Background
Methods
Study variables
Statistical methods
Results
Population
Variable | “Complete” population | ‘Counselled’ population | “Steroids only” population | ||||||
---|---|---|---|---|---|---|---|---|---|
N | % | N | % |
P-valuea
| N | % |
P-valueb
| ||
Antenatal steroids | 1701 | — | 1484 | — | — | 1213 | — | — | |
None | 488 | 28.69 | 358 | 24.12 | 0.01 | 0 | 0.00 | <0.01 | |
Partial | 452 | 26.57 | 400 | 26.95 | 452 | 37.26 | |||
Full | 761 | 44.74 | 726 | 48.92 | 761 | 62.74 | |||
Tocolysis | 1720 | — | 1495 | — | — | 1213 | — | — | |
No | 1283 | 74.59 | 1085 | 72.58 | 0.21 | 807 | 66.53 | <0.01 | |
Yes | 437 | 25.41 | 410 | 27.42 | 406 | 33.47 | |||
Delivery mode | 1717 | — | 1495 | — | — | 1213 | — | — | |
Vaginal | 1361 | 79.27 | 1170 | 78.26 | 0.51 | 901 | 74.28 | <0.01 | |
Caesarean | 356 | 20.73 | 325 | 21.74 | 312 | 25.72 | |||
Gestational age | 1722 | — | 1495 | — | — | 1213 | — | — | |
22 weeks | 204 | 11.85 | 165 | 11.04 | 0.90 | 19 | 1.57 | <0.01 | |
23 weeks | 281 | 16.32 | 252 | 16.86 | 139 | 11.46 | |||
24 weeks | 366 | 21.25 | 322 | 21.54 | 303 | 24.98 | |||
25 weeks | 436 | 25.32 | 391 | 26.15 | 374 | 30.83 | |||
26 weeks | 435 | 25.26 | 365 | 24.41 | 378 | 31.16 | |||
Fetal sex | 1719 | — | 1492 | — | — | 1213 | — | — | |
Female | 804 | 46.77 | 699 | 46.85 | 0.99 | 586 | 48.31 | 0.43 | |
Male | 915 | 53.23 | 793 | 53.15 | 627 | 51.69 | |||
HR >100 5 min after birth | 1722 | — | 1495 | — | — | 1213 | — | — | |
No | 600 | 34.84 | 505 | 33.78 | 0.55 | 274 | 22.59 | <0.01 | |
Yes | 1122 | 65.16 | 990 | 66.22 | 939 | 77.41 | |||
Delivery room death | 1722 | — | 1495 | — | — | 1213 | — | — | |
No | 1238 | 71.89 | 1078 | 72.11 | 0.92 | 1035 | 85.33 | <0.01 | |
Yes | 484 | 28.11 | 417 | 27.89 | 178 | 14.67 | |||
Counselled by... | 1722 | — | 1495 | — | — | 1213 | — | — | |
No one/not counselled | 227 | 13.18 | 0 | 0.00 | <0.01 | 87 | 7.17 | <0.01 | |
Junior obstetrician only | 168 | 9.76 | 168 | 11.24 | 94 | 7.75 | |||
Senior obstetrician only | 165 | 9.58 | 165 | 11.04 | 96 | 7.91 | |||
Paediatrician and junior obstetrician | 418 | 24.27 | 418 | 27.96 | 353 | 29.10 | |||
Paediatrician and senior obstetrician | 744 | 43.21 | 744 | 49.77 | 583 | 48.06 | |||
Decision to not perform C/S | 1158 | — | 1017 | — | — | 820 | — | — | |
No | 807 | 69.69 | 666 | 65.49 | 0.04 | 571 | 69.63 | 1.00 | |
Yes | 351 | 30.31 | 351 | 34.51 | 249 | 30.37 | |||
Resuscitation choice expressed | 1235 | — | 1130 | — | — | 881 | — | — | |
No choice expressed | 508 | 41.13 | 403 | 35.66 | 0.06 | 332 | 37.68 | <0.01 | |
