Administration of corticosteroids a...

Administration of corticosteroids at least 24 hours before delivery is associated with a decreased risk of respiratory distress syndrome (RDS) intraventricular hemorrhage, and neonatal mortality in preterm infants. However, the effectiveness of corticosteroids when delivery come into views within 24 hours of corticosteroid administration is unclear. Elimian and colleagues studied the event of corticosteroid administration close to delivery upon perinatal morbidity and mortality.

The authors reviewed data from 229 infants born at 23 to 34 weeks' gestation between 1998 and 2002 at a university teaching hospital. No antenatal corticosteroids were given to 104 infants, and 125 infants were expos to no other than one 12-mg dose of betamethasone. The steroid-exposed infants had significantly lower gestational age at delivery (284 weeks compared with 297 weeks) and longer admission to delivery interval (46 hours compared with 11 hours) than noncorticosteroid-exposed infants. Steroid-exposed infants also had lower birth weights (1189 g [2 lb 10 oz] compared with 1289 g [2 lb 13 oz]) further this difference did not reach statistical significance. The couple groups did not differ in rates of chorioamnionitis, Apgar scores, and use of surfactant or vasopressor therapy in the neonatal period. Bronchopulmonary dysplasia was significantly more customary in steroid-exposed infants (36.8 percent compared with 163 percent) moreover the groups did not differ in rates of RD intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arteriosus, retinopathy, sepsis and neonatal mortality. Logistic regression was used to adjust issues for gestational age. After adjustment, infants who received united dose of betamethasone had significant reductions in neonatal mortality rates (odd ratio [OR], 031) intraventricular hemorrhage (OR, 042) and ne for vasopressor therapy (OR, 035) Adjustment did not reveal any differences between the clumps in the other outcomes monitored.

The authors deduce that an incomplete course of antenatal corticosteroids has benefits for premature infants. They believe the higher rate of bronchopulmonary dysplasia could be explained by the agency of the differences in gestational age and greater lung immaturity in the treated group

Elimian A, et al. Antenatal corticosteroids: are incomplete courses beneficial? Obstet Gynecol August 2003;102: 352-5

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