title: Single versus weekly courses of antenatal corticosteroids: evaluation of safety and efficacy.
abstract: OBJECTIVE
  The purpose of this study was to determine if weekly corticosteroids improve neonatal outcome without undue harm.
  
  
  METHODS
  Women 23 to 32 weeks receiving 1 course of corticosteroids 7 to 10 days prior were randomized to weekly betamethasone or placebo.
  
  
  RESULTS
  The study was terminated by the independent data and safety monitoring committee with 495 of the anticipated 2400 patients enrolled. There was no significant reduction in the composite primary morbidity outcome (8.0% vs 9.1%, P = .67). Repeated courses significantly reduced neonatal surfactant administration (P = .02), mechanical ventilation (P = .004), CPAP (P = .05), pneumothoraces (P = .03). There was no significant difference in mean birth weight or head circumference. The repeat group had a reduction in multiples of the birth weight median by gestational age (0.88 vs 0.91) (P = .01) and more neonates weighing less than the 10th percentile (23.7 vs 15.3%, P = .02). Significant weight reductions occurred for the group receiving > or = 4 courses.
  
  
  CONCLUSIONS
  Repeat antenatal corticosteroids significantly reduce specific neonatal morbidities but do not improve composite neonatal outcome. This is accompanied by reduction in birth weight and increase in small for gestational age infants.
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA. rw2191@columbia.edu
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Thom
authors.forename: Francee
authors.initials: F
authors.lastname: Johnson
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Dudley
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Leveno
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Menachem
authors.initials: M
authors.lastname: Miodovnik
authors.forename: Brian
authors.initials: B
authors.lastname: Mercer
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Atef
authors.initials: A
authors.lastname: Moawad
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Susan
authors.initials: S
authors.lastname: Ramin
authors.forename: Marshall W
authors.initials: MW
authors.lastname: Carpenter
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: Baha
authors.initials: B
authors.lastname: Sibai
authors.forename: Steven G
authors.initials: SG
authors.lastname: Gabbe
mesh_terms: D000328:Adult; D000886:Anthropometry; D001623:Betamethasone / Q000008:administration & dosage*; D001724:Birth Weight; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk / Q000187:drug effects*; D019233:Retreatment
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone