Antenatal steroid therapy appears to benefit extremely preterm infants
Exposure to steroids in utero in extremely premature infants may decrease the risk for certain birth defects and neurodevelopmental outcomes, study data show.
“For women at risk of premature delivery, antenatal steroids should be initiated even in situations where the likelihood of completing the course of antenatal steroids is low due to lack of time in case of imminent delivery, as even an incomplete course of steroid before birth was associated with significantly lower rates of death, complications in the neonatal period including severe bleeding in the brain and low neurodevelopmental impairment,” Sanjay Chawla, MD, of the department of pediatrics at Wayne State University in Detroit, told Endocrine Today.
Chawla and colleagues evaluated data from the National Institute of Child Health and Human Development Neonatal Research Network on 6,121 extremely premature infants (birth weight range, 401 g-1,000 g; gestational age, 22-27 weeks) born between 2006 and 2011. Researchers sought to compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no steroids before birth or to a partial or complete course of antenatal steroids.
Participants were divided into three groups based on exposure to antenatal steroids: no exposure (n = 848), partial exposure (one dose of betamethasone or fewer than four doses of dexamethasone; n = 1,581) or complete exposure (two doses of betamethasone or four doses of dexamethasone; n = 3,692).
The lowest rates of death; death or severe intracranial hemorrhage or cystic periventricular leukomalacia; severe intracranial hemorrhage and cystic periventricular leukomalacia among survivors; death or bronchopulmonary dysplasia; and death or necrotizing enterocolitis were found in the complete antenatal steroid group compared with the other groups. The primary outcome of death or neurodevelopmental impairment was lowest in the complete antenatal steroid group (48.1%) compared with the no antenatal steroid group (68.1%) and partial antenatal steroid group (54.4%; P < .001). The complete antenatal steroid group had the highest intact survival, whereas the no antenatal steroid group had the lowest.
The risk for death or neurodevelopmental impairment at 18 to 22 months was reduced in the complete antenatal steroid group compared with the no antenatal steroid group (OR = 0.63; 95% CI, 0.53-0.76) and partial antenatal steroid group (OR = 0.77; 95% CI, 0.63-0.95). Each additional week of gestation also decreased the risk for death or neurodevelopmental impairment (OR = 0.59; 95% CI, 0.56-0.62).
“A complete course of antenatal steroids is known to improve survival and reduce complications in the neonatal period for premature neonates born between 24 and 34 weeks of gestation,” Chawla told Endocrine Today. “Infants in the complete steroid treatment group had the lowest death and complications. Infants in the complete treatment group had significantly lower death, neonatal complications and neurodevelopmental impairment, as compared to infants without any exposure to antenatal steroids. The study also noted dose dependent benefits of antenatal steroids for extremely premature infants born even at 23 weeks of gestation. The improved neurodevelopmental outcome with a complete course of antenatal steroids was noted to be partly mediated by a reduction in severe brain bleeding in the neonatal period.” – by Amber Cox
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Sanjay Chawla, MD, can be reached at firstname.lastname@example.org.
Disclosure: The researchers report no relevant financial disclosures.