Neurodevelopmental outcome of extremely premature infants exposed to incomplete, no or complete antenatal steroids

Objective: To compare the neurodevelopmental outcomes at 18-22 months' corrected age of extremely premature infants exposed to a complete course, an incomplete course or no dose of antenatal steroids (ANS). Methods: Retrospective chart review of extremely premature (<28 weeks gestational age) neonates over a 3-year period. Neurodevelopmental assessment at 18-22 months' corrected age included a standardized neurologic examination and the Bayley Scales of Infant and Toddler development II or III. Intact survival was defined as survival without cerebral palsy (CP), blindness or deafness and mental developmental index (MDI)/cognitive score ≥85. Neurodevelopmental impairment (NDI) was defined as any of the following: moderate or severe CP, MDI/cognitive score <70, deafness or blindness. Patients were categorized into three groups: (A) no ANS; (B) incomplete course and (C) complete course of ANS. Results: Outcome data were available for 134 (88%) patients of our cohort (n=153). Severe intraventricular hemorrhage (IVH) was significantly lower and intact survival was higher in the complete ANS group (p<0.01). On logistic regression, with gestational age, gender, maternal insurance and ANS exposure as covariates, an incomplete (versus complete) course of ANS (p=0.006) and gestational age were significantly associated with lower intact survival at 18-22 months. Conclusions: A complete course of ANS was associated with an increased likelihood of intact survival at a corrected age of 18-22 months among extremely premature infants, compared with an incomplete course. Follow-up studies should account for the differential benefit of complete versus incomplete course of ANS administration.