Antenatal steroids and neonatal periventricular leukomalacia

Objective: To evaluate the effect of antenatal steroid treatment on the dev elopment of neonatal periventricular leukomalacia. Methods: This retrospective cohort study included 1161 neonates with gestat ional ages of 24-34 weeks and birth weights of 500-1750 g, divided into two groups on the basis of antenatal steroid treatment. Neonatal neurosonogram s were done on days 3 and 7 of life and labeled normal or abnormal. The abn ormal; outcomes evaluated were periventricular leuicamalacia or intraventri cular hemorrhage, periventricular leukomalacia with intraventricular hemorr hage, and isolated periventricular leukomalacia. The group treated with ant enatal Steroids was compared with the untreated group for these outcomes. Results: Antenatal steroids were associated with significantly less periven tricular leukomalacia or intraventricular hemorrhage (23% Versus 31%, P = . 005), periventricular leukomalacia with intraventricular hemorrhage (5% Ver sus 11%, P = .001), and isolated periventricular leukomalacia (3% versus 7% , P = .009). Logistic regression analysis of antenatal steroid treatment, c ontrolling for confounding maternal and neonatal characteristics, indicated that neonates treated with antenatal steroids had a 56% lower likelihood o f periventricular leukomalacia with intraventricular hemorrhage (adjusted o dds ratio [OR] 0.44, 95% confidence interval [CI] 0.25, 0.77) and a 58% low er likelihood of isolated periventricular leukomalacia (adjusted OR 0.42, 9 5% CI 0.20, 0.88). Conclusion: Antenatal steroid treatment was associated with over 50% reduct ion in the incidence of periventricular leukomalacia in preterm neonates. I ncreased use of antenatal steroid therapy might improve long-term neonatal neurologic outcomes. (C) 2001 by The American College of Obstetricians and Gynecologists.