6fc0;&#x7d20;&#xff08;antenatal corticosteroid, ACS&#xff09;&#x5bf9;&#x598a;&#x5a20;&#x7cd6;&#x5c3f;&#x75c5;&#x6bcd;&#x4eb2;&#x5206;&#x5a29;&#x7684;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x751f;&#x540e;24 h&#x5185;&#x65b0;&#x751f;&#x513f;&#x6e7f;&#x80ba;&#x3001;&#x65b0;&#x751f;&#x513f;&#x547c;&#x5438;&#x7a98;&#x8feb;&#x7efc;&#x5408;&#x5f81;&#x53d1;&#x751f;&#x98ce;&#x9669;&#x7684;&#x5f71;&#x54cd;&#x3002;&#x65b9;&#x6cd5;: &#x56de;&#x987e;&#x6027;&#x5206;&#x6790;2017&#x5e74;1&#x6708;&#x2014;2023&#x5e74;12&#x6708;&#x53a6;&#x95e8;&#x5e02;&#x5987;&#x5e7c;&#x4fdd;&#x5065;&#x9662;&#x4ea7;&#x79d1;&#x6536;&#x6cbb;&#x7684;&#x598a;&#x5a20;&#x7cd6;&#x5c3f;&#x75c5;&#x6bcd;&#x4eb2;&#x53ca;&#x5176;&#x5206;&#x5a29;&#x7684;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x7684;&#x4e34;&#x5e8a;&#x8d44;&#x6599;&#x3002;&#x6839;&#x636e;&#x751f;&#x540e;24 h&#x5185;&#x662f;&#x5426;&#x9700;&#x8981;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x5206;&#x4e3a;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x7ec4;&#xff08;322&#x4f8b;&#xff09;&#x548c;&#x5bf9;&#x7167;&#x7ec4;&#xff08;1 098&#x4f8b;&#xff09;&#xff0c;&#x6bd4;&#x8f83;&#x4e24;&#x7ec4;&#x60a3;&#x513f;&#x56f4;&#x4ea7;&#x671f;&#x53ca;&#x6bcd;&#x4eb2;&#x598a;&#x5a20;&#x671f;&#x60c5;&#x51b5;&#x3002;&#x6839;&#x636e;&#x9996;&#x5242;ACS&#x7ed9;&#x836f;&#x81f3;&#x5206;&#x5a29;&#x65f6;&#x95f4;&#x95f4;&#x9694;&#x5206;&#x4e3a;<2 d&#x7ec4;&#xff08;399&#x4f8b;&#xff09;&#x3001;2~7 d&#x7ec4;&#xff08;305&#x4f8b;&#xff09;&#x548c;>7 d&#x7ec4;&#xff08;60&#x4f8b;&#xff09;;&#x6839;&#x636e;ACS&#x4e0d;&#x540c;&#x5242;&#x91cf;&#x5206;&#x4e3a;&#x672a;&#x7528;ACS&#x7ec4;&#xff08;656&#x4f8b;&#xff09;&#x3001;ACS&#x4e0d;&#x8db3;&#x7ec4;&#xff08;<2&#x5242;&#xff0c;399&#x4f8b;&#xff09;&#x548c;&#x8db3;&#x91cf;ACS&#x7ec4;&#xff08;&#x2265;2&#x5242;&#xff0c;365&#x4f8b;&#xff09;&#x3002;&#x5206;&#x6790;ACS&#x4e0d;&#x540c;&#x7ed9;&#x836f;&#x65f6;&#x673a;&#x548c;&#x5242;&#x91cf;&#x4e0e;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x65b0;&#x751f;&#x513f;&#x6e7f;&#x80ba;&#x3001;&#x65b0;&#x751f;&#x513f;&#x547c;&#x5438;&#x7a98;&#x8feb;&#x7efc;&#x5408;&#x5f81;&#x7684;&#x76f8;&#x5173;&#x6027;&#x3002;&#x7ed3;&#x679c;: &#x5171;&#x7eb3;&#x5165;1 420&#x4f8b;&#x60a3;&#x513f;&#x3002;&#x591a;&#x56e0;&#x7d20;logistic&#x56de;&#x5f52;&#x5206;&#x6790;&#x663e;&#x793a;&#xff0c;&#x4f7f;&#x7528;ACS&#x662f;&#x598a;&#x5a20;&#x7cd6;&#x5c3f;&#x75c5;&#x6bcd;&#x4eb2;&#x5206;&#x5a29;&#x7684;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x751f;&#x540e;24 h&#x5185;&#x9700;&#x8981;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x7684;&#x4fdd;&#x62a4;&#x56e0;&#x7d20;&#xff08;OR=0.125&#xff0c;95%CI:0.085~0.183&#xff09;&#x3002;&#x8db3;&#x91cf;ACS&#x7ec4;&#x60a3;&#x513f;&#x7684;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x7387;&#x4e0b;&#x964d;&#x66f4;&#x4e3a;&#x663e;&#x8457;&#xff08;OR=0.080&#xff0c;95%CI:0.049~0.130&#xff09;&#xff0c;&#x4e14;&#x6709;&#x52a9;&#x4e8e;&#x964d;&#x4f4e;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x6e7f;&#x80ba;&#x53d1;&#x751f;&#x7387;&#xff08;P<0.001&#xff09;&#xff0c;&#x4f46;&#x65b0;&#x751f;&#x513f;&#x547c;&#x5438;&#x7a98;&#x8feb;&#x7efc;&#x5408;&#x5f81;&#x53d1;&#x751f;&#x7387;&#x6bd4;&#x8f83;&#x5dee;&#x5f02;&#x65e0;&#x7edf;&#x8ba1;&#x5b66;&#x610f;&#x4e49;&#xff08;P>0.05&#xff09;&#x3002;ACS&#x7ed9;&#x836f;&#x81f3;&#x5206;&#x5a29;&#x65f6;&#x95f4;&#x95f4;&#x9694;>7 d&#x5bf9;&#x964d;&#x4f4e;&#x65b0;&#x751f;&#x513f;&#x751f;&#x540e;24 h&#x5185;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x9700;&#x6c42;&#x7684;&#x5f71;&#x54cd;&#x6700;&#x660e;&#x663e;&#xff08;OR=0.127&#xff0c;95%CI:0.047~0.348&#xff09;&#x3002;&#x7ed3;&#x8bba;: ACS&#x4e0d;&#x80fd;&#x964d;&#x4f4e;&#x598a;&#x5a20;&#x7cd6;&#x5c3f;&#x75c5;&#x6bcd;&#x4eb2;&#x5206;&#x5a29;&#x7684;&#x665a;&#x671f;&#x65e9;&#x4ea7;&#x513f;&#x547c;&#x5438;&#x7a98;&#x8feb;&#x7efc;&#x5408;&#x5f81;&#x53d1;&#x751f;&#x7387;&#xff0c;&#x4f46;&#x80fd;&#x6709;&#x6548;&#x964d;&#x4f4e;&#x65b0;&#x751f;&#x513f;&#x6e7f;&#x80ba;&#x53d1;&#x751f;&#x7387;&#x548c;&#x51cf;&#x5c11;&#x751f;&#x540e;24 h&#x5185;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x9700;&#x6c42;&#x3002;&#x4e14;&#x8db3;&#x91cf;ACS&#x53ca;ACS&#x7ed9;&#x836f;&#x81f3;&#x5206;&#x5a29;&#x65f6;&#x95f4;&#x95f4;&#x9694;>7 d&#x5bf9;&#x964d;&#x4f4e;&#x65b0;&#x751f;&#x513f;&#x6e7f;&#x80ba;&#x53d1;&#x751f;&#x7387;&#x53ca;&#x51cf;&#x5c11;&#x751f;&#x540e;24 h&#x5185;&#x673a;&#x68b0;&#x901a;&#x6c14;&#x9700;&#x6c42;&#x6548;&#x679c;&#x6700;&#x597d;&#x3002;.

