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      Antenatal corticosteroids is associated with better postnatal growth outcomes of very preterm infants: A national multicenter cohort study in China

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          Abstract

          Introduction

          Antenatal corticosteroids (ACS) administration is a standardized prenatal care for accelerating fetal maturation before anticipated preterm delivery, however, its effect on nutrition and growth is yet uncertain. This study aimed to examine if ACS application is associated with improvement in postnatal growth and nutrition in very preterm infants (VPIs).

          Methods

          This was a secondary analysis of a multicenter prospective survey included infants born before 32 weeks gestation and admitted to 28 tertiary neonatal intensive care units throughout China from September 2019 to December 2020. Infants were divided into no ACS, partial ACS and complete ACS groups according to the steroids exposure. For infants exposed to antenatal corticosteroids, complete ACS was defined as receiving all doses of steroids 24 h-7 days before delivery, otherwise it was referred to partial ACS. The primary outcomes of postnatal growth were compared among the 3 groups. The multivariable regression analyses were applied to evaluate the association of different steroids coverage with postnatal growth and nutritional outcomes while adjusting for potential confounders. For each outcome, no ACS coverage was defined as the reference group. Data were presented as unstandardized coefficients or adjusted odds ratios with 95% confidence intervals, P < 0.05 (2-sided) indicated statistical significance.

          Results

          Among 2,514 infants included, complete ACS, partial ACS and no ACS group accounted for 48.7% (1,224/2,514), 29.2% (735/2,514) and 22.1% (555/2,514), respectively. The median weight growth velocity was 14.6 g/kg/d, 14.1 g/kg/d and 13.5 g/kg/d in complete, partial and no ACS group respectively with significant difference ( P < 0.001). In multivariable analyses, both complete and partial ACS coverage were associated with shorter cumulative fasting time, faster weight growth velocity, less dramatic decline in Z-score of weight, and lower incidence of extrauterine growth restriction [aOR (95%CI): 0.603 (0.460, 0.789) and 0.636 (0.476,0.851), respectively] when compared with no ACS. Moreover, the faster length growth velocity and earlier enteral feeding start time were observed only in infants with complete ACS coverage.

          Conclusions

          Both complete and partial ACS are associated with better postnatal growth outcomes in very preterm infants. This efficacy appeared to be more obvious in infants exposed to complete ACS.

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          Most cited references29

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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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            A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

            Background The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Methods Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Results Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. Conclusions The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.
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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

                Contributors
                Journal
                Front Pediatr
                Front Pediatr
                Front. Pediatr.
                Frontiers in Pediatrics
                Frontiers Media S.A.
                2296-2360
                11 January 2023
                2022
                : 10
                : 1086920
                Affiliations
                [ 1 ]Department of Neonatology, Women and Children’s Hospital, School of Medicine, Xiamen University , Xiamen, China
                [ 2 ]Xiamen Key Laboratory of Perinatal-Neonatal Infection , Xiamen University, Xiamen, China
                [ 3 ]Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, China
                [ 4 ]Department of Pediatrics, Shengjing Hospital of China Medical University , Shenyang, China
                [ 5 ]Department of Neonatology, Guiyang Maternal and Child Health Hospital·Guiyang Children’s Hospital , Guiyang, China
                [ 6 ]Department of Pediatrics, Peking University Third Hospital , Beijing, China
                [ 7 ]Department of Neonatology, Children’s Hospital of Fudan University , Shanghai, China
                [ 8 ]Department of Neonatology, Guangdong Province Maternal and Children’s Hospital , Guangzhou, China
                [ 9 ]Department of Neonatology, General Hospital of Ningxia Medical University , Yinchuan, China
                [ 10 ]Department of Neonatology, Children’s Hospital of Hebei Province , Shijiazhuang, China
                [ 11 ]Department of Neonatology, Children’ Hospital of Nanjing Medical University , Nanjing, China
                [ 12 ]Department of Neonatology, The First Hospital of Jilin University , Changchun, China
                [ 13 ]Department of Neonatology, Quanzhou Maternity and Children’s Hospital , Quanzhou, China
                [ 14 ]Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
                [ 15 ]Department of Neonatology, Liaocheng People’s Hospital , Liaocheng, Shandong China
                [ 16 ]Department of Neonatology, the Affiliated Hospital of Inner Mongolia Medical University , Hohhot, Inner Mongolia, China
                [ 17 ]Department of Neonatology, Suzhou Municipal Hospital , Suzhou, China
                [ 18 ]Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University , Zhengzhou, China
                [ 19 ]Department of Neonatology, Chengdu Women’ and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China , Chengdu, China
                Author notes

                Edited by: Shi Yuan, Children’s Hospital of Chongqing Medical University, China

                Reviewed by: Shan He, The First People's Hospital of Yunnan Province, China Enrico Cocchi, Columbia University, United States Dongli Song, Santa Clara Valley Medical Center, United States

                [* ] Correspondence: Xinzhu Lin xinzhufj@ 123456163.com Xiaomei Tong tongxm2007@ 123456126.com
                [ † ]

                These authors have contributed equally to this work and share first authorship.

                [ ‡ ]

                These authors have contributed equally to this work

                Specialty Section: This article was submitted to Neonatology, a section of the journal Frontiers in Pediatrics

                Article
                10.3389/fped.2022.1086920
                9875845
                36542c90-c2b7-4f00-b48a-985e05714816
                © 2023 Li, Shen, Wu, Mao, Liu, Chang, Zhang, Ye, Qiu, Ma, Cheng, Wu, Chen, Chen, Xu, Mei, Wang, Xu, Ju, Zheng, Lin and Tong.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 November 2022
                : 14 December 2022
                Page count
                Figures: 1, Tables: 7, Equations: 0, References: 30, Pages: 0, Words: 0
                Funding
                Funded by: Guidance Project of Xiamen Science and Technology Plan
                Award ID: 3502Z20199139, 3502Z20214ZD1225
                Funded by: Natural Science Foundation of Fujian Province, doi 10.13039/501100003392;
                Award ID: 2022D004
                This study was supported by Guidance Project of Xiamen Science and Technology Plan (grant number 3502Z20199139, 3502Z20214ZD1225); Natural Science Foundation of Fujian Province (2022D004).
                Categories
                Pediatrics
                Original Research

                antenatal corticosteroids,enteral feeding,extrauterine growth restriction,nutrition,postnatal growth,very preterm infants,weight growth velocity,z-score

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