title: Mid-Childhood Outcomes of Repeat Antenatal Corticosteroids: A Randomized Controlled Trial.
abstract: To assess if exposure to repeat dose(s) of antenatal corticosteroids has beneficial effects on neurodevelopment and general health in mid-childhood, at 6 to 8 years' corrected age.
  
  
  
  Women at risk for very preterm birth, who had received a course of corticosteroids ≥7 days previously, were randomized to intramuscular betamethasone (11.4 mg Celestone Chronodose) or saline placebo, repeated weekly if risk of very preterm birth remained. Mid-childhood assessments included neurocognitive function, behavior, growth, lung function, blood pressure, health-related quality of life, and health service utilization. The primary outcome was survival free of neurosensory disability.
  
  
  
  Of the 1059 eligible long-term survivors, 963 (91%) were included in the primary outcome; 479 (91%) in the repeat corticosteroid group and 484 (91%) in the placebo group. The rate of survival free of neurosensory disability was similar in both groups (78.3% repeat versus 77.3% placebo; risk ratio 1.00, 95% confidence interval, 0.94-1.08). Neurodevelopment, including cognitive function, and behavior, body size, blood pressure, spirometry, and health-related quality of life were similar in both groups, as was the use of health services.
  
  
  
  Treatment with repeat dose(s) of antenatal corticosteroids was associated with neither benefit nor harm in mid-childhood. Our finding of long-term safety supports the use of repeat dose(s) of antenatal corticosteroids, in view of the related neonatal benefits. For women at risk for preterm birth before 32 weeks' gestation, ≥7 days after an initial course of antenatal corticosteroids, clinicians could consider using a single injection of betamethasone, repeated weekly if risk remains.
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand; c.crowther@auckland.ac.nz.|Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Crowther
authors.affiliation: Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Anderson
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Christopher J D
authors.initials: CJ
authors.lastname: McKinlay
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Harding
authors.affiliation: Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Pat J
authors.initials: PJ
authors.lastname: Ashwood
authors.affiliation: The Women's and Children's Hospital, Adelaide, South Australia, Australia; and.
authors.forename: Ross R
authors.initials: RR
authors.lastname: Haslam
authors.affiliation: Discipline of Obstetrics and Gynaecology, School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Robinson
authors.affiliation: Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.|Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.|Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Lex W
authors.initials: LW
authors.lastname: Doyle
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D001794:Blood Pressure; D049628:Body Size; D002648:Child; D002652:Child Behavior; D002657:Child Development; D003071:Cognition; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D009483:Neuropsychological Tests; D011247:Pregnancy; D047928:Premature Birth / Q000188:drug therapy*; D011295:Prenatal Care; D011788:Quality of Life; D013147:Spirometry
chemical_list: D005938:Glucocorticoids; C018230:betamethasone acetate phosphate; D001623:Betamethasone