title: Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates.
abstract: OBJECTIVE
  Determine whether the increased neonatal mortality following repeated courses of antenatal corticosteroids (ANCS), observed in the Thyrotropin-Releasing Hormone (TRH) Trial, was related to confounding maternal risk factors or specific preterm morbidities.
  
  
  METHODS
  A post hoc analysis of 595 TRH trial neonates, 26 to 32 weeks' gestation, studied the association between > or =3 courses ANCS and mortality. Potential confounding maternal factors and preterm morbidities were evaluated using logistic regression and log likelihood modeling.
  
  
  RESULTS
  Mortality was 9.2% after > or =3 courses (13/141) vs. 4.8% after 1 or 2 courses (22/454). This association was not explained by maternal factors, or other common preterm morbidities. However, 15/141 infants receiving > or =3 courses (10.6%) had early severe lung disease (ESLD) with 10 deaths, compared to 16/454 of the 1- to 2-course infants (3.5%) with 7 deaths (odds ratio 3.5, p<0.001).
  
  
  CONCLUSIONS
  ESLD, but not maternal risk factors, was associated with increased mortality in preterm infants after > or =3 courses ANCS.
authors.affiliation: Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA 19104, USA.
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Banks
authors.forename: George
authors.initials: G
authors.lastname: Macones
authors.forename: Avital
authors.initials: A
authors.lastname: Cnaan
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Merrill
authors.forename: Philip L
authors.initials: PL
authors.lastname: Ballard
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Ballard
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000704:Analysis of Variance; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D016014:Linear Models; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology* / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000305:Adrenal Cortex Hormones