Time interval from late preterm antenatal corticosteroid administration to delivery and the impact on neonatal outcomes

Gulersen, Moti; Gyamfi-Bannerman, Cynthia; Greenman, Michelle; Lenchner, Erez; Rochelson, Burton; Bornstein, Eran

doi:10.1016/j.ajogmf.2021.100426

Cited by 17 publications

(20 citation statements)

References 36 publications

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“…We observed an increased likelihood of neonatal hypoglycemia among neonates born within 2 days of ACS administration, which was consistent with findings of other's research ( 14 , 29 ). Gupta et al ( 14 ) found that ACS administration in ETSCS among women with GDM or DIP is associated with more neonatal hypoglycemia (24.2 vs. 4.4%; aOR, 18.96; 95% CI, 2.18–165.23), although they made the presumption that ACS administered at different time points before delivery would confer equal risk to neonatal hypoglycemia.…”

Section: Discussionsupporting

confidence: 92%

“…Gupta et al ( 14 ) found that ACS administration in ETSCS among women with GDM or DIP is associated with more neonatal hypoglycemia (24.2 vs. 4.4%; aOR, 18.96; 95% CI, 2.18–165.23), although they made the presumption that ACS administered at different time points before delivery would confer equal risk to neonatal hypoglycemia. A recently large cohort study (115/1,248 women with GDM) demonstrated that late preterm infants' risk of hypoglycemia decreased as the time interval from ACS administration to delivery increased, and the risk for hypoglycemia was highest in the delivery of <2 days group ( 29 ). Reports have suggested that even mild hypoglycemia which responds to treatment is still associated with poor neurocognitive and developmental outcomes ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Time Interval From Early-Term Antenatal Corticosteroids Administration to Delivery and the Impact on Neonatal Outcomes

Zhang

Hao

et al. 2022

Front. Pediatr.

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ObjectivesTo determine the association between the time interval from antenatal corticosteroids administration to delivery and neonatal complications in diabetic mothers undergoing early term (37+0 to 38+6 weeks) scheduled cesarean section (ETSCS).Study DesignA retrospective cohort study of women with any form of diabetes in pregnancy undergoing ETSCS was included. Cases were stratified into the following groups based on the time interval from the first dose of corticosteroids administration to delivery: <2, 2–7, and >7 days. Women undergoing ETSCS, who did not receive corticosteroids were included as controls. We assessed the association between the time interval and neonatal outcomes in a multivariate regression model that controlled for potential confounders. Primary outcomes were the incidence of respiratory distress syndrome (RDS)/transient tachypnea of the newborn (TTN) and neonatal hypoglycemia.ResultsThe study cohort comprised 1,165 neonates. Of those, 159 (13.6%) were delivered within 2 days of maternal corticosteroids administration, 131 (11.2%) were delivered within 2–7 days after maternal corticosteroids administration, and 137 (11.8%) delivered more than 7 days after maternal corticosteroids administration. The remaining 738 (63.3%) were not exposed to corticosteroids. Multivariate analysis demonstrated that delivery within any time of antenatal corticosteroids administration was not associated with decreased risks of RDS/TTN. The risk of neonatal hypoglycemia was highest in the delivery of <2 days group (adjusted odds ratio [aOR]: 2.684, 95% confidence interval [CI]: 1.647–4.374 for control group; aOR: 2.827, 95% CI: 1.250–6.392 for delivery 2–7 days group; aOR:2.975, 95% CI: 1.265–6.996 for delivery >7 days group).ConclusionsCorticosteroids treatment for diabetic mothers undergoing ETSCS was not associated with beneficial neonatal respiratory outcomes. In addition, delivery, <2 days after antenatal corticosteroids administration was associated with an increased risk of neonatal hypoglycemia.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Time Interval From Early-Term Antenatal Corticosteroids Administration to Delivery and the Impact on Neonatal Outcomes

Zhang

Hao

et al. 2022

Front. Pediatr.

