October 11, 2016

Even Partial Steroid Treatment Can Benefit Extremely Preterm Infants

BETHESDA, Md -- October 11, 2016 -- Steroids improve survival and reduce the chances of certain birth defects for extremely premature infants, even if the treatment course is not finished before delivery, according to a study published online by JAMA Pediatrics.

Steroids are a standard treatment for pregnant women likely to deliver before 34 weeks because these drugs are known to reduce the chance of complications and death among premature infants. However, because completing the entire course takes at least 48 hours, healthcare providers may opt not to begin treatment when premature delivery is imminent.

For the current study, Rosemary Higgins, MD, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health (NIH), Bethesda, Maryland, evaluated 6,121 extremely premature infants who had been born between 22 and 27 weeks of pregnancy at sites in NICHD’s Neonatal Research Network.

The study followed the infants from birth to age 18 to 22 months and measured survival and brain and nervous system outcomes. The infants were grouped according to the mother's steroid treatment -- no treatment, partial treatment or complete treatment.

Among the 3 groups, researchers found significant differences in rates of death, complications such as severe intracranial haemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, and brain and nervous system impairment.

Infants in the complete treatment group fared best. Infants in the partial treatment group fared better than untreated infants.

The study team also found evidence that the better outcomes likely were due to lower rates of bleeding in the brain and of a brain injury called cystic periventricular leukomalacia.

Overall, the findings suggest that starting steroid treatment promptly -- even if the likelihood of completion is low -- is beneficial when extremely premature birth is imminent.

SOURCE: National Institutes of Health

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