Effects of 'rescue' dose of antenatal corticosteroids on placental histopathology in preterm births

Objectives The primary aims of this study were to investigate if exposure to antenatal corticosteroids (ACS) was associated with lower rates of perinatal mortality (primary outcome) and other adverse perinatal outcomes (i.e., stillbirth, early neonatal mortality, APGAR score of < 7 at 5 mins, neonatal sepsis and respiratory distress syndrome) in preterm infants in hospitals in Tanzania. We also examine factors associated with administration of ACS among women at risk of preterm delivery. Methods A hospital-based prospective chart review study was undertaken in four hospitals located in Nyamagana and Sengerema districts, Tanzania. The study population included all stillborn and live born preterm infants delivered between 24 to 34 weeks of gestation between July 2019 to February 2020. A total 1125 preterm infants were delivered by 1008 women (895 singletons, 230 multiple). Sociodemographic and medical data were recorded from participants’ medical records. Results Three hundred and fifty-six (35.3%) women were administered at least one dose of ACS between 24 to 34 weeks’ gestation and 385 (34.2%) infants were exposed to ACS. Infants exposed to ACS had a lower rate of perinatal mortality (13.77%) compared to those who were not exposed (28.38%). Multivariate analysis indicated that infants exposed to ACS were less likely to die during perinatal period, aRR 0.34 (95%CI 0.26-0.44). Only one-third of the sample was provided with ACS. Administration of ACS was associated with maternal education, attending antenatal care more than 3 times, method used to assess gestational age, maternal infection, exposure to maternal antibiotics, delivery mode and level of health facility. Conclusion ACS significantly reduced the risk in perinatal mortality among infants born preterm in a limited resource setting. However, only about one-third of eligible women were provided with ACS, indicating low usage of ACS. Numerous factors were associated with low usage of ACS in this setting.

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Factors Associated with Formula Feeding among Late Preterm Neonates

American Journal of Perinatology ◽

10.1055/s-0040-1712952 ◽

2020 ◽

Vol 37 (14) ◽

pp. 1393-1399

Author(s):

Michal Fishel Bartal ◽

Han-Yang Chen ◽

Sean C. Blackwell ◽

Suneet P. Chauhan ◽

Baha M. Sibai

Keyword(s):

Secondary Analysis ◽

Preterm Births ◽

Formula Feeding ◽

Late Preterm ◽

Preterm Neonates ◽

Chronic Hypertension ◽

Antenatal Corticosteroids ◽

Singleton Pregnancy ◽

Factors Associated ◽

Increased Risk

Objective Late preterm births (delivery at 34–36 weeks) account for nearly three quarters of the preterm births and among them there is a knowledge gap about an important aspect of infant care: breast versus formula feeding. The aim of this study was to assess factors associated with formula feeding in late preterm neonates. Study Design Secondary analysis of a multicenter randomized trial of antenatal corticosteroids for women at risk for late preterm birth. All women with a singleton pregnancy who delivered at 340/7 to 366/7 weeks were included. Women with no information on neonatal feeding or known fetal anomalies were excluded. The outcome evaluated was the type of neonatal feeding during hospital stay. Maternal and neonatal characteristics were compared among women who initiated breast versus formula feeding. Adjusted relative risks (aRRs) for formula feeding with 95% confidence intervals (CIs) were calculated. Results Of the 2,831 women in the parent trial, 2,329 (82%) women met inclusion criteria and among them, 696 (30%) were formula feeding. After multivariable regression, the following characteristics were associated with an increased risk of formula feeding: maternal age < 20 years (aRR: 1.47, 95% CI: 1.20–1.80) or ≥35 years (aRR: 1.19, 95% CI: 1.02–1.40), never married status (aRR: 1.39, 95% CI: 1.20–1.60), government-assisted insurance (aRR: 1.41, 95% CI: 1.16–1.70), chronic hypertension (aRR: 1.19, 95% CI: 1.01–1.40), smoking (aRR: 1.51, 95% CI: 1.31–1.74), cesarean delivery (aRR: 1.16, 95% CI: 1.03–1.32), and admission to neonatal intensive care unit (aRR: 1.31, 95% CI: 1.16–1.48). Hispanic ethnicity (aRR: 0.78, 95% CI: 0.64–0.94), education >12 years (aRR: 0.81, 95% CI 0.69–0.96), and nulliparity (aRR 0.71, 95% CI: 0.62–0.82) were associated with a reduced risk for formula feeding. Conclusion In this geographically diverse cohort of high-risk deliveries, 3 out 10 late preterm newborns were formula fed. Smoking cessation was a modifiable risk factor that may diminish the rate of formula feeding among late preterm births. Key Points

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