Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. Copyright © 2004 by Sociedade Brasileira de Pediatria.804277284Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3), pp. CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States National Reference for fetal growth (1996) Obstet Gynecol, 87, pp. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio

Antenatal Corticosteroid Use And Clinical Evolution Of Preterm Newborn Infants [uso Antenatal De Corticosteóide E Evolução Clínica De Recém-nascidos Pré-termo]

Objectives: To describe the use of antenatal corticosteroid and clinical evolution of preterm babies. Methods: An observational prospective cohort study was carried out. All 463 pregnant women and their 514 newborn babies with gestational age ranging from 23 to 34 weeks, born at the Brazilian Neonatal Research Network units, were evaluated from August 1 to December 31, 2001. The data were obtained through maternal interview, analysis of medical records, and follow-up of the newborn infants. Data analysis was performed with the use of chi-square, t Student, Mann-Whitney, and ANOVA tests and multiple logistic regression, with level of significance set at 5%. Results: Treatment was directly associated with the number of prenatal visits, with maternal hypertension and with the antenatal use of tocolytic agents. Babies from treated pregnant women presented better Apgar scores at the 1st and 5th minute, reduced need for intervention in the delivery room and lower SNAPPE II. They were born with higher birth weight, longer gestational age and needed less surfactant use, ventilation, and oxygenation time. After multiple logistic regression, the use of antenatal corticosteroid independently improved birth conditions, decreased ventilation time, being related to increased occurrence of neonatal sepsis. Conclusions: The use of corticosteroid was associated with better prenatal care and birth conditions, better preterm evolution but higher risk of infection. © 2007 Sociedad Chilena de Pediatría.775531532Liggins, G.C., Howie, R.N., A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants (1972) Pediatrics, 50, pp. 515-525Crowley, P., Prophylactic corticosteroids for preterm birth (2002) Cochrane Database Syst Rev, (3). , CD000065Ryan, C.A., Finer, N.N., Antenatal corticosteroid therapy to prevent respiratory distress syndrome (1995) J Pediatr, 126, pp. 317-319Chien, L., Ohlsson, A., Seshia, M.M.K., Boulton, J., Sankaran, K., Lee, S.K., Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of evidence (2002) Obstet Gynecol, 99, pp. 401-408Albuquerque, I.C.C., Amorim, M.M.R., Meneses, J., Katz, L., Santos, L.C., Avaliação do impacto da corticiterapia antenatal para a aceleração da maturidade pulmonar fetal nos recém-nascidos em maternidade escola brasileira (2002) RBGO, 24, pp. 655-661Krauss-Silva, L., Costa, T.P., Reis, A.F., Iamada, N.O., Azevedo, A.P., Albuquerque, C.P., Avaliação da qualidade da assistência hospitalar obstétrica: Uso de corticóides no trabalho de parto prematuro (1999) Cad Saúde Pública, 15, pp. 817-829Chung, C.S., Myrianthopoulos, N.C., Congenital anomalies: Mortality and morbidity, burden and classification (1987) Am J Med Genet, 27, pp. 505-523Ballard, J.L., Khoury, J.C., Wedig, K., Wang, L., Eilers-Walsman, B.L., Lipp, R., New Ballard Score, expanded to include extremely premature infants (1991) J Pediatr, 119, pp. 417-423Alexander, G.R., Himes, J.H., Kaufman, R.B., Mor, J., Kogan, M., A United States National Reference for fetal growth (1996) Obstet Gynecol, 87, pp. 163-168Niermeyer, S., Kattwinkel, J., Van Reempts, P., Nadkarni, V., Phillips, B., Zideman, D., International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines (2000) Pediatrics, 106 (3), pp. E29Apgar, V., A proposal for a new method of evaluation