Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Haidari, Eman S.; Lee, Henry; Illuzzi, Jessica L.; Phibbs, Ciaran S.; Lin, Haiqun; Xu, Xiao

doi:10.1038/s41372-020-00775-z

Cited by 46 publications

(37 citation statements)

References 17 publications

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“…The newborns of COVID-19 positive women were two times as likely to be admitted to the NICU. The rate of 16% of NICU admission of newborns of COVID positive women is higher than expected NICU admission based on pre-COVID samples 27 and accords with other COVID studies 9 . Physical contact and proximity in the hours of life has known benefits for maternal and infant health.…”

Section: Discussionsupporting

confidence: 90%

COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital

Mayopoulos

Ein‐Dor

et al. 2021

Sci Rep

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As the novel coronavirus (COVID-19) has spread globally, a significant portion of pregnant and delivering women were infected with COVID-19. While emerging studies examined birth outcomes in COVID-19 positive women, knowledge of the psychological experience of childbirth and maternal wellness remains lacking. This matched-control survey-based study included a sample of women recruited during the first wave of the pandemic in the US who gave birth in the previous six months. Women reporting confirmed/suspected COVID-19 (n = 68) during pregnancy or childbirth were matched on background factors with women reporting COVID-19 negativity (n = 2,276). We found nearly 50% of COVID positive women endorsed acute traumatic stress symptoms at a clinical level in response to childbirth. This group was more than twice as likely to endorse acute stress and to have no visitors during maternity hospitalization than COVID negative women; they were also less likely to room-in with newborns. The COVID positive group reported higher levels of pain in delivery, lower newborn weights, and more infant admission to neonatal intensive care units. Our findings suggest COVID-19 affected populations are at increased risk for traumatic childbirth and associated risk for psychiatric morbidity. Attention to delivering women’s wellbeing is warranted during the pandemic.

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Section: Discussionsupporting

confidence: 90%

COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital

Mayopoulos

Ein‐Dor

et al. 2021

Sci Rep

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“…Overall, our work in neonatal piglets implies that reduced maternal bonding and formula feeding can impair postnatal lung development in newborns. This is particularly important for preterm infants, with a global rate of approximately 11% (54), and other high-risk infants, with a recent study from the United States showing that 6.3% of all infants born are admitted to a neonatal intensive care unit (NICU) (55). Admission to the NICU interrupts the mother-infant bonding and the establishment of breastfeeding, resulting in lower long-term breastfeeding rates, with implications for infant health (55)(56)(57).…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly important for preterm infants, with a global rate of approximately 11% (54), and other high-risk infants, with a recent study from the United States showing that 6.3% of all infants born are admitted to a neonatal intensive care unit (NICU) (55). Admission to the NICU interrupts the mother-infant bonding and the establishment of breastfeeding, resulting in lower long-term breastfeeding rates, with implications for infant health (55)(56)(57). Furthermore, our data clearly indicate that increasing the use of breast milk, whether through breastfeeding or donated breast milk, and equally important maternal contact during the early neonatal period are intervention measures to promote postnatal lung development.…”

Section: Discussionmentioning

confidence: 99%

Influence of Nutrition and Maternal Bonding on Postnatal Lung Development in the Newborn Pig

Schlosser-Brandenburg

Ebner

Klopfleisch

et al. 2021

Front. Immunol.

