Clinical Health Updates

No long-term benefit from multiple courses of antenatal corticosteroids

Clinical Question:
Do multiple courses of antenatal corticosteroids improve the long-term outcomes of children more than a single course?

Bottom Line:
Children treated with multiple courses of antenatal betamethasone showed no evidence of improved outcomes at 2 years to 3 years of age compared with those who received a single course. The study was too small to determine whether a 2% absolute increase in incidence of cerebral palsy with multiple courses was a true difference.

Reference:
Wapner RJ, Sorokin Y, Mele L, et al, for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Long-term outcomes after repeat doses of antenatal corticosteroids. N Eng J Med 2007;357(12):1190-1198.

Study Design:
Randomized controlled trial (double-blinded)

Synopsis:
Previous trials have shown that repeat courses of antenatal corticosteroids improve some neonatal outcomes in preterm infants but reduce birth weight and increase the risk of intrauterine growth restriction. They reported long-term follow-up results of children enrolled in a randomized trial comparing single and repeat courses of antenatal corticosteroids. Women at 23 through 31 weeks of gestation who remained pregnant 7 days after an initial course of corticosteroids were randomly assigned to weekly courses of betamethasone, consisting of 12 mg given intramuscularly and repeated once at 24 hours, or an identical-appearing placebo. We studied the children who were born after these treatments when they were between 2 and 3 years of corrected age. Prespecified outcomes included scores on the Bayley Scales of Infant Development, anthropometric measurements, and the presence of cerebral palsy. A total of 556 infants were available for follow-up; 486 children (87.4%) underwent physical examination and 465 (83.6%) underwent Bayley testing at a mean (+/-SD) corrected age of 29.3+/-4.6 months. There were no significant differences in Bayley results or anthropometric measurements. Six children (2.9% of pregnancies) in the repeat-corticosteroid group had cerebral palsy as compared with one child (0.5% of pregnancies) in the placebo group (relative risk, 5.7; 95% confidence interval, 0.7 to 46.7; P=0.12).