Association Between Antenatal Corticosteroid Administration-to-Birth Interval and Outcomes of Preterm Neonates

In Brief OBJECTIVE: To assess the association between antenatal corticosteroid administration-to-birth interval and outcomes. METHODS: In this retrospective cohort study, data on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada during 2010–2012 were obtained from the Canadian Neonatal Network. Neonatal outcomes were compared among four groups based on the interval between antenatal corticosteroid administration and birth: no antenatal corticosteroids, partial antenatal corticosteroids (less than 24 hours before birth), antenatal corticosteroids 1–7 days before birth, and antenatal corticosteroids greater than 7 days before birth. Composite outcome was defined as any of neonatal mortality, bronchopulmonary dysplasia, grade 3–4 intraventricular hemorrhage, periventricular leukomalacia, or stage 3 or higher retinopathy. RESULTS: Of 6,870 eligible neonates, 1,378 (20%) received no antenatal corticosteroids; 1,473 (21%) received partial antenatal corticosteroids; 2,721 (40%) received antenatal corticosteroids 1–7 days before birth; and 1,298 (19%) received antenatal corticosteroids greater than 7 days before birth. The odds of the composite adverse outcome were significantly higher in all groups compared with neonates who received antenatal corticosteroids 1–7 days before birth (no antenatal corticosteroids: adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.69–2.65; partial antenatal corticosteroids: adjusted OR 1.48, 95% CI 1.22–1.80; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.46, 95% CI 1.20–1.77). Similar findings were observed with respect to neonatal mortality (no antenatal corticosteroids: adjusted OR 2.56, 95% CI 1.83–3.59; partial antenatal corticosteroids: adjusted OR 1.59, 95% CI 1.16–2.18; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.40, 95% CI 1.00–1.97). CONCLUSION: Antenatal corticosteroids had maximum benefit when given between 1 and 7 days before birth. LEVEL OF EVIDENCE: II Administration of antenatal corticosteroids has maximum benefit when given between 1 and 7 days before birth.