bluuebunny/crossref_metadata_2025_split huggingface dataset:
Red cell use in trauma
Authors: Shander Aryeh , Zacharowski Kai , Spahn Donat R. 
Published: February 2020

Purpose of review
Red cell transfusions are commonly used in management of hemorrhage in trauma patients. The appropriate indications and criteria for transfusion are still debated. Here, we summarize the recent findings on the use of red cell transfusion in trauma setting.

Recent findings
Recent evidence continues to support the long-established link between allogeneic transfusion and worse clinical outcomes, reinstating the importance of more judicious use of allogeneic blood and careful consideration of benefits versus risks when making transfusion decisions. Studies support restrictive transfusion strategies (often based on hemoglobin thresholds of 7–8 g/dl) in most patient populations, although some argue more caution in specific populations (e.g. patients with traumatic brain injury) and more studies are needed to determine if these patients benefit from less restrictive transfusion strategies. It should be remembered that anemia remains an independent risk factor for worse outcomes and red cell transfusion does not constitute a lasting treatment. Anemia should be properly assessed and managed based on the cause and using hematinic medications as indicated.

Summary
Although the debate on hemoglobin thresholds for transfusion continues, clinicians should not overlook proper management of the underlying issue (anemia).
Variables Associated With Administration of Nurse-initiated Analgesia in Pediatric Triage
Authors: Shavit Itai , Hecht-Sagie Lior , Allon Raviv , Leiba Ronit , Barbi Egidio , Poonai Naveen , Shavit Danielle , Feldman Oren 
Published: February 2020

Objectives:
Triage nurse-initiated analgesia (TNIA) has been shown to be associated with decreased time to the provision of analgesia and improved patient satisfaction. We examined variables that influence the provision of analgesia in a pediatric emergency department that uses TNIA.

Methods:
A 4-year retrospective cohort study of all children with triage pain scores ≥1 was conducted. Data on demographics and patients’ and nurses’ characteristics were collected. Logistic regression analyses were used to examine the effect of multiple variables on the provision of any analgesia and opioid analgesia.

Results:
Overall, 28,746 children had triage pain scores ≥1; 14,443 (50.2%) patients received analgesia of any type and 1888 (6.6%) received opioid analgesia. Mean time to any analgesia was 8.0±3.7 minutes. Of the 9415 patients with severe pain, 1857 (19.7%) received opioid analgesia. Age, sex, hourly number of patients waiting to be triaged, and nurse experience were not associated with the provision of any analgesia or opioid analgesia. Severe pain had the highest odds ratios (ORs) for the provision of any analgesia and opioid analgesia (7.7; 95% confidence interval [CI]: 7.1-8.2 and 22.8; 95% CI: 18.1-28.8, respectively). Traumatic injury and time-to-triage <8 minutes were associated with the provision of opioid analgesia (OR: 4.7; 95% CI: 4.2-5.2 and OR: 1.6; 95% CI: 1.5-1.8, respectively).

Discussion:
TNIA yielded a short time to analgesia, but rates of any analgesia and opioid analgesia were low. Several variables associated with the provision of any analgesia and opioid analgesia were identified. Our findings provide evidence to guide future educational programs in this area.
Gay Fatherhood in the NICU
Authors: Logan Rickey 
Published: February 2020

Background:
With advances in reproductive health, gay males are increasingly given the opportunity to reproduce. It is not a common occurrence for infants of gay male fathers to enter the neonatal intensive care unit (NICU); however, this may change and should be acknowledged.

Purpose:
To give insight into the barriers, perspectives, and stresses of gay male caregivers (families) in their time spent in the NICU and to offer recommendations as to how better to serve them and their families.

Methods/Search Strategy:
Searched using PubMed, CINAHL, SCOPUS, and Google Scholar. Key words used were “gay families,” “fatherhood,” “neonatal intensive care unit,” “lesbians,” and “surrogacy.”

