The interval between a single course of antenatal steroids and delivery and its association with neonatal outcomes

Alan M. Peaceman*, Komal Bajaj, Praveen Kumar, William A. Grobman

*Corresponding author for this work

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Objective: This study was undertaken to determine whether the benefits of a single course of antenatal steroid treatment for neonatal respiratory morbidity diminish beyond 7 days. Study design: A retrospective chart review was performed of all deliveries less than 34 weeks' gestation where delivery occurred after completing a single course of antenatal steroids (dexamethasone or betamethasone). Maternal and neonatal charts were reviewed, treatment course was confirmed, and neonatal morbidities were collected. Results: Of 197 neonates whose mothers received a full course of antenatal steroids, 98 delivered within 7 days and 99 delivered more than 7 days after the initial dose. The 2 groups were similar in gestational age at delivery (30 weeks 0 days vs 30 weeks 4 days). The groups were also similar in maternal age, race, payor status, type of steroid given, route of delivery, gender, and birth weight. Overall, infants delivering within 7 days had a lower incidence of receiving respiratory support for more than 24 hours (62% vs 81%, P < .01), but there were no significant differences between the groups in surfactant treatment (39% vs 47%), use of mechanical ventilation (49% vs 59%), necrotizing enterocolitis (6% vs 4%), intraventricular hemorrhage (15% vs 20%), oxygen dependence at 28 days (24% vs 23%) or at 36 weeks estimated gestational age (13% vs 12%), length of stay (34 days vs 38 days), or mortality (2 vs 0). These results were no different when evaluating only infants delivered before 30 weeks. Conclusion: Among infants exposed to a single course of antenatal steroids, delivering more than 7 days after initiation of treatment was associated with an increased need for short-term respiratory support, but not other measures of neonatal morbidity. These data challenge the concept of diminishing efficacy of steroids after 7 days, and question the need for considering a rescue course.

Original languageEnglish (US)
Pages (from-to)1165-1169
Number of pages5
JournalAmerican journal of obstetrics and gynecology
Volume193
Issue number3 SUPPL.
DOIs
StatePublished - Sep 1 2005

Keywords

  • Antenatal steroids
  • Neonatal respiratory distress syndrome
  • Prematurity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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