Antenatal steroids and neurodevelopment in 12‐year‐old children born extremely preterm

Abstract Background Perinatal decision-making affects outcomes for extremely preterm babies (22–26 weeks’ gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We examined mortality and morbidity outcomes at age two for babies born at 27–28 weeks’ GA in relation to the intensity of perinatal care provided to extremely preterm babies. Methods Fetuses from the 2011 French national prospective EPIPAGE-2 cohort, alive at maternal admission to a level 3 hospital and delivered at 27–28 weeks’ GA, were included. Morbidity-free survival (survival without sensorimotor (blindness, deafness or cerebral palsy) disability) and overall survival at age two were examined. Sensorimotor disability and Ages and Stages Questionnaire (ASQ) result below threshold among survivors were secondary outcomes. Perinatal care intensity level was based on birth hospital, grouped using the ratio of 24–25 weeks’ GA babies admitted to neonatal intensive care to fetuses of the same gestation alive at maternal admission. Sensitivity analyses used ratios based upon antenatal steroids, Caesarean section, and newborn resuscitation. Multiple imputation was used for missing data; hierarchical logistic regression accounted for births nested within centres. Results 633 of 747 fetuses (84.7%) born at 27–28 weeks’ GA survived to age two. There were no differences in survival or morbidity-free survival: respectively, fully adjusted odds ratios were 0.96 (95% CI: 0.54 to 1.71) and 1.09 (95% CI: 0.59 to 2.01) in medium and 1.12 (95% CI: 0.63 to 2.00) and 1.16 (95% CI: 0.62 to 2.16) in high compared to low-intensity hospitals. Among survivors, there were no differences in sensorimotor disability or ASQ below threshold. Sensitivity analyses were consistent with the main results. Conclusions No difference was seen in survival or morbidity-free survival at two years of age among fetuses alive at maternal hospital admission born at 27–28 weeks’ GA, or in sensorimotor disability or presence of an ASQ below threshold among survivors. There is no evidence for an impact of intensity of perinatal care for extremely preterm babies on births at a higher gestational age.

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OUTCOMES IN EXTREMELY PREMATURE INFANTS WITH TWIN-TWIN TRANSFUSION SYNDROME TREATED BY LASER THERAPY

Paediatrics & Child Health ◽

10.1093/pch/pxy054.052 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e20-e21

Author(s):

Julie Sommer ◽

Gabriel Altit ◽

Anne-Monique Nuyt ◽

François Audibert ◽

Véronique Dorval ◽

...

Keyword(s):

Laser Therapy ◽

Growth Parameters ◽

Demographic Data ◽

Short Term ◽

Neurodevelopmental Outcomes ◽

Antenatal Steroids ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Similar Survival

Abstract BACKGROUND Twin pregnancies and fetal therapies are associated with increased risk of preterm delivery. Limited literature exists on outcomes for extremely preterm infants born in the context of a pregnancy complicated with twin-twin transfusion syndrome (TTTS). OBJECTIVES To compare mortality of preterm newborns who received laser therapy for TTTS to preterm controls born in the context of a dichorionic-diamniotic (di-di) pregnancy. Secondary outcomes are: short-term neonatal morbidities and neurodevelopmental measures at 18 months of corrected gestational age (cGA). DESIGN/METHODS Case-control retrospective study of all twins infant born <29 weeks of gestation between 2006 and 2015 at Sainte-Justine Hospital. Preterm with TTTS and fetal laser therapy were compared to preterm di-di twins. Survival analysis was done using Cox proportional regression model. RESULTS Thirty-three preterms with TTTS (TTTS-laser group) were compared to 101 preterms without TTTS (non-TTTS group). Demographic data and comparisons for short-term morbidities are presented in Table 1. TTTS status was not associated with increased mortality when adjusting for birth weight and antenatal steroids (Table 2). No differences were found for Bayley-3rd edition score, cerebral palsy, vision impairment, hearing impairment and growth parameters at 18-month cGA. CONCLUSION Extremely premature newborns exposed to fetal laser therapy due to TTTS had similar survival and neurodevelopmental outcomes compared to contemporaneous extremely preterm di-di twins.

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Increased incidence of necrotizing enterocolitis associated with routine administration of Infloran™ in extremely preterm infants

Beneficial Microbes ◽

10.3920/bm2017.0098 ◽

2018 ◽

Vol 9 (5) ◽

pp. 683-690 ◽

Cited By ~ 10

Author(s):

E. Escribano ◽

C. Zozaya ◽

R. Madero ◽

L. Sánchez ◽

J. van Goudoever ◽

...

