Long Term Follow-up of Infants Receiving Single vs Repeat Courses of Antenatal Corticosteroids

view the interview video:  Antenatal Steroids

Abstract

Objective: In the RCT, repeat courses of ACS improved specific neonatal respiratory outcomes but reduced birth weight and increased IUGR, especially in infants that received 4 or more courses. Here we report the 2 year follow up evaluation.

Study Design: Woman between 24 and 32 weeks gestation remaining pregnant 7 days after an initial course of ACS were randomized to weekly courses of betamethasone or a placebo. Between 22 and 36 months corrected age a physical examination and Bayley MDI and PDI were performed by trained examiners using standardized criteria.

Results: From the 495 women randomized (581 surviving infants), 484 infants (83.3%) had physical exams and 465 (80.0%) had Bayley exams. There were no differences in gestational age at delivery, latency period or frequency of twins. At follow-up (Table), there were no differences in anthropometric measurements or Bayley results. However, more in the repeat group had cerebral palsy (RR 5.68: 95%: CI 0.69, 46.7). 5 of the 6 infants with CP in the repeat group received ≥4 courses and 5 were beyond 33 weeks at delivery. The mean GA at birth of the infants with CP in the repeat group was 35 wks.

Conclusion: At 2 years there was no difference in weight, head circumference, or Bayley scores between infants exposed to single vs. repeat courses of ACS. Although not statistically significant, the rate of CP in infants exposed to multiple courses is concerning. We suggest that exposure to repeat courses of ACS should be limited.

References:

0002-9378/$ - see front matter

doi:10.1016/j.ajog.2006.10.004

American Journal of Obstetrics and Gynecology

Volume 195, Issue 6, Supplement S (December 2006)