Hospital Birth Research Articles

Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018

Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes. To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds. This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks' gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024. Redlining (as characterized by the federal Home Owners' Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information). Mixed-effects logistic regression models were used to assess the association of census tract-level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods. Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.

The Impact of Hospital Delivery Volumes of Newborns Born Very Preterm on Mortality and Morbidity

To examine if the annual patient volume of infants born very preterm (VPT, gestational age <32weeks) at a hospital is associated with neonatal mortality and morbidity. We performed an observational, secondary data analysis using a 20-year panel of birth certificates linked to hospital discharge abstracts, including transfers in California, Michigan, Missouri, Oregon, Pennsylvania, and South Carolina from 1996 through 2015. The study included all in-hospital VPT deliveries (n=208 261). Study outcomes were in-hospital mortality or serious morbidity (intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, or bronchopulmonary dysplasia), attributed to the hospital of birth. Poisson regression models estimated the risk-adjusted relative risk (RR) for mortality and serious morbidity across different patient volume categories within a given hospital using hospital fixed effects. The risk of mortality and serious morbidity for VPT infants increased as the number of infants born VPT at a hospital decreased. Compared with VPT delivery volumes >100 infants per year, the risk of mortality increased when a given hospital had VPT delivery volumes < 60 per year, ranging from a RR of 1.13 (95% C.I. 1.02-1.25) for volumes between 50 to 59 and 1.39 (1.19-1.62) for VPT volumes <10, and the risk of mortality or serious morbidity increased when a given hospital had VPT volumes <100, ranging from a RR of 1.05 (1.02-1.08) for volumes between 90 to 99 and 1.27 (1.19-1.36) for VPT volumes <10. These results suggest that, for VPT infants, the risk of both mortality and mortality or serious morbidity is increased as the VPT volume within a given hospital declines.

Trends and determinants of the use of episiotomy in a prospective population-based registry from central India

BackgroundFindings from research and recommendations from the World Health Organization favor restrictive use of episiotomy, but whether this guidance is being followed in India, and factors associated with its use, are not known. This study sought to document trends in use of episiotomy over a five-year period (2014–2018); to examine its relationship to maternal, pregnancy, and health-system characteristics; and to investigate its association with other obstetric interventions.MethodsWe conducted a secondary analysis of data collected by the Maternal Newborn Health Registry, a prospective population-based pregnancy registry established in Central India (Nagpur, Eastern Maharashtra). We examined type of birth and use of episiotomy in vaginal deliveries from 2014 to 2018, as well as maternal and birth characteristics, health systems factors, and concurrent obstetric interventions associations with its use with multivariable Poisson regression models.ResultsDuring the five-year interval, the rate of episiotomy in vaginal birth rose from 13 to 31% despite a decline in assisted vaginal birth. Associations with episiotomy were found for the following factors: prior birth, multiple gestations, seven or more years of maternal education, higher gestational age, higher birthweight, delivery by an obstetrician (as compared to midwife or general physician), and birth in hospital (as compared to clinic or health center). After adjusting for these factors, year over year rise in episiotomy was significant with an adjusted incidence rate ratio (AIRR) of 1.10 [95% confidence interval (CI) 1.08–1.12; p = 0.002]. We found an association between episiotomy and several other obstetric interventions, with the strongest relationship for maternal treatment with antibiotics (AIRR 4.23, 95% CI 3.12–5.73; p = 0.001).ConclusionsEpisiotomy in this population-based sample from central India steadily rose from 2014 to 2018. This increase over time was observed even after adjusting for patient characteristics, obstetric risk factors, and health system features, such as specialty of the birthing provider. Our findings have important implications for maternal-child health and respectful maternity care given that most women prefer to avoid episiotomy; they also highlight a potential target for antibiotic stewardship as part of global efforts to combat antimicrobial resistance.Trial RegistrationThe study was registered at ClinicalTrials.gov under reference number NCT01073475.

Tracing ocular biometry and their heritability in twins in a hospital-based cohort in South India.

