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BJOG. 2016 Oct;123(11):1779-86. doi: 10.1111/1471-0528.13723. Epub 2015 Nov 10.

Antenatal corticosteroid treatment in singleton, small-for-gestational-age infants born at 24-31 weeks' gestation: a population-based study.

Author information

1
Department of Obstetrics and Gynaecology, Lady Davis Carmel Medical Center, Haifa, Israel. shlomitri@gmail.com.
2
Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. shlomitri@gmail.com.
3
Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
4
Department of Neonatology, Bnai Zion Medical Centre, Haifa, Israel.
5
Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel.
6
Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.

Abstract

OBJECTIVE:

To assess the impact of antenatal corticosteroid therapy on mortality and severe morbidities in preterm, small-for-gestational-age (SGA) neonates compared with preterm non-SGA neonates.

DESIGN:

Population-based study.

SETTING/POPULATION:

Israel National Very Low Birth Weight infant database from 1995-2012.

METHODS:

Singleton infants of 24-31 weeks' gestation, without major malformations. Antenatal corticosteroids were considered either any treatment or no treatment.

MAIN OUTCOME MEASURES:

Univariate and multivariable logistic regression analyses were performed to assess the effect of antenatal corticosteroids on neonatal mortality and a composite adverse outcome of mortality or severe neonatal morbidity.

RESULTS:

Among the 10 887 study infants, 1771 were SGA. Of these, 70.4% of SGA and 66.7% of non-SGA neonates were exposed to antenatal corticosteroids. Among SGA neonates, antenatal corticosteroids were associated with decreased mortality (32.2 versus 19.3%, P < 0.0001) and composite adverse outcome (54.1 versus 43.4%, P < 0.0001), similar to the effect in non-SGA neonates (mortality 26.7 versus 12.2%, P < 0.0001; composite outcome 50.5 versus 34.6%, P < 0.0001). Multivariable logistic regression analyses demonstrated a 50% reduction in mortality risk among SGA and 57% reduction in non-SGA neonates exposed to corticosteroids [OR = 0.50, 95% confidence interval (95% CI) 0.39-0.64 and OR = 0.43, 95% CI 0.38-0.47, respectively], P-value for interaction = 0.08. Composite adverse outcome risk was significantly reduced in SGA (OR = 0.67, 95% CI 0.54-0.83) and non-SGA infants (OR = 0.57, 95% CI 0.52-0.63), P-value for interaction = 0.04.

CONCLUSIONS:

Antenatal corticosteroids significantly reduced mortality and severe morbidities among preterm SGA neonates, with slightly a less pronounced effect compared with non-SGA preterm infants. Antenatal corticosteroids should be given to fetuses suspected of intrauterine growth retardation, at risk for preterm delivery, in order to improve perinatal outcome.

TWEETABLE ABSTRACT:

Antenatal steroids reduced mortality and severe morbidities among singleton, preterm SGA neonates.

KEYWORDS:

Adverse perinatal outcome; antenatal corticosteroids; intrauterine growth restriction; preterm delivery; small for gestational age

PMID:
26552861
DOI:
10.1111/1471-0528.13723
[Indexed for MEDLINE]
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