Relationships between antenatal corticosteroids and catecholamine blood pressure support in neonates: considering of maternal stress-related diseases

Garafova, Alexandra; Korňanová, E; Chovancova, Darina; Borovský, Miroslav; Karailiev, Peter; Hlavacova, Natasa; Ježová, Daniela

doi:10.1080/10253890.2020.1806227

“…We have excluded ex-utero babies who were admitted to participating units after 12 hours of age to avoid bias due to difference in BP management practice in referring hospitals. Confounding factors which may influence the clinical outcomes studied were taken into consideration to avoid bias and make the study findings more reliable 47,48 . Both babies with invasive and non-invasive BP monitored were included to reflect the actual clinical practice.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Aladangady

¹

,

Sinha

²

,

Banerjee

³

et al. 2023

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Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

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“… 2 3 4 5 6 Antenatal corticosteroids, administered for pregnancies at increased risk of preterm birth (24-34 weeks+6 days) accelerate maturation of fetal organs, especially the lungs. 7 8 9 10 However, some fetuses exposed to antenatal corticosteroids exceed expectations and are born at term (≥37 weeks). Even infants born during the late preterm period (34-36 weeks) may not benefit from early antenatal corticosteroids (<33 weeks+6 days).…”

Section: Introductionmentioning

confidence: 99%

The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants

Ninan,

Gojic,

Wang

et al. 2023

BMJ

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Objective To systematically review the proportions of infants with early exposure to antenatal corticosteroids but born at term or late preterm, and short term and long term outcomes. Design Systematic review and meta-analyses. Data sources Eight databases searched from 1 January 2000 to 1 February 2023, reflecting recent perinatal care, and references of screened articles. Eligibility criteria for selecting studies Randomised controlled trials and population based cohort studies with data on infants with early exposure to antenatal corticosteroids (<34 weeks) but born at term (≥37 weeks), late preterm (34-36 weeks), or term/late preterm combined. Data extraction and synthesis Two reviewers independently screened titles, abstracts, and full text articles and assessed risk of bias (Cochrane risk of bias tool for randomised controlled trials and Newcastle-Ottawa scale for population based studies). Reviewers extracted data on populations, exposure to antenatal corticosteroids, and outcomes. The authors analysed randomised and cohort data separately, using random effects meta-analyses. Main outcome measures The primary outcome was the proportion of infants with early exposure to antenatal corticosteroids but born at term. Secondary outcomes included the proportions of infants born late preterm or term/late preterm combined after early exposure to antenatal corticosteroids and short term and long term outcomes versus non-exposure for the three gestational time points (term, late preterm, term/late preterm combined). Results Of 14 799 records, the reviewers screened 8815 non-duplicate titles and abstracts and assessed 713 full text articles. Seven randomised controlled trials and 10 population based cohort studies (1.6 million infants total) were included. In randomised controlled trials and population based data, ∼40% of infants with early exposure to antenatal corticosteroids were born at term (low or very low certainty). Among children born at term, early exposure to antenatal corticosteroids versus no exposure was associated with increased risks of admission to neonatal intensive care (adjusted odds ratio 1.49, 95% confidence interval 1.19 to 1.86, one study, 5330 infants, very low certainty; unadjusted relative risk 1.69, 95% confidence interval 1.51 to 1.89, three studies, 1 176 022 infants, I 2 =58%, τ 2 =0.01, low certainty), intubation (unadjusted relative risk 2.59, 1.39 to 4.81, absolute effect 7 more per 1000, 95% confidence interval from 2 more to 16 more, one study, 8076 infants, very low certainty, one study, 8076 infants, very low certainty), reduced head circumference (adjusted mean difference −0.21, 95% confidence interval −0.29 to −0.13, one study, 183 325 infants, low certainty), and any long term neurodevelopmental or behavioural disorder in population based studies (eg, any neurodevelopmental or behavioural disorder in children born at term, adjusted hazard ratio 1.47, 95% confidence interval 1.36 to 1.60, one study, 641 487 children, low certainty). Conclusions About 40% of infants exposed to early antenatal corticosteroids were born at term, with associated adverse short term and long term outcomes (low or very low certainty), highlighting the need for caution when considering antenatal corticosteroids. Systematic review registration PROSPERO CRD42022360079.

show abstract

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Aladangady

¹

,

Sinha

²

,

Banerjee

³

et al. 2023

View full text Add to dashboard Cite

Background: There remains uncertainty about the definition of normal blood pressure (BP), and when to initiate treatment for hypotension for extremely preterm infants. To determine the short-term outcomes of extremely preterm infants managed by active compared with permissive BP support regimens during the first 72 hours of life. Method: This is a retrospective medical records review of 23+0–28+6 weeks’ gestational age (GA) infants admitted to neonatal units (NNU) with active BP support (aimed to maintain mean arterial BP (MABP) >30 mmHg irrespective of the GA) and permissive BP support (used medication only when babies developed signs of hypotension) regimens. Babies admitted after 12 hours of age, or whose BP data were not available were excluded. Results: There were 764 infants admitted to the participating hospitals; 671 (88%) were included in the analysis (263 active BP support and 408 permissive BP support). The mean gestational age, birth weight, admission temperature, clinical risk index for babies (CRIB) score and first haemoglobin of infants were comparable between the groups. Active BP support group infants had consistently higher MABP and systolic BP throughout the first 72 hours of life (p<0.01). In the active group compared to the permissive group 56 (21.3%) vs 104 (25.5%) babies died, and 21 (8%) vs 51 (12.5%) developed >grade 2 intra ventricular haemorrhage (IVH). Death before discharge (adjusted OR 1.38 (0.88 – 2.16)) or IVH (1.38 (0.96 – 1.98)) was similar between the two groups. Necrotising enterocolitis (NEC) ≥stage 2 was significantly higher in permissive BP support group infants (1.65 (1.07 – 2.50)). Conclusions: There was no difference in mortality or IVH between the two BP management approaches. Active BP support may reduce NEC. This should be investigated prospectively in large multicentre randomised studies.

show abstract

Relationships between antenatal corticosteroids and catecholamine blood pressure support in neonates: considering of maternal stress-related diseases

Cited by 5 publications

References 25 publications

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants

Comparison of clinical outcomes between active and permissive blood pressure management in extremely preterm infants

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