Full intensive care | 391 | 31.66 | 391 | 34.60 | 346 | 39.27 | |||
Withhold intensive care | 45 | 3.64 | 45 | 3.98 | 9 | 1.02 | |||
At paediatric discretion | 291 | 23.56 | 291 | 25.75 | 194 | 22.02 | |||
Discussion about withholding care | 1178 | — | 1048 | — | — | 816 | — | — | |
Not discussed | 713 | 60.53 | 583 | 55.63 | 0.02 | 545 | 66.79 | 0.01 | |
Discussed | 465 | 39.47 | 465 | 44.37 | 271 | 33.21 |
Antenatal steroids
Partial course | Full course |
P-valuea
| |||||
---|---|---|---|---|---|---|---|
N | Effect | (95 % CI) | Effect | (95 % CI) | |||
Confounding only models | |||||||
Baseline | 1701 | 5.08 | (3.84 – 6.72) | 7.24 | (5.60 – 9.36) | — | |
Baseline + GA | 1701 | 2.09 | (1.51 – 2.90) | 2.53 | (1.85 – 3.45) | <0.001 | |
’Clinical’ modelb
| 1602 | 1.42 | (0.99 – 2.05) | 1.64 | (1.14 – 2.36) | 0.013 | |
Complete modelc
| 1602 | 1.38 | (0.93 – 2.03) | 1.82 | (1.22 – 2.71) | <0.001 | |
Models with effect modification by mode of deliveryb, c
| |||||||
Clinical model: Vaginal delivery | 1602 | 1.61 | (1.09 – 2.37) | 1.66 | (1.13 – 2.44) | 0.018 | |
Clinical model: Caesarean delivery | 1.31 | (0.46 – 3.69) | 0.48 | (0.17 – 1.39) | |||
Complete model: vaginal delivery | 1.84 | (1.20 – 2.82) | 1.63 | (1.08 – 2.47) | 0.021 | ||
Complete model: Caesarean delivery | 1.23 | (0.42 – 3.61) | 0.42 | (0.14 – 1.26) |
Partial course | Full course |
P-valuea
| |||||
---|---|---|---|---|---|---|---|
N | Effect | (95% CI) | Effect | (95% CI) | |||
Confounding only models | |||||||
Baseline | 1701 | 0.13 | (0.10 – 0.18) | 0.09 | (0.07 – 0.12) | — | |
Baseline + GA | 1701 | 0.39 | (0.27 – 0.56) | 0.35 | (0.25 – 0.50) | <0.001 | |
’Clinical’ modelb
| 1656 | 0.47 | (0.32 – 0.70) | 0.45 | (0.30 – 0.67) | 0.215 | |
Complete modelc
| 1656 | 0.47 | (0.31 – 0.74) | 0.37 | 0.23 – 0.58) | <0.001 | |
Models with effect modification by mode of deliveryb, c
| |||||||
Clinical model: vaginal delivery | 1656 | 0.44 | (0.29 – 0.67) | 0.42 | (0.28 – 0.63) | 0.10 | |
Clinical model: caesarean delivery | 0.72 | (0.21 – 2.50) | 1.63 | (0.44 – 6.09) | |||
Complete model: vaginal delivery | 0.34 | (0.21 – 0.55) | 0.41 | (0.26 – 0.64) | 0.083 | ||
Complete model: caesarean delivery | 0.93 | (0.24 – 3.63) | 2.06 | (0.49 – 8.65) |
Sensitivity analysis
Tocolysis
Model | Complete population | Steroids-only population | |||||||
---|---|---|---|---|---|---|---|---|---|
N | OR | 95% CI |
P-valuea
| N | OR | 95% CI |
P-valuea
| ||
Condition at birth | |||||||||
