Repeated antenatal corticosteroid treatments. Do they reduce neonatal morbidity

OBJECTIVE: To compare the effectiveness of single, as compared to multiple, courses of antenatal steroid treatments in reducing neonatal morbidity. STUDY DESIGN: A retrospective chart review of 204 patients who delivered preterm and received antenatal corticosteroids between June 1996 and December 1998 was performed and data extracted. All patients who delivered prior to 35 weeks of gestation and received corticosteroids were included, The number of antenatal treatments was chosen by the obstetrician caring for the patient as well as by the opportunity to administer steroids. RESULTS: There were 61 patients in the multiple-course group. Gestational age was greater in the multiple-course group (31.6 vs. 30.6, P=.03), but Apgar scores, neonatal hospital stay, specific neonatal morbidity and combined morbidity were not different between the two groups. Combined neonatal morbidity was higher after three courses of antenatal steroids (29% vs. 50%). Logistic regression analyses adjusting for gestational age suggest a possible adverse effect of multiple courses, development of respiratory distress syndrome (odds ratio 1.3; confidence interval 1.02; 1.8; P=.02) and combined neonatal morbidity (odds ratio 1.3; confidence interval 1.04; 1.7; P=.02). CONCLUSION: Weekly antenatal steroids do not improve neonatal morbidity.