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Zhao J, Feng Z, Dai Y, Zhang W, Jiang S, Wang Y, Gu X, Sun J, Cao Y, Lee SK, Tian X, Yang Z. Use of antenatal corticosteroids among infants with gestational age at 24 to 31 weeks in 57 neonatal intensive care units of China: a cross-sectional study. Chin Med J (Engl) 2023; 136:822-829. [PMID: 36848141 PMCID: PMC10150864 DOI: 10.1097/cm9.0000000000002266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Antenatal corticosteroids (ACS) can significantly improve the outcomes of preterm infants. This study aimed to describe the ACS use rates among preterm infants admitted to Chinese neonatal intensive care units (NICU) and to explore perinatal factors associated with ACS use, using the largest contemporary cohort of very preterm infants in China. METHODS This cross-sectional study enrolled all infants born at 24 +0 to 31 +6 weeks and admitted to 57 NICUs of the Chinese Neonatal Network from January 1st, 2019 to December 30th, 2019. The ACS administration was defined as at least one dose of dexamethasone and betamethasone given before delivery. Multiple logistic regressions were applied to determine the association between perinatal factors and ACS usage. RESULTS A total of 7828 infants were enrolled, among which 6103 (78.0%) infants received ACS. ACS use rates increased with increasing gestational age (GA), from 177/259 (68.3%) at 24 to 25 weeks' gestation to 3120/3960 (78.8%) at 30 to 31 weeks' gestation. Among infants exposed to ACS, 2999 of 6103 (49.1%) infants received a single complete course, and 33.4% (2039/6103) infants received a partial course. ACS use rates varied from 30.2% to 100% among different hospitals. Multivariate regression showed that increasing GA, born in hospital (inborn), increasing maternal age, maternal hypertension and premature rupture of membranes were associated with higher likelihood to receive ACS. CONCLUSIONS The use rate of ACS remained low for infants at 24 to 31 weeks' gestation admitted to Chinese NICUs, with fewer infants receiving a complete course. The use rates varied significantly among different hospitals. Efforts are urgently needed to propose improvement measures and thus improve the usage of ACS.
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Affiliation(s)
- Jing Zhao
- Division of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300052, China
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300052, China
- Nankai University Maternity Hospital, Tianjin 300052, China
| | - Zongtai Feng
- Division of Neonatology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, China
| | - Yun Dai
- Division of Neonatology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, China
| | - Wanxian Zhang
- Division of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300052, China
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300052, China
- Nankai University Maternity Hospital, Tianjin 300052, China
| | - Siyuan Jiang
- Division of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Jianhua Sun
- Department of Neonatology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yun Cao
- Division of Neonatology, Children's Hospital of Fudan University, Shanghai 201102, China
- NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Shoo K. Lee
- Maternal-Infants Care Research Centre, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Xiuying Tian
- Division of Neonatology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin 300052, China
- Tianjin Key Laboratory of Human Development and Reproductive Regulation, Tianjin 300052, China
- Nankai University Maternity Hospital, Tianjin 300052, China
| | - Zuming Yang
- Division of Neonatology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215002, China
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Ondusko DS, Garg B, Caughey AB, Pilliod RA, Carter EH. Is Appropriate Administration of Antenatal Corticosteroids Associated with Maternal Race? Am J Perinatol 2022; 39:1204-1211. [PMID: 33374022 DOI: 10.1055/s-0040-1721717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Antenatal corticosteroids (ACSs) improve outcomes for premature infants; however, not all pregnant women at risk for preterm delivery receive ACS. Racial minorities are less likely to receive adequate prenatal care and more likely to deliver preterm. The objective of this study was to determine if maternal race is associated with a lower rate of ACS administration in Washington for women at risk of preterm labor (between 23 and 34 weeks). STUDY DESIGN This was a population-based retrospective cohort study of singleton, nonanomalous, premature deliveries in Washington state between 2007 and 2014. Descriptive data included maternal sociodemographics, pregnancy complications, facility of birth, and neonatal characteristics. The primary outcome was maternal receipt of ACS and the independent variable was maternal race/ethnicity. The secondary outcomes included neonatal need for assisted ventilation, both initially and for more than 6 hours, and administration of surfactant. Data were analyzed using chi-square tests and logistic regression models. RESULTS A total of 8,530 nonanomalous, singleton neonates were born between 23 and 34 weeks' gestation. Of those, 55.8% of mothers were self-identified as white, 7.5% as