Antenatal Steroids Improved Outcomes for Extremely Preterm Infants

Even just one dose of antenatal steroids administered mere hours before birth can improve outcomes for extremely preterm infants, a cohort study found.

Among infants born after exposure to a single antenatal steroid dose, each 1-hour increase in the administration-to-birth interval was tied to a 1% higher rate of survival to hospital discharge (adjusted RR 1.01, 95% CI 1.00-1.01), as well as a 1% higher rate of survival without severe neonatal morbidity (aRR 1.01, 95% CI 1.01-1.02), Sanjay Chawla, MD, a neonatologist at Children’s Hospital of Michigan in Detroit, and colleagues reported in JAMA Network Open.

Additionally, each 6-hour increase between antenatal steroid administration and birth was associated with both a 4% higher rate of survival to hospital discharge (aRR 1.04, 95% CI 1.01-1.07) and 9% higher rate of survival without severe neonatal morbidity (aRR 1.09, 95% CI 1.04-1.14).

The study’s goal “was to determine if and how steroids given within a few hours before birth affected the outcome of extreme preterm infants,” Chawla told MedPage Today. It showed that “infants born after exposure to a single dose of steroid had a 1% increase in survival as well as survival without several complications for every hour that passed between administering steroid and birth.”

Giving pregnant women antenatal steroids prior to delivery is one of the most beneficial interventions for improving preterm infants’ outcomes, Chawla said, adding that betamethasone is the most commonly used steroid for this treatment. However, many women don’t get antenatal steroids, or only get partial courses, for reasons like inadequate access to healthcare, lack of immediate access to steroids, or missing the signs of preterm labor, he added.

Now, this study shows that for extremely preterm infants, even a couple of hours of exposure to a single dose of steroids may improve the chances of survival and reduce major complications — and the benefits “improve with every additional hour before birth for the first 24 hours from the administration of the steroid,” Chawla said.

Ultimately, the researchers said their results support a “proactive approach” to antenatal steroid administration when preterm delivery is imminent in order to “improve survival and reduce major morbidities in this high-risk population.”

This study was a retrospective analysis of prospectively collected data that took place from January 2016 to February 2021 at National Institute of Child Health and Human Development Neonatal Research Network centers. The cohort of extremely preterm infants were born between 22 0/7 and 27 6/7 weeks’ gestation.

Survival to discharge was the primary outcome and secondary outcomes included survival without major morbidity as well as composites of individual morbidities and death.

Exclusion criteria included infants with major congenital anomalies, those who were outborn, had a birth weight more than 1,500 g, and who received more than one dose of antenatal steroids.

During the study period, a total of 7,464 infants were born, of which 1,806 were included in the cohort. Most (1,331) had exposure to a single dose of betamethasone within 24 hours before birth (median administration-to-birth interval: 3.8 [1.4-9.5] hours) while 475 had no betamethasone.

Chawla noted a few limitations, including the observational design, residual confounding, and the possible need for emergent obstetric intervention for infants born without or soon after antenatal steroids.

In terms of future directions, Chawla said the team hopes to assess the “long-term outcomes of these infants in relation to the timing of antenatal steroids,” as well as work with obstetricians to conduct quality-improvement initiatives.

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