ASSOCIATION OF TOCOLYTIC THERAPY WITH ANTENATAL STEROID-ADMINISTRATION AND INFANT OUTCOMES

The use of tocolytic agents to halt premature labor is controversial. We examine a database on very low-birth-weight infants born following the onset of premature labor (n = 540) for association between tocolyt ic and antenatal steroid therapy, and to assess neonatal and childhood outcomes following combined therapy. Data are from a multicenter regi onally based study of all infants below 1501 g at seven neonatal inten sive care units (NICUs) in Wisconsin and Iowa, born August 1, 1988 thr ough June 30, 1991. Infant outcomes analyzed are death in the first 30 days, respiratory distress syndrome (RDS), and intraventricular hemor rhage (IVH). Fewer deliveries occurred within 12 hours of labor onset with tocolytics (61 vs. 75% without). A strong association between toc olytic therapy and antenatal steroid administration was found [adjuste d odds ratio OR = 5.7, 95% confidence interval CI: (3.3, 10.0)]. Tocol ytics were associated with lower mortality in the first 30 days [OR = 0.29, CI: (0.15, 0.56)]. Joint administration of tocolytics and antena tal steroids versus neither was associated with lower incidence of the combined outcome of respiratory distress syndrome (RDS) or death [OR = .30, CI: (0.15, 0.60)] and grade III-IV IVH or death [OR = 0.35, CI: (0.14, 0.98)]. Tocolytic therapy alone was not associated with IVH gr ade III-IV [OR = 1.0, CI: (0.57, 1.9)] among survivors.