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Özkan S, Dereli ML, Kurt D, Kurt A, Sucu S, Fıratlıgil FB, İşleyen F, Çelen Ş, Üstün YE. The use of late preterm antenatal corticosteroids in women with gestational diabetes : a puzzle worth solving. BMC Pregnancy Childbirth 2024; 24:286. [PMID: 38637735 PMCID: PMC11027230 DOI: 10.1186/s12884-024-06510-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND To investigate the association between late preterm antenatal corticosteroid treatment and outcome in late preterm neonates born to mothers with gestational diabetes mellitus, METHODS: All patients with gestational diabetes mellitus who had a late preterm delivery at Etlik Lady Zübeyde Hospital between 2017 and 2021 were included. Women who met the inclusion criteria and were not given antenatal corticosteroid treatment during current pregnancy before 34 0/7 weeks of gestation were divided into two groups according to whether or not they received late preterm antenatal corticosteroid treatment. The two groups were compared in terms of adverse neonatal complications. The main outcomes were composite respiratory outcome and composite neonatal outcome. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. RESULTS This retrospective cohort study included a total of 400 participants with gestational diabetes mellitus who had a late preterm delivery within the study period. Of these women, 196 (49%) received late preterm antenatal corticosteroid treatment. Main outcomes showed no difference. Decreasing gestational age at birth was identified as an independent risk factor predicting both composite respiratory outcome and composite neonatal outcome in multivariate logistic regression analysis. CONCLUSIONS Antenatal corticosteroid treatment at or after 34 0/7 weeks of gestation in women with gestational diabetes mellitus who had a late preterm delivery was not associated with improvement in adverse neonatal outcomes. Decreasing gestational age at birth was the only independent risk factor predicting composite neonatal and composite respiratory outcomes.
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Affiliation(s)
- Sadullah Özkan
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey.
| | - Murat Levent Dereli
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Dilara Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Ahmet Kurt
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Sadun Sucu
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fahri Burçin Fıratlıgil
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Fatih İşleyen
- Department of Neonatology, Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Şevki Çelen
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
| | - Yaprak Engin Üstün
- Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik Lady Zübeyde Maternity and Women's Health Teaching and Research Hospital, P.O. box 06010, New Etlik Street No:55 Etlik, Keçiören, Ankara, Turkey
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Takahashi T, Jobe AH, Fee EL, Newnham JP, Schmidt AF, Usuda H, Kemp MW. The complex challenge of antenatal steroid therapy nonresponsiveness. Am J Obstet Gynecol 2022; 227:696-704. [PMID: 35932879 DOI: 10.1016/j.ajog.2022.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
Antenatal steroid therapy is standard care for women at imminent risk of preterm delivery. When deliveries occur within 7 days of treatment, antenatal steroid therapy reduces the risk of neonatal death and improves preterm outcomes by exerting diverse developmental effects on the fetal organs, in particular the preterm lung and cardiovascular system. There is, however, sizable variability in antenatal steroid treatment efficacy, and an important percentage of fetuses exposed to antenatal steroid therapy do not respond sufficiently to derive benefit. Respiratory distress syndrome, for example, is a central metric of clinical trials to assess antenatal steroid outcomes. In the present analysis, we addressed the concept of antenatal steroid nonresponsiveness, and defined a failed or suboptimal response to antenatal steroids as death or a diagnosis of respiratory distress syndrome following treatment. For deliveries at 24 to 35 weeks' gestation, the number needed to treat to prevent 1 case of respiratory distress syndrome was 19 (95% confidence interval, 14-28). Reflecting gestation-dependent risk, for deliveries at >34 weeks' gestation the number needed to treat was 55 (95% confidence interval, 30-304), whereas for elective surgical deliveries at term this number was 106 (95% confidence interval, 61-421). We reviewed data from clinical and animal studies investigating antenatal steroid therapy to highlight the significant incidence of antenatal steroid therapy nonresponsiveness (ie, residual mortality or respiratory distress syndrome after treatment), and the potential mechanisms underpinning this outcome variability. The origins of this variability may be related to both the manner in which the therapy is applied (ie, the treatment regimen itself) and factors specific to the individual (ie, genetic variation, stress, infection). The primary aims of this review were: (1) to emphasize to the obstetrical and neonatal communities the extent of antenatal steroid response variability and its potential impact; (2) to propose approaches by which antenatal steroid therapy may be better applied to improve overall benefit; and (3) to stimulate further research toward the empirical optimization of this important antenatal therapy.
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Affiliation(s)
- Tsukasa Takahashi
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia; Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Alan H Jobe
- Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH
| | - Erin L Fee
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | - John P Newnham
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
| | | | - Haruo Usuda
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia; Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan
| | - Matthew W Kemp
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia; Center for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Japan; School of Veterinary and Life Sciences, Murdoch University, Perth, Australia; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Odufalu FD, Long M, Lin K, Mahadevan U. Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: results from the PIANO registry. Gut 2022; 71:1766-1772. [PMID: 34686575 DOI: 10.1136/gutjnl-2021-325317] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/09/2021] [Indexed: 12/08/2022]
Abstract
OBJECTIVE Active inflammatory bowel disease (IBD) during pregnancy may require the use of corticosteroids. The aim of this study was to investigate the impact of in utero corticosteroid exposure on adverse pregnancy outcomes, congenital malformations, infections and neurocognitive development among offspring of mothers with IBD. DESIGN Using the prospective Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes registry, data were collected at each trimester, delivery; and in the 12 months post partum. Bivariate statistics and multivariate logistic regression models compared pregnancy outcomes by corticosteroid exposure. RESULTS A total of 1490 mothers with IBD were enrolled, with 1431 live births recorded. Corticosteroid use was associated with increased risk of preterm birth, small for gestational age, low birth weight (LBW), intrauterine growth restriction and neonatal intensive care unit (NICU) admission. On adjusted multivariate models, corticosteroid use was associated with preterm birth (OR 1.79, 95% CI 1.18 to 2.73), LBW (OR 1.76, 95% CI 1.07 to 2.88) and NICU admission (OR 1.54, 95% CI 1.03 to 2.30). Late corticosteroid use (second and/or third trimester) was associated with serious infections at 9 and 12 months (4% vs 2% and 5% vs 2%, respectively, p=0.03 and p=0.001). There were five newborns with in utero corticosteroid exposure born with orofacial clefts versus one without corticosteroid exposure. Developmental milestones were similar across corticosteroid exposure groups. CONCLUSION In this prospective pregnancy registry, offspring of women exposed to corticosteroids during pregnancy were more likely to have adverse pregnancy outcomes. This emphasises the importance of controlling disease activity before and during pregnancy with steroid-sparing therapy.
