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Antenatal steroid exposure improves outcomes in very preterm infants

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Infants born as early as 23 weeks’ gestation are more likely to survive and have less impairments if their mothers are given corticosteroids when they go into labor, according to the results of a multicenter study reported in the Journal of the American Medical Association for December 7.

“However, even though intact survival doubled with the administration of antenatal steroids in the entire cohort, it remained relatively low (36%),” the authors point out.

Dr. Waldemar A. Carlo, at the University of Alabama in Birmingham, and colleagues note that antenatal corticosteroids are currently recommended for mothers in preterm labor at 24 to 34 weeks’ gestation. To see if the benefits might extend to infants born even more prematurely, the team prospectively collected data on 10,541 children born at 22 to 25 weeks gestation in 23 academic perinatal centers.

The mothers of 7808 these infants (74.1%) received antenatal corticosteroids.

For the cohort as a whole, hospital mortality was lower with antenatal corticosteroid exposure than nonexposure (35.5% vs 56.0%, respectively), and intraventricular hemorrhage or periventricular leukomalacia occurred in 19.2% vs 27.6% of infants, respectively. However, the higher survival rate with exposure to antenatal corticosteroids was partially offset by higher rates of bronchopulmonary dysplasia (60.3%) than without exposure (54.0%), the team found.

Follow-up neurodevelopmental assessments were performed on 4924 infants when they reached the corrected age of 18-22 months.

Rates of death or neurodevelopmental impairment at this point among infants born at 23 weeks’ gestation were significantly lower with exposure to antenatal corticosteroids (83.4%) than without exposure (90.5%; adjusted odds ratio 0.58), the authors report. Corresponding figures for infants born at 24 weeks were 68.4% vs 80.3% (aOR, 0.62), and for those born at 25 weeks they were 52.7% vs 67.9% (aOR, 0.61).

However, rates of death or impairment were not significantly different among infants born at 22 weeks’ gestation: 90.2% with exposure to antenatal corticosteroids vs 93.1% without exposure (aOR, 0.80), the report indicates.

Overall, “Intact survival (no death or neurodevelopmental impairment by follow-up) at 18 to 22 months was higher in infants whose mothers received antenatal corticosteroids (35.8% with exposure to antenatal corticosteroids vs 18.5% without exposure; AOR, 1.66),” Dr. Carlo and colleagues report.

Based on these findings, they conclude, “Initiation of antenatal corticosteroids may be considered starting at 23 weeks’ gestation and later if the infant will be given intensive care because this therapy is associated with reduced mortality and morbidity.”

Reference:

JAMA 2011; 306:2348-2358.