195: Timing two doses of antenatal corticosteroid treatment for PPROM at 22 weeks: a decision analysis

Abstract

Despite their benefits, there is evidence that the effects of antenatal corticosteroids (ACS) decrease 7 days after treatment, thus the timing of antenatal corticosteroids impacts neonatal outcomes. The objective of this study was to use decision analysis to determine the optimal time for administering two doses of ACS for women with preterm premature rupture of membranes (PPROM) at 22 weeks. A decision-analytic model was constructed using TreeAge software to compare neonatal outcomes following ACS treatment in a theoretical cohort of 10,000 women who present with PPROM at 22 weeks. The model compared administering steroids at 22 and 24 weeks, 23 and 25 weeks, 24 and 26 weeks, or 25 and 27 weeks gestational age. The outcomes of neonatal death, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and neurodevelopmental delay were assessed along with maternal and neonatal quality-adjusted life years (QALYs). All probabilities and utilities were derived from literature. Deterministic and probabilistic sensitivity analyses were performed to interrogate model assumptions. In our theoretical cohort of 10,000 women who present with PPROM at 22 weeks, administering ACS at 23 weeks and a second dose at 25 weeks resulted in 5,599 neonates born with the benefits of steroids. Overall, delaying administration by one week led to higher QALYs when compared to immediate treatment. Compared to administering at 22 and 24 weeks, starting steroids at 23 weeks results in 318 fewer neonatal deaths and 73 fewer neonates with RDS. However, there would be 70 more neonates with IVH and 74 more children with neurodevelopmental delay. With sensitivity analysis, we found that when the latency period was shortened by 69% or greater following rupture of membranes at 22 weeks, administering steroids at 22 and 24 weeks gestational age would be the optimal treatment. Our results support that the optimal time for administering two doses of antenatal corticosteroids in women with PPROM at 22 weeks is at 23 and 25 weeks gestation to reduce mortality and minimize morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)