[Prenatal corticosteroid and early surfactant therapy in infants born at < or = 30 weeks gestation].
BACKGROUND
Prenatal corticosteroid (PNC) exposure and postnatal surfactant therapy improve outcome in very low birth weight infants (VLBWI). However, the efficacy of PNC in the prevention of chronic lung disease is debated.


OBJECTIVE
To study the effects of PNC exposure on outcome in VLBWI born at < or = 30 weeks' gestation.


METHODS
We performed a multicenter, longitudinal study. The Spanish Surfactant Group database (n 5 1,275) was searched and 211 VLBWI born at < or = 30 weeks who received early surfactant therapy (< or = 30 min) were identified. Perinatal events, neonatal management and rates of mortality and complications were evaluated. Data on the subgroup of infants who received PNC (157, 74.4 %) were compared with data on 54 infants who did not receive this therapy.


RESULTS
Mean (+/- SD) birth weight and gestational age were 944 (226) g and 27 (1.8) weeks. Surfactant was given at 16 +/- 13 min (61 % < or = 15 min). A total of 124 infants (58.8 %) developed respiratory distress syndrome. No differences were found in birth weight, gestational age, or Apgar score at 1 and 5 min. However the age at first surfactant dose was lower in infants exposed to PNC. PNC-exposed infants required fewer doses of surfactant, were extubated earlier (58.9 vs. 161 h) and needed a lower FiO2 at 48 h (0.28 vs. 0.35). Moreover, neonatal mortality (15.9 vs. 27.8 %), the incidence of intraventricular hemorrhage (25.2 vs. 50 %), ductus arteriosus (40.3 vs. 63.5 %) and necrotizing enterocolitis (9 vs. 19.2 %) were lower in infants receiving PNC. However, the incidence of chronic lung disease was similar in both groups.


CONCLUSIONS
PNC exposure of VLBWI born at < or = 30 weeks receiving early surfactant therapy reduced mortality and the incidence of certain complications but did not decrease the incidence of chronic lung disease.
Unidad Neonatal, Departamento de Pediatría, Hospital de Cruces, Universidad del País Vasco/EHU, Baracaldo, Bilbao, Spain. enadolf@eresmas.net
A
A
Valls i Soler
S
S
Páramo Andrés
B
B
Fernández-Ruanova
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000453:epidemiology / Q000517:prevention & control; D007752:Obstetric Labor, Premature; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000517:prevention & control
D000305:Adrenal Cortex Hormones; D011663:Pulmonary Surfactants