Abstract
There are growing concerns that antenatal corticosteroid administration may harm children's neurodevelopment. We investigated the safety of antenatal corticosteroid administration practices for children's overall developmental health (skills and behaviors) at early school age. We linked population health and education databases from British Columbia (BC), Canada to identify a cohort of births admitted to hospital between 31 weeks, 0 days gestation (31+0 weeks), and 36+6 weeks, 2000 to 2013, with routine early school age child development testing. We used a regression discontinuity design to compare outcomes of infants admitted just before and just after the clinical threshold for corticosteroid administration of 34+0 weeks. We estimated the median difference in the overall Early Development Instrument (EDI) score and EDI subdomain scores, as well as risk differences (RDs) for special needs designation and developmental vulnerability (<10th percentile on 2 or more subdomains). The cohort included 5,562 births admitted between 31+0 and 36+6 weeks, with a median EDI score of 40/50. We found no evidence that antenatal corticosteroid administration practices were linked with altered child development at early school age: median EDI score difference of -0.5 [95% CI: -2.2 to 1.7] (p = 0.65), RD per 100 births for special needs designation -0.5 [-4.2 to 3.1] (p = 0.96) and for developmental vulnerability of 3.9 [95% CI:-2.2 to 10.0] (p = 0.24). A limitation of our study is that the regression discontinuity design estimates the effect of antenatal corticosteroid administration at the gestational age of the discontinuity, 34 + 0 weeks, so our results may become less generalisable as gestational age moves further away from this point. Our study did not find that that antenatal corticosteroid administration practices were associated with child development at early school age. Our findings may be useful for supporting clinical counseling about antenatal corticosteroids administration at late preterm gestation, when the balance of harms and benefits is less clear.
Highlights
Clinical practice guidelines have long recommended that a single dose of antenatal corticosteroids should be administered to women with threatened preterm birth at 24 to 34 weeks gestation [1,2,3]
We found no evidence that antenatal corticosteroid administration practices were linked with altered child development at early school age: median Early Development Instrument (EDI) score difference of −0.5 [95% confidence interval (CI): −2.2 to 1.7] (p = 0.65), risk difference (RD) per 100 births for special needs designation −0.5 [−4.2 to 3.1] (p = 0.96) and for developmental vulnerability of 3.9 [95% CI: −2.2 to 10.0] (p = 0.24)
Our study did not find that that antenatal corticosteroid administration practices were associated with child development at early school age
Summary
Clinical practice guidelines have long recommended that a single dose of antenatal corticosteroids should be administered to women with threatened preterm birth at 24 to 34 weeks gestation [1,2,3]. In 2016, the Antenatal Late Preterm Steroids (ALPS) trial examined the effectiveness of antenatal corticosteroids at late preterm gestation (34+0 to 36+6 weeks) [4]. They reported a 20% reduction in neonatal respiratory treatment or mortality in the intervention arm, providing evidence that corticosteroids are beneficial for preterm births of all gestational ages. In the United Kingdom and Canada, updated clinical practice guidelines only recommend that antenatal corticosteroids should be “considered” at late preterm ages, not “offered” [2,5].
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