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Timing of antenatal corticosteroid administration and survival in extremely preterm infants : A national population-based cohort study

Norberg, H. LU ; Kowalski, B. J. ; Maršál, K. LU and Norman, M (2017) In BJOG: An International Journal of Obstetrics & Gynaecology 124(10). p.1567-1574
Abstract

Objective: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population-based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0-27 days) and infant (0-365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of... (More)

Objective: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population-based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0-27 days) and infant (0-365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of prematurity stage ≥ 3, periventricular leukomalacia, necrotising enterocolitis, or severe bronchopulmonary dysplasia). Results: Five-hundred and ninety-one (84%) infants were exposed to ACS. In the final adjusted model, infant survival was lower in infants unexposed to ACS [hazard ratio (HR) = 0.26; 95% confidence interval 0.15-0.43], in infants born <24 h [HR = 0.53 (0.33-0.87)] and >7 days after ACS [HR = 0.56 (0.32-0.97)], but not in infants born 24-47 h after ACS [HR = 1.60 (0.73-3.50)], as compared with infants born 48 h to 7 days after administration. The findings were similar for neonatal survival. Survival without major neonatal morbidity among live-born infants was 14% in unexposed infants and 30-39% in steroid-exposed groups, indicating that any ACS exposure was valuable. Conclusions: Administration of ACS 24 h to 7 days before extremely preterm birth was associated with significantly higher survival than in unexposed infants and in infants exposed to ACS at shorter or longer administration-to-birth intervals. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Administration-to-birth interval, Antenatal glucocorticoids, Extremely preterm birth, Major neonatal morbidity, Mortality
in
BJOG: An International Journal of Obstetrics & Gynaecology
volume
124
issue
10
pages
1567 - 1574
publisher
Wiley-Blackwell
external identifiers
  • pmid:28294496
  • wos:000407971500020
  • scopus:85015192976
ISSN
1470-0328
DOI
10.1111/1471-0528.14545
language
English
LU publication?
yes
id
2e1a29e8-a691-48b2-839d-69e29a938a76
date added to LUP
2017-04-07 11:28:52
date last changed
2025-03-18 21:45:22
@article{2e1a29e8-a691-48b2-839d-69e29a938a76,
  abstract     = {{<p>Objective: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population-based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0-27 days) and infant (0-365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of prematurity stage ≥ 3, periventricular leukomalacia, necrotising enterocolitis, or severe bronchopulmonary dysplasia). Results: Five-hundred and ninety-one (84%) infants were exposed to ACS. In the final adjusted model, infant survival was lower in infants unexposed to ACS [hazard ratio (HR) = 0.26; 95% confidence interval 0.15-0.43], in infants born &lt;24 h [HR = 0.53 (0.33-0.87)] and &gt;7 days after ACS [HR = 0.56 (0.32-0.97)], but not in infants born 24-47 h after ACS [HR = 1.60 (0.73-3.50)], as compared with infants born 48 h to 7 days after administration. The findings were similar for neonatal survival. Survival without major neonatal morbidity among live-born infants was 14% in unexposed infants and 30-39% in steroid-exposed groups, indicating that any ACS exposure was valuable. Conclusions: Administration of ACS 24 h to 7 days before extremely preterm birth was associated with significantly higher survival than in unexposed infants and in infants exposed to ACS at shorter or longer administration-to-birth intervals. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival.</p>}},
  author       = {{Norberg, H. and Kowalski, B. J. and Maršál, K. and Norman, M}},
  issn         = {{1470-0328}},
  keywords     = {{Administration-to-birth interval; Antenatal glucocorticoids; Extremely preterm birth; Major neonatal morbidity; Mortality}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1567--1574}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJOG: An International Journal of Obstetrics & Gynaecology}},
  title        = {{Timing of antenatal corticosteroid administration and survival in extremely preterm infants : A national population-based cohort study}},
  url          = {{http://dx.doi.org/10.1111/1471-0528.14545}},
  doi          = {{10.1111/1471-0528.14545}},
  volume       = {{124}},
  year         = {{2017}},
}