L773:1471 0528
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Timing of antenatal corticosteroid administration and survival in extremely preterm infants : A national population-based cohort study
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- Norberg, H. (author)
- Karolinska Institute
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- Kowalski, B. J. (author)
- Karolinska Institute
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- Maršál, K. (author)
- Lund University,Lunds universitet,Obstetrik och gynekologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Obstetrics and Gynaecology (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine
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- (creator_code:org_t)
- 2017-03-15
- 2017
- English.
- In: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 124:10, s. 1567-1574
- Journal article (peer-reviewed)
Abstract
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- Objective: To explore the association between administration-to-birth interval of antenatal corticosteroids (ACS) and survival in extremely preterm infants. Design: Population-based prospective cohort study. Setting: All obstetric and neonatal units in Sweden from 1 April 2004 to 31 March 2007. Population: All live-born infants (n = 707) born at 22-26 completed weeks of gestation. Methods: The relationship between time from first administration of ACS to delivery and survival was investigated using Cox proportional hazards regression analysis. Main outcome measures: Neonatal (0-27 days) and infant (0-365 days) survival, and infant survival without major neonatal morbidity (intraventricular haemorrhage grade ≥ 3, retinopathy of prematurity stage ≥ 3, periventricular leukomalacia, necrotising enterocolitis, or severe bronchopulmonary dysplasia). Results: Five-hundred and ninety-one (84%) infants were exposed to ACS. In the final adjusted model, infant survival was lower in infants unexposed to ACS [hazard ratio (HR) = 0.26; 95% confidence interval 0.15-0.43], in infants born <24 h [HR = 0.53 (0.33-0.87)] and >7 days after ACS [HR = 0.56 (0.32-0.97)], but not in infants born 24-47 h after ACS [HR = 1.60 (0.73-3.50)], as compared with infants born 48 h to 7 days after administration. The findings were similar for neonatal survival. Survival without major neonatal morbidity among live-born infants was 14% in unexposed infants and 30-39% in steroid-exposed groups, indicating that any ACS exposure was valuable. Conclusions: Administration of ACS 24 h to 7 days before extremely preterm birth was associated with significantly higher survival than in unexposed infants and in infants exposed to ACS at shorter or longer administration-to-birth intervals. Tweetable abstract: Timing of antenatal corticosteroids is important for extremely preterm infants' survival.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)
Keyword
- Administration-to-birth interval
- Antenatal glucocorticoids
- Extremely preterm birth
- Major neonatal morbidity
- Mortality
Publication and Content Type
- art (subject category)
- ref (subject category)
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- Norberg, H.
- Kowalski, B. J.
- Maršál, K.
- Norman, M
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