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Antenatal steroids

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
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
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 7, 2018: Journal of Maternal-fetal & Neonatal Medicine
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
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
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...
January 22, 2018: Journal of Pediatrics
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
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
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
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...
January 3, 2018: Journal of Pediatrics
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
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
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...
December 29, 2017: Pediatrics
W Muhsen, R Roy
INTRODUCTION: Despite recent advances in respiratory support, the wide use of antenatal steroids and surfactant replacement therapy, respiratory problems continue to represent the leading cause of mortality in premature infants during the neonatal period. In the last few years, HHHFNC has been widely adopted as a mode of noninvasive respiratory support for infants with respiratory difficulties. However, data of the safety and efficacy of HHHFNC use in extremely premature infants are scarce...
December 27, 2017: Journal of Maternal-fetal & Neonatal Medicine
Ga Young Park, Won Soon Park, Hye Soo Yoo, So Yoon Ahn, Se In Sung, Sung Shin Kim, Yun Sil Chang
OBJECTIVE: To determine the updated outcomes of preterm infants with acute hypoxic respiratory failure attributable to presumed pulmonary hypoplasia (PH) following maternal midtrimester prolonged preterm premature rupture of membranes (PPROM). STUDY DESIGN: Among preterm infants with birthweight <1500 g and 23-34 weeks gestational age in a single center, infants exposed to maternal prolonged (≥7 days) PPROM before 25 gestational weeks (PPPROM25, n = 76) were retrospectively reviewed...
January 8, 2018: Journal of Maternal-fetal & Neonatal Medicine
Kevin Visconti, Paranthaman Senthamaraikannan, Matthew W Kemp, Masatoshi Saito, Boris W Kramer, John P Newnham, Alan H Jobe, Suhas G Kallapur
BACKGROUND: The efficacy of antenatal steroids for fetal lung maturation in the periviable period is not fully understood. OBJECTIVE: We sought to determine the lung maturational effects of antenatal steroids and inflammation in early gestation sheep fetuses, similar to the periviable period in human beings. STUDY DESIGN: Date-mated ewes with singleton fetuses were randomly assigned to 1 of 4 treatment groups (n = 8/group): (1) maternal intramuscular injection of betamethasone; (2) intraamniotic lipopolysaccharide; (3) betamethasone + lipopolysaccharide; and (4) intraamniotic + intramuscular saline (controls)...
December 21, 2017: American Journal of Obstetrics and Gynecology
Andrea Ciardulli, Francesco D'Antonio, Elena Rita Magro-Malosso, Gabriele Saccone, Lamberto Manzoli, Mackenzy Radolec, Vincenzo Berghella
INTRODUCTION: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by immune-mediated complete atrio-ventricular block (CAVB) in utero. MATERIAL AND METHODS: Pubmed, Embase, Cinahl and databases were searched. Only studies reporting the outcome of fetuses with immune CAVB diagnosed on prenatal ultrasound without any cardiac malformations and treated with fluorinated steroids compared to those not treated were included...
December 17, 2017: Journal of Maternal-fetal & Neonatal Medicine
Dawid Szpecht, Janusz Gadzinowski, Irmina Nowak, Dorothy Cygan, Agnieszka Seremak-Mrozikiewicz, Grażyna Kurzawińska, Dariusz Madajczak, Krzysztof Drews, Marta Szymankiewicz
Introduction: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects primarily preterm infants. Genetic factors are also taken into consideration in the pathogenesis of BPD. Genetic predispositions to higher production of inflammation mediators seem to be crucial. Material and methods: The aim of this study was to evaluate the possible relationship between polymorphisms: interleukin-1β +3953 C>T, interleukin-6 -174 G>C and -596 G>A, tumour necrosis factor -308 G>A and interleukin-1RN VNTR 86bp and the occurrence of BPD in a population of 100 preterm infants born from singleton pregnancy, before 32+0 weeks of gestation, exposed to antenatal steroids therapy, and without congenital abnormalities...
2017: Central-European Journal of Immunology
Tiffany L Walker, Dorothy A Shannon
Pneumopericardium occurs when air accumulates in the pericardial sac surrounding the heart and is one of the rarest forms of air leaks in neonates. Because of various advances in neonatal care, including gentler modes of ventilation, surfactant replacement, and antenatal steroids, the incidence of pneumopericardium has decreased. Despite the decrease in incidence of pneumopericardium, most cases arise in premature infants with a history of respiratory distress and mechanical ventilation. Evidence has shown that the incidence is inversely related to birth weight and that pneumopericardium has high mortality and morbidity rates...
November 1, 2017: Neonatal Network: NN
Kjell Helenius, Gunnar Sjörs, Prakesh S Shah, Neena Modi, Brian Reichman, Naho Morisaki, Satoshi Kusuda, Kei Lui, Brian A Darlow, Dirk Bassler, Stellan Håkansson, Mark Adams, Maximo Vento, Franca Rusconi, Tetsuya Isayama, Shoo K Lee, Liisa Lehtonen
OBJECTIVES: To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS: A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population...
December 2017: Pediatrics
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