Antenatal Corticosteroid Therapy Before 24 Weeks of Gestation

Park, Christina K.; Isayama, Tetsuya; McDonald, Sarah D.

doi:10.1097/aog.0000000000001355

Cited by 50 publications

(36 citation statements)

References 45 publications

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“…[29] We obtained additional data on request from authors Mori et al, Bajwa et al and Guinsburg et al[23, 25, 28] We used the systematic review by Park et al for the data on Bader et al and Guthrie et al as we were unable to get it from the original authors. [12, 22, 29] Only 2 studies reported on long-term neurodevelopment at the corrected age of 12–24 months. [23, 24] The characteristics and quality assessment of the included studies are described in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Our findings are in line with the recent systematic review by Park et al, which showed reduced mortality of neonates born at 22 and 23 weeks’ gestation. [12] However, we have also provided data on neonates born at 24 weeks’ gestation which is important to optimise parental counselling and management of such pregnancies given the controversy around ANC at such early gestation.…”

Section: Discussionmentioning

confidence: 99%

“…Our review provides additional information compared to Park et al[12] We included neonates born not only at 22 and 23 weeks, but also at 24 weeks’ gestation because the controversy about active intervention including ANC involves this gestational age group. Our review provides additional data from the UK, Brazilian and Swiss neonatal networks.…”

Section: Discussionmentioning

confidence: 99%

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Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis

Deshmukh

Patole

2017

PLoS ONE

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BackgroundEfficacy of antenatal corticosteroids before 25 weeks of gestation is unclear.ObjectiveTo assess and compare neonatal outcomes following ANC exposure at 22, 23 and 24 weeks of gestation by conducting systematic review and meta- analysis.MethodsA systematic review of randomised controlled trials (RCT) and non-RCTs reporting on neonatal outcomes after exposure to ANC up to 246 weeks of gestation using the Cochrane systematic review methodology. Databases Pubmed, CINAHL, Embase, Cochrane Central library, and online abstracts of conference proceedings including the Pediatric Academic Society (PAS) were searched in Feb 2017. Primary outcome was in-hospital mortality defined as death before discharge during the first admission. Secondary outcomes included severe intraventricular hemorrhage (IVH> grade III and IV)/or periventricular leukomalacia (PVL), necrotising enterocolitis (NEC >stage II) and chronic lung disease (CLD). Meta-analysis was performed using a random-effects model. The level of evidence (LOE) was summarised using the GRADE guidelines.Main resultsThere were no RCTs; 8 high quality non-RCTs were included in the review. Meta-analysis showed reduction in mortality [N = 10109; OR = 0.47(0.39–0.56), p<0.00001; LOE: Moderate] and severe IVH and PVL [N = 5084; OR = 0.71(0.61–0.82), p<0.00001; LOE: Low] after exposure to ANC in neonates born <25 weeks. There was no significant difference in CLD [N = 4649; OR = 1.19(0.85–1.65) p = 0.31; LOE: Low] and NEC [N = 5403; OR = 0.95 (0.76–1.19) p = 0.65; LOE: Low]. Mortality was comparable in neonates born at 22, 23 or 24 weeks.ConclusionModerate to low quality evidence indicates that exposure to ANC is associated with reduction in mortality and IVH/or PVL in neonates born before 25 weeks.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Antenatal corticosteroids for neonates born before 25 Weeks—A systematic review and meta-analysis

Deshmukh

Patole

2017

PLoS ONE

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“…In addition, observational studies have consistently demonstrated a lower risk of death among neonates born <24 weeks’ of gestation exposed to antenatal corticosteroids. 55 In a population based study of infants at 22 to 26 weeks’ of gestation in France, 96% of those infants who had neonatal intensive care withheld or withdrawn died in the delivery room compared to 1% of those who received intensive treatment, including oxygen therapy and endotracheal intubation. 56 At 22 weeks’ and 23 weeks’ of gestation, 96% and 91% of live births, respectively, had intensive care withheld or withdrawn and the limitation in active treatment mirrored the 96% and 92% of live births at these gestational ages that died in the delivery room.…”

Section: Additional Factors Influencing Survival Rates For Periviablementioning

confidence: 99%

Survival of Infants Born at Periviable Gestational Ages

Patel

Rysavy

Bell

et al. 2017

Clinics in Perinatology

135

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Synopsis/abstract Periviable births are defined as births occurring from 20 0/7 through 25 6/7 weeks of gestation. Among and within developed nations, significant variation exists in the approach to obstetrical and neonatal care for periviable birth. Understanding gestational age-specific survival, including factors that may influence survival estimates and how these estimates have changed over time, may guide approaches to the care of periviable births and inform conversations with families and caregivers. This review provides a historical perspective on survival following periviable birth, summarizes recent and new data on gestational age-specific survival rates, and addresses factors that have a significant impact on survival.

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“…5 Caution should be exercised in the interpretation of data suggesting benefit at gestational ages before active resuscitation is the standard, which occurs at 25 weeks' gestation in most high income countries. Surfactant is another important advance in neonatal care that substantially improves neonatal respiratory outcomes.…”

mentioning

confidence: 99%