of the newborn infant (1953) Curr Res Anesth Analg, 32, pp. 260-267Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Walsh, M.C., Kliegman, R.M., Necrotizing enterocolitis: Treatment based on staging criteria (1986) Pediatr Clin North Am, 33, pp. 179-201Papile, L.A., Burstein, J., Burstein, R., Koffler, H., Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1,500 gm (1978) J Pediatr, 92, pp. 529-534Bloom, S.L., Leveno, K.J., Corticosteroid use in special circumstances: Preterm ruptured membranes, hypertension, fetal growth restriction, multiple fetuses (2003) Clin Obstet Gynecol, 45, pp. 150-160Gardner, M.O., Goldenberg, R.L., Gaudier, F.L., Dubard, M.B., Nelson, K.G., Hauth, J.C., Predicting low Apgar scores of infants weighing less than 1000 grams: The effect of corticosteroids (1995) Obstet Gynecol, 85, pp. 170-174Banks, B.A., Macones, G., Cnaan, A., Merrill, J.D., Ballard, J.D., Ballard, R.A., Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates (2002) J Perinatol, 22, pp. 101-107Vermillion, S.T., Soper, D.E., Chasedunn-Roak, J., Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes (1999) Am J Obstet Gynecol, 181, pp. 320-327Gunkel, J.H., Mitchell, B.R., Observational evidence for the efficacy of antenatal steroids from randomized studies of surfactant replacement (1995) Am J Obstet Gynecol, 173, pp. 281-285Antenatal corticosteroid therapy for fetal maturation (2002) Obstet Gynecol, 99, pp. 871-873. , ACOG Committee Opinio

Evaluation Of The Neonatal Outcomes Of The Kangaroo Mother Method In Brazil [avaliação Dos Resultados Neonatais Do Método Canguru No Brasil]

Objective: To evaluate the results of the kangaroo mother method in Brazil. Methods: A prospective cohort study comparing 16 units that have or do not have the second phase of the kangaroo mother method: eight were national centers of excellence for the kangaroo mother method (study group) and eight were part of the Brazilian Neonatal Research Network (control group). A total of 985 newborn infants with birth weights of 500 to 1,749 g were enrolled. Multivariate analyses employedmultiple linear regression and Poisson regression with robust adjustment. Results: The adjusted analysis (controlled for birth weight, gestational age, Score for Neonatal Acute Physiology Perinatal Extension II, Neonatal Therapeutic Intervention Scoring System, and maternal age and educational level) demonstrated that mean length of hospital stay (p = 0.14) and intercurrent clinical conditions in the intermediate or kangaroo unit were equal for both groups. Weight (p = 0.012), length (p = 0.039) and head circumference (p = 0.006) at 36 weeks' corrected gestational age were all lower at the kangaroo units. The kangaroo units exhibited superior performance in relation to exclusive breastfeeding at discharge (69.2 vs. 23.8%, p=0.022). Conclusions: The evidence suggests that the humanization strategy adopted by the Brazilian Ministry of Health is a safe alternative to conventional treatment and a good strategy for promoting breastfeeding. Copyright © 2008 by Sociedade Brasileira de Pediatria.845428435Mathelin, C., (1999) Osorriso da Gioconda: Clínica psicanalí ticacombebês prematuros, , Rio de Janeiro: Companhia de Freud;Lamy, Z.C., (2000) Unidade neonatal: Um espaço de conflitos e negociações [Tese], , Rio de Janeiro, RJ: Fundação Oswaldo Cruz;Walsh-Sukys M, Reitenbach A, Hudson-Barr D, DePompei P. Reducing light and sound in the neonatal intensive care unit: an evaluation of patient safety, staff satisfaction, and costs. J Perinatol. 2001;21:230-5. Erratum in: J Perinatol. 