Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants

OBJECTIVE: The relationship between antenatal steroids, delivery mode, and early-onset ventricular hemorrhage was examined in very-low-birth-weight infants. STUDY DESIGN: A total of 505 preterm infants (birth weight 600 to 1250 gm) were enrolled in a multicenter, prospectively randomized, controlled trial evaluating the efficacy of postnatal indomethacin to prevent intraventricular hemorrhage. All infants had echoencephalography between 5 and 11 hours of life. RESULTS: Seventy-three infants had intraventricular hemorrhage within the first 5 to 11 hours (mean age at echoencephalography 7.5 hours). Four hundred thirty-two infants did not have early intraventricular hemorrhage. There was less antenatal steroid treatment (19% vs 32%, p = 0.03) and more vaginal deliveries (71% vs 45%, p< 0.0001) in the group with early intraventricular hemorrhage. Of 152 infants intraventricular hemorrhage than did those delivered vaginally (4% vs 17%, p = 0.02). Of the 353 not had early intraventricular hemorrhage (p = 0.003). CONCLUSION: These data are the first to suggest that both antenatal steroids and cesarean section delivery have an important and independent rol ein lowering the risk of early-onset intraventricular hemorrhage.