Composite neonatal outcome è 2-3 years • Body size, neurocognitive function tests è • (Cerebral palsy é (p=0.12)) Peltoniemi et al • RDS é 2 years • Survival without severe developmental impairment, cerebral palsy, growth, rehospitalisation è è = no difference, ê = decreased, é = increased 21 1.2.5.3 Recommendations about repeat courses of ACS The clinical recommendations regarding use of repeat courses of ACS are diverging as illustrated in figure 5. More studies about the effects and possible adverse outcomes after repeat courses of ACS are warranted before a more conclusive recommendation can be stated. Figure 5. Recommendations about repeat courses of ACS ? Cochrane review 2015: “The short-term benefits for babies of less respiratory distress and fewer serious health problems in the first few weeks after birth support the use of repeat courses of ACS for women still at risk of preterm birth seven days or more after an initial course. These benefits were associated with a small reduction in size at birth. The current available evidence reassuringly shows no significant harm in early childhood, although no benefit.”67 ACOG recommendations 2016: “A single repeat course of antenatal corticosteroids should be considered in women who are less than 34 0/7 weeks of gestation who have an imminent risk of preterm delivery within the next 7 days, and whose prior course of antenatal corticosteroids was administered more than 14 days previously. Rescue course corticosteroids could be provided as early as 7 days from the prior dose, if indicated by the clinical scenario. Regularly scheduled repeat courses or serial courses (more than two) are not currently recommended.”57 NICE guidelines 2015: ”Do not routinely offer repeat courses of maternal corticosteroids, but take into account: the interval since the end of last course, gestational age and the likelihood of birth within 48 hours.”58 WHO guidelines 2015: “A single repeat course of antenatal corticosteroid is recommended if preterm birth does not occur within 7 days after the initial dose, and a subsequent clinical assessment demonstrates that there is a high risk of preterm birth in the next 7 days.”56 22 0 10 20 30 40 50 60 70 80 90 100 22 w 23 w 24 of live-born infants exposed to ACS Gestational week Sweden 2004-2007 France 2011 1.2.6 ACS in extremely preterm gestations Most studies evaluating the effect of ACS on neonatal outcome have been conducted in moderately preterm or very preterm gestations. There are very sparse data on ACS´s effects in extremely preterm gestations. It is important to note that the evidence supporting ACS atPlans of Safe Care for Infants With Prenatal Substance Exposure and Their Families WHAT'S INSIDE Notification/reporting requirements Assessment of the infant and family What is a plan of safe care? Children’s 1 STATE STATUTES CURRENT THROUGH AUGUST 2019 To find statute information for a particular State, go to for the infant Services for the parents or other caregivers Responsibility for development of the plan of safe care Monitoring plans of safe care Summaries of State laws Children’s Bureau/ACYF/ACF/HHS | 800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov 2 substance abuse or withdrawal symptoms resulting from prenatal drug exposure or Fetal Alcohol Spectrum Disorder (FASD), including a requirement that health-care providers involved in the delivery or care of such infants notify the child protective services (CPS) system of the occurrence of such condition of such infants The development of a plan of safe care (POSC) for infants born and identified as being affected by substance abuse or withdrawal symptoms or FASD to ensure the safety and well-being of such infant following his or her release from the care of health-care providers, including through addressing the health and substance use disorder treatment needs of the infants and affected family or caregivers For this publication, statutes, regulations, and policies regarding requirements for providing appropriate care for these infants were collected from across all States, the District of Columbia, and the U.S. territories, and an analysis of the information informs the discussion that follows. Information and technical assistance on POSCs are available through the Children’s Bureau Regional Offices https://www.acf. hhs.gov/cb/resource/regional-programmanagers and the National Center on Substance Abuse and Child Welfare https:// ncsacw.samhsa.gov/resources/substanceexposed-infants.aspx. WHAT IS A PLAN OF SAFE CARE? A POSC is a plan designed to ensure the safety and well-being of an infant with prenatal substance exposure following his or her release from the care of a healthcare provider by addressing the health and substance use treatment needs of the infant and affected family or caregiver. States have flexibility as to the implementation consideration of their POSCs. For example, the plan can be initiated in advance of the infant’s birth by a designated community organization, including a substance use disorder treatment provider, the health-care provider at the birth hospital, or as part of the discharge process to