Twin studies, in the background of lack of twin registry in India, are a challenge. We report the response rates in tracing a hospital birth register-based cohort of twins using mail and door to door survey, ocular parameters influencing refractive errors, and their heritability. Twins born from 1991 to 1995 in a tertiary hospital in the Vellore District of South India from a database were traced by mail and home survey from March 2011 to September 2013. Consenting live twin pairs who presented to the eye department were examined, including best corrected visual acuity, cycloplegic refraction, slit lamp examination, measurements of intraocular pressure (IOP) by Goldmann Applanation tonometry, axial length (AL) and anterior chamber depth (ACD), central corneal thickness (CCT), specular microscopy for endothelial count (EC), and a dilated fundus examination. Zygosity was determined by a validated zygosity questionnaire. Heritability was determined using the Falconers formula. Postal contact was made in 14%, and a home visit was successful in another 23% of the cohort. Of those presenting for examination, 51.3% were found to be monozygous. Heritability (h2) of IOP was 0.34, that of ACD was 0.88, that of AL was 0.92, that of CCT was 0.96, and that of EC was 0.58. Tracing of twins using postal and home visits is challenging. Heritability for AL and CCT was found to be high, similar to that reported in other studies. This implies that a large proportion of variation found in AL and CCT is due to genetic causes as seen in twins from South India.

How Can Newborn Toxicology Testing Be More Equitable? An Interactive Ethics Workshop.

Practice variation in newborn toxicology testing during the birth hospitalization exists across institutions and legal jurisdictions. While testing can provide benefits, indiscriminate testing has been shown to perpetuate health care inequities. In the backdrop of an opioid epidemic and a charged medicolegal landscape, this workshop guides participants to reexamine newborn toxicology testing through a shared ethical lens. We conducted a live, 90-minute workshop in English at an international pediatric conference. Physicians, residents, and fellows participated in large- and small-group breakout sessions to learn relevant clinical and bioethical frameworks, share their own local context and expertise, and explore ethical applications through case-based discussions. We administered two anonymous online follow-up surveys to assess self-perceived impact on participant knowledge, behavior, and clinical practice. Seven facilitators and 45 individuals participated in the workshop. Eighteen participants completed survey 1 immediately following workshop conclusion, and six participants completed survey 2 after 3 months had elapsed. Immediately following the workshop, 94% of respondents reported that they had been introduced to a new idea, and 82% were considering practice change. A low response rate to survey 2 limited interpretation, but some respondents reported self-perceived change following workshop attendance. This workshop facilitated conversation between physician participants on a complex pediatric health care inequity issue using an ethical framework.

Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial

In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage (n = 497) or cleavage-stage (n = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; Pnon-inferiority < 0.001, Psuperiority = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643).

The Impact of Maternal Smoking on Perinatal Complications in Iraq

Smoking is negatively associated with birth outcomes for Iraqi pregnant women, with the fetus being at risk of stillbirth, neonatal death, and severe complications. The present study aims to investigate and enrol the clinical outcomes of perinatal complications among Iraqi smokers who are pregnant. A total of 63 pregnant Iraqi women, aged between 25 and 45 years, who had given birth in maternity hospitals in Baghdad, Iraq, were recruited between March 2023 and April 2024. The study enrolled the women's intrapartum outcomes, their daily cigarette use, and the dose of cigarettes they consumed during pregnancy. The clinical data pertaining to both the women and the fetuses were determined in terms of complications, pain, obstetric outcomes, and quality of life assessment. The study revealed that women in the 25–30 age group were the most prevalent participants, with 24 cases. The daily cigarette consumption was classified into four categories: &lt;10 cigarettes per day (29 cases), ≥ 10 cigarettes per day (20 cases), and ≥20 cigarettes per day (14 cases). A total of 14 cases were identified, with gestational age in ≥ 37 weeks representing 53.97% of the total patient population. The mode of delivery was predominantly caesarean section (28.57%), while the remaining 71.43% underwent vaginal delivery. Low birth weight was identified as a risk factor. Of the total number of cases, ten were identified as having perinatal complications, representing a rate of 41.27% among all patients. Additionally, 22 cases were classified as having a birth weight of less than 2500 g. There were four instances of stillbirth. Pregnancy outcomes perinatal ones are adversely affected by cigarette smoking based on the dosages.

