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Prenatal Steroids May Improve Outcomes in Extremely Preterm Infants


A complete course of antenatal steroids was associated with higher survival in extremely preterm infants, a cohort study showed.

Among infants born at 22 weeks to less than 24 weeks, 53.9% who had full exposure to antenatal steroids at gestational age 21 to 22 weeks survived to discharge, compared with 37.5% who had partial steroid exposure and 35.5% who had no exposure, according to Sanjay Chawla, MD, of Children’s Hospital of Michigan in Detroit, and colleagues.

Compared with those who did not receive antenatal steroid full exposure, extremely preterm infants who received full treatment were 1.95 times more likely to survive (adjusted OR 1.95, 95% CI 1.07-3.56) and 2.74 times more likely to survive without major morbidities such as bronchopulmonary dysplasia, intracranial hemorrhage (ICH), or sepsis (adjusted OR 2.74, 95% CI 1.19-6.30), the researchers reported in JAMA Network Open.

Giving antenatal corticosteroids to pregnant patients at gestational age 22 weeks remains controversial even though the treatment has been tied to an improved short-term outcome in preterm infants, along with lower risk of mortality, respiratory distress syndrome, necrotizing enterocolitis, and ICH, Chawla and co-authors pointed out.

A September 2021 practice advisory by the American College of Obstetricians/Gynecologists and the Society for Maternal-Fetal Medicine (ACOG/SMFM) recommended that antenatal steroids may be considered starting at gestational age 22 weeks if neonatal resuscitation is planned and after appropriate counseling.

“The data from our study support the September 2021 ACOG and SMFM recommendation to consider antenatal steroids at GA [gestational age] 22 weeks when there is an intention for providing postnatal intensive care,” the authors said.

They added that the current findings bolster those from previous studies — one in 2011 and one in 2018 — on the benefits of providing antenatal steroids to mothers at 22 weeks’ gestation. However, Chawla and co-authors cautioned that the “small number of infants who were exposed to antenatal steroids at GA 21 weeks precludes separate evaluation of the safety or efficacy of antenatal steroid exposure at this GA.”

The current cohort study enrolled infants (n=431) born between January 2016 and December 2019 at centers in the National Institutes of Child Health and Human Development Neonatal Research Network (NRN). The mean gestational age was 22.6 weeks and 53.8% were boys.

Infants were classified into three groups: the no antenatal steroids group, the partial antenatal steroids group (one dose of betamethasone), and the complete antenatal steroids group (two doses of betamethasone). Overall, 25.5% received no antenatal steroids, 18.6% received a partial course, and 55.9% received a complete antenatal steroid course.

Infants were excluded from the study if they were born outside an NRN center, had major congenital anomalies, received antenatal dexamethasone, received antenatal steroids at gestational age 23 weeks, or received more than one course of antenatal steroids. Infants who died within 12 hours without receiving perinatal life support were also excluded.

Postnatal life support included receiving endotracheal intubation, surfactant therapy, continuous positive airway pressure, manual ventilation or mechanical ventilation, chest compressions, epinephrine, volume resuscitation, blood pressure support, or parenteral nutrition.

Data were adjusted for gestational age, sex, race, maternal education, small for gestational age status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and NRN center.

Study limitations included its observational nature and not enough statistical power to determine the role of a partial course of antenatal steroids versus no antenatal steroids.

Chawla and colleagues highlighted that the ACOG/SMFM advisory is based on “low certainty evidence,” but that “a randomized clinical trial to evaluate the beneficial effects of antenatal steroids for pregnant women at 22 weeks’ gestation would be very challenging.”

In fact, one such proposed study was canceled for “lack of equipoise,” they added. As a result, their findings “provide additional evidence…and may help in further clarification of [ACOG/SMFM] guidelines.”

  • James Lopilato is a staff writer for Medpage Today. He covers a variety of topics being explored in current medical science research.

Disclosures

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center for Advancing Translational Sciences.

Chawla disclosed no relationships with industry. Co-authors disclosed relationships with Tellus Therapeutics, Provepharm, UpToDate, and Iron Health.



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