title: Antenatal steroid administration for premature neonates in California.
abstract: OBJECTIVE
  To estimate risk factors for premature neonates not receiving antenatal steroids in a population-based cohort and to determine whether the gains of a quality-improvement collaborative project on antenatal steroid administration were sustained long-term.
  
  
  METHODS
  Clinical data for premature neonates born in 2005–2007 were obtained from the California Perinatal Quality Care Collaborative, which collects data on more than 90% of neonatal admissions in California. Eligible neonates had a birth weight of less than 1,500 g or gestational age less than 34 weeks and were born at a Collaborative hospital. These data were linked to administrative data from California Vital Statistics. Sociodemographic and medical risk factors for not receiving antenatal steroids were determined. We also examined the effect of birth hospital participation in a previous quality-improvement collaborative project. A random effects logistic regression model was used to determine independent risk factors.
  
  
  RESULTS
  Of 15,343 eligible neonates, 23.1% did not receive antenatal steroids in 2005–2007. Hispanic mothers (25.6%), mothers younger than age 20 (27.6%), and those without prenatal care (52.2%) were less likely to receive antenatal steroids. Mothers giving birth vaginally (26.8%) and mothers with a diagnosis of fetal distress (26.5%) were also less likely to receive antenatal steroids. Rupture of membranes before delivery and multiple gestations were associated with higher likelihood of antenatal steroid administration. Hospitals that participated in a quality-improvement collaborative in 1999– 2000 had higher rates of antenatal steroid administration (85% compared with 69%, P<.001).
  
  
  CONCLUSIONS
  A number of eligible mothers do not receive antenatal steroids. Quality-improvement initiatives to improve antenatal steroid administration could target specific high-risk groups.
authors: From the Department of Pediatrics, Department of Family Health Care Nursing, and Departments of Medicine and Health Policy, University of California, San Francisco, San Francisco, California; California Perinatal Quality Care Collaborative, Palo Alto, California; and the Departments of Obstetrics and Gynecology and Pediatrics, Stanford University, Stanford, California.
authors: Henry C
authors: HC
authors: Lee
authors: Audrey
authors: A
authors: Lyndon
authors: Yair J
authors: YJ
authors: Blumenfeld
authors: R Adams
authors: RA
authors: Dudley
authors: Jeffrey B
authors: JB
authors: Gould
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000706:statistics & numerical data; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones