Title | Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Rysavy MA, Bell EF, Iams JD, Carlo WA, Li L, Mercer BM, Hintz SR, Stoll BJ, Vohr BR, Shankaran S, Walsh MC, Brumbaugh JE, Colaizy TT, Das A, Higgins RD |
Corporate Authors | Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network |
Journal | J Pediatr |
Volume | 208 |
Pagination | 156-162.e5 |
Date Published | 2019 05 |
ISSN | 1097-6833 |
Keywords | Adrenal Cortex Hormones, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Infant, Extremely Premature, Infant, Newborn, Infant, Premature, Diseases, Male, Multivariate Analysis, Premature Birth, Prospective Studies, Resuscitation, Treatment Outcome |
Abstract | OBJECTIVE: To describe discordance in antenatal corticosteroid use and resuscitation following extremely preterm birth and its relationship with infant survival and neurodevelopment. STUDY DESIGN: A multicenter cohort study of 4858 infants 22-26 weeks of gestation born 2006-2011 at 24 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, with follow-up through 2013. Survival and neurodevelopmental outcomes were available at 18-22 months of corrected age for 4576 (94.2%) infants. We described antenatal interventions, resuscitation, and infant outcomes. We modeled the effect on infant outcomes of each hospital increasing antenatal corticosteroid exposure for resuscitated infants born at 22-24 weeks of gestation to rates observed at 25-26 weeks of gestation. RESULTS: Discordant antenatal corticosteroid use and resuscitation, where one and not the other occurred, were more frequent for births at 22 and 23 but not 24 weeks (rate ratio [95% CI] at 22 weeks: 1.7 [1.3-2.2]; 23 weeks: 2.6 [2.2-3.2]; 24 weeks: 1.0 [0.8-1.2]) when compared with 25-26 weeks. Among infants resuscitated at 23 weeks, adjusting each hospital's rate of antenatal corticosteroid use to the average at 25-26 weeks (89.2%) was projected to increase infant survival by 7.1% (95% CI 5.4-8.8%) and survival without severe impairment by 6.4% (95% CI 4.7-8.1%). No significant change in outcomes was projected for infants resuscitated at 22 weeks, where few (n = 22) resuscitated infants received antenatal corticosteroids. CONCLUSIONS: Infants born at 23 weeks were more frequently resuscitated without antenatal corticosteroids than other extremely preterm infants. When resuscitation is intended, consistent provision of antenatal corticosteroids may increase infant survival and survival without impairment. TRIAL REGISTRATION: ClinicalTrials.govNCT00063063 (Generic Database) and NCT00009633 (Follow-Up Study). |
DOI | 10.1016/j.jpeds.2018.12.063 |
Alternate Journal | J Pediatr |
PubMed ID | 30738658 |
PubMed Central ID | PMC6486854 |
Grant List | U10 HD021364 / HD / NICHD NIH HHS / United States UG1 HD087229 / HD / NICHD NIH HHS / United States U10 HD027904 / HD / NICHD NIH HHS / United States U10 HD027915 / HD / NICHD NIH HHS / United States UG1 HD034216 / HD / NICHD NIH HHS / United States UG1 HD027904 / HD / NICHD NIH HHS / United States UG1 HD021364 / HD / NICHD NIH HHS / United States UG1 HD027880 / HD / NICHD NIH HHS / United States UG1 HD053109 / HD / NICHD NIH HHS / United States UG1 HD027851 / HD / NICHD NIH HHS / United States U10 HD034216 / HD / NICHD NIH HHS / United States U24 HD095254 / HD / NICHD NIH HHS / United States U10 HD021385 / HD / NICHD NIH HHS / United States L40 HD099827 / HD / NICHD NIH HHS / United States U10 HD040544 / HD / NICHD NIH HHS / United States UL1 TR002548 / TR / NCATS NIH HHS / United States U01 HD036790 / HD / NICHD NIH HHS / United States F32 HD098782 / HD / NICHD NIH HHS / United States U10 HD027880 / HD / NICHD NIH HHS / United States UG1 HD027853 / HD / NICHD NIH HHS / United States U10 HD053109 / HD / NICHD NIH HHS / United States U10 HD027851 / HD / NICHD NIH HHS / United States UG1 HD021385 / HD / NICHD NIH HHS / United States |