Effect of Antenatal Dexamethasone on Respiratory Distress in Late Preterm Infants: Results from the First Vietnamese Matched Cohort Study

Abstract BackgroundRespiratory distress (RD) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This study aimed to evaluate the effect of antenatal dexamethasone on the RD rate in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation.MethodsThis was a prospective cohort study of 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group (no dexamethasone) included 78 pregnant women with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 hours for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software.ResultsThe rate of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), with relative risk [RR] 0.44; 95% confidence interval [CI] 0.21 – 0.96 and p = 0.03. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; RR, 2.00; 95% CI, 1.00 – 3.99; p = 0.04). There were no significant between-group differences in the incidence of respiratory support, NICU admission or length of hospital stay.ConclusionsAdministration of antenatal dexamethasone to women at risk for late preterm birth could significantly reduce the rate of respiratory distress in late preterm infants.

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Antenatal dexamethasone use and respiratory distress in late preterm infants: results from first Vietnamese matched cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04019-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tran Tuan Hung Ho ◽

Quang Vinh Truong ◽

Thi Kim Anh Nguyen ◽

Minh Tam Le ◽

Vu Quoc Huy Nguyen

Keyword(s):

Cohort Study ◽

Treatment Group ◽

Respiratory Distress ◽

Preterm Infants ◽

Matched Control ◽

Late Preterm ◽

Control Group ◽

Matched Control Group ◽

Late Preterm Infants ◽

Nicu Admission

Abstract Background Respiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This matched cohort study aimed to assess how the antenatal dexamethasone use affect the respiratory distress (RD) proportion in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation. Methods This was a prospective cohort study on 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone, who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group without dexamethasone use included 78 pregnant women diagnosed with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 h for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software, version 26.0. Results The proportion of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), adjusted Odds Ratio [aOR] 0.29; 95% confidence interval [CI] 0.10 – 0.83 and p = 0.021. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; aOR, 2.59; 95% CI, 1.06 – 6.33; p = 0.037). There were no significant between-groups differences in the incidence of respiratory support, NICU admission or length of hospital stay. Conclusions Administration of antenatal dexamethasone to women at risk for late preterm birth could help to lower the proportion of respiratory distress in late preterm infants.

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Respiratory distress syndrome in moderately late and late preterm infants and risk of cerebral palsy: a population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2016-011643 ◽

2016 ◽

Vol 6 (10) ◽

pp. e011643 ◽

Cited By ~ 10

Author(s):

Sandra Kruchov Thygesen ◽

Morten Olsen ◽

John R Østergaard ◽

Henrik Toft Sørensen

Keyword(s):

Cerebral Palsy ◽

Cohort Study ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Preterm Infants ◽

Distress Syndrome ◽

Population Based ◽

Late Preterm ◽

Late Preterm Infants

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Lung ultrasound features predict admission to the neonatal intensive care unit in infants with transient neonatal tachypnoea or respiratory distress syndrome born by caesarean section

European Journal of Pediatrics ◽

10.1007/s00431-020-03789-z ◽

2020 ◽

Author(s):

Antonio Poerio ◽

Silvia Galletti ◽

Michelangelo Baldazzi ◽

Silvia Martini ◽

Alessandra Rollo ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Neonatal Intensive Care Unit ◽

Respiratory Distress ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Lung Ultrasound ◽

Late Preterm ◽

Late Preterm Infants ◽

Nicu Admission

Abstract We aimed to evaluate the reliability of lung ultrasound (LU) to predict admission to the neonatal intensive care unit (NICU) for transient neonatal tachypnoea or respiratory distress syndrome in infants born by caesarean section (CS). A prospective, observational, single-centre study was performed in the delivery room and NICU of Sant’Orsola-Malpighi Hospital in Bologna, Italy. Term and late-preterm infants born by CS were included. LU was performed at 30’ and 4 h after birth. LU appearance was graded according to a previously validated three-point scoring system (3P-LUS: type-1, white lung; type-2, black/white lung; type-3, normal lung). Full LUS was also calculated. One hundred infants were enrolled, and seven were admitted to the NICU. The 5 infants with bilateral type-1 lung at birth were all admitted to the NICU. Infants with type-2 and/or type-3 lung were unlikely to be admitted to the NICU. Mean full-LUS was 17 in infants admitted to the NICU, and 8 in infants not admitted. In two separate binary logistic regression models, both the 3P- and the full LUS proved to be independently associated with NICU admission (OR [95% CI] 0.001 [0.000–0.058], P = .001, and 2.890 [1.472–5.672], P = .002, respectively). The ROC analysis for the 3P-LUS yielded an AUC of 0.942 (95%CI, 0.876–0.979; P<.001), while ROC analysis for the full LUS yielded an AUC of 0.978 (95%CI, 0.926–0.997; P<.001). The AUCs for the two LU scores were not significantly different (p = .261). Conclusion: the 3P-LUS performed 30 min after birth proved to be a reliable tool to identify, among term and late preterm infants born to CS, those who will require NICU admission for transient neonatal tachypnoea or respiratory distress syndrome. What is known• Lung ultrasound (LU) has become an attractive diagnostic tool in neonatal settings, and guidelines on point-of-care LU in the neonatal intensive care unit (NICU) have been recently issued.• LU is currently used for diagnosing several neonatal respiratory morbidities and has been also proposed for predicting further intervention, such as NICU admission, need for surfactant treatment or mechanical ventilation in preterm infants. What is new• LU performed 30′ after birth and evaluated through a simple three-point scoring system represents a reliable tool to identify, among term and late preterm infants born to caesarean section, those with transient neonatal tachypnoea or respiratory distress syndrome who will require NICU admission.• LU performed in the neonatal period confirms its potential role in ameliorating routine neonatal clinical management.

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