RELATIONSHIP BETWEEN ANTENATAL STEROID-ADMINISTRATION AND GRADE-III AND GRADE-IV INTRACRANIAL HEMORRHAGE IN LOW-BIRTH-WEIGHT INFANTS

Antenatal corticosteroid therapy was introduced to reduce the incidenc e of respiratory distress syndrome in preterm neonates.(1-4) A reducti on in the incidence of other adverse effects associated with premature birth, such as necrotizing enterocolitis and patent ductus arteriosus , has been reported.(4,5) In 1990 Crowley et al.,(3) while performing a meta-analysis of controlled trials evaluating the effect of corticos teroids before preterm delivery, noted that antenatal corticosteroid a dministration reduced the risk of neonatal intracranial hemorrhage (IC H) in preterm neonates. Secondary analysis of recent trials evaluating the impact of antenatal corticosteroid administration on neonatal res piratory distress syndrome has also revealed a reduction in the incide nce of ICH.(6.7) A decrease in the incidence of neonatal ICH was noted in the March of Dimes Multicenter registry data analyzing the effect of corticosteroid administration in very premature infants.(8) We rece ntly evaluated prenatal and perinatal risk and protective factors for grades III and IV ICH in a large cohort of singleton low birth weight infants in the National Institute of Child Health and Human Developmen t (NICHD) Neonatal Research Network.(9) Staged logistic regression mod eling revealed that antenatal corticosteroid administration was associ ated with a reduced incidence of grades III and IV ICI-I in infants wi th a birth weight between 501 and 1500 gm. The purpose of this article is to describe the relationship between antenatal corticosteroid admi nistration and grade III and IV ICH controlling for potential prenatal and perinatal confounders influencing ICH. The risk of grade III and IV ICH was examined, rather than mild a or overall hemorrhage, because adverse neurodevelopmental outcomes are more commonly associated with grades III and IV ICH.(10-13)