FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 341:1190-1196 October 14, 1999 Number 16 Next

	Full Text PDF Editorial by Fanaroff, A. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Antenatal glucocorticoid therapy decreases the incidence of several complications among very premature infants. However, its effect on the occurrence of cystic periventricular leukomalacia, a major cause of cerebral palsy, remains unknown.

Methods We retrospectively analyzed a cohort of 883 live-born infants, with gestational ages ranging from 24 to 31 weeks, who were born between January 1993 and December 1996 at three perinatal centers in the Paris area. The mothers of 361 infants had received betamethasone before delivery, the mothers of 165 infants had received dexamethasone before delivery, and the mothers of 357 infants did not receive glucocorticoids. We compared the rates of cystic periventricular leukomalacia among the three groups of infants in bivariate and multivariate analyses after adjustment for confounding factors.

Results The rate of cystic periventricular leukomalacia was 4.4 percent among the infants whose mothers had received betamethasone, 11.0 percent among the infants whose mothers had received dexamethasone, and 8.4 percent among the infants whose mothers had not received a glucocorticoid. After adjustment for gestational age, the mode of delivery, and the presence or absence of chorioamnionitis, prolonged interval between the rupture of membranes and delivery (>24 hours), preeclampsia, and the use of tocolytic drugs, antenatal exposure to betamethasone was associated with a lower risk of cystic periventricular leukomalacia than was either the absence of glucocorticoid therapy (adjusted odds ratio, 0.5; 95 percent confidence interval, 0.2 to 0.9) or exposure to dexamethasone (adjusted odds ratio, 0.3; 95 percent confidence interval, 0.1 to 0.7). The adjusted odds ratio for the group of infants whose mothers had received dexamethasone as compared with the group of infants whose mothers had not received a glucocorticoid was 1.5 (95 percent confidence interval, 0.8 to 2.9).

Conclusions Antenatal exposure to betamethasone but not dexamethasone is associated with a decreased risk of cystic periventricular leukomalacia among very premature infants.

Source Information

From the Services de Réanimation Néonatale et Gynécologie–Obstétrique, University Hospital Antoine Béclère, Clamart (O.B., L.F.-L., F.A., M.D., T.L.-M.); the Unité de Recherches Epidémiologiques sur la Santé des Femmes et des Enfants, INSERM, Unité 149, Villejuif (L.F.-L., M.K.); the Services de Réanimation Néonatale et Gynécologie–Obstétrique, University Hospital Cochin Port Royal, Paris (P.-H.J., E.P.); and the Services de Réanimation Néonatale et Gynécologie–Obstétrique, University Hospital Saint Vincent de Paul, Paris (C.H., J.L.) — all in France.

Address reprint requests to Dr. Lacaze-Masmonteil at Réanimation et Pédiatrie Néonatales, Hôpital Antoine Béclère, Assistance Publique–Hôpitaux de Paris, 157, rue de la Porte-de-Trivaux, 92141 Clamart, France.

Full Text of this Article

This article has been cited by other articles:

