Multiple courses of antenatal corticosteroids are associated with early severe lung disease in preterm neonates.
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.
Banks
Beverly A
BA
Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Division of Neonatology, Philadelphia, PA 19104, USA.
Macones
George
G
Cnaan
Avital
A
Merrill
Jeffrey D
JD
Ballard
Philip L
PL
Ballard
Roberta A
RA
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
D000305:Adrenal Cortex Hormones