DÉJÀ VU: LPS and Neonatal Sugars (April 2026 AJP)

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1:11Well podcast family, I hesitated whether I was going to do this episode or not because we've covered a version of this in the past. But as we have said many, many times before, nothing new under the sun. And because this is brand new as of April 2026, when this is officially now in print in the American Journal of Perry, Natalogy, I had to stick with our mission of letting you know what is brand new in print as it relates to clinical practice. Now I hesitated a little bit because the topic of neonatal hypoglycemia with antenatal late preterm steroids or Alps and part of late preterm steroids has already been discussed. We know this is the thing. It's actually a thing even before the late preterm interval because even between 24 and 34 weeks, we know that the child can have a degree of hypoglycemia. The issue is in the late preterm interval when the brain is really

2:11putting down its malination and brain development is really ramped up. It is that hypoglycemia more impactful in the negative sense in the late preterm interval. That's what we're looking for here now. This is not a long-term study. This is looking specifically at neonatal hypoglycemia in terms of reference to the injection. So this is what's new. Even though we've covered hypoglycemia in the child after steroid in the late preterm interval and how even steroids in late preterm interval is super complicated and super controversial with some professional societies outside of the U.S. X-Nane it completely and where we're going to settle on here in the U.S. is is going to be a yes to have to document a discussion with the patient on the potential risks of neonatal hypoglycemia and potential long-term neonatal childhood outcomes later on down the road and the short-term risk of neonatal hypoglycemia and maybe the small benefit of some minor

3:14respiratory decrease morbidity. So that's going to be a very complicated shared decision making process versus the standard. Please do give steroids between 24 and 34 weeks. We've covered the controversy on late preterm steroids in the past and again it will settle on. It's going to have to be documented. Patients are going to have to understand that this is a risk versus benefit issue with the potential controversial issues of long-term neurodevelopmental outcomes which again are a little controversial. However, however, because this new April 2026 publication, even though it's retrospective, it was very well done, it gives this good insight and this is that of UMass out of Chan Medical School in Warchester, okay, Warchester, Massachusetts. This gives good information to do that informed consent that shared decision making so that you can try to time this and engage neonatal hypoglycemia based on when you give either the complete course two shots or one shot of beta-methasone. So specifically, this is looking at beta-methasone,

4:20not DEX as most people use beta-methasone simply because it's less injections, all right? But it's absolutely true. At some point, this stuff kind of sounds a little bit like deja-vu. So deja-vu is it's actually one of these things I think that some of the surveys suggest that like 75 percent of people report having a deja-vu experience one time or another. I don't where that came from, but I've pulled people in my class and most of them say they've experienced deja-vu. It's not deja-vu. The French term for I have seen this before. That's what deja-vu means and this is a nice little clip. It's from a neuroscientist who teaches on, well, neurochemistry and neuroscience and there's a small section of the class on deja-vu and now you can get metaphysical about it and you know metaphysical. I believe it's more anatomical and physiologic and part of our memory stores in the hippocampus where you kind of, something is

5:25familiar. Your brain tries to integrate what you're seeing now with the past memory and so the feeling of that is the deja-vu. I have seen this before, deja-vu, okay? But yes, steroids in the late preterm interval for us on this podcast because you all know that steroids are one of my areas of research and study. Definitely deja-vu, but brand new publication from the American Journal of Paranetology, April 2026, we're going to be true to our mission. I'm going to tell you what the degree of hypoglycemia is based on timing of injection so you can do this as part of the shared decision making if, I'm going to say that again, if you decide to give steroids in the late preterm interval, which we do not. So anyway, just throwing that out there thing, I've set it up enough, let's get on with our deja-vu. We'll be right back. This is Dr. Topma's OB-GYN, no spin podcast.

