THE EFFECT OF CORTICOSTEROID-THERAPY IN THE VERY PREMATURE-INFANT

OBJECTIVE: Our purpose was to determine the efficacy of maternal corti costeroid therapy between 26 and 31 weeks' gestation. STUDY DESIGN: Th e data in this study were derived from 32,658 women who participated i n the March of Dimes-sponsored multicenter prematurity prevention prog ram. Of the 432 women who were delivered at 26 to 31 weeks, 67 receive d betamethasone before delivery and 365 did not. The frequency and rel ative risks of adverse outcomes, including respiratory distress syndro me, intraventricular hemorrhage, necrotizing enterocolitis, and neonat al death were compared for each of two gestational age periods by mean s of univariate and multivariate techniques. RESULTS: When betamethaso ne was administered greater-than-or-equal-to 2 days before delivery (n = 45), there was a lower incidence of respiratory distress syndrome i n both the 26 to 28 week group (53.9% vs 86.5%, p = 0.008) and the 29 to 31 week group (25.0% vs 59.1 %, p = 0.0003). The rate of intraventr icular hemorrhage was less in the betamethasone group at 26 to 28 week s (1 5.4% vs 32.3%, p = 0.17), but the difference reached statistical significance only at 29 to 31 weeks (3.1% vs 16.5%, p = 0.029). Neonat al death occurred significantly less often in infants who were deliver ed at 26 to 28 weeks when their mothers received betamethasone compare d with infants of the same gestational age whose mothers did not recei ve betamethasone treatment (0% vs 34.6%, p = 0.01). In a regression an alysis of infants born between 26 and 31 weeks in which birth weight, gestational age, race, infant sex, and tocolytic use were controlled, the odds ratio for respiratory distress syndrome associated with betam ethasone use was 0.20 (0.10, 0.42), for intraventricular hemorrhage 0. 26 (0.08, 0.90), and for neonatal death 0.14 (0.02, 1.09). Insufficien t numbers of women were given betamethasone before 26 weeks for analys is. CONCLUSION: Betamethasone appears to significantly reduce neonatal death and the morbidity between 26 and 31 weeks' gestation.