Late preterm antenatal steroids

The Antenatal Late Preterm Steroids (ALPS) trial was designed to address respiratory morbidity common in infants born late preterm. The study was published in April, 2016 and, shortly thereafter, changed clinical practice in obstetrics in the United States. The following chapter describes the ALPS trial study design in detail, including the background leading to the trial, the study outcomes, and the initial findings of the long-term follow-up study. The ALPS story would not be complete without Elizabeth Thom, PhD, who died before her time...

IMPORTANCE: The Antenatal Late Preterm Steroids (ALPS) trial changed clinical practice in the United States by finding that antenatal betamethasone at 34 to 36 weeks decreased short-term neonatal respiratory morbidity. However, the trial also found increased risk of neonatal hypoglycemia after betamethasone. This follow-up study focused on long-term neurodevelopmental outcomes after late preterm steroids. OBJECTIVE: To evaluate whether administration of late preterm (34-36 completed weeks) corticosteroids affected childhood neurodevelopmental outcomes...

BACKGROUND: The recent paradigm shift of treating individuals at risk of late preterm birth with antenatal corticosteroids warrants an assessment of the effect of single dosage. OBJECTIVE: To compare outcomes of neonates born in the late preterm period (34.0-36.6 weeks) following a single dose of antenatal corticosteroids versus placebo. STUDY DESIGN: We performed a secondary analysis of the Antenatal Late Preterm Steroids (ALPS) trial (Gyamfi-Bannerman C...

BACKGROUND: Respiratory Distress Syndrome (RDS) is strongly associated with prematurity, including late preterm births. RDS has been shown to be associated with certain neonatal morbidities and mortality, but these associations are not well described among late preterm births. OBJECTIVE: We sought to determine the association between RDS and adverse neonatal outcomes among late preterm (34-36 weeks) born singleton neonates. STUDY DESIGN: This is a retrospective cohort study using California's linked vital statistics-patient discharge data (2008-2019)...

OBJECTIVE: To characterize late preterm antenatal steroids (AS) use and associated neonatal outcomes in a single academic center. STUDY DESIGN: Retrospective study of 503 singleton, mother-infant dyads delivered between 34 0/7 and 36 6/7 weeks gestation between January 1, 2016 and December 31, 2020. RESULTS: Forty-three percent did not receive AS (No AS) prior to delivery. Among AS treated, 50% were sub-optimal dosing. No AS had higher preterm premature rupture of membranes and maternal diabetes...

OBJECTIVE: To evaluate if antenatal steroid use was associated with a lower rate of respiratory complications in neonates born late preterm to patients with pregestational diabetes mellitus (PGDM). METHODS: This was a retrospective cohort study of live, singleton, non-anomalous, late preterm births complicated by PGDM using data from the Centers for Disease Control and National Vital Statistics System from 2017 to 2021. The primary (assisted ventilation use >6 h) and secondary neonatal outcomes (immediate assisted ventilation, Apgar score, neonatal intensive care unit [NICU] admission, and surfactant use) were compared between births that received steroids and those that did not...

OBJECTIVE: To evaluate the efficacy of antenatal corticosteroids in reducing neonatal respiratory complications when administered to those at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. METHODS: This was a single-center, triple-blind, randomized, placebo-controlled trial in southern India enrolling pregnant participants at risk of preterm delivery between 34 and 36 6/7 weeks of gestation. Computer-generated block randomization was used with participants randomized to either one course of intramuscular betamethasone or placebo...

BACKGROUND: Unlike pregestational diabetes mellitus, the American College of Obstetricians and Gynecologists recommends antenatal corticosteroids in those with gestational diabetes mellitus at risk for preterm birth. However, this recommendation is based on limited data, only 10.6% of the Antenatal Late Preterm Steroids study sample had gestational diabetes mellitus. There is a paucity of data on the risk of neonatal respiratory and other morbidity in this population. OBJECTIVE: This study aimed to examine respiratory outcomes in parturients with gestational diabetes mellitus who received antenatal corticosteroids and delivered during the late preterm period vs those who did not...

BACKGROUND: Corticosteroids, thiopurines, and biologics may come into play during pregnancy in women with inflammatory bowel disease and potentially impact the developing fetal immune system. We aimed to assess the risk of serious infections in children stratified by in utero exposure to biologics and immunomodulators or concomitant treatment with corticosteroids. METHODS: All singleton IBD pregnancies between 2008 and 2022 at a tertiary IBD center in Denmark were included...

IMPORTANCE: The publication of the Antenatal Late Preterm Steroids (ALPS) trial in February 2016 demonstrated that antenatal administration of betamethasone in the late preterm period (between 34 to 36 weeks of gestation) for individuals with a high risk of delivery decreased neonatal respiratory morbidity. National estimates have suggested the trial did change obstetric practice, but little is known if the evidence was adopted uniformly or equitably. OBJECTIVE: To assess regional variation in the use of late preterm steroids after the publication of the Antenatal Late Preterm Steroids (ALPS) Trial and to understand factors associated with a region's pace of adoption...

