1
|
Bae SP, Hahn WH, Park S, Jung YH, Park JY, Oh KJ, Choi CW. Effects of antenatal corticosteroids on neonatal outcomes in twin and singleton pregnancies: a Korean national cohort study. BMJ Paediatr Open 2023; 7:e001754. [PMID: 36690386 PMCID: PMC9872481 DOI: 10.1136/bmjpo-2022-001754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To investigate whether effects of antenatal corticosteroids on neonatal outcomes in preterm infants with very low birth weight were different by plurality. DESIGN Nationwide prospective cohort study. PATIENTS Twins and singletons with very low birth weight (<1500 g) who were born between 23+0 and 33+6 weeks of gestation and registered in the Korean Neonatal Network from January 2014 to December 2019. MAIN OUTCOME MEASURES Morbidity and mortality before discharge from neonatal intensive care unit. RESULTS Among a total of 9531 preterm infants with very low birth weight, there were 2364 (24.8%) twins and 7167 (75.2%) singletons. While 83.9% of singletons were exposed to at least one dose of antenatal corticosteroids, so were 87.9% of twins.Interaction analysis demonstrated that there was no significant difference in the effect of antenatal corticosteroids on morbidities or mortality between twins and singletons in either gestational age group (23-28 weeks or 29-33 weeks).Antenatal corticosteroids significantly decreased the risk of surfactant use (adjusted relative risk (aRR): 0.972 (95% CI: 0.961 to 0.984)), high-grade intraventricular haemorrhage (aRR: 0.621 (95% CI: 0.487 to 0.794)), periventricular leucomalacia (aRR: 0.728 (95% CI: 0.556 to 0.954)) and mortality (aRR: 0.758 (95% CI: 0.679 to 0.846)) in the gestational age group of 23-28 weeks. In the gestational age group of 29-33 weeks, antenatal corticosteroids significantly decreased the risk of surfactant use (aRR: 0.914 (95% CI: 0.862 to 0.970)) and mortality (aRR: 0.409 (95% CI: 0.269 to 0.624)) but increased the risk of sepsis (aRR: 1.416 (95% CI: 1.018 to 1.969)). CONCLUSION This study demonstrates that effect of antenatal corticosteroids on neonatal outcomes of preterm infants with very low birth weight does not differ significantly by plurality (twin or singleton pregnancy).
Collapse
Affiliation(s)
- Seong Phil Bae
- Pediatrics, Soonchunhyang University Hospital Seoul, Yongsan-gu, Korea
- Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of)
| | - Won-Ho Hahn
- Pediatrics, Soonchunhyang University Hospital Seoul, Yongsan-gu, Korea
- Pediatrics, Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of)
| | - Suyeon Park
- Biostatistics, Soonchunhyang University Hospital Seoul, Yongsan-gu, Korea (the Republic of)
- Applied Statistics, Chung-Ang University, Seoul, Korea (the Republic of)
| | - Young Hwa Jung
- Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Pediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jee Yoon Park
- Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Kyung Joon Oh
- Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Chang Won Choi
- Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
- Pediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| |
Collapse
|
2
|
Outcomes of Very Preterm Neonates Born by Assisted Reproductive Techniques (ART): A Propensity Score Matched Retrospective Cohort Study. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
3
|
Abiramalatha T, Bandyopadhyay T, Ramaswamy VV, Shaik NB, Thanigainathan S, Pullattayil AK, Amboiram P. Risk Factors for Periventricular Leukomalacia in Preterm Infants: A Systematic Review, Meta-analysis, and GRADE-Based Assessment of Certainty of Evidence. Pediatr Neurol 2021; 124:51-71. [PMID: 34537463 DOI: 10.1016/j.pediatrneurol.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/20/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We analyzed the certainty of evidence (CoE) for risk factors of periventricular leukomalacia (PVL) in preterm neonates, a common morbidity of prematurity. METHODS Medline, CENTRAL, Embase, and CINAHL were searched. Cohort and case-control studies and randomised randomized controlled trials were included. Data extraction was performed in duplicate. A random random-effects meta-analysis was utilizedused. CoE was evaluated as per Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. RESULTS One hundred eighty-six studies evaluating 95 risk factors for PVL were included. Of the 2,509,507 neonates assessed, 16,569 were diagnosed with PVL. Intraventricular hemorrhage [adjusted odds ratio: 3.22 (2.52-4.12)] had moderate CoE for its association with PVL. Other factors such as hypocarbia, chorioamnionitis, PPROM >48 hour, multifetal pregnancy reduction, antenatal indomethacin, lack of antenatal steroids, perinatal asphyxia, ventilation, shock/hypotension, patent ductus arteriosus requiring surgical ligation, late-onset circulatory collapse, sepsis, necrotizing enterocolitis, and neonatal surgery showed significant association with PVL after adjustment for confounders (CoE: very low to low). Amongst the risk factors associated with mother placental fetal (MPF) triad, there was paucity of literature related to genetic predisposition and defective placentation. Sensitivity analysis revealed that the strength of association between invasive ventilation and PVL decreased over time (P < 0.01), suggesting progress in ventilation strategies. Limited studies had evaluated diffuse PVL. CONCLUSION Despite decades of research, our findings indicate that the CoE is low to very low for most of the commonly attributed risk factors of PVL. Future studies should evaluate genetic predisposition and defective placentation in the MPF triad contributing to PVL. Studies evaluating exclusively diffuse PVL are warranted.
