96 - Impact of Antenatal Corticosteroids on Neonatal Outcome among Very Preterm Infants Born to Mothers with Chorioamnionitis: a Multicenter Cohort Study

Poster Number: 96
Publication Number: 96.438

qingqing lin, Xiamen Children’s Hospital, Xiamen, China, Fujian, China (People's Republic); Yanchen Wang, Children‘s Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Shuping Han, Women's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (People's Republic); Xiuyong Cheng, The First Affiliated Hospital of Zhengzhou University, zhengzhou, Henan, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Wenhao Zhou, Children's Hospital, Shanghai, Shanghai, China (People's Republic); Deyi zhuang, NICU, Xiamen, Fujian, China (People's Republic); Yun Cao, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: There are still uncertainties and controversies of different guidelines concerning the efficacy of antenatal corticosteroids (ACS) on women with suspected chorioamnionitis who are likely to deliver preterm.

Objective: To assess the impact of ACS on neonatal outcomes among very preterm infants born to mothers with chorioamnionitis.

Design/Methods: This was a prospectively-designed retrospective cohort study at 70 tertiary neonatal intensive care units in the Chinese Neonatal Network. Study participants included infants born at < 32 weeks' gestation to mothers with chorioamnionitis, who were admitted between January 1st, 2019 and December 31st, 2020. Infants were excluded if they had major congenital anomalies, missing information on antenatal corticosteroids, or withdrawal of care during NICU stay. ACS exposure was defined as maternal receipt of at least one dose of dexamethasone or betamethasone before delivery. Multivariable generalized linear modeling was used to assess the association of ACS and neonatal outcomes among study population. Sensitivity analysis was conducted between Infants with maternal suspected and histologic chorioamnionitis

Results: We identified 2193 infants eligible for this study. Among them, 10.4%, 25.0%, 50.7% and 12.8% of infants received nil, partial, complete and repeated ACS courses respectively. The Mortality in Non-ACS group was 11%, which was significantly higher than that in any-ACS group. Risk of mortality in any ACS group was 0.69 (95% CI 0.45,1.08) times lower than that in Non-ACS group among very preterm infants born to mothers with chorioamnionitis, after adjustment for maternal age, primigravida, maternal hypertension, maternal diabetes, gestational age, SGA, infant sex, multiple birth, c-section, inborn and Apgar score < 7 at 5 min. Any ACS use was significantly associated with decreased risk of mortality (aRR 0.47 , 95% CI 0.27,0.80) and death within seven days after birth (aRR 0.43, 95%CI 0.20,0.92) for very preterm infants born to mothers with histologic chorioamnionitis, after adjustment for the same confounders. Single partial course (aRR 1.19, 95% CI 1.06,1.33) waa independently associated with increased risk of bronchopulmonary dysplasia, compared with infants whose mothers received a single complete course.Conclusion(s): Any ACS is associated with dramatic reduction of risk for neonatal mortality among very preterm infants exposed to maternal chorioamnionitis.
Table 1. Neonatal outcomes of very preterm infants with or without antenatal corticosteroids born to mothers with suspected chorioamnionitisa Incidence of brain injury was calculated among infants with neuroimaging results.
b Incidence of severe ROP was calculated among infants with eye examinations in the NICU.

Abbreviations: ACS, antenatal corticosteroids; BPD, bronchopulmonary dysplasia; IVH,intraventricular hemorrhage; NEC, necrotizing enterocolitis; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity.
Table 2. Association of antenatal corticosteroids and neonatal outcomes among very preterm infants born to mothers with suspected and histologic chorioamnionitisa Relative risk was calculated using generalized linear regression. Infants without non-ACS group served as reference.
bAdjusted for Maternal Age, Primigravida, Maternal Hypertension, Maternal Diabetics, Gestational Age, SGA,Infant Sex and Multiple Birth, C-section, Inborn, Apgar Score < 7 at 5 min
c Relative risk of brain injury was calculated among infants with neuroimaging results.
d Relative risk of ROP was calculated among infants with eye examinations in the NICU.
Abbreviations: ACS, antenatal corticosteroids; BPD, bronchopulmonary dysplasia; CI, confidence interval; IVH, intraventricular hemorrhage; NEC, necrotizing enterocolitis; RR, relative risk; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity.