Association of Antenatal Steroid Exposure at 21 to 22 Weeks of Gestation With Neonatal Survival and Survival Without Morbidities-Reference-Cited by-同舟云学术

Association of Antenatal Steroid Exposure at 21 to 22 Weeks of Gestation With Neonatal Survival and Survival Without Morbidities

Published:2022-09-26 Issue:9 Volume:5 Page:e2233331
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

Chawla Sanjay¹,Wyckoff Myra H.²,Rysavy Matthew A.³,Patel Ravi Mangal⁴,Chowdhury Dhuly⁵,Natarajan Girija¹,Laptook Abbot R.⁶,Lakshminrusimha Satyan⁷,Bell Edward F.⁸,Shankaran Seetha⁹,Van Meurs Krisa P.¹⁰,Ambalavanan Namasivayam¹¹,Greenberg Rachel G.¹²,Younge Noelle¹²,Werner Erika F.¹³,Das Abhik¹⁴,Carlo Waldemar A.¹¹,Collins Monica V.¹⁵,Cosby Shirley S.¹⁵,Hensman Angelita M.¹⁵,Keszler Martin¹⁵,St. Pierre Lucille¹⁵,Vieira Elisa¹⁵,Guilford Stephanie¹⁵,Li Emily¹⁵,Reynolds Anne Marie¹⁵,Sacilowski Michael G.¹⁵,Hibbs Anna Maria¹⁵,Newman Nancy S.¹⁵,Siner Bonnie S.¹⁵,Walsh Michele C.¹⁵,Williams Angelia¹⁵,Beiersdorfer Traci¹⁵,Grisby Cathy¹⁵,Kirker Kristin¹⁵,Poindexter Brenda B.¹⁵,Schibler Kurt¹⁵,Thompson Julia¹⁵,Polin Richard A.¹⁵,Brion Luc P.¹⁵,De Leon Maria M.¹⁵,Eubanks Frances¹⁵,Sepulveda Pollieanna¹⁵,Vasil Diana M.¹⁵,Cotten C. Michael¹⁵,Finkle Joanne¹⁵,Fisher Kimberley A.¹⁵,Goldberg Ronald N.¹⁵,Bear Kelly¹⁵,Bergstedt Vicki¹⁵,Moore Ryan¹⁵,Moseley Sherry¹⁵,Bottcher Diane I.¹⁵,Carlton David P.¹⁵,Loggins Yvonne C.¹⁵,Mackie Colleen¹⁵,Franco Claudia I.¹⁵,Kennedy Kathleen A.¹⁵,Khan Amir M.¹⁵,Lis Anna E.¹⁵,Martin Sara C.¹⁵,McDavid Georgia Elaine¹⁵,Orekoya Patricia Ann¹⁵,Pedroza Claudia¹⁵,Pierce Tate Patti L.¹⁵,Stephens Emily K.¹⁵,Tyson Jon E.¹⁵,Gunn Susan¹⁵,Herron Dianne E.¹⁵,Joyce Jeffery¹⁵,Sokol Gregory M.¹⁵,Colaizy Tarah T.¹⁵,Faruqui Sarah E.¹⁵,Goeke Claire A.¹⁵,Johnson Karen J.¹⁵,Schmelzel Mendi L.¹⁵,Walker Jacky R.¹⁵,Gaetano Lisa¹⁵,Gauldin Cheri¹⁵,Holmes Anne M.¹⁵,Kilbride Howard W.¹⁵,Pallotto Eugenia K.¹⁵,Parimi Prabhu S.¹⁵,Scott Allison¹⁵,Truog William E.¹⁵,Clark Erna¹⁵,Gutentag Julie¹⁵,Jadcherla Sudarshan R.¹⁵,Luzader Patricia¹⁵,Nelin Leif D.¹⁵,Park Courtney¹⁵,Sánchez Pablo J.¹⁵,Shadd Julie C.¹⁵,Stein Melanie¹⁵,Sullivan Margaret¹⁵,Bremer Andrew A.¹⁵,Higgins Rosemary D.¹⁵,Wilson Archer Stephanie¹⁵,Abbasi Soraya¹⁵,Catts Christine¹⁵,Chaudhary Aasma S.¹⁵,DeMauro Sara B.¹⁵,Dhawan Megan A.¹⁵,Eichenwald Eric C.¹⁵,Ghavam Sarvin¹⁵,Kirpalani Haresh¹⁵,Mancini Toni¹⁵,Schmidt Barbara¹⁵,Snyder Jonathan M.¹⁵,Binion Kyle¹⁵,Boylin Elizabeth¹⁵,D'Angio Carl T.¹⁵,Guillet Ronnie¹⁵,Jensen Rosemary L.¹⁵,Jones Rachel¹⁵,Kachelmeyer Jennifer¹⁵,Kent Alison¹⁵,Maffett Deanna¹⁵,Orme Constance¹⁵,Prinzing Diane M.¹⁵,Rochez Daisy¹⁵,Rowan Mary¹⁵,Sabaratnam Premini¹⁵,Scorsone Ann Marie¹⁵,Wadkins Holly I.M.¹⁵,Bann Carla M.¹⁵,Gabrio Jenna¹⁵,Gantz Marie G.¹⁵,Leblond David¹⁵,O’Donnell Auman Jeanette¹⁵,Wallace Dennis¹⁵,Zaterka-Baxter Kristin M.¹⁵,Baack Michelle L.¹⁵,Broadbent Megan¹⁵,Elenkiwich Chelsey¹⁵,Henning Megan M.¹⁵,Van Muyden Sarah¹⁵,Ball M. Bethany¹⁵,Chock Valerie Y.¹⁵,Proud Melinda S.¹⁵,Reichert Elizabeth N.¹⁵,Sivakumar Dharshi¹⁵,Stevenson David K.¹⁵,Williams R. Jordan¹⁵,Chanlaw Teresa¹⁵,Devaskar Uday¹⁵,Garg Meena¹⁵,Geller Rachel¹⁵,Bernhardt Janice¹⁵,Bose Carl L.¹⁵,Clark Cynthia L.¹⁵,Laughon Matthew Maxwell¹⁵,Talbert Jennifer¹⁵,Backstrom Lacy Conra¹⁵,Fuller Janell¹⁵,Hanson Mary¹⁵,Kuan Elizabeth¹⁵,Ohls Robin K.¹⁵,Sundquist Beauman Sandra¹⁵,Watterberg Kristi L.¹⁵,Barks John¹⁵,White Diane F.¹⁵,Baserga Mariana¹⁵,Burnett Jill¹⁵,Christensen Susan¹⁵,Coleman Kathleen¹⁵,Davis Brandy¹⁵,Elmont Jennifer O.¹⁵,Francom Barbara L.¹⁵,Jordan Jamie¹⁵,Loertscher Manndi C.¹⁵,Marchant Trisha¹⁵,Maxson Earl¹⁵,McGrath Kandace M.¹⁵,Mickelsen Hena G.¹⁵,Minton Stephen D.¹⁵,Parry D. Melody¹⁵,Rau Carrie A.¹⁵,Schaefer Susan T.¹⁵,Sheffield Mark J.¹⁵,Tice Katherine¹⁵,Weaver-Lewis Kimberlee¹⁵,Woodbury Kathryn D.¹⁵,Yoder Bradley A.¹⁵,Kicklighter Stephen D.¹⁵,Rhodes-Ryan Ginger¹⁵,White Donna¹⁵,Childs Kirsten¹⁵,Panaitescu Bogdan¹⁵,

