Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants

Sanjay Chawla; Myra H Wyckoff; Satyan Lakshminrusimha; Matthew A Rysavy; Ravi Mangal Patel; Dhuly Chowdhury; Abhik Das; Rachel G Greenberg; Girija Natarajan; Seetha Shankaran; Edward F Bell; Namasivayam Ambalavanan; Noelle E Younge; Abbot R Laptook; Leeann R Pavlek; Carl H Backes; Krisa P Van Meurs; Erika F Werner; Waldemar A Carlo; National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN)

doi:10.1001/jamanetworkopen.2024.61312

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Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants

Journal article

Open access

Peer reviewed

Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants

Sanjay Chawla, Myra H Wyckoff, Satyan Lakshminrusimha, Matthew A Rysavy, Ravi Mangal Patel, Dhuly Chowdhury, Abhik Das, Rachel G Greenberg, Girija Natarajan, Seetha Shankaran, …

JAMA network open, Vol.8(2), e2461312

02/03/2025

DOI: 10.1001/jamanetworkopen.2024.61312

PMCID: PMC11846007

PMID: 39982720

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Abstract

When preterm delivery is imminent, it remains unclear whether the timing from administration of antenatal betamethasone to birth may reduce mortality and morbidity among extremely preterm infants. To evaluate the association of duration from exposure to first dose of antenatal betamethasone with outcomes among extremely preterm infants. This cohort study enrolled infants born at 22 0/7 to 27 6/7 weeks' gestation from January 2016 to February 2021 at National Institute of Child Health and Human Development Neonatal Research Network centers. Infants exposed to multiple doses of antenatal betamethasone, infants who did not receive intensive care, and infants with congenital anomalies were excluded. Data were analyzed from October 2021 to December 2024. Time in hours from anenatal betamethasone administration to birth. The primary outcome was survival to discharge. Secondary outcomes included survival without major morbidity and composites of individual morbidities and death. The association of time from antenatal betamethasone administration to birth with neonatal survival and morbidity was assessed using generalized linear models, adjusting for gestational age, infant sex, maternal race, education, small for gestational age, mode of delivery, multiple birth, prolonged rupture of membranes, and center of birth. Of 7464 infants born during the study period, 1806 infants (928 [51.3%] boys) were included in the cohort: 475 with no betamethasone and 1331 with exposure to a single dose of betamethasone within 24 hours before birth. The median (IQR) administration-to-birth interval for infants born after a single dose of betamethasone was 3.8 (1.4-9.5) hours. The administration-to-birth interval was independently associated with survival (adjusted relative risk [aRR] per 1-hour increase, 1.01 [95% CI, 1.00-1.01]; aRR per 6-hour increase, 1.04 [95% CI, 1.01-1.07]) and survival without severe neonatal morbidity (aRR per 1-hour increase, 1.01 [95% CI, 1.01-1.02]; aRR per 6-hour increase, 1.09 [95% CI, 1.04-1.14]. In this cohort study, for women at risk of imminent preterm birth, even short duration of exposure to antenatal betamethasone was associated with improved neonatal survival and survival without severe neonatal morbidity.

Pregnancy

Betamethasone - administration & dosage

Betamethasone - therapeutic use

Cohort Studies

Female

Gestational Age

Glucocorticoids - administration & dosage

Glucocorticoids - adverse effects

Glucocorticoids - therapeutic use

Humans

Infant

Infant, Extremely Premature

Infant, Newborn

Infant, Premature, Diseases - mortality

Infant, Premature, Diseases - prevention & control

Male

Prenatal Care - methods

Time Factors

Details

Title: Subtitle: Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants
Creators: Sanjay Chawla - Children's Hospital of Michigan
Myra H Wyckoff - The University of Texas Southwestern Medical Center
Satyan Lakshminrusimha - UC Davis Children's Hospital
Matthew A Rysavy - The University of Texas Health Science Center at Houston
Ravi Mangal Patel - Emory University
Dhuly Chowdhury - RTI International
Abhik Das
Rachel G Greenberg - Duke University
Girija Natarajan - Wayne State University
Seetha Shankaran - The University of Texas at Austin
Edward F Bell - University of Iowa
Namasivayam Ambalavanan - University of Alabama at Birmingham
Noelle E Younge - Duke University
Abbot R Laptook - Women & Infants Hospital of Rhode Island
Leeann R Pavlek - Nationwide Children's Hospital
Carl H Backes - Nationwide Children's Hospital
Krisa P Van Meurs - Stanford University
Erika F Werner - Tufts University
Waldemar A Carlo - University of Alabama at Birmingham
National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN)
Resource Type: Journal article
Publication Details: JAMA network open, Vol.8(2), e2461312
DOI: 10.1001/jamanetworkopen.2024.61312
PMID: 39982720
PMCID: PMC11846007
NLM abbreviation: JAMA Netw Open
ISSN: 2574-3805
eISSN: 2574-3805
Publisher: AMER MEDICAL ASSOC
Grant note: National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN)
This work was supported by grants from the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN).
Language: English
Date published: 02/03/2025
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984792363802771

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