Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth - 24/04/19
, Edward F. Bell, MD 1, Jay D. Iams, MD 2, Waldemar A. Carlo, MD 3, Lei Li, PhD 4, Brian M. Mercer, MD 5, Susan R. Hintz, MD, MS 6, Barbara J. Stoll, MD 7, Betty R. Vohr, MD 8, Seetha Shankaran, MD 9, Michele C. Walsh, MD, MS 10, Jane E. Brumbaugh, MD 11, Tarah T. Colaizy, MD, MPH 1, Abhik Das, PhD 12, Rosemary D. Higgins, MD 13for the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network†
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.gov NCT00063063 (Generic Database) and NCT00009633 (Follow-Up Study)
Le texte complet de cet article est disponible en PDF.Abbreviations : NICHD, Bayley-III, GMFCS
Plan
| The National Institutes of Health (NIH) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network (NRN) to obtain the data used in this study. The NICHD staff had input into the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors declare no conflicts of interest. |
Vol 208
P. 156 - mai 2019 Retour au numéro
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