New Study Finds Benefits of Repeat Prenatal Corticosteroid Treatments
Infants born prematurely (before 37 weeks gestation) face numerous risks that those born at term do not. They may experience breathing problems, brain problems, heart problems, temperature control problems, immune system problems, and other short-term issues that usually require a stay in the NICU (1). Furthermore, they are at a higher risk of developing long-term issues such as cerebral palsy, behavioral and psychological problems, learning disabilities, and others.
Prenatal corticosteroids are one of the most common treatments given to women at risk of having a preterm birth.These drugs may improve neonatal outcomes in the following ways (2):
- Increase preemie survival rate
- Shorten preemie hospital stays
- Accelerate lung maturity and decrease respiratory distress syndrome (RDS) rates
- Stabilize the baby’s intracranial vasculature
- Decrease periventricular leukomalacia (PVL) incidence
- Decrease intracranial hemorrhage incidence
- Decrease necrotizing enterocolitis (NEC) incidence
ACOG recommendations state (2):
- A single dose of the prenatal steroid betamethasone can be given to women between 24 and 34 weeks of pregnancy who are at risk of preterm delivery within seven days.
- Betamethasone may also be given to women between 34 and 37 weeks of pregnancy, who are at risk of preterm delivery within seven days and haven’t had the treatment yet.
- One repeat course of corticosteroids can be considered for women who are less than 24 weeks gestation, at risk for preterm delivery within seven days, and who received the first dose more than 24 days prior.
But what do we know about repeating corticosteroids treatment several times?
An April 2019 individual participant data (IPD) meta-analysis found 11 trials between the years 2002 and 2010 wherein women considered at risk for preterm birth had been given repeat corticosteroids (3).
This meta-analysis found that babies in the trial who were exposed to repeat corticosteroid treatments required less respiratory support than those who were not exposed. It should be noted that birth weights and body size measurements were lower in infants exposed to repeat corticosteroid treatments. Because of the apparent body size results of the repeat treatments, the question of how many repeat treatments should be given was assessed.
The study found that infants exposed to between two and five courses of repeat corticosteroids showed a reduction in serious outcomes as well as the need for respiratory support, compared to those exposed to only a single repeat course of the drug (3). Increasing numbers of corticosteroids resulted in increasingly lower birth z-scores for weight, head circumference, and length. This means that as the number of repeat treatments increased, the baby’s size decreased.
The study concluded that, in order to benefit the baby’s lungs and overall outcomes, while also not affecting the baby’s proper growth, the number of repeat corticosteroid treatments should be given at a maximum of three treatments of between 24 mg and 48 mg.
This study will help doctors establish treatment plans for mothers who are at risk of preterm delivery, given the confirmed benefits of the corticosteroid treatment options. This is significant because corticosteroid treatments are not only effective, but also easy to administer and relatively inexpensive. This study provides support for the decision to administer repeat corticosteroid treatments for women at risk of preterm birth under the above ACOG guidelines, as long as the maximum number of administrations is three. If these techniques are adopted in more areas, it could lead to significant global health benefits.
About ABC Law Centers
ABC Law Centers was established to focus exclusively on birth injury cases. A “birth injury” is any type of harm to a baby that occurs just before, during, or after birth. This includes issues such as hypoxic-ischemic encephalopathy (HIE), infection, preterm birth, and trauma. While some children with birth injuries make a complete recovery, others develop disabilities such as cerebral palsy and epilepsy.
If a birth injury/subsequent disability could have been prevented with proper care, then it constitutes medical malpractice. Settlements from birth injury cases can cover the costs of lifelong treatment, care, and other crucial resources.
If you believe you may have a birth injury case for your child, please contact us today to learn more. We are happy to talk to you free of any obligation or charge. In fact, clients pay nothing throughout the entire legal process unless we win.
- Premature Birth and its Prevention
- ACOG Updates Guidelines for Treating Preemies with Corticosteroids
- Cost-effectiveness of betamethasone therapy for women at risk of delivering a premature baby (between 34 and 36 weeks)
- Premature birth. (2017, December 21). Retrieved April 22, 2019, from https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-20376730
- Women’s Health Care Physicians. (n.d.). Retrieved March 5, 2019, from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Antenatal-Corticosteroid-Therapy-for-Fetal-Maturation?IsMobileSet=false
- Effects of repeat prenatal corticosteroids given to women at risk of preterm birth: An individual participant data meta-analysis Crowther CA, Middleton PF, Voysey M, Askie L, Zhang S, et al. (2019) Effects of repeat prenatal corticosteroids given to women at risk of preterm birth: An individual participant data meta-analysis. PLOS Medicine 16(4): e1002771. https://doi.org/10.1371/journal.pmed.1002771