black, 21.4% as Hispanic, 10.9% as Asian, and 4.3% as Native American. After adjusting for confounders, black woman-neonate dyads had significantly lower odds of receiving ACS, (adjusted odds ratio [aOR] = 0.62; 95% confidence interval [CI]: 0.51-0.76), assisted ventilation immediately following delivery (aOR = 0.76; 95% CI: 0.61-0.94) and for more than 6 hours (aOR = 0.64; 95% CI: 0.49-0.84) and surfactant therapy (aOR = 0.62; 95% CI: 0.42-0.92) as compared with whites. CONCLUSION These findings contribute to the current body of literature by describing racial disparities in ACS administration for pregnant women at risk for preterm delivery. To better understand the association between black race and administration of ACS, future studies should focus on differences within and between hospitals (including quality, location, resources), patient health literacy, social determinants of health, and exposure to systemic racism and discrimination. KEY POINTS · Black women were less likely to receive antenatal steroids.. · Black neonates had lower odds of respiratory support.. · Black neonates had lower odds of receiving surfactant..
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Affiliation(s)
- Devlynne S Ondusko
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Rachel A Pilliod
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
| | - Emily H Carter
- Division of Neonatology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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Kearsey EO, Been JV, Souter VL, Stock SJ. The impact of the Antenatal Late Preterm Steroids trial on the administration of antenatal corticosteroids. Am J Obstet Gynecol 2022; 227:280.e1-280.e15. [PMID: 35341727 DOI: 10.1016/j.ajog.2022.03.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/24/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2016 the Antenatal Late Preterm Steroids study was published, demonstrating that antenatal corticosteroid therapy given to women at risk of late preterm delivery reduces respiratory morbidity in infants. However, the administration of antenatal corticosteroid therapy in late-preterm infants remains controversial. Late-preterm infants do not suffer from the same rates of morbidity as early-preterm infants, and the short-term benefits of antenatal corticosteroid therapy are less pronounced; consequently, the risk of possible harm is more difficult to balance. OBJECTIVE This study aimed to evaluate the association between the publication of the Antenatal Late Preterm Steroids study or the subsequent changes in guidelines and the rates of antenatal corticosteroid therapy administration in late-preterm infants in the United States. STUDY DESIGN Data analyzed were publicly available US birth certificate data from January 1, 2016 to December 31, 2018. An interrupted time series design was used to analyze the association between publication of the Antenatal Late Preterm Steroids study and changes in monthly rates of antenatal corticosteroid administration in late preterm gestation (34+0 to 36+6 weeks). Births at 28+0 to 31+6 weeks' gestation were used as a control. Antenatal corticosteroid therapy administration in women with births at 32+0 to 34+6 weeks was explored to analyze whether the intervention influenced antenatal corticosteroid therapy administration in women in the subgroup approaching 34 weeks' gestation. Antenatal corticosteroid therapy administration in women with term births (>37 weeks' gestation) was analyzed to explore if the intervention influenced the number of term babies exposed to antenatal corticosteroid therapy. Our regression model allowed analysis of both step and slope changes. February 2016 was chosen as the intervention period. RESULTS Our sample size was 18,031,950 total births. Of these, 1,056,047 were births at 34+0 to 36+6 weeks' gestation, 123,788 at 28+0 to 31+6 weeks, 153,708 at 32 to 33 weeks, and 16,602,699 were term births. There were 95,708 births at <28 weeks' gestation. There was a statistically significant increase in antenatal corticosteroid therapy administration rates in late preterm births following the online publication of the Antenatal Late Preterm Steroids study (adjusted incidence rate ratio, 1.48; 95% confidence interval, 1.36-1.61; P=.00). A significant increase in antenatal corticosteroid therapy administration rates was also seen in full-term births following the online publication of the Antenatal Late Preterm Steroids study. No significant changes were seen in antenatal corticosteroid administration rates in gestational age groups of 32+0 to 33+6 weeks or 28+0 to 31+6 weeks. CONCLUSION Online publication of the Antenatal Late Preterm Steroids study was associated with an immediate and sustained increase in the rates of antenatal corticosteroid therapy administration in late preterm births across the United States, demonstrating a swift and successful implementation of the Antenatal Late Preterm Steroids study guidance into clinical practice. However, there is an unnecessary increase in full-term infants receiving antenatal corticosteroid therapy. Given that the long-term consequences of antenatal corticosteroid therapy are yet to be elucidated, efforts should be made to minimize the number of infants unnecessarily exposed to antenatal corticosteroid therapy.
