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Previous Volume 357:1179-1189 September 20, 2007 Number 12 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set CME Exam Editorial by Stiles, A. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background We previously reported the results of a randomized, controlled trial showing that repeat doses of antenatal corticosteroids reduced the risk of respiratory distress syndrome and serious neonatal morbidity. However, data have not been available regarding longer-term effects of this treatment.

Methods Women who had received an initial course of corticosteroid treatment 7 or more days previously were randomly assigned to receive an intramuscular injection of corticosteroid (11.4 mg of betamethasone) or saline placebo; the dose was repeated weekly if the mother was still considered to be at risk for preterm delivery and the duration of gestation was less than 32 weeks. We assessed survival free of major neurosensory disability and body size of the children at 2 years of corrected age.

Results Of the 1085 children who were alive at 2 years of age, 1047 (96.5%) were seen for assessment (521 exposed to repeat-corticosteroid treatment and 526 exposed to placebo). The rate of survival free of major disability was similar in the repeat-corticosteroid and placebo groups (84.4% and 81.0%, respectively; adjusted relative risk, 1.04, 95% confidence interval, 0.98 to 1.10; adjusted P=0.20). There were no significant differences between the groups in body size, blood pressure, use of health services, respiratory morbidity, or child behavior scores, although children exposed to repeat doses of corticosteroids were more likely than those exposed to placebo to warrant assessment for attention problems (P=0.04).

Conclusions Administration of repeat doses of antenatal corticosteroids reduces neonatal morbidity without changing either survival free of major neurosensory disability or body size at 2 years of age. (Current Controlled Trials number, ISRCTN48656428 [controlled-trials.com] .)

Source Information

From the Disciplines of Obstetrics and Gynaecology (C.A.C., J.S.R.) and Public Health (J.E. Hiller), University of Adelaide, Adelaide; the Department of Obstetrics and Gynaecology and Paediatrics, University of Melbourne, Melbourne (L.W.D.); and the Department of Neonatal Medicine, Women's and Children's Hospital, Adelaide (R.R.H.) — all in Australia; and the Liggens Institute, University of Auckland, Auckland, New Zealand (J.E. Harding).

Address reprint requests to Dr. Crowther at the Discipline of Obstetrics and Gynaecology, University of Adelaide, Women's and Children's Hospital, 72 King William Rd., North Adelaide SA 5006, Australia, or at caroline.crowther{at}adelaide.edu.au.

Full Text of this Article

This article has been cited by other articles:

• Wapner, R. J., Sorokin, Y., Mele, L., Johnson, F., Dudley, D. J., Spong, C. Y., Peaceman, A. M., Leveno, K. J., Malone, F., Caritis, S. N., Mercer, B., Harper, M., Rouse, D. J., Thorp, J. M., Ramin, S., Carpenter, M. W., Gabbe, S. G., the National Institute of Child Health and Human D, (2007). Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids. NEJM 357: 1190-1198 [Abstract] [Full Text]  
• Stiles, A. D. (2007). Prenatal Corticosteroids -- Early Gain, Long-Term Questions. NEJM 357: 1248-1250 [Full Text]