Findings/Results:
There remains a very limited amount of data for healthcare providers as these relate to gay male fathers in the NICU, aside from narratives. Most of the research and literature that highlight potential barriers stem from heterosexual fatherhood in the NICU and lesbian parenting in the healthcare system.

Implications for Practice:
To have an understanding and knowledge to improve support for gay fathers in the NICU.

Implications for Research:
Research on gay fathers in the NICU and further research on lower economic gay fatherhood and gay men of color and fatherhood are required. Because of the small sample size, multicentered studies may warranted to aid in clinical significance.
Association of Time of Delivery With Composite Adverse Outcomes in Low-Risk Pregnancies
Authors: Wagner Stephen M. , Chen Han-Yang , Gupta Megha , Chauhan Suneet P. 
Published: February 2020

OBJECTIVE:
To compare the composite neonatal and maternal adverse outcomes among low-risk pregnant women who labor and subsequently deliver at different time shifts.

METHODS:
This was a population-based retrospective cohort study using the U.S. vital statistics data set on Period Linked Birth-Infant Death Data from 2012 to 2016. The study population was restricted to live births from low-risk women with nonanomalous singletons who labored and delivered at 37 0/7 to 41 6/7 weeks of gestation. Time of delivery was categorized as the first shift (7:00–15:00), the second shift (15:00–23:00), and the third shift (23:00–7:00). The primary outcome was composite neonatal adverse outcome, and the secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models were used to estimate the association between the time of delivery and adverse outcomes (using adjusted relative risk [aRR] and 95% CI).

RESULTS:
Of 19.9 million live births during the study period, 58.8% (more than 11.6 million) met the inclusion criteria. The overall composite neonatal adverse outcome was 6.6 per 1,000 live births. The multivariable adjusted analysis demonstrated that, compared with neonates delivered at the first shift, the risk of composite neonatal adverse outcome was higher at the second shift (relative risk [RR] 1.15, aRR 1.07, 95% CI 1.05–1.09), and the third shift (RR 1.28, aRR 1.24, 95% CI 1.22–1.27). The overall composite maternal adverse outcome was 2.45 per 1,000 live births. After adjustment, there was no significant difference in the risk of composite maternal adverse outcome based on the time of delivery.

CONCLUSION:
Among low-risk singleton pregnancies, compared with delivery at 7:00–15:00, the composite neonatal adverse outcome is marginally but significantly higher if the delivery occurs at the second (15:00–23:00) and the third (23:00–7:00) shifts. The composite maternal adverse outcome is similar among the three different time shifts.
Association of Overweight and Obesity Development Between Pregnancies With Stillbirth and Infant Mortality in a Cohort of Multiparous Women
Authors: Yu Ya-Hui , Bodnar Lisa M. , Himes Katherine P. , Brooks Maria M. , Naimi Ashley I. 
Published: February 2020

OBJECTIVE:
To identify the association of newly developed prepregnancy overweight and obesity with stillbirth and infant mortality.

METHODS:
We studied subsequent pregnancies of mothers who were normal weight at fertilization of their first identified pregnancy, from a population-based cohort that linked birth registry with death records in Pennsylvania, 2003–2013. Women with newly developed prepregnancy overweight and obesity were defined as those whose body mass index (BMI) before second pregnancy was between 25 and 29.9 or 30 or higher, respectively. Our main outcomes of interest were stillbirth (intrauterine death at 20 weeks of gestation or greater), infant mortality (less than 365 days after birth), neonatal death (less than 28 days after birth) and postneonatal death (29–365 days after birth). Associations of both prepregnancy BMI categories and continuous BMI with each outcome were estimated by nonparametric targeted minimum loss-based estimation and inverse-probability weighted dose–response curves, respectively, adjusting for race–ethnicity, smoking, and other confounders (eg, age, education).