Keyword(s):

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Gestational Age ◽

Late Onset ◽

Blood Cultures ◽

Antenatal Steroids ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Routine Administration ◽

Probiotic Product

We aimed to evaluate the isolation of strains contained in the Infloran™ probiotic preparation in blood cultures and its efficacy in reducing necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) in extremely preterm infants. Routine use of probiotics was implemented in 2008. Infants born at <28 weeks gestational age were prospectively followed and compared with historical controls (HC) born between 2005 and 2008. Data on sepsis due to any of the two probiotic strains contained in Infloran and rates of LOS and NEC were analysed. A total of 516 infants were included. During the probiotic period (PC), none of the strains included in the administered probiotic product were isolated from blood cultures. Probiotic administration was associated with an increase in NEC stage II or higher (HC 10/170 [5.9%]; PC 46/346 [13.3%]; P=0.010). Surgical NEC was 12.1% in PC (42/346) versus 5.9% (10/170) in HC (P=0.029). Adjusting for confounders (sex, gestational age, antenatal steroids and human milk) did not change those trends (P=0.019). Overall, clinical LOS and the incidence of staphylococcal sepsis were lower in PC (172/342, 50.3, and 37%, respectively) compared with HC (102/169, 60.3 and 50.9%, respectively) (P=0.038 and P=0.003, respectively). No episodes of sepsis attributable to the probiotic product were recorded. The period of probiotic administration was associated with an increased incidence of NEC after adjusting for neonatal factors, but also with a reduction in the LOS rate.

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Extremely preterm fetal sheep lung responses to antenatal steroids and inflammation

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.12.207 ◽

2018 ◽

Vol 218 (3) ◽

pp. 349.e1-349.e10 ◽

Cited By ~ 5

Author(s):

Kevin Visconti ◽

Paranthaman Senthamaraikannan ◽

Matthew W. Kemp ◽

Masatoshi Saito ◽

Boris W. Kramer ◽

...

Keyword(s):

Fetal Sheep ◽

Antenatal Steroids ◽

Extremely Preterm

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Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience

Journal of Neonatology ◽

10.1177/09732179211059725 ◽

2021 ◽

pp. 097321792110597

Author(s):

Jennifer Peterson ◽

Mia Kahvo ◽

Ramiyya Tharumakunarajah ◽

Nabiah Malik ◽

Ranganath Ranganna

Keyword(s):

Premature Infants ◽

Gestational Age ◽

Perinatal Care ◽

Management Strategies ◽

Age Groups ◽

P Value ◽

Chest Compressions ◽

Infant Outcomes ◽

Antenatal Steroids ◽

Extremely Preterm

Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants. Infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.

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Lung function at term in extremely preterm-born infants: a regional prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2017-016868 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016868 ◽

Cited By ~ 15

Author(s):

Mariann Haavik Bentsen ◽

Trond Markestad ◽

Knut Øymar ◽

Thomas Halvorsen

Keyword(s):

Lung Function ◽

Minute Ventilation ◽

Hospital Readmissions ◽

Respiratory Morbidity ◽

First Year ◽

Tidal Breathing ◽

Equivalent Age ◽

Antenatal Steroids ◽

Extremely Preterm ◽

First Year Of Life

ObjectivesTo compare lung function of extremely preterm (EP)-born infants with and without bronchopulmonary dysplasia (BPD) with that of healthy term-born infants, and to determine which perinatal characteristics were associated with lung function at term and how predictive these measurements were for later respiratory health in EP-born infants.MethodsPerinatal variables were recorded prospectively, and tidal breathing parameters were measured at term-equivalent age using electromagnetic inductance plethysmography. Respiratory morbidity was defined by hospital readmissions and/or treatment with asthma medications during the first year of life.ResultsFifty-two EP-born infants (mean gestational age 261, range 226–276weeks) and 45 term-born infants were included. There was evidence of significant airway obstruction, higher tidal volumes and increased minute ventilation in the EP-born infants with and without BPD, although generally more pronounced for those with BPD. Male gender, antenatal steroids and number of days on continuous positive airway pressure were associated with lung function outcomes at term. A prediction model incorporating two unrelated tidal breathing parameters, BPD, birth weight z-score and gender, predicted respiratory morbidity in the first year of life with good accuracy (area under the curve 0.818, sensitivity and specificity 81.8% and 75.0%, respectively).ConclusionLung function measured at term-equivalent age was strikingly abnormal in EP-born infants, irrespective of BPD. Tidal breathing parameters may be of value in predicting future pulmonary health in infants born premature.Trial registration numberNCT01150396; Results.

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Improving Feeding Outcomes in the NICU: Moving From Volume-Driven to Infant-Driven Feeding

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd19.3.68 ◽

2010 ◽

Vol 19 (3) ◽

pp. 68-74 ◽

Cited By ~ 9

Author(s):

Catherine S. Shaker

Keyword(s):

Intensive Care Unit ◽

Dynamic Systems ◽

Neonatal Intensive Care ◽

Well Being ◽

Dynamic Systems Theory ◽

Feeding Problems ◽

Care Giving ◽

Extremely Preterm ◽

Extremely Preterm Infants

Current research on feeding outcomes after discharge from the neonatal intensive care unit (NICU) suggests a need to critically look at the early underpinnings of persistent feeding problems in extremely preterm infants. Concepts of dynamic systems theory and sensitive care-giving are used to describe the specialized needs of this fragile population related to the emergence of safe and successful feeding and swallowing. Focusing on the infant as a co-regulatory partner and embracing a framework of an infant-driven, versus volume-driven, feeding approach are highlighted as best supporting the preterm infant's developmental strivings and long-term well-being.

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