• Campbell, W. A. (2007). Antenatal Betamethasone Compared With Dexamethasone (Betacode Trial): A Randomized Controlled Trial. Obstet Gynecol 110: 930-930 [Full Text]  
• Murphy, K. E. (2007). Betamethasone Compared With Dexamethasone for Preterm Birth: A Call for Trials. Obstet Gynecol 110: 7-9 [Full Text]  
• Elimian, A., Garry, D., Figueroa, R., Spitzer, A., Wiencek, V., Quirk, J. G. (2007). Antenatal Betamethasone Compared With Dexamethasone (Betacode Trial): A Randomized Controlled Trial. Obstet Gynecol 110: 26-30 [Abstract] [Full Text]  
• Amin, S. B., Guillet, R. (2007). Auditory Neural Maturation After Exposure to Multiple Courses of Antenatal Betamethasone in Premature Infants as Evaluated by Auditory Brainstem Response. Pediatrics 119: 502-508 [Abstract] [Full Text]  
• Chatterjee, J., Gullam, J., Vatish, M., Thornton, S. (2007). The management of preterm labour. Arch. Dis. Child. Fetal Neonatal Ed. 92: F88-F93 [Full Text]  
• Parke, A (2006). Drug exposure, pregnancy outcome and fetal and childhood development occurring in the offspring of mothers with systemic lupus erythematosus and other chronic autoimmune diseases. Lupus 15: 808-813 [Abstract]  
• Shankaran, S., Langer, J. C., Kazzi, S. N., Laptook, A. R., Walsh, M., for the National Institute of Child Health and Hum, (2006). Cumulative Index of Exposure to Hypocarbia and Hyperoxia as Risk Factors for Periventricular Leukomalacia in Low Birth Weight Infants. Pediatrics 118: 1654-1659 [Abstract] [Full Text]  
• Airo, P, Scarsi, M, Brucato, A, Benicchi, T, Malacarne, F, Cavazzana, I, Danieli, E, LiDestri, M, Motta, M, Caimi, L, Tincani, A, Imberti, L (2006). Characterization of T-cell population in children with prolonged fetal exposure to dexamethasone for anti-Ro/SS-A antibodies associated congenital heart block. Lupus 15: 553-561 [Abstract]  
• Jobe, A. H. (2006). Prenatal Corticosteroids: A Neonatologist's Perspective. NeoReviews 7: e259-e267 [Full Text]  
• Lee, B. H., Stoll, B. J., McDonald, S. A., Higgins, R. D., for the National Institute of Child Health and Hum, (2006). Adverse Neonatal Outcomes Associated With Antenatal Dexamethasone Versus Antenatal Betamethasone. Pediatrics 117: 1503-1510 [Abstract] [Full Text]  
• Tincani, A, Bompane, D, Danieli, E, Doria, A (2006). Pregnancy, lupus and antiphospholipid syndrome (Hughes syndrome). Lupus 15: 156-160 [Abstract]  
• Walsh, M. C., Szefler, S., Davis, J., Allen, M., Van Marter, L., Abman, S., Blackmon, L., Jobe, A. (2006). Summary proceedings from the bronchopulmonary dysplasia group.. Pediatrics 117: S52-S56 [Abstract] [Full Text]  
• Vural, M, Yilmaz, I, Oztunc, F, Ilikkan, B, Erginoz, E, Perk, Y (2006). Cardiac effects of a single course of antenatal betamethasone in preterm infants. Arch. Dis. Child. Fetal Neonatal Ed. 91: F118-F122 [Abstract] [Full Text]  
• Costedoat-Chalumeau, N, Georgin-Lavialle, S, Amoura, Z, Piette, J-C (2005). Anti-SSA/Ro and anti-SSB/La antibody-mediated congenital heart block. Lupus 14: 660-664 [Abstract]  
• Wood, N S, Costeloe, K, Gibson, A T, Hennessy, E M, Marlow, N, Wilkinson, A R, for the EPICure Study Group, (2005). The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth. Arch. Dis. Child. Fetal Neonatal Ed. 90: F134-F140 [Abstract] [Full Text]  
• Foix-L'Helias, L, Baud, O, Lenclen, R, Kaminski, M, Lacaze-Masmonteil, T (2005). Benefit of antenatal glucocorticoids according to the cause of very premature birth. Arch. Dis. Child. Fetal Neonatal Ed. 90: F46-F48 [Abstract] [Full Text]  
