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Antenatal steroids to prevent respiratory distress syndrome: multiple gestation as an effect modifier
E C Quist-Therson1, T L Myhr, A Ohlsson
1Integrated Neonatal/Perinatal Training Programme, University of Toronto, Canada.
Insights
Antenatal steroids did not reduce respiratory distress syndrome (RDS) in white infants from multiple gestations. However, they showed benefits for singleton infants of black mothers and other races.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Pharmacology
Background:
- Respiratory distress syndrome (RDS) is a significant concern in low-birth-weight infants.
- Antenatal steroid therapy is a common intervention to mature fetal lungs.
- The efficacy of antenatal steroids may vary based on infant and maternal factors.
Purpose of the Study:
- To evaluate the impact of antenatal steroids on RDS incidence and surfactant requirement in low-birth-weight infants (501-1500g).
- To identify potential effect modifiers, such as multiple gestation and maternal race.
Main Methods:
- A 6-year prospective cohort study of 946 infants.
- Comparison between infants receiving complete antenatal steroids and those who did not.
- Stratified analysis and multivariate logistic regression to adjust for covariates including multiple birth, maternal race, sex, delivery mode, Apgar score, birth weight, and gestational age.
Main Results:
- Maternal race and multiple gestation were identified as effect modifiers.
- RDS reduction was most pronounced in singleton infants of black mothers.
- No significant reduction in RDS was observed for white infants in multiple gestations.
- Surfactant need reduction was observed only in singleton infants of non-black, non-white mothers.
Conclusions:
- Antenatal steroid therapy did not decrease the incidence of RDS in white infants from multiple gestations.
- The benefits of antenatal steroids in reducing RDS and surfactant need may be specific to certain racial and gestational subgroups.
Background:
To determine the effect of antenatal steroids on the incidence of respiratory distress syndrome and the need for surfactant in low-birth-weight infants (501-1500 grams).
Methods:
A 6 year cohort of 946 infants (396 received complete steroids and 550 received no steroids) was studied for the occurrence of respiratory distress syndrome and the need for surfactant following antenatal steroid therapy. A stratified analysis identified confounding baseline characteristics or effect modifiers. The covariates used were multiple birth, maternal race, sex, mode of delivery, Apgar score <7 at 5 minutes, birth weight and gestational age. A multivariate logistic regression model was used to adjust odds ratios simultaneously for all statistically significant covariates.
Results:
Multiple gestation and race were effect modifiers. The reduction in RDS was greatest among singleton infants of black mothers with no significant reduction for multiple gestation white infants. The need for surfactant following steroids was reduced only in the group of singletons of other race (not black or white).
Conclusion:
In this retrospective analysis of cohort data collected prospectively antenatal steroid therapy did not reduce the incidence of RDS in multiple gestation white infants.