September 2002 · Vol. 14, No. 9This simple and inexpensive treatment can cut neonatal
This simple and inexpensive treatment can cut neonatal mortality rates in half, but not all common regimens are supported by evidence. The author reviews the literature and summarizes recommendations from the NIH.
WILLIAM
H.
CLEWELL,
MDDr. Clewell is director of maternal-fetal medicine at Phoenix Perinatal Associates, an affiliate of Obstetrix Medical Group of Phoenix, Ariz, and clinical professor of obstetrics and gynecology at the University of Arizona College of Medicine.
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KEY POINTS
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Antepartum glucocorticoids are highly effective in reducing neonatal morbidity and mortality in prematurely born infants.
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Single courses have shown no adverse effect on the mother or newborn.
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Data on the risks and benefits of repeat courses are inconclusive.
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Repeat courses should not be used.
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Since optimal benefit occurs when the drug is given between 2 and 7 days before delivery, every attempt should be made to time administration accordingly.
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Premature birth is the largest unsolved problem in obstetrics today and the single most significant cause of neonatal morbidity and mortality.1 And although clinicians have been largely unable to reduce the incidence of preterm deliveries, the introduction of maternal antenatal glucocorticoid treatment to accelerate fetal lung maturity has allowed us to significantly reduce associated mortality and morbidity.
Research shows that this simple and inexpensive treatment can cut the neonatal mortality rate by about 50%, substantially lower the incidence of neonatal intracranial hemorrhage and diminish the cost of neonatal care. But following the first Consensus Development Conference on this therapy by the National Institutes of Health (NIH), held in 1994, many physicians became overly enthusiastic in their administration of antepartum steroids, often prescribing regimens and dose schedules not yet subjected to clinical trials.
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