Original ArticleAntenatal Corticosteroids Promote Survival of Extremely Preterm Infants Born 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
References (17)
- et al.
Antenatal corticosteroid treatment: what’s happened since Drs Liggins and Howie?
Am J Obstet Gynecol
(2009) - et al.
Survival and major neonatal complications in infants born between 22 0/7 and 24 6/7 weeks of gestation (1999-2003)
Am J Obstet Gynecol
(2006) Preventing preterm birth
N Engl J Med
(1991)- et al.
Japanese experience with micropremies weighing less than 600 grams born between 1984 to 1993
Pediatrics
(1997) - et al.
Mortality rates for extremely low birth weight infants born in Japan in 2005
Pediatrics
(2009) - et al.
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth
Cochrane Database Syst Rev
(2006) - et al.
Coordinators of World Association of Perinatal Medicine Prematurity Working Group. Guideline for the use of antenatal corticosteroids for fetal maturation
J Perinat Med
(2008) - et al.
Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation: a randomized controlled trial
JAMA
(1999)
Cited by (117)
The new frontier in ECLS: Artificial placenta and artificial womb for premature infants
2023, Seminars in Pediatric SurgeryActive Treatment of Infants Born at 22-25 Weeks of Gestation in California, 2011-2018
2022, Journal of PediatricsCitation Excerpt :Moreover, maternal receipt of antenatal steroids and cesarean delivery were factors most positively associated with neonatal interventions. These interventions, despite lacking high-quality evidence of efficacy and safety, likely reflect a decision to pursue postnatal resuscitative intervention.27-33 The finding of preterm premature rupture of membranes may be closely related to the latency period between hospital presentation and delivery provided in part by tocolysis, allowing for more maternal interventions such as antenatal steroids, magnesium sulfate neuroprophylaxis, and antenatal counseling to determine delivery plan and initiation of intensive care.29,30
Adverse effects of prenatal dexamethasone exposure on fetal development
2022, Journal of Reproductive ImmunologyPerinatal care for the extremely preterm infant
2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :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.
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.