Antenatal Steroid Use Research Articles

Outcome of patients with congenital diaphragmatic hernia requiring ECMO: can we predict?

In spite of the advances in pre-neonatal and neonatal intensive care including the use of antenatal steroids, foetal surgery, nitric oxide (NO), surfactant, high-frequency oscillation (HFOV), liquid ventilation and extracorporeal membrane oxygenation (ECMO), the mortality of patients with congenital diagrammatic hernia (CDH) remains high. The use of ECMO is generally reserved for patients who cannot be managed by other treatments such as HFOV, NO and surfactant. The aim of this study was to identify factors that could predict the outcome in patients with CDH requiring ECMO.

Oxidative stress in infants born to preeclamptic mothers

Oxidative stress may play an important role in the pathophysiology of preeclampsia. An increase in lipid peroxidation products and a decrease in antioxidant activity in preeclamptic women have been reported in many papers. The objective of this study was to evaluate oxidative stress in infants born to preeclamptic mothers. Malondialdehyde (MDA) and glutathione (GSH) levels and glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured in cord plasma of infants born to preeclamptic (n = 18) or normotensive (n = 9) mothers. Gestational age was similar in both groups. The mean birth weight was significantly lower in the preeclamptic group (P = 0.007). Maternal age, primigravidity, antenatal steroid use, premature rupture of the membranes, clinical chorioamnionitis and adverse neonatal outcomes including sepsis, respiratory distress syndrome and neonatal mortality did not differ between groups. Cesarean delivery was significantly higher in the preeclamptic group. There was no significant difference in cord plasma levels of MDA and GSH, and activity of GPx between the preeclamptic and control groups. SOD was found to be increased in preeclamptic group (P = 0.03). We concluded that although cord plasma MDA levels were similar in both the preeclamptic and control groups, increased SOD activity might be an indicator of increased oxidative stress in infants born to preeclamptic mothers.

Use of the bayley infant neurodevelopmental screener with premature infants

Objective: To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) for the neurodevelopmental follow up of high-risk preterms. Methods: The study group consisted of 122 preterm infants of the gestational ages between 26 and 37 weeks. Medical factors such as; mean birth weight, gestational age, gender, birth place and type, number of multiple pregnancy, days of hospitalization and oxygen therapy, use of antenatal steroids, and occurence of sepsis for each patient were evaluated. The neurodevelopmental examination and BINS administration was made at each visit to the patients whose ages were adjusted for prematurity. Results: At the corrected age of 7–10 months patients at 26–29 GA had significantly lower total means of BINS scores when compared to those of the other two groups at 30–32 and 33–37 GA ( P<0.01 and P<0.001). At the corrected age of 3–4 months, the total means of the BINS scores of the patients at 30–32 GA were lower than that of the patients at 33–37 GA ( P<0.009). at 7–10 months the scores of the items defining the expressive and cognitive functions of the patients at 26–29 GA were lower than those of the patients at 30–32 GA ( P<0.05) and 33–37 GA ( P<0.05). At 16–20 months the mean scores of the items of expressive functions were significantly lower in patients of the 26–29 GA compared to those of the patients of 33–37 GA ( P<0.03). Conclusion: As data accumulates, BINS will turn out to be a quick way of determining infants at risk of developmental delay in many aspects of neurologically high risk conditions.

Risk Factors for Severe Retinopathy of Prematurity Among Very Preterm Infants: A Unit-Based or Population-Based Approach?

