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Aim: To investigate trends in receipt and timing of antenatal corticosteroid (ACS) administration over a ten-year interval., Methods: Retrospective cohort study of all live births from 2006 to 2015 occurring at a tertiary level teaching hospital in Adelaide, Australia. We analysed temporal trends in the receipt of single courses and repeat doses of ACSs, according to administration timing prior to birth. The main outcome measures were receipt of a single course of ACS and whether administration was 'Optimal' (≥24 h to

Since the concept of "evidence-based medicine" was first launched 20 years ago as a new method of teaching the practice of medicine, it has had an enormous impact on practice in many fields of health care. From the very start, professionals in pregnancy and perinatal care were at the forefront of attempts to collect good evidence systematically on the benefits and harms of health care interventions during pregnancy and in and around childbirth. Perinatal practice has largely benefitted from that endeavor. However, it has also suffered from the ill-effects of the narrow view that evidence, to be good evidence, needs to be randomized evidence. Twenty years on, it may be time to reflect on what is meant by evidence and how to use it, not as a doctrine or dogma, but as a valuable tool and a tremendous asset to improve outcomes for mothers and babies., (© 2012, Copyright the Authors Journal compilation © 2012, Wiley Periodicals, Inc.)

Aim: To investigate trends in mortality and morbidity in very preterm infants., Methods: Population-based perinatal register; liveborn infants 22 + 0 to 31 + 6 gestational weeks were investigated (time period 1995-2004). Time trends for mortality and common morbidities were explored using logistic regression analyses., Results: Data from 1614 liveborn infants were included. There was an increase in live born infants below 25 gestational weeks, annual odds ratio (OR) 1.15 (95% CI: 1.08-1.23) and a decrease in mortality annual OR 0.82 (95% CI: 0.69-0.98). The rates of bronchopulmonary dysplasia (BPD) and sepsis increased during the study period, annual ORs of 1.10 (95% CI: 1.04-1.17) and 1.09 (95% CI: 1.03-1.16). The duration of mechanical ventilation increased for surviving infants <25 gestational weeks (p = 0.003), while the duration of continuous positive airway pressure (CPAP) increased for infants <28 gestational weeks (p = <0.001). There were no changes in the rates of intraventricular haemorrhages (IVH, 3-4), retinopathy of prematurity (ROP, 3-5), seizures or necrotizing enterocolitis (NEC)., Conclusion: During the 10-year period changes in mortality and morbidity were most pronounced for infants with GA <28 gestational weeks. The increasing rate of sepsis was present in infants <28 gestational weeks, whereas the increase in BPD was demonstrated in the whole study population <32 gestational weeks.

Objective: To investigate the trend of neonatal resuscitation by intubation or mask ventilation over time and to assess its association with changes in prevalence of caesarean section and use of general anaesthesia in labour., Methods: All women booking pregnancy at any of 15 maternity units, analysed using logistic regression., Design: Prospective study., Setting: UK hospital-based maternity units (15 centres)., Population: A total of 221,322 first singleton births of babies weighing 200 g or more in the St Mary's Maternity Information System cohort, 1988-2000, covering the North West Thames area of London., Main Outcome Measures: Prevalence of intermittent positive-pressure ventilation (IPPV) (by intubation or mask) by calendar year., Results: Overall use of IPPV decreased markedly (two-sided P<0.01) over the course of the study, and this decrease was evident by all modes of delivery. Adjusted mean prevalence of intubated IPPV decreased from 0.51% (95% CI 0.44-0.58) in 1988 to 0.07% (95% CI 0.06-0.09) in 2000. There was a similar decrease in the prevalence of IPPV by mask. However, despite substantial increases in prevalence of caesarean sections and reductions in the use of general anaesthesia over the course of the study, adjusting for these variables made little difference to the temporal trends in intubation or use of mask ventilation., Conclusions: There has been a marked reduction in the prevalence of infants given resuscitation by positive-pressure ventilation that cannot be explained by changes in the prevalence of caesarean section or use of general anaesthesia in labour.