Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

Abstract

Background: Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants.

Methods: A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23-37 weeks' gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes.

Results: A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28-32 weeks' gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54-25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed.

Conclusions: Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28-32 weeks' gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

Keywords: Antenatal corticosteroids; Growth; Nutrition; Very low birth weight.

Fig. 1

Curves trajectories of weight-growth and weight-growth velocity in the VLBW infants according to ACS regimens. VLBW, very-low-birth-weight; ACS, antenatal corticosteroids; GA, gestational age. Data are mean weight (a and b) or mean weight-growth velocity (c and d). a: Curve trajectories of mean weight in total VLBW preterm infants. b: Curve trajectories of mean weight in total VLBW preterm infants stratified by GA. c: Curve trajectories of mean weight-growth velocity in total VLBW preterm. d: Curve trajectories of mean weight-growth velocity in total VLBW preterm stratified by GA. GA: 1 = GA < 28 weeks, 2 = 28 weeks ≤ GA < 32 weeks, 3 = 32 weeks ≤ GA < 37 weeks. Data were collected until 37 postmenstrual age