1
|
Yenuberi H, Lal A, Thomas N, Mathew JE. In Reply. Obstet Gynecol 2024; 144:e10. [PMID: 38949546 DOI: 10.1097/aog.0000000000005620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Hilda Yenuberi
- Department of Obstetrics and Gynecology, Christian Medical College, Vellore, India
| | - Aadarsh Lal
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Niranjan Thomas
- Newborn Services, Joan Kirner Women's and Children's at Sunshine Hospital, St. Albans, and Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
2
|
Bart Y, Blackwell S, Sibai BM. Secondary analysis of the antenatal late preterm steroids trial. Am J Obstet Gynecol 2024:S0002-9378(24)00685-9. [PMID: 38908648 DOI: 10.1016/j.ajog.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Yossi Bart
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, TX.
| | - Sean Blackwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, TX
| | - Baha M Sibai
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston, Houston, TX
| |
Collapse
|
3
|
Vidaeff AC, Asztalos E. Late Preterm Corticosteroids Exposure and Neurodevelopmental Outcomes. JAMA 2024; 331:1626-1627. [PMID: 38656755 DOI: 10.1001/jama.2024.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Alex C Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston
| | - Elizabeth Asztalos
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Maines E, Cardellini MC, Stringari G, Leonardi L, Piccoli G, Urru SAM, Maiorana A, Soffiati M, Franceschi R. Drug-Induced Hypoglycemia in Neonates Born to Nondiabetic Women Treated with Medications during the Pregnancy or the Labor: A Systematic Review of the Literature. Am J Perinatol 2024; 41:e2850-e2861. [PMID: 37848046 DOI: 10.1055/s-0043-1776061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
The prompt identification of at-risk newborns for drug-induced hypoglycemia can minimize the risk for adverse side effects, inappropriate investigations, and considerable unnecessary costs. Existing literature discusses drug-induced hypoglycemia, but a systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing. We reviewed the association between neonatal hypoglycemia and maternal medications. We systematically searched the literature according to the PICOS model on drug-induced hypoglycemia in neonates born to nondiabetic women treated with medications during the pregnancy or the labor. The main outcomes of the review were: (1) prevalence of hypoglycemia, (2) risk factors and potential confounders, (3) time at onset and severity of hypoglycemia, (4) dose-response gradient, (5) metabolic features of hypoglycemia, (6) modalities to treat hypoglycemia, and (7) quality of the studies. We included 69 studies in this review and we identified 11 groups of maternal drugs related to neonatal hypoglycemia. Results were classified for each outcome. Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia and in the differential diagnosis of neonatal hypoglycemia. Further studies are necessary to assess the risk of neonatal hypoglycemia associated with common maternal medications. KEY POINTS: · A systematic description of neonatal hypoglycemia induced or exacerbated by maternal medications is missing.. · In our review we identified 11 groups of maternal drugs related to neonatal hypoglycemia.. · Our review aims at supporting clinicians in the identification of the newborn at risk for hypoglycemia..
Collapse
Affiliation(s)
- Evelina Maines
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | | | - Giovanna Stringari
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
| | - Letizia Leonardi
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
| | - Giovanni Piccoli
- CIBIO - Department of Cellular, Computational and Integrative Biology, Università degli Studi di Trento, Trento, Italy
| | | | - Arianna Maiorana
- Division of Metabolism and Research Unit of Metabolic Biochemistry, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimo Soffiati
- Division of Pediatrics, S. Chiara General Hospital, APSS, Trento, Italy
- Division of Neonatology, S. Chiara General Hospital, APSS, Trento, Italy
| | | |
Collapse
|
5
|
McDougall AR, Aboud L, Lavin T, Cao J, Dore G, Ramson J, Oladapo OT, Vogel JP. Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic review. EClinicalMedicine 2023; 58:101916. [PMID: 37007738 PMCID: PMC10050784 DOI: 10.1016/j.eclinm.2023.101916] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Background Antenatal corticosteroids (ACS) are highly effective at improving outcomes for preterm newborns. Evidence suggests the benefits of ACS may vary with the time interval between administration-to-birth. However, the optimal ACS administration-to-birth interval is not yet known. In this systematic review, we synthesised available evidence on the relationship between ACS administration-to-birth interval and maternal and newborn outcomes. Methods This review was registered with PROSPERO (CRD42021253379). We searched Medline, Embase, CINAHL, Cochrane Library, Global Index Medicus on 11 Nov 2022 with no date or language restrictions. Randomised and non-randomised studies of pregnant women receiving ACS for preterm birth where maternal and newborn outcomes were reported for different administration-to-birth intervals were eligible. Eligibility screening, data extraction and risk of bias assessment were performed by two authors independently. Fetal and neonatal outcomes included perinatal and neonatal mortality, preterm birth-related morbidity outcomes and mean birthweight. Maternal outcomes included chorioamnionitis, maternal mortality, endometritis, and maternal intensive care unit admission. Findings Ten trials (4592 women; 5018 neonates), 45 cohort studies (at least 22,992 women; 30,974 neonates) and two case-control studies (355 women; 360 neonates) met the eligibility criteria. Across studies, 37 different time interval combinations were identified. There was considerable heterogeneity in included administration-to-birth intervals and populations. The odds of neonatal mortality, respiratory distress syndrome and intraventricular haemorrhage were associated with the ACS administration-to-birth interval. However, the interval associated with the greatest improvements in newborn outcomes was not consistent across studies. No reliable data were available for maternal outcomes, though odds of chorioamnionitis might be associated with longer intervals. Intepretation An optimal ACS administration-to-birth interval likely exists, however variations in study design limit identification of this interval from available evidence. Future research should consider advanced analysis techniques such as individual patient data meta-analysis to identify which ACS administration-to-birth intervals are most beneficial, and how these benefits can be optimised for women and newborns. Funding This study was conducted with funding support from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research (SRH), a co-sponsored programme executed by the World Health Organization.
Collapse
Affiliation(s)
- Annie R.A. McDougall
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Lily Aboud
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tina Lavin
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Jenny Cao
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Gabrielle Dore
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Jen Ramson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Olufemi T. Oladapo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
6
|
Sweet DG, Carnielli VP, Greisen G, Hallman M, Klebermass-Schrehof K, Ozek E, te Pas A, Plavka R, Roehr CC, Saugstad OD, Simeoni U, Speer CP, Vento M, Visser GH, Halliday HL. European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology 2023; 120:3-23. [PMID: 36863329 PMCID: PMC10064400 DOI: 10.1159/000528914] [Citation(s) in RCA: 115] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 02/17/2023]
Abstract
Respiratory distress syndrome (RDS) care pathways evolve slowly as new evidence emerges. We report the sixth version of "European Guidelines for the Management of RDS" by a panel of experienced European neonatologists and an expert perinatal obstetrician based on available literature up to end of 2022. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, appropriate maternal transfer to a perinatal centre, and appropriate and timely use of antenatal steroids. Evidence-based lung-protective management includes initiation of non-invasive respiratory support from birth, judicious use of oxygen, early surfactant administration, caffeine therapy, and avoidance of intubation and mechanical ventilation where possible. Methods of ongoing non-invasive respiratory support have been further refined and may help reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation by targeted use of postnatal corticosteroids remains essential. The general care of infants with RDS is also reviewed, including emphasis on appropriate cardiovascular support and judicious use of antibiotics as being important determinants of best outcome. We would like to dedicate this guideline to the memory of Professor Henry Halliday who died on November 12, 2022.These updated guidelines contain evidence from recent Cochrane reviews and medical literature since 2019. Strength of evidence supporting recommendations has been evaluated using the GRADE system. There are changes to some of the previous recommendations as well as some changes to the strength of evidence supporting recommendations that have not changed. This guideline has been endorsed by the European Society for Paediatric Research (ESPR) and the Union of European Neonatal and Perinatal Societies (UENPS).
