Use Of Antenatal Corticosteroids Research Articles

A Growing Dilemma: Antenatal Corticosteroids and Long-Term Consequences.

A single course of synthetic antenatal corticosteroids is standard care for women considered to be at risk for preterm birth before 34 weeks of gestation. While the intended target is the fetal lung, the fetal brain contains remarkably high levels of glucocorticoid receptors in structures critical in the regulation of behavior and endocrine function. Negative programming signals may occur which can lead to permanent maladaptive changes and predispose the infant/child to an increased risk in physical, mental, and developmental disorders. Framed around these areas of concerns for physical, mental, and developmental disorders, this narrative review drew on studies (animal and clinical), evaluating the long-term effects of antenatal corticosteroids to present the case that a more targeted approach to the use of antenatal corticosteroids for the betterment of the fetus urgently needed. Studies raised concerns about the potential negative long-term consequences, especially for the exposed fetus who was born beyond the period of the greatest benefit from antenatal corticosteroids. The long-term consequences are more subtle in nature and usually manifest later in life, often beyond the scope of most clinical trials. Continued research is needed to identify sufficient safety data, both short term and long term. Caution in the use of antenatal corticosteroids should be exercised while additional work is undertaken to optimize dosing strategies and better identify women at risk of preterm birth prior to administration of antenatal corticosteroids. · A single-course ACS is a remarkable therapy with substantial benefits.. · There is a potential of long-term neurodevelopmental consequences in the ACS-exposed fetus.. · There is a need to improve dosing strategies and identification of appropriate at risk women..

Improving NICU outcomes–A worldwide endeavor

In this volume of The Journal, D’Apremont et al report on mortality and morbidity outcomes over 15 years (2001-2016) for nearly 14 000 very low birthweight infants (500-1500 grams) at NEOCOSUR centers (30 Neonatal Units from Argentina, Brazil, Chile, Paraguay, Peru, and Uruguay). While many national and international NICU collectives from the US, Canada, Europe, Australia, and Japan have published large scale NICU outcome data, D’Apremont et al provide the first substantial multi-year report from a similar NICU collaborative based in middle-income countries. Despite introducing many evidence-based practices, including increased use of antenatal corticosteroids and noninvasive ventilation, the NEOCOSUR centers did not observe a reduction in mortality in VLBW infants in NICUs. This was probably because of a drop in survival for the most premature babies born at ≤25 weeks gestational age. On the other hand, survival without major morbidity substantially improved for moderately preterm babies >29 weeks gestational age. The NEOCOSUR report demonstrates the ability to collect high quality data from middle-income countries, which is particularly meaningful as neonatal mortality remains stubbornly high in middle- and low-income countries and accounts for over 98% of neonatal mortality worldwide. We hope that NEOCOSUR finds novel ways to compare and contrast their findings with those of high income countries as they continue to improve care for their youngest NICU citizens—these are countries that have learned to walk and deserve to run. Article page 44 ▸ Trends in Perinatal Practices and Neonatal Outcomes of Very Low Birth Weight Infants during a 16-year Period at NEOCOSUR CentersThe Journal of PediatricsVol. 225PreviewTo describe trends in mortality, major morbidity, and perinatal care practices of very low birth weight infants born at NEOCOSUR Neonatal Network centers from January 1, 2001, through December 31, 2016. Full-Text PDF

Gestational age-related neonatal survival at a tertiary health institution in Nigeria: The age of fetal viability dilemma

Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our approach to the management of such infants.
 Aim: To determine the GAspecific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja.
 Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over 96% of cases.Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188 (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths.
 Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria.
 Key words: Gestational age. Fetal viability

51th Annual General and Scientific Conference of the Paediatrics Association of Nigeria (PANCONF), 21st - 24th January, 2020