Resolution Of Cases Of Alleged Malpractice Of Bidan In Supporting Birth In Hospitals By Penal Mediation (Case Study Of Alleged Midwife Malpractice In A Cirebon Regency Hospital)

Malpractice is an error of medical personnel in carrying out their profession that is not in accordance with professional standards and standard operating procedures, resulting in the patient receiving serious injuries, disabilities, and even death. This study aims to analyze the factors that cause the alleged malpractice of midwives in assisting childbirth and the settlement of cases of alleged malpractice with penal mediation. In this study, the method used is a normative juridical approach that involves analyzing the applicable laws related to malpractice cases by midwives as well as reviewing recent cases, with the use of secondary data collection techniques focused on literature review. The results of this study conclude that the main factor in the occurrence of malpractice in midwives is the existence of errors in the form of both negligence and culpa caused by carelessness. The settlement of alleged malpractice cases with penal mediation is a settlement of cases outside the court by bringing together the parties involved, one of the alternative solutions is Penal Mediation. These findings can provide a deeper understanding of the application of responsibility in the context of alleged malpractice by midwives and can contribute to the improvement of legal norms that are more effective in dealing with these problems. The implications of the results of this study are expected to serve as a guide for the authorities, legal practitioners, and the public in facing and understanding the challenges associated with alleged malpractice cases involving midwives.

Readmission Rates After Expedited Postpartum Discharge.

To characterize national trends in expedited postpartum discharge and, secondarily, to identify predictors of expedited postpartum discharge and assess whether expedited postpartum discharge was associated with postpartum readmissions within 60 days of delivery hospitalization discharge. Birth hospitalizations and subsequent 60-day postpartum readmissions were extracted from the 2016-2020 Nationwide Readmissions Database for this retrospective cohort study. Postpartum discharge was categorized as expedited (less than 2 days after vaginal birth or less than 3 days after cesarean birth), routine (2 days after vaginal birth or 3 days after cesarean birth), or prolonged (more than 2 days after vaginal birth or more than 3 days after cesarean birth). Trends in expedited discharge were assessed over the study period with joinpoint regression. Unadjusted and adjusted logistic regression models were performed to assess clinical, hospital, and demographic predictors of expedited postpartum discharge. Sixty-day postpartum readmission risk was calculated, and adjusted regression models were performed to evaluate the association between expedited postpartum discharge and readmission. Of 17.9 million birth hospitalizations, 32.9% had expedited postpartum discharge. The overall 60-day postpartum readmission rate after delivery hospitalization discharge was 1.7% for all patients, 1.4% for expedited postpartum discharge, 1.6% for routine discharge, and 3.3% for prolonged discharge. Rates of expedited postpartum increased from 29.1% in 2016 to 31.4% in 2019 and to 43.8% in 2020. This trend was not significant (average annual percent change: 9.9%, 95% CI, -1.6% to 23.7%), although rates of expedited discharge were significantly higher in 2020 than in 2016-2019 ( P <.01). Younger and older age, chronic comorbid conditions, mental health conditions, and obstetric complications (eg, transfusion, chorioamnionitis or endometritis) were associated with lower likelihood of expedited postpartum discharge. Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (adjusted odds ratio 0.86, 95% CI, 0.85-0.88). Rates of expedited postpartum discharge increased significantly in 2020 compared with 2016-2019 and were not associated with 60-day postpartum readmission. These findings suggest that broader use of expedited postpartum discharge has not resulted in increased risk of postpartum readmissions.

Knowledge and Attitudes of Pregnant Women towards Bankjo Lamp Technology: Case Study of Choosing a Birth Place

Background: A high-risk pregnancy jeopardizes both maternal and fetal lives. Despite recommendations for hospital births, six out of ten high-risk expectant mothers in Kawedanan opt for PMB or Community Health Center Maternity. To identify high-risk pregnancies, Kawedanan Community Health Center employs the innovative Bankjo lamp. This study investigates how pregnant women's attitudes and knowledge about Bankjo lamps influence their maternity location choice. Methods: This type of research uses quantitative descriptive research. This observational analytical research involved 57 expectant mothers due to maternity in January, February, or March. Using a cross-sectional design, the study treated knowledge and attitudes about Bankjo lamps as independent variables, with maternity location preference as the dependent variable. Data collection methods included knowledge and attitude questionnaires and monthly midwife reports. The data was analyzed using the Chi-Square test and descriptive statistics in the form of frequency distribution with presentation. Results: Findings indicate that pregnant women generally possess adequate knowledge about suitable maternity locations, with some showing insufficient understanding. A significant correlation (p = 0.013) exists between knowledge levels and preferred birthplace. Despite the preference for hospital births among nearly all expectant mothers, a majority hold negative attitudes, strongly correlated (p = 0.000) with their birthplace choices. Interestingly, while most pregnant women understand the Bankjo lamp innovation well, they harbor negative attitudes toward it. Nevertheless, almost all opt for hospital births, prioritizing medical safety despite reservations about new technologies. Conclusions: The study underscores the need for government support in advancing maternal health initiatives, including innovative technologies like Bankjo lamps. Enhancing awareness and promoting positive attitudes among expectant mothers can foster safer childbirth practices. By disseminating knowledge and addressing misconceptions, healthcare providers can better support high-risk pregnancies, ensuring better outcomes for both mothers and babies.

