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Antenatal steroids

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https://www.readbyqxmd.com/read/29758177/the-efficacy-of-antenatal-steroid-therapy-is-dependent-on-the-duration-of-low-concentration-fetal-exposure-evidence-from-a-sheep-model-of-pregnancy
#1
Matthew W Kemp, Masatoshi Saito, Haruo Usuda, Shimpei Watanabe, Shinichi Sato, Takushi Hanita, Yusaku Kumagai, Timothy J Molloy, Michael Clarke, Peter J Eddershaw, Gabrielle C Musk, Augusto Schmidt, Demelza Ireland, Lucy Furfaro, Matthew S Payne, John P Newnham, Alan H Jobe
OBJECTIVE: Antenatal corticosteroids (ANS) are among the most important and widely used interventions to improve outcomes for preterm infants. ANS dosing regimens remain un-optimized and without maternal weight-adjusted dosing. We, and others, have hypothesised that once a low concentration of materno-fetal steroid exposure is achieved and maintained, the duration of the steroid exposure determines treatment efficacy. Using a sheep model of pregnancy, we tested the relationship between steroid dose, and duration of exposure, and treatment efficacy...
May 9, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29754865/incidence-trends-and-risk-factor-variation-in-severe-intraventricular-hemorrhage-across-a-population-based-cohort
#2
Sara C Handley, Molly Passarella, Henry C Lee, Scott A Lorch
OBJECTIVE: To quantify the current burden of severe intraventricular hemorrhage (IVH), describe time trends in severe IVH, identify IVH-associated risk factors, and determine the contribution of mediating factors. STUDY DESIGN: The retrospective cohort included infants 220/7 -316/7 weeks of gestation without severe congenital anomalies, born at hospitals in the California Perinatal Quality Care Collaborative between 2005 and 2015. The primary study outcome was severe (grade III or IV) IVH...
May 10, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29694989/is-less-invasive-surfactant-administration-necessary-or-only-helpful-or-just-a-fashion
#3
Gianluca Lista, Ilia Bresesti, Laura Fabbri
In the 1990s, the most relevant pillars in the treatment of neonatal respiratory distress syndrome (RDS) have been improvements in ventilation strategies, the introduction of exogenous surfactant replacement therapy, and the use of antenatal steroids. Lately, in addition to the standard INSURE (INtubation-SURfactant administration-Extubation) method to administer surfactant, a new technique has been gaining increasing popularity. It is the so-called less invasive surfactant administration (LISA) method, which has shown promising results in preventing bronchopulmonary dysplasia development and in reducing mortality in preterm neonates...
May 2018: American Journal of Perinatology
https://www.readbyqxmd.com/read/29672221/glucocorticoid-receptor-isoform-specific-regulation-of-development-circadian-rhythm-and-inflammation-in-mice
#4
Robert H Oakley, Sivapriya Ramamoorthy, Julie F Foley, Jonathan T Busada, Nick Z Lu, John A Cidlowski
Glucocorticoids are primary stress hormones, and their synthetic derivatives are widely used clinically. The therapeutic efficacy of these steroids is limited by side effects and glucocorticoid resistance. Multiple glucocorticoid receptor (GR) isoforms are produced from a single gene by alternative translation initiation; however, the role individual isoforms play in tissue-specific responses to glucocorticoids is unknown. We have generated knockin mice that exclusively express the most active receptor isoform, GR-C3...
April 19, 2018: FASEB Journal: Official Publication of the Federation of American Societies for Experimental Biology
https://www.readbyqxmd.com/read/29662925/factors-associated-with-improvements-in-mortality-and-morbidity-rates-of-very-low-birth-weight-infants-a-cohort-study
#5
Giancarlo Mari, Zoran Bursac, Patricia Jean Goedecke, Ramasubbareddy Dhanireddy
Objective . The objective of this study was to determine factors contributing to improvements in infant mortality rates (IMR) and composite morbidity-mortality in very-low-birth-weight (VLBW) infants after initiating a new perinatal program in 2009 at Regional One Health (ROH). VLBW infants account for 67% of infant deaths. Design . This is a pre-/postintervention cohort study of prospectively gathered data. Population . VLBW infants delivered at ROH during the 2004 to 2015 study period. Setting . ROH is a Regional Perinatal Center affiliated with the University of Tennessee Health Science Center...
