Document Detail


Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation.
MedLine Citation:
PMID:  22147379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care.
OBJECTIVE: To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10,541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables.
MAIN OUTCOME MEASURES: Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age.
RESULTS: Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]).
CONCLUSION: Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.
Authors:
Waldemar A Carlo; Scott A McDonald; Avroy A Fanaroff; Betty R Vohr; Barbara J Stoll; Richard A Ehrenkranz; William W Andrews; Dennis Wallace; Abhik Das; Edward F Bell; Michele C Walsh; Abbot R Laptook; Seetha Shankaran; Brenda B Poindexter; Ellen C Hale; Nancy S Newman; Alexis S Davis; Kurt Schibler; Kathleen A Kennedy; Pablo J Sánchez; Krisa P Van Meurs; Ronald N Goldberg; Kristi L Watterberg; Roger G Faix; Ivan D Frantz; Rosemary D Higgins;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JAMA     Volume:  306     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-07     Completed Date:  2011-12-08     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2348-58     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use*
Child Development / drug effects*
Cognition
Cohort Studies
Developmental Disabilities / etiology,  prevention & control*
Female
Gestational Age
Humans
Infant
Infant Mortality*
Infant, Newborn
Infant, Premature*
Male
Nervous System / drug effects*,  growth & development
Pregnancy
Pregnancy Trimester, Second
Prenatal Care
Prenatal Exposure Delayed Effects*
Prospective Studies
Psychomotor Disorders
Treatment Outcome
Grant Support
ID/Acronym/Agency:
M01 RR125/RR/NCRR NIH HHS; M01 RR2172/RR/NCRR NIH HHS; M01 RR2635/RR/NCRR NIH HHS; M01 RR30/RR/NCRR NIH HHS; M01 RR32/RR/NCRR NIH HHS; M01 RR39/RR/NCRR NIH HHS; M01 RR44/RR/NCRR NIH HHS; M01 RR54/RR/NCRR NIH HHS; M01 RR59/RR/NCRR NIH HHS; M01 RR6022/RR/NCRR NIH HHS; M01 RR633/RR/NCRR NIH HHS; M01 RR64/RR/NCRR NIH HHS; M01 RR70/RR/NCRR NIH HHS; M01 RR7122/RR/NCRR NIH HHS; M01 RR750/RR/NCRR NIH HHS; M01 RR80/RR/NCRR NIH HHS; M01 RR8084/RR/NCRR NIH HHS; M01 RR997/RR/NCRR NIH HHS; U10 HD034216/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21397/HD/NICHD NIH HHS; U10 HD21415/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34167/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS; U10 HD36790/HD/NICHD NIH HHS; U10 HD40461/HD/NICHD NIH HHS; U10 HD40492/HD/NICHD NIH HHS; U10 HD40498/HD/NICHD NIH HHS; U10 HD40521/HD/NICHD NIH HHS; U10 HD40689/HD/NICHD NIH HHS; U10 HD53089/HD/NICHD NIH HHS; U10 HD53109/HD/NICHD NIH HHS; U10 HD53119/HD/NICHD NIH HHS; U10 HD53124/HD/NICHD NIH HHS; UL1 RR024160/RR/NCRR NIH HHS; UL1 RR025008/RR/NCRR NIH HHS; UL1 RR24139/RR/NCRR NIH HHS; UL1 RR24160/RR/NCRR NIH HHS; UL1 RR24979/RR/NCRR NIH HHS; UL1 RR25008/RR/NCRR NIH HHS; UL1 RR25744/RR/NCRR NIH HHS; UL1 RR25761/RR/NCRR NIH HHS; UL1 RR25764/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones
Investigator
Investigator/Affiliation:
