Short Duration of Antenatal Corticosteroid Exposure and Outcomes in Extremely Preterm Infants
Authors: Sanjay Chawla, Myra H. Wyckoff, Satyan Lakshminrusimha, Matthew A. Rysavy, Ravi Mangal Patel, Dhuly Chowdhury, Abhik Das, Rachel G. Greenberg, Girija Natarajan, Seetha Shankaran, Edward F. Bell, Namasivayam Ambalavanan, Noelle E. Younge, Abbot R. Laptook, Leeann R. Pavlek, Carl H. Backes, Krisa P. Van Meurs, Erika F. Werner, Waldemar A. Carlo, Namasivayam Ambalavanan, Waldemar A. Carlo, Monica V. Collins, Shirley S. Cosby, Samuel J. Gentle, Tara E. McNair, Colm P. Travers, Angelita M. Hensman, Martin Keszler, Abbot R. Laptook, Lucille St. Pierre, Elisa Vieira, Erika F. Werner, Satyan Lakshminrusimha, Emily Li, Anne Marie Reynolds, Michael G. Sacilowski, Anna Maria Hibbs, Nancy S. Newman, Michele C. Walsh, Traci Beiersdorfer, Juanita Dudley, Cathy Grisby, Lenora Denise Jackson, Jae Kim, Kristin Kirker, Stephanie L. Merhar, Greg Muthig, Brenda B. Poindexter, David Russell, Kurt Schibler, Julia Thompson, Sandra Wuertz, Richard A. Polin, Luc P. Brion, Maria M. De Leon, Joanne Duran, Frances Eubanks, Pollieanna Sepulveda, Diana M. Vasil, Michelle Webbon, Myra H. Wyckoff, C. Michael Cotten, Kimberley A. Fisher, Ronald N. Goldberg, Rachel G. Greenberg, Deesha Mago-Shah, Joanne Probst, Mollie Warren, Noelle E. Younge, Vicki Bergstedt, Ryan Moore, Sherry Moseley, Diane I. Bottcher, David P. Carlton, Judith Laursen, Yvonne C. Loggins, Colleen Mackie, Ravi M. Patel, Amy Sanders, Donna J. Hall, Kathleen A. Kennedy, Amir M. Khan, Karen Martin, Georgia Elaine McDavid, Matthew A. Rysavy, Emily K. Stephens, Barbara J. Stoll, Jon E. Tyson, Michelle White, Sharon L. Wright, Edward F. Bell, Tarah T. Colaizy, Claire A. Goeke, Karen J. Johnson, Mendi L. Schmelzel, Jacky R. Walker, Dan L. Ellsbury, Tracy L. Tud, Carl H. Backes, Nancy Batterson, Hallie Baugher, Demi R. Beckford, Stephanie Burkhardt, Helen Carey, Michelle Chao, Courtney Cira, Erna Clark, Brittany DeSantis, Omid Fathi, Christine A. Fortney, Aubry Fowler, Jennifer L. Grothause, Julie Gutentag, Cole D. Hague, Sudarshan R. Jadcherla, Sarah A. Keim, Katelyn Levengood, Patricia Luzader, Laura Marzec, Jacqueline McCool, Bethany Miller, Leif D. Nelin, Julia Newton, Courtney Park, Leeann R. Pavlek, Lindsay Pietruszewski, Jessica Purnell, Pablo J. Sánchez, Julie C. Shadd, Jonathan L. Slaughter, Melanie Stein, Margaret Sullivan, Rox Ann Sullivan, Christopher J. Timan, Kyrstin Warnimont, Lina Yossef-Salameh, Andrew A. Bremer, Rosemary D. Higgins, Stephanie Wilson Archer, Soraya Abbasi, Christine Catts, Aasma S. Chaudhary, Sara B. DeMauro, Megan A. Dhawan, Eric C. Eichenwald, Sarvin Ghavam, Haresh Kirpalani, Toni Mancini, Karen M. Puopolo, Barbara Schmidt, Jonathan M. Snyder, Kyle Binion, Elizabeth Boylin, Carl T. D'Angio, Ronnie Guillet, Rachel Jones, Jennifer Kachelmeyer, Alison Kent, Constance Orme, Diane M. Prinzing, Daisy Rochez, Mary Rowan, Premini Sabaratnam, Ann Marie Scorsone, Holly I.M. Wadkins, Annie M. Bayard, Dhuly Chowdhury, Abhik Das, Jenna Gabrio, David Leblond, Amanda Lewis, Jeanette O’Donnell Auman, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, Michelle L. Baack, Megan Broadbent, Chelsey Elenkiwich, Megan M. Henning, Laurie A. Hogden, Sarah Van Muyden, Marian M. Adams, Dona Bahmani, M. Bethany Ball, Valerie Y. Chock, Jennifer E. Chuck, Beth