2018: Global Pediatric Health
https://www.readbyqxmd.com/read/29660063/five-successful-pregnancies-with-antenatal-anakinra-exposure
#6
Chelsey J F Smith, Christina D Chambers
Objectives: Our aim is to add to the limited existing prospective data on IL-1 inhibitor use in pregnancy. Methods: Data were obtained from the Organization of Teratology Information Specialists Autoimmune Disease in Pregnancy Project, a prospective cohort study of pregnancy outcomes in the USA and Canada. Eligible women were enrolled prior to 19 weeks' gestation between 2004 and 2017. Outcomes were obtained by maternal interview and medical record abstraction. Results: Five pregnancies with anakinra exposure were identified, all resulting in full-term singleton live births with no major or long-term complications...
April 12, 2018: Rheumatology
https://www.readbyqxmd.com/read/29618468/tumour-lysis-in-newborn-spontaneous-or-secondary-to-antenatal-steroids
#7
Nithya J Ponmudi, Shafini Beryl, Sridhar Santhanam, Manisha Beck
Malignancies are rare in the early neonatal period. Common congenital tumours include malignant teratoma and neuroblastomas. Tumour lysis syndrome is a serious condition usually seen after commencement of chemotherapy for a malignancy. Rare case reports of spontaneous tumour lysis have been reported though not in the newborn period. We report here an instance of tumour lysis syndrome in a newborn with congenital rhabdoid tumour, where the cause was either spontaneous or related to antenatal steroid exposure...
April 4, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29540896/intra-partum-management-of-women-with-diabetes
#8
Roopa Jewel, Jubbin Jagan Jacob
Management of hyperglycaemia is crucial during labour to improve outcomes both in the newborn and in the mother. This is particularly crucial in mothers with pregestational type 1 diabetes and in all mothers requiring insulin treatment during pregnancy. The use of antenatal steroids in mothers at risk of preterm delivery complicates management of hyperglycaemia in the immediate antepartum period and requires appropriate dosing adjustments of insulin therapy. Mothers are generally asked to be nil per orum during active labour...
March 2018: JPMA. the Journal of the Pakistan Medical Association
https://www.readbyqxmd.com/read/29460549/igm-and-iga-enriched-polyclonal-immunoglobulins-reduce-short-term-mortality-in-extremely-low-birth-weight-infants-elbw-with-sepsis-a-retrospective-cohort-study
#9
Letizia Capasso, Angela C Borrelli, Maria R Pirozzi, Laura Bucci, Roberta Albachiara, Teresa Ferrara, Francesco Raimondi
BACKGROUND: Immunoglobulin supplementation is a debated strategy in fighting sepsis. We evaluated a polyclonal IgM and IgA enriched immunoglobulin (IgMeIVIG) preparation in reducing the short term mortality in extremely low birth weight neonates (ELBW) with proven infection. METHODS: ELBW infants born from January 2008 to December 2014 were eligible for this retrospective casecontrol analysis if they were symptomatic and had a positive blood culture after 72hours of life...
February 19, 2018: Minerva Pediatrica
https://www.readbyqxmd.com/read/29415590/the-mortality-of-very-low-birth-weight-infants-the-benefit-and-relative-impact-of-changes-in-population-and-therapeutic-variables
#10
Sorina Grisaru-Granovsky, Valentina Boyko, Liat Lerner-Geva, Cathy Hammerman, Misgav Rottenstreich, Arnon Samueloff, Michael S Schimmel, Brian Reichman
OBJECTIVE: Very low birth weight (VLBW, ≤1500 g) infants' mortality rates have decreased markedly. We aimed to quantify the relative contribution of changes in the distribution of population characteristics and changes in specific mortality rates on the decline in mortality rates of VLBW infants. STUDY DESIGN: A population-based observational study of the Israel national VLBW infant database. The study population comprised singleton VLBW infants of 24-32 weeks' gestation born during the epochs 1995-2000 (n = 3728) and 2006-2010 (n = 3246)...
