Category: Prematurity
Poster Session III
This is a secondary analysis of the multiple courses of ACS for preterm birth (MACS) trial. The MACS study was a randomized clinical trial conducted in 80 centers in 20 different countries from 2001 to 2006. Participants who received only one course of intervention, i.e. either a second course of ACS vs. placebo, were included in this study.
The primary outcome was a composite of perinatal or neonatal mortality and severe neonatal morbidity. Two subgroup analyses were planned to address the effect of the second course of ACS on infants born before 32 weeks or within seven days from the intervention.
Results: There were 385 and 365 participants included in the ACS and placebo groups, respectively. Composite of primary outcome occurred in 24% and 20% in the ACS and placebo groups, respectively (adjusted odds ratio (aOR) 1.11, 95%CI 0.77-1.60). Newborns exposed to ACS were more likely to be smaller for gestational age, 14.9% versus 10.6% (aOR 1.58, 95%CI 1.05-2.39). Subgroup analyses of infants born before 32 weeks or infants born within seven days from the intervention did not show any benefits in terms of a composite of the primary outcome in ACS versus the placebo group, 50.5% versus 41.8% (aOR 1.18, 95%CI 0.80-1.76) and 42.3% versus 37.1% (aOR 1.05, 95%CI 0.69-1.61), respectively.
Conclusion: Neonatal mortality and severe morbidities, including severe respiratory distress syndrome were not improved by a second course of ACS. Providers need to be thoughtful when prescribing a second course of ACS and consider what benefits are hoped to be gained from its administration not only short-term but also long-term.
Haitham Baghlaf, MD, MPH
Assistant professor
Jewish General Hospital/McGill University
Montreal, Quebec, Canada
John Snelgrove, MD
University of Toronto
Toronto, Ontario, Canada
Qixuan Li, MSc
University Health Network
Toronto, Ontario, Canada
Ella Huszti, PhD
University Health Network
Toronto, Ontario, Canada
Sarah D. McDonald, MD,MSC,FRCSC,BA
Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
Hamilton, Ontario, Canada
Elizabeth Asztalos, MD, MSc
Department of Paediatrics, University of Toronto
Toronto, Ontario, Canada
Mario Palermo, MD
University of Buenos Aires
Buenos Aires, Argentina, Argentina
Kellie E. Murphy, MD
Professor
Mount Sinai Hospital
Toronto, Ontario, Canada