Optimizing antenatal corticosteroid timing for preterm birth

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A recent study reported the link between antenatal corticosteroid timing and the 5 and a half-year survival and neurological outcomes in preterm children, highlighting the importance of evaluating and optimizing the interval between administration and birth for improved long-term results.

Optimizing antenatal corticosteroid timing for preterm birth | Image Credit: © RFBSIP - © RFBSIP - stock.adobe.com.

Optimizing antenatal corticosteroid timing for preterm birth | Image Credit: © RFBSIP - © RFBSIP - stock.adobe.com.

A 7 day or greater period between antenatal corticosteroid (ACS) administration and birth is associated with a lower survival rate among children aged 5 and a half years, according to a recent study published in the American Journal of Obstetrics & Gynecology.

Takeaways

  1. A period of 7 days or more between ACS administration and birth is linked to a lower survival rate among children aged 5 and a half years, according to a study published in the American Journal of Obstetrics & Gynecology.
  2. Over 15 million preterm births occur annually, causing approximately 1 million deaths in children under 5 years. Administering 2 ACS dosages 24 hours apart is associated with decreased risks of various complications in preterm infants.
  3. Administering ACS to extremely preterm infants may reduce the likelihood of neurodevelopmental disabilities. However, the timing of ACS administration significantly impacts neonatal benefits, emphasizing the need for evaluating long-term effects.
  4. The study evaluated the interval between ACS administration and birth's impact on neurological disabilities in children aged 5 and a half years. Data from the EPIPAGE-2 study, including live births between 22 and 34 weeks and 6 days of gestation, was used.
  5. The study found that a longer interval (greater than 7 days) between ACS treatment and birth decreased the odds of survival without neurological disabilities at 5 and a half years among preterm children.

Over 15 million preterm births occur annually, causing approximately 1 million deaths in children aged under 5 years. The administration of 2 ACS dosages 24 hours apart is associated with significantly decreased risks of neonatal respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and neonatal mortality.

Neurodevelopmental disabilities may also be less likely in children born extremely preterm after an ACS course. However, neonatal benefits are significantly impacted by ACS administration timing, making it important to evaluate the long-term effects of the timing between ACS administration and birth.

Investigators conducted a study to evaluate the long-term impact of the interval between ACS administration and birth on neurological disabilities among patients aged 5 and a half years. Data was obtained from the EPIPAGE-2 study, which included live births between 22 weeks and 34 weeks and 6 days of gestation from March 28 December 31, 2011.

Patients were included if they had a complete course of ACS, defined by study authors as, “injections of 12 mg of a combination of betamethasone phosphate and acetate, 24 hours apart.” Children born before 24 weeks of gestation were excluded from the analysis.

Additional exclusion criteria included missing information for exposure, births before 3 days after the first injection, limitation of care decided before birth, and severe congenital malformation. The length from first corticosteroid injection to birth measured by days was used to determine ACS exposure. ACS exposure was categorized as day 3 to day 7 or after day 7.

Survival without moderate or severe neurological disabilities was evaluated as the primary outcome in offspring aged 5 and a half years. Neurodevelopmental disabilities assessed included cerebral palsy, visual acuity, hearing disability, and cognitive ability. Investigators also evaluated rates of survival and of neurologic disabilities in survivors.

There were 2613 children included in the final analysis, 2427 of which were alive at age 5 and a half years. A complete evaluation was reported in 63.2% of survivors, an incomplete evaluated in 0.2%, and a postal questionnaire only in 8.3%. Birth between day 3 and day 7 was reported in 49.9% of patients, and only 1 course of ACS in 85.7%.

In patients with longer intervals from treatment to birth, preterm birth rates, gestational age at delivery, and multiple pregnancy rates were higher. Cesarean delivery was reported in 67.3% of the day 3 to day 7 group and 55.3% of the after day 7 group.

Survival at 5 and a half years was reported in 96.6% of patients and survival without moderate or severe neurological disabilities in 86%. A lower survival rate at 5 and a half years was reported in the after day 7 group compared to the day 3 to day 7 group, with an adjusted odds ratio (aOR) of 0.68.

Moderate or severe disabilities were also more common in the after day 7 group, with an aOR of 1.43. Survival without moderate or severe disabilities was lower in this group, with an aOR of 0.70.

These results indicated decreased odds of survival without neurological disabilities at age 5 and a half years among preterm children with an interval greater than 7 days between ACS treatment and birth. Investigators recommended research to improve identification of patients needing a first corticosteroid course to optimize treatment timing.

Reference

Guerini C, Goffinet F, Marchand-Martin L, et al. Timing of antenatal corticosteroids and survival without neurologic disabilities at 5½ years in children born before 35 weeks of gestation. Am J Obstet Gynecol. 2023;229:675.e1-18. doi:10.1016/j.ajog.2023.06.047

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