The Effect of Antenatal Corticosteroids on Survival in Extreme Prematurity [22D

Abstract

INTRODUCTION: The decision to administer antenatal corticosteroids (ACS) to women who in preterm labor prior to 25 weeks remains controversial. Recent studies suggest reduction in morbidity and mortality with administration of ACS prior to 25 weeks. Our primary objective was to evaluate the effect of ACS on survival in extreme prematurity. Our secondary objective was to assess the effect of ACS on morbidities such as respiratory distress syndrome (RDS), chronic lung disease (CLD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). METHODS: A retrospective chart review was conducted on patients who delivered between gestational ages (GA) of 23-25 weeks at a large tertiary academic center between Jan 1st 2003 and Dec 31st 2017. Multiple gestation pregnancies, terminations, and patients who declined neonatal resuscitation were excluded. Logistic regression was used to assess the effect of ACS treatment on neonatal mortality and morbidity, while controlling for maternal age, GA, and maternal complications. RESULTS: A total of 407 singleton births met criteria, with 394 (96.8%) mothers receiving at least one dose of ACS and 13 (3.2%) receiving no ACS. Neonatal mortality was significantly lower for infants exposed to a full course of ACS (OR=0.30, 95% CI=0.09-0.99). Administration of ACS did not show any significant effect on morbidity, but did show a reduction in IVH (OR=0.63, 95% CI=0.15-2.64), increase odds of CLD (OR=1.51, 95% CI=0.43-5.30), and NEC (OR=1.14, 95% CI=0.22-5.93). CONCLUSION: Treatment with ACS for infants born at 23 to 25 weeks gestation was associated with a lower rate of neonatal mortality. No significant effect on morbidity was demonstrated.