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187: Respiratory morbidity in the late preterm neonate (LPN)
Poster Session I
Clinical Obstetrics, Neonatology, Physiology-Endocrinology
187 Respiratory morbidity in the late preterm neonate (LPN) Judith U Hibbard1, Isabelle Wilkins1, Jun Zhang2, Jennifer Bailit3, Ronald Burkman4, Ware Branch5, Victor Gonzalez-Quintero6, Kimberly Gregory7, Shoshana Haberman8, Christos Hatjis9, Matthew Hoffman10, Michelle Kominiarek11, Helain Landy12, Mildred Ramirez13, Uma Reddy14, James Troendle14, Paul Vanveldhuisen15 1 University of Illinois at Chicago, Chicago, Illinois, 2Division of Epidemiology, Statistics and Prevention Research, NICHD, NIH, Maryland, 3MetroHealth, Case Western Reserve University, Cleveland, Ohio, 4Tufts University, Springfield, Massachusetts, 5Intermountain Healthcare and the University of Utah, Salt Lake City, Utah, 6University of Miami, Miami, Florida, 7Cedars-Sinai Medical Center, Los Angeles, California, 8Maimonides Medical Center, Brooklyn, New York, 9 Children’s Hospital Medical Center of Akron, Akron, Ohio, 10 Christiana Care Health System, Newark, Delaware, 11Indiana University, Indianapolis, Indiana, 12Georgetown University, Washington, District of Columbia, 13University of Texas Health Science Center at Houston, Houston, Texas, 14National Institute of Health (NIH), Bethesda, Maryland, 15Emmes Corporation, Rockville, Maryland
OBJECTIVE: To assess short-term respiratory morbidity in LPN compared to term in a large cohort across the US. STUDY DESIGN: The Consortium on Safe Labor retrospectively collected electronic data from 12 institutions on 233,844 deliveries 2002-08 and selected neonates: 34-40 6/7 wks, admitted to NICU with respiratory compromise. Delivery room resuscitation, respiratory support, surfactant, final diagnoses were obtained from detailed chart extractions and compared across wks GA using Chi square analysis. RESULTS: 199,645 infants delivered 34-40 6/7 wks; 20,618 were 34-36 6/7 wks: 6,467 admitted to NICU; 177,522 were 37-40 6/7 wks: 8,878 admitted to NICU. Detailed chart extractions were performed for 1,942 LPN and 1,693 term neonates with respiratory morbidity. There were more maternal cases of hypertensive and renal diseases, multiple gestations, and IUGR in the LPN group. The incidences (%) of all respiratory outcomes (table) were inversely proportional to GA, and significantly higher (p⬍0.05) across all weeks 38 wks. Intubation, ventilator use and any respiratory morbidity were significantly lower at 39 compared to 38 wks. GA (wks) 34 35 36 37 38 39 40 ........................................................................................................................................................................................................... Births(n)
3927
5840
10851
22212
45389
67407
44109
...........................................................................................................................................................................................................
Intub DR 3.24 1.82 0.91 0.33 0.14 0.09 0.10 ........................................................................................................................................................................................................... Ventilator 7.70 5.27 3.27 1.20 0.43 0.31 0.31 ........................................................................................................................................................................................................... Surfactant 8.74 5.04 2.43 0.78 0.16 0.16 0.14 ........................................................................................................................................................................................................... RDS 17.00 9.91 4.53 1.45 0.47 0.40 0.48 ........................................................................................................................................................................................................... TTN 7.67 5.33 2.74 1.06 0.38 0.32 0.36 ........................................................................................................................................................................................................... Pneum 1.16 1.13 0.67 0.28 0.14 0.12 0.18 ........................................................................................................................................................................................................... Resp fail 1.69 1.00 0.79 0.32 0.13 0.10 0.07 ........................................................................................................................................................................................................... All resp 20.81 12.25 5.98 2.25 0.89 0.70 0.77 ...........................................................................................................................................................................................................
