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Antenatal corticosteroids and outcomes of small for gestational age infants born at 24–31 gestational weeks: a population-based propensity score matching analysis

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effect of antenatal corticosteroid (ACS) treatment on neonatal outcomes in small for gestational age (SGA) infants born at 24–31 gestational weeks compared with non-SGA infants.

Methods

A population-based retrospective study was conducted that analyzed clinical data from the Neonatal Research Network of Japan database, which enrolls neonates born at < 32 gestational weeks and weighing 1500 g or less (n = 22,414). Propensity score matching (with the ratio of ACS to no-ACS groups of 1:1) was performed in SGA (n = 7028) and non-SGA (n = 15,386) infants, respectively. Univariate logistic and interaction analyses were performed to compare the short-term neonatal outcomes of infants with and without ACS treatment in utero.

Results

In the SGA and non-SGA infants, ACS treatment significantly reduced in-hospital mortality (odds ratio 0.67 95% confidence interval [0.50–0.88] and 0.62 [0.50–0.78], respectively), respiratory distress syndrome (0.77 [0.69–0.87] and 0.63 [0.58–0.68], respectively), and composite adverse outcomes (0.73 [0.58–0.91] and 0.57 [0.50–0.65], respectively). ACS treatment also significantly reduced intraventricular hemorrhage (grade III/IV), periventricular leukomalacia, and sepsis in the non-SGA infants, but not in the SGA infants. However, interaction analyses revealed no significant differences between the SGA and non-SGA infants in the efficacy of ACS treatment on short-term outcomes except for respiratory distress syndrome.

Conclusions

ACS treatment was associated with beneficial effects on mortality, respiratory distress syndrome, and adverse composite outcomes in extremely and very preterm SGA infants, with similar efficacy on all neonatal outcomes except for respiratory distress syndrome observed in the non-SGA infants.

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Availability of data and materials

Data that support the findings of this study are available from the corresponding author (TU) upon reasonable request and with permission from the Neonatal Research Network of Japan.

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Acknowledgements

This study was supported by JSPS KAKENHI [grant number: JP 22H04923 (CoBiA)]. We would like to thank Editage for the English language editing.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan

    Takafumi Ushida, Noriyuki Nakamura, Kazuya Fuma, Yukako Iitani, Kenji Imai, Hiroaki Kajiyama & Tomomi Kotani

  2. Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Takafumi Ushida & Tomomi Kotani

  3. Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Masahiro Nakatochi

  4. Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan

    Yumiko Kobayashi

  5. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Yoshiaki Sato & Masahiro Hayakawa

Authors
  1. Takafumi Ushida
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Consortia

on behalf of the Neonatal Research Network of Japan

Contributions

TU, MN, and TK contributed to the concept and design of the study. TU, MN, and YK performed the statistical analyses. TU drafted the first version of this manuscript. TU, TK, NN, KF, YI, KI, YS, MH, and HK analyze and interpreted the data. TK and HK critically reviewed the manuscript, and all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Takafumi Ushida.

Ethics declarations

Conflict of interest

The authors have no potential conflicts of interest to disclose.

Ethical approval

This study was approved by the Institutional Ethic Board of Nagoya University (approval number 2018-0026 on May 9, 2018), and the use of this database was permitted by the Japan Neonatal Network Executive Committee.

Consent to participate

Informed consent was obtained from parents at each facility.

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Supplementary Information

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404_2022_6834_MOESM1_ESM.tif

Supplementary Figure 1. Flowchart of the cohort selection process for the additional analysis. The clinical data of infants born at <32 gestational weeks between 2008 and 2017 were obtained. A total of 22,671 infants were eligible for the multivariate logistic regression analysis (TIF 10515 KB)

Supplementary File2 (DOCX 27 KB)

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Ushida, T., Nakatochi, M., Kobayashi, Y. et al. Antenatal corticosteroids and outcomes of small for gestational age infants born at 24–31 gestational weeks: a population-based propensity score matching analysis. Arch Gynecol Obstet 308, 1463–1471 (2023). https://doi.org/10.1007/s00404-022-06834-4

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  • DOI: https://doi.org/10.1007/s00404-022-06834-4

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