Antenatal Corticosteroids Appear to Reduce the Risk of Postnatal Germinal Matrix Hemorrhage in Intubated Low Birth Weight Newborns
1 From the Children's Hospital, and Harvard Medical School, Boston, MA.
2 From the Children's Hospital, Harvard Medical School, and Brigham and Women's Hospital, Boston, MA.
3 From the Children's Hospital, and Harvard School of Public Health, Boston, MA.
4 From the Children's Hospital, Boston, MA.
Objective. To determine to what extent the reduced risk in preterm newborns of intracranial hemorrhage attributed to antenatal corticosteroids (ANCS) reflects reductions in the incidence of respiratory distress and its correlates.
Methods. In a sample of 239 very low birth weight newborns recruited for a clinical trial of phenobarbital prophylaxis of subependymal/intraventricular hemorrhage, we explored the relationship between ANCS, the occurrence of germinal matrix hemorrhage (GMH) that first became evident after the 12th postnatal hour, and putative intervening variables such as acidosis, elevated peak inspiratory pressure, pneumothorax-pulmonary interstitial emphysema, and elevated continuous positive airway pressure.
Results. In multivariate models adjusting for confounders, newborns exposed to ANCS were at approximately one third the risk of GMH experienced by newborns not exposed to a full course of ANCS. The additions of measures and correlates of respiratory distress severity to these models did not change the GMH risk associated with ANCS.
Conclusion. The GMH-protective effect of ANCS does not appear to be a consequence of enhanced pulmonary maturation.
Key Words: corticosteroids • cerebral hemorrhage • respiratory distress syndrome • low birth weight • neonate
Submitted on August 24, 1992
Accepted on December 30, 1992
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