• Bar-Lev, M. R. R., Maayan-Metzger, A., Matok, I., Heyman, Z., Sivan, E., Kuint, J. (2004). Short-Term Outcomes in Low Birth Weight Infants Following Antenatal Exposure to Betamethasone Versus Dexamethasone. Obstet Gynecol 104: 484-488 [Abstract] [Full Text]  
• Jobe, A. H. (2004). Postnatal Corticosteroids for Preterm Infants -- Do What We Say, Not What We Do. NEJM 350: 1349-1351 [Full Text]  
• Baud, O (2004). Postnatal steroid treatment and brain development. Arch. Dis. Child. Fetal Neonatal Ed. 89: F96-F100 [Abstract] [Full Text]  
• Costedoat-Chalumeau, N, Amoura, Z, Le Thi Hong, D, Wechsler, B, Vauthier, D, Ghillani, P, Papo, T, Fain, O, Musset, L, Piette, J-C (2003). Questions about dexamethasone use for the prevention of anti-SSA related congenital heart block. Ann Rheum Dis 62: 1010-1012 [Abstract] [Full Text]  
• Carteaux, P., Cohen, H., Check, J., George, J., McKinley, P., Lewis, W., Hegwood, P., Whitfield, J. M., McLendon, D., Okuno-Jones, S., Klein, S., Moehring, J., McConnell, C. (2003). Evaluation and Development of Potentially Better Practices for the Prevention of Brain Hemorrhage and Ischemic Brain Injury in Very Low Birth Weight Infants. Pediatrics 111: e489-496 [Abstract] [Full Text]  
• Goldenberg, R. L. (2002). The Management of Preterm Labor. Obstet Gynecol 100: 1020-1037 [Abstract] [Full Text]  
• LeFlore, J. L., Salhab, W. A., Broyles, R. S., Engle, W. D. (2002). Association of Antenatal and Postnatal Dexamethasone Exposure With Outcomes in Extremely Low Birth Weight Neonates. Pediatrics 110: 275-279 [Abstract] [Full Text]  
• Walfisch, A., Hallak, M., Mazor, M. (2001). Multiple Courses of Antenatal Steroids: Risks and Benefits. Obstet Gynecol 98: 491-497 [Abstract] [Full Text]  
• Kadhim, H., Tabarki, B., Verellen, G., De Prez, C., Rona, A.-M., Sebire, G. (2001). Inflammatory cytokines in the pathogenesis of periventricular leukomalacia. Neurology 56: 1278-1284 [Abstract] [Full Text]  
• Goldenberg, R. L., Wright, L. L. (2001). REPEATED COURSES OF ANTENATAL CORTICOSTEROIDS. Obstet Gynecol 97: 316-317 [Abstract] [Full Text]  
• Thébaud, B., Lacaze-Masmonteil, T., Watterberg, K. (2001). Postnatal Glucocorticoids in Very Preterm Infants: "The Good, the Bad, and the Ugly"?. Pediatrics 107: 413-415 [Full Text]  
• CANTERINO, J. C., VERMA, U., VISINTAINER, P. F., ELIMIAN, A., KLEIN, S. A., TEJANI, N. (2001). Antenatal Steroids and Neonatal Periventricular Leukomalacia. Obstet Gynecol 97: 135-139 [Abstract] [Full Text]  
• Shinwell, E S, Karplus, M, Reich, D, Weintraub, Z, Blazer, S, Bader, D, Yurman, S, Dolfin, T, Kogan, A, Dollberg, S, Arbel, E, Goldberg, M, Gur, I, Naor, N, Sirota, L, Mogilner, S, Zaritsky, A, Barak, M, Gottfried, E (2000). Early postnatal dexamethasone treatment and increased incidence of cerebral palsy. Arch. Dis. Child. Fetal Neonatal Ed. 83: 177F-181 [Abstract] [Full Text]  
• Wu, Y. W., Colford, J. M. Jr (2000). Chorioamnionitis as a Risk Factor for Cerebral Palsy: A Meta-analysis. JAMA 284: 1417-1424 [Abstract] [Full Text]  
• Whitelaw, A., Thoresen, M. (2000). Antenatal steroids and the developing brain. Arch. Dis. Child. Fetal Neonatal Ed. 83: 154F-157 [Abstract] [Full Text]  
• Merrill, J. D., Ballard, R. A. (2000). Clinical Use of Antenatal Corticosteroids: Benefits and Risks. NeoReviews 1: e91-98 [Full Text]  
• Fanaroff, A. A., Hack, M. (1999). Periventricular Leukomalacia -- Prospects for Prevention. NEJM 341: 1229-1231 [Full Text]