Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation

Waldemar A. Carlo, Scott A. McDonald, Avroy A. Fanaroff, Betty R. Vohr, Barbara J. Stoll, Richard A. Ehrenkranz, William W. Andrews, Dennis Wallace, Abhik Das, Edward F. Bell, Michele C. Walsh, Abbot R. Laptook, Seetha Shankaran, Brenda B. Poindexter, Ellen C. Hale, Nancy S. Newman, Alexis S. Davis, Kurt Schibler, Kathleen A. Kennedy, Pablo J. Sánchez & 6 others Krisa P. Van Meurs, Ronald N. Goldberg, Kristi L. Watterberg, Roger G. Faix, Ivan D. Frantz, Rosemary D. Higgins

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

Context: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks'gestation are provided intensive care. Objective: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. Design, Setting, and Participants: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N=10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. Main Outcome Measures: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. Results: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49- 0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]). Conclusion: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

Original languageEnglish (US)
Pages (from-to)2348-2358
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume306
Issue number21
DOIs
StatePublished - Dec 7 2011

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Adrenal Cortex Hormones
Pregnancy
Mortality
Odds Ratio
Necrotizing Enterocolitis
Mothers
Logistic Models
Periventricular Leukomalacia
Premature Obstetric Labor
Critical Care
Birth Weight
Gestational Age
Cohort Studies
Outcome Assessment (Health Care)
Guidelines
Hemorrhage

ASJC Scopus subject areas

  • Medicine(all)

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Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. / Carlo, Waldemar A.; McDonald, Scott A.; Fanaroff, Avroy A.; Vohr, Betty R.; Stoll, Barbara J.; Ehrenkranz, Richard A.; Andrews, William W.; Wallace, Dennis; Das, Abhik; Bell, Edward F.; Walsh, Michele C.; Laptook, Abbot R.; Shankaran, Seetha; Poindexter, Brenda B.; Hale, Ellen C.; Newman, Nancy S.; Davis, Alexis S.; Schibler, Kurt; Kennedy, Kathleen A.; Sánchez, Pablo J.; Van Meurs, Krisa P.; Goldberg, Ronald N.; Watterberg, Kristi L.; Faix, Roger G.; Frantz, Ivan D.; Higgins, Rosemary D.

In: JAMA - Journal of the American Medical Association, Vol. 306, No. 21, 07.12.2011, p. 2348-2358.

Research output: Contribution to journalArticle

Carlo, WA, McDonald, SA, Fanaroff, AA, Vohr, BR, Stoll, BJ, Ehrenkranz, RA, Andrews, WW, Wallace, D, Das, A, Bell, EF, Walsh, MC, Laptook, AR, Shankaran, S, Poindexter, BB, Hale, EC, Newman, NS, Davis, AS, Schibler, K, Kennedy, KA, Sánchez, PJ, Van Meurs, KP, Goldberg, RN, Watterberg, KL, Faix, RG, Frantz, ID & Higgins, RD 2011, 'Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation', JAMA - Journal of the American Medical Association, vol. 306, no. 21, pp. 2348-2358. https://doi.org/10.1001/jama.2011.1752
Carlo, Waldemar A. ; McDonald, Scott A. ; Fanaroff, Avroy A. ; Vohr, Betty R. ; Stoll, Barbara J. ; Ehrenkranz, Richard A. ; Andrews, William W. ; Wallace, Dennis ; Das, Abhik ; Bell, Edward F. ; Walsh, Michele C. ; Laptook, Abbot R. ; Shankaran, Seetha ; Poindexter, Brenda B. ; Hale, Ellen C. ; Newman, Nancy S. ; Davis, Alexis S. ; Schibler, Kurt ; Kennedy, Kathleen A. ; Sánchez, Pablo J. ; Van Meurs, Krisa P. ; Goldberg, Ronald N. ; Watterberg, Kristi L. ; Faix, Roger G. ; Frantz, Ivan D. ; Higgins, Rosemary D. / Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. In: JAMA - Journal of the American Medical Association. 2011 ; Vol. 306, No. 21. pp. 2348-2358.
@article{92f2747c0c5e4756be289802b1be8a1a,
title = "Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation",
abstract = "Context: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks'gestation are provided intensive care. Objective: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. Design, Setting, and Participants: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N=10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5{\%}) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. Main Outcome Measures: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. Results: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4{\%} with exposure to antenatal corticosteroids vs 90.5{\%} without exposure; AOR, 0.58 [95{\%} CI, 0.42-0.80]), at 24 weeks' gestation (68.4{\%} with exposure to antenatal corticosteroids vs 80.3{\%} without exposure; AOR, 0.62 [95{\%} CI, 0.49- 0.78]), and at 25 weeks' gestation (52.7{\%} with exposure to antenatal corticosteroids vs 67.9{\%} without exposure; AOR, 0.61 [95{\%} CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2{\%} with exposure to antenatal corticosteroids vs 93.1{\%} without exposure; AOR, 0.80 [95{\%} CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5{\%} with exposure to antenatal corticosteroids vs 84.5{\%} without exposure; AOR, 0.54 [95{\%} CI, 0.30-0.97]). Conclusion: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.",
author = "Carlo, {Waldemar A.} and McDonald, {Scott A.} and Fanaroff, {Avroy A.} and Vohr, {Betty R.} and Stoll, {Barbara J.} and Ehrenkranz, {Richard A.} and Andrews, {William W.} and Dennis Wallace and Abhik Das and Bell, {Edward F.} and Walsh, {Michele C.} and Laptook, {Abbot R.} and Seetha Shankaran and Poindexter, {Brenda B.} and Hale, {Ellen C.} and Newman, {Nancy S.} and Davis, {Alexis S.} and Kurt Schibler and Kennedy, {Kathleen A.} and S{\'a}nchez, {Pablo J.} and {Van Meurs}, {Krisa P.} and Goldberg, {Ronald N.} and Watterberg, {Kristi L.} and Faix, {Roger G.} and Frantz, {Ivan D.} and Higgins, {Rosemary D.}",
year = "2011",
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doi = "10.1001/jama.2011.1752",
language = "English (US)",
volume = "306",
pages = "2348--2358",
journal = "JAMA - Journal of the American Medical Association",
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TY - JOUR

T1 - Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation

AU - Carlo, Waldemar A.

AU - McDonald, Scott A.

AU - Fanaroff, Avroy A.

AU - Vohr, Betty R.

AU - Stoll, Barbara J.

AU - Ehrenkranz, Richard A.

AU - Andrews, William W.

AU - Wallace, Dennis

AU - Das, Abhik

AU - Bell, Edward F.

AU - Walsh, Michele C.

AU - Laptook, Abbot R.

AU - Shankaran, Seetha

AU - Poindexter, Brenda B.

AU - Hale, Ellen C.

AU - Newman, Nancy S.

AU - Davis, Alexis S.

AU - Schibler, Kurt

AU - Kennedy, Kathleen A.

AU - Sánchez, Pablo J.

AU - Van Meurs, Krisa P.

AU - Goldberg, Ronald N.

AU - Watterberg, Kristi L.

AU - Faix, Roger G.

AU - Frantz, Ivan D.

AU - Higgins, Rosemary D.

PY - 2011/12/7

Y1 - 2011/12/7

N2 - Context: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks'gestation are provided intensive care. Objective: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. Design, Setting, and Participants: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N=10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. Main Outcome Measures: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. Results: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49- 0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]). Conclusion: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

AB - Context: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks'gestation are provided intensive care. Objective: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. Design, Setting, and Participants: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N=10 541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. Main Outcome Measures: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. Results: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49- 0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]). Conclusion: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

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