Dosage escalation of antenatal steroids in preterm twin pregnancies does not improve long-term outcome.

Thorsten Braun,Wolfgang Henrich,Vivien Filleböck,Christoph Bührer,Boris Metze,Andreas Plagemann

doi:10.1515/jpm-2020-0575

Thorsten Braun, Wolfgang Henrich + Show 4 more

Open Access

https://doi.org/10.1515/jpm-2020-0575

Copy DOI

Abstract

To analyze long-term effects of antenatal betamethasone (≤16mg, =24mg and >24mg) in preterm twins on infant and childhood morbidity. Retrospective cohort study among 198 preterm twins. Three follow up time points, including a total of 84 outcomes, were evaluated: first neonatal examination after birth and in the neonatal period up to 10days after birth using data from the clinic charts; examination from the 21st to the 24th month of life and examination from the 60th to the 64th months, using data from copies of the children's examination booklets sent back by the parents. Dosage-dependent and sex-specific long-term effects of antenatal betamethasone treatment on neonatal, infant and early childhood development and morbidity up to 5.3 years of age were analyzed. Dosage escalation of >24mg was not associated with improved neonatal, infant or early child hood outcome, independent of twin pair structure. In contrast, higher doses >24mg were significantly linked to increased rates of congenital infections (OR 5.867, 95% CI 1.895-18.167). Male sex as a factor was obvious for lower rates of apnea-bradycardia-syndrome in neonates, higher rates ofno free steps after 15months in infancy and highest rates of motor clumsiness in early childhood. Betamethasone dosage escalation >24mg in twins born between 23+5 and 33+6 weeks of gestation did not improve neonatal, infant or early childhood morbidity. In contrast, higher doses >24mg total dose resulted in significantly higher rates of congenital infections and are not recommended. For males, 24mg betamethasone appears to be the preferable dose.

Highlights

In singleton pregnancies threatened with preterm birth, antenatal steroid (ANS) treatment to induce fetal lung maturation and to reduce neonatal morbidity and mortality is common practice [1], in twin pregnancies, the optimal treatment strategy of ANS has not been clarified [2]
Eighty four categorial outcome parameters in total were analyzed at neonatal, infant and early childhood according to the effect of antenatal betamethasone treatment and twin pair structure, if the group prevalence in the different subsets was >5%, shown in Table 1 in descending order
For the first time we demonstrate that betamethasone dosage escalation >24 mg in twin pregnancies born between 23+5 and 33+6 weeks of gestation, obviously does not improve neonatal, infant or early childhood morbidity

Summary

Introduction

In singleton pregnancies threatened with preterm birth, antenatal steroid (ANS) treatment to induce fetal lung maturation and to reduce neonatal morbidity and mortality is common practice [1], in twin pregnancies, the optimal treatment strategy of ANS has not been clarified [2]. The effects of antenatal lung maturation with glucocorticoids in multiple pregnancies still remains unclear, as trials in twins are limited and evidence is lacking [1, 3,4,5,6,7,8,9]. In a Cochrane meta-analysis from 2017 of randomized controlled studies with multiples, no significant reduction within the occurrence of respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH) or within the rate of neonatal mortality was found after ANS therapy [2]. Other studies confirmed the benefit of ANS in

Objectives

Results

Discussion

Conclusion