A. Earhart, Lynne C. Huffman, Melinda S. Proud, Barbara P. Recine, Elizabeth N. Reichert, Lilia Rutkowska, David K. Stevenson, Krisa P. Van Meurs, Hali E. Weiss, R. Jordan Williams, Janice Bernhardt, Carl L. Bose, Gennie Bose, Matthew Maxwell Laughon, Jennifer Talbert, Conra Backstrom Lacy, Janell Fuller, Elizabeth Kuan, Mary Ruffner Hanson, Sandra Sundquist Beauman, Kristi L. Watterberg, Mariana Baserga, Jill Burnett, Susan Christensen, Kathleen Coleman, Brandy Davis, Jennifer O. Elmont, Roger G. Faix, Barbara L. Francom, Erick B. Gerday, Jamie Jordan, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Kandace M. McGrath, Hena G. Mickelsen, Stephen D. Minton, Robin K. Ohls, D. Melody Parry, Carrie A. Rau, Susan T. Schaefer, Mark J. Sheffield, Katherine Tice, Kimberlee Weaver-Lewis, Kathryn D. Woodbury, Bradley A. Yoder, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Donna White, Sanjay Chawla, Girija Natarajan, Seetha Shankaran
Journal: JAMA Network Open (2025)

Importance When preterm delivery is imminent, it remains unclear whether the timing from administration of antenatal betamethasone to birth may reduce mortality and morbidity among extremely preterm infants. Objective To evaluate the association of duration from exposure to first dose of antenatal betamethasone with outcomes among extremely preterm infants. Design, Setting, and Participants This cohort study enrolled infants born at 22 0/7 to 27 6/7 weeks’ gestation from January 2016 to February 2021 at National Institute of Child Health and Human Development Neonatal Research Network centers. Infants exposed to multiple doses of antenatal betamethasone, infants who did not receive intensive care, and infants with congenital anomalies were excluded. Data were analyzed from October 2021 to December 2024. Exposure Time in hours from anenatal betamethasone administration to birth. Main Outcomes and Measures The primary outcome was survival to discharge. Secondary outcomes included survival without major morbidity and composites of individual morbidities and death. The association of time from antenatal betamethasone administration to birth with neonatal survival and morbidity was assessed using generalized linear models, adjusting for gestational age, infant sex, maternal race, education, small for gestational age, mode of delivery, multiple birth, prolonged rupture of membranes, and center of birth. Results Of 7464 infants born during the study period, 1806 infants (928 [51.3%] boys) were included in the cohort: 475 with no betamethasone and 1331 with exposure to a single dose of betamethasone within 24 hours before birth. The median (IQR) administration-to-birth interval for infants born after a single dose of betamethasone was 3.8 (1.4-9.5) hours. The administration-to-birth interval was independently associated with survival (adjusted relative risk [aRR] per 1-hour increase, 1.01 [95% CI, 1.00-1.01]; aRR per 6-hour increase, 1.04 [95% CI, 1.01-1.07]) and survival without severe neonatal morbidity (aRR per 1-hour increase, 1.01 [95% CI, 1.01-1.02]; aRR per 6-hour increase, 1.09 [95% CI, 1.04-1.14]. Conclusions and Relevance In this cohort study, for women at risk of imminent preterm birth, even short duration of exposure to antenatal betamethasone was associated with improved neonatal survival and survival without severe neonatal morbidity.