Does Antenatal Corticosteroid Therapy have a Protective Effect on the Occurrence of Periventricular Leukomalacia in Singleton, Very Low Birthweight, Very Preterm Infants?

Objective: To evaluate the independent effect of antenatal corticosteroids (ACS) therapy on the risk for cystic periventricular leukomalacia (c-PVL) in a population of very low birth weight (VLBW), very preterm infants, whilst accounting for the occurrence of major neonatal morbidities (NM) including sepsis, necrotizing enterocolitis, severe intraventricular hemorrhage and bronchopulmonary dysplasia.

Study design: This population-based observational cohort study was based on analysis of data collected by the Israel national VLBW infant database between January 1995 and December 2016.

Results: Cystic PVL was diagnosed in 692 (6.8%) of the 10,170 study infants. A total of 7,522 infants (74%) were exposed to ACS. Among infants receiving ACS the rate of c-PVL was 5.4%, compared to 10.7% among those not exposed to ACS (p<0.0001). ACS treatment was associated with a significantly lower odds for c-PVL (Odds Ratio [OR] 0.69, 95% Confidence Interval [CI] 0.57-0.84). NM were associated with significantly higher rates and OR’s for c-PVL. In subgroup analyses, excluding infants with each NM or combinations of NM, the rates of c-PVL ranged from 2.7% to 5.4% among infants receiving ACS compared to 5.6% to 10.7% in those not exposed to ACS (all p<0.0001). ACS was associated with significantly lower OR’s for c-PVL in all the subgroups, ranging from 0.52 (95% CI 0.40-0.66) to 0.62 (95% CI 0.50-0.77).

Conclusions: Infants exposed to ACS had a significantly lower risk of c-PVL. Subgroup analyses excluding infants NM showed a consistent reduction of 40-50% in the risk for c-PVL following ACS.