Association of Antenatal Steroid Exposure at 21 to 22 Weeks of Gestation With Neonatal Survival and Survival Without Morbidities

Abstract

ImportanceThe provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials.ObjectiveTo compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks’ gestation or less vs no exposure to antenatal steroids.Design, Setting, and ParticipantsThis cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of Child Health and Human Development Neonatal Research Network. Infants who did not receive intensive care and infants with antenatal steroid exposure after GA 22 6/7 weeks were excluded.ExposureInfants were classified as having no, partial, or complete exposure to antenatal steroids.Main Outcomes and MeasuresThe primary outcome was survival to discharge. The main secondary outcome was survival without major neonatal morbidity. The associations of differential exposures to antenatal steroids with outcomes were evaluated using logistic regression, adjusting for GA, sex, race, maternal education, small for GA status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and Neonatal Research Network center.ResultsA total of 431 infants (mean [SD] GA, 22.6 [0.5] weeks; 232 [53.8%] boys) were included, with 110 infants (25.5%) receiving no antenatal steroids, 80 infants (18.6%) receiving partial antenatal steroids, and 241 infants (55.9%) receiving complete antenatal steroids. Seventeen infants were exposed to antenatal steroids at GA 21 weeks. Among infants exposed to complete antenatal steroids, 130 (53.9%) survived to discharge, compared with 30 infants (37.5%) with partial antenatal steroid exposure and 239 infants (35.5%) with no antenatal steroids. Infants born after complete antenatal steroid exposure, compared with those without antenatal steroid exposure, were more likely to survive to discharge (adjusted odds ratio [aOR], 1.95 [95% CI, 1.07-3.56]) and to survive without major morbidity (aOR, 2.74 [95% CI, 1.19-6.30]).Conclusions and RelevanceIn this retrospective cohort study, among infants born between GA 22 0/7 and 23 6/7 weeks who received intensive care, exposure to a complete course of antenatal steroids at GA 22 6/7 weeks or less was independently associated with greater odds of survival and survival without major morbidity. These data suggest that the use of antenatal steroids in patients at GA 22 6/7 weeks or less could be beneficial when active treatment is considered.

Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018–2021) across a change in national guidance

“…There can be delays between parents presenting in suspected labour at 22-weeks and the senior obstetric and neonatal clinicians being available to have detailed discussions with parents about management at birth and appropriateness of antenatal optimisation. Data from other centres clearly demonstrates an association between antenatal steroid administration and survival in 22-week infants, with provision of AN steroids doubling the likelihood of survival compared to postnatal survival-focused care alone ( 14 ).…”

Neonatal and Maternal Outcomes at 22–28 Weeks of Gestation by Mode of Delivery

“…Bivariate comparisons were conducted with the χ 2 test or Fisher exact test. Adjustments were performed for predetermined potential confounders: race, 12 ethnicity, 12 maternal age, 13 chronic hypertension, 14 pregestational diabetes, parity, 13 preeclampsia, eclampsia, gestational hypertension, 15 gestational diabetes, chorioamnionitis, 15,16 antenatal steroid exposure, 17 and insurance type. 12 Race and ethnicity were included in the model because these demographic characteristics are associated with differences in neonatal and maternal outcomes.…”

Antenatal Corticosteroids at 21–23 Weeks of Gestation

“…Although this study provides important data on the timing of corticosteroid administration and included neonates exposed to corticosteroids at 21 weeks of gestation, only 17 neonates received corticosteroids at 21 weeks; thus, no definitive conclusions can be made about the efficacy of antenatal corticosteroids at less than 22 weeks. 17…”

“…3,16 Another recent study using the NICHD Neonatal Research Network database evaluated neonates born at 22-23 weeks of gestation who were exposed to betamethasone between 21 0/7 and 22 6/7 weeks (Table 1). 17 Although neonates who did not receive intensive care after birth were excluded, this study provides important information for obstetricians when trying to decide whether they should administer corticosteroids when they encounter a patient at 21 or 22 weeks of gestation with threatened preterm birth because delivery timing cannot be accurately predicted. In this retrospective cohort study of 431 neonates, administration of a complete course of antenatal corticosteroids increased the odds of survival to discharge (aOR 1.95, 95% CI 1.07-3.56) and survival without major morbidities (aOR 2.74, 95% CI 1.19-6.30) compared with those who did not receive steroids.…”