Collapse
Affiliation(s)
- Thangaraj Abiramalatha
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Tapas Bandyopadhyay
- Department of Neonatology, Dr Ram Manohar Lohia Hospital & Post Graduate Institute of Medical Education and Research, New Delhi, India
| | | | - Nasreen Banu Shaik
- Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, India
| | - Sivam Thanigainathan
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| |
Collapse
|
4
|
Roychoudhury S, Lodha A, Synnes A, Abou Mehrem A, Canning R, Banihani R, Beltempo M, Theriault K, Yang J, Shah PS, Soraisham AS, Ting J, Abou Mehrem A, Alvaro R, Adie M, Ng E, Pelausa E, Beltempo M, Claveau M, Barrington K, Lapoint A, Ethier G, Drolet C, Piedboeuf B, Afifi J, Dahlgren L, Wood S, Metcalfe A, O’Quinn C, Helewa M, Taboun F, Melamed N, Abenhaim H, Wou K, Gratton R, Boucoiran I, Taillefer C, Theriault K, Allen V, Synnes A, Grunau R, Hendson L, Moddemann D, de Cabo C, Nwaesei C, Church P, Banihani R, Pelausa E, Nguyen KA, Khairy M, Beltempo M, Dorval V, Luu TM, Bélanger S, Afifi J. Neurodevelopmental outcomes of preterm infants conceived by assisted reproductive technology. Am J Obstet Gynecol 2021; 225:276.e1-276.e9. [PMID: 33798481 DOI: 10.1016/j.ajog.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There have been concerns about the development of children conceived through assisted reproductive technology. Despite multiple studies investigating the outcomes of assisted conception, data focusing specifically on the neurodevelopmental outcomes of infants conceived through assisted reproductive technology and born preterm are limited. OBJECTIVE This study aimed to evaluate and compare the neurodevelopmental outcomes of preterm infants born at <29 weeks' gestation at 18 to 24 months' corrected age who were conceived through assisted reproductive technology and those who were conceived naturally. STUDY DESIGN This retrospective cohort study included inborn, nonanomalous infants, born at <29 weeks' gestation between January 1, 2010, and December 31, 2016, who had a neurodevelopmental assessment at 18 to 24 months' corrected age at any of the 10 Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment at 18 to 24 months, defined as the presence of any of the following: cerebral palsy; Bayley-III cognitive, motor, or language composite score of <85; sensorineural or mixed hearing loss; and unilateral or bilateral visual impairment. Secondary outcomes included mortality, composite of mortality or neurodevelopmental impairment, significant neurodevelopmental impairment, and each component of the primary outcome. We compared outcomes between infants conceived through assisted reproductive technology and those conceived naturally, using bivariate and multivariable analyses after adjustment. RESULTS Of the 4863 eligible neonates, 651 (13.4%) were conceived using assisted reproductive technology. Maternal age; education level; and rates of diabetes mellitus, receipt of antenatal corticosteroids, and cesarean delivery were higher in the assisted reproduction group than the natural conception group. Neonatal morbidity and death rates were similar except for intraventricular hemorrhage, which was lower in the assisted reproduction group (33% [181 of 546] vs 39% [1284 of 3318]; P=.01). Of the 4176 surviving infants, 3386 (81%) had a follow-up outcome at 18 to 24 months' corrected age. Multivariable logistic regression adjusting for gestational age, antenatal steroids, sex, small for gestational age, multiple gestations, mode of delivery, maternal age, maternal education, pregnancy-induced hypertension, maternal diabetes mellitus, and smoking showed that infants conceived through assisted reproduction was associated with lower odds of neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86) and the composite of death or neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.54-0.84). Conception through assisted reproductive technology was associated with decreased odds of a Bayley-III composite cognitive score of <85 (adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.99) and composite language score of <85 (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.88). CONCLUSION Compared with natural conception, assisted conception was associated with lower odds of adverse neurodevelopmental outcomes, especially cognitive and language outcomes, at 18 to 24 months' corrected age among preterm infants born at <29 weeks' gestation. Long-term follow-up studies are required to assess the risks of learning disabilities and development of complex visual-spatial and processing skills in these children as they reach school age.