Baseline | 1720 | 2.25 | (1.75 – 2.90) | <0.0001 | 1213 | 1.44 | (1.08 – 1.95) | 0.0138 | |
Baseline + GAb
| 1720 | 1.64 | (1.24 – 2.18) | <0.0001 | 1213 | 1.53 | (1.12 – 2.09) | <0.0001 | |
Clinicalc
| 1655 | 1.37 | (1.01 – 1.87) | <0.0001 | 1205 | 1.42 | (1.04 – 1.96) | <0.0001 | |
Counsellingd
| 1655 | 1.45 | (1.05 – 2.00) | <0.0001 | 1205 | 1.47 | (1.06 – 2.04) | <0.0001 | |
Delivery Room death | |||||||||
Baseline | 1720 | 0.33 | (0.24 – 0.44) | <0.0001 | 1213 | 0.53 | (0.36 – 0.76) | 0.0005 | |
Baseline + GAb
| 1720 | 0.46 | (0.32 – 0.65) | <0.0001 | 1213 | 0.47 | (0.31 – 0.70) | <0.0001 | |
Clinicalc
| 1655 | 0.58 | (0.39 – 0.84) | <0.0001 | 1211 | 0.49 | (0.32 – 0.73) | <0.0001 | |
Counsellingd
| 1655 | 0.48 | (0.32 – 0.73) | <0.0001 | 1211 | 0.43 | (0.28 – 0.66) | <0.0001 |
Sensitivity analysis
Mode of delivery
Model | N | ≤24 weeks | 25 weeks | 26 weeks |
P-valuea
| ||||
---|---|---|---|---|---|---|---|---|---|
OR | (95% CI) | OR | (95% CI) | OR | (95% CI) | ||||
Condition at birth | |||||||||
Baseline | 1717 | 3.89 | (2.00 – 7.58) | 1.85 | (1.02 – 3.34) | 1.22 | (0.69 – 2.18) | 0.031 | |
Baseline: no labour | 1712 | 13.5 | (3.50 – 52.08) | 4.13 | (1.35 – 12.62) | 0.98 | (0.11 – 8.41) | 0.018 | |
Baseline: spontaneous labour | 1.79 | (0.76 – 4.24) | 1.95 | (0.79 – 4.79) | 0.75 | (0.35 – 1.58) | |||
Clinical: no labourb
| 1680 | 22.96 | (5.19 – 101.52) | 8.24 | (2.49 – 27.33) | 2.22 | (0.24 – 20.16) | 0.001 | |
Clinical: spontaneous labourb
| 1.18 | (0.47 – 2.96) | 2.01 | (0.80 – 5.08) | 0.71 | (0.33 – 1.54) | |||
Complete: no labourc
| 1680 | 12.67 | (2.79 – 57.60) | 4.94 | (1.44 – 16.90) | 1.56 | (0.16 – 14.81) | <0.001 | |
Complete: spontaneous labourc
| 0.95 | (0.38 – 2.40) | 1.58 | (0.62 – 4.03) | 0.70 | (0.32 – 1.52) | |||
Delivery room death | |||||||||
Baseline | 1717 | 0.24 | (0.12 – 0.50) | 0.79 | (0.39 – 1.63) | 0.63 | (0.24 – 1.70) | 0.055 | |
Baseline: no labour | 1712 | 0.05 | (0.01 – 0.23) | 0.20 | (0.06 – 0.67) | 0.39 | (0.04 – 3.76) | 0.019 | |
Baseline: spontaneous labour | 0.56 | (0.23 – 1.35) | 0.82 | (0.27 – 2.44) | 0.65 | (0.14 – 2.97) | |||
Clinical: no labourb
| 1680 | 0.01 | (0.00 – 0.09) | 0.06 | (0.02 – 0.25) | 0.09 | (0.01 – 1.03) | <0.001 | |
Clinical: spontaneous labourb
| 0.96 | (0.36 – 2.55) | 0.77 | (0.25 – 2.43) | 0.63 | (0.13 – 3.00) | |||
Complete: no labourc
| 1680 | 0.03 | (0.01 – 0.21) | 0.13 | (0.03 – 0.55) | 0.12 | (0.01 – 1.63) | <0.001 | |
Complete: spontaneous labourc
| 1.36 | (0.50 – 3.70) | 1.07 | (0.33 – 3.46) | 0.63 | (0.13 – 3.00) |