Timing and Challenges of Antenatal Steroid Administration

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In this week’s Journal Club, Ben and Daphna dissect six critical studies reshaping our understanding of neonatal care. Kicking off with the Canadian Neonatal Network’s multicenter cohort on inhaled nitric oxide (iNO), they explore how early pulmonary hypertension responsiveness to iNO may predict survival in preterm infants. They then examine a poignant study on maternal decision regret following extremely preterm births, revealing elevated regret across all pathways—comfort, active care, or otherwise—underscoring the emotional complexity of shared decision-making. The duo dives into data from the NICHD Neonatal Research Network on how even a single dose of antenatal steroids improves outcomes incrementally by the hour, strengthening the case for early administration. Ben highlights an AI-driven TPN algorithm that may outperform clinicians in individualized nutrition planning, while Daphna introduces an unexpected intervention—xylitol chewing gum—to reduce preterm birth in low-resource settings. Rounding out the discussion is a provocative look at intermittent hypoxemia as a predictor of systemic hypertension and the landmark NICHD trial on therapeutic hypothermia for infants 33–35 weeks GA. With a striking 87% probability of harm, this trial challenges the current drift toward “cooling creep.” Essential listening for any neonatologist seeking evidence-based clarity in an ever-evolving field.

As always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below.

Enjoy!