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Affiliation(s)
- Florence-Damilola Odufalu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Millie Long
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kirk Lin
- Department of Gastroenterology, Palo Alto Medical Foundation, Fremont, California, USA
| | - Uma Mahadevan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Ruben-Castillo C, Mier Y Teran-Ellis S, Anaya-Ayala JE, Contreras-Jimenez E, Lopez-Peña G, Luna L, Arzola LH, Silerio E, Guerrero-Hernández M, Hinojosa CA. Complex and Successful Management of a Symptomatic Isolated Abdominal Aortic Aneurysm in a Pregnant Woman with Marfan Syndrome. Vasc Endovascular Surg 2022; 56:529-534. [PMID: 35452326 DOI: 10.1177/15385744221087820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortopathies associated to Marfan syndrome (MFS) are important causes of maternal death during pregnancy. We present a 27-year-old and 24-week pregnant MFS woman who arrived to the emergency department with increasing abdominal pain; an obstetric ultrasound showed an Abdominal Aortic Aneurysm (AAA), a multislice computed tomography angiography (CTA) confirmed and demonstrated a 7.3 centimeter (cm) infrarenal AAA without evidence of dissection. A multidisciplinary committee determined that an open repair would lead to a significantly high maternal-fetal morbidity and mortality. Although endovascular repair (EVAR) in MFS patients remains controversial, an urgent bridge therapy was considered to be the best option. She was transferred to the angiography suite for EVAR to prevent AAA rupture and ensure a satisfactory pregnancy. The patient and fetus presented no complications during the procedure and were discharged 3 days later. She continued her pregnancy without eventualities and an elective C-section was performed on week 36. A CTA imaging at 12 months revealed type 1A and 3 endoleaks, we decided to perform endograft explant and a definitive open repair, there were no complications during the procedure, the patient is currently asymptomatic. Our case illustrates a complex decision and management that successfully avoid morbidity and mortality of a MFS mother and her product; additionally, this experience reinforces the need for lifelong and close surveillance in these patients.
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Affiliation(s)
- Christopher Ruben-Castillo
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Santiago Mier Y Teran-Ellis
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Emmanuel Contreras-Jimenez
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gabriel Lopez-Peña
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lizeth Luna
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis H Arzola
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ernesto Silerio
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Manuel Guerrero-Hernández
- Department of Radiology, Section of Interventional Radiology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Mwita S, Kamala BA, Konje E, Ambrose EE, Izina A, Chibwe E, Kongola G, Dewey D. Association between antenatal corticosteroids use and perinatal mortality among preterm singletons and twins in Mwanza, Tanzania: an observational study. BMJ Open 2022; 12:e059030. [PMID: 35393329 PMCID: PMC8991063 DOI: 10.1136/bmjopen-2021-059030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine the association between antenatal corticosteroids (ACS) use and perinatal mortality in singletons and twins delivered before 35 weeks of gestation. DESIGN Secondary analysis of data from an observational prospective chart review study that investigated if exposure to ACS was associated with lower rates of perinatal mortality in preterm infants. SETTING This study was conducted in four hospitals located in Mwanza region, Tanzania. PARTICIPANTS The study population included all preterm singletons and twins delivered at these hospitals between 24 weeks 0 days and 34 weeks 6 days of gestation from July 2019 to February 2020. OUTCOME MEASURES The primary outcome was perinatal mortality; the secondary outcome was respiratory distress syndrome (RDS). RESULTS The study included 844 singletons and 210 twin infants. Three hundred and fourteen singletons (37.2%) and 52 twins (24.8%) were exposed to at least one dose of ACS. Adjusted multivariate analyses revealed that among singletons' exposure to ACS was significantly associated with a lower likelihood of perinatal mortality, adjusted relative risk (aRR) 0.30 (95% CI 0.22 to 0.40) and RDS, aRR 0.92 (95% CI 0.87 to 0.97). In twin infants, exposure to ACS was associated with a reduced risk of RDS only, aRR 0.87 (95% CI 0.78 to 0.98). CONCLUSION The use of ACS between 24 weeks 0 days and 34 weeks 6 days of gestation in both singletons and twins in low-resource settings is associated with positive infant outcomes. No adverse effects were noted. Further research that examines the benefits of ACS for twin infants is needed.
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Affiliation(s)
- Stanley Mwita
- School of Pharmacy, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Benjamin Anathory Kamala
- Department of Research, Haydom Lutheran Hospital, Mbulu, Manyara, United Republic of Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Eveline Konje
- Department of Epidemiology and Biostatistics, Catholic University of Health and Allied, Mwanza, United Republic of Tanzania
| | - Emmanuela Eusebio Ambrose
- Department of Peadiatrics and Child Health, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Angelina Izina
- Department of Radiology, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Elieza Chibwe
- Department of Obstetrics and Gynaecology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Gilbert Kongola
- Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Deborah Dewey
- Owerko Centre at the Alberta Children's Hospital Research Institute and Departments of Pediatrics and Community Health Sciences, The University of Calgary, Calgary, Alberta, Canada
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Hwang M, Tierradentro-García LO, Hussaini SH, Cajigas-Loyola SC, Kaplan SL, Otero HJ, Bellah RD. Ultrasound imaging of preterm brain injury: fundamentals and updates. Pediatr Radiol 2022; 52:817-836. [PMID: 34648071 DOI: 10.1007/s00247-021-05191-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 11/25/2022]
Abstract
Neurosonography has become an essential tool for diagnosis and serial monitoring of preterm brain injury. Preterm infants are at significantly higher risk of hypoxic-ischemic injury, intraventricular hemorrhage, periventricular leukomalacia and post-hemorrhagic hydrocephalus. Neonatologists have become increasingly dependent on neurosonography to initiate medical and surgical interventions because it can be used at the bedside. While brain MRI is regarded as the gold standard for detecting preterm brain injury, neurosonography offers distinct advantages such as its cost-effectiveness, diagnostic utility and convenience. Neurosonographic signatures associated with poor long-term outcomes shape decisions regarding supportive care, medical or behavioral interventions, and family members' expectations. Within the last decade substantial progress has been made in neurosonography techniques, prompting an updated review of the topic. In addition to the up-to-date summary of neurosonography, this review discusses the potential roles of emerging neurosonography techniques that offer new functional insights into the brain, such as superb microvessel imaging, elastography, three-dimensional ventricular volume assessment, and contrast-enhanced US.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Luis O Tierradentro-García
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Syed H Hussaini
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie C Cajigas-Loyola
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Summer L Kaplan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard D Bellah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lin D, Fan D, Chen G, Luo C, Guo X, Liu Z. Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies. BMJ Open 2021; 11:e047651. [PMID: 34580092 PMCID: PMC8477320 DOI: 10.1136/bmjopen-2020-047651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies. METHODS The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre. RESULTS A total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations. DISCUSSION ACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Caihong Luo
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
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Maternal epilepsy- perinatal outcome and long-term neurological morbidity of the offspring: a population-based cohort study. Arch Gynecol Obstet 2021; 305:55-62. [PMID: 34100131 DOI: 10.1007/s00404-021-06114-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The current study was aimed to assess whether maternal epilepsy is linked to long-term neurological morbidity of the offspring, and to examine whether maternal epilepsy is associated with adverse pregnancy outcomes. METHODS A population-based cohort study was conducted comparing perinatal outcomes of women with and without epilepsy, including long-term neurological morbidity of the offspring. Both the exposed and unexposed groups were followed up to 18 years of age for neurological-related morbidity. To assess perinatal outcomes of women with epilepsy, generalized estimation equation (GEE) models were used to control for confounders. To compare the cumulative incidence of long-term neurological morbidity a Kaplan-Meier survival curve was used. A Cox proportional hazards model was built to control for confounders. RESULTS During the study period, 243,682 deliveries met the inclusion criteria; 711 (0.29%) were of mothers with epilepsy. Maternal epilepsy was noted as an independent risk factor for preterm delivery, cesarean delivery, and low birth weight using GEE models controlling for maternal age and parity. Offspring born to mothers with epilepsy had higher rates of long-term neurological morbidity (Kaplan-Meier log-rank test, p < 0.001). A Cox proportional hazards model, controlled for maternal age, hypertensive disorders, gestational age, and diabetes mellitus, demonstrated that being born to a mother with epilepsy was an independent risk factor for long-term neurological morbidity of the offspring (adjusted HR 2.7, 95% CI 2.12-3.56, p < 0.001). CONCLUSIONS The pregnancy of epileptic women is independently associated with the adverse perinatal outcome as well as a higher risk for long-term neurological morbidity of the offspring.
