American journal of perinatology最新文献

{"title":"Cerebrospinal Fluid Composition of Infants with Ischemic Stroke.","authors":"Katherine B Daniel, Daniel K Benjamin, P Brian Smith, C Michael Cotten, Reese H Clark, Rachel G Greenberg","doi":"10.1055/a-2511-8842","DOIUrl":"10.1055/a-2511-8842","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to characterize the cerebrospinal fluid (CSF) of infants with stroke and compare those findings to the CSF of infants with bacterial meningitis and neither condition in the first 14 postnatal days.</p><p><strong>Study design: </strong> Cohort study of 30,092 infants who received a lumbar puncture in the first 14 postnatal days discharged from >400 neonatal intensive care units from 1997 to 2020. CSF parameters were compared between infants with stroke and bacterial meningitis using non-parametric hypothesis testing and quantile regression.</p><p><strong>Results: </strong> Compared to infants with bacterial meningitis, infants with stroke had a significantly lower median protein concentration, higher median glucose concentration, higher median red blood cell count, and higher median monocyte count. Using quantile regression at the 75th percentile, infants with stroke had a significantly lower white blood cell count, segmented neutrophil count, and lymphocyte count than infants with bacterial meningitis.</p><p><strong>Conclusion: </strong> This study addresses the paucity of literature describing the CSF of infants with ischemic stroke. Knowledge of the differences in CSF parameters between infants with stroke and meningitis may allow for faster recognition and intervention before CSF culture results are available.</p><p><strong>Key points: </strong>· Neonatal stroke is a serious and morbid event.. · Neonatal stroke and meningitis can present similarly.. · The CSF of neonatal stroke is poorly described..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between Advanced Paternal Age and Adverse Reproductive Outcomes in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b).","authors":"Rachel A Newman, Patrick Conley, Tania Esakoff, William Grobman, David Haas, Ronald Wapner, Judith Chung, George Saade, Natalie A Bello","doi":"10.1055/a-2507-7428","DOIUrl":"https://doi.org/10.1055/a-2507-7428","url":null,"abstract":"<p><strong>Objective: </strong> The association between paternal age and adverse pregnancy outcomes (APOs) has not been well studied. We sought to determine whether advanced paternal age (APA) is associated with adverse maternal or neonatal outcomes.</p><p><strong>Study design: </strong> Secondary analysis of 8,863 pregnancies from the Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-Be (nuMoM2b) prospective cohort in which both maternal and paternal age at conception were known. APA was defined as age ≥ 40 years and AMA was defined as age ≥ 35 years. Composite maternal and fetal/neonatal APO outcomes were adjudicated by experts using previously defined methods. Univariable and multivariable logistic regression models were used to estimate the associations between APA, AMA, and their combination (AMA and APA), with the outcomes of interest (APO, fetal/neonatal, and combined APO or fetal/neonatal outcomes). Multivariable analyses were adjusted for covariates identified a priori: self-reported race and ethnicity, education, body mass index, maternal medical conditions, assisted reproductive technology (ART), and maternal age in APA only models.</p><p><strong>Results: </strong> APA in isolation was not significantly associated with maternal or fetal/neonatal adverse outcomes (adjusted odds ratio [aOR] = 1.08, 95% confidence interval [CI]: 0.89 - 1.32). In contrast, AMA pregnancies and pregnancies in which both parents were of advanced age were associated with significantly increased risk of maternal or fetal/neonatal adverse outcome (aOR = 1.37, 95% CI: 1.17 - 1.59, <i>p</i> < 0.001 and aOR = 1.60, 95% CI: 1.25 - 2.05, <i>p</i> < 0.001), respectively. Findings were similar when individuals who used assisted reproductive technology (ART) were excluded from analyses.</p><p><strong>Conclusion: </strong> In our study of nulliparous birthing people, in contrast to AMA pregnancies, APA alone was not significantly associated with a heightened risk of maternal or fetal/neonatal APOs. However, pregnancies from both AMA and APA individuals demonstrated a trend toward a higher risk of APOs compared with AMA pregnancies. Further research is needed to delineate the mechanism driving this finding.</p><p><strong>Key points: </strong>· There is an established association between older maternal age and increased risk of adverse pregnancy outcomes. Determining the influence of paternal age on pregnancy outcomes is of equal importance.. · Prior data are inconclusive on the association of APA and rates of miscarriage, fertilization rates, and aneuploidy, and to our knowledge, the associations with adverse pregnancy outcomes have not been previously examined.. · This study examines if APA (paternal age ≥ 40 years) is an independent risk factor for adverse pregnancy outcomes in a cohort of nulliparous birthing people..