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“…This finding concurs with a recent report among late preterm neonates. 14 Although the prediction of spontaneous preterm birth occurrence is particularly challenging, among medically indicated preterm births the healthcare provider often dictates delivery timing. Therefore, the risk of neonatal hypoglycemia may be taken into consideration in determining the optimal delivery timing following ACS utilization.…”

Section: Discussionmentioning

confidence: 99%

“…The factors associated with the development of neonatal hypoglycemia in those exposed to ACS are largely unclear. Moreover, the association of ACS‐to‐delivery interval with neonatal hypoglycemia is controversial with conflicting results reported 13,14 . Given the paucity of literature, we aimed to evaluate the risk factors associated with neonatal hypoglycemia after ACS administration.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing

Zigron

Rotem

Erlichman

et al. 2021

Intl J Gynecology & Obste

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Preterm birth remains the leading cause of perinatal morbidity and mortality worldwide, despite significant advancements in prenatal and neonatal care. 1,2 Antenatal corticosteroid (ACS) administration to women at risk of early preterm delivery (<34 weeks of pregnancy), represents one of the most effective interventions to improve perinatal outcomes. 3,4 Despite the well-established beneficial effects of ACS, its utilization may be associated with various adverse perinatal outcomes including decreased birth weight and head circumference. 5,6 In addition, increased risk of neonatal hypoglycemia was observed after ACS administration, 7,8 plausibly due to maternal hyperglycemia or fetal adrenal suppression. [8][9][10][11] While neonatal hypoglycemia is usually easily managed by care providers, a delay in its diagnosis and

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“…Previous studies showed that the incidence of NRDS and neonatal mortality rates were significantly reduced after a complete course of ACS [5][6][7][8][9], while the effect of ACS on the need for respiratory support in the delivery room and neonatal intensive care unit (NICU) among preterm infants has been sparsely investigated. e effect of a single course of ACS appears more pronounced when a premature birth occurs between 2 and 7 d, and its effectiveness is markedly declined at ACS-to-birth intervals of less than 48 h and more than 7 d [10][11][12][13][14][15]. In contrast, women admitted for progressive labour tended not to receive ACS or only received a partial course of ACS before delivery.…”

Section: Introductionmentioning

confidence: 96%

The Relationship between Antenatal Corticosteroid Administration-to-Delivery Intervals and Neonatal Respiratory Distress Syndrome and Respiratory Support

Jiang

et al. 2022

Journal of Healthcare Engineering

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Background. Administration of antenatal corticosteroids (ACSs) is an effective strategy for managing preterm infants, which improves neonatal respiratory distress syndrome (NRDS) and attenuates the risk of neonatal mortality. However, many preterm infants are not exposed to a complete course of ACS administration, and the effects of different ACS-to-delivery intervals on NRDS and respiratory support remain unclear. Therefore, this study explored the relationship between ACS-to-birth intervals and NRDS and respiratory support in preterm infants. Methods. In this retrospective cohort study, the preterm infants born between 240/7 and 316/7 wks of gestation were recruited from January 2015 to July 2021. All participants were categorised based on the time interval from the first ACS dose to delivery: <24 h, 1-2 d, 2–7 d, and >7 d. Multivariable logistic regression analysis examined the relationships between the ACS-to-birth interval and primary or secondary outcome while adjusting for potential confounders. Results. Of the 706 eligible neonates, 264, 83, 292, and 67 received ACS-to-delivery intervals of <24 h, 1-2 d, 2–7 d, and >7 d, respectively. After adjusting these confounding factors, the multivariable logistic analysis showed a significantly increased risk of NRDS (aOR: 1.8, 95% CI: 1.2–2.7), neonatal mortality (aOR: 2.8, 95% CI: 1.1–6.8), the need for surfactant use (aOR: 2.7, 95% CI: 1.7–4.4), endotracheal intubation in the delivery room (aOR: 1.9, 95% CI: 1.0–3.7), and mechanical ventilation (aOR: 1.9, 95% CI: 1.1–3.4) in the ACS-to-delivery interval of <24 h group when compared with the ACS-to-birth interval of 2–7 d group. Conclusions. Neonatal outcomes such as NRDS, neonatal mortality, the need for surfactant use, intubation in the delivery room, and the risk of mechanical ventilation are higher when the neonates are exposed to an ACS interval for less than 24 h before delivery.

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Time interval from late preterm antenatal corticosteroid administration to delivery and the impact on neonatal outcomes

Cited by 17 publications

References 36 publications

Time Interval From Early-Term Antenatal Corticosteroids Administration to Delivery and the Impact on Neonatal Outcomes

Time Interval From Early-Term Antenatal Corticosteroids Administration to Delivery and the Impact on Neonatal Outcomes

Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing

The Relationship between Antenatal Corticosteroid Administration-to-Delivery Intervals and Neonatal Respiratory Distress Syndrome and Respiratory Support

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