To the Editor .— In the interesting article by Darlow et al,1 the authors correctly remark that, although many factors (including prenatal factors) have been suggested to have some causal association with retinopathy of prematurity (ROP), most studies have been unit based or from hospital groupings, rather than being population based, and may have introduced bias into the results. These limits in the available studies may explain the fact that the same prenatal variables are reported as associated to an increased risk of ROP by some single-center, cohort studies and as not associated or even protective in others (eg, the use of antenatal steroids [no association according to refs 2–4; an association with a protective effect based on refs 5 and 6] or the maternal history of preeclampsia [no association according to ref 7; an …

243 Admission Temperature After Transport from Delivery to Nursery: A Randomised Trial Comparing Radiant Warmer and Incubator in Preterm Infants

Introduction: Low admission temperature has been associated with increased morbidity and mortality in preterm infants.Aim: To compare admission axillary temperatures of preterm infants <31 weeks transported from delivery to nursery on either radiant warmers (RW) or in incubators (INC). Target axillary temperature on admission was 36.5 to 37.5 degrees C.Method: Following delivery infants were wrapped in plastic and resuscitated under radiant warmers. When stable (5–10 minutes) they were transported on either RW (with power source) or in a pre-warmed INC with power source and air temperature 39 degrees C. Allocation for transport was by randomisation and use of sealed envelopes; randomisation was stratified by gestation. Numbers allowed for detection of 35% difference in proportion of infants with admission temperature in target range; p<0.05, study power 80%.Results: Of 71 eligible infants, 64 were analysed (32 in each group). 25 were 23–25 weeks gestation, 29 were 26–28 weeks; 10 were 29–30 weeks. Median birth weight (900g) and gestation (26.3wks) were similar in the two groups (p>0.05). Median time to admission was 16 minutes (RW group) and 17 minutes (INC group; p>0.05). The 2 groups were comparable with regard to antenatal steroid use, delivery mode, number of males and 5 minute Apgar score (p >0.05). Median (interquartile range) of admission temperatures was 36.8 (36.5 − 37) deg C for the RW group and 36.8 (36.2–37.3) deg C for the INC group (p>0.05). Overall, 7 infants in the RW group and 11 in the INC group had temperatures outside the target range (p>0.05). Rates of other neonatal outcomes were similar (p>0.05) in the 2 groups.Conclusion: Both radiant warmer and incubator transport provided satisfactory admission temperatures in most infants. The use of plastic wrap probably helped achieve these results.Funding was obtained from Fisher and Paykel Health Care, manufacturers of the radiant warmer.

Retinopathy of prematurity and risk factors: a prospective cohort study

BackgroundIncreased survival of extremely low birth infants due to advances in antenatal and neonatal care has resulted in a population of infants at high risk of developing retinopathy of prematurity (ROP). Therapeutic interventions include the use of antenatal and postnatal steroids however, their effects on the severity of ROP is in dispute. In addition, it has not been investigated whether severe ROP is due to therapeutic interventions or due to the severity of illness. The aim of the present study was to assess the association between the incidence of severe retinopathy of prematurity (greater than stage 2 – International classification of ROP) and mechanical ventilation, oxygen therapy, gestational age, antenatal and postnatal steroids in extremely low birth weight infants.MethodsNeonates admitted to the neonatal intensive care unit in Lansing, Michigan, during 1993–2000 were followed to determine factors influencing the development of severe retinopathy of prematurity. Ophthalmologic examinations were started at 6 weeks and followed until resolution. We used logistic regression to estimate the relative risk (odds ratio) associated with risk factors of ROP.ResultsOf the neonates with ≤ 1500 g birth weight, admitted to the neonatal intensive care unit, 85% (616/725) survived. Severe retinopathy of prematurity was detected in 7.8% of 576 neonates who had eye examinations. Neonates of lower gestational age (≤ 25 weeks and 26–28 weeks) had an increased odds ratio of 8.49 and 3.19 for the development of severe retinopathy of prematurity, respectively, compared to those 29 weeks and older. Late postnatal steroid treatment starting after 3 weeks of life showed 2.9-fold increased odds ratio, in particular administration for two weeks and more (OR: 4.09, 95% CI: 1.52–11.03). With increasing antenatal steroids courses the risk of severe retinopathy of prematurity decreased, however, it was not significant. Lower gestational age, dependence on ventilation, and use of postnatal steroids were intertwined. Simultaneous presence of these factors seems to indicate severe disease status.ConclusionProlonged and late postnatal steroids treatment in very low birth weight infants may pose an increased risk for the development of severe retinopathy of prematurity; however, use of postnatal steroids may also be a marker for severity of illness. Further studies need to focus on biologic markers in the pathogenesis of retinopathy of prematurity and to better understand the influence of therapies.