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved growth velocity using a new liquid human milk fortifier in Very Low Birth Weight infants: a multicenter, retrospective study.","authors":"Fernando Rodrigo Moya, Jennifer Fowler, Adrian Florens, Jennifer Dombrowski, Olivia Davis, Tiffony Blanks, Austin Gratton","doi":"10.1055/a-2527-4638","DOIUrl":"https://doi.org/10.1055/a-2527-4638","url":null,"abstract":"<p><strong>Objective: </strong>To compare growth outcomes and tolerance among very low birth weight (VLBW) infants receiving a new, liquid human milk fortifier (LHMF-NEW) or a human milk fortifier-acidified liquid (HMF-AL).</p><p><strong>Study design: </strong>Retrospective, multicenter study of 515 VLBW infants in three regional NICUs. The primary objective was to compare growth velocity (g/kg/day) during fortification between groups by repeated measures regression. Secondary outcomes of interest were feeding tolerance and the incidence of late onset sepsis, necrotizing enterocolitis and metabolic acidosis. Student's t, ANOVA, Wilcoxon, and Kruskal-Wallis tests were used for numeric variables, or, chi-squared and Fisher's exact test for categorical variables.</p><p><strong>Results: </strong>No demographic differences were identified between the groups (HMF-AL, n= 242; LHMF-NEW, n= 273). Growth velocity during fortification was significantly higher in the group receiving LHMF-NEW, despite relatively similar total fluid, calorie or protein intake (p=. ). Feeding intolerance was comparable between fortifiers. Necrotizing enterocolitis and late onset sepsis did not differ between groups and metabolic acidosis was diagnosed less frequently with the LHMF-NEW. Anthropometric measures at discharge and length of stay were comparable.</p><p><strong>Conclusion: </strong>Infants receiving human milk fortified with the LHMF-NEW had faster growth velocity during fortification, similar tolerance and less metabolic acidosis compared with an earlier cohort of infants who received human milk fortified with a HMF-AL.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Diabetes-in-Pregnancy Outcomes Requires a Care Continuum.","authors":"Audrey M Huang, Menachem Miodovnik, E Albert Reece","doi":"10.1055/a-2505-5330","DOIUrl":"https://doi.org/10.1055/a-2505-5330","url":null,"abstract":"<p><p>This study aimed to assess the strengths, limitations, opportunities, and threats presented by diabetes-in-pregnancy. We review the improvements in maternal and fetal mortality since the advent of insulin therapy, evaluate current health challenges, and identify opportunities for preventing increased mortality due to diabetes-in-pregnancy. Prior to 1922, women with type 1 diabetes mellitus (T1DM) of childbearing age were discouraged from becoming pregnant as the maternal and fetal/neonatal mortality rates were extremely high. Starvation-level dietary restriction was the only \"treatment,\" with limited success in managing the disease. The discovery of insulin coupled with careful clinical management presented the possibility of successful pregnancies for women with T1dm. Over the course of the next half-century, maternal survival increased from 54 to 97%. However, the gains made in reducing adverse outcomes of diabetes in pregnancy are eroding due to modern challenges. The global obesity epidemic has led to an increase in type 2 and gestational diabetes mellitus (DM). T1DM also is on the rise. Together, the rise in the prevalence of pregestational diabetes has increased the risks for adverse outcomes. Here we review the ongoing challenges as well as opportunities for research to improve outcomes. We suggest that overweight, obesity, and diabetes management must be coupled with preconception counseling and education and must include, in addition to, Ob/Gyns, primary care, nutrition, weight management, and other experts to ensure that those at risk of pregnancy complications due to diabetes have the best possible outcomes. KEY POINTS: · Diabetes in pregnancy is affecting more people.. · The obesity epidemic is fueling an increase in pregestational diabetes.. · Research is needed to reduce inequities in diabetes in pregnancy outcomes.. · Blood glucose control should start prior to pregnancy..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies.","authors":"Sydney C Timmer-Murillo, Alyssa Mowrer, Maddie R Rundell, Kelly Jazinski-Chambers, Isela Piña, Terri A deRoon-Cassini, Amy J Wagner","doi":"10.1055/a-2508-2490","DOIUrl":"https://doi.org/10.1055/a-2508-2490","url":null,"abstract":"<p><strong>Objective: </strong> Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs.</p><p><strong>Study design: </strong> Women diagnosed with fetal anomalies (<i>N</i> = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes.</p><p><strong>Results: </strong> Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not.