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Published on: September 10, 2018
The variation of antenatal corticosteroids administration for the singleton preterm birth in China, 2017 to 2018
Qing Wang1, Siyuan Jiang2, Xuefeng Hu1
1Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, #2699, Gaoke western Road, Pudong District, Shanghai, 201204, China.
Insights
Antenatal corticosteroids (ACS) reduce preterm infant mortality and morbidity. This study found significant variation in ACS use across Chinese hospitals, highlighting a need for quality improvement in administration for better infant outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatology
- Perinatal Medicine
Background:
- Antenatal corticosteroids (ACS) are crucial for reducing mortality and major morbidities in preterm infants.
- The utilization rates and associated perinatal factors of ACS in China remain unclear.
- This study addresses the knowledge gap regarding ACS use in Chinese tertiary maternal centers.
Purpose of the Study:
- To investigate the rate of antenatal corticosteroid administration in at-risk pregnant women in China.
- To identify perinatal factors associated with antenatal corticosteroid use.
- To assess the impact of antenatal corticosteroids on preterm infant outcomes.
Main Methods:
- Retrospective observational study using data from the REIN-EPIQ trial clinical database.
- Inclusion criteria: infants born <34 weeks gestation admitted to 18 tertiary maternal centers in China (2017-2018).
- Analysis of dexamethasone administration prior to preterm delivery and associated perinatal factors.
Main Results:
- The overall rate of ACS exposure was 71.2%, with significant variation (20.2% - 92.0%) among centers.
- ACS use was higher in cases of preeclampsia, caesarean delivery, antibiotic treatment, and for infants with lower gestational age or small for gestational age.
- ACS exposure was linked to reduced odds of bronchopulmonary dysplasia or death (OR 0.778) and invasive respiratory support (OR 0.668).
Conclusions:
- Significant variability exists in antenatal corticosteroid administration rates across Chinese maternity hospitals.
- Quality improvement initiatives for ACS administration are necessary.
- Optimizing ACS use can further improve outcomes for preterm infants.
Background:
The administration of antenatal corticosteroids (ACS) to women who are at risk of preterm birth has been proven to reduce not only the mortality, but also the major morbidities of the preterm infants. The rate of ACS and the risk factors associated with ACS use in Chinese population is unclear. This study aimed to investigate the rate of ACS use and the associated perinatal factors in the tertiary maternal centers of China.
Methods:
Data for this retrospective observational study came from a clinical database of preterm infants established by REIN-EPIQ trial. All infants born at < 34 weeks of gestation and admitted to 18 tertiary maternal centers in China from 2017 to 2018 were enrolled. Any dose of dexamethasone was given prior to preterm delivery was recorded and the associated perinatal factors were analyzed.
Results:
The rate of ACS exposure in this population was 71.2% (range 20.2 - 92%) and the ACS use in these 18 maternal centers varied from 20.2 to 92.0% in this period. ACS exposure was higher among women with preeclampsia, caesarean section delivery, antibiotic treatment and who delivered infants with lower gestational age and small for gestational age. ACS use was highest in the 28-31 weeks gestational age group, and lowest in the under 26 weeks of gestational age group (x2 = 65.478, P < 0.001). ACS exposure was associated with lower odds of bronchopulmonary dysplasia or death (OR, 0.778; 95% CI 0.661 to 0.916) and invasive respiration requirement (OR, 0.668; 95% CI 0.585 to 0.762) in this population.
Conclusion:
The ACS exposure was variable among maternity hospitals and quality improvement of ACS administration is warranted.
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