Antenatal glucocorticoid (ANS) treatment is reported to improve outcome in VLBW infants.

Following the NIH ANS Consensus Development Conference (CDC) held 2/28/94, there was an increase in ANS treatment at the 12 Network Centers: 21% (65% complete course) for the 34 mos pre-CDC vs. 57% (68% complete course) for the 29 mos post-CDC. Objective: To compare VLBW risk for mortality and severe morbidity post vs. pre CDC. Design: Registry data were collectived prospectively on VLBW infants admitted ≤14 days to the 12 Network centers. Risk for mortality (n=13830) and severe morbidity (n=12880 survivors ≥12 hrs) were compared post vs. pre-CDC with univariable and multivariable analyses. Results: The two groups were similar: mean BW (1047, 1035 gms); mean GA (28, 28 wks); inborn (87, 86%); black (52, 48%); male (51, 51%); surfactant (50, 56%). Mortality post-CDC was 17.7%; pre-CDC it was 19.4%. The estimated unadjusted OR (post vs. pre) and 95% CI for selected outcomes were as follows: Table Risk of mortality was reduced 8 - 22% and risk of RDS was reduced 25 - 51% across BW groups. Despite increased survival, there was a decrease in severe ICH and no increase in sepsis, although risk of NEC was increased. On multivariable analysis, ANS reduced estimated risk of mortality by 47% (pre-CDC) and 58% (post-CDC).Conclusion: Increased ANS use was associated with significant decreases in VLBW mortality and respiratory morbidity, and an increased risk of NEC. The association between ANS use and NEC should be explored further.

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