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Medications and in-hospital outcomes in infants born at 22-24 weeks of gestation.

ABSTRACT: OBJECTIVE:To evaluate the most commonly used medications and in-hospital morbidities and mortality in infants born 22-24 weeks of gestation. STUDY DESIGN:Multicenter retrospective cohort study of infants born 22-24 weeks of gestation (2006-2016), without major congenital anomalies and with available medication data obtained from neonatal intensive care units managed by the Pediatrix Medical Group. RESULTS:This study included 7578 infants from 195 sites. Median (25th, 75th percentile): birthweight was 610?g (540, 680); the number of distinct medications used was 13 (8, 18); and different antimicrobial exposure was 4 (2, 5). The most common morbidities were BPD (41%) and grade III or IV IVH (20%), and overall survival varied from 46% (2006) to 57% (2016). CONCLUSIONS:A large number of medications were used in periviable infants. There was a high prevalence of in-hospital morbidities, and survival of this population increased over the study period.

SUBMITTER: Puia-Dumitrescu M

PROVIDER: S-EPMC7293630 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Medications and in-hospital outcomes in infants born at 22-24 weeks of gestation.

Puia-Dumitrescu Mihai M Younge Noelle N Benjamin Daniel K DK Lawson Katie K Hume Cordelia C Hill Kennedy K Mengistu Jonathan J Wilson Aryeona A Zimmerman Kanecia O KO Ahmad Kaashif K Greenberg Rachel G RG

Journal of perinatology : official journal of the California Perinatal Association 20200217 5

<h4>Objective</h4>To evaluate the most commonly used medications and in-hospital morbidities and mortality in infants born 22-24 weeks of gestation.<h4>Study design</h4>Multicenter retrospective cohort study of infants born 22-24 weeks of gestation (2006-2016), without major congenital anomalies and with available medication data obtained from neonatal intensive care units managed by the Pediatrix Medical Group.<h4>Results</h4>This study included 7578 infants from 195 sites. Median (25th, 75th p ...[more]

PMID: 32066843

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Project description:CONTEXT:Current guidelines, initially published in 1995, recommend antenatal corticosteroids for mothers with preterm labor from 24 to 34 weeks' gestational age, but not before 24 weeks due to lack of data. However, many infants born before 24 weeks' gestation are provided intensive care. OBJECTIVE:To determine if use of antenatal corticosteroids is associated with improvement in major outcomes for infants born at 22 and 23 weeks' gestation. DESIGN, SETTING, AND PARTICIPANTS:Cohort study of data collected prospectively on inborn infants with a birth weight between 401 g and 1000 g (N = 10,541) born at 22 to 25 weeks' gestation between January 1, 1993, and December 31, 2009, at 23 academic perinatal centers in the United States. Certified examiners unaware of exposure to antenatal corticosteroids performed follow-up examinations on 4924 (86.5%) of the infants born between 1993 and 2008 who survived to 18 to 22 months. Logistic regression models generated adjusted odds ratios (AORs), controlling for maternal and neonatal variables. MAIN OUTCOME MEASURES:Mortality and neurodevelopmental impairment at 18 to 22 months' corrected age. RESULTS:Death or neurodevelopmental impairment at 18 to 22 months was significantly lower for infants who had been exposed to antenatal corticosteroids and were born at 23 weeks' gestation (83.4% with exposure to antenatal corticosteroids vs 90.5% without exposure; AOR, 0.58 [95% CI, 0.42-0.80]), at 24 weeks' gestation (68.4% with exposure to antenatal corticosteroids vs 80.3% without exposure; AOR, 0.62 [95% CI, 0.49-0.78]), and at 25 weeks' gestation (52.7% with exposure to antenatal corticosteroids vs 67.9% without exposure; AOR, 0.61 [95% CI, 0.50-0.74]) but not in those infants born at 22 weeks' gestation (90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure; AOR, 0.80 [95% CI, 0.29-2.21]). If the mothers had received antenatal corticosteroids, the following events occurred significantly less in infants born at 23, 24, and 25 weeks' gestation: death by 18 to 22 months; hospital death; death, intraventricular hemorrhage, or periventricular leukomalacia; and death or necrotizing enterocolitis. For infants born at 22 weeks' gestation, the only outcome that occurred significantly less was death or necrotizing enterocolitis (73.5% with exposure to antenatal corticosteroids vs 84.5% without exposure; AOR, 0.54 [95% CI, 0.30-0.97]). CONCLUSION:Among infants born at 23 to 25 weeks' gestation, antenatal exposure to corticosteroids compared with nonexposure was associated with a lower rate of death or neurodevelopmental impairment at 18 to 22 months.

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Medications and in-hospital outcomes in infants born at 22-24 weeks of gestation.

Publications

Medications and in-hospital outcomes in infants born at 22-24 weeks of gestation.

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