Journal List > Perinatology > v.29(3) > 1102885

Park, Kim, and Kim: The Effects of Incomplete Antenatal Corticosteroid Therapy Prior to Delivery on Clinical Outcomes of Preterm Infants

Abstract

Objective

To investigate the effect of incomplete antenatal corticosteroid therapy (ACST) prior to delivery on clinical outcomes of preterm infants.

Methods

Preterm infants born between 24 0/7 and 33 6/7 weeks of gestation from 2010 through 2016 were included and divided into the three groups according to the ACST; the no ACST group, the incomplete ACST group (inadequate dose of antenatal corticosteroid in pregnancy), and the complete ACST group (recommended dose of antenatal corticosteroid in pregnancy). The effect of risk factors including ACST on clinical outcomes of preterm infants was further explored using logistic regression analysis.

Results

Among 198 infants who fulfilled the study criteria, 32 (16.2%) were classified as the no ACST group, 71 (35.9%) as the incomplete ACST group, and 95 (48.0%) as the complete ACST group. The incidence of low Apgar score at 5-minutes (≤4) was significantly higher in the no ACST group than in the complete ACST group (adjusted odds ratio [OR] 4.49; 95% confidence interval [CI] 1.41-14.32; P=0.011). The incidence of necrotizing enterocolitis (NEC, stage ≥2a) was not different between the no ACST group and the incomplete/the complete group, but significantly higher in the incomplete ACST group than in the complete ACST group (adjusted OR 10.49; 95% CI 1.13-97.28; P=0.039).

Conclusion

Incomplete ACST within 24 hours prior to delivery appears to significantly increase NEC (stage ≥2a) in preterm infants born between 24 0/7 and 33 6/7 weeks gestation.

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Fig. 1
Flow diagram showing the study design of 198 preterm infants included in this study. ACST, antenatal corticosteroid therapy.
pn-29-101f1.tif
Fig. 2
Distribution of gestational age at birth of each subgroup. ACST, antenatal corticosteroid therapy.
pn-29-101f2.tif
Table 1.
Clinical Characteristics of the Study Subjects by Group
Characteristic No ACST (n=32) ACST Total (n=166)
Incomplete ACST (n=71) Complete ACST (n=95)
Male 16 (50) 30 (42) 54 (57) 84 (51)
Cesarean section 12 (38) 51 (72) 56 (59) 59 (36)
Gestational age (weeks) 30.0±2.9 29.5±2.8 30.0±2.7 29.84±2.9
Birth weight (g) 1,580.2±704.6 1,465.6±626.4 1,426.5±547.0 1,443.2±537.0
Head circumference (cm) 27.6±3.5 27.5±3.8 27.3±3.0 27.4±3.1
1-min Apgar scores 5.0 (4.0-7.0) 5.0 (4.5-7.0) 6.0 (5.0-8.0) 6.0 (5.0-7.0)
5-min Apgar scores 8.0 (6.0-9.0) 8.0 (7.0-9.0) 8.0 (7.5-9.0) 8.0 (7.0-9.0)
Gestational diabetes 1 (0) 3 (4) 6 (6) 9 (5)
Preeclampsia 3 (1) 10 (14) 22 (23) 32 (19)
PPROM 5 (16) 12 (17) 39 (41) 51 (31)
HCAM 14 (44) 30 (42) 44 (46) 74 (45)

Nonparametric data denote the median with interquartile range. Abbreviations: ACST, antenatal corticosteroid therapy; PPROM, preterm premature rupture of membrane; HCAM, histologic chorioamnionitis.

P<0.05 vs. complete ACST.

P<0.05 vs. no ACST.

Table 2.
Neonatal Outcomes of the Study Subjects by Group
Outcome No ACST (n=32) ACST Total (n=166)
Incomplete ACST (n=71) Complete ACST (n=95)
Mortality 4 (12) 6 (8) 5 (5) 11 (7)
BPD (≥moderate) 7 (22) 9 (13) 10 (11) 19 (11)
5-min Apgar scores (≤4) 11 (34) 11 (15) 15 (16) 26 (16)
Sepsis (early-onset) 1 (3) 4 (5) 6 (6) 10 (6)
IVH (stage ≥3) 2 (6) 5 (7) 5 (5) 10 (6)
ROP (stage ≥3) 1 (3) 4 (6) 6 (6) 10 (6)
NEC (stage ≥2a) 2 (6) 6 (8) 1 (1) 7 (4)
PDA 16 (50) 29 (41) 39 (41) 68 (41)
RDS 17 (53) 39 (55) 45 (47) 84 (50)

Abbreviations: ACST, antenatal corticosteroid therapy; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity; NEC, necrotizing enterocolitis; PDA, patent ductus arteriosus; RDS, respiratory distress syndrome.

P<0.05 vs. no ACST.

P<0.05 vs. complete ACST.

Table 3.
Multiple Logistic Regression Analysis for Neonatal Outcomes According to the Antenatal Corticosteroid Therapy to Birth Interval
Outcome No ACST relative to complete ACST No ACST relative to incomplete ACST Incomplete ACST relative to complete ACST
Adjusted OR CI P-value Adjusted OR CI P-value Adjusted OR CI P-value
Mortality 2.64 0.40-17.47 0.31 2.72 0.53-14.05 0.23 1.99 0.45-8.82 0.37
5-min Apgar scores (≤4) 4.49 1.41-14.32 0.011 3.38 1.19-9.59 0.022 0.91 0.36-2.32 0.85
Sepsis (early-onset) 0.24 0.02-2.61 0.24 0.41 0.04-4.62 0.47 0.91 0.21-3.88 0.90
BPD (≥moderate) 1.54 0.49-4.89 0.46 1.15 0.36-3.72 0.82 1.11 0.43-2.87 0.84
IVH (stage ≥3) 0.79 0.09-6.72 0.83 1.14 0.17-7.57 0.89 1.46 0.33-6.50 0.62
ROP (stage ≥3) 2.54 0.13-47.98 0.54 1.14 0.07-17.91 0.92 0.68 0.14-3.36 0.64
NEC (stage ≥2a) 6.16 0.47-81.24 0.17 0.74 0.11-5.20 0.76 10.49 1.13-97.28 0.039
RDS 1.62 0.41-4.26 0.33 1.11 0.44-2.84 0.82 1.45 0.71-2.96 0.32
PDA 1.86 0.73-4.74 0.19 2.06 0.75-5.69 0.16 1.00 0.44-2.23 0.99

Abbreviations: ACST, antenatal corticosteroid therapy; OR, odds ratio; CI, confidence interval; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity; NEC, necrotizing enterocolitis; PDA, patent ductus arteriosus; RDS, respiratory distress syndrome.

Adjusted for antenatal corticosteroid therapy, gestational age, birth weight, delivery mode, and histologic chorioamnionitis.

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