Antenatal glucocorticoid treatment and cystic periventricular leukomalaciain very premature infants

Background Antenatal glucocorticoid therapy decreases the incidence of seve ral complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebra l palsy, remains unknown. Methods We retrospectively analyzed a cohort of 883 live-born infants, with gestational ages ranging from 24 to 31 weeks, who were born between Januar y 1993 and December 1996 at three perinatal centers in the Paris area. The mothers of 361 infants had received betamethasone before delivery, the moth ers of 165 infants had received dexamethasone before delivery, and the moth ers of 357 infants did not receive glucocorticoids. We compared the rates o f cystic periventricular leukomalacia among the three groups of infants in bivariate and multivariate analyses after adjustment for confounding factor s. Results The rate of cystic periventricular leukomalacia was 4.4 percent amo ng the infants whose mothers had received betamethasone, 11.0 percent among the infants whose mothers had received dexamethasone, and 8.4 percent amon g the infants whose mothers had not received a glucocorticoid. After adjust ment for gestational age, the mode of delivery, and the presence or absence of chorioamnionitis, prolonged interval between the rupture of membranes a nd delivery (>24 hours), preeclampsia, and the use of tocolytic drugs, ante natal exposure to betamethasone was associated with a lower risk of cystic periventricular leukomalacia than was either the absence of glucocorticoid therapy (adjusted odds ratio, 0.5; 95 percent confidence interval, 0.2 to 0 .9) or exposure to dexamethasone (adjusted odds ratio, 0.3; 95 percent conf idence interval, 0.1 to 0.7). The adjusted odds ratio for the group of infa nts whose mothers had received dexamethasone as compared with the group of infants whose mothers had not received a glucocorticoid was 1.5 (95 percent confidence interval, 0.8 to 2.9). Conclusions Antenatal exposure to betamethasone but not dexamethasone is as sociated with a decreased risk of cystic periventricular leukomalacia among very premature infants. (N Engl J Med 1999;341:1190-6.) (C)1999, Massachus etts Medical Society.