title: Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study.
abstract: ObjectiveTo determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended.DesignProspective cohort study.Settings300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States.Participants117 941 infants 23 0/7 to 34 6/7 weeks' gestational age born between 1 January 2009 and 31 December 2013.ExposureAny antenatal corticosteroids.Main outcomes measuresDeath or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births.ResultsInfants exposed to antenatal corticosteroids (n=81 832) had a significantly lower rate of death before discharge at each gestation 29 weeks or less, 31 weeks, and 33-34 weeks compared with infants without exposure (range of adjusted odds ratios 0.32 to 0.55). The number needed to treat with antenatal corticosteroids to prevent one death before discharge increased from six at 23 and 24 weeks' gestation to 798 at 34 weeks' gestation. The rate of survival without major hospital morbidity was higher among infants exposed to antenatal corticosteroids at the lowest gestations. Infants exposed to antenatal corticosteroids had lower rates of severe intracranial hemorrhage or death, necrotizing enterocolitis stage 2 or above or death, and severe retinopathy of prematurity or death compared with infants without exposure at all gestations less than 30 weeks and most gestations for infants born at 30 weeks' gestation or later.ConclusionAmong infants born from 23 to 34 weeks' gestation, antenatal exposure to corticosteroids compared with no exposure was associated with lower mortality and morbidity at most gestations. The effect size of exposure to antenatal corticosteroids on mortality seems to be larger in infants born at the lowest gestations.
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, AL 35233, USA.
authors.forename: Colm P
authors.initials: CP
authors.lastname: Travers
authors.affiliation: Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA.
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.affiliation: Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Spitzer
authors.affiliation: Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA.
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.affiliation: Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA.|Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Garite
authors.affiliation: Division of Neonatology, University of Alabama at Birmingham, AL 35233, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000494:pharmacology*; D001724:Birth Weight / Q000187:drug effects; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones