Original Article
Antenatal Corticosteroids Promote Survival of Extremely Preterm Infants Born at 22 to 23 Weeks of Gestation

https://doi.org/10.1016/j.jpeds.2010.12.039Get rights and content

Objective

To evaluate the effectiveness of antenatal corticosteroid (ACS) to improve neonatal outcomes for infants born at <24 weeks of gestation.

Study design

We performed a retrospective analysis of 11 607 infants born at 22 to 33 weeks of gestation between 2003 and 2007 from the Neonatal Research Network of Japan. We evaluated the gestational age effects of ACS administered to mothers with threatened preterm birth on several factors related to neonatal morbidity and mortality.

Results

By logistic regression analysis, ACS exposure decreased respiratory distress syndrome and severe intraventricular hemorrhage in infants born between 24 and 29 weeks of gestation. Cox regression analysis revealed that ACS exposure was associated with a significant decrease in mortality of preterm infants born at 22 or 23 weeks of gestation (adjusted hazard ratio, 0.72; 95% CI, 0.53 to 0.97; P = .03). This effect was also observed at 24 to 25 and 26 to 27 weeks of gestation and in the overall study population.

Conclusions

ACS exposure improved survival of extremely preterm infants. ACS treatment should be considered for threatened preterm birth at 22 to 23 weeks of gestation.

Section snippets

Methods

Patient data were obtained from the NRN database established in 2003 with a grant from the Ministry of Health, Labor, and Welfare, Japan. This data base contains information on the morbidity and mortality of very low birth weight infants with birth weight ≤1500 g and born in the participating hospitals or admitted to these facilities within 28 days of birth. All tertiary neonatal units designated by the government except three units participate in this data base in Japan. Data for infants who

Results

Data of 11 607 infants were available for the period 2003 to 2007 and were included in the analysis. The demographic and baseline characteristics of the study population are shown in Table I. Significant differences in several baseline characteristics were observed between the no-ACS and ACS groups. Multivariate logistic regression analysis was performed with adjustment for maternal age, parity, multiplicity, gestational diabetes mellitus, hypertension, premature rupture of membranes, mode of

Discussion

Retrospective data base analysis of the 11 607 preterm infants from 87 tertiary hospitals participating in the NRN database showed that ACS treatment was administered to only 42% of women who delivered prematurely (22 to 33 weeks of gestation). Although ACS treatment was effective in decreasing RDS, surfactant use, and duration of O2 use in preterm infants born between 24 and 29 weeks of gestation, it was not as effective in the 22- to 23-week group. Furthermore, ACS treatment was extremely

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    A study by Mori assessing the benefit of ANS on babies born 22–23 weeks' gestation found that use of ANS was associated with a reduction in neonatal death, but had no effect on respiratory morbidity [79]. This finding is consistent with other studies assessing the boarder of viability [79,81]. One challenge with ANS in the ePTB population is that there are no randomised data (around only 100 infants in the Roberts [81] meta-analysis received ANS before 28 weeks’ gestation) for very early preterm infants.

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Supported by a grant-in-aid from the Ministry of Health, Labor, and Welfare, Japan. The authors declare no conflicts of interest.

A list of members of the Neonatal Research Network Japan is available in the Appendix at www.jpeds.com.

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