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Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth

Matthew A Rysavy1, Edward F Bell1, Jay D Iams2

  • 1Department of Pediatrics, University of Iowa, Iowa City, IA.

The Journal of Pediatrics
|February 11, 2019
PubMed

Insights

Consistent antenatal corticosteroids for extremely preterm infants, especially at 23 weeks gestation, may improve survival and neurodevelopment. This is crucial when resuscitation is planned, reducing discordant care.

Area of Science:

  • Neonatal Medicine
  • Perinatal Research
  • Pediatric Outcomes

Background:

  • Extremely preterm birth presents significant challenges for infant survival and neurodevelopment.
  • Discordance between antenatal corticosteroid administration and resuscitation efforts complicates care.
  • Variations in care practices can impact outcomes for vulnerable neonates.

Purpose of the Study:

  • To analyze discordance in antenatal corticosteroid use and resuscitation for extremely preterm infants.
  • To investigate the relationship between these practices and infant survival and neurodevelopmental outcomes.
  • To model the potential impact of optimizing antenatal corticosteroid use on infant outcomes.

Main Methods:

  • A multicenter cohort study involving 4858 infants born between 22-26 weeks gestation.
  • Follow-up data on survival and neurodevelopmental outcomes were collected at 18-22 months corrected age.
  • Statistical modeling was used to assess the effect of increasing antenatal corticosteroid exposure.

Main Results:

  • Discordant care (one intervention without the other) was more common at 22 and 23 weeks gestation compared to 25-26 weeks.
  • For 23-week infants receiving resuscitation, increasing antenatal corticosteroid use to 89.2% was projected to improve survival by 7.1% and survival without impairment by 6.4%.
  • No significant outcome improvement was projected for 22-week infants due to very low antenatal corticosteroid use in resuscitated infants.

Conclusions:

  • Infants born at 23 weeks gestation frequently received resuscitation without antenatal corticosteroids.
  • Consistent antenatal corticosteroid administration, when resuscitation is intended, may enhance infant survival and reduce severe impairment.
  • Optimizing antenatal corticosteroid use is a critical strategy for improving outcomes in extremely preterm neonates.
Abstract

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