Background Antenatal steroids have been shown to reduce mortality and morbidity in neonates born less than 29 weeks gestation. Counselling of parents regarding outcomes is generally based on data that includes all neonates whether they have received a complete course of antenatal steroids or not. In the acute setting where delivery is imminent more accurate estimation of outcomes for parents is required.
Aims To determine the differences in survival, short and long term morbidity for those neonates receiving no antenatal steroids or an incomplete course of steroids in comparison to those receiving a complete course.
Methods A retrospective review of prospectively collected data from 10 NICU’s between January 1998 to December 2004.
Results 2549 neonates were included in the study with 319 (12.5%) not given any ante-natal steroids. Hospital mortality was significantly worse without steroids (30% versus 20% p<0.001). Those with no steroid coverage were more likely to have NEC (11% vs 7%; p=0.018) and Grade 3 or 4 IVH (19% vs 12%; p=0.001). In a multivariate model, factors predictive of mortality included: lack of antenatal steroids, male gender, smaller gestation and hypertensive disease of pregnancy.
Long-term data was available for 1473 survivors. There was no difference in long term neurological outcome between those not receiving steroids and those receiving any steroids.
Conclusions Antenatal steroids still confers a survival benefit in neonates born < 29 weeks gestation and reduces short term morbidities of NEC and severe IVH, but does not have an impact on long term neurodevelopment.