Evidence from multicenter networks on the current use and effectiveness of antenatal corticosteroids in low birth weight infants

Article Abstract:

Corticosteroids administered before birth appear to greatly reduce the risk of death and disease among in premature infants, although these hormones are not widely used. The National Institute of Child Health and Development Neonatal Research Network registry of 5,123 infants from seven sites during 1988 to 1991 was studied. Antenatal corticosteroids lowered the risk of death before 28 days and before hospital discharge. The incidence of intraventricular hemorrhage (IVH) ranged from 25% to 46% among infants not treated with the steroids. Among the infants treated with steroids, marked reductions in IVH risk were noted. The risk of pulmonary disease, including respiratory distress syndrome and bronchopulmonary dysplasia, also was lowered. Steroid use, however, increased the risk of sepsis, except for early sepsis, which was decreased. Antenatal corticosteroids are used only in about 20% of women whose babies could benefit from the treatment. Wider use is advised.

Evaluation

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Associations between use of antenatal corticosteroids and neonatal outcomes within the Exosurf Neonatal Treatment Investigational New Drug program

Article Abstract:

The combination of steroids antenatally and surfactant replacement therapy postnatally appears to substantially reduce death and disease in premature infants, compared to using surfactant alone. Lung surfactant is an agent that decreases the surface tension of pulmonary fluids. A total of 11,455 premature infants in the U.S. and Canada were enrolled in the Exosurf Neonatal Treatment Investigational New Drug program; 88% received surfactant for rescue purposes and 12% received surfactant as a preventive measure. Of the 11,077 infants whose exposure to steroids was known, 1,660 (15%) received antenatal steroids, 950 were exposed 24 hours or longer prior to delivery and 509 were exposed less than 24 hours before delivery. Sepsis appeared to increase with exposure to steroids, but most other adverse outcomes were reduced, especially mortality and intraventricular hemorrhage.

Lung surfactant, Synthetic, Synthetic lung surfactants

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Antenatal corticosteroid administration and neonatal outcome in very low birth weight infants: the NICHD Neonatal Research Network

Article Abstract:

Steroid treatment before delivery appears to help protect premature infants against many complications of prematurity by assisting in fetal maturation. Researchers for the National Institute of Child Health and Human Development Neonatal Research Network studied data from 1,910 infants exposed to antenatal steroids. Steroid treatment decreased the risk of these very low birthweight babies from neonatal death, intraventricular hemorrhage, respiratory distress syndrome, bronchopulmonary dysplasia, and early sepsis, but increased the risk of sepsis diagnosed late and necrotizing entercolitis. A full course of steroids is recommended before delivery.

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