Is there a beneficial effect of single dose antenatal steroid therapy on mortality and morbidities in infants <30 weeks gestational age?

Year 2022, Volume: 12 Issue: 2, 165 - 169, 31.08.2022

Handan Bezirganoglu Fatma Nur Sari Serife Suna Oguz Evrim Alyamac Dizdar Alyamac Dizdar Mehmet Buyuktiryaki

Abstract

Aim: Our knowledge regarding the impact of single dose antenatal corticosteroid treatment on neonatal morbidities of VLBW is still scarce. In this study we aimed evaluate outcomes of infants born <30 weeks' gestation that received no ACS, partial course of ACS, and complete course of ACS.
Material and Method: In this retrospective study, infants <30 weeks in gestation at birth were included and divided into three groups based on exposure to ACS; Group 1, infants born without ACS exposure, Group 2, infants born after exposure to one dose of betamethasone, Group 3, infants born after exposure to complete course. Our primary outcome was mortality. Secondary outcomes included the following: PDA, NEC, severe IVH, bronchopulmonary dysplasia, and cystic periventricular leukomalacia (PVL).
Results: 616 infants were included. The incidence of chorioamnionitis was significantly higher in the complete course ACS group ( p<0.05). The mortality rate was highest in the no ACS group (16.0%) compared to other groups but not statistically different. There was a trend toward lower morbidity in the partial course ACS group compared to none.
Conclusion: As a result, we found no statistically significant benefit of incomplete antenatal corticosteroids in infants born <30 weeks' gestation.

Keywords

antenatal corticosteroids, betamethasone, neonatal outcomes, very low birth weight infants

References

• 1. Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515-25.
• 2. Vyas J, Kotecha S. Effects of antenatal and postnatal corticosteroids on the preterm lung. Arch Dis Child Fetal Neonatal Ed. 1997;77(2):F147-50.
• 3. Laudy JA, Wladimiroff JW. The fetal lung. 1: Developmental aspects. Ultrasound Obstet Gynecol. 2000;16(3):284-90.
• 4. Schwab M, Roedel M, Anwar MA, Muller T, Schubert H, Buchwalder LF, et al. Effects of betamethasone administration to the fetal sheep in late gestation on fetal cerebral blood flow. J Physiol. 2000;528(Pt 3):619-32.
• 5. McGoldrick E, Stewart F, Parker R, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2020 Dec 25;12(12): CD004454.
• 6. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consensus Development Panel on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. JAMA. 1995;273(5):413-8.
• 7. Elimian A, Figueroa R, Spitzer AR, Ogburn PL, Wiencek V, Quirk JG. Antenatal corticosteroids: are incomplete courses beneficial? Obstet Gynecol. 2003;102(2):352-5.
• 8. Costa S, Zecca E, De Luca D, De Carolis MP, Romagnoli C. Efficacy of a single dose of antenatal corticosteroids on morbidity and mortality of preterm infants. Eur J Obstet Gynecol Reprod Biol. 2007;131(2):154-7.
• 9. Alexander JM, Gilstrap LC, Cox SM, McIntire DM, Leveno KJ. Clinical chorioamnionitis and the prognosis for very low birth weight infants. Obstet Gynecol. 1998;91(5 Pt 1):725-9.
• 10. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187(1):1-7.
• 11. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529-34.
• 12. Özkan H, Erdeve Ö, Kutman HGK. Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment. Turk Pediatri Ars. 2018;53(Suppl 1):S45-S54
• 13. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Care Med. 2001;163:1723–29.
• 14. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006(3):CD004454
• 15. Schmidt AF, Kemp MW, Rittenschober-Bohm J, Kannan PS, Usuda H, Saito M, et al. Low-dose betamethasone-acetate for fetal lung maturation in preterm sheep. Am J Obstet Gynecol. 2018;218(1):132 e1- e9.
• 16. Ballard PL, Ning Y, Polk D, Ikegami M, Jobe AH. Glucocorticoid regulation of surfactant components in immature lambs. Am J Physiol. 1997;273(5):L1048-57.
• 17. Norman J, Shennan A, Jacobsson B, Stock SJ; FIGO Working Group for Preterm Birth. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm. Int J Gynaecol Obstet. 2021 Oct;155(1): 26-30.
• 18. Chawla S, Natarajan G, Rane S, Thomas R, Cortez J, Lua J. Outcomes of extremely low birth weight infants with varying doses and intervals of antenatal steroid exposure. J Perinat Med. 2010;38(4):419-23.
• 19. Salhab WA, Hynan LS, Perlman JM. Partial or complete antenatal steroids treatment and neonatal outcome in extremely low birth weight infants < or =1000 g: is there a dose-dependent effect? J Perinatol. 2003;23(8):668-72.
• 20. Figueras-Aloy J, Serrano MM, Rodríguez JP, Pérez CF, Serradilla VR, SEN1500 Spanish Neonatal Network et al. Antenatal glucocorticoid treatment decreases mortality and chronic lung disease in survivors among 23- to 28-week gestational age preterm infants. Am J Perinatol. 2005 Nov;22(8):441-8
• 21. Kemp MW, Saito M, Usuda H, Watanabe S, Sato S, Hanita T, et al. The efficacy of antenatal steroid therapy is dependent on the duration of low-concentration fetal exposure: evidence from a sheep model of pregnancy. Am J Obstet Gynecol. 2018;219(3):301 e1- e16.
• 22. Miracle X, Di Renzo GC, Stark A, Fanaroff A, Carbonell-Estrany X, Saling E, et al. Guideline for the use of antenatal corticosteroids for fetal maturation. J Perinat Med. 2008;36(3):191-6.
• 23. Peaceman AM, Bajaj K, Kumar P, Grobman WA. The interval between a single course of antenatal steroids and delivery and its association with neonatal outcomes. Am J Obstet Gynecol. 2005;193(3 Pt 2):1165-9.
• 24. Schmitz T, Alberti C, Ursino M, Baud O, Aupiais C, Group Bs et al. Full versus half dose of antenatal betamethasone to prevent severe neonatal respiratory distress syndrome associated with preterm birth: study protocol for a randomised, multicenter, double blind, placebo-controlled, non-inferiority trial (BETADOSE). BMC Pregnancy Childbirth. 2019;19(1):67.
• 25. Doyle LW, Kitchen WH, Ford GW, Rickards AL, Lissenden JV, Ryan MM. Effects of antenatal steroid therapy on mortality and morbidity in very low birth weight infants. J Pediatr. 1986;108(2):287-92.
• 26. Watterberg KL, Demers LM, Scott SM, Murphy S. Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops. Pediatrics. 1996;97(2):210-5.