197: The additional benefit of a repeat corticosteroid therapy for neonates born < 34 week’ gestation

Abstract

To explore the neonatal outcome of a rescue course of corticosteroids (r-CS) in preterm neonates born at 26+0 – 33 +6 weeks’ gestation. A retrospective cohort study of all preterm neonates in a single tertiary center (2011-2016). The respiratory (RDS, TTN, Bronchopulmonary dysplasia, meconium aspiration syndrome) and CNS (Encephalopathy, IVH grade III-IV, seizures, PVL) and long-term morbidity (retinopathy of prematurity and necrotizing enterocolitis) were compared between neonates who were treated with only a single course of CS (CS-group) to those treated with r- CS (at least 14 days following the first CS administration – r-CS group). 1) Of 67,007 neonates (66,553 deliveries) born during the study period, 660 (1%) met inclusion criteria. Of them, 87 (13.2%) neonates were treated with r-CS. 2) The mean gestational age at delivery and birthweight were comparable between the groups (31.6±1.8 vs. 31.7±2.0 weeks, p=0.839, and 1,607±429 vs. 1,675±473g, p=0.206, respectively). The median (IQR) of the time-interval from CS and r-CS administration to delivery was 4.9 (1-19.5) and 4 (1-17) days, respectively. 3) The r-CS group had significantly lower rates of RDS (23.0 vs. 34.8%, p=0.037), respiratory morbidity (27.6 vs. 40.5%, p=0.025) and total morbidity (31.0 vs. 44.7%, p=0.020). No differences were found in terms of small for gestational age rate (16.1 vs. 12.0%, p=0.298) or in CNS morbidity. 4) Furthermore, we assessed the complications rates according to gestational age at delivery. Neonatal morbidity was inversely correlated with gestational age at delivery, with an additional reduction for neonates treated with r-CS (Figure). In multivariable analysis, after controlling for maternal age, HTN disorders, multiple gestations, gestational age at delivery, mode of delivery, meconium-stained amniotic fluid. birthweight centile and neonatal gender, neonatal morbidity rate was significantly lower in r-CS group (Table). A repeat course of antenatal corticosteroids can reduce the risk for RDS and respiratory morbidity as compared to neonates treated with only a single course born in the same gestational week. No adverse effect on the neonate birthweight was shown. Therefore, a single repeat course of antenatal corticosteroids should be considered in women who are less than 34 weeks’ gestation who are at risk for preterm delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)