6:42Right now I'm having amnesia and deja-vu with the same timing. That was Steven Wright, I don't know if you remember Steven Wright. That was a weird dude, very a dry pan, very monotone delivery of jokes, but I remember that right now I'm having amnesia and deja-vu at the same time. Okay, I don't know, you figured that out, this kind of cute, but he was one weird dude, not a sponsor. All right, so what we're talking about here is neonatal hypoglycemia after beta methamethasone, nothing wrong with DEX, but most people use beta methamethasone just for ease of administration because you give a dose, boom, then you're done for 24 hours, although DEX is just fine. So most people, of course, do the 12 milligrams of DEX in 24 for fetal maturation, right? Not just lung maturation, but remember that steroids do a lot of things, decreased risk of IVH, decreased risk of necrotizing interoclytus, but of course,

7:43the main function is pulmonary function and surfactant stimulation and maturation. So this is not unique to the late preterm interval, which is between 34 and 0 and 36 and 6, because anything that exposes or gives mom hypoglycemia and beta methamethasone is really good at that, although it's temporary, when you give mom a beta methamethasone, sugars are going to go up, that sugar passes to the kid, the child then makes his own insulin, and because of immaturity already, it is hard for the child to figure that out, and then when the child is delivered, you've got all this insulin floating around in the child. He can't keep up with his own gluconeogenesis, and so you get hypoglycemia, all right? So it's not that the shot is giving the child hypoglycemia, is that the shot is giving the mom hypoglycemia, which passes to the child, the child then does what it does with high sugar level, which is make insulin, and then you take the plug away from the high

8:45sugar level and the insulin drops the sugar in the child, all right? So we get the pastoral physiology not unique to the late preterm interval, but as we mentioned in the intro, the concern is that hypoglycemia is bad in general, especially if it's prolonged, with temporary episodes being, you know, less worrisome, but it's also critical timing so that when it happens in the late preterm interval, when the brain is really using up that sugar, and to fire those neurons, you know, that's where the concern lies, okay? So we've known this, and neonatal hypoglycemia was in fact found, of course, in the pivotal Alps trials, steroids in the late endopartum interval by Cynthia Gayanfi, who, by the way, I admire, she's phenomenal, and that's, so that's nothing new. We know that this is a real thing, but now this new publication from April of 2026 gives us some information on what we can tell patients regarding dose of the administration,

9:48and finding in the child, right? It also tells PD, hey, we give the shot at X hours, so be on the lookout, which she should be already, but this is a big deal because now we can fine tune it to these many hours, okay? So this is, again, retrospective, and it's not a prospective study, it's not an RCT, but they also did a secondary analysis to see what the outcomes were after a partial course of endopartum late preterm steroids, meaning just one injection. This is, of course, between 34 and 0 and 36 and 6. This was a, a, a, a, a, a, a timeframe of 2017 to 2020, all right? So the fall of 2017 to fall of 2020, at one tertiary care medical center, they wanted to see what the neonatal hypoglycemia was in terms of dose administration, okay? So this is good for counseling, we're gonna do this relatively quickly because I don't want to be labored this because, again,

10:49it is kind of deja vu because we've covered this in the past. The short of it is that there was absolutely a time from dose given to the mom and peak percentages or and severity of neonatal hypoglycemia. Let me read this directly again, it's retrospective, and I'm gonna get into a lot of the data, I just want to let you know what, what you can tell patients quickly as our commitment is to let you know what you need to know and then keep moving on. So here it is, quote, deliveries that occurred less than 48 hours after the first dose were more likely to have neonatal hypoglycemia and neonatal ICU admissions. In the adjusted model, the incidence of hypoglycemia was highest, here it is guys, from 12 to 35 hours after the first beta-methasone exposure, okay? So remember, you give one shot, then you give another one again in 24 hours and so based on this study, the peak

11:49ranged from 12 hours to 35 hours after the first beta-methasone injection, those babies tended to have higher rates of neonatal hypoglycemia and NICU admissions, okay? Now, this is not looking at long-term data, this is just exactly what happened as retrospective study at that time, they go on to say, quote, this information may aid in decision-making on whether to offer and to part of late preterm steroids to patients who are at higher risk of delivery in less than 48 hours and with increased odds for neonatal hypoglycemia, okay? So shorter exposure to delivered time had increased odds of neonatal hypoglycemia and that makes sense because when you give the mom the shot, I mean, it works very quickly to increase maternal glucose levels so that makes sense, okay? This is not, you know, rocket science here, all of this makes physiological and biological sense, quote, shorter APL exposures to delivery had increased odds of neonatal hypoglycemia.

