Adverse neonatal outcomes associated with antenatal dexamethasone versus antenatal betamethasone.
OBJECTIVE
Antenatal dexamethasone and betamethasone may not be equally efficacious in the prevention of adverse neonatal outcomes. We compared the risks of periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and neonatal death among very low birth weight infants who were exposed to dexamethasone, betamethasone, or neither steroid.


METHODS
Infants (401-1500 g) in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Multivariate logistic regression analyses compared the 3 groups with regard to PVL, IVH, ROP, and neonatal death, adjusting for network center and selected covariates.


RESULTS
A total of 3600 infants met entry criteria. Compared with no antenatal steroids, there were trends for a reduced risk for PVL associated with dexamethasone and betamethasone but no difference in risk between dexamethasone and betamethasone. Dexamethasone reduced the risk for IVH and severe IVH, compared with no antenatal steroid exposure. Betamethasone reduced the risk for IVH, severe IVH, and neonatal death, compared with no antenatal steroids. Compared with betamethasone, dexamethasone had a statistically significant increased risk for neonatal death. There were trends for greater risks associated with dexamethasone compared with betamethasone for IVH and severe ROP.


CONCLUSIONS
Betamethasone was associated with a reduced risk for neonatal death, with trends of decreased risk for other adverse neonatal outcomes, compared with dexamethasone. It may be in the best interest of neonates to receive betamethasone rather than dexamethasone when available.
Lee
Ben H
BH
Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. ben_lee@oz.ped.emory.edu
Stoll
Barbara J
BJ
McDonald
Scott A
SA
Higgins
Rosemary D
RD
D001623:Betamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D005325:Fetal Organ Maturity / Q000187:drug effects*; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D007969:Leukomalacia, Periventricular / Q000517:prevention & control; D008168:Lung / Q000187:drug effects / Q000196:embryology*; D012178:Retinopathy of Prematurity / Q000517:prevention & control
D005938:Glucocorticoids; D003907:Dexamethasone; D001623:Betamethasone