Inhaled Nitric Oxide Therapy in the Preterm Infant Who Has Respiratory Distress Syndrome

After completing this article, readers should be able to: 1. Delineate the rationale for inhaled nitric oxide (iNO) use in respiratory distress syndrome. 2. List the toxicities of iNO. 3. Describe the primary findings of iNO therapy in major clinical trials. Respiratory distress syndrome (RDS) has been a major factor determining the limits of viability in the preterm infant. RDS is, in large part, the result of surfactant deficiency. Surfactant replacement and antenatal steroid use are the two major advances in the treatment of RDS to date and have resulted in significant decreases in mortality and chronic lung disease (CLD). Surfactant replacement became widely available in 1991, and antenatal steroids achieved widespread use following the National Institutes of Health Consensus Conference in 1994. (1) However, substantial mortality and CLD still are seen in the very low-birthweight infant (Fig. 1). Figure 1 National Institute of Child and Human Development (NICHD) Neonatal Research Network mortality and CLD rates for 2003 in preterm infants born at 23 to 30 weeks’ gestation. Following the identification of nitric oxide (NO) as the vascular endothelial relaxing factor, use of the agent has moved rapidly from bench to bedside. Inhaled nitric oxide (iNO) was found to improve oxygenation in adult and pediatric patients who had hypoxic respiratory failure. (2)(3)(4) Subsequent randomized, controlled trials in term and near-term infants who had hypoxic respiratory failure demonstrated an improvement in oxygenation as well as a significant decrease in death or the need for extracorporeal membrane oxygenation. (5)(6)(7) Following United States Food and Drug Administration review of these trials, iNO was approved for use in term and near-term infants who had hypoxic respiratory failure. The role of iNO in the preterm infant who has RDS has been an active area of investigation over the last decade. This …

Preterm Birth and the Visual System

Author Disclosure Drs Madan and Good did not disclose any relationships relevant to this article. After completing this article, readers should be able to: 1. Chart the development of the structures of the eye. 2. Describe the primary visual problems seen in preterm neonates. Despite several interventions, preterm birth remains one of the major causes of poor perinatal outcome. It is estimated that approximately 57,000 preterm infants weighing less than 1,500 g, comprising 1.5% of all live births in the United States, are born each year. (1) Considerable advances in neonatal intensive care in the 1990s, including use of surfactant replacement therapy for preterm infants and antenatal steroid use for women in preterm labor, has led to the increased survival of these infants. However, despite improvements in survival, preterm infants, particularly extremely low-birthweight infants whose birthweights are less than 1,000 g, continue to be at increased risk for abnormal cognitive function, visual-perceptual, visuomotor, and tactile-perceptual skills; cerebral palsy; blindness; and deafness. (2) Many severely handicapped infants have multiple impairments. Cortical visual impairment has emerged as the major cause of visual impairment in the United States. It is well known that appropriate procession of sensory cues is an important requirement for normal motor, mental, and emotional development in infants, and the association between vision problems and neurologic and mental disability is well recognized in several studies. (3) An increased understanding of the impact of extrauterine stimuli on visual development along with improved methods of detecting vision problems can help in prevention, early diagnosis, and rehabilitation of visual impairment in infants. (4) In this article, we review current knowledge of visual development in the preterm infant and the spectrum of visual disturbances seen in preterm infants. Visualization of an image requires refraction of light emanating from the object passing through the lens onto …

The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth

Aims: To describe perinatal factors associated with later morbidity among extremely preterm children at 30 months of age corrected for prematurity. Population: Of 308 surviving children born at ⩽25 weeks...

