Women and Children’s Hospital of Chongqing Medical University chongqing, Chongqing, China (People's Republic)
Background: Antenatal corticosteroids (ACS) effective in reducing preterm mortality and severe morbidities remains lower coverage in China than that in high-income countries. Objective: To 1) describe the prevalence of potentially missed ACS (PM-ACS) in very preterm infants (VPIs) in China and 2) assess the association between PM-ACS and adverse outcomes of VPIs. Design/Methods: Infants born at 24+0-31+6 weeks’ gestation in the Chinese Neonatal Network between January 2019 and December 2021 were included. PM-ACS was defined as no ACS but having prenatal intravenous magnesium sulphate or antibiotic exposure within 24 hours before delivery, or experienced rupture of membranes for more than 24 hours which implying enough time for ACS administration. The prevalence of PM-ACS in both individual-level and hospital-level were analyzed and the associations with preterm-related complications were detected by multivariate logistic regression models with any ACS as comparison. Results: A total of 25,562 VPIs were included, of which 77.2% (19744) were exposed to any ACS, 8.3% (2110) were PM-ACS. The proportions of PM-ACS increased as gestational age decreased: 18.8% at 24 weeks of gestation, 15.1% at 25 weeks of gestation and less than 10.9% at 26-31+6 weeks of gestation. No significant trendy variation in PM-ACS rate was observed from 2019 to 2022 (p for trend =0.293), although any ACS rate significantly increased during the same period (p for trend: ＜0.001). Significant between-hospital variations were observed in PM-ACS rate, with observed proportions in different NICUs ranging from 0.7% to 21.2%. Infants in the PM-ACS group had higher risk of death (16.7% vs 9.3%, aOR 1.81, 95% CI 1.55-2.12) and higher risk-adjusted hospital mortality (p ＜0.001) compared with infants in any ACS group.
Conclusion(s): PM-ACS common among VPIs in China was associated with high rates of individual-level mortality and hospital-level mortality. Reduction of PM-ACS should be one of the priorities for increasing implementation of ACS in China.
.jpg)
