Association of antenatal steroids with neonatal mortality and morbidity in preterm infants born to mothers with diabetes mellitus and hypertension

Association of antenatal steroids with surfactant administration in moderate preterm infants born to women with diabetes mellitus and/or hypertension

“…The association between ANS exposure and outcomes among preterm neonates born to women with HTN and/or DM appears to differ when GA is considered. In our previous study, we examined ELGANs and observed an independent association of ANS exposure with less frequent severe IVH and death or severe IVH, but not mortality or surfactant administration in neonates born to women with HTN and/or DM [ 5 ]. In the current study, we examined moderate preterm neonates, i.e., 29 0/7 –33 6/7 weeks GA, and observed an independent association of ANS exposure with decreased surfactant administration and decreased GMH-IVH, but not DR-ETT or mortality in neonates born to women with HTN.…”

“…This study in moderate preterm neonates included two sections. First, a birth cohort study included retrospective (from April 25, 2011 until September 30, 2014, n = 740) and prospective (from October 1st, 2014 until December 31st, 2018, n = 1073) data, similar to the study in ELGANs recently reported [ 5 ]. Second, a subgroup of neonates born at Parkland Hospital between February 2012 and November 2013 was compared with those from other centers in the NICHD NRN Moderate Preterm Registry by subtracting data from Parkland Hospital from those for all NRN centers [ 13 , 14 ].…”

“…Based on a lack of evidence, pregnant women with gestational hypertension, preeclampsia or eclampsia (HTN) and/or with diabetes mellitus (DM) were excluded from ANS administration at Parkland Hospital for several years [ 4 , 5 ]. On September 21, 2015, a bundle of care for extremely low gestational age (GA) neonates (23 0/7 –28 6/7 weeks) (ELGANs) was introduced [ 5 ]. The bundle of care included sequential steps, one of which was expansion of maternal ANS administration to pregnant women with HTN and/or DM and at-risk for delivery [ 5 ].…”

“…On September 21, 2015, a bundle of care for extremely low gestational age (GA) neonates (23 0/7 –28 6/7 weeks) (ELGANs) was introduced [ 5 ]. The bundle of care included sequential steps, one of which was expansion of maternal ANS administration to pregnant women with HTN and/or DM and at-risk for delivery [ 5 ]. This expansion involved mothers at risk for delivery at 24 0/7 –33 6/7 weeks.…”

“…This expansion involved mothers at risk for delivery at 24 0/7 –33 6/7 weeks. We have previously shown that maternal ANS administration to women with HTN and/or DM delivering at 23 0/7 –28 6/7 weeks GA was associated with an improvement in severe IVH and death or severe IVH but not in surfactant administration [ 5 ]. Since the risk of RDS may decrease with maternal HTN but increase with maternal DM [ 6 – 12 ], we aimed in the current report at comparing neonatal outcomes after ANS administration to women with/without HTN and with/without DM at risk for moderate preterm delivery (29 0/7 –33 6/7 weeks GA).…”