Intimate Partner Violence and Depression Screening of Mothers with Infants in the Neonatal Intensive Care Unit.

OBJECTIVE: This study aimed to determine the prevalence of partner violence and depression in neonatal intensive care unit (NICU) mothers. STUDY DESIGN: This was a descriptive study. Mothers were screened in a safe room away from their partner with the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen Tool (AAS) within 2 days of the newborn's admission. The EPDS was administered again 2 weeks later and then at discharge. RESULTS: Nearly 20% of mothers reported on the AAS that they had experienced physical abuse since pregnancy. Abuse significantly predicted baseline depression 48 hours after delivery. A significant relationship emerged between depression and past year partner violence, with 100% experiencing abuse in the past year after pregnancy. Regular hospital intake questions underreported NICU mothers' partner violence experience and feelings of depression. CONCLUSION: There was a marked difference between what mothers reported in their health history at admission versus evidence-based surveys in a private setting. These results challenge assumptions that accurate screening happens at hospital admission. It is imperative to use evidence-based scales after delivery to improve outcomes. KEY POINTS: · Intake questions undermeasure partner violence and depression.. · Clinical depression emerges by 2 weeks postdelivery.. · Screening is optimal postdelivery, rather than at admission..

Effects of prophylactic probiotics supplementation on infants born very preterm or very low birth weight.

OBJECTIVE: To evaluate the effects of guideline-driven prophylactic supplementation of a multi-strain neonatal intensive care unit-specific probiotic product on infants born very preterm (VP) or very low birth weight (VLBW). STUDY DESIGN: A prospective cohort of 125 infants born in one year after implementation who received probiotics were compared to a retrospective cohort of eligible 126 VP or VLBW infants who did not receive probiotics. The primary outcome of interest was necrotizing enterocolitis (NEC). RESULT: The incidence of NEC decreased from 6.3 to 1.6%. After adjusting for multiple variables, there were no significant differences in primary or other outcomes of interest; odds ratio (95% confidence interval) NEC 0.27 (0.05-1.33), death 0.76 (0.26-2.21) and late-onset sepsis 0.54 (0.18-1.63). No adverse effects related to probiotics supplementation were observed. CONCLUSION: Although nonsignificant, prophylactic probiotics supplementation in infants born VP or VLBW was associated with reduction of NEC.

Delayed cord clamping during deliveries with meconium-stained amniotic fluid.

In this cohort study of deliveries affected with meconium, the perinatal factors that were significantly associated with non-performance of delayed cord clamping were primigravida, maternal diabetes, chorioamnionitis, rupture of membranes ≥18 h, assisted vaginal delivery, cesarean section, breech presentation, thick meconium, fetal distress and nonvigorous status of the newborn.

Perinatal risk factors associated with the need for resuscitation in newborns born through meconium-stained amniotic fluid.

OBJECTIVE: The Neonatal Life Support 2020 guidelines emphasize that meconium-stained amniotic fluid (MSAF) remains a significant risk factor for a newborn to receive advanced resuscitation, especially if additional risk factors are present at the time of birth. However, these additional perinatal risk factors are not clearly identified. The purpose of this study was to evaluate the importance of additional independent ante- and intrapartum risk factors in the era of no routine endotracheal suctioning that determine the need for resuscitation in newborns born through MSAF. METHODS: This retrospective cohort study included deliveries ≥ 35 weeks' gestation associated with MSAF that occurred between January 1, 2017 and December 31, 2019. The newborns needing resuscitation (any intervention beyond the initial steps) were compared to those not needing resuscitation. Among newborns needing resuscitation, those needing advanced resuscitation (continuous positive airway pressure/ positive pressure ventilation or beyond) were compared to those not needing advanced resuscitation. RESULTS: Logistic regression analysis revealed that among various perinatal factors, primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age ≥ 42 weeks), cesarean section or shoulder dystocia independently significantly increased the odds of a meconium-stained newborn needing resuscitation. Among these factors, fetal distress, chorioamnionitis or cesarean section independently further increased the odds of needing advanced resuscitation. CONCLUSION: Risk stratification of perinatal factors associated with the need for newborn resuscitation and advanced resuscitation in the deliveries associated with MSAF may help neonatal teams and resources to be appropriately prioritized and optimally utilized.

