Abstract
OBJECTIVES: To assess the outcome of extremely low birth weight (ELBW) infants ≤1000 g as it relates to antenatal steroids (ANS) therapy.
STUDY DESIGN: A retrospective analysis of 124 infants born between January 1995 and December 1997. Infants born to mothers with pregnancy-induced hypertension, diabetes, and severe growth restriction were excluded. In all, 77 (62%) infants were exposed to ANS, of whom 31 (25%) received one to two doses (partial course), and 46 (37%) received three to four doses (complete course). A total of 47 infants (38%) were not exposed to ANS.
RESULTS: Infants not exposed to ANS, who exhibited more HMD, PDA, and IVH, were administered more surfactants, and were more likely to die versus infants with complete ANS dosing. Regression models revealed a dose-dependent effect of ANS on HMD, surfactant use, IVH, and CLD or death, with a significant decrease in HMD with ≥2 ANS doses.
CONCLUSIONS: ANS, in a dose-dependent way, are associated with improved outcome in ELBW infants ≤1000 g, with the best outcome seen after a complete course.
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References
Hoyert DL, Freedman MA, Strobino DM, Guyer B . Annual summary of vital statistics — 2000. Pediatrics 2001;108(6):1241–1255.
NIH Consensus Development Conference Statement. Am J Obstet Gynecol 1995;173:246–252.
Crowley P . Antenatal corticosteroids therapy: a meta-analysis of the randomized trials, 1972 to 1994. Am J Obstet Gynecol 1995;173:322–335.
Crowley P . Prophylactic corticosteroids for preterm birth (Cochrane Review)erm delivery (Cochrane review). In: The Cochrane Library, Issue 2, 1999. Oxford: Update Software.
Liggins GC . Premature delivery of foetal lambs infused with glucocorticoids. J Endocrinol 1969 45(4):515–523.
Liggins GC, Howie RN . A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972 50(4):515–525.
Cunningham FG, MacDonald PC, Gant NF, et al. Williams Obstetrics. Stamford, CT: Appleton & Lange; 1997. p. 797–826.
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M . A United States national reference for fetal growth. Obstet Gynecol 1996;87(2):163–168.
Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92(4):529–534.
Alexander JM, Gilstrap LC, Cox SM, McIntire DM, Leveno KJ . Clinical chorioamnionitis and the prognosis for very low birth weight infants. Obstet Gynecol 1998;91(5 Part 1):725–729.
Centers for Disease Control; Prevention of Neonatal Group B Streptococcal Diseases: A Public Health Perspective. MWR 1996;45:RR-7(1).
Multiple comparisons for proportions. In Zar JH, editor. Biostatistical Analysis. Upper Saddle River, NJ, USA; 1996. p. 560.
Papageorgiou AN, Doray JL, Ardila R, Kunos I . Reduction of mortality, morbidity, and respiratory distress syndrome in infants weighing less than 1,000 grams by treatment with betamethasone and ritodrine. Pediatrics 1989;83(4):493–497.
Jobe AH, Mitchell BR, Gunkel JH . Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. Am J Obstet Gynecol 1993;168(2):508–513.
Wright LL, Horbar JD, Gunkel H, et al. Evidence from multicenter networks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants. Am J Obstet Gynecol 1995;173(1):263–269.
Shankaran S, Bauer CR, Bain R, Wright LL, Zachary J . Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants. Am J Obstet Gynecol 1995;173(1):305–312.
Ikegami M, Polk D, Jobe A . Minimum interval from fetal betamethasone treatment to postnatal lung responses in preterm lambs. Am J Obstet Gynecol 1996;174(5):1408–1413.
Ballard PL, Ning Y, Polk D, Ikegami M, Jobe AH . Glucocorticoid regulation of surfactant components in immature lambs. Am J Physiol 1997;273(5 Part 1):L1048–L1057.
Perlman JM, Nissen P . Glial acidic protein mRNA gene expression in human astroglial cells is modulated by dexamethasone. Ann Neurol 1995;38:495 (abstract).
Perlman JM, Goodman S, Kreusser KL, Volpe JJ . Reduction in intraventricular hemorrhage by eliminiation of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med 1985;312:1353–1357.
Demarini S, Dollberg S, Hoath SB, Ho M, Donovan EF . Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life. J Perinatol 1999;19(6 Part 1):419–425.
Eronen M, Kari A, Pesonen E, Hallman M . The effect of antenatal dexamethasone administration on the fetal and neonatal ductus arteriosus. A randomized double-blind study. Am J Dis Child 1993;147(2):187–192.
Clyman RI . Ductus arteriosus: current theories of prenatal and postnatal regulation. Semin Perinatol 1987;11:64–71.
Tsai MY, Brown DM . Effect of dexamethasone on fetal lung 15-hydroxy-prostaglandin dehydrogenase: possible mechanism for the prevention of patent ductus arteriosus by maternal dexamethasone therapy. Prostagland Leukotr Med 1987;27(2–3):237–245.
Iams JD, Goldenberg RL, Meis PJ, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med 1996;334(9):567–572.
Goldenberg RL, Mercer BM, Meis PJ, Copper RL, Das A, McNellis D . The preterm prediction study: fetal fibronectin testing and spontaneous preterm birth. NICHD Maternal Fetal Medicine Units Network. Obstet Gynecol 1996;87(5 Part 1):643–648.
Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Copper RL . Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;333(26):1732–1736.
Watterberg KL, Demers LM, Scott SM, Murphy S . Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics 1996;97(2):210–215.
Abman SH, Groothius JR . Pathophysiology and treatment of bronchopulmonary dysplasia. Current issues. Pediatr Clin North Am 1994;41(2):277–315.
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Salhab, W., Hynan, L. & Perlman, J. Partial or Complete Antenatal Steroids Treatment and Neonatal Outcome in Extremely Low Birth Weight Infants ≤1000 g: Is There a Dose-Dependent Effect?. J Perinatol 23, 668–672 (2003). https://doi.org/10.1038/sj.jp.7211007
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DOI: https://doi.org/10.1038/sj.jp.7211007
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