Original ArticlesAntenatal glucocorticoid treatment does not reduce chronic lung disease among surviving preterm infants☆,☆☆,★
Section snippets
Methods
This non-randomized observational study of antecedents of CLD was nested in an epidemiologic study of 1607 infants born weighing 500 to 1500 g between January 1991 and December 1993 at 4 medical centers in Massachusetts, New York, and New Jersey.6 All of the centers were metropolitan academic high-risk referral centers with both high-risk perinatal services and newborn intensive care units. The final analyses included all infants who survived until 36 weeks' postmenstrual age and for whom
Results
A total of 1454 study infants survived to 36 weeks' PMA and therefore were eligible for inclusion in the analyses. Rates of CLD and antenatal glucocorticoid administration differed markedly among the 4 medical centers (Table I).Empty Cell (N) Medical center Total (1454) Center A (732) Center B (293) Center C (170) Center D (259) Oxygen required at 28 d (508) 45
Discussion
In this large multicenter study of VLBW infants, neither a partial nor a complete course of AGT was associated with reduced rates of CLD. This finding contrasts with observational studies,4, 5 conducted before surfactant treatment was routinely administered to infants with respiratory distress syndrome, which demonstrated lower rates of CLD among preterm infants born to mothers who had received AGT. Like others, we found inter-center variation in the use of AGT.5, 10 However, the current
Acknowledgements
We are grateful to the parents of the study infants for their participation in this study. In addition, we thank our nursing and respiratory therapy colleagues for their support and assistance with this research project. We would especially like to acknowledge the contributions of David Beadles and Michael Jackson for their insights concerning neonatal respiratory management and Katherine Holahan for her assistance in manuscript preparation.
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Cited by (49)
Maternal Asthma, Preterm Birth, and Risk of Bronchopulmonary Dysplasia
2015, Journal of PediatricsCitation Excerpt :There is a complex relationship between antenatal corticosteroid use and the development of BPD. Some previous studies have not identified such a relationship,17-20 whereas other studies have found this relationship.21,22 Gagliardi et al23 suggested that previous studies overcorrected in their modeling, including mediators for the development of BPD such as severity of early disease, duration of mechanical ventilation, and patent ductus arteriosus, and concluded that antenatal steroids do have an effect on BPD.23
Predictors of bronchopulmonary dysplasia
2012, Clinics in PerinatologyCitation Excerpt :Therefore, antenatal steroids were initially believed to decrease the risk of BPD.30 In a multivariate analysis, Van Marter and colleagues31 examined the independent effect of antenatal steroids on the risk of BPD. They found that treatment with either a partial or full course of antenatal steroids did not convey any additional benefit in reducing the likelihood of BPD after adjustment for other important confounders, such as gestational age, infection, and respiratory management strategies (odds ratio [OR], 0.98; 95% CI, 0.66, 1.5).
Myth: Mechanical ventilation is a therapeutic relic
2011, Seminars in Fetal and Neonatal MedicineCitation Excerpt :One of these eight units (Columbia University) managed babies with CPAP from birth and had significantly lower rates of CLD at comparative gestations. Because this study was performed in pre-surfactant era, Van Marter did another comparison in the surfactant era4 and confirmed that the use of mechanical ventilation on day 1 increased the odds of an infant developing CLD. These studies were observational, and the findings require confirmation from randomised controlled trials.
New Developments in the Presentation, Pathogenesis, Epidemiology and Prevention of Bronchopulmonary Dysplasia
2008, The Newborn Lung: Neonatology Questions and ControversiesNasal CPAP or intubation at birth for very preterm infants
2008, New England Journal of MedicineBronchopulmonary dysplasia
2021, Perinatology: Evidence-Based Best Practices in Perinatal Medicine
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*Neonatology Committee: Farrokh Shahrivar, MD , Thomas Hegyi, MD , Mark Hiatt, MD , Ulana Sanocka, MD , and Linda J. Van Marter, MD, MPH.
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Supported by funds provided by the National Institutes of Neurological Disorders and Stroke (NS 27306) and the National Heart, Lung, and Blood Institute (HL 56398).
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Reprint requests: Linda J. Van Marter, MD, MPH, Hunnewell 438, Children's Hospital, 300 Longwood Ave, Boston, MA 02115.