209 Association of antenatal corticosteroid exposure and infant survival at 22 and 23 weeks

Abstract

Antenatal corticosteroid (ANCS) administration between 22 0/7 – 22 6/7 wks is not recommended by SMFM and ACOG given current existing evidence. We sought to evaluate whether ANCS exposure was associated with improved survival among resuscitated newborns delivered at 22 and 23 wks. We conducted a population-based cohort study of all resuscitated livebirths delivered between 22 0/7 and 23 6/7 wks in the United States from 2009-2014. The primary outcome was difference in rate of survival to 1 year of life (YOL) based on ANCS exposure. Secondary outcomes included neonatal survival (< 28 days of life), cesarean delivery, and composite adverse maternal outcome (CAMO) associated with ANCS utilization. Multivariable logistic regression provided confounder adjusted effect estimates. In the United States between 2009-2014, there were 2,635 and 7,992 infants who received postnatal resuscitation after delivery between 22 0/7 – 22 6/7 and 23 0/7 – 23 6/7 wks, respectively. Few infants who were resuscitated after birth between 22 0/7 – 22 6/7 (15.9%) and 23 0/7-23 6/7 (26.0%) wks received ANCS. Infant survival to 1 YOL was 45.2 vs 27.8% (aRR 1.6, 95% CI 1.2-2.1) among infants exposed to ANCS compared to those who did not receive ANCS at 22 wks. Survival to 1 YOL was 57.9 vs 47.7% (aRR 1.3, 95% CI 1.1-1.5) among infants exposed to ANCS compared to those who did not receive ANCS at 23 wks. When stratified by 100g birthweight category (400-499g, 500-599g, 600-699g, and 700-799g), ANCS was associated with increased survival among neonates weighing 500-599g (aRR 1.9, 95% CI 1.3-2.9) and 600-699g (aRR 1.7, 95% CI 1.1-2.6) at 22 wks. ANCS exposure had a positive association with cesarean delivery (aRR 2.1, 95% CI 1.4-3.0) and composite adverse maternal outcome (aRR 2.3, 95% CI 1.2-4.3) among infants born at 22 wks. Exposure to ANCS was associated with increased survival to 1 YOL among infants born at 22 and 23 wks. Counseling regarding the utilization of ANCS at the limits of viability should be investigated further given emerging evidence of benefit.View Large Image Figure ViewerDownload Hi-res image Download (PPT)