Objective Inflammatory bowel disease (IBD) can have an impact on maternal and neonatal outcomes. This study reports the pregnancy outcomes, rates of gestational diabetes (GDM) and hypertensive disorders of pregnancy (HOP) in women with IBD cared for in a dedicated IBD-maternal fetal medicine (IBD-MFM) clinic compared with a group of age-matched controls. Design/methods A retrospective cohort study comparing the outcomes of 146 patients with IBD cared for in a dedicated IBD-MFM clinic and 292 consecutive, age-matched controls without IBD. We analysed the associations between IBD and maternal/neonatal outcomes. ORs were calculated and a multivariate logistic regression model was used to correct for confounding variables. Results A diagnosis of IBD was significantly associated with the development of GDM compared with controls (OR 1.86, CI 1.05 to 3.29, p=0.033). This was independent of confounding variables such as corticosteroid exposure. A diagnosis of IBD was associated with a significantly lower rate of HOP compared with controls (OR 0.04, CI 0.01 to 0.37, p=0.004). 45.2% of patients with IBD had active disease during pregnancy which significantly increased the risk of small for gestational age (SGA) (OR 5.16, CI 1.35 to 19.68, p=0.02) but not low birth weight (LBW), preterm birth or risk of neonatal intensive care admissions (NICU). Biologic use was not associated with adverse maternal or neonatal outcomes. Conclusions A diagnosis of IBD is associated with a significant increase in the risk of GDM and is independent of confounding variables. Active disease in pregnancy was significantly associated with SGA but not LBW, preterm birth or NICU admissions.

ABSTRACT Objective To assess whether the hemoglobin–albumin–lymphocyte–platelet (HALP) score distinguishes fetal growth restriction (FGR) from small for gestational age (SGA) and its association with composite adverse perinatal outcome (CAPO). Method This retrospective study included 444 singleton pregnancies (214 FGR; 230 SGA) at a tertiary center (2021–2023). FGR was defined as early‐onset (< 32 weeks) or late‐onset (≥ 32 weeks) by Delphi/ISUOG criteria. HALP was calculated at diagnosis as [hemoglobin × albumin × lymphocytes ÷ platelets]. CAPO comprised ≥ 1 of neonatal intensive care admission, Apgar < 7 at 5 min, cord pH < 7.2, or perinatal death. Group comparisons and ROC analyses were performed. Results FGR cases had lower HALP (31.5 vs. 40.0, p < 0.001) and higher CAPO (15% vs. 7%, p = 0.04) than SGA. They delivered earlier, with lower birthweight, cord pH, and more NICU admissions. HALP moderately differentiated FGR from SGA (AUC 0.667; cutoff < 26.8: 44% sensitivity, 81% specificity) but did not predict CAPO (AUC 0.542, p = 0.334). A biological gradient was observed (EO‐FGR < LO‐FGR < SGA; all p < 0.001). Conclusions HALP is decreased in FGR, especially in early‐onset cases, and somewhat differentiates FGR from constitutionally small SGA. While it does not predict short‐term morbidity, it could be a simple addition to Doppler assessments when evaluating suspected growth restriction.