Association of maternal antepartum management with mortality and morbidity of the extremely low birthweight (ELBW) neonate

MORBIDITY OF THE EXTREMELY LOW BIRTHWEIGHT (ELBW) NEONATE AMY WHITSEL, AARON INSEL, HEMA DESILVA, BRUCE BERNSTEIN, University of Connecticut Health Center, Obstetrics and Gynecology, Farmington, Connecticut, Saint Francis Hospital, Pediatrics, Hartford, Connecticut OBJECTIVE: Explore the associations of antepartum management with ELBW neonatal outcomes: hospital mortality, hospital morbidity and length of stay. STUDY DESIGN: Hospital outcomes of 118 viable, non-anomalous infants %1000 g and/or !28 weeks born January 1997-December 2002 and their obstetrical data were evaluated via retrospective record review. Antepartum management factors were delivery route and indication (preterm labor, preeclampsia, abruption, chorioamnionitis, non-reassuring fetal status), steroids, magnesium sulfate and antibiotic exposure (none, prophylactic or treatment). Neonatal outcomes included mortality, length of stay (LOS), oxygen dependence at day 28 and 36 weeks corrected estimated gestational age (EGA), pneumothorax, retinopathy of prematurity, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, patent ductus arteriosis, and both early and late sepsis. Bivariate relationships between maternal variables and neonatal outcomes were explored with chi square and t tests. Multivariate logistic regression and analysis of covariance models were used to control for possible confounders. RESULTS: The overall hospital mortality rate was 17.8% (21/118). The median survivors’ LOS was 90 G 32 days. Neontal mortality, LOS and morbidity were similar when compared by delivery route (61.9% cesarean deliveries), indication for delivery and use of antenatal steroids (83.5%) when corrected for EGA and birthweight. Prophylactic antibiotics were given to 43% of the women for group B streptococcal risk and/or preterm rupture of membranes and 25% received antibiotics for known or clinically suspected infection. Neonatal mortality and morbidity were similar in the antibiotic naive, prophylactic and treatment groups. Intrapartum exposure to magnesium sulfate did not change the mortality rate; however, a greater incidence of late bacterial sepsis was noted (P = .046). CONCLUSION: The ELBW neonatal survival rate and morbidity were related to birthweight and EGA and not the indication for delivery, route, steroids or exposure to antibiotics. SMFM Abstracts S75

163 Implementation of CPAP for The Early Stabilization of VLBW Infants

Background: The introduction of continuous positive airway pressure (CPAP) in neonatal units offers a new strategy in the early stabilization and management of the newborn, especially in very-low-birth-weight (VLBW) infants. Aims: To compare the number of VLBW infants intubated within the first 36 hours of life when CPAP was introduced for early stabilization, with another group of VLBW infants managed without the use of early CPAP. To compare in both groups of VLBW infants the frequency of pneumothorax, bronchopulmonary dysplasia (BPD), mortality, severe brain injury, length of stay and days of intubation. Methods: Study of evaluation with comparison before-after of VLBW infants born in a tertiary care hospital during two periods: Group 1: 78 VLBW infants born during 2001 and Group 2: 80 VLBW infants born from June 2003 to February 2004. In the group 1, conventional management was performed (intubation and administration of surfactant in the delivery room in <28wks or <1000g with respiratory distress syndrome). In the group 2, CPAP was introduced for early stabilization. Results: In the group 1 mean weight was 1059±309 g and in the group 2 was 1127±295 g (p= 0.15). The mean gestational age was 29±3.3 weeks in the group 1 and 29±2.8 weeks in the group 2 (p=1). There were no significant differences in intrauterine growth restrictions, CRIB and use of antenatal steroids. In the group 1 CPAP was used for early stabilization in 8,9% and in the group 2 in 48,7% (p<0,0001). Intubated in the delivery room, 54% in group 1 versus 31% in the group 2 (p=0,004). Intubated in the first 36 hours 73% versus 49% respectively (RR=1,5(1,15–1,95). Mean days of intubation were 4±11 in the group 1 and 2.7±5,8 in the group 2 (p=0,15). The mortality rate was the same (15%) in both groups. BPD at 36 weeks was 19% in the group 1 and 14.5% in the group 2 (RR=1,34 (0,63–2,84)). Mean days on oxygen were 34±47 and 21±25 respectively (p=0,04). Pneumothorax was similar in both groups (RR=1,03 (0,21– 4,95)). Severe brain injury was similar in both groups: intraventricular haemorrhage III RR=1,03 (0,15–7,10) and cystic brain lesions RR=1,03 (0,22– 4,92). The mean length of stay was 68±37 days in the group 1 and 58±25 in the group 2 (p=0,08). Conclusion: The use of CPAP for early stabilization of VLBW infants seems to be a reasonable alternative as any adverse effects has been observed, although we have not long term follow up outcomes.