Alan H Jobe / ; Michael S Caplan / ; William Oh / ; Bonnie Stephens / ; Robert Burke / ; Barbara Alksninis / ; Melinda Caskey / ; Katharine Johnson / ; Angelita M Hensman / ; Suzy Ventura / ; Victoria E Watson / ; Theresa M Leach / ; Ann R Stark / ; Kerri Fournier / ; Stacy Dow / ; Kimberly Gronsman Lee / ; Colleen Driscoll / ; Deanne Wilson-Costello / ; Bonnie S Siner / ; Edward F Donovan / ; Kate Bridges / ; Barbara Alexander / ; Jean Steichen / ; Kimberly A Yolton / ; Cathy Grisby / ; Holly L Mincey / ; Jody Hessling / ; Marcia Worley Mersmann / ; Teresa L Gratton / ; C Michael Cotten / ; Ricki Goldstein / ; Kathy J Auten / ; Kimberley A Fisher / ; Katherine A Foy / ; Sandra Grimes / ; Melody Lohmeyer / ; David P Carlton / ; Lucky Jain / ; Ira Adams-Chapman / ; Linda L Wright / ; Stephanie Wilson Archer / ; Elizabeth M McClure / ; Elisabeth C McGowan / ; Brenda L MacKinnon / ; Anne Furey / ; Ellen Nylen / ; James A Lemons / ; Anna M Dusick / ; Diana D Appel / ; Dianne E Herron / ; Lucy C Miller / ; Leslie Dawn Wilson / ; Leslie Richard / ; W Kenneth Poole / ; Jeanette O'Donnell Auman / ; Margaret Cunningham / ; Betty K Hastings / ; Carolyn M Petrie Huitema / ; Elizabeth M McClure / ; Jamie E Newman / ; James W Pickett / ; Kristin M Zaterka-Baxter / ; David K Stevenson / ; Susan R Hintz / ; Marian M Adams / ; Barry E Fleisher / ; Jean G Kohn / ; Robert D Stebbins / ; Hali Weiss / ; Joan M Baran / ; Barbara Bentley / ; Lori Bond / ; Ginger K Brudos / ; Elizabeth Bruno / ; Maria Elena DeAnda / ; Julie Lee-Ancajas / ; Renee P Pyle / ; Nicholas St John / ; M Bethany Ball / ; Anne M DeBattista / ; Melinda S Proud / ; Namasivayam Ambalavanan / ; Monica V Collins / ; Shirley S Cosby / ; Myriam Peralta-Carcelen / ; Vivien Phillips / ; Fred J Biasini / ; Reed Dimmitt / ; David Randolph / ; Neil N Finer / ; Maynard R Rasmussen / ; Paul R Wozniak / ; Yvonne E Vaucher / ; Kathy Arnell / ; Renee Bridge / ; Clarence Demetrio / ; Martha G Fuller / ; Chris Henderson / ; Wade Rich / ; John A Widness / ; Michael J Acarregui / ; Karen J Johnson / ; Diane L Eastman / ; Shahnaz Duara / ; Charles R Bauer / ; Ruth Everett-Thomas / ; Amy Mur Worth / ; Kasey Hamlin-Smith / ; Michelle Berkovits / ; Silvia M Frade Eguras / ; Mary Allison / ; Lu-Ann Papile / ; Janell Fuller / ; Jean Lowe / ; Conra Backstrom Lacy / ; Rebecca Montman / ; Dale L Phelps / ; Gary Myers / ; Diane Hust / ; Linda J Reubens / ; Erica Burnell / ; Rosemary L Jensen / ; Mary Rowan / ; Kelley Yost / ; Lauren Zwetsch / ; Julie Babish Johnson / ; Emily Kushner / ; Cassandra A Horihan / ; Joan Merzbach / ; Sheldon B Korones / ; Henrietta S Bada / ; Marilyn G Williams / ; Kimberly Yolton / ; Charles R Rosenfeld / ; Walid A Salhab / ; Jon E Tyson / ; Roy J Heyne / ; Luc P Brion / ; Alicia Guzman / ; Jackie F Hickman / ; Nancy A Miller / ; Diana M Vasil / ; Lizette E Torres / ; Janet S Morgan / ; Cathy Twell Boatman / ; Jon E Tyson / ; Esther G Akpa / ; Magda Cedillo / ; Patricia Ann Orekoya / ; Susan E Dieterich / ; Patricia W Evans / ; Claudia I Franco / ; Charles E Green / ; Beverly Foley Harris / ; Margarita Jiminez / ; Terri L Major-Kincade / ; Anna E Lis / ; Sarah C Martin / ; Georgia E McDavid / ; Brenda H Morris / ; M Layne Poundstone / ; Stacey Reddoch / ; Saba Khan Siddiki / ; Maegan C Simmons / ; Patti L Pierce Tate / ; Laura L Whitely / ; Sharon L Wright / ; Bradley A Yoder / ; Karen A Osborne / ; Jennifer J Jensen / ; Cynthia Spencer / ; Kimberlee Weaver-Lewis / ; Jill Burnett / ; Shawna Baker / ; T Michael O'Shea / ; Robert Dillard / ; Nancy J Peters / ; Barbara Jackson / ; Athina Pappas / ; Yvette R Johnson / ; Virginia Delaney-Black / ; Rebecca Bara / ; Geraldine Muran / ; Deborah Kennedy / ; Laura A Goldston / ; Harris Jacobs / ; Linda C Mayes / ; Patricia Cervone / ; Patricia Gettner / ; Monica Konstantino / ; JoAnn Poulsen / ; Elaine Romano / ; Janet Taft / ; Joanne Williams / ; Nancy L Close / ; Walter S Gilliam / ; Christine G Butler / ; Sheila Greisman /
Comments/Corrections

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