Document Detail

The Alabama preterm birth study: corticosteroids and neonatal outcomes in 23- to 32-week newborns with various markers of intrauterine infection.
MedLine Citation:
PMID:  17000235     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Intrauterine inflammation/infection is cited as a contraindication to the use of corticosteroids (CS). Our goal was to determine if CS given prenatally to enhance fetal maturity were harmful to infants with various indications of intrauterine infection. STUDY DESIGN: This was a retrospective analysis of data obtained from 457 consecutively enrolled infants delivered between 23 and 32 weeks. Cultures and a histologic examination of the placenta, and cord blood interleukin (IL)-6 levels were obtained. Neonatal outcomes included periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), chronic lung disease (CLD), necrotizing enterocolitis (NEC), systemic inflammatory response syndrome (SIRS), and infant death. RESULTS: Of the 457 pregnancies, 57.6% had a positive placental culture, 49.8% had histologic chorioamnionitis/funisitis, 28.8% had elevated cord IL-6 levels, and 12.5% had clinical chorioamnionitis. With intrauterine infection/inflammation, none of the neonatal outcomes were significantly worse if mothers were treated with CS. For those with histologic chorioamnionitis/funisitis, of the outcomes historically improved with CS, RDS (59.9 vs 72.2% P = .16), IVH (9.7 vs 14.7% P = .38), and neonatal death (9.9 vs 11.1% P = .82) all occurred less frequently with CS treatment, but differences were not significant. Similar results were seen for women with a positive placental culture. For women with an elevated IL-6, RDS was significantly reduced (59.4 vs 84.2 %, P = .045). Neonatal SIRS was significantly reduced with CS in women with histologic chorioamnionitis/funisitis (39.7 vs 65.7%, P = .005), positive placental cultures (32.7 vs 56.3%, P = .01), and elevated IL-6 levels (42.7 vs 73.7%, P = .02). CONCLUSION: In women with intrauterine infection/inflammation, CS use was not associated with significant worsening in any neonatal outcome, and was associated with significant reductions in RDS and SIRS. These data suggest that CS use may not be contraindicated in the presence of intrauterine inflammation/infection.
Robert L Goldenberg; William W Andrews; Ona M Faye-Petersen; Suzanne P Cliver; Alice R Goepfert; John C Hauth
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  195     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-26     Completed Date:  2006-10-26     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1020-4     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of Alabama at Brimingham, 35233-1602, USA.
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MeSH Terms
Adrenal Cortex Hormones / adverse effects*
Chorioamnionitis / etiology*
Fetus / drug effects*
Infant, Newborn
Interleukin-6 / blood
Premature Birth / etiology*
Respiratory Distress Syndrome, Newborn / prevention & control
Retrospective Studies
Systemic Inflammatory Response Syndrome / prevention & control
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Interleukin-6

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