RECEIPT OF ANTENATAL STEROIDS AND RESPIRATORY SUPPORT AMONG PREMATURE INFANTS EXPOSED TO PRENATAL SMOKING AND SUBSTANCE USE

Washin Y, Goldstein ND, Mackley A, Locke R, Paul DA. Pediatr Nurs 2018;44(4):177-181.

Polysubstance abuse can increase the risk of adverse pregnancy outcomes including preterm birth, stillborn, miscarriage, low birth weight, and neurocognitive disorders. In addition, there is a recommendation for the administration of antenatal corticosteroid treatment for threatened premature birth between 24 and 34 weeks. In this secondary data analysis from a retrospective cohort conducted from 1997 to 2015 for infants of a gestational age of 24 to 34 weeks (n = 7505), the researchers sought to examine the likelihood of receipt of newborn respiratory support among preterm infants whose mother reported substance abuse and/or cigarette smoking while pregnant. The infants in this study were singletons, and most were given antenatal corticosteroid treatment.

Of the 7505 infants, 17% were exposed to prenatal cigarette smoking, 8% were exposed to any illicit drug, and 5% were exposed to more than 1 substance. Adjusted analysis showed exposure to cigarette smoking was associated with lower likelihood of the infants receiving respiratory support, and thought related to prenatal cigarette smoking exposure facilitates lung maturity via surfactant gene simulation by nicotine. Exposure to cocaine was associated with lower likelihood of receiving antenatal corticosteroids and more use of mechanical ventilation.

The researchers concluded that nicotine-exposed infants, identification of polysubstance use, and counseling smoking parents on the effects of secondhand smoke exposure to their infants should be emphasized with discharge teaching. The researchers also concluded that identifying mothers who use illicit drugs should be encouraged to be seen in triage sooner in threatened preterm labor as it may increase the use of antenatal corticosteroid treatment and possibly avoid respiratory support in infants.