From 2022 onwards, several countries, including the Netherlands, reported a marked increase in invasive group A streptococcal (iGAS) infections. Therefore, we aimed to describe the clinical presentation, disease course, treatment and outcomes of group A streptococcus (GAS) meningitis, a rare but severe manifestation of GAS infection in pediatric patients. Children with GAS meningitis were selected from the COPP-iGAS study, a national observational cohort study in children 0-17 years of age with in-hospital diagnosis of iGAS between 2015 and June 2024, conducted across 20 hospitals in the Netherlands, including all 7 academic centers with a pediatric intensive care unit. Twenty-seven children were included, of whom 41% (11/27) were younger than 5 years of age. Most patients presented during the first quarter of the year (n = 13/27, 48%). Admission to an intensive care unit occurred in 15/27 (56%) patients and 4/27 (15%) patients died. Detailed clinical data were available for 13/27 patients. Clinical course data could be evaluated for 12 of these patients. Among those 12 patients, almost two-thirds had a complicated disease course, mainly involving cardiorespiratory failure (4/12, 33%). All 12 patients received prolonged antibiotic therapy [median 43 days (IQR 14-61)], predominantly intravenously [median 42 days (IQR 14-50)]. Adjunctive therapy included corticosteroids (6/12, 50%), antiviral agents (3/12, 25%) and anticoagulants (3/12, 25%). Our findings highlight that pediatric GAS meningitis is a severe condition characterized by high intensive care admission rates and substantial mortality. In the subgroup with detailed clinical data, complications were frequent and prolonged antibiotic treatment was common. Increased clinical awareness is warranted.

Pediatric pneumonia remains a major cause of morbidity and mortality in low- and middle-income countries (LMICs), imposing both health and financial burdens. While the clinical aspects of pediatric pneumonia are well-studied, less attention has been paid to its economic implications for households, particularly regarding out-of-pocket (OOP) expenditure. This paper synthesizes current evidence from Kenya, India, Bangladesh, and Vietnam and introduces a proposed econometric framework designed to identify cost determinants and model policy interventions. The framework integrates microeconomic data, identifies cost determinants, and models the effects of clinical and policy factors (e.g., intensive care, vaccination, insurance coverage) on household expenditures. Simulated results illustrate potential findings from such an approach. Existing studies show substantial variability in hospitalization costs, with OOP payments ranging from US$30 to US$250 per episode, often exceeding 20% of monthly household income. Econometric modeling using generalized linear models (GLMs) and difference-in-differences (DiD) can disentangle the impact of hospital practices, disease severity, and policy interventions. Simulated regression results demonstrate that length of stay, intensive care admission, and absence of insurance significantly increase household costs, while pneumococcal conjugate vaccine (PCV) introduction reduces both admissions and financial burden. Hospitalization for pediatric pneumonia imposes significant OOP costs on households in LMICs. An econometric framework provides rigorous tools to estimate cost drivers, evaluate policy impacts, and guide equitable health financing reforms.

Psychiatric disorders are common among general hospital patients. A large study conducted previously showed that timely contact with a consultation-liaison psychiatry (CLP) service is associated with a shorter length of stay (LOS). The aim of this work was to replicate this study with recent data covering the pandemic period to confirm the impact of timely contact with CLP on LOS. We retrospectively included 2070 patients referred to CLP between 2018 and 2022 at the University Hospital of Lille. General linear models were used to assess associations between the timing of CLP interventions and LOS and to identify predictors of the timing of CLP interventions (e.g., age, sex, type of ward, psychiatric diagnosis, and year of admission). The timing of CLP interventions was significantly positively associated with LOS. Referral time (i.e. log(days before consultation)/log(LOS)) was significantly associated with log-transformed LOS (Model 1: β=0.11, P<.001), and this association remained consistent after adjustment for covariates (Model 2: β=0.13, P<.001). Admissions in 2020 and 2021 were associated with shorter times before CLP interventions (Model 3: β=-0.06, P=.020 and β=-0.06, P=.022, respectively), whereas surgical and intensive care admissions were associated with longer times to consultation (Model 3: β=0.04, P=.036 and β=0.08, P<.001, respectively). The present study confirms that earlier CLP intervention is associated with shorter LOS in general hospitals. Given the current health emergency, it is an opportunity to demonstrate the benefits of early psychiatric consultation to reduce LOS.

Intensive care admissions in older adults: are we moving from ageism to ableism?

