The purpose of this study is to develop a scale (Perinatal Anxiety Screening Scale, PASS) to screen for a broad range of problematic anxiety symptoms which is sensitive to how anxiety presents in perinatal women and is suitable to use in a variety of settings including antenatal clinics, inpatient and outpatient hospital and mental health treatment settings. Women who attended a tertiary obstetric hospital in the state of Western Australia antenatally or postpartum (n = 437) completed the PASS and other commonly used measures of depression and anxiety. Factor analysis was used to examine factor structure, and ROC analysis was used to evaluate performance as a screening tool. The PASS was significantly correlated with other measures of depression and anxiety. Principal component analyses (PCA) suggested a four-factor structure addressing symptoms of (1) acute anxiety and adjustment, (2) general worry and specific fears, (3) perfectionism, control and trauma and (4) social anxiety. The four subscales and total scale demonstrated high to excellent reliabilities. At the optimal cutoff score for detecting anxiety as determined by ROC analyses, the PASS identified 68 % of women with a diagnosed anxiety disorder. This was compared to the EPDS anxiety subscale which detected 36 % of anxiety disorders. The PASS is an acceptable, valid and useful screening tool for the identification of risk of significant anxiety in women in the perinatal period.

A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions.

Background: Early-onset sepsis (EOS) is a potentially fatal condition that affects about 0.3–0.8/1,000 infants born at ≥35 weeks’ gestation in developed countries. Current EOS management algorithms result in 8–15% of infants receiving antibiotics for suspected sepsis. The Neonatal Sepsis Calculator provides evidence-based estimates of individual sepsis risk, but data on its clinical application is limited. Objectives: To evaluate the feasibility, safety, and effect on the newborn infants that were investigated and that received antibiotic treatment for suspected EOS following the introduction of the Neonatal Sepsis Calculator. Methods: This was a prospective, observational, single-centre cohort study comparing the rates of newborn infants born at ≥35 weeks’ gestation requiring evaluation and/or treatment for suspected EOS in a large tertiary perinatal centre before versus after the prospective introduction of the Neonatal Sepsis Calculator (Epoch 1: October 2014 to January 2015 vs. Epoch 2: July to December 2016). Results: There were 1,732 and 2,502 eligible infants born during Epochs 1 and 2, respectively. Of these, 425 (24.2%) and 530 (21.2%), respectively, were admitted to the neonatal unit. The proportion of infants investigated for sepsis decreased from 15.2 to 11.1%, and that of infants treated with antibiotics from 12.0 to 7.6%. One case of EOS occurred during each Epoch. Conclusions: The implementation of the Neonatal Sepsis Calculator was feasible and safe in our unit. Application of this clinical decision support tool may reduce the number of infants undergoing investigations and empirical treatment for suspected EOS.

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Short running head: Physiology of impaired gas exchange in BPD Descriptor: 14.3 Manuscript Body Word Count: 3639 At a Glance Commentary: Scientific Knowledge on the Subject: Assessment of impaired gas exchange may provide a continuous outcome measure for sensitive and equitable determination of severity of bronchopulmonary dysplasia (BPD). Previous gas exchange studies in BPD infants used small cohorts and targeted moderate-severe BPD. These studies show right shift of the peripheral oxyhemoglobin saturation (SpO2) versus inspired oxygen partial pressure (PIO2) curve and reduced ventilation-perfusion ratio reliably predict hypoxaemia in preterm infants breathing air, and further, that many infants also have a right-left shunt. What This Study Adds to the Field: We provide measures of right shift, ventilation/perfusion and shunt, across the full spectrum of lung disease in a large (n=219) group of preterm infants. Shift increases and ventilation/perfusion decreases with increased severity of BPD as defined by the NIH classification of BPD. Shunt is primarily a feature of infants with moderate-severe BPD who require supplemental oxygen. Non-invasive bedside assessment of shift, ventilation/perfusion and shunt provide physiological continuous outcome measures of severity of respiratory disease in very preterm infants with/without BPD independent of altitude and unit practices. Routine analysis of the SpO2/PIO2 curve may improve accuracy of BPD severity classification and provide a sensitive continuous outcome measure for clinical trials evaluating pulmonary outcomes.