CONCLUSION: We confirmed higher rates of respiratory morbidity in
LPN, allowing for improved counseling regarding risks of delivering late preterm and supporting that delivery prior to 39 weeks should not be performed without clear indications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.202
188 Maternal azithromycin or erythromycin administration is associated with a reduction in neonatal RDS Joseph Biggio1, Alan Tita1, Suzanne Cliver1, Wally Carlo1, WW Andrews1 1
University of Alabama at Birmingham, Birmingham, Alabama
OBJECTIVE: Ureaplasma (UU) colonization of the respiratory tract of
preterm infants is associated with neonatal lung disease, therefore postnatal treatment for UU has been proposed. Because many UU infections occur in utero, we examined whether antenatal exposure to
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macrolides is associated with a decrease in isolation of UU or Mycoplasma (Myco) in cord blood or placenta or a lower rate of neonatal lung disease. STUDY DESIGN: Maternal and neonatal data were collected prospectively in 293 singleton spontaneous births from 23-32 weeks gestation. We examined associations of antenatal administration of azithromycin (Azith) or erythromycin (Eryth), including timing prior to delivery, with culture data for UU and Myco in the cord blood and placenta. We also compared rates of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), and chronic lung disease (CLD) in relation to Azith or Eryth exposure. RESULTS: Mean GA at delivery was 28.4⫾ 2 weeks. 49% of births were due to PPROM and 51% spontaneous preterm labor. 70 women received either Azith or Eryth antenatally. Baseline maternal and fetal demographics were similar in those receiving and not receiving antibiotics. 56% of patients had UU or Myco isolated from the cord blood or the placenta. Azith or Erythro exposure was not associated with a difference in isolation of UU or Myco from either site (50 vs 58%, p⫽0.26). However, neonates whose mothers received Azith or Erythro had a lower rate of RDS (51 vs 66%, p⫽0.03), especially if treatment had been given 6 or more hours prior to delivery (48 vs 66%, p⫽0.01). Rates of BPD (14 vs 20%), and CLD (3 vs 9%) were nominally lower with at least 6 hours of antibiotic therapy, although not statistically significant (p⫽0.3; p⫽0.14, respectively). CONCLUSION: Maternal administration of azithromycin or erythromycin antenatally is associated with a lower rate of RDS, and potentially BPD, in preterm infants born between 23-32 weeks. Issues related to timing of antibiotic administration and the effect on neonatal UU colonization, BPD, and CLD warrant further investigation. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.203
189 The association of cord serum cytokines with neurodevelopmental outcomes Michael Varner1, Nicole Marshall1 1 for the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network, Bethesda, Maryland
OBJECTIVE: Children born of pregnancies complicated by spontane-
ous preterm birth are at increased risk of subsequent cerebral palsy (CP) and neurodevelopmental delay (NDD). We conducted this analysis to test whether inflammatory cytokine levels in umbilical cord blood are associated with CP or NDD. STUDY DESIGN: Nested case-control analysis within an RCT of antenatal MgSO4 before anticipated preterm birth (PTB) for prevention of CP. Surviving children were evaluated at age 2 for evidence of CP and NDD. NDD was defined as a Bayley PDI and/or MDI ⬍ 70. Controls, defined as surviving children without CP and with Bayley PDI and MDI ⬎ 85, were matched by race and early preterm birth (⬍32 vs ⬎⫽32 weeks). Cord serum was collected and frozen at ⫺70 F until thawed for batch ELISA analysis of IL-8, IL-1 and TNF-␣ levels. Elevated cord serum cytokine levels were those above the 75th %ile in placebo-exposed controls. Univariate and multivariate analyses compared cytokine levels between cases and controls. Adjustments were made for MgSO4 exposure, gestational age (GA), and maternal education (MDI score only). RESULTS: In univariate analysis, elevated IL-1 was more common in cord blood from infants with subsequent low MDI than controls, but there were no differences for CP or low PDI. IL-8 and TNF-␣ were not elevated with CP or NDD. After adjusting for confounders, the significant differences were no longer evident (Table). CONCLUSION: Umbilical cord serum levels of IL-8, IL-1, and TNF-␣ are not altered in infants with subsequent CP or NDD.
