BACKGROUND AND PURPOSE:

• Antenatal corticosteroids and magnesium sulfate are recommended for pregnancies at risk for preterm birth between 24w0d and 33w6d
  • Data regarding extreme preterm period are limited
• Gentle et al. (Obstetrics & Gynecology, 2020) examined whether there was neurodevelopmental benefit for extremely preterm children (22w0d to 26w6d) with administration of corticosteroids and/or magnesium sulfate

METHODS:

• Prospective observational study (2011 to 2014)
  • NICHD Neonatal Research Network
• Participants
  • Children born at 22w0d to 26w6d weeks
• Exposures
  • Antenatal corticosteroids and magnesium sulfate
  • Antenatal corticosteroids alone
  • Magnesium sulfate alone
  • Neither
• Primary outcome
  • Severe neurodevelopmental impairment or death at 18 to 26 months age-corrected follow-up based on exposure to
    • Antenatal corticosteroids and magnesium sulfate
    • Antenatal corticosteroids alone
• Secondary outcomes
  • Severe neurodevelopmental impairment or death based on exposure to
    • Antenatal corticosteroids and magnesium sulfate
    • Magnesium sulfate alone
    • Neither antenatal corticosteroids nor magnesium sulfate

RESULTS:

• Total of 3093 children were included
  • Antenatal corticosteroids and magnesium sulfate: 72.5%
  • Antenatal corticosteroids alone: 16.4%
  • Magnesium sulfate alone: 2.9%
  • Neither: 8.1%
• Children exposed to both antenatal corticosteroids and magnesium sulfate had a lower rate of severe neurodevelopmental impairment or death compared to either treatment alone, or neither
  • Antenatal corticosteroids and magnesium sulfate: 36.3%
  • Antenatal corticosteroids alone: 44.3%
    • Adjusted odds ratio (aOR) 0.73 (95% CI, 0.58 to 0.91)
  • Magnesium sulfate alone: 53%
    • aOR 0.49 (95% CI, 0.29 to 0.82)
  • Neither therapy: 48.2%
    • aOR 0.66, 95% CI 0.49 to 0.89
• Children exposed to both antenatal corticosteroids and magnesium sulfate had a lower rate of death compared with either or neither therapy
  • The rate of severe neurodevelopmental impairment did not differ between exposure groups

CONCLUSION:

• In this cohort of children born <27 weeks, a combination of antenatal treatment with both corticosteroids and magnesium sulfate was associated with lower rates of severe neurodevelopmental impairment or death vs corticosteroids alone
• The authors state

Increased rates of magnesium sulfate exposure through quality improvement or other interventions may improve severe neurodevelopmental impairment or death without increasing the risk of neurodevelopmental impairment in survivors

Learn More – Primary Sources:

Association of Antenatal Corticosteroids and Magnesium Sulfate Therapy With Neurodevelopmental Outcome in Extremely Preterm Children

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