Comparison of single and repeated antenatal corticosteroid therapy to prevent neonatal death and morbidity in the preterm infant.
BACKGROUND
In the case of threatened preterm delivery, repeat administration of antenatal corticosteroids is a common practice in women who have not delivered 7-14 days after the first course of corticosteroids. However, the benefits of this policy as compared to single-course administration have not been proven.


OBJECTIVE
Our purpose was to compare neonatal death and morbidity after repeat antenatal courses of corticosteroids with neonatal death and morbidity after a single course.


METHODS
We performed a cohort study with matched controls. Neonates treated with repeat antenatal courses of corticosteroids were matched with neonates treated with a single course. Matching criteria were sex, single or multiple gestation, route of delivery, gestational age at delivery and year of birth. Intrauterine growth-restricted infants were matched separately. We excluded neonates with congenital malformation and neonates with an unknown number of antenatal corticosteriod courses. Outcome measures were the incidences of neonatal death, respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis.


RESULTS
From the neonates treated with two or three courses of antenatal corticosteroids, 56 appropriate grown neonates and 24 intrauterine growth-restricted neonates could be matched. The incidences of neonatal death, respiratory distress syndrome, intraventricular haemorrhage and necrotizing enterocolitis did not show statistically significant differences after single and repeat courses of corticosteroids. Appropriate grown and intrauterine growth-restricted neonates showed the same results.


CONCLUSIONS
From our study, it can be concluded that in preterm neonates, repetition of antenatal corticosteroids seems not to improve neonatal outcome.
Wijnberger
Lia D E
LD
Department of Obstetrics, University Medical Center Utrecht, KJ02.507.0, Wilhelmina Children's Hospital, P.O. Box 85090, 3508 AB Utrecht, The Netherlands. l.wijnberger@dog.azu.nl
Mostert
Johanneke M
JM
van Dam
Karen I
KI
Mol
Ben W J
BW
Brouwers
Hens
H
Visser
Gerard H A
GH
D000328:Adult; D002543:Cerebral Hemorrhage / Q000517:prevention & control; D015331:Cohort Studies; D004334:Drug Administration Schedule; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control; D005260:Female; D005313:Fetal Death / Q000517:prevention & control*; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control
D005938:Glucocorticoids