To evaluate the effectiveness and safety of short (&#x2264;8 days) vs long (&#x2265;9 days) duration of antibiotic therapy for uncomplicated gram-negative (GN) bloodstream infections (BSI) among infants in the neonatal intensive care unit (NICU). Retrospective analysis of infants treated for GN BSI at 7 NICUs within 2 health care systems. Infants were identified by review of positive blood cultures from the microbiology laboratory and electronic health records. Patients were excluded if they had polymicrobial BSI, meningitis/osteomyelitis/endocarditis, or died before completion of therapy as ordered. The primary outcome was recurrence of BSI with the same organism within 14 days of discontinuation of effective antimicrobial therapy ("treatment failure.") Secondary outcomes were emergence of GN multidrug-resistant organisms (MDRO) and mortality. In all, 76 infants (39 short duration; 37 long duration) were included; 15 (38%) and 25 (69%) infants had a central venous catheter in place at onset of BSI in the short and long duration groups, respectively. Escherichia coli was the most common pathogen in both groups (27 [69%], short duration; 18 [49%], long duration). There were 2 recurrences of BSI, both in the long duration group. Among study infants, 5 had a subsequent GN MDRO infection; all were in the long duration group. Treatment failure and GN MDROs occurred among infants who received &#x2265;9 days of antibiotic therapy. Shorter antibiotic duration (&#x2264;8 days) appeared to be an effective intervention that could reduce antibiotic exposure and its adverse consequences among NICU infants.

