Impact of excessive gestational weight gain on exclusive breastfeeding among women with Type 1 and Type 2 diabetes and obesity.

Background: Pregestational diabetes, obesity and gestational weight gain (GWG) are associated with adverse perinatal outcomes, however, the influence of excessive GWG on lactation at discharge is less known. Our aim is to evaluate the impact of excessive GWG using the LifeCycle project guidelines on exclusive breastfeeding (EBF) and any BF rates at discharge among 171 women with Type 1 and 294 Type 2 diabetes and obesity who intended to BF.

Methods And Findings: Retrospective cohort study.

Exclusive breastfeeding among women with type 1 and type 2 diabetes mellitus.

Objective: To compare exclusive breastfeeding (BF) and BF initiation among 185 women with Type 1 and 212 women with Type 2 pregestational diabetes who intended exclusive or partial BF and delivered at ≥34 weeks of gestation.

Methods: Retrospective cohort study. At discharge, exclusive BF is direct BF or BF complemented with expressed breast milk.

Trends in breastfeeding initiation, continuation, and exclusivity by maternal prepregnancy weight: 2004-2011.

Objective: To examine trends in breastfeeding initiation, continuation, and exclusivity by prepregnancy weight from 2004 to 2011 and the associations between these outcomes and prepregnancy weight.

Methods: Data from the 2004 to 2011 Pregnancy Risk Assessment Monitoring System, a survey of women with a recent live birth from 34 states and New York City, were used. Trends in breastfeeding initiation, continuation, and exclusivity at 12 weeks postpartum were evaluated by prepregnancy BMI.

Breastfeeding initiation among macrosomic infants born to obese nondiabetic mothers.

Background: Women who are overweight or obese are at risk for maternal and neonatal medical complications, including macrosomia (birth weight ≥4,000 g), that may contribute to breastfeeding initiation failure. This study examined factors associated with breastfeeding initiation among obese women without diabetes who delivered macrosomic infants.

Study Design And Methods: A retrospective chart review was conducted from 2008 to 2011.

Pediatrics residents' preparedness for neonatal resuscitation assessed using high-fidelity simulation.

Background: Pediatrics residents are expected to demonstrate preparedness for neonatal resuscitation, yet research has shown gaps in residents' readiness to perform this skill.

Objective: To evaluate procedural skills and team performance of pediatrics residents during neonatal resuscitation (NR) using a high-fidelity mannequin, and to assess residents' confidence in their NR skills before and after training.

Methods: Two teams of residents (all had completed NR program training) participated in 2 separate, 90-minute sessions (2 to 3 weeks apart) in an off-site delivery room during their neonatal intensive care rotation.

Neonatal outcomes following in utero exposure to buprenorphine/naloxone or methadone.

Objectives: To study neonatal outcomes following buprenorphine/naloxone and methadone exposure during pregnancy.

Methods: This study is a retrospective review of clinical and demographic information of 58 infants whose mothers were treated with buprenorphine/naloxone and 92 infants whose mothers were treated with methadone for opioid dependence during pregnancy.

Results: Gestational age, birth weight, prematurity, admission to neonatal intensive care unit, and length of stay were similar between both groups of infants.

Delivery room triage of large for gestational age infants of diabetic mothers.

Objective: To review our 4-year experience (2008-2011) with delivery room triage of large for gestational age infants of diabetic mothers.

Design/methods: Retrospective cohort investigation of 311 large for gestational age infants of diabetic mothers (White's Class A1 (77), A2 (87), B (77), and C-R (70)).

Results: Of 311 women, 31% delivered at 34-36 weeks gestational age and 69% at term.

Breast-feeding initiation in women with pregestational diabetes mellitus.

Objective: To examine feeding practices and factors associated with breast-feeding initiation (BFI) in women with pregestational diabetes mellitus (PGDM) and their infants.

Methods: In all, 392 PGDM (135 late preterm and 257 term) pregnancies were studied. Infant feeding preference was ascertained on admission.

Deliberate practice improves pediatric residents' skills and team behaviors during simulated neonatal resuscitation.

Objective: To evaluate the skills and team behavior of pediatric residents during resuscitation with a high-fidelity mannequin before and after a deliberate practice intervention.

Methods: Each month residents participate in two 90-minute videorecorded sessions (2-3 weeks apart) in an "off-site" delivery room during their neonatal ICU rotation. Teams responded to a scenario that required 5 skills (positive pressure ventilation, chest compressions, endotracheal intubation, umbilical vein catheterization, and epinephrine administration).

Early feeding and neonatal hypoglycemia in infants of diabetic mothers.

Objectives: To examine the effects of early formula feeding or breast-feeding on hypoglycemia in infants born to 303 A1-A2 and 88 Class B-RF diabetics.

Methods: Infants with hypoglycemia (blood glucose < 40 mg/dL) were breast-fed or formula-fed, and those with recurrences were given intravenous dextrose.

Results: Of 293 infants admitted to the well-baby nursery, 87 (30%) had hypoglycemia, corrected by early feeding in 75 (86%), while 12 (14%) required intravenous dextrose.

Breastfeeding in women with severe preeclampsia.

Background: In the United States, breastfeeding initiation is reported for 75% of all live births; however, little information is available for mothers affected by severe preeclampsia (SP) who because of magnesium sulfate treatment are separated from their infants in the immediate postpartum period. This study examined feeding practices and factors associated with breastfeeding initiation in 281 women with SP and their 200 late-preterm and 81 term infants.

Subjects And Methods: SP was diagnosed according to established clinical and laboratory criteria.

Maternal preeclampsia and neonatal outcomes.

Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus.

Use of polyethylene bags in extremely low birth weight infant resuscitation for the prevention of hypothermia.

Objective: To compare the clinical responses of extremely low birth weight (ELBW) infants resuscitated in polyethylene bags with ELBW infants who were resuscitated using traditional temperature control measures.

Study Design: Retrospective cohort investigation of 70 ELBW infants who were resuscitated using polyethylene bags (study) and 70 ELBW infants (control) resuscitated without polyethylene bags matched by birth weight, gestational age and gender.

Results: Infants in the study and control groups were comparable demographically and in obstetric risk factors.

High-dose methadone in pregnant women and its effect on duration of neonatal abstinence syndrome.

Objective: The purpose of this study was to examine high-dose methadone in pregnant women and its effect on the duration of neonatal abstinence syndrome.

Study Design: This was a retrospective chart review of 68 neonates and their mothers who received methadone therapy during pregnancy. The last dosage of maternal methadone just before delivery and the length of treatment for neonatal abstinence syndrome were examined with an analysis of variance model.

Use of recombinant human erythropoietin and risk of severe retinopathy in extremely low-birth-weight infants.

Study Objectives: To evaluate the frequency and severity of retinopathy of prematurity in extremely low-birth-weight (ELBW) infants who received recombinant human erythropoietin (rHuEPO), and to compare the frequency of blood cell transfusions these infants required with a matched control group who did not receive rHuEPO.

Design: Retrospective cohort analysis.

Setting: Level III neonatal intensive care unit in a large academic medical center.

Monochorionic diamniotic infants without twin-to-twin transfusion syndrome.

Background: Monochorionic-diamniotic twins (MoDi) occur in 0.3% of all pregnancies. Twin-to-twin transfusion syndrome (TTS) that occurs in 20% of MoDi pregnancies is associated with high perinatal morbidity and mortality.

Mean arterial pressure in concordant and discordant triplets during the first week of life.

Objective: To retrospectively determine mean arterial pressure (MAP) for stable concordant and discordant triplets during the first 7 days of life.

Background: Morbidity and mortality for prematurely born triplets is high, therefore, MAP monitoring during the first day of life is important for their clinical management. MAP reference values for special populations such as triplets have not been published.

Enteric gram-negative bacilli bloodstream infections: 17 years' experience in a neonatal intensive care unit.

Objective: To assess the occurrence of enteric gram-negative bacilli (EGNB) bloodstream infections (BSI) in a neonatal intensive care setting during a 17-year period in which a consistent antibiotic treatment program was in place. To document infections, outbreaks, or epidemics, emergence of antibiotic resistance, clinical correlates, and outcomes of the most prevalent EGNB (Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae).

Methods: This study analyzed demographic, clinical, and bacteriologic information from 360 infants born 1986-2002 who developed 633 blood culture-proven BSI.

Impact of computerized physician order entry on clinical practice in a newborn intensive care unit.

Objective: To study the impact of computerized physician order entry (CPOE) on selected neonatal intensive care unit (NICU) practices.

Design: Retrospective review.

Setting: Nursing units in an academic health system where CPOE has been implemented in adult services since 2000 and in the NICU since 2002.

Mean arterial pressure in very low birth weight (801 to 1500 g) concordant and discordant twins during the first day of life.

Objective: To determine retrospectively mean arterial pressure (MAP) for stable and unstable concordant and discordant very low birth weight (VLBW: 801 to 1500 g) twins during the first 24 hours of life.

Background: Morbidity and mortality are much higher for extremely low birth weight (ELBW < or =800 g) than for VLBW twins. Recently, we reported MAP trends and reference values in concordant and discordant ELBW twins.

Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants.

Objectives: To study multicenter antibiotic practices for suspected early-onset sepsis (EOS) with negative blood cultures (NegBCs) and to identify opportunities for reduction of antimicrobial exposure.

Design: Retrospective study.

Setting: Thirty academic hospitals (University HealthSystem Consortium) located in 24 states.

Mean arterial pressure in extremely low birth weight concordant and discordant twins during the first day of life.

Objective: To determine mean arterial pressure (MAP) values during the first 24 hours for stable concordant and discordant extremely low birth weight (ELBW) twins and to ascertain its association with perinatal factors.

Background: In ELBW infants, whether singletons or concordant or discordant twins, hypotension is diagnosed by nonspecific clinical signs together with reference arterial pressure values extrapolated from regression models or from scarce actual observations.

Design: Retrospective cohort study.

Mean arterial pressures during the first 24 hours of life in < or = 600-gram birth weight infants.

Objective: To determine mean arterial pressure values during the first 24 hours for "stable" and "unstable" extremely low birth weight (ELBW) infants and to ascertain its association with perinatal factors.

Background: In ELBW infants, hypotension is diagnosed by nonspecific clinical signs together with reference arterial pressure values extrapolated from regression models or from scarce actual observations.

Design: Retrospective cohort study.

Surveillance of ventilator-associated pneumonia in very-low-birth-weight infants.

Background: Surveillance of ventilator-associated pneumonia (VAP) is an essential part of quality patient care. Very-low-birth-weight (VLBW) infants, many with tracheal microbial colonization and bronchopulmonary dysplasia (BPD), comprise a difficult group in whom to make a diagnosis of pneumonia with the Centers for Disease Control and Prevention (CDC) criteria for infants younger than 1 year.

Objective: Our objective was to retrospectively compare VAP surveillance diagnoses made by the hospital infection control practitioner (ICP) with those made by a panel of experts with the same clinical and laboratory evidence and supportive radiologic data.