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