Effect of maternal glucocorticoid exposure on risk of severe intraventricular hemorrhage in surfactant-treated preterm infants.
OBJECTIVE
To determine whether the reduced risk of severe intraventricular hemorrhage (SIVH) that follows antenatal maternal glucocorticoid (AMG) receipt is mediated by an AMG effect on blood pressure or improved respiratory function in infants who receive artificial surfactant as rescue therapy.


METHODS
Retrospective cohort study.


METHODS
Two level III neonatal intensive care units, Boston, Mass.


METHODS
Two hundred twenty-five infants < or = 32 weeks of gestational age and < or = 1.7 kg birth weight, treated with surfactant.


RESULTS
SIVH occurred in 10% (10/102) of infants who were exposed to AMG, compared with 23% (25/111) of infants not exposed (odds ratio, 0.4; 95% confidence interval, 0.2 to 0.8). Hypotension and need for colloid or dopamine were associated with both SIVH and the absence of AMG exposure (p < or = 0.03). Logistic regression models of SIVH risk and AMG exposure, with adjustment for antenatal potential confounders, were altered by the addition of measures of hypotension. Most clinical measures of pulmonary function, both before and after surfactant receipt, were not associated with reduced risk of SIVH and did not appear to account for the increased risk of SIVH in babies not exposed to AMG.


CONCLUSIONS
The reduced risk of SIVH in preterm newborn infants whose mothers received AMG was associated with normal blood pressures. The association between AMG and SIVH was not consistently enhanced by respiratory function improvement after surfactant therapy.
Joint Program in Neonatology, Harvard Medical School, Boston, Massachusetts.
J S
JS
Garland
R
R
Buck
A
A
Leviton
D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D002552:Cerebral Ventricles / Q000000981:diagnostic imaging; D015331:Cohort Studies; D004453:Echoencephalography; D015987:Effect Modifier, Epidemiologic; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids; D011663:Pulmonary Surfactants