Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

Nansi S Boghossian; Scott A McDonald; Edward F Bell; Waldemar A Carlo; Jane E Brumbaugh; Barbara J Stoll; Abbot R Laptook; Seetha Shankaran; Michele C Walsh; Abhik Das; Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1001/jamapediatrics.2016.0104

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Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

Journal article

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Peer reviewed

Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

Nansi S Boghossian, Scott A McDonald, Edward F Bell, Waldemar A Carlo, Jane E Brumbaugh, Barbara J Stoll, Abbot R Laptook, Seetha Shankaran, Michele C Walsh, Abhik Das, …

JAMA pediatrics, Vol.170(6), pp.593-601

06/01/2016

DOI: 10.1001/jamapediatrics.2016.0104

PMCID: PMC5270648

PMID: 27088897

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Abstract

Little is known about the effects of antenatal corticosteroids (ANS) on extremely preterm multiples. To examine if use of ANS is associated with improvement in major outcomes in extremely preterm multiples. Infants with a gestational age between 22 and 28 weeks born at a National Institute of Child Health and Human Development Neonatal Research Network center were studied between January 1998 and December 2013. Generalized estimating equation models were used to generate adjusted relative risks (aRR) controlling for important maternal and neonatal variables. Antenatal corticosteroids. In-hospital mortality and the composite outcome of neurodevelopmental impairment at 18 to 22 months' corrected age or death before assessment. A total of 6925 multiple-birth infants were studied; 5775 of 6925 (83.4%) were twins, and 4276 (61.7%) were white. Of the total study population, 6094 (88%) were born to women who received ANS. In-hospital mortality was lower among infants with exposure to ANS vs no exposure (aRR = 0.87; 95% CI, 0.78-0.96). Neurodevelopmental impairment or death was not significantly lower among those exposed to ANS vs no exposure (aRR = 0.93; 95% CI, 0.84-1.03). Other adverse outcomes that occurred less frequently among infants of women receiving ANS included severe intraventricular hemorrhage (aRR = 0.68; 95% CI, 0.58-0.78) and the combined outcomes of necrotizing enterocolitis or death and severe intraventricular hemorrhage or death. Subgroup analyses indicated that exposure to ANS was associated with a lower risk of mortality and a lower composite of neurodevelopmental impairment or mortality among nonsmall for gestational age multiples (aRR = 0.82; 95% CI, 0.74-0.92; and aRR = 0.89; 95% CI, 0.80-0.98, respectively) and a higher risk among small for gestational age multiples (aRR = 1.40; 95% CI, 1.02-1.93; and aRR = 1.62; 95% CI, 1.22-2.16, respectively). Antenatal corticosteroids were associated with higher neurodevelopmental impairment or mortality among multiple-birth infants of mothers with diabetes (aRR = 1.55; 95% CI, 1.00-2.38) but not among infants of mothers without diabetes (aRR = 0.91; 95% CI, 0.83-1.01). Compared with no exposure, exposure to ANS was associated with a lower risk of mortality in extremely preterm multiples, with no significant differences in the composite of neurodevelopmental impairment or death. Future research should investigate the increased risks of mortality and the composite of neurodevelopmental impairment or death associated with exposure to corticosteroids among small for gestational age multiples.

United States - epidemiology

Pregnancy, Multiple

Prenatal Exposure Delayed Effects

Prenatal Care - methods

Prospective Studies

Hospital Mortality

Enterocolitis, Necrotizing - prevention & control

Humans

Cerebral Hemorrhage - mortality

Child, Preschool

Enterocolitis, Necrotizing - mortality

Male

Adrenal Cortex Hormones - therapeutic use

Pregnancy

Cerebral Hemorrhage - prevention & control

Neurodevelopmental Disorders - mortality

Female

Infant, Extremely Premature

Neurodevelopmental Disorders - prevention & control

Registries

Pregnancy Outcome

Details

Title: Subtitle: Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants
Creators: Nansi S Boghossian - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
Scott A McDonald - RTI International, Research Triangle Park, North Carolina
Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City
Waldemar A Carlo - Department of Pediatrics, University of Alabama at Birmingham
Jane E Brumbaugh - Department of Pediatrics, University of Iowa, Iowa City
Barbara J Stoll - Department of Pediatrics, University of Texas Health Science Center at Houston
Abbot R Laptook - Department of Pediatrics, Warren Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island, Providence
Seetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, Michigan
Michele C Walsh - Department of Pediatrics, Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio
Abhik Das - RTI International, Rockville, Maryland
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: JAMA pediatrics, Vol.170(6), pp.593-601
DOI: 10.1001/jamapediatrics.2016.0104
PMID: 27088897
PMCID: PMC5270648
ISSN: 2168-6203
eISSN: 2168-6211
Grant note: UG1 HD021385 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS UG1 HD087226 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD027856 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS
Language: English
Date published: 06/01/2016
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093219602771

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