A Timely Administration of Antenatal Steroids Is Highly Protective Against Intraventricular Hemorrhage: An Observational Multicenter Cohort Study of Very Low Birth Weight Infants

Abstract

AimThe aim of the study is to evaluate the influence of the timing of antenatal steroids (ANSs) on neonatal outcome of very low birth weight infants (VLBWI) born before 30 weeks of gestation in the German Neonatal Network.MethodsThe German Neonatal Network is a large population-based cohort study enrolling VLBWIs since 2009. We included 672 neonates, who were born between January 1, 2009 and December 31, 2019 in our analysis in 10 selected centers. Infants were divided into four subgroups based on the interval between the first steroid administration and preterm birth: (I) two doses of betamethasone, ANS-birth interval: >24 h to 7 days, n = 187, (II) only one dose of betamethasone, ANS-birth interval 0–24 h, n = 70, (III) two doses of betamethasone, ANS-birth interval >7 days, n = 177, and (IV) no antenatal steroids, n = 238. Descriptive statistics and logistic regression analyses were performed for the main neonatal outcome parameters. Group IV (no ANS) was used as a reference.ResultsAn ANS-birth interval of 24 h to 7 days after the first dose was associated with a reduced risk for intraventricular hemorrhage (OR 0.17; 95% CI 0.09–0.31, p < 0.001) and mechanical ventilation (OR 0.37; 95% CI 0.23–0.61, p < 0.001), whereas the group of infants that only received a single dose of steroids reflected a subgroup at high risk for adverse neonatal outcomes; an ANS-birth interval of >7 days was still associated with a lower risk for intraventricular hemorrhage (OR 0.43; 95% CI 0.25–0.72, p = 0.002) and the need for mechanical ventilation (OR 0.43; 95% CI 0.27–0.71, p = 0.001).ConclusionOur observational data indicate that an ANS-birth interval of 24 h to 7 days is strongly associated with a reduced risk of intraventricular hemorrhage in VLBWIs. Further research is needed to improve the prediction of preterm birth in order to achieve a timely administration of antenatal steroids that may improve neonatal outcomes such as intraventricular hemorrhage.

Effect of antenatal corticosteroid administration-to-birth interval on maternal and newborn outcomes: a systematic review

“…At <24 h compared to no ACS, two studies (1195 and 169 newborns) found reduced odds of IVH, 32 , 61 while four studies found no differences. 36 , 37 , 54 , 70 For 1–7 days, four studies found reduced odds of IVH. 32 , 36 , 61 , 64 At 2–7 days, one study (548 newborns) found no differences, 37 though one study (2549 newborns) found reduced odds of IVH.…”

“… 36 , 37 , 54 , 70 For 1–7 days, four studies found reduced odds of IVH. 32 , 36 , 61 , 64 At 2–7 days, one study (548 newborns) found no differences, 37 though one study (2549 newborns) found reduced odds of IVH. 70 At >7 days, all five studies found that odds of IVH were reduced.…”

Care Bundle Application Decreases The Frequency and Severity of Intraventricular Hemorrhage in Preterm Neonates: Single Center Study

“…One such study drafted a charter using the Model for Improvement which included prolongation of infusion rates of saline and blood products, minimizing bicarbonate infusions, using an IVH risk calculator, implementing delayed cord clamping, midline head positioning, bed head elevation, and minimal handling of babies (20). Another study by Schmid et al applied a bundle of preventive measures including preference of caesarean section as a method of delivery, delayed clamping of the umbilical cord, and additional dose of betamethasone during pregnancy which resulted in decreased incidence and severity of IVH (21,22).…”

Short and long-term outcomes of outborn vs. inborn infants <32 weeks’ in Western Australia: A cohort study of infants born between 2005 and 2018

“…Extremely preterm infants born in a non-tertiary hospital and transferred <48 hours have poor outcomes compared to those born in a tertiary setting(39) and in utero transport should be prioritised. Antenatal steroids given even a few hours before birth may be effective in reducing mortality (40), and in reducing the risk of ICH in at risk infants before delivery and those transported <72 h (23, 41). Survival is improved and morbidity reduced in infants <25 weeks who received antenatal steroids and should be considered even in babies at the limit of viability(42).…”