Administration of antenatal corticosteroids for singleton preterm birth in China, 2017 to 2018

Abstract Background The administration of antenatal corticosteroids (ACS) to women who are at risk of preterm birth has been proven to reduce not only the mortality, but also the major morbidities of the preterm infants. The rate of ACS and the risk factors associated with ACS use in Chinese population is unclear. This study aimed to investigate the rate of ACS use and the associated perinatal factors in the tertiary maternal centers of China. Methods Data for this retrospective observational study came from a clinical database of preterm infants established by REIN-EPIQ trial. All infants born at <34 weeks of gestation and admitted to 18 tertiary maternal centers in China from 2017 to 2018 were enrolled. Any dose of dexamethasone was given prior to preterm delivery was recorded and the associated perinatal factors were analyzed. Results The rate of ACS exposure in this population was 71.2% (range 20.2% – 92%) and the ACS use in these 18 maternal centers varied from 20.2–92.0% in this period. ACS exposure was higher among women with preeclampsia, caesarean section delivery, antibiotic treatment and who delivered infants with lower gestational age and small for gestational age. ACS use was highest in the 28-31 weeks gestational age group, and lowest in the under 26 weeks of gestational age group (x2=65.478, P < 0.001). ACS exposure was associated with lower odds of bronchopulmonary dysplasia or death (OR, 0.778; 95% CI 0.661 to 0.916) and invasive respiration requirement (OR, 0.668; 95% CI 0.585 to 0.762) in this population. Conclusion The ACS exposure was variable among maternity hospitals and quality improvement of ACS administration is warranted.

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Faculty Opinions recommendation of Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727458913.793572657 ◽

2020 ◽

Author(s):

Katie-Jane Wynne

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Prospective Cohort Study ◽

Gestational Age ◽

Prospective Cohort ◽

Antenatal Corticosteroids

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A birth population-based survey of preterm morbidity and mortality by gestational age

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojing Guo ◽

Xiaoqiong Li ◽

Tingting Qi ◽

Zhaojun Pan ◽

Xiaoqin Zhu ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Preterm Infants ◽

Birth Defects ◽

Gestational Age ◽

Death Rate ◽

Preterm Births ◽

Mortality Rates ◽

Morbidity And Mortality ◽

Hospital Death

Abstract Background Despite 15–17 millions of annual births in China, there is a paucity of information on prevalence and outcome of preterm birth. We characterized the outcome of preterm births and hospitalized preterm infants by gestational age (GA) in Huai’an in 2015, an emerging prefectural region of China. Methods Of 59,245 regional total births, clinical data on 2651 preterm births and 1941 hospitalized preterm neonates were extracted from Huai’an Women and Children’s Hospital (HWCH) and non-HWCH hospitals in 2018–2020. Preterm prevalence, morbidity and mortality rates were characterized and compared by hospital categories and GA spectra. Death risks of preterm births and hospitalized preterm infants in the whole region were analyzed with multivariable Poisson regression. Results The prevalence of extreme, very, moderate, late and total preterm of the regional total births were 0.14, 0.53, 0.72, 3.08 and 4.47%, with GA-specific neonatal mortality rates being 44.4, 15.8, 3.7, 1.5 and 4.3%, respectively. There were 1025 (52.8% of whole region) preterm admissions in HWCH, with significantly lower in-hospital death rate of inborn (33 of 802, 4.1%) than out-born (23 of 223, 10.3%) infants. Compared to non-HWCH, three-fold more neonates in HWCH were under critical care with higher death rate, including most extremely preterm infants. Significantly all-death risks were found for the total preterm births in birth weight < 1000 g, GA < 32 weeks, amniotic fluid contamination, Apgar-5 min < 7, and birth defects. For the hospitalized preterm infants, significantly in-hospital death risks were found in out-born of HWCH, GA < 32 weeks, birth weight < 1000 g, Apgar-5 min < 7, birth defects, respiratory distress syndrome, necrotizing enterocolitis and ventilation, whereas born in HWCH, antenatal glucocorticoids, cesarean delivery and surfactant use decreased the death risks. Conclusions The integrated data revealed the prevalence, GA-specific morbidity and mortality rate of total preterm births and their hospitalization, demonstrating the efficiency of leading referral center and whole regional perinatal-neonatal network in China. The concept and protocol should be validated in further studies for prevention of preterm birth.

