title: Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis.
abstract: OBJECTIVE
  To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA).
  
  
  METHODS
  We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22 + 0 and 33 + 6 weeks of gestation between 2003 and 2007, who registered to the Neonatal Research Network Japan. The effects of AC therapy on mortality, neurodevelopmental outcomes at 3 years of age and neonatal morbidities were analyzed in the groups with or without HCA using logistic regression analysis.
  
  
  RESULTS
  In the study subjects, 840 were with HCA, 2734 were without HCA, and 1666 were excluded without data for HCA. AC therapy was significantly associated with decreasing mortality before 3 years of age; [0.52 (0.32-0.86)], [odds ratio (95 % confidence intervals]. There were no differences between the two groups regarding neurodevelopmental outcomes, including cerebral palsy [0.90 (0.41-1.99)], development quotient <70 [0.93 (0.48-1.81)], visual impairment [0.46 (0.04-5.18)], and severe hearing impairment [4.00 (0.30-53.4)] in the group with HCA as well as without HCA. Regarding neonatal morbidities, AC therapy was associated with a lower incidence of respiratory distress syndrome [0.67 (0.50-0.91)], sepsis [0.62 (0.41-0.94)], late-onset adrenal insufficiency [0.62 (0.39-0.98)] and an increased incidence of chronic lung disease [1.62 (1.18-2.24)] in the group with HCA. In the group without HCA, AC therapy was associated with decreasing respiratory distress syndrome [0.60 (0.43-0.84)] and increasing chronic lung disease [1.34 (1.11-1.62)].
  
  
  CONCLUSIONS
  AC therapy is significantly associated with reduced mortality before 3 years of age in VLBW infants with HCA, but not with neurodevelopmental outcomes, which was same as the results found in infants without HCA. AC therapy is recommended for women with suspected chorioamnionitis, as well as those without chorioamnionitis.
authors.affiliation: Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan. goldencaesar21@yahoo.co.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: Department of Obstetrics and Gynecology, Japanese Red Cross Nagoya Daiichi Hospital, 3-15 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
authors.forename: Madoka
authors.initials: M
authors.lastname: Furuhashi
authors.affiliation: Department of Endowed Chair for Regeneration of Medicine in Kuwana District, Suzuka University of Medical Science, Mie, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tamakoshi
authors.affiliation: Department of Obstetrics and Gynecology, Kochi Health Sciences Center, Kochi, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hayashi
authors.affiliation: Department of Neonatology, Aizenbashi Hospital, Osaka, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kai
authors.affiliation: Department of Obstetrics, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Murabayashi
authors.affiliation: Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: Department of Pediatrics, Jichi Medical University, Tochigi, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kono
authors.affiliation: Department of Neonatology, Maternal and perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kusuda
authors.affiliation: Department of Neonatology, Osaka Medical Center and Research Institute for maternal and Child Health, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujimura
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000188:drug therapy* / Q000453:epidemiology; D002658:Developmental Disabilities / Q000473:pathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000473:pathology; D019102:Infant, Very Low Birth Weight; D007564:Japan; D008171:Lung Diseases; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids
keywords: Antenatal corticosteroids; Cerebral palsy; Histologic chorioamnionitis; Neurodevelopmental outcome; Very premature infants