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Published on: November 20, 2015
Tocolysis and Neurodevelopment of Children Born Very Preterm
Thibault Plouchart1,2, Thibaut Sabatier3, Jean-Baptiste Muller1
1Department of Neonatal Pediatrics, Intensive Care and Neuropediatrics, Rouen University Hospital, Rouen, France.
Insights
Tocolytics administered for spontaneous preterm labor did not impact neurodevelopmental outcomes in very preterm children at 5.5 years. This finding suggests no significant association between tocolysis and long-term neurodevelopmental disabilities.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Pharmacology
Background:
- Neurodevelopmental outcomes for very preterm infants exposed to tocolytic medications are not well-established.
- Understanding the long-term effects of tocolysis is crucial for optimizing care for preterm infants.
Purpose of the Study:
- To determine if tocolysis during spontaneous preterm labor is linked to neurodevelopmental outcomes at 5.5 years.
- To assess if different types of tocolytic drugs (atosiban vs. calcium channel blockers) influence these outcomes.
Main Methods:
- A prospective, national, population-based cohort study in France.
- Included children born between 24 to 31 weeks gestation following spontaneous preterm labor without infection.
- Neurodevelopmental disabilities assessed at 5.5 years, including cerebral palsy, sensory deficits, cognitive, and behavioral issues.
Main Results:
- No significant difference in neurodevelopmental disabilities was found between preterm children exposed and not exposed to tocolytics (RR, 1.11; 95% CI, 0.85-1.45).
- Comparison of specific tocolytics showed no difference in outcomes between atosiban and calcium channel blockers (RR, 0.94; 95% CI, 0.67-1.32).
- The study analyzed data from 1320 children born to 1055 mothers.
Conclusions:
- Tocolytic treatment following spontaneous preterm labor was not associated with neurodevelopmental disabilities in very preterm children at 5.5 years.
- The type of tocolytic drug used did not appear to influence neurodevelopmental outcomes.
- These findings suggest that tocolysis does not adversely affect long-term neurodevelopment in this population.
Importance:
Neurodevelopmental outcomes of very preterm children exposed to tocolytics are not well described.
Objective:
To investigate whether tocolysis administered after spontaneous preterm labor is associated with neurodevelopmental outcomes at 5.5 years and to assess whether the type of tocolytic drug is associated with neurodevelopmental outcomes among infants exposed.
Design, Setting, And Participants:
This prospective, national, population-based cohort study used data from the French Etude Épidémiologique sur les Petits Âges Gestationnels-2 cohort. Children who were alive and participated in an assessment at 5.5 years and whose mothers experienced spontaneous preterm labor without an infectious context and delivered at 24 to 31 weeks were eligible for this study. Recruitment occurred from March to December 2011. Follow-up at age 5.5 years was conducted from September 2016 to December 2017. Data analysis was performed from July 2023 through April 2024.
Exposures:
The primary analysis examined tocolytics (yes vs no), and the secondary analysis examined the type of tocolytic (atosiban vs calcium channel blockers [CCBs]).
Main Outcome And Measure:
The composite outcome neurodevelopmental disabilities included cerebral palsy; visual, hearing, and cognitive deficiencies; developmental coordination disorders; or behavioral problems.
Results:
A total of 1055 mothers (mean [SD] age, 29.2 [5.7] years) had preterm labor without fever and gave birth to 1320 children (704 male [weighted percentage, 53.3%; 95% CI, 50.6%-56.1%]; mean [SD] gestational age, 28.8 [2.0] weeks). Overall, 776 mothers (weighted percentage, 73.5%; 95% CI, 70.8%-76.2%) received tocolytics; 136 mothers (weighted percentage, 17.9%; 95% CI, 15.3%-20.8%) received only a CCB, and 295 mothers (weighted percentage, 37.6%; 95% CI, 34.2%-41.0%) received only atosiban. From modified Poisson regression with propensity score matching, the risk of overall neurodevelopmental disabilities (mild, moderate, or severe) at 5.5 years did not differ between preterm children exposed and not exposed to tocolytics (relative risk [RR], 1.11; 95% CI, 0.85-1.45; P = .44) or in preterm infants exposed to atosiban compared with those exposed to CCBs (RR, 0.94; 95% CI, 0.67-1.32; P = .71).
Conclusions And Relevance:
In this study, tocolytics were not associated with neurodevelopmental disabilities among very preterm children surviving at 5.5 years.
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