Background: Although the official age of fetal viability in Nigeria is 28 weeks, there are pockets of reports some anecdotal, of survival of babies delivered at younger gestational age (GA) from different parts of the country. The routine resuscitation and management of premature infants born before the official age of fetal viability (28 weeks) is likely to generate important ethical and medical concerns that are bound to influence our approach to the management of such infants. Aim: To determine the GAspecific neonatal mortality and survival among preterm deliveries at the National Hospital Abuja. Subjects and Methods: A retrospective review of relevant data from the National Hospital Neonatal Registry Database based on the Research Electronic Data Capture software (REDCap) was undertaken to determine the mortality rate of preterm babies managed in the neonatal intensive care unit (NICU) from January 2017 to February 2018. Disaggregated GA specific mortality rates were also computed to determine the fetal age at which extra uterine neonatal survival rate was at least 50%. Gestational age estimation was based on mothers’ last menstrual period (LMP) in over 96% of cases.Results: Sixty-three (63) of 305 preterm babies admitted died during hospitalization giving a mortality rate of 20.7%. This was significantly higher than the mortality rate among term babies (7.5%, P=0.01) hospitalized over the same period. Antenatal corticosteroid use was low (11.2%), 188 (25.8%) received CPAP for Respiratory Distress Syndrome (RDS), and none of the babies received surfactant or mechanical ventilation. There were no survivors among babies delivered at GA of 22-25 weeks (11, 3.6%). However, the survival rate at 26 weeks gestation was 53.8%, and this subsequently increased, reaching a peak of 96.5% survival at 35 weeks. RDS accounted for 53.9% of all deaths. Conclusion: It is concluded that the survival rate (53.8%) of babies at GA of 26 weeks despite minimal antenatal interventions and limited postnatal respiratory support was reasonably high, and this could serve the basis for discussions for a downward review of the age of fetal viability in Nigeria. Key words: Gestational age. Fetal viability

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Racial/Ethnic Disparities Among Extremely Preterm Infants in the United States From 2002 to 2016

Racial/ethnic disparities in quality of care among extremely preterm infants are associated with adverse outcomes. To assess whether racial/ethnic disparities in major outcomes and key care practices were changing over time among extremely preterm infants. This observational cohort study used prospectively collected data from 25 US academic medical centers. Participants included 20 092 infants of 22 to 27 weeks' gestation with a birth weight of 401 to 1500 g born at centers participating in the National Institute of Child Health and Human Development Neonatal Research Network from 2002 to 2016. Of these infants, 9316 born from 2006 to 2014 were eligible for follow-up at 18 to 26 months' postmenstrual age (excluding 5871 infants born before 2006, 2594 infants born after 2014, and 2311 ineligible infants including 64 with birth weight >1000 g and 2247 infants with gestational age >26 6/7 weeks), of whom 745 (8.0%) did not have known follow-up outcomes at 18 to 26 months. Rates of mortality, major morbidities, and care practice use over time were evaluated using models adjusted for baseline characteristics, center, and birth year. Data analyses were conducted from 2018 to 2019. In total, 20 092 infants with a mean (SD) gestational age of 25.1 (1.5) weeks met the inclusion criteria and were available for the primary outcome: 8331 (41.5%) black infants, 3701 (18.4%) Hispanic infants, and 8060 (40.1%) white infants. Hospital mortality decreased over time in all groups. The rate of improvement in hospital mortality over time did not differ among black and Hispanic infants compared with white infants (black infants went from 35% to 24%, Hispanic infants went from 32% to 27%, and white infants went from 30% to 22%; P = .59 for race × year interaction). The rates of late-onset sepsis among black infants (went from 37% to 24%) and Hispanic infants (went from 45% to 23%) were initially higher than for white infants (went from 36% to 25%) but decreased more rapidly and converged during the most recent years (P = .02 for race × year interaction). Changes in rates of other major morbidities did not differ by race/ethnicity. Death before follow-up decreased over time (from 2006 to 2014: black infants, 14%; Hispanic infants, 39%, white infants, 15%), but moderate-severe neurodevelopmental impairment increased over time in all racial/ethnic groups (increase from 2006 to 2014: black infants, 70%; Hispanic infants, 123%; white infants, 130%). Rates of antenatal corticosteroid exposure (black infants went from 72% to 90%, Hispanic infants went from 73% to 83%, and white infants went from 86% to 90%; P = .01 for race × year interaction) and of cesarean delivery (black infants went from 45% to 59%, Hispanic infants went from 49% to 59%, and white infants went from 62% to 63%; P = .03 for race × year interaction) were initially lower among black and Hispanic infants compared with white infants, but these differences decreased over time. Among extremely preterm infants, improvements in adjusted rates of mortality and most major morbidities did not differ by race/ethnicity, but rates of neurodevelopmental impairment increased in all groups. There were narrowing racial/ethnic disparities in important care practices, including the use of antenatal corticosteroids and cesarean delivery.

Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study

In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants. A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression. Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds. Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay.

Antenatal corticosteroids for pregnant women with COVID-19 infection and preterm prelabor rupture of membranes: a decision analysis

Background While antenatal corticosteroids are routinely used to decrease adverse neonatal outcomes following preterm delivery, corticosteroids are also associated with worse outcomes in patients with viral respiratory infections. Currently in the setting of the COVID-19 pandemic, it is unclear whether antenatal corticosteroids for infant benefit outweigh the potential harm to a pregnant woman with a COVID-19 infection. Objective To determine at which gestational ages administering antenatal corticosteroids is the optimal management strategy for hospitalized women with preterm prelabor rupture of membranes (PPROM) who have a COVID-19 infection. Methods We designed a decision-analytic model to assess the maternal and infant outcomes associated with antenatal corticosteroid administration for risk of preterm delivery following rupture of membranes in the setting of a COVID-19 infection. We used a theoretical cohort of 10,000 women at each gestational age between 24 and 32 weeks who were hospitalized with PPROM and found to be COVID-19 positive. Maternal outcomes included intensive care unit admission and death related to COVID-19 infection. The infant outcomes of interest included respiratory distress syndrome, intraventricular hemorrhage, neurodevelopmental delay, and death, and were assessed along with maternal and infant quality-adjusted life years (QALYs). Deterministic and probabilistic sensitivity analyses were used to evaluate model assumptions. Results In our theoretical cohort of 10,000 women with COVID-19 infection and preterm prelabor rupture of membrane between 24 and 32 weeks, corticosteroid administration resulted in 2,200 women admitted to the ICU and 110 maternal deaths at each gestational age. No antenatal corticosteroid use resulted in 1,500 ICU admissions and 75 maternal deaths at each gestational age. Antenatal corticosteroid administration also resulted in fewer cases of respiratory distress syndrome, intraventricular hemorrhage, and infant death. Overall, we found that between 24 and 30 weeks of gestation, administering antenatal corticosteroids was the optimal management strategy as it resulted in higher combined QALYs than no corticosteroid use. For 31 and 32 weeks of gestation, antenatal corticosteroid administration resulted in lower combined QALYs. On sensitivity analyses, we found that with increasing gestational age, the probability which antenatal corticosteroids was the optimal management strategy decreased. Conclusion Administration of antenatal corticosteroids was an effective management strategy compared to no corticosteroid administration at gestational ages less than 31 weeks. These results provide data for clinicians to utilize when counseling pregnant patients hospitalized with PPROM and have a COVID-19 infection.

Preterm birth in women with diabetes mellitus

Hypothesis/aims of study. Diabetes mellitus (DM) is associated with an increased risk of obstetric complications, including preterm birth (PB). The incidence rate of PB in women with DM is higher than in the general population and amounts to 3040%. Nevertheless, there are still open questions on the structure of PB, pharmacological approaches to its prevention and treatment, as well as the feasibility of prolonging the timing of glucocorticoid therapy to reduce perinatal morbidity and mortality. The objective of this study was to research the features of structure and clinical approaches in the case of PB in women with different types of DM, based on a literature review.
 Study design, materials and methods. The study was performed using literature search, screening, data extraction, and analysis of publications collected in world databases such as MEDLINE, EMBASE, CNKI, and Cochrane.
 Results. The rate of PB is the highest in women with pregestational DM: 2130% in type 1 DM and 1940% in type 2 DM. The incidence of PB in gestational DM (710%) is almost equal to the general population level (79%) and depends on the type of diabetes therapy: insulin 16%, diet 7%. Risk factors for PB in women with DM are poor glycaemic control, microvascular complications of DM, hypertension, obesity, infection, age, fetal macrosomia, polyhydramnios, and congenital malformations. Adequate glycemic control from early gestation is an important condition for PB prevention. The structure of PB in patients with pregestational DM changes due to an increase in both spontaneous and induced PB proportions. The most common indications for early delivery in DM are preeclampsia, premature placental abruption, impaired renal function in diabetic nephropathy, severe forms of carbohydrate metabolism disorders, diabetic fetopathy, and fetal distress. The risk of fetal respiratory distress syndrome in newborns of mothers with DM is higher than in the general population. The maturity of the lungs of a newborn may be insufficient, even in the case of term delivery. The use of antenatal corticosteroids is effective prophylaxis of respiratory disorders. However, these corticosteroids can increase the risk of neonatal hypoglycemia.
 Conclusion. Despite the term weight and height, the newborn of a mother with DM may remain immature, therefore, delivery at term is recommended. The gestational age, until which it is advisable to prescribe corticosteroids for pregnant women with DM, and the mode of delivery in the case of PB, remain a matter of debate.