113 Antenatal Betamethasone Decreases Cord Plasma Adiponectin in Pre-Term Infants

Background: Adiponectin is an adipocyte-derived hormone with profound metabolic effects that include increased insulin sensitivity and decreased atherogenesis. Glucocorticoids downregulate adiponectin in vitro. Despite the wide use of antenatal steroids, their in vivo effect on adiponectin in preterm infants has not been studied. Our aim was to study whether cord blood adiponectin concentration is related to the time from the last dose of betamethasone.

Short‐term outcome after active perinatal management at 23—25 weeks of gestation. A study from two Swedish tertiary care centres. Part 2: infant survival

To determine neonatal survival rates based on both foetal (stillborn) and neonatal deaths among infants delivered at 23-25 wk, and to identify maternal and neonatal factors associated with survival. The medical records of 224 infants who were delivered in two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Data were analysed by gestational age groups and considered in three time periods. Logistic regression models were used to identify factors associated with survival. The rate of foetal death was 5%. Of infants born alive, 63% survived to discharge. Survival rates including foetal deaths in the denominator at 23, 24 and 25 wk were 37%, 61% and 74%, respectively, and survival rates excluding foetal deaths were 43%, 63% and 77%, respectively. Of infants born with 1-min Apgar scores of 0-1, 43% survived. In the total cohort, survival rates including foetal deaths in the denominator increased from 52% in time period 1 to 61% in time period 2 and 74% in time period 3 (p < 0.02). On multivariate logistic regression analysis, higher birthweight (OR: 1.91 per 100 g increment; 95% CI: 1.45-2.52), female gender (OR: 3.33; 95% CI: 1.65-6.75), administration of antenatal steroids (OR: 2.95; 95% CI: 1.46-5.98) and intrauterine referral from a peripheral hospital (OR: 2.35; 95% CI: 1.18-4.68) were associated with survival. Apgar score < or = 3 at 1 min (OR: 0.46; 95% CI: 0.22-0.95) was associated with decreased survival. The use of antenatal steroids was protective at 23-24 wk (OR: 5.2; 95% CI: 2.0-13.7), but not at 25 wk. Active perinatal management that included universal initiation of neonatal intensive care virtually eliminated intrapartum stillbirths and delivery room deaths, and resulted in survival rates that compare favourably with those of recent studies. However, the policies of active care postponed death in non-survivors. Individual variations in outcome in relation to the infant's condition at birth as reflected by the Apgar scores preclude the making of treatment decisions in the delivery room.

Short‐term outcome after active perinatal management at 23–25 weeks of gestation. A study from two Swedish tertiary care centres. Part 1: maternal and obstetric factors

