Journal article
Potential missed opportunities for antenatal corticosteroid exposure and outcomes among periviable births: observational cohort study
BJOG : an international journal of obstetrics and gynaecology, Vol.129(12), pp.2039-2051
05/24/2022
DOI: 10.1111/1471-0528.17230
PMCID: PMC9684347
PMID: 35611472
Abstract
Test the hypothesis potential missed opportunities for antenatal corticosteroids increase as gestational age decreases and are associated with adverse outcomes.
Observational cohort study.
24 US centers in the Neonatal Research Network.
Actively treated infants 22-25 weeks' gestation and birth weight 401-1000 grams, without major birth defects, born 2006-2018.
Potential missed opportunity was defined as no antenatal corticosteroids but did have prenatal antibiotics, and/or magnesium sulfate, and/or prolonged rupture of membranes. Poisson regression models adjusted for baseline characteristics.
Antenatal corticosteroid exposure, mortality, and severe intracranial hemorrhage or periventricular leukomalacia.
6966 (87.5%) were exposed to antenatal corticosteroids, 454 (5.7%) had no exposure but potential missed opportunities for antenatal corticosteroid exposure, and 537 (6.7%) had no exposure and no evidence of potential missed opportunities. Compared with infants born at 25 weeks, potential missed opportunities for antenatal corticosteroid exposure were more likely at 22 weeks (adjusted relative risk (aRR) [95% CI] 11.06 [7.52-16.27]) and 23 weeks (3.24 [2.44-4.29]) but did not differ at 24 weeks (1.08 [0.82-1.42]). Potential missed opportunities for antenatal corticosteroids decreased over time at 22-23 weeks' gestation. Antenatal corticosteroid exposed infants had lower risk of death (31.0% vs 54.8%; 0.77 [0.70-0.84]) and survivors had lower risk of severe brain injury (25.0% v 44.5%; 0.64 [0.55-0.73]) compared with infants with potential missed opportunities.
Potential missed opportunities for antenatal corticosteroid exposure increased with decreasing gestational age and were associated with higher rates of death and severe brain injury among actively treated periviable births.
Details
- Title: Subtitle
- Potential missed opportunities for antenatal corticosteroid exposure and outcomes among periviable births: observational cohort study
- Creators
- Colm P Travers - University of Alabama at BirminghamNellie I Hansen - RTI InternationalAbhik Das - RTI InternationalMatthew A Rysavy - University of IowaEdward F Bell - University of IowaNamasivayam Ambalavanan - University of Alabama at BirminghamMyriam Peralta-Carcelen - University of Alabama at BirminghamAlan T Tita - University of Alabama at BirminghamKrisa P Van Meurs - Stanford UniversityWaldemar A Carlo - University of Alabama at BirminghamEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Contributors
- John M Dagle (Contributor) - University of Iowa, Stead Family Department of Pediatrics
- Resource Type
- Journal article
- Publication Details
- BJOG : an international journal of obstetrics and gynaecology, Vol.129(12), pp.2039-2051
- DOI
- 10.1111/1471-0528.17230
- PMID
- 35611472
- PMCID
- PMC9684347
- ISSN
- 1470-0328
- eISSN
- 1471-0528
- Grant note
- DOI: 10.13039/100009633, name: Eunice Kennedy Shriver National Institute of Child Health and Human Development, award: UG1 HD034216
- Language
- English
- Date published
- 05/24/2022
- Academic Unit
- Stead Family Department of Pediatrics; Epidemiology; Biochemistry and Molecular Biology; Neonatology
- Record Identifier
- 9984288719402771
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