Maternal antenatal steroids use and outcomes in gastroschisis

  • Carnaghan H & al.
  • Prenat Diagn
  • 13 May 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Maternal antenatal corticosteroids use in gastroschisis was not associated with any effect on neonatal outcomes such as time to full enteral feeds or length of hospital stay (LOS).

Why this matters

  • Findings warrant further research to determine the pathophysiology underlying gastroschisis-related intestinal dysfunction in order to develop either prenatal or postnatal therapies to improve intestinal function.

Study design

  • This multicentre retrospective cohort study included 500 infants with gastroschisis (1992-2013).
  • Primary outcome: time to full enteral feeds (a surrogate measure for bowel function).
  • Secondary outcome: LOS, length of intensive care unit (ICU) stay, and necrotising enterocolitis (NEC).
  • Funding: The Wellcome Trust and Newlife Foundation for disabled children.

Key results

  • 69 infants (gestational age [GA] at birth, 34 [25-38] weeks) were born to mothers who received antenatal corticosteroids and 431 (GA at birth, 37 [31-41] weeks) were born to mothers who did not receive antenatal corticosteroids.
  • Antenatal corticosteroids had no effect on time to full enteral feeds (HR, 1.0; 95% CI, 0.8-1.4), LOS (HR, 1.1; 95% CI, 0.7-1.5) and length of ICU stay (HR, 0.9; 95% CI, 0.6-1.4).
  • Complex gastroschisis was associated with a significant increase in time to reach full enteral feeds and LOS (HR, 0.3; 95% CI, 0.2-0.4 for both).
  • Later GA at birth was associated a reduced time to reach full feeds (HR, 1.1 [95% CI, 1.1-1.2] per week of later birth) and LOS (HR, 1.2 [95% CI, 1.1-1.3] per week of later birth; P<.001 for both>
  • Higher proportion of infants who received antenatal steroids experienced an episode of NEC vs those who did not (11/69 vs 21/431; P=.002).

Limitations

  • The antenatal care, delivery, and post-natal care of cases were not standardised.
  • Dosage and timing of antenatal corticosteroids were not controlled.