Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

Boghossian, Nansi S.; McDonald, Scott A.; Bell, Edward F.; Carlo, Waldemar A.; Brumbaugh, Jane E.; Stoll, Barbara J.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Das, Abhik; Higgins, Rosemary D.

doi:10.1001/jamapediatrics.2016.0104

Cited by 57 publications

(43 citation statements)

References 23 publications

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“…Recently, a large multicentre observational study has shown that ANSs are effective in reducing mortality and severe IVH in extremely preterm (22–28 weeks) multiples, with effect estimates of 0.87 (95% CI 0.78, 0.96) and 0.68 (95% CI 0.58, 0.78), respectively, that is, quite similar to our own estimates. That study did not compare the effect of ANS in multiples vs. singletons.…”

Section: Commentsupporting

confidence: 88%

“…In our study, we only studied in‐hospital mortality and short‐term neurological morbidity and could not replicate this finding. Differences between the two studies include a difference in GA span investigated, hence a different baseline risk; a difference in SGA frequency (about 5% in Boghossian's study vs. 16.8% in ours); and a difference in variables and statistical methods used for risk adjustment which included a propensity score in our study, which might explain some of the discordance. A recent study in twins carried out within the Israel Neonatal Network also showed a protective effect of ANS in SGA neonates …”

Section: Commentmentioning

confidence: 59%

“…As death and severe IVH could be considered competing risks, a composite outcome of death or severe IVH was also calculated and analysed. We chose these outcomes because for mortality and IVH (but not for PVL), a clear demonstration of ANS effect exists from randomised controlled trials, while concerns have been raised of a potential adverse effect of ANS on infants' neurodevelopment . Twins and higher‐order multiples ( n = 1775) were analysed as a combined group.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

Gagliardi

Lucchini

Bellù

et al. 2017

Paediatric Perinatal Epid

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Section: Commentsupporting

confidence: 88%

Section: Commentmentioning

confidence: 59%

Section: Methodsmentioning

confidence: 99%

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Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

Gagliardi

Lucchini

Bellù

et al. 2017

Paediatric Perinatal Epid

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“…Prenatal corticosteroid therapy is recommended in all pregnancies with threatened preterm labour before 34 weeks' gestation where active care of the newborn is anticipated. Although there are limited RCT data in babies <26 weeks' gestation or very immature twins, observational studies support the concept that antenatal corticosteroids also reduce mortality in these infants [19,20]. In pregnancies between 34 and 36 weeks' gestation, prenatal steroids will also reduce the risk of short-term respiratory morbidity but not mortality, and there is a paucity of data on longer-term follow-up [21].…”

Section: Prenatal Carementioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…No significant long-term effects of ACT were found, regarding neurodevelopmental impairment (aOR 1.03 [0.62-1.7]) [23]. In their retrospective study on extremely preterm multiple gestations, Boghossian et al [24 ]found a higher risk of neurodevelopmental impairment among SGA infants who received ACT (adjusted [a]RR 1.62 [1.22-2.16]) than in infants with normal growth (aRR 0.89 [0.8-0.98]).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Basset

Nusinovici²,

Huetz

et al. 2017

Neonatology

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Background: There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. Objective: To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. Methods: This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. Results: ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. Conclusion: We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD.

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Association of Antenatal Corticosteroids With Mortality, Morbidity, and Neurodevelopmental Outcomes in Extremely Preterm Multiple Gestation Infants

Cited by 57 publications

References 23 publications

Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

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