Effect of Antenatal Corticosteroids on Survival for Neonates Born at 23 Weeks of Gestation
- 1 April 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 111 (4), 921-926
- https://doi.org/10.1097/aog.0b013e318169ce2d
Abstract
To estimate if exposure to antenatal corticosteroids was associated with decreased rate of death in neonates born at 23 weeks of gestation. This is a retrospective cohort study performed at three tertiary centers of neonates born at 23 weeks of gestation between 1998 and 2007. Stillbirths, voluntary terminations, or parental elected nonresuscitations were excluded. Clinical and demographic variables were examined to determine possible confounding variables. A multivariable logistic regression model was used to assess the effect of steroids on the odds of death after adjustment for these confounders. The sample included 181 neonates. Of the multiple variables examined (institution, race, diagnosis, illicit drug use, antibiotics, assisted reproduction, birth weight, gender, and route of delivery), only multiple gestations were significantly associated (P<or=.15) with steroid use and increased odds of death (odds ratio [OR] 3.66, 95% confidence interval [CI] 1.05-12.73) and controlled for in the final model. The multivariable model revealed those exposed to antenatal corticosteroids had decreased odds of death (OR 0.32, 95% CI 0.12-0.84), with no significant differences in the occurrence of necrotizing enterocolitis among survivors (15.4% compared with 28.6%, P=.59) or severe intraventricular hemorrhage (23.1% compared with 57.1%, P=.17). In analyzing the effect of steroid dose, only a complete course of corticosteroids was associated with a decreased odds of death (OR 0.18, 95% CI 0.06-0.54). Neonates at 23 weeks of gestation whose mothers completed a course of antenatal corticosteroids had an associated 82% reduction in odds of death.Keywords
This publication has 12 references indexed in Scilit:
- Very-Low-Birthweight Neonates: Do Outcomes Differ in Multiple Compared with Singleton Gestations?American Journal of Perinatology, 2007
- Trends in neonatal morbidity and mortality for very low birthweight infantsAmerican Journal of Obstetrics and Gynecology, 2007
- The Ethics of Neonatal Resuscitation at the Margins of Viability: Informed Consent and OutcomesThe Journal of Pediatrics, 2005
- Antenatal corticosteroids: we continue to learnAmerican Journal of Obstetrics and Gynecology, 2004
- ACOG practice bulletin number 38, September 2002: perinatal care at the threshold of viabilityObstetrics & Gynecology, 2002
- Contemporary Trends in the Management of Delivery at 23 Weeks' GestationAmerican Journal of Perinatology, 2002
- Scientific basis and therapeutic regimens for use of antenatal glucocorticoidsAmerican Journal of Obstetrics and Gynecology, 1995
- Effects of antenatal steroid therapy on mortality and morbidity in very low birth weight infantsThe Journal of Pediatrics, 1986
- Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicapsThe Journal of Pediatrics, 1983
- Neonatal Necrotizing EnterocolitisAnnals of Surgery, 1978