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01-06-2014 | Maternal-Fetal Medicine

The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis

Authors: Ken Miyazaki, Madoka Furuhashi, Kaoru Ishikawa, Koji Tamakoshi, Tomoaki Ikeda, The Neonatal Research Network Japan

Published in: Archives of Gynecology and Obstetrics | Issue 6/2014

Abstract

Purpose

To evaluate the effectiveness of antenatal corticosteroids (AC) therapy on outcomes of very low birthweight infants with histologic chorioamnionitis.

Methods

We performed a retrospective analysis of 10,935 single infants born at a gestational age between 22 + 0 and 33 + 6 weeks and birth weight <1,500 g. Clinical data were obtained from the Neonatal Research Network that included the tertiary neonatal intensive care units throughout Japan between 2003 and 2008.

Results

Data of 7,896 infants were available for the period 2003–2008 and were included in the analysis. According to logistic regression analysis, AC were significantly associated with reduced mortality [odds ratio (OR) = 0.50; p < 0.001], lower incidence of respiratory distress syndrome (OR = 0.72; p < 0.001), neonatal seizure (OR = 0.65; p = 0.003) and intraventricular hemorrhage (OR = 0.68; p = 0.001) in cases after histologic chorioamnionitis compared with the cases had no AC therapy (n = 3,271 vs. 4,625). Antenatal corticosteroids were significantly associated with reduced mortality [odds ratio (OR) = 0.60; p < 0.001] among the cases without histologic chorioamnionitis.

Conclusion

In the retrospective population-based study in Japan, AC exposure was significantly associated with a lower rate of death and neurological morbidity in cases with histologic chorioamnionitis. These outcome data in Japan will be important for further improvement of antenatal practice and care.

Brownfoot FC, Gagliardi DI, Bain E, Middleton P, Crowther CA (2013) Different corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 8:CD006764PubMed

Crowly P (2002) Prophylactic corticosteroids for preterm birth. Cochrane Database Syst Rev 4:CD000065

Crowly PA (1995) Antenatal corticosteroid therapy: a meta-analysis of the randomized trial, 1972–1994. Am J Obstet Gynecol 173:322–335CrossRef

Antenatal corticosteroid therapy for fetal maturation (2011) ACOG Committee Opinion No. 475. American College of Obstetricians and Gynecologists. Obstet Gynecol 117:422–424CrossRef

(1994) Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement. 12:1–24

Stutchfield P, Whitaker R, Russell I, Antenatal Steroids for Term Elective Caesarean Section Research Team (2005) Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarian section: pragmatic randomized trial. BMJ 331:662PubMedCentralPubMedCrossRef

Murphy KE, Hannah ME, Willan AR, Hewson SA, Ohlsson A, Kelly EN et al (2008) Multiple course of antenatal corticosteroids for preterm birth (MACS): a randomized controlled trial. Lancet 372:2143–2151PubMedCrossRef

Qublan H, Malkawi H, Hiasat M, Hindawi IM, Al-Taani MI, Abu-Khait SA et al (2001) The effect of antenatal corticosteroid therapy on pregnancies complicated by premature rupture of membranes. Clin Exp Obstet Gynecol 28:183–186PubMed

Garite TJ, Rumney PJ, Briggs GG, Harding JA, Nageotte MP, Towers CV et al (1992) A randomized placebo-controlled trial of betamethasone for the prevention of respiratory distress syndrome at 24–28 weeks gestation. Am J Obstet Gynecol 166:646–651PubMedCrossRef

10.

Kent A, Lomas F, Hurrion E, Dahlstrom JE (2005) Antenatal steroids may reduce adverse neurological outcome following chorioamnionitis: neurodevelopmental outcome and chorioamnionitis in premature infants. J Paediatr Child Health 41:186–190PubMedCrossRef

11.

Baud O, Zupan V, Lacaze-Masmonteil T, Audibert F, Shojaei T, Thebaud B et al (2000) The relationships between antenatal management, the cause of delivery and neonatal outcome in a large cohort of very preterm singleton infants. BJOG 107:877–884PubMedCrossRef

12.

Goldenberg RL, Andrews WW, Faye-Petersen OM, Cliver SP, Goepfert AR, Hauth JC (2006) The Alabama Preterm Study: corticosteroids and neonatal outcome in 23- to 32- week newborns with various markers of intrauterine infection. Am J Obstet Gynecol 195:1020–1024PubMedCrossRef

13.

