Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity

Zeng, Yue; Ge, Ge; Lei, Chunyan; Zhang, Meixia

doi:10.3389/fphar.2022.759742

Cited by 6 publications

(3 citation statements)

References 76 publications

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“…Our study found that ACS was associated with a decreased incidence of severe ROP in NICU infants born to mothers with both clinical and histological chorioamnionitis. Recently, a meta-analysis showed the association between ACS exposure and the development of ROP in preterm infants, including 63 cohort studies involving infants born at gestational ages from 25 to 32 weeks [ 26 ]. The results showed ACS exposure was associated with significantly lower odds of ROP progression (aOR 0.48, 95% CI 0.26–0.89).…”

Section: Discussionmentioning

confidence: 99%

Association of Antenatal Corticosteroids with Neonatal Outcomes among Very Preterm Infants Born to Mothers with Clinical Chorioamnionitis: A Multicenter Cohort Study

Lin,

Wang,

Huang

et al. 2024

Children

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The objective of this study was to assess the relationship of ACS with neonatal outcomes among very preterm infants born to mothers with clinical chorioamnionitis in China. This was a multicenter retrospective cohort study. Study participants included infants born at <32 weeks’ gestation with clinical chorioamnionitis and registered in the Chinese Neonatal Network from 1 January 2019 to 31 December 2020. Infants were divided into two groups: any amount of ACS or no administration of ACS. Multivariable generalized linear models using generalized estimating equations were used to assess the association between ACS and neonatal outcomes among the study population. We identified 2193 infants eligible for this study; 1966 (89.6%) infants had received ACS therapy, and 227 (10.4%) had not received any ACS therapy. Among very preterm infants born to mothers with clinical chorioamnionitis, any ACS usage was significantly associated with decreased risks of early death (aRR 0.56, 95% CI 0.32, 0.99) and severe ROP (aRR 0.51, 95% CI 0.28, 0.93) after adjustment for maternal hypertension, gestational age at birth, Caesarean section, being inborn, and administration of systemic antibiotics to the mother within 24 h before birth. In addition, out of the 2193 infants, the placentas of 1931 infants underwent pathological examination with recorded results. Subsequently, 1490 of these cases (77.2%) were diagnosed with histological chorioamnionitis. In 1490 cases of histologic chorioamnionitis, any ACS usage was significantly related to decreased risks of overall mortality (aRR 0.52, 95% CI 0.31, 0.87), severe ROP (aRR 0.47, 95% CI 0.25, 0.97), and respiratory distress syndrome (aRR 0.52, 95% CI 0.31, 0.87). We concluded that any ACS was associated with reduced risks for neonatal early death and severe ROP among very preterm infants born to mothers with clinical chorioamnionitis.

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Section: Discussionmentioning

confidence: 99%

Association of Antenatal Corticosteroids with Neonatal Outcomes among Very Preterm Infants Born to Mothers with Clinical Chorioamnionitis: A Multicenter Cohort Study

Lin,

Wang,

Huang

et al. 2024

Children

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“…Postnatal systemic glucocorticoids reduce the incidence of severe ROP in some but not all studies [25,26]. Meta-analysis of 196,264 infants from 63 studies (Pubmed search: "steroid*", "cortico*", "betamethasone", "dexamethasone") shows that antenatal corticosteroid exposure may decrease ROP severity but not prevent ROP [27]. In a large cohort study of 1,472 neonates with birth weight < 500 g, postnatal steroid exposure is associated with a higher risk of ROP.…”

Section: Discussionmentioning

confidence: 99%

Timed topical dexamethasone eye drops improve mitochondrial function to prevent severe retinopathy of prematurity.

