Journal article
Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation
JAMA : the journal of the American Medical Association, Vol.306(21), pp.2348-2358
2011
DOI: 10.1001/jama.2011.1752
PMCID: PMC3565238
PMID: 22147379
Abstract
Context Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.
Objective To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.
Design, Setting, and Participants Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.
Main Outcome Measures Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.
Results Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).
Conclusion Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.
Details
- Title: Subtitle
- Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation
- Creators
- Waldemar A CARLO - Department of Pediatrics, University of Alabama, Birmingham, United StatesScott A MCDONALD - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, United StatesAvroy A FANAROFF - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United StatesBetty R VOHR - Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island, United StatesBarbara J STOLL - Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United StatesRichard A EHRENKRANZ - Department of Pediatrics, University of Alabama, Birmingham, United StatesWilliam W ANDREWS - Department of Pediatrics, University of Alabama, Birmingham, United StatesDennis WALLACE - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, United StatesAbhik DAS - Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Dr Ehrenkranz); Statistics and Epidemiology Unit, RTI International, Rockville, Maryland, United StatesEdward F BELL - Department of Pediatrics, Wayne State University, Detroit, Michigan, United StatesMichele C WALSH - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United StatesAbbot R LAPTOOK - Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island, United StatesSeetha SHANKARAN - Department of Pediatrics, University of Iowa, Iowa City, United StatesBrenda B POINDEXTER - Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United StatesEllen C HALE - Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United StatesNancy S NEWMAN - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United StatesAlexis S DAVIS - Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, United StatesKurt SCHIBLER - Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United StatesKathleen A KENNEDY - Department of Pediatrics, University of Texas Medical School, Houston, United StatesPablo J SANCHEZ - Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, United StatesKrisa P VAN MEURS - Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California, United StatesRonald N GOLDBERG - Department of Pediatrics, Duke University, Durham, North Carolina, United StatesKristi L WATTERBERG - Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, United StatesRoger G FAIX - Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, United StatesIvan D FRANTZ - Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts, United StatesRosemary D HIGGINS - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, United StatesEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.306(21), pp.2348-2358
- DOI
- 10.1001/jama.2011.1752
- PMID
- 22147379
- PMCID
- PMC3565238
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Publisher
- American Medical Association
- Language
- English
- Date published
- 2011
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984093602502771
Metrics
32 Record Views