title: Evolving neonatal steroid prescription habits and patient outcomes.
abstract: OBJECTIVE
  Indications for post-natal steroids among preterm infants are evolving. The objective of this study was to compare steroid use in 2 cohorts 5 years apart and to document the short- and long-term outcomes of our most recent cohort.
  
  
  METHODS
  Retrospective chart review of infants born under 28 weeks of gestational age for two cohorts (January 2002-August 2003 and July 2008-March 2010).
  
  
  RESULTS
  Two hundred and fourteen infants were included. More infants received steroids in the later cohort (20% vs 35%, p = 0.021) but survival rates did not improve. There was a shift towards hydrocortisone use (<7% vs 76%) and pulmonary indications (36% vs 61% of courses; p = 0.021). Patients died later (8 days vs 30 days; p = 0.02), with a strong correlation between time of death and total dose of steroids (r = 0.91; p = 0.01). Neurodevelopmental outcomes for patients who received steroids for pulmonary indications were inferior to those for the rest of the cohort (severe adverse outcome 26% vs 4.8%, p = 0.03).
  
  
  CONCLUSIONS
  The improvement in short-term respiratory status of ill preterm patients was offset by a disturbing increase in age at death and no improvement in survival rates.
authors: Neonatology division, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke University, Sherbrooke, QC, Canada. etienne.fortin-pellerin@usherbrooke.ca
authors: Etienne
authors: E
authors: Fortin-Pellerin
authors: Claire
authors: C
authors: Petersen
authors: Francine
authors: F
authors: Lefebvre
authors: Keith J
authors: KJ
authors: Barrington
authors: Annie
authors: A
authors: Janvier
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones; D002423:Cause of Death; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D007363:Intensive Care Units, Neonatal; D008297:Male; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones