EFFECT OF CORTICOSTEROIDS FOR FETAL MATURATION ON PERINATAL OUTCOMES,FEBRUARY 28 TO MARCH 2, 1994 (REPRINTED FROM JAMA, VOL 273, PG 413-418, 1995)

The National Institutes of Health Consensus Development Conference on the Effect of Corticosteroids for Fetal Maturation on Perinatal Outcom es brought together specialists in obstetrics, neonatology, pharmacolo gy, epidemiology, and nursing, basic scientists in physiology and cell ular biology, and the public to address the following questions: (1) F or what conditions and purposes are antenatal corticosteroids used, an d what is the scientific basis for that use? (2) What are the short-te rm and long-term benefits of antenatal corticosteroid treatment? (3) W hat are the short-term and long-term adverse effects for the infant an d mother? (4) What is the influence of the type of corticosteroid, dos age, timing and circumstances of administration, and associated therap y on treatment outcome? (5) What are the economic consequences of this treatment? (6) What are the recommendations for use of antenatal cort icosteroids? and (7) What research is needed to guide clinical care? A fter 1 1/2 days of presentations by experts and discussion by the audi ence, a consensus panel weighed the evidence and prepared its consensu s statement. The consensus panel concluded that antenatal corticostero id therapy for fetal maturation reduces mortality, respiratory distres s syndrome, and intraventricular hemorrhage in preterm infants. These benefits extend to a broad range of gestational ages (24 to 34 weeks) and are not limited by gender or race. Although the beneficial effects of corticosteroids are greatest more than 24 hours after beginning tr eatment, treatment less than 24 hours in duration may also improve out comes. The benefits of antenatal corticosteroids are additive to those derived from surfactant therapy. In the presence of preterm premature rupture of the membranes, antenatal corticosteroid therapy reduces th e frequency of respiratory distress syndrome, intraventricular hemorrh age, and neonatal death, although to a lesser extent than with intact membranes. Whether this therapy increases either neonatal or maternal infection is unclear. However, the risk of intraventricular hemorrhage and death from prematurity is greater than the risk from infection. D ata from trials with follow-up of children up to 12 years of age indic ate that antenatal corticosteroid therapy does not adversely affect ph ysical growth or psychomotor development, Antenatal corticosteroid the rapy is indicated for women at risk of premature delivery with few exc eptions and will result in a substantial decrease in neonatal morbidit y and mortality, as well as substantial savings in health care costs. The use of antenatal corticosteroids for fetal maturation is a rare ex ample of a technology that yields substantial cost savings in addition to improving health. The full text of the consensus panel's statement follows.