</p><p><strong>Conclusion: </strong> The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health.</p><p><strong>Key points: </strong>· Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Surgical Morbidity following Planned Hysterectomy versus Conservative Management for Placenta Accreta Spectrum: A Systematic Review and Meta-analysis\".","authors":"Lakshmi Thangavelu","doi":"10.1055/a-2523-2247","DOIUrl":"https://doi.org/10.1055/a-2523-2247","url":null,"abstract":"<p><p>Not applicable.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Community Characteristics as Measured by Social Deprivation Index Score with Prenatal Care and Obstetrical Outcomes.","authors":"Alexa M Sassin, Natalie Osterlund, Haleh Sangi-Haghpeykar, Kjersti Aagaard","doi":"10.1055/a-2507-7371","DOIUrl":"10.1055/a-2507-7371","url":null,"abstract":"<p><strong>Objective: </strong> We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications.</p><p><strong>Study design: </strong> All spontaneously conceived singleton deliveries of nulliparous gravida with residence zip code available (<i>n</i> = 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis (Q1 [<i>n</i> = 1,342], Q2 + 3 [<i>n</i> = 1,752], and Q4 [<i>n</i> = 1,692]) with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method.</p><p><strong>Results: </strong> Among our cohort, gravida in the lowest (least-deprived) SDI quartile (Q1) were older, had lower prepregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravida residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits (mean [standard deviation] 11.17 [2.9]) than those living in Q1 (12.04 [2.3], <i>p</i> < 0.0001). Gravida in Q4 were less likely to receive sufficient PNC compared with those in Q1 (52 vs. 64.2%, <i>p</i> < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, <i>p</i> < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile.</p><p><strong>Conclusion: </strong> Outer quartile social deprivation was associated with higher proportions of primigravida not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravida are likely important steps toward health equity.</p><p><strong>Key points: </strong>· Neighborhood social deprivation was not associated with composite maternal or neonatal morbidity.. · Community-level deprivation was associated with decreased PNC utilization.. · It is important to understand the underlying disparities that lend to suboptimal patterns of PNC.. · Doing so may inform programs that promote favorable birth outcomes in at-risk communities..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Hypovitaminosis D in Pregnancy and Potential Benefits of Oral Supplementation.","authors":"Gabriele Saccone, Giorgia Buonomo, Serena Guerra, Doriana Gentile, Attilio Di Spiezio Sardo","doi":"10.1055/a-2502-7295","DOIUrl":"10.1055/a-2502-7295","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate prevalence of hypovitaminosis D in a cohort of Italian pregnant women, and to evaluate potential benefits of oral supplementation STUDY DESIGN:  Observational cohort of women with singleton gestations who were referred to our institution for first trimester prenatal visit. Screening for hypovitaminosis D was performed at the time of first trimester routine scan between 11 and 13 weeks of gestations. Women were offered measurement of serum 25-hydroxyvitamin D (25[OH]D). Levels of 25(OH)D are interpreted as follows: 12 to <20 ng/mL: Vitamin D insufficiency; < 12 ng/mL: Vitamin D deficiency. Women with Vitamin D insufficiency or deficiency were offered daily oral supplementation at the dose of 2.000 UI, along with folic acid. The primary outcome was the prevalence of hypovitaminosis D in our cohort.</p><p><strong>Results: </strong> During the study period, between January 2023 and January 2024, 250 pregnant women were included in the study and screened for 25(OH)D. More than half of the screened women had 25(OH)D < 20 ng/mL, with a prevalence of <12 ng/mL of 14%. Out of the 140 (140/250 = 56%) women with 25(OH)D < 20 ng/mL, 127/140 (90%) accepted supplementation with Vitamin D, whereas 13 refused the therapy for fear of teratogenic effects of the fetus. The overall rate of preterm delivery before 37 weeks was 8.4%, whereas the incidence of preeclampsia was 2.8%. Rate of preterm delivery was higher in women who did not received supplementation (9.5 vs. 30.8%), but the study was not powered for such comparison.</p><p><strong>Conclusion: </strong> Hypovitaminosis D has high prevalence in pregnant women. Universal screening in the first trimester with measurement of serum 25-hydroxyvitamin D (25[OH]D) can identify women at risk that may benefit of oral supplementation.</p><p><strong>Key points: </strong>· Hypovitaminosis D has high prevalence in pregnant women.. · Universal screening with measurement of serum 25(OH)D can identify women at risk.. · Oral supplementation can be recommended in women with vitamin D insufficiency..