title: Area-based study identifies risk factors associated with missed antenatal corticosteroid prophylaxis in women delivering preterm infants.
abstract: OBJECTIVE
  All women delivering a preterm infant should receive antenatal corticosteroid prophylaxis, but many miss this opportunity. We determined the risk factors associated with missed prophylaxis in a geographically defined area of Italy.
  
  
  METHODS
  We prospectively studied all mothers who delivered babies between 24 and 31 completed weeks of gestation, from 2009 to 2013, in all maternity units in Tuscany.
  
  
  RESULTS
  Of 1232 mothers, 186 (15.1%) did not receive prophylaxis. The risk was higher in migrant mothers, with an adjusted risk ratio (RR) of 1.28 and 95% confidence interval (95% CI) of 1.04-1.56, and in mothers hospitalised for less than 24 hours (RR 4.09, 95% CI: 2.90-5.78). Preterm prelabour rupture of membranes (RR 0.63, 95% CI: 0.41-0.96) and maternal antepartum transfer (RR 0.24, 95% CI: 0.18-0.32) were protective. Hospital level at birth and gestational age did not influence the prophylaxis rate. The population-attributable fractions were 50.4% for late hospital admissions and 10.2% for migrant status.
  
  
  CONCLUSIONS
  In a highly organised network of hospitals, neither level of care nor gestational age influenced prophylaxis. Timely arrival of women in hospital, better recognition of the imminence of delivery and tighter steroids administration guidelines are the most relevant targets to further increase prophylaxis.
authors: Department of Woman and Child Health, Versilia Hospital, Viareggio, Italy.
authors: Luigi
authors: http://orcid.org/0000-0001-6074-8975
authors: L
authors: Gagliardi
authors: Department of Fetal-Neonatal Medicine, Anna Meyer Children's University Hospital, Florence, Italy.
authors: Carolina
authors: C
authors: Amador
authors: Health Agency of Tuscany, Florence, Italy.
authors: Monia
authors: M
authors: Puglia
authors: Department of Gynecology, Perinatology and Human Reproduction, Careggi University Hospital, Florence, Italy.
authors: Federico
authors: F
authors: Mecacci
authors: Department of Neuroscience, Psychology, Drug Research and Child Health, Careggi University Hospital, Florence, Italy.
authors: Simone
authors: S
authors: Pratesi
authors: Department of Pediatrics, Division of Neonatology and Neonatal Intensive Care Unit, University Hospital of Pisa, Pisa, Italy.
authors: Emilio
authors: E
authors: Sigali
authors: Neonatal Intensive Care Unit, University Hospital of Siena, Siena, Italy.
authors: Barbara
authors: B
authors: Tomasini
authors: Unit of Epidemiology, Anna Meyer Children's University Hospital, Florence, Italy.
authors: Franca
authors: F
authors: Rusconi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D011247:Pregnancy; D047928:Premature Birth; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Antenatal steroid prophylaxis; Migrant mothers; Pregnancy; Premature infant; Risk factors