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Antenatal corticosteroids and outcomes in gastroschisis: A multicenter retrospective cohort study
Helen Carnaghan1, Catherine P James2, Paul B Charlesworth3
1UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children, London, UK.
Insights
Maternal antenatal corticosteroids did not improve gut function in infants with gastroschisis. This study found no significant effect on the time to full enteral feeds for these newborns.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Maternal-Fetal Medicine
Background:
- Gastroschisis is a congenital condition often associated with gut dysfunction.
- Gut dysfunction in gastroschisis may develop secondary to bowel inflammation.
Purpose of the Study:
- To evaluate the effect of maternal antenatal corticosteroids on time to full enteral feeds in infants with gastroschisis.
- To assess if antenatal steroid administration impacts neonatal outcomes in gastroschisis.
Main Methods:
- A multicenter retrospective cohort study of 500 infants with gastroschisis.
- Primary outcome: time to full enteral feeds. Secondary outcome: length of hospital stay.
- Statistical analysis included Mann-Whitney and Cox regression.
Main Results:
- Antenatal corticosteroids showed no significant effect on reaching full enteral feeds (HR 1.0 [95% CI: 0.8-1.4]).
- Complex gastroschisis was associated with increased time to full feeds (HR 0.3 [95% CI: 0.2-0.4]).
- Later gestational age at birth correlated with faster achievement of full feeds.
Conclusions:
- Maternal antenatal corticosteroid use, per current protocols, does not improve neonatal outcomes in gastroschisis.
- The study did not find antenatal steroids to be associated with improved time to full enteral feeds or reduced hospital stay.
Objective:
In gastroschisis, there is evidence to suggest that gut dysfunction develops secondary to bowel inflammation; we aimed to evaluate the effect of maternal antenatal corticosteroids administered for obstetric reasons on time to full enteral feeds in a multicenter cohort study of gastroschisis infants.
Methods:
A three center, retrospective cohort study (1992-2013) with linked fetal/neonatal gastroschisis data was conducted. The primary outcome measure was time to full enteral feeds (a surrogate measure for bowel function) and secondary outcome measure was length of hospital stay. Analysis included Mann-Whitney and Cox regression.
Results:
Of 500 patients included in the study, 69 (GA at birth 34 [25-38] weeks) received antenatal corticosteroids and 431 (GA at birth 37 [31-41] weeks) did not. Antenatal corticosteroids had no effect on the rate of reaching full feeds (Hazard ratio HR 1.0 [95% CI: 0.8-1.4]). However, complex gastroschisis (HR 0.3 [95% CI: 0.2-0.4]) was associated with an increased time to reach full feeds and later GA at birth (HR 1.1 per week increase in GA [95% CI: 1.1-1.2]) was associated with a decreased time to reach full feeds.
Conclusion:
Maternal antenatal corticosteroids use, under current antenatal steroid protocols, in gastroschisis is not associated with an improvement in neonatal outcomes such as time to full enteral feeds or length of hospital stay.
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