February 20, 2018: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/29408744/the-use-of-antenatal-fetal-magnetic-resonance-imaging-in-the-assessment-of-patients-at-high-risk-of-preterm-birth
#11
REVIEW
L Story, J Hutter, T Zhang, A H Shennan, M Rutherford
Preterm birth, defined as birth occurring prior to 37 weeks gestation is a common obstetric complication affecting 8% of pregnancies and is associated with significant morbidity and mortality. Infection/inflammation has been implicated in both the aetiology of preterm birth itself and associated neonatal pulmonary and neurological morbidity. Treatment options are currently limited to prolongation of the pregnancy using cervical cerclage, pessaries or progesterone or administration of drugs including steroids to promote lung maturity and neuroprotective agents such as magnesium sulphate, the timing of which are highly critical...
March 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/29401400/cord-blood-metabolic-signatures-of-birth-weight-a-population-based-study
#12
Oliver Robinson, Pekka Keski-Rahkonen, Leda Chatzi, Manolis Kogevinas, Tim Nawrot, Costanza Pizzi, Michelle Plusquin, Lorenzo Richiardi, Nivonirina Robinot, Jordi Sunyer, Roel Vermeulen, Martine Vrijheid, Paolo Vineis, Augustin Scalbert, Marc Chadeau-Hyam
Birth weight is an important indicator of maternal and fetal health and a predictor of health in later life. However, the determinants of variance in birth weight are still poorly understood. We aimed to identify the biological pathways, which may be perturbed by environmental exposures, that are important in determining birth weight. We applied untargeted mass-spectrometry-based metabolomics to 481 cord blood samples collected at delivery in four birth cohorts from across Europe: ENVIRONAGE (Belgium), INMA (Spain), Piccolipiu (Italy), and Rhea (Greece)...
March 2, 2018: Journal of Proteome Research
https://www.readbyqxmd.com/read/29395186/antecedents-and-outcomes-of-abnormal-cranial-imaging-in-moderately-preterm-infants
#13
Girija Natarajan, Seetha Shankaran, Shampa Saha, Abbot Laptook, Abhik Das, Rosemary Higgins, Barbara J Stoll, Edward F Bell, Waldemar A Carlo, Carl D'Angio, Sara B DeMauro, Pablo Sanchez, Krisa Van Meurs, Betty Vohr, Nancy Newman, Ellen Hale, Michele Walsh
OBJECTIVES: To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7 -336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics. STUDY DESIGN: We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center...
April 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29374627/morbidity-and-mortality-with-early-pulmonary-haemorrhage-in-preterm-neonates
#14
Kaashif Aqeeb Ahmad, Monica Michelle Bennett, Samiya Fatima Ahmad, Reese Hunter Clark, Veeral Nalin Tolia
OBJECTIVE: There are no large studies evaluating pulmonary haemorrhage (PH) in premature infants. We sought to quantify the clinical characteristics, morbidities and mortality associated with early PH. DESIGN: Data were abstracted from the Pediatrix Clinical Data Warehouse, a large de-identified data set. For incidence calculations, we included infants from 340 Pediatrix United States Neonatal Intensive Care Units from 2005 to 2014 without congenital anomalies. Infants <28 weeks' gestation with PH within 7 days of birth were then matched with two controls for birth weight, gestational age, gender, antenatal steroid exposure, day of life 0 or 1 intubation and multiple gestation...
January 27, 2018: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/29371627/volume-size-professionals-specialization-and-nutrition-management-of-nicus-and-their-association-with-treatment-quality-in-vlbw-infants
#15
Felix Miedaner, Kristina Langhammer, Christian Enke, Wolfgang Göpel, Angela Kribs, Anika Nitzsche, Rainer Riedel, Christiane Woopen, Ludwig Kuntz, Bernhard Roth
OBJECTIVE: To assess the association of volume, size, the availability of highly-specialized professionals and nutrition management of NICUs with treatment quality among VLBW infants. STUDY DESIGN: A prospective multicenter study of 923 VLBW infants in 66 German NICUs, born between May and October 2013. Using multilevel modeling, we examined the association between the aforementioned organizational characteristics and treatment quality, measured via major morbidities (severe IVH, PVL, BPD, NEC, FIP, ROP, and discharge without severe complications) and medical process measures of VLBW infants...
