Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study

Wong, Deborah; Abdel-Latif, Mohamed E; Kent, AL

doi:10.1136/archdischild-2013-304705

Cited by 86 publications

(72 citation statements)

References 23 publications

(22 reference statements)

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“…In the presence of threatening preterm delivery, foetal lung maturation with antenatal corticosteroids was recommended from 24 0/7 weeks of gestation in Switzerland,9 similar to other recommendations 27 28. Our work and the NICUs network of Australia report a similar and significant increase in BPD or CLD in extremely premature infants after or despite prenatal steroids 29. Given these observations, it becomes necessary to better explore the association between antenatal corticosteroids and BPD (oxygen requirement at 36 weeks) as well as long-term respiratory morbidities.…”

Section: Discussionsupporting

confidence: 75%

Thirteen-year mortality and morbidity in preterm infants in Switzerland

Chen

Bajwa

Rimensberger

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionsupporting

confidence: 75%

Thirteen-year mortality and morbidity in preterm infants in Switzerland

Chen

Bajwa

Rimensberger

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…Antenatal corticosteroids are one of the most effective interventions. 27–31 The 1995 National Institutes of Health consensus statement on antenatal corticosteroids led to widespread use. Recent studies have documented benefits to infants as young as 22–23 weeks.…”

Section: Discussionmentioning

confidence: 99%

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

Stoll

Hansen

Bell

et al. 2015

JAMA

2,186

1,357

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Importance Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants Prospective registry of 34,636 infants 22–28 weeks’ gestational age (GA) and 401–1500 gram birthweight born at 26 Network centers, 1993–2012. Exposure Extremely preterm birth. Main Outcomes Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92–0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26–27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23 weeks (41/152 [27%] to 50/150 [33%], aRR: 1.09 [95% CI, 1.05–1.14]) and 24 weeks (156/248 [63%] to 174/269 [65%], aRR: 1.05 [95% CI, 1.03–1.07]), with smaller relative increases for infants 25 and 27 weeks and no change for infants 22, 26 and 28 weeks. Survival without major morbidity increased approximately 2% per year for infants 25–28 weeks with no change for infants 22–24 weeks. Conclusions and Relevance Among extremely preterm infants born at US academic centers over the last 20 years, changes in maternal and infant care practices and modest reductions in several morbidities were observed, although bronchopulmonary dysplasia increased. Survival increased most markedly for infants born at 23 and 24 weeks and survival without major morbidity increased for infants 25–28 weeks. These findings may be valuable in counselling families and developing novel interventions.

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“…Eriksson, et al, observaron que los prematuros de 24 a 34 semanas cuyas madres habían sido tratadas con corticoides en el periodo prenatal tenían menor riesgo de síndrome de dificultad respiratoria, muerte neonatal tardía, displasia broncopulmonar, retinopatía del prematuro, hemorragia intraventricular y parálisis cerebral infantil, sin que se registrara un aumento del riesgo de alteraciones neurosensoriales a largo plazo, aunque sí observaron un aumento en la tasa de epilepsia en varones (29). Wong, et al (30), evidenciaron que los prematuros de menos de 29 semanas cuyas madres habían sido tratadas con un esquema completo de corticoides en el periodo prenatal presentaban tasas de supervivencia más elevadas y tasas más bajas de hemorragia intraventricular y enterocolitis necrosante, en comparación con los expuestos al esquema incompleto o con quienes no recibieron tratamiento. Estos autores no observaron diferencias significativas en los resultados en el neurodesarrollo en los niños de dos a tres años de edad.…”

Section: Discussionunclassified

Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

2016

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Contribución de los autores:Marita Lardón: diseño de la investigación, recolección de datos y escritura del manuscrito Jose Uberos: diseño de la investigación, análisis de datos y revisión crítica del contenido del manuscrito Eduardo Narbona: recolección de datos, interpretación de los resultados y revisión crítica del contenido del manuscrito ¿Afecta el tratamiento con corticoides en los periodos prenatal y posnatal el neurodesarrollo del recién nacido prematuro?Marita Lardón, José Uberos, Eduardo Narbona Servicio de Pediatría, Hospital Universitario San Cecilio, Granada, EspañaIntroducción. Los glucocorticoides, ampliamente utilizados en el periodo perinatal, pueden asociarse con efectos adversos en el neurodesarrollo. Objetivo. Analizar los resultados del tratamiento con corticoides en el periodo prenatal y en el posnatal en el neurodesarrollo de una cohorte de recién nacidos de muy bajo peso. Materiales y métodos. Se hizo un estudio prospectivo de cohortes en los recién nacidos de muy bajo peso hospitalizados en la unidad de cuidados intensivos neonatales de un hospital de tercer nivel entre el 2008 y el 2013. Se comparó el neurodesarrollo entre aquellos que no recibieron tratamiento prenatal con corticoides y quienes recibieron el esquema completo (dos dosis de 12 mg de betametasona) o el incompleto (una dosis). También, se compararon los resultados en el neurodesarrollo de los recién nacidos que no recibieron tratamiento posnatal y aquellos que sí (dexametasona sistémica a partir de la primera semana de vida). Se evaluó la función motora, la neurosensorial y la cognitiva, así como los trastornos de conducta durante los dos primeros años de vida.Resultados. Se analizaron 225 recién nacidos de muy bajo peso; 83,6 % de las madres había recibido tratamiento prenatal con corticoides (esquema incompleto: 24 %; esquema completo: 59,6 %). Durante el periodo posnatal solamente el 13,3 % había recibido dexametasona sistémica. El seguimiento neurológico se llevó a cabo en 194 neonatos. En el análisis de regresión logística no se detectó que el tratamiento prenatal no el posnatal se asociara con más trastornos neurológicos, ni hubo diferencias significativas entre quienes recibieron el esquema completo y los que recibieron el incompleto durante el periodo prenatal. Conclusión. Los resultados de este estudio no pudieron demostrar que el tratamiento perinatal con corticoides se asociara con peores resultados en el neurodesarrollo en recién nacidos de muy bajo peso.Palabras clave: corticosteroides; dexametasona; betametasona; terapéutica; nacimiento prematuro; trastornos del neurodesarrollo. Materials and methods:This was a prospective cohort study in which we included all very low birth weight babies admitted to the neonatal intensive care unit of a tertiary hospital between 2008 and 2013. We compared the neurodevelopment among very low birth-weight newborns who did not receive prenatal corticosteroid therapy and those who received a complete course (two doses of 12 mg betamethasone) and an incomplete course (one dose)...

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Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study

Cited by 86 publications

References 23 publications

Thirteen-year mortality and morbidity in preterm infants in Switzerland

Thirteen-year mortality and morbidity in preterm infants in Switzerland

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

Does the corticosteroid’s treatment during the pre and postnatal period affect the neurodevelopmental outcome of premature newborns?

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