Neonatal Med.  2018 Nov;25(4):161-169. 10.5385/nm.2018.25.4.161.

Antenatal Corticosteroids and Clinical Outcomes of Preterm Singleton Neonates with Intrauterine Growth Restriction

• Kim YJ
• Choi SH
• Oh S
• Sohn JA
• Jung YH
• Shin SH
• Choi CW
• Kim EK
• Kim HS
• Kim BI
• Lee JA

• KMID: 2436134
• DOI: http://doi.org/10.5385/nm.2018.25.4.161

Abstract

PURPOSE
We assessed the influence of antenatal corticosteroid (ACS) on the inhospital outcomes of intrauterine growth restriction (IUGR) infants.
METHODS
A retrospective study was conducted with singletons born at 23⁺⁰ to 33⁺⁶ weeks of gestation at Seoul National University Hospital from 2007 to 2014. We compared clinical outcomes between infants who received ACS 2 to 7 days before birth (complete ACS), at < 2 or >7 days (incomplete ACS), and those who did not receive ACS in IUGR and AGA infants. Multivariate logistic regression using Firth's penalized likelihood was performed.
RESULTS
304 neonates with 91 IUGR neonates were eligible. Among AGA neonates, mortality (adjusted odds ratio [aOR], 0.13; 95% confidence interval [CI], 0.02 to 0.78), hypotension within 7 postnatal days (aOR, 0.20; 95% CI, 0.06 to 0.64), and severe bronchopulmonary dysplasia (BPD) or death (aOR, 0.24; 95% CI, 0.07 to 0.77) were lower in complete ACS group after adjusting for pregnancy induced hypertension and uncontrolled preterm labor. Mortality (aOR, 0.18; 95% CI, 0.04 to 0.78), hypotension (aOR, 0.26; 95% CI, 0.09 to 0.70), and severe BPD or death (aOR, 0.33; 95% CI, 0.12 to 0.92) were also lower in the incomplete ACS group. Among IUGR infants, after adjusting for birth weight and 5-minute Apgar score, inhaled nitric oxide use within 14 postnatal days was lower in both complete ACS (aOR, 0.07; 95% CI, 0.01 to 0.67) and incomplete ACS (aOR, 0.04; 95% CI, 0.01 to 0.37) groups.
CONCLUSION
ACS was not effective in reducing morbidities in IUGR preterm infants.

Keyword

Prenatal care; Steroids; Fetal growth retardation; Premature infant; Outcome assessment (health care)

MeSH Terms

Adrenal Cortex Hormones*
Apgar Score
Birth Weight
Bronchopulmonary Dysplasia
Female
Fetal Growth Retardation
Humans
Hypertension, Pregnancy-Induced
Hypotension
Infant
Infant, Newborn*
Infant, Premature
Logistic Models
Mortality
Nitric Oxide
Obstetric Labor, Premature
Odds Ratio
Outcome Assessment (Health Care)
Parturition
Pregnancy
Prenatal Care
Retrospective Studies
Seoul
Steroids
Adrenal Cortex Hormones
Nitric Oxide
Steroids

Figure

• 

  Figure 1. Flow chart of the study population. A total of 340 singleton infants born at 23+0 to 33+6 weeks age of gestation between January 2007 and December 2014, satisfying the inclusion criteria of eligibility for this study. There was no significant difference in the proportion of each group divided according to antenatal corticosteroid (ACS) use (P=0.271). Abbreviations: AGA, appropriate for gestational age; IUGR, intrauterine growth restriction.

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