The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study.
OBJECTIVE
This study was undertaken to determine whether the neonatal benefit of a single complete course of antenatal corticosteroids diminishes when delivery is remote from administration (> 14 days).


METHODS
This retrospective 2 center cohort trial included women who received a single complete course of antenatal corticosteroids and delivered a viable singleton infant between 26 and 34 weeks of gestation. Patients were divided into 1 of 2 groups on the basis of the interval from first corticosteroid dose to delivery (2-14 days and > 14 days). Neonatal outcomes among treatment groups were stratified by gestational age at delivery (< 28 weeks, > or = 28 weeks). Regression models were used to control for potential confounders.


RESULTS
Three hundred fifty-seven pregnancies were included, of which 98 women delivered at > 14 days after antenatal corticosteroids. Neonates at > or = 28 weeks of gestation and who delivered at > 14 days after antenatal corticosteroids were more likely to require surfactant therapy (60% vs 48%; p = .02) and to require ventilatory support for > 24 hours (58% vs 46%; P = .02). Differences in outcomes between groups remained in regression models that were controlled for confounders. There was no significant difference between treatment groups for neonates who delivered at < 28 weeks of gestation. Rates of survival without chronic lung disease and intraventricular hemorrhage were similar between groups.


CONCLUSIONS
A time interval of > 14 days between the administration of antenatal corticosteroids and delivery is associated with an increased risk for ventilatory support and surfactant use in neonates who deliver at > 28 weeks of gestation.
Ring
Allison M
AM
Department of Obstetrics and Gynecology, Medical College of Wisconsin Affiliated Hospitals, St. Joseph Regional Medical Center, Milwaukee, WI, USA.
Garland
Jeffery S
JS
Stafeil
Brian R
BR
Carr
Margaret H
MH
Peckman
Gail S
GS
Pircon
Richard A
RA
D001623:Betamethasone / Q000008:administration & dosage; D036861:Delivery, Obstetric; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D003907:Dexamethasone; D001623:Betamethasone