Elsevier

The Journal of Pediatrics

Volume 181, February 2017, Pages 62-66.e1
The Journal of Pediatrics

Original Articles
Pulmonary Function at Hospital Discharge in Preterm Infants Randomized to a Single Rescue Course of Antenatal Steroids

https://doi.org/10.1016/j.jpeds.2016.10.022Get rights and content

Objective

To compare the pulmonary function, measured at birth and at hospital discharge, of infants whose mothers had been randomized to a single rescue course of antenatal steroids versus those whose mothers had been randomized to placebo.

Study design

This study involved follow-up at hospital discharge of subjects of a randomized, double-blinded trial. In the original trial, pregnant women at ≥14 days after their initial course of antenatal steroids and <34 weeks' gestation were randomized to rescue antenatal steroids (44 mothers, 56 infants) or placebo (41 mothers, 57 infants). Passive respiratory compliance (Crs), passive respiratory resistance, and functional residual capacity were measured in all infants at birth and again at discharge to evaluate changes in pulmonary mechanics over time. Statistical analyses were based on intention to treat.

Results

We previously reported that compared with infants in the placebo group, infants in the rescue antenatal steroids group had a higher mean Crs value measured within 72 hours of birth (1.21 vs 1.01 mL/cm H2O/kg; P < .05). Here we show that the Crs benefit in the antenatal steroids group was sustained until discharge. Infants in the placebo group demonstrated improvement in Crs such that by discharge, there was no difference in mean Crs between the rescue antenatal steroids and placebo groups (1.18 vs 1.22 mL/cm H2O/kg).

Conclusions

Rescue antenatal steroids significantly increased Crs measured within 72 hours of birth, and this increase was sustained until hospital discharge. Preterm infants in the placebo group demonstrated a decreased initial Crs compared with the rescue antenatal steroids group, but achieved a comparable Crs by the time of discharge.

Trial registration

ClinicalTrials.gov: NCT00669383.

Section snippets

Methods

This study is an extension of a previously published prospective, randomized, placebo-controlled study of the impact of rescue antenatal steroids on pulmonary mechanics measured after delivery (ClinicalTrials.gov: NCT00669383).5 In brief, the study was conducted at the neonatal intensive care units at Oregon Health & Science University (Portland, Oregon) and Sacred Heart Hospital (Pensacola, Florida). Randomization was stratified by gestational age at rescue antenatal steroid dosing (≤28 vs >28

Results

As reported previously, patients were recruited from June 2001 through May 2007. Of the 135 women approached to participate in the study, 27 declined participation and 23 showed no further evidence of preterm labor. The remaining 85 women were randomized to the rescue antenatal steroids arm (44 women) or the placebo arm (41 women). A total of 113 infants were born to these women and were included in the study, 56 from the rescue antenatal steroids arm and 57 from the placebo arm (Figure 1;

Discussion

Our findings demonstrate improved Crs in the rescue antenatal steroids group that was sustained from delivery until discharge in infants randomized to a single rescue course of antenatal steroids vs placebo. At the time of hospital discharge (34-36 weeks of corrected gestational age), there was no significant difference in Crs between the rescue antenatal steroids and placebo groups.

In previous work, we showed that compared with placebo, rescue antenatal steroids improved Crs at birth by 20% in

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    • Supported by National Center for Advancing Translational Sciences/National Institutes of Health (NIH; UL1TR000128), NIH/National Heart Lung Blood Institute (K23 HL080231 and R01 HL105447), Office of Dietary Supplement, and American Lung Association (to C.M.). The authors declare no conflicts of interest.

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