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Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03510-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajia Jing ◽

Yiheng Dai ◽

Yanqi Li ◽

Ping Zhou ◽

Xiaodong Li ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Postnatal Growth ◽

Weight Increase ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Growth Outcomes

Abstract Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

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Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study

BMJ ◽

10.1136/bmj.j1039 ◽

2017 ◽

pp. j1039 ◽

Cited By ~ 41

Author(s):

Colm P Travers ◽

Reese H Clark ◽

Alan R Spitzer ◽

Abhik Das ◽

Thomas J Garite ◽

...

Keyword(s):

Cohort Study ◽

Preterm Infants ◽

Prospective Cohort Study ◽

Gestational Age ◽

Prospective Cohort ◽

Antenatal Corticosteroids

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Perinatal factors associated with initiation of breastfeeding following very preterm birth < 29 weeks

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.756 ◽

2022 ◽

Vol 226 (1) ◽

pp. S455

Author(s):

Meg Raymond ◽

Christy Pylypjuk ◽

Molly Seshia ◽

Ruben Alvaro ◽

Michael Helewa ◽

...

Keyword(s):

Preterm Birth ◽

Perinatal Factors ◽

Factors Associated ◽

Very Preterm ◽

Very Preterm Birth ◽

Initiation Of Breastfeeding

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Exposure to Any Antenatal Corticosteroids and Outcomes in Preterm Infants by Gestational Age

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000527027.63123.44 ◽

2017 ◽

Vol 37 (4) ◽

pp. 185 ◽

Cited By ~ 1

Author(s):

Colm P. Travers ◽

Reese H. Clark ◽

Alan R. Spitzer ◽

Abhik Das ◽

Thomas J. Garite ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Antenatal Corticosteroids

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Improving preterm newborn identification in low-resource settings with machine learning

10.1101/334904 ◽

2018 ◽

Cited By ~ 1

Author(s):

Katelyn J. Rittenhouse ◽

Bellington Vwalika ◽

Alex Keil ◽

Jennifer Winston ◽

Marie Stoner ◽

...

Keyword(s):

Machine Learning ◽

Birth Weight ◽

Preterm Birth ◽

Preterm Infants ◽

Preterm Newborn ◽

Maternal Factors ◽

Factors Associated ◽

Improve Accuracy ◽

Hiv Serostatus ◽

Twin Delivery

AbstractBackgroundGlobally, preterm birth is the leading cause of neonatal death with estimated prevalence and associated mortality highest in low‐ and middle‐income countries (LMICs). Accurate identification of preterm infants is important at the individual level for appropriate clinical intervention as well as at the population level for informed policy decisions and resource allocation. As early prenatal ultrasound is commonly not available in these settings, gestational age (GA) is often estimated using newborn assessment at birth. This approach assumes last menstrual period to be unreliable and birthweight to be unable to distinguish preterm infants from those that are small for gestational age (SGA). We sought to leverage machine learning algorithms incorporating maternal factors associated with SGA to improve accuracy of preterm newborn identification in LMIC settings.Methods and FindingsThis study uses data from an ongoing obstetrical cohort in Lusaka, Zambia that uses early pregnancy ultrasound to estimate GA. Our intent was to identify the best set of parameters commonly available at delivery to correctly categorize births as either preterm (<37 weeks) or term, compared to GA assigned by early ultrasound as the gold standard. Trained midwives conducted a newborn assessment (<72 hours) and collected maternal and neonatal data at the time of delivery or shortly thereafter. New Ballard Score (NBS), last menstrual period (LMP), and birth weight were used individually to assign GA at delivery and categorize each birth as either preterm or term. Additionally, machine learning techniques incorporated combinations of these measures with several maternal and newborn characteristics associated with prematurity and SGA to develop GA at delivery and preterm birth prediction models. The distribution and accuracy of all models were compared to early ultrasound dating. Within our live‐born cohort to date (n = 862), the median GA at delivery by early ultrasound was 39.4 weeks (IQR: 38.3 ‐ 40.3). Among assessed newborns with complete data included in this analysis (n = 458), the median GA by ultrasound was 39.6 weeks (IQR: 38.4 ‐ 40.3). Using machine learning, we identified a combination of six accessible parameters (LMP, birth weight, twin delivery, maternal height, hypertension in labor, and HIV serostatus) that can be used by machine learning to outperform current GA prediction methods. For preterm birth prediction, this combination of covariates correctly classified >94% of newborns and achieved an area under the curve (AUC) of 0.9796.ConclusionsWe identified a parsimonious list of variables that can be used by machine learning approaches to improve accuracy of preterm newborn identification. Our best performing model included LMP, birth weight, twin delivery, HIV serostatus, and maternal factors associated with SGA. These variables are all easily collected at delivery, reducing the skill and time required by the frontline health worker to assess GA.

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