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009
Clinical Obstetrics, Neonatology, Physiology-Endocrinology
187 Respiratory morbidity in the late preterm neonate (LPN) Judith U Hibbard1, Isabelle Wilkins1, Jun Zhang2, Jennifer Bailit3, Ronald Burkman4, Ware Branch5, Victor Gonzalez-Quintero6, Kimberly Gregory7, Shoshana Haberman8, Christos Hatjis9, Matthew Hoffman10, Michelle Kominiarek11, Helain Landy12, Mildred Ramirez13, Uma Reddy14, James Troendle14, Paul Vanveldhuisen15 1 University of Illinois at Chicago, Chicago, Illinois, 2Division of Epidemiology, Statistics and Prevention Research, NICHD, NIH, Maryland, 3MetroHealth, Case Western Reserve University, Cleveland, Ohio, 4Tufts University, Springfield, Massachusetts, 5Intermountain Healthcare and the University of Utah, Salt Lake City, Utah, 6University of Miami, Miami, Florida, 7Cedars-Sinai Medical Center, Los Angeles, California, 8Maimonides Medical Center, Brooklyn, New York, 9 Children’s Hospital Medical Center of Akron, Akron, Ohio, 10 Christiana Care Health System, Newark, Delaware, 11Indiana University, Indianapolis, Indiana, 12Georgetown University, Washington, District of Columbia, 13University of Texas Health Science Center at Houston, Houston, Texas, 14National Institute of Health (NIH), Bethesda, Maryland, 15Emmes Corporation, Rockville, Maryland
OBJECTIVE: To assess short-term respiratory morbidity in LPN compared to term in a large cohort across the US. STUDY DESIGN: The Consortium on Safe Labor retrospectively collected electronic data from 12 institutions on 233,844 deliveries 2002-08 and selected neonates: 34-40 6/7 wks, admitted to NICU with respiratory compromise. Delivery room resuscitation, respiratory support, surfactant, final diagnoses were obtained from detailed chart extractions and compared across wks GA using Chi square analysis. RESULTS: 199,645 infants delivered 34-40 6/7 wks; 20,618 were 34-36 6/7 wks: 6,467 admitted to NICU; 177,522 were 37-40 6/7 wks: 8,878 admitted to NICU. Detailed chart extractions were performed for 1,942 LPN and 1,693 term neonates with respiratory morbidity. There were more maternal cases of hypertensive and renal diseases, multiple gestations, and IUGR in the LPN group. The incidences (%) of all respiratory outcomes (table) were inversely proportional to GA, and significantly higher (p⬍0.05) across all weeks 38 wks. Intubation, ventilator use and any respiratory morbidity were significantly lower at 39 compared to 38 wks. GA (wks) 34 35 36 37 38 39 40 ........................................................................................................................................................................................................... Births(n)
3927
5840
10851
22212
45389
67407
44109
...........................................................................................................................................................................................................
Intub DR 3.24 1.82 0.91 0.33 0.14 0.09 0.10 ........................................................................................................................................................................................................... Ventilator 7.70 5.27 3.27 1.20 0.43 0.31 0.31 ........................................................................................................................................................................................................... Surfactant 8.74 5.04 2.43 0.78 0.16 0.16 0.14 ........................................................................................................................................................................................................... RDS 17.00 9.91 4.53 1.45 0.47 0.40 0.48 ........................................................................................................................................................................................................... TTN 7.67 5.33 2.74 1.06 0.38 0.32 0.36 ........................................................................................................................................................................................................... Pneum 1.16 1.13 0.67 0.28 0.14 0.12 0.18 ........................................................................................................................................................................................................... Resp fail 1.69 1.00 0.79 0.32 0.13 0.10 0.07 ........................................................................................................................................................................................................... All resp 20.81 12.25 5.98 2.25 0.89 0.70 0.77 ...........................................................................................................................................................................................................
