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BJOG. 2018 Aug;125(9):1164-1170. doi: 10.1111/1471-0528.15014. Epub 2017 Dec 14.

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE-2 cohort study.

Author information

1
IMR 1027 INSERM, Team SPHERE, Toulouse III University, Toulouse, France.
2
Department of Medical Information, Albi Hospital, Albi, France.
3
Neonatal Intensive Care Unit, CHU Toulouse, Toulouse University, Toulouse, France.
4
Department of Neonatal Intensive Care Unit, Jeanne de Flandre Hospital, CHRU Lille, Lille, France.
5
Department of Obstetrics and Gynaecology, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France.
6
UMR 1053 INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France.
7
Port-Royal Maternity, CHU Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.
8
Clinical Research Unit, Center for Clinical Investigation P1419, CHU Cochin Broca Hôtel-Dieu, Paris, France.
9
Clinical Epidemiology Unit, Toulouse III University, Toulouse, France.
10
Department of Obstetrics and Gynaecology, Paule de Viguier Hospital, CHU Toulouse, Toulouse, France.

Abstract

OBJECTIVES:

To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short-term neonatal outcomes in preterm twins, and further document the influence of the ACS-to-delivery interval.

DESIGN:

EPIPAGE-2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation.

SETTING:

All French maternity units, except in a single administrative region, between March and December 2011.

POPULATION:

A total of 750 twin neonates born between 24 and 31 weeks of gestation.

METHODS:

Exposure to ACSs was examined in four groups: single complete course, with an ACS administration-to-delivery interval of ≤7 days; single complete course, with an ACS-to-delivery interval of >7 days; repeated courses; or no ACS treatment.

MAIN OUTCOME MEASURES:

Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in-hospital mortality, and a composite indicator of severe outcomes.

RESULTS:

Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration-to-delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1-0.5), in-hospital mortality (0.3; 0.1-0.6), and the composite indicator (0.1; 0.1-0.3), whereas a single course of ACDs with an administration-to-delivery interval of >7 days did not significantly reduce the frequency of in-hospital mortality (0.7; 0.3-1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course.

CONCLUSION:

In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in-hospital mortality was seen only when the ACS-to-delivery interval was ≤7 days.

TWEETABLE ABSTRACT:

A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24-31 weeks).

KEYWORDS:

Antenatal corticosteroids; betamethasone; prematurity; preterm birth; preterm delivery; short-term morbidity; steroid-to-delivery interval; twin pregnancy; twins

PMID:
29119673
DOI:
10.1111/1471-0528.15014

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