51: Inhaled and Systemic Corticosteroid Administration to Preterm Infants Across Canadian NICUs
Bibliographic record
Abstract
Inhaled corticosteroids (ICS) are used to treat BPD despite limited evidence of efficacy and safety. Systemic corticosteroids (SCS) yield significant morbidity, but have not been recently examined in a large population-based study. To examine variation in ICS and SCS use and neonatal outcomes across Canadian NICUs. A retrospective cohort study of neonates 22≤ GA <29 weeks, receiving steroids for BPD, and admitted between 2010 and 2012 was conducted using data from the Canadian Neonatal Network (CNN) database. Demographics, ventilation status, and rates of mortality, BPD, nosocomial infection (NI), ROP, and NEC were compared between those who received ICS, SCS, and both ICS+SCS, and those who did not. ICS and SCS use were compared across sites. A total of 4087 infants met inclusion criteria; 368 (9%) received SCS, 234 (6%) ICS, and 137 (3%) both. Baseline comparison revealed a significantly lower GA (P<0.0001), birth weight (P<0.0001) and higher SNAP II score (P<0.0001) among those who received ICS and/or SCS. Antenatal steroid use was not associated with ICS and/or SCS use (P=0.05). Mortality was more common among those who received SCS after exclusion of neonates that died prior to median SCS initiation (AOR 4.98 [95% CI 3.15 to 7.88]). Severe ROP was more common in infants who received SCS (AOR 2.95 [95% CI 2.16 to 4.05]). NEC and NI preceded steroid use. Site-specific BPD rates did not correlate with SCS or ICS use. SCS use varied significantly between units (AOR range 0.0 [95% CI 0.0 to 0.0) to 4.2 (95% CI 1.1 to 16]). ICS use ranged from 0% to 39.8% (median 1.2% [IQR 0% to 8.3%]); nine sites did not use ICS. ICS and SCS are commonly used medications in Canadian NICUs, although considerable site variation exists. Further study of efficacy and safety is required to develop guidelines for neonatal steroid use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".