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Marinelli KC, Lyden ER, Peeples ES. Clinical risk factors for the development of late-onset circulatory collapse in premature infants. Pediatr Res 2021; 89:968-973. [PMID: 32492694 DOI: 10.1038/s41390-020-0990-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Very low birth weight (VLBW) infants may be at risk for late-onset circulatory collapse (LCC) where otherwise stable infants develop hypotension resistant to vasoactive agents. The risk factors for LCC development are poorly defined, and it has been theorized that it may be in part due to withdrawal from exogenous prenatal steroids. The goal of this study was to define the clinical characteristics of LCC and investigate its association with antenatal steroid administration. METHODS This is a retrospective cohort study of infants born ≤1500 g. LCC was retrospectively diagnosed in infants requiring glucocorticoids for circulatory instability at >1 week of life. Demographic and clinical characteristics were compared between groups using Mann-Whitney test. RESULTS Three hundred and ten infants were included; 19 (6.1%) developed LCC. Infants with LCC were born at a median 4.6 weeks' lower gestation, 509 g lower birth weight than those without LCC. There was no difference in antenatal steroid delivery between the groups. CONCLUSIONS LCC occurs in a distinct subset of VLBW infants, suggesting the need for monitoring in this high-risk population. Antenatal steroids did not significantly increase the risk of LCC development in this study. IMPACT Late-onset circulatory collapse (LCC) is a life-threatening clinical entity occurring in around 6% in VLBW infants and is likely underdiagnosed in the United States. Targeting specific demographic characteristics such as birth weight (<1000 g) and gestational age at birth (<26 weeks) may allow for early identification of high-risk infants, allowing close monitoring and prompt treatment of LCC. No significant association was found between antenatal steroid administration and LCC development, suggesting that the theoretical risks of antenatal steroids on the fetal HPA axis does not outweigh the benefits of antenatal steroids in fetal lung maturity. To date, no studies characterizing LCC have originated outside of Asia. Therefore, providing a description of LCC in a U.S.-based cohort will provide insight into both its prevalence and presentation to inform clinicians about this potentially devastating disorder and foster early diagnosis and treatment. This study validates LCC characteristics and prevalence previously outlined by Asian studies in a single-center U.S.-based cohort while also identifying potential risk factors for LCC development. This manuscript will provide education for U.S. physicians about the risk factors and clinical presentation of LCC to facilitate early diagnosis and treatment, potentially decreasing neonatal mortality. With prompt recognition and treatment of LCC, infants may have decreased exposure to vasoactive medications that have significant systemic effects.
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Affiliation(s)
| | - Elizabeth R Lyden
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Eric S Peeples
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
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10
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Abstract
Periviable deliveries (less than 26 weeks) are a small percentage of deliveries but account for a disproportionately high number of long-term morbidities. Few studies describe interventions and outcomes for periviable preterm premature rupture of membranes (PPROM). The available reports may include only those neonates who received resuscitation, making interpretation and application difficult. Counseling should consider the impact of oligohydramnios on fetal lung development. This article discusses standard and experimental interventions that may offer neonatal benefit. Antenatal corticosteroids, antibiotics, and magnesium sulfate may improve outcomes but data to support an improvement in outcome are limited. Studies specifically evaluating these interventions are needed.
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Affiliation(s)
- Kelly S Gibson
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA.
| | - Kerri Brackney
- Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University, The MetroHealth System, Suite G240, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA
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11
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Kim JK, Hwang JH, Lee MH, Chang YS, Park WS. Mortality rate-dependent variations in antenatal corticosteroid-associated outcomes in very low birth weight infants with 23-34 weeks of gestation: A nationwide cohort study. PLoS One 2020; 15:e0240168. [PMID: 33017428 PMCID: PMC7535030 DOI: 10.1371/journal.pone.0240168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022] Open
Abstract
Antenatal corticosteroid (ACS) administration has been known as one of the most effective treatment in perinatal medicine, but the beneficial effects of ACS may vary not only gestational age, but also the quality of perinatal and neonatal care of the institution. This nationwide cohort study of the Korean Neonatal Network (KNN) data was consisted of <1,500g infants born at 23–34 weeks at 67 KNN hospitals between 2013 and 2017. The 9,142 eligible infants were assigned into two groups–group 1 and 2 <50% and ≥50% mortality rate, respectively, for 23–24 weeks’ gestation–reflecting the quality of perinatal and neonatal care. Each group of infants were further stratified into 23–24, 25–26, 27–28, and 29–34 weeks of gestation age. Despite comparable ACS usage between group 1 (82%) and group 2 (81%), the benefits of ACS were only observed in group 1. In the multivariable analyses, infants of group 1 showed significant decrease in mortality and IVH at gestational age 23–24 weeks with ACS use, and the decrease was also seen in early-onset sepsis and respiratory distress syndrome at gestational age of 29–34 weeks while there were no significant decrease in group 2. In this study the overall data was congruent with the previous findings stating that ACS use decreases mortality and morbidity. These results indicate that the improved mortality of infants at 23–24 weeks’ gestation reflects the quality improvement of perinatal and neonatal intensive care, which is a prerequisite to the benefits of ACS.
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Affiliation(s)
- Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Ilsan Paik Hospital, InJe University College of Medicine, Goyang, Korea
| | - Myung Hee Lee
- Statistic and Data Center, Samsung Medical Center, Seoul, Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Soon Park
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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12
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Kong X, Xu F, Wang Z, Zhang S, Feng Z. Antenatal corticosteroids administration on mortality and morbidity in premature twins born at 25∼34 gestational weeks: A retrospective multicenter study. Eur J Obstet Gynecol Reprod Biol 2020; 253:259-265. [PMID: 32898771 DOI: 10.1016/j.ejogrb.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of antenatal corticosteroids (ACS) administration on mortality and major neonatal complications in early life of preterm twins. STUDY DESIGN This study retrospectively enrolled 1 662 twins delivered at 25∼34+6gestational weeks in China from January 2013 to December 2014. They were divided into ACS group and no-ACS group according to weather their mothers received ACS or not. Moreover, they were subgrouped as 25∼27+6 and 28∼34+6gestational week groups. Multivariable logistic regression was used to analyze the effects of ACS on the incidence of mortality and major morbidities. RESULTS A total of 910 neonates (54.8 %) received one or more doses of ACS, and 752 neonates (45.2 %) did not receive any ACS. No significant difference in infant mortality was observed between the ACS and no-ACS groups (P = 0.321). The ACS group had decreased incidence of respiratory distress syndrome (RDS) and mild RDS compared with the no-ACS group (both P < 0.05). There were no significant differences in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, sepsis and severe RDS between the two groups (all P > 0.05). The subgroup analysis showed that the incidence of RDS was lower in the ACS group than in the no-ACS group (P = 0.036) at 28∼34+6weeks. However, the incidence of mild ROP was higher in the ACS group than that in the no-ACS group (P = 0.047) at 25∼27+6 weeks. Multivariable logistic regression analysis demonstrated a decreasing risk of RDS (aOR = 0.661, 95 %CI:0.506-0.863, P = 0.002) after adjusting the gestational week, birth weight, small for gestational age, delivery mode, 5 min Apgar score, and maternal perinatal complications. CONCLUSION In twin preterm infants, ACS administration is associated with a reduced risk of RDS. However, our data suggest that it may not have a beneficial effect on mortality and other short-term morbidities.
