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Published on: November 20, 2015
Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants
L R Ment1, W Oh, R A Ehrenkranz
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510.
Insights
Antenatal steroids and cesarean delivery significantly reduce the risk of early-onset intraventricular hemorrhage in very-low-birth-weight infants. These interventions appear to have independent protective effects against this serious neonatal complication.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Pediatric Neurology
Background:
- Early-onset intraventricular hemorrhage (IVH) is a significant concern in very-low-birth-weight (VLBW) infants.
- Risk factors for IVH include prematurity and delivery complications.
- Understanding protective factors is crucial for improving neonatal outcomes.
Purpose of the Study:
- To investigate the relationship between antenatal steroid administration, mode of delivery, and the incidence of early-onset intraventricular hemorrhage in VLBW infants.
- To determine if antenatal steroids and cesarean section delivery independently influence the risk of IVH.
Main Methods:
- A multicenter, prospectively randomized, controlled trial involving 505 preterm infants (birth weight 600-1250 gm) was conducted.
- The study evaluated the efficacy of postnatal indomethacin and assessed IVH using echoencephalography within 5-11 hours of life.
- Infants were analyzed based on exposure to antenatal steroids and delivery mode (vaginal vs. cesarean section).
Main Results:
- Seventy-three infants (14.5%) developed early-onset IVH.
- Infants with early IVH had lower rates of antenatal steroid treatment (19% vs. 32%) and higher rates of vaginal delivery (71% vs. 45%).
- Both antenatal steroid exposure (cesarean: 4% vs. vaginal: 17%; p=0.02) and cesarean delivery (no steroids: 10% vs. 22%; p=0.003) were associated with significantly reduced IVH risk.
Conclusions:
- Antenatal steroids and cesarean section delivery play a significant and independent role in reducing the risk of early-onset intraventricular hemorrhage in VLBW infants.
- These findings highlight the importance of these interventions in neonatal intensive care.
- Further research may explore optimal timing and protocols for these protective measures.
Objective:
The relationship between antenatal steroids, delivery mode, and early-onset intraventricular hemorrhage was examined in very-low-birth-weight infants.
Study Design:
A total of 505 preterm infants (birth weight 600 to 1250 gm) were enrolled in a multicenter, prospectively randomized, controlled trial evaluating the efficacy of postnatal indomethacin to prevent intraventricular hemorrhage. All infants had echoencephalography between 5 and 11 hours of life.
Results:
Seventy-three infants had intraventricular hemorrhage within the first 5 to 11 hours (mean age at echoencephalography 7.5 hours). Four hundred thirty-two infants did not have early intraventricular hemorrhage. There was less antenatal steroid treatment (19% vs 32%, p = 0.03) and more vaginal deliveries (71% vs 45%, p < 0.0001) in the group with early intraventricular hemorrhage. Of 152 infants who received antenatal steroids, those delivered by cesarean section had significantly less early-onset intraventricular hemorrhage than did those delivered vaginally (4% vs 17%, p = 0.02). Of the 353 not exposed to antenatal steroids, 10% of infants delivered by cesarean section and 22% delivered vaginally had early intraventricular hemorrhage (p = 0.003).
Conclusion:
These data are the first to suggest that both antenatal steroids and cesarean section delivery have an important and independent role in lowering the risk of early-onset intraventricular hemorrhage.
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