The effect of multiple courses of antenatal corticosteroid therapy on perinatal outcome of the preterm neonates / 대한산부인과학회지

OBJECTIVE: To investigate the effect of multiple courses of antenatal corticosteroid (ACS) therapy on perinatal outcomes, especially the respiratory distress syndrome (RDS), of the premature neonates. METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes of 622 singleton pregnancies delivered at 24-34 weeks of gestation from January 1996 to December 2005. Subjects were categorized into three groups according to ACS exposure: (1) a non-user group (n=234), (2) a single-course group (n=299) and (3) a repeated-course group (n=89). Univariate and multiple logistic regression analyses were used for the incidences of RDS. RESULTS: Pregnancy outcomes including gestational age at delivery, occurrence of clinical and histological chorioamnionitis, birth weight, neonatal intensive care unit (NICU) admission rate, duration of NICU stay and neonatal mortality were similar in the three groups. The incidence of RDS was significantly lower in ACS user groups than the non-user group, with lowest incidence in multiple-course group (44.9% vs. 37.8% vs. 12.4%, p<0.001). The incidence of bronchopulmonary dysplasia and overall neonatal composite morbidity were also lowest in multiple-course group. Multivariate analysis showed that multiple courses of ACS were associated with reduced incidence of RDS (OR 0.100, 95% CI 0.042, 0.240, p<0.001) independently with gestational age at delivery, admission-to-delivery interval and premature rupture of membranes. CONCLUSION: Multiple courses of ACS administered to women with risk of preterm delivery were found to be associated with decreased incidence of RDS of the premature neonates.

The effect of antenatal corticosteroid therapy on fetal growth / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to determine the effects of antenatal corticosteroid therapy on fetal growth. METHODS: We performed a retrospective analysis of 797 singleton-pregnant women with high risk of preterm delivery who admitted between 24 and 34 weeks' gestation. They were categorized into three groups; (1) no antenatal corticosteroid users (non-user group), (2) single course of corticosteroid users (single-course group), (3) multiple courses of corticosteroid users (multiple-course group). The birth weight, head circumference (HC), abdominal circumference (AC) and chest circumference (CC) of their neonates were measured. We surveyed if the neonates were small-for-gestational age (SGA) or not. RESULTS: According to antenatal corticosteroid use, 295 patients were included in the non-user group, 409 patients in the single-course group and 93 patients in the multiple-course group, respectively. The birth weight, HC, AC, CC and the rate of SGA of the neonates did not differ between any of the three groups. After adjusting the gestational age at delivery, the birth weight, HC, AC, CC and the rate of SGA of the neonates still showed no difference between any of the three groups. CONCLUSION: The antenatal corticosteroid administration to patients with risk of preterm delivery seems to have no effect on the birth weight and biometries of the neonates, and fetal growth does not seem to be associated with the number of courses of antenatal corticosteroid.

The Benefits and Risks of Multiple Courses of Antenatal Corticosteroid Therapy in Patients with Preterm Premature Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: This study was performed to determine the benefits and risks of multiple courses of corticosteroids in patients with preterm premature rupture of membranes (PPROM). METHODS: We retrospectively evaluated the pregnancy and neonatal outcomes for women of singleton pregnancy with PPROM admitted at 24-32 weeks of gestation. Patients were categorized into 3 groups according to antenatal corticosteroids exposure: (1) non-user group, (2) single-course group, (3) multiple-course group. Chi-square test, analysis of variances, Kruskal-Wallis test, and multiple logistic regression analysis were used for statistical analyses. RESULTS: A total of 170 patients were included, with 50 in non-use group, 76 in single-course group, and 44 in multiple-course group. Univariate analyses showed that clinical chorioamnionitis occurred in the highest incidence in multiple-course group (x2=6.20, p<0.05) and the decreased incidence of RDS in multiple-course group (x2=10.0, p<0.01). Multiple logistic regression analyses demonstrated that no significant association was found after adjustment of confounding variables (odds ratio=0.28, p=0.063) whereas multiple courses of corticosteroids were independently associated with clinical chorioamnionitis (odds ratio=13.15, p=0.025). CONCLUSION: Multiple courses of antenatal corticosteroids therapy did not reduce the incidence of RDS in neonates and were associated with increased risk of clinical chorioamnionitis in patients with PPROM.

The effects of multiple courses of antenatal corticosteroid therapy on perinatal outcomes in premature neonates / 대한산부인과학회잡지

OBJECTIVE: The aims of this study are to determine the effects of multiple courses of antenatal corticosteroid therapy on the perinatal outcomes, especially the respiratory outcomes of the preterm neonates and to compare them with the single course of antenatal corticosteroid therapy. METHODS: We performed a retrospective analysis of 282 mothers who admitted between 24 and 34 weeks' gestation with high risk of preterm delivery and delivered before 34 weeks' gestation. They were categorized into three groups; (1) no antenatal corticosteroid user (non-user group), (2) single course of corticosteroid user (single-course group), (3) multiple courses of corticosteroid user (multiple-course group). Then we compared the pregnancy results and the perinatal outcomes, especially the respiratory outcomes of neonates in each groups. RESULTS: One hundred twenty-four patients were included in steroid non-user group, 111 patients in single- course group and 47 patients in multiple-course group respectively. There were no statistical differences of pregnancy results including the occurrence of clinical and histological chorioamnionitis, gestational age at delivery, birth weight, neonatal intensive care unit admission rate and hospital stay, ventilator treatment rate and neonatal death among the three groups. But the duration of ventilator treatment was significantly shorter in multiple-course group. The incidence of neonatal respiratory distress syndrome was significantly lower in multiple-course group, and the incidence tends to decrease as the number of corticosteroid use increases. Multiple logistic regression analysis and Spearman's partial correlation test revealed that multiple courses of antenatal corticosteroid treatment were significantly associated with lower incidence of neonatal respiratory distress syndrome and shorter duration of ventilator treatment respectively, even after the adjustment of other independent variables. There were no significant differences of other neonatal morbidities among the three groups. CONCLUSION: Multiple doses of antenatal corticosteroid administered to patients with risk of preterm delivery is associated with shorter duration of ventilator therapy and lower incidence of respiratory distress syndrome of the premature neonates without complicating any other perinatal outcomes.