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329: Antenatal corticosteroids and adverse neonatal outcomes in preterm birth in the United States

      Objective

      Antenatal corticosteroid (ACS) administration in women at risk of preterm delivery remains an important intervention to reduce rates of neonatal morbidity. However, there are limited data on ACS administration and neonatal outcomes in large nationwide populations. Thus, we set out to determine whether there was an association between use of ACS and adverse neonatal outcomes in a large US population.

      Study Design

      This retrospective cohort study utilized the United States Natality Live Birth database from the Center for Disease and Prevention for the years 2016-2017. Women with in-hospital, non-anomalous, singleton preterm births (23 to 37 weeks of gestation) were identified. Cases where ACS exposure was unknown were excluded. Neonates were divided into two groups based on whether the mother received a course of ACS before delivery or not. The incidence of reported neonatal outcomes (assisted ventilation, assisted ventilation > 6 hours, NICU admission, surfactant replacement therapy, antibiotics for suspected neonatal sepsis and seizures) was calculated and compared between both groups at three gestational age intervals (23-28, 28-34 and 34-37 weeks). Chi-squared test was used for statistical analysis and Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

      Results

      Of the 586,081 non-anomalous singleton preterm births where ACS exposure was known, 124,009 (21.1%) had been exposed to ACS. There was a significant increase in assisted ventilation, assisted ventilation > 6 hours, NICU admission, surfactant replacement therapy and antibiotics for suspected neonatal sepsis among neonates exposed to ACS compared to unexposed at each gestational age interval (Table 1).

      Conclusion

      In this large US cohort, the overall rate of ACS administration was surprisingly low. In addition, administration of ACS did not show neonatal benefit. In fact, a higher incidence of adverse outcomes was seen in neonates exposed to ACS. Further research is needed to investigate this surprising association.
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