Perinatal risk factors of symptomatic preterm patent ductus arteriosus and secondary ligation

There has been conflicting evidence for the association between antenatal factors and the development of symptomatic patent ductus arteriosus (PDA) or failure of pharmacologic treatment, especially for maternal pregnancy-induced hypertension (PIH) or chorioamnionitis. We assessed the perinatal risk factors of symptomatic PDA in preterm infants and those of secondary ligation in infants with pharmacologic treatment for symptomatic PDA using a national cohort. A total of 2961 infants with 22-29 weeks of gestation with symptomatic PDA or no PDA were included from the Korean Neonatal Network database. To identify significant perinatal risk factors associated with symptomatic PDA or secondary ligation, all perinatal factors were included in the univariate and multivariate generalized estimating equation analysis and final model was selected using backward elimination method based on Quasi-likelihood Information Criterion. Lower gestational age (GA), female gender, maternal PIH and surfactant use were significant risk factors of symptomatic PDA. Antenatal corticosteroid use decreased the risk of symptomatic PDA. For secondary ligation, lower GA and cesarean section were significant risk factors. Adjusted odds ratio (aOR) of PIH as a risk factor of symptomatic PDA was 1.56 [95% confidence interval 1.17-2.08]. In the subgroup analysis according to the GA, lower GA, female gender, multiple pregnancy, maternal PIH and surfactant use increased the risk of symptomatic PDA, and histologic chorioamnionitis and antenatal corticosteroid use decreased the risk of symptomatic PDA only in GA 26-29 weeks group. Lower GA increased the risk of symptomatic PDA and secondary ligation. Maternal PIH and surfactant use increased the risk of symptomatic PDA; however, antenatal corticosteroid use decreased it. Close observation of the clinical symptoms of PDA is needed in preterm infants with maternal PIH.

Antenatal corticosteroid administration for foetal lung maturation.

Antenatal corticosteroids are an essential component in the management of women at risk for preterm labour. They promote lung maturation and reduce the risk of other preterm neonatal complications. This narrative review discusses the contentious issues and controversies around the optimal use of antenatal corticosteroids and their consequences for both the mother and the neonate. The most recent evidence base is presented.

Controversies in antenatal corticosteroid treatment.

Antenatal corticosteroids are now established as one of the cornerstones of therapy in the prevention of neonatal morbidity and mortality prior to preterm birth. Although this practice is widely accepted, a significant number of controversies exist. This review explores the knowledge gaps regarding the use of antenatal corticosteroids in the preterm, late preterm and term populations. Furthermore, the role of antenatal corticosteroids in special populations, such as diabetes, multiple pregnancies and periviable gestations, where high-quality data from randomized controlled trials are lacking, is also considered.

Effect of Early-Onset Preeclampsia on Offspring's Blood Pressure during the First Month of Life

To explore the effect of early-onset preeclampsia on the blood pressure of offspring during the first month of life. This prospective case-control study included 106 neonates of mothers with early-onset preeclampsia (developing at <34weeks of gestation) and 106 infants of normotensive mothers, matched 1-to-1 for sex and gestational age. Serial blood pressure measurements were obtained on admission, daily for the first postnatal week, and then weekly up to the fourth week of life. There were no differences in blood pressure values on admission and the first day of life between cases and controls. Conversely, infants exposed to preeclampsia had significantly higher systolic (SBP), diastolic (DBP), and mean blood pressure (MBP) on the subsequent days up to the fourth postnatal week (P<.001-.033). Multiple regression analyses with adjustment for sex, gestational age, antenatal corticosteroid use, and maternal antihypertensive medication use confirmed the foregoing findings (P<.001-.048). Repeated-measures ANOVA also identified preeclampsia as a significant determinant of trends in SBP, DBP, and MBP during the first month of life (F=16.2, P<.001; F=16.4, P<.001; and F=17.7, P<.001, respectively). Infants of mothers with early-onset preeclampsia have elevated blood pressure values throughout the neonatal period compared with infants born to normotensive mothers.

