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      Trends, Characteristic, and Outcomes of Preterm Infants Who Received Postnatal Corticosteroid: A Cohort Study from 7 High-Income Countries

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          Abstract

          Introduction

          Our objective was to evaluate the temporal trend of systemic postnatal steroid (PNS) receipt in infants of 24–28 weeks’ gestational age, identify characteristics associated with PNS receipt, and correlate PNS receipt with the incidence of bronchopulmonary dysplasia (BPD) and BPD/death from an international cohort included in the iNeo network.

          Methods

          We conducted a retrospective study using data from 2010 to 2018 from seven international networks participating in iNeo (Canada, Finland, Israel, Japan, Spain, Sweden, and Switzerland). Neonates of 24 and 28 weeks’ gestational age who survived 7 days and who received PNS were included. We assessed temporal trend of rates of systemic PNS receipt and BPD/death.

          Results

          A total of 47,401 neonates were included. The mean (SD) gestational age was 26.4 (1.3) weeks and birth weight was 915 (238) g. The PNS receipt rate was 21% (12–28% across networks) and increased over the years (18% in 2010 to 26% in 2018; p < 0.01). The BPD rate was 39% (28–44% across networks) and remained unchanged over the years (35.2% in 2010 to 35.0% in 2018). Lower gestation, male sex, small for gestational age status, and presence of persistent ductus arteriosus (PDA) were associated with higher rates of PNS receipt, BPD, and BPD/death.

          Conclusion

          The use of PNS in extremely preterm neonates increased, but there was no correlation between increased use and the BPD rate. Research is needed to determine the optimal timing, dose, and indication for PNS use in preterm neonates.

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          Most cited references31

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          Bronchopulmonary dysplasia.

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            Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012.

            Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality.
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              European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

              As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.
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                Author and article information

                Journal
                Neonatology
                Neonatology
                NEO
                NEO
                Neonatology
                S. Karger AG (Basel, Switzerland )
                1661-7800
                1661-7819
                25 April 2023
                August 2023
                : 120
                : 4
                : 517-526
                Affiliations
                [a ]Department of Pediatrics, Sinai Health System, University of Toronto, Toronto, ON, Canada
                [b ]Maternal-Infant Care Research Center (Mi-Care), Sinai Health System, Toronto, ON, Canada
                [c ]Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Ramat Gan, Israel
                [d ]Department of Pediatrics, Neonatal Research Network of Japan, Kyorin University, Tokyo, Japan
                [e ]Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
                [f ]Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
                [g ]Division of Neonatology and Health Research Institute La Fe, Valencia, Spain
                [h ]Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden
                [i ]Department of Neonatal Medicine, Karolinska University Hospital, Stockholm, Sweden
                [j ]Division of Neonatology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
                [k ]Division of Neonatology, Center of Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
                [l ]Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden
                Author notes
                Correspondence to: Prakesh S. Shah, Prakeshkumar.Shah@ 123456sinaihealth.ca

                The list of investigators for iNeo is provided in the online supplementary file, available at www.karger.com/doi/10.1159/000530128.

                Article
                530128
                10.1159/000530128
                10614478
                37166345
                cdebb2cb-1fb0-4178-a55e-9a3c535f4a81
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 22 January 2023
                : 7 March 2023
                : 2023
                Page count
                Figures: 1, Tables: 5, References: 31, Pages: 10
                Funding
                The International Network for Evaluating Outcomes of Neonates (iNeo) has been supported by the Canadian Institutes of Health Research [APR-126340 and PBN 150642 to P.S.S.]. The Australian and New Zealand Neonatal Network is predominantly funded by membership contributions from the participating centers. The Canadian Neonatal Network is supported by a team grant from the Canadian Institutes of Health Research [CTP 87518] and by the participating centers. The Finnish Medical Birth Register is governmentally funded and kept by the National Institute for Health and Welfare (THL). The Israel Neonatal Network very low birth weight infant database is partially funded by the Israel Center for Disease Control and the Ministry of Health. The Neonatal Research Network of Japan is partly funded by a Health Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan. The Spanish Neonatal Network is supported by funds from the Spanish Neonatal Society (SENeo). The Swedish Neonatal Quality Register is funded by the Swedish Government (Ministry of Health and Social Affairs), the Swedish Association of Local Communities and Regions (SALAR), and the participating units. The Swiss Neonatal Network is partially funded by the participating units in the form of membership fees. This research was also supported by Instituto de Investigación Sanitaria Carlos III (Ministry of Science, Innovation and Universities, Kingdom of Spain) [FIS17/0131 to M.V.]; and RETICS funded by the PN 2018–2021 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion, and the European Regional Development Fund (ERDF) [RD16/0022]; and by grants from a regional agreement on clinical research (ALF) between Region Stockholm and Karolinska Institutet [2020-0443 to M.N.]. The funding body played no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
                Categories
                Sources of Neonatal Medicine

                infant,preterm,bronchopulmonary dysplasia,postnatal steroid

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