The effect of a prolonged time interval between antenatal corticosteroid administration and delivery on outcomes in preterm neonates: a cohort study

• Published in: American journal of obstetrics and gynecology Vol. 196; no. 5; pp. 457.e1 - 457.e6
• Main Authors: Ring, Allison M., MD, Garland, Jeffery S., MD, SM, Stafeil, Brian R., MD, Carr, Margaret H., MD, Peckman, Gail S., MS, Pircon, Richard A., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2007
• Subjects: antenatal steroid; Betamethasone - administration & dosage; Delivery, Obstetric; Dexamethasone - administration & dosage; Female; Gestational Age; Glucocorticoids - administration & dosage; Humans; Infant, Newborn; Infant, Premature; latency; neonatal morbidity; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; premature; Prenatal Care; Pulmonary Surfactants - therapeutic use; Respiration, Artificial; Respiratory Distress Syndrome, Newborn - prevention & control; Respiratory Distress Syndrome, Newborn - therapy; Retrospective Studies; Time Factors; Treatment Outcome; premature; antenatal steroid; neonatal morbidity; latency
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2006.12.018

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). Study Design 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, ≥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 ≥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. Conclusion 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.