Affiliation:

1. Departments of Pediatrics, Central Michigan University, Wayne State University, Children’s Hospital of Michigan, Detroit

2. Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas

3. Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center, Houston

4. Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia

5. RTI International, Rockville, Maryland

6. Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island

7. Department of Pediatrics, UC Davis Children’s Hospital, Sacramento, California

8. Department of Pediatrics, University of Iowa, Iowa City

9. Department of Pediatrics, Wayne State University, Detroit, Michigan

10. Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California

11. Department of Pediatrics, University of Alabama at Birmingham, Birmingham

12. Department of Pediatrics, Duke University, Durham, North Carolina

13. Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island

14. Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland

15. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Abstract

ImportanceThe provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials.ObjectiveTo compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks’ gestation or less vs no exposure to antenatal steroids.Design, Setting, and ParticipantsThis cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of Child Health and Human Development Neonatal Research Network. Infants who did not receive intensive care and infants with antenatal steroid exposure after GA 22 6/7 weeks were excluded.ExposureInfants were classified as having no, partial, or complete exposure to antenatal steroids.Main Outcomes and MeasuresThe primary outcome was survival to discharge. The main secondary outcome was survival without major neonatal morbidity. The associations of differential exposures to antenatal steroids with outcomes were evaluated using logistic regression, adjusting for GA, sex, race, maternal education, small for GA status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and Neonatal Research Network center.ResultsA total of 431 infants (mean [SD] GA, 22.6 [0.5] weeks; 232 [53.8%] boys) were included, with 110 infants (25.5%) receiving no antenatal steroids, 80 infants (18.6%) receiving partial antenatal steroids, and 241 infants (55.9%) receiving complete antenatal steroids. Seventeen infants were exposed to antenatal steroids at GA 21 weeks. Among infants exposed to complete antenatal steroids, 130 (53.9%) survived to discharge, compared with 30 infants (37.5%) with partial antenatal steroid exposure and 239 infants (35.5%) with no antenatal steroids. Infants born after complete antenatal steroid exposure, compared with those without antenatal steroid exposure, were more likely to survive to discharge (adjusted odds ratio [aOR], 1.95 [95% CI, 1.07-3.56]) and to survive without major morbidity (aOR, 2.74 [95% CI, 1.19-6.30]).Conclusions and RelevanceIn this retrospective cohort study, among infants born between GA 22 0/7 and 23 6/7 weeks who received intensive care, exposure to a complete course of antenatal steroids at GA 22 6/7 weeks or less was independently associated with greater odds of survival and survival without major morbidity. These data suggest that the use of antenatal steroids in patients at GA 22 6/7 weeks or less could be beneficial when active treatment is considered.

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2796666/chawla_2022_oi_220947_1663354304.75619.pdf

Reference21 articles.

1. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.;Roberts;Cochrane Database Syst Rev,2017

2. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants.;Liggins;Pediatrics,1972

3. The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials.;Crowley;Br J Obstet Gynaecol,1990

4. Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice.;Mactier;Arch Dis Child Fetal Neonatal Ed,2020

5. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids.;Chawla;JAMA Pediatr,2016

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