Departments of Pediatrics, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit.
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas.
JAMA Netw Open. 2022 Sep 1;5(9):e2233331. doi: 10.1001/jamanetworkopen.2022.33331.
The provision of antenatal corticosteroids to pregnant patients at gestational age (GA) 22 6/7 weeks or less remains controversial and lacks support from randomized clinical trials.
To compare rates of survival and survival without major morbidities among infants born at GA 22 0/7 to 23 6/7 weeks after exposure to antenatal steroids at 22 6/7 weeks' gestation or less vs no exposure to antenatal steroids.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled infants born at GA 22 0/7 to 23 6/7 weeks between January 1, 2016, and December 31, 2019, at centers in the National Institute of Child Health and Human Development Neonatal Research Network. Infants who did not receive intensive care and infants with antenatal steroid exposure after GA 22 6/7 weeks were excluded.
Infants were classified as having no, partial, or complete exposure to antenatal steroids.
The primary outcome was survival to discharge. The main secondary outcome was survival without major neonatal morbidity. The associations of differential exposures to antenatal steroids with outcomes were evaluated using logistic regression, adjusting for GA, sex, race, maternal education, small for GA status, mode of delivery, multiple birth, prolonged rupture of membranes, year of birth, and Neonatal Research Network center.
A total of 431 infants (mean [SD] GA, 22.6 [0.5] weeks; 232 [53.8%] boys) were included, with 110 infants (25.5%) receiving no antenatal steroids, 80 infants (18.6%) receiving partial antenatal steroids, and 241 infants (55.9%) receiving complete antenatal steroids. Seventeen infants were exposed to antenatal steroids at GA 21 weeks. Among infants exposed to complete antenatal steroids, 130 (53.9%) survived to discharge, compared with 30 infants (37.5%) with partial antenatal steroid exposure and 239 infants (35.5%) with no antenatal steroids. Infants born after complete antenatal steroid exposure, compared with those without antenatal steroid exposure, were more likely to survive to discharge (adjusted odds ratio [aOR], 1.95 [95% CI, 1.07-3.56]) and to survive without major morbidity (aOR, 2.74 [95% CI, 1.19-6.30]).
In this retrospective cohort study, among infants born between GA 22 0/7 and 23 6/7 weeks who received intensive care, exposure to a complete course of antenatal steroids at GA 22 6/7 weeks or less was independently associated with greater odds of survival and survival without major morbidity. These data suggest that the use of antenatal steroids in patients at GA 22 6/7 weeks or less could be beneficial when active treatment is considered.
在妊娠 22 6/7 周或以下的孕妇中提供产前皮质类固醇仍然存在争议，并且缺乏随机临床试验的支持。
比较在 22 周 6/7 周妊娠或以下接触产前类固醇的妊娠 22 周 0/7 至 23 周 6/7 周出生的婴儿与未接触产前类固醇的婴儿之间的存活率和无主要并发症存活率。
设计、地点和参与者：这项队列研究纳入了 2016 年 1 月 1 日至 2019 年 12 月 31 日期间在国家儿童健康与人类发展研究所新生儿研究网络中心出生的妊娠 22 周 0/7 至 23 周 6/7 周的婴儿。未接受重症监护的婴儿和 GA 22 周 6/7 周后接受产前类固醇暴露的婴儿被排除在外。
婴儿分为未暴露、部分暴露或完全暴露于产前类固醇。
主要结局是存活至出院。主要次要结局是无主要新生儿并发症的存活率。使用逻辑回归评估差异暴露于产前类固醇与结局的相关性，调整了 GA、性别、种族、母亲教育程度、GA 状态、分娩方式、多胎、延长胎膜破裂、出生年份和新生儿研究网络中心。
共纳入 431 名婴儿（平均[SD]GA，22.6[0.5]周；232[53.8%]为男性），其中 110 名婴儿（25.5%）未接受产前类固醇，80 名婴儿（18.6%）接受部分产前类固醇，241 名婴儿（55.9%）接受完全产前类固醇。17 名婴儿在 GA 21 周时接触了产前类固醇。在接受完全产前类固醇治疗的婴儿中，有 130 名（53.9%）存活至出院，而部分接受产前类固醇治疗的婴儿有 30 名（37.5%），未接受产前类固醇治疗的婴儿有 239 名（35.5%）。与未接受产前类固醇暴露的婴儿相比，接受完全产前类固醇暴露的婴儿更有可能存活至出院（调整优势比[aOR]，1.95[95%CI，1.07-3.56]）和无主要并发症存活（aOR，2.74[95%CI，1.19-6.30]）。
在这项回顾性队列研究中，在接受重症监护的妊娠 22 周 0/7 至 23 周 6/7 周之间出生的婴儿中，在 GA 22 周 6/7 周或以下接受完整疗程产前类固醇治疗与存活几率和无主要并发症存活几率的增加独立相关。这些数据表明，在考虑积极治疗时，在 GA 22 周 6/7 周或以下的患者中使用产前类固醇可能是有益的。
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