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Affiliation(s)
- Xiangyong Kong
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China; Clinical Medical College, The Seventh Medical Center, General Hospital of the People's Liberation Army, Southern Medical University, Beijing 100700, China.
| | - Fengdan Xu
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, 523325, China; Department of Pediatrics, Guangdong Medical University, Dongguan, 523808, China
| | - Zizhen Wang
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China
| | - Shan Zhang
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China
| | - Zhichun Feng
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China; Clinical Medical College, The Seventh Medical Center, General Hospital of the People's Liberation Army, Southern Medical University, Beijing 100700, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing 100700, China; National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing 100700, China.
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13
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Puia-Dumitrescu M, Younge N, Benjamin DK, Lawson K, Hume C, Hill K, Mengistu J, Wilson A, Zimmerman KO, Ahmad K, Greenberg RG. Medications and in-hospital outcomes in infants born at 22-24 weeks of gestation. J Perinatol 2020; 40:781-789. [PMID: 32066843 PMCID: PMC7293630 DOI: 10.1038/s41372-020-0614-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the most commonly used medications and in-hospital morbidities and mortality in infants born 22-24 weeks of gestation. STUDY DESIGN Multicenter retrospective cohort study of infants born 22-24 weeks of gestation (2006-2016), without major congenital anomalies and with available medication data obtained from neonatal intensive care units managed by the Pediatrix Medical Group. RESULTS This study included 7578 infants from 195 sites. Median (25th, 75th percentile): birthweight was 610 g (540, 680); the number of distinct medications used was 13 (8, 18); and different antimicrobial exposure was 4 (2, 5). The most common morbidities were BPD (41%) and grade III or IV IVH (20%), and overall survival varied from 46% (2006) to 57% (2016). CONCLUSIONS A large number of medications were used in periviable infants. There was a high prevalence of in-hospital morbidities, and survival of this population increased over the study period.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Noelle Younge
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | | | - Katie Lawson
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Kennedy Hill
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kaashif Ahmad
- MEDNAX Center for Research, Education, Quality and Safety, San Antonio, TX, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
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14
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Regional and Racial-Ethnic Differences in Perinatal Interventions Among Periviable Births. Obstet Gynecol 2020; 135:885-895. [PMID: 32168210 DOI: 10.1097/aog.0000000000003747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine whether there are: 1) regional differences in three perinatal interventions that reflect active treatment among periviable gestations and 2) racial-ethnic differences in the receipt of these perinatal interventions after accounting for hospital region. METHODS We conducted a retrospective study on neonates born at 776 U.S. centers that participated in the Vermont Oxford Network (2006-2017) with a gestational age of 22-25 weeks. The primary outcome was postnatal life support. Secondary outcomes included maternal administration of antenatal corticosteroids and cesarean delivery. We examined rates and 99% CI of the three outcomes by region. We also calculated the adjusted relative risks (aRRs) and 99% CIs for the three outcomes by race and ethnicity within each region using modified Poisson regression models with robust variance estimation. RESULTS Major regional variation exists in the use of the three interventions at 22 and 23 weeks of gestation but not at 24 and 25 weeks. For example, at 22 weeks of gestation, rates of life support in the South (38.3%; 99% CI 36.3-40.2) and the Midwest (32.7%; 99% CI 30.4-35.0) were higher than in the Northeast (20.2%; 99% CI 17.6-22.8) and the West (22.2%; 99% CI 20.0-24.4). Particularly in the Northeast, black and Hispanic neonates born at 22 or 23 weeks of gestation had a higher provision of postnatal life support than white neonates (at 22 weeks: black: aRR 1.84 [99% CI 1.33-2.56], Hispanic: aRR 1.80 [1.23-2.64]; at 23 weeks: black: aRR 1.14 [99% CI 1.08-1.20], Hispanic: aRR 1.12 [1.05-1.19]). In the West, black and Hispanic neonates born at 23 weeks of gestation also had a higher provision of life support (black: aRR 1.11 [99% CI 1.03-1.19]; Hispanic: aRR 1.10 [1.04-1.16]). CONCLUSION Major regional variation exists in perinatal interventions when managing 22- and 23-week neonates. In the Northeast and the West regions, minority neonates born at 22 and 23 weeks of gestation had higher provision of postnatal life support.
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15
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Parodi A, Govaert P, Horsch S, Bravo MC, Ramenghi LA. Cranial ultrasound findings in preterm germinal matrix haemorrhage, sequelae and outcome. Pediatr Res 2020; 87:13-24. [PMID: 32218535 PMCID: PMC7098890 DOI: 10.1038/s41390-020-0780-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Germinal matrix-intraventricular haemorrhage (GMH-IVH), periventricular haemorrhagic infarction (PHI) and its complication, post-haemorrhagic ventricular dilatation (PHVD), are still common neonatal morbidities in preterm infants that are highly associated with adverse neurodevelopmental outcome. Typical cranial ultrasound (CUS) findings of GMH-IVH, PHI and PHVD, their anatomical substrates and underlying mechanisms are discussed in this paper. Furthermore, we propose a detailed descriptive classification of GMH-IVH and PHI that may improve quality of CUS reporting and prediction of outcome in infants suffering from GMH-IVH/PHI.
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Affiliation(s)
- Alessandro Parodi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy
| | - Paul Govaert
- Department of Neonatology, Erasmus Medical Center University, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Neonatology, ZNA Middelheim, Antwerp, Belgium
- Department of Rehabilitation and Physical Therapy, Gent University Hospital, Gent, Belgium
| | - Sandra Horsch
- Department of Neonatology, Helios Klinikum Berlin Buch, Berlin, Germany
| | | | - Luca A Ramenghi
- IRCCS, Istituto Giannina Gaslini, DINOGMI Department University of Genoa, Via Gaslini 5, 16148, Genoa, Italy.
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16
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Liu SY, Yang HI, Chen CY, Chou HC, Hsieh WS, Tsou KI, Tsao PN. The gestational effect of antenatal corticosteroids on respiratory distress syndrome in very low birth weight infants: A population-based study. J Formos Med Assoc 2019; 119:1267-1273. [PMID: 31761503 DOI: 10.1016/j.jfma.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/01/2019] [Accepted: 11/04/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE The aim of this study was to evaluate the efficacy of antenatal corticosteroids for preventing very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) from surfactant use at different gestational ages (GA). METHODS We retrospectively analyzed the VLBW preterm infants registered in the Premature Baby Foundation of Taiwan from 1997 through 2014. Infants at 20-37 weeks' gestation were included, and infants with lethal congenital anomaly, chromosomal anomaly, and congenital infection were excluded. Antenatal corticosteroid courses were classified into two groups (<2 doses or ≧2 doses). The beneficial effect of antenatal corticosteroids on preventing VLBW infants with RDS from surfactant use was evaluated according to gestational ages. RESULTS Total 12,685 VLBW infants were included. For VLBW infants with gestational age 26-33 weeks, antenatal corticosteroid therapy has significantly protective effect (odds ratio 0.43 [95% CI 0.26 to 0.72] - 0.60 [95% CI 0.48 to 0.75], P < 0.05). The effect was not obvious for VLBW infants with gestational age 34 weeks and more (odds ratio 0.32 [95% CI 0.08 to 1.38], P = 0.127). CONCLUSION For VLBW infants with RDS at 34 weeks' gestation and more, the beneficial effect of antenatal corticosteroids on preventing surfactant use was not evident. In conclusion, completion of two doses or more of antenatal corticosteroids is of great importance for VLBW infants with RDS at gestational age between 26 and 33 weeks on preventing surfactant use.