COPD exacerbations, often triggered by viral infections like COVID-19, are associated with increased cardiovascular risk. We hypothesized that COVID-19-related exacerbations carry higher short-term cardiovascular and mortality risks than non-COVID-19-related exacerbations. To compare 28-day risk of stroke, pulmonary embolism (PE), acute myocardial infarction (AMI), major adverse cardiovascular events (MACE) and all-cause mortality following COVID-19-related vs. non-COVID-19-related COPD exacerbations and assess variation across the pandemic. Using Swedish national registers, we identified COPD with moderate (treated with oral corticosteroids with/without antibiotics) or severe (hospitalized) exacerbations from March 2020 to June 2023. Exacerbations with infection, hospitalization or intensive care admission for COVID-19 were defined as COVID-19-related. A target trial was emulated and adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) estimated for each outcome, stratified by exacerbation severity and COVID-19 variants. Among 266,273 exacerbations (87.2% moderate, 12.8% severe), 5,425 (2%) were COVID-19-related. COVID-19-related vs. non-COVID-19-related moderate exacerbations were associated with risk of PE (aHR 2.26, 95%CI 1.49-3.42), overall cardiovascular (1.94, 1.47-2.56), MACE (1.88, 1.28-2.76), and mortality (4.58, 4.06-5.17), but not significantly with AMI and stroke. Severe COVID-19-related exacerbations were only associated with higher mortality (1.46, 1.28-1.66). Cardiovascular risks were highest during pre-Alpha and Delta for moderate exacerbations. Mortality remained elevated for both moderate and severe exacerbations, particularly during the same periods. COVID-19-related exacerbations increased MACE, short-term cardiovascular and mortality risks, mainly for moderate exacerbations, with attenuation during Alpha and Omicron, highlighting the need for proactive cardiovascular care during respiratory outbreaks.

The aim of this study was to determine which factors influence consumer engagement in, experience of, and outcome of physical rehabilitation interventions during critical illness. An inductive qualitative study using semistructured interviews was conducted between September 2019 and July 2020. Ten adult, English-speaking intensive care survivors and five of their caregivers were recruited after discharge from a major metropolitan health service. Framework analysis was used to interpret the collected data following five key steps. (i) Audio transcription and data familiarisation; (ii) open inductive coding to guide development of an initial framework; (iii) two rounds of framework application, review, and refinement; (iv) charting of data into the matrix; and (v) interpretation of the findings. Analytical memo taking and independent coding were undertaken by two researchers. Five key themes were elicited that described factors important to the approach to rehabilitation, rehabilitation during critical illness, and the recovery phase following intensive care admission. The presence of pre-existing factors such as consumer beliefs, patient well-being, and therapist skills, as well as the strength of the therapeutic alliance, influenced consumer engagement in rehabilitation interventions while critically ill. Patients had diverse experiences and outcomes of rehabilitation. Caregivers and the social network of the patient play an invaluable but variable role in facilitating patient participation in rehabilitation during intensive care admission. Consumers identified important factors influencing participation in physical rehabilitation during critical illness. These factors should be considered in the future design and delivery of intensive care physiotherapy interventions to improve patient-centred care.

Many pregnancies are unexpected. We therefore assessed the impact of an early pregnancy HbA1c above or below non-pregnant targets on perinatal outcomes and HbA1c trajectories throughout pregnancy and 12 months postpartum among individuals with type 2 diabetes (T2D).We conducted a retrospective cohort study of pregnant individuals with T2D. Outcomes and HbA1c trajectories were compared among those who had an HbA1c <7 versus ≥7% at <20 weeks' gestation. Data were analyzed using logistic regression for perinatal outcomes and linear mixed models to assess trajectories of HbA1c during pregnancy and the postpartum period.HbA1c was <7% in 128/281 (46%) and ≥7% in 153/281 (54%) individuals. HbA1c ≥7% was associated with risk for preterm birth (adjusted odds ratio [aOR] = 2.3, 95% confidence interval [CI]: 1.3-4.0), cesarean delivery (aOR = 1.7, 95% CI: 1.1-2.9), and neonatal intensive care admission (aOR = 2.9, 95% CI: 1.7-4.9). HbA1c values decreased during pregnancy in both groups but returned to early pregnancy values by the postpartum period.Adverse perinatal outcomes are high among individuals with type 2 diabetes mellitus regardless of early pregnancy glucose levels, and strategies are needed to improve maternal glucose levels in the postpartum period. · HbA1c ≥7% in early pregnancy increases risk for pregnancy complications.. · Pregnancy complication rates in T2D are high even with HbA1c <7%.. · In T2D, HbA1c levels improve throughout gestation.. · These improvements do not persist 1-year postpartum..

