771 - A Matter of Moments: Antenatal Steroid Exposure Opportunities at the Edge of Viability

Publication Number: 2752.771

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

Background: Optimal antenatal steroid (ANS) exposure is defined as 48 hours to 7 days after the first dose. For extremely preterm infants, even one additional hour of exposure reduces morbidity and mortality. The Vermont Oxford Network (VON) records ANS exposure as binary (yes/no), rather than exposure duration.

Objective: To determine the rate of suboptimal ANS exposure ( < 48 hours, >7 days) and identify modifiable factors that could increase exposure duration.

Design/Methods: After IRB approval, maternal records for all live births between 2019-2024 at 22 0/7 to 25 6/7 weeks gestation were reviewed. Data included admission time, medications given before ANS, ANS administration time, antenatal transfer, neonatal resuscitation consult details, and delivery time.

Results: The cohort contained 66 mothers. Of these, 56 (85%) participated in a neonatal consult and 4 chose comfort care. Among the 62 mothers who planned for neonatal resuscitation, VON data would classify 98% as having received ANS, whereas chart review showed that 36 (58%) did not achieve optimal ANS exposure (Figure 1).

Admission time to ANS delivery: 11 mothers (31%) with suboptimal exposure received ANS prior to delivery admission. Among the remaining mothers without pre-admission exposure (n=25), the mean interval between admission and ANS administration was 6.6 hours (range 0.32-43 hours) (Figure 2). Transfer status: 12 (33%) were transferred from another facility; 4 of these did not receive ANS before transfer. Competing medications: 19 of the 36 mothers with suboptimal exposure (53%) received another medication before ANS (Table 1). On average, 6.8 hours (range 0.03-38.5 hours) elapsed between the first non-ANS medication and ANS administration. Consult time: Neonatal resuscitation consults occurred a median of 2.75 hours after admission. 4 (16%) mothers without pre-admission exposure did not receive ANS until after the consult. If ANS had been administered before the consult, 2 additional mothers would have achieved optimal exposure.

Conclusion(s): Opportunities exist to optimize ANS exposure for extremely preterm infants, as even hourly gains can reduce morbidity and mortality. Delays occur in transferred mothers, when ANS is deferred until after neonatal consults, or when other medications are given first. More research is needed to quantify impacts of these delays on outcomes. Quality improvement efforts targeting these modifiable gaps may enhance ANS fetal exposure and improve birth outcomes.

Figure 1
Antenatal steroid exposure duration among 22-25 week gestation births, n=62. Of the 58% with suboptimal exposure, 40% had <48 hours and 18% had >7 days (168 hours) of exposure without adequate exposure to rescue doses.

Table 1
Medications administered prior to ANS to mother with suboptimal exposure

Figure 2
Histogram demonstrating wait from admission to ANS administration among mothers with suboptimal exposure