Comparative effects of latanoprost and latanoprostene bunod on intraocular pressure and pupil size in ophthalmologically normal Beagle dogs.

OBJECTIVE: To compare effects of latanoprost, a topical prostaglandin analogue (PGA) commonly used to treat glaucoma and lens instability in dogs, and latanoprostene bunod, a novel PGA with a nitric oxide-donating moiety, on intraocular pressure (IOP) and pupil diameter (PD). ANIMALS STUDIED: Ten ophthalmologically normal Beagle dogs. PROCEDURES: Dogs were treated twice a day for 5 days in a randomly selected eye with either latanoprost or latanoprostene bunod. After a 6-week washout period, dogs were treated with the opposite drug. IOP and PD were measured at treatment times, at midday on days 1 and 5, and for 6 days post-treatment. RESULTS: Both drugs significantly decreased IOP and PD. At midday on day 5 of treatment, mean IOP in eyes treated with latanoprost was 4.5 mmHg lower than the fellow eye and 3.0 mmHg lower than the same eye at baseline, while mean IOP in eyes treated with latanoprostene bunod was 5.5 mmHg lower than the fellow eye and 3.6 mmHg lower than baseline. Mean PD was 0.94 mm in eyes treated with latanoprost and 0.76 mmHg in eyes treated with latanoprostene bunod. There was no significant difference between the two drugs for either parameter at that time point (p = .372 and .619, respectively, for IOP relative to control and to baseline; p = .076 for PD) or when analyzed longitudinally. Significant diurnal variation in PD was noted and may have implications for treatment of lens' instability. CONCLUSIONS: Latanoprost and latanoprostene bunod produce similar IOP reduction and miosis in normal canine eyes.

The effects of placental transfusion on mothers.

OBJECTIVE: While there is ample evidence supporting delayed cord clamping (DCC) in neonates, the data on the maternal outcomes related to DCC are relatively sparse. Moreover, the outcomes, such as postpartum hemorrhage (PPH), were mostly reported for uncomplicated term vaginal deliveries. The objective of this study was to present the two primary maternal outcomes, incidence of PPH and change in hematocrit pre- and post-delivery in complex situations of preterm deliveries and term cesarean sections. STUDY DESIGN: Maternal data were collected prospectively since the placental transfusion process was implemented in a step-wise fashion in our delivery hospitals, starting August, 2013. These data on very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections with DCC or umbilical cord milking (UCM) were compared with respective retrospective cohorts of deliveries in which immediate cord clamping (ICC) was performed. RESULTS: Comparing very preterm singleton deliveries, the incidence of PPH was similar between the ICC and DCC groups (2.3% vs. 1.7%). There was no significant difference in mean hematocrit change pre- and postdelivery (3.06 ± 1.32 vs. 3.47 ± 1.52). When 45 s DCC cohort was compared with 60 s DCC cohort, there were no significant differences in the incidence of PPH (1.7% vs. 4.8%) or the hematocrit change pre- and postdelivery (3.47 ± 1.52 vs. 4.32 ± 1.88). PPH was not observed in either group when comparing retrospective ICC cohort with prospective DCC cohort with 60 s delay in very preterm twin gestation deliveries. There was no significant difference between the mean hematocrit change pre- and postdelivery (5.5 ± 3.3 vs. 5.8 ± 3.9). When moderate and early late preterm deliveries between 32° to 346 weeks of gestation were compared, there were no differences between the incidence of PPH (0.9% vs. 0%) or hematocrit change pre- and postdelivery (4.2 ± 2.3 vs. 4.8 ± 2.9). Comparing late preterm deliveries between 35° and 366 weeks of gestation, there was no significant difference in the incidence of PPH (13% vs. 11.4%) or the mean hematocrit change pre- and postdelivery (5.0 ± 3.0 vs. 5.1 ± 2.8). In term cesarean deliveries, the incidence of PPH was 2.2% in the retrospective ICC group and 1.4% in the prospective UCM group. There was no difference in mean hematocrit change pre- and postdelivery (5.9 ± 3.7 vs. 6.2 ± 2.8). CONCLUSION: DCC or UCM was not associated with the increased risk for PPH or significant change in maternal hematocrit pre- and postdelivery in very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections.

