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Exposure to any antenatal corticosteroids and outcomes in preterm infants by gestational age: prospective cohort study

BMJ 2017; 356 doi: (Published 28 March 2017) Cite this as: BMJ 2017;356:j1039
  1. Colm P Travers, clinical fellow1,
  2. Reese H Clark, vice president and co-director2,
  3. Alan R Spitzer, senior vice president and director2,
  4. Abhik Das, senior research statistician3,
  5. Thomas J Garite, professor2 4,
  6. Waldemar A Carlo, professor1
  1. 1Division of Neonatology, University of Alabama at Birmingham, AL 35233, USA
  2. 2Center for Research, Education, and Quality, Pediatrix Medical Group and MEDNAX, Sunrise, FL, USA
  3. 3Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA
  4. 4Department of Obstetrics and Gynecology, University of California, Irvine, CA, USA
  1. Correspondence to: W A Carlo wcarlo{at}
  • Accepted 12 February 2017


Objective To determine whether exposure to any antenatal corticosteroids is associated with a lower rate of death at each gestational age at which administration is currently recommended.

Design Prospective cohort study.

Settings 300 participating neonatal intensive care units of the Pediatrix Medical Group in the United States.

Participants 117 941 infants 23 0/7 to 34 6/7 weeks’ gestational age born between 1 January 2009 and 31 December 2013.

Exposure Any antenatal corticosteroids.

Main outcomes measures Death or major hospital morbidities analyzed by gestational age and exposure to antenatal corticosteroids with models adjusted for birth weight, sex, mode of delivery, and multiple births.

Results Infants exposed to antenatal corticosteroids (n=81 832) had a significantly lower rate of death before discharge at each gestation 29 weeks or less, 31 weeks, and 33-34 weeks compared with infants without exposure (range of adjusted odds ratios 0.32 to 0.55). The number needed to treat with antenatal corticosteroids to prevent one death before discharge increased from six at 23 and 24 weeks’ gestation to 798 at 34 weeks’ gestation. The rate of survival without major hospital morbidity was higher among infants exposed to antenatal corticosteroids at the lowest gestations. Infants exposed to antenatal corticosteroids had lower rates of severe intracranial hemorrhage or death, necrotizing enterocolitis stage 2 or above or death, and severe retinopathy of prematurity or death compared with infants without exposure at all gestations less than 30 weeks and most gestations for infants born at 30 weeks’ gestation or later.

Conclusion Among infants born from 23 to 34 weeks’ gestation, antenatal exposure to corticosteroids compared with no exposure was associated with lower mortality and morbidity at most gestations. The effect size of exposure to antenatal corticosteroids on mortality seems to be larger in infants born at the lowest gestations.


  • Contributors: CPT and WAC were responsible for study concept and design. RHC and ARS acquired the data. CPT, RHC, AD, and WAC analyzed the data, and all authors interpreted the data. CPT and WAC drafted the manuscript, which all the authors critically revised for important intellectual content. All authors approved the final manuscript. WAC supervised the study and is the guarantor.

  • Funding: CPT is supported by the Agency for Healthcare Research and Quality grant number 5T32HS013852-14, the Perinatal Health and Human Development Research Program of the University of Alabama at Birmingham, and the Children’s of Alabama Centennial Scholar Fund. These funders had no role in: the study design; the collection, analysis, or interpretation of data; the writing of the report; or in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.

  • Competing interests: All authors have completed the ICJME uniform disclosure form at (available on request from the corresponding author) and declare: CPT is supported by the Agency for Healthcare Research and Quality grant number 5T32HS013852-14, the Perinatal Health and Human Development Research Program of the University of Alabama at Birmingham, and the Children’s of Alabama Centennial Scholar Fund; WAC is on the board of MEDNAX, Inc; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study protocol was approved by the Institutional Review Board at the University of Alabama at Birmingham (protocol number N141125009) and by the Research Advisory Committee at MEDNAX, Inc.

  • Data sharing: No additional data available.

  • Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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