ANTENATAL STEROIDS, DELIVERY MODE, AND INTRAVENTRICULAR HEMORRHAGE INPRETERM INFANTS

OBJECTlVE: The relationship between antenatal steroids, delivery mode, and early-onset intraventricular hemorrhage was examined in very-low- birth-weight infants. STUDY DESIGN: A total of 505 preterm infants (bi rth weight 600 to 1250 gm) were enrolled in a multicenter, prospective ly randomized, controlled trial evaluating the efficacy of postnatal i ndomethacin to prevent intraventricular hemorrhage. All infants had ec hoencephalography between 5 and 11 hours of life. RESULTS: Seventy-thr ee infants had intraventricular hemorrhage within the first 5 to 11 ho urs (mean age at echoencephalography 7.5 hours). Four hundred thirty-t wo infants did not have early intraventricular hemorrhage. There was l ess antenatal steroid treatment (19% vs 32%, p = 0.03) and mote vagina l deliveries (71% vs 45%, p < 0.0001) in the group with early intraven tricular hemorrhage. Of 152 infants who received antenatal steroids, t hose delivered by cesarean section had significantly less early-onset intraventricular hemorrhage than did those delivered vaginally (4% vs 17%, p = 0.02). Of the 353 not exposed to antenatal steroids, 10% of i nfants delivered by cesarean section and 22% delivered vaginally had e arly intraventricular hemorrhage (p = 0.003). CONCLUSION: These data a re the first to suggest that both antenatal steroids and cesarean sect ion delivery have an important and independent role in lowering the ri sk of early-onset intraventricular hemorrhage.