Yagi,

Boeck,

Petrishka-Lozenska

et al. 2024

Preprint

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Pathological neovascularization in retinopathy of prematurity (ROP) can cause visual impairment in preterm infants. Current ROP treatments which are not preventative and only address late neovascular ROP, are costly and can lead to severe complications. We showed that topical 0.1% dexamethasone eye drops administered prior to peak neovessel formation prevented neovascularization in five extremely preterm infants at high risk for ROP and suppressed neovascularization by 30% in mouse oxygen-induced retinopathy (OIR) modeling ROP. In contrast, in OIR, topical dexamethasone treatment before any neovessel formation had limited efficacy in preventing later neovascularization, while treatment after peak neovessel formation had a non-statistically significant trend to exacerbating disease. Optimally timed topical dexamethasone suppression of neovascularization in OIR was associated with increased retinal mitochondrial gene expression and decreased inflammatory marker expression, predominantly found in immune cells. Blocking mitochondrial ATP synthetase reversed the inhibitory effect of dexamethasone on neovascularization in OIR. This study provides new insights into topical steroid effects in retinal neovascularization and into mitochondrial function in phase II ROP, and suggests a simple clinical approach to prevent severe ROP.

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“…Some studies have shown that infants born extremely preterm and with very low birth weight have a decreased risk of severe ROP after ACS [31,32]. However, a recent meta-analysis suggests that ACS treatment may decrease, but not prevent, the severity of ROP [33]. At present, the evidence of the effect of ACS on ROP is based on some retrospective studies, and more rigorously designed RCT experiments are needed to improve the level of evidence.…”

Section: Plos Onementioning

confidence: 99%

Antenatal corticosteroid administration-to-birth interval and neonatal outcomes in very preterm infants: A secondary analysis based on a prospective cohort study

Zhu

2023

PLoS ONE

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Introduction Despite the prevalent use of antenatal corticosteroids (ACS) to prevent preterm infants’ adverse neonatal complications, there is currently no consensus on administration-to-birth intervals of ACS. International guidelines broadly agree that the administration of antenatal corticosteroids should be within 7 days prior to preterm birth. However, there is little evidence to support narrower optimal ACS administration-to-birth interval time. This study was undertaken to investigate the association between the administration-to-birth interval of ACS which is bounded by 48 hours and neonatal outcomes in very preterm infants. Materials and methods This is a single-center prospective observational study. Data were collected prospectively from eligible infants from January 2008 to April 2014 at the Santa Clara Valley Medical Center, neonatal outcomes were compared between two groups based on the interval of antenatal corticosteroid administration-to-birth: the interval of <48h, and the interval of >48h. It was noted that the entire study was completed by Dongli Song et al., and uploaded the data to the DATADRYAD website. The author only used this data for secondary analysis. Results After adjusting potential confounders (gestational age, sex, birth weight, duration of cord clamping and delivery mode), the interval of >48h group compared to the interval of <48h group had significant reductions in mortality (OR: 0.17; 95% CI: 0.05–0.59), any retinopathy of prematurity (OR: 0.36; 95% CI: 0.16–0.82), severe retinopathy of prematurity (OR: 0.07; 95% CI: 0.01–0.45), any intubation (OR: 0.39; 95% CI: 0.20–0.75) and higher 1 min Apgar (β: 0.56; 95% CI: 0.10–1.02). Conclusion This study shows that in very preterm infants, compared with the interval of ACS<48h, the interval of ACS>48 hours has a significant health promotion effect.

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Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity

Cited by 6 publications

References 76 publications

Association of Antenatal Corticosteroids with Neonatal Outcomes among Very Preterm Infants Born to Mothers with Clinical Chorioamnionitis: A Multicenter Cohort Study

Association of Antenatal Corticosteroids with Neonatal Outcomes among Very Preterm Infants Born to Mothers with Clinical Chorioamnionitis: A Multicenter Cohort Study

Timed topical dexamethasone eye drops improve mitochondrial function to prevent severe retinopathy of prematurity.

Antenatal corticosteroid administration-to-birth interval and neonatal outcomes in very preterm infants: A secondary analysis based on a prospective cohort study

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