Area‐based study identifies risk factors associated with missed antenatal corticosteroid prophylaxis in women delivering preterm infants

Gagliardi, Luigi; Amador, Carolina; Puglia, Monia; Mecacci, Federico; Pratesi, Simone; Sigali, Emilio; Tomasini, Barbara; Rusconi, Franca

doi:10.1111/apa.13563

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…Data quality is checked centrally every 2–3 months. Details about perinatal organization in Tuscany and “TIN Toscane online” are reported elsewhere (12).…”

Section: Methodsmentioning

confidence: 99%

Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place

et al. 2018

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Background: Great variability in enteral feeding practices for very preterm (<32 weeks gestational age-GA) and very low birth weight infants (VLBW; ≤1,500 g) have been reported. We aimed to describe data on enteral feeding in Tuscany (Italy), where a network of 6 donor milk banks is in place.Methods: A 4-years (2012–2015) observational study was performed analyzing the database “TIN Toscane online” on very preterm and VLBW infants. The database covers all 25 hospitals with a neonatal unit.Results: Data concerning the beginning of enteral nutrition were available for 1,302 newborns with a mean (standard deviation) GA of 29.3 (2.9) weeks, while information at the time of full enteral nutrition was available for 1,235 and at discharge for 1,140. Most infants (74.1%) started enteral feeding during the first 24 h of life. Overall, 80.1% of newborns were fed exclusive human milk, donor milk having the larger prevalence of use (66.8%). Few infants (13.3%) started with exclusive mother's milk. Full enteral feeding was achieved using exclusive human milk in most cases (80%). Full enteral feeding was reached earlier in newborns who were fed human milk than in those fed formula, regardless of GA. Sixty-four percent of infants were still fed with any human milk at discharge. When data at the achievement of full enteral nutrition and at discharge were analyzed stratified by the type of milk used to start enteral feeding, newborns initially fed donor milk presented the highest prevalence (91.3%) of exclusive human milk at full enteral feeding, an important period to prevent necrotizing enterocolitis, while no differences were observed at discharge.Conclusions: Donor milk was widely used for newborns during the first hours of life, when mother's milk availability may be quite challenging. Starting enteral nutrition with donor milk was associated with early start of enteral feeding and early achievement of full enteral nutrition without affecting mother lactation. The overall prevalence of human milk at discharge (when donor milk is not available anymore) was high (64%), irrespective of the type of milk used to start nutrition.

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“…Data quality is checked centrally every 2–3 months. Details about perinatal organization in Tuscany and “TIN Toscane online” are reported elsewhere (12).…”

Section: Methodsmentioning

confidence: 99%

Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place

et al. 2018

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“…Although DIP is a common medical complication in pregnancy, affecting 9% of women in New Zealand [24], there are few data regarding current practice for ANC administration in these women, who comprise a small percentage of all women who receive ANC, and types of diabetes are seldom differentiated [5,[25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Patterns of antenatal corticosteroid administration in a cohort of women with diabetes in pregnancy

et al. 2020

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Antenatal corticosteroids administered to the mother prior to birth decrease the risk of mortality and major morbidity in infants born at less than 35 weeks' gestation. However, the evidence relating to women with diabetes in pregnancy is limited. Clinical guidelines for antenatal corticosteroid administration recommend that women with diabetes in pregnancy are treated in the same way as women without diabetes, but there are no recent descriptions of whether contemporary practice complies with this guidance. This study is a retrospective review of antenatal corticosteroid administration at a New Zealand tertiary hospital in women with diabetes in pregnancy. We found that in this cohort, for both an initial course at less than 35 weeks' gestation and repeat courses at less than 33 weeks', the administration of antenatal corticosteroid to women with diabetes in pregnancy is largely consistent with current Australian and New Zealand recommendations. However, almost 25% of women received their last dose of antenatal corticosteroid at or beyond the latest recommended gestation of 35 weeks' gestation. Pre-existing diabetes and planned caesarean section were independently associated with an increased rate of antenatal corticosteroid administration. We conclude that diabetes in pregnancy does not appear to be a deterrent to antenatal corticosteroid administration. The high rates of administration at gestations beyond recommendations, despite the lack of evidence of benefit in this group of women, highlights the need for further research into the risks and benefits of antenatal corticosteroid administration to women with diabetes in pregnancy, particularly in the late preterm and early term periods.

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“…The non-tertiary centres will deliver fewer babies at extreme prematurity as an attempt to transfer antenatally to tertiary centres is standard care. Where parents presenting to these centres discuss the prognosis for their extremely premature babies, a more negative impression for potential survival will already have been conveyed to parents prior to transfer, and may have led to less optimisation of the fetus for postnatal survival, such as the administration of steroids [21,33] at the referring hospital. The parents, in turn will have a more negative outlook for the baby and this may influence their decision making.…”

Section: Discussionmentioning

confidence: 99%

Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region

Ireland

Larkins

Ray

et al. 2020

matern health, neonatol and perinatol

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Background: Extremely preterm babies are at risk of significant mortality and morbidity due to their physiological immaturity. At periviable gestations decisions may be made to either provide resuscitation and intensive care or palliation based on assessment of the outlook for the baby and the parental preferences. Health care professionals (HCP) who counsel parents will influence decision making depending on their individual perceptions of the outcome for the baby. This paper aims to explore the knowledge and attitudes towards extremely preterm babies of HCP who care for women in pregnancy in a tertiary, regional and remote setting in North Queensland. Methods: A cross sectional electronic survey of HCP was performed. Perceptions of survival, severe disability and intact survival data were collected for each gestational age from 22 to 27 completed weeks gestation. Free text comment enabled qualitative content analysis. Results: Almost all 113 HCP participants were more pessimistic than the actual outcome data suggests. HCP caring for women antenatally were the most pessimistic for survival (p = 0.03 at 23 weeks, p = 0.02 at 25,26 and 27 weeks), severe disability (p = 0.01 at 24 weeks) and healthy outcomes (p = 0.01 at 24 weeks), whilst those working in regional and remote centres were more negative than those in tertiary unit for survival (p = 0.03 at 23,24,25 weeks). Perception became less negative as gestational age increased. Conclusion: Pessimism of HCP may be negatively influencing decision making and will negatively affect the way in which parents perceive the chances of a healthy outcome for their offspring.

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Area‐based study identifies risk factors associated with missed antenatal corticosteroid prophylaxis in women delivering preterm infants

Cited by 9 publications

References 17 publications

Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place

Feeding Practices in Very Preterm and Very Low Birth Weight Infants in an Area Where a Network of Human Milk Banks Is in Place

Patterns of antenatal corticosteroid administration in a cohort of women with diabetes in pregnancy

Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region

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