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Postnatal corticosteroid response in neonates < 32 weeks and relation with placental pathology

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Abstract

Acute chorioamnionitis and maternal vascular malperfusion are associated with an increased risk of bronchopulmonary dysplasia. To prevent bronchopulmonary dysplasia, postnatal corticosteroids are given to preterm neonates. Clinical observations indicate not all neonates respond to corticosteroids, the so-called non-responders. This study aimed to investigate the association between placental pathology and short-term response to postnatal corticosteroids in neonates < 32 weeks postconceptional age at risk for bronchopulmonary dysplasia. All neonates < 32 weeks born between 2009 and 2016, receiving corticosteroids in the course of BPD, were included. The preterm neonates were divided into three groups depending on placental histology: acute chorioamnionitis, maternal vascular malperfusion, or no placental pathology. Respiratory support was assessed prior to treatment and at days 4 and 7. A responder was defined as extubation within 7 days after starting corticosteroid treatment. In total, 52% of the chorioamnionitis neonates, 67% of the maternal vascular malperfusion neonates, and 58% of neonates in the no pathology group were responders. The odds ratio for extubation was 0.53 (0.18–1.55) at day 4 and 0.66 (0.23–1.97) at day 7, in the chorioamnionitis group compared to the maternal vascular malperfusion.

Conclusion: Short-term response to postnatal corticosteroids did not significantly differ between premature neonates born after acute chorioamnionitis, maternal vascular malperfusion, or no placenta pathology. However, a trend of better corticosteroid response in maternal vascular malperfusion neonates was found, potentially due to differences in prenatal pulmonary development and postnatal cortisol.

What is Known:

• Bronchopulmonary dysplasia is related to chorioamnionitis and maternal vascular malperfusion.

• Corticosteroids remain an important treatment in the course of bronchopulmonary dysplasia despite conflicting results and non-responsiveness in some preterm neonates.

What is New:

• Non-responsiveness might be related to differences in pulmonary inflammation and systemic cortisol due to predispositions triggered by chorioamnionitis or maternal vascular malperfusion.

• Neonates born after maternal vascular malperfusion seem to respond better to postnatal corticosteroid treatment.

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Abbreviations

BPD :

Bronchopulmonary dysplasia

BW :

Birth weight

CA :

Chorioamnionitis

CPAP:

Continues positive airway pressure

FGR:

Fetal growth restriction

FIR:

Fetal inflammatory response

FiO2 :

Oxygen demand

GA:

Gestational age

HFO:

High frequency oscillation

MAP:

Mean airway pressure

MVM:

Maternal vascular malperfusion

LF :

Low flow

NIPPV:

Non-invasive positive pressure ventilation

NP:

No pathology

PEEP:

Positive end expiratory pressure

PH:

Pulmonary hypertension

PIP:

Peak inspiratory pressure

PROM:

Premature rupture of membranes

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Acknowledgements

We are grateful for the reviewers to assess our article.

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Authors and Affiliations

  1. Isala Hospital (Neonatal Intensive Care Unit), Zwolle, The Netherlands

    V. M. Koenders, A. Appels, H. L. M. van Straaten & M. A. C. Hemels

  2. Isala Hospital (Department of Pathology), Zwolle, The Netherlands

    A. C. Dutman

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  1. V. M. Koenders
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  2. A. Appels
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  3. H. L. M. van Straaten
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  4. A. C. Dutman
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  5. M. A. C. Hemels
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Contributions

V. M. Koenders retrieved and assessed the data and wrote the main manuscript. A. Appels debated the results and made editorial comments. H. L. M. van Straaten and M. A. C. Hemels debated the results and reviewed the article. A. C. Dutman assessed all placentas and made editorial comments. All authors advised and reviewed the manuscript.

Corresponding author

Correspondence to V. M. Koenders.

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The hospitals’ medical ethical committee approved the study.

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Communicated by Daniele De Luca.

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Koenders, V.M., Appels, A., van Straaten, H.L.M. et al. Postnatal corticosteroid response in neonates < 32 weeks and relation with placental pathology. Eur J Pediatr 182, 265–274 (2023). https://doi.org/10.1007/s00431-022-04672-9

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  • DOI: https://doi.org/10.1007/s00431-022-04672-9

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