Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.
OBJECTIVE
The relationship between antenatal steroids, delivery mode, and early-onset intraventricular hemorrhage was examined in very-low-birth-weight infants.


METHODS
A total of 505 preterm infants (birth weight 600 to 1250 gm) were enrolled in a multicenter, prospectively randomized, controlled trial evaluating the efficacy of postnatal indomethacin to prevent intraventricular hemorrhage. All infants had echoencephalography between 5 and 11 hours of life.


RESULTS
Seventy-three infants had intraventricular hemorrhage within the first 5 to 11 hours (mean age at echoencephalography 7.5 hours). Four hundred thirty-two infants did not have early intraventricular hemorrhage. There was less antenatal steroid treatment (19% vs 32%, p = 0.03) and more vaginal deliveries (71% vs 45%, p < 0.0001) in the group with early intraventricular hemorrhage. Of 152 infants who received antenatal steroids, those delivered by cesarean section had significantly less early-onset intraventricular hemorrhage than did those delivered vaginally (4% vs 17%, p = 0.02). Of the 353 not exposed to antenatal steroids, 10% of infants delivered by cesarean section and 22% delivered vaginally had early intraventricular hemorrhage (p = 0.003).


CONCLUSIONS
These data are the first to suggest that both antenatal steroids and cesarean section delivery have an important and independent role in lowering the risk of early-onset intraventricular hemorrhage.
Ment
L R
LR
Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510.
Oh
W
W
Ehrenkranz
R A
RA
Philip
A G
AG
Duncan
C C
CC
Makuch
R W
RW
D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D011247:Pregnancy; D011295:Prenatal Care; D011446:Prospective Studies; D013256:Steroids / Q000627:therapeutic use*
D013256:Steroids; D007213:Indomethacin