• Nir Melamed, Jyotsna Shah, Amuchou Soraisham, Eugene W Yoon, Shoo K Lee, Prakesh S Shah, and Kellie E Murphy.
• Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Center, the Departments of Obstetrics and Gynecology and Paediatrics, University of Toronto, and the Departments of Pediatrics and Obstetrics and Gynecology and the Maternal-Infant Research Centre (MiCare), Mount Sinai Hospital, Toronto, Ontario, and the Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
• Obstet Gynecol. 2015 Jun 1; 125 (6): 1377-84.

ObjectiveTo assess the association between antenatal corticosteroid administration-to-birth interval and outcomes.MethodsIn this retrospective cohort study, data on singleton neonates born between 24 0/7 and 33 6/7 weeks of gestation and admitted to tertiary neonatal units in Canada during 2010-2012 were obtained from the Canadian Neonatal Network. Neonatal outcomes were compared among four groups based on the interval between antenatal corticosteroid administration and birth: no antenatal corticosteroids, partial antenatal corticosteroids (less than 24 hours before birth), antenatal corticosteroids 1-7 days before birth, and antenatal corticosteroids greater than 7 days before birth. Composite outcome was defined as any of neonatal mortality, bronchopulmonary dysplasia, grade 3-4 intraventricular hemorrhage, periventricular leukomalacia, or stage 3 or higher retinopathy.ResultsOf 6,870 eligible neonates, 1,378 (20%) received no antenatal corticosteroids; 1,473 (21%) received partial antenatal corticosteroids; 2,721 (40%) received antenatal corticosteroids 1-7 days before birth; and 1,298 (19%) received antenatal corticosteroids greater than 7 days before birth. The odds of the composite adverse outcome were significantly higher in all groups compared with neonates who received antenatal corticosteroids 1-7 days before birth (no antenatal corticosteroids: adjusted odds ratio [OR] 2.12, 95% confidence interval [CI] 1.69-2.65; partial antenatal corticosteroids: adjusted OR 1.48, 95% CI 1.22-1.80; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.46, 95% CI 1.20-1.77). Similar findings were observed with respect to neonatal mortality (no antenatal corticosteroids: adjusted OR 2.56, 95% CI 1.83-3.59; partial antenatal corticosteroids: adjusted OR 1.59, 95% CI 1.16-2.18; and antenatal corticosteroids at greater than 7 days: adjusted OR 1.40, 95% CI 1.00-1.97).ConclusionAntenatal corticosteroids had maximum benefit when given between 1 and 7 days before birth.Level Of EvidenceII.

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