January 25, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
https://www.readbyqxmd.com/read/29365196/effect-of-antenatal-steroids-on-respiratory-morbidity-of-late-preterm-newborns-a-randomized-controlled-trial
#16
Vijaya Ontela, Gowri Dorairajan, Vishnu B Bhat, Palanivel Chinnakali
Objective: The objective of this article was to study the effect of antenatal dexamethasone on the respiratory morbidity of late preterm newborns. Study design: A randomized controlled trial, conducted in Obstetrics and Gynecology Department in collaboration with Neonatology department at JIPMER, India. In total, 155 women were studied in each group. Intention to treat analysis and per protocol analysis were done. Results: Overall 31 (10%) newborns were admitted to intensive care unit...
January 22, 2018: Journal of Tropical Pediatrics
https://www.readbyqxmd.com/read/29306493/delivery-room-resuscitation-and-short-term-outcomes-in-moderately-preterm-infants
#17
Monika Bajaj, Girija Natarajan, Seetha Shankaran, Myra Wyckoff, Abbot R Laptook, Edward F Bell, Barbara J Stoll, Waldemar A Carlo, Betty R Vohr, Shampa Saha, Krisa P Van Meurs, Pablo J Sanchez, Carl T D'Angio, Rosemary D Higgins, Abhik Das, Nancy Newman, Michele C Walsh
OBJECTIVES: To describe the frequency and extent of delivery room resuscitation and evaluate the association of delivery room resuscitation with neonatal outcomes in moderately preterm (MPT) infants. STUDY DESIGN: This was an observational cohort study of MPT infants delivered at 290/7 to 336/7 weeks' gestational age (GA) enrolled in the Neonatal Research Network MPT registry. Infants were categorized into 5 groups based on the highest level of delivery room intervention: routine care, oxygen and/or continuous positive airway pressure, bag and mask ventilation, endotracheal intubation, and cardiopulmonary resuscitation including chest compressions and/or epinephrine use...
April 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29305780/corticosteroid-injection-for-an-orthopedic-complaint-in-a-female-with-gestational-diabetes
#18
Palee Myrex, Lorie Harper, Sara Gould
A female with gestational diabetes presented with hip pain characteristic of meralgia paresthetica and trochanteric bursitis. She had similar episodes prior to pregnancy that were treated successfully with non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections. However, NSAID use during pregnancy poses risks to the fetus and corticosteroids carry a risk of hyperglycemia, especially in those with diabetes. Unfortunately, all attempts made to treat her conservatively failed to improve her symptoms...
January 5, 2018: Sports Medicine—Open
https://www.readbyqxmd.com/read/29305231/neurodevelopmental-outcomes-of-infants-born-at-29-weeks-of-gestation-admitted-to-canadian-neonatal-intensive-care-units-based-on-location-of-birth
#19
Reem Amer, Diane Moddemann, Mary Seshia, Ruben Alvaro, Anne Synnes, Kyong-Soon Lee, Shoo K Lee, Prakesh S Shah
OBJECTIVE: To compare mortality and neurodevelopmental outcomes of outborn and inborn preterm infants born at <29 weeks of gestation admitted to Canadian neonatal intensive care units (NICUs). STUDY DESIGN: Data were obtained from the Canadian Neonatal Network and Canadian Neonatal Follow-up Network databases for infants born at <29 weeks of gestation admitted to NICUs from April 2009 to September 2011. Rates of death, severe neurodevelopmental impairment (NDI), and overall NDI were compared between outborn and inborn infants at 18-21 months of age, corrected for prematurity...
January 3, 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29288162/retrospective-consent-in-a-neonatal-randomized-controlled-trial
#20
Nils T Songstad, Calum T Roberts, Brett J Manley, Louise S Owen, Peter G Davis
BACKGROUND AND OBJECTIVES: The requirement for prospective consent in clinical trials in acute settings may result in samples unrepresentative of the study population, potentially altering study findings. However, using retrospective consent may raise ethical issues. We assessed whether using retrospective consent affected recruitment, participant characteristics, and outcomes within a randomized controlled trial. METHODS: We conducted a secondary analysis of a randomized trial, which compared nasal high flow (nHF) with nasal continuous positive airway pressure (CPAP) for primary respiratory support in preterm infants...
January 2018: Pediatrics
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