RESULTS:
A cohort of 212,889 women were included for infant mortality analysis (192,941 women for stillbirth analysis). The crude rate of stillbirth and infant mortality in these final analytic cohorts were 3.3 per 1,000 pregnancies and 2.9 per 1,000 live births, respectively. Compared with women who stayed at a normal weight in their second pregnancies, those becoming overweight had 1.4 (95% CI 0.6–2.1) excess stillbirths per 1,000 pregnancies. Those becoming obese had 3.6 (95% CI 1.3–5.9) excess stillbirths per 1,000 pregnancies and 2.4 (95% CI 0.4–4.4) excess neonatal deaths per 1,000 live births. There was a dose–response relationship between prepregnancy BMI increases of more than 2 units and increased risk of stillbirth and infant mortality. In addition, BMI increases were associated with higher risks of infant mortality among women with shorter interpregnancy intervals (less than 18 months) compared with longer intervals.

CONCLUSION:
Transitioning from normal weight to overweight or obese between pregnancies was associated with an increased risk of stillbirth and neonatal mortality.
Placental Growth Factor and the Risk of Adverse Neonatal and Maternal Outcomes
Authors: Parchem Jacqueline G. , Brock Clifton O. , Chen Han-Yang , Kalluri Raghu , Barton John R. , Sibai Baha M. ,   for the Preeclampsia Triage by Rapid Assay Trial (PETRA) Investigators
Published: February 2020

OBJECTIVE:
To evaluate whether abnormal plasma placental growth factor (PlGF) level is associated with adverse neonatal and maternal outcomes.

METHODS:
This was a secondary analysis of the Preeclampsia Triage by Rapid Assay Trial (PETRA), a prospective, multicenter, observational study that enrolled women with suspected preeclampsia. Our analysis included women age 18–45 years with a singleton pregnancy between 20 and 41 weeks of gestation. Plasma collected at enrollment was used for PlGF measurement. Abnormal PlGF was defined as low (100 pg/mL or less) or very low (less than 12 pg/mL). The primary outcomes were composite adverse neonatal and maternal outcomes. We used multivariable Poisson regression models to examine the association between PlGF and outcomes.

RESULTS:
Of 1,112 women who met the inclusion criteria, plasma PlGF was low in 742 (67%) and very low in 353 (32%). In the cohort, the overall rates of the composite adverse neonatal and maternal outcomes were 6.4% and 4.8%, respectively. Compared with normal PlGF (more than 100 pg/mL), low PlGF was significantly associated with an increased risk of the composite neonatal outcome (9.2% vs 0.8%; adjusted relative risk [aRR] 17.2, 95% CI 5.2–56.3), and the composite maternal outcome (6.2% vs 1.9%; aRR 3.6, 95% CI 1.7–8.0). Very low PlGF was also significantly associated with both neonatal and maternal outcomes. The sensitivity and specificity of low PlGF were 95.8% and 35.3%, respectively, for the composite neonatal outcome, and 86.8% and 34.3% for the composite maternal outcome. Although the positive predictive values were low (9.2% and 6.2%, respectively), the negative predictive value of low PlGF for neonatal and maternal outcomes was 99.2% and 98.1%, respectively.

CONCLUSION:
Among women being evaluated for preeclampsia, those with abnormal PlGF are significantly more likely to experience adverse neonatal and maternal outcomes. These outcomes occur infrequently when the PlGF is normal. These findings suggest that PlGF may be useful for risk stratification of women with suspected preeclampsia.

FUNDING SOURCE:
No funding was received for this study. The original PETRA study was supported by funding from Alere.
Maternal Sense of Control During Childbirth and Infant Feeding Method
Authors: Dude Annie , Fette Lida M. , Reddy Uma M. , Tita Alan T.N. , Silver Robert M. , El-Sayed Yasser Y. , Wapner Ronald J. , Rouse Dwight J. , Saade George R. , Thorp John M. , Chauhan Suneet P. , Iams Jay D. , Chien Edward K. , Casey Brian M. , Srinivas Sindhu K. , Swamy Geeta K. , Simhan Hyagriv N. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network
Published: February 2020

OBJECTIVE:
To estimate whether maternal sense of control in labor is associated with breastfeeding at 4–8 weeks postpartum.

