411 - Patent ductus arteriosus treatment mitigates the benefit of antenatal corticosteroids on postnatal growth in infants born at less than 32 weeks of gestation

Publication Number: 411.5717

Wan-Hsin Liu, Taipei Veterans General Hospital, Chiayi County, Chiayi, Taiwan (Republic of China); Ting Hsuan Sung, National Yang-Ming Chiao-Tung University Hospital, yilan, Yilan, Taiwan (Republic of China); Fu-Sheng Chou, Kaiser Permanente Bernard J. Tyson School of Medicine, Riverside, CA, United States; Pei-Chen Tsao, Taipei Veteran General Hospital, Taipei, Taipei, Taiwan (Republic of China); Mei-Jy Jeng, National Yang Ming Chiao Tung University, Taipei, Taipei, Taiwan (Republic of China)

Background: Achieving satisfactory postnatal growth is crucial for preterm infants, as it is linked to short-term morbidities such as bronchopulmonary dysplasia and retinopathy of prematurity, as well as neurodevelopmental outcomes. Previous studies have primarily focused on delineating the association between single factors and postnatal growth. However, factors contributing to growth may interact with each other. Antenatal corticosteroids (ANS) are widely used to reduce neonatal morbidities, with emerging evidence suggesting that they may also improve postnatal growth. Hemodynamically significant patent ductus arteriosus (PDA) can cause gut underperfusion and feeding intolerance, often necessitating restricted enteral nutrition in infants undergoing PDA treatment (PDATx). Understanding the combined effect of ANS and PDATx on postnatal growth is therefore vital to guide clinical management.

Objective: To examine the interaction between ANS and PDA treatment on postnatal growth of infants born < 32 weeks’ gestation.

Design/Methods: This retrospective cohort study was conducted at Taipei Veterans General Hospital, a level IV NICU in Taiwan. We included infants born < 32 weeks’ gestation from 2012 to 2020. Postnatal growth was assessed using the Postnatal Growth Charts for Preterm Infants. Instead of using changes in weight z-scores, we utilized changes in weight trajectory percentiles (ΔGTP) between birth to day of life (DOL) 10 and between birth to 34 weeks postmenstrual age. A ΔGTP < -10 is considered postnatal growth faltering (PGF). Logistic regression was employed to assess the odds of PGF associated with ANS and PDATx, adjusting for confounders. We also modeled weight percentile by DOL using generalized additive mixed modeling.

Results: The cohort included 313 infants, 106 (34%) of whom had PGF. Maternal and neonatal characteristics are summarized in Table 1. While ANS independently reduced the odds of PGF, and PDATx showed no independent impact on PGF, the interaction between ANS and PDATx mitigated the benefit of ANS (Fig 1A). Similar findings were observed after adjusting for birth weight, gestational age, and other morbidities (Fig 1B,C). The distributions of ΔGTP by ANS exposure and PDATx are presented in Fig 2A. Longitudinal modeling indicated a continuous decline in estimated weight percentile trajectories among infants with PDATx, regardless of ANS exposure (Fig 2B).

Conclusion(s): The interaction between ANS and PDATx influences postnatal growth outcomes. Understanding the interplay among morbidity factors is essential for comprehensive risk-benefit assessment and informed clinical decision-making.

Table 1: Perinatal characteristics of infants with and without postnatal growth faltering(PGF)
Table 1.jpeg

Figure 1. Impact of antenatal corticosteroids, treatment for patent ductus arteriosus, and their interaction on postnatal growth faltering
Odds ratios (OR) and 95% confidence intervals from regression models . (A) Primary analysis, (B) Multivariate analysis adjusting for gestational age and birth weight, (C) Multivariate analysis adjusting for additional neonatal morbidities.

Figure 2. Comparison of weight growth by antenatal corticosteroids(ANS) exposure and treatment of patent ductus arteriosus(PDATx)
Figure 2A-2B.jpeg(A) Box plot of change in weight trajectory percentile(ΔGTP) stratified by ANS exposure and PDATx,
(B) Longitudinal weight percentile trajectories by day of life (DOL): In the groups without PDATx, ANS exposure was associated with a lower birth percentile, consistent with its known impact on fetal growth. By DOL 14, percentile estimates were similar across ANS-exposed and non-exposed infants, suggesting an overall smaller change in percentiles in the ANS-exposed group. In the groups with PDATx, weight percentile initially increased during the first 7 days, followed by a continuous decline, irrespective of ANS exposure.