[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.197.171.35. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 863
Citations 0
Original Investigation
October 10, 2016

Association of Neurodevelopmental Outcomes and Neonatal Morbidities of Extremely Premature Infants With Differential Exposure to Antenatal Steroids

Author Affiliations
  • 1Department of Pediatrics, Wayne State University, Detroit, Michigan
  • 2Department of Pediatrics, Emory University, Atlanta, Georgia
  • 3Department of Pediatrics, University of Alabama, Birmingham
  • 4Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
  • 5Department of Pediatrics, Women and Infants Hospital, Providence, Rhode Island
  • 6Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
JAMA Pediatr. Published online October 10, 2016. doi:10.1001/jamapediatrics.2016.1936
Key Points

Question  What are the neonatal and early childhood outcomes associated with no, partial, and complete courses of antenatal steroids to preterm infants?

Finding  In this observational cohort study, antenatal steroid administration was associated with a protective effect on death or neurodevelopmental impairment. The beneficial effect of antenatal steroids was dose-dependent, with maximal benefit associated with a complete course of antenatal steroids.

Meaning  Antenatal steroids should be administered promptly, even in situations when the likelihood of a complete course of antenatal steroids is low because of insufficient time, as outcomes of premature infants born after an incomplete course of antenatal steroids are better than outcomes of infants born without exposure to any antenatal steroids.

Abstract

Importance  Many premature infants are born without exposure to antenatal steroids (ANS) or with incomplete courses. This study evaluates the dose-dependent effect of ANS on rates of neonatal morbidities and early childhood neurodevelopmental outcomes of extremely premature infants.

Objective  To compare rates of neonatal morbidities and 18- to 22-month neurodevelopmental outcomes of extremely premature infants exposed to no ANS or partial or complete courses of ANS.

Design, Setting, and Participants  In this observational cohort study, participants were extremely premature infants (birth weight range, 401-1000 g; gestational age, 22-27 weeks) who were born at participating centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 2006 and December 2011. Data were analyzed between October 2013 and May 2016.

Main Outcomes and Measures  Rates of death or neurodevelopmental impairment at 18 to 22 months’ corrected age. Neurodevelopmental impairment was defined as the presence of any of the following: moderate to severe cerebral palsy, a cognitive score less than 85 on the Bayley Scales of Infant and Toddler Development III, blindness, or deafness.

Results  There were 848 infants in the no ANS group, 1581 in the partial ANS group, and 3692 in the complete ANS group; the mean (SD) birth weights were 725 (169), 760 (173), and 753 (170) g, respectively, and the mean (SD) gestational ages were 24.5 (1.4), 24.9 (2), and 25.1 (1.1) weeks. Of 6121 eligible infants, 4284 (70.0%) survived to 18- to 22-month follow-up, and data were available for 3892 of 4284 infants (90.8%). Among the no, partial, and complete ANS groups, there were significant differences in the rates of mortality (43.1%, 29.6%, and 25.2%, respectively), severe intracranial hemorrhage among survivors (23.3%, 19.1%, and 11.7%), death or necrotizing enterocolitis (48.1%, 37.1%, and 32.5%), and death or bronchopulmonary dysplasia (74.9%, 68.9%, and 65.5%). Additionally, death or neurodevelopmental impairment occurred in 68.1%, 54.4%, and 48.1% of patients in the no, partial, and complete ANS groups, respectively. Logistic regression analysis revealed that complete (odds ratio, 0.63; 95% CI, 0.53-0.76) and partial (odds ratio, 0.77; 95% CI, 0.63-0.95) ANS courses were associated with lower rates of death or neurodevelopmental impairment compared with the no ANS group. The reduction in the rate of death or neurodevelopmental impairment associated with exposure to a complete ANS course may be mediated through a reduction in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia in the neonatal period.

Conclusions and Relevance  Antenatal steroid exposure was associated with a dose-dependent protective effect against death or neurodevelopmental impairment in extremely preterm infants. The effect was partly mediated by ANS-associated reductions in rates of severe intracranial hemorrhage and/or cystic periventricular leukomalacia. These results support prompt administration of ANS, with the goal of a complete course prior to delivery.

×