Collapse
|
5
|
The Risk of Retinopathy of Prematurity in the Infants following Assisted Reproductive Technology: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2095730. [PMID: 31380413 PMCID: PMC6657639 DOI: 10.1155/2019/2095730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 02/08/2023]
Abstract
Currently, the use of assisted reproductive technology (ART) is increasing. Because of the poor prognosis of retinopathy of prematurity (ROP), the association between ART and the ROP has been explored in several studies, but the result was still inconclusive. Conducting a meta-analysis, we evaluated the risk of ROP in relation to the ART. Subgroup analysis as well as groups with different embryo numbers and different ROP stages was further analyzed. The PubMed, Embase, and Cochrane Library databases were searched for studies recording data about both the use of ART and ROP occurrence simultaneously. Odds ratios (ORs) and 95% confidence interval (95%CI) were calculated to analyze the association by using random- or fixed-effect models based on heterogeneity test. In total 15 observational studies containing 10392 ART cases and 39474 spontaneous conception cases were included. Results showed that there was a significant association between the use of ART and ROP occurrence in the offspring (OR = 1.34, 95% CI: 1.05 to 1.73, P = 0.02). With subgroup analysis, we found that the influence actually came from a subgroup of ART, the in vitro fertilization (IVF). Moreover, there was a significant association between ART and ROP in singletons. Though insignificant, the ORs were larger than 1 in the analysis between ART and stage 1 and 2 ROP. But ART showed significant association with stage 3 ROP. Our study preliminarily indicated that the use of IVF was associated with higher risk of ROP occurrence. And ART is more likely to result in severe ROP and ROP in singletons. Further specific, high-quality studies with large sample size are still needed to draw more precise conclusion.
Collapse
|
6
|
Outcomes of preterm infants conceived with in vitro fertilization. J Perinatol 2019; 39:717-722. [PMID: 30723282 DOI: 10.1038/s41372-019-0332-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/12/2018] [Accepted: 01/15/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To determine if there is increased risk of prematurity-related complications for in vitro fertilization (IVF)-conceived preterm infants compared to matched controls. STUDY DESIGN Cohort study of 23-34 weeks' preterm infants from 329 US NICUs discharged from 2009 to 2016. Each IVF patient was matched to three controls. RESULTS We identified 6,756 IVF-conceived preterm infants who were matched with 20,268 controls. IVF-conceived infants had no increase in non-respiratory morbidities but had significantly higher rates of bronchopulmonary dysplasia (8.4% vs 7%, p < 0.001) and significantly greater exposure to common chronic respiratory medications. CONCLUSIONS In this large cohort of IVF-conceived preterm infants we found similar outcomes to controls with the exception of bronchopulmonary dysplasia and respiratory medication exposure. Further research is needed to explore the influence of in vitro fertilization on the development of neonatal respiratory disease.
Collapse
|
7
|
Molines L, Nusinovici S, Moreau M, Remy M, May-Panloup P, Flamant C, Roze JC, Van Bogaert P, Bouet PE, Gascoin G. Impact of mode of conception on neonatal and neurodevelopmental outcomes in preterm infants. Hum Reprod 2018; 34:356-364. [DOI: 10.1093/humrep/dey345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 11/04/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lisa Molines
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Simon Nusinovici
- INSERM CIC 1413, Clinical Investigation Center, Nantes University Hospital, Nantes, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
| | - Marie Moreau
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Mathilde Remy
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
| | - Pascale May-Panloup
- Department of Reproductive Biology, Angers University Hospital, Angers, France
| | - Cyril Flamant
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Jean-Christophe Roze
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Neonatal Medicine, Nantes University Hospital, Nantes, France
| | - Patrick Van Bogaert
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
- Department of Paediatric Neurology, Angers University Hospital, Angers, France
| | | | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France
- Loire Infant Follow-up Team (LIFT) Network, Pays de Loire, France
| |
Collapse
|
8
|
Is artificial reproductive technology a risk factor for retinopathy of prematurity independent of the generation of multiple births? Eur J Ophthalmol 2016; 27:174-178. [PMID: 27445066 DOI: 10.5301/ejo.5000832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE There is some debate regarding whether artificial reproductive technology (ART) constitutes an independent risk factor for retinopathy of prematurity (ROP). We wanted to assess the prevalence of ART in multiple birth infants seen for ROP screening and whether or not ROP was identified or treated, in order to evaluate whether ART contributes a risk factor for ROP independent of the generation of multiple births. METHODS A retrospective audit was performed of all multiple birth babies admitted to a tertiary neonatal unit who met the UK ROP screening criteria (<32 weeks gestational age [GA] and/or <1,501 g birthweight [BW]). RESULTS A total of 205 babies met our criteria, of whom 87.3% were twins. A total of 39.5% were born following ART. A total of 30.5% of the non-ART group developed ROP vs 34% of the ART group (p = 0.837). Stage 3 ROP developed in 5.1% of non-ART babies and 6% of ART babies. A total of 8.5% of non-ART babies and 10% of ART babies required treatment for ROP. Logistic regression demonstrated that ART was not independently associated with development of ROP. CONCLUSIONS Artificial reproductive technology multiple birth babies make up a considerable proportion of the ROP screening burden and their number is likely to increase as ART is increasingly available and utilized. We found no significant difference between the numbers of babies developing ROP in the ART vs non-ART groups, but the numbers are small. The estimated odds of developing ROP are slightly higher in the ART babies, so our data do not rule out a possible association.
Collapse
|