Antenatal corticosteroids and cranial ultrasonographic abnormalities

• Published in: American journal of obstetrics and gynecology 1999-10, Vol.181 (4), p.1007-1017
• Main Authors: Leviton, Alan, Dammann, Olaf, Allred, Elizabeth N., Kuban, Karl, Pagano, Marcello, Van Marter, Linda, Paneth, Nigel, Reuss, M.Lynne, Susser, Mervyn
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - therapeutic use; Antenatal corticosteroids; Biological and medical sciences; Brain - abnormalities; Brain Diseases - diagnostic imaging; Brain Diseases - prevention & control; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - prevention & control; Cerebral Ventricles - abnormalities; Cerebral Ventricles - diagnostic imaging; Cohort Studies; cranial ultrasonography abnormalities; Delivery. Postpartum. Lactation; Disorders; Echoencephalography; Female; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Medical sciences; Multivariate Analysis; Pregnancy; Retrospective Studies; Risk Factors; very low birth weight
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(99)70344-3

Objective: This study was undertaken to determine whether very-low-birth-weight infants whose mothers received a course of antenatal corticosteroids were at decreased risk for 3 cranial ultrasonographic entities that predict neurodevelopmental dysfunction. Study Design: This retrospective cohort study evaluated 1604 infants weighing 500 to 1500 g who underwent ≥1 of 3 cranial ultrasonographic scans required by design at specified postnatal intervals and whose own and mother’s hospital charts were reviewed. Infants were classified according to mother’s course of antenatal corticosteroids (none, partial, or complete). Results: In the total sample the risks of intraventricular hemorrhage and of an echolucent image in the cerebral white matter were only modestly (and not statistically significantly) reduced after a full course of antenatal corticosteroids, whereas antenatal corticosteroids appeared to significantly reduce the risk of ventriculomegaly after even a partial course. Antenatal corticosteroids appeared to halve the risk of ventriculomegaly and echolucent image among the gestationally youngest infants and those with intraventricular hemorrhage, hypothyroxinemia, or vasculitis of the umbilical cord or chorionic plate of the placenta. Conclusion: These observations are consistent with the hypothesis that antenatal corticosteroids protect very-low-birth-weight infants, especially those who are most vulnerable, against the risk of cranial ultrasonographic abnormalities. (Am J Obstet Gynecol 1999;181:1007-17.)