Shorter Intervals of Antenatal Corticosteroid Administration Can Influence Short- and Long-Term Outcomes in Premature Infants

Abstract

Background: Studies examining shorter intervals between antenatal corticosteroid administration (ACS) and delivery are limited. This study analyzed effects of the timing of ACS on short-term and long-term outcomes in premature infants. Methods: This retrospective cohort study analyzed 534 deliveries between 220/7 and 296/7 gestational weeks, from January 2008 through December 2015, at the Department of Obstetrics and Gynecology of the University Hospital in Ulm, Germany. The initiation of antenatal corticosteroids to delivery was categorized using cutoffs of >/≤24 hours. The study reported on gestational age, birthweight, the time interval between the first ACS and delivery, Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score, umbilical pH, delivery mode, incidences of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), the use of surfactant, as well as the neurodevelopment after 2 years (mental development index (MDI) and psychomotor development index (PDI)), and mortality. Results: Gestational ages were significantly advanced in the >24 hours group (p < 0.001). The incidences of BPD and IVH were significantly higher in neonates with less than 24 hours to delivery (BPD: 51.0% vs. 41.2%, p = 0.045; IVH: 10.5% vs. 3.0%, p = 0.001). There were no significant differences in ROP (p = 0.083), NEC (p = 0.856), or neurodevelopment after 2 years (MDI: p = 0.465, PDI: p = 0.116). Conclusions: Complications such as NEC and ROP, along with long-term neurological outcomes, do not seem to be influenced by shorter ACS intervals. In contrast, BPD, IVH, and surfactant administration appear to occur more frequently with ACS <24 hours.

Keywords

• antenatal corticosteroid administration
• premature infants
• respiratory distress syndrome
• bronchopulmonary dysplasia
• intraventricular hemorrhage