Adequacy of antenatal steroids, rather than place of birth, determines survival to discharge in extreme prematurity in North Queensland

Ireland, Susan, Larkins, Sarah, Ray, Robin, Woodward, Lynn, and Devine, Kirsty (2019) Adequacy of antenatal steroids, rather than place of birth, determines survival to discharge in extreme prematurity in North Queensland. Journal of Paediatrics and Child Health, 55 (2). pp. 205-212.

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Aim: The Townsville Hospital cares for babies in a large geographical area, many of who are outborn, are of Aboriginal or Torres Strait Islander origin and have families who reside in areas of deprivation. This study examined the outcomes of babies born at all locations in North Queensland to assess the predictors of poor outcomes.

Methods: A retrospective observational study examined the survival of 313 babies born from 22 completed weeks gestation to 27 + 6 weeks gestation in North Queensland between January 2010 and December 2016. Additional analyses were performed for the 300 non-syndromal babies whose mothers usually resided in North Queensland, studying demographics of gestation, gender, birthweight, Indigenous status, regionality of maternal residence and adequacy of antenatal steroids. Short-term morbidities of intraventricular aemorrhage/periventricular leukomalacia (IVH/PVL), surgical necrotizing enterocolitis, retinopathy of prematurity requiring treatment and chronic lung disease and death were studied in relation to demographic factors and clinical treatment.

Results: Adequacy of steroids was significantly associated with a decreased mortality odds ratio of 2.872 (95% confidence interval 1.228–6.715), whilst no difference in outcome was seen by retrieval status or ethnic origin. Babies from remote locations were at increased risk for IVH/PVL, 2.334 (1.037–5.255). Male babies suffered more chronic lung disease, 1.608 (1.010–2.561), and IVH/PVL, 2.572 (1.215–5.445). Aboriginal and Torres Strait Islander babies were at lower risk of IVH/PVL.

Conclusions: Steroids should be administered wherever there is any possibility of the provision of intensive care for periviable babies. Place of birth and ethnicity of mother should not unduly influence antenatal counselling.

Item ID: 55240
Item Type: Article (Research - C1)
ISSN: 1440-1754
Keywords: ethics; general paediatrics; intensive care; neonatology
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Copyright Information: © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)
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A version of this publication was included as Chapter 4 of the following PhD thesis: Ireland, Susan Carol (2021) 'Do you people even think about the lives you ruin?' Perspectives and influences on the provision of care for extreme preterm and periviable babies in North Queensland. PhD thesis, James Cook University, which is available Open Access in ResearchOnline@JCU. Please see the Related URLs for access.

Date Deposited: 05 Oct 2018 04:21
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3215 Reproductive medicine > 321501 Foetal development and medicine @ 50%
32 BIOMEDICAL AND CLINICAL SCIENCES > 3213 Paediatrics > 321303 Neonatology @ 50%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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