Document Detail


Antenatal steroid administration for premature neonates in California.
MedLine Citation:
PMID:  21446208     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To estimate risk factors for premature neonates not receiving antenatal steroids in a population-based cohort and to determine whether the gains of a quality-improvement collaborative project on antenatal steroid administration were sustained long-term.
METHODS: Clinical data for premature neonates born in 2005–2007 were obtained from the California Perinatal Quality Care Collaborative, which collects data on more than 90% of neonatal admissions in California. Eligible neonates had a birth weight of less than 1,500 g or gestational age less than 34 weeks and were born at a Collaborative hospital. These data were linked to administrative data from California Vital Statistics. Sociodemographic and medical risk factors for not receiving antenatal steroids were determined. We also examined the effect of birth hospital participation in a previous quality-improvement collaborative project. A random effects logistic regression model was used to determine independent risk factors.
RESULTS: Of 15,343 eligible neonates, 23.1% did not receive antenatal steroids in 2005–2007. Hispanic mothers (25.6%), mothers younger than age 20 (27.6%), and those without prenatal care (52.2%) were less likely to receive antenatal steroids. Mothers giving birth vaginally (26.8%) and mothers with a diagnosis of fetal distress (26.5%) were also less likely to receive antenatal steroids. Rupture of membranes before delivery and multiple gestations were associated with higher likelihood of antenatal steroid administration. Hospitals that participated in a quality-improvement collaborative in 1999– 2000 had higher rates of antenatal steroid administration (85% compared with 69%, P<.001).
CONCLUSION: A number of eligible mothers do not receive antenatal steroids. Quality-improvement initiatives to improve antenatal steroid administration could target specific high-risk groups.
Authors:
Henry C Lee; Audrey Lyndon; Yair J Blumenfeld; R Adams Dudley; Jeffrey B Gould
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  117     ISSN:  1873-233X     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-29     Completed Date:  2011-04-12     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  603-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, University of California, San Francisco, San Francisco, California 94143, USA. LeeHC@peds.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / administration & dosage*
Adult
California
Female
Humans
Infant, Newborn
Infant, Premature*
Logistic Models
Pregnancy
Prenatal Care / standards,  statistics & numerical data*
Quality Improvement / statistics & numerical data
Risk Factors
Young Adult
Grant Support
ID/Acronym/Agency:
KL2 RR024130/RR/NCRR NIH HHS; KL2 RR024130/RR/NCRR NIH HHS; KL2 RR024130-04/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones
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