Maternal and Child Health Journal

, Volume 14, Issue 3, pp 430–436

Approaching NIH Guideline Recommended Care for Maternal–Infant Health: Clinical Failures to Use Recommended Antenatal Corticosteroids

  • Elizabeth A. Howell
  • Joanne Stone
  • Lawrence C. Kleinman
  • Sarla Inamdar
  • Stephen Matseoane
  • Mark R. Chassin
Article

DOI: 10.1007/s10995-009-0480-3

Cite this article as:
Howell, E.A., Stone, J., Kleinman, L.C. et al. Matern Child Health J (2010) 14: 430. doi:10.1007/s10995-009-0480-3

Abstract

To assess the use of antenatal corticosteroids in clinical circumstances for which both the NIH Guideline and local experts recommend their use and to describe characteristics associated with failure to use recommended antenatal steroids. We convened local experts to adapt the NIH statement by identifying clinical circumstances for which they agree antenatal steroids should always be used. We conducted a retrospective chart review on a cohort study of mothers who delivered premature (24–34 weeks) infants between 2000 and 2002 at three New York City hospitals and investigated the association of failure to treat with antenatal steroids with characteristics of the mother, pregnancy, delivery, and hospital. Twenty percent (101/515) of eligible mothers failed to receive indicated antenatal corticosteroid therapy. Of these, 43% delivered more than 2 h after admission, and 33% delivered more than 4 h after admission, indicating sufficient time to have treated them. Lack of prenatal care, longer gestation, advanced cervical exam, and intact membranes at admission were associated with failure to receive the recommended therapy. Antenatal steroids were under-utilized in our sample. If our results our generalizable, opportunities for quality improvement in the antenatal management of mothers in preterm labor exist.

Keywords

Quality of care Antenatal corticosteroids Practice patterns 

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Elizabeth A. Howell
    • 1
    • 2
  • Joanne Stone
    • 2
  • Lawrence C. Kleinman
    • 1
    • 3
  • Sarla Inamdar
    • 4
  • Stephen Matseoane
    • 5
  • Mark R. Chassin
    • 6
  1. 1.Department of Health PolicyMount Sinai School of MedicineNew York CityUSA
  2. 2.Department of Obstetrics, Gynecology, and Reproductive ScienceMount Sinai School of MedicineNew York CityUSA
  3. 3.Department of PediatricsMount Sinai School of MedicineNew York CityUSA
  4. 4.Department of PediatricsMetropolitan HospitalNew York CityUSA
  5. 5.Department of Obstetrics and GynecologyHarlem HospitalNew York CityUSA
  6. 6.The Joint CommissionChicagoUSA

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