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

Background and Objectives: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. We studied the relationship between different perinatal characteristics, i.e., sex; gestational age (GA); birth weight (BW); C-reactive protein (CRP) and lactate dehydrogenase (LDH) concentrations; ventilation, continuous positive airway pressure (CPAP), and surfactant administration; and the incidence of Stage 1–3 ROP. Materials and Methods: This study included 247 preterm infants with gestational age (GA) < 32 weeks that were successfully screened for ROP. Univariate and multivariate binary analyses were performed to find the most significant risk factors for ROP (Stage 1–3), while multivariate multinomial analysis was used to find the most significant risk factors for specific ROP stages, i.e., Stage 1, 2, and 3. Results: The incidence of ROP (Stage 1–3) was 66.40% (164 infants), while that of Stage 1, 2, and 3 ROP was 15.38% (38 infants), 27.53% (68 infants), and 23.48% (58 infants), respectively. Following univariate analysis, multiple perinatal characteristics, i.e., GA; BW; and ventilation, CPAP, and surfactant administration, were found to be statistically significant risk factors for ROP (p < 0.001). However, in a multivariate model using the same characteristics, only BW and ventilation were significant ROP predictors (p < 0.001 and p < 0.05, respectively). Multivariate multinomial analysis revealed that BW was only significantly correlated with Stage 2 and 3 ROP (p < 0.05 and p < 0.001, respectively), while ventilation was only significantly correlated with Stage 2 ROP (p < 0.05). Conclusions: The results indicate that GA; BW; and the use of ventilation, CPAP, and surfactant were all significant risk factors for ROP (Stage 1–3), but only BW and ventilation were significantly correlated with ROP and specific stages of the disease, namely Stage 2 and 3 ROP and Stage 2 ROP, respectively, in multivariate models.

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Differentiating Transient Idiopathic Hyperglycaemia and Neonatal Diabetes Mellitus in Preterm Infants

Hormone Research in Paediatrics ◽

10.1159/000381621 ◽

2015 ◽

Vol 84 (1) ◽

pp. 68-72 ◽

Cited By ~ 5

Author(s):

Kanetee Busiah ◽

Julie Auger ◽

Anne-Laure Fauret-Amsellem ◽

Sonia Dahan ◽

Nathalie Pouvreau ◽

...

Keyword(s):

Diabetes Mellitus ◽

Preterm Infants ◽

Neonatal Diabetes ◽

Neonatal Diabetes Mellitus

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Late Breaking Abstract - Less invasive surfactant administration (LISA) to preterm infants on high flow nasal cannula (nHFT)

10.1183/13993003.congress-2021.oa3963 ◽

2021 ◽

Author(s):

Asad Nasim ◽

Sanja Zivanovic ◽

Muhammad Abubakar ◽

Alexandra Scrivens ◽

Charles Roehr

Keyword(s):

Preterm Infants ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Less Invasive ◽

Surfactant Administration

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Neonatal Outcomes in Late Preterm Infants of Diabetic Mothers Exposed to Antenatal Steroids: A Cohort Study

10.1055/s-0041-1735776 ◽

2021 ◽

Author(s):

Jean W. Thermolice ◽

Lillian Singer ◽

Michael J. Sheridan

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Neonatal Outcomes ◽

Late Preterm ◽

Late Preterm Infants ◽

Infants Of Diabetic Mothers ◽

Antenatal Steroids ◽

Diabetic Mothers

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A Web-Based Calculator for the Prediction of Severe Neurodevelopmental Impairment in Preterm Infants Using Clinical and Imaging Characteristics

Children ◽

10.3390/children5110151 ◽

2018 ◽

Vol 5 (11) ◽

pp. 151

Author(s):

Zachary Vesoulis ◽

Nathalie El Ters ◽

Maja Herco ◽

Halana Whitehead ◽

Amit Mathur

Keyword(s):

Preterm Infants ◽

Predictive Value ◽

White Matter Injury ◽

Delivery Mode ◽

Clinical Factors ◽

Binary Logistic Regression Model ◽

Neurodevelopmental Outcomes ◽

Web Based ◽

Antenatal Steroids ◽

Imaging Characteristics

Although the most common forms of brain injury in preterm infants have been associated with adverse neurodevelopmental outcomes, existing MRI scoring systems lack specificity, do not incorporate clinical factors, and are technically challenging to perform. The objective of this study was to develop a web-based, clinically-focused prediction system which differentiates severe neurodevelopmental outcomes from normal-moderate outcomes at two years. Infants were retrospectively identified as those who were born ≤30 weeks gestation and who had MRI imaging at term-equivalent age and neurodevelopmental testing at 18–24 months. Each MRI was scored on injury in three domains (intraventricular hemorrhage, white matter injury, and cerebellar hemorrhage) and clinical factors that were strongly predictive of an outcome were investigated. A binary logistic regression model was then generated from the composite of clinical and imaging components. A total of 154 infants were included (mean gestational age = 26.1 ± 1.8 weeks, birth weight = 889.1 ± 226.2 g). The final model (imaging score + ventilator days + delivery mode + antenatal steroids + retinopathy of prematurity requiring surgery) had strong discriminatory power for severe disability (AUC = 0.850), with a PPV (positive predictive value) of 76% and an NPV (negative predictive value) of 90%. Available as a web-based tool, it can be useful for prognostication and targeting early intervention services to infants who may benefit the most from such services.

