Impact of Antenatal Corticosteroid Therapy in Very Low Birth Weight Infants on Chronic Lung Disease and Other Morbidities of Prematurity

Abstract

OBJECTIVE:To assess the effect of antenatal corticosteroids on very low birth weight (VLBW) infants through 36 weeks' postconceptional age. STUDY DESIGN:Data were collected prospectively on all VLBW (Յ1500 gm) infants (n ϭ 670) admitted to a single newborn intensive care unit from 1991 to 1996. Mortality rate and the frequency of medical morbidities attributable to prematurity were compared between VLBW infants who received antenatal corticosteroid therapy and those who did not. RESULTS:Antenatal steroid therapy was associated with a significantly lower rate of mortality ( p ϭ 0.02) and of mortality due to respiratory causes ( p ϭ 0.01). Although the frequency of chronic lung disease (oxygen requirement at 36 weeks' postconceptional age) was not significantly different between the groups ( p ϭ 0.48), the frequency of infants surviving without chronic lung disease was significantly greater in the steroid-exposed group ( p ϭ 0.02). There were no significant differences between the groups in the frequency of sepsis, necrotizing enterocolitis, length of hospital stay, or retinopathy of prematurity requiring surgery. CONCLUSION:In our study, antenatal corticosteroid therapy was associated with a beneficial effect on mortality and respiratory morbidity for VLBW infants and was not associated with any known increased risks.In 1972, Liggens and Howie 1 first reported the use of antenatal corticosteroid therapy (ANS) for the prevention of respiratory distress syndrome (RDS) in premature infants. Meta-analysis of subsequent studies conducted in the 1970s and 1980s noted not only a lower frequency of RDS but also an increased neonatal survival rate, a decrease in the frequency of intraventricular hemorrhage (IVH), and no clear-cut evidence of adverse effects. 2 Despite published data demonstrating the efficacy of ANS, Ͻ20% of women in the United States in preterm labor received ANS in 1992. 3 Although ANS use has increased since the panel of the 1994 National Institutes of Health Consensus Conference on the Effect of Corticosteroids for Fetal Maturation and Perinatal Outcomes recommended the use of corticosteroids for the majority of women in premature labor, ϳ45% of women in preterm labor did not receive ANS in 1996. 3 Although the primary focus of most published clinical studies of ANS has been the prevention of RDS, animal and human data indicate that corticosteroids induce maturation of other organ systems besides the lung. 4 Our study focused on assessing the efficacy of ANS in reducing the frequency of neonatal morbidities associated with prematurity, other than RDS. We specifically looked at chronic lung disease (CLD), IVH, cystic periventricular leukomalacia (PVL), patent ductus arteriosus (PDA), surgery for retinopathy of prematurity, and mortality. We also reviewed the association of corticosteroids with necrotizing enterocolitis (NEC) and neonatal sepsis. METHODSAll very low birth weight (VLBW) infants admitted to the newborn intensive care unit at the University of New Mexico Hospital between May of 1991 and Ju...

Population-based study of bronchopulmonary dysplasia in very low birth weight infants in Switzerland

“…In other words, further improvement of ventilatory strategies and administration of NCPAP may be less likely to have a dramatic impact on BPD rates. However, other factors not investigated in this study such as prenatal infection and inflammation [6,20] or factors affecting lung growth [3,9,13,21] may have an effect on the remaining incidence and could therefore be a target for further improvement.…”

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…The effect of antenatal steroids on LONS is less clear. While the NICHD Neonatal Network found an increased risk for LONS in infants exposed to antepartum corticosteroids (OR, 1.29; CI, 1.10 to 1.51) (507), other studies have not found this association (212,499). In any case, the benefits of antenatal steroids, including decreased mortality, intraventricular hemorrhage, respiratory distress syndrome, and EONS, strongly outweight the risk for LONS.…”

Efficacy of dexamethasone for lung maturity in preterm delivery in association with lamellar bodies count

“…Immaturity of the lungs commonly occurs in preterm infants and may lead to RDS caused by the deficiency of surfactant called as HMD. 3,8,11,[15][16][17][18][19] Because of its efficacy, our hospital policy recommends the use of prenatal dexametasone for women at risk of preterm delivery. 20 Antenatal dexamethasone therapy may decrease the incidence of RDS caused by HMD in preterm infants.…”

“…Thus, its assessment is very important in preterm infant management. [11][12][13][14] A study on the association of lamellar bodies with lung maturity by Atlanta Maternal Fetal medical suggests cut off point of lung maturity is 16,000/mL. 15 This study aimed to determine the efficacy of dexamethasone for lung maturity in preterm delivery measured by lamellar bodies count.…”