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Comparison of Antenatal Steroids
Lee BH, Stoll BJ, McDonald SA, et al. Adverse Neonatal Outcomes Associated With Antenatal Dexamethasone Versus Antenatal Betamethasone. Pediatrics (May 2006); 117:1503-10. [Full text] [PDF]
Objective: Antenatal dexamethasone and betamethasone may not be equally efficacious in the prevention of adverse neonatal outcomes. We compared the risks of periventricular leukomalacia (PVL), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and neonatal death among very low birth weight infants who were exposed to dexamethasone, betamethasone, or neither steroid.
Methods: Infants (401–1500 g) in the National Institute of Child Health and Human Development Neonatal Research Network were studied. Multivariate logistic regression analyses compared the 3 groups with regard to PVL, IVH, ROP, and neonatal death, adjusting for network center and selected covariates.
Results: A total of 3600 infants met entry criteria. Compared with no antenatal steroids, there were trends for a reduced risk for PVL associated with dexamethasone and betamethasone but no difference in risk between dexamethasone and betamethasone. Dexamethasone reduced the risk for IVH and severe IVH, compared with no antenatal steroid exposure. Betamethasone reduced the risk for IVH, severe IVH, and neonatal death, compared with no antenatal steroids. Compared with betamethasone, dexamethasone had a statistically significant increased risk for neonatal death. There were trends for greater risks associated with dexamethasone compared with betamethasone for IVH and severe ROP.
Conclusions: Betamethasone was associated with a reduced risk for neonatal death, with trends of decreased risk for other adverse neonatal outcomes, compared with dexamethasone. It may be in the best interest of neonates to receive betamethasone rather than dexamethasone when available.
Comments: The risk of neonatal death was significantly less when betamethasone was used instead of dexamethasone or no antenatal steroids. There was also a trend toward less ROP with betamethasone vs. dexamethasone. Since neonatal treatment with dexamethasone has been associated with an increased risk of cerebral palsy (see 2-056), the authors plan to do long-term neurodevelopmental follow up of patients in this study. In the meantime, it makes sense to stick with betamethasone for antenatal steroid treatment. ABK
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