Confirming the Most Effective Strategy for Improving Neonatal Outcomes in Threatened Preterm Birth

Summary and Comment |
March 28, 2017

Confirming the Most Effective Strategy for Improving Neonatal Outcomes in Threatened Preterm Birth

  1. Robert L. Barbieri, MD

Maternal antenatal glucocorticoids lowered risk for newborn mortality and morbidity, particularly when administered at the earliest gestational ages.

  1. Robert L. Barbieri, MD

Despite the known survival benefits of antenatal glucocorticoids, administration before 24 weeks' gestation is still based on consensus. To determine infant mortality following antenatal glucocorticoids by gestational age at maternal treatment, investigators prospectively evaluated outcomes among 117,941 preterm births (range, 23 to <35 weeks' gestation) using a database from 300 U.S. neonatal intensive care units.

In utero glucocorticoid exposure reduced preterm neonatal mortality across all gestational ages; benefit was statistically significant at 23 to 29, 31, 33, and 34 weeks' gestation. The number needed to treat to prevent 1 infant death rose from 6 at 23 and 24 weeks' gestation to 798 at 34 weeks' gestation. Treatment also significantly lowered composite risks for severe intracranial hemorrhage or death, necrotizing enterocolitis or death, and severe retinopathy of prematurity or death at all gestations <30 weeks and most gestations ≥30 weeks.

Comment

Until recently, mothers with threatened preterm birth at 22 and 23 weeks' gestation were not routinely offered antenatal glucocorticoids. This large cohort study confirms and extends previous findings in showing that the benefits of this treatment were greatest at the earliest gestational ages. Still, decisions to maximize chances of survival for infants this premature are wrenching and require extensive counsel and support, given the very real potential for severe lifelong disability.

Editor Disclosures at Time of Publication

  • Disclosures for Robert L. Barbieri, MD at time of publication Editorial boards UpToDate (Editor-in-Chief, Obstetrics/Gynecology and Women’s Health); OBG Management (Editor-in-Chief)

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