Hamm Rebecca Feldman, Combs C Andrew, Aghajanian Paola, Friedman Alexander M
Am J Obstet Gynecol. 2022 Jun;226(6):B2-B10. doi: 10.1016/j.ajog.2022.02.021. Epub 2022 Feb 18.
Preterm birth is a leading cause of perinatal morbidity and mortality. Antenatal corticosteroid administration before preterm birth reduces the risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and reduces the costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, in part because it is difficult to predict the precise timing of preterm birth. Until 2020, The Joint Commission had a Perinatal Care quality metric measuring the rate of antenatal corticosteroid administration at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached more than 97% in The Joint Commission-accredited hospitals. However, the metric did not evaluate whether the timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multistakeholder Cooperative Workshop recommended the development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. Furthermore, we propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that the use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates.
早产是围产期发病和死亡的主要原因。早产前给予产前糖皮质激素可降低围产期死亡、呼吸系统疾病、坏死性小肠结肠炎和脑室内出血的风险，并降低围产期护理成本。早产前7天内使用产前糖皮质激素效果最佳。然而，只有20%至40%的极早早产儿在出生前7天内接受了产前糖皮质激素治疗，部分原因是难以准确预测早产的确切时间。直到2020年，联合委员会有一项围产期护理质量指标，用于衡量极早早产之前任何时间使用产前糖皮质激素的比例。该指标促使医疗服务提供者广泛使用产前糖皮质激素。在联合委员会认证的医院中，该指标的比例达到97%以上后，联合委员会于2020年取消了该指标。然而，该指标并未评估产前糖皮质激素的使用时间是否最佳，即是否在出生后7天内。2016年的一次多方利益相关者合作研讨会建议制定一项新的质量指标，以评估极早早产中产前糖皮质激素最佳使用时间的比例。在本声明中，我们概述了该指标的拟议规范，并讨论了其潜在用途、优点、局限性和障碍。此外，我们提出了一项平衡指标，用于跟踪接受产前糖皮质激素治疗并最终足月分娩的患者比例。我们建议使用这些新指标可能会促使更保守地选择产前糖皮质激素的使用时间，进而可能为早产新生儿带来显著改善的结局。
