Association of Antenatal Steroid Exposure at 21 to 22 Weeks of Gestation With Neonatal Survival and Survival Without Morbidities
Authors: Chawla Sanjay , Wyckoff Myra H. , Rysavy Matthew A. , Patel Ravi Mangal , Chowdhury Dhuly , Natarajan Girija , Laptook Abbot R. , Lakshminrusimha Satyan , Bell Edward F. , Shankaran Seetha , Van Meurs Krisa P. , Ambalavanan Namasivayam , Greenberg Rachel G. , Younge Noelle , Werner Erika F. , Das Abhik , Carlo Waldemar A. ,   Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Collins Monica V. , Cosby Shirley S. , Hensman Angelita M. , Keszler Martin , St. Pierre Lucille , Vieira Elisa , Guilford Stephanie , Li Emily , Reynolds Anne Marie , Sacilowski Michael G. , Hibbs Anna Maria , Newman Nancy S. , Siner Bonnie S. , Walsh Michele C. , Williams Angelia , Beiersdorfer Traci , Grisby Cathy , Kirker Kristin , Poindexter Brenda B. , Schibler Kurt , Thompson Julia , Polin Richard A. , Brion Luc P. , De Leon Maria M. , Eubanks Frances , Sepulveda Pollieanna , Vasil Diana M. , Cotten C. Michael , Finkle Joanne , Fisher Kimberley A. , Goldberg Ronald N. , Bear Kelly , Bergstedt Vicki , Moore Ryan , Moseley Sherry , Bottcher Diane I. , Carlton David P. , Loggins Yvonne C. , Mackie Colleen , Franco Claudia I. , Kennedy Kathleen A. , Khan Amir M. , Lis Anna E. , Martin Sara C. , McDavid Georgia Elaine , Orekoya Patricia Ann , Pedroza Claudia , Pierce Tate Patti L. , Stephens Emily K. , Tyson Jon E. , Gunn Susan , Herron Dianne E. , Joyce Jeffery , Sokol Gregory M. , Colaizy Tarah T. , Faruqui Sarah E. , Goeke Claire A. , Johnson Karen J. , Schmelzel Mendi L. , Walker Jacky R. , Gaetano Lisa , Gauldin Cheri , Holmes Anne M. , Kilbride Howard W. , Pallotto Eugenia K. , Parimi Prabhu S. , Scott Allison , Truog William E. , Clark Erna , Gutentag Julie , Jadcherla Sudarshan R. , Luzader Patricia , Nelin Leif D. , Park Courtney , Sánchez Pablo J. , Shadd Julie C. , Stein Melanie , Sullivan Margaret , Bremer Andrew A. , Higgins Rosemary D. , Wilson Archer Stephanie , Abbasi Soraya , Catts Christine , Chaudhary Aasma S. , DeMauro Sara B. , Dhawan Megan A. , Eichenwald Eric C. , Ghavam Sarvin , Kirpalani Haresh , Mancini Toni , Schmidt Barbara , Snyder Jonathan M. , Binion Kyle , Boylin Elizabeth , D'Angio Carl T. , Guillet Ronnie , Jensen Rosemary L. , Jones Rachel , Kachelmeyer Jennifer , Kent Alison , Maffett Deanna , Orme Constance , Prinzing Diane M. , Rochez Daisy , Rowan Mary , Sabaratnam Premini , Scorsone Ann Marie , Wadkins Holly I.M. , Bann Carla M. , Gabrio Jenna , Gantz Marie G. , Leblond David , O’Donnell Auman Jeanette , Wallace Dennis , Zaterka-Baxter Kristin M. , Baack Michelle L. , Broadbent Megan , Elenkiwich Chelsey , Henning Megan M. , Van Muyden Sarah , Ball M. Bethany , Chock Valerie Y. , Proud Melinda S. , Reichert Elizabeth N. , Sivakumar Dharshi , Stevenson David K. , Williams R. Jordan , Chanlaw Teresa , Devaskar Uday , Garg Meena , Geller Rachel , Bernhardt Janice , Bose Carl L. , Clark Cynthia L. , Laughon Matthew Maxwell , Talbert Jennifer , Backstrom Lacy Conra , Fuller Janell , Hanson Mary , Kuan Elizabeth , Ohls Robin K. , Sundquist Beauman Sandra , Watterberg Kristi L. , Barks John , White Diane F. , Baserga Mariana , Burnett Jill , Christensen Susan , Coleman Kathleen , Davis Brandy , Elmont Jennifer O. , Francom Barbara L. , Jordan Jamie , Loertscher Manndi C. , Marchant Trisha , Maxson Earl , McGrath Kandace M. , Mickelsen Hena G. , Minton Stephen D. , Parry D. Melody , Rau Carrie A. , Schaefer Susan T. , Sheffield Mark J. , Tice Katherine , Weaver-Lewis Kimberlee , Woodbury Kathryn D. , Yoder Bradley A. , Kicklighter Stephen D. , Rhodes-Ryan Ginger , White Donna , Childs Kirsten , Panaitescu Bogdan 
Published: September 2022

Importance

The 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.

Objective

To 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 Participants

This 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.

Exposure

Infants were classified as having no, partial, or complete exposure to antenatal steroids.

Main Outcomes and Measures

The 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.

Results

A 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 Relevance

In 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.