Contributions of the NICHD neonatal research network's generic database to documenting and advancing the outcomes of extremely preterm infants

Bell, Edward F.; Stoll, Barbara J.; Hansen, Nellie I.; Wyckoff, Myra H.; Walsh, Michele C.; Sánchez, Pablo J.; Rysavy, Matthew A.; Gabrio, Jenna; Archer, Stephanie Wilson; Das, Abhik; Higgins, Rosemary D.

doi:10.1016/j.semperi.2022.151635

Cited by 2 publications

(1 citation statement)

References 62 publications

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“…21 Furthermore, additional research is needed to evaluate the increased prevalence of infectious morbidity with periviable corticosteroids observed in some studies and potential for harm in unstudied special populations such as those with pregestational diabetes. Large, diverse population-based studies, such as those performed by the NICHD Neonatal Research Network, 22 will continue to be instrumental in evaluating these uncommon outcomes. Ideally, efforts should be made to include all deliveries in the population rather than only deliveries that occur in highly resourced settings and to include measures assessing long-term sequelae, including quality of life, socialization, and school achievement.…”

Section: Discussionmentioning

confidence: 99%

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Battarbee

2023

Obstetrics &Amp; Gynecology

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Neonates born at the cusp of viability are at particularly high risk of severe morbidity and mortality. With advances in medicine and technology, the ability to resuscitate smaller, more premature neonates has become possible, and survival as early as 21 weeks of gestation has been reported. Although administration of antenatal corticosteroids has been shown to reduce the risk of morbidity and mortality at later gestational ages, neonates born before 24 weeks of gestation have not been included in randomized clinical trials. Changing clinical practices surrounding neonatal resuscitation with intervention offered after birth at earlier gestational ages has prompted re-evaluation of the use of antenatal corticosteroids at these very early gestational ages. Recent observational data demonstrate that antenatal corticosteroids administered before deliveries at or after 22 weeks of gestation are associated with lower risks of neonatal mortality, although survival with severe morbidity remains high. Future research is needed to determine the efficacy of antenatal corticosteroids for deliveries before 22 weeks of gestation and should evaluate the timing of corticosteroid administration. Furthermore, efforts should be made to include diverse populations and clinically meaningful long-term outcomes. At this time, the decision surrounding antenatal corticosteroids for threatened periviable deliveries should incorporate multidisciplinary counseling with the goal of achieving concordant prenatal and postnatal management aligned with the patient’s desires.

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Section: Discussionmentioning

confidence: 99%

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Battarbee

2023

Obstetrics &Amp; Gynecology

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Predictors of CPAP failure after less-invasive surfactant administration in preterm infants

Alsina-Casanova,

Brito,

Balcells-Esponera

et al. 2024

Front. Pediatr.

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IntroductionLess-invasive surfactant administration (LISA) is associated with better respiratory outcomes in preterm infants with respiratory distress syndrome. However, mechanical ventilation (MV) shortly after the LISA procedure has been related to lower survival. This study aimed to analyze the trends and main predictors of continuous positive airway pressure (CPAP) failure after LISA.Material and methodsPreterm infants born between 230 and 336 weeks gestational age (GA) in two level III neonatal units who received surfactant were included (2017–2022). Demographic data, lung ultrasound (LUS) scores, the saturation/fraction of inspired oxygen (SF) ratio, technique, time to surfactant administration, and the main neonatal outcomes were collected.ResultsOver the study period, 289 inborn preterm infants received surfactant, 174 with the LISA method (60.2%). Patients who received surfactant after intubation in the delivery room (n = 56) were more immature and exhibited worse outcomes. Patients who received surfactant via an endotracheal tube in the neonatal intensive care unit (n = 59) had higher LUS scores and a lower SF ratio than those treated with LISA. The LISA method was associated with less death or bronchopulmonary dysplasia (BPD), with an adjusted odds ratio (aOR) = 0.37 [95% confidence interval (CI), 0.18–0.74, p = 0.006]. CPAP failure after LISA (defined as the need for intubation and MV in the first 72 h of life) occurred in 38 patients (21.8%), inversely proportional to GA (38.7% at 23–26 weeks, 26.3% at 27–30 weeks, and 7.9% at 30–33 weeks (p < 0.001). CPAP failure after LISA was significantly related to death, with an aOR = 12.0 (95% CI, 3.0–47.8, p < 0.001), and moderate to severe BPD, with an aOR = 2.9 (95% CI, 1.1–8.0, p = 0.035), when adjusting for GA. The best predictors of CPAP failure after LISA were GA, intrauterine growth restriction, temperature at admission, the SF ratio, and the LUS score, with a Nagelkerke's R2 = 0.458 (p < 0.001). The predictive model showed an area under the curve = 0.84 (95% CI, 0.75–0.93, p < 0.001).ConclusionsCPAP failure after LISA is still common in extremely preterm infants, leading to an increase in death or disability. Clinicians must acknowledge the main risk factors of CPAP failure to choose wisely the right patient and the best technique. LUS and the SF ratio at admission can be useful when making these decisions.

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Contributions of the NICHD neonatal research network's generic database to documenting and advancing the outcomes of extremely preterm infants

Cited by 2 publications

References 62 publications

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Antenatal Corticosteroids at 21–23 Weeks of Gestation

Predictors of CPAP failure after less-invasive surfactant administration in preterm infants

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