Neonatal sepsis after betamethasone administration to patients with preterm premature rupture of membranes

OBJECTIVE: We sought to determine the effect of antenatal betamethasone exp osure on the incidence of early onset neonatal sepsis in patients with pret erm premature rupture of membranes. STUDY DESIGN: We performed a nonconcurrent prospective analysis of infants delivered between 24 and 34 weeks' gestation after preterm premature ruptur e of membranes. Patients with preterm premature rupture of membranes were c ategorized into 3 groups on the basis of the following betamethasone exposu res: (1) none (control subjects), (2) two 12-mg doses in a 24-hour interval an admission (single course), and (3) weekly administration after the init ial single course (multiple courses). All included patients received prophy lactic antibiotics for group B streptococci. Discrete data were tested for significance with the chi(2) test. Continuous data were tested for signific ance with an analysis of variance. Multiple logistic regression analysis wa s performed to determine the confounding effect of the multiple variables t hat were considered risk factors for early-onset neonatal sepsis. All P val ues of < .05 were considered significant. RESULTS: Three hundred seventy-four patients with preterm premature rupture of membranes were included, 203 of whom were evaluated in the control grou p, 99 in the single-course group, and 72 in the group receiving multiple co urses of betamethasone. Early-onset neonatal sepsis was significantly assoc iated with multiple courses of corticosteroids (P < .001) and gestational a ge (P=.002). Multiple courses of antenatal betamethasone were significantly associated with chorioamnionitis (P=.004) and endometritis (P=.004). Singl e-course corticosteroid administration was not significantly associated wit h any maternal or neonatal infectious complications. CONCLUSIONS: Multiple courses of antenatal betamethasone administered to pa tients with preterm premature rupture of membranes is associated with an in creased risk of early-onset neonatal sepsis development.