Multiple courses of antenatal corticosteroids and outcome of premature neonates

OBJECTIVES: We sought to examine outcome for premature neonates after multi ple courses of antenatal corticosteroids compared with a single course. STUDY DESIGN: We performed a post hoc nonrandomized analysis on 710 neonate s of 25-32 weeks' ges ration who were born to mothers enrolled in the North American Thyrotropin-Releasing Hormone Trial and who received 1, 2, or gre ater than or equal to 3 courses of antenatal corticosteroids. RESULTS: There was no detectable clinical difference in incidence of respir atory distress syndrome, chronic lung disease, and intraventricular hemorrh age related to courses of antenatal corticosteroids, and outcome was simila r for infants delivered at 7-13 days compared with those delivered at 1-6 d ays after receiving antenatal corticosteroids. Compared with those who rece ived a single course, neonates who received greater than or equal to 2 cour ses had lower birth weights (-39 g, P = .02), and those receiving greater t han or equal to 3 courses had increased risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.3-5.9; P = .01) and lower levels of plasma cortisol at age 2 hours. CONCLUSION: In this retrospective analysis multiple courses of antenatal co rticosteroids did not improve outcome and were associated with increased mo rtality, decreased fetal growth, and prolonged adrenal suppression.