Antenatal corticosteroids and the influence of sex on morbidity and mortality of preterm infants

Ramos‐Navarro, Cristina; Sánchez‐Luna, Manuel; Zeballos-Sarrato, Susana; Pescador-Chamorro, Isabel

doi:10.1080/14767058.2020.1819977

Cited by 10 publications

(6 citation statements)

References 35 publications

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“…The flow diagram of the search process is shown in Figure S1 . Of 1365 potentially relevant studies, 41 (including 625,680 infants, 319,470 males) were included [ 2 , 3 , 4 , 5 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Their characteristics are summarized in Table S2 .…”

Section: Resultsmentioning

confidence: 99%

Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression

et al. 2021

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A widely accepted concept is that boys are more susceptible than girls to oxidative stress-related complications of prematurity, including bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and periventricular leukomalacia (PVL). We aimed to quantify the effect size of this male disadvantage by performing a systematic review and meta-analysis of cohort studies exploring the association between sex and complications of prematurity. Risk ratios (RRs) and 95% CIs were calculated by a random-effects model. Of 1365 potentially relevant studies, 41 met the inclusion criteria (625,680 infants). Male sex was associated with decreased risk of hypertensive disorders of pregnancy, fetal distress, and C-section, but increased risk of low Apgar score, intubation at birth, respiratory distress, surfactant use, pneumothorax, postnatal steroids, late onset sepsis, any NEC, NEC > stage 1 (RR 1.12, CI 1.06–1.18), any IVH, severe IVH (RR 1.28, CI 1.22–1.34), severe IVH or PVL, any BPD, moderate/severe BPD (RR 1.23, CI 1.18–1.27), severe ROP (RR 1.14, CI 1.07–1.22), and mortality (RR 1.23, CI 1.16–1.30). In conclusion, preterm boys have higher clinical instability and greater need for invasive interventions than preterm girls. This leads to a male disadvantage in mortality and short-term complications of prematurity.

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Section: Resultsmentioning

confidence: 99%

Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression

et al. 2021

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“…The two recently published studies on ANS and the in uence of sex reported different information. Ramos-Navorro et al found a positive effect of ANS in male infants born before 29 weeks' gestation [7], whereas Lee et al demonstrated the bene cial effect of ANS in female infants compared to males in reducing death before discharge [8]. Of infants who received ANS in present study, the rate of mortality was lower with a higher rate of BPD in male infants compared to female ones.…”

Section: Discussionmentioning

confidence: 53%

“…ANS is known to reduce the neonatal mortality, respiratory morbidity, and intraventricular haemorrhage (IVH) [4][5][6]. In studies that evaluating the effect of ANS on mortality and preterm associated morbidities according to sex, one found positive effects of ANS in male preterm infants on acute respiratory morbidity and mortality, whereas the other showed a greater bene cial effect of ANS in female infants in reducing death before discharge [7,8].…”

Section: Introductionmentioning

confidence: 99%

The effects of antenatal corticosteroid and sex on morbidity and mortality in preterm infants: a cohort study

Şeker

Kraja

Çakır

et al. 2023

Preprint

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Objective: To study the linked result of a complete course of antenatal corticosteroids (ANS) on mortality and short-term morbidity rates among preterm infants in our population. Study design: This single-center retrospective study included the infants born before 32 weeks’ gestation and admitted to neonatal intensive care unit (NICU) between January 1, 2018 and December 31, 2020. The following data of gestational age, birth weight, sex, the etiology of labor, type of delivery, need for intubation in delivery room, APGAR scores (1st and 5th min), the rates of respiratuvary distress syndrome (RDS), surfactant administration, patent ductus arteriosus (PDA), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), and bronchopulmonary dysplasia (BPD) were collected from medical records. Results: The study included 210 infants with a median gestational age of 28.6 weeks (24-31.6), a birth weight of 1065 g (445-2165) and with an ANS use rate of 80%. The mortality rate was lower (p=0.001) with a longer hospital stay (p=0.029), but the rate of BPD was higher (p=0.014) in male infants who received ANS than who did not. According to sex distribution, there was a significant decrease in mortality rate in male infants compared with female ones in ANS received group (11% vs. 23%, p=0.038) with a higher BPD rate (p=0.005). Conclusion: ANS is related with less mortality in male infants born before 32 weeks’ gestation. Further research is currently needed to evaluate advantage of antenatal steroids in different populations.

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“…Some recent studies have found the impact of ACS versus nonexposure to vary based on infant sex. 20 21 One observational study of 710 infants born preterm found significantly improved odds of survival in males exposed to ACS, but no significant association with mortality in females exposed to ACS. 20 A recent secondary analysis of an RCT in which 2,331 fetuses were exposed to late preterm betamethasone or placebo found that infant sex was a significant effect modifier of severe neonatal morbidity ( p = 0.047, male sex was associated with a higher odds of severe neonatal morbidity, adjusted OR: 1.95, 95% CI: 1.25–3.05, 2,331 infants).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Infant Sex on Multiple Courses versus a Single Course of Antenatal Corticosteroids: A Secondary Analysis of a Randomized Controlled Trial

Ninan,

Murphy,

Asztalos

et al. 2023

Am J Perinatol

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Objective Animal literature has suggested that the impact of antenatal corticosteroids (ACS) may vary by infant sex. Our objective was to assess the impact of infant sex on the use of multiple courses versus a single course of ACS and perinatal outcomes. Study Design We conducted a secondary analysis of the Multiple Courses of Antenatal Corticosteroids for Preterm Birth trial, which randomly allocated pregnant people to multiple courses versus a single course of ACS. Our primary outcome was a composite of perinatal mortality or clinically significant neonatal morbidity (including neonatal death, stillbirth, severe respiratory distress syndrome, intraventricular hemorrhage [grade III or IV], cystic periventricular leukomalacia, and necrotizing enterocolitis [stage II or III]). Secondary outcomes included individual components of the primary outcome as well as anthropometric measures. Baseline characteristics were compared between participants who received multiple courses versus a single course of ACS. An interaction between exposure to ACS and infant sex was assessed for significance and multivariable regression analyses were conducted with adjustment for predefined covariates, when feasible. Results Data on 2,300 infants were analyzed. The interaction term between treatment status (multiple courses vs. a single course of ACS) and infant sex was not significant for the primary outcome (p = 0.86), nor for any of the secondary outcomes (p > 0.05). Conclusion Infant sex did not modify the association between exposure to ACS and perinatal outcomes including perinatal mortality or neonatal morbidity or anthropometric outcomes. However, animal literature indicates that sex-specific differences after exposure to ACS may emerge over time and thus investigating long-term sex-specific outcomes warrants further attention. Key Points

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Antenatal corticosteroids and the influence of sex on morbidity and mortality of preterm infants

Cited by 10 publications

References 35 publications

Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression

Male Disadvantage in Oxidative Stress-Associated Complications of Prematurity: A Systematic Review, Meta-Analysis and Meta-Regression

The effects of antenatal corticosteroid and sex on morbidity and mortality in preterm infants: a cohort study

The Impact of Infant Sex on Multiple Courses versus a Single Course of Antenatal Corticosteroids: A Secondary Analysis of a Randomized Controlled Trial

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