Lessons learned from life-threatening respiratory and cardiac complications in diphtheria: A case report and literature review

IntroductionThere is a need for understanding the newborn outcomes among SARS-CoV-2 infected mothers during pregnancy.ObjectiveTo assess the associations between SARS-CoV-2 infection during pregnancy and perinatal death (PD) and admission to the neonatal intensive care unit (NICU).MethodsThis population-based cohort study used health data from the Georgian Birth Registry combined with the vital registration system, LabCov (COVID registry) and immunisation electronic module between 26 February 2020 and 31 August 2022.ResultsIn total, 111 490 women gave birth to 113 398 newborns who were included in this study. The participants were classified into three groups based on SARS-CoV-2 infection status during pregnancy: no infection during pregnancy (reference), infection from conception through 14 days before delivery, and infection 14 days before or at delivery. Of women, 15% (16 713) were SARS-CoV-2 positive during pregnancy, and of these, 10.3% (1,564) tested positive within 2 weeks of delivery. The latter group had the highest PD and NICU admission rates. Compared with non-infected women, those with SARS-CoV-2 infection ≤14 days prior to or at delivery had 2.34 (95% CI 1.74 to 3.16) times higher odds of PD; women with SARS-CoV-2 >14 days prior to or at delivery had 36% (adjusted OR 0.64, 95% CI 0.53 to 0.77) lower odds of PD. Likewise, NICU admission was 3.06 (95% CI 2.73 to 3.44) times higher among women with SARS-CoV-2 ≤14 days prior to or at delivery and 8% (95% CI 0.87 to 0.97) lower among women with SARS-CoV-2 >14 days prior to or at delivery compared with women with no documented infection.ConclusionsMaternal SARS-CoV-2 infection detected within 14 days before or at delivery was associated with higher odds of PD and NICU admission, while infection occurring earlier in pregnancy (>14 days before delivery) was not associated with increased odds of these outcomes.

Objective:This study aimed to identify maternal and neonatal risk factors associated with admission to special or intensive neonatal care in a referral hospital in Indonesia.Methods:A hospital-based cross-sectional study was conducted from November 2024 to April 2025. Data were collected from medical records and analyzed using binary logistic regression. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported, with P < .05 considered significant.Results:Among 348 neonates, 60 (17.2%) were admitted to special or intensive neonatal care. Significant predictors included no antenatal care attendance (AOR: 2.54; 95% CI: 1.23, 5.24), low birth weight (AOR: 3.07; 95% CI: 1.28, 7.34), Apgar score <7 at first minute (AOR: 7.87; 95% CI: 3.70, 16.73), and preterm birth (AOR: 5.69; 95% CI: 2.50, 12.92).Conclusion:No antenatal care attendance, low birth weight, low Apgar score, and preterm birth were independent predictors of neonatal care admission.

Improved survival and health care use with CAR-T vs historical care in relapsed/refractory large B-cell lymphoma.

