The appropriate use of antenatal corticosteroids improves neonatal outcomes, including decreased severity and/or frequency of respiratory distress syndrome (RDS), intracranial hemorrhage, necrotizing enterocolitis and death. Antenatal corticosteroids, when appropriate, are administered in a clinical setting where patients are at risk for preterm delivery within 7 days, irrespective of membrane status and fetal number.
Between 24w0d to 33w6d – ‘Recommended’
Between 22w0d and 23w6d – ‘May be Considered’
Note: ACOG and SMFM revised recommendation states
Antenatal corticosteroids may be considered at 22 0/7 weeks to 22 6/7 weeks of gestation if neonatal resuscitation is planned and after appropriate counseling
Some families may choose to forgo resuscitation and support after appropriate counseling
Between 20w0d and 21w6d – ‘Not Recommended’
ACOG Committee Opinion 713: Antenatal Corticosteroid Therapy for Fetal Maturation
ACOG Practice Advisory: Use of Antenatal Corticosteroids at 22 Weeks of Gestation
ACOG Practice Bulletin No. 171 : Management of Preterm Labor
Society for Maternal-Fetal Medicine (SMFM) Consult #58: Use of Antenatal Corticosteroids for Individuals at Risk for Late Preterm Delivery
Society for Maternal-Fetal Medicine Special Statement: Quality metrics for optimal timing of antenatal corticosteroid administration – American Journal of Obstetrics & Gynecology (ajog.org)
The prevalence of peanut allergy in the US has more than doubled between 1997 to 2008 and is a leading cause of death due to food related allergic reactions. 26 professional organizations, including the NIH, have issued new clinical guidelines to prevent peanut allergy. In 2010, an expert panel determined that there was insufficient evidence to advise the delay of introducing peanuts into children’s diets. Based on strong evidence, to prevent severe peanut allergy the latest guidelines now promote early introduction of peanuts, which for most infants will be between 4 to 6 months of age.
Infants at high risk for peanut allergy—based on severe eczema and/or egg allergy—are suggested to begin consuming peanut-enriched foods between 4 to 6 months of age, but only after parents check with their health care providers.
Infants already showing signs of peanut sensitivity in blood and/or skin-prick tests should try peanuts for the first time under the supervision of their doctor or allergist. In some cases, test results indicating a strong reaction to peanut protein might lead a specialist to recommend that a particular child avoid peanuts.
Infants with mild to moderate eczema should incorporate peanut-containing foods into their diets by about 6 months of age. It’s generally OK for them to have those first bites of peanut at home and without prior testing.
Infants without eczema or any other food allergy aren’t likely to develop an allergy to peanuts. To be on the safe side, it’s still a good idea for them to start eating peanuts from an early age.
The FDA has released a statement regarding food labeling based on the above NIH recommendations and the Du Toit et al. (NEJM, 2015) study. Aside from the current messaging on food that provides information on whether food contains peanuts or peanut residue
Recognizing the importance of science-based food decisions, the FDA has responded to a petition for a new qualified health claim that states “for most infants with severe eczema and/or egg allergy who are already eating solid foods, introducing foods containing ground peanuts between 4 and 10 months of age and continuing consumption may reduce the risk of developing peanut allergy by 5 years of age.” This is the first time the FDA has recognized a qualified health claim to prevent a food allergy. Our goal is to make sure parents are abreast of the latest science and can make informed decisions about how they choose to approach these challenging issues. The new claim on food labels will recommend that parents check with their infant’s healthcare provider before introducing foods containing ground peanuts.
Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases – sponsored expert panel
NIH Director’s Blog: Peanut Allergy: Early Exposure Is Key to Prevention
NEJM: Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy
Statement from FDA Commissioner Scott Gottlieb, M.D., on a new qualified health claim advising that early introduction of peanuts to certain high-risk infants may reduce risk of peanut allergy
AAP: New guidelines detail use of ‘infant-safe’ peanut to prevent allergy
Annual screening of all sexually active women aged <25 years for chlamydia is recommended, as is screening of older women at increased risk for infection (e.g., those who have a new sex partner, more than one sex partner, a sex partner with concurrent partners, or a sex partner who has an STD).
To diagnose a chlamydia infection:
Chlamydial infection is the most frequently reported infectious disease in the United States, and prevalence is highest in persons aged ≤24 years. Several sequelae can result from C. trachomatis infection in women, the most serious of which include PID (pelvic inflammatory disease), ectopic pregnancy, and infertility. Some women who receive a diagnosis of uncomplicated cervical infection already have subclinical upper-reproductive–tract infection.
Chlamydia treatment should be provided promptly for all persons testing positive for infection; treatment delays have been associated with complications
PREGNANCY AND CHLAMYDIAL INFECTION
Risks in pregnancy include preterm labor, premature rupture of membranes and low birth weight with neonates at risk for conjunctivitis (ophthalmia neonatorum) and pneumonia. It is therefore imperative to screen and treat pregnant women with the following:
CDC: Chlamydial Infections in Adolescents and Adults
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