The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study

SUMMARY The optimal time interval from neoadjuvant therapy to surgery in the treatment of esophageal cancer is not known. The aim of this study was to investigate if a prolonged interval between completed neoadjuvant chemoradiotherapy and surgery was associated with improved histological response rates and survival in a population-based national register cohort. The population-based cohort study included patients treated with neoadjuvant chemoradiotherapy and esophagectomy due to cancer in the esophagus or gastroesophageal junction. Patients were divided into two groups based on the median time from completed neoadjuvant treatment to surgery. The primary outcome was complete histological response. Secondary outcomes were lymph node tumor response, postoperative complications, R0 resection rate, 90-day mortality, and overall survival. In total, 643 patients were included, 344 (54%) patients underwent surgery within 49 days, and 299 (47%) after 50 days or longer. The groups were similar concerning baseline characteristics except for a higher clinical tumor stage (P = 0.009) in the prolonged time to surgery group. There were no significant differences in complete histological response, R0 resection rate, postoperative complications, 90-day mortality, or overall survival. Adjusted odds ratio for ypT0 in the prolonged time to surgery group was 0.99 (95% confidence interval: 0.64–1.53). Complete histological response in the primary tumor (ypT0) was associated with significantly higher overall survival: adjusted hazard ratio: 0.55 (95% CI 0.41–0.76). If lymph node metastases were present in these patients, the survival was, however, significantly lower: adjusted hazard ratio for ypT0N1: 2.30 (95% CI 1.21–4.35). In this prospectively collected, nationwide cohort study of esophageal and junctional type 1 and 2 cancer patients, there were no associations between time to surgery and histological complete response, postoperative outcomes, or overall survival. The results suggest that it is safe for patients to postpone surgery at least 7 to 10 weeks after completed chemoradiotherapy, but no evidence was seen in favor of recommending a prolonged time to surgery after neoadjuvant chemoradiotherapy for esophageal cancer. A definitive answer to this question requires a randomized controlled trial of standard vs. prolonged time to surgery.

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Faculty Opinions recommendation of Trends in receipt of single and repeat courses of antenatal corticosteroid administration among preterm and term births: A retrospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727796570.793572673 ◽

2020 ◽

Author(s):

Katie-Jane Wynne

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antenatal Corticosteroid ◽

Corticosteroid Administration ◽

Term Births

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Relationship between the time interval from antenatal corticosteroid administration until preterm birth and the occurrence of respiratory morbidity

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2011.03.035 ◽

2011 ◽

Vol 205 (1) ◽

pp. 49.e1-49.e7 ◽

Cited By ~ 27

Author(s):

Femke F. Wilms ◽

Jolande Y. Vis ◽

Desiree A.P.M. Pattinaja ◽

Rosanna A. Kuin ◽

Monique C. Stam ◽

...

Keyword(s):

Preterm Birth ◽

Respiratory Morbidity ◽

Time Interval ◽

Antenatal Corticosteroid ◽

Corticosteroid Administration

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Is There a Benefit of Antenatal Corticosteroid When Given < 48 Hours Before Delivery?

10.21203/rs.3.rs-921511/v1 ◽

2021 ◽

Author(s):

Yoav Siegler ◽

Naphtali Justman ◽

Gal Bachar ◽

Roy Lauterbach ◽

Yaniv Zipori ◽

...

Keyword(s):