Rectal carriage of carbapenemase-producing Gram-negative bacteria (CP-GNB-RC) increases the risk of invasive infections and horizontal transmission. This study aimed to identify predictors of CP-GNB-RC in hospitalized patients. A case-control study was conducted in a 300-bed hospital in Santa Fe, Argentina, between 2022 and 2023. Cases and controls were randomly selected and included in a 1:2 ratio. A multivariate binary logistic regression model was built using variables significant in univariate analysis (p<0.05). Among 258 patients, 34.5% yielded at least one CP-GNB. Most isolates were Klebsiella spp. (79.0%) and 56.0% produced KPC. In the multivariate analysis, intensive care admission in the past 6 months (OR 3.61), patient transfer from another hospital (OR 2.89), antibiotic exposure (OR 2.34), and length of hospital stay (OR 1.05) were the only independent predictors of CP-GNB-RC. These findings may inform infection control strategies and antimicrobial stewardship interventions in our region.

This pilot randomized controlled trial investigated whether a patient decision aid (PtDA) could enhance preparedness for advance care planning (ACP) among participants treated in the intensive care unit (ICU) following surgery. Participants were recruited online through a private research company in Japan. The intervention group received a researcher-developed PtDA aligned with international standards, while the control group received an informational pamphlet. The SURE test, a screening tool for decisional conflict, was used as the primary outcome to assess confidence in health-related decision-making. A post-intervention web-based survey was also conducted to assess participants’ preferences for ACP support from healthcare professionals. The proportion of participants unable to make an ACP decision was significantly lower in the intervention group (P < .05); more participants scored 4 on the SURE test, indicating full decisional confidence (P < .05). Participants expressed needs for healthcare professional presence and psychological support during ACP discussions with families. These findings suggest that a PtDA may effectively enhance decision-making about ACP among ICU survivors, even outside clinical settings, and highlight its potential as a scalable tool supporting post-discharge ACP in community-based contexts.

The relationship between gestational weight gain and perinatal outcomes in women with gestational diabetes remains inadequately studied, and specific weight gain recommendations are lacking for this population. We conducted a retrospective cross-sectional study by extracting natality data from the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention in the United States, including 1,368,789 record (2015-2020) as the main sample and 280,165 (2021) as the validation sample. The composite adverse outcome is defined as a composite of gestational hypertension or preeclampsia, primary cesarean delivery, maternal transfusion, maternal intensive care admission, preterm birth<37 weeks, small or large size for gestational age at birth and neonatal intensive care unit admission. Optimal gestational weight gain ranges were estimated for each pre-pregnancy body mass index category through multivariable logistic regression model to identify the odds ratio targets at which any adverse outcome decreased. Model discrimination was evaluated using area under the receiver operating characteristic curve. Adverse outcomes occur in 52.67% of pregnancies, with incidence rising substantially with body mass index (44.28% in normal weight vs 67.08% in class 3 obesity). The optimal gestational weight gain ranges are: underweight (12.0- < 20.0 kg), normal weight (8.0- < 16.0 kg), overweight (weight loss-<14 kg), class 1 obesity (weight loss-<10.0 kg) and obesity classes 2-3 (weight loss <8.0 kg). These ranges demonstrate low to moderate discrimination between affected and unaffected pregnancies (ranges of area under the receiver operating characteristic curve, 0.57-0.68). Minimal weight gain or weight loss is associated with a decreased risk of adverse perinatal outcomes among women with overweight or obesity complicated by gestational diabetes.