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Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants?

Early Human Development ◽

10.1016/j.earlhumdev.2014.04.006 ◽

2014 ◽

Vol 90 (9) ◽

pp. 527-530 ◽

Cited By ~ 19

Author(s):

G.P.G. Fung ◽

L.M. Chan ◽

Y.C. Ho ◽

W.K. To ◽

H.B. Chan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Preterm Infants ◽

Late Preterm ◽

Late Preterm Infants ◽

Respiratory Outcome

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Antenatal steroids and thyroid hormone function in preterm infants

Journal of Perinatology ◽

10.1038/s41372-018-0225-5 ◽

2018 ◽

Vol 38 (11) ◽

pp. 1466-1470 ◽

Cited By ~ 3

Author(s):

Dinushan C. Kaluarachchi ◽

Qianqian Zhao ◽

Tarah T. Colaizy

Keyword(s):

Thyroid Hormone ◽

Preterm Infants ◽

Antenatal Steroids

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Is Less Invasive Surfactant Administration Necessary or “Only” Helpful or Just a Fashion?

American Journal of Perinatology ◽

10.1055/s-0038-1637759 ◽

2018 ◽

Vol 35 (06) ◽

pp. 530-533 ◽

Cited By ~ 4

Author(s):

Ilia Bresesti ◽

Laura Fabbri ◽

Gianluca Lista

Keyword(s):

Large Scale ◽

Exogenous Surfactant ◽

Preterm Neonates ◽

Positive Pressure ◽

Less Invasive ◽

Antenatal Steroids ◽

Surfactant Replacement Therapy ◽

Short And Long Term ◽

Surfactant Administration ◽

A New Technique

AbstractIn the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation–SURfactant administration–Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates. The rationale behind this technique is to avoid positive pressure ventilation and the endotracheal tube, being surfactant delivered through a thin catheter while the neonate is maintained on continuous positive airway pressure. Given the paucity of large-scale randomized trials on LISA method to prove its effects on short- and long-term outcomes, some questions still remain unanswered. Then, uncertainty regarding the feasibility of this maneuver needs to be better clarified before gaining wide acceptance in routine clinical practice. In our report, we aim at hypothesizing the main mechanisms behind the efficacy of LISA, considering it as a single maneuver in a comprehensive approach for RDS management in the delivery room.

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INSURE (INtubate, SURfactant and Extubate) method in preterm infants with respiratory distress syndrome: a retrospective study

10.21203/rs.3.rs-30812/v1 ◽

2020 ◽

Author(s):

Mohamed Mubarak Shaik Kidur Mohideen ◽

Deepika Wagh ◽

Sam Athikarisamy

Keyword(s):

Mechanical Ventilation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Preterm Infants ◽

Distress Syndrome ◽

Retrospective Chart Review ◽

Tertiary Hospital ◽

P Value ◽

Severe Respiratory Distress ◽

Surfactant Administration

Abstract Background: Preterm infants with severe respiratory distress syndrome (RDS) are usually managed with endotracheal intubation and surfactant administration followed by mechanical ventilation however this has immediate and long-term complications. Hence, INSURE (Intubate, surfactant administration and extubate) method combined with continuous positive airway pressure (CPAP) support has been accepted as an alternative method in eligible infants. Aim of this study is to look at our experience of administering INSURE and to look at the factors predisposing to the failure of INSURE. Methods: A retrospective chart review was done of all the babies who were born in a tertiary hospital between 1 st January 2014 to 31 st December 2015 (2 years) and received surfactant through INSURE method. Infants requiring reintubation and mechanical ventilation within 3 days post INSURE are considered as INSURE failure for our study purpose. Results: Eighty-five infants were included in the review with gestational age (GA) ranging from 26 +3 to 35 +5 weeks and birth weight ranging from 680 to 3340 grams. Of these, 22 infants (26%) had INSURE failure. INSURE failure rate was higher in infants born <30 weeks gestation (40%). Higher FiO2 requirement prior to INSURE (mean FIO 2 0.5 vs 0.3, P value <0.001) and preeclampsia in mothers of infants < 30 weeks of GA (P value 0.027) were strongly associated with INSURE failure. No mortality was noted in either group. Conclusion: We found that INSURE method may be useful in preventing the need for mechanical ventilation in late preterm infants with RDS. However, this method may be less successful in preterm infants with lower GA (<30 weeks) and higher FiO2 requirement (≥0.5). More prospective studies are needed to assess the effectiveness of INSURE method.

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