Timing of antenatal corticosteroid administration and survival in extremely preterm infants: a national population‐based cohort study. (15th March 2017)

• Record Type: Journal Article
• Authors: Norberg, H; Kowalski, J; Maršál, K; Norman, M
• Is Part Of: BJOG. Volume 124:Number 10(2017)
• Page Start: 1567
• Page End: 1574
• Publication Date: 2017-03-15
• Subjects: Administration‐to‐birth interval -- antenatal glucocorticoids -- extremely preterm birth -- major neonatal morbidity -- mortality; Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.14545
• Languages: English
• ISSNs: 1470-0328

Abstract

Abstract : Objective: To explore the association between administration‐to‐birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population‐based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live‐born infants ( n = 707) born at 22–26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0–27 days) and infant (0–365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of prematurity stage ≥ 3, periventricular leukomalacia, necrotising enterocolitis, or severe bronchopulmonary dysplasia). Results: Five‐hundred and ninety‐one (84%) infants were exposed to ACS. In the final adjusted model, infant survival was lower in infants unexposed to ACS [hazard ratio (HR) = 0.26; 95% confidence interval 0.15–0.43], in infants born <24 h [HR = 0.53 (0.33–0.87)] and >7 days after ACS [HR = 0.56 (0.32–0.97)], but not in infants born 24–47 h after ACS [HR = 1.60 (0.73–3.50)], as compared with infants born 48 h to 7 days after administration. The findings were similar for neonatal survival. Survival without major neonatal morbidity among live‐born infants was 14% in unexposed infants and 30–39% in steroid‐exposed groups, indicating that any ACS exposure was valuable. Conclusions: Administration of ACS 24 h to 7 days before extremely preterm birth was associated with significantly higher survival than in unexposed infants and in infants exposed to ACS at shorter or longer administration‐to‐birth intervals. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival.