1219 Differences in Mortality/Morbidity with a Complete Course of Antenatal Steroids Compared to an Incomplete/No Course in Extremely Premature Neonates

AbstractObjectivesTo compare the long-term effects of antenatal betamethasone (ANS, ≤16 mg, =24 mg and >24 mg) in twins on infant and childhood growth.MethodsA retrospective cohort follow up study among 198 twins after ANS including three time points: U1 first neonatal examination after birth and in the neonatal period; U7 examination from the 21st to the 24th month of life and U9 examination from the 60th to the 64th month of life using data from copies of the children’s examination booklets. Inclusion criteria are twin pregnancies with preterm labor, cervical shortening, preterm premature rupture of membranes, or vaginal bleeding, and exposure to ANS between 23+5 and 33+6 weeks. Outcome measures are dosage-dependent and sex-specific effects of ANS on growth (body weight, body length, head circumference, body mass index and ponderal index) up to 5.3 years.ResultsOverall, 99 live-born twin pairs were included. Negative effects of ANS on fetal growth persisted beyond birth, altered infant and childhood growth, independent of possible confounding factors. Overall weight percentile significantly decreased between infancy and early childhood by 18.8%. Birth weight percentiles significantly changed in a dose dependent and sex specific manner, most obviously in female-female and mixed pairs. The ponderal index significantly decreased up to 42.9%, BMI index increased by up to 33.8%.ConclusionsANS results in long-term alterations in infant and childhood growth. Changes between infancy and early childhood in ponderal mass index and BMI, independent of dose or twin pair structure, might indicate an ANS associated increased risk for later life disease.SynopsisFirst-time report on long-term ANS administration growth effects in twin pregnancies, showing persisting alterations beyond birth in infant and childhood growth up to 5.3 years as potential indicator of later life disease risk.

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Salivary cytokine — A non-invasive predictor for bronchopulmonary dysplasia in premature neonates

Cytokine ◽

10.1016/j.cyto.2021.155616 ◽

2021 ◽

pp. 155616

Author(s):

Ting-Yu Su ◽

I-Lun Chen ◽

Tsu-Fuh Yeh ◽

Hung-Ren Yu ◽

Ying-Lun Hsu ◽

...

Keyword(s):

Bronchopulmonary Dysplasia ◽

Premature Neonates ◽

Non Invasive

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894 Antenatal steroids in diabetic mothers and neonatal hypoglycemia: a retrospective cohort study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2020.12.917 ◽

2021 ◽

Vol 224 (2) ◽

pp. S554-S555

Author(s):

Sarah Al-Nafisee ◽

Eve Overton ◽

Cynthia Gyamfi-Bannerman

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Neonatal Hypoglycemia ◽

Antenatal Steroids ◽

Diabetic Mothers

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Intraventricular haemorrhage in a Ugandan cohort of low birth weight neonates: the IVHU study

BMC Pediatrics ◽

10.1186/s12887-020-02464-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

R. MacLeod ◽

J. N. Paulson ◽

N. Okalany ◽

F. Okello ◽

L. Acom ◽

...

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Intraventricular Haemorrhage ◽

Sub Saharan Africa ◽

Cranial Ultrasound ◽

High Grade ◽

Odds Ratios ◽

Antenatal Steroids ◽

Eastern Uganda

Abstract Background Globally, 15 million neonates are born prematurely every year, over half in low income countries (LICs). Premature and low birth weight neonates have a higher risk of intraventricular haemorrhage (IVH). There are minimal data regarding IVH in sub-Saharan Africa. This study aimed to examine the incidence, severity and timing of and modifiable risk factors for IVH amongst low-birth-weight neonates in Uganda. Methods This is a prospective cohort study of neonates with birthweights of ≤2000 g admitted to a neonatal unit (NU) in a regional referral hospital in eastern Uganda. Maternal data were collected from interviews and medical records. Neonates had cranial ultrasound (cUS) scans on the day of recruitment and days 3, 7 and 28 after birth. Risk factors were tabulated and are presented alongside odds ratios (ORs) and adjusted odds ratios (aORs) for IVH incidence. Outcomes included incidence, timing and severity of IVH and 28-day survival. Results Overall, 120 neonates were recruited. IVH was reported in 34.2% of neonates; 19.2% had low grade (Papile grades 1–2) and 15% had high grade (Papile grades 3–4). Almost all IVH (90.2%) occurred by day 7, including 88.9% of high grade IVH. Of those with known outcomes, 70.4% (81/115) were alive on day 28 and survival was not associated with IVH. We found that vaginal delivery, gestational age (GA) < 32 weeks and resuscitation in the NU increased the odds of IVH. Of the 6 neonates who received 2 doses of antenatal steroids, none had IVH. Conclusion In this resource limited NU in eastern Uganda, more than a third of neonates born weighing ≤2000 g had an IVH and the majority of these occurred by day 7. We found that vaginal birth, earlier gestation and need for resuscitation after admission to the NU increased the risk of IVH. This study had a high rate of SGA neonates and the risk factors and relationship of these factors with IVH in this setting needs further investigation. The role of antenatal steroids in the prevention of IVH in LICs also needs urgent exploration.

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Quality Improvement and Antenatal Steroids

The Journal of Pediatrics ◽

10.1016/j.jpeds.2020.12.073 ◽

2020 ◽

Author(s):

Alan H. Jobe

Keyword(s):

Quality Improvement ◽

Antenatal Steroids

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PREDICTIVE VALUE OF LOW AT III LEVELS FOR THE OCCURRENCE OF IVH, IRDS AND DEATH IN PREMATURE NEONATES

10.1055/s-0038-1644268 ◽

1987 ◽

Author(s):

W van den Berg ◽

M Peters ◽

C Breederveld ◽

J W ten Cate ◽

J G Koppe

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Distress Syndrome ◽

Peripheral Vein ◽

Premature Neonates ◽

Significant Difference ◽

At Iii ◽

Diffuse Intravascular Coagulation ◽

Idiopathic Respiratory Distress Syndrome ◽

A Prospective Study

The observation of AT III deficiency in premature neonates with Idiopathic Respiratory Distress Syndrome (IRDS), suggests a positive predictive value for a poor outcome. The underlying diffuse intravascular coagulation could generate serious hemorrhagic complications like Peri/Intraventricular Hemorrhage (IVH).A prospective study was performed in consecutively born neonates to assess the predictive value of low AT III for theoccurrence of IVH, (gr. III/IV), IRDS, and death. Eighty-one neonates were included in the study during a period of 5 months. AT III levels were determined immediately after birth by a chromogenic substrate assay. Values in umbilical cord blood were identical with values in capillary or peripheral vein blood samples taken within 6 hours after birth. There was no correlation between AT III values and gestational age (r: 0.18). Twenty-four neonates with IRDS showed a mean AT III value of 0.23 U/ml (S. D. ± 0.07 U/ml) which was significantly lower than a mean AT III value of 0.35 U/ml (S. D. ± 0.1 U/ml) for neonates without IRDS (p ≺0.00005). When IVH gr. III/IV was diagnosed in neonates having IRDS (8/24) no significant difference in mean AT IIIact was observed with respect to jnean AT III levels of remaining neonates without this complication. No death occurred in neonates without IRDS. Mean AT IIIact (0.21 U/ml) in neonates with IRDS who died (9/24) was low compared with mean AT III levels of neonates with IRDS who survived (0.25 U/ml), but did not reach significance (p≻0.1). Assuming a critical value of AT III of 20% a positive predictive value of 89% for IRDS, 44% for IVH, and 56% for death was calculated. It is concluded that low AT Illact levels have a high predictive value for IRDS.

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