WIP 23 - Timing of Antenatal Corticosteroids: Association with Mortality in Periviable Infants

Publication Number: WIP 23.7445

Taylor W. Deall, Tampa General Hospital Children's Medical Center, Tampa, FL, United States; Erica E. Elseed Peterson, USF Health Morsani College of Medicine, Tampa, FL, United States; Keyur Donda, University of South Florida, Brandon, FL, United States; Jose R. Duncan, UNIVERSITY OF SOUTH FLORIDA, Tampa, FL, United States; Peeraya Sawangkum, University of South Florida, Tampa, FL, United States; Lilla Markel, USF Health Morsani College of Medicine, Tampa, FL, United States; Ciara Alvarez, USF Health Morsani College of Medicine, Tampa, FL, United States

Background: The current recommended antenatal corticosteroids (ACS) course is either two 12-mg doses of betamethasone given intramuscularly (IM) 24 hours apart or four 6-mg doses of dexamethasone administered IM every 12 hours for pregnant women 24 0/7 to 33 6/7 weeks of gestation, who are at risk of preterm delivery within 7 days. Previous studies have shown the beneficial effects of ACS administration between 24 0/7 weeks and 33 6/7 weeks of gestation by improving neonatal outcomes including less respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). However, there is a knowledge gap on the utility of ACS for pregnant women < 24 0/7 weeks and on the minimum time interval that ACS administration can improve neonatal outcomes. Gaining insight into this can help guide prenatal counseling, especially for mothers who may deliver a periviable infant imminently, who have not completed the recommended dose of ACS.

Objective: The primary objective is to determine the association between the timing of ACS administration prior to delivery and periviable neonatal mortality. The secondary objectives are to determine the associations between the timing of ACS prior to delivery and rates of RDS, NEC, IVH and periventricular leukomalacia in periviable neonates.

Design/Methods: This retrospective cohort study includes women who delivered at TGH between 1/2013-1/2024 and their periviable infants with GA < 25 6/7 weeks. Exclusion criteria include intrauterine fetal demise, limited fetal resuscitation, complex fetal anomalies, and placental abruption. The project is IRB exempt. 310 infants are included. The demographic and perinatal characteristics, and the primary and secondary outcomes will be compared using chi-square or Wilcoxon-Rank sum test, as appropriate. Multinominal logistic regression analysis will be performed including clinically relevant variables in the model to evaluate the factors predicting outcomes in the study population. The p-value < 0.05 will be considered significant. Data analyzation will be complete by the end of January.