CONCLUSION: We confirmed higher rates of respiratory morbidity in
LPN, allowing for improved counseling regarding risks of delivering late preterm and supporting that delivery prior to 39 weeks should not be performed without clear indications. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.202
188 Maternal azithromycin or erythromycin administration is associated with a reduction in neonatal RDS Joseph Biggio1, Alan Tita1, Suzanne Cliver1, Wally Carlo1, WW Andrews1 1
University of Alabama at Birmingham, Birmingham, Alabama
OBJECTIVE: Ureaplasma (UU) colonization of the respiratory tract of
preterm infants is associated with neonatal lung disease, therefore postnatal treatment for UU has been proposed. Because many UU infections occur in utero, we examined whether antenatal exposure to
S82
www.AJOG.org
macrolides is associated with a decrease in isolation of UU or Mycoplasma (Myco) in cord blood or placenta or a lower rate of neonatal lung disease. STUDY DESIGN: Maternal and neonatal data were collected prospectively in 293 singleton spontaneous births from 23-32 weeks gestation. We examined associations of antenatal administration of azithromycin (Azith) or erythromycin (Eryth), including timing prior to delivery, with culture data for UU and Myco in the cord blood and placenta. We also compared rates of respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), and chronic lung disease (CLD) in relation to Azith or Eryth exposure. RESULTS: Mean GA at delivery was 28.4⫾ 2 weeks. 49% of births were due to PPROM and 51% spontaneous preterm labor. 70 women received either Azith or Eryth antenatally. Baseline maternal and fetal demographics were similar in those receiving and not receiving antibiotics. 56% of patients had UU or Myco isolated from the cord blood or the placenta. Azith or Erythro exposure was not associated with a difference in isolation of UU or Myco from either site (50 vs 58%, p⫽0.26). However, neonates whose mothers received Azith or Erythro had a lower rate of RDS (51 vs 66%, p⫽0.03), especially if treatment had been given 6 or more hours prior to delivery (48 vs 66%, p⫽0.01). Rates of BPD (14 vs 20%), and CLD (3 vs 9%) were nominally lower with at least 6 hours of antibiotic therapy, although not statistically significant (p⫽0.3; p⫽0.14, respectively). CONCLUSION: Maternal administration of azithromycin or erythromycin antenatally is associated with a lower rate of RDS, and potentially BPD, in preterm infants born between 23-32 weeks. Issues related to timing of antibiotic administration and the effect on neonatal UU colonization, BPD, and CLD warrant further investigation. 0002-9378/$ – see front matter • doi:10.1016/j.ajog.2009.10.203
189 The association of cord serum cytokines with neurodevelopmental outcomes Michael Varner1, Nicole Marshall1 1 for the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network, Bethesda, Maryland
OBJECTIVE: Children born of pregnancies complicated by spontane-
ous preterm birth are at increased risk of subsequent cerebral palsy (CP) and neurodevelopmental delay (NDD). We conducted this analysis to test whether inflammatory cytokine levels in umbilical cord blood are associated with CP or NDD. STUDY DESIGN: Nested case-control analysis within an RCT of antenatal MgSO4 before anticipated preterm birth (PTB) for prevention of CP. Surviving children were evaluated at age 2 for evidence of CP and NDD. NDD was defined as a Bayley PDI and/or MDI ⬍ 70. Controls, defined as surviving children without CP and with Bayley PDI and MDI ⬎ 85, were matched by race and early preterm birth (⬍32 vs ⬎⫽32 weeks). Cord serum was collected and frozen at ⫺70 F until thawed for batch ELISA analysis of IL-8, IL-1 and TNF-␣ levels. Elevated cord serum cytokine levels were those above the 75th %ile in placebo-exposed controls. Univariate and multivariate analyses compared cytokine levels between cases and controls. Adjustments were made for MgSO4 exposure, gestational age (GA), and maternal education (MDI score only). RESULTS: In univariate analysis, elevated IL-1 was more common in cord blood from infants with subsequent low MDI than controls, but there were no differences for CP or low PDI. IL-8 and TNF-␣ were not elevated with CP or NDD. After adjusting for confounders, the significant differences were no longer evident (Table). CONCLUSION: Umbilical cord serum levels of IL-8, IL-1, and TNF-␣ are not altered in infants with subsequent CP or NDD.
American Journal of Obstetrics & Gynecology Supplement to DECEMBER 2009