Evaluation of Hypoglycemia in Neonates of Women at Risk for Late Preterm Delivery : An Antenatal Late Preterm Steroids Trial Cohort Study

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OBJECTIVE: In the antenatal late preterm steroids (ALPS) trial betamethasone significantly decreased short-term neonatal respiratory morbidity but increased the risk of neonatal hypoglycemia, diagnosed only categorically (<40 mg/dL). We sought to better characterize the nature, duration, and treatment for hypoglycemia.

STUDY DESIGN: Secondary analysis of infants from ALPS, a multicenter trial randomizing women at risk for late preterm delivery to betamethasone or placebo. This study was a reabstraction of all available charts from the parent trial, all of which were requested. Unreviewed charts included those lost to follow-up or from sites not participating in the reabstraction. Duration of hypoglycemia (<40 mg/dL), lowest value and treatment, if any, were assessed by group. Measures of association and regression models were used where appropriate.

RESULTS: Of 2,831 randomized, 2,609 (92.2%) were included. There were 387 (29.3%) and 223 (17.3%) with hypoglycemia in the betamethasone and placebo groups, respectively (relative risk [RR]: 1.69, 95% confidence interval [CI]: 1.46-1.96). Hypoglycemia generally occurred in the first 24 hours in both groups: 374/385 (97.1%) in the betamethasone group and 214/222 (96.4%) in the placebo group (p = 0.63). Of 387 neonates with hypoglycemia in the betamethasone group, 132 (34.1%) received treatment, while 73/223 (32.7%) received treatment in placebo group (p = 0.73). The lowest recorded blood sugar was similar between groups. Most hypoglycemia resolved by 24 hours in both (93.0 vs. 89.3% in the betamethasone and placebo groups, respectively, p = 0.18). Among infants with hypoglycemia in the first 24 hours, the time to resolution was shorter in the betamethasone group (2.80 [interquartile range: 2.03-7.03) vs. 3.74 (interquartile range: 2.15-15.08) hours; p = 0.002]. Persistence for >72 hours was rare and similar in both groups, nine (2.4%, betamethasone) and four (1.9%, placebo, p = 0.18).

CONCLUSION: In this cohort, hypoglycemia was transient and most received no treatment, with a quicker resolution in the betamethasone group. Prolonged hypoglycemia was uncommon irrespective of steroid exposure.

KEY POINTS: · Hypoglycemia was transient and approximately two-thirds received no treatment.. · Neonates in the ALPS trial who received betamethasone had a shorter time to resolution than those with hypoglycemia in the placebo group.. · Prolonged hypoglycemia occurred in approximately 2 out of 100 late preterm newborns, irrespective of antenatal steroid exposure.

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:40
Enthalten in:	American journal of perinatology - 40(2023), 5 vom: 01. Apr., Seite 532-538

Sprache:	Englisch

Beteiligte Personen:

Gyamfi-Bannerman, Cynthia [VerfasserIn] Jablonski, Kathleen A [VerfasserIn] Blackwell, Sean C [VerfasserIn] Tita, Alan T N [VerfasserIn] Reddy, Uma M [VerfasserIn] Jain, Lucky [VerfasserIn] Saade, George R [VerfasserIn] Rouse, Dwight J [VerfasserIn] Clark, Erin A S [VerfasserIn] Thorp, John M [VerfasserIn] Chien, Edward K [VerfasserIn] Peaceman, Alan M [VerfasserIn] Gibbs, Ronald S [VerfasserIn] Swamy, Geeta K [VerfasserIn] Norton, Mary E [VerfasserIn] Casey, Brian M [VerfasserIn] Caritis, Steve N [VerfasserIn] Tolosa, Jorge E [VerfasserIn] Sorokin, Yoram [VerfasserIn] VanDorsten, J Peter [VerfasserIn] Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network [VerfasserIn]

Links:	Volltext

Themen:	9842X06Q6M Betamethasone Journal Article Multicenter Study Research Support, N.I.H., Extramural

Anmerkungen:	Date Completed 22.03.2023 Date Revised 02.04.2023 published: Print-Electronic Citation Status MEDLINE

doi:	10.1055/s-0041-1729561

funding:
Förderinstitution / Projekttitel:

PPN (Katalog-ID):	NLM325932557