Objective To characterize late preterm antenatal steroids (AS) use and associated neonatal outcomes in a single academic center. Study Design Retrospective study of 503 singleton, mother-infant dyads delivered between 34 0/7 to 36 6/7 weeks gestation between January 1, 2016 to December 31, 2020. Results 43% did not receive AS (No AS) prior to delivery. Among AS treated, 50% were sub-optimal dosing. No AS had higher preterm premature rupture of membranes and maternal diabetes. AS group had lower mean gestational age and birthweight and longer time from admission to delivery and longer NICU study...

Introduction Multisystem inflammatory syndrome in neonates (MIS-N) is an emerging clinical entity observed in neonates born to mothers with exposure to the SARS-CoV-2 virus before or during the antenatal period. Methods We report 18 neonates diagnosed with MIS-N from retrospectively collected data. A total of 18 neonates (13 term and five late-preterm; 10 males) admitted to the neonatal intensive care unit (NICU) of a tertiary care medical institute, between June 2021 to November 2022, were diagnosed with MIS-N...

BACKGROUND: Neonatal hypothermia is a drop in the newborn's core temperature less than 36.5°C. It is crucial in neonatal morbidity and mortality, particularly in preterm infants. This research aimed to assess the incidence and risk factors of neonatal hypothermia and its effect on neonatal mortality and short-term morbidity during Neonatal Intensive Care Unit (NICU) admission. METHODS: This observational study was conducted on all neonates admitted to the NICU at Benha University Hospital...

Antenatal steroid therapy is increasingly central to the obstetrical management of women at imminent risk of preterm birth. For women likely to deliver between 24 and 34 weeks' gestation, antenatal steroid therapy is the standard of care, conferring sizable benefits and few risks in high-resource environments when appropriately targeted. Recent studies have focused on antenatal steroid use in periviable and late preterm populations, and in term cesarean deliveries. As a result, antenatal steroid therapy has now been applied from 22 to 39+6 weeks of estimated gestational age...

Objective: To systematically evaluate the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates. Methods: Eight databases in either Chinese or English, including PubMed, the Cochrane Library, Embase, Medline, Scopus, CNKI, Wanfang and VIP, were searched to extract the studies on the correlation between prenatal steroid exposure and hypoglycemia in late preterm neonates published from the establishment of each database to December 2022. The Meta-analysis was performed using Stata 14...

BACKGROUND: The Antenatal Late Preterm Steroids (ALPS) trial found that corticosteroid administration decreased respiratory complications by 20% among late preterm singleton deliveries. After the ALPS trial, the administration of corticosteroids increased by 76% among twin pregnancies and 113% among singleton pregnancies with pregestational diabetes (PDM) compared to expected rates based on the pre-APLS trial trend. However, the effect of corticosteroids on twin pregnancies and pregnancies complicated by PDM is not well studied, as the ALPS trial excluded twin pregnancies and pregnancies with PDM...

Being born before 37 weeks' gestation, or preterm birth, is a leading cause of early childhood death and life-long disability. Antenatal steroids (ANS) are recommended for women judged at risk of imminent preterm delivery. The primary intent of ANS treatment is to rapidly mature the fetal lungs to reduce the risk of mortality and lasting morbidity. Despite being used clinically for some 50 years, a large number of uncertainties remain surrounding the use of ANS. In particular, the choice of agent, dose/regimen, and appropriate gestational age range for ANS therapy all remain unclear...

AIM AND OBJECTIVE: To determine the efficacy of antenatal corticosteroids given in the late preterm period. METHODOLOGY: We conducted a retrospective case-control study on patients with singleton pregnancies who were at a risk of delivering in the late preterm period (34 weeks to 36 weeks 6 days). A total of 126 patients who had received antenatal corticosteroids (prenatal administration of either betamethasone or dexamethasone, minimum one dose) during the late preterm period were taken as cases, and 135 patients who had not received steroids antenatally due to various reasons, for example, who were clinically unstable, presented with active bleeding, non-reassuring foetal status that obligated an imminent delivery and those in active labour were included as controls...

BACKGROUND: Very preterm infants are at risk for neurodevelopmental impairment because of postnatal morbidities. This study aims to (1) compare the outcomes of very-low-birth-weight (VLBW) infants in Singapore during two time periods over a decade; 2) compare performances among Singaporean neonatal intensive care units (NICUs); and 3) compare a Singapore national cohort with one from the Australian and New Zealand Neonatal Network (ANZNN). METHODS: Singapore national data on VLBW infants born during two periods, 2007-2008 (SG2007, n = 286) and 2015-2017 (SG2017, n = 905) were extracted from patient medical records...

OBJECTIVES: We investigated how the Antenatal Late Preterm Steroids (ALPS) trial findings have been translated into clinical practice in Canada and the United States (U.S.). METHODS: The study included all live births in Nova Scotia, Canada and the United States from 2007 to 2020. ACS administration within specific categories of gestational age was assessed by calculating rates per 100 live births, and temporal changes were quantified using odds ratios (OR) and 95% CI...