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Gagliardi L, Amador C, Puglia M, Mecacci F, Pratesi S, Sigali E, Tomasini B, Rusconi F, Banchini R, Papi MC, Pecori D, Dani C, Ingargiola A, Moroni M, Fiorini P, Vuerich M, Santarlasci S, Boldrini A, Dilucia S, Panariello G, Vinciguerra F, Giovannoni A, Dolfi P, Moschetti R, Tognetti S, Capuzzo L, Magnanensi S, Mariotti P, Brioschi A, Martelli E, Vasarri PL, Carlotti C, Danieli R, Gragnani S, Benetti GL, Tiezzi M, Civitelli F, Magi L, Martini M, Cardinale A, Magni C, Bini R, De Filippo M, Cafaggi L, Bosi C, Gambi B, Pezzati M, Strano M, Bartoli A, Gabrielli P, Verucci E, Berni R, Corsi A, Voller F. Area-based study identifies risk factors associated with missed antenatal corticosteroid prophylaxis in women delivering preterm infants. Acta Paediatr 2017; 106:250-255. [PMID: 27577326 DOI: 10.1111/apa.13563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/02/2016] [Accepted: 08/29/2016] [Indexed: 11/28/2022]
Abstract
AIM All women delivering a preterm infant should receive antenatal corticosteroid prophylaxis, but many miss this opportunity. We determined the risk factors associated with missed prophylaxis in a geographically defined area of Italy. METHODS We prospectively studied all mothers who delivered babies between 24 and 31 completed weeks of gestation, from 2009 to 2013, in all maternity units in Tuscany. RESULTS Of 1232 mothers, 186 (15.1%) did not receive prophylaxis. The risk was higher in migrant mothers, with an adjusted risk ratio (RR) of 1.28 and 95% confidence interval (95% CI) of 1.04-1.56, and in mothers hospitalised for less than 24 hours (RR 4.09, 95% CI: 2.90-5.78). Preterm prelabour rupture of membranes (RR 0.63, 95% CI: 0.41-0.96) and maternal antepartum transfer (RR 0.24, 95% CI: 0.18-0.32) were protective. Hospital level at birth and gestational age did not influence the prophylaxis rate. The population-attributable fractions were 50.4% for late hospital admissions and 10.2% for migrant status. CONCLUSION In a highly organised network of hospitals, neither level of care nor gestational age influenced prophylaxis. Timely arrival of women in hospital, better recognition of the imminence of delivery and tighter steroids administration guidelines are the most relevant targets to further increase prophylaxis.
