Patrick Morhart1, Janis Gärtner2, Christel Weiss3, Florian Matthias Stumpfe2, Ulf Dammer2, Florian Faschingbauer2, Fabian B Fahlbusch4, Matthias W Beckmann2, Sven Kehl2. 1. Department of Neonatology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; patrick.morhart@uk-erlangen.de. 2. Department of Gynecology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany. 3. Department of Medical Statistics, Biomathematics and Information Processing, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. 4. Department of Neonatology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abstract
BACKGROUND/AIM: We investigated the impact of the timing of antenatal corticosteroid (ACS) administration on the clinical outcome of preterm infants. PATIENTS AND METHODS: Two hundred and fifty-five preterm infants between 28+0 and 34+0 weeks of gestation were retrospectively assigned to one of two groups: In the first group, ACS was given within 7 days before birth; the second group, did not receive ACS during that period. The primary outcome parameter was respiratory failure (defined by need for continuous positive airway pressure or mechanical ventilation) due to grade 1-4 respiratory distress syndrome (RDS). Secondary outcomes included the rates of intraventricular hemorrhage (IVH), periventricular leukomalacia, and necrotizing enterocolitis. RESULTS: The rate of RDS was significantly higher in the no ACS group (40% vs. 62%, p=0.0009), especially of the more severe grades 24 (n=37 vs. n=48, p=0.0121). In addition, IVH (1% vs. 9%, p=0.0041) and neonatal infections (72% vs. 89%, p=0.0025) were significantly increased. Univariable and multivariable regression analyses showed a lower likelihood of RDS in the ACS group [odds ratio (OR)=0.295] in infants born closer to term (OR=0.907) and following preterm onset of labor (OR=0.495). Similarly, we observed a lower probability of IVH in the ACS group (OR=0.098), with a higher probability of occurrence of IVH in pre-eclampsia/HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) (OR=7.914). CONCLUSION: ACS treatment within the last 7 days before birth significantly reduced the risk of RDS and IVH in preterm. These data emphasize that the timing of ACS administration determines its success.
BACKGROUND/AIM: We investigated the impact of the timing of antenatal corticosteroid (ACS) administration on the clinical outcome of preterm infants. PATIENTS AND METHODS: Two hundred and fifty-five preterm infants between 28+0 and 34+0 weeks of gestation were retrospectively assigned to one of two groups: In the first group, ACS was given within 7 days before birth; the second group, did not receive ACS during that period. The primary outcome parameter was respiratory failure (defined by need for continuous positive airway pressure or mechanical ventilation) due to grade 1-4 respiratory distress syndrome (RDS). Secondary outcomes included the rates of intraventricular hemorrhage (IVH), periventricular leukomalacia, and necrotizing enterocolitis. RESULTS: The rate of RDS was significantly higher in the no ACS group (40% vs. 62%, p=0.0009), especially of the more severe grades 24 (n=37 vs. n=48, p=0.0121). In addition, IVH (1% vs. 9%, p=0.0041) and neonatal infections (72% vs. 89%, p=0.0025) were significantly increased. Univariable and multivariable regression analyses showed a lower likelihood of RDS in the ACS group [odds ratio (OR)=0.295] in infants born closer to term (OR=0.907) and following preterm onset of labor (OR=0.495). Similarly, we observed a lower probability of IVH in the ACS group (OR=0.098), with a higher probability of occurrence of IVH in pre-eclampsia/HELLP syndrome (hemolysis, elevated liver enzyme levels, low platelet count) (OR=7.914). CONCLUSION: ACS treatment within the last 7 days before birth significantly reduced the risk of RDS and IVH in preterm. These data emphasize that the timing of ACS administration determines its success.
Authors: Sanjay Chawla; Girija Natarajan; Dhuly Chowdhury; Abhik Das; Michele Walsh; Edward F Bell; Abbot R Laptook; Krisa Van Meurs; Carl T D'Angio; Barbara J Stoll; Sara B DeMauro; Seetha Shankaran Journal: Am J Perinatol Date: 2018-04-27 Impact factor: 1.862
Authors: Nansi S Boghossian; Scott A McDonald; Edward F Bell; Waldemar A Carlo; Jane E Brumbaugh; Barbara J Stoll; Abbot R Laptook; Seetha Shankaran; Michele C Walsh; Abhik Das; Rosemary D Higgins Journal: JAMA Pediatr Date: 2016-06-01 Impact factor: 16.193
Authors: Angela Kribs; Claudia Roll; Wolfgang Göpel; Christian Wieg; Peter Groneck; Reinhard Laux; Norbert Teig; Thomas Hoehn; Wolfgang Böhm; Lars Welzing; Matthias Vochem; Marc Hoppenz; Christoph Bührer; Katrin Mehler; Hartmut Stützer; Jeremy Franklin; Andreas Stöhr; Egbert Herting; Bernhard Roth Journal: JAMA Pediatr Date: 2015-08 Impact factor: 16.193
Authors: Ronald J Wapner; Yoram Sorokin; Elizabeth A Thom; Francee Johnson; Donald J Dudley; Catherine Y Spong; Alan M Peaceman; Kenneth J Leveno; Margaret Harper; Steve N Caritis; Menachem Miodovnik; Brian Mercer; John M Thorp; Atef Moawad; Mary Jo O'Sullivan; Susan Ramin; Marshall W Carpenter; Dwight J Rouse; Baha Sibai; Steven G Gabbe Journal: Am J Obstet Gynecol Date: 2006-07-17 Impact factor: 8.661