Primary Outcome ◽

Neonatal Outcome ◽

Neonatal Morbidity ◽

Time Interval ◽

Outcome Study ◽

Antenatal Corticosteroid ◽

Time Intervals ◽

Corticosteroid Administration ◽

Adverse Neonatal Outcome ◽

Adverse Neonatal Outcomes

Abstract Objective We assessed the association between a short Antenatal Corticosteroid Administration-to-Birth Interval and neonatal outcome. Study design: A retrospective study between 2010- 2020. Eligible cases were singleton preterm live-born neonates born between 24 0/7 and 33 6/7 weeks of gestation and were initiated an ACS course of Betamethasone. We divided the first 48 hours following 1st ACS administration to four-time intervals and compared each time interval to those born more than 48 hours following ACS administration. The primary outcome was a composite of adverse neonatal outcome, including neonatal mortality or any major neonatal morbidity. Results A total of 200 women gave birth less than 48 hours from receiving the first betamethasone injection, and 172 women gave birth within 2-7 days (48-168 hours) from ACS administration. Composite adverse neonatal outcome was higher for neonates born less than 12 hours from initial ACS administration compared to neonates born 2-7 days from first betamethasone injection (55.45% vs. 29.07%, OR 3.45 95% CI [2.02-5.89], p.value<0.0001). However, there was no difference in composite adverse neonatal outcomes between neonates born 12-48 hours following ACS administration and those born after 2-7 days. That was also true after adjusting for confounders. Conclusions 12-24 hours following ACS Administration may be sufficient in reducing the same risk of neonatal morbidities as > 48 hours following ACS administration. It may raise the question regarding the utility of the second dose of ACS.

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Antenatal corticosteroid administration is associated with decreased growth of the fetal thymus: a prospective cohort study

Journal of Perinatology ◽

10.1038/s41372-019-0554-z ◽

2019 ◽

Vol 40 (1) ◽

pp. 30-38 ◽

Cited By ~ 1

Author(s):

Claire A. Jones ◽

Rosane Nisenbaum ◽

Leanne R. De Souza ◽

Howard Berger

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antenatal Corticosteroid ◽

Corticosteroid Administration ◽

Fetal Thymus

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Maternal and neonatal glycaemic control after antenatal corticosteroid administration in women with diabetes in pregnancy: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0246175 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246175

Author(s):

Jeremy F. Tuohy ◽

Frank H. Bloomfield ◽

Caroline A. Crowther ◽

Jane E. Harding

Keyword(s):

Cohort Study ◽

Blood Glucose ◽

Glycaemic Control ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Antenatal Corticosteroid ◽

Diabetes In Pregnancy ◽

Neonatal Hypoglycaemia ◽

Corticosteroid Administration ◽

In Pregnancy

Objective To describe maternal and neonatal glycaemic control following antenatal corticosteroid administration to women with diabetes in pregnancy. Design Retrospective cohort study Setting A tertiary hospital in Auckland, New Zealand Population Women with diabetes in pregnancy who received antenatal corticosteroids from 2006–2016. Methods Corticosteroid administration, maternal and neonatal glycaemia data were retrieved from electronic patient records. Demographic data were downloaded from the hospital database. Relationships between variables were analysed using multivariate analysis. Main outcome measures Maternal hyperglycaemia and neonatal hypoglycaemia Results Corticosteroids were administered to 647 of 7317 of women with diabetes (8.8%) who gave birth to 715 babies. After an initial course of corticosteroids, 92% and 52% of women had blood glucose concentrations > 7 and > 10 mmol/L respectively. Median peak blood glucose concentration of approximately 10 mmol/L occurred 9 hours after corticosteroid administration and hyperglycaemia lasted approximately 72 hours. Thirty percent of women gave birth within 72 hours of the last dose of corticosteroids. Babies of women who were hyperglycaemic within 24 hours of birth were more likely to develop hypoglycaemia (< 2.6 mmol/L, OR 1.51 [95% CI 1.10–2.07], p = 0.01) and severe hypoglycaemia (≤ 2.0 mmol/L, OR 2.00 [95% CI 1.41–2.85], p < 0.0001) than babies of non-hyperglycaemic mothers. There was no association between maternal glycaemia within 7 days of the last dose of corticosteroids and neonatal hypoglycaemia. Conclusions Hyperglycaemia is common in women with diabetes in pregnancy following antenatal corticosteroid administration. Maternal hyperglycaemia in the 24 hours prior to birth is associated with increased risk of neonatal hypoglycaemia. Limitations included the retrospective study design, so that not all data were available for all women and babies and the glucose testing schedule was variable.

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