2001;21:572Martín Ancel, A., Iriondo Sanz, M., Fina Martí, A., Roqués Serradilla, V., García Del Río, M., López Sastre, J.B., On recommendations, protocols, and clinical guidelines (2001) An Esp Pediatr, 55, pp. 99-100Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS1999Brasil. Ministério da Saúde. Norma da atenção humanizada ao recém-nascido de baixo peso - Método Canguru. Brasília, DF: MS2000Rey, E., Martínez, H., Manejo racional del niño prematuro (1983) Bogotá, (Colombia): Universidad NacionalCurso de Medicina FetalAnderson GC, Marks EA, Wahlberg V. Kangaroo care for premature infants. AmJ Nurs. 1986;86:807-9. Erratum in: Am J Nurs. 1986;86:1000Anderson, G.C., Current knowledge about skin-to-skin (kangaroo) care for preterm infants (1991) J Perinatol, 11, pp. 216-226Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Mãe canguru para reduzir morbidade e mortalidade em recém-nascidos com baixo peso ao nascer (Cochrane Review). In: Resumos de Revisões Sistemáticas em Português, Issue 2, 2007. Oxford: Update SoftwareFeldman, R., Weller, A., Sirota, L., Eidelman, A.I., Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration (2002) Dev Psychol, 38, pp. 194-207Kirsten, G.F., Bergman, N.J., Hann, K.M., Kangaroo mother care in the nursery (2001) Pediatr Clin North Am, 48, pp. 443-452Ramanathan, K., Paul, V.K., Deorari, A., Taneja, U., George, G., Kangaroo Mother Care in very low birth weight infants (2001) Indian J Pediatr, 68, pp. 1019-1023Ludington-Hoe, S.M., Johnson, M.W., Morgan, K., Lewis, T., Gutman, J., Wilson, P.D., Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized, controlled trial of skin contact with preterm infants (2006) Pediatrics, 117, pp. e909-e923Gray, L., Watt, L., Blass, E.M., Skin-to-skin contact is analgesic in healthy newborns (2000) Pediatrics, 105, pp. e14Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., A randomized, controlled trial of kangaroo mother care: Results of follow-up at 1 year of corrected age (2001) Pediatrics, 108, pp. 1072-1079Penalva, O., Schwartzman, J.S., Descriptive study of the clinical and nutritional profile and follow-up of premature babies in a Kangaroo Mother Care Program (2006) J Pediatr (Rio J), 82, pp. 33-39Charpak, N., Ruiz-Pelaez, J.G., Figueroa de, C.Z., Charpak, Y., Kangaroo mother versus traditional care for newborn infants >/= 2,000 grams: A randomized, controlled trial (1997) Pediatrics, 100, pp. 682-688Ruiz-Peláez, J.G., Charpak, N., Cuervo, L.G., Kangaroo Mother Care, an example to follow from developing countries (2004) BMJ, 329, pp. 1179-1181Venancio, S.I., Almeida, H., Método Mãe Canguru: Aplicação no Brasil, evidências científicas e impacto sobre o aleitamento materno. (2004) J Pediatr (Rio J), 80, pp. S173-S180Richardson, D.K., Corcoran, J.D., Escobar, G.J., Lee, S.K., SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores (2001) J Pediatr, 138, pp. 92-100Gray, J.E., Richardson, D.K., McCormick, M.C., Workman-Daniels, K., Goldmann, D.A., Neonatal therapeutic intervention scoring system: A therapy-based severity-of-illness index (1992) Pediatrics, 90, pp. 561-567Barros, A.J., Hirakata, V.N., Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio (2003) BMC Med Res Methodol, 3, p. 21Roberts, K.L., Paynter, C., McEwan, B., A comparison of kangaroo mother care and conventional cuddling care (2000) Neonatal Netw, 19, pp. 31-35Cattaneo, A., Davanzo, R., Worku, B., Surjono, A., Echeverria, M., Bedri, A., Kangaroo mother care for low birth weight infants: A randomised controlled trial in different settings (1998) Acta Paediatr, 87, pp. 976-985Kadam, S., Binoy, S., Kanbur, W., Mondkar, J.A., Fernandez, A., Feasibility of kangaroo mother care in Mumbai (2005) Indian J Pediatr, 72, pp. 35-38Sloan, N.L., LeonCamacho, L.W., PintoRojas, E., Stern, C., Maternidad IsidroAyora Study Team. Kangaroo mother method: Randomised controlled trial of an alternative method of care for stabilised low-birthweight infants. Maternidad Isidro Ayora Study Team (1994) Lancet, 344, pp. 782-78