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JAMA. 2011 Dec 7;306(21):2348-58. doi: 10.1001/jama.2011.1752.

Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.

Collaborators (198)

Jobe AH, Caplan MS, Oh W, Stephens B, Burke R, Alksninis B, Caskey M, Johnson K, Hensman AM, Ventura S, Watson VE, Leach TM, Stark AR, Fournier K, Dow S, Lee KG, Driscoll C, Wilson-Costello D, Siner BS, Donovan EF, Bridges K, Alexander B, Steichen J, Yolton KA, Grisby C, Mincey HL, Hessling J, Mersmann MW, Gratton TL, Cotten CM, Goldstein R, Auten KJ, Fisher KA, Foy KA, Grimes S, Lohmeyer M, Carlton DP, Jain L, Adams-Chapman I, Wright LL, Archer SW, McClure EM, McGowan EC, MacKinnon BL, Furey A, Nylen E, Lemons JA, Dusick AM, Appel DD, Herron DE, Miller LC, Wilson LD, Richard L, Poole WK, Auman JO, Cunningham M, Hastings BK, Huitema CM, McClure EM, Newman JE, Pickett JW 2nd, Zaterka-Baxter KM, Stevenson DK, Hintz SR, Adams MM, Fleisher BE, Kohn JG, Stebbins RD, Weiss H, Baran JM, Bentley B, Bond L, Brudos GK, Bruno E, DeAnda ME, Lee-Ancajas J, Pyle RP, St John N, Ball MB, DeBattista AM, Proud MS, Ambalavanan N, Collins MV, Cosby SS, Peralta-Carcelen M, Phillips V, Biasini FJ, Dimmitt R, Randolph D, Finer NN, Rasmussen MR, Wozniak PR, Vaucher YE, Arnell K, Bridge R, Demetrio C, Fuller MG, Henderson C, Rich W, Widness JA, Acarregui MJ, Johnson KJ, Eastman DL, Duara S, Bauer CR, Everett-Thomas R, Worth AM, Hamlin-Smith K, Berkovits M, Eguras SM, Allison M, Papile LA, Fuller J, Lowe J, Lacy CB, Montman R, Phelps DL, Myers G, Hust D, Reubens LJ, Burnell E, Jensen RL, Rowan M, Yost K, Zwetsch L, Johnson JB, Kushner E, Horihan CA, Merzbach J, Korones SB, Bada HS, Williams MG, Yolton K, Rosenfeld CR, Salhab WA, Tyson JE, Heyne RJ, Brion LP, Guzman A, Hickman JF, Miller NA, Vasil DM, Torres LE, Morgan JS, Boatman CT, Tyson JE, Akpa EG, Cedillo M, Orekoya PA, Dieterich SE, Evans PW, Franco CI, Green CE, Harris BF, Jiminez M, Major-Kincade TL, Lis AE, Martin SC, McDavid GE, Morris BH, Poundstone ML, Reddoch S, Siddiki SK, Simmons MC, Tate PL, Whitely LL, Wright SL, Yoder BA, Osborne KA, Jensen JJ, Spencer C, Weaver-Lewis K, Burnett J, Baker S, O'Shea TM, Dillard R, Peters NJ, Jackson B, Pappas A, Johnson YR, Delaney-Black V, Bara R, Muran G, Kennedy D, Goldston LA, Jacobs H, Mayes LC, Cervone P, Gettner P, Konstantino M, Poulsen J, Romano E, Taft J, Williams J, Close NL, Gilliam WS, Butler CG, Greisman S.

Author information

  • 1Department of Pediatrics, University of Alabama, 9380 Women and Infants Center, 1700 Sixth Ave S, Birmingham, AL 35249, USA. wcarlo@peds.uab.edu

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.

PMID:
22147379
[PubMed - indexed for MEDLINE]
PMCID:
PMC3565238
Free PMC Article

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