Pneumococcal surveillance typically focuses on cases identified by positive microbiology and collects limited clinical data. The majority of pneumococcal studies in the literature focus on invasive respiratory disease. This study includes a cohort of all cause pneumococcal disease, including non-invasive disease and non-respiratory invasive disease with detailed clinical outcomes, allowing a more complete view of pneumococcal disease burden, and particularly meningitis cases. A longitudinal adult cohort of invasive and non-invasive pneumococcal disease inpatients in three hospitals between 2006 and 2022, was retrospectively collected. The demographics and outcomes of invasive and non-invasive hospitalised cases were compared. Features of invasive disease in different clinical presentations, particularly meningitis, were compared to invasive respiratory disease. Serotype distributions of different presentations in invasive disease were compared using bootstrap resampling. Out of a total 3719 all cause pneumococcal disease, 1419 cases (38.2%) were invasive respiratory disease. Non-invasive disease was seen in 2033 cases (54.7%). Non-invasive disease had a lower (but clinically substantial) 30day case-fatality rate than invasive disease (11.7% versus 14.8%; P = 0.005), and similar lengths of stay in hospital. Among the 1686 invasive cases, 258 (15.3%) were outside the respiratory tract. The 172 cases presenting with meningitis were younger (54.9y vs. 66.8y; P < 0.001) than those with lower respiratory tract infection; and had high rates of intensive care admission (63.4% vs. LRTI 10.2%; P < 0.001). We found no evidence of a different serotype distribution between different clinical presentations. There is a substantial burden of pneumococcal disease that is not represented by studies that focus on invasive respiratory disease, or by surveillance that focus only on culture positive disease alone. Outcomes are particularly poor in the case of meningitis, but non-invasive disease also has a high case fatality rate. Given the same serotypes are found in meningitis as invasive respiratory disease, we anticipate that the same vaccines that target respiratory disease should be relevant to the prevention of meningitis.

The prediction of the onset of sepsis, a life-threatening condition resulting from a dysregulated response to an infection, is one of the most common prediction tasks in intensive care-related machine learning research. To assess the performance of such models, different evaluation strategies, including fixed horizon (a single prediction at a set time before onset), peak score (a single prediction using the maximum predicted risk across time), and continuous evaluation (multiple predictions assessed continuously across time), are commonly implemented, but there is no clear consensus on which approach should be used in order to provide clinically meaningful performance evaluation. This study aimed to assess different evaluation approaches of sepsis prediction models trained on a public intensive care dataset applied to German intensive care data. In this retrospective, observational cohort study, we assessed the efficacy of machine learning models, pretrained on the Medical Information Mart for Intensive Care IV dataset, when applied to BerlinICU, a multisite German intensive care dataset. To understand the real-world impact of implementing these models, we examined the performance variability across various evaluation strategies. The BerlinICU dataset includes 40,132 intensive care admissions spanning 10 years (2012-2021). Using the latest Sepsis-3 definition, we identified 4134 septic admissions (10.3% prevalence). Application of a temporal convolutional network model to BerlinICU yielded an area under the receiver operating characteristic curve (AUROC) of 0.67 (95% CI 0.66-0.68) for continuous evaluation with a 6-hour prediction horizon, compared with 0.84 (95% CI 0.83-0.85) on the test set of Medical Information Mart for Intensive Care IV. On BerlinICU, peak score evaluation showed a similar AUROC compared with continuous evaluation, while fixed horizon evaluation showed a reduced AUROC of 0.61 (95% CI 0.60-0.62). Onset matching had minimal impact on performance estimates using continuous evaluation or fixed horizon evaluation, but increased estimates for peak score evaluation. Performance metrics improved with shorter prediction horizons across all strategies. Our results demonstrate that the choice of evaluation strategy has a significant impact on the performance metrics of intensive care prediction models. The same model applied to the same dataset yields markedly different performance metrics depending on the evaluation approach. Therefore, careful selection of the evaluation approach is essential to ensure that the interpretation of performance metrics aligns with clinical intentions and enables meaningful comparisons between studies. In our view, the continuous evaluation approach best reflects the continual monitoring of patients that is performed in real-world clinical practice. In contrast, fixed-horizon and peak score evaluation approaches may produce skewed results when not properly matching the length of stay distributions between sepsis cases and control cases. Especially for peak score evaluation, longer visits tend to produce higher maximum scores because sampling from more values increases the likelihood of capturing higher values purely by chance.