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother-Baby Unit.

OBJECTIVE: Well-appearing late preterm infants admitted to a mother baby unit may benefit from either delayed cord clamping (DCC) or umbilical cord milking (UCM). However, there are concerns of adverse effects of increased blood volume such as polycythemia and hyperbilirubinemia. The purpose of this study is to examine the short-term effects of placental transfusion on late preterm infants born between 350/7 and 366/7 weeks of gestation. STUDY DESIGN: In this pre- and postimplementation retrospective cohort study, we compared late preterm infants who received placental transfusion (161 infants, DCC/UCM group) during a 2-year period after guideline implementation (postimplementation period: August 1, 2017, to July 31, 2019) to infants who had immediate cord clamping (118 infants, ICC group) born during a 2-year period before implementation (preimplementation period: August 1, 2015, to July 31, 2017). RESULTS: The mean hematocrit after birth was significantly higher in the DCC/UCM group. Fewer infants had a hematocrit <40% after birth in the DCC/UCM group compared with the ICC group. The incidence of hyperbilirubinemia needing phototherapy, neonatal intensive care unit (NICU) admissions, or readmissions to the hospital for phototherapy was similar between the groups. Fewer infants in the DCC/UCM group were admitted to the NICU primarily for respiratory distress. Symptomatic polycythemia did not occur in either group. Median hospital length of stay was 3 days for both groups. CONCLUSION: Placental transfusion (DCC or UCM) in late preterm infants admitted to a mother baby unit was not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions to the hospital for phototherapy. KEY POINTS: · Placental transfusion was feasible in late preterm infants.. · Placental transfusion resulted in higher mean hematocrit after birth.. · Placental transfusion did not increase the need for phototherapy.. · Fewer admissions to the NICU for respiratory distress were noted in the placental transfusion group..

REPRINT OF: Physical and Mental Health Effects of Intimate Partner Violence for Men and Women.

EDITOR'S NOTE: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Coker AL, Davis KE, Arias I, et al. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 1985;1(6):1-8. BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

Effects of Dextrose Gel in Newborns at Risk for Neonatal Hypoglycemia in a Baby-Friendly Hospital.

OBJECTIVE: To describe the effects of the introduction of dextrose gel to the neonatal hypoglycemia (NH) protocol on exclusive breastfeeding rates at discharge and NICU admission rates among clinically well newborns born at 35 weeks gestation or greater who were at risk for NH in a Baby-Friendly hospital. DESIGN: Quasi-experimental, pre- and postintervention. SETTING: A suburban, Baby-Friendly hospital with approximately 2,000 births annually. PARTICIPANTS: Clinically well newborns born at 35 weeks gestation or greater at risk for NH who were admitted to the mother-baby unit. METHODS: We compared 198 newborns at risk for NH born in the 6-month period before the introduction of dextrose gel (November 15, 2016, through May 14, 2017) versus 203 newborns born in the 6-month period after the introduction (May 15, 2017, through November 14, 2017). In the preintervention group, the NH protocol included blood glucose monitoring, prolonged skin-to-skin contact, feeding, and dextrose administered intravenously. In the postintervention group, oral dextrose gel was added to the NH protocol. RESULTS: We found no differences in maternal or newborn characteristics between the pre- and postintervention groups. Dextrose gel was given to 50 newborns (approximately 25%) of 203 in the postintervention group. The proportion of newborns who were exclusively breastfed at discharge was similar between groups (56.6% of 198 vs. 59.1% of 203, p = .62), as were the NICU admission rates for hypoglycemia (2.5% of 198 vs. 1.5% of 203, p = .50). CONCLUSIONS: In a suburban Baby-Friendly hospital, introduction of dextrose gel into the NH protocol had no significant effect on exclusive breastfeeding at discharge or NICU admission rates.

