ACOG Updates Guidelines on Corticosteroid Administration for Preemies

The American College of Obstetricians and Gynecologists (ACOG) has updated its recommendations on when corticosteroids should be used when mothers are at risk of preterm labor.

The guidelines regarding what treatments doctors should administer to premature babies often change, and it is important to be aware of how these guidelines can impact a premature birth. Physicians should be up-to-date on the latest recommendations, and they must provide care in accordance with these standards. If they do not, they are committing medical negligence, which means that they are providing care beneath the standard their patients should be receiving.

What New Changes Does ACOG Recommend for the Treatment of Preemies?

Before discussing what new changes ACOG recommends, it’s useful to first know what they have recommended in the past. Before this recent update, ACOG recommended that women at 24 weeks to 33 weeks 6 days of gestation at risk of preterm labor (ie, women with twins or triplets, or women whose membranes ruptured early) have a single course of corticosteroids (usually administered in the form of intramuscular betamethasone injections in two doses, spaced 24 hours apart).

Now, ACOG has expanded its recommendations further, suggesting that babies at both younger and older gestational ages may benefit from corticosteroid administration to help mature their lungs more quickly, regardless of fetal number. Now, ACOG recommends that:

  • Antenatal corticosteroids should be considered as early as 23 weeks gestation when a mother is at risk of delivery (whether or not her membranes have ruptured early).
  • Antenatal corticosteroids should be considered between 34 weeks to 36 weeks 6 days of gestation in women at high risk for delivering within the next week who haven’t yet received corticosteroids.
  • A second course of antenatal corticosteroids should be considered if women are at less than 34 weeks of gestation and have a risk of giving birth within the upcoming week (if their prior course of corticosteroids was more than two weeks prior). However, if clinically indicated, rescue course corticosteroids can be administered as early as 7 days from a prior dose.

Corticosteroids are administered to help preterm and late preterm babies’ lungs mature more quickly. If a mother is at risk of going into preterm labor, corticosteroids should be delivered to help avoid respiratory complications in the baby. Because premature babies’ lungs are not yet fully developed, they are at a much higher risk of having trouble breathing, needing resuscitation and/or intubation, having insufficient surfactant, and other respiratory difficulties.

Did You Have a Preterm Birth? Did Your Child Have Poor Developmental Outcomes?

When a mother is at risk of preterm birth, it is critical to follow standards of care to make sure that outcomes are maximized for the mother and the baby. Making sure the baby’s lungs are mature enough to properly provide its tissues with oxygen is a significant part of the challenge of managing preterm birth. If you had a preterm birth and you didn’t receive corticosteroid injections, it may be useful to have a birth injury attorney investigate the cause of your child’s developmental delays. In some cases, poor developmental outcomes can be prevented with proper management. The law provides relief for those injured by medical practitioners that failed to provide proper care; this allows the families of these children to have peace of mind knowing their child will be cared for, no matter what.


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