Multiple courses of antenatal corticosteroids and outcome of premature neonates. North American Thyrotropin-Releasing Hormone Study Group.
OBJECTIVE
We sought to examine outcome for premature neonates after multiple courses of antenatal corticosteroids compared with a single course.


METHODS
We performed a post hoc nonrandomized analysis on 710 neonates of 25-32 weeks' gestation who were born to mothers enrolled in the North American Thyrotropin-Releasing Hormone Trial and who received 1, 2, or >/=3 courses of antenatal corticosteroids.


RESULTS
There was no detectable clinical difference in incidence of respiratory distress syndrome, chronic lung disease, and intraventricular hemorrhage related to courses of antenatal corticosteroids, and outcome was similar for infants delivered at 7-13 days compared with those delivered at 1-6 days after receiving antenatal corticosteroids. Compared with those who received a single course, neonates who received >/=2 courses had lower birth weights (-39 g, P =.02), and those receiving >/=3 courses had increased risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P =.01) and lower levels of plasma cortisol at age 2 hours.


CONCLUSIONS
In this retrospective analysis multiple courses of antenatal corticosteroids did not improve outcome and were associated with increased mortality, decreased fetal growth, and prolonged adrenal suppression.
Banks
B A
BA
Department of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, USA.
Cnaan
A
A
Morgan
M A
MA
Parer
J T
JT
Merrill
J D
JD
Ballard
P L
PL
Ballard
R A
RA
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000139:chemically induced; D005260:Female; D005865:Gestational Age; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D008171:Lung Diseases / Q000517:prevention & control*; D007752:Obstetric Labor, Premature; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D006854:Hydrocortisone