Collapse
Affiliation(s)
- David G. Sweet
- Regional Neonatal Unit, Royal Maternity Hospital, Belfast, UK
| | - Virgilio P. Carnielli
- Department of Neonatology, University Polytechnic Della Marche, University Hospital Ancona, Ancona, Italy
| | - Gorm Greisen
- Department of Neonatology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Mikko Hallman
- Department of Children and Adolescents, Oulu University Hospital and Medical Research Center, University of Oulu, Oulu, Finland
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Medical University of Vienna, Vienna, Austria
| | - Eren Ozek
- Department of Pediatrics, Marmara University Medical Faculty, Istanbul, Turkey
| | - Arjan te Pas
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Richard Plavka
- Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czechia
| | - Charles C. Roehr
- Faculty of Health Sciences, University of Bristol, UK and National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Ola D. Saugstad
- Department of Pediatric Research, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
- Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Christian P. Speer
- Department of Pediatrics, University Children's Hospital, Wuerzburg, Germany
| | - Maximo Vento
- Department of Pediatrics and Neonatal Research Unit, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gerry H.A. Visser
- Department of Obstetrics and Gynecology, University Medical Centre, Utrecht, The Netherlands
| | - Henry L. Halliday
- Department of Child Health, Queen's University Belfast and Royal Maternity Hospital, Belfast, UK
| |
Collapse
|
7
|
Antenatal corticosteroid administration-to-birth interval and neonatal outcomes in very preterm infants: A secondary analysis based on a prospective cohort study. PLoS One 2023; 18:e0281509. [PMID: 36763575 PMCID: PMC9916588 DOI: 10.1371/journal.pone.0281509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Despite the prevalent use of antenatal corticosteroids (ACS) to prevent preterm infants' adverse neonatal complications, there is currently no consensus on administration-to-birth intervals of ACS. International guidelines broadly agree that the administration of antenatal corticosteroids should be within 7 days prior to preterm birth. However, there is little evidence to support narrower optimal ACS administration-to-birth interval time. This study was undertaken to investigate the association between the administration-to-birth interval of ACS which is bounded by 48 hours and neonatal outcomes in very preterm infants. MATERIALS AND METHODS This is a single-center prospective observational study. Data were collected prospectively from eligible infants from January 2008 to April 2014 at the Santa Clara Valley Medical Center, neonatal outcomes were compared between two groups based on the interval of antenatal corticosteroid administration-to-birth: the interval of <48h, and the interval of >48h. It was noted that the entire study was completed by Dongli Song et al., and uploaded the data to the DATADRYAD website. The author only used this data for secondary analysis. RESULTS After adjusting potential confounders (gestational age, sex, birth weight, duration of cord clamping and delivery mode), the interval of >48h group compared to the interval of <48h group had significant reductions in mortality (OR: 0.17; 95% CI: 0.05-0.59), any retinopathy of prematurity (OR: 0.36; 95% CI: 0.16-0.82), severe retinopathy of prematurity (OR: 0.07; 95% CI: 0.01-0.45), any intubation (OR: 0.39; 95% CI: 0.20-0.75) and higher 1 min Apgar (β: 0.56; 95% CI: 0.10-1.02). CONCLUSION This study shows that in very preterm infants, compared with the interval of ACS<48h, the interval of ACS>48 hours has a significant health promotion effect.
Collapse
|
8
|
Ozdemir F, Acmaz G, Madendag Y, Madendag IC, Muderris II. The effect of steroid administration on fetal diaphragm function. BMC Pregnancy Childbirth 2022; 22:762. [PMID: 36224559 PMCID: PMC9555001 DOI: 10.1186/s12884-022-05074-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal steroid administrations lead to not only accelerated lung maturation, improved blood gas measurements but also lung dynamics and lung compliance. This study aimed to investigate structural and functional changes in diaphragm after antenatal steroid administration. Methods The 79 volunteers were divided into 2 groups according to presence of preterm delivery. Betamethasone (CelestoneR) 12 mg intramuscularly was routinely administered to pregnancies complicated with preterm delivery between 28th -34th weeks of gestation. Same dose was repeated 24 h later. In all patients, diaphragm thickness, diaphragmatic excursion and costophrenic angle were measured in both the inspirium and expirium stage of respiration. This is an observational cross-sectional study. Results Diaphragm thickness, diaphragmatic excursion and diaphragm thickening fraction parameters were improved but costophrenic angle was not different 7 days after steroid administration. Diaphragm thickness, diaphragmatic excursion and costophrenic angle changes during inspiration and expiration stage after 7 days of betamethasone treatment reflects the effect of steroid administration on diaphragm muscle. Comparisons of the differences that occur after steroid rescue protocol were done by subtracting the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters before the treatment from the diaphragm thickness, diaphragmatic excursion and costophrenic angle parameters 7 days after steroid treatment respectively. Conclusion Diaphragm became more mobile in patients with preterm labor, 7 days after steroid administration. This situation reflects positive effect of steroid administration on diaphragm function.
