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Effects of Antenatal Corticosteroid Administration on Mortality and Long-term Morbidity in Early Preterm, Growth-Restricted Infants

From the Departments of Obstetrics and Neonatology, Academic Medical Center, University of Amsterdam, Amsterdam; the Department of Obstetrics, University Medical Center, Utrecht; and the Department of Neonatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands.

Address reprint requests to: Arty H. Schaap, MD P.O. Box 22660 1100 DD Amsterdam The Netherlands E-mail: A.H.Schaap{at}amc.uva.nl

Objective: To evaluate the effect of antenatal corticosteroids on mortality, morbidity, and disability or handicap rate in early preterm, growth-restricted infants.

Methods: This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insufficiency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26–32 weeks during the years 1984–1991. Infants who had been treated antenatally with corticosteroids more than 24 hours and less than 7 days before birth were matched by birth weight, sex, and year of birth with infants whose mothers had been admitted more than 24 hours before delivery but were not treated antenatally with steroids. The main outcome measure was survival without disability or handicap at 2 years corrected age. A sample of 60 case-control pairs would give 81% power to demonstrate 50% increase of this outcome [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire.

Results: The study group and control group consisted of 62 infants each. Survival without disability or handicap at 2 years’ corrected age was more frequent in the corticosteroid group [OR 3.2, confidence interval (CI) 1.1, 11.2]. In the long-term follow-up at school age there was a statistically significant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected.

Conclusion: Benefits from antenatal corticosteroids for early preterm, growth-restricted infants appear to outweigh possible adverse effects.

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