Area‐based study identifies risk factors associated with missed antenatal corticosteroid prophylaxis in women delivering preterm infants. (23rd September 2016)

• Record Type: Journal Article
• Authors: Gagliardi, Luigi; Amador, Carolina; Puglia, Monia; Mecacci, Federico; Pratesi, Simone; Sigali, Emilio; Tomasini, Barbara; Rusconi, Franca
• Other Names: Banchini Roberto investigator.; Papi Maria Celeste investigator.; Pecori Debora investigator.; Dani Carlo investigator.; Ingargiola Anna investigator.; Moroni Marco investigator.; Fiorini Patrizio investigator.; Vuerich Marco investigator.; Santarlasci Sara investigator.; Boldrini Antonio investigator.; Dilucia Sofia investigator.; Panariello Giorgio investigator.; Vinciguerra Filomena investigator.; Giovannoni Armando investigator.; Dolfi Pina investigator.; Moschetti Riccardo investigator.; Tognetti Simona investigator.; Capuzzo Leila investigator.; Magnanensi Stefania investigator.; Mariotti Paola investigator.; Brioschi Alessandra investigator.; Martelli Elena investigator.; Vasarri Pier Luigi investigator.; Carlotti Carla investigator.; Danieli Roberto investigator.; Gragnani Samuele investigator.; Benetti Gian Luca investigator.; Tiezzi Monica investigator.; Civitelli Flavio investigator.; Magi Letizia investigator.; Martini Marco investigator.; Cardinale Antonio investigator.; Magni Carla investigator.; Bini Rita investigator.; De Filippo Marcello investigator.; Cafaggi Leonardo investigator.; Bosi Cristiana investigator.; Gambi Beatrice investigator.; Pezzati Marco investigator.; Strano Massimo investigator.; Bartoli Ambra investigator.; Gabrielli Paolo investigator.; Verucci Elena investigator.; Berni Roberto investigator.; Corsi Andrea investigator.; Voller Fabio investigator.;
• Is Part Of: Acta pædiatrica. Volume 106:Number 2(2017)
• Page Start: 250
• Page End: 255
• Publication Date: 2016-09-23
• Subjects: Antenatal steroid prophylaxis -- Migrant mothers -- Pregnancy -- Premature infant -- Risk factors; Pediatrics -- Periodicals; Pediatrics; 618.92
• DOI: 10.1111/apa.13563
• Languages: English
• ISSNs: 0803-5253

Abstract

Abstract: Aim: All women delivering a preterm infant should receive antenatal corticosteroid prophylaxis, but many miss this opportunity. We determined the risk factors associated with missed prophylaxis in a geographically defined area of Italy. Methods: We prospectively studied all mothers who delivered babies between 24 and 31 completed weeks of gestation, from 2009 to 2013, in all maternity units in Tuscany. Results: Of 1232 mothers, 186 (15.1%) did not receive prophylaxis. The risk was higher in migrant mothers, with an adjusted risk ratio (RR) of 1.28 and 95% confidence interval (95% CI) of 1.04–1.56, and in mothers hospitalised for less than 24 hours (RR 4.09, 95% CI: 2.90–5.78). Preterm prelabour rupture of membranes (RR 0.63, 95% CI: 0.41–0.96) and maternal antepartum transfer (RR 0.24, 95% CI: 0.18–0.32) were protective. Hospital level at birth and gestational age did not influence the prophylaxis rate. The population‐attributable fractions were 50.4% for late hospital admissions and 10.2% for migrant status. Conclusion: In a highly organised network of hospitals, neither level of care nor gestational age influenced prophylaxis. Timely arrival of women in hospital, better recognition of the imminence of delivery and tighter steroids administration guidelines are the most relevant targets to further increase prophylaxis. Abstract :