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Antenatal Corticosteroids to Reduce Neonatal Morbidity: A Single Course Is Best

Based on strong evidence that antenatal corticosteroids reduce neonatal morbidity, the NIH issued a consensus statement recommending that they be given to women at risk for delivery before 34 weeks' gestation. Although widely practiced, weekly administration of antenatal corticosteroids in such cases had not been evaluated in a randomized trial. These U.S. researchers conducted a randomized, double-blind, placebo-controlled study to determine whether weekly-course therapy is more effective for reducing neonatal morbidity than single-course therapy.

After receiving an initial single course of antenatal corticosteroids, 502 pregnant women at risk for preterm delivery were randomized to receive weekly corticosteroids or placebo. Composite neonatal morbidity -- including severe respiratory distress, bronchopulmonary dysplasia, severe intraventricular hemorrhage, periventricular leukomalacia, proven sepsis, necrotizing enterocolitis, and perinatal death -- was compared between the groups.

The difference in composite neonatal morbidity between the weekly-course group and the single-course group was not significant (22.5 percent vs. 28.0 percent; unadjusted relative risk, 0.80; 95 percent CI, 0.59-1.10). The application of a recently developed NIH consensus definition of composite morbidity -- a strict definition including only variables most predictive of long-term morbidity -- yielded similar results: 14.5 percent of neonates in the weekly-course group had significant morbidity, compared with 14.3 percent in the single-course group (unadjusted RR, 1.01; 95 percent CI, 0.65-1.55).

Comment: These findings question the weekly use of antenatal corticosteroids in women at risk for preterm birth. Compared with single-course therapy, weekly courses were not more effective in reducing neonatal morbidity; in addition, weekly courses may increase the risk for intraventricular hemorrhage, sepsis, necrotizing enterocolitis, and chorioamnionitis. To define the best approach to this serious perinatal problem, investigators are conducting trials to analyze the use of longer dosage intervals of antenatal corticosteroids and fewer numbers of steroid exposures.

— AJ Davis

Published in Journal Watch Women's Health November 20, 2001

Citation(s):

Guinn DA et al. Single vs weekly courses of antenatal corticosteroids for women at risk of preterm delivery: A randomized controlled trial. JAMA 2001 Oct 3 286 1581-1587.

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