Collapse
Affiliation(s)
- Fatma Ozdemir
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Yenidogan District, Turhan Baytop Street No:1, 38280, Kayseri, Melikgazi Kayseri, Turkey
| | - Gokhan Acmaz
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Yenidogan District, Turhan Baytop Street No:1, 38280, Kayseri, Melikgazi Kayseri, Turkey.
| | - Yusuf Madendag
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Yenidogan District, Turhan Baytop Street No:1, 38280, Kayseri, Melikgazi Kayseri, Turkey
| | - Ilknur Col Madendag
- Obstetrics and Gynecology Department, Kayseri City Hospital, Kayseri, Turkey
| | - Iptisam Ipek Muderris
- Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Yenidogan District, Turhan Baytop Street No:1, 38280, Kayseri, Melikgazi Kayseri, Turkey
| |
Collapse
|
9
|
McElwee ER, Wilkinson K, Crowe R, Hardy KT, Newman JC, Chapman A, Wineland R, Finneran MM. Latency of late preterm steroid administration to delivery and risk of neonatal hypoglycemia. Am J Obstet Gynecol MFM 2022; 4:100687. [PMID: 35820608 DOI: 10.1016/j.ajogmf.2022.100687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/13/2022] [Accepted: 06/30/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Late preterm antenatal corticosteroid administration has been associated with an increased risk of neonatal hypoglycemia. The mechanism is thought to be secondary to transient fetal hyperinsulinemia, which may be more likely if delivery occurs during peak antenatal corticosteroid levels. OBJECTIVE This study aimed to investigate whether there is a latency interval between antenatal corticosteroid administration and delivery that places neonates at the greatest risk of hypoglycemia. STUDY DESIGN This was a retrospective matched cohort study of pregnant women who received antenatal corticosteroid vs unexposed women between 34 0/7 and 36 6/7 weeks of gestation from 2016 to 2019. Unexposed women were those who did not receive antenatal corticosteroid matched according to gestational age at delivery, diabetes mellitus status, and maternal body mass index from 2010 to 2015. Latency periods from initial steroid administration to delivery were defined in grouped intervals until ≥72 hours. The primary outcome was neonatal hypoglycemia, defined as a neonatal glucose level of <40 mg/dL within 24 hours of life. Poisson regression was used to generate an adjusted relative risk of hypoglycemia for each latency period adjusting for confounders. RESULTS A total of 812 women were included in the analysis (406 exposed and 406 unexposed). Women who received antenatal corticosteroids were more likely to be nulliparous (P=.009); moreover, the women were well matched on pregnancy complications and baseline demographics. Neonatal hypoglycemia was more frequently identified in women receiving antenatal corticosteroids than in women not receiving antenatal corticosteroids (42% vs 26%; P<.001). Severe hypoglycemia, defined as a glucose level of <20 mg/dL, was significantly more common in patients receiving antenatal corticosteroids than in patients not receiving antenatal corticosteroids (8.4% vs 2.7%; P<.001). Latency time intervals of 12 to 71 hours from antenatal corticosteroid administration were significantly associated with neonatal hypoglycemia in exposed women compared with unexposed women after adjustment; within this time frame, the highest risk was 24 to 47 hours after antenatal corticosteroid administration (adjusted relative risk, 2.09; 95% confidence interval, 1.29-3.38). CONCLUSION In the late preterm period, the risk of neonatal hypoglycemia is the greatest in the latency period of 12 to 71 hours between steroid administration and delivery. Neonates exposed to antenatal corticosteroids were more likely to experience severe hypoglycemia within 24 hours of life than unexposed neonates.
