[Influence of antenatal steroids on perinatal mortality and morbidity in extremely low birth weight newborns].

UNLABELLED: Recently used antenatal steroids for induction of fetus lung maturity remain as standard procedure in the treatment of premature labour. However, the effect of antenatal steroids to the fetus may not be only the positive one.

OBJECTIVE: Investigate the role of antenatal steroids on total mortality and severe morbidity in extremely low birth weight newborns under 1000 grams.

DESIGN: Comparative case-control study.

SETTING: Institute for the Care of Mother and Child, Prague, Czech Republic.

METHODS: Antenatal steroids were used in 55 cases (group ANS+) and no steroids were used in 65 control newborns (group ANS-). Both study groups were comparable in birth weight, gestational age, gender, mode of delivery and presence of intrauterine growth retardation. Statistical significant difference was in time of premature rupture of membrane (ANS+ 108+/-228 hrs versus ANS- 27+/-56 hrs, p<0.007). The Epi Info 6 (CDC, U.S.) software package and ANOVA was used for statistical analysis.

RESULTS: We have found statistical significant differences in total mortality (ANS+ 22%, ANS- 45%, p<0.008), in severity of respiratory distress syndrome (ANS+ median 2, ANS- median 3, p<0.0008), in total cumulative dose of surfactant (ANS+ 73 mg, ANS- 111 mg, p<0.0003), in the incidence of periventricular-intraventricular haemorrhage (ANS+ median 1, ANS- median 2, p<0.005) and posthaemorrhagic hydrocephalus (ANS+ 6%, ANS- 23%, p<0.008). Statistical significant differences were also in CRIB value (ANS+ median 7, ANS- median 11, p<0.007) and NEOMOD value (ANS+ median 5, ANS- median 7, p<0.002). In the other parameters (pneumothorax, sepsis, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia) no statistical differences were found.

CONCLUSIONS: Our study confirmed positive effect of antenatal steroids on mortality, severe respiratory morbidity and incidence of intraventricular haemorrhage. No negative effect of antenatal steroids to higher frequency of infection complications and/or periventricular leukomalacia was observed.