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Are antenatal steroids beneficial to severely growth restricted fetuses?

George Mitsiakos1, Lajos Kovacs, Apostolos Papageorgiou

  • 1Papageorgiou General Hospital , Thessaloniki , Greece and.

The Journal of Maternal-Fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
|April 9, 2013
PubMed

Insights

Antenatal steroids (AS) did not improve neonatal outcomes for premature infants with severe intrauterine growth restriction. While AS improved cord pH and Apgar scores, potential risks necessitate re-evaluation of their use in this population.

Area of Science:

  • Neonatalogy
  • Perinatology
  • Developmental Pediatrics

Background:

  • Antenatal steroids (AS) are known to enhance fetal maturation and improve outcomes in preterm infants.
  • Intrauterine growth restriction (IUGR) is associated with increased neonatal morbidity and mortality.
  • The efficacy of AS in premature infants with severe IUGR requires specific investigation.

Purpose of the Study:

  • To evaluate the efficacy of antenatal steroids (AS) in improving neonatal outcomes for premature infants experiencing severe intrauterine growth restriction (IUGR).

Main Methods:

  • Retrospective review of 149 inborn infants born between 24 and 31 6/7 weeks of gestational age (GA) with a birth weight (BW) ≤3rd percentile.
  • Exclusion of infants with congenital anomalies or syndromes.
  • Comparison of outcomes between infants who received two doses of AS (n=87) and those who did not (n=62).

Main Results:

  • AS did not significantly improve overall neonatal outcomes in this cohort.
  • A better cord pH and 5-minute Apgar score were observed in the AS group.
  • No significant difference in the Griffith's test at 2 years corrected age, with a trend towards higher severe global delay in the AS group.
  • Survival rates were 78% in the AS group and 85% in the no-AS group.

Conclusions:

  • Antenatal steroids may not confer significant benefits for neonatal outcomes in premature infants with severe IUGR.
  • Potential risks, including cerebral and cardiovascular side effects, warrant a re-evaluation of AS indications in this specific high-risk population.
  • Further research is needed to clarify the risk-benefit profile of AS in severe IUGR.

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