Effect of antenatal corticosteroids therapy on the mortality and morbidity of small for gestational age infants born at 24-34 completed weeks: a retrospective multicenter study / 中华儿科杂志

ABSTRACT

Objective@#To assess the impact of antenatal corticosteroids (ACS) therapy on mortality and morbidities in small for gestational age (SGA) preterm infants.@*Method@#A retrospective database analysis was performed. Preterm infants born at 24-34 completed weeks who were diagnosed as SGA in 14 hospitals in China between 2013 and 2014 were evaluated for mortality and major morbidities including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotising enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis. These cases were classified into two groups ACS group and non-ACS group (NACS). Multivariate logistic regression analysis was performed to assess the effect of ACS on neonatal mortality and morbidities.@*Result@#Among the 6 437 infants born at 24-34 completed weeks, 602 were SGA(9.4%), and ACS was administered to 3 432 infants (53.3%). Among SGA infants at gestational age (GA) of 24-31 completed weeks, ACS treatment were associated with decreased mortality (16.9%(13/77) vs. 32.1%(17/53), χ2=4.082, P<0.05), incidence of RDS (48.1%(37/77) vs. 79.2%(42/53), χ2=12.183, P<0.05) and incidence of severe RDS (33.8%(26/77) vs. 55.6%(30/53), χ2=6.677, P<0.05). The incidence of IVH was higher in ACS group than that in NACS group (10.9%(27/248) vs. 5.8%(13/224), χ2=3.921, P<0.05) among 32-34 completed weeks infants. There were no significant differences between the ACS group and the NACS group in the incidence of BPD, NEC, ROP, PDA and sepsis (P all >0.05). Multivariate logistic regression analysis demonstrated a decreased mortality (OR=0.375, 95% confidence interval (CI) 0.188-0.749, P=0.005)and incidence of RDS (OR=0.697, 95% CI 0.462-0.953, P=0.041) in SGA infants exposed to antenatal steroids. There were no significant differences in BPD, IVH, NEC, ROP, PDA and sepsis risks in ACS group compared with NACS group (P all >0.05).@*Conclusion@#ACS administration could reduce the mortality and major morbidities in SGA preterm infants less than 32 weeks GA. This study suggests that ACS should be given to growth restricted fetuses at risk of preterm delivery in order to improve perinatal outcome.