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Affiliation(s)
- Luigi Gagliardi
- Department of Woman and Child Health Versilia Hospital Viareggio Italy
| | - Carolina Amador
- Department of Fetal‐Neonatal Medicine Anna Meyer Children's University Hospital Florence Italy
| | | | - Federico Mecacci
- Department of Gynecology, Perinatology and Human Reproduction Careggi University Hospital Florence Italy
| | - Simone Pratesi
- Department of Neuroscience, Psychology, Drug Research and Child Health Careggi University Hospital Florence Italy
| | - Emilio Sigali
- Department of Pediatrics Division of Neonatology and Neonatal Intensive Care Unit University Hospital of Pisa Pisa Italy
| | - Barbara Tomasini
- Neonatal Intensive Care Unit University Hospital of Siena Siena Italy
| | - Franca Rusconi
- Unit of Epidemiology Anna Meyer Children's University Hospital Florence Italy
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Yasuhi I, Myoga M, Suga S, Sugimi S, Umezaki Y, Fukuda M, Yamashita H, Kusuda N. Influence of the interval between antenatal corticosteroid therapy and delivery on respiratory distress syndrome. J Obstet Gynaecol Res 2016; 43:486-491. [DOI: 10.1111/jog.13242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/21/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Ichiro Yasuhi
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Mai Myoga
- Department of Obstetrics & Gynecology; School of Medicine, University of Occupational and Environmental Health; Fukuoka Japan
| | - Sachie Suga
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - So Sugimi
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Yasushi Umezaki
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Masashi Fukuda
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Hiroshi Yamashita
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
| | - Nobuko Kusuda
- Department of Obstetrics & Gynecology; Nagasaki Medical Center; Omura Nagasaki Japan
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Kaplan HC, Sherman SN, Cleveland C, Goldenhar LM, Lannon CM, Bailit JL. Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals. BMJ Qual Saf 2015; 25:173-81. [DOI: 10.1136/bmjqs-2015-003984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/24/2015] [Indexed: 11/04/2022]
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Germany L, Saurel-Cubizolles MJ, Ehlinger V, Napoletano A, Alberge C, Guyard-Boileau B, Pierrat V, Genolini C, Ancel PY, Arnaud C. Social context of preterm delivery in France in 2011 and impact on short-term health outcomes: the EPIPAGE 2 cohort study. Paediatr Perinat Epidemiol 2015; 29:184-95. [PMID: 25847031 DOI: 10.1111/ppe.12189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low socio-economic context increases the risk of preterm delivery and may affect short-term outcomes in children born preterm. We described the social context of preterm delivery in France in 2011 and compared it with the general population of deliveries over the same period. We also studied how social context influenced pregnancy and delivery characteristics in the preterm population, and how it affected mortality and short-term morbidity in liveborn preterm children (<35 weeks). METHODS We created an individual socio-economic vulnerability index, derived from multiple correspondence analysis based on maternal social information in the French National Perinatal Survey (NPS-2010). Weighted coordinates were applied to families from the EPIPAGE 2 study, a population-based cohort of preterm infants born in 2011, to quantify the infant's exposure to socio-economic vulnerability. Multivariable logistic models were used to relate the socio-economic context to pregnancy and delivery characteristics, and to assess its impact on short-term outcomes of the infants. RESULTS Among mothers of preterm infants, gestational age decreased as socio-economic conditions worsened. In the most deprived group, women had more irregular pregnancy care, a higher prevalence of infection during pregnancy, and a lower rate of antenatal corticosteroid administration. The most deprived group was associated with a higher risk of severe morbidity for the preterm neonates. CONCLUSION Our results emphasise the need for a large population-based surveillance system to identify the most deprived mothers, and to propose appropriate follow-up and care to these women and their infants in order to enhance long-term health.
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Affiliation(s)
- Laurence Germany
- Research Unit on Perinatal Epidemiology, Childhood Disabilities and Adolescent Health, INSERM UMR 1027, Toulouse, France; Paul Sabatier University, Toulouse, France
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Burguet A, Menget A, Chary-Tardy AC, Savajols E, Abed N, Thiriez G. [Variables determining the amount of care for very preterm neonates: the concept of medical stance]. Arch Pediatr 2013; 21:134-41. [PMID: 24355651 DOI: 10.1016/j.arcped.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/18/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the amount of medical interventions on very preterm neonates (24-31 weeks of gestation) in two French university tertiary care centers, one of which is involved in a Neonatal Developmental Care program. A secondary objective is to assess whether this difference in medical interventions can be linked to a difference in mortality and morbidity rates. METHODS We prospectively included all very preterm neonates free from lethal malformation born live in these two centers between 2006 and 2010. These inclusion criteria were met by 1286 patients, for whom we compared the rate of five selected medical interventions: birth by caesarean section, chest intubation in the delivery room, surfactant therapy, pharmacological treatment of patent ductus arteriosus, and red blood cell transfusion. RESULTS The rates of the five medical interventions were systematically lower in the center that is involved in Neonatal Developmental Care. There was no significant difference in survival at discharge with no severe cerebral ultrasound scan abnormalities between the two centers. There were, however, significantly higher rates of bronchopulmonary dysplasia and nosocomial sepsis and longer hospital stays when the patients were not involved in a Neonatal Developmental Care program. DISCUSSION This benchmarking study shows that in France, in the first decade of the 21st century, there are as many ways to handle very preterm neonates as there are centers in which they are born. This brings to light the concept of medical stance, which is the general care approach prior to the treatment itself. This medical stance creates the overall framework for the staff's decision-making regarding neonate care. The different parameters structuring medical stance are discussed. Moreover, this study raises the problematic issue of the aftermath of benchmarking studies when the conclusion is an increase of morbidity in cases where procedure leads to more interventions.