Thoracoamniotic shunting (TAS) in fetuses with macrocystic congenital pulmonary airway malformation (CPAM) is mostly performed with pigtail shunts like the rocket shunt or the Harrison fetal bladder stent. The aim of this study was to assess the prenatal course, perinatal outcome and complications of TAS for severe macrocystic CPAM using the Somatex&#xae; intrauterine shunt. This was a two center (Cologne/Bonn) observational retrospective study of fetuses that underwent TAS using the Somatex&#xae; intrauterine shunt for severe macrocystic CPAM with and without hydrops between 2016-2024. Outcome parameters were perinatal survival, complications, gestational age at delivery and visibility of the shunt outside the skin after birth. During the study period, 25 fetuses were treated with the Somatex&#xae; shunt (13&#x2009;=&#x2009;Cologne, 12&#x2009;=&#x2009;Bonn), including 24 singletons and one fetus of a monochorionic-diamniotic twin pregnancy Mean gestational age at intervention was 24.7&#xa0;weeks (range 19-30). The mean diameter of the dominant cyst within the lesion was 34&#xa0;mm (range 18-55). Fetal hydrops prior to TAS (ascites and fetal scalp oedema) was present in 36% (9/25). Dislocation in the further course of pregnancy occurred in 8% (2/25) with the need for reintervention in two cases. Resolution of hydrops and regression of the lesion occurred in 96% (24/25). Mean gestational age at delivery was 38.3&#xa0;weeks (range 26-41), the preterm birth rate&#x2009;<&#x2009;37&#xa0;weeks was 20% (5/25), 12% (3/25) were due to PPROM. Live birth rate was 100% and 92% (23/25) of neonates survived the neonatal period. Of the 12 liveborns delivered at the two study centers, in one case the shunt (8.3%) was dislocated in the amniotic cavity, 5 (41.7%) had a visible shunt outside the skin, whereas in the other 6 (50.0%) cases the shunt was covered with skin at birth. TAS in macrocystic CPAM with the Somatex&#xae; shunt has a high technical success rate leading to high neonatal survival rates even in cases associated with hydrops. The intrauterine course and neonatal outcome are comparable to TAS for fetal macrocystic CPAM using other types of shunts. Therefore, the choice of the shunt in macrocystic CPAM can be made freely at the discretion of the physician in charge, the availability of devices and economic factors. Due to the short length of 25&#xa0;mm and its straight design, the outer end of the Somatex&#xae; shunt is covered by skin at birth in up to 50% of cases, which may complicate its removal.

To determine the concordance between the causes of death reported in the neonatal departement and the data obtained from the fetopathologic examination. We included all newborns admitted to the Neonatal Resuscitation Unit who died there before the 28th day of life and in whom a fetopathological examination was performed. The causes of neonatal deaths were characterized by the dominance of respiratory pathologies (31%) then palliative cares (18%), neurological causes (9%), heart disease (9%), inherited diseases of metabolism (6%) and sudden deaths (6%). A total concordance between fetopathological and neonatological examinations was noted in 27% of the cases, a partial concordance in 40%, a total discordance in 27%, and in only 6% of the cases the fetopathological examination didn't show any abnormalities. We emphasize of the importance of fetopathological examination in the determination of the cause of neonatal deaths by providing an exhaustive diagnosis essential to the management of future pregnancies.

To examine the correlation between the severity of isolated oligohydramnios at term and adverse perinatal outcomes, aiming to inform clinical management strategies. This retrospective cohort study conducted at a tertiary university-affiliated hospital from 2028 to 2024 included women at 37-42&#x2009;weeks of gestation diagnosed with isolated oligohydramnios, defined as an amniotic fluid index (AFI) &#x2264; 5&#x2009;cm. Exclusion criteria included maternal comorbidities, fetal anomalies, abnormal Doppler studies, multifetal pregnancies, and fetuses with growth restriction or small for gestational age. Participants were categorized into severe (AFI &#x2264; 2&#x2009;cm) and mild (AFI 2.1-5.0&#x2009;cm) oligohydramnios groups. The primary outcome was a composite measure of adverse perinatal outcomes, including cesarean or vacuum delivery for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.1, meconium-stained amniotic fluid, neonatal intensive care unit admission, or birth asphyxia. Among 29,759 deliveries during the study period, 432 (1.5%) involved isolated oligohydramnios, of which 66 (15%) had severe and 366 (85%) had mild oligohydramnios. The incidence of adverse perinatal outcomes was significantly higher in the severe group compared to the mild group (22.7% vs. 12.8%; p&#x2009;=&#x2009;.039). Severe oligohydramnios remained an independent predictor of adverse outcomes after adjusting for confounders, with an adjusted odds ratio of 1.96 (95% CI:1.09-3.779, p&#x2009;=&#x2009;.044). Severe isolated oligohydramnios at term is associated with nearly double the risk of adverse perinatal outcomes compared to mild cases. These findings underscore the importance of close monitoring and timely delivery planning in severe cases of isolated oligohydramnios at term.

