Neonatal outcomes of antenatal corticosteroids in preterm multiple pregnancies compared to singletons.

BACKGROUND: Antenatal corticosteroids (ACS) during preterm labour reduce neonatal mortality and morbidity. Evidence on preterm multiple pregnancies is limited and contradictory. OBJECTIVE: Compare the effect of ACS on very low birth weight infant's (VLBW) mortality and morbidity among singleton and multiple pregnancies. STUDY DESIGN: Retrospective cohort study, employing prospectively collected data, of infants 23 to 34 weeks' gestation and 500 to 1500 g born at the Neocosur Neonatal Network centers during 2007-2016. Neonatal outcomes were compared among singleton and multiple pregnancies exposed to at least one dose of ACS to those not exposed using logistic regression analyses controlled for birthweight, gestational age, sex, small for gestational age (SGA) and mode of delivery. RESULTS: A total of 13,864 infants were studied; 2948 multiple (21.3%) and 10,904 singleton pregnancies (78.7%). Overall, 11,218 (81.4%) received at least one dose of ACS with a significant reduction in the risk of death, RDS and grade III or IV IVH compared to those not exposed. Both singleton and multiple pregnancies exposed to ACS showed similar reduced risk of death (aRR 0.41 [95% CI, 0.36-0.47] vs. aRR 0.46 [95% CI, 0.34-0.64]). However, ACS were not associated with reduced odds of RDS (aRR 0.89 [95% CI, 0.66-1.23]) or grade III or IV IVH (aRR 0.99 [95% CI, 0.67-1.48]) in multiple pregnancies. CONCLUSION: The benefit of administration of at least one dose of ACS in VLBW multiple and singleton pregnancies is comparable in terms of death. However, ACS showed no relevant impact in short-term morbidity in multiple pregnancies.

[Incidence of group B streptococcal early-onset sepsis in infants born at Centro Hospitalario Pereira Rossell between 2007-2015]. / Incidencia de sepsis precoz por Streptococcus agalactiae en recién nacidos del Centro Hospitalario Pereira Rossell en el período 2007-2015.

BACKGROUND: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. AIMS: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. METHODS: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. RESULTS: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. CONCLUSION: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.

Outcomes of preterm infants treated with hypothermia for hypoxic-ischemic encephalopathy.

BACKGROUND: Therapeutic hypothermia reduces the risk of death, or moderate to severe neurodevelopmental impairment (NDI) in term infants with hypoxic-ischemic encephalopathy (HIE). Reports of its safety and efficacy in preterm infants are scarce. OBJECTIVE: Report short and long-term outcomes of preterm infants with HIE who received therapeutic hypothermia. METHODS: A retrospective cohort analysis of all preterm infants <36 weeks' gestation with HIE who received whole body hypothermia in a single center from January 2007 to April 2015. The primary outcome was death or moderate to severe NDI defined by moderate or severe cerebral palsy, severe hearing or visual impairment, or cognitive score < 85 on the Bayley Scales of Infant Development III (BSID III) at 18-24 months' adjusted age. RESULTS: 30 infants with a median gestational age and birthweight of 35 weeks' (range; 33-35) and 2575 g (1850-4840) and a median first postnatal blood pH of 6.81 (6.58-7.14). Complications included coagulopathy (50%), early clinical seizures (43.3%), arterial hypotension (40%), persistent metabolic acidosis (37%) and thrombocytopenia (20%). Four infants died before or soon after discharge (18.2%). Eighteen surviving infants (69.2%) had follow up data; 7 of them had moderate to severe NDI (38.9%). Cognitive, motor and language mean composite BSID III scores were 84 (54-110), 83 (46-118), and 78 (46-112). Death or moderate to severe NDI occurred in 11/22 (50%) infants with known outcomes. CONCLUSION: Large randomized trials on efficacy and safety are needed in this highly vulnerable population as the incidence of complications and the combined outcome of death and NDI is concerning.

Incidencia de sepsis precoz por Streptococcus agalactiae en recién nacidos del Centro Hospitalario Pereira Rossell en el período 2007-2015 / Incidence of group B streptococcal early-onset sepsis in infants born at Centro Hospitalario Pereira Rossell between 2007-2015

Resumen Introducción La infección por Streptococcus agalactiae (β-hemolítico del grupo B (SGB) continúa siendo una de las principales causas de sepsis precoz en países desarrollados a pesar de la implementación de profilaxis efectiva. Objetivos Describir la incidencia, características clínicas y mortalidad de sepsis precoz por SGB en recién nacidos del Centro Hospitalario Pereira Rossell (CHPR), y analizar las fallas de adherencia a las estrategias de prevención. Métodos Estudio retrospectivo de descripción de casos entre los años 2007 a 2015 identificados a partir de la base de datos del laboratorio de bacteriología. Resultados Se identificaron 15 casos de sepsis neonatal precoz a SGB con una incidencia en el período de estudio de 0,23‰. La quimioprofilaxis intraparto no fue realizada en caso alguno. Todos los recién nacidos se presentaron sintomáticos en las primeras 15 h de vida. La dificultad respiratoria fue el signo más frecuente (80%). En un caso se aisló SGB de líquido cefalorraquídeo. La mortalidad fue de 20%. Todas las muertes ocurrieron en las primeras 24 h de vida, siendo dos tercios prematuros. Conclusión La incidencia de sepsis precoz por SGB en el CHPR fue similar a la incidencia en centros donde se realiza quimioprofilaxis. Una mejor adherencia a las estrategias de prevención podría disminuir la incidencia.

Background: Group B Streptococcus (GBS) disease remains the leading cause of early-onset sepsis (EOS) in developed countries despite effective prophylaxis strategies. Aims: To describe the incidence, clinical features and mortality of GBS EOS in infants born at Centro Hospitalario Pereira Rossell (CHPR) and analyse failure of adherence to prevention strategies. Methods: Retrospective review of EOS cases between 2007 and 2015 collected from the bacteriology laboratory database. Results: Fifteen cases of GBS EOS were identified, with an incidence of 0.23% during the study period. Intrapartum antibiotic prophylaxis (IAP) was not administered in any of the cases. All infants were symptomatic within the first 15 hours of life, mainly due to respiratory signs (80%). In one case, GBS was isolated from spinal fluid. Mortality rate was 20%. All deaths occurred in the first 24 hours of life, corresponding two thirds to preterm infants. Conclusion: The incidence of GBS EOS at CHPR was similar to other centers where IAP is implemented. Better adherence to prophylaxis strategies could reduce the incidence.