EFFECT OF CORTICOSTEROIDS FOR FETAL MATURATION ON PERINATAL OUTCOMES

Objective.-To develop a consensus on the use of antenatal corticostero ids for fetal maturation in preterm infants. Participants.-A nonfedera l, nonadvocate, 16-member consensus panel including representatives fr om neonatology, obstetrics, family medicine, behavioral medicine, psyc hology, biostatistics, and the public; 19 experts in neonatology, obst etrics, and pharmacology presented data to the consensus panel and a c onference audience of approximately 500. Evidence.-An extensive biblio graphy of references was produced for the consensus panel and the conf erence audience using a variety of on-line databases including MEDLINE . The consensus panel met several times prior to the conference to rev iew the literature. It also commissioned an updated meta-analysis, a n eonatal registry review, and an economic analysis that were presented at the conference. The experts prepared abstracts for distribution at the conference, presented data, and answered questions from the panel and audience. The panel evaluated the strength of the scientific evide nce using the grading system developed by the Canadian Task Force on t he Periodic Health Examination and adapted by the US Preventive Servic es Task Force, Consensus.-The consensus panel, answering predefined co nsensus questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. Conse nsus Statement.-The consensus panel composed a draft statement that wa s read in its entirety at the conference for comment. The panel releas ed a revised statement at the end of the conference and finalized the revisions a few weeks after the conference. Conclusions.-Antenatal cor ticosteroid therapy is indicated for women at risk of premature delive ry with few exceptions and will result in a substantial decrease in ne onatal morbidity and mortality, as well as substantial savings in heal th care costs, The use of antenatal corticosteroids for fetal maturati on is a rare example of a technology that yields substantial cost savi ngs in addition to improving health.