Joanna E. Adamczak

The soluble receptor for advanced glycation end products can prospectively identify patients at greatest risk for preterm birth

Objective: Our primary objective was to determine whether there was an association between levels of antenatal maternal serum soluble RAGE (sRAGE), drawn at the time of presentation with preterm labor (PTL), and subsequent preterm birth (PTB). Secondary objectives were to determine whether levels of sRAGE – analyzed from both antenatal maternal serum (MS) and postpartum umbilical cord serum (CS) – were associated with neonatal sepsis. Methods: Nested case-control analyses were performed within a prospective cohort of patients at risk for PTB. MS was obtained at enrollment and CS at delivery. The sRAGE levels were analyzed. Non-parametric calculations and receiver-operator analyses were performed. Results: Overall, 39.8% of patients delivered < 37 weeks (n = 498) and 15% had neonatal sepsis (n = 193). In comparing cases and controls, sRAGE was significantly lower in those with than those without an adverse event (PTB: median MS-sRAGE 771.79 versus 948.485 pg/mL, p = 0.004; neonatal sepsis: 25-centile CS-sRAGE 1220.49 versus 2244.41 pg/mL, p = 0.0013). Adding MS-sRAGE to models of clinical variables significantly enhanced the ability of the model to predict both PTB (area under the curve [AUC] 0.71 versus 0.79, p = 0.004) and neonatal sepsis (AUC 0.65 versus 0.75, p = 0.04). The negative predictive value of CS-sRAGE for neonatal sepsis was very strong (NPV = 0.91). Conclusions: The sRAGE can be used to help predict adverse perinatal outcomes. Patients with higher levels of sRAGE – who therefore may have an enhanced capability to regulate their immune response – appear less likely to experience PTB and neonatal sepsis.

Antenatal Corticosteroids for Late-Preterm Infants: A Decision-Analytic and Economic Analysis

Objectives. Antenatal corticosteroids (ACS) are not routinely administered to patients at risk for delivery between 34 and 36 6/7 weeks. Our objective was to determine whether ACS are cost-effective for late-preterm infants at risk for imminent preterm delivery. We hypothesized that the preferred strategy <36 weeks would include ACS while the preferred strategy ≥36 weeks would not. Methods. We performed decision-analytic and cost-effectiveness analyses to determine whether ACS was cost-effective at 34, 35, and 36 weeks. We conducted a literature review to determine probability, utility, and cost estimates absent of patient-level data. Base-case cost-effectiveness analysis, univariable sensitivity analysis, and Monte Carlo simulation were performed. A threshold of

Trends in Prematurity: What do Changes at an Urban Institution Suggest About the Public Health Impact of 17-Alpha Hydroxyprogesterone Caproate?

100,000/QALY was considered cost-effective. Results. The incremental cost-effectiveness ratio favored the administration of a full course of ACS at 34, 35, and 36 weeks (

511: Revealing the molecular profile of the cervix during pregnancy

62,888.25/QALY,

672: Does health care system distrust influence utilization of prenatal care services?

64,425.67/QALY, and

489: Assessing whether biomarkers of cervical remodeling are correlated with cervical length in nulliparous women

64,793.71/QALY, resp.). A partial course of ACS was not cost-effective. While ACS was the consistently dominant strategy for acute respiratory outcomes, all models were sensitive to changes in variables associated with chronic respiratory disease. Conclusions. Our findings suggest that the administration of ACS to patients at risk of imminent delivery 34-36 weeks could significantly reduce the cost and acute morbidity associated with late-preterm birth.