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Affiliation(s)
- Szu-Yu Liu
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pediatrics, Cathay General Hospital, Taipei, Taiwan
| | - Kuo-Inn Tsou
- Department of Pediatrics, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; The Research Center of Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.
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17
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Lee SK, Qi Z. Antenatal corticosteroids prior to preterm birth: betamethasone or dexamethasone? THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:750-751. [PMID: 31523038 DOI: 10.1016/s2352-4642(19)30293-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Shoo K Lee
- Departments of Paediatrics, Obstetrics & Gynecology, and Public Health, University of Toronto Toronto, ON, Canada; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
| | - Zhou Qi
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada; Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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18
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Villamor-Martinez E, Fumagalli M, Alomar YI, Passera S, Cavallaro G, Mosca F, Villamor E. Cerebellar Hemorrhage in Preterm Infants: A Meta-Analysis on Risk Factors and Neurodevelopmental Outcome. Front Physiol 2019; 10:800. [PMID: 31293454 PMCID: PMC6603211 DOI: 10.3389/fphys.2019.00800] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Cerebellar hemorrhage (CBH) represents the most commonly acquired lesion of the posterior fossa in the neonatal period. We aimed to perform a systematic review and meta-analysis of studies exploring the perinatal risk factors and neurological outcome of CBH in preterm infants. A comprehensive literature search was conducted using PubMed/MEDLINE and EMBASE. Studies were included if they examined preterm infants and reported primary data on maternal, obstetric, or perinatal characteristics, and/or outcomes of infants with and without CBH. A random-effects model was used to calculate mean differences (MD), odds ratios (OR), and 95% confidence intervals (CI). We found 231 potentially relevant studies, of which 15 met the inclusion criteria (4,236 infants, 347 CBH cases). Meta-analysis could not demonstrate a significant association between CBH and multiple gestation, chorioamnionitis, pre-eclampsia, placental abruption, use of antenatal corticosteroids, mode of delivery, or infant sex. Infants with CBH had a significantly lower gestational age (6 studies, MD −1.55 weeks, 95% CI −1.93 to −1.16) and birth weight (6 studies, MD −173 g, 95% CI −225 to −120), and significantly higher rates of intubation at birth, hypotension, patent ductus arteriosus, intraventricular hemorrhage, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia. CBH was significantly associated with delayed mental (6 studies, OR 2.95, 95% CI 1.21 to 7.20) and psychomotor (6 studies, OR 3.62, 95% CI 1.34 to 9.76) development, and higher rates of cerebral palsy (4 studies, OR 3.09, 95% CI 1.55 to 6.19). In conclusion, the present meta-analysis shows that the youngest and sickest preterm infants are at higher risk of developing CBH. Our results highlight the multifactorial nature of CBH and reinforce the idea that cerebellar injury in very preterm newborns has important neurodevelopmental consequences among survivors.
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Affiliation(s)
- Eduardo Villamor-Martinez
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Monica Fumagalli
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Yaser Ibrahim Alomar
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
| | - Sofia Passera
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Center, Maastricht, Netherlands
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Huber HF, Kuo AH, Li C, Jenkins SL, Gerow KG, Clarke GD, Nathanielsz PW. Antenatal Synthetic Glucocorticoid Exposure at Human Therapeutic Equivalent Doses Predisposes Middle-Age Male Offspring Baboons to an Obese Phenotype That Emerges With Aging. Reprod Sci 2019; 26:591-599. [PMID: 29871548 PMCID: PMC6728579 DOI: 10.1177/1933719118778794] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Women threatening premature delivery receive synthetic glucocorticoids (sGC) to accelerate fetal lung maturation, reducing neonatal mortality and morbidity. Few investigations have explored potential long-term offspring side effects. We previously reported increased pericardial fat and liver lipids in 10-year-old (human equivalent 40 years) male baboons exposed to 3 antenatal sGC courses. We hypothesized middle-aged sGC male offspring show obesity-related morphometric changes. METHODS Pregnant baboons received courses of 2 betamethasone injections (175 μg·kg-1·d-1 intramuscular) at 0.6, 0.64, and 0.68 gestation. At 10 to 12.5 years, we measured morphometrics and serum lipids in 5 sGC-exposed males and 10 age-matched controls. We determined whether morphometric parameters predicted amount of pericardial fat or lipids. Life-course serum lipids were measured in 25 males (7-23 years) providing normal regression formulas to compare sGC baboons' lipid biological and chronological age. RESULTS Birth weights were similar. When studied, sGC-exposed males showed a steeper weight increase from 8 to 12 years and had increased waist and hip circumferences, neck and triceps skinfolds, and total and low-density lipoprotein cholesterol. Triceps skinfold correlated with apical and midventricular pericardial fat thickness, hip and waist circumferences with insulin. CONCLUSIONS Triceps skinfold and waist and hip circumferences are useful biomarkers for identifying individuals at risk for obesity and metabolic dysregulation following fetal sGC exposure. Prenatal sGC exposure predisposes male offspring to internal adiposity, greater body size, and increased serum lipids. Results provide further evidence for developmental programming by fetal sGC exposure and call attention to potential emergence of adverse life-course effects.
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Affiliation(s)
| | - Anderson H. Kuo
- Radiology, University of Texas Health Science Center at San Antonio, San
Antonio, TX, USA
| | - Cun Li
- Animal Science, University of Wyoming, Laramie, WY, USA
- Southwest National Primate Research Center and Texas Biomedical Research
Institute, San Antonio, TX, USA
| | | | | | - Geoffrey D. Clarke
- Radiology, University of Texas Health Science Center at San Antonio, San
Antonio, TX, USA
- Southwest National Primate Research Center and Texas Biomedical Research
Institute, San Antonio, TX, USA
| | - Peter W. Nathanielsz
- Animal Science, University of Wyoming, Laramie, WY, USA
- Southwest National Primate Research Center and Texas Biomedical Research
Institute, San Antonio, TX, USA
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Kulali F, Bas AY, Erol S, Yucel H, Guzel FI, Yalvac S, Demirel N. Survival of periviable infants: 5-year experience at a single center. J Matern Fetal Neonatal Med 2019; 33:3725-3731. [PMID: 30843755 DOI: 10.1080/14767058.2019.1583734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The primary aim of the present study was to investigate the survival rates of periviable births in a referral Level III NICU center in Turkey; the secondary aim was to determine the perinatal and natal risk factors related to mortality.Methods: This retrospective cross-sectional study was conducted at the Neonatal Intensive Care Unit between 1 January 2011 and 31 December 2015. All live deliveries occurring from 22 0/7 weeks to 25 6/7 week of gestation were included in the study (total n = 165). We documented prenatal, natal, and postnatal clinical processes in each case and assessed morbidity, mortality, and factors related to long-term prognosis.Results: While none of the infants born at 22 weeks of gestation survived until discharge, the survival rates for those admitted to the NICU were 7.5% for infants born at 23 weeks, 29.1% at 24 weeks, and 43.5% at 25 weeks. A total of 46 survived (27.9%), and follow-up data beyond 12 months were available for 22. The prevalence of neurodevelopmental impairment or neurosensory impairment was inversely associated with gestational age.Conclusions: The most important risk factors associated with mortality in periviable infants were SNAPPE score, antenatal corticosteroid use, and gestational age.
