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Multiple Courses of Antenatal Corticosteroids are Associated With Early Severe Lung Disease in Preterm Neonates

Journal of Perinatology volume 22, pages 101–107 (2002)Cite this article

Abstract

OBJECTIVE: Determine whether the increased neonatal mortality following repeated courses of antenatal corticosteroids (ANCS), observed in the Thyrotropin-Releasing Hormone (TRH) Trial, was related to confounding maternal risk factors or specific preterm morbidities.

STUDY DESIGN: A post hoc analysis of 595 TRH trial neonates, 26 to 32 weeks' gestation, studied the association between ≥3 courses ANCS and mortality. Potential confounding maternal factors and preterm morbidities were evaluated using logistic regression and log likelihood modeling.

RESULTS: Mortality was 9.2% after ≥3 courses (13/141) vs. 4.8% after 1 or 2 courses (22/454). This association was not explained by maternal factors, or other common preterm morbidities. However, 15/141 infants receiving ≥3 courses (10.6%) had early severe lung disease (ESLD) with 10 deaths, compared to 16/454 of the 1- to 2-course infants (3.5%) with 7 deaths (odds ratio 3.5, p<0.001).

CONCLUSIONS: ESLD, but not maternal risk factors, was associated with increased mortality in preterm infants after ≥3 courses ANCS.

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Acknowledgements

We thank the investigators (see Appendix listing), physicians and nurses at all of the TRH study centers for their participation in the original TRH study. We thank Christine Coburn for her role as study coordinator and Peggy McDonald for her assistance in preparation of the manuscript.

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Authors and Affiliations

  1. Departments of Pediatrics and Biostatistics, Division of Neonatology, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA

    Beverly A Banks MD, PhD, Avital Cnaan PhD, Philip L Ballard MD, PhD & Roberta A Ballard MD

  2. Departments of Obstetrics and Gynecology and Pediatrics, Divisions of Maternal–Fetal Medicine and Neonatology, University of Pennsylvania School of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA

    George Macones MD & Jeffrey D Merrill MD

Authors
  1. Beverly A Banks MD, PhD
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  2. George Macones MD
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  3. Avital Cnaan PhD
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  4. Jeffrey D Merrill MD
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  5. Philip L Ballard MD, PhD
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  6. Roberta A Ballard MD
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Consortia

North American TRH Study Group

Additional information

This study was supported by grants RO1-HD29201, P50-HL56401, MO1-RR00240, MO1-RR00040, MO1-RR00042, and MO1-RR01271 and by Perinatal Associates, Inc., and the Children's Hospital of Eastern Ontario Research Institution.

APPENDIX

APPENDIX

In addition to the authors, the following members of the North American Thyrotropin-Releasing Hormone Study Group participated in this study: J. Pinto-Martin, B. Planer, M. McCarthy and E. Escobar, The Children's Hospital of Philadelphia, Philadelphia; M. Morgan, E. Anday, K. Mooney, and M. Johnson, Hospital of the University of Pennsylvania, Philadelphia; W. Parer, R. Phibbs, N. Newton and J. Milar, University of California, San Francisco and San Francisco Medical Center, San Francisco; J. Padbury, M. Ross, D. Polk and S. Harrington, Harbor-University of California, Los Angeles Medical Center, Torrence; D. Davis, K. Ash and J. Frank, Ottawa General Hospital, Ottawa; E. Tyrala and L. Chan, Temple University Hospital, Philadelphia; J. Lioy and R. Librizzi, West Jersey Hospital, Voorhees; M. Hart, J. Garbaciak and E. Ramthun, St. Joseph's Hospital, Phoenix; S. Sawai and C. Carballo, Good Samaritan Hospital, Phoenix; F. Mannino, T. Moore and E. Milan, University of California, San Diego Medical Center, San Diego; H. Schneider and D. Block, Kaiser-Permanente Medical Center, San Diego; J. Keith and M. Rivera-Alsina, Naval Medical Center, San Diego; N. Ragavan and N. Dunn, Abington Memorial Hospital, Philadelphia; V. Bhutani, S. Weiner and M. Grous, Pennsylvania Hospital, Philadelphia.

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Banks, B., Macones, G., Cnaan, A. et al. Multiple Courses of Antenatal Corticosteroids are Associated With Early Severe Lung Disease in Preterm Neonates. J Perinatol 22, 101–107 (2002). https://doi.org/10.1038/sj.jp.7210604

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