Improved outcomes for very low birth weight infants associated with the use of combined maternal corticosteroids and tocolytics.
OBJECTIVE
To determine the effects of maternal antenatal treatment with tocolytics, corticosteroids and the use of combined tocolytics and corticosteroids on the morbidity and mortality of very low birth weight infants.


METHODS
This retrospective study was conducted on all infants born in Tennessee in 1989 and 1990 who weighed < 1,500 g at birth and had no serious malformations. Registered nurses traveled to the delivery hospitals of all study subjects and abstracted information using a structured data collection form. Mortality was ascertained through the computerized linkage of birth and death certificates. Multiple logistic regression analysis was used to control for covariates.


RESULTS
As compared to infants whose mothers received no treatment, infants whose mothers received both corticosteroids and tocolysis had a reduced risk of infant (odds ratio 0.38, 95% confidence interval 0.25-0.58) and neonatal mortality (OR 0.32, CI 0.19-0.51) as well as a reduced risk of seizures (OR 0.46, CI 0.23-0.93). Restricting the analysis of infants at 24-28 weeks' gestation and < 1,000 g at birth revealed similar findings regarding mortality.


CONCLUSIONS
The use of combined corticosteroids with tocolytics was associated with better neonatal outcomes than the use of corticosteroids alone, tocolytics alone or no treatment.
Piper
J M
JM
Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Atkinson
M W
MW
Mitchel
E F
EF
Cliver
S P
SP
Snowden
M
M
Wilson
S C
SC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012189:Retrospective Studies; D012307:Risk Factors; D015149:Tocolytic Agents / Q000627:therapeutic use*
D000305:Adrenal Cortex Hormones; D015149:Tocolytic Agents