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Do prenatal steroids improve the survival of late preterm infants with complex congenital heart defects?
M A Attar1, R E Dechert2, R E Schumacher1
1Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI, USA.
Insights
Prenatal steroids (PNS) did not independently affect hospital survival in late preterm infants with complex congenital heart defects (CHD). Delivery room intubation and hypoplastic left heart syndrome were associated with increased mortality risk.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Maternal-Fetal Medicine
Background:
- Late preterm infants with complex congenital heart defects (CHD) face significant mortality risks.
- Prenatal steroid (PNS) administration is a common intervention in high-risk pregnancies, but its impact on this specific population is not well-defined.
Purpose of the Study:
- To evaluate the association between prenatal steroid (PNS) use and hospital mortality in late preterm infants diagnosed with complex congenital heart defects (CHD).
Main Methods:
- Retrospective review of medical records for late preterm infants with complex CHD.
- Multivariate logistic regression analysis to identify independent predictors of hospital death.
Main Results:
- Of 106 infants, 31% died; 14% received PNS. Non-survivors had higher rates of delivery room intubation, necrotizing enterocolitis, and hypoplastic left heart syndrome.
- Prenatal steroid (PNS) use was more frequent in non-survivors (23% vs. 11%), but this difference was not statistically significant (p=0.131).
- Delivery room intubation (OR 4.91) and hypoplastic left heart syndrome (OR 3.29) were independently associated with increased hospital mortality; PNS was not.
Conclusions:
- Prenatal steroid (PNS) treatment did not demonstrate an independent association with hospital survival in this cohort of late preterm infants with complex CHD.
- Risk factors like delivery room intubation and specific cardiac defects significantly impact mortality in this vulnerable population.
Aim:
We evaluated the use of prenatal steroids (PNS) and the effect of that practice on hospital mortality of late preterm infants with complex congenital heart defects (CHD).
Methods:
Retrospective review of records of late preterm infants with complex CHD infants that were cared for in a single tertiary perinatal center between 2002 and 2009. Multivariate logistic regression analysis was performed to determine which of the risk factors commonly associated with death prior to discharge from the hospital predict the outcome (hospital death).
Results:
Of the 106 late preterm infants with complex CHD, 31(29%) died and 15 (14%) received PNS. Endotracheal intubation in the delivery room (42% vs 15%), necrotizing enterocolitis (10% vs 0%) and hypoplastic left heart syndrome (52% vs 25%) were statistically more frequent in non-surviving infants. Non-surviving infants were more frequently treated with PNS (23% vs 11%) but this difference was not statistically significant (p = 0.131). Using logistic regression analysis, delivery room intubation (OR 4.91; 95% CI 1.78 - 13.51) and the hypoplastic left heart syndrome (OR 3.29; 95% CI 1.28 - 8.48), but not prenatal steroids were independently associated with increased risk of hospital death.
Conclusions:
In a selected population of late preterm infants with complex CHD, prenatal steroid treatment did not independently influence survival.
