ANTENATAL CORTICOSTEROIDS APPEAR TO REDUCE THE RISK OF POSTNATAL GERMINAL MATRIX HEMORRHAGE IN INTUBATED LOW-BIRTH-WEIGHT NEWBORNS

Objective. To determine to what extent the reduced risk in preterm new borns of intracranial hemorrhage attributed to antenatal corticosteroi ds (ANCS) reflects reductions in the incidence of respiratory distress and its correlates. Methods. In a sample of 239 very low birth weight newborns recruited for a clinical trial of phenobarbital prophylaxis of subependymal/intraventricular hemorrhage, we explored the relations hip between ANCS, the occurrence of germinal matrix hemorrhage (GMH) t hat first became evident after the 12th postnatal hour, and putative i ntervening variables such as acidosis, elevated peak inspiratory press ure, pneumothorax-pulmonary interstitial emphysema, and elevated conti nuous positive airway pressure. Results. In multivariate models adjust ing for confounders, newborns exposed to ANCS were at approximately on e third the risk of GMH experienced by newborns not exposed to a full course of ANCS. The additions of measures and correlates of respirator y distress severity to these models did not change the GMH risk associ ated with ANCS. Conclusion. The GMH-protective effect of ANCS does not appear to be a consequence of enhanced pulmonary maturation.