Intracranial Bleeding in Pre-Term Liveborns after Antepartum Administration of Corticosteroids [Article in Bosnian]

Abstract

Antepartum administration of corticosteroids induces biochemical and structural maturation of a number of fetal organs which enables the reduction of complications caused by pre-term birth. The aim of this study was to assess the impact of antepartum administration of corticosteroids to the mother on the incidence, time, beginning, degree and death rate from intracranial bleeding in pre-term live-borns. The retrospecive study in the Clinic for Gynaecology and Obstetrisc in Tuzla in the period from 1st January 2002 to 31st December 2005 includes all live-borns with body weight below 2000 grams and gestation age between 28. and 34 weeks, of both sexes, from single pregnancies and without visible anomalies (n=418). The children were then divided into two groups: the study group (sample) whose mothers received antepartum administration of dexametazon (n=279), and the test group whose mothers did not receive antepartum administration of dexametazon (n=139). Multiple ultrasonic examination of the cranium was used to look for intracranial bleeding which was graded according to Papile into four degrees. Intracranial bleeding was found in 203 of 418 pre-terms (48.6%). The incidence of bleeding among 279 examined babies was 108/279 = 38.7%, and in the test group of 139 there were 95/139=68.3% bleedings. The relative risk of bleeding among the sample babies compared to the risk from bleeding in the test group was considerably smaller (29.2%). The increased relative risk for the occurrence of bleeding was found in low body weight (64.2%), and reduced in higher body weight(10.3%). Comparing the time of the beginning of bleeding, the risk for the occurrence of bleeding in the first three days is considerably lower in the study group (20.1%) when compared to the risk of the beginning of bleeding in the test group. Considering the degree of bleeding, the study group shows less profuse bleeding (59.2%) when compared to the test group (49.5%), but the difference is not statistical significant. In the total number of 418 studied preterm babies (both study group and test group) there were 57 lethal outcomes in the studied period, so the mortality was 13.6%. The relative likelihood of survival of all studied patients (with and without bleeding) was 4.69 times higher compared to the likelihood of survival of all babies in the test group. The likelihood of survival of the babies with bleeding is the same as the likelihood of survival of babies with bleeding from the test group [RR = 1,078 (95% CI= 0.501-2.318)] while the likelihood of survival of babies without bleeding from the study group was considerably higher than the ones in the test group [RR=41.75 (95% CI= 13.161-132.433)]. In conclusion antepartum administration of corticosteroids to the mother decreases the risk of intracranial bleeding in pre-term babies compared to the risk of pre-term babies whose mothers were not given antepartum corticosteroids. When bleeding develops in spite of steroids, the risk of the beginning of bleeding moves in prenatally treated pre-term babies compared to test group from the first three days to the period between the 4th and 7th day of life. In preterm baby when bleeding develops in spite of steroids, the likelihood of survival is the same in both groups, which leads to the conclusion that corticosteroids received antepartum do not have any impact on survival. Despite this, our investigation showed that the likelihood of survival of the study group who received antepartum corticosteroids without intracranial bleeding was higher compard with the test group without bleeding, because of corticosteroids received antepartum may have some other good impact for survival apart from stopping bleeding.