Exogenous oxytocin administered to induce or augment labour is positively associated with quality of observed mother-infant bonding

Oxytocin is a key hormone in the transition to motherhood. The maternal endogenous oxytocin system facilitates many physiological and biological adaptations, including breastfeeding, maternal wellbeing, and brain plasticity. Additionally, maternal endogenous oxytocin works as a finetuned orchestrator prior to, during, and after the birth of a child to support birth progression and mother-infant bonding. Exogenous oxytocin may be administered to induce or augment labour when this is not progressing naturally and is a common obstetric intervention worldwide. However, the lasting impact of these widely varying levels of systemic exogenous oxytocin on mother-infant bonding is currently unknown. This study aimed to investigate the association between exogenous oxytocin administered to induce or augment labour and quality of observed mother-infant bonding.Thirty-eight mother and infant dyads participated (mothers aged 24–48 years; infants aged 2–5 months). Mother-infant bonding quality was assessed via the Recorded Interaction Task and hospital birth records were consulted to obtain exogenous oxytocin administration data. Demographic information and possible confounding factors were collected from dyads, and salivary oxytocin concentration was measured for both mother and infant.Mother's perception of infant sleep difficulty was identified as a confounding factor for quality of mother-infant bonding. After controlling for the confounding factor, receiving exogenous oxytocin to induce or augment labour, as opposed to not, was found to be significantly positively associated with higher quality of observed mother-infant bonding (p = 0.029). These novel findings highlight the need for further exploration, both of the impact of the treatment and of the mechanisms of action of intrapartum exogenous oxytocin on the endogenous oxytocin system. It is argued that particular focus be given to investigate action on the central oxytocin receptors, and if this may play a role in subsequent mother-infant bonding outcomes. It is vital to understand the full breadth and the clinical implications of this commonplace procedure.

Peripartum lithium management: Early maternal and neonatal outcomes

BackgroundIt has been suggested that a 30–50 % lithium dose reduction or lithium discontinuation 24-48 h before delivery could minimize neonatal complications. We investigated the maternal lithemia changes around delivery after a brief discontinuation, the placental transfer of lithium at delivery, and the association between neonatal lithemia at delivery and acute neonatal outcomes. MethodsA retrospective observational cohort study was conducted in a teaching hospital (November/2006-December/2018). Data was extracted from the medical records. We included psychopathologically stable women, with a singleton pregnancy, treated with lithium in late pregnancy, with at least one maternal and neonatal lithemia at delivery. Lithium was discontinued 12 h before a scheduled caesarean section or induction, or at admission day to hospital birth; and restarted 6-12 h post. ResultsSixty-six mother-infant pairs were included, and 226 maternal and 66 neonatal lithemias were obtained. We found slight maternal lithemia fluctuations close to 0.20 mEq/L, and early postpartum relapse of 6 %. The mean (SD) umbilical cord/mother intrapartum lithemia ratio was 1.10 (0.17). Fifty-six percent of neonates presented transient acute complications. Neonatal hypotonia was the most frequent outcome (N = 15). Mean lithemia were 0.178 mEq/L higher in those with hypotonia than in those without (p = 0.028). LimitationsIt is a retrospective cohort of a moderate sample size of healthy uncomplicated pregnancies and results cannot be generalized to all pregnant treated with lithium. ConclusionsLithium transfers completely across the placenta. A brief predelivery lithium discontinuation was associated with slight maternal lithemia fluctuations. Neonates exposed intrautero to lithium present frequent but transient acute effects.

Perinatal Airway Management Mandibular Anomalies: A National Inpatient Cohort Analysis.