METHODS:
This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6–96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4–8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders.

RESULTS:
Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4–8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145–182). The median Labor Agentry Scale score was 169 (interquartile range 151–183) for women exclusively breastfeeding, 166 (interquartile range 142–182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142–181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant.

CONCLUSION:
After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4–8 weeks postpartum among nulliparous women.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01990612.
Multidrug Therapy for Refractory Immune Thrombocytopenia in Pregnancy
Authors: Chon Andrew H. , Chan Randall , Lee Richard H. , Kwong Kenny , Wertheimer Fiona B. , Weitz Ilene C. 
Published: February 2020

BACKGROUND:
Severe immune thrombocytopenia complicating pregnancy may require treatment beyond first-line medications (intravenous immunoglobulins or corticosteroids), but there is a paucity of literature on the use of such second-line agents in pregnancy.

CASE:
The patient is a 29-year-old woman with early-onset severe immune thrombocytopenia at 13 weeks of gestation. Maternal platelet counts reached a nadir of less than 5×109/L. The thrombocytopenia persisted despite first-line medications. Romiplostim, rituximab, and azathioprine were added to the therapeutic regimen. Platelet counts eventually stabilized at greater than 150×109/L before delivery. After delivery at term, the neonate had transient B-cell suppression, which was presumed to be secondary to rituximab, but was otherwise doing well and meeting all milestones at 7 months of age.

CONCLUSION:
The addition of second-line agents was associated with sustained elevation in maternal platelet counts and may have obviated the need for splenectomy.
Occult Tubal Carcinoma After Risk-Reducing Salpingo-oophorectomy
Authors: Piedimonte Sabrina , Frank Cairina , Laprise Claudie , Quaiattini Andrea , Gotlieb Walter H. 
Published: February 2020

OBJECTIVE:
To perform a systematic review of the literature to estimate the prevalence and outcomes of occult tubal carcinoma in BRCA mutation carriers and high-risk patients undergoing risk-reducing salpingo-oophorectomy.

DATA SOURCE:
A search was done using OVID MEDLINE, EMBASE, and ClinicalTrials.gov between 1946 and March 2019 with keywords and MeSH terms selected by an expert medical librarian and coauthors.

METHODS OF STUDY SELECTION:
Two independent reviewers performed study selection with an initial screen on abstracts and a second on full articles. Articles were rejected if they were irrelevant to the study question, pertained to a different population or did not report occult tubal neoplasia. Quality was assessed using methodologic index for nonrandomized studies criteria.

TABULATION, INTEGRATION, AND RESULTS:
Data were extracted and recorded in an Excel database. Forest plots for the prevalence of occult carcinoma were done using STATA. Among 2,402 studies assessed, 27 met the inclusion criteria for qualitative and quantitative analysis. A total of 6,283 patients underwent risk-reducing salpingo-oophorectomy between 2002 and 2019: 2,894 cases were BRCA1, 1,579 BRCA2, and 1,810 high-risk based on family history. Among these, 75 patients were diagnosed with occult tubal carcinoma at the time of surgery. The pooled prevalence was 1.2% (I2=7.1%, P=.363) occurring at a median age of 53.2 years (range 42.4–67). In a subanalysis of 18 studies reporting follow-up data, 10 recurrences (18.7%, 95% CI 7.5–53%) and 24 cases of post–risk-reducing salpingo-oophorectomy peritoneal cancer (0.54%, 95% CI 0.4–1.9%) were reported after a median follow-up of 52.5 months. BRCA1, older age, and previous breast cancer were more often associated with occult malignancy.

CONCLUSION:
Occult tubal carcinomas found at risk-reducing salpingo-oophorectomy in high-risk patients and BRCA mutation carriers have significant potential for recurrence despite the frequent administration of postoperative chemotherapy.
A Collaborative Model of a Community Birth Center and a Tertiary Care Medical Center
Authors: Lotshaw Richard R. , Phillippi Julia C. , Buxton Margaret , McNeill-Simaan Edwina , Newton J Michael 
Published: February 2020

OBJECTIVE:
To describe the development, implementation, and evaluation of a collaborative model between a freestanding birth center and a tertiary care medical center.