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular Air Embolism in Neonates: A Literature Review.","authors":"Qi Zhou, Shoo K Lee","doi":"10.1055/a-2508-2733","DOIUrl":"10.1055/a-2508-2733","url":null,"abstract":"<p><p>Neonatal vascular air embolism is a rare but often fatal condition. The literature comprises mostly case reports and a few dated systematic reviews. Our objective was to review all case reports of neonatal vascular air embolism to date and provide up-to-date information about patient characteristics, clinical presentations, outcomes, pathogenesis, diagnosis, prevention, treatment, and prognosis. We searched the literature for case reports of neonatal vascular air embolism, using MEDLINE, CINAHL, and EMBASE, and the keywords \"neonates\" and \"vascular air embolism.\" Results were summarized. There were 117 cases of neonatal vascular air embolism, with a mean gestational age of 30.4 weeks (range: 23-40), mean birth weight of 1,422 g (range 830-3,844), and median age of occurrence of 2 days (range: 1-540) after birth. The majority were preterm (75.2%), male (62.7%), on assisted respiratory support (90.5%), and had air leak syndrome (52.9%). The most common clinical presentation was sudden acute clinical deterioration, sometimes accompanied by crying, cardiac rhythm abnormalities, skin discoloration, and a decrease in end-tidal carbon dioxide concentration. Incidence of mortality and adverse neurological sequelae among survivors was 73.9 and 16.6%, respectively, overall, but significantly (<i>p</i> < 0.05) higher among preterm infants (81.8 and 31.2%, respectively) and lower among surgical infants (23.8 and 0%, respectively). Diagnosis included visualizing air in infusion lines or retinal vessels, a decrease in the end-tidal carbon dioxide levels, and radiographic, doppler ultrasound, transesophageal echocardiography, or computed tomography (CT) imaging. The prognosis for neonatal air embolism is poor, especially for preterm infants requiring mechanical ventilation. Prevention is key and treatment is supportive. KEY POINTS: · Vascular air embolism is a rare but often fatal neonatal condition that is often underrecognized.. · Preterm infants on mechanical ventilation and with air leak syndromes are at particular risk.. · Prognosis is poor, prevention is key, and treatment is supportive..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratracheal Administration of Budesonide with Surfactant for Prevention of Death or Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A before-after Study.","authors":"Anish Pillai, Nandkishor Kabra, Sharayu Kothavade, Anita Chevle, Sachin Sakharkar, Deepika Tiwari, Richa Choubey, Haribalakrishna Balasubramanian","doi":"10.1055/a-2506-2893","DOIUrl":"10.1055/a-2506-2893","url":null,"abstract":"<p><strong>Objective: </strong> Previous studies have suggested a potential role for inhaled corticosteroids, such as budesonide, in reducing bronchopulmonary dysplasia (BPD) among preterm infants. The objective of our study was to investigate the effectiveness of intratracheal administration of corticosteroid with surfactant on the composite outcome of death or BPD at 36 weeks in extremely low birth weight (ELBW) infants.</p><p><strong>Study design: </strong> This before-after cohort study compared outcomes in ELBW infants with respiratory distress syndrome (RDS) who received intratracheal surfactant with budesonide to a historical cohort who received surfactant alone. Data were collected retrospectively for neonates in the surfactant group and prospectively for those receiving surfactant plus budesonide.</p><p><strong>Results: </strong> A total of 385 ELBW infants were included. Death or BPD occurred in 123/203 (60.5%) in the surfactant with budesonide group versus 105/182 (57.6%) in the surfactant group; adjusted odds ratio 1.10 (95% CI: 0.69-1.75; <i>p</i> = 0.69). Statistical analysis revealed no significant difference in the incidence of the composite primary outcome (death or BPD at 36 weeks of postmenstrual gestational age), and its components, between the two study groups.</p><p><strong>Conclusion: </strong> In our study, coadministration of budesonide and surfactant was deemed safe and feasible among ELBW infants with RDS. However, we did not observe a significant reduction in the rates of composite or individual outcomes of death or BPD. Larger, randomized controlled trials are necessary to explore the potential advantages of this intervention.</p><p><strong>Key points: </strong>· Small clinical trials have shown promising benefits of intratracheal administration of budesonide with surfactant for improving respiratory outcomes in preterm infants.. · This before-after intervention study showed that intratracheal budesonide with surfactant was safe and feasible in ELBW infants.. · However, coadministration of budesonide and surfactant did not reduce the composite outcome of death or BPD in the study population..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}