Influence of antenatal corticosteroids and sex on the mortality and morbidity of extremely prematurely born infants
Rebecca Lee, Emma Williams, Theodore Dassios, Anne Greenough
Abstract
Objective To report the effect of antenatal corticosteroids (ANS) on mortality, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and the duration of ventilation according to sex in extremely preterm infants.Methods All extremely preterm infants admitted to any neonatal unit in England between 2014 and 2019.Results Eleven thousand seven hundred and fourteen infants (54% male) were included with a median (IQR) gestational age of 26 + 1 (24 + 6 − 27 + 1) weeks, birth weight of 809 (670 − 960) grams and birth weight z-score of −0.38 (-0.88 to 0.07). ANS were administered in 10,449 infants (89%); equally in males and females. Infants who received ANS compared to those who did not, had a lower mortality before discharge (18.7 versus 32.3%, p < .001), a lower incidence of IVH grade III–IV (14.5 versus 25.5%, p < .001) and a shorter median (IQR) duration of mechanical ventilation [10 (3–27) versus 13 (5–31) days, p < .001]. Female compared to male infants had a lower mortality (18.7 versus 21.7%, p < .001), a lower incidence of IVH grade III–IV (10.9 versus 13.9%, p < .001), a lower incidence of bronchopulmonary dysplasia (61.6 versus 68.2%, p= <.001) and a shorter median (IQR) duration of mechanical ventilation days [9 (3–26) versus 13 (4–29) days, p= <.001]. In females, the risk of dying before discharge from hospital was greater in those who did not receive ANS (odds ratio (OR) 1.81, 95% CI 1.35–2.44) than in those who did (OR 0.55, 95% CI 0.41–0.74). In males the risk of dying was also greater in those that did not receive ANS (OR 1.36, 95% CI 1.03–1.77) compared to those who did (OR 0.74, 95% CI 0.57–0.96).Conclusion Antenatal corticosteroids had a greater beneficial effect in female compared to male extremely prematurely born infants in reducing death before discharge.