Prevention of respiratory disorders in late preterm neonates born to mothers with abnormally invasive placenta

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Abstract

Objective: To evaluate the efficacy of antenatal prevention of neonatal respiratory distress syndrome (RDS) at 34/0–36/6 weeks of gestation at preterm delivery in patients with abnormally invasive placenta and to determine the optimal timing and frequency of maternal antenatal corticosteroid (AC) administration in pregnant women with abnormally invasive placenta.

Materials and methods: This study included 226 late preterm neonates born to mothers with abnormally invasive placenta. The patients were divided into Group 1 (study group, n=80), which comprised children whose mothers received a full course of RDS prevention within 7 days before delivery, and Group 2 (control group, n=146), which consisted of children born to mothers who received antenatal RDS prevention for > 7 days before delivery. Furthermore, the children were divided into four subgroups: subgroup 1A (n=42) included children whose mothers received a single course of RDS prevention no more than seven days before delivery; subgroup 1B (n=35) included children whose mothers received two courses of RDS prevention, one of which was no more than seven days before delivery. Subgroups 2A (n=97) and 2B (n=45) represented children whose mothers had received RDS prevention more than seven days before delivery once and twice, respectively. The analyzed parameters included gestational age (GA) of the newborns, birth weight and length, sex, Apgar score at 1 and 5 minutes, frequency and duration of neonatal respiratory therapy (non-invasive respiratory support, invasive mechanical ventilation (IMV), high-frequency oscillatory ventilation (HFOV), maximum required mean airway pressure, frequency and duration of supplemental oxygen delivery, frequency of surfactant therapy and neonatal hypoglycemia, length of stay in the NICU, and total length of infant hospitalization.

Results: Infants born to mothers with abnormally invasive placentas who were given RDS prevention seven days before birth were 1.6 times less likely to require intubation and invasive respiratory therapy (RR [95%CI] 0.62 [0.39; 0.96]), 1.8 times less likely to require HFOV (RR [95%CI] 0.57 [0.35;0.93]), and 1.7 times less likely to require supplemental oxygen (RR [95%CI] 0.59 [0.39;0.87]). The required oxygen concentration in this group was significantly lower, and there was a significantly shorter total duration of respiratory support and a shorter length of stay in the NICU. When comparing cases with single and double courses of RDS prevention, considering the time of administration in relation to labor, no significant benefits of increasing the frequency of courses were found.

Conclusion: Antenatal RDS prevention during the latest 7 days before delivery is effective in reducing the severity of respiratory disorders in late preterm infants of 34/0-36/6 gestational age born to mothers with abnormally invasive placenta. The course of RDS prevention in the earlier stages of pregnancy is not decisive, and in patients with abnormally invasive placenta, an additional course is required during the week before the planned delivery.

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About the authors

Anastasia D. Nikonets

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: nikon.na@yandex.ru
ORCID iD: 0000-0002-4717-1865

MD, PhD Student at the Neonatal Intensive Care Unit named after Prof. A.G. Antonov, Institute of Neonatology and Pediatrics

Russian Federation, 117997, Moscow, Oparina str., 4

Ekaterina N. Balashova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_balashova@oparina4.ru
ORCID iD: 0000-0002-3741-0770

MD, PhD, Leading Researcher at the Neonatal Intensive Care Unit named after Prof. A.G. Antonov, Institute of Neonatology and Pediatrics

Russian Federation, 117997, Moscow, Oparina str., 4

Oleg V. Ionov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); Research Clinical Institute of Childhood, Ministry of Health of the Moscow Region

Email: o_ionov@oparina4.ru
ORCID iD: 0000-0002-4153-133X

Dr. Med. Sci., Head of the Neonatal Intensive Care Unit named after Prof. A.G. Antonov, Institute of Neonatology and Pediatrics, Professor of Neonatology Department at the Faculty of Pediatrics

Russian Federation, 117997, Moscow, Oparina str., 4; 119991, Moscow, Trubetskaya str., 8-2; 115093, Moscow, Bolshaya Serpukhovskaya st., 62

Anna R. Kirtbaya

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: a_kirtbaya@oparina4.ru
ORCID iD: 0000-0002-7628-8157

Dr. Med. Sci., Clinical Care Supervisor at the Neonatal Intensive Care Unit named after Prof. A.G. Antonov, Institute of Neonatology and Pediatrics, Professor at the Neonatology Department at the Faculty of Pediatrics

Russian Federation, 117997, Moscow, Oparina str., 4; 119991, Moscow, Trubetskaya str., 8-2

Victor V. Zubkov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: v_zubkov@oparina4.ru
ORCID iD: 0000-0001-8366-5208

Dr. Med. Sci., Director of the Institute of Neonatology and Pediatrics, Professor of Neonatology Department

Russian Federation, 117997, Moscow, Oparina str., 4; 119991, Moscow, Trubetskaya str., 8-2

Roman G. Shmakov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: r_shmakov@oparina4.ru
ORCID iD: 0000-0002-2206-1002

Dr. Med. Sci., Professor, Director of the Institute of Obstetrics

Russian Federation, 117997, Moscow, Oparina str., 4

Dmitriy N. Degtyarev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: d_degtiarev@oparina4.ru
ORCID iD: 0000-0001-8975-2425

Dr. Med. Sci., Professor, Deputy Director, Head of Neonatology Department

Russian Federation, 117997, Moscow, Oparina str., 4; 119991, Moscow, Trubetskaya str., 8-2

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Supplementary files

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2. Fig. 1. Sequence of forming a sample of patients

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3. Fig. 2. Frequency of use of respiratory therapy, high-pitched breathing therapy, additional oxygen supplementation and frequency of hypoglycemia in late premature newborns, depending on the frequency and duration of RDS prophylaxis

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4. Fig. 3. Duration of respiratory therapy in late premature newborns, depending on the frequency and duration of RDS prevention

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5. Fig. 4. Maximum oxygen concentration in late premature newborns depending on the frequency and duration of RDS prophylaxis

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6. Fig. 5. Length of bed days in the NICU in late premature newborns, depending on the frequency and duration of RDS prevention

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