732 - Steroids on the Clock: Identifying Opportunities to Improve Antenatal Steroid Exposure for Infants Born at 30-33 Weeks’ Gestation

Publication Number: 1709.732

Charlotte Jacobs, Medical College of Wisconsin, Wauwatosa, WI, United States; Amanda M. Jentsch, Medical College of Wisconsin, New Berlin, WI, United States; Siobhan M. McDonnell, Medical College of Wisconsin, Willmar, MN, United States; Kathleen Meskin, Medical College of Wisconsin, New Berlin, WI, United States; Sunil K. Sati, Phoenix Children's Hospital, Phoenix, AZ, United States; Meredith Cruz, Medical College of Wisconsin, New Berlin, WI, United States; Mir A Basir, Medical College of Wisconsin, Brookfield, WI, United States

Background: Antenatal steroids (ANS) substantially improve preterm infant outcomes, with greatest benefit when exposed for 48 hours to 7 days before delivery. However, national databases such as the Vermont-Oxford Neonatal Network (VON) and Neonatal Research Network (NRN) capture ANS exposure as a binary (yes/no) or categorical (partial/full course) variables, obscuring true exposure duration and masking opportunities for improvement. Most studies have focused on deliveries < 28 weeks; quantifying ANS timing among 30–33-week deliveries may reveal opportunities to optimize this critical component of prenatal care.

Objective: To determine rate of optimal ANS exposure (≥48 hours, ≤ 7 days) and identify factors associated with suboptimal exposure, including admission-ANS interval, administration of other medications before ANS, admission timing (day [6 am-10 pm] vs. night [10 pm-6 am]), maternal race, and maternal antenatal transfer status.

Design/Methods: After IRB approval, maternal records for deliveries between 2019-2024 at 30 0/7 weeks to 33 6/7 weeks’ gestation were reviewed. Random selection in Excel identified 100 eligible mothers. Mothers who delivered outside our center and had received ANS prior to hospitalization were excluded.

Results: Between 2019-2024, 584 mothers delivered at 30-33 weeks' gestation and from these 100 mothers were randomly selected. While VON data would classify 92% of the sample as having received ANS and NRN would categorize 30% as partial and 62% as full courses, we found that only 40% had optimal exposure, Figure 1. The mean time from admission to the first ANS dose was 4.4 hours, Figure 2. Among ANS recipients, 52% received other medications before ANS, Table 1. Of 19 mothers transferred from a referring hospital, 8 (42%) had not received ANS before transfer; among the 11 who received ANS before transfer, 6 (55%) had suboptimal exposure. Rate of optimal ANS exposure did not differ by day (42%) vs night (29%) admission, p=0.71, or Black (48%) vs White (30%) maternal race, p=0.85.

Conclusion(s): Most mothers delivering between 30-33 weeks’ gestation did not receive optimal ANS exposure. Reducing the time from admission-ANS administration presents an actionable target to improve exposure time. Prioritizing ANS over nonurgent medications and promoting pretransfer ANS administration at referring hospitals may further enhance optimal exposure rates.

Figure 1
Charlotte ANS cohort Figures 1.pdfThis chart shows 100 mothers in the study cohort. Their ANS exposure since delivery admission is grouped by 6-hour intervals. At >168-hours (more than 7 days) mothers become eligible to receive a rescue course as these mothers did not have any ANS exposure prior to delivery hospitalization, meaning that without the rescue course their final exposure status was suboptimal.

Figure 2
Charlotte ANS cohort Figures2.pdfHistogram representing the relationship between time of admission and first ANS dose for mothers who received ANS.

Table 1
Charlotte ANS cohort Figures 3.pdfMedications given prior to ANS for the mothers who received suboptimal ( <48 hours or >7 days) ANS exposure.