title: Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth.
abstract: BACKGROUND
  A single dose of prenatal betamethasone treatment decreases neonatal morbidity rates when administered within 7 days before preterm delivery. A single repeat dose or booster dose of betamethasone before delivery has been proposed to be effective, but its efficacy has not been subjected to a randomized, blinded trial.
  
  
  METHODS
  Women with imminent delivery before 34.0 gestational weeks were eligible if they remained without delivery for >7 days after a single course of betamethasone. After stratification, a single repeat dose of betamethasone (12 mg) or placebo was administered. The primary outcome was survival without respiratory distress syndrome or severe intraventricular hemorrhage (grade 3 or 4).
  
  
  RESULTS
  A total of 249 mothers had been enrolled by the time the study was discontinued. All of the 159 infants in the betamethasone group and 167 in the placebo group were born before 36 weeks of gestation. The intact survival rate was unaffected and was lower than anticipated, because the gestational age-adjusted incidence of respiratory distress syndrome was higher than the population incidence. The requirement for surfactant therapy in respiratory distress syndrome was increased in the betamethasone group. According to posthoc analysis of the data for 206 infants who were delivered within 1 to 24 hours, the betamethasone booster tended to increase the risk of respiratory distress syndrome and to decrease intact survival rates.
  
  
  CONCLUSIONS
  According to this study, a single booster dose of betamethasone just before preterm birth may perturb respiratory adaptation. These results caution against uncontrolled use of a repeat dose of glucocorticoid in high-risk pregnancies.
authors.affiliation: Department of Pediatrics, University of Oulu, Oulu, Finland.
authors.forename: Outi M
authors.initials: OM
authors.lastname: Peltoniemi
authors.forename: M Anneli
authors.initials: MA
authors.lastname: Kari
authors.forename: Outi
authors.initials: O
authors.lastname: Tammela
authors.forename: Liisa
authors.initials: L
authors.lastname: Lehtonen
authors.forename: Riitta
authors.initials: R
authors.lastname: Marttila
authors.forename: Erja
authors.initials: E
authors.lastname: Halmesmäki
authors.forename: Pentti
authors.initials: P
authors.lastname: Jouppila
authors.forename: Mikko
authors.initials: M
authors.lastname: Hallman
mesh_terms: D001623:Betamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000517:prevention & control*; D008297:Male; D047928:Premature Birth; D011295:Prenatal Care; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D016037:Single-Blind Method
chemical_list: D005938:Glucocorticoids; D001623:Betamethasone