BackgroundAntenatal corticosteroids (ANS) enhance pulmonary maturation in preterm neonates, but their renal effects remain incompletely understood. This study evaluated the association ANS exposure with the prevalence and severity of acute kidney injury (AKI) in preterm neonates.MethodologyThis prospective cross-sectional study was conducted in NICU, Fatima Memorial Hospital, Shadman, Lahore, Pakistan from March 2023 to January 2025. It included 399 preterm neonates of 28-36 + 6&#xa0;weeks gestation. Neonates were categorized based on antenatal steroids exposure as complete, incomplete, or no ANS groups. AKI was defined and staged according to KDIGO criteria during the first 14&#xa0;days of life. All variables in descriptive statistics with p < 0.05 incorporated into multivariate logistic regression. The model fit was assessed using Hosmer-Lemeshow test.ResultsOf 399 neonates, 64 (16%) of neonates received a complete ANS course, 51.4% incomplete, and 32.6% none. The incidence of AKI was significantly lower in the complete ANS group compared with the incomplete and no-ANS groups (23.4% vs 47.3% and 45.4%, respectively (p = 0.003). On multivariate analysis, complete ANS remained an independent protective factor (p = 0.006, AOR 0.33, 95% CI 0.15-0.73) reducing the odds of renal failure by approximately 63%.ConclusionComplete antenatal steroid (ANS) exposure in preterm neonates was associated with lower incidence and severity of acute kidney injury, with multivariate analysis confirming reduced odds of AKI.

Bronchopulmonary dysplasia (BPD) is a major respiratory morbidity in preterm infants. Early recognition of neonates at risk is essential to guide management and improve prognosis. Serum Krebs von den Lungen-6 (KL-6), has been identified as a promising marker of alveolar epithelial injury. This study evaluated the diagnostic, prognostic and predictive value of serum KL-6 levels for BPD development in preterm neonates and examined their association with clinical and neonatal characteristics. A prospective cohort study was conducted on sixty-five preterm infants, of whom sixty-two completed follow-up and were included in the final analysis. preterm infants &#x2264;32 weeks gestation and &#x2264;1500 g birth weight admitted to the Neonatal Intensive Care Unit at Demerdash Hospital, Ain Shams University, Egypt. Serum KL-6 levels were measured on postnatal Days 7 and 14 using enzyme-linked immunosorbent assay (ELISA). Clinical and perinatal data, including ventilation duration, oxygen therapy and hospitalization length, were recorded. BPD diagnosis followed the National Institute of Child Health and Human Development (NICHD) criteria. Neonates who developed BPD exhibited significantly elevated KL-6 levels on both Day 7 (p = 0.005) and Day 14 (p < 0.001), as compared to those who didn't develop BPD, respectively. Among BPD group; An optimal cutoff of 254 U/mL yielded 80.8% sensitivity and 80.6% specificity, on Day 14 evaluation. KL-6 correlated inversely with gestational age and birth weight, but positively with oxygen and ventilation duration. Persistently high KL-6 during the first two weeks strongly predicted BPD, suggesting that recurrent KL-6 assessment offers a valuable, non-invasive tool for early identification of at-risk preterm infants.

BackgroundLamellar body count serves as a crucial indicator of pulmonary surfactant production, with deficiencies implicated in various pulmonary conditions causing respiratory distress in term infants. This study aimed to assess lamellar body count in gastric aspirates of healthy term newborns using an automated hematology analyzer.MethodsA prospective study was conducted, obtaining gastric aspirates from healthy infants within 30 min of birth, with dithiothreitol utilized as a liquefying agent. Lamellar body count analysis was conducted using the platelet channel of the cell counter.ResultsA total of 262 gastric aspirate samples were analyzed. The median lamellar body count was found to be 441,000/&#x3bc;L (49,000-3,493,000). Gestational age-specific lamellar body count values were described using percentile distributions.ConclusionThis pioneering study presents the first evaluation of lamellar body count in gastric aspirates of healthy term newborns. The findings suggest that lamellar body count measurement in gastric aspirates may provide supportive information on pulmonary surfactant status in term newborns and offer baseline physiological data in healthy term infants, serving as a foundation for future studies evaluating its potential role in the management of respiratory disorders.