Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis

• K. Miyazaki
• M. Furuhashi
• K. Ishikawa
• K. Tamakoshi
• K. Hayashi
• A. Kai
• H. Ishikawa
• N. Murabayashi
• T. Ikeda
• Y. Kono
• S. Kusuda
• M. Fujimura

Abstract

Purpose. To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA).

Methods. We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22+ 0 and 33+ 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurode- velopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis.

Results. In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded with­out data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95% confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quo­tient \70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was as­sociated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was asso- ciated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)].

Conclusion. AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.

Arch Gynecol Obstet. 2015; Vol. 292 (6): 1239-46.

doi: 10.1007/s00404-015-3762-6.

Keywords:histologic chorioamnionitis, antenatal corticosteroids, neurodevelopmental outcome, cerebral palsy, very premature infants

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