Is there a lower limit for birth-weight/gestational age and antenatal steroid therapy?
The aim of this study was to determine if there is a lower limit for birth-weight/gestational age below which antenatal steroid therapy may not improve fetal survival. The association between antenatal steroid therapy and survival to 2 years of age was assessed in 2 cohorts of children of birth-weight below 800 g or of gestational ages below 27 weeks. Antenatal steroid therapy was associated with significantly higher survival rates in infants of birth-weight 500-599 g and 700-799 g, and at gestational ages of 25 and 26 weeks. There were few survivors before 25 weeks and none below 500 g birth-weight. After adjustment for extraneous prognostic variables, antenatal steroid therapy was associated overall with approximately a doubling of the survival rates of infants of birth-weight 500-799 g, and of gestational ages 24-26 weeks. In the absence of maternal contraindications, if the goal is to deliver a surviving infant, this study suggests that the obstetrician may assist the survival chances of the tiniest and most immature infants by treating the mother with steroids before birth, with no apparent lower limit of birth-weight or gestational age.
Doyle
L W
LW
Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
Permezel
M J
MJ
Kitchen
W H
WH
D001724:Birth Weight; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011295:Prenatal Care; D012044:Regression Analysis; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D015996:Survival Rate
D013256:Steroids