Multiple Courses of Antenatal Steroids

Risk factors and clinical outcomes of pulmonary hypertension associated with bronchopulmonary dysplasia in extremely premature infants: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the risk factors for bronchopulmonary dysplasia associated pulmonary hypertension (BPD-PH) in extremely premature infants (gestational age < 32 weeks) and its impact on outcomes. A computerized search of eight databases was performed, from the time of library construction to February 2024. The quality of the included studies was assessed with the Newcastle‒Ottawa scale. Statistical analyses were performed using RevMan 5.4.1 and Stata 16.0 software. Meta-analysis of 2137 extremely premature infants revealed that oligohydramnios (OR = 2.21, 95% CI 1.06-4.61), low gestational age (SMD = -0.36, 95% CI -0.47 to -0.24), low birth weight (SMD = -0.54, 95% CI -0.74 to -0.35), small for gestational age (OR = 1.61, 95% CI 1.06-2.44), neonatal respiratory distress syndrome (OR = 2.05, 95% CI 1.45-2.91), grade III bronchopulmonary dysplasia (OR = 4.67, 95% CI 1.34-16.30), and sepsis (OR = 2.25, 95% CI 1.69-4.66) were risk factors for BPD-PH, whereas antenatal steroids (OR = 0.66, 95% CI 0.49-0.88) were protective factors. BPD-PH led to the extension of oxygen therapy (SMD = 0.67, 95% CI 0.42-0.92) and hospital stay (SMD = 0.77, 95% CI 0.14-1.40), and elevated the risk of discharged on oxygen (OR = 2.77, 95% CI 1.35-5.70) and death (OR = 4.38, 95% CI 2.21-8.69). BPD-PH is a multifactorial disease. In this study, a total of seven risk factors, and one protective factor for BPD-PH were identified in extremely premature infants. By managing and mitigating these factors, it is possible to decrease the occurrence of BPD-PH. Furthermore, BPD-PH may increase the risk of a poor prognosis in extremely premature infants.

Effects of three courses of maternally administered dexamethasone at 0.7, 0.75, and 0.8 of gestation on prenatal and postnatal growth in sheep

OBJECTIVES

To evaluate the effects of repeated low doses of maternally administered dexamethasone (DM) on growth in sheep during fetal life and the first 2 years of postnatal life.

METHODS

Ewes received 3 courses of DM (1 course: four 2-mg intramuscular injections at 12-hour intervals) or saline beginning at 103, 110, and 117 days of gestation (dGA). At 119 dGA, fetal BW and organ weight were recorded. Total placentome number, weight, and morphologic distributions were recorded. Placentome glucocorticoid receptor expression was determined by immunocytochemistry. Newborn BW and organ weight were recorded within 12 hours of birth. Duration of gestation was recorded. Measurements were collected on body weight (BW), biparietal diameter (BPD), crown-to-rump length, thoracic girth circumference, abdominal girth circumference, and radial bone length for 2 months. Maternal estradiol and progesterone levels were measured daily from 135 dGA.

RESULTS

At 119 dGA, DM significantly decreased BW. Placentome glucocorticoid receptor expression increased after DM exposure. DM did not significantly decrease BW at birth but did prolong gestation length. DM decreased maternal estradiol before lambing. DM decreased newborn brain weight and BPD. After 2 weeks of age, no effect of DM on postnatal growth could be found.

CONCLUSIONS

This study shows that repeated maternal DM treatment at doses threefold lower than what women in preterm labor receive results in decreased fetal BW, prolonged gestation length, decreased newborn brain weight, and BPD.