To provide descriptive data on women who delivered at 23-25 wk of gestation, and to relate foetal and neonatal outcomes to maternal factors, obstetric management and the principal reasons for preterm birth. Medical records of all women who had delivered in two tertiary care centres in 1992-1998 were reviewed. At the two centres, policies of active perinatal and neonatal management were universally applied. Logistic regression models were used to identify prenatal factors associated with survival. Of 197 women who delivered at 23-25 wk, 65% had experienced a previous miscarriage, 15% a previous stillbirth and 12% a neonatal death. The current pregnancy was the result of artificial reproduction in 13% of the women. In 71%, the pregnancy was complicated either by pre-eclampsia, chorioamnionitis, placental abruption or premature rupture of membranes. Antenatal steroids were given in 63%. Delivery was by caesarean section in 47%. The reasons for preterm birth were idiopathic preterm labour in 36%, premature rupture of membranes in 41% and physician-indicated deliveries in 23% of the mothers. Demographic details, use of antenatal steroids, caesarean section delivery and birthweight differed between mothers depending on the reason for preterm delivery. Of 224 infants, 5% were stillbirths and 63% survived to discharge. On multivariate logistic regression analysis comprising prenatally known variables, reasons for preterm birth were not associated with survival. Advanced gestational duration (OR: 2.43 per wk; 95% CI: 1.59-3.74), administration of any antenatal steroids (OR: 2.21; 95% Cl: 1.14-4.28) and intrauterine referral from a peripheral hospital (OR: 2.93; 95% CI: 1.5-5.73) were associated with survival. Women who deliver at 23-25 wk comprise a risk group characterized by a high risk of reproductive failure and pregnancy complications. Survival rates were similar regardless of the reason for preterm birth. Policies of active perinatal management virtually eliminated intrapartum stillbirths.

Chorioamnionitis/funisitis and the development of bronchopulmonary dysplasia.

To examine the association between chorioamnionitis with or without funisitis and bronchopulmonary dysplasia in infants less than 30 completed weeks gestation given the current standards of antenatal steroid and surfactant use. Infants included in the study were those delivered at less than 30 completed weeks gestation from January 1996 to July 2001, identified from a prospectively managed database. Placental pathology was reviewed for the presence or absence of chorioamnionitis and funisitis. Infants were divided into three groups depending on degree of exposure to fetal inflammation (no inflammation, chorioamnionitis only and chorioamnionitis and funisitis). Data relating to gestational age, sex, antenatal steroid exposure, surfactant treatment, days of positive pressure ventilation and days of oxygen required were collected. Bronchopulmonary dysplasia was defined as death due to respiratory failure or any oxygen requirement at 36 weeks postmenstrual age. Two hundred and forty-one infants were included in the study. The mean gestational age was 27.7 weeks and mean birthweight 1089 g. One hundred and sixty-one infants were not exposed to any in utero inflammation, 40 showed chorioamnionitis and 40 showed chorioamnionitis and funisitis. There was no significant difference between antenatal steroid and surfactant treatment between the three groups. There was no significant difference between the three groups in the development of bronchopulmonary dysplasia. Low gestational age was the most significant predictor of developing bronchopulmonary dysplasia. The risk of developing bronchopulmonary dysplasia is not increased following exposure to chorioamnionitis or funisitis in the context of current antenatal steroid and surfactant use. The most significant predictor for developing bronchopulmonary dysplasia is gestational age at the time of delivery.

Détresses respiratoires du nouveau-né (en dehors des malformations et des maladies génétiques ou constitutionnelles)

Respiratory disorders are one of the main cause of neonatal morbidity and mortality. Their aetiology is predominantly linked to an inappropriate cardio-respiratory adaptation at birth and to infections. Recent improvements in the management of these disorders diminished dramatically the mortality. These improvements are due to a better perinatal care organization, and to substantial advances in obstetrics and paediatrics, among which a wide use of antenatal steroids, exogenous surfactants and improvements in mechanical ventilation. Nevertheless, bronchopulmonary dysplasia remains a major problem in the outcome of the most preterm infants. A better knowledge of its physiopathology may open new therapeutic advances.

