title: Rescue corticosteroids in twin pregnancies and short-term neonatal outcomes.
abstract: OBJECTIVE
  To estimate the efficacy of a rescue course of antenatal corticosteroids in twin pregnancies.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care centre.
  
  
  METHODS
  Twins born from 24 to <34 weeks of gestation in a single maternal and fetal medicine practice from 2006 to 2011.
  
  
  METHODS
  We compared neonatal outcomes in 88 twins exposed to a single course of corticosteroids with outcomes in 42 twins exposed to two courses of corticosteroids: the initial course and a single rescue course. Analyses were adjusted to control for correlation between twins born to the same mother.
  
  
  METHODS
  Short-term neonatal respiratory morbidity.
  
  
  RESULTS
  Rescue corticosteroids were associated with fewer days of mechanical ventilation (7.3 ± 3.3 versus 33.9 ± 25.3 days, P = 0.003), fewer days with a fraction of inspired oxygen of >21% (6.3 ± 4.3 versus 33.3 ± 25.8 days, P = 0.003), a lower incidence of mechanical ventilation >14 days or death while on mechanical ventilation (0 versus 12.5%, P = 0.016), and a lower incidence of retinopathy of prematurity (0 versus 12.5%, P = 0.016). The proportion of neonates with respiratory distress syndrome did not differ between the groups (adjusted odds ratio 1.28, 95% confidence interval 0.50-3.26). There were no differences found for birthweight, head circumference and length.
  
  
  CONCLUSIONS
  In twins born before 34 weeks of gestation, exposure to rescue corticosteroids may be associated with improved neonatal outcomes. Further studies are warranted to assess the effect of rescue corticosteroids in twin pregnancies.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bibbo
authors.forename: L
authors.initials: L
authors.lastname: Deluca
authors.forename: K A
authors.initials: KA
authors.lastname: Gibbs
authors.forename: D H
authors.initials: DH
authors.lastname: Saltzman
authors.forename: A
authors.initials: A
authors.lastname: Rebarber
authors.forename: R S
authors.initials: RS
authors.lastname: Green
authors.forename: N S
authors.initials: NS
authors.lastname: Fox
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care / Q000379:methods*; D011247:Pregnancy; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000188:drug therapy; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D019141:Respiratory System Agents / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D019141:Respiratory System Agents