Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth

Matthew A Rysavy; Edward F Bell; Jay D Iams; Waldemar A Carlo; Lei Li; Brian M Mercer; Susan R Hintz; Barbara J Stoll; Betty R Vohr; Seetha Shankaran; Michele C Walsh; Jane E Brumbaugh; Tarah T Colaizy; Abhik Das; Rosemary D Higgins; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1016/j.jpeds.2018.12.063

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Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth

Journal article

Open access

Peer reviewed

Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth

Matthew A Rysavy, Edward F Bell, Jay D Iams, Waldemar A Carlo, Lei Li, Brian M Mercer, Susan R Hintz, Barbara J Stoll, Betty R Vohr, Seetha Shankaran, …

The Journal of pediatrics, Vol.208, pp.156-162.e5

05/2019

DOI: 10.1016/j.jpeds.2018.12.063

PMCID: PMC6486854

PMID: 30738658

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https://doi.org/10.1016/j.jpeds.2018.12.063View

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Abstract

To describe discordance in antenatal corticosteroid use and resuscitation following extremely preterm birth and its relationship with infant survival and neurodevelopment. A multicenter cohort study of 4858 infants 22-26 weeks of gestation born 2006-2011 at 24 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, with follow-up through 2013. Survival and neurodevelopmental outcomes were available at 18-22 months of corrected age for 4576 (94.2%) infants. We described antenatal interventions, resuscitation, and infant outcomes. We modeled the effect on infant outcomes of each hospital increasing antenatal corticosteroid exposure for resuscitated infants born at 22-24 weeks of gestation to rates observed at 25-26 weeks of gestation. Discordant antenatal corticosteroid use and resuscitation, where one and not the other occurred, were more frequent for births at 22 and 23 but not 24 weeks (rate ratio [95% CI] at 22 weeks: 1.7 [1.3-2.2]; 23 weeks: 2.6 [2.2-3.2]; 24 weeks: 1.0 [0.8-1.2]) when compared with 25-26 weeks. Among infants resuscitated at 23 weeks, adjusting each hospital's rate of antenatal corticosteroid use to the average at 25-26 weeks (89.2%) was projected to increase infant survival by 7.1% (95% CI 5.4-8.8%) and survival without severe impairment by 6.4% (95% CI 4.7-8.1%). No significant change in outcomes was projected for infants resuscitated at 22 weeks, where few (n = 22) resuscitated infants received antenatal corticosteroids. Infants born at 23 weeks were more frequently resuscitated without antenatal corticosteroids than other extremely preterm infants. When resuscitation is intended, consistent provision of antenatal corticosteroids may increase infant survival and survival without impairment. ClinicalTrials.govNCT00063063 (Generic Database) and NCT00009633 (Follow-Up Study).

Adrenal Cortex Hormones - therapeutic use

Female

Follow-Up Studies

Gestational Age

Humans

Infant

Infant, Extremely Premature

Infant, Newborn

Infant, Premature, Diseases - mortality

Infant, Premature, Diseases - therapy

Male

Multivariate Analysis

Premature Birth

Prospective Studies

Resuscitation - methods

Treatment Outcome

Details

Title: Subtitle: Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth
Creators: Matthew A Rysavy - University of Iowa
Edward F Bell - University of Iowa
Jay D Iams - The Ohio State University
Waldemar A Carlo - University of Alabama at Birmingham
Lei Li - RTI International
Brian M Mercer - Case Western Reserve University
Susan R Hintz - Stanford University
Barbara J Stoll - The University of Texas at Austin
Betty R Vohr - Women & Infants Hospital of Rhode Island
Seetha Shankaran - Wayne State University
Michele C Walsh - Case Western Reserve University
Jane E Brumbaugh - Mayo Clinic in Florida
Tarah T Colaizy - University of Iowa
Abhik Das - RTI International
Rosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.208, pp.156-162.e5
DOI: 10.1016/j.jpeds.2018.12.063
PMID: 30738658
PMCID: PMC6486854
ISSN: 0022-3476
eISSN: 1097-6833
Grant note: UG1 HD021385 / NICHD NIH HHS L40 HD099827 / NICHD NIH HHS U10 HD040544 / NICHD NIH HHS UG1 HD027851 / NICHD NIH HHS F32 HD098782 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U24 HD095254 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027915 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS UG1 HD053109 / NICHD NIH HHS U01 HD036790 / NICHD NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS UL1 TR002548 / NCATS NIH HHS U10 HD027904 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS
Language: English
Date published: 05/2019
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984354146802771

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