Neonatal sepsis and death after multiple courses of antenatal betamethasone therapy

OBJECTIVE: This study was undertaken to compare the effects of single versu s multiple courses of betamethasone therapy on the frequencies of neonatal outcomes and perinatal infectious morbidity among singleton pregnancies com plicated by preterm delivery. STUDY DESIGN: We performed a nonconcurrent prospective analysis of singleto n pregnancies delivered between 24 and 34 weeks' gestation after antenatal betamethasone exposure. Patients were categorized into two groups according to betamethasone exposure: (1) two 12-mg doses in a 24-hour interval on ad mission (single-course group) and (2) repeated dosing after the initial sin gle course (multiple-course group). All patients received prophylactic anti biotics for group B streptococci. Any patients with ruptured membranes for >24 hours before delivery were excluded. Data were analyzed with the Studen t t test, the chi (2) test, and the Fisher exact test. Multiple logistic re gression analyses were performed to examine the effect of each steroid dosi ng regimen on early-onset neonatal sepsis and neonatal death. P < .05 was c onsidered significant for all 2-tailed tests. RESULTS: A total of 453 patients were included, with 267 in the single-cour se group and 186 in the multiple-course group. The two groups were similar with respect to maternal demographic characteristics, gestational age at de livery mode of delivery, birth weight, and maternal group B streptococcal c olonization. Multiple courses were significantly associated with early-onse t neonatal sepsis (odds ratio, 5.00; 95% confidence interval, 1.3-23.2), ch orioamnionitis (odds ratio, 9.96; 95% confidence interval, 2.1-64.6), endom etritis (odds ratio, 3.61; 95% confidence interval, 1.7-8.1), and neonatal death (odds ratio, 2.92; 95% confidence interval, 1.3-6.9). The frequencies of the other neonatal outcomes analyzed, including respiratory distress sy ndrome and grade III or IV intraventricular hemorrhage, were similar betwee n the 2 groups. Multiple logistic regression analyses confirmed that multip le courses of antenatal betamethasone were independently associated with ea rly-onset neonatal sepsis (odds ratio, 1.25; 95% confidence interval, 1.1-1 .9) and neonatal death (odds ratio, 1.70; 95% confidence interval, 1.1-1.9) . CONCLUSIONS: Multiple courses of antenatal betamethasone are associated wit h increased risks of perinatal infectious morbidity and neonatal death.