461 - Late Preterm Antenatal Steroid Use And Infant Outcomes In A Single Center

Poster Number: 461
Publication Number: 461.130

Madison D. Wahl, Oregon Health & Science University School of Medicine, Portland, OR, United States; CIndy T. McEvoy, Oregon Health & Science University, Portland, OR, United States; Mitzi Donabel A. Go, Oregon Health & Science University, Portland, OR, United States

Background: Antenatal steroids (AS) have been shown to lower respiratory complications in late preterm infants (LPI) and is now part of the management of pregnancies at risk for delivery between 34 0/7- 36 6/7 weeks gestational age (GA).

Objective: We aim to determine our center’s adherence to current expert recommendations based on the Antenatal Late Preterm Steroids (ALPS) trial (PMID26842679) and assess neonatal outcomes related to its use.

Design/Methods: We conducted a retrospective chart review of mother-LPI dyads who delivered in our center from January 2019 to December 2020. We excluded those with major congenital anomalies. Data on AS use, maternal characteristics and neonatal outcomes were recorded and analyzed.

Results: There were 175 singleton mother-infant dyads, and 25 mothers with twin gestations (48 infants) within our study timeframe. The proportion of mothers who received AS was similar between singletons (92/175, 53%) and twin gestations (13/25, 52%) prior to delivery. Maternal characteristics between the AS and NO AS groups such as age, race, ethnicity, delivery mode, smoking status, gestational hypertension and preeclampsia were similar. As expected, there were more diabetics in the singleton No AS group (37.4% vs 9% AS, p < 0.01) due to being an exclusion criteria for ALPS, while the incidence of preterm premature rupture of membranes (PPROM) was 66% compared to 52% in the No AS group (p=0.02). The mean GA was 35.5 wks at delivery, with an average time from admission to delivery of 58.2 hrs, compared to the No AS group (36.1 wks, p < 0.05 and 19.96 hrs, p=0.01, respectively). Among the mothers with twins, PPROM was found only in the No AS group (42%, p=0.008), and time from admission to delivery was shorter (1.2 hrs AS vs 0.89 hr No AS) compared to singleton pregnancies (p=0.008) Neonatal outcomes such as birth weight, need for respiratory support, hypoglycemia, NICU admission and hospital length of stay, were similar between AS and No AS groups when controlled for GA. We found 83% adherence to ALPS recommendations within our center for singleton pregnancies.Conclusion(s): We continue to see variation in the administration of AS in the late preterm gestation, more so for twin gestations where no guidelines exist. In our study, AS administration did not improve short-term neonatal outcomes such as the need for respiratory support, NICU admission, and overall hospital length of stay, although we are underpowered for these clinical results. We recommend that more studies are needed to evaluate the impact, including longer term, of AS use on subpopulations of late preterm infants.
Maternal Characteristics of Patients Who Delivered During The Late Preterm Gestation In a Single Center From January 2019 to December 2020
Infant Characteristics of Patients Delivered As Late Preterms in A Single Center From January 2019 to December 2020