12:54So once again, their take-home message was, quote, delivery from 12 to 35 hours after and a part of late preterm steroids was associated with the highest risk of neonatal hypoglycemia, and quote, something to consider. So again, it's one more factor where we're going to land on this thing with steroids in the late preterm interval is you can have to have a discussion with the patient. Look, maybe some small benefit in, you know, minor respiratory issues, but there are some real concerns here with certain international organizations no longer offering it. It just, you know, carte blanche just said, no, we're not going to do it after 34 and zero. Now, there are some caveats I get that of there's unsure dates. You don't know what's going on. She was seeing maybe once and she was, you know, didn't have an ultrasound before 22 weeks and zero days. You have no idea where she's at. Maybe it's potentially a little bit less. I get that. Those are caveats, and that's why it's part of shared decision making. But in the setting of

13:55sure dates, steroids in the late preterm interval is going to be part of shared decision making and documentation of the risks and benefits of steroids in this, knowing that they're controversial long-term, nor developmental outcomes, again, that are controversial. But this is brand new. So, people are still looking at this. This is officially coming out in print April of 2026. The authors from this once again come out of University of Massachusetts at Winchester, Winchester, Massachusetts at Chan Medical School. Good for them for looking this up. This was the retrospective and it confirmed what was in the Alps with the caveat now that we have much more fine tuning of time. So, the short of it is the short interval makes a big deal here for a neonatal hypoglycemia. The short of it is the shorter of the interval from injection to delivery, the higher the risk of neonatal hypoglycemia peaking at 12 to 35 hours after first exposure.

14:59Again, I'm not saying not to do it. I'm saying you do what you do. Follow your hospital policy. This is definitely something to talk about in an academic group. We've covered this many, many times on the past on our show. But this is very nice and I'm all about new information. So, American Journal of Parenting Technology. And by the way, I mentioned that this is nothing new because this is something that can hit babies at 24 to 34 weeks. We also have that data just to be clear. There was a publication out of the International General of Gynecology and Obstetrics about four years ago. This was August of 2022, out of Israel, quote, factors associated with the development of neonatal hypoglycemia after Anteninal Corticosteroid Administration. It's all about timing. End quote. That's the title. It's all about timing. Y'all get that. So, that's exactly what we said here in the late preacher Minerval. The shorter the interval from injection to delivery, the higher the risk. And in this publication from 2022, that looked at steroid administration when we should give steroids

16:01between 24 and 34 weeks, they found that neonatal hypoglycemia, again, was highest when delivery occurred within 24 to 48 hours. So, it's a little bit longer. You see that between 24 and 34 weeks, PK Bulgisemia happened within 24 to 48 hours after first exposure. Whereas in the late preacher Minerval, those higher risk of neonatal hypoglycemia earlier on, with less time from exposure to final outcome. And the reason is, is that as the babies get bigger, they're more in gestation, than they have less ability actually to fight that hyperinsulinic response. So, in the late preacher Minerval is 12 to 35 hours, whereas between 24 and 34 weeks, the peak time when we should give steroids, according to the 2022, is Rayleigh Study. Hypoglycemia was in 24 to 48 hours. Isn't that interesting? And of course, smaller babies, babies who have smaller birth weight,

17:05all right, even higher risk, because they don't have the metabolic processes and the extra weight to kind of cushion that, all right? So, smaller babies have even higher risk. I just thought this was interesting. Neonatal hypoglycemia, after a steroid exposure, is not unique to the late preacher Minerval. It's actually anytime mom's sugar level goes up. And it's all about the timing. As this publication from 2022 reminds us, it's all about the timing. Between 24 and 34, hyperglycemia and the child happens at 24 to 48 hours. And in the late preacher Minerval, it tends to happen a little bit quicker between 12 and 35 hours. Podcast Family, I think what we've done here is our job. I think we've done what we're supposed to do. Thank you to the Stephen Wright Clips, not a sponsor. And that concludes our episode of Deja Vu. Podcast Family, as always, we're thankful for you. We're glad you're part of our podcast community. And now we've done all that, Michael. Let's take it home.

18:31We are counting on you. Republicans want to steal enough seats in Congress to raid the next election and wield unchecked power for two more years. But you can stop them by voting yes by April 21st. Help put our elections back on a level playing field and let voters decide not politicians. Vote yes by April 21st. Paid for by Virginians for fair elections. You're listening to a podcast right now, driving, working out, walking the dog. If you're in a podcast, chances are you have something to say too. With RSS.com, starting your own podcast is free and easy. Upload an episode and we distribute it to Apple Podcasts, Spotify, Amazon Music, and more. Track your listeners, see where they're from, and start earning from ads just like this. If you've been thinking about starting a podcast, this is your sign. Start your new podcast for free today at rss.com.