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Reported adherence to current antenatal corticosteroid guidelines in Australia and New Zealand
Jeremy F Tuohy1, Jane E Harding1, Caroline A Crowther1
1Liggins Institute, University of Auckland, Auckland, New Zealand.
Insights
Antenatal corticosteroids (ANC) are recommended for preterm birth, but Australian and New Zealand obstetricians often prescribe them outside guidelines. Adherence to guidelines could reduce unnecessary ANC exposure in infants.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Clinical Practice Guidelines
Background:
- Antenatal corticosteroids (ANC) are crucial for reducing mortality and morbidity in preterm infants.
- Current prescription practices for ANC demonstrate significant variability.
Purpose of the Study:
- To evaluate obstetricians' adherence to Australian and New Zealand clinical practice guidelines for ANC use.
- To identify discrepancies in ANC prescribing patterns.
Main Methods:
- An anonymous online questionnaire was administered to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
- The survey assessed current prescribing habits for initial and repeat courses of ANC.
Main Results:
- While initial ANC courses align with guidelines for expected preterm birth <28 weeks, 22% prescribed ANC without imminent birth.
- 52% prescribed initial ANC at ≥35 weeks, with 93% doing so before elective C-section.
- 76% prescribed repeat ANC courses, with 89% exceeding gestational age recommendations (≥33 weeks) and 29% exceeding the number of recommended courses.
Conclusions:
- ANC prescribing for infants <35 weeks generally aligns with guidelines, ensuring high administration rates.
- Commonly reported ANC administration occurs in groups lacking demonstrated benefit.
- Greater adherence to guidelines would minimize unnecessary ANC exposure in infants without proven benefit.
Background:
Antenatal corticosteroids (ANC) reduce mortality and morbidity in preterm babies, but prescription practices vary.
Aims:
To assess obstetricians' compliance with the recommendations of the Australian and New Zealand clinical practice guidelines on use of ANC.
Materials And Methods:
An anonymous online questionnaire was distributed to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Results:
All respondents reported prescribing an initial course of ANC according to the guidelines if preterm birth at 28 weeks' gestation was expected within 24 or 72 h. However, 22% reported prescribing ANC even if birth was not expected within seven days. This was reported more often by practitioners not using adjunct tests to predict preterm birth (14% vs 69%; P < 0.001). An initial course of ANC at ≥35 weeks was prescribed by 52% of respondents. However, 93% reported prescribing ANC at ≥35 weeks prior to elective caesarean section. Repeat courses of ANC were prescribed by 76% of respondents. Of these, 89% reported prescribing repeat courses beyond the guideline recommendations at ≥33 weeks and 29% exceeded the recommendations on number of repeat courses.
Conclusions:
For infants born at <35 weeks, current ANC prescribing patterns in Australia and New Zealand are consistent with the guideline recommendations and result in high rates of administration in this group. However, administration of ANC to groups where benefits have not been demonstrated is commonly reported. Adherence to the guideline recommendations would decrease ANC exposure to babies for whom there is no strong evidence of benefit.
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