Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE‐2 cohort study

Objectives To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short‐term neonatal outcomes in preterm twins, and further document the influence of the ACS‐to‐delivery interval. Design EPIPAGE‐2 is a nationwide observational multicentre prospective cohort study of neonates born...

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Bibliographic Details
Published in:BJOG : an international journal of obstetrics and gynaecology 2018-08, Vol.125 (9), p.1164-1170
Main Authors: Palas, D, Ehlinger, V, Alberge, C, Truffert, P, Kayem, G, Goffinet, F, Ancel, P‐Y, Arnaud, C, Vayssière, C
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - administration & dosage
Antenatal corticosteroids
betamethasone
Bronchopulmonary Dysplasia
Cerebral Intraventricular Hemorrhage - etiology
Cerebral Intraventricular Hemorrhage - prevention & control
Cohort analysis
Corticosteroids
Diseases in Twins - etiology
Diseases in Twins - prevention & control
Drug Administration Schedule
Dysplasia
Female
Gestation
Health risk assessment
Hemorrhage
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases - etiology
Infant, Premature, Diseases - prevention & control
Leukomalacia, Periventricular - etiology
Leukomalacia, Periventricular - prevention & control
Male
Morbidity
Mortality
Neonates
Perinatal Mortality
Periventricular leukomalacia
Pregnancy
Premature birth
Premature Birth - etiology
Premature Birth - prevention & control
prematurity
Prenatal Care - methods
preterm birth
preterm delivery
Prospective Studies
short‐term morbidity
Steroid hormones
steroid‐to‐delivery interval
Time Factors
Treatment Outcome
twin pregnancy
Twins
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Summary:Objectives To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short‐term neonatal outcomes in preterm twins, and further document the influence of the ACS‐to‐delivery interval. Design EPIPAGE‐2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation. Setting All French maternity units, except in a single administrative region, between March and December 2011. Population A total of 750 twin neonates born between 24 and 31 weeks of gestation. Methods Exposure to ACSs was examined in four groups: single complete course, with an ACS administration‐to‐delivery interval of ≤7 days; single complete course, with an ACS‐to‐delivery interval of >7 days; repeated courses; or no ACS treatment. Main outcome measures Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in‐hospital mortality, and a composite indicator of severe outcomes. Results Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration‐to‐delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1–0.5), in‐hospital mortality (0.3; 0.1–0.6), and the composite indicator (0.1; 0.1–0.3), whereas a single course of ACDs with an administration‐to‐delivery interval of >7 days did not significantly reduce the frequency of in‐hospital mortality (0.7; 0.3–1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course. Conclusion In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in‐hospital mortality was seen only when the ACS‐to‐delivery interval was ≤7 days. Tweetable A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24–31 weeks). Tweetable A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24–31 weeks). This paper includes Author Insights, a video available at https://vimeo.com/rcog/authorinsights15014
ISSN:1470-0328
1471-0528
DOI:10.1111/1471-0528.15014