Use of cyanoacrylate adhesive in the surgical management of feline corneal sequestrum: 16 cases (2011-2018).

OBJECTIVE: To evaluate the use of cyanoacrylate adhesive as an adjunct to lamellar keratectomy in cats with corneal sequestrum. METHODS: Medical records were reviewed to identify cats with naturally occurring midstromal corneal sequestra treated with lamellar keratectomy and cyanoacrylate adhesive. All cats also had a bandage contact lens placed for postoperative comfort. Data collected included breed, age, sex, and reproductive status of the cat, eye involved, presence or absence of neovascularization at the time of surgery, history of prior sequestra, additional ocular procedures performed, use of neuromuscular blocking agents, procedure time, time to cessation of topical medications, time to recurrence or last follow-up, and complications aside from recurrence. RESULTS: Sixteen cats met study criteria, with a median follow-up time of 17.5 months in those without recurrence. Median time to cessation of topical medications was 4 weeks. Fourteen cats (87%) have not experienced recurrence. Other than recurrence in two cats, no significant complications were noted. Aside from purebred status, no commonalities were found between the two cats with recurrence. Neuromuscular blocking agents were not used during surgery in most cases. Median procedure time was 10 minutes. CONCLUSIONS: Cyanoacrylate adhesive is an effective and safe alternative to grafting procedures in cats undergoing lamellar keratectomy for treatment of corneal sequestrum. Recurrence rates are comparable to those seen with grafting techniques. Benefits of this approach include decreased anesthesia time, lower procedure costs, and short duration of postoperative treatment.

Delivery Room Management of Meconium-Stained Newborns and Respiratory Support.

: media-1vid110.1542/5839992674001PEDS-VA_2018-1485Video Abstract BACKGROUND AND OBJECTIVES: Recently, the Neonatal Resuscitation Program (NRP) recommended against routine endotracheal suctioning of meconium-stained nonvigorous newborns but suggested resuscitation with positive pressure ventilation. Our purpose is to study the effects of this change in management. METHODS: In this multicenter cohort study, we compare 130 nonvigorous newborns born during the retrospective 1-year period before the implementation of new NRP guidelines (October 1, 2015, to September 30, 2016) to 101 infants born during the 1-year prospective period after implementation (October 1, 2016, to September 30, 2017). RESULTS: Endotracheal suctioning was performed predominantly in the retrospective group compared with the prospective group (70% vs 2%), indicating the change in practice. A significantly higher proportion of newborns were admitted to the NICU for respiratory issues in the prospective group compared with the retrospective group (40% vs 22%) with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 1.2-3.9). Similarly, a significantly higher proportion of infants needed oxygen therapy (37% vs 19%) with an OR of 2.5 (95% CI: 1.2-4.5), mechanical ventilation (19% vs 9%) with an OR of 2.6 (95% CI: 1.1-5.8), and surfactant therapy (10% vs 2%) with an OR of 5.8 (95% CI: 1.5-21.8). There were no differences in the incidence of other outcomes, including meconium aspiration syndrome. CONCLUSIONS: The recent NRP guideline change was not associated with an increased incidence of meconium aspiration syndrome but was associated with an increased incidence of NICU admissions for respiratory issues. Also, the need for mechanical ventilation, oxygen, and surfactant therapy increased.

Implementation of an Automatic Stop Order and Initial Antibiotic Exposure in Very Low Birth Weight Infants.

Objective To evaluate if an antibiotic automatic stop order (ASO) changed early antibiotic exposure (use in the first 7 days of life) or clinical outcomes in very low birth weight (VLBW) infants. Study Design We compared birth characteristics, early antibiotic exposure, morbidity, and mortality data in VLBW infants (with birth weight <= 1500 g) born 2 years before (pre-ASO group, n = 313) to infants born in the 2 years after (post-ASO, n = 361) implementation of an ASO guideline. Early antibiotic exposure was quantified by days of therapy (DOT) and antibiotic use > 48 hours. Secondary outcomes included mortality, early mortality, early onset sepsis (EOS), and necrotizing enterocolitis. Results Birth characteristics were similar between the two groups. We observed reduced median antibiotic exposure (pre-ASO: 6.5 DOT vs. Post-ASO: 4 DOT; p < 0.001), and a lower percentage of infants with antibiotic use > 48 hours (63.4 vs. 41.3%; p < 0.001). There were no differences in mortality (12.1 vs 10.2%; p = 0.44), early mortality, or other reported morbidities. EOS accounted for less than 10% of early antibiotic use. Conclusion Early antibiotic exposure was reduced after the implementation of an ASO without changes in observed outcomes.