To characterize incidence of mandibular anomalies (MAs) and compare gestational age, airway interventions, and complications among individuals with MA phenotypes (isolated retrognathia, isolated micrognathia, syndromic micrognathia, micrognathia plus cleft palate/cleft lip and palate, agnathia/micrognathia plus cervical auricle/otocephaly, and agnathia/micrognathia plus microstomia) and unaffected individuals. The Healthcare Cost and Utilization Project Kids' Inpatient Database was used to collect data over a 20-year period beginning in 2000. Interventions were classified as perinatal when performed on day of life (DOL) 0 or 1 and subsequent when performed during the birth hospitalization after DOL 1. Hypoxic complications included cardiac arrest, birth asphyxia, hypoxic-ischemic encephalopathy, anoxic brain damage, intraventricular hemorrhage or cerebral infarction. Descriptive statistics are reported, and the Rao-Scott chi-square test compared groups. MAs affected 119 per 100,000 birth visits. Preterm delivery was more frequent for all MA phenotypes. Individuals with MA phenotypes are more likely to require medical attention (airway intervention on DOL 0 or 1 OR no airway intervention received but patient sustained hypoxic complication/mortality): 16.2%-70.7% vs. 3.8%, p < 0.01. Despite receipt of airway interventions at a higher rate, collectively individuals with MAs who received an airway intervention on DOL 0 or 1 have a mildly elevated risk of hypoxic complication or mortality (32.4% vs. 26.4%, p < 0.01). Preterm birth is more common, however, does not account for the elevated rate of airway intervention. Individuals with MAs require higher rates of medical attention, and current airway management paradigms are insufficient to prevent complications and mortality. III Laryngoscope, 2024.

Antibiotic Diversity Index: A novel metric to assess antibiotic variation among hospitalized children.

Despite nationally endorsed treatment guidelines and stewardship programs, variation and deviation from evidence-based antibiotic prescribing occur, contributing to inappropriate use and medication-related adverse events. Measures of antibiotic prescribing variability can aid in quantifying this problem but are not adequate. The objective of this study is to develop a standardized metric to quantify antibiotic prescribing variability (diversity) within and across children's hospitals, and to examine its association with outcomes. We performed a cross-sectional study of empiric antibiotic exposure among children hospitalized during 2017-2019 with one of 15 common pediatric infections using the Pediatric Health Information System database. Encounters for children with complex chronic conditions, transfers in, and birth hospitalizations were excluded. Using the Shannon-Weiner entropy index, we quantified antibiotic diversity for each infection type using the d-measure of diversity. Generalized linear mixed-effects models were used to examine the association between hospital-level antibiotic diversity and risk-adjusted length of stay and costs. A total of 79,515 hospitalizations for common pediatric infections were included. Antibiotic diversity varied within and across hospitals. Infections with low mean antibiotic diversity included appendicitis (mean diversity [mDiv] = 4.9, SD = 2.5) and deep neck space infections (mDiv = 5.9, SD = 1.9). Infections with high mean antibiotic diversity included pneumonia (mDiv = 23.4, SD = 5.6) and septicemia/bacteremia (mDiv = 28.5, SD = 12.1). There was no statistically significant association between hospital-level antibiotic diversity and risk-adjusted LOS or costs. We developed and applied a novel metric to quantify diversity in antibiotic prescribing that permits comparisons across hospitals and can be leveraged to identify high-priority areas for local and national stewardship interventions.

Prenatal Prognosis of Omphalocele Using Magnetic Resonance Imaging Measurement of Fetal Lung Volumes

