title: Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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]).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Alabama, 9380 Women and Infants Center, 1700 Sixth Ave S, Birmingham, AL 35249, USA. wcarlo@peds.uab.edu
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Scott A
authors.initials: SA
authors.lastname: McDonald
authors.forename: Avroy A
authors.initials: AA
authors.lastname: Fanaroff
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Richard A
authors.initials: RA
authors.lastname: Ehrenkranz
authors.forename: William W
authors.initials: WW
authors.lastname: Andrews
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Brenda B
authors.initials: BB
authors.lastname: Poindexter
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Newman
authors.forename: Alexis S
authors.initials: AS
authors.lastname: Davis
authors.forename: Kurt
authors.initials: K
authors.lastname: Schibler
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Kennedy
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.forename: Krisa P
authors.initials: KP
authors.lastname: Van Meurs
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Watterberg
authors.forename: Roger G
authors.initials: RG
authors.lastname: Faix
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Frantz
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002657:Child Development / Q000187:drug effects*; D003071:Cognition; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009420:Nervous System / Q000187:drug effects* / Q000254:growth & development; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D011596:Psychomotor Disorders; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones