Antenatal glucocorticoids and neonatal inflammation-associated proteins.

BACKGROUND: To date, studies of the relationship between antenatal glucocorticoids (AGC) and neonatal inflammation in preterm newborns have been largely limited to umbilical cord blood specimens. AIM: To explore the association between exposure to antenatal glucocorticoids and concentrations of inflammation-related proteins in whole blood collected from very preterm newborns at multiple times during the first postnatal month. METHODS: We measured the protein concentrations on postnatal day 1 (N=1118), day 7 (N=1138), day 14 (N=1030), day 21 (N=936) and day 28 (N=877) from infants born before the 28th week of gestation and explored the relationship between antenatal steroid receipt and protein concentrations in the highest and lowest quartiles. The creation of multinomial logistic regression models (adjusted for potential confounders) allowed us calculate odds ratios and 95% confidence intervals. RESULTS: Twenty of 420 assessments [21 (proteins)×2 (exposure levels: partial and full)×2 (quartile levels: top and bottom)×5 (days)] were statistically significant without any cohesive pattern. CONCLUSION: Among infants born before 28 weeks of gestational age, neither full, nor partial courses of antenatal glucocorticoids have a sustained anti-inflammatory effect.

Randomised trial estimating length of endotracheal tube insertion using gestational age or nasal-tragus length in newborns: a study protocol.

INTRODUCTION: Endotracheal tube (ETT) insertion depth estimation is important for optimal placement of ETT tip and balanced ventilation of the lungs. Various methods are available to determine the ETT insertion depth. The Neonatal Resuscitation Programme recommends the gestational age and nasal-tragus length (NTL) methods for estimating ETT insertion depth during cardiopulmonary resuscitation. However, the prospective data comparing these two methods is lacking. METHODS AND ANALYSIS: This is an open-label multi-centre randomised controlled trial, where gestational age and NTL methods will be used to determine the initial ETT insertion depth in term and preterm infants that are less than 28 days old, requiring oral intubation in the delivery room or neonatal intensive care unit (NICU). SITES AND SAMPLE SIZE: The trial is aimed to recruit 454 infants over 3 years across tertiary level NICUs. OUTCOMES: The primary outcome includes an optimally positioned ETT, defined as an ETT tip between the upper border of the first thoracic vertebra and the lower border of the second thoracic vertebra. The outcome is assessed by a paediatric radiologist, who will be masked to the group assignment. Secondary outcomes are malpositioned ETT tips, pneumothorax, ETT repositioning, chronic lung disease, invasive ventilation days, and death. ANALYSIS: Data will be analysed using the intention-to-treat principle. The primary and categorical secondary outcomes will be compared using the χ2 test. Adjusted risk ratios of outcomes will be calculated along with 95% CIs through multivariable logistic regression analysis, including covariates deemed biologically to influence the outcomes. ETHICS AND DISSEMINATION: The study has been approved by the PNU Research Ethics Board (20-0148) and the respective ethical review boards of the participating centres. The results will be disseminated through conference meetings, social media platforms, and publications in scientific journals. TRIAL REGISTRATION NUMBER: NCT04393337.

Association of maternal diabetes mellitus with preterm infant outcomes: a systematic review and meta-analysis.

CONTEXT: The association between maternal diabetes and outcomes of infants who are born preterm is unclear. OBJECTIVE: To perform a systematic review and meta-analysis of clinical studies exploring the association between maternal diabetes and preterm infant outcomes. METHODS: Medline, PubMed and Cumulative Index of Nursing and Allied Health Literature databases were searched without language restriction from 1 January 2000 until 19 August 2019. Studies examining preterm infants <37 weeks gestational age and reporting prespecified outcomes of this review based on maternal diabetes as primary exposure variable were included. RESULTS: Of 7956 records identified through database searches, 9 studies were included in the study. No significant association was found between maternal diabetes and in-hospital mortality (adjusted RR (aRR) 0.90 (95% CI 0.73 to 1.11); 6 studies; participants=1 191 226; I2=83%). Similarly, no significant association was found between maternal diabetes and bronchopulmonary dysplasia (aRR 1.00 (95% CI 0.92 to 1.07); 4 studies; participants=107 902; I2=0%), intraventricular haemorrhage or cystic periventricular leukomalacia (aRR 0.91 (95% CI 0.80 to 1.03); 3 studies; participants=115 050; I2=0%), necrotising enterocolitis (aRR 1.13 (95% CI 0.90 to 1.42); 5 studies; participants=142 579; I2=56%) and retinopathy of prematurity (ROP) (aRR 1.17 (95% CI 0.85 to 1.61); 5 studies; participants=126 672; I2=84). A sensitivity analysis where low risk of bias studies were included in the meta-analyses showed similar results; however, the heterogeneity was lower for in-hospital mortality and ROP. CONCLUSION: Maternal diabetes was not associated with in-hospital mortality and severe neonatal morbidities in preterm infants. Future studies should explore the association between the severity of maternal diabetes with preterm infant outcomes.

Impact of antenatal corticosteroids in preterm neonates based on maternal body mass index.

OBJECTIVE: Impact of antenatal corticosteroid (ACS) in context of maternal body mass index (BMI) as it relates to neonatal outcomes remains unclear. We sought to evaluate effects of ACS on clinical outcomes of preterm infants based on maternal BMI. METHODS: We performed a retrospective cohort study among neonates 23-33 weeks' GA at a tertiary neonatal intensive care unit from 2011 to 2015. Outcomes of neonates exposed to any ACS and pre-pregnancy maternal BMI ≥ 25 (N = 491) were compared with maternal BMI < 25 (N = 484). A priori planned subgroup analyses based on ACS exposure (partial ACS; complete ACS ≤ 7 days prior to delivery (PTD); and complete ACS > 7 days PTD) were conducted. Primary outcome was composite of mortality or any of moderate/severe bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity, necrotizing enterocolitis stage, or primary bloodstream infection. RESULTS: Preterm neonates with maternal BMI ≥ 25 (exposed to any ACS) were not at increased risk of composite outcome vs. BMI < 25 (adjusted odd ratio (aOR) 1.03, 95% confidence interval (CI) 0.84-1.48), nor any individual neonatal morbidities. Similar findings were noted in subgroup analyses by type of ACS exposure. CONCLUSION: Impact of ACS on neonatal outcomes do not appear to be influenced by maternal BMI based on data from this cohort. However, further research is required to definitively elucidate the impact of BMI on ACS with regards to pharmacokinetics and neonatal outcomes.