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Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.

Publication ,  Journal Article
Carlo, WA; McDonald, SA; Fanaroff, AA; Vohr, BR; Stoll, BJ; Ehrenkranz, RA; Andrews, WW; Wallace, D; Das, A; Bell, EF; Walsh, MC; Laptook, AR ...
Published in: JAMA
December 7, 2011

CONTEXT: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care. OBJECTIVE: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10,541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. MAIN OUTCOME MEASURES: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. RESULTS: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]). CONCLUSION: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 7, 2011

Volume

306

Issue

21

Start / End Page

2348 / 2358

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Psychomotor Disorders
  • Prospective Studies
  • Prenatal Exposure Delayed Effects
  • Prenatal Care
  • Pregnancy Trimester, Second
  • Pregnancy
  • Nervous System
  • Male
  • Infant, Premature
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Carlo, W. A., McDonald, S. A., Fanaroff, A. A., Vohr, B. R., Stoll, B. J., Ehrenkranz, R. A., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, . (2011). Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA, 306(21), 2348–2358. https://doi.org/10.1001/jama.2011.1752
Carlo, Waldemar A., Scott A. McDonald, Avroy A. Fanaroff, Betty R. Vohr, Barbara J. Stoll, Richard A. Ehrenkranz, William W. Andrews, et al. “Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.JAMA 306, no. 21 (December 7, 2011): 2348–58. https://doi.org/10.1001/jama.2011.1752.
Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, et al. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA. 2011 Dec 7;306(21):2348–58.
Carlo, Waldemar A., et al. “Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.JAMA, vol. 306, no. 21, Dec. 2011, pp. 2348–58. Pubmed, doi:10.1001/jama.2011.1752.
Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, Andrews WW, Wallace D, Das A, Bell EF, Walsh MC, Laptook AR, Shankaran S, Poindexter BB, Hale EC, Newman NS, Davis AS, Schibler K, Kennedy KA, Sánchez PJ, Van Meurs KP, Goldberg RN, Watterberg KL, Faix RG, Frantz ID, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA. 2011 Dec 7;306(21):2348–2358.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

December 7, 2011

Volume

306

Issue

21

Start / End Page

2348 / 2358

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Psychomotor Disorders
  • Prospective Studies
  • Prenatal Exposure Delayed Effects
  • Prenatal Care
  • Pregnancy Trimester, Second
  • Pregnancy
  • Nervous System
  • Male
  • Infant, Premature