Antenatal corticosteroid therapy and late preterm infant morbidity and mortality

IntroductionLate preterm infants (34–36 weeks gestation) have a morbidity rate significantly higher than those born at term. However, few interventions have been undertaken to reduce this increased morbidity and mortality. Antenatal corticosteroid administration could be an effective preventive measure.ObjectiveThe aim of this study was to describe the morbidity associated with late prematurity in our institution, and determine if there are differences between those who received antenatal corticosteroids.Patients and methodsA prospective observational study was conducted on late preterm infants born in a tertiary hospital from October 2011 until September 2012. Two groups were formed according to whether or not they had received antenatal steroids. The rates of morbidity and mortality for each of the groups were analysed and compared.ResultsThere was a total of 4127 live newborns during the study period, of whom 3795 were term and 332 were preterm (the overall prematurity rate was 8.04%). There were 247 late preterm deliveries, representing 6% of live born infants, and 74.4% of all premature infants. Of late preterm infants, 63.2% were admitted to the Neonatal Unit and 29.6% had received antenatal steroids. The incidence of admission to the Neonatal Unit and Neonatal Intensive Care, transient tachypnea, need for respiratory support in the form of continuous positive pressure airway and oxygen therapy, incidence of hypoglycemia, feeding difficulty, and jaundice requiring phototherapy were significantly higher (P < 0.05) in the late preterm group that did not receive antenatal steroids.ConclusionsOur finding suggests that the administration of antenatal corticosteroids to patients at risk of 34–36 weeks delivery could significantly reduce the cost and acute morbidity associated with late preterm birth.

ResumenIntroducciónSe define al prematuro tardío como al recién nacido de 34 a 36 semanas de gestación. Este grupo presenta mayor riesgo de complicaciones que los nacidos a término. Sin embargo, son pocas las intervenciones que se realizan para reducir esta mayor morbimortalidad. La administración prenatal de corticoides podría ser una medida preventiva eficaz.ObjetivoDescribir la morbilidad asociada a la prematuridad tardía y determinar si existen diferencias en los prematuros tardíos que recibieron corticoides prenatales.Pacientes y métodosEstudio observacional prospectivo de los prematuros tardíos nacidos en un hospital terciario desde octubre de 2011 a octubre de 2012. Se clasificaron en 2 grupos, según hubiesen o no recibido corticoides prenatales, y se compararon las tasas de morbimortalidad entre los 2 grupos.ResultadosLa tasa de prematuridad global fue del 8,04%, de los cuales el 74,4% (n = 247) fueron prematuros tardíos. Precisaron ingreso el 63,2% (n = 156), suponiendo el 17% del total de ingresados y el 20,6% de los ingresos en la unidad de cuidados intensivos neonatales. Recibieron corticoides prenatales el 29,6% (n = 73). La incidencia de ingreso en neonatología y cuidados intensivos neonatales, la presencia de taquipnea transitoria, hipoglucemia, intolerancia digestiva, ictericia, asistencia respiratoria en forma de presión positiva continua en la vía respiratoria nasal, oxigenoterapia, sueroterapia y fototerapia fueron significativamente superiores (p < 0,05) en el grupo que no recibió corticoides prenatales.ConclusionesLa morbilidad de los prematuros tardíos de nuestro medio es significativamente inferior en los que recibieron corticoides prenatales, por lo que podría ser útil prolongar su administración más allá de las 34 semanas.