METHODS:
An interdisciplinary team developed a freestanding accredited birth center in collaboration with a tertiary care medical center in the southeast United States. We performed a retrospective cohort study of all women obtaining care at the birth center and assessed the rate (and 95% CIs) of cesarean delivery, patient transfers, and adverse maternal and neonatal events.

RESULTS:
Between January 2017 and December 2018, 1,394 women initiated prenatal care at the birth center. The study cohort consisted of 1,061 women who continued their prenatal care and planned to deliver at the birth center, of whom 358 (34%) were subsequently transferred before admission and 703 (66%) presented to the birth center in labor. Of those, 573 (82%) were subsequently delivered vaginally in the birth center, and 130 (18%) were transferred for hospital birth. Of those admitted to the birth center in labor, 41 ultimately underwent cesarean delivery for an overall cesarean delivery rate of 6% (95% CI 4–8%). Maternal transfers for postpartum hemorrhage occurred in eight patients (1%; 95% CI 1–2%). There were 39 neonatal intensive care admissions (6%; 95% CI 4–8%), eight cases (1%; 95% CI 0.5–2%) of 5-minute Apgar scores less than 7, and two previable neonatal deaths (0.3%; 95% CI 0–1%).

CONCLUSION:
We describe a collaborative model between a freestanding birth center and a tertiary care medical center, which provided women with access to a traditional birth center experience while maintaining access to the specialized care provided by a tertiary care medical center. We believe that the model may facilitate options for maternity care in regional perinatal systems.
The 5-Year Outcome of the Ponseti Method in Children With Idiopathic Clubfoot and Arthrogryposis
Authors: Church Chris , McGowan Abigail , Henley John , Donohoe Maureen , Niiler Tim , Shrader Michael W. , Nichols Louise R. 
Published: February 2020

Background:
The Ponseti method effectively treats idiopathic clubfoot, but its effectiveness in treating the stiffer clubfoot associated with arthrogryposis is less clear. The purpose of this study was to assess the comparative effectiveness of the Ponseti method in 5-year-old children with either idiopathic clubfoot or clubfoot due to arthrogryposis.

Methods:
The outcomes of the Ponseti method were retrospectively evaluated in children with idiopathic clubfoot and clubfoot associated with arthrogryposis. The children with clubfoot were seen at our hospital between 2012 and 2019 and were 4.0 to 6.9 years old at the time of their evaluation. Outcomes of the 2 groups of children with clubfoot were assessed using passive range of motion, foot pressure analysis, the Gross Motor Function Measure Dimension-D, and parent report using the Pediatric Outcomes Data Collection Instrument. These results were also compared with the same measures from a group of typically developing children. Surgical and bracing history was also recorded.

Results:
A total of 117 children were included (89 idiopathic clubfoot and 28 associated with arthrogryposis) with an average age of 4.8±0.8 years. The historical gait analyses of 72 typically developing children were used as a control, with an average age of 5.2±0.8 years. Significant residual equinovarus was seen in both children with idiopathic clubfoot and associated with arthrogryposis according to passive range of motion and foot pressure analysis when compared with normative data. Children with arthrogryposis demonstrated limited transfer and basic mobility, sports functioning, and global functioning while children with idiopathic clubfoot were significantly different from their typically developing peers in only transfer and basic mobility.

Conclusions:
Although children with idiopathic clubfoot continue with some level of residual deformity, the Ponseti method is effective in creating a pain-free, highly functional foot. In children with clubfoot associated with arthrogryposis, the Ponseti method is successful in creating a braceable foot that can delay the need for invasive surgical intervention.

Level of Evidence:
Level III, Therapeutic Studies—Investigating the Results of Treatment.