Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension

ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p<0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.

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Outcome of premature babies with RDS using bubble CPAP

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171702 ◽

2017 ◽

Vol 4 (3) ◽

pp. 939

Author(s):

Vivek Arora ◽

Sandip G Gediya ◽

Rupali Jain

Keyword(s):

Mechanical Ventilation ◽

Preterm Infants ◽

Work Of Breathing ◽

Mortality And Morbidity ◽

X Ray ◽

Antenatal Steroids ◽

Chest X Ray ◽

Bubble Cpap ◽

Ventilation Rates ◽

Spontaneously Breathing

Background: Respiratory distress syndrome (RDS) contributes significantly to mortality and morbidity. Continuous positive airway pressure (CPAP), when applied to premature infants with RDS, re-expands collapsed alveoli, splints the airway, reduces work of breathing and improves the respiration. Objectives: To ascertain the immediate outcome of preterm infants with RDS on Bubble CPAP and identify risk factors associated with its failure.Methods: This was a prospective analytical study and inborn preterm infants (gestation 28 to 34 weeks) admitted to the NICU with RDS were included in the study. All the spontaneously breathing infants were stared on bubble CPAP and different variables were recorded. Those in whom CPAP failed were given surfactant and mechanical ventilation.Results: 170 neonates were enrolled in the study. 52 (30.5%) babies failed CPAP. The predictors of failure were; partial or no response to Antenatal Steroids (ANS), white-out on the chest X-ray, Silverman Anderson scoring >6 or FiO2 > 0.4 after 15-20 minutes of CPAP, extreme prematurity. Other maternal and neonatal variables did not influence the need for ventilation. Rates of mortality and duration of oxygen requirement was significantly higher in babies who failed CPAP. No baby had chronic lung disease.Conclusions: Infants with no or partial exposure to antenatal steroids, white-out chest X-ray and those with higher FiO2 requirement after initial stabilization on CPAP are at high risk of CPAP failure (needing mechanical ventilation). Bubble CPAP is safe for preterm infants with RDS; it decreases need of surfactant and mechanical ventilation.

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Association of antenatal steroids with surfactant administration in moderate preterm infants born to women with diabetes mellitus and/or hypertension

Journal of Perinatology ◽

10.1038/s41372-021-01273-6 ◽

2021 ◽

Author(s):

Heather M. Weydig ◽

Charles R. Rosenfeld ◽

Myra H. Wyckoff ◽

Mambarambath A. Jaleel ◽

Patti J. Burchfield ◽

...

Keyword(s):

Diabetes Mellitus ◽

Preterm Infants ◽

Antenatal Steroids ◽

Surfactant Administration

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Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity

The Journal of Pediatrics ◽

10.1016/j.jpeds.2016.04.016 ◽

2016 ◽

Vol 175 ◽

pp. 61-67.e4 ◽

Cited By ~ 42

Author(s):

Emilija Wilson ◽

Rolf F. Maier ◽

Mikael Norman ◽

Bjoern Misselwitz ◽

Elizabeth A. Howell ◽

...

Keyword(s):

Neonatal Mortality ◽

Preterm Infants ◽

Very Preterm Infants ◽

Mortality And Morbidity ◽

Very Preterm

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Rooming-in organization to prevent neonatal mortality and morbidity in late preterm infants

Italian Journal of Pediatrics ◽

10.1186/1824-7288-40-s2-a4 ◽

2014 ◽

Vol 40 (S2) ◽

Author(s):

Mariano Manzionna ◽

Antonio Di Mauro

Keyword(s):

Neonatal Mortality ◽

Preterm Infants ◽

Late Preterm ◽

Mortality And Morbidity ◽

Late Preterm Infants

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Impact of Maternal Diabetes Mellitus on Mortality and Morbidity of Preterm Infants (24–33 Weeksʼ Gestation)

Obstetrical & Gynecological Survey ◽

10.1097/ogx.0b013e318247c588 ◽

2012 ◽

Vol 67 (2) ◽

pp. 82-84

Author(s):

Yoram Bental ◽

Brian Reichman ◽

Yakov Shiff ◽

Meir Weisbrod ◽

Valentina Boyko ◽

...

Keyword(s):

Diabetes Mellitus ◽

Preterm Infants ◽

Maternal Diabetes ◽

Mortality And Morbidity ◽

Maternal Diabetes Mellitus

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OUTCOME OF PRETERM INFANTS AFTER DELIVERY ROOM CARDIOPULMONARY RESUSCITATION. A RETROSPECTIVE OBSERVATIONAL STUDY

Paediatrics & Child Health ◽

10.1093/pch/pxy054.048 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e19-e19

Author(s):

Bishal Gautam ◽

Sarah McKnight ◽

Michael Miller ◽

Bryan Richardson ◽

Abrar Ahmed ◽

...

Keyword(s):

Neonatal Mortality ◽

Preterm Infants ◽

Chest Compression ◽

Ductus Arteriosus ◽

Tertiary Care ◽

Neonatal Resuscitation ◽

Delivery Room ◽

Bivariate Analysis ◽

Care Hospital ◽

Mortality And Morbidity

Abstract BACKGROUND Chest compression in the delivery room (CPR-DR) during neonatal resuscitation is considered as an extreme measure. When respiratory support alone is unable to establish circulatory transition, chest compression with or without epinephrine is necessary. The results of earlier studies have shown varied results in mortality and morbidity of preterm infants who received CPR-DR. OBJECTIVES To examine the relationship between need of CPR-DR in infants born between 23 and 32 weeks gestation and neonatal mortality and morbidity. DESIGN/METHODS This was a population-based cohort study of 23 0/7 to 32 6/7 weeks gestational age infants born at a Canadian tertiary care hospital between January 1, 2007 and December 31, 2016. Data were retrieved from the Neonatal-Perinatal database. Neonatal mortality and morbidities were examined between infants who did and did not need CPR-DR. RESULTS Of 1443 newborns meeting study criteria, 55 (3.8%) received CPR-DR. On bivariate analysis, outcome of infants requiring CPR-DR was associated with higher mortality (40% vs. 5.8%, p <0.001), intraventricular hemorrhage grade 3 or 4 (21.8% vs. 6.1%, p <0.001), patent ductus arteriosus (54.5% vs. 27.7%, p<0.001), bronchopulmonary dysplasia (35.4% vs. 19.6%, p=0.007), need of mechanical ventilation (90.9% vs. 61.1%, p<0.001) and sepsis (23.6% vs. 13.5%, p=0.034). However, in a multivariable logistic regression analysis controlling for predictor variables, CPR-DR was only associated with increased neonatal mortality (aOR=4.41 p<0.001, 95%CI [2.18, 8.92]). CONCLUSION While CPR-DR is associated with a high mortality rate in infants less than 32 weeks gestation, associated morbidities are largely predicted by other risk factors.

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