Elsevier

The Journal of Pediatrics

Volume 138, Issue 2, February 2001, Pages 198-204
The Journal of Pediatrics

Original Articles
Antenatal glucocorticoid treatment does not reduce chronic lung disease among surviving preterm infants,☆☆,

https://doi.org/10.1067/mpd.2001.110980Get rights and content

Abstract

Background: Antenatal glucocorticoid treatment (AGT) is associated with a number of postnatal benefits to the preterm infant, including reduced risk of respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, and necrotizing enterocolitis. Objective: To evaluate the hypothesis that maternal AGT not only reduces the risk of surfactant deficiency but also reduces the occurrence of chronic lung disease (CLD) among surviving preterm infants. Study Design: Case-referent study of 1454 very low birth weight infants born between January 1991 and December 1993 at 4 university medical centers. Results: Rates of AGT varied among the 4 centers (11%-69%), as did rates of CLD (4%-21%), defined as a requirement for supplemental oxygen at 36 weeks' postmenstrual age. CLD rates at each center, however, did not vary with the rate of AGT exposure. In multivariate logistic regression analyses, AGT did not contribute significantly to CLD risk. Conclusion: AGT may play a less prominent role in modifying CLD risk than other factors such as biologic immaturity, infection, or neonatal intensive care unit practices, such as mechanical ventilation, continuous positive airway pressure, and surfactant replacement therapy. (J Pediatr 2001;138:198-204)

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).

. Medical center–specific rates of antenatal glucocorticoid administration and requirement for supplemental oxygen at 28 days' postnatal age and 36 weeks' PMA

Empty Cell(N)Medical centerTotal (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.

References (22)

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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.

    ☆☆

    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).

    Reprint requests: Linda J. Van Marter, MD, MPH, Hunnewell 438, Children's Hospital, 300 Longwood Ave, Boston, MA 02115.

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