Changing Tocolytic Exposures among Neonatal Intensive Care Unit Admitted Preterm Infants

Meghan L. Jarman; Monica M. Bennett; Judette M. Louis; Reese H. Clark; Veeral N. Tolia; Kaashif A. Ahmad

doi:10.1055/a-1745-3262

American Journal of Perinatology, Table of Contents

Am J Perinatol 2022; 39(16): 1745-1749
DOI: 10.1055/a-1745-3262

Short Communication

Changing Tocolytic Exposures among Neonatal Intensive Care Unit Admitted Preterm Infants

Meghan L. Jarman

¹Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas

,

Monica M. Bennett

²Research Analytics and Development Cores, Baylor Scott and White Research Institute, Dallas, Texas

,

Judette M. Louis

³Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida

,

Reese H. Clark

⁴MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida

,

Veeral N. Tolia

⁵Department of Pediatrics, Baylor University Medical Center, Dallas, Texas

⁶Pediatrix Medical Group, Dallas, Texas

,

Kaashif A. Ahmad

¹Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas

⁴MEDNAX Center for Research Education, Quality, and Safety, Sunrise, Florida

⁷Pediatrix Medical Group of San Antonio, San Antonio, Texas

⁸Department of Pediatrics, Baylor College of Medicine, San Antonio, Texas

⁹Pediatrix and Obstetrix Specialists of Houston, Houston, Texas

¹⁰Department of Neonatology, The Woman's Hospital of Texas, Houston, Texas

› Author Affiliations

Abstract

Objective Since 2010, the American College of Obstetrics and Gynecology have released three committee opinions to recommend and reaffirm the utility of magnesium sulfate for neuroprotection and later for tocolysis to achieve antenatal steroid course completion in preterm labor. We sought to determine changes in antenatal magnesium sulfate exposure and other tocolytic agents for pregnancies resulting in neonatal intensive care unit (NICU)-admitted preterm infants.

Study Design Using the Pediatrix Clinical Data Warehouse, we evaluated all inborn infants delivered between 22 and 33 weeks' gestation and admitted to the intensive care units from 2009 to 2018. We classified patients based on antenatal exposure to tocolytic medications: calcium channel blockers (nifedipine and amlodipine), betamimetics (terbutaline, theophylline, and ritodrine), prostaglandin inhibitors (indomethacin), and magnesium sulfate.

Results A total of 229,781 patients met inclusion criteria. During the study period, magnesium sulfate exposure increased from 27.6 to 57.7% of births while betamimetic exposure decreased from 10.2 to 5.2%. Increasing magnesium sulfate exposure over time was seen at all gestational ages examined and magnesium exposure was most common between 23 and 31 weeks' gestation. By 2017 to 2018, 70.5% of 24 to 29 weeks' gestation NICU infants received exposure to at least one tocolytic agent while this remained at 53.7% of 32 to 33 weeks' NICU admitted infants. Antenatal steroid exposure increased from 74.8 to 87.4% during the study period.

Conclusion For NICU-admitted preterm infants, prenatal exposure patterns to tocolytic agents has shifted since 2009 with prenatal magnesium sulfate exposure increasing significantly. Antenatal steroid exposure has risen concurrently. Exposure to tocolytic agents is the highest among preterm infants born between 24 and 29 weeks' gestation.

Key Points

Exposure to magnesium sulfate significantly increased from 2009 to 2018 for NICU admitted infants.
Concurrently, the use of other tocolytics decreased significantly.
The use of antenatal steroids has been rising over time.

Keywords

NICU - tocolytics - antenatal steroids - medications in pregnancy

Full Text

References

References
1 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
2 Committee Opinion No. Committee opinion no. 455: magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol 2010; 115 (03) 669-671
3 American College of Obstetricians and Gynecologists Committee on Obstetric Practice Society for Maternal-Fetal Medicine. Committee opinion no. 573: magnesium sulfate use in obstetrics. Obstet Gynecol 2013; 122 (03) 727-728
4 Yokoyama K, Takahashi N, Yada Y. et al. Prolonged maternal magnesium administration and bone metabolism in neonates. Early Hum Dev 2010; 86 (03) 187-191
5 Committee Opinion No 652: Magnesium Sulfate Use in Obstetrics. Obstet Gynecol 2016; 127 (01) e52-e53
6 Spitzer AR, Ellsbury DL, Handler D, Clark RH. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system–tools for “meaningful use” in continuous quality improvement. Clin Perinatol 2010; 37 (01) 49-70
7 Centers for Disease Control and Prevention. About natality public-use data 2007–202019. Accessed October 25, 2021 at http://wonder.cdc.gov/natality-current.html
8 Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 2011; 104 (12) 510-520
9 Laiteerapong N, Huang ES. The pace of change in medical practice and health policy: collision or coexistence?. J Gen Intern Med 2015; 30 (06) 848-852
10 Leviton LC, Goldenberg RL, Baker CS. et al. Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial. JAMA 1999; 281 (01) 46-52
11 Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev 2010; 2010 (11) CD000025
12 Doyle LW, Crowther CA, Middleton P, Marret S. Antenatal magnesium sulfate and neurologic outcome in preterm infants: a systematic review. Obstet Gynecol 2009; 113 (06) 1327-1333
13 Jung EJ, Byun JM, Kim YN. et al. Antenatal magnesium sulfate for both tocolysis and fetal neuroprotection in premature rupture of the membranes before 32 weeks' gestation. J Matern Fetal Neonatal Med 2018; 31 (11) 1431-1441
14 Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2006; 3 (03) CD004454
15 Shepherd E, Salam RA, Manhas D. et al. Antenatal magnesium sulphate and adverse neonatal outcomes: a systematic review and meta-analysis. PLoS Med 2019; 16 (12) e1002988