Antenatal corticosteroids and cranial ultrasonographic abnormalities

doi:10.1016/S0002-9378(99)70344-3

American Journal of Obstetrics and Gynecology

Volume 181, Issue 4, October 1999, Pages 1007-1017

https://doi.org/10.1016/S0002-9378(99)70344-3 Get rights and content

Abstract

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.)

Section snippets

Sample

A total of 1607 infants were eligible for this study because they weighed 500 to 1500 g at birth at 1 of 5 participating hospitals (participating institutions are listed at the end of the article) between January 1991 and December 1993, underwent ≥1 of 3 cranial ultrasonographic scans at times established by the study design, and had information available from medical records about correlates and expressions of maternal infection and about potential confounders.31, 32, 33, 34, 35 Since the

Correlates of antenatal corticosteroid exposure (Table I)

Exposure to a partial or complete course of antenatal corticosteroids was more common among infants born between the 26th and 28th weeks of gestation (the 2 rightmost columns on the second line of data, 25% + 33% = 58%) than among their gestationally older (19% + 30% = 49%) or younger (15% + 22% = 37%) peers. More than a quarter of the gestationally oldest and most growth-restricted infants (often the same infants) received a complete course. A complete course most often preceded deliveries >24

Comment

We wanted not only to know whether antenatal corticosteroids appeared to reduce the risk of echolucency, the cranial ultrasonographic image that best predicts developmental disabilities, but also to identify the infant characteristics that predicted such a benefit. Comments about intraventricular hemorrhage and ventriculomegaly are best appreciated in light of these goals.

Acknowledgements

Participating institutions and committee members and affiliations for The Developmental Epidemiology Network Investigators are as follows.

Participating institutions: Children’s Hospital, Brigham & Women’s Hospital, and Beth Israel Deaconess Medical Center, Boston; Babies Hospital and St Luke’s Hospital, New York; and St Peter’s Hospital, New Brunswick, NJ.

Neonatology Committee: Thomas Hegyi, MD,^{a, b} Mark Hiatt, MD,^{a, b} Ulana Sanocka, MD,^{c, d} and Farrokh Shahrivar, MD,^{d, e}

Ultrasound Committee:

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^☆: Supported by the National Institute of Neurological Disorders and Stroke (NS 27306) and the United Cerebral Palsy Research and Education Foundation (R-712-96).

^☆☆: Reprints not available from the authors.

^★: 0002-9378/99 $8.00 + 06/1/100650

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Antenatal corticosteroids and cranial ultrasonographic abnormalities☆,☆☆,★

Abstract

Section snippets

Sample

Correlates of antenatal corticosteroid exposure (Table I)

Comment

Acknowledgements

Pediatr Neurol

Am J Obstet Gynecol

J Pediatr

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

J Pediatr

Lancet

J Pediatr

Early Hum Dev

Am J Obstet Gynecol

Am J Obstet Gynecol

Semin Pediatr Neurol

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

Cerebral palsy

N Engl J Med

A quantitative review of mortality and developmental disability in extremely premature newborns

Arch Pediatr Adolesc Med

Brain damage in the preterm newborn

Province-based study of neurologic disability of children weighing 500 through 1249 grams at birth in relation to neonatal cerebral ultrasound findings

Pediatrics

Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population

Pediatrics

Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age

Pediatrics

Psychiatric outcomes in low birth weight children at age 6 years: relation to neonatal cranial ultrasound abnormalities

Arch Gen Psychiatry

Sonography of the premature brain: intracranial hemorrhage and periventricular leukomalacia

Neuroradiology

Periventricular intraparenchymal echodensities in the premature newborn: critical determinant of neurologic outcome

Pediatrics

Periventricular leucomalacia and intraventricular haemorrhage in the preterm neonate

Arch Dis Child

Neuropathologic findings in short-term survivors of intraventricular hemorrhage

Am J Dis Child