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Affiliation(s)
- Ferit Kulali
- Division of Neonatology, Etlik Zübeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Ahmet Yagmur Bas
- Division of Neonatology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Sara Erol
- Division of Neonatology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Husniye Yucel
- Division of Neonatology, Etlik Zübeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Fatma Iyigun Guzel
- Division of Neonatology, Etlik Zübeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Serdar Yalvac
- Department of Gynecology and Obstetrics, Etlik Zübeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey
| | - Nihal Demirel
- Division of Neonatology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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21
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Herrera TI, Vaz Ferreira MC, Toso A, Villarroel L, Silvera F, Ceriani-Cernadas JM, Tapia JL. Neonatal outcomes of antenatal corticosteroids in preterm multiple pregnancies compared to singletons. Early Hum Dev 2019; 130:44-50. [PMID: 30665038 DOI: 10.1016/j.earlhumdev.2019.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Antenatal corticosteroids (ACS) during preterm labour reduce neonatal mortality and morbidity. Evidence on preterm multiple pregnancies is limited and contradictory. OBJECTIVE Compare the effect of ACS on very low birth weight infant's (VLBW) mortality and morbidity among singleton and multiple pregnancies. STUDY DESIGN Retrospective cohort study, employing prospectively collected data, of infants 23 to 34 weeks' gestation and 500 to 1500 g born at the Neocosur Neonatal Network centers during 2007-2016. Neonatal outcomes were compared among singleton and multiple pregnancies exposed to at least one dose of ACS to those not exposed using logistic regression analyses controlled for birthweight, gestational age, sex, small for gestational age (SGA) and mode of delivery. RESULTS A total of 13,864 infants were studied; 2948 multiple (21.3%) and 10,904 singleton pregnancies (78.7%). Overall, 11,218 (81.4%) received at least one dose of ACS with a significant reduction in the risk of death, RDS and grade III or IV IVH compared to those not exposed. Both singleton and multiple pregnancies exposed to ACS showed similar reduced risk of death (aRR 0.41 [95% CI, 0.36-0.47] vs. aRR 0.46 [95% CI, 0.34-0.64]). However, ACS were not associated with reduced odds of RDS (aRR 0.89 [95% CI, 0.66-1.23]) or grade III or IV IVH (aRR 0.99 [95% CI, 0.67-1.48]) in multiple pregnancies. CONCLUSION The benefit of administration of at least one dose of ACS in VLBW multiple and singleton pregnancies is comparable in terms of death. However, ACS showed no relevant impact in short-term morbidity in multiple pregnancies.
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Affiliation(s)
- Tamara I Herrera
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay.
| | - María C Vaz Ferreira
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | - Alberto Toso
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Luis Villarroel
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Fernando Silvera
- Departamento de Neonatología, Centro Hospitalario Pereira Rossell, Universidad de la República, Montevideo, Uruguay
| | | | - José L Tapia
- Departamento de Neonatología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
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Koschnitzky JE, Keep RF, Limbrick DD, McAllister JP, Morris JA, Strahle J, Yung YC. Opportunities in posthemorrhagic hydrocephalus research: outcomes of the Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop. Fluids Barriers CNS 2018; 15:11. [PMID: 29587767 PMCID: PMC5870202 DOI: 10.1186/s12987-018-0096-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/09/2018] [Indexed: 12/19/2022] Open
Abstract
The Hydrocephalus Association Posthemorrhagic Hydrocephalus Workshop was held on July 25 and 26, 2016 at the National Institutes of Health. The workshop brought together a diverse group of researchers including pediatric neurosurgeons, neurologists, and neuropsychologists with scientists in the fields of brain injury and development, cerebrospinal and interstitial fluid dynamics, and the blood-brain and blood-CSF barriers. The goals of the workshop were to identify areas of opportunity in posthemorrhagic hydrocephalus research and encourage scientific collaboration across a diverse set of fields. This report details the major themes discussed during the workshop and research opportunities identified for posthemorrhagic hydrocephalus. The primary areas include (1) preventing intraventricular hemorrhage, (2) stopping primary and secondary brain damage, (3) preventing hydrocephalus, (4) repairing brain damage, and (5) improving neurodevelopment outcomes in posthemorrhagic hydrocephalus.
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Affiliation(s)
| | - Richard F. Keep
- University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA
| | - David D. Limbrick
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - James P. McAllister
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Jill A. Morris
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Neuroscience Center, 6001 Executive Blvd, NSC Rm 2112, Bethesda, MD 20892 USA
| | - Jennifer Strahle
- Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110 USA
| | - Yun C. Yung
- Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Rd., Building 7, La Jolla, CA 92037 USA
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Abstract
Periviable birth contributes disproportionately to perinatal morbidity and mortality. By analyzing the most relevant outcomes after a preterm birth some information can be provided on the potential benefit of interventions. This article discusses surgical and medical interventions that may offer neonatal benefit including cerclage, amniocentesis, progesterone, antenatal corticosteroids, magnesium sulfate for neuroprotection, and tocolysis. Cervical cerclage has the greatest promise at reducing morbidity and mortality related to periviable birth even though it may not reduce the overall preterm birth rate. The use of antenatal corticosteroids, magnesium sulfate, progesterone, and tocolytics may also improve outcome. Studies specifically evaluating these interventions are needed.
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Ananth CV, Chauhan SP. Epidemiology of Periviable Births: The Impact and Neonatal Outcomes of Twin Pregnancy. Clin Perinatol 2017; 44:333-345. [PMID: 28477664 DOI: 10.1016/j.clp.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article discusses a study that estimated the prevalence of twin live births in the United States that were delivered in the periviable (20-25 weeks) gestational age, and compared changes in twin neonatal mortality and morbidity rates between 2005 and 2013 overall, and at periviable gestations. Although the decline in twin neonatal mortality rates at 23 and 24 weeks is encouraging, and suggests advancement in the neonatal care of these extremely small twins, the concomitant increase in neonatal morbidity at 23 weeks is concerning. Efforts to understand if twins delivered at periviable gestations suffer from long-term consequences of neurodevelopmental and cognitive deficits remain important.
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Affiliation(s)
- Cande V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, 622 West 168 Street, New York, NY 10032, USA; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, 722 West 168 Street, New York, NY 10032, USA.
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, University of Texas, 6432 Fannin Street, MSB 3.286, Houston, TX 77030, USA
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Deshmukh M, Patole S. Antenatal corticosteroids for neonates born before 25 Weeks-A systematic review and meta-analysis. PLoS One 2017; 12:e0176090. [PMID: 28486556 PMCID: PMC5423600 DOI: 10.1371/journal.pone.0176090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Efficacy of antenatal corticosteroids before 25 weeks of gestation is unclear. OBJECTIVE To assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis. METHODS A systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 246 weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines. MAIN RESULTS There were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39-0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61-0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85-1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76-1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks. CONCLUSION Moderate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks.
