Betamethasone: In-Utero Steroids Help Prevent Birth Injuries in Premature Babies

Betamethasone is a type of medicine called a corticosteroid. It is a synthetic medicine that mimics naturally occurring hormones. Betamethasone can treat skin conditions in adults but can also help premature babies to develop more quickly.

If doctors expect an infant will be born premature, they may give the pregnant patient doses of betamethasone. Doctors inject betamethasone into the mother’s arm, leg, or buttocks. The medicine travels through the mother’s bloodstream to reach the baby. 

Betamethasone can help the baby’s organs and tissues mature faster. Otherwise, a premature baby’s lungs and other organs may develop problems trying to adapt to the world outside the womb too early.

Premature babies are at risk for serious health problems, including:

• breathing problems: respiratory distress syndrome (RDS), transient tachypnea of the newborn, and a need for ventilator and surfactant
• brain bleeds
• periventricular leukomalacia (white matter brain damage)
• necrotizing enterocolitis (intestinal infection)

Antenatal betamethasone, or betamethasone given before birth, primarily  speeds up lung development in preterm babies. It stimulates the synthesis and release of surfactant, which lubricates the lungs. Surfactant allows the baby to breathe easily. Full-term babies produce enough surfactant to breathe without assistance, but premature babies often do not.

Antenatal betamethasone can significantly reduce the risk of serious respiratory problems and death.  Studies show dosing of corticosteroids like betamethasone makes it less likely a premature baby will need immediate resuscitation or respiratory support once they are born. 

Betamethasone helps premature babies in other ways besides preparing the baby’s lungs for the outside world. Betamethasone can also reduce the risk of other complications:  

Brain bleeds: Premature babies are at risk for brain bleeds. The blood vessels in their brains are underdeveloped and fragile. If a premature baby experiences stress like oxygen deprivation (hypoxia) or other trauma early in life, the blood vessels in their brains can rupture. The bleeding may be a severe kind of brain bleed called an intraventricular hemorrhage. 

Intestinal infections: Premature babies are at risk for a severe intestinal infection called necrotizing enterocolitis. Their developing intestines are especially vulnerable. According to StatPearls, necrotizing enterocolitis affects up to 5% of all premature infants, and it accounts for nearly 8% of all NICU admissions. Necrotizing enterocolitis can be a dangerous and lethal infection and must be treated as soon as possible. 

Overall, antenatal betamethasone may reduce a premature infant’s chance of death by as much as 40 percent. The treatment can decrease the risk of lifelong conditions, including: 

• periventricular leukomalacia
• cerebral palsy (CP)
• seizures
• intellectual disabilities

Research indicates that the risks for betamethasone are minimal when given late in pregnancy and in small doses.  Women at high risk of delivering prematurely can benefit from betamethasone with limited doses during pregnancy. Multiple doses of steroids could cause lower birth weights and smaller heads, so repeated courses are no longer recommended in most cases.

If a baby is at risk of premature birth, doctors may give the pregnant mother the corticosteroid betamethasone. Betamethasone is most effective if given between two and seven days prior to the baby’s birth. Doctors should always consider each situation fully before administering corticosteroids.

The American College of Obstetricians and Gynecologists (ACOG) currently makes the following recommendations regarding corticosteroid administration:

• Single course of corticosteroids: 
  • Between 24-34 weeks of gestation
  • At risk of a preterm delivery within 7 days
  • Includes situations with ruptured membranes or multiple gestations
• Single course of betamethasone:
  • Between 34-36 weeks of gestation
  • Risk of preterm delivery within 7 days
  • Patient has not received a previous course of antenatal corticosteroids
• Single, repeat course of steroids: 
  • Less than 34 weeks gestation
  • Risk of preterm delivery within 7 days
  • Prior course of antenatal corticosteroids occurred more than 14 days previously

Besides giving antenatal betamethasone, there are other things doctors may recommend in order to help a fetus that is likely to be born prematurely or a baby that already has. These interventions for premature birth include:

1. Cervical cerclage to prevent preterm birth in women with incompetent cervix
2. Progesterone therapy to prevent preterm birth
3. Medications to stop contractions (terbutaline and brethine)
4. Antenatal magnesium sulfate to protect the baby from brain injuries
5. Surfactant given to the baby after birth
6. Careful monitoring for and prevention of infection
7. Ventilatory and respiratory support

Physicians, nurses, midwives, and other medical professionals are obligated to do everything in their power to prevent premature birth. You should trust your medical staff to

• diagnose potential causes of preterm birth 
• use betamethasone and other interventions in high-risk situations
• plan for delivery
• call for emergency C-sections when needed
• provide all other means of care

If medical staff did not properly handle or intervene to prevent your child’s premature birth, it is medical negligence. If it leads to a preventable  birth injury, it is medical malpractice.

If your child has a permanent disability such as cerebral palsy, the award-winning attorneys at ABC Law Centers: Birth Injury Lawyers can help.

Our firm is dedicated to families like yours who are navigating the consequences of a birth injury. We have helped children throughout the country obtain compensation for lifelong treatment, therapy, and a secure future. Our team gives personal attention to each child and family we represent. 

Call us today for a free consultation. There is no obligation to work with us, and you pay nothing unless we win your case. Our staff can help you through this difficult time, listen to your story, and help determine if medical malpractice caused your child’s injuries.