Does serial versus single course betamethasone therapy increase neonatal morbidity?

OBJECTIVE: To determine if serial versus single course steroids to enhance fetal lung maturity is associated with adverse neonatal or maternal outcome. STUDY DESIGN: A retrospective cohort studv was conducted. Patients who rect ived one full course of beiamethasone (12 mg IM, 2 doses), (n = 102), were compared to those who received an initial course plus serial sieroids 12 mg IM weekK). (u = 107). The rates of ROS. IYH, sepsis. NEC, postpartum endotnetritis, and chorioamnionitis were studied. Neonatal outcomes were stratified for (iA (24 to 28 and 29 to 'i(i weeks). Chi square for linear trend w.is performed to explore a dose response effect. Odds ratio and 95% confidence intervals (CI) were calculated; a p value <0.05 was considered significant. RESULTS: A higher risk ol NEC in (he lepeated steroid group compared to the sirgle group was identified (OR: 7.07:95% CI (0.85-155.7); p < 0.04). particularly in the 29-36 week group (p < 0.05). Analysis of linear trend showed LU increased risk of NEC with repeated closes (p = (1.01). A higher rate of sepsis was seen in the 29-38 week group with repeated dosing (p = 0.05). Aralvsis for linear trend suggested an increased risk of neonatal sepsis with repeated doses (p < 0.05). There was a reduced risk of RDS in the 94,99 wek group with repeated dosing (OR: 0.27; 95% CI (0.09-0.79); p < 0.01 ). IYH was less likelv with repeated dosing in the 24-29 week group (OR: 0.19; 95% CI (0.02-1.23). p = 0.05. Risk of endomethtis (OR: 1.14: Wt CI (0.4,2.9 ; p = 0.7) or chorioamnionitis after PROM (OR: 1.5; 95% CI (0.2, I 1.8); p = 0.5) was not increased. CONCLUSION: Exposuie to weekly corticosteroids during pregnancx may he associated with an increased risk of neonatal sepsis and necrotizing enterocolitis in the newborn infant. Weeklvdnsing of sieroids versus a single course may reduce the risk of RDS and IVH al a GA <29 weeks.