Mark J. Polak

Background/Objectives: Infants exposed to opioids in utero are at risk of neonatal opioid withdrawal syndrome (NOWS). We compared clinical, family-related, and classification-derived resource outcomes before and after implementation of Eat, Sleep, Console (ESC) in an Appalachian hospital. Methods: This single-center retrospective cohort study compared outcomes of opioid-exposed neonates assessed with Finnegan Scoring system (FNASS) (Epoch 1, N = 252) versus the Eat, Sleep, Console (ESC) method (Epoch 2, N = 100). Multivariable logistic regression and gamma generalized linear models with log links evaluated outcomes after adjustment for gestational age and maternal tobacco, fentanyl, and methamphetamine exposure. Results: ESC was associated with lower adjusted odds of NOWS classification (adjusted odds ratio (aOR) 0.32, 95% Confidence Interval (CI) 0.19–0.54), rescue morphine (aOR 0.36, 95% CI 0.17–0.75), and morphine taper (aOR 0.32, 95% CI 0.12–0.85). Adjusted mean length of stay was lower (ratio 0.66, 95% CI 0.54–0.79). Adjusted associations with foster care discharge (aOR 0.97, 95% CI 0.49–1.93) and parental involvement (aOR 1.24, 95% CI 0.66–2.32) were not statistically significant. Conclusions: ESC implementation was associated with shorter hospitalization and less pharmacological treatment after adjustment for measured differences between epochs. Unadjusted differences in foster care discharge and parental involvement did not persist after adjustment. The observational, sequential-epoch design precludes causal attribution.

Neonatal opioid withdrawal syndrome has become a prevalent diagnosis with the rise of maternal substance use during pregnancy. Manifestation of this syndrome is characterized by altered activity of the central nervous system with symptoms including irritability, gastrointestinal dysfunction, and activation of the autonomic nervous system. There is currently no standardized pharmacological protocol for the treatment of this syndrome. Opioids such as morphine and methadone are first‐line medications with clonidine as the recommended adjunct therapy. We observed increases in urinary tract infection in infants, especially male infants, with neonatal opioid withdrawal syndrome that were treated with morphine and clonidine. Urinary tract infection is uncommon among newborns and poses a significant risk to their health secondary to their immature renal and immune systems. We describe 4 cases in newborns treated with morphine and clonidine, prompting an investigation into the individual cases to highlight a potential association between clonidine exposure and urinary tract infection.

Background/Objectives: The COVID-19 pandemic period from 2020 to 2022 had a significant impact on maternal infant health with mothers impacted more than their infants. We questioned whether there have been any lingering effects from the pandemic. Methods: We examined intermediate and long-term pandemic effects on maternal and neonatal outcomes before, during, and after the COVID-19 pandemic period. We reviewed mother–infant pairs from the following three epochs: (1) the pre–COVID-19 period, (2) the COVID-19 pandemic period, and (3) the post-pandemic period. The Case Mix Index (CMI) for the neonates from all three epochs were detailed. Results: Post-pandemic, we noted a rising trend of LGA infants (10%) and an increase in SGA infants (13%). For women in 2023, we noted an increase in hypertension, preeclampsia, diabetes, and a higher BMI than in the pre-pandemic period. There have also been more congenital anomalies (9%), and neonatal CMI increased in the post-pandemic period. Conclusions: Well after the pandemic period, maternal–infant health continues to be affected. For women, the increase in hypertension and diabetes during pregnancy is concerning. For infants, being LGA or SGA may have long-term consequences. The post-pandemic increase in infants with congenital anomalies compared to the pre-pandemic era is an area that needs ongoing review.

The COVID-19 pandemic period, from 2020 - 2022 had a significant impact on maternal infant health with mothers impacted more than their infants. We questioned whether there have been any lingering effects from the pandemic. We examined intermediate and long-term pandemic effects of maternal and neonatal outcomes before, during and after the COVID-19 pandemic period. We reviewed mother-infant pairs from three epochs: 1) the pre-COVID-19 period, 2) the COVID-19 pandemic period, and 3) the post-pandemic period. The Case Mix Index (CMI) for the neonates from all 3 epochs were detailed. Post-pandemic we noted a rising trend of LGA infants (10%), and an increase in SGA infants (13%). For women in 2023 we noted an increase in hypertension, preeclampsia, diabetes, and a higher BMI than the pre- pandemic period. There have also been more congenital anomalies (9%), and neonatal CMI increased in the post-pandemic period. Well after the pandemic period, maternal-infant health continues to be affected. For women, increase in hypertension and diabetes during pregnancy is concerning. For the infants, being LGA or SGA may have long-term consequences. The post-pandemic increase in infants with congenital anomalies compared to the pre-pandemic era is an area that needs ongoing review.

Objective Diagnosis-related groups (DRGs) are used to summarize hospital morbidity and mortality. Each DRG has a weight which is important in calculating the case mix index (CMI), a numeric summary of disease complexity in a population of patients. We utilized DRG weight and resultant CMI to compare postnatal outcomes among singletons versus monochorionic and monoamniotic, monochorionic diamniotic, and dichorionic diamniotic twins. Study Design This single-center and retrospective cohort study evaluated DRGs assigned by the investigators, birth weight, gestational age, length of stay (LOS), NICU admission rate, and mortality in twin births between 2014 and 2016. Twins were analyzed depending on chorionicity and amnionicity. Overall, 3 months of singleton births served as the control. The CMI derived from DRG weights were compared across groups. Results Twins (n = 288) had lower gestational ages and birth weights and higher mortality, LOS, NICU admission rates and DRG weights/CMI compared with singletons (n = 327; p < 0.001 for each). The LOS was no different between twin subtypes; monochorionic monoamniotic twins had the highest mortality and DRG weight (p < 0.001). Conclusion DRG weight and CMI values summarize in-hospital complexity and can be a useful tool to evaluate differences in care complexity among groups of patients. Key Points

Using an isolated salt-perfused rat lung model, the authors investigated whether N-methyl-D-aspartate (NMDA) (1 mM) in the pulmonary circulation effects the pulmonary vascular responses to an acute stimulus of hypoxic insult under baseline, nitric oxide synthetase (NOS)-blocked conditions (N- Ω -nitro-L arginine methyl ester; L-NAME, 2 mM), and with an NMDA receptor blocker, MK-801 (0.3 μ M) added. NOS activityat baseline, and in response tohypoxia, NMDA, L-NAME, and a combination of these stimuli were also assessed. NMDA did not in itself alter hypoxic pulmonary vasoconstriction (HPV), but did significantly attenuate HPV during NOS blockade. This effect of NMDA was erased by MK-801. Assessment of NOS activity showed that hypoxia alone caused a doubling of NO production within the lung. This effect was erased by the addition of L-NAME. NMDA alone caused a significant, 3-fold increase in NOS activity, which was not further affected by hypoxic challenge. L-NAME did not depress NOS activity in the hypoxia + NMDA group. These data suggest that NMDA receptor activation results in increased NOS activity and presumably increased production of NO. The increased NOS activity induced by NMDA receptor stimulation is resistant to the blockade effect of L-NAME. The actions of NMDA receptor activation may represent a natural protective mechanism, at least within the pulmonary vasculature, in face of acute, abnormal stimuli such as hypoxia.