Effects of Skin-to-Skin Care on Late Preterm and Term Infants At-Risk for Neonatal Hypoglycemia.

OBJECTIVE: The objective of this study was to evaluate the effects of prolonged skin-to-skin care (SSC) during blood glucose monitoring (12-24 hours) in late preterm and term infants at-risk for neonatal hypoglycemia (NH). STUDY DESIGN: We conducted a retrospective pre- and postintervention study. We compared late preterm and term infants at-risk for NH born in a 1-year period before the SSC intervention, May 1, 2013, to April 30, 2014 (pre-SSC) to at-risk infants born in the year following the implementation of SSC intervention, May 1, 2014, to April 30, 2015 (post-SSC). RESULTS: The number of hypoglycemia admissions to neonatal intensive care unit among at-risk infants for NH decreased significantly from 8.1% pre-SSC period to 3.5% post-SSC period (P = 0.018). The number of infants receiving intravenous dextrose bolus in the newborn nursery also decreased significantly from 5.9% to 2.1% (P = 0.02). Number of infants discharged exclusively breastfeeding increased from 36.4% to 45.7%, although not statistically significant (P = 0.074). CONCLUSION: This SSC intervention, as implemented in our hospital, was associated with a significant decrease in newborn hypoglycemia admissions to neonatal intensive care unit. The SSC intervention was safe and feasible with no adverse events.

Gender differences in long-term health consequences of physical abuse of children: data from a nationally representative survey.

OBJECTIVES: This study investigated the effects of physical abuse in childhood on health problems in adulthood and assessed gender differences in these associations. METHODS: We used data from 8000 men and 8000 women who were interviewed in the National Violence Against Women Survey. We used multivariate logistic regression to test for main and interactive effects and conducted post hoc probing of significant moderational effects. RESULTS: Men were more likely than women to have experienced physical abuse during childhood. Whereas abuse had negative consequences for both boys and girls, it was generally more detrimental for girls. CONCLUSIONS: Findings suggest the need to consider gender differences and long-term adverse health consequences in the development of intervention strategies to address physical abuse in childhood.

The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women.

This study examines whether experiences with four different types of intimate partner violence (IPV) increase risk for posttraumatic stress disorder (PTSD) symptoms. We examined impacts of physical, sexual, psychological, and stalking victimization by a current partner on PTSD symptoms, the extent to which each type of IPV accounted for significant variance in PTSD symptoms when controlling for other forms, and the increase in PTSD symptoms from multiple forms of IPV. Findings reveal that all types of violence were associated with increased PTSD symptoms. When controlling for other types of violence, physical, psychological, and stalking violence were still associated with PTSD symptoms. There was evidence of a dose response in which the more types of violence experienced, the more PTSD symptoms.

Physical and mental health effects of intimate partner violence for men and women.

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.

Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men.

The purpose of this study was to identify whether experiences of childhood physical and/or sexual victimization would increase women's and men's risk for victimization in adulthood by different perpetrators (any perpetrator regardless of the relationship to the victim; intimate partner perpetrator; non-intimate perpetrator) using a nationally representative sample. Results of hierarchical logistic regression analyses indicated that childhood victimization increased the risk for adulthood victimization by any perpetrator for men and women, and by an intimate partner for women but not men. Female and male victims of physical and/or sexual child abuse are at higher risk for adult victimization by non-intimate perpetrators. These results suggest the appropriateness of interventions among adults or young adults who have been victims of child abuse, to prevent any future victimization in adulthood. To guide the development of such prevention programs, research is needed to identify factors that affect the probability of adulthood victimization among child abuse victims.