Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study
- 1Australian National University Medical School, Canberra, Australian Capital Territory, Australia
- 2Department of Neonatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Correspondence to Alison Kent, Department of Neonatology, Canberra Hospital, PO Box 11, Woden, 2606 ACT, Australia;
- Received 25 June 2013
- Revised 11 September 2013
- Accepted 18 September 2013
- Published Online First 18 October 2013
Objective To compare mortality, short-term morbidity and long-term neurodevelopmental outcomes of <29 week premature infants with antenatal steroid exposure (none, incomplete and complete).
Patients and methods Multicentre retrospective cohort study, within a geographically defined area in Australia served by a network of 10 neonatal intensive care units (NICUs), of infants <29 weeks gestational age, admitted to NICUs between 1998 and 2004. Outcome measures included hospital survival, perinatal complications and functional disability at 2–3 years follow-up.
Results 2549 neonates were included; 319 (12.5%) received no exposure to steroids. Hospital mortality (OR 0.59, 95% CI 0.45 to 0.76, p<0.001, intraventricular haemorrhage (IVH) (OR 0.58, 95% CI 0.42 to 0.81, p=0.001) and necrotising entercolitis (NEC) (OR 0.62, 95% CI 0.42 to 0.91, p=0.018) was less likely in infants with any steroid exposure. Any steroid exposure was associated with less need for surfactant (OR 0.41, 95% CI 0.30 to 0.57, p<0.001) and mechanical ventilation (OR 0.30, 95% CI 0.17 to 0.52, p<0.001). Subgroup analyses demonstrated differences in outcomes only with complete steroid coverage and not with incomplete coverage. Survival benefit and reduction in the incidence of severe IVH was evident from 24 to 28 weeks. Long-term neurodevelopmental data available for 1473 survivors showed no significant difference in outcomes with steroid exposure after multivariate analysis.
Conclusions Exposure to a complete course of antenatal steroids is associated with higher infant survival rates, lower rates of severe IVH and NEC compared to an incomplete course or no exposure. Any exposure to steroids reduces the risk of moderate cerebral palsy, however, long-term neurodevelopmental outcome may not be affected by steroid exposure.