LAUSR

Preterm birth is a leading cause of perinatal morbidity and mortality. Administration of antenatal corticosteroids before preterm birth reduces risks of perinatal death, respiratory morbidity, necrotizing enterocolitis, and intraventricular hemorrhage and also reduces costs of perinatal care. Antenatal corticosteroids are optimally effective when administered within 7 days before preterm birth. However, only 20% to 40% of early preterm infants receive antenatal corticosteroids within 7 days before birth, partly because it is difficult to predict the precise timing of preterm birth. Until 2020, the Joint Commission had a perinatal core quality metric (PC-03) measuring the rate of administration of antenatal corticosteroids at any time before early preterm birth. This metric incentivized providers to use antenatal corticosteroids liberally. The Joint Commission retired the metric in 2020 after the rate reached over 97% in Joint Commission-accredited hospitals. However, PC-03 did not evaluate whether timing of antenatal corticosteroid administration was optimal, that is, within 7 days of birth. A 2016 multi-stakeholder Cooperative Workshop recommended development of a new quality metric to assess the rate of optimally timed antenatal corticosteroids among early preterm births. In this statement, we outline proposed specifications for such a metric and discuss potential uses, advantages, limitations, and barriers. We also propose a balancing metric that tracks the percentage of patients treated with antenatal corticosteroids who ultimately give birth at term. We suggest that use of these new metrics may incentivize more conservative antenatal corticosteroid timing, which could, in turn, lead to meaningfully improved outcomes for preterm neonates.