BackgroundOmphalocele is a congenital midline abdominal wall defect resulting in herniation of viscera into a membrane-covered sac. Pulmonary complications, including pulmonary hypoplasia, pulmonary hypertension, and prolonged respiratory support are a leading cause of neonatal morbidity and mortality. Objective(s)This study aimed to assess the role of fetal MRI-derived lung volumes and omphalocele defect size as clinical tools to prognosticate postnatal pulmonary morbidity and neonatal mortality in those with a prenatally diagnosed omphalocele (PDO). Study DesignThis was a retrospective cohort study of all pregnancies with PDO at our fetal center from 2007–2023. Pregnancies with aneuploidy or concurrent life-limiting fetal anomalies were excluded. Using fetal MRI, observed-to-expected total fetal lung volume (O/E TLV) ratios were determined by a previously published method. The transverse diameter of the abdominal defect was also measured. The O/E TLV ratios and abdominal defect measurements were compared with postnatal outcomes. The primary outcome was death at any time. Secondary outcomes included death in the first 30 days of life or before discharge from birth hospitalization, the requirement of respiratory support with intubation and mechanical ventilation, or development of pulmonary hypertension. ResultsOf 101 pregnancies with a PDO, 54 pregnancies (53.5%) with prenatally diagnosed omphalocele met inclusion criteria. There was a significant increase in the rate of death when compared between the three O/E TLV classifications: 1/36 (2.8%) in the O/E≥50% group, 3/14 (21.4%) in the O/E 25%–49.9% group, and 4/4 (100%) in the O/E<25% group (P<.001). The rate of intubation increased with the severity of O/E TLV classification, with 27.8% in the O/E≥50% group, 64.3% in the O/E 25%–49.9% group, and 100% in the O/E<25% group (P=.003). The rate of pulmonary hypertension was also higher in the O/E 25%–49.9% (50.0%) and the O/E<25% (50.0%) groups compared to the O/E≥50% group (8.3%, P=.002). There was no association between the transverse diameter of the abdominal wall defect and the primary outcome of death (OR=1.08 95% CI=[0.65–1.78], P=.77). ConclusionsIn our cohort of patients with PDO, O/E TLV<50% is associated with death, need for intubation, prolonged intubation, and pulmonary hypertension. In contrast, omphalocele size demonstrated no prognostic value for these outcomes. The strong association between low fetal lung volume on MRI and poor neonatal outcomes highlights the utility of fetal MRI for estimating postnatal prognosis. Clinicians can utilize fetal lung volumes to direct perinatal counseling and optimize the plan of care.

Women's experiences in institutional childbirth care in times of the first and second waves of COVID in Mexico.

This is a qualitative study that explores the perspectives and experiences of a group of Mexican women who experienced institutionalized childbirth care in the first and second waves of the COVID-19 pandemic. Through a semi-structured script, nine women who experienced childbirth care were interviewed between March and October 2020 in public and private hospitals in the city of San Luis Potosí, Mexico. Under the Grounded Theory analysis proposal, it was identified that the health strategies implemented during the pandemic brought with them a setback in the guarantee of humanized childbirth. Women described themselves as distrustful of the protocols that personnel followed to attend to their births in public sector hospitals and very confident in those implemented in the private sector. The intervention of cesarean sections without a clear justification emerged as a constant, as did early dyad separation. Healthcare personnel's and institutions' willingness and conviction to guarantee, protect and defend the right of women to experience childbirth free of violence remain fragile. Resistance persists to rethink childbirth care from a non-biomedicalizing paradigm.

Hospitalization Patterns for Rural-Residing Children from 2002 to 2017

ObjectiveThe closure of inpatient pediatric units within general hospitals has contributed to the regionalization of pediatric care. For children in rural areas, the distance traveled for hospitalization impacts the quality of care for children, the impact upon families, and the preparedness for disaster planning within rural communities. We assessed trends in location of hospitalization over time for rural-residing children. MethodsUsing the Healthcare Cost and Utilization Project’s State Inpatient Databases, we studied 256,947 hospitalizations for rural-residing children 0–17 years of age within eight states (CO, FL, KY, NC, NJ, NY, OR, WA) from 2002 to 2017. Level of rurality was defined by Rural-Urban Commuting Area Codes: micropolitan, small rural, and isolated rural. Birth, psychiatric, and surgical hospitalizations were excluded. Trends in number of hospitalizations by hospital location, interfacility transfer (IFT), and whether the hospital location was the same level of rurality as the patient’s home residence were assessed with the Cochran-Armitage trend test. ResultsFrom 2002 to 2017, hospitalizations for rural-residing children decreased by 52.7% (56,168 to 26,548) and IFTs increased from 6.7% to 26.5% (P < .001). The proportion of total hospitalizations within metropolitan areas for rural-residing children increased from 32.2% to 72.8% (P < .001). Local-area agreement between the patient’s residence and hospital utilized decreased from 53.6% to 21.5% (P < .001). ConclusionsAlthough overall hospitalizations for rural-residing children decreased, IFTs increased, and the proportion hospitalized in metropolitan areas increased. The impact of this shift in inpatient health services on efficiency and quality of care for rural-residing children needs further exploration.