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Affiliation(s)
- A Burguet
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France; Inserm-UMR S 953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, hôpital Cochin, 75014 Paris, France; UMPC université Paris 06, UMR S 953, 75005 Paris, France.
| | - A Menget
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
| | - A-C Chary-Tardy
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - E Savajols
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - N Abed
- Service de pédiatrie 2, CHU de Dijon, hôpital du Bocage, 21079 Dijon cedex, France
| | - G Thiriez
- Service de réanimation pédiatrique et néonatologie, CHU de Besançon, hôpital Saint-Jacques, 25000 Besançon, France
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Blondel B, Lelong N, Kermarrec M, Goffinet F. La santé périnatale en France métropolitaine de 1995 à 2010. Résultats des enquêtes nationales périnatales. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.sagf.2012.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Blondel B, Lelong N, Kermarrec M, Goffinet F. Trends in perinatal health in France from 1995 to 2010. Results from the French National Perinatal Surveys. ACTA ACUST UNITED AC 2012; 41:e1-e15. [DOI: 10.1016/j.jgyn.2012.04.014] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 04/10/2012] [Accepted: 04/16/2012] [Indexed: 11/24/2022]
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La santé périnatale en France métropolitaine de 1995 à 2010. Résultats des enquêtes nationales périnatales. ACTA ACUST UNITED AC 2012; 41:151-66. [DOI: 10.1016/j.jgyn.2011.11.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/07/2011] [Accepted: 11/21/2011] [Indexed: 11/21/2022]
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Abstract
OBJECTIVES To estimate risk factors for premature neonates not receiving antenatal steroids in a population-based cohort and to determine whether the gains of a quality-improvement collaborative project on antenatal steroid administration were sustained long-term. METHODS Clinical data for premature neonates born in 2005–2007 were obtained from the California Perinatal Quality Care Collaborative, which collects data on more than 90% of neonatal admissions in California. Eligible neonates had a birth weight of less than 1,500 g or gestational age less than 34 weeks and were born at a Collaborative hospital. These data were linked to administrative data from California Vital Statistics. Sociodemographic and medical risk factors for not receiving antenatal steroids were determined. We also examined the effect of birth hospital participation in a previous quality-improvement collaborative project. A random effects logistic regression model was used to determine independent risk factors. RESULTS Of 15,343 eligible neonates, 23.1% did not receive antenatal steroids in 2005–2007. Hispanic mothers (25.6%), mothers younger than age 20 (27.6%), and those without prenatal care (52.2%) were less likely to receive antenatal steroids. Mothers giving birth vaginally (26.8%) and mothers with a diagnosis of fetal distress (26.5%) were also less likely to receive antenatal steroids. Rupture of membranes before delivery and multiple gestations were associated with higher likelihood of antenatal steroid administration. Hospitals that participated in a quality-improvement collaborative in 1999– 2000 had higher rates of antenatal steroid administration (85% compared with 69%, P<.001). CONCLUSION A number of eligible mothers do not receive antenatal steroids. Quality-improvement initiatives to improve antenatal steroid administration could target specific high-risk groups.
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