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BackgroundMicrobial colonization and immune cell maturation coincide at mucosal sites and are decisive for postnatal lung development. How external factors influence neonatal pulmonary immune development is poorly understood.ObjectiveTo elucidate the impact of key determinants in early life, nutrition, and maternal bonding, on postnatal lung maturation in a human-relevant animal model. To investigate the underlying immunological changes of impaired lung maturation and study the mechanisms of conversion.MethodsNewborn piglets were kept with or without isolation from their mothers and fed bovine milk-based infant formula or received milk of sow. Lung growth, histomorphology, respiratory immune responses, and lung microbiota were analyzed. Mother- and sow-milk-deprived piglets received maternal material or were reintroduced to the maternal environment at varying intervals to study options for reversal.ResultsFormula feeding combined with isolation of newborn piglets resulted in disturbed postnatal lung maturation. Reduced lung growth correlated with dampened IL-33 expression, impaired lung myeloid cell activation, and decreased Th1 differentiation, along with diminished richness and diversity of the lung microbiota. Transfer of bacteria-enriched maternal material reversed the negative effects on pulmonary immune maturation. Early (within 3 days) but not late (within 7 days) reintroduction to the mother allowed restoration of normal lung development.ConclusionOur findings reveal that lung growth, respiratory immunity, and microbial lung colonization in newborns depend on postnatal diet and maternal contact, and targeting these key regulators could promote lung development during this critical life stage.SummaryDisturbances in natural diet and reduced maternal contact during the neonatal period impair postnatal lung maturation. In pediatrics, timely breast milk feeding and intensive maternal bonding represent valuable intervention measures to promote early postnatal lung development.

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“…For example, two studies remarked the occurrence of unnecessary NICU admissions in recent years. [36,37] Thus, to reduce unnecessary NICU admission, the need to scrutinize and loosen the NICU admission criteria was suggested; doing so may thereby decrease adverse breast-feeding events resulted from unnecessary NICU admission.…”

Section: Discussionmentioning

confidence: 99%

Why does mode of conception affect early breast-feeding outcomes? A retrospective cohort study

Weng¹,

Chien²,

Chang³

2020

Preprint

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Background: Women who conceived through Assisted Reproductive Technology (ART) may experience poorer breast-feeding outcomes compared to women who conceived naturally; nevertheless, the mechanism of this relationship has not been explored. This study aimed to examine the effect of mode of conception on breast-feeding outcomes during the first two months postpartum and identify the potential pathways for this relationship.Methods: A retrospective cohort study was conducted in a sample of 5,474 women with live births using hospital administrative data from January 2014 through December 2018. Participants were classified by mode of conception as follows: fertile women who conceived naturally (fertile women; n=4,363), women with infertility who conceived naturally (sub-fertile women; n=706), and women with infertility who conceived through ART (women with infertility; n=405). The patterns of infant feeding were acquired at hospital discharge, the first week, the first month, and the second month postpartum. Binary and multinomial logistic regression and causal mediation analyses were performed.Results: Infertile and sub-fertile women had 34% (95% CI 1.03, 1.73) and 60% (95% CI 1.11, 2.31) increased risks of introducing formula prior to the first week postpartum, respectively, and 31% (95% CI 1.01, 1.70) and 59% (95% CI 1.10, 2.31) higher risks of exclusive breastfeeding for less than one week during the first two months postpartum, respectively, compared to fertile women. The relationships were mediated through delivery complications, multiple gestations, preterm delivery, low birth weight, and admission to neonatal/paediatric intensive care units (NICU/PICU). The path with the highest proportion mediated was through multiple gestations (60.47% for infertile women) and admission to NICU/PICU (68.60-72.61%). The effect of mode of conception on breastfeeding outcomes was not significant in cases of no maternal and infant morbidities. Conclusions: During the first two months postpartum, infertile and sub-fertile women both had short duration (<7 days) of exclusive breastfeeding and introduction of formula prior to the first week postpartum. The relationships were mainly mediated through multiple gestations and admission to NICU/PICU. Designing programmes to reduce adverse maternal and infant health events, like a single embryo transfer policy, is suggested to improve perinatal outcomes, together with the following breast-feeding outcomes.

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Hospital variation in admissions to neonatal intensive care units by diagnosis severity and category

Cited by 46 publications

References 17 publications

COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital

COVID-19 positivity associated with traumatic stress response to childbirth and no visitors and infant separation in the hospital

Influence of Nutrition and Maternal Bonding on Postnatal Lung Development in the Newborn Pig

Why does mode of conception affect early breast-feeding outcomes? A retrospective cohort study

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