Bronchiolitis is a leading cause of hospitalisation and paediatric intensive care admissions in infants. Moderate-to-severe cases often require inter-hospital transfer for respiratory support, usually organised by specialised paediatric emergency transport services (PETS). The optimal composition of transport teams, whether nurse-led or medicalised, remains uncertain. To identify predictive factors available during the regulation call that can help determine when an inter-hospital transfer of infants with moderate-to-severe bronchiolitis can be safely conducted by a nurse-led team without a paediatrician, by predicting the need for clinical intervention during transport. A retrospective observational study was conducted from 2021 to 2023 within the PETS of a French University Hospital. Infants under 2 years transferred for moderate-to-severe bronchiolitis were included. The primary outcome was the occurrence of a clinical intervention during transport, defined as any event requiring physician-level management: apnoea requiring manual ventilation, fluid bolus, initiation of two-level non-invasive ventilation or endotracheal intubation. Clinical and paraclinical parameters available at the regulation call-particularly ventilatory support mode, FiO2 and blood gas values-were analysed for their ability to predict the occurrence of such interventions using receiver operating characteristic (ROC) analysis. Among 167 included infants (mean age 157 ± 169 days; weight 5.9 ± 2.7 kg), 20 (12%) required a clinical intervention. Higher FiO2 (51.3% ± 19.3% vs. 34.8% ± 10.2%; p < 0.01), lower pH (7.30 ± 0.08 vs. 7.34 ± 0.07; p = 0.03) and higher pCO2 (62.9 ± 17.9 vs. 49.6 ± 11.2 mmHg; p = 0.01) were associated with interventions. The presence of high-flow nasal cannula (HFNC) with FiO2 > 40%, or continuous positive airway pressure (CPAP) with FiO2 > 35% or pCO2 > 65 mmHg predicted the need for a medicalised team (AUC = 0.83; sensitivity 90%, specificity 78%, negative predictive value 98%). Most inter-hospital transfers of infants with moderate-to-severe bronchiolitis can be safely undertaken by nurse-led teams when predefined respiratory or blood gas thresholds are not exceeded. This study provides objective criteria to guide decision-making regarding team composition during the regulation of inter-hospital transfers for infants with moderate-to-severe bronchiolitis. FiO2 and pCO2 thresholds measured at the initial call can help identify cases requiring physician presence, while allowing most transfers to be safely conducted by nurse-led teams. These results support the development of standardised triage protocols and strengthen the role of advanced paediatric critical care nurses in retrieval medicine. Integrating such evidence-based criteria into practice could optimise human resources, maintain safety and improve response times in paediatric emergency transport systems.

Background: Adverse newborn outcomes in patients with severe maternal morbidity (SMM) are understudied, and this study examines their association with insurance type (Medicaid vs. commercial) in patients who experienced SMM. The aim of this study is to examine disparities in preterm birth, low birthweight, and neonatal intensive care (NICU) admission among Medicaid vs. commercially insured patients with severe maternal morbidity in Maryland. Methods: This cross-sectional study analyzed data from 588 SMM patients enrolled in Maryland's Severe Maternal Morbidity (SMM) Surveillance Program (August 2020-December 2023). We utilized unadjusted and multivariable logistic regression models to evaluate the relationship between primary insurance type and the outcomes of interest: preterm birth (<37 weeks), low birthweight (<2500 g), and neonatal intensive care unit (NICU) admissions. Results: Of 588 patients with SMM, 45.1% had Medicaid. These patients were younger, more often non-Hispanic Black or Hispanic, had higher parity and comorbidity scores, and initiated prenatal care later compared with commercially insured patients. Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for other socio-demographic and medical factors. Patients' comorbidities significantly increased the odds of adverse newborn outcomes, as did all other primary SMM causes other than obstetric hemorrhage. Conclusions: Adverse newborn outcomes were more prevalent among Medicaid than commercially insured patients who experienced SMM. Differences in maternal health status and primary SMM cause partly explain the observed differences in newborn outcomes. Our findings emphasize the need for comprehensive prenatal care and improved healthcare access for women with high-risk pregnancies.