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Single course of antenatal steroids associated with small increased incidence of serious infection in infants
Clinical Question
Is exposure to a single course of antenatal corticosteroids associated with increased incidence of serious infection within 12 months of life?
Bottom line
This large cohort study suggests that a single course of antenatal corticosteroids is associated with a small, but statistically significant, increase in the incidence of serious infection during the first year of life. This should be weighed against the known benefit for the prevention of respiratory distress syndrome among preterm neonates. The overall risk is higher for infants born preterm versus full term, but the more important argument is that the hazard ratio is higher for full term than for preterm, indicating that the increased risk of steroids might be more pronounced in infants who receive treatment and are then born full term. 2b
Reference
Study design: Cohort (retrospective)
Funding: Government
Setting: Population-based
Synopsis
This was a large retrospective cohort study from Taiwan, conducted in 2008 and 2019, that compared the incidence of serious infection during the first 12 months of life in 45,232 infants exposed to a single course of antenatal corticosteroids with 1,915,393 infants who were not exposed. Serious infection was defined as hospital admission for any serious infection including sepsis, pneumonia, acute gastroenteritis, pyelonephritis, meningitis, cellulitis, septic arthritis, osteomyelitis, and endocarditis. Corticosteroid regimens were betamethasone or dexamethasone as recommended by the American College of Obstetricians and Gynecologists. Data were obtained from national databases. The investigators used propensity scoring to account for systematic baseline differences between groups. The authors calculated an adjusted hazard ratio (aHR) of 1.32 for the primary outcome (95% CI 1.18 - 1.47; P < .0001). Individual components of the primary outcome that were statistically higher in the exposed group included sepsis (aHR 1.74), pneumonia (aHR 1.65), and acute gastroenteritis (aHR 1.35). A sibling-matched analysis had similar results. Results were similar whether the corticosteroid used was betamethasone or dexamethasone. In a subgroup analysis comparing infants born preterm versus full term, those born preterm had significantly higher rates of overall serious infection, pneumonia, and acute gastroenteritis.
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Antenatal Steroids
'The investigators used propensity scoring to account for systematic baseline differences between groups'
One thing that cannot be accounted for is that each of these pregnancies had a reason for administering steroids. What were the indications? These may also affect infant health.
Impact assessment
Excellent