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- W2059643743 abstract "To determine the efficacy and safety of repetitive courses of corticosteroids. Randomized, placebo-controlled, clinical trial at nineteen centers. Women <32 wks gestation at risk for spontaneous preterm delivery with intact membranes and pregnant one week after an initial course of corticosteroids were randomized to weekly courses of betamethasone or placebo; limited to 4 courses after the first 67 patients. The primary outcome was a composite of stillbirth/neonatal death, severe RDS, grade III-IV IVH, periventricular leukomalacia or chronic lung disease. The initial sample size was 2200 but the Data/Safety Committee recommended termination at interim analysis. Of 495 randomized women, 492 (591 infants) were available for analysis; 252 received repetitive steroids. We found no difference in the primary outcome between multiple courses and placebo (7.7% vs 9.2%, P = 0.67). However, for those delivering <32 weeks, we found a trend towards reduction in the primary outcome after repeat steroids (21.3 vs 38.5%, P = 0.083). In the entire cohort, trends towards improvement were seen in the repeat group for each component of the primary outcome and for secondary outcomes related to lung function: use of surfactant (12.5% vs 18.4%, P = 0.02), mechanical ventilation (15.5% vs 23.5% P = 0.005), treatment for hypotension (5.7% vs 11.2%, P = .02). Multiple courses were associated with insignificant trends towards reduced infant weight (2194 vs 2289 gm, P = .09) and length (44.2 vs 44.7 cm, P = .09). Infants exposed to ≥4 courses had a significant decrease in birth weight (2396 vs 2561 gm, P = 0.01). There was no difference in head circumference overall, nor in those exposed to ≥4 courses. Four or more weekly courses of antenatal steroids significantly reduce birth weight. However, repeated courses may reduce infant morbidity, especially when delivery occurs before 32 weeks. Further investigation of limited repeated steroid administration to women at high risk for early preterm birth is warranted." @default.
- W2059643743 created "2016-06-24" @default.
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- W2059643743 date "2003-12-01" @default.
- W2059643743 modified "2023-10-16" @default.
- W2059643743 title "A randomized trial of single vs weekly courses of corticosteroids" @default.
- W2059643743 doi "https://doi.org/10.1016/j.ajog.2003.10.003" @default.
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