Been JV, Rours IG, Kornelisse RF, Passos VL, Kramer BW, Schneider TAJ et al. (2009) Histologic chorioamnionitis, fetal involvement, and antenatal steroids: effects on neonatal outcome in preterm infants. Am J Obstet Gynecol. 201:587.e1-8

14.

Been JV, Degraeuwe PL, Kramer BW, Zimmermann LJI (2011) Antenatal steroids and neonatal outcome after chorioamnionitis: a meta-analysis. BJOG 118:113–122PubMedCrossRef

15.

Gomez R, Romero R, Edwin SS, David C (1997) Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection. Infect Dis Clin North Am 11:135–176PubMedCrossRef

16.

Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA et al. (2007) Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 196:147.e1-8

17.

Kusuda S, Fujimura M, Sakuma I, Aotani H, Kabe K, Itani Y et al (2006) Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics 118:e1130–e1138PubMedCrossRef

18.

Lencki SG, Maciulla MB, Eglinton GS (1995) Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis. Am J Obstet Gynecol 170:1345–1351CrossRef

19.

Blanc WA (1981) Pathology of the placenta, membranes, and umbilical cord in bacterial, fungal, and viral infections in man. In: Naeye RL, Kissane JM, Kaufman N (eds) Perinatal diseases. Internal Academy of Pathology Monograph. Williams & Wilkins, Baltimore, pp 67–132

20.

Papile L, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage; a study of infants with birth weights less than 1500. J Pediatr 92:5229–5534CrossRef

21.

Ng PC, Lee CH, Lam CWK, Ma KC, Fok TF, Chan IH et al (2004) Transient adrenocortical insufficiency of prematurity and systemic hypotension in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 89:119–126CrossRef

22.

Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L et al (1978) Neonatal necrotizing enterocolitis. Therapeutic decision based upon clinical staging. Ann Surg 187:1–7PubMedCentralPubMedCrossRef

23.

Moody DM, Brown WR, Challa VR, Blocks SM (1994) Alkaline phosphatase histochemical staining in the study of germinal matrix hemorrhage and brain vascular morphology in a very-low-birth-weight neonate. Pediatr Res 35:424–430PubMedCrossRef

24.

Volpe JJ (2001) Neurobiology of periventricular leukomalacia in the preterm infants. Pediatr Res 50:553–562PubMedCrossRef

25.

Koenen SV, Mecenas CA, Smith GS, Jenkins S, Nathanielsz PW (2002) Effects of maternal betamethasone administration on fetal and maternal blood pressure and heart rate in the baboon at 0.7 of gestation. Am J Obstet Gynecol 186:812–817PubMedCrossRef

26.

Perlman JM (1998) Antenatal glucocorticoids, Magnesium exposure, and the prevention of brain injury of prematurity. Semin Pediatr Neurol 5:202–210PubMedCrossRef

27.

Lyon A (2000) Chronic lung disease of prematurity. The role of intra-uterine infection. Eur J Pediatr 159:798–802PubMedCrossRef

28.

Yoon BH, Romero R, Park JS, Kim CJ, Kim SH, Choi JH et al (2000) Fetal exposure to an intra-amniotic inflammation and development cerebral palsy at the age of three years. Am J Obstet Gynecol 182:675–681PubMedCrossRef

29.

Kurkinen-Raty M, Koivisto M, Jouppila P (1998) Perinatal and neonatal outcome and late pulmonary sequelae in infants born after preterm premature rupture of membranes. Obstet Gynecol 92:408–415PubMedCrossRef

30.

Harding JE, Pang J, Knight DB, Liggins GC (2001) Do antenatal corticosteroids help in the setting of preterm rupture of membranes? Am J Obstet Gynecol 184:131–139PubMedCrossRef

Title: The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis
Authors: Ken Miyazaki
Madoka Furuhashi
Kaoru Ishikawa
Koji Tamakoshi
Tomoaki Ikeda
The Neonatal Research Network Japan
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 6/2014
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-013-3106-3

At a glance: The STEP trials

Springer Medicine

The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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Erratum to: The effects of antenatal corticosteroids therapy on very preterm infants after chorioamnionitis