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Antenatal corticosteroids and neonatal outcomes according to gestational age: a cohort study
  1. Bradley Manktelow1,
  2. Mithilesh Kumar Lal2,
  3. David Field1,
  4. Sunil Sinha2,*
  1. 1 University of Leicester, United Kingdom;
  2. 2 The James Cook University Hospital, United Kingdom
  1. Correspondence to: Sunil Sinha, James Cook Univ Hosp, Neonatal Office, James Cook Univ Hosp, Middlesborough,, TS4 3BW, United Kingdom; sunil.sinha{at}stees.nhs.uk

Abstract

Objective: To see if there was any difference in the effect of antenatal corticosteroids on neonatal outcomes according to different gestational ages at birth.

Design: Prospective cohort study in a geographically defined population.

Setting: Trent Region, UK.

Patients: Infants admitted for neonatal care, of 23 to 32 weeks gestation, born to Trent resident mothers during a 15 year period.

Intervention: Antenatal corticosteroid treatment to pregnant women at risk of preterm birth.

Primary outcome was survival until discharge from neonatal unit. Secondary outcomes included length of stay on the neonatal unit, duration of artificial respiratory support (mechanical ventilation and CPAP), and chronic lung disease (CLD).

Results: The overall mortality amongst babies born between 24 to 29 weeks with maternal steroid was lower ( n=850 /4370; 19.4%) as compared to their counterparts whose mothers did not receive steroids (n=323/920;35.1%) The gestation specific mortality (percent) in the steroid treated group between 24 to 29 was significantly lower than the group without steroid treatment. There was a 9.9% reduction in mortality amongst babies born at 23 weeks gestation in the steroid treated group [n= 81/102;79.4%] compared to non-steroid group [ n=75/84; 89.3 %] (p=0.068). There was no significant effect of antenatal steroid treatment on length of stay, duration of respiratory support and CLD among infants who survived till discharge.

Conclusion: Antenatal corticosteroid treatment is associated with improved survival in babies born between 24 to 29 weeks gestation. This, however, does not lead to any significant improvements in length of stay, duration of respiratory support and CLD amongst survivors.

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