Effects of antenatal corticosteroid administration on mortality and long-term morbidity in early preterm, growth-restricted infants

Objective: To evaluate the effect of antenatal corticosteroids on mortality , morbidity, and disability or handicap rate in early preterm, growth-restr icted infants. Methods: This case-control study in two tertiary care centers included all live-born singleton infants with growth-restriction due to placental insuff iciency, who were delivered by cesarean because of cardiotocographic signs of fetal distress before the beginning of labor at a gestational age of 26- 32 weeks during the years 1984-1991. Infants who had been treated antenatal ly with corticosteroids more than 24 hours and less than 7 days before birt h were matched by birth weight, sex, and year of birth with infants whose m others had been admitted more than 24 hours before delivery but were not tr eated antenatally with steroids. The main outcome measure was survival with out disability or handicap at 2 years corrected age. A sample of 60 case-co ntrol pairs would give 81% power to demonstrate 50% increase of this outcom e [odds ratio (OR) 3.0] by corticosteroid treatment. Behavior and physical growth were evaluated at school age by questionnaire. Results: The study group and control group consisted of 62 infants each. Su rvival without disability or handicap at 2 years' corrected age was more fr equent in the corticosteroid group [OR 3.2 confidence interval (CI) 1.1, 11 .2]. In the long-term follow-up at school age there was a statistically sig nificant negative effect on physical growth (OR 5.1, CI 1.4, 23.8), but no differences in behavior were detected. Conclusion: Benefits from antenatal corticosteroids for early preterm, grow th-restricted infants appear to outweigh possible adverse effects. (Obstet Gynecol 2001;97:954-60. (C) 2001 by The American College of Obstetricians a nd Gynecologists.).