Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

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Abstract

Background

Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants.

Methods

A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes.

Results

A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed.

Conclusions

Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

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Most cited references 37

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Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

C Agostoni, G. Buonocore, VP Carnielli … (2010)

The number of surviving children born prematurely has increased substantially during the last 2 decades. The major goal of enteral nutrient supply to these infants is to achieve growth similar to foetal growth coupled with satisfactory functional development. The accumulation of knowledge since the previous guideline on nutrition of preterm infants from the Committee on Nutrition of the European Society of Paediatric Gastroenterology and Nutrition in 1987 has made a new guideline necessary. Thus, an ad hoc expert panel was convened by the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in 2007 to make appropriate recommendations. The present guideline, of which the major recommendations are summarised here (for the full report, see http://links.lww.com/A1480), is consistent with, but not identical to, recent guidelines from the Life Sciences Research Office of the American Society for Nutritional Sciences published in 2002 and recommendations from the handbook Nutrition of the Preterm Infant. Scientific Basis and Practical Guidelines, 2nd ed, edited by Tsang et al, and published in 2005. The preferred food for premature infants is fortified human milk from the infant's own mother, or, alternatively, formula designed for premature infants. This guideline aims to provide proposed advisable ranges for nutrient intakes for stable-growing preterm infants up to a weight of approximately 1800 g, because most data are available for these infants. These recommendations are based on a considered review of available scientific reports on the subject, and on expert consensus for which the available scientific data are considered inadequate.

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European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

David G. Sweet, Virgilio Carnielli, Gorm Greisen … (2019)

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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Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

Devender Roberts, Julie Brown, Nancy Medley … (2017)

Respiratory morbidity including respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. While researching the effects of the steroid dexamethasone on premature parturition in fetal sheep in 1969, Liggins found that there was some inflation of the lungs of lambs born at gestations at which the lungs would be expected to be airless. Liggins and Howie published the first randomised controlled trial in humans in 1972 and many others followed.

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Author and article information

Contributors

Yanna Zhu:

ORCID: http://orcid.org/0000-0003-4160-3695

zhuyn3@mail.sysu.edu.cn

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 12 January 2021

Publication date PMC-release: 12 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 50

Affiliations

[1 ]GRID grid.12981.33, ISNI 0000 0001 2360 039X, Department of Maternal and Child Health, School of Public Health, , Sun Yat-sen University, ; No. 74 Zhongshang 2nd Road, Guangzhou, 510080 China

[2 ]Department of Neonatology, Foshan Woman and Children’s Hospital, Foshan, China

[3 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, Comparative Pediatrics and Nutrition, , University of Copenhagen, ; Copenhagen, Denmark

[4 ]GRID grid.440221.1, Department of Neonatology, , Shenzhen Bao’an Maternal and Child Health Hospital, ; Shenzhen, China

[5 ]Department of Neonatology, Shenzhen Nanshan People’s Hospital, Shenzhen, China

[6 ]Department of Neonatology, Shenzhen Maternity & Child Health Care Hospital, Shenzhen, China

[7 ]GRID grid.459579.3, Department of Neonatology, , Guangdong Women and Children Hospital, ; Guangzhou, China

[8 ]GRID grid.475435.4, Department of Pediatrics and Adolescent Medicine, ; Rigshospitalet, Copenhagen, Denmark

Author information

Yanna Zhu http://orcid.org/0000-0003-4160-3695

Article

Publisher ID: 3510

DOI: 10.1186/s12884-020-03510-w

PMC ID: 7801876

PubMed ID: 33435921

SO-VID: fe000b3d-bccd-45a0-9f0d-54f676b5f726

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 22 July 2020

Date accepted : 21 December 2020

Funding

Funded by: Guangdong Provincial Natural Science Foundation

Award ID: 2017A030313844

Award Recipient : Yanna Zhu

Funded by: FundRef http://dx.doi.org/10.13039/501100012151, Sanming Project of Medicine in Shenzhen;

Award ID: SZSM201803061

Award Recipient : Yanna Zhu

Funded by: the Fundamental Research Funds for the Central Universities in SYSU

Award ID: 15ykpy09

Award Recipient : Yanna Zhu

Funded by: NEOMUNE

Award ID: 51000-71030047

Award Recipient : Yanna Zhu

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal corticosteroids,growth,nutrition,very low birth weight

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal corticosteroids, growth, nutrition, very low birth weight

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Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

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Animal models of intrauterine growth restriction (IUGR)

Most cited references 37

Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.

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