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Affiliation(s)
- Mangesh Deshmukh
- Department of Neonatal Pediatrics, St. John of God Hospital, Subiaco, Perth, Western Australia
- Department of Neonatal Pediatrics, Fiona Stanley Hospital, Perth, Western Australia
| | - Sanjay Patole
- Department of Neonatal Pediatrics, King Edward Memorial Hospital, Perth, Western Australia
- Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia
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Borges CS, Pacheco TL, Guerra MT, Barros AL, Silva PV, Missassi G, da Silva KP, Anselmo-Franci JA, Pupo AS, Kempinas WDG. Reproductive disorders in female rats after prenatal exposure to betamethasone. J Appl Toxicol 2017; 37:1065-1072. [PMID: 28326570 DOI: 10.1002/jat.3457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
Abstract
Betamethasone is the drug of choice for antenatal treatment, promoting fetal lung maturation and decreasing mortality. Previous studies in rats reported male programming and alteration in sperm parameters and sexual behavior following intrauterine betamethasone exposure. The impact on the female reproductive development is not known. In this study, rat female offspring was assessed for sexual development, morphophysiology of the reproductive tract and fertility after maternal exposure to 0.1 mg kg-1 of betamethasone or vehicle on gestational days 12, 13, 18 and 19. The treatment promoted reduction of litter weight on postnatal day 1, morphological masculinization in females, delay in the age of puberty onset, reduction in estrus number, increase in estrous cycle length and increase in luteinizing hormone serum levels and uterus weight. The females from the betamethasone group showed an increase of myometrial uterine area and decrease in endometrial uterine area. These animals also performed less lordosis during the sexual behavior test and showed impaired reproductive performance. The uterus showed higher contraction in the treated group as shown by a pharmacological assay. In conclusion, prenatal betamethasone exposure in rats promoted female masculinization, altered sexual development and reproductive parameters. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Cibele S Borges
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Tainá L Pacheco
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Marina T Guerra
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Aline L Barros
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Patricia V Silva
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Gabriela Missassi
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Katiussia Pinho da Silva
- Departments of Pharmacology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Janete A Anselmo-Franci
- Department of Morphology, Stomatology and Physiology, Dental School of Ribeirão Preto, University of São Paulo-USP, Ribeirão Preto, SP, Brazil
| | - André S Pupo
- Departments of Pharmacology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
| | - Wilma De G Kempinas
- Departments of Morphology, Institute of Biosciences, Univ Estadual Paulista-UNESP, Distrito de Rubião Junior s/n°, 18618-970, Botucatu, SP, Brazil
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Zeballos Sarrato S, Villar Castro S, Ramos Navarro C, Zeballos Sarrato G, Sánchez Luna M. Risks factors associated with intra-partum foetal mortality in pre-term infants. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Zeballos Sarrato S, Villar Castro S, Ramos Navarro C, Zeballos Sarrato G, Sánchez Luna M. Factores de riesgo asociados a mortalidad fetal intraparto en recién nacidos pretérmino. An Pediatr (Barc) 2017; 86:127-134. [DOI: 10.1016/j.anpedi.2016.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 10/21/2022] Open
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İşcan B, Tuzun F, Cilaker Micili S, Tugyan K, Duman N, Ozkan H, Kumral A. The effects of perinatal steroid therapy on growth factor levels during different stages of the developing brain. J Matern Fetal Neonatal Med 2017; 30:1820-1828. [PMID: 28052712 DOI: 10.1080/14767058.2016.1228051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Excess glucocorticoid (GC) exposure on the fetal brain during critical stages of development has considerable effects on the development of the central nervous system (CNS). This study thus aimed to evaluate the differential effects of GC exposure on critical growth factor levels during different stages of brain maturation. METHODS For this purpose, forty-two rat pups were divided into six groups based on the timing of betamethasone administration. Rats in the treatment groups were exposed to intraperitoneal betamethasone injections beginning at different time points (postnatal days 1, 2, and 3). Rats in the placebo group received the same volume of 0.9% saline via the same fashion. Pups were sacrificed at 24 h following the final injection for determining the neuronal density and immunohistochemical evaluation of critical growth factors. RESULTS In the groups treated with betamethasone on postnatal day 1 (P1) and P2, which correspond to 22-24 and 24-28 gestational weeks in humans, the neuronal count in the hippocampal regions was significantly lower than their control groups. However, if steroid therapy was administered on P3, corresponding to 28-32 weeks in humans, no difference was observed between the two groups. Growth factors were affected in different ways depending on the steroid administration time and evaluated region. CONCLUSIONS The results suggest that the modulating effect of steroids on neuron count and growth factor response depends on the stage of brain development at the time of exposure. Therefore, this may be one of the key determinants affecting the deleterious and beneficial effects of GCs on the CNS.
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Affiliation(s)
- Burçin İşcan
- a Division of Neonatology, Department of Pediatrics , School of Medicine, Dokuz Eylul University , Izmir , Turkey
| | - Funda Tuzun
- a Division of Neonatology, Department of Pediatrics , School of Medicine, Dokuz Eylul University , Izmir , Turkey
| | - Serap Cilaker Micili
- b Department of Histology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey
| | - Kazim Tugyan
- b Department of Histology, Faculty of Medicine , Dokuz Eylül University , Izmir , Turkey
| | - Nuray Duman
- a Division of Neonatology, Department of Pediatrics , School of Medicine, Dokuz Eylul University , Izmir , Turkey
| | - Hasan Ozkan
- a Division of Neonatology, Department of Pediatrics , School of Medicine, Dokuz Eylul University , Izmir , Turkey
| | - Abdullah Kumral
- a Division of Neonatology, Department of Pediatrics , School of Medicine, Dokuz Eylul University , Izmir , Turkey
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Chen F, Bajwa NM, Rimensberger PC, Posfay-Barbe KM, Pfister RE. Thirteen-year mortality and morbidity in preterm infants in Switzerland. Arch Dis Child Fetal Neonatal Ed 2016; 101:F377-83. [PMID: 27059074 DOI: 10.1136/archdischild-2015-308579] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/09/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To report the population-based, gestational age (GA)-stratified mortality and morbidity for very preterm infants over 13 years in Switzerland. DESIGN A prospective, observational study including 95% of Swiss preterm infants (GA <32 weeks) during three time periods: 2000-2004 (P1), 2005-2008 (P2) and 2009-2012 (P3). SETTING The Swiss Neonatal Network, covering all level III neonatal intensive care units (NICUs) and affiliated paediatric hospitals. PATIENTS 8899 live-born preterm infants with GA <32 weeks. MAIN OUTCOME MEASURES Trends in GA-specific mortality (overall, delivery room and NICU), 'survival free of major complications' and major short-term morbidities: bronchopulmonary dysplasia (BPD, oxygen requirement at 36 weeks), grades 3 and 4 intraventricular haemorrhage (IVH 3-4), necrotising enterocolitis (NEC) and cystic periventricular leukomalacia (cPVL). RESULTS Survival rate was 84.4%; 5.7% died in the delivery room and 9.9% died in the NICU. Neonatal mortality was 8.6% and post-neonatal mortality in NICU admissions was 1.3%. Reductions were observed in overall mortality from 18.4% (95% CI 17.0% to 19.8%) in P1 to 13.8% (13% to 15%) in P3, NICU mortality from 12.6% (11.4% to 13.8%) to 8.2% (7.2% to 9.2%) and IVH 3-4 from 7.8% (6.8% to 8.7%) to 5.8% (4.9% to 6.6%). There was no change in the incidence of cPVL and NEC. The BPD (oxygen requirement at 36 weeks) incidence displayed a U-shaped distribution across the three time periods. Overall, 71.0% (70.0% to 72.0%) had 'survival free of major complications' at the time of hospital discharge, and this significantly improved from 66.7% (65.0% to 68.4%) to 72.4% (70.8% to 74.0%) between P1 and P3. CONCLUSIONS Survival rates of very preterm infants increased with decreasing delivery room and neonatal mortalities, mostly in extremely preterm infants. The incidence of IVH 3-4 decreased, whereas the incidences of cPVL, NEC and BPD (oxygen requirement at 36 weeks) remained largely unchanged from 2000 to 2012 in Switzerland.