Small for gestational age very preterm infants present a higher risk of developing bronchopulmonary dysplasia.

Several studies assessed the influence of a low birth weight on bronchopulmonary dysplasia (BPD), but not all could find a significant association. Our aim was to assess the association between low birth weight and BPD in preterm infants, prospectively recruited at 11 level III Portuguese neonatal centers. Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 after a surveilled pregnancy, were analyzed. Neonates were considered small for gestational age (SGA) when their birthweight was below the 10th centile of Fenton's growth chats and BPD was defined as the dependency for oxygen therapy until 36 weeks of corrected age. Statistical analysis was performed using IBM SPSS® statistics 23 and a p-value <0.05 was considered statistically significant. Out of 614, a total of 494 preterm infants delivered from 410 women were enrolled in the study; 40 (8.0%) infants with SGA criteria. SGA were more often associated with a single pregnancy, had greater use of antenatal corticosteroids, increased prevalence of gestational hypertensive disorders, C-section, rupture of membranes below 18 hours, rate of intubation in the delivery room, use of surfactant treatment, oxygen therapy, mechanical ventilation need, BPD, cystic periventricular leukomalacia, nosocomial sepsis and pneumonia; had lower prevalence of chorioamnionitis, and lower Apgar scores. The multivariate analysis by logistic regression, adjusted for BPD risk factors revealed a significant association between SGA and BPD: OR = 5.2 [CI: 1.46-18.58]; p = 0.01. The results of this study increase the scientific evidence that SGA is an independent risk factor for BPD.

产前糖皮质激素使用情况对&lt;34周早产儿预后的影响

产前糖皮质激素使用情况对&lt;34周早产儿预后的影响

Antenatal betamethasone administration before elective caesarean section in term pregnant women

Objective: The aim of this study is to show that respiratory problems such as respiratory distressed syndrome and transient tachypnea of newborn can be reduced by antenatal betamethasone administration. Method: The study was conducted on 50 mothers and their babies aged between 21 and 38 years in the Obstetrics and Gynecology Clinic of Haydarpasa Numune Training and Research Hospital between January 2007 and March 2008. Betamethasone was administered to 25 patients who were planned for cesarean section at term due to elective reasons (Group I). The Group II consisted of 25 patients planned for elective caesarean section at term and no betamethasone was administered. Groups were compared according to maternal age, maternal smoking, maternal chronic disease history, gestation day, cesarean section type of anesthesia, birth weight and sex of the baby. Postnatal infants were evaluated according to Apgar scores of 1 and 5 minutes, ventilation with mask, intubation, resuscitation or intensive care needs. RDS and TNT were recorded. Results: I n the non-corticosteroid-treated group (group 2), two babies developed TNT of the newborn. However, no statistically significant difference was found between the groups (p> 0.05). Respiratory distress syndrome did not develop in any of our patients. The abortion rate in Group I (20%) was significantly higher than the abortion rate in Group II (0%) (p 0.05). Conclusions: T he use of antenatal corticosteroid in elective caesarean sections over 37 weeks may cause a decrease in the development of respiratory problems such as RDS and YGT.

Advances in antenatal corticosteroids for improving perinatal outcomes of extremely preterm infants

Large population-based cohort studies conducted in the industrialized countries in different eras revealed that the use of antenatal corticosteroids for extremely preterm births (EPT, <28 gestational weeks) reached 60% or higher in the mid-1990s, accompanying by steadily declined perinatal mortality to 13%-22% in EPT with gestational age ≥25 weeks in developed countries. Notably, the survival rate of EPT with 23-24 weeks of gestation was over 50% in Sweden since 2005. There's a link between the increment of antenatal corticosteroids use and steady decline of mortality in EPT in the past three decades. High-quality evidence is needed to demonstrate the impact of antenatal corticosteroids on EPT perinatal outcomes under the current healthcare background in China. This review, focusing on the progression of antenatal corticosteroid treatment for EPT, may facilitate the quality improvement of maternal-fetal and infant healthcare in China. Key words: Glucocorticoids; Infant, extremely premature; Peripartum period; Prognosis

Disparities in the use of antenatal corticosteroids among women with hypertension in North Carolina.