Relationship between Maternal Stress and Neurobehavioral Indicators of Preterm Infants in the Neonatal Intensive Care Unit.

Preterm birth and prolonged neonatal hospitalization are potential sources of stress for mothers of preterm and low birth weight infants. To evaluate maternal stress and its association with neurobehavioral indicators of preterm infants during hospitalization in the neonatal intensive care unit. A cross-sectional study was conducted in a neonatal intensive care unit of a hospital in Goiânia, Brazil. The study included preterm and low birth weight infants of both genders and their mothers. The Parental Stressor Scale: Neonatal Intensive Care Unit and the Neurobehavioral Assessment of the Preterm Infant were respectively applied to mothers and infants in the neonatal intensive care unit. The study involved 165 premature infants and their mothers. The mean age of the mothers was 26.3 years and most had a high school education level (57.6%). Mothers perceived the experience of having an infant in the neonatal intensive care unit as moderately stressful (2.96 ± 0.81). The parental role alteration (4.11 ± 1.03) and sights and sounds (2.15 ± 0.90) subscales exhibited the highest and lowest stress levels, respectively. Significant correlations (rho < -0.3; p < 0.05) were found between maternal stress and neurobehavioral indicators of infants. In the multivariate analysis, low leg tone was a predictor of higher maternal stress. Low tone and limited arm movement were predictors of higher maternal stress in the maternal role item. The experience of having a preterm infant hospitalized was considered moderately stressful for mothers. Maternal stress levels were significantly correlated with low scores on neonatal neurobehavioral indicators.

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Health Care Needs and Costs for Children Exposed to Prenatal Substance Use to Adulthood.

Children exposed to substance use during pregnancy have increased health needs but whether these are influenced by engagement in out-of-home care is uncertain. To evaluate the association between substance use during pregnancy, out-of-home care and hospitalization utilization, and costs from birth up to age 20 years. This was a retrospective cohort study using individual-linked population birth, hospital, and out-of-home care information of all liveborn infants from New South Wales, Australia, between 2001 and 2020 using longitudinal population-based linkage records from administrative databases. Substance use during pregnancy included newborns with neonatal abstinence syndrome (n = 5946) and intrauterine exposure to drugs of addiction (n = 1260) and other substances (eg, tobacco, alcohol, and illicit drugs or misused prescription drugs; n = 202 098). Children not exposed to substance use during pregnancy were those without known exposure to substance use during pregnancy (n = 1 611 351). Data were analyzed from July 2001 to December 2021. Main outcomes were hospital readmission, length of stay, and cost burden associated with substance use during pregnancy from birth up to age 20 years. Outcomes were investigated using 2-part and Poisson regression models adjusted for sociodemographic characteristics. Mediation analysis was used to evaluate whether the association of substance use during pregnancy with risk of readmission was mediated through engagement with out-of-home care. Of the 1 820 655 live births, 935 807 (51.4%) were male. The mean (SD) age of mothers was 30.8 (5.5) years. Compared with children who were not exposed to substance use during pregnancy, those who were exposed incurred significantly higher birth hospital costs (adjusted mean difference, A$1585 per child [US$1 = A$1.51]; 95% CI, 1585-1586). If discharged alive, more children with exposure to substance use during pregnancy had at least 1 readmission (90 433/209 304 [43.4%] vs 616 425/1 611 351[38.3%]; adjusted relative risk [RR], 1.06; 95% CI, 1.06-1.07), most commonly for respiratory conditions (RR, 1.11; 95% CI, 1.09-1.12) and mental health/behavioral disorders (RR, 1.36; 95% CI, 1.33-1.41). Excess hospital costs associated with substance use during pregnancy were A$129.0 million in 2019 to 2020. Mediation analyses showed that any out-of-home care contact mediated the association between substance use during pregnancy and risk of inpatient readmission and lower health care cost (decreased by A$25.4 million). For children with neonatal abstinence syndrome, any out-of-home care contact mediated readmission risk by approximately 30%, from adjusted RR, 1.28; 95% CI, 1.19-1.35, to RR, 1.01; 95% CI, 0.98-1.02. Children who were exposed to substance use during pregnancy incurred more hospital costs than children who were not exposed up to 20 years of age, but this was reduced in association with any contact with out-of-home care. This provides insights into possible strategies for reducing health and financial burdens associated with exposure to substance use during pregnancy for children.