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Affiliation(s)
- Fei Chen
- Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland Department of Child Health-Care, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Nadia M Bajwa
- Department of Paediatrics, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Peter C Rimensberger
- Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
| | - Riccardo E Pfister
- Division of Neonatology and Paediatric Intensive Care, Children's University Hospital of Geneva and University of Geneva, Geneva, Switzerland
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Haram K, Mortensen JH, Magann EF, Morrison JC. Antenatal corticosteroid treatment: factors other than lung maturation. J Matern Fetal Neonatal Med 2016; 30:1437-1441. [DOI: 10.1080/14767058.2016.1219716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Swanson JR, Sinkin RA. Antenatal corticosteroids before 24 weeks: is it time? J Perinatol 2016; 36:329-30. [PMID: 27109232 DOI: 10.1038/jp.2016.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J R Swanson
- Division of Neonatology, University of Virginia Children's Hospital, Charlottesville, VA, USA
| | - R A Sinkin
- Division of Neonatology, University of Virginia Children's Hospital, Charlottesville, VA, USA
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Abstract
KEY POINTS Respiratory distress is a common presenting feature among newborn infants.Prompt investigation to ascertain the underlying diagnosis and appropriate subsequent management is important to improve outcomes.Many of the underlying causes of respiratory distress in a newborn are unique to this age group.A chest radiograph is crucial to assist in diagnosis of an underlying cause. EDUCATIONAL AIMS To inform readers of the common respiratory problems encountered in neonatology and the evidence-based management of these conditions.To enable readers to develop a framework for diagnosis of an infant with respiratory distress. The first hours and days of life are of crucial importance for the newborn infant as the infant adapts to the extra-uterine environment. The newborn infant is vulnerable to a range of respiratory diseases, many unique to this period of early life as the developing fluid-filled fetal lungs adapt to the extrauterine environment. The clinical signs of respiratory distress are important to recognise and further investigate, to identify the underlying cause. The epidemiology, diagnostic features and management of common neonatal respiratory conditions are covered in this review article aimed at all healthcare professionals who come into contact with newborn infants.
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Affiliation(s)
| | | | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Tucker Edmonds B, McKenzie F, Robinson BK. Maternal-Fetal Medicine physicians' practice patterns for 22-week delivery management. J Matern Fetal Neonatal Med 2015; 29:1829-33. [PMID: 26135790 DOI: 10.3109/14767058.2015.1064388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe Maternal-Fetal Medicine (MFM) physicians' practice patterns for 22-week delivery management. MEHODS Surveyed 750 randomly-sampled members of the Society of Maternal-Fetal Medicine, querying MFMs' practices and policies guiding 22-week delivery management. RESULTS Three hundred and twenty-five (43%) MFMs responded. Nearly all (87%) would offer induction. Twenty-eight percent would order steroids, and 12% would perform cesarean for a patient desiring resuscitation. Offering induction differed significantly based on the provider's practice setting, region, religious service attendance and political affiliation. In multivariable analyses, political affiliation remained a significant predictor of offering induction (p = 0.03). CONCLUSIONS Most MFMs offer induction for PPROM at 22 weeks. A noteworthy proportion is willing to order steroids and perform cesarean. Personal beliefs and practice characteristics may contribute to these decisions. While little is known about the efficacy of these interventions at 22 weeks, some MFMs will offer obstetrical intervention if resuscitation is intended.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA and
| | - Fatima McKenzie
- a Department of Obstetrics and Gynecology , Indiana University School of Medicine , Indianapolis , IN , USA and
| | - Barrett K Robinson
- b Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine , NorthShore University Health System, Pritzker School of Medicine, University of Chicago , Evanston , IL , USA
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Arnold CC, Eichenwald EC. Proactive care at the edge of viability: making the gray zone less gray? Pediatrics 2015; 135:e1288-9. [PMID: 25896836 DOI: 10.1542/peds.2015-0536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Cody C Arnold
- University of Texas Medical School, Houston, Texas; and Children's Memorial Hermann Hospital, Houston, Texas
| | - Eric C Eichenwald
- University of Texas Medical School, Houston, Texas; and Children's Memorial Hermann Hospital, Houston, Texas
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Falah N, Haas DM. Antenatal corticosteroid therapy: current strategies and identifying mediators and markers for response. Semin Perinatol 2014; 38:528-33. [PMID: 25256192 DOI: 10.1053/j.semperi.2014.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Landmark early work has led to the nearly universal use of antenatal corticosteroids to accelerate fetal lung maturity with pregnancies complicated by impending preterm birth. Antenatal corticosteroids clearly reduce respiratory morbidity, death, and other adverse neonatal outcomes. Limited pregnant human pharmacokinetic data and some animal data give clinicians some information as to the behavior of the drug in the body. However, there is controversy about the type, amount, and frequency of steroid to use for this therapy. This review article summarizes the history, clinical use, and pharmacology of antenatal steroids. In addition, the review highlights some potential mediators of steroid response and current research strategies aimed at possible optimization of this therapy.
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Affiliation(s)
- Nadia Falah
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.
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Maheshwari R, Luig M. Review of respiratory management of extremely premature neonates during transport. Air Med J 2014; 33:286-291. [PMID: 25441522 DOI: 10.1016/j.amj.2014.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/01/2014] [Accepted: 08/19/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The objective was to evaluate the respiratory management of neonates of 23 to 26 weeks' gestation transported after birth outside a tertiary center. Another objective was to collect data regarding survival, intraventricular hemorrhage (IVH), and chronic lung disease. METHODS This was a retrospective study of transports from a statewide dedicated neonatal and pediatric transport service over a 3-year period. Data were collected from the local databases. Neonates with and without transcutaneous carbon dioxide (TcCO2) monitoring were compared. Outcomes were compared with the inborn group from the same period. RESULTS A total of 43 mechanically ventilated neonates were included. Significant hypocarbia and/or hypercarbia were seen in 49%. Hyperoxia was noted in 46.5%. Despite the moderate correlation between PCO2 and TcCO2 readings, no clinical benefit was seen with TcCO2 monitoring. Survival was 65.1%. Rates of IVH were 60% for any IVH and 27.5% for severe IVH. IVH was more common in the study cohort. CONCLUSIONS Neonates born at 23 to 26 weeks' gestation outside tertiary centers have high rates of mortality and morbidity. The avoidance of hypocarbia, hypercarbia, and hyperoxia is challenging in the transport environment. Transcutaneous monitoring is an imperfect tool for following PCO2 levels.
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Affiliation(s)
- Rajesh Maheshwari
- New South Wales Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia.
| | - Melissa Luig
- New South Wales Newborn and Paediatric Emergency Transport Service, Westmead, New South Wales, Australia
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