To evaluate antenatal corticosteroids (ANS) use in pregnant women with hypertension. Retrospective analysis of ANS use in the Perinatal Quality Collaborative of North Carolina between 2015 and 2017. Twenty-five centers participated, with 9% (1580/17,692) of mothers delivering at <34 weeks; of these, 81% (1286/1580) received a full course of ANS, which was not different between phases (p = 0.32), or between Level III/IV neonatal intensive care units (NICUs; 82%), and I/II NICUs (76%) (p = 0.05). In Level III/IV NICUs, White mothers were more likely to receive ANS (87%) than African Americans (77%) or other race/ethnicity (80%) (including Hispanics) (p = 0.001). ANS use did not differ among mothers with different payers (p = 0.94). The rates of full ANS courses did not significantly increase from 2015-2017 and disparities persisted. Targeted efforts to improve ANS exposures among hypertensive African American and Hispanic mothers, as well as in community hospital settings are needed.

Exercise fitness at 14 years: Good news for antenatal corticosteroids

The lungs of infants born with very low birth weight (VLBW) are not normal at term, even without a history of prematurity associated lung disease. Their lungs can continue to remodel for perhaps 20 years to be functionally close to normal, but the effects of aging on the previously preterm lung remain essentially unknown. Lung function of infants born at normal term can be categorized into quartiles from lower to higher function. Remarkably, the children, and subsequently the adults, track within each quartile to at least 30 years of age. And the lowest quartile has increased risk of asthma and chronic obstructive lung disease as adults. Virtually nothing is known about how the lung function of infants born preterm tracks across age. However, in early childhood, infants born preterm with a history of bronchopulmonary dysplasia (BPD) have several overlapping phenotypes that include large airway malacia, small airway disease, and parenchymal (alveolar and vascular) abnormalities. This mix of abnormalities likely also are present to lesser degrees in infants born VLBW without BPD. Within this context of respiratory outcomes in infants with VLBW, Nixon et al report that antenatal corticosteroid (ACS) use in a cohort of 14-year-old children improved peak oxygen uptake with maximal exercise in non-black males relative to black males or females. This result correlated with greater physical activity in non-black males. The result was contrary to their hypothesis that ACS would decrease exercise tolerance because ACS inhibit alveolar and vascular development in the premature lung. My concern is that the % predicted peak oxygen uptake values were 85 ± 19% for ACS exposed and 78 ± 19% for ACS unexposed children born VLBW. These children thus are in the lowest quartile for normal lung function. There must be concerns for how these lungs will age. At least ACS did not seem to aggravate the problem. Article page 98▸ Antenatal Steroid Exposure, Aerobic Fitness, and Physical Activity in Adolescents Born Preterm with Very Low Birth WeightThe Journal of PediatricsVol. 215PreviewTo determine whether antenatal corticosteroid exposure is associated with aerobic fitness or physical activity participation in adolescents born preterm with very low birth weight (VLBW). Full-Text PDF

Neonatal outcomes of multiple versus single very preterm infants.

Neonatal morbidity and mortality differ between very preterm infants that result from single and those that result from a multiple order pregnancy. The aim of our study was to assess and compare the neonatal morbidity and mortality of multiple versus single very preterm infants. Obstetrical and neonatal data on mothers and preterm infants with gestational ages between 24 and 30 weeks, born during 2015 and 2016 at 11 level III perinatal centers after a surveilled pregnancy, were analyzed and compared. Statistical analysis was performed using IBM SPSS® statistics 25 and a p-value < 0.05 was considered statistically significant. A total of 494 infants delivered from 410 women were enrolled in the study; 320 (64.8%) infants resulted from single gestation and 174 (35.2%) resulted from multiple order gestation (153 double, 21 triple). Multiples were associated with a higher maternal age, a greater use of medically assisted reproduction techniques, higher C-section rates, more frequent full cycle use of antenatal corticosteroids, higher gestational age with adequate birth weight, spent less days on oxygen therapy, presented less prevalence of BPD and cPVL, needed less surgical closure of PDA and had a lower length of stay in NICU. Abruptio placenta, hypertensive disorders of pregnancy and preeclampsia were more frequent in single pregnancies. The multivariate analysis by logistic regression adjusted to gestational age and confounding variables did not show any significant difference on the outcomes of multiples compared to singles. The results of our study support the scientific evidence that, with the current practices, the neonatal morbidity and mortality of very premature infants are not different between those resulting from single and multiple gestations.