High versus low thresholds for repeat administration of surfactant in intubated preterm neonates

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: 1. To determine, in preterm infants who have received an initial dose of surfactant either as prophylaxis or treatment of established respiratory distress syndrome, whether the use of a high threshold for administration of a second or subsequent dose of surfactant when compared to a low threshold leads to improved respiratory outcome, decreased morbidity associated with prematurity, decreased resource utilization and decreased mortality. 2. To compare the effects of high versus low thresholds in different subgroups formed on initial dosing strategy (prophylactic dosing versus rescue dosing), degree of prematurity, birth weight, type of ventilator (conventional versus HFOV), antenatal steroid use, and the type of surfactant (natural versus synthetic)

Decreasing incidence of neonatal nosocomial bloodstream infections in a neonatal intensive care unit: antenatal corticosteroid treatment an innocent bystander?

We studied the effect of the use of antenatal steroid treatment on the incidence of nosocomial bloodstream infections (NBSI). All episodes of culture proven NBSI occurring after 96 h of hospitalisation were identified retrospectively during a 10-year period (1991-2001). Throughout the study period, the use of antenatal steroids, demographic characteristics and morbidity of the patients were recorded prospectively. Since 1996 more efforts were made to use antenatal steroids to decrease neonatal morbidity and mortality. The incidence rates of NBSI were compared between period 1 (1991-1995) and period 2 (1996-2001). The overall incidence rate of NBSI dropped significantly from 7.4% (6.1%-8.9%) in period 1 to 5.0% (4.0%-6.2%) in period 2 and was most pronounced in the birth weight category 1000 g-1500 g (11.7%, 7.9%-15.0% to 6.9%, 4.3%-10.5%) and 1500 g-2500 g (3.6%, 2.2%-5.6% to 1.4%, 0.6%-2.8%). Antenatal use of steroids increased overall from 19% in 1991 to 51% in 2001 ( P<0.001). Since 1996 there was a decreasing number of ventilation days ( P=0.011) and decreasing incidence of patent ductus arteriosus ( P=0.001), while the incidence of neonatal surgery, chronic lung disease and duration of hospitalisation remained constant over time. increased use of antenatal steroids is associated with a decreasing incidence rate of nosocomial bloodstream infections in neonates with birth weights between 1000 g and 2500 g, probably by decreasing the incidence of patent ductus arteriosus and/or due to improved respiratory outcome. This finding needs to be confirmed by randomised control trials or by a large prospective cohort study in similar population groups.

Is discordant growth in twins an independent risk factor for adverse neonatal outcome?

To estimate whether discordant growth is associated with adverse perinatal outcomes in twins after adjusting for growth restriction. This was a retrospective, hospital-based cohort study of twin gestations with 2 live births delivered at 24 weeks or later from 1992 to 2001. Twin gestations were classified as small for gestational age (SGA) if one or both infants was less than the 10th percentile at birth by singleton Brenner norms and discordant if there was a 20% or more weight discordance. Of 1318 twin pairs, 856 were appropriate for gestational age (AGA) and concordant, 70 pairs were AGA and discordant, 254 pairs were SGA and concordant, and 138 pairs were SGA and discordant. The 4 groups had similar maternal demographics and medical comorbidity. When adjusting for chorionicity, antenatal steroid use, oligohydramnios, preeclampsia, and gestational age at delivery, discordant twins were more likely to have a cesarean delivery (odds ratio 1.87; 95% confidence interval 1.22, 2.87) and to be associated with some adverse neonatal outcomes (low and very low birthweight, neonatal intensive care unit admission, neonatal oxygen requirement and hyperbilirubinemia) independent of SGA status. A statistically nonsignificant trend (odds ratio 2.4; 95% confidence interval 0.99, 6.01) toward higher rates of intraventricular hemorrhage was noted in discordant twins, and no difference was seen for ventilator requirement, respiratory distress syndrome, or necrotizing enterocolitis. Discordance places twins at increased risk for some adverse perinatal outcomes, whether they are AGA or SGA. Discordance was not an independent risk factor for serious neonatal morbidity or mortality; however, this study was underpowered to detect those differences.

Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers

Contemporary management of preterm premature rupture of membranes (PPROM): a survey of maternal-fetal medicine providers