Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation | Cerebrovascular Disease | JAMA | JAMA Network
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Original Contribution
December 7, 2011

Association of Antenatal Corticosteroids With Mortality and Neurodevelopmental Outcomes Among Infants Born at 22 to 25 Weeks' Gestation

Author Affiliations

Author Affiliations: Department of Pediatrics, University of Alabama, Birmingham (Drs Carlo and Andrews); Children's Hospital of Alabama, Birmingham (Drs Carlo and Andrews); Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina (Mr McDonald and Dr Wallace); Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio (Drs Fanaroff and Walsh and Ms Newman); Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island (Drs Vohr and Laptook); Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia (Dr Stoll and Ms Hale); Children's Healthcare of Atlanta, Atlanta, Georgia (Dr Stoll and Ms Hale); Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Dr Ehrenkranz); Statistics and Epidemiology Unit, RTI International, Rockville, Maryland (Dr Das); Department of Pediatrics, University of Iowa, Iowa City (Dr Bell); Department of Pediatrics, Wayne State University, Detroit, Michigan (Dr Shankaran); Department of Pediatrics, Indiana University School of Medicine, Indianapolis (Dr Poindexter); Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California (Drs Davis and van Meurs); Lucile Packard Children's Hospital, Palo Alto, California (Drs Davis and van Meurs); Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio (Dr Schibler); Department of Pediatrics, University of Texas Medical School, Houston (Dr Kennedy); Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas (Dr Sanchez); Department of Pediatrics, Duke University, Durham, North Carolina (Dr Goldberg); Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque (Dr Watterberg); Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City (Dr Faix); Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts (Dr Frantz); and Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland (Dr Higgins).

JAMA. 2011;306(21):2348-2358. doi:10.1001/jama.2011.1752
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.

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