Association of Short Antenatal Corticosteroid Administration-to-Birth Intervals With Survival and Morbidity Among Very Preterm Infants: Results From the EPICE Cohort
Mikael Norman, Aurelie Piedvache, Klaus Børch, Lene Drasbek Huusom, Anna-Karin Edstedt Bonamy, Elizabeth A. Howell, Pierre-Henri Jarreau, Rolf F. Maier, Ole Pryds, Liis Toome, Heili Varendi, Tom Weber, Emilija Wilson, Arno Van Heijst, Marina Cuttini, Jan Mazela, Henrique Barros, Patrick Van Reempts, Elizabeth S. Draper, Jennifer Zeitlin, for the Effective Perinatal Intensive Care in Europe (EPICE) Research Group
JAMA Pediatr. (2017)
Antenatal corticosteroids (ANS) are administered to pregnant women at risk of delivery before 34 weeks of gestation, in order to reduce morbidity and mortality in their infants. The administration-to-birth intervals of ANS varies, and it is not known how close to delivery ANS administration is efficient. The aim was to explore the association between the time from first ANS injection to delivery and survival and morbidity among 4594 singleton very preterm infants in all 19 of the EPICE regions.
Use of any ANS (85% in the cohort) was regardless of timing associated with reduced mortality in infants, also after taking potential confounders into account. Mortality declined rapidly after ANS administration, reaching a 50% lower risk already at an administration-to-birth interval of 6-12 h. Administration-to-birth intervals of48 h or more were associated with significantly reduced risk of severe neonatal brain injury. Intervals of ANS exceeding 1 week were associated with increasing risks of mortality and brain injury. Mortality could have been reduced by 26% in the group of children who never received ANS, had it been administered to them 3-5 h before delivery.
Infants at risk of imminent preterm birth may benefit from ANS use only hours before delivery. A more proactive management of women at risk for preterm birth may reduce infant mortality and severe neonatal brain injury.
See article here: JAMA Pediatr. (2017)