Collapse
Affiliation(s)
- Eliza R McElwee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (Drs McElwee, Wilkinson, Crowe, Wineland, Finneran).
| | - Kyla Wilkinson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (Drs McElwee, Wilkinson, Crowe, Wineland, Finneran)
| | - Rebecca Crowe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (Drs McElwee, Wilkinson, Crowe, Wineland, Finneran)
| | - K Thomas Hardy
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC (Drs Thomas and Chapman)
| | - Jill C Newman
- Division of Gastroenterology and Hepatology, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC (Ms Newman)
| | - Alison Chapman
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC (Drs Thomas and Chapman)
| | - Rebecca Wineland
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (Drs McElwee, Wilkinson, Crowe, Wineland, Finneran)
| | - Matthew M Finneran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC (Drs McElwee, Wilkinson, Crowe, Wineland, Finneran)
| |
Collapse
|
10
|
Badreldin N, Dude AM, Peaceman A, Grobman WA, Yee LM. Association of timing from steroid administration to delivery and neonatal outcomes in the late preterm period. Am J Obstet Gynecol 2022; 227:107-108.e2. [PMID: 35278375 PMCID: PMC10583222 DOI: 10.1016/j.ajog.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL
| | - Annie M Dude
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, 3010 Old Clinic Bldg., Campus Box 7570, Chapel Hill, NC 27599.
| | - Alan Peaceman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University, Evanston, IL
| |
Collapse
|
11
|
The Relationship between Antenatal Corticosteroid Administration-to-Delivery Intervals and Neonatal Respiratory Distress Syndrome and Respiratory Support. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2310080. [PMID: 35295172 PMCID: PMC8920661 DOI: 10.1155/2022/2310080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Background Administration of antenatal corticosteroids (ACSs) is an effective strategy for managing preterm infants, which improves neonatal respiratory distress syndrome (NRDS) and attenuates the risk of neonatal mortality. However, many preterm infants are not exposed to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear. Therefore, this study explored the relationship between ACS-to-birth intervals and NRDS and respiratory support in preterm infants. Methods In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wks of gestation were recruited from January 2015 to July 2021. All participants were categorised based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2–7 d, and >7 d. Multivariable logistic regression analysis examined the relationships between the ACS-to-birth interval and primary or secondary outcome while adjusting for potential confounders. Results Of the 706 eligible neonates, 264, 83, 292, and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2–7 d, and >7 d, respectively. After adjusting these confounding factors, the multivariable logistic analysis showed a significantly increased risk of NRDS (aOR: 1.8, 95% CI: 1.2–2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1–6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7–4.4), endotracheal intubation in the delivery room (aOR: 1.9, 95% CI: 1.0–3.7), and mechanical ventilation (aOR: 1.9, 95% CI: 1.1–3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2–7 d group. Conclusions Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in the delivery room, and the risk of mechanical ventilation are higher when the neonates are exposed to an ACS interval for less than 24 h before delivery.
Collapse
|
12
|
Li J, Zhang J, Hao Q, Du Y, Lu J, Chen H, Cheng X. Time Interval From Early-Term Antenatal Corticosteroids Administration to Delivery and the Impact on Neonatal Outcomes. Front Pediatr 2022; 10:836220. [PMID: 35479760 PMCID: PMC9035847 DOI: 10.3389/fped.2022.836220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To determine the association between the time interval from antenatal corticosteroids administration to delivery and neonatal complications in diabetic mothers undergoing early term (37+0 to 38+6 weeks) scheduled cesarean section (ETSCS). STUDY DESIGN A retrospective cohort study of women with any form of diabetes in pregnancy undergoing ETSCS was included. Cases were stratified into the following groups based on the time interval from the first dose of corticosteroids administration to delivery: <2, 2-7, and >7 days. Women undergoing ETSCS, who did not receive corticosteroids were included as controls. We assessed the association between the time interval and neonatal outcomes in a multivariate regression model that controlled for potential confounders. Primary outcomes were the incidence of respiratory distress syndrome (RDS)/transient tachypnea of the newborn (TTN) and neonatal hypoglycemia. RESULTS The study cohort comprised 1,165 neonates. Of those, 159 (13.6%) were delivered within 2 days of maternal corticosteroids administration, 131 (11.2%) were delivered within 2-7 days after maternal corticosteroids administration, and 137 (11.8%) delivered more than 7 days after maternal corticosteroids administration. The remaining 738 (63.3%) were not exposed to corticosteroids. Multivariate analysis demonstrated that delivery within any time of antenatal corticosteroids administration was not associated with decreased risks of RDS/TTN. The risk of neonatal hypoglycemia was highest in the delivery of <2 days group (adjusted odds ratio [aOR]: 2.684, 95% confidence interval [CI]: 1.647-4.374 for control group; aOR: 2.827, 95% CI: 1.250-6.392 for delivery 2-7 days group; aOR:2.975, 95% CI: 1.265-6.996 for delivery >7 days group). CONCLUSIONS Corticosteroids treatment for diabetic mothers undergoing ETSCS was not associated with beneficial neonatal respiratory outcomes. In addition, delivery, <2 days after antenatal corticosteroids administration was associated with an increased risk of neonatal hypoglycemia.
Collapse
Affiliation(s)
- Jing Li
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Jing Zhang
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Qingfei Hao
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Yanna Du
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Jie Lu
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Haoming Chen
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| | - Xiuyong Cheng
- Department of Neonatology, The First Affiliated Hospital of Zheng Zhou University, Zhengzhou, China
| |
Collapse
|
13
|
Zhou C, Zheng W, Zhang M, Tung TH, Wang L, Wang L. Effects of antenatal corticosteroids on neonatal blood glucose fluctuation in late-preterm infants. Front Pediatr 2022; 10:1036565. [PMID: 36440338 PMCID: PMC9691838 DOI: 10.3389/fped.2022.1036565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effects of antenatal corticosteroids (ACS) on blood glucose fluctuations in late-preterm neonates. METHODS A retrospective study was performed on 236 neonates with gestational age of 34+0 to 36+6 weeks who were admitted to the neonatology department of a tertiary general hospital in China's Zhejiang Province between April 2020 and February 2022. The neonates were divided into three groups: complete course, partial course, and control. Primary outcome was the neonatal blood glucose levels within the first 48 h of life. RESULTS 134 (56.8%) newborns were exposed to a complete course of ACS, 56 (23.7%) had a to a partial course of ACS, and 46 (19.5%) had no exposure to ACS. The patients in the complete course group had the highest proportion of neonatal hypoglycemia (16.4% vs. 3.6% and 6.5%).The patients exposed to a complete course of dexamethasone had significantly lower blood glucose levels within 12 h of birth than the control group, although no significant differences were observed after 24 h. Differences in blood glucose levels were more significant among male infants, although blood glucose curves of the male and female infants remained close to the overall trend. CONCLUSIONS Blood glucose levels in late-preterm neonates may decrease after ACS administration, especially after exposure to a complete course. The effects are more pronounced in the first 12 h of life, with males being more severely affected; however, the effects on blood glucose levels were not significant 24 h after birth. This can provide a reference for future clinical studies.
Collapse
Affiliation(s)
- Cailing Zhou
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| | - Wanli Zheng
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| | - Meixian Zhang
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| | - Tao-Hsin Tung
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| | - Linghua Wang
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| | - Lizhen Wang
- Department of Neonatology, Taizhou Enze Medical Center (Group), Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou, China
| |
Collapse
|
14
|
Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet 2021; 158:385-389. [PMID: 34625970 DOI: 10.1002/ijgo.13975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/29/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the factors associated with neonatal hypoglycemia among neonates exposed to antenatal corticosteroid (ACS). METHODS A retrospective study conducted during 2017-2019 at a tertiary-care center including all neonates delivered between 24 and 34 weeks of gestation after ACS administration. The primary outcome was neonatal hypoglycemia (<40 mg/dl). RESULTS Overall, 362 early preterm neonates, including 205 singletons and 157 twins, were exposed to ACS before delivery and constituted the study group. Of them, 275 (76.0%) were exposed to a single ACS course and 87 (24.0%) to an additional rescue ACS course. Neonatal hypoglycemia occurred in 84 (23.2%) neonates. The incidence of neonatal hypoglycemia was significantly higher in those delivered between 24 and 48 h after ACS administration compared with those delivered outside this time interval (10/25, 40.0% vs 74/337, 21.9%; P = 0.049). In multivariate analysis, after adjusting for neonatal birth weight and gestational age, delivery within 24-48 h after ACS administration was the only independent risk factor associated with neonatal hypoglycemia (adjusted odds ratio 2.41, 95% confidence interval 1.03-5.68; P = 0.044). CONCLUSION Neonatal hypoglycemia occurred in over one-fifth of those exposed to ACS, and was independently associated with delivery between 24 and 48 h after ACS administration.
Collapse
Affiliation(s)
- Roy Zigron
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ira Erlichman
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|