Antenatal steroid use is associated with increased gastroesophageal reflux in neonates

The objective of this study was to analyze if repetitive administration of antenatal steroids (ANS) had an adverse impact on neonatal outcome at hospital discharge in premature infants. We used a retrospective analysis of 306 infants of gestational age (GA) ≤ 34 weeks born between January 1997 and June 1999. A detailed review of maternal and neonatal charts was done. Seventy-one percent (216/306) received ANS. While there was no difference in birth weight (1.37 ± 0.04 versus 1.49 ± 0.06 kg; p = 0.09), infants receiving ANS were of lesser GA (29.5 ± 0.2 versus 30.5 ± 0.4 weeks; p = 0.02). More babies who received ANS had clinical evidence of gastroesophageal reflux (GER) [59/216 (27%) versus 11/90 (12%); p = 0.007]. After correcting for GA, infants receiving ANS were less likely to need surfactant (p = 0.03) and more likely to be diagnosed with clinical GER (p = 0.02). Ninety (29%) infants received no ANS, 47 (15%) received a sub-optimal course, 112 (37%) infants received 1 course of ANS, and 57 (19%) infants received ≥ 2 courses. There was a significant increase in the incidence of GER with increasing courses of ANS: 0 course 11/90 (12%), suboptimal 12/47 (26%), 1 course 28/112 (25%), 2 or more courses 18/57 (32%); p = 0.006, linear trend. The increased incidence of GER (p = 0.01) still held true among infants who had GER confirmed by a pH-probe study. Use of ANS is associated with a significantly decreased need for surfactant; however, there is an increased incidence of GER.