Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center

Kim, Woo Jeng; Han, Young Sin; Ko, Hyun Sun; Park, In Yang; Shin, Jong Chul; Wie, Jeong Ha

doi:10.5468/ogs.2018.61.1.7

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…Preclinical and clinical evidence demonstrates that antenatal steroids may exacerbate growth restriction (particularly repeat doses) (18) and that the FGR fetus differentially responds to antenatal steroids compared to appropriately-grown fetuses, likely mediated via altered placental response to steroids (19). Antenatal glucocorticoids may not significantly improve neonatal outcomes in FGR preterm infants (20), and indeed, may have adverse effects on brain development (21, 22). Further research is clearly needed in this area.…”

Section: Etiology and Uteroplacental Factorsmentioning

confidence: 99%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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Being born small lays the foundation for short-term and long-term implications for life. Intrauterine or fetal growth restriction describes the pregnancy complication of pathological reduced fetal growth, leading to significant perinatal mortality and morbidity, and subsequent long-term deficits. Placental insufficiency is the principal cause of FGR, which in turn underlies a chronic undersupply of oxygen and nutrients to the fetus. The neonatal morbidities associated with FGR depend on the timing of onset of placental dysfunction and growth restriction, its severity, and the gestation at birth of the infant. In this review, we explore the pathophysiological mechanisms involved in the development of major neonatal morbidities in FGR, and their impact on the health of the infant. Fetal cardiovascular adaptation and altered organ development during gestation are principal contributors to postnatal consequences of FGR. Clinical presentation, diagnostic tools and management strategies of neonatal morbidities are presented. We also present information on the current status of targeted therapies. A better understanding of neonatal morbidities associated with FGR will enable early neonatal detection, monitoring and management of potential adverse outcomes in the newborn period and beyond.

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Section: Etiology and Uteroplacental Factorsmentioning

confidence: 99%

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

et al. 2019

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“…Rather, ACS seemed to increase the risk of RDS. They concluded that ACS therapy for women who are at risk for preterm delivery with IUGR fetus, need to be further evaluated, espe cially after 32 weeks of gestation [13]. A recent meta-analysis, examined 16 observational cohort and case-control studies published from 1995 to 2018, they concluded that ACS reduces neonatal mortality in SGA infants delivered preterm, with no apparent effect on neonatal morbidity (RDS, NEC, IVH and periventricular leukomalacia, bronchopulmonary dysplasia or chronic lung disease of prematurity, or neonatal sepsis).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies reported no effect of ACS on neonatal morbidity or mortality among IUGR fetuses in the early preterm (up to 34 weeks of gestational age) [8,11,12,13,14]. Van Stralen et al demonstrated that administration of ACS to IUGR fetuses does not appear to be bene cial with respect to short term neonatal outcome in preterm deliveries [8].…”

Section: Discussionmentioning

confidence: 99%

Small for Gestational Age in Late Preterm Deliveries - The Impact of Antenatal Corticosteroids on Perinatal Outcome

Zloto¹,

Krispin²,

Shmueli³

et al. 2021

Preprint

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Purpose The aim of this study is to evaluate the impact of antenatal corticosteroids (ACS) on late preterm small for gestational age neonates. Methods A retrospective cohort study of all women, carrying a singleton gestation, who had late preterm delivery (34 + 0–36 + 6, gestational weeks) of small for gestational age neonates, in a single, tertiary, university-affiliated medical center (July 2012- December 2017). Exclusion criteria included: birth weight above the 10th percentile, termination of pregnancy and intrauterine fetal death. Outcomes were compared between those who were treated with ACS prior to delivery and those who did not receive ACS. The primary outcome was neonatal composite outcome which included: neonatal intensive care unit admission, respiratory distress syndrome, mechanical ventilation and transient tachypnea of the newborn. Results Overall, 228 women met inclusion criteria.102 (44.7%) received ACS and 126 did not (55.3%). Birth weight among non-ACS group was significantly higher (1880.38 ± 171.54 vs 1774.84 ± 229.15 grams p < 0.001). Rates of NICU and Jaundice requiring phototherapy were higher among the ACS group (53.92% vs 31.74%, p = 0.01 and 12.74% vs 5.55%, p = 0.05, respectively). Composite neonatal outcome was significantly higher among the ACS group (53.92% vs 32.53%, OR 2.42, CI 1.41–4.15, p = 0.01). After adjustment for potential confounders, using multivariate regression analysis this association remained significant (OR 2.38, 95% CI 1.39–4.10, p = 0.002). Conclusion Our findings suggest that ACS delivered during pregnancy did not improve respiratory adverse outcome for SGA neonates born in late preterm. ACS in this specific cohort might be associated with worse outcome than those not treated with ACS.

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“…Preterm prelabor rupture of membranes (PPROM) is defined as rupture of membranes before 37 weeks [2]. Both SGA and PPROM infants are at an increased risk for adverse outcomes [2][3][4], and SGA appears to complicate pregnancies with preterm labor and PPROM more often than uncomplicated pregnancies [5,6]. Therefore, the accurate prediction of SGA in pregnancies with PPROM will assist in creating surveillance protocols to reduce such adverse outcomes [7].…”

Section: Introductionmentioning

confidence: 99%

Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts

et al. 2021

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Objective: The primary outcome was to compare the diagnostic accuracy of neonatal Small for gestational age (SGA) by the Hadlock and Fetal Medicine Foundation (FMF) charts in our cohort, followed by the ability to predict composite severe neonatal outcomes (SNO) in pregnancies with preterm prelabor rupture of membranes (PPROM).Methods: This study was a secondary analysis of a prospective cohort of pregnancies with PPROM from 2015 to 2018, from 23 to 36 completed weeks of gestation. Sensitivity, specificity, and positive and negative predictive values for the primary and secondary outcomes of the Hadlock and FMF fetal charts were calculated. The discriminatory ability of each chart was compared using the area under the receiver's operating curves of clinical characteristics.Results: Of the 106 women who met the inclusion criteria, 48 (45%) were screened positive using the FMF fetal growth chart and 22 (21%) were screened positive using the Hadlock chart. SGA was diagnosed in 12 infants (11%). Both fetal growth charts had comparable diagnostic accuracies and were statistically significant predictors of SGA (Hadlock: area under the receiver operating characteristic curves [AUC], 0.76, risk ratio [RR], 7.6, 95% confidence interval [CI], and FMF: AUC, 0.76, RR, 95% CI,). Both growth standards were poor predictors of SNO. Conclusion:The Hadlock and FMF fetal growth charts have a similar accuracy to predict SGA in pregnancies complicated by PPROM. The FMF fetal growth chart may result in a 2-fold increase in positive screens, potentially increasing fetal surveillance.

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Antenatal corticosteroids and outcomes of preterm small-for-gestational-age neonates in a single medical center

Cited by 10 publications

References 20 publications

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Neonatal Morbidities of Fetal Growth Restriction: Pathophysiology and Impact

Small for Gestational Age in Late Preterm Deliveries - The Impact of Antenatal Corticosteroids on Perinatal Outcome

Detection of small for gestational age in preterm prelabor rupture of membranes by Hadlock versus the Fetal Medicine Foundation growth charts

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