4 years ago

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE2 cohort study

Déborah Palas, Virginie Ehlinger, Patrick Truffert, François Goffinet, Gilles Kayem, Catherine Arnaud, Corinne I. Alberge, Pierre-Yves Ancel, Christophe Vayssiere
Objectives To investigate the efficacy of ACS therapy on short-term neonatal outcomes in preterm twins and further document the influence of the ACS-to-delivery interval. Design EPIPAGE2 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 regions, between March and December 2011. Population 750 twin neonates born between 24 and 31 weeks of gestation. Methods Exposure to antenatal corticosteroids was examined in 4 groups: single complete course with ACS administration-to-delivery interval ≤7 days, single complete course with ACS-to-delivery >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 ACS, in multivariable analysis, a single ACS course with administration-to-delivery ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (0.2; 0.1-0.5), in-hospital mortality (0.3; 0.1-0.6) and composite indicator (0.1; 0.1-0.3), whereas a single course of antenatal corticosteroids with administration-to-delivery >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. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/1471-0528.15014

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