Factors Related to Corticosteroid Utilization in Preterm Birth

ABSTRACT

We sought to determine the rate of corticosteroid administration in preterm births in our institution and to describe factors associated with lack of corticosteroid exposure. We performed a retrospective case-control analysis. Of the 312 eligible women who delivered between 24 and 34 weeks' gestation, maternal corticosteroid administration was documented in 262 (84%) and no exposure in 50 (16%). A shorter admission to delivery interval (< 48 hours) decreased the likelihood of corticosteroid administration (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.03 to 0.28, p < 0.001). Use of tocolytics was associated with a lower risk of corticosteroid nonexposure (OR 0.21, 95% CI 0.04 to 0.69, p = 0.006). Lack of prenatal care was associated with an increased risk of corticosteroid nonexposure (OR 3.18, 95% CI 1.01 to 9.15, p = 0.01). The likelihood of corticosteroid administration was also decreased by gestational ages at the upper limit of the spectrum (33 to 34 weeks; OR 0.22, 95% CI 0.09 to 0.53, p < 0.001). The latter effect persisted after exclusion of premature rupture of membranes cases. In our population, factors associated with no maternal corticosteroid administration were shorter interval between admission and delivery, gestational age at the upper limit of the currently recommended interval for corticosteroid administration, and lack of prenatal care.

Antenatal corticosteroids - preterm birth - utilization

REFERENCES

• 1 Robert S, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.  Cochrane Database Syst Rev. 2006;  (3) CD004454
• 2 National Institutes of Health .Report of the Consensus Development Conference on the effect of corticosteroids for fetal maturation on perinatal outcomes. National Institute of Child Health and Human Development. NIH publication no. 95–3784 Bethesda, MD: National Institutes of Health; 1994
• 3 Khoo C, Welsh J, Owen P. Perinatal Effectiveness Committee, Glasgow (PEC) . Antenatal corticosteroid prescribing: a complete audit cycle.  J Obstet Gynaecol. 2007;  27 33-36
• 4 Polyakov A, Cohen S, Baum M, Trickey D, Jolley D, Wallace E M. Patterns of antenatal corticosteroid prescribing 1998–2004.  Aust N Z J Obstet Gynaecol. 2007;  47 42-45
• 5 Lindner U, Hilgendorff A, Frey G, Gortner L. Drug utilisation in very preterm infants: any changes during the past decade?.  Klin Padiatr. 2008;  220 238-242
• 6 Howell E A, Stone J, Kleinman L C, Inamdar S, Matseoane S, Chassin M R. Approaching NIH guideline recommended care for maternal-infant health: clinical failures to use recommended antenatal corticosteroids.  Matern Child Health J. 2010;  14 430-436
• 7 Elimian A, Figueroa R, Spitzer A R, Ogburn P L, Wiencek V, Quirk J G. Antenatal corticosteroids: are incomplete courses beneficial?.  Obstet Gynecol. 2003;  102 352-355
• 8 Miracle X, Di Renzo G C, Stark A, Fanaroff A, Carbonell-Estrany X, Saling E. Coordinators Of World Association of Perinatal Medicine Prematurity Working Group . Guideline for the use of antenatal corticosteroids for fetal maturation.  J Perinat Med. 2008;  36 191-196