Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants
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Published on: November 20, 2015
A H Schaap1, H Wolf, H W Bruinse
1Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. A.H.Schaap@amc.uva.nl
Insights
Antenatal corticosteroids improved survival without disability in preterm, growth-restricted infants. However, long-term follow-up showed a negative impact on physical growth, though behavior was unaffected.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Endocrinology
Background:
- Preterm infants, especially those with growth restriction, face significant mortality and morbidity risks.
- Placental insufficiency leading to fetal distress necessitates careful management in preterm deliveries.
Purpose of the Study:
- To assess the impact of antenatal corticosteroids on mortality, morbidity, and long-term disability in early preterm, growth-restricted infants.
Main Methods:
- A case-control study matched 62 infants treated with antenatal corticosteroids to 62 untreated infants.
- Infants were born via cesarean section between 26-32 weeks gestation due to fetal distress.
- Outcomes evaluated included survival without disability at 2 years corrected age and physical growth/behavior at school age.
Main Results:
- Survival without disability at 2 years corrected age was significantly higher in the corticosteroid group (OR 3.2).
- Long-term follow-up at school age revealed a statistically significant negative effect on physical growth (OR 5.1).
- No significant differences in behavior were detected between the groups.
Conclusions:
- Antenatal corticosteroid administration appears to offer benefits in terms of survival without disability for early preterm, growth-restricted infants.
- Potential adverse effects on physical growth warrant consideration in the long-term management of these infants.
Objective:
To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants.
Methods:
This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insufficiency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26-32 weeks during the years 1984-1991. Infants who had been treated antenatally with corticosteroids more than 24 hours and less than 7 days before birth were matched by birth weight, sex, and year of birth with infants whose mothers had been admitted more than 24 hours before delivery but were not treated antenatally with steroids. The main outcome measure was survival without disability or handicap at 2 years corrected age. A sample of 60 case-control pairs would give 81% power to demonstrate 50% increase of this outcome [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire.
Results:
The study group and control group consisted of 62 infants each. Survival without disability or handicap at 2 years' corrected age was more frequent in the corticosteroid group [OR